Agenda and minutes

Apologies for absence were received from Councillor D P Bond (West Lindsey District Council), Councillor Mrs P F Watson (East Lindsey District Council) and Councillor Mrs R Kaberry-Brown (South Kesteven District Council).

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor D Edginton to the Committee in place of Councillor Mrs P F Watson (East Lindsey District Council) and Councillor B Russell in place of Councillor Mrs R Kaberry-Brown (South Kesteven District Council) for this meeting only.

Apologies for absence were also received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison and Community Engagement), Chris Weston (Consultant in Public Health) and Gary James (Accountable Officer for Lincolnshire East CCG).

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

Councillor Dr G Gregory advised that, although an employee of United Lincolnshire Hospitals NHS Trust, he did not feel it necessary to declare a pecuniary interest in the item on United Lincolnshire Hospitals Trust - Pharmacy Services as he had no involvement with this area of the Trust.

Councillor S L W Palmer advised the Committee that he was currently involved in a complaints process with United Lincolnshire Hospitals NHS Trust, however this was not a pecuniary interest and for members' information only.

The Chairman welcomed everyone to the Committee and made the following announcements.

i)             Celebrating Success Awards – Lincolnshire Community Health Services NHS Trust

On 21 September 2015, the Chairman attended the Celebrating Success Awards, held by Lincolnshire Community Health Services NHS Trust, at the Show Room in Lincoln, where she presented the Emily Jane Glen Memorial Award for Volunteers.  Councillor S L W Palmer also attended the Awards and his report was available within Item 9 of the Agenda Pack – Annual General/Public Meetings and Annual Reports.

ii)            Joint Ambulance Conveyance Project

The Joint Ambulance Conveyance Project was a joint initiative between the East Midlands Ambulance Service, Lincolnshire Fire and Rescue and Lincolnshire Integrated Voluntary Emergency Service (LIVES).  On 23 September 2015, the project won a prestigious Health Service Journal (HSJ) Value in Healthcare Award in the Acute Service Redesign Category.  The Chairman would send a letter on behalf of the Committee offering congratulations to all those involved.

iii)           United Lincolnshire Hospitals NHS Trust – Financial Position

Minute 38 of the Health Scrutiny Committee for Lincolnshire meeting held on 16 September 2015, covered the financial position of United Lincolnshire Hospitals NHS Trust.  The Trust Board of ULHT held their monthly meeting on 6 October 2015 where the Trust reported a deficit of £27.3m for the period 1 April to 31 August 2015.  The in-month deficit for August was £5.7 million as opposed to £4.1 million in July which meant the Trust was £9.2 million worse than plan.  The Chairman advised that a meeting with the Acting Chief Executive had been arranged for 27 October 2015.

The Chairman was scheduled to meet Jan Sobieraj, Chief Executive designate, on 4 November 2015 and his official start date was 7 December 2015.

iv)           NHS Provider Trusts – Overall Financial Position

On 9 October 2015 both the Trust Development Authority and Monitor released figures which showed that, for the first quarter of 2015/16, NHS provider trusts were running a total deficit of £930 million between them, with an overall deficit of £2 billion anticipated by the end of the year.

v)            East Midlands Congenital Heart Centre – Stakeholder Meetings

A programme of stakeholder meeting dates of the East Midlands Congenital Heart Centre had been advised, the first of which was to take place in January 2016.  It was hoped that all local authorities in the East Midlands would participate in these meetings.

vi)           Meeting with Lincolnshire West Clinical Commissioning Group

On 13 October 2015, a meeting was held with senior management from Lincolnshire West Clinical Commissioning Group, including Richard Childs (Chairman), Dr Sunil Hindocha (Chief Clinical Officer) and Sarah Newton (Operating Officer).  It was agreed that the Health Scrutiny Committee for Lincolnshire would consider an item on co-commissioning at the November meeting.

vii)         Emergency Planning – Exercise Black Swan

On 15 October 2015, the Chairman together with Councillors C J T H Brewis, R Kaberry-Brown, J Kirk and Mrs S Ransome, attended Exercise Black Swan, an emergency planning exercise.  The scenario  ...  view the full minutes text for item 46.

RESOLVED

          That the minutes of the meeting held on 16 September 2015 be approved and signed by the Chairman as a correct record.

The Chairman also confirmed that Replacement Members would also be invited to participate in the training also.

