Agenda and minutes

Apologies for absence were received from County Councillors C E H Marfleet and Mrs S M Wray.

It was noted that Councillor G Wiseman was attending on behalf of Councillor M Leaning, West Lindsey District Council, for this meeting only.

It was also noted that John Rose was attending on behalf of Dr B Wookey, Healthwatch Lincolnshire, for this meeting only.

Councillor Dr G Samra declared an interest in Minute 54 – 'Lincolnshire West Clinical Commissioning Group', as an Intensive Care Consultant at United Lincolnshire Hospitals NHS Trust.

Councillor Dr G Samra also declared an interest in Minute 55 – 'United Lincolnshire Hospitals NHS Trust – Quality Improvement Journey and Other Issues', as an employee of United Lincolnshire Hospitals NHS Trust and, therefore, would not partake in any discussions regarding the Trust.

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

i)          Five Year Forward View

On 23 October 2014, NHS England had published the 'Five Year Forward View', which set the overall direction of travel of the National Health Service for the next five years.  The Chairman emphasised how important the document would be for the development of the NHS in the future.  The document referred to prevention of illness and the promotion of public health; breaking down the barriers between health services; and keeping small local hospitals viable.  The Chairman advised that the Committee would need to revisit the themes in the 'Five Year Forward View' in the future. 

ii)         Health Summit – East Midlands All Party Parliamentary Group

On 30 October 2014, the Chairman had attended an East Midlands All Party Parliamentary Group Health Summit in Westminster, which had focused on the health needs of the region.  A number of Members of Parliament and Local Authority representatives had participated.  The summit included a presentation from Shona MacLeod (Postgraduate Dean from the East Midlands Healthcare Workforce Deanery), which had highlighted that 40% of GP training vacancies in the region remained unfilled.  Copies of the report of the Summit, together with the presentation would be circulated with the Chairman's announcements after the meeting.

iii)        Peterborough and Stamford Hospitals NHS Foundation Trust – Chief Nurse

Peterborough and Stamford Hospitals NHS Foundation Trust had appointed Joanne Bennis, as its new Chief Nurse to replace Chris Wilkinson, who was retiring in January 2015. 

iv)        Healthy Lives, Healthy Futures – Hyperacute Stroke Services and Ear, Nose        and Throat Services

On 17 September 2014, the Committee had approved its response to a consultation on proposals to make permanent the transfer of Hyperacute Stroke Services from Diana Princess of Wales Hospital in Grimsby to Scunthorpe General Hospital; and to move Ear, Nose and Throat inpatient services from Scunthorpe General Hospital to Diana Princess of Wales Hospital, Grimsby.  The proposals formed part of the Healthy Lives, Healthy Futures programme, which was being undertaken by North Lincolnshire and North East Lincolnshire Clinical Commissioning Groups. 

The Chairman advised that she had received formal notification of the outcome of the consultation, which had confirmed that the two proposals had been approved.  The full decision letter would be circulated after the meeting.

v)         Healthy Lives, Healthy Futures – Workshop 17 November 2014

On 17 November 2014, the Vice Chairman, Councillor C J T H Brewis, and Councillor C Burke had attended a workshop at Grimsby Town Hall on the Healthy Lives, Healthy Futures programme.  The workshop had provided an update on the challenges facing North Lincolnshire and North East Lincolnshire, but which may also impact on Lincolnshire, as £35 million of NHS money from Lincolnshire was spent on services provided at Scunthorpe General Hospital and the Diana Princess of Wales Hospital, Grimsby.  It was noted that there would be a short report on the event for consideration at a future meeting.  

vi)  ...  view the full minutes text for item 52.

During consideration of the minutes of the meeting held on 22 October 2014, it was suggested that further to Minute 45 – 'Healthwatch Lincolnshire', it was suggested that the Chairman of the Committee would write a letter to the Chairman of the Lincolnshire Health and Wellbeing Board requesting that the Board consider promoting a trial to weigh school children in Year Three, in addition to Reception and Year Six.

RESOLVED

(1)         That the minutes of the meeting held on 22 October 2014 be     agreed as a correct record and signed by the Chairman,    subject to       the following amendment being made to Minute 46:

                   'NOTE: At this stage in the proceedings, Councillor Dr G Samra                        declared         an interest as a Consultant at United Lincolnshire                                     Hospitals NHS Trust, and therefore, would not partake in any                            discussions regarding the Trust.'

