Agenda and minutes

RESOLVED

That Councillor Mrs C A Talbot be elected as Chairman of the Health Scrutiny Committee for Lincolnshire for 2015/2016.

COUNCILLOR MRS C A TALBOT IN THE CHAIR

RESOLVED

That Councillor C J T H Brewis be elected as Vice-Chairman of the Health Scrutiny Committee for Lincolnshire for 2015/2016.

An apology of absence was received from District Councillor Mrs R Kaberry-Brown.

In relation to item 11 – Review of Suicides and Deliberate Self-Harm with Intent to Die within Lincolnshire Partnership NHS Foundation Trust, Councillor Mrs C A Talbot declared an interest as she provided financial support to the Lincolnshire Rural Support Network.

i)            Membership Changes – District Councillors

The annual general meetings of the district councils would be taking place on 19, 20 and 21 May 2015, following the recent elections and the Chairman was expecting all the representatives of the district councils on the Committee to be confirmed by 22 May. 

It was reported that in addition to Malcolm Leaning from West Lindsey District Council, who did not seek re-election, three other members of the Committee would not be continuing:

·         Miss Joyce Frost; who represented North Kesteven District Council on the Committee for eleven years;

·         Dr Gurdip Samra, who represented Boston Borough Council for three years; and

·         Carl Macey, who represented East Lindsey District Council for the last year.  

The Chairman had written to Joyce Frost, Gurdip Samra and Carl Macey, thanking them for their contributions to the work of the Committee.

ii)         United Lincolnshire Hospitals NHS Trust – CQC Reports

The Chairman confirmed that the Care Quality Commission had published its inspection reports on United Lincolnshire Hospitals NHS Trust on 27 March 2015.  Overall the Trust was in the 'requires improvement' category, but it was no longer in 'special measures'. 

In addition to a report on the Trust overall, there were also four further CQC reports on individual hospital sites: namely, Grantham and District Hospital; Louth County Hospital; Pilgrim Hospital, Boston; and Lincoln County Hospital. The CQC website links for all these reports would be circulated with these announcements.  

iii)        Meeting with Chief Executive of United Lincolnshire Hospitals NHS Trust

On 21 April 2015, the Chairman met Jane Lewington, the Chief Executive of United Lincolnshire Hospitals NHS Trust (ULHT) for a briefing meeting.  Mark Brassington, the Trust's Director of Performance Improvement, was also in attendance.  As a result of the meeting it was agreed that ULHT would present their Clinical Strategy to the Committee on 22 July 2015, in addition to the existing item on ULHT's Complaints Handling. 

The Chairman also confirmed that Jane Lewington announced on 24 April that she would be standing down as Chief Executive of the Trust for personal reasons.  The Trust was looking to recruit a replacement for her role.  In the meantime, Kevin Turner, the Deputy Chief Executive, would be acting as the Interim Chief Executive.

iv)        Meeting with Chairman and Chief Executive of Lincolnshire Community Services NHS Trust

On 22 April the Chairman had met Elaine Baylis, the Chairman, and Andrew Morgan, the Chief Executive, of Lincolnshire Community Services NHS Trust. The Chairman had been briefed on the progress with the foundation trust application, and the Neighbourhood Team element of Lincolnshire Health and Care programme.  

v)         Care Quality Commission Training Session – 22 April 2015

The Chairman was pleased to report that ten members of the Committee attended the training session on 22 April, which was conducted by Michele Hurst.  It was good to get an understanding of how the CQC planned, undertook and executed inspections of GP practices.  There was a paper on the agenda for this meeting which reported the formal  ...  view the full minutes text for item 5.

RESOLVED

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

(To receive a report by Nikki Silver (General Manager for Family and Healthy Lifestyles, Lincolnshire Community Health Services NHS Trust), which enables the Committee to gain an insight into the health visiting and school nursing services, which are provided by the Trust.  Sue Cousland (Director of Operations) and the General Manager for Family and Healthy Lifestyles of the Trust will both be in attendance at the meeting)

Consideration was given to a report which enabled the Committee to gain an insight into the Health Visiting and School Nursing Services, which were provided in Lincolnshire by Lincolnshire Community Health Services NHS Trust (LCHS).  Nikki Silver and Andrew Morgan from the Trust were present for this item.

The Committee was advised that LCHS was commissioned to provide a health visiting service to deliver the Healthy Child Programme to children aged from 0?5 years, who were registered with a GP practice in Lincolnshire.  Health visitors had a crucial role in ensuring children had the best possible start in life and were the backbone of delivering the Healthy Child programme 0-5, in partnership with health and social care colleagues.

From October 2015, health visiting would be transferred to Lincolnshire County Council and children would qualify by being resident in Lincolnshire rather than GP registration.  This was to ensure children who were not registered with a GP would still receive the service.

The Healthy Child Programme was structured to provide four levels of service based on the need of the child and family.  These were:

·         Building community capacity and ensuring families are aware of the services available to them

·         Universal services available to all families to ensure a healthy start in life

·         Universal Plus service available to families who need specific expert help in areas such as parenting, weaning or maternal mental health concerns

·         Universal Partnership Plus when families need ongoing support from a multi-agency team to deal with more complex issues over a longer period of time.

