Agenda item

(To receive a report from representatives from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with the opportunity to consider proposals for Urgent and Emergency Care.  Dr David Baker, Chair, South West Lincolnshire Clinical Commissioning Group, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust and Ruth Cumbers, Urgent Care Programme Director, Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Chairman welcomed to the meeting the following representatives from the Lincolnshire Sustainability and Transformation Partnership:-

·         Dr David Baker, Chair, South West Lincolnshire Clinical Group;

·         Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust;

·         Ruth Cumbers, Urgent Care Programme Director, Lincolnshire Sustainability and Transformation Partnership; and

·         John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership.

The Committee was reminded of its decision from the 20 March 2019 meeting to focus over the coming months on items from the Healthy Conversation 2019.

The report presented provided the Committee with the national and local context regarding the vision and strategy to deliver an effective and accessible Urgent and Emergency Care System in Lincolnshire.  It was noted that it had been estimated that between 1.5 and 3 million people nationally who arrived at A & E each year could have had their needs addressed elsewhere, for instance by contacting NHS111, visiting a local pharmacy or by visiting their GP.

Attached at Appendix A to the report was a copy of the Healthy Conversation 2019 leaflet; and Appendix B provided details relating to Accident and Emergency Department Classification.

The Committee was advised of the milestones for Urgent and Emergency Care in the Long Term Plan. Page 27 of the report provided details as what all hospitals with a major A & E department would provide.

The Committee was advised of the role of the Urgent Care Treatment Centres (UTCs); that the centres would be typically GP led; and that the development of UTCs was a logical step, as they would reduce duplication of provision, confusion and simplify access for members of the public, and provide a more consistent approach across the county.  It was noted that the centres would be accessible at least twelve hours a day 365 days a year offering appointments that could be booked through NHS111, or via GP referral.  It was noted further that the Urgent Treatment Centres had been designed to ease pressure on hospitals to allow Emergency Departments to treat the most serious cases,  and that the UTCs would be staffed by multi-disciplinary teams of doctors, nurses, therapists and other professionals, with at least one person being trained in advanced life support for adults and children. 

It was highlighted there had been a dedicated section in the Healthy Conversation 2019 on urgent and emergency care, including a description 'as is' and proposed 'to be'.  Appendix A to the report provided the Committee with details of what was currently available in Lincolnshire; and like the rest of England what was proposed to simplify urgent and emergency care with the introduction of Urgent Treatment Centres and GP Extended Access Hubs. 

The Committee was advised that the main concerns raised so far by the public were: transport to services for patients and family; NHS 111 and its effectiveness; East Midlands Ambulance Service; and issues of overburden on Lincoln County Hospital. Some of the comments raised from the events were shown on pages 30 to 32 of the report.

It was reported that a workforce model was being developed for the future delivery of Urgent Care, which involved getting the right skill mix, location of services and recruitment.  The Committee noted that there was still a national and countywide shortage of NHS staff and that locally, providers and commissioners, in partnership, were responsible and would be working to make the expectations a reality.

During discussion, the Committee raised the following comments:-

·         That the future of Grantham had still not been determined; and the need for 24/7 cover at Grantham.  The Committee was advised that an emerging option for Grantham was to have 24/7 access to urgent care through the introduction of an Urgent Treatment Centre; and that the emerging option suggested that in the out of hours period, access would be made through NHS111 for the reasons of patient safety.  It was highlighted that all feedback would be considered when assessing how the service could best be accessed.  One member provided the Committee with a personal account of why the provision of an A & E at Grantham was so important.  A further question was asked as to whether resuscitation would be available.  Confirmation was given that resuscitation provision would be available at a UTC;

·         The need to make sure that every effort was made to engage the difficult to reach groups across the county.  Reassurance was given that every avenue was being explored to reach as many people as possible.  The Committee was advised that awareness training had been provided to the Butlins Holiday Centre in Ingoldmells.  This had involved the inclusion of a 'Z card' within the Butlins welcome pack.  As a result of this action, the Committee was advised there had been a reduction in the number of ambulance calls to the site from 144 in 2017; to 24 in 2018.  There was however, an acceptance that there was still more education on raising awareness on what the public should do when they needed urgent care;

·         The need for better information flow; and for the information to be timed better, to coincide with what was current, and to be accurate;

·         Some members welcomed the update and offered support to the principle of the Urgent Treatment Centres; but still felt there was some work to be done to sort out specific local issues that had not been resolved;   

