Agenda item

To receive a report submitted on behalf of the Lincolnshire Sustainability and Transformation Partnership on the progress with the development of urgent treatment centres in Lincolnshire.  Urgent treatment centres are a national initiative led by NHS England and the aim is that a network of these centres will be open from December 2019 across the country.   The report was written by Ruth Cumbers, Urgent Care Programme Director and Sarah Stringer, Urgent Care Programme Manager. 

The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group.

The Urgent Care Programme Director provided the Committee with an update on the delivery of transformation of Urgent and Emergency Care in Lincolnshire.

The Committee was advised that in response to the Keogh Review, the Lincolnshire Urgent and Emergency Care system had introduced an Urgent and Emergency Care Strategy (which had been presented to the Committee on 21 March 2018), which set out a vision for Urgent and Emergency Care in line with nationally mandated actions and local STP priorities.  It was highlighted that the strategy would help with the standardisation of services across the County; and would ensure that patients got the right care in the right place when they needed it.

It was highlighted that the ambition was to transform urgent and emergency care to ensure that it served those patients with serious or life threatening emergencies, as well as those with urgent care needs better.  The report highlighted that it was estimated that nationally up to 3 million people who used A & E each year could have had their needs addressed elsewhere in the urgent care system.  It was highlighted further that patients were confused as to what alternatives were available to them.

The Committee was advised that the principal aim of creating urgent treatment centres was to increase public confidence in where to go if they had urgent, non-emergency care needs by removing different titles such as urgent care centres, minor illness/injury units and walk in centres.  It was noted that there was also an aim to extend the remit of urgent treatment centres clinical assessment capability, to manage an increased range of lower acuity cases currently managed in A & E departments.  Details of the December 2019 national targets for patients and public to access were shown on page 51 of the report presented.

It was highlighted that in Lincolnshire there were two urgent care centres at Louth County Hospital and Skegness Hospital; and Minor Injury/Illness Units at the Gainsborough John Coupland Hospital, Spalding Johnson Hospital; and Sleaford Medical Group.  It was noted further that the North West Anglia NHS Foundation Trust also ran a Minor Injuries Unit at Stamford Hospital.

Page 52 of the report provided the Committee with information relating to recommended sites for Urgent Treatment Centres.  The report highlighted that a full and open public consultation would take place to inform any final decisions on the configuration of services through the Acute Services Review and that this would happen during the spring of 2019.  Details relating to the programme implementation, service Type Classification; and Timescale for implementation were shown on pages 53 and 54 of the report.

It was highlighted that other transformation projects particular digital technology were key enablers to helping to deliver the national and local Urgent and Emergency Care Strategy.  Particular reference was made to the ASAPLincs website and app, the NHS 111 online; and the Integrated Dashboard.

In conclusion, the Committee was advised that this was an exciting opportunity to ensure that the public had access to quality services, at the right place and at the right time and for there to be improved accessibility across the County.

Attached at Appendix A to the report was a copy of the Urgent Treatment Centres – Principles and Standards 2017, issued by NHS England, for the Committee's consideration.

During discussion, the Committee raised the following points:-

·        Some concern was expressed that Grantham A & E remained out of scope for the Lincolnshire Urgent Emergency Care Strategy.  The Committee was advised that the future of Grantham and District Hospital was a separate issue; and that nothing had yet been decided with regard to this matter.  It was highlighted that as the Committee was looking at services across the County; there was a lack of understanding as to why Grantham had been omitted.  Some members felt that Grantham and District Hospital should be offered an Urgent Treatment Centre;

·        Clarification was sought as to the classification of the Louth County Hospital site.  The Committee was advised that services at Louth would be no less than at present; and would most likely be enhanced, as Louth was likely to become an Urgent Treatment Centre;

·        One member expressed disappointment to the proposals and to the lack of provision in the south of the County. The Urgent Care Programme Director based at Lincolnshire East Clinical Commissioning Group, agreed to feedback the views expressed to the  South and South West CCG's;

·        GP Extended Access Hubs – The Committee was advised that 90% of urgent cases could be dealt with by a GP; and that the Federation Teams and Hubs would allow GP's to respond. It was confirmed that the Hubs would be open for up to 12 hours Monday to Friday, and also provide weekend cover.  GP's at surgeries could then concentrate on long term conditions, which would then increase the number of on the day non-urgent appointments;

·        Some concern was expressed to the proposed opening times for Louth County Hospital and Skegness Hospital; as currently provision at the Louth and Skegness urgent care centres was 24 hour; and it was felt that this provision needed to be maintained.  Confirmation was given that GP Access Hubs would be open for 12 hours and that Urgent Treatment Centres would be open 24 hours;

·        Effect of the summer period – It was confirmed that there would be a greater offer at the Louth and Skegness sites;

·        The impact of the closure of the Lincoln Walk-in Centre.  The Committee was advised that there had been little impact on the Lincoln A & E following the closure of the Lincoln Walk-in Centre;

·        The effect on the public as a result of reclassification.  It was reported that proposed provision across the County had been based on information from CCGs.  It was highlighted that GP Access Hubs could provide more enhanced services.  It was highlighted that the plans were still at an early stage and that comments would be fed back to the CCGs;

·         Some members advised that they had little faith in the NHS 111 service in ensuring that patients received the appropriate treatment.  The Committee noted that 111 was the first point of access and that this had been driven by a national directive.  The Committee noted further that Lincolnshire had a clinical assessment service, which ensured that patients were signposted to the appropriate service;

·         Functions of the App – It was noted that the ASAP Lincs website and App had been designed to allow residents to identify their symptoms or condition(s) from some of the most commonly seen in emergency departments, before displaying the most appropriate treatment service suitable for them;

·         Concern was expressed as to whether there would be issues with regard to recruitment and retention of staff at the centres.  The Committee was advised that there was confidence that there would be few problems in staffing the new centres; as most staff were community based;

·         One member felt that if Minor Injuries Units were to be discontinued, there would be decrease in the service provided.  It was felt that an enhanced service would also be dependent on the geographical area; and

·         Consultation for Urgent Care – Confirmation was given that there would be a consultation in the spring of 2019; separate to any consultation on the acute services review; and that decisions taken would be based on the outcomes of the consultation.  The Committee was reminded that at the moment changes to provision were only proposals; and that the Committee would receive a further detailed report when available.

The Chairman on behalf of the Committee expressed disappointment that Grantham and District Hospital was out of the Lincolnshire Urgent and Emergency Care Review; and a request was made for an in-depth report for the Committee to consider at the 23 January 2019 meeting.

The Chairman on behalf of the Committee extended thanks to the Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group for her presentation.

RESOLVED

1.    That the update on the progress with the development of Urgent Treatment Centres be noted.

2.    That the Committee receive an update on the outcome of the capital bid submitted to NHS England with regard to establishing urgent treatment centres at Pilgrim Hospital Boston and Lincoln County Hospital.

3.    That a further report be received by the Committee at its 23 January 2019 meeting prior to the commencement of the consultation on urgent treatment centres, and if appropriate as early as the 23 January 2019 meeting.