Agenda and minutes

Apologies for absence were received from Councillors R Kendrick, Mrs R Kaberry-Brown (South Kesteven District Council), P Howitt-Cowan (West Lindsey District Council) and T Boston (North Kesteven District Council).

It was noted that the Chief Executive, having received notice under Regulation 13 of the Local Government (Committee and Political Groups) Regulations 1990, had appointed Councillor B Russell (South Kesteven District Council) to the Committee in place of Councillor Mrs R Kaberry-Brown (South Kesteven District Council) for this meeting only.

Councillor Mrs P F Watson advised the Committee that she was currently a patient of United Lincolnshire Hospitals NHS Trust.

Councillor C J T H Brewis advised the Committee that he was currently a patient of the Anglia Community Eye Service, Wisbech.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 13 September 2017 be approved and signed by the Chairman as a correct record.

Further to the Chairman's announcements contained within the agenda for the meeting, the Chairman advised the meeting that an item from NHS England on Dental Services in Lincolnshire had been withdrawn just prior to the agenda being finalised.  The rescheduling of this item would therefore be considered as part of the work programme item further in the agenda.

Circulated at the meeting was a letter and accompanying document from Wendy Martin, Executive Lead Nurse/Midwife & Quality, NHS Lincolnshire West Clinical Commissioning Group, concerning the Lincoln Walk-in Centre Consultation, which had been received by the Health Scrutiny Officer on Tuesday 10 October 2017.  The Chairman invited the Committee to take five minutes to consider the document.

During a short discussion, the Committee commented on the following issues:-

·         The Health Scrutiny Officer confirmed that in relation to item 1 – (Briefing on Financial Position of United Lincolnshire Hospitals NHS Trust) no further information had been received, other than that already made available in the public domain;

·         One member advised that in relation to item 2 – (United Lincolnshire Hospitals NHS Trust: Recruitment of Nurses) announcement had been made that there would be an expansion in the training of nursing associates (which involved support staff working alongside fully qualified nurses).  The nursing associate could then start a nursing apprenticeship over a two year period, which would then lead them to becoming a fully qualified nurse over a total of four years, rather than three years as for current degree students.  A request was made for future reports to indicate the net recruitment position. The Health Scrutiny Officer confirmed that the Committee would be receiving an update from United Lincolnshire Hospitals NHS Trust at its 8 November 2017 meeting; and

·         One member enquired as to whether the Director of Finance, Procurement and Corporate Affairs at United Lincolnshire Hospitals NHS Trust had given any indication as to what the overspend would be at the end of the year.  The Chairman advised that the projected figure had been stated as £75m; and that a further update would be received at the November meeting.   

To receive a report from Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership (STP), which provides the Committee with an update on the current position of the STP)

The Chairman welcomed to the meeting John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP), Andrew Morgan, Chief Executive, Lincolnshire Community Services NHS Trust and Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership.

In a short introduction, the Chairman advised the Committee that two councillors had made a request to address the Committee on this item in relation to Grantham A & E, which was referred to in the report.  The Chairman highlighted that as the STP was a county-wide issue, there was not an automatic right for local members to speak on this item.  However, on this occasion, the Chairman highlighted that he had decided to allow the councillors to speak, and he urged the Committee to give full consideration to all aspects of the STP report; and not just the Grantham A & E issue.

The Chairman welcomed Councillors Mrs L Wootten and R Wootten to the meeting; and advised the Committee that he proposed to allocate them both three minutes each, and that they would be invited to speak to members of the Committee following officers presenting the report.

The Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP) started his address by advising the Committee that throughout the county on a day to day basis, dedicated NHS staff provided excellent services.  However, stepping back from day to day provision, the NHS in Lincolnshire had some very challenging issues to address.

The Committee was advised that there were significant challenges across the county relating to recruitment of specialist staff; and that agency staff were helping to keep NHS services across the county working.  Other challenges for the NHS included the demographics of Lincolnshire; in particular, it's increasingly ageing population.

It was reported that the current model of NHS provision across Lincolnshire was out of date and inconsistent and that over the years the NHS had been reactive in its planning, rather than being proactive.  The current model clearly was not sustainable and was not suitable for patients, or for staff.  It was highlighted that the Sustainability and Transformation Plan would try and address the challenges and ensure that health services in Lincolnshire were delivered in an efficient and effective way, ensuring that the services provided met the needs of patients.  The Committee noted that many services across the county were working well and that there were no plans to change them.

The Committee was advised that the STP plan was a plan that focussed on progressing seven key priorities, which comprised of:-

·         Mental Health;

·         Neighbourhood Teams;

·         Implementation of GP Forward View;

·         Acute Care Reconfiguration;

·         Urgent and Emergency Care Transformation;

·         Operational Efficiencies; and

·         Planned Care.

Outline details against each of the seven priorities was provided within the report for the Committees consideration.

It was reported that the seven priorities were all supported by a number of enabling work streams such as IT solutions; ensuring that the estate was able to support the delivery of service reconfiguration; the up-skilling of the workforce; delivering  ...  view the full minutes text for item 32.

(To receive a report from Annette Lumb, Head of Planning and Corporate Governance, Lincolnshire West Clinical Commissioning Group, which invites the Committee to consider the proposed consultation document and consultation plan)

Councillor Mrs K Cook wished it to be noted that she was currently a patient of Lincolnshire Partnership NHS Foundation Trust.

