Agenda and minutes

An apology for absence was received from District Councillor Dr G Samra.

It was noted that the Chief Executive, having received a notice under Regulation 13 of the Local Government (Committees and Political Groups) Regulations 1990, had appointed Mrs H N J Powell as a replacement member of the Committee in place of Councillor Mrs S L W Palmer, for this meeting only.

Councillor Mrs C A Talbot declared an interest in Minute 26 'Burton Road GP Surgery, Lincoln' to the extent that there were patients registered at the GP Surgery within her Electoral Division, Bracebridge Heath and Waddington.

The Chairman welcomed everyone to the meeting and advised the Committee of the following items: -

i)          Care Quality Commission Report – United Lincolnshire Hospitals NHS      Trust

On 10 July 2014, the Care Quality Commission (CQC) had published an overview report on United Lincolnshire Hospitals NHS Trust (ULHT), following inspections in April and May 2014.  The Chairman reminded Members that ULHT was one of eleven hospital trusts in England placed in special measures during the summer of 2013, as part of the Keogh review process.  The CQC's overview report on ULHT had concluded that the Trust "requires improvement" and it would remain in special measures for a further six months, at least. 

In addition to the overview report, there were four individual hospital reports for Lincoln County, Pilgrim Hospital, Grantham and District Hospital, and for the services provided by ULHT at Louth County Hospital.  Those reports were available on the CQC's website: http://www.cqc.org.uk/provider/RWD .

Of the four ULHT hospitals, Lincoln County had presented the most challenges: for example, the outpatient services at Lincoln County were rated as "inadequate" overall.  There was one piece of good news: the responsiveness of Critical Care at Lincoln County was rated as "outstanding". 

The Chairman recognised the progress made by ULHT in the last year.  For example, it had implemented 55 out of the 57 actions arising from last year's Keogh inspection.  However, the Chairman was disappointed that the outcome was not better and that ULHT remained in special measures. 

The Chairman provided some context to this: of the eleven trusts in England placed in special measures last year, Professor Sir Mike Richards, the Chief Inspector of Hospitals, had recommended that six trusts, including ULHT, remained in special measures following their re?inspection this year.   The Chairman hoped that ULHT would leave the category of special measures very soon.  

In a statement to the House of Commons on 16 July 2014, the Secretary of State for Health had referred to ULHT and stated that although ULHT had made progress, including the employment of additional nurses, work remained to be done. 

The Chairman reminded Members that the Committee would be considering the ULHT's action and implementation plan at its September meeting. 

ii)         Care Quality Commission Report – Northern Lincolnshire and Goole          NHS Foundation Trust

On 17 July 2014, the CQC had published its overview report on Northern Lincolnshire and Goole NHS Foundation Trust (NLaG), following inspections in April and May 2014.  As with ULHT, this was a follow up report to last year's inspection as part of the Keogh Review of 14 hospitals, announced in February 2013.  The overview report for NLaG had concluded that the Trust "requires improvement".  However, the Trust was no longer in special measures.  The Chairman was pleased with their progress.  

In addition to the overview report, there were three reports on individual hospitals: Diana, Princess of Wales Hospital, Grimsby, Scunthorpe General Hospital, and Goole Hospital.  Those reports were available on  ...  view the full minutes text for item 24.

RESOLVED

That the minutes of the meeting held on 25 June 2014 be agreed as a correct record and signed by the Chairman.

(To receive a report by Di Pegg (Head of Primary Care, NHS England, Leicestershire and Lincolnshire Area Team), which invites the Committee to consider and comment upon the update on the future arrangements for the Burton Road Surgery and the current state of progress.  David Sharp (Director) and Di Pegg (Head of Primary Care) of NHS England, Leicestershire and Lincolnshire Area Team, will both be in attendance)

The Chairman stated that in accordance with the minutes of the previous meeting she had met Andrew Morgan, Chief Executive of Lincolnshire Community Services NHS Trust, on 30 June 2014.  She had also met David Sharp, Director of the Leicestershire and Lincolnshire Area Team, on 7 July 2014.  Following the discussions with David Sharp, it had been suggested that a protocol would be introduced between the NHS England Area Team and the Health Scrutiny Committee, which would be based on the protocol, which had been approved by the Committee and the Clinical Commissioning Groups in Lincolnshire. 

The Chairman also referred to the public meeting, which had taken place on the evening of 7 July 2014. 

David Sharp referred to the fact that the Area Team had made an erroneous presumption that the Burton Road GP Practice was a small GP practice and the best outcome for the practice was the dispersal of patients to neighbouring GP practices.  The Area Team had not consulted with patients and had misjudged the strength of local feeling in support of retaining the surgery.  David Sharp apologised to the Committee for the way the whole episode had been handled. 

As a result, two pieces of work were under way: to seek an interim provider for the Burton Road GP Surgery, on which an announcement would be expected on 1 August 2014; and to seek to procure a longer term provider under an APMS [Alternative Provider of Medical Services] contract, from 1 July 2015.

