Agenda and minutes

An apology for absence was received from Lynne Moody (Director of Quality and Executive Nurse, South Lincolnshire Clinical Commissioning Group).

Councillor Dr G Gregory declared a pecuniary interest in the item on United Lincolnshire Hospitals NHS Trust – Financial Position, as an employee of United Lincolnshire Hospitals NHS Trust and would therefore be leaving the meeting room for the consideration of this item of business.

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

i)          Care Quality Commission Report on Peterborough City Hospital

On 22 July 2015, the Care Quality Commission (CQC) had published its inspection report on Peterborough City Hospital.  The CQC had rated the Hospital as "good", as and as a result the overall rating for the Trust was also now "good".  The July report was based on an inspection which took place in April 2015 and followed a previous inspection in May 2014, which had found the hospital required improvement. 

ii)         Peterborough and Stamford Hospitals NHS Foundation Trust

On 30 July 2015, Monitor had announced that it had agreed with Peterborough and Stamford NHS Foundation Trust further steps to improve the Trust's overall financial position and cut waiting times for Accident and Emergency patients.  The Chairman advised that this would include cost savings of at least £13 million in 2015/2016. 

iii)        Care Quality Commission Annual Report

The Care Quality Commission had published its Annual Report for 2014-15 on 22 July 2015.  The Chairman advised that in the report the CQC had made reference to Branston and Heighington Family Practice as an example of a GP practice that had demonstrated improvement in the quality of its care, following concerns in an earlier inspection.  The CQC's Annual Report was available on its website:

www.cqc.org.uk/content/annual-report-201415

iv)        East Midlands Ambulance Service Reputation Audit

The East Midlands Ambulance Service NHS Trust (EMAS) had announced that it was undertaking its second reputation audit 'to gather a snapshot of stakeholder’s thoughts, feelings and perceptions about EMAS to influence improvements.'

There were 3,071 responses to the 2014 reputation audit, which had included the following findings:  87% of respondents were satisfied with the level of care they received; 73% felt that EMAS had improved over the previous twelve months; 84% of staff were proud to work for EMAS.  

v)         Congenital Heart Disease Services

On 28 July 2015, the Chairman had written to John Holden (Director of System Policy at NHS England), seeking clarification on how NHS England was planning to engage with local authority overview and scrutiny committees on the implementation of the new standards and specification for Congenital Heart Disease Services.  John Holden had replied to the Chairman on 5 August indicating that local authorities would continue to be involved as stakeholders.  John Holden had also stated that providers would be submitting proposals on how they would deliver these services by October 2015.  Decisions on the location of services would be taken as part of the commissioning process.  John Holden's work on this activity was now complete and a separate directorate of NHS England would be undertaking the commissioning process.

The Chairman also advised that on 27 August 2015, University Hospitals of Leicester NHS Trust had announced that it was planning to invest over £1 million as part of a long term plan to bring all children’s services together in an integrated children’s hospital.  In addition, the  ...  view the full minutes text for item 35.

RESOLVED

That the minutes of the meeting held on 22 July 2015 be approved and signed by the Chairman as a correct record, subject to the inclusion of the following wording to the end of Minute 25 – 'The Critical Path to Developing Options for Future Healthcare Delivery in Lincolnshire': -

"A concern was also raised on the benchmarking figure of one hour used for the transfer of mothers to maternity services referred to in the presentation, as this figure had been superseded by the figure of 25 minutes, which arose from two recent research papers."

(To receive a report from Chris Weston (Consultant in Public Health), which provides an update on the review of content, processes and methodologies underpinning the Joint Strategic Needs Assessment (JSNA) for Lincolnshire. Particularly, this report details the current stakeholder engagement phase of the work. Chris Weston (Consultant in Public Health) and Katy Thomas (Programme Manager (Health Intelligence)) will both be in attendance)

A report by Katy Thomas (Programme Manager – Health Intelligence) was considered, which provided the Committee with an update on the review of content, processes and methodologies underpinning the Joint Strategic Needs Assessment for Lincolnshire.  The report particularly updated the Committee on the current stakeholder engagement phase of the work.

