Agenda and minutes

Apologies for absence were received from County Councillor T M Trollope-Bellew and District Councillor Mrs R Kaberry-Brown (South Kesteven District Council).

It was noted that Councillors J Kirk (City of Lincoln Council) and M Harness (East Lindsey District Council) were attending on behalf of Councillors C Burke and C Macey, respectively, for this meeting only.

Councillor S L W Palmer declared a pecuniary interest in Minute 94 – 'United Lincolnshire Hospitals NHS Trust – Update Report', as he had an outstanding personal complaint against the Trust and advised that he would leave the meeting room for the duration of the item.

Councillor Mrs C A Talbot declared an interest in Minute 97 – 'Annual Report of the Director of Public Health on the Health of the People of Lincolnshire 2014', as she financially supported the Lincolnshire Rural Support Network.

Councillor Dr G Samra also declared a pecuniary interest in Minute 94 – 'United Lincolnshire Hospitals NHS Trust – Update Report', as an employee of the Trust and advised that he would leave the meeting room for the duration of the item.

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

i)             Burton Road GP Surgery

The Chairman reminded the Committee that Burton GP Surgery was one of only five GP contracts in Lincolnshire, which were managed under Alternative Provider of Medical Services (APMS) arrangements.  Unlike other GP contracts, which were perpetual, these APMS contracts were time limited.  On 11 March 2015, NHS England had announced the outcome of the procurement exercise for Burton Road GP Surgery in Lincoln.  This had been the topic of detailed consideration by this Committee during 2014.

The Chairman reported that the contract, which would begin on 1 July 2015 and would run for a minimum of five years, had been awarded to Universal Health Ltd.   Letters had been posted to patients on 9 March, advising them of the new provider and it was likely that existing staff would continue at the surgery. 

This represented excellent news for the patients of Burton Road GP Surgery who could now look to the future of their service with some certainty.  This Committee had taken the matter very seriously and had pursued it on behalf of the patients.  The Chairman was very pleased that the hard work had paid off for the Committee, for the campaigners and for NHS England who had worked with the Committee to find a better way forward for patients.

ii)            GP Contracts

On 27 February 2015, the Chairman was advised of the outcomes of the procurement exercise for the other four GP contracts in Lincolnshire under the Alternative Provider of Medical Services (APMS) arrangements.  The APMS contract for the Lincoln University GP Practice had been awarded to Danum Medical Services Ltd.  The APMS contracts for Metheringham, the Arboretum Lincoln, and the Pottergate Gainsborough GP Surgeries had been awarded to Universal Health Ltd.  These four contracts would be effective from 1 April 2015. 

iii)          Co-Commissioning and Lincolnshire Clinical Commissioning Groups

The Chairman reported that all four Lincolnshire Clinical Commissioning Groups (CCGs) had been included in the group of 64 CCGs in England, who had been given approval to take on the ‘delegated’ commissioning role for GP Services from April 2015, referred to as "co-commissioning". 

Whilst the CCGs would be receiving funding for these GP services, they would not be receiving any funding for the additional administration and management of these GP contracts, which they would have to undertake. 

The Chairman had agreed with Lincolnshire West CCG and Lincolnshire East CCG that they would present separate items on co-commissioning later in 2015.  

iv)          Meetings with Clinical Commissioning Group Colleagues

On 17 February 2015, the Chairman had met Richard Childs, the Chairman, and Sarah Newton, the Chief Operating Officer, of Lincolnshire West CCG.  Arising from this meeting, an item on the development of neighbourhood teams in Lincolnshire had been planned for the June meeting; and an item on co?commissioning had been planned for later in the year.

On 5 March 2015,  ...  view the full minutes text for item 93.

RESOLVED

          That the minutes of the meeting held on 11 February 2015 be agreed as a   correct record and signed by the Chairman.

NOTE: At this stage in the proceedings Councillor S L W Palmer declared a pecuniary interest in Minute 94 – 'United Lincolnshire Hospitals NHS Trust – Update Report', as he had an outstanding personal complaint against the Trust and left the meeting room for the duration of the item.