The Chairman welcomed Dr Sue Elcock, Medical Director, Lincolnshire Partnership NHS Foundation Trust and Jane Marshall, Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust to the meeting.

The Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership introduced the item and provided some background information to the proposed consultation plan.  Attached at Appendix A to the report was a copy of the proposed consultation document for the Committee's consideration.

In a joint presentation, the Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust (LPFT) and the Medical Director, Lincolnshire Partnership NHS Foundation Trust advised the Committee that following the temporary closure of the inpatient service at Long Leys Court, extensive engagement had been undertaken with patients, family members and the wider public to explore what already worked well in learning disability services in Lincolnshire; and to also establish what could be done better.  The feedback received from patients, family members and staff had then informed the development of a new integrated community service, which had been in place from 1 April 2016.

It was reported that the current community service had significantly reduced the delays that often occurred between different teams of professionals, and ensured that most patients were treated in their own home.  It was highlighted that the service was more consistent and was accessible across Lincolnshire, as the four hubs were situated in Boston, Lincoln, Spalding and Grantham.

The Committee was advised that in addition to the community service, and working alongside the hubs, was a Crisis Home Assessment and Treatment (CHAT) team which operated 24 hours a day, seven days a week, to provide intensive support in service users' homes.

It was highlighted that on the occasions when people needed more than the community service, more intensive support was provided into the person's home environment.  And on the rare occasions some patients with a learning disability required admission to a specialist learning disability hospital, a specialist inpatient bed would be sought from outside of the county.  The Committee noted that since the 1 April 2016, when the new community model had become fully operational, only three service users had needed to be admitted into a specialist learning disability hospital.

The Committee was advised that the £5 million a year expenditure on the new community based learning disability services was approximately the same as the former inpatient service.  Reference was made to the '£635,000 STP footprint' saving cited in the report and a request was made for more detail on the expenditure of the former and current service.

In conclusion, it was felt that the current community service had proved to be very successful and it was believed that it should be retained. It was believed that there was no longer a need for a dedicated inpatient unit in Lincolnshire.

During discussion, the Committee raised the following issues:--

·         One member enquired whether  ...  view the full minutes text for item 33.

(To receive a report from Simon Evans, Health Scrutiny Officer, which advises the Committee of the decision of Lincolnshire West Clinical Commissioning Group in relation to the Lincoln Walk-in-Centre)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which advised the Committee of the decision of Lincolnshire West Clinical Commissioning Group in relation to the Lincoln Walk-in-Centre and invited the Committee to consider a way forward.

A copy of the decision taken by the Lincolnshire West Clinical Commissioning Group on 27 September 2017 was detailed on page 49 of the report.

During discussion, the Committee expressed concern to the lateness of information received from the Lincolnshire West Clinical Commissioning Group; and to the fact that the intention was to close the centre following the winter period, despite comments from members of the public to keep the Centre open. 

A further concern raised was that little seemed to have been done in relation to educating the public with regard to alternative routes to health services.

It was agreed that for the 13 December 2017 and 21 February 2018 meetings information from the Lincolnshire West Clinical Commissioning Group should be circulated in advance in accordance with the statutory standard agenda and report publication requirements. 

RESOLVED

1.    That the decision of the Lincolnshire West Clinical Commissioning Group Governing Body on 27 September 2017 on the Lincoln Walk-in Centre, set out below, be noted:-

"To continue to implement plans to enhance primary care services and raise awareness of the public as to the alternative provisions available and subject to evidence-based reviews by the Governing Body in November 2017 and January 2018 in the key areas of:

·                       university students;

·                       children under-five;

·                       additional primary care appointments; and

·                       access for patients requiring treatment at weekends

to close the Lincoln Walk-in-Centre at the end of the winter period."

2.    That updates from the Lincolnshire West Clinical Commissioning Group on 13 December 2017 and 21 February 2018 (following each Governing meeting of the CCG) be received as to the progress made on providing alternatives to the Lincoln Walk-in-Centre, including the four items listed in the Governing Body's decision.

3.    That assurance and evidence be sought as part of the updates that alternatives to the Lincoln Walk-in-Centre are in place, before the Committee make a decision on whether it can support the closure or decide on any future action.

4.    That the Chairman be authorised specifically to request clear and jargon-free information from Lincolnshire West Clinical Commissioning Group, with this information being made available and circulated to the Committee in accordance with the standard agenda and report publication requirements (five clear days prior to the date of the of the meeting).

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on its work programme)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which enabled the Committee to consider and comment on the content of its work programme to ensure that scrutiny activity was focussed where it could be of greatest benefit.

Appendix A to the report provided the work programme from 8 November 2017 to 16 May 2018 for the Committee's consideration.

The Committee was invited to highlight any additional scrutiny activity which could be included for consideration in the work programme.

The items to be taken forward onto the work programme for future meetings included:-

·         Quarterly updates on the progress of the STP;

·         Dental Services in Lincolnshire;

·         Update on the workings of the Gainsborough Neighbourhood Team;

·         Detailed consideration of the following four priorities from the Lincolnshire Sustainability and Transformation Plan:- Mental Health; Neighbourhood Teams; Implementation of the G P Forward View, and Operational Efficiencies (Including Finance); and

·         Updates from Lincolnshire West Clinical Commissioning Group for 13 December 2017 and 21 February 2018 meetings.

RESOLVED

That the work programme as detailed in Appendix A be received, subject to the inclusion of the items listed above.