(2)         That the Chairman be requested to write a letter to the Chairman of      the      Lincolnshire Health and Wellbeing Board requesting that the          Board             consider whether it was prepared to trial the weighing of   primary school          children in Year Three, in addition to Reception      and Year Six.

(To receive a report by Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group), which describes the progress Lincolnshire West Clinical Commissioning Group has made since its creation in April 2013. In particular it highlights work undertaken to improve access to services including Ear, Nose and Throat; Dermatology; Dementia; and the development of Neighbourhood teams.  Sarah Newton (Chief Operating Office) and Dr Sunil Hindocha (Chief Clinical Officer) of the Lincolnshire West Clinical Commissioning Group will be in attendance)

Consideration was given to a report by Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group) which described the progress that Lincolnshire West Clinical Commissioning Group had made since its creation in April 2013.  In particular, it highlighted the work undertaken to improve access to services including Ear, Nose and Throat; Dermatology; Dementia; and the development of Neighbourhood Teams. 

Sarah Newton (Chief Operating Officer), Dr Sunil Hindocha (Chief Clinical Officer) and Richard Childs (Chairman) of Lincolnshire West Clinical Commissioning Group were in attendance and provided Members with detailed information by way of a presentation, which covered the following areas: -

·    Background;

·    Key Achievements; and

·    Future Opportunities.

Members were reminded that Lincolnshire West Clinical Commissioning Group (CCG) was formed in April 2013 following the abolition of the Lincolnshire Primary Care Trust.  It was one of four Clinical Commissioning Groups in Lincolnshire and commissioned health services for a population of 23,000, with a budget of £267.8million.  The CCG had responsibility for the commissioning of hospital, community and mental health services, but currently excluded primary care and highly specialised services.  Those latter services were commissioned by the NHS England, largely through the Leicestershire and Lincolnshire Area Team.

A number of successful initiatives had been undertaken in partnership with other local health commissioners, health providers, social care and the voluntary sector, which included: -

·    Creation of Neighbourhood Teams;

·    Ear, Nose and Throat Pathway Redesign;

·    Paediatric Audiology;

·    Tele dermatology pilot; and

·    Memory Assessment and Management Service.

Creation of Neighbourhood Teams

Members were advised that as part of the CCG's approach to managing an increasingly old and frail population, the CCG was developing and implementing a total of four Neighbourhood Teams (South of Lincoln; Lincoln City South; North Lincoln; and Gainsborough Locality).

The Teams had been formed around geographical groups of GP Practices.  The Teams worked with GP Practices; Mental Health workers; Community Nursing; and Social Workers to deliver integrated working in support of those people with increasing frailty, to help them remain well, independent and safe at home for as long as possible, and to avoid unnecessary hospital admissions.

This worked had started to demonstrate a real impact and at the end of June 2014, 443 fewer people had been admitted to hospital when compared to the end of June 2013 and 345 fewer people over 65 had been admitted to hospital.

Ear, Nose and Throat Pathway Redesign

The CCG had been working with Lincoln County Hospital clinicians and local GPs to review the way that Ear, Nose and Throat conditions were treated in the area.  The review included providing clear guidelines for GPs to enable them to treat more conditions in the community and better communication with the hospital to ensure the patient saw the correct hospital clinician each time.  A new specification for a community based service had been jointly developed and was currently out to tender.  It was hoped that the new improved services would be in place by the spring 2015.

Paediatric Audiology

The CCG had  ...  view the full minutes text for item 54.

(To receive a report by Jane Lewington (Chief Executive, United Lincolnshire Hospitals NHS Trust), which invites Members to consider and comment on the information presented by United Lincolnshire Hospitals NHS Trust on a number of issues.  Jane Lewington (Chief Executive) and Michelle Rhodes (Director of Operations) of the Trust will be in attendance)

A report by Jane Lewington (Chief Executive, United Lincolnshire Hospitals NHS Trust) was considered, which set out the Quality Improvement Journey of United Lincolnshire Hospitals NHS Trust, in response to the reports published by the Care Quality Commission in June 2014.  The report also provided information on five other areas, as follows: -

·    Financial Update 2014/15;

·    Waiting Times;

·    Cancer Care;

·    Breast Services; and

·    Recruitment and Retention.

