Agenda and minutes

Apologies for absence were received from Councillor C Macey (East Lindsey District Council), and also his replacement member, Councillor M Harness.

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

Apologies for absence were also received from Lynne Moody (Executive Nurse and Quality Lead, South Lincolnshire Clinical Commissioning Group) and Tony McGinty (Consultant, Public Health – Children's Services).

Councillor Mrs S M Wray reported that, although she did not have an interest on this occasion, she had recently been appointed as the new County Co-ordinator for the Lincolnshire Neurological Alliance.

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

i)          Care Quality Commission – Lincolnshire Community Health Services NHS          Trust

On 9 December 2014, the Care Quality Commission (CQC) had published a series of reports on Lincolnshire Community Health Services NHS Trust (LCHS).  The overall rating for LCHS was good, with only one of the five domains requiring improvement.  The CQC had also published five detailed reports on the Trust, which covered Inpatient Services; Services for Adults; Services for Children, Young People and Families; End of Life Care; and Urgent Care Services.  All those individual services were also rated as good, with the exception of Services for Children, which also required improvement.  It was agreed that copies of the overview report, as well as the individual reports, would be emailed to the Committee.

The Chairman advised that she had attended the Health Summit meeting in Sleaford on 4 December 2014, where stakeholders were advised of the content of the reports.  The Committee would be considering a full report from LCHS at its meeting on 14 January 2015, together with the Trust's action plan in response to the CQC.      

ii)         Healthwatch Lincolnshire Event – 1 December 2014

On 1 December 2014, the Chairman and Councillor Mrs S Ransome had attended the Healthwatch Lincolnshire Event in Sleaford, at which four Healthwatch reports had been launched.  The Committee was advised that the event had been well?organised.  The Committee would be considering a report later on in the agenda, Minute 69 refers, which included the executive summary and recommendations from each of the four reports.

iii)        Protocol with Health and Wellbeing Board, and Healthwatch Lincolnshire

The Chairman confirmed that the protocol between the Committee, the Lincolnshire Health and Wellbeing Board and Healthwatch Lincolnshire had now been approved by all three bodies.  The protocol acknowledged the respective roles and responsibilities of each body and aimed to clarify working relationships, to help deliver the shared vision of improved health and wellbeing for the people of Lincolnshire.  It was noted that the Committee would need to bear in mind the contents of the protocol throughout our work.  It was agreed that the Health Scrutiny Officer would email a copy of the protocol to Members.

It was noted that the protocol between the Committee and NHS England was still under discussion.

iv)        Care Quality Commission Report on the Health of Looked After Children and       Safeguarding

The Chairman reminded Members that at the last meeting of the Committee on 19 November 2014, it had been reported that she had written to Allan Kitt (Chief Officer of South West Lincolnshire CCG), to express her disappointment that the Committee would not be receiving an item on their progress in relation to the recommendations in the CQC's report on Looked After Children until 14 January 2015.  It was noted that the Chairman had received a reply from Allan Kitt, in which he had explained the reasons for  ...  view the full minutes text for item 63.

During consideration of the minutes of the meeting held on 19 November 2014, it was suggested that further to Minute 55 – 'United Lincolnshire Hospitals NHS Trust – Quality Improvement Journey and Other Issues', it was agreed that the Chairman of the Committee would write a letter to the Chief Executive of United Lincolnshire Hospitals NHS Trust requesting the additional information on the current cost of locums and the retention rates of European nurses at each hospital site.

It was also suggested that the Health Scrutiny Officer should provide the Executive Councillor for Adult Care, Health Services and Children's Services with a copy of Minute 58 – 'Annual Report on Suicide and Self Harm in Lincolnshire, authored by Public Health Lincolnshire', for her information.

RESOLVED

(1)  That the minutes of the meeting held on 19 November 2014 be agreed as             a correct record and signed by the Chairman.

(2)  That the Chairman be requested to write a letter to the Chief Executive of United Lincolnshire Hospitals NHS Trust requesting the additional information on the current cost of locums and the retention rates of European nurses at each hospital site, Minute 55 refers.

(3)  That the Health Scrutiny Officer be requested to provide the Executive Councillor for Adult Care, Health Services and Children's Services with a            copy of Minute 58 – 'Annual Report on Suicide and Self Harm in Lincolnshire, authored by Public Health Lincolnshire', for her information.

(To receive a report by Debra Burley (Chief Executive), which invites the Committee to consider and comment on the report from the Lincolnshire Local Medical Committee on GP Access.  Debra Burley (Chief Executive) and Dr Kieran Sharrock (Medical Director) of the Lincolnshire Local Medical Committee are due to attend the meeting)

A report by the Debra Burley (Chief Executive) and Dr Kieran Sharrock (Medical Director) of the Lincolnshire Local Medical Committee was considered, which invited the Committee to consider information on GP Access.  As background information, copies of the Healthwatch Lincolnshire report on the 'Impact of Patient "Did Not Attends" Appointments at GP Surgeries in Lincolnshire" had been circulated to Members of the Committee.