Councillor Mrs S Woolley (Chairman of the Lincolnshire Health and Wellbeing Board and Executive Councillor for NHS Liaison and Community Engagement), Chris Weston (Consultant in Public Health) and Katy Thomas (Programme Manager – Health Intelligence) were all in attendance.

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

Members were advised that the procedures by which the Joint Strategic Needs Assessment (JSNA) was created and maintained were currently under review, including an investigation of all elements of format, content and processes.  The full review and implementation were taking place from 2015 to 2017, to feed into the production of the Joint Health and Wellbeing Strategy for 2018-2023, the publishing of which would coincide with the existing Joint Health and Wellbeing Strategy coming to an end on 31 March 2018.

The objectives of the review were to: -

·       Undertake a thorough examination of the process, content and structure of the current JSNA;

·       Capture stakeholder views on usefulness, format and content, including suggestions for improvement;

·       Identify opportunities to refine information held within the JSNA and to fill gaps in knowledge;

·       Encourage engagement and challenge;

·       Further integrate an asset-based approach to health improvement, ensuring that Lincolnshire's asset information forms part of future JSNA;

·       Provide an on-going opportunity for stakeholders to feed into the continuous improvement of the JSNA and to continue to encourage engagement, contribution and use;

·       Ensure that engagement through the plan was aligned with the strategic framework for engagement agreed by the Lincolnshire Health and Wellbeing Board and the principles, as set out in the framework, were respected and adhered to;

·       Ensure transparency and opportunity within the various engagement activities to allow all stakeholders to influence and engage in the process.

The current phase of the review was the Stakeholder Engagement phase, taking place until the end of December 2015.  The purpose of this phase was to ensure that stakeholders in the JSNA had a shared understanding of the scope and purpose of the review, the opportunity to feed in their views on future content, format and processes and that they were able to become better engaged with the evidence base.  The Engagement Plan takes account of statutory guidance and specifically puts in place mechanisms for engaging with statutory and recommended partners.

Members were advised that a range of activities had been carried out to date, including: -

·       A Steering Group had been established to oversee the review on behalf of the Health and Wellbeing Board. The Membership of the group included representatives from Public Health, Healthwatch, District Councils, Children's Services, Adult Care, Lincolnshire's Clinical Commissioning Groups and Involving Lincolnshire;

·       Beneath the Steering  ...  view the full minutes text for item 37.

(To receive a report from Kevin Turner (Acting Chief Executive, United Lincolnshire Hospitals NHS Trust), which provides the Committee with information on the financial position of United Lincolnshire Hospitals NHS Trust.  The Acting Chief Executive will be in attendance)

A report by Kevin Turner (Acting Chief Executive, United Lincolnshire Hospitals NHS Trust) 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 1 September 2015 that the Trust had recorded a deficit of £21.679 million for the period of 1 April 2015 to 31 July 2015.  The Board had previously approved a projected deficit for 2015/2016 of £40.3 million.

Kevin Turner (Acting Chief Executive) was in attendance at the meeting and presented the report to Members.

In response to a question, Members were advised that the Trust had recently appointed Jan Sobieraj as its new Chief Executive and it was hoped that he would commence his employment with the Trust towards the end of 2015 / beginning of 2016.

Members were advised that on 1 September 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 the year to date (ending 31 July 2015) of £21.679 million;

·       The July 2015 position was £7.825 million worse than the planned position at this point in the year, and that was 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 £21.679 million was for the period to 31 July 2015.  The in-month deficit was £4.140 million, as opposed to £4.993 million in June 2015, £6.255 million in May and £6.291 million in April 2015.  The position at the end of July was £7.825 million worse than the planned budget. 