Jane Lewington (Chief Executive), Ron Buchanan (Chairman) Michelle Rhodes (Director of Operations), Elizabeth Ball (Deputy Director of Nursing and Safeguarding) of United Lincolnshire Hospitals NHS Trust were all in attendance and provided Members with a detailed presentation, which covered the following areas: -

·    Achievements since July 2013;

·    The CQC Inspection key findings;

·    Trust wide ratings;

·    Areas of good practice;

·    Progress the Trust had made since Keogh;

·    Quality Improvement Plan;

·    Outpatients;

·    Performance;

·    Financial Performance;

·    Staffing levels; and

·    Next steps.

Quality Improvement Journey

Overall, the Care Quality Commission (CQC) had found that the Trust required improvement and the overall domain ratings were:

Safe:                   Requires Improvement

Effective:            Requires Improvement

Caring:               Good

Responsive:      Requires Improvement

Well-Led:           Requires Improvement

The Trust had not received any compliance actions; however, there were a number of essential areas where the Trust needed to make further improvements.  Those further improvements were set out as 'Must Do' recommendations.  The report also identified a number of 'Should Do' recommendations for each hospital site.  The Committee's report detailed the Trust Level 'Must Do' actions, page 20 refers. 

In addition, the CQC had rated the Lincoln Outpatients Department as inadequate and Safety in Surgery (Lincoln) was also inadequate.  The Safety in Surgery finding had related to Stow Ward where immediate action was taken by the Trust and, at the CQC's later unannounced inspection, the CQC had confirmed those improvements.

Members were reassured that the Trust had set up a weekly Quality Improvement Programme Board, which was chaired by the Chief Executive, and a Quality Improvement Plan had been developed setting out the key milestones for each of its nineteen Improvement Projects.  Three outstanding Keogh Actions were also included in the Plan.  Detailed delivery plans had been developed for each project/work area.

Financial Update 2014/15

As at 30 September 2014, the Trust had a deficit of £13.4 million on turnover of £207.3 million.  This was £2.4 million behind the year to date target in the Trust's full year £25.4 million deficit plan.  The adverse position was due to underperformance in receiving income from NHS contracts. 

Members were reassured that the Trust was working on actions to recover the current financial position, although it was anticipated that this would be challenging within the context of the CQC inspection requirements.

Waiting Times

Members were advised that throughout 2013/14, there was a growth in demand which had resulted in an increase in waiting times across all specialities.  This had subsequently impacted upon the Trust's ability to meet the 18 week wait target. 

Members were reassured that recovery plans were in place and there had been a focus on releasing  ...  view the full minutes text for item 55.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider the attached consultation document on the Proposed Congenital Heart Disease Standards and Service Specifications.  John Holden (Director of Systems Policy, NHS England) is due to attend the meeting to present information on the proposals in the document)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited the Committee to consider NHS England's Consultation document on the Proposed Congenital Heart Disease Standards and Service Specification. 

John Holden (Director of Systems Policy, NHS England) and Sara Webb (Acute Supplier Manager, Leicestershire and Lincolnshire Area Team, NHS England) were in attendance and provided Members with a detailed presentation, covering the following areas: -

·         The 'New Congenital Heart Disease Review';

·         Objectives;

·         Standards;

·         Areas covered;

·         Next steps; and

·         Member Engagement.

Members were reminded that on 15 September 2014, NHS England had launched a national consultation on the Proposed Congenital Heart Disease Standards and Service Specifications.  The consultation document was attached at Appendix A to the Committee's report. 

As part of its development of the standards and service specifications, NHS England had engaged widely with clinicians and service users.  Its engagement had also included two engagement events aimed at Local Authority and local Healthwatch representatives.  Those events took place on 8 January 2014 and 9 October 2014, both held in Birmingham.  It was noted that the Chairman had attended both events.

There were twelve consultation questions in the consultation document, which were detailed on page 30 of the Committee's report. 

Members' recalled that during the pre-consultation activity, there had been significant discussion on three particular issues: -

·         the preference for four surgeons at each centre, to provide a one-in-four rota;

·         the preference for each surgeon to undertake a minimum of 125 operations each year; and

·         the co-location of children's congenital heart services with other paediatric services.

