Agenda and minutes

An apology for absence was received from District Councillor Dr G Gregory (Boston Borough Council).

Apologies for absence were also received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison and Community Engagement) and Lynne Moody (Executive Nurse and Quality Lead, South Lincolnshire Clinical Commissioning Group).

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

It was also noted that District Councillor Mrs K Cook (North Kesteven District Council) was attending on behalf of Councillor T Boston, for this meeting only.

Members were advised that Councillor B Russell was acting as the Member for South Kesteven District Council for this meeting, pending the confirmation of the substantive appointment.  

Councillors Mrs C A Talbot declared an interest as she had recently lodged a complaint with United Lincolnshire Hospitals NHS Trust, which had now been resolved.

In response to a question, District Councillor Mrs P F Watson (East Lindsey District Council) advised the Committee that she did not have a disclosable pecuniary interest to declare in 'Minute 20 – United Lincolnshire Hospitals NHS Trust – Financial Position'.

The Chairman welcomed everyone to the Committee and made the following announcements: -

i)   Role of Health Scrutiny Committee Members

As there were a number of new and returning members at the meeting, the Chairman took the opportunity to reflect briefly on the Committee's role, which was to review and scrutinise health provision as a whole as it affects the residents of Lincolnshire.  The Chairman emphasised that it was not the Committee's role to investigate individual complaints or consider each matter of local concern.

ii)   South Kesteven District Council Representation

The Chairman advised that officers were still waiting confirmation from South Kesteven District Council of their representative, as to comply with the Regulations there was a need to ensure that District Councillor Members of the Health Scrutiny Committee for Lincolnshire were also members of a Scrutiny Committee at their own District Council.   

iii)   Long Leys Court - Learning Disability Inpatient Unit

The Chairman referred to the recent media reports in relation to Long Leys Court – Learning Disability Inpatient Unit.  Lincolnshire Partnership NHS Foundation Trust and South West Lincolnshire Clinical Commissioning Group had decided to temporarily close the Learning Disability Inpatient Unit at Long Leys Court in Lincoln to new inpatients, owing to concerns about the quality of care and a number of serious incidents at the Unit recently.  All new admissions had ceased with immediate effect and alternative provision was being made for the inpatients. 

A Police investigation was continuing into the serious incidents.  However, the Chairman expressed her concern on behalf of the Health Scrutiny Committee for Lincolnshire in relation to the temporary closure of Long Leys Court.  The Chairman also offered the Committee's condolences to the family and friends of the patient, who was a former patient of Long Leys Court and had passed away on 9 June 2015 at Lincoln County Hospital.

iv)   United Lincolnshire Hospitals NHS Trust – Revenue Expenditure

The Chairman advised Members that an item on 'United Lincolnshire Hospitals NHS Trust – Financial Position' had been included on the agenda for the meeting as a matter of urgency, because at the Trust's Board meeting on 2 June 2015, the monthly budget item had reported an overspend in April 2015 (month one of the financial year) of £6.291 million.

It was noted that if the Trust was to take no action on the £6.291 million overspend, and this level of overspend were to continue for the twelve months of the financial year, a deficit of £75 million would accrue by 31 March 2016. 

v)   United Lincolnshire Hospitals NHS Trust - Capital Expenditure

On 21 May 2015, United Lincolnshire Hospitals NHS Trust had announced capital expenditure totalling £25 million at the Trust's three main hospitals.  At Pilgrim Hospital, Boston, there would be the development of new multi?purpose clinical accommodation, enabling some of the maternity and gynaecology services to be moved into improved facilities.

At Lincoln County Hospital, areas of the five-storey maternity wing would be modernised.  In addition, two further wards  ...  view the full minutes text for item 14.

During consideration of the minutes of the meeting held on 20 May 2015, the Health Scrutiny Officer was requested to pass the extracts of the minutes for 'Minute 7 – Update on Health Visiting and School Nursing Services' and 'Minute 8 – Health Education East Midlands – Lincolnshire Workforce Development' to the Executive Director for Children's Services and the Executive Councillor for Adult Care and Health Services, Children's Services.

RESOLVED

(1)  That the minutes of the meeting held on 20 May 2015 be approved and signed by the Chairman as a correct record, subject to the inclusion of Councillor Mrs J M Renshaw in the list of attendees on page one of the minutes.