NOTE:       In line with his declarations of interest, Councillor Dr G Gregory left the meeting room for the following item of business (Minute 48).

(To receive a report from Kevin Turner, Acting Chief Executive United Lincolnshire Hospitals NHS Trust, which provides an update on progress following the which establishment of an Improvement Portfolio to cover the four key recovery work streams – Quality Improvement, Workforce and Organisational Development, Constitutional Standards and Financial Recovery)

A report by Kevin Turner (Acting Chief Executive – United Lincolnshire Hospitals NHS Trust) was considered which provided an update on progress following the establishment of an Improvement Portfolio covering the four key recovery work streams – Quality Improvement, Workforce and Organisational Development, Constitutional Standards and Financial Recovery.

Kevin Turner (Acting Chief Executive – United Lincolnshire Hospitals NHS Trust), Pauleen Pratt (Acting Chief Nurse – United Lincolnshire Hospitals NHS Trust) and Mark Brassington (Director of Performance and Improvement – United Lincolnshire Hospitals NHS Trust) were all in attendance for this item of business.

Members were given a brief overview of the complex plans which focussed on the four main themes.  The Board had agreed the Trust's priorities for 2015/16 alongside a programme management approach to managing the recovery of performance.  A coordinated programme approach had been established with full executive support to address the key recovery streams identified.

The core themes had been broken down in to key project areas which had been Red Amber Green (RAG) Rated to indicate the progress made.  Most projects had a rating of Amber which acknowledged that there were significant issues which required attention but that these issues were resolvable and successful delivery of the project remained feasible.

Members agreed to take the report in sections to allow introduction and the opportunity to ask questions on those particular sections:-

Section 1

Quality Improvement Programme (Rating – Amber/Green)

Senior Responsible Owner – Pauleen Pratt, Acting Chief Nurse

This programme would embed and sustain the changes delivered in response to the CQC Inspections whilst moving into the third phase of the Trust's continuous quality improvement journey.  A monthly progress report was submitted to the Quality Governance Committee with CQC Compliance Notice issues also being reported directly to the CQC.  The main achievements for this programme were:-

Louth – The Governance arrangements in Louth had been improved and there was now a Medical and Nursing Lead responsible for leading the newly established Governance Meeting for Louth Hospital with a focus on learning issues;

Pharmacy – Recruitment to Pharmacy posts had been successful including a new Consultant Antimicrobial Pharmacist;

Outpatient Department – The environment had improved in Lincoln Out-Patient Department with new "self-check-in" and a new central reception desk had opened with all staff wearing a uniform.  The booking system for follow-up patients to Out-Patients had also been improved;

See It My Way – If patients or carers would like to raise concern about services, response times had improved by doing so through the new PALS Teams.

Main areas of concern where significant issues existed were:-

Safeguarding (Amber rating) – Additional safeguarding training had been established and there was sufficient capacity to deliver training to all relevant staff.  The project was behind trajectory primarily due to DNA (did not attend) rates at training events.  A new HR process had been introduced for managers to apply when staff did not attend booked training sessions.

Hospital at Night (Amber rating) – A new Hospital at Night model had been introduced  ...  view the full minutes text for item 48.

(To receive a report from Colin Costello, Chief Pharmacist of United Lincolnshire Hospitals NHS Trust, which provides details of the processes in place for the delivery of Specialist Hospital Pharmacy Services to provide services in accordance with nationally defined Department of Health and NHS England commissioner requirements.  The Committee are asked to comment on the information presented and, in particular, the implementation of United Lincolnshire Hospitals NHS Trust's Constitutional Standards for discharge medication and the processes for development and implementation of the electronic prescribing and medicines administration system (ePMA))

A report by Colin Costello (Chief Pharmacist – ULHT) was considered which provided details of the processes in place for the delivery of Specialist Hospital Pharmacy Services to provide services in accordance with nationally defined Department of Health and NHS England commissioner requirements.

Kevin Turner (Acting Chief Executive – ULHT) was also in attendance for this item.

Members were advised that this was part of a wider programme within the Trust for discharge, and despite some delays in this area, they were now being addressed.  Issues in regard to enabling patients to leave hospital with their medication was also being addressed as part of the redesign of the discharge management process, which formed part of the wider Constitutional Standards process. 

The process was to be trialled at Pilgrim Hospital but this was a paper based system which also added to the delay in discharge.  That information needed to be transcribed by Junior Doctors from the patient chart on to the system which also had to be accurate.