Members raised concerns over the proposal for four surgeons at each centre, as some clinicians believed that three surgeons was a viable option and could safely deliver results.  Members were reminded that NHS England had engaged widely with clinicians and service users in developing the service specifications and standards. 

In answer to a question, Members were advised that Extra Corporeal Membrane Oxygenation (ECMO) had been excluded from the consultation at the recommendation of the Independent Reconfiguration Panel.

The Chairman suggested that the Committee established a working group to draft and finalise a response to the consultation, as the closing date for the consultation was 8 December 2014.  Councillors Mrs C A Talbot, C J T H Brewis, Miss J Frost and Dr G Samra volunteered to sit on the working group.  It was agreed that the working group would meet on 24 November 2014, at 10.00 am.

The Chairman thanked those officers present for their detailed report and presentation.

RESOLVED

(1)  That the report, presentation and comments made be noted.

(2)  That a working group be established and held on 24 November 2014 at 10.00am to form a response to NHS England's consultation on the Proposed Congenital Heart Disease Standards and Service Specifications.

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

County Councillors

Councillors Mrs C A Talbot (Chairman), R C Kirk, S L W Palmer,  ...  view the full minutes text for item 56.

(To receive a report by Peter Aldrick (Chief Executive, Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust), which outlines the Helicopter Emergency Medical Service provided by the Charitable Trust to the public within the designated areas of operation. The Chief Executive of the Charitable Trust will be in attendance)

A report by Peter Aldrick (Chief Executive Officer, Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust) was considered, which provided Members with an outline of the Helicopter Emergency Medical Service.  This Service was provided by the Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust to the public within the designated areas of operation. The report also covered the establishment and the development of the service over the past twenty years and how this was financed.  The close working relationship with the East Midlands Ambulance Service was explained and information was provided on the number and type of missions that were currently attended by the Air Ambulance.  

The Chairman advised the Committee that Chief Pilot Captain Paul Smith from Lincolnshire and Nottinghamshire Air Ambulance had been named as Air Ambulance Pilot of the Year at the Association of Air Ambulances Awards of Excellence in London. 

Gladys Tingle, 83 years old, who runs six miles every morning before breakfast, was also named Air Ambulance Volunteer of the Year with her extraordinary achievement of raising over £11,000 by completing two London Marathons, and several half marathons and 10k runs since turning 72 years old. 

NOTE: At this stage in the proceedings, Councillor C J T H Brewis declared an interest as the Sutton Bridge Fund Raisers had recently raised £1,000 for the Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust.

It was also noted that Councillor T M Trollope-Bellew had previously donated £500 from two businesses to the Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust.

Peter Aldrick (Chief Executive Officer, Lincolnshire and Nottinghamshire Air Ambulance Charitable Trust) was in attendance at the meeting and provided Members with a detailed presentation, which covered the following areas: -

·    Background history;

·    Information on the Charitable Trust's current and previous aircraft;

·    Medical Aviation Service;

·    Air Ambulance Paramedics;

·    Medical Crew;

·    Support provided to the East Midlands Ambulance Service;

·    Support provided by East Midlands Ambulance Service;

·    Response times;

·    Benefits of an air ambulance over a land ambulance;

·    Number of missions – 2013/14;

·    Equipment available on an air ambulance;

·    Rapid Response Vehicle;

·    Costings;

·    Charity Funding ; and

·    Future Issues.

Members were advised that the Charitable Trust was established in 1993 as a result of concerns raised by a number of hospital consultants in Lincolnshire over the poor survival rates of seriously injured patients during their transportation to hospitals within the rural environment.  The Lincolnshire Air Ambulance had commenced operations in May 1994, once sufficient funds had been raised to lease a suitable helicopter. 

The Air Ambulance was currently based at RAF Waddington, which was considered to be positioned centrally in the Charitable Trust's area of operation, which totalled 3,000 square miles.  The location provided secure facilities for the aircrew and helicopter and readily available support at the airbase.

Members were provided with an opportunity to ask questions, where the following points were noted: -

·         It was confirmed that all calls were initially handled by the East Midlands Ambulance Service Emergency Control in Nottingham, where there was a dedicated Helicopter Emergency Medical Service Desk  ...  view the full minutes text for item 57.