(2)  That the Health Scrutiny Officer be requested to pass the extracts of the minutes for 'Minute 7 – Update on Health Visiting and School Nursing Services' and 'Minute 8 – Health Education East Midlands – Lincolnshire Workforce Development' to the Executive Director for Children's Services and the Executive Councillor for Adult Care and Health Services, Children's Services.

(To receive a report by Sue Noyes (Chief Executive, East Midlands Ambulance Service NHS Trust), which outlines the key areas of performance within the East Midlands Ambulance Service (EMAS).  Andy Hill (General Manager, Lincolnshire Division) will be in attendance)

Consideration was given to a report from Sue Noyes (Chief Executive, East Midlands Ambulance Service), which outlined the key areas of performance within the East Midlands Ambulance Service NHS Trust and in particular on the four Clinical Commissioning Groups in Lincolnshire.  The report also included an update on the work and ongoing projects being carried out to enhance and support performance.

Richard Wheeler (Director of Finance), Andy Hill (General Manager, Lincolnshire Division) and Steve Kennedy (Divisional Support Manager) of the East Midlands Ambulance Service were in attendance at the meeting.

The Committee received updates on the following areas: -

·    East Midlands Ambulance Service performance;

·    Joint Ambulance Conveyance Project Data;

·    LIVES First Responder Performance;

·    Toughbook Usage;

·    Handover Delays;

·    Fleet Strategy; and

·    Care Quality Commission Visit – Summer 2015.

East Midlands Ambulance Service – Performance

Members were reminded that national ambulance performance standards were related to timely responses to standards for attending a 999 call.  Achieving those standards depended on prompt turnaround times within the hospital setting, both within wards and the Accident and Emergency department. Those targets are as follows: -

·         Red 1 – immediately life threatening calls.  For example, cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions such as airway obstruction.  Red 1 patients accounted for less than 5% of all ambulance calls.  Response time: 8 minutes from call received and 19 minutes for conveying resource to scene;

·         Red 2 – Life threatening calls, such as cardiac chest pains.  Response time: 8 minutes from call received and 19 minutes for conveying resource to scene;

·         Green 1 – serious, but not life threatening.  Response time of 20 minutes from call received;

·         Green 2 – serious, but not life threatening and with no serious clinical need.  Response time of 30 minutes of call received;

·         Green 3 – Non-life threatening non-emergency call.  Telephone assessment within 20 minutes of call received; and

·         Green 4 – Non-life threatening non-emergency call.  Telephone assessment within 60 of call received.

On page 19 of the report were two tables which provided performance at Clinical Commissioning Group level for Red 1; Red 2; Green 1; Green 2; Green 3; and Green 4.  The overall trend was that there had been improvement in performance across two Clinical Commissioning Group areas in Lincolnshire.  In South Lincolnshire and the Lincolnshire East Clinical Commissioning Group areas further improvement was required to bring them in line with the rest of Lincolnshire.

The Committee was advised that as a service, the Trust fell short on performance even though Lincolnshire as a division continued to improve.  The improvements in Lincolnshire were largely due to a number of key developments, as follows: -

• The Mental Health Car Initiative; Mobile Incident Unit at Butlins in Skegness;
• Clinical Assessment Care Initiative;
• South Lincolnshire Investments/Initiatives;
• Joint Ambulance Conveyance Project;
• Clinical Navigator Role at Lincoln County Hospital;
• Management of Lincoln City centre roadworks and the management of consequences; and
• Addressing patient handover delays at the acute trusts.

Joint Ambulance Conveyance Project Data  ...  view the full minutes text for item 16.

(To receive a report by Tracy Johnson (Scrutiny Officer), which invites the Health Scrutiny Committee for Lincolnshire to appoint Looked After Children / Care Leaver Representatives, following the approval of the Corporate Parenting Strategy at the County Council meeting on 19 December 2014.  The Health Scrutiny Officer will present this item)

Consideration was given to a report by Tracy Johnson (Scrutiny Officer), which invited the Committee to appoint a Looked After Children/Care Leaver Representatives for the Committee, following approval of the Corporate Parenting Panel at the meeting of County Council on 19 December 2014.  It was proposed that one representative be selected from the County Council element of the Committee's membership; and the other representative be selected from the District Council element of the Committee's membership.