Members were advised that the July financial position had seen a further substantial in month deficit, albeit lower than the previous three months, as detailed above.  Overspending, particularly on medical and nursing staff, had continued to drive the in-month financial position.  The in-month position in July had improved and this was because of a combination of reduced over spending and a higher income level.

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.

The Trust had acknowledge that the month four financial position was not acceptable and significant management and leadership time was being given to recover the in-year additional monthly run rate to return to the original plan for a projected deficit for 2015/2016 of £40.3 million. A full list of identified schemes could be found on page 41 of the report.  However, the delivery of those schemes in full would still fall short of  ...  view the full minutes text for item 38.

(To receive a report by John Brewin (Chief Executive, Lincolnshire Partnership NHS Foundation Trust), which updates the Committee on the current position at Long Leys Court.  The Chief Executive will be in attendance)    

Consideration was given to a report by John Brewin (Chief Executive, Lincolnshire Partnership NHS Foundation Trust), which provided the Committee with an update on the Long Leys Court, Lincoln.  The Chief Executive and Ian Jerams (Director of Operations, Lincolnshire Partnership NHS Foundation Trust) were both in attendance.

The Chief Executive reminded Members that Long Leys Court in Lincoln provided an assessment and treatment unit for adults with learning disabilities, who also had related healthcare needs, including mental health issues and challenging behaviours that may have an impact on their mental wellbeing.

It was reported to the Committee on 11 June 2015 that a number of serious incidents had occurred and the Unit had closed to new admissions.  Members were advised that on 6 April 2015, two serious incidents involving patients at Long Leys Court were reported to the Lincolnshire Partnership NHS Trust Executive Team.  Three further incidents had occurred from this time until 2 June 2015.

The Committee was advised that the Police were investigating the incidents, including whether the correct multi-agency safeguarding and incident procedures were followed, and until such times as they gave the Trust the 'go ahead', the Trust was unable to commence its internal conduct procedures.  The Trust was not yet in a position to share specific details of the incidents.

At present, there were two remaining patients at Long Leys Court.  Both were in process for moving but due to complex issues and legal restraints the time related to provision of appropriate services was difficult to ascertain.  However, all efforts to do this both efficiently but also in line with the needs of the patient, were being made. 

Members were assured that the Trust was also working closely with relatives and carers to keep them updated on progress.  Further to this, Members were advised that those patients who had already been moved to alternative service provision were still located within Lincolnshire. 

Members were also assured that NHS England, Monitor, the Care Quality Commission and Clinical Commissioning Groups had been significantly involved with the Trust to oversee and monitor the development of a comprehensive improvement plan.

RESOLVED

That the information presented on the Long Leys Court, Lincoln, and comments made by the Committee be noted

(To receive a report from David Powell (Head of Emergency Planning), which provides the Committee with information on Exercise Black Swan. David Powell (Head of Emergency Planning) and Cheryl Thomson (Emergency Planning Manager) will both be in attendance)

A report from Cheryl Thomson (Emergency Planning Manager) was considered, which provided the Committee with information on the Council's emergency planning arrangements for 'Exercise Black Swan'.

The Emergency Planning Manager advised the Committee that following on from the cancellation of the national Tier 1 pandemic influenza exercise, Exercise Cygnus in October 2014, the Lincolnshire Resilience Forum Management Group agreed in March 2015 to support the delivery of a multi-agency exercise within the county focussing on a pandemic influenza scenario. 

The exercise would take place on Thursday, 15 October 2015 and would allow the Emergency Planning Team to test not only health and social care resilience, but also to consider the wider business continuity aspects of a pandemic influenza.  Members of the Committee were invited to observe the exercise and the Chairman advised that any Member wishing to attend should contact the Committee's Health Scrutiny Officer.

Members were provided with detailed information as part of a presentation, which covered the following points: -

·    Influenza Pandemic;

·    Exercise Aim;

·    Exercise Objectives;

·    Scenario;

·    Exercise Design;

·    Exercise Evaluation; and

·    Conclusion.