(To receive a report from Nicole Hilton (Community Resilience and Assets Commissioning Manager), which provides an overview of suicide and self-harm in Lincolnshire, with the purpose of demonstrating findings from the audit.  The Community Resilience and Assets Commissioning Manager will be in attendance)

Consideration was given to a report by Nicole Hilton (Community Resilience and Assets Commissioning Manager) which provided Members with an overview of suicide and self-harm in Lincolnshire, with the purpose of demonstrating findings from the audit.  The most up-to-date information was available from Health and Social Care Information Centre and Public Health Mortality Files on suicides registered during 2013.  More detailed information had been accessed via patient records and relates to those suicides registered in the calendar year 2011. 

The Community Resilience and Assets Commissioning Manager was in attendance at the meeting and presented the report to the Committee, making particular reference to the following points: -

·         Lincolnshire had a higher rate of death from suicide for both males and females than in England;

·         Nationally, the majority of suicides had continued to occur in adult males, accounting for approximately three quarters of all suicides.  Latest information for Lincolnshire had shown that 64 deaths were registered in 2013, of which 52 were male;

·         In Lincolnshire, the majority of male deaths were of those aged 35-44 and 45?54 years, which was consistent with recent years.  Historically, the majority of female suicides had been within the 55+ age group, but for 2013, Lincolnshire data had shown a more even distribution across all age groups;

·         Child suicides were uncommon in Lincolnshire, reflecting the national picture.  However, there had been an increase in the number of suicides with four confirmed suicides in children and young people under 18 years old and two suspected suicides since September 2011.  There had been an increase in the number of children admitted to hospital with self-harm.  All of the confirmed and suspected suicides were male; aged between 11 and 17 years old;

·         2011 patient records had shown that 43% of males and 63% of females had some previous contact with mental health services.  A history of depression was evident in 33% of males and 56% of female records.  Lincolnshire Partnership NHS Foundation Trust had confirmed 33% of individuals were in contact with services within the 12 months prior to death;

·         With adults, bereavement and relationship breakdown or difficulties had featured in more than a third of records, with 23% of records making reference to bereavement, which had included suicide and attempted suicide of family members;

·         With children, an investigation had identified a number of common themes, including: death, abandonment or separation from parent; abuse; taken in to care or fostered; alcohol parent or parent with mental ill-health; and special educational needs.  The majority of children had a history of self-harm;

·         As there was a high rate of suicide within the City of Lincoln in 2008-2010, a further investigation of the risk factors for this population had been initiated, which had indicated the greatest number of deaths were of residents from Abbey, Park and Carholme wards; and a greater proportion of deaths within the 25-43 age group;

·         There were a number of known risk factors and it was often a combination of those that had led to suicide.  Many  ...  view the full minutes text for item 58.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites Members to consider and approve the Committee's response to the consultation on the draft Lincolnshire Pharmaceutical Needs Assessment)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited Members to consider the Committee's draft response to the Lincolnshire Pharmaceutical Needs Assessment, make any amendments as required; and to approve it for submission to the Lincolnshire Health and Wellbeing Board in response to the consultation.

Members were reminded that on 22 October 2014, the Committee had considered a report on the draft Lincolnshire Pharmaceutical Needs Assessment, on which the Lincolnshire Health and Wellbeing Board had launched a consultation from 6 October until 4 December 2014.

The Committee had appointed Councillors Mrs C A Talbot, C Burke, C J T H Brewis, R C Kirk and T M Trollope-Bellew to serve on the working group, which had met on 3 November 2014.  The working group had received a presentation from several officers expert in this area.  The Committee's draft response was attached at Appendix A to the report.

Members approved the content of the Committee's draft response, subject to the inclusion of a sentence on promotion of services.  The Chairman thanked the Members of the Working Group for their contribution.

RESOLVED

That the Committee's draft response to the Lincolnshire Pharmaceutical Needs Assessment be approved, subject to the inclusion of a sentence on promotion of services.

(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 its meetings over the coming months.

Members were reminded that an informal development workshop on the East Midlands Ambulance Service NHS Trust had been arranged for the afternoon of 14 January 2015.

RESOLVED

That the work programme and changes made therein be approved.