The role of the Looked After Children/Care Leaver Representatives would be to make sure that the Committee actively considered the potential impact upon Looked After Children and Care Leavers of any policy, strategy or action carried out by the Committee and to seek further advice from the relevant officer, the Assistant Director of Children's Safeguarding, where this was unclear or unsure.

Further to this, Members sought clarity on the exact role of the representatives as the report did not specifically specify what would be required of them.  Councillor Mrs J M Renshaw indicated that she would be interested in undertaking this role, provided that she received a briefing from the Assistant Director of Children's Safeguarding on the expectations of the representatives.  It was therefore suggested to defer the consideration of this item to the meeting scheduled to be held on 22 July 2015, when a more detailed report would be presented.

RESOLVED

That consideration of this item be deferred to the meeting of the Committee scheduled to be held on 22 July 2015, when a more detailed report would be presented to the Committee.

NOTE: At this stage in the proceedings, Councillors Miss E L Ransome and Mrs S Ransome left the meeting for the remainder of the items.

(To receive a report by Simon Evans (Health Scrutiny Officer), which provides the Committee with an opportunity to review its work programme for the coming months)

The Committee considered its work programme for forthcoming meetings. 

The Committee was advised that it was possible that an item on Lincolnshire Health Care might be considered by the Committee on 22 July 2015.  The Committee reviewed its list of expected items for 22 July, and agreed that the item on Operation Black Swan item should be deferred from the meeting on 22 July 2015 to the meeting on 16 September 2015, to enable the item on Lincolnshire Health and Care to be given sufficient consideration, because of its importance to the future of health care in Lincolnshire.  The remaining items on the list for 22 July 2015 should proceed as planned.

A question arose on the extent to which the Committee's work programme reflected the theme of 'prevention'.  In response the Committee was advised that the County Council's Community and Public Safety Committee acted as the 'home' committee for public health activities, which largely supported the prevention agenda.  The role of the Health Scrutiny Committee included taking an overview of all health related services, and this included, for example, many aspects of the Joint Health and Wellbeing Strategy, part of which included several priorities which would support the prevention agenda.      

RESOLVED

(1)          That the contents of the work programme be approved.

(2)          That the item on Operation Black Swan would be deferred from the meeting on 22 July 2015 to the meeting on 16 September 2015, to enable the item on Lincolnshire Health and Care to be given sufficient consideration, with the remaining items on the list expected items for 22 July 2015 proceeding as planned.

(To receive a report by Alex Mehaffey and Duncan Richardson (Lincolnshire Health and Care Programme), to inform and update the Health Scrutiny Committee on the implementation of Neighbourhood Teams across the county)

Consideration was given to a report by Nigel Gooding (Head of Portfolio and Programme Management Office, Lincolnshire Health and Care Programme Office), which informed and updated the Committee on the implementation of Neighbourhood Teams across the county.

Dr Tony Hill (Executive Director of Community Wellbeing and Public Health) and Nigel Gooding (Head of Portfolio and Programme Management Office, Lincolnshire Health and Care Programme Office) were both in attendance at the meeting and provided Members were a detailed presentation, covering the following areas: -

·    Background;

·    The solution;

·    Neighbourhood Teams and wider services;

·    Locations of the Neighbourhood Teams;

·    Benefits;

·    Measuring success;

·    Case studies.

Members were advised that in order to meet the challenges facing Lincolnshire and establish a sustainable and safe health and social care economy, commissioning and provider organisations across the county have established a joint programme of work known as Lincolnshire Health and Care. Without Lincolnshire Health and Care, the health economy in Lincolnshire would not be sustainable in future years.

It was noted that Neighbourhood Teams were a key component of the Proactive Care Programme and were absolutely fundamental to the delivery of the Lincolnshire Health and Care Vision.  Lincolnshire Health and Care aspired to a population-based model of health where wellbeing was maximised through communities, voluntary and statutory services working together.  The aspiration was for the development of services from "cradle to grave".

There would be a core team in all of the Neighbourhood Teams, which would include such individuals as: -

·    GP;

·    Community and practice nurses;

·    Social care practitioner;

·    Community Psychiatric Nurse;

·    Independent Living Team.

