Agenda item

(To receive a report from Allan Kitt (Chief Officer – South West Lincolnshire Clinical Commissioning Group), which provides an update on the activities within South West Lincolnshire Clinical Commissioning Group, covering urgent care, planned care, primary care and commissioning support in addition to information on mental health and learning disabilities for which South West Lincolnshire CCG is the lead commissioner)

A report by Allan Kitt (Chief Officer – South West Lincolnshire Clinical Commissioning Group) was considered which provided an update on the activities within South West Lincolnshire Clinical Commissioning Group covering urgent care, planned care, primary care and commissioning support in addition to information on mental health and learning disabilities for which South West Lincolnshire CCG was the lead commissioner.

Allan Kitt (Chief Officer – South West Lincolnshire CCG), Dr Vindi Bhandal (GP Chair) and Clair Raybould (Chief Commissioning Manager) were all in attendance for this item of business.

Members were given a brief overview of the report, the aim of which was to update the Committee on developments with South West Lincolnshire CCG.  The CCG covered a population of approximately 130,000 and was centred around the market towns of Grantham and Sleaford.  Although there was only one practice area within the CCG's area where deprivation was above the national average, the prevalence of disease was significantly higher than the national average.  This included cardiovascular disease, diabetes and respiratory disease.  Cancer mortality was improving overall with mortality for breast, lung and gastrointestinal better than the national average.  Overall, cancer survival rates were worse than the national average despite steady improvement.

The CCG's Strategic Plan had been underpinned by the work consulted on and shared with the Scrutiny Committee and of the Shaping Health for Mid Kesteven Programme.  The work had focussed on the following key areas:-

·       Urgent Care

o   The Hospice in Hospital was a joint venture between local GPs, St Barnabas Hospice, ULHT and the CCG.  It was fully operational at Grantham and District Hospital and was, for the first time, providing local inpatient palliative care;

o   Fifteen new intermediate care beds had been commissioned in partnership with Lincolnshire County Council, Lincolnshire Community Health Services and local GPs.  This provided an alternative to hospital admission as well as a means to avoiding unnecessary hospital stays.  In order to manage the inevitable winter pressures, it was planned to expand these bed numbers;

o   Close working with ULHT and Lincolnshire Community Health Services had enabled a single integrated reception area to open where Out of Hours, the GP in A&E and the Emergency Assessment Unit (EAU) team worked in partnership;

o   Ambulatory emergency care at Grantham Hospital was now complete and was being made operational for the winter enabling a robust alternative to admission to ensure more patients received a diagnosis and urgent treatment without unnecessary hospital stays;

o   Non-elective admissions across all providers within South West Lincolnshire CCG, including ULHT, Nottingham University Hospitals NHS Trust, Sherwood Forest NHS Foundation Trust, fell by 7% in 2014/15.  The CCG's non-elective admissions had fallen between 6% and 7% each year for the past three years and it was not expected that, in light of the aging population and high disease burden, that this would continue;

o   Emergency admission rates for the CCG were significantly lower than the national average although it was reported that admission rates for all Lincolnshire CCG's were lower than average.

·       Planned Care

o   Focus was on the delivery of referrals to treatment standards for our patients as significant problems as a result of difficult access at ULHT had been experienced by patients.  The CCG now reported that 92% of patients were scheduled to be treated on time and not subjected to any delays;

o   Focus was on improving cancer access following the loss of breast services at Grantham as a result of staff shortages.  Despite the current standard of service and access not being satisfactory to the CCG, this had shown a steady improvement, largely as a result of the use of services outside Lincolnshire in both Nottingham and Peterborough;

o   New provider relationships were being developed and access to the independent sector and NHS Trusts outside of Lincolnshire were increasing in an attempt to secure steady access.  The CCG was well placed to access alternative providers due to a lack of capacity in Grantham, Lincoln and Boston;

o   A pilot scheme had been launched for a new hearing loss service within Specsavers in Grantham to provide an alternative to current hospital services which were unable to meet demand.  The service was expected to enable hospital services to focus on serious cases and give faster local access.  An evaluation of the pilot would take place after twelve months and, if successful, would be fully procured.

·       Mental Health and Learning Disabilities

o   As the lead CCG for the area, the CCG were leading the work on the deployment of £2m of recurrent investment from the Lincolnshire CCG's on the Parity of Esteem Programme.  This was focussed on the delivery of a robust 24 hour 7 day liaison service and response to A&E, working with urgent services and to ensure that the 24 hour and 7 day CAMHS services worked coherently with adult mental health services;

o   Work was ongoing with Lincolnshire Partnership NHS Foundation Trust (LPFT) to manage the impacts for the closure of Long Leys Court Assessment and Treatment Unit and to work closely with them to ensure that high quality safe placement alternatives were located for the remaining service users in that unit;

o   Development of a community based model was being jointly considered with LPFT as an alternative, giving full compliance with requirements of national policy, and was expected to put Lincolnshire at the leading edge of modern learning disability services;

o   Work also continued with LPFT's leadership and clinical teams to deliver improvements set out in a single quality plan which had been reviewed by the Health Scrutiny Committee for Lincolnshire;