·         Page 33 – The potential rise in workforce costs of 5%.  The Committee noted that Lincolnshire had challenges financially; and that it would continue to be challenging, and that was why it was very important to get the design of the service and the quality of care right, which would then have an impact on the finances;

·         The inability of members of the general public to get a GP appointment.  It was highlighted to the Committee that there was an underutilisation of the GP service; if the NHS111 service was used out of hours there were appointments available elsewhere.  Confirmation was given that there would be a publicity campaign to help give the public confidence in the NHS111 service.  It was also noted that there was further education needed regarding accessing GPs, as sometimes patients were able to be seen by other professionals.  It was accepted that there was a need to ensure that the public understood what was planned, and the facilities offered by a UTC, the NHS111 system and GPs;

·         Clarity concerning access to medical records.  Confirmation was given that clinicians had access to patients records;

·         A question was asked as to how formal consultation might work for urgent treatment centres, for example urgent treatment centres in Boston and Lincoln were in effect a requirement, whereas, in Louth and Skegness, 24/7 urgent treatment centres were proposed in place of 24/7 urgent care centres.  The Committee was advised that normally consultation would be carried out when there were plans for significant service changes; whereas other changes might just be an enhancement of existing services.  It was concluded that a view would be taken, which would be based on law and guidance, and also influenced by a common sense approach;

·         Whether lessons had been learnt from the implementation of urgent treatment centres in other areas.  The Committee was advised that it was too early to gain intelligence from formal analysis; as it was the patient experience and expectation that would inform the findings.  As the implementation of integrated care had been nationally mandated, it was crucial to get the right care, at the right time, in the right place. Confirmation was given that speaking to neighbouring authorities had been undertaken and would continue; and more education of the public would improve the level of views on the services provided;

·         Page 30 – A question was asked as to why UTC opening hours would be determined following public engagement as this was causing concern to those areas who currently had a 24/7 walk in service.  The Committee was advised that there was no intention to reduce the existing opening hours of urgent care centres in Louth and Skegness;

·         One member queried that page 29 of the report stated that Grantham would be returned to 24/7; and that access to services overnight would be via a booked appointment.  A question was asked as to why the proposal for Grantham had not included a 24/7 walk in service.  The Committee was advised that there would be a 24/7 service, just how it was to be delivered had not yet been agreed;

·         Some concern was expressed that the report did not provide the Committee with the responses or answers to the questions that had been raised; and that no evidence had been provided to show how the responses received were going to help shape future plans;

·         A question was asked relating to a previous capital funding bid for new UTCs, including expanded resuscitation at Pilgrim and Lincoln hospitals, and whether a further bid would be made; or whether there was a plan B, if no capital funding was received.  The Committee was advised that an application would be made for more capital money as part of 'Wave Five'.  The Committee was advised further that every effort would be made to deliver the project, if no capital funding was awarded;

·         Clarification was sought as to what services were currently offered at Grantham as an A & E, in comparison to what was being offered as a UTC. The Committee was guided to the current designation of Grantham A & E as detailed in the report on page 30; and to the designation of urgent treatment centres as detailed on pages 27 and 28 of the report.  It was noted that there was very little difference between the two services; and an 'exclusions protocol' was in place for Grantham A & E, listing conditions which could not be treated there; and

·         A question asked as to how the proposals linked into neighbouring STP areas; and whether there was any expected impact on urgent/emergency care patient flows.  Clarification was given that some patients would be expected to access emergency and urgent care outside Lincolnshire, but there was also some unexpected flow of patients outside Lincolnshire as a result of patient choice.  The Committee also noted that it was proposed that North and North East Lincolnshire were going to adopt the same ASAPLincs website and app, so that patients received a consistent service.  It was also noted that 70% of patients in the south of the county used services outside of Lincolnshire; and that more would be done to encourage more use of Lincolnshire services, where this was appropriate.

The Chairman on behalf of the Committee extended thanks to the representatives for their presentation and responses to questions; and for the open and frank way in which they had been delivered.

RESOLVED

1.    That the Healthy Conversation 2019 – Urgent and Emergency Care report presented, be noted.   

2.    That the Chairman be authorised to make a written response to the urgent and emergency care strand of Healthy Conversation 2019 on the basis of the Committee's discussion and to request evidence of the responses made to the public, with examples of how this has or is influencing the plans moving forward.