Agenda and minutes

Apologies for absence were received from Councillors R H Trollope-Bellew Mrs R Kaberry-Brown (South Kesteven District Council) and Dr B Wookey (Healthwatch).

The Committee was advised that John Bains (Heathwatch) was the replacement member for Dr B Wookey (Healthwatch) for this meeting only.

An apology for absence was also received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison and Community Engagement).

Councillor Mrs K Cook advised the Committee that she was a patient; and on the governing body of Lincolnshire Partnership NHS Foundation Trust.

Councillor C J T H Brewis advised that he was a patient of Addenbrooke's Hospital, Cambridge.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 17 October 2018 be agreed and signed by the Chairman as a correct record, subject to Councillor T Boston (North Kesteven District Council) name being added to the list of apologies for absence received.

Further to the Chairman's announcements circulated with the agenda, the Chairman brought to the Committee's attention the Supplementary Chairman's announcements circulated at the meeting.

The Supplementary Chairman's announcements made reference to:

·         Grantham and District Hospital: Overnight Closure of the Accident and Emergency Department – Correspondence from the Department of Health and Social Care;

·         An update on the Ambulance Service in Lincolnshire Summit Meeting held on 7 November 2018;

·         That information relating to the Bi-Polar Support Group; workforce plan; and the locations of the physical health care clinics would be circulated to members of the Committee once received; and

·         Non-Emergency Patient Transport – Thames Ambulance Service Ltd (TASL) Performance Figures – A copy of the performance report for September/October was provided for the Committee to consider.

One member referred to a statement made by BBC Look North that two options had been developed for Grantham and District Hospital A & E Department; and that concerns had been expressed that the public had not been involved in the development of these options.  Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust advised that options were being developed by the Lincolnshire Sustainability and Transformation Partnership; and that any consultation would be led by the Lincolnshire Clinical Commissioning Groups, as commissioners of accident and emergency services during 2019.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 17 and 18; and the supplementary announcements circulated at the meeting be noted.

To receive a report from United Lincolnshire Hospitals NHS Trust on the latest position on the interim model of paediatric care, which has been operating at Pilgrim Hospital, Boston, since 6 August 2018.  The report, which was written by Dr Neill Hepburn the Trust's Medical Director, will be presented by senior managers from the Trust.  The report also makes reference to the contingency arrangements if the interim model of care should fail. 

The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust.

As agreed at the 12 September 2018 meeting, the Committee received an update on Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust. 

The Committee were reminded of the temporary model of care that had been implemented on 6 August 2018; which included an enhanced paediatric presence in the Pilgrim Hospital Emergency Department; and an acute paediatric assessment unit with a twelve-hour length of stay.  Attached to the report were the following Appendices:-

·         Appendix A - Children & Young Persons Services at United Lincolnshire Hospitals NHS Trust (ULHT) – Risk to the sustainability of the Service (26 October 2018);

·         Appendix B – Contingency Plan – Proposed Relocation Plan;

·         Appendix C – Health Scrutiny Committee – Questions on Contingency Plan – September 2018; and

·         Appendix D – Communications and Engagement Plan Update – United Lincolnshire Hospitals NHS Trust (29 October 2018).

The Committee was advised that the interim service model remained in place and that services were still fragile.  The Committee was advised further that the workforce was still heavily dependent on locums and agency doctors; and that there was now one substantive middle grade doctor and six agency locum middle grade doctors within the current rota.  It was highlighted that the Women's and Children's Clinical Directorate were continuing with national and international recruitment.  Other areas reported on included:-

·         The Committee was advised that following the analysis of the first six weeks' data, the dedicated transport provision that began with two ambulances being available 24 hours a day had now been reduced; and the contract had been extended until 31 December 2018; 

·         It was also reported that in the first six weeks of operation up to 31 October 2018, 674 patients had been seen in the Paediatric Assessment Unit; with 99 children being transferred.  It was highlighted that no issues had been experienced or reported, however, there was an acknowledgment that the transfers of patients had caused some disruption to the patients and their families.  It was noted that each transfer direct from Pilgrim Hospital, Boston to Lincoln County Hospital had taken on average 90 minutes;

·         The Committee was also advised that there had been six in-utero transfers of pregnant ladies during the period up to the end of October 2018;

·         The Committee was advised that the risks would continue to be managed through the project risk register.  It was highlighted that no incidents of patient harm had been reported;

·         The Committee was advised that if needed the contingency plan would be to centralise paediatric services from the Pilgrim site onto the Lincoln County Hospital site, if services could not be maintained at the Pilgrim site.  Details of the proposed Relocation were shown in Appendix B to the report.  The report highlighted the Trust's three incremental plans for the next six months.  These were detailed on page 22 of the report;  ...  view the full minutes text for item 54.