·       Primary Care

o   Three successful bids had been submitted to the Primary Care Infrastructure Fund, following work with practices in the CCG area, to provide additional consulting and team working space.  A programme of building work was currently being rolled out as a result;

o   Development of a quality infrastructure, including quality dashboards and a process based on practice visits by the CCG, was ongoing in conjunction with practices to ensure that they were making best use of resources and delivery high quality services;

o   CQC inspections had taken place with certain practices in the South West Lincolnshire CCG area and work was ongoing with those practices highlighted by the CQC as "requiring improvement" to ensure that issues were improved as soon as possible;

o   There had been investment in practices in care coordination at a local level to ensure that practices were able to provide coordinated and joined up care.  This had included provision of non GP resources enabling practices to free time to manage the care of those with the most complex needs;

o   It was reported that South West Lincolnshire CCG had again delivered all of its financial obligations and was awarded the "Best CCG to Work In" by the Health Service Journal and Nursing Times in 2015.  This accolade resulted in the CCG being one of the five best NHS organisations to work in nationally which was acknowledged as a significant achievement for the team;

o   Close working with partners on the development of the Lincolnshire Health and Care Strategic Outline Case was to continue in the future;

·       Commissioning Support

o   Partnership working with South Lincolnshire CCG had resulted in the CCG being the first in the country to successfully access the new national Lead Provider Framework for commissioning support.  The framework offered CCG's a choice of accredited providers for 'back office functions' which ranged from payroll to IT support.  It was reported that, following a rigorous selection process, Optum had been selected as the new provider of these services.  A transition process would commence from the current provider, Greater East Midlands Commissioning Support Unit.

Members were given the opportunity to ask questions during which the following points were noted:-

·       Lincolnshire West CCG were leading a piece of work to bring together all organisations who held responsibility for end of life care.  This was expected to improve those services by developing an alliance format.  Additionally, medical support within hospices were delivered by GPs rather than hospitals which further improved the communication;

·       Challenges faced across Lincolnshire were varied and it was acknowledged that health problems as a result of good living could be as complex as those in an area of deprivation;

·       The role of Neighbourhood Teams had not been included in the report as it had now become a fundamental part of the service.  It was suggested and agreed that future reports should include the explicit role of Neighbourhood Teams to make it clear for both the Committee and the public;

·       Emergency units were in place across all three hospitals within Lincolnshire although had differing names.  Clarification was received that it was the Emergency Assessment Unit (EAU) in Grantham and the Medical Assessment Unit (MAU) in Lincoln;

·       The Ambulatory Care Unit was also able to undertake some of the emergency assessments without admitting patients.  The Ambulatory Care Unit was physically located near to A&E and also to the Emergency Assessment Unit (EAU) to ensure the flow of patients was clear and easy for all involved;

·       Intelligence and service user voice would be included within the contract monitoring with Lincolnshire Partnership NHS Foundation Trust and all issues addressed within the Quality Improvement Plan.  The CCG were confident that the temporary closure of services had not reduced the quality of service but improved them.  The ambition was for Lincolnshire to be at the forefront of these types of services;

·       Mental health patients picked up by the police were required to be taken to a place of safety under Section 136.  The police were working with LPFT to fully develop a suitable and safe pathway;

·       It was acknowledged that the report could read that partnership working had ceased due to the language used.  It was stressed that partnership working was a continuous process and one which was key to service delivery success;

·       It was confirmed that cost efficiencies would arise from Optum undertaking the Commissioning Support Unit functions for the CCG, and there was expected to be a quality gain, the process for awarding the contract was done as part of the National Framework Agreement from NHS England which include ten approved providers, all of which were within the quality and monetary framework requirements;

·       Although CQC inspections of GP practices often highlighted poor practice, the Committee was asked to acknowledge that these inspections found examples of good practice, but the aim was to be outstanding;

·       The district councillor representing South Kesteven District Council on the Committee asked it to be recorded that the South Kesteven District Council was impressed by the improvements made by the CCG in the area;

·       Discussions were ongoing with the Communications Lead to promote to the public how positive these improvements had been.  It was though that a paid editorial may be required to ensure that the public were aware of the changes;

·       In relation to Neurology, work was ongoing to develop a more community-based, nurse-led, neurology base and proposals around those developments would be presented at a future date.  It was anticipated that the Lincolnshire model would change considerably;

·       A Cancer Improvement Plan was in development which would be shared with the Committee;

·       It had been agreed to open an additional four beds, over and above the 16 already open, as and when needed to support winter pressures.  Those beds were in one location which would help to manage staff and ensure efficiency.  The beds were also based in the Order of St John Care Home in Grantham and not the hospital as it was more cost effective and efficient to have them set up in this way;

·       Grantham's proximity to Nottingham led to more patient availability in Lincolnshire when patients chose to take treatment out-of-county.  Although there was a financial pressure it was due to the market forces factor and, on balance, the CCG would prefer that people received the appropriate treatment without delays;

The Chairman thanked officers for their presentation and gave formal congratulations, on behalf of the Committee, on their recent achievements.

RESOLVED

          That the report and comments made be noted.

It was agreed to take Item 8 – Work Programme prior to Item 7 – Urgent Care – Constitutional Standards Recovery and Winter Resilience.