Agenda and minutes

Apologies were received from Councillor C E H Marfleet and District Councillor N D Cooper.

No interests were declared.

The Chairman welcomed Councillor Chris Burke to his first meeting of the Health Scrutiny Committee for Lincolnshire as the representative of the City of Lincoln Council.

i           East Midlands Ambulance Service – Additional Information

The Chairman referred to Minute 7 of the minutes from the last meeting which related to Improvements and Performance of the East Midlands Ambulance Service.  Information on three outstanding questions in the minutes was emailed to members of the Committee on 2 June.  On the same evening, this information had been forwarded to a member of the public by one of the recipients of the email.

Whilst it had been subsequently clarified that the information provided by EMAS and included in the email was in the public domain, the Chairman expressed her disappointment that someone had shared this information without first checking whether it was of a public or confidential nature.  Furthermore, the Chairman was worried that this would have an impact on what colleagues from the NHS would share with the Committee in future, as they may fear that information would be passed on indiscriminately.  She acknowledged that most members of the Committee exercised discretion with the information which they received, but she urged all members to adopt a discreet approach in the future.

ii          East Midlands Ambulance Service – Estates Strategy Clarification

The Chairman again referred to Minute 7 of the minutes from the meeting on 21 May.  Since the publication of these minutes, Sue Noyes had asked the Chairman to clarify that the estates programme had been paused at the end of 2013 whilst the organisation focused on stabilisation of response times.  The estates strategy was currently being reviewed, taking account of the feedback received from staff and the public.  EMAS would make a statement at the end of June, with a revised estates strategy being prepared for September 2014.  In the meantime, community ambulance stations, which provided facilities for crews to stop off at whilst they were out on the road, were continuing to be implemented.

iii         New Review of Congenital Heart Services

On Friday 30 May, the NHS England Congenital Heart Services Review Team visited the East Midlands Congenital Heart Centre at Glenfield Hospital in Leicester as part of the new Review of Congenital Heart Services.  The Review Team from NHS England had been visiting all congenital heart centres in England.  These visits had been an opportunity for the Review Team to update the clinical teams, patients and parents about the review; to hear from each Trust about their particular functions; and to listen to staff and patients.

The Chairman had been advised that the visit to Glenfield had gone well and was a good opportunity to meet the key people leading the review.  This was in the light of the Ministerial announcement about the delay to the consultation period of the review as there had been some slippage in the timetable.

A further meeting would be arranged at the end of July or early August by the University Hospitals of  ...  view the full minutes text for item 14.

RESOLVED

That the minutes of the meeting held on 21 May 2014 be agreed as a correct record and signed by the Chairman subject to the addition of the following wording in Minute 3, as follows:

"Councillor Miss E Ransome was appointed as a permanent member replacing Councillor C E D Mair.

(To receive a report by Andy Leary (Director of Finance and Commissioning, NHS England Leicestershire and Lincolnshire Area Team), which invites the Committee to consider the NHS England Area Team roles, in particular their direct commissioning of healthcare services.  The Director of Finance and Commissioning will be in attendance)

Consideration was given to a report which presented information on the activities of NHS England, Leicestershire and Lincolnshire Area Team.

Andy Leary, Director of Finance and Commissioning and Di Pegg, Head of Primary Care both from NHS England Leicestershire and Lincolnshire Area Team were present for this item.

Andy Leary gave an introduction to NHS England and his role within it.  During this, the following points were noted:

·         NHS England was a national organisation with one strategic board.  Its operating base was in Leeds;

·         There were four regional tiers with 27 area teams in total.  The Leicestershire and Lincolnshire Area Team came under the Midlands and East tier along with 7 other area teams;

·         The national team covered a number of directorates:

o   Operations and Delivery;

o   Nursing;

o   Informatics (information management, knowledge management, information and communication technology);

·         Each area team had three fundamental roles:

o   Direct commissioning of hospital care services - £1.4billion of funding which was mainly spent on specialist services.  Services came from a range of organisations and also from hospitals.  Ten area teams undertook a commissioning role across the country;

o   Primary Care – paramedical, pharmaceutical, ophthalmic and dental services came under this heading for which £400million was available.  These services were returned to NHS England in 2013 when some services were transferred to local government;

o   System Convener – This role was as a system leader/manager, improving the quality of care for NHS organisations. 

·         The Area Team was represented on the Health and Wellbeing Board and participation with the Lincolnshire Health and Care Programme.  They had also developed relationships with other organisations like Healthwatch.

In response to questions from the Committee, the following was confirmed;

·         GP appointment waiting times were monitored jointly with the CCGs in Lincolnshire to ensure timings at surgeries were satisfactory;

·         The size of the area teams had been determined to a greater extent by population;

·         Measuring the effect of NHS England on the healthcare received by people in Lincolnshire was not undertaken directly by NHS England.  However the CCGs had a range of clinical indicators to measure whether improvements were being made;

·         Members felt that there were a number of complexities within the NHS England organisation within the NHS;

·         NHS England had a responsibility to ensure the services commissioned provided patient care to the same standards in all geographical areas;

·         The Care Quality Commission existed as a national body to ensure that healthcare providers were meeting national standards.  The CQC had an inspection and enforcement role.  NHS England's role was to contract providers to do a certain job, with a certain amount of money in a certain time period.  It would be CQC's role to take action if standards were not being met.