The position of Lincolnshire Community Health Services (LCHS) NHS Trust was clarified: LCHS had run the Burton Road GP Practice from 2011, when LCHS was formally established; prior to 2011, the Surgery had been operated by the provider arm of Lincolnshire Primary Care Trust.

There were five time-limited GP contracts, where Lincolnshire Community Health Services NHS Trust (LCHS) provided GP services.  These contracts were referred to as APMS [Alternative Provider of Medical Services] contracts.  These five contracts had originally been due to expire in March 2014.  In May 2013 the Area Team had advised LCHS that it wished to extend all the contracts until 31 March 2015.  In March 2014, the Area Team had begun a preferred procurement exercise and had issued pre?qualification questionnaires, with a view to re-procuring four of the five contracts. Burton Road Surgery had not been included in the re-procurement exercise.

LCHS understood that the Area Team had decided to end the Burton Road Surgery contract early, and to disperse the list, on the basis that the practice list size was uneconomical for future service delivery and the premises were not fit for purpose. 

Questions from members of the Committee clarified the following items:

·         There were ten GP practices in the Lincoln area.

·         Meetings would be taking place with the neighbouring GP practices.

·         97% of the patients registered at Burton Road Surgery lived within one mile of another GP practice.

·         An APMS [Alternative Provider of Medical Services] GP contract was always time limited  ...  view the full minutes text for item 26.

(To receive a report by Jan Gunter (Designated Safeguarding Nurse, South West Lincolnshire Clinical Commissioning Group), which invites the Committee to consider and comment on the 'Review of Health Services for Children Looked After and Safeguarding in Lincolnshire', published by the Care Quality Commission on 21 February 2014, the associated Action Plan and any progress to date.  The Designated Safeguarding Nurse will be in attendance)

Jan Gunter, the Designated Safeguarding Nurse, from South Lincolnshire Clinical Commissioning Group, attended the Committee to present a report on the Review of Health Services for Children Looked After and Safeguarding in Lincolnshire. 

In addition to the report, the following documents were submitted to the Committee:

• the Review of Health Services for Children Looked After and Safeguarding in Lincolnshire, published by the Care Quality Commission (CQC) on 21 February 2014;
• the associated action plan submitted to the CQC on 21 March 2014 in response to the recommendations of the CQC's report; and
• a progress update against the action plan, dated July 2014.

The Committee was advised that the CQC's review, which had taken place between 4 and 8 November 2013, had explored the effectiveness of health services for looked after children and the effectiveness of safeguarding arrangements within health for all children. The review also considered the role of healthcare providers and commissioners; the role of healthcare organisations in understanding risk factors, identifying needs, communicating effectively with children and families, liaising with other agencies, assessing needs and responding to those needs and contributing to multi-agency assessments and reviews.

The CQC had made 25 recommendations for both commissioning and provider organisations across Lincolnshire and the NHS England Area Team, leading to 45 strategic actions, which were being co-ordinated through the Federated Safeguarding Service Team.  The review did not identify any issues that were unknown to the commissioning and provider services.

Jan Gunter highlighted the key issues, which had been set out in the documentation:

·                    the capacity of the designate professionals for safeguarding and looked after children to undertake strategic leadership and commissioning planning;

·                    Paediatric expertise within unscheduled care and in A&E settings;

·                    the development of self- harm pathway to ensure that is embedded in practice;

·                    Variance in quality of the statutory health assessment for looked after children; and

·                    The impact of externally placed children in independent care settings on local resources.

Following questions from the Committee the following points were established:

·                     The Lincolnshire Safeguarding Children Board took an overview of the number of looked after children placed in Lincolnshire by other local authorities, but the County Council did not act as the corporate parents for these children, as the placing local authority retained the corporate parenting role.  There was limited leverage in relation to the independent care home, which provided places for children from other local authority areas and other local authorities were not passing on the relevant information.  There were currently 402 looked after children placed in Lincolnshire by other local authorities. 

·                     Where a looked after child presented with drug or alcohol problems at Accident and Emergency, their health record indicated that they were a looked after child, even if they did not disclose this.

·                     Initial Health Assessments for Looked After Children under five years of age would be conducted by paediatricians. It was hoped that these arrangements would be in place by October 2014.   The new arrangements would be in place once the paediatricians had been  ...  view the full minutes text for item 27.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to determine whether it wishes to respond to the 'Healthy Lives, Healthy Futures' a consultation by North Lincolnshire and North East Lincolnshire Clinical Commissioning Groups and then to establish a working group to draft a response)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which outlined the content of the 'Health Lives, Healthy Future', a consultation by North Lincolnshire and North East Lincolnshire Clinical Commissioning Groups.  The report also invited the Committee to determine whether it wished to respond to the consultation and then to establish a working group to draft a response.