Members were given the opportunity to ask questions on this section of the report during which the following points were noted:-

·       Confirmation was provided that the inpatient chart was accurate at all times.  Errors occurred when a manual, handwritten, transcription was done.  In order to prevent those delays, four discharge processes were being implemented so that the majority of medication for patients was ready and correct, to remove or minimise the delay;

·       It was aimed to rollout the pilot programme at Pilgrim Hospital at the start of the next financial year;

·       The idea was to utilise the inpatient chart as the prescription itself.  Pharmacists would then be able to respond more quickly and any information could be transcribed on to a summary of care.  The process would mirror what would eventually become an electronic prescribing system;

·       Patients would also be able to utilise the Discharge Lounge which would free the bed.  Lockers next to the bed would also give patients access to their own medication thus empowering them to have the ability to self-medicate in hospital, wherever it was safe to do so;

·       The same people currently completing the manual charts would complete the electronic system once they were in place.  The computer system would be made up of specifically written algorithms which would highlight issues with drug treatment, ensuring that medical staff were aware of any potential discrepancies with combined prescriptions.  The system also builds in further checks and balances;

·       Although not directly related, the Johnson Ward at Lincoln County Hospital was piloting an electronic monitoring system where the observation statistics of patients were input which then reminded nurses when the next set of observations were due.  It was hoped this would be widely rolled out in the New Year;

·        It was hoped to have medication processed and ready for patients to be discharged the following day.  To ensure that the pharmacy were prepared they would need to be advised of patients discharge dates, it was acknowledged that better communication and organisation  ...  view the full minutes text for item 49.

(To receive a report from Alison Christie, Programme Manager Health and Wellbeing, Lincolnshire County Council, which provides an overview of the strategy, including details of the Mid Term Review agreed by the Health and Wellbeing Board in June 2015 in addition to the assurance arrangements in place to assess the progress being made to deliver improving health and wellbeing outcomes)

Consideration was given to a report by Alison Christie, Programme Manager Health and Wellbeing) which provided an overview of the strategy, including details of the Mid Term Review agreed by the Health and Wellbeing Board in June 2015 in addition to the assurance arrangements in place to assess the progress being made to deliver improving health and wellbeing outcomes.

Dr Tony Hill (Executive Director of Community Wellbeing and Public Health) and Alison Christie (Programme Manager, Health and Wellbeing) were both in attendance.  Dr Hill explained that the Joint Health and Wellbeing Strategy was owned and approved by the Health and Wellbeing Board and was recently reviewed halfway through the strategy period.  The strategy provided some of the detail about that review and the outcomes.

Members were given a detailed presentation, covering the following areas:-

·         Introduction

·         Promoting healthier lifestyles – Outcome: People lead healthier lives (Priorities)

·         Promoting healthier lifestyles – What are our plans?

·         Improve the health and wellbeing of older people – Outcome:  Older people are able to live life to the full and free part of their community (Priorities)

·         Improve the health and wellbeing of older people –What are our plans?

·         Delivering high quality systematic care for major causes of ill health and disability – Outcome:  People are prevented from developing long term health conditions, have them identified early if they do develop them and are supported effectively to manage them (Priorities)

·         Delivering high quality systematic care for major causes of ill health and disability – What are our plans?

·         Improve health and social outcomes for children and reduce inequalities – Outcome: ensure all children get the best possible start in life and achieve their potential (Priorities)

·         Improve health and social outcomes for children and reduce inequalities – What are our plans?

·         Tackling the social determinants of health – Outcome:  Peoples health and wellbeing is improved through addressing wider determining factors of health that affect the whole community (Priorities)

·         Tackling the social determinants of health – What are our plans?

The detail of each slide was taken from Appendix A to the report which detailed how the improvements would be measured over the next few years.  Appendix B of the report showed the Boards Assurance Framework which had been agreed in June 2015.  The Health and Wellbeing Board were assured by this strategy but did have some reservations in regard to Theme 3 – Delivering high quality systematic care for major causes of ill health and disabilities.

The Committee would be the "lead scrutiny committee" involved for Theme 3 of the strategy, which was sponsored by Dr Peter Holmes of Lincolnshire East Clinical Commissioning Group.  Due to the sizeable piece of work, the Chairman suggested a small group of the Committee meet with the Programme Manager Health and Wellbeing to ensure a clearer understanding of each area and each theme.  This was agreed and volunteers were sought.