The Chairman reflected that the Government had spent some £4 billion on reorganising the NHS, however the system seemed even more confusing than before and accountability was not always clear.  Andy Leary responded that there was a mandate between NHS England and the Department of Health  ...  view the full minutes text for item 16.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider the future arrangements for the Burton Road Surgery in Lincoln)

Consideration was given to a report which outlined the details of the consultation on the future arrangements for the Burton Road Surgery in Lincoln, which had approximately 2,700 patients at the end of May 2014.  Andy Leary and Di Pegg from NHS England were present for this item.

The Chairman expressed her disappointment at how the closure of Burton Road Surgery had been handled.  An initial letter, dated 27 May 2014, outlining closure plans for the surgery, had been sent to patients registered at the surgery addressed to “The Occupier”.  However, following this, a statement had been released by NHS England on 5 June 2014, stating they had not yet made a final decision to close it.  At no point had a consultation with patients been conducted.

At a meeting of Lincoln City Council the previous day, a motion had been passed urging NHS England to examine alternatives to the closure, ensure all patients were kept informed, carry out meaningful consultation and ensure decisions made were transparent.

The Committee felt:

·         The way in which NHS England had dealt with the situation was unacceptable;

·         There appeared to be a lack of preparation for meeting with the Committee, with no facts or figures to hand;

·         If patients had been informed the practice was closing, what incentive would there have been to respond to a consultation;

·         There was a duty of care to patients, to ensure they were able to reach an alternative surgery easily and safely;

·         The other contracts coming to an end needed attention to ensure the same pattern was not repeated;

·         As the provider of the service, Lincolnshire Community Health Services (LCHS) was not present to provide its views of the situation.

It was agreed that Councillor R B Parker, County Councillor for Lincoln West, the division in which Burton Road Surgery was located, would be permitted to address the committee:

·         Ordinary people felt powerless when confronted by the NHS.  It had a heavily managerial framework, but there were not many references to value;

·         If there had been no other services in the area, would the contract still have come to an end?;

·         The initial letter began with the words “after careful consideration...” however, this didn't seem to be the case;

·         As well as the letters not being personally addressed, there were some patients of the surgery who didn't receive a letter at all;

·         If there were substantial changes to delivery of services, surely another decision process needed to be gone through.

Following extensive questioning to the NHS England representatives, the following was confirmed:

·         The contract for Burton Road Surgery was time limited and originally due to expire in March 2014. NHS England had sought to negotiate an extension to the contract, until 1 October 2014, for this surgery and four others in the same situation;

·         LCHS were the current providers of the service;

·         During the time of the extension, NHS England would seek an alternative provider or find another surgery willing to takeover as caretakers until an alternative  ...  view the full minutes text for item 17.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider and comment on the content of 'A Five Year Strategy for Clinical Services' at United Lincolnshire Hospitals NHS Trust – 2014-2019.  Dr Suneil Kapadia (Medical Director, United Lincolnshire Hospitals NHS Trust) will be in attendance)

On 4 March 2014, United Lincolnshire Hospitals NHS Trust (ULHT) Board approved a Five Year Strategy for Clinical Services at United Lincolnshire Hospitals NHS Trust – 2014-2019.  Dr Suneil Kapadia, the Medical Director for the Trust was welcomed to the meeting and presented the five year strategy to the Committee.

The presentation covered the following areas:

·         The case for change: ULHT models of clinical care had to change;

·         Future service model;

·         Areas currently under pressure;

·         Clinical Strategy for ULHT: to focus on emergency care in order to reconfigure services;

·         Emergency care networks;

·         Emergency Centres and one Major Emergency Centre;

·         Interdependencies with Major Emergency Centre;

·         Interdependencies with Emergency Centres;

·         Interdependencies with Urgent Care Centres;

·         Less critical services;

·         Clinical strategy for ULHT;

·         Our assumptions;

·         Priorities.

In response to questions from Members, the following was confirmed by Dr Kapadia and Tracy Pilcher:

·         Community hospitals did not come under ULHT's remit.  They were run by LCHS. The Strategy dealt with acute services and was attempting to balance services between district, general and community hospitals;

·         There was a funding deficit across Lincolnshire.  Lincolnshire Health and Care Programme was developing proposals to redesign health services in Lincolnshire;

·         Staff preferences would be taken into account if moving services to a different location meant moving long-serving staff also;

·         Representatives from the CCGs attended meetings to ensure residents' views were heard.

The Chairman thanked Dr Kapadia for attending the Committee.

RESOLVED

That consideration be given to the content of A Five Year Strategy for Clinical Services at United Lincolnshire Hospitals NHS Trust – 2014-2019.

(To receive a report by Simon Evans (Health Scrutiny Officer), which provides information on the four Annual Reports and Accounts of the Clinical Commissioning Groups in Lincolnshire)

Consideration was given to a report which provided information on the four Annual Reports and Accounts of the Clinical Commissioning Groups in Lincolnshire. 