Members were advised that on 30 June 2014, North Lincolnshire and North East Lincolnshire Clinical Commissioning Groups had launched a consultation on their 'Healthy Lives, Healthy Futures', which affected the provision of services at Northern Lincolnshire and Goole NHS Foundation Trust, in particular Scunthorpe General Hospital, and Diana, Princess of Wales Hospital, Grimsby.  The consultation related to Hyperactive Stroke Services and Ear, Nose and Throat services and the consultation period was due to close on 26 September 2014.

In the absence of Councillors M Leaning (West Lindsey District Council) and C E H Marfleet (Lincolnshire County Council), it was suggested that those members should be contacted to ascertain whether they would wish to sit on the working group, as constituents within their respective divisions could be affected by the proposals.

RESOLVED

(1)          That a joint working group be formed, comprising members of the Health Scrutiny Committee for Lincolnshire to prepare a response to the 'Healthy Lives, Healthy Futures' consultation.

(2)          That Councillors Mrs C A Talbot, C J T H Brewis and Mrs S M Wray become members of the working group.

(3)          That Councillors M Leaning (West Lindsey District Council) and C E H Marfleet (Lincolnshire County Council) be contacted to ascertain whether they wish to sit on the working group.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider and comment on the content of 'Local Authority Health Scrutiny – Guidance to Support Local Authorities and Their Partners to Deliver Effective Health Scrutiny', issued by the Department of Health on 27 June 2014)

A report by Simon Evans (Health Scrutiny Officer) was considered, which highlighted the key elements of the 'Local Authority Health Scrutiny – Guidance to Support Local Authorities and Their Partners to Deliver Effective Health Scrutiny'. 

Members were advised that on 27 June 2014, the Department of Health had issued guidance to local authorities on their health overview and scrutiny function.  The Department of Health had stated that "the guidance needs to be conscientiously taken into account", but it was not a substitute for the legislation.  Detailed information was provided as part of the report, which covered the following areas: -

·    Key Messages;

·    Description of the Existing Legislation;

·    Conflicts of Interest;

·    Consultation; and

·    Delegation of Referrals to Health Overview and Scrutiny Committee.

The Committee welcomed that the guidance had included a statement in paragraph 4.7.6 to the effect that the power to make a referral to the Secretary of State could also be delegated to health overview and scrutiny committees.  In light of this, the previous legal advice had been reviewed and it was now possible for such power to be delegated by the County Council to an overview and scrutiny committee.  However, this would require a change to the County Council's Constitution.

RESOLVED

(1)  That the content of 'Local Authority Health Scrutiny – Guidance to Support Local Authorities and Their Partners to Deliver Effective Health Scrutiny', issued by the Department of Health on 27 June 2014 and comments made be noted.

(2)  That it be noted that the Committee and the four Clinical Commissioning Groups in Lincolnshire had approved a protocol to support joint working, which covers consultations by the Clinical Commissioning Groups on substantial developments and substantial variations in local health service provision.

(3)  That a separate protocol be developed between the Committee and the NHS England Area Team, similar to that between the Committee and the Clinical Commissioning Groups.

(4)  That a protocol be developed between the Committee and Healthwatch Lincolnshire, similar to that between the Committee and the Clinical Commissioning Groups.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to note the statements on eight Quality Accounts, relating to providers of local NHS-funded services)

Consideration was given to a report by Simon Evans (Scrutiny Officer), which invited the Committee to note the statements on eight Quality Accounts, relating to providers of local NHS-funded services.

Members were reminded that every year each provider of NHS-funded services was required to prepare a Quality Account, which included the provider's priorities for the coming year; progress with priorities for the previous year; and other prescribed information.  The Committee was one of the organisations entitled to submit a statement on the draft Quality Account of each local provider.  The report also provided the Committee with information on the Quality Account statements, which had been prepared on the Committee's behalf during April, May and June 2014.  In four instances, joint statements had been prepared with Healthwatch Lincolnshire, with a further four statements prepared on behalf of the Committee alone.

The Chairman took the opportunity to thank the Health Scrutiny Officer for his work on the Quality Accounts, in particular those which he had drafted on behalf of the Committee.

RESOLVED

That the statements on eight Quality Accounts, relating to providers of local NHS-funded services be noted.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider its work programme for the coming months)

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

The Committee was also invited to consider its meeting arrangements in advance of the General Election on 7 May 2015.

A discussion took place regarding the scheduled item on 'Public Health Annual Report and Action Plan on Suicide and Self-Harm in Lincolnshire', which was due to be considered by the Committee on 22 October 2014.  It queried whether it would be possible to combine this item with an update on the Lincolnshire Rural Support Network, where it was subsequently agreed that this should be a separate item for the Committee's agenda in November 2014.

NOTE: At this stage in the proceedings, Councillor Mrs C A Talbot declared an interest as she made donations to the Lincolnshire Rural Support Network.

RESOLVED

(1)  That the work programme and changes made therein be noted.

(2)  That the Committee holds a meeting on 11 March 2015, instead of 18 March 2015.

(3)  That the meeting scheduled to be held on 22 April 2015 be cancelled.