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  ...  view the full minutes text for item 55.

(To receive a report from Samantha Milbank, Accountable Officer, Lincolnshire East Clinical Commissioning, which enables the Committee to give consideration to the Annual Report for 2017/18 for Lincolnshire East Clinical Commissioning Group)

The Chairman welcomed to the meeting Samantha Milbank, Accountable Officer, Lincolnshire East Clinical Commissioning Group (LECCG).

In guiding the Committee through the report the Accountable Officer LECCG advised of the statutory duty of each clinical commissioning group to produce an annual report and accounts.  Appendix A to the report provided the Committee with a copy of the Annual Report and Accounts 2017/18 of Lincolnshire East CCG (Pages 1 – 37 only) for their consideration.

A short discussion ensued, from which the Committee raised the following points:-

·         Why a consultation event had been held outside of Boston.  The Committee was advised that nine events had been held across Lincolnshire; The Committee was reassured that comments raised would be taken on board when arranging future events;

·         The impact of 'hidden' residents on future services and finances.  It was highlighted that this problem was not just restricted to health services;

·         Clarification was given regarding the CQC inspection outcomes as detailed on pages 88/89;

·         Page 97 – Reference was made to the fact that to transform health services, consideration needed to be taken of the public's views;

·         The availability of information on CCG websites – Some members highlighted that information need to be more readily available on CCG websites for members of the public to view;

·         Waiting times – The Committee was advised that waiting times were set nationally.  It was highlighted that work was ongoing with GPs to improve waiting times;

·         Mixed sex accommodation breaches at Northern Lincolnshire and Goole NHS Foundation Trust.  The Committee was advised that this was being addressed;

·         Page 81 – Clarification was sought as to what 'Other' referred to.  The Committee was advised this information would have to be provided after the meeting, as the figure was not known;

·         CQC classification, 'requires improvement' would mean that not every item had been completed but there was still some work to be done.  It was highlighted processes and measures that led to the the CQC ratings were very detailed;

·         One member requested that documents where appropriate should be made available to the Committee in colour.  Officers agreed to look into this matter; and

·         Some reassurance was sought regarding the provision of services provided at Louth County Hospital and Skegness Hospital.  A further question asked was when the outcomes of the recent engagement exercise concerning in-patient services at Louth would be published.  The LECCG acknowledged the provision of services at each of the two sites; and that these would be looked at to ensure the right services at the right time were made available to patients.  The Committee was advised that with regard to in-patient services at Louth, steps would be taken to ensure that there was sufficient capacity going forward.

RESOLVED

That the Annual Report of the Lincolnshire East Clinical Commissioning Group be received and that a performance summary update be received by the Committee before the March 2019 meeting.

The Committee adjourned at 12.55pm and re-convened at 2.00pm.

Additional apologies for absence for the afternoon part of  ...  view the full minutes text for item 56.

To receive a report submitted on behalf of the Lincolnshire Sustainability and Transformation Partnership on the progress with the delivery of the NHS England National Cancer Strategy (Achieving World-Class Cancer Outcomes) in Lincolnshire.  This report was written by and will be presented by Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group.  

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West CCG, Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning Group and Louise Jeanes, Cancer Programme Manager.

The Chairman also advised that a member of the public, Mrs Penny West had made a request to address the Committee with regard to the report.  The Chairman invited Mrs West to speak for a period of 3 minutes to address the issues set out in the report.

In her short statement to the meeting, Mrs West expressed concern relating to the de-skilling of the workforce; and as a result of the de-skilling how many wrong decisions had been made; the need to diagnose faster; whether complaint processes were fit for purpose; and that each patient needed to have their own individual pathway; and what methods of quality control were in place to monitor performance.

The Chairman invited the representatives to respond to the matter raised by Mrs West.

Reassurance was given that pathways were put in place by a clinician when a patient was thought to have cancer and that Lincolnshire was working to reach the constitutional standards and thus improve referral times.  The report presented made reference to workforce challenges.  It also highlighted that performance was monitored through the various CCG governing bodies. 

The report presented advised the Committee of the progress made in delivery the NHS England National Cancer Strategy across Lincolnshire, as part of the Lincolnshire Sustainability and Transformation Partnership.  The Chief Operating Officer, Lincolnshire West CCG thanked Mrs West for her questions; and advised that she would meet her after the meeting to discuss some of the issues further. 