The Chairman thanked the Emergency Planning Manager for her report and presentation.

RESOLVED

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

(2)  That any Member wishing to observe the exercise on 15 October 2015 be requested to notify the Health Scrutiny Officer.

(3)  That the Committee be presented with an update report at a future meeting detailing the results of the exercise.

NOTE: At this stage in the proceedings, the Committee adjourned for luncheon and 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, Mrs J Renshaw, T M Trollope-Bellew and Mrs S M Wray.

District Councillors

Councillors C J T H Brewis ((Vice-Chairman) (South Holland District Council), T Boston (North Kesteven District Council), Dr G Gregory (Boston Borough Council), Mrs R Kaberry-Brown (South Kesteven District Council), J Kirk (City of Lincoln Council) and Mrs P F Watson (East Lindsey District Council).

Healthwatch Lincolnshire

Dr B Wookey.

Officers in attendance

Kakoli Choudhury (Consultant in Public Health), Sue Cousland (Chief Nurse and Director of Operations, Lincolnshire Community Health Services NHS Trust), Simon Evans (Health Scrutiny Officer), Cheryl Hall (Democratic Services Officer) and Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust).

(To receive a report from Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust), which invites the Committee to consider an update on the Lincolnshire Community Health Services NHS Trust's Clinical Strategy.  The Chief Executive and Sue Cousland (Chief Nurse/ Director of Operations, Deputy Chief Executive) of the Trust will both be in attendance)

Consideration was given to a report by Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust), which invited the Committee to comment on the content of the report and the associated Clinical Strategy, as detailed at Appendix A to the report.

Andrew Morgan (Chief Executive) and Sue Cousland (Chief Nurse / Director of Operations) of the Trust were both in attendance and provided Members with a detailed presentation, covering the following areas: -

·    Background;

·    Key Elements;

·    How the Trust would achieve it;

·    Intended Business model;

·    Examples;

·    Clinical Model;

·    New Dynamics of Care;

·    Key Outcomes;

·    Challenges; and

·    Summary.

The Committee was reminded that Lincolnshire Community Health Services NHS Trust Board had approved a five year Clinical Strategy, as detailed at Appendix A to the report, that encompassed the outline vision of Lincolnshire Health and Care and the five year Forward View of NHS England.

The key elements of the strategy were as follows: -

·       'To encourage people to self-care or co-manage their long term conditions;

·       To focus on keeping the patients in their own home or as close to it for as long as possible;

·       To ensure staff have the appropriate skills and knowledge to care for a diverse and complex group of patients in the community;

·       To establish and support complex care pathways, using a variety of bed based environments outside of an acute hospital setting;

·       To work with others locally and nationally to create new community models that are sustainable for the future by harnessing the power of the wider community;

·       To work on the principle that in future patients will only be 'loaned' to an acute hospital for a defined period of time based on clinical need.'

The Strategy outlined that this would be achieved by further strengthening the access to services; building closer working relationships with other providers in the county; and by supporting patients to take a greater responsibility for their own health care needs.

The Trust had outlined in its Clinical Strategy an intention to act as a 'Care Navigator' in the community in order to manage a larger cohort of patients outside of the acute hospital setting.  In order to achieve this, it would be working with patients and families to take greater ownership of their own health needs and were working with other local providers to 'harness' the power of the wider community.

The Committee was also advised that the Trust was also operating a policy called 'Making Every Contact Count'.  Making Every Contact Count would ensure that any healthcare profession who came into contact with patients in their home would also consider the patients environment. For example, if a paramedic responded to a call to an elderly patient, they would ensure that the patient's surroundings were acceptable.  Any concerns should be escalated to the relevant authorities.  The Trust was also in conversations with local supermarket chains, as it was felt that supermarket delivery men could play an active role in highlighting any potential concerns to the NHS or local authorities.

Members  ...  view the full minutes text for item 41.