Councillor Dr G Samra also declared a pecuniary interest in Minute 94 – 'United Lincolnshire Hospitals NHS Trust – Update Report', as an employee of the Trust and left the meeting room for the duration of the item.

(To receive a report by Jane Lewington (Chief Executive of United Lincolnshire Hospitals NHS Trust), which provides a general update on the following areas as requested by the Committee: Cancer Care including breast cancer services; Staff recruitment and retention; the implementation of care bundles; Delayed Transfers of Care; Infection Control; Accident and Emergency Attendances; and Financial Position.  The Chief Executive of the Trust and colleagues will be in attendance for this item)

A report by Jane Lewington (Chief Executive, United Lincolnshire Hospitals NHS Trust) was considered, which provided information on topic areas, which had been requested by the Committee on 19 November 2014, as follows: -

·                     Cancer Care, including breast cancer services

·                     Staff recruitment and retention

·                     The implementation of care bundles

·                     Delayed Transfers of Care

·                     Infection Control

·                     Accident and Emergency Attendances

·                     Financial Position

Ron Buchanan (Chairman), Jane Lewington (Chief Executive), Michelle Rhodes (Director of Operations) and Pauline Pratt (Acting Chief Nurse) of United Lincolnshire Hospitals NHS Trust were all in attendance and provided Members with a detailed presentation.

Cancer Care

The presentation highlighted the following performance figures for Cancer Care:

The report referred to the Cancer Summit, which had taken place on 6 February 2015.  The Committee asked for an outline of the outcomes from the Summit, which had been a full day event and had included clinicians, commissioners, public health professionals and patients, as well as representatives from Healthwatch Lincolnshire.  The Committee was advised that local outcomes for patients with cancer compared well with other areas; but the number of cancer referrals was increasing in Lincolnshire, for example in the areas of skin cancer and prostate cancer.  The County Council's Public Health function had been asked to investigate why the incidence of certain cancers was higher than the national average.   The Summit had also concluded that an integrated approach to cancer care was required, including the use of tertiary centres.  It was explained that the responsibility for developing a cancer strategy for Lincolnshire rested with the commissioners and South West Lincolnshire Clinical Commissioning Group was the lead commissioner for cancer services.  The Committee asked that the formal outcomes from the Cancer Summit and subsequent developments in relation to cancer be pursed with the commissioners at the appropriate time.      

It was expected that the Trust's Quarter 4 performance figures would demonstrate improvements, as a result of the actions put in place. 

Two new radiologists had been recruited.  In response to a question it was confirmed that one of the radiologists was working three days per week at Pilgrim and two days per week at Lincoln County Hospital. 

Referral to Treatment Waiting Times

The following referral to treatment waiting time information was presented to the Committee:

The Committee was advised that targets would not improve until this work on improving performance  ...  view the full minutes text for item 95.

(To receive a report by Sarah Furley (Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group), which invites the Committee to receive an update on Winter Pressures 2014/15. Gary James (Accountable Officer) and Sarah Furley (Urgent Care Programme Director) of Lincolnshire East Clinical Commissioning Group will both be in attendance for this item)

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

·       An update on the current performance of the Lincolnshire Urgent Care System.

·       Explanation of the problems.

·       Description of what had worked well since Christmas 2014.

·       Recovering Performance.

Gary James (Accountable Officer, Lincolnshire East Clinical Commissioning Group) was in attendance and presented the report to the Committee.

Local Current Performance

Lincolnshire Accident and Emergency performance had deteriorated during the Winter of 2014.  Despite being a national issue, the Lincolnshire health and care system had coped with the pressures better than many neighbouring systems, despite the reduced acute hospital bed capacity.  This had been achieved by greater inter-agency working than ever achieved previously, and the introduction of new services and initiatives.  Detailed updates were given on the following areas: -

(a)       Accident and Emergency Attendances

As of 1 March 2015, United Lincolnshire Hospitals NHS Trust's Accident and Emergency attendances were up by 1.59% compared to the same year to date period in 2013/14.  This was equivalent to 2,263 additional people being seen in Accident and Emergency through 2014/15.  However in the last quarter, attendances were down by 4.14% compared to the same quarter in 2013/14.  This was the equivalent to 955 people less using Accident and Emergency compared to January and February in 2013/14.  This would suggest that activity was greater in the spring and summer months, opposed to winter and also suggested that the winter initiatives had been successful.