The Lincolnshire Local Medical Committee (LMC) was a representative body for all GPs in Lincolnshire.  The LMC did not commission GP services.  NHS England commissioned core services from GP practices under the relevant contracts.

The Chief Executive and the Medical Director presented the report to the Committee, making particular reference to: -

·    GP Access;

·    Availability of Appointments;

·    Patients who failed to attend appointments (Did Not Attends);

·    GP Recruitment and Retention Issues; and

·    Seven-day Working.

GP Access

Members were advised that there had been a significant increase in GP consultations since 1998 and over 90% of all contacts with the NHS occurred in general practice. 

The average member of the public sees a GP six times a year; double the number of visits from a decade ago. On average, a person aged over 85 years visited their GP on average fourteen times per year.  There had been no corresponding increase in funding to match the increased demand for GP appointments.

It was also stressed that Lincolnshire was in the highest 20% for patients with long-term conditions. 

Availability of Appointments

A recent survey had shown that within Lincolnshire, 83% of patients had reported that they were able to see or speak to a GP when they last tried to make an appointment, though 10% had to call back. This was only 3% worse than the national average.

GP Practices in Lincolnshire tried various methods of working to manage their patients, for example: GP or Nurse Triage; open surgeries; special children's clinics or telephone conversations; the success of which was dependent on the individual practice.  A specific and successful example of this was given: the Galletly Practice in Bourne had undertaken several adjustments to their appointment system; GP Triage and telephone access to meet increased demand whilst maintaining continuity of care.

Practices were required under their contacts to be available for their patients between the hours of 8.00 am and 6.30 pm, many practices also offered extended hours; and this could allow patients to be seen from 7.00 am in the morning, or up to 8.30 pm in the evening for some up to six hours on a Saturday.

Patients who failed to attend appointments (Did Not Attends)

It was reported that the average Did Not Attends (DNAs) rate in Lincolnshire was 4%, ranging from 1% to 11%, depending on the GP Practice.  It was also reported that the DNA rate for Practice Nurses was 6%, ranging from 1% to 15%, again depending on the GP Practice.

All GP Practices monitored their DNA rates; publishing them in their practice on notice boards; on their website and practice newsletters.  ...  view the full minutes text for item 65.

(To receive a report by Sarah Furley (Urgent Care Programme Director), which invites the Committee to consider and comment on the ongoing work and progress, being undertaken by Lincolnshire’s System Resilience Group.  Gary James (Accountable Officer) and Sarah Furley (Urgent Care Programme Director) of Lincolnshire East Clinical Commissioning Group will both be in attendance)

Consideration was given to a report by Sarah Furley (Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group), which outlined three areas for consideration: -

·       the current policy / national context around operational resilience particularly focusing on winter 2014/15;

·       the current performance of the health care system (internally to Lincolnshire and across the county borders); and

·       the Lincolnshire schemes that would operate during the winter of 2014/15.

Gary James (Accountable Officer, Lincolnshire East Clinical Commissioning Group) and Sarah Furley (Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group) were both in attendance.

Current Policy / National Context

It was noted that Lincolnshire had a successful Urgent Care Working Group, which had overseen health and social care urgent care plans, for the last two years. 

In June 2014, national guidance ‘Operational resilience and capacity planning for 2014/15’ was issued.  The guidance mandated changes to existing Urgent Care Working Groups to build on their existing role and to expand their remit to include elective, as well as urgent care. This “new” forum was called the System Resilience Group, which now co-ordinated capacity planning and operational delivery across the health and social care system.  Lincolnshire’s System Resilience Group (SRG) first met in July 2014 and continued to meet monthly.  Lincolnshire also liaised with the SRGs across the county boundaries. 

Bringing together both elective and urgent care within one planning process had underlined the importance of whole system resilience.

There had been six separate non recurrent funding streams since July 2014 to support whole system resilience.  Those funding streams had been targeted specifically at urgent care (including ambulance services) and elective care, A&E, mental health, health visiting, NHS 111 and primary care. 

Local Current Performance

The health economy in Lincolnshire, in common with other parts of the country, had experienced pressure from rising levels of demand, particularly in urgent care; difficulty in meeting constitutional guarantees in A&E, cancer, and referral to treatment (RTT) waiting times consistently; and resource constraints in terms of both workforce availability and financial resources. Increasing levels of cooperation and integrated planning amongst stakeholders through the System Resilience Group had made demonstrable gains in several areas, but so far had not fully reconciled those demands.  The current system performance was described within the report, pages 38 and 39 refers.

Operational Resilience Schemes for this Winter

It was noted that there had been six separate non-recurrent funding streams announced since July 2014 to support whole system resilience.  Those funding streams had been targeted as follows: -

·        Tranche One monies (£7.84 million) - specifically targeted at urgent care (£4.48 million) and elective care (£3.36 million): Urgent care included schemes that were addressing A&E attendance and admission avoidance, seven day services in hospital, early hospital discharge and enablers; and within elective care, additional resources had been invested to secure capacity at alternative providers to enable extension of patient choice and support demand management during the winter period;

·         Tranche Two monies (£2.27 million) – targeted at delivering the A&E 95% standard  ...  view the full minutes text for item 66.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites Members to endorse the Committee's final response to NHS England's consultation on the Proposed Congenital Heart Disease Standards and Service Specifications.  The Committee is also asked to determine that these proposals are potentially a substantial variation and development in healthcare provision)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited Members to endorse the Committee's final response to NHS England's consultation on the Proposed Congenital Heart Disease Standards and Service Specifications.  The Committee was also asked to determine whether the proposals were potentially a substantial variation or substantial development in healthcare provision.