(To receive a report by Simon Evans (Health Scrutiny Officer), which invites the Committee to consider information on Annual General / Public Meetings and Annual Reports)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer), which invited the Committee to consider information on Annual General / Public Meetings and Annual Reports.

The Health Scrutiny Officer advised the Committee that Clinical Commissioning Groups, NHS Trusts, and NHS Foundation Trusts were required to prepare an annual report and accounts each year, and to hold an annual meeting in public.  In terms of local NHS organisations, five such meetings had taken place by the date of the Committee meeting.  Where it had been possible for a member of the Committee to attend, their reports had been included within the report to the Committee. 

The Committee was advised of forthcoming Annual General / Public Meeting dates, and the following Members volunteered to attend those meetings: -

·       21 September at 12 noon – Lincolnshire Community Services NHS Trust – Councillor S L W Palmer;

·       22 September at 5.00 pm – South West Lincolnshire Clinical Commissioning Group – Apologies;

·       23 September at 4.00 pm – Lincolnshire West Clinical Commissioning Group – Councillor J Kirk;

·       24 September at 5.00 pm – Lincolnshire East Clinical Commissioning Group – Councillor Dr G Gregory;

·       29 September at 5.30 pm – United Lincolnshire Hospitals NHS Trust – Councillor C J T H Brewis.

The Chairman reminded those Councillors who had volunteered that they would be required to produce an update report from their attendance at a future meeting.

RESOLVED

(1)  That the content of the report be noted.

(2)  That the following Councillors be requested to attend the following             meetings on behalf of the Committee: -

·           21 September at 12 noon – Lincolnshire Community Services NHS     Trust – Councillor S L W Palmer;

·           22 September at 5.00 pm – South West Lincolnshire Clinical     Commissioning Group – Apologies;

·           23 September at 4.00 pm – Lincolnshire West Clinical     Commissioning        Group – Councillor J Kirk;

·           24 September at 5.00 pm – Lincolnshire East Clinical      Commissioning        Group – Councillor Dr G Gregory;

·           29 September at 5.30 pm – United Lincolnshire Hospitals NHS             Trust –            Councillor C J T H Brewis.

(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 the forthcoming meetings.

The Health Scrutiny Officer advised the Committee of the following changes to the work programme: -

21 October 2015

It was agreed that the item on Lincolnshire Health and Care – Strategic Outline Case and Consultation Plan, which was originally scheduled for the meeting on 21 September 2015 could potentially be an item for 21 October 2015.  The Chairman advised the Committee that there was a possibility that this item could contain exempt information.

18 November 2015

It was noted that an item on South West Lincolnshire Clinical Commissioning Group – General Update had been added to the work programme for the meeting on 18 November 2015.

16 December 2015 and 20 January 2016

It was noted that the item on Cancer Strategy in Lincolnshire had been deferred from 16 December to 20 January.

It was also noted that an update from Healthwatch Lincolnshire had been added to the work programme for the meeting on 16 December 2015.

Further to Minute 38, as detailed above, it was noted that United Lincolnshire Hospitals NHS Trust – Financial Position had been added to the work programme for 20 January 2016.

Members of the Committee requested that the following items were added to the work programme: -

·       It was requested that an item on the Queen Elizabeth Hospital, King's Lynn, was added to the work programme for a future meeting;

·       A discussion took place regarding the infrastructure for new housing developments and it was agreed that this was a planning matter and not a matter for the Health Scrutiny Committee for Lincolnshire.

NOTE: At this stage in the proceedings, Councillor Mrs C A Talbot declared an interest as a reserve member on the Central Lincolnshire Joint Strategic Planning Committee.

·     It was queried whether the Committee could look into the issue of drug usage in Lincoln and in response to this, Members were advised that this was a matter for the Community and Public Safety Scrutiny Committee.

RESOLVED

That the contents of the work programme, subject to the above amendments being made, be approved.