However, Neighbourhood Teams would work with all other organisations and groups including the voluntary sector and patients and carers to develop the best plan for the individual.  They may hold multidisciplinary review meetings, carry out work to proactively identify people at risk or with higher need, and signpost people to community resources open to them.

Measuring the performance of Neighbourhood Teams would be based on the Better Care Fund metrics, but with other metrics used as well.

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

In response to a question, it was agreed that Councillor Mrs S M Wray would email the Executive Director of Community Wellbeing and Public Health with details of the voluntary sector hubs, which had been established.

Evidence had shown that Integrated Teams could deliver a better service to people.  By building on work already undertaken in Lincolnshire, Neighbourhood Teams could be developed across the county.  There was a range of benefits linked to the development of Neighbourhood Teams, which include: -

·       Providing a mechanism for health and care organisations in the local community to pool their resources;

·       Providing proactive care, closer to people's homes, that improves clinical effectiveness and patient/service user experience;

·       Reduction in hospital admissions and delayed discharges;

·       Removing frustrations of the patient/service user's journey that too often cause people to fall into the gaps between services;

·       Preventing patients/service  ...  view the full minutes text for item 19.

(The purpose of this item is to provide the Committee with information on the financial position of United Lincolnshire Hospitals NHS Trust.  It was reported to the Trust's Board on 2 June 2015 that the Trust had recorded a deficit of £6.291 million in April 2015.  The Board also approved a projected deficit for 2015/2016 of £40.3 million.   Kevin Turner (Deputy Chief Executive) and David Pratt (Director of Finance and Corporate Affairs) from United Lincolnshire Hospitals NHS Trust, will be in attendance for this item)

A report by Simon Evans (Health Scrutiny Officer) was considered, which provided the Committee with information on the financial position of United Lincolnshire Hospitals NHS Trust.  It was reported to the Trust's Board on 2 June 2015 that the Trust had recorded a deficit of £6.291 million in April 2015.  The Board also approved a projected deficit for 2015/2016 of £40.3 million.

Kevin Turner (Deputy Chief Executive), David Pratt (Director of Finance and Corporate Affairs) and Pauline Pratt (Acting Chief Nurse) were all in attendance at the meeting and presented the report to Members.

Members were advised that on 2 June 2015, the Board of United Lincolnshire Hospitals NHS Trust, which meets every month, considered its standard report on its financial position.  The report's highlights included the following: -

·    A deficit for April 2015 of £6.291 million; and

·    The April 2015 position was £2.173 million worse than that consistent with a £40.3 million deficit for 2015/2016.

The report to the Trust Board was attached at Appendix A to the Committee's report.

It was stressed to the Committee that the figure of £6.291 million was the figure for one month, April 2015, and the Trust's forecast and approved deficit remained at £40.3 million for 2015/2016.  Whilst reference had been made to a deficit of £75 million, this was not the Trust's forecast.  Reference was made to the 2014/15 budget and the fact that the Trust had achieved its target deficit of £25 million and had also achieved the Trust's Cost Improvement Programme (CIP) for 2014/15.

Budget pressures had included loss of commissioner income of £9 million; £13 million through loss of elective activity; and an extra £2.5 million was spent on Safer Staffing.  

Reference was made to elective activity being undertaken by other trusts, which would ordinarily be undertaken by ULHT.  A further impact on the Lincolnshire economy was the Market Forces Factor of the Tariff Arrangements, which meant procedures undertaken by other local trusts were more expensive.  It was explained that the Trust simply did not have enough beds for meeting all elective care, as there were too many beds being used for emergency admitted patients.

It was explained to the Committee that in the short term, the Trust would need to remove a certain number of beds and improve the use of its remaining beds with the following three additional activities, which would all require input from partners and commissioners: -

(1)  Increased provision outside the hospital, for example, services for patients            with frailties;

(2)  Improved processes within the hospital in order to reduce the average        length of stay for patients;

(3)  Improve discharge arrangements so that patients would not stay in             hospital any longer than they needed to.

The Trust would again be recruiting nationally as there was a significant shortage of nurses in Lincolnshire and this reflected national and regional trends.  The Trust was short by approximately 200 nurses.  Members were advised that following the last overseas recruitment drive, over 50% of those nurses were retained  ...  view the full minutes text for item 20.