The universal services element of the Healthy Child Programme included five universal checks that are provided to every child. 

• Antenatal health-promoting contact
• New baby review - primary birth visit
• 6 - 8 week assessment
• 1 year assessment
• 2 to 2 and half year review

These five checks have been mandated for 18 months following the transition to local authority commissioning in October 2015.  In addition, the Health Visiting service provided individual packages of care and safeguarding services where there was an identified need for a child or family.

There were six high impact areas that were the focus on the Health Visiting specification.  These were maternal mental health, transition to parenthood, breastfeeding, healthy weight, child development and the management of minor illness/accident prevention.

Lincolnshire Community Health Services NHS Trust (LCHS) was commissioned by Lincolnshire County Council to provide the School Nursing service to children and young people of school age who lived or attended school in Lincolnshire.  This included:

·      National Child Measurement Programme for children in reception and year 6.

·      Health Needs Assessments for all children in reception and year 6.

·      Hearing screening for children in reception.

·      ‘Clinic in a Box’ sexual health offer in schools and community settings.

·      Health and wellbeing and drop in clinics in schools and community settings.

The service also provides an immunisation service for school aged children, which is commissioned by NHS England.  This includes the HPV (Human Papilloma Virus) vaccination for year 8 and 9 girls and  ...  view the full minutes text for item 7.

(To receive a report by Dr Adrian Brooke (Deputy Postgraduate Dean and Secondary Care Dean, Health Education East Midlands), which invites the Committee to consider information on how Health Education East Midlands supports the development of the Lincolnshire NHS workforce.  The Deputy Postgraduate Dean and Secondary Care Dean will be in attendance at the meeting)

Consideration was given to a report which provided information on Health Education East Midlands (HEEM) which undertook a variety of activities to support development of a skilled healthcare workforce to meet the needs of the population of Lincolnshire.

Dr Adrian Brooke summarised his report for the Committee and the following points were noted:

·         Training to become a GP or surgeon was a long process which included a five year medical degree, followed by three years of training in their specialist area;

·         HEEM received approximately £360 million to train staff in the East Midlands, however many graduates, on completion of their training, would leave the region to work elsewhere, usually attracted to larger cities in other parts of the country;

·         Discussion took place regarding the possibility of an incentive to employ students in the county once their training had ended.  Members felt a statutory period of employment, to recoup the expense of training would be a good solution;

·         The population across the East Midlands was widely dispersed and had expanded in recent years.  The medical workforce did not match this and HEEM had tried to ensure trainees were distributed evenly across the region;

·         Rating the quality of training from different providers was an ongoing task.  Teaching hospitals worked in partnership with universities and had large academic departments with substantial numbers of trainees;

·         The Chairman drew the Committee's attention to information, which she had received, which stated it was clear that currently Lincolnshire did not benefit from an appropriate allocation of training posts for doctors (based on population distribution across East Midlands).  Without this vital stream of doctors it would become increasingly difficult to sustain the healthcare needs of our Lincolnshire population.  While they were in training their salaries were 50% HEEM funded under the tariff system and attracted £12.5k per trainee to support the training.  So as well as providing patient care under supervision, they also helped in the overall financial challenges for the Lincolnshire providers.  Clearly they were a pool from which to attract future consultants and GPs as they will have directly experienced the benefits of living and working in Lincolnshire.  HEEM had made a commitment to redistribute funding and this would pose significant challenges that will require ongoing scrutiny.  In response, Dr Brooke explained that a suite of programmes had been created to address exactly the issue raised and demonstrate to trainees that the East Midlands and Lincolnshire was a good place to work;

·         When asked, trainees tended to say that they wanted to work in large, busy cities as trainees were mainly in their early to mid-twenties.  When trainees were a little older, and developed a desire to settle down, areas like the East Midland and Lincolnshire would become more attractive.  Because of this trend, London had nearly double the number of doctors per head of population than the East Midlands;

·         In addition to this, most GP practices in the county were small, private practices and young, newly trained GPs did not have the experience to become  ...  view the full minutes text for item 8.

(To receive a report by Michele Hurst (Inspection Manager Primary Medical Services and Integrated Care, Care Quality Commission – Central Region), which provides the Committee with a position statement on the progress and themes coming out of the Care Quality Commission's inspections of General Practice in Lincolnshire.  The Inspection Manager will be in attendance at the meeting)

The Committee considered a report which provided a position statement on the progress and themes coming out of the Care Quality Commission's (CQC) inspections of General Practice in Lincolnshire.  Michele Hurst from CQC was in attendance for this item. 

The inspections undertaken were carried out in accordance with the Health and Care Social Care Act 2008 (Regulated Activities) Regulations 2014 and individual services were rated as follows:

·         Outstanding

·         Good

·         Requires improvement

• Inadequate

The CQC inspected twelve General Practices in Lincolnshire under 'The Wave Pilot' and found that three of those practices were in breach of the Regulations and one was served a warning notice. The practice served with a Warning Notice had been inspected and has addressed the concerns and is now rated as a 'good' practice. The other two practices will be inspected soon.