(b)       Accident and Emergency 95% Standard (year to date)

As of 1 March 2015, United Lincolnshire Hospitals NHS Trust Accident and Emergency 95% standard was down by 3.56% at 91.23%, compared to the same year to date period in 2013/14.  This was comparable with national performance.

(c)       Emergency admissions

As of 1 March 2015, all emergency admissions in United Lincolnshire Hospitals NHS Trust were down by 2.2%, compared to the same year to date period in 2013/14.  This was equivalent to 1,188 people not being admitted to hospital.  This had suggested that the winter initiatives had been successful.

(d)       Delayed Transfers of Care

There had been significant deterioration in Delayed Transfers of Care at United Lincolnshire Hospitals NHS Trust since the summer of 2013/14.  Findings had shown that in the nine months between April and December 2014, a total of 10,208 bed days had been lost to Delayed Transfers of Care.  This was equivalent to 37 beds at 100% occupancy, and 44 beds at 85% occupancy.  Whether measured as an acute trust or as a local authority, United Lincolnshire Hospitals NHS Trust and Lincolnshire, ranked poorly nationally.

(e)       Planned Care

During December 2014 and January 2015, 500 elective operations had been cancelled.  Cancer and clinically urgent patients had been prioritised.

Explanation of the problems

The start of the winter pressures had begun the weekend before Christmas 2014, with high ambulance turnaround delays and a deteriorating Accident and Emergency standard.  The Accident and Emergency standard had not been  ...  view the full minutes text for item 96.

(To receive a report by Dr Tony Hill (Executive Director of Community Wellbeing and Public Health), which invites the Committee to receive a presentation and to consider and comment on the recommendations included in each chapter of the Director of Public Health's Annual Report on the Health of the People of Lincolnshire 2014.  The Executive Director of Public Health will be in attendance at the meeting)

Consideration was given to a report by Dr Tony Hill (Executive Director of Community Wellbeing and Public Health), which set out the Annual Report of the Director of Public Health on the Health of the People of Lincolnshire 2014. 

The Executive Director presented the Annual Report to the Committee and provided a detailed update on the following chapters: -

-       Progress on previous recommendations;

-       Premature Mortality in Lincolnshire;

-       Cancer;

-       Circulatory diseases;

-       Suicide and mortality from undetermined causes;

-       Respiratory diseases;

-       Accidents; and

-       Chronic liver disease.

Twenty-two recommendations were included within the report, which Members were invited to consider and comment upon.

Following the presentation of the report, the Committee was provided with an opportunity to ask questions, where the following points were noted: -

·         100 hard copies of the Annual Report were printed, costing under £2 per copy;

·         It was noted that the upper age range for cervical cancer screening and breast cancer mammograms had been extended from 65 to 73;

• Members were assured that the Executive Director of Community Wellbeing and Public Health had taken ownership of the recommendations contained within the report and that the relevant partner organisations were encouraged to take them forward;
• There were two/three GP Practices within Lincolnshire which did not provide Health Checks within their practice.  However, Members were assured that other GP practices covered those patients who were registered with one of the two/three GP practices not delivering this service.  The reason why those practices were not providing this service was owing to capacity issues;
• A Councillor commented that within the Lincolnshire East Clinical Commissioning Group area the overall quality of health was lower compared to any of the other Lincolnshire clinical commissioning group areas;
• The Annual Report had been considered by the Clinical Commissioning Group Council.  The Annual Report would also be presented to the individual Clinical Commissioning Group Governing Body meetings during April 2015;
• It was agreed that the Health Scrutiny Officer would investigate the National Funding Formula and in particular, how it was allocated;
• A Member queried the content of Figure 7.2 – 'from Chronic Liver Disease, directly standardised rate per 10,000 population in Lincolnshire, 2010/12', page 45 of the Annual Report refers, and it was agreed that an explanation of its content would be emailed to the Vice-Chairman of the Committee;
• It was noted that the training provided through the SafeTALK and ASIST programmes were free of charge;
• It was queried whether the disease registers should also include Neurological Diseases.