Councillors Mrs S M Wray, Mrs J M Renshaw, S L W Palmer, J Kirk, C J T H Brewis and the  ...  view the full minutes text for item 50.

(To receive a report from Jane Marshall, Director for Strategy, Lincolnshire Partnership NHS Foundation Trust, which provides the draft clinical strategy for review and feedback.  The Committee are also asked to consider holding a focus group to refine the draft priorities.  Chris Higgins, Associate Director of Business Development, Lincolnshire Partnership NHS Foundation Trust, will also be in attendance)

Prior to commencement of this item, the Chairman advised that whilst the meeting was ongoing, the Care Quality Commission (CQC) had published the results of the community mental health survey based on adult mental health services across England – CQC's response to the 2015 Community Mental Health Survey (October 2015).

Page 18 of the report highlighted "Trusts achieving 'worse than expected' results".  Table 4 referred to "Trusts with high proportions of questions where their performance is 'worse than expected' compared with other trusts" and included within the five trusts was Lincolnshire Partnership NHS Foundation Trust.  Table 5 on page 19 also notes that the Trust was also included in Table 5 which was "CQC inspection ratings for trusts with high proportions of 'worse' community mental health survey scores".

John Brewin, Chief Executive of Lincolnshire Partnership NHS Foundation Trust, was invited to address the Committee in light of the report.  The Trust was very disappointed with the results and being placed in the bottom five in the country although they were aware of the vast number of issues identified and steps were being taken to address them.  The Trust was optimistic that the changes implemented would improve the figures.  Approximately 70 inspectors from the CQC were expected w/c 30 November 2015 across a large part of the Trust and would visit all inpatient facilities, various stakeholders, commissioners, patients, carers and focus groups who would help to inform their decision.

The Chairman thanked the Mr Brewin for the update.

Item 8 – Lincolnshire Partnership NHS Foundation (LPFT) – Draft Clinical Strategy

Consideration was given to a report from Jane Marshall (Director for Strategy, Lincolnshire Partnership NHS Foundation Trust) which provided the draft clinical strategy to the Committee for review and feedback.  The Committee were also asked to consider holding a working group to refine the draft priorities.

John Brewin (Chief Executive, Lincolnshire Partnership NHS Foundation Trust), Jane Marshall (Director for Strategy, Lincolnshire Partnership NHS Foundation Trust) and Chris Higgins (Associate Director of Business Development, Lincolnshire Partnership NHS Foundation Trust) were all in attendance and provided members with a detailed presentation on the following areas:-

·         Introduction

·         Proud of this year……….

·         Future View

·         Review of our clinical strategy

·         Feedback to date (1)

·         Feedback to date (2)

·         Lincolnshire Alignment

·         Clinical priorities – short term

·         Clinical priorities – long term

·         Welcome view and feedback

Members were provided with an opportunity to ask questions, where the following points were noted:-

·       It was suggested that it would be helpful to include the full picture within the strategy to give the context of the issues and the reason for implementing the strategy;

·       It was hoped that a full working draft would be available by the end of November 2015, which the working group would have fed into.  This would then form the final draft clinical strategy which would go out for consultation;

·       The Lincolnshire-wide suicide prevention action plan would also be included within the strategy and it was suggested that some elements from the mental health  ...  view the full minutes text for item 51.

(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 since the last meeting of the Committee.  Where it had been possible for a member of the Committee to attend, their reports had been included within the report to the Committee.

RESOLVED

          That the content of the report be noted.

The Chairman requested that the media release from Peterborough and Stamford Hospitals, introducing car parking charges as part of its development plans following complaints from patients, staff and relatives, be sent to the Committee for their information. 

NOTE:       At this part of the proceedings, Councillor B Russell left the meeting and did not return.

(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 that there were no changes to the published work programme for consideration.

Members made the following suggestions for topics on the training session scheduled for the afternoon of 18 November 2015:-

·       Definition of terminology within prevention strategies;

·       Remit and scope of the Health Scrutiny Committee for Lincolnshire (including the Terms of Reference and formal agreement between NHS England, Healthwatch, CCGs and Health and Wellbeing, and protocol in general);

In relation to the work programme, members requested the following items be scheduled for a future meeting:-

·       Lincolnshire Dentistry

·       Exercise Black Swan – Update

RESOLVED

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