Since October 2014, the CQC had also inspected 22 General Practices. These inspections identified a variety of breaches of the Regulations.  Some of these reports were still be finalised through the quality assurance process. Hence some of the following judgments may change: one GP practice was rated as Outstanding; 14 GP practices were rated as Good; and seven were rated overall as Requires Improvement.

Within the individual domains the majority of breaches were in the 'Safe and Well-led' domain. The Caring domain had been outstanding for two practices and good for the remainder. The most common breaches of the regulations were: Regulation 12 - Safe Care and Treatment; and Regulation 17 - Good Governance.

The Committee was advised that under Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 service providers were required to display at their premises the most recent overall rating from the CQC, including ratings for each of the services provided.  Surgeries not found to be displaying their rating certificate could be prosecuted.

It was found that leadership was usually the underlying issue with the problems encountered.

Discussion took place regarding non-attendance of GP appointments by patients and whether a policy for fining those patients could be implemented.  This would save a considerable amount of money across the county.  It was highlighted that patient experience on any issue relating to GPs could be shared with the CQC via its website – www.cqc.org.uk.

It was agreed that Adam Whittaker, the CQC Inspection Manager for Lincolnshire for Acute Hospital Services, would be invited to a future meeting of the Committee.

RESOLVED

1.      That the report and comments made be noted;

2.      That the Committee receive further updates on the CQC General Practice Inspection and that Adam Whittaker, the CQC Inspection Manager for Lincolnshire for Acute Hospital Services, be invited to a future meeting, be agreed.

NOTE: At this stage in the proceedings, the Committee adjourned for lunch and on return, the following Members and Officers were in attendance:-

County Councillors

Councillors Mrs C A Talbot (Chairman), B W Keimach, C R Oxby, S L W Palmer, T M Trollope-Bellew, Miss E L Ransome, Mrs S Ransome, Mrs J  ...  view the full minutes text for item 9.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider the report on the Review of Suicides and Deliberate Self-Harm with Intent to Die within Lincolnshire Partnership NHS Foundation Trust and the response of the Trust on the recommendations as contained within the Review.  Dr John Brewin (Chief Executive, Lincolnshire Partnership NHS Foundation Trust) will be in attendance at the meeting)

Consideration was given to a report which presented the Review of Suicides and Deliberate Self-Harm with Intent to Die within Lincolnshire Partnership NHS Foundation Trust.  The review had been commissioned by the four Lincolnshire Clinical Commissioning Groups and Lincolnshire Partnership NHS Foundation Trust (LPFT) and had been undertaken by Professor Mandy Ashton, an independent consultant, and completed on 30 November 2014.  The review had embraced a total of 88 serious incident reports, covering a period from January 2012 to June 2014; and had included 73 user suicides (known to the service). 

The Chairman stated that the findings of the review had been disappointing and were a cause for concern.  This was echoed by the Committee.

John Brewin emphasised that as Chief Executive of LPFT he was also very disappointed and concerned regarding the Review.  He stressed that the Trust's Board of Directors had accepted the findings and recommendations in the Review.  He intended to provide some assurance to the Committee on the response of LPFT to the Review's findings and recommendations.

The Committee received a presentation on the review from John Brewin, Michelle Persaud and Sharon Robson.  The presentation outlined the context for the suicide trends: for example there were many causes of suicide and these could not be correlated with service provision, as societal and demographic factors were more important.  Factors such as deprivation, age, gender and occupation also had to be taken into account.  Rates of suicide had fallen since the 1990's but had begun to increase again since 2008 as a result of the recession.  Suicide was prevalent in young males, but there was a more alarming increase in deliberate self-harm in adolescents.  Suicide remained a rare event, so it was always prudent to apply caution when undertaking trend analysis.

In 2014/15 LPFT had received 4,365 referral per month and had 28,074 contacts per month on average.  A total of 92 incidents had been reported during the year, with 18 attempted suicides. 

The main elements of the Service Improvement Action Plan were outlined to the Committee.  These include actions in the areas of risk assessment; record keeping; communication; IT and training; medicines management; safeguarding; commissioning; benchmarking; and changing practice.  It was also reported that commissioners has agreed a CQUIN [Commissioning for Quality and Innovation] for 2015-16, specifically focused on risk assessment.  The Quality Assurance process was also outlined in the final slide, including the various groups, such as the Quality Surveillance Group and LPFT Contract Quality Review Group. 

Not all Members of the Committee were reassured by the information in the presentation.  Some members of the Committee specifically referred to the final slide of the presentation, which did not provide reassurance on the response to the recommendations. 

During discussion of the report and the presentation, the following points were noted:

·         The Committee had not been informed of the Review at the time of its publication, even though it had been presented to Board of Director of LPFT on 26 February 2015,  and the minutes from the Board  ...  view the full minutes text for item 10.

(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 meetings over the coming months.

It was noted that Councillor Palmer would be unable to attend the next meeting on 11 June 2015.

RESOLVED

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