Councillor Mrs P F Watson (East Lindsey District Council) advised that she was currently a patient of United Lincolnshire Hospitals NHS Trust.

The Committee was advised that in January 2017, Lincolnshire had held its first ever Cancer Summit, which had brought colleagues from across the Lincolnshire health and care system together with colleagues from the East Midlands Cancer Care Alliance, patients and members of the public together to consider a Case for Change. It was noted that work was ongoing with public health colleagues to encourage people to change their lifestyle to minimise risks to certain cancers.  It was noted further that making the public aware of how they can help themselves, for example by taking up screening programmes.  It was highlighted that screening programmes were well attended across Lincolnshire.  As part of the screening, it was highlighted that steps were being taken to look at the way the tests were being carried out, to quicken up the process of receiving results.

The Committee was advised of the priorities that had been developed and agreed at the Lincolnshire Cancer Summit.  These were:-

·         Improve delivery of the 62 day constitutional standard (details of the changes made were shown on pages 111/112 of the report presented).  There was an understanding that there was more to do to reduce delays.  It was reported that an independent audit of  ...  view the full minutes text for item 57.

To receive a report submitted on behalf of the Lincolnshire Sustainability and Transformation Partnership on the Integrated Community Care Portfolio and the progress made in four of the key programme areas: neighbourhood working; the GP Forward View; the 'Integrated Accelerator Programme'; and other work realted to data modelling, business change and integrated care.  This report was written by and will be presented by Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group. 

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group and Kirsteen Redmile, Lead Change Manager, Integrated Care, STP System Delivery Unit.

The report circulated provided the Committee with an update on the implementation of the Integrated Community Care portfolio; and the progress that had been made in four of the key programme areas: Neighbourhood Working, GP Forward View, the Integrated Accelerator programme; and the KPMG and Optum commissioned work.

The Committee was advised that the ambition for the Lincolnshire system was for care to be provided in the community unless there was a clinical need or value for money reason that care and treatment should be provided in an acute hospital setting.  It was noted that Neighbourhood working was an essential element of the Lincolnshire Sustainability and Transformation Partnership, as it allowed equity of services to meet the demographic needs of the residents of Lincolnshire.  It was noted further that the Neighbourhood working approach was now being implemented across the whole of the County with 10 Neighbourhood leads having been appointed.  The Committee was advised that over the last six months the Neighbourhood leads and GP practices had been working closely with their communities and staff working in the area to agree key areas of focus which would have the greatest impact.  Page 125 of the report provided the Committee with details of the key focus area of the individual Neighbourhood Teams.

The Committee was also advised that during the last year other key pieces of work had been progressing which would provide the foundation for integrated community care, these included: Library of information and Services; Local Area Coordination; and Personalised Care and Support Planning.

During discussion, the Committee raised the following points:-

Councillor C L Burke advised the meeting that he was a Board Member of the YMCA; and had also been a former housing manager for young people.

·         That more needed to be done to integrate mental health services with other health services;

·         Extended GP Services - Confirmation was given that extended access to GPs had been rolled out across Lincolnshire from 1 October 2018. It was further highlighted that there had been good usage of the service and that patients had been happy to travel to other GP practices for their appointment as part of the extended access;

·         A question was asked as to whether the system had good working relationships with other organisations such as the YMCA and homelessness charities.  The Committee was advised that the Lincoln City South, Lincoln South and Lincoln North Neighbourhood Teams all had good working relationships with key partners; and

·         One member enquired whether there was adequate capacity to cope with the holistic approach.  Confirmation was given that there were adequate resources, these just needed to be used in a different ways.

The Chairman extended his thanks to the presenters for their attendance.

RESOLVED

1.    That the update on the Integrated Community Care Portfolio be noted and that further updates be received in  ...  view the full minutes text for item 58.

(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 scrutiny activity was focussed where it could be of greatest benefit.

The Committee gave consideration to the work programme as detailed on pages 137 to 139 of the report presented. 

The Committee was advised that the Dental Services item would be consider at the 20 March 2019 meeting.

During a short discussion the following suggestion were put forward for consideration at future meetings:

·         North West Anglia NHS Foundation Trust Update;

·         The NHS Long Term Plan;

·         Community Pain Management; and

·         And the items put forward for further consideration from the meeting at minute numbers 54 (2) & (3), 55(2) & (3) 56, 57, & 58(1).

RESOLVED

That the work programme presented be agreed subject to the changes as detailed above.