Members were reminded that on 19 November 2014, the Committee had established a working group (Councillors Mrs C A Talbot, C J T H Brewis, Miss J Frost and Dr G Samra and Dr B Wookey) to draft a response to the consultation by NHS England on the Proposed Congenital Heart Disease Standards and Service Specifications.  The Working Group had met on 24 November and 2 December 2014, with the final response, agreed by the Chairman and the Vice-Chairman of the Committee and submitted to NHS England on 8 December 2014.  There were twelve questions in the consultation document, including a question enabling general comments to be made.

The Chairman took the opportunity to thank the Members of the Working Group for their work on the response.  The Chairman also gave special thanks to the Committee's Health Scrutiny Officer for his work on bringing together the views of the working group and forming a comprehensive response.

The Chairman advised the Committee that Sir Bruce Keogh KBE, FRCS, FRCP (Medical Director of NHS England) and the University Hospitals of Leicester NHS Trust had been made aware of the Committee's response.

The Committee thanked the Chairman for her hard work over recent years on this matter since 2009.

It was noted that although the working group had reached a consensus, Healthwatch Lincolnshire differed on two aspects:

Whilst the Committee's response supported teams of three surgeons, Healthwatch Lincolnshire supported teams of four surgeons; the Committee's response urged NHS England to be clear on its preferred model of care, whereas Healthwatch Lincolnshire supported a flexible approach to the three levels of care proposed.

 RESOLVED

(1)    That the consultation on the Proposed Congenital Heart Disease Standards and Service Specifications constitute a substantial development of the health service and a substantial variation in the        provision of the health service, on the basis that the implementation of the      Standards and Service Specifications is likely to lead to serious impacts         for Lincolnshire patients and their families, particularly in terms of the            accessibility of the services at Level 1 centres for both Specialist            Children's Surgical Centres and Specialist Adult Congenital Heart Disease         Surgical Centres.

(2)    That the submission to NHS England's consultation on the Proposed       Congenital Heart Disease Standards and Service Specifications, as     detailed at Appendix A to the report, be endorsed.

(3)    That the next steps for the New Review of Congenital Heart Services be noted, as follows: -

·       an expected decision by NHS England on the Congenital Heart Disease Standards and Service Specifications in March 2015;

·       the commissioning of new services by NHS England during 2015/2016; and

·       the award of the contracts from 1 April 2016, with all the Standards and  ...  view the full minutes text for item 67.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider the main outcomes from the Healthy Lives, Healthy Futures engagement event on 17 November 2014 in Grimsby)

A report by Simon Evans (Health Scrutiny Officer) was considered, which updated Members on the outcomes of the Healthy Lives, Healthy Futures Engagement Event on 17 November 2014, which was attended by Councillors C J T H Brewis and C Burke. 

It was noted that Councillor C Burke's written report would be circulated to Members, via email, by the Health Scrutiny Officer.

RESOLVED

          That the report and comments be noted.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to note that Healthwatch Lincolnshire has issued four reports which could inform the Committee's work programme)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited Members to note that Healthwatch Lincolnshire had issued four reports on the following topics: -

·       'Hear Our Voice' – Children and Young People in Lincolnshire;

·       The Impact of Patient 'Did Not Attend' Appointments at GP Surgeries in Lincolnshire; and

·       Service Users, Patients and Carers Views on Mental Health Services (Interim Report).

Members were advised that the purpose of the item was to draw the Committee's attention to those four reports; so that they could be borne in mind as the Committee develops its work programme.

RESOLVED

That the four recently published reports by Healthwatch Lincolnshire on the following topics be noted and be borne in mind as the Committee develop its work programme: -

·  'Hear Our Voice' – Children and Young People in Lincolnshire;

·  The Impact of Patient 'Did Not Attend' Appointments at GP Surgeries in Lincolnshire; and

·  Service Users, Patients and Carers Views on Mental Health Services (Interim Report).

(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.

A Member of the Committee advised that Circle Partnership UK was due to take over the delivery of Dermatology Services at Nottingham and it was therefore requested that the Committee explored the impact on Lincolnshire patients.  It was agreed that information on this would be passed onto the Committee's Health Scrutiny Officer for further investigation.

The following amendments and additions were made to the work programme:-

·       'Recruitment and Retention of Healthcare Staff in Lincolnshire' to be considered by the Committee on 11 February 2015; and

·       'Winter Pressures 2014/15' to be considered by the Committee on 11 March 2015.

RESOLVED

          That the work programme and changes made therein be approved.