The Annual Reports were physically substantial documents and Members were advised to only read the report which related to their areas.

RESOLVED

1.            That the publication of the Annual Reports and Accounts of the four Clinical Commissioning Groups in Lincolnshire be noted;

2.            That the content of the patient focused elements of the Annual Reports and accounts be used to inform the Committee's work programme.

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

The Committee considered its work programme for the Committee's meetings over the next few months.

It was noted that the Lincolnshire and Nottinghamshire Air Ambulance would be invited to Committee to see how their work affected ambulance response times in Lincolnshire.

Lincolnshire Health and Care needed to be removed from the work programme as it was unlikely to be ready for consultation by September 2014.  However, one element of the Lincolnshire Health and Care Programme would continue and that was the implementation of neighbourhood team pilot sites which were at Stamford, Skegness, Sleaford and Lincoln City South.  There would be no need for a full three month consultation on these proposals, if other elements of the programme did not go forward.

RESOLVED

That the work programme and changes made therein be noted.

NOTE: At this stage in the proceedings, the Committee adjourned for lunch.  On return, the following Members were in attendance: -

County Councillors

Councillors Mrs C A Talbot (Chairman), R C Kirk, Miss E L Ransome, Mrs S Ransome, S L W Palmer, T M Trollope-Bellew, Mrs S M Wray.

District Councillors

Councillors C J T H Brewis (Vice-Chairman) South Holland District Council), C Burke (City of Lincoln Council), Miss J Frost (North Kesteven District Council), Mrs R Kaberry-Brown (South Kesteven District Council), M Leaning (West Lindsey District Council) and Dr G Samra (Boston Borough Council).

Councillor B W Keimach (Executive Support Councillor NHS Liaison, Community Engagement) was also in attendance.

Officers in attendance

Simon Evans (Health Scrutiny Officer), Caroline Walker (Interim Chief Executive, Peterborough and Stamford Hospitals NHS Foundation Trust), Chris Wilkinson (Director of Care Quality and Chief Nurse, Peterborough and Stamford Hospitals NHS Foundation Trust) and Catherine Wilman (Democratic Services Officer).

(To receive a report by Caroline Walker (Interim Chief Executive Officer, Peterborough and Stamford Hospitals NHS Foundation Trust), which invites the Committee to consider and comment on the content of the report and determine whether it requires additional information or further updates.  The Interim Chief Executive will be in attendance at the meeting)

Consideration was given to a report which provided an update on developments and enforcement actions following a CQC inspection at Peterborough and Stamford Hospitals NHS Foundation Trust, as requested by the Committee.

Caroline Walker, Interim Chief Executive and Chris Wilkinson, Director of Care Quality and Chief Nurse both from Peterborough and Stamford Hospitals NHS Foundation Trust were present for this item.

The Committee received a presentation, which covered the following points:

•                     Action planning process;

•                     Ensuring safe services;

•                     Ensuring effective services;

•                     Ensuring services are caring;

•                     Ensuring responsive services;

•                     Ensuring well led services;

•                     CQC Action Plan Steering Group.

A table contained in the report showed how services had been rated by CQC.  All services provided at Peterborough City Hospital and Stamford Hospital had been rated either 'good' or 'requires improvement', with the majority being rated as 'good'.  There had been no areas rated with 'non-compliance' or 'requiring immediate change'.

CQC had produced one report per site and one overarching report for the Trust as a whole.

Inspectors had highlighted particular examples of good practice which were:

•                     Orthopaedic;

•                     Maternity debrief after birth;

•                     Mortuary/bereavement services;

•                     Critical care around ventilator acquired pneumonia;

•                     'Flooding the ward' initiative.

During the presentation and discussion that followed, the points below were noted:

•                     Software to monitor patient bells was being installed which would record details of how long it took for a patient's bedside alarm to be answered and would provide data on each individual bell.  It would not be able to tell if a bell call had been cancelled without a visit, however this would be picked up by intentional rounding in which nurses would visit every patient at hourly intervals;

•                     Discussion took place regarding patient falls and it was noted that national evidence had seen that falls could not be prevented or predicted.  The Trust had attempted to reduce the number of falls and the harm done by installing low rise beds and crash mats in single rooms;

•                     The Trust provided a multi-faith service with a chaplaincy and had recently employed Muslim representation.  In addition, volunteers helped to get patients to chapel and volunteer sitters could be with people at end of life whose families may not be able to be with them;

•                     Patients could be discharged during the night if necessary and this could help both incoming and outgoing patients; a significant number of overnight discharges were children, as it was better to discharge them home following treatment rather than keep them in hospital unnecessarily;

•                     Medi-Rest held the contract for cleaning in the hospitals and their work was checked and monitored by the Facilities Team.

Discussion took place regarding the future of the hospital site in Stamford.  Architects and building contractors were currently ready and waiting for further instruction once a decision had been made. The site had a mixture of listed and new buildings with an area in the centre which was not fit for use.  Some buildings  ...  view the full minutes text for item 21.