NOTE: At this stage in the proceedings, Councillor Mrs S M Wray declared an interest as the County Coordinator of the Lincolnshire Neurological Alliance.

The Chairman thanked the Executive Director of Community Wellbeing and Public Health for his report.

RESOLVED

That the Annual Report of the Director of Public Health on the Health of the People of Lincolnshire 2014 and the comments made by the Committee be noted.

(To receive a report by Chris Weston (Consultant in Public Health), which provides the Committee with an overview to the upcoming review of content, processes and methodologies underpinning the Joint Strategic Needs Assessment.  The Consultant in Public Health will be in attendance for this item)

Consideration was given to a report by Chris Weston (Consultant in Public Health), which provided an overview to the upcoming review of content, processes and methodologies underpinning the Joint Strategic Needs Assessment (JSNA).

The Consultant in Public Health presented the report to the Committee and in doing so, made particular reference to the scale of the review, resources required and some indicative timescales for the review process.

It was noted that the current format of the JSNA had been in place since 2011.  In 2011, the commitment was made in the JSNA overview report that future iterations of the JSNA would become more 'asset focused'.  It was proposed that this review would also evaluate the potential for information linked to community assets to be included within the format.

It was suggested that the full consultation document be presented to the Committee, at the appropriate time.

RESOLVED

(1)  That the Review of Processes for Lincolnshire's Joint Strategic Needs Assessment, as detailed at Appendix A to the report, and the comments made the Committee be noted.

(2)  That the scale, scope and timescale of the whole Joint Strategic Needs Assessment review be noted.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to note the decision of the Board of Directors of Peterborough and Stamford Hospitals NHS Foundation Trust on 24 February 2015 on the redevelopment of Stamford and Rutland Hospital.  Councillor T M Trollope-Bellew attended the Board meeting on behalf of the Committee and his report is included within the item)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited the Committee to note the decision of the Board of Directors of Peterborough and Stamford Hospitals NHS Foundation Trust on 24 February 2015 on the redevelopment of Stamford and Rutland Hospital. 

Councillor T M Trollope-Bellew had attended the Board meeting on behalf of the Committee and his update was included within the report, page 28 refers.

The Chairman recorded her thanks to Councillor T M Trollope-Bellew for his update following the meeting.

RESOLVED

That the decision of the Board of Directors of Peterborough and Stamford Hospitals NHS Foundation Trust on 24 February 2015 on the redevelopment of Stamford and Rutland Hospital, including the report from Councillor T M Trollope-Bellew 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 its meetings over the coming months.

During consideration of the content of the work programme, the following items were suggested for inclusion: -

·       Further to Minute 95, it was suggested that the Chairman and Vice-Chairman should consider Cancer Care at the next scheduled Agenda Setting Meeting;

·       It was noted that the items on 'Burton Road GP Surgery'  and 'Health Education East Midlands' scheduled for 20 May 2015 had now been confirmed;

·       Also further to Minute 95, it was noted that a general update from United Lincolnshire Hospitals NHS Trust had been added to the work programme for 22 July 2015;

·       It was suggested that the items on St Barnabas Hospice and the Butterfly Hospice, listed under 'Items to be Programmed', should be combined into one item;

·       It was also noted that there would be an item on co-commissioning at the meeting scheduled to be held on 16 September 2015; and

·       It was also suggested that an item on Neurological Services in Lincolnshire should be added to the work programme.

The Chairman took the opportunity to thank the District Councillors who sat on the Committee and wished them well in the forthcoming election.

RESOLVED

That the work programme and the changes made therein be approved.