Agenda and minutes

Apologies for absence were received from Councillor D P Bond (West Lindsey District Council) and Councillor J Kirk (Lincoln City Council).

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor Mrs A White to the Committee in place of Councillor D P Bond (West Lindsey District Council) for this meeting only.

Apologies for absence were also received from Chris Weston (Consultant in Public Health).

Notice had also been received that Councillors T Boston and G Gregory would arrive late and asked that their apologies be conferred to the Committee.

There were no declarations of Members' interests at this point in the proceedings.

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

i)          St Barnabas Hospice – Chief Executive

On 30 October 2015, St Barnabas Hospice announced the appointment of Chris Wheway as its new Chief Executive, having replaced Sarah-Jane Mills who was now leading on the Cancer Strategy within Lincolnshire.  Chris Wheway had joined St Barnabas after twelve years' experience in the NHS in both Lincolnshire and Derbyshire.  The Chairman was scheduled to meet the new Chief Executive in the next few weeks.

ii)         Hospice Within a Hospital Award

With delight, the Chairman announced that on 8 November 2015 the Hospice in a Hospital, at Grantham and District Hospital, won the Building Better Healthcare Award.  The unit at Grantham and District hospital was the first of its kind in the UK and was recognised for its innovative approach to patient experience.  The unit was successful as best End of Life Care Project, and was recognised for its unique approach of providing care to patients under the responsibility of GPs, but with access to hospital nurses, doctors and therapists.  The six-bed community hospice opened in September 2014 as part of a joint venture between St Barnabas Lincolnshire Hospice, United Lincolnshire Hospitals NHS Trust and South West Lincolnshire Clinical Commissioning Group.

iii)       United Lincolnshire Hospitals NHS Trust

The Chairman had met with senior managers at United Lincolnshire Hospitals NHS Trust (ULHT) on two separate occasions.  On 27 October 2015, a meeting was held with Kevin Turner, Acting Chief Executive, where a briefing was received on some of the system issues which had led to the continued deterioration of the Trust's financial position.  On 4 November 2015, a meeting was held with Jan Sobieraj, Chief Executive Designate, where the challenges facing the Trust over coming months were discussed.  Jan was due to take on the substantive role as Chief Executive on 7 December 2015.

iv)       Lincolnshire Partnership NHS Foundation Trust

On 3 November 2015 the Chairman met with Alan Lockwood, Vice-Chairman, and John Brewin, Chief Executive of Lincolnshire Partnership NHS Foundation Trust (LPFT) to discuss the process for the Care Quality Commission Inspection scheduled between 30 November and 4 December 2015.  Approximately 70 inspectors will form the inspection team and would visit the services provided by the Trust.  The CQC report was expected to be published no earlier than March 2016.

It was also agreed that two items would be brought forward on to the Work Programme for the meeting scheduled for 17 February 2015.  These were Adult Psychology Services and Universal Health.

v)         Lincolnshire and Nottinghamshire Air Ambulance

The Lincolnshire and Nottinghamshire Air Ambulance had given a presentation to the Committee in October 2014.  Peter Aldrick, who had been the Chief Executive of the Lincolnshire and Nottinghamshire Air Ambulance for sixteen years, would be retiring in January 2016 and Karen Jobling had been appointed as his replacement.  Karen had 25 years' experience at senior management level in the charity sector and previously held the post of Executive Director  ...  view the full minutes text for item 56.

RESOLVED

          That the minutes of the meeting held on 21 October 2015 be approved and signed by the Chairman as a correct record.

(To receive a report from Dr Sunil Hindocha (Chief Clinical Officer – Lincolnshire West Clinical Commissioning Group) and Sarah Newton (Chief Operating Officer – Lincolnshire West Clinical Commissioning Group), which describes the new responsibility Lincolnshire West Clinical Commissioning Group has for commissioning GP services and the governance arrangements in place to mitigate potential conflicts of interest)

A report by Dr Sunil Hindocha (Chief Clinical Officer – Lincolnshire West Clinical Commissioning Group) and Sarah Newton (Chief Operating Officer – Lincolnshire West Clinical Commissioning Group) was considered which described the new responsibility Lincolnshire West Clinical Commissioning Group had for commissioning GP services and the governance arrangements in place to mitigate potential conflicts of interest.

Dr Sunil Hindocha (Chief Clinical Officer – Lincolnshire West Clinical Commissioning Group) and Sarah Newton (Chief Operating Officer – Lincolnshire West Clinical Commissioning Group) were in attendance for this item of business.

Members were advised that commissioning of primary care services had previously been carried out by NHS England, but NHS England had invited all CCG's to take over responsibility for commissioning those services.  All four CCGs in Lincolnshire had applied to take on delegated responsibility for GP commissioning.  Since 1 April 2015, the CCG had been responsible for carrying out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, other than those relating to individual GP performance management which had been reserved to NHS England.

The following activities were included:-

·       General Medical Services (GMS), Primary Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts, including the design of PMS, APMS contracts, contract monitoring, contractual action and removing a contract but not the alteration of the Terms and Conditions of any national contract;

·       Design, development, introduction and monitoring of newly enhanced services ("Local Enhanced Services" and "Directed Enhanced Services"), and modification or cessation of existing schemes;

·       Design and management of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

·       To determine whether to establish new GP practices within the area;

·       Approval of practice mergers;

·       Decision making on 'discretionary' payment (e.g. returner/retainer schemes).

All CCGs responsible for GP commissioning were required to establish an independent Primary Care Commissioning Committee to exercise and oversee the delegated Primary Care commissioning functions.  Lincolnshire West CCG had a committee of 11 members and was chaired by a lay member, as per guidelines, and made up of the following (those with voting rights are indicated with a *):-

·       Lay Chair of the CCG*

·       Chief Operating Officer or nominated deputy*

·       Chief Nurse or nominated deputy*

·       Chief Finance Officer or nominated deputy*

·       Lay member for Public and Patient Involvement*

·       Lay member for Primary Care*

·       Secondary Care Clinician Governing Body member*

·       NHS England representation

·       Clinical Accountable Officer

·       GP Clinical Advisor

·       The four CCG locality chairs

Since the report had been published, a further lay member had been appointed.

It was further noted that the Conflicts of Interest Policy had been revised in accordance with new guidance and approved as part of the CCGs application to take on delegated primary care commissioning.

The revenue budget for commissioning GP primary care services had been delegated to the CCG along with the budget for GP IT.  At present, infrastructure funding had been retained centrally.  Some NHS England staff had been assigned to the four Lincolnshire CCGs to support administration but the management  ...  view the full minutes text for item 58.

(To receive a report from Allan Kitt (Chief Officer – South West Lincolnshire Clinical Commissioning Group), which provides an update on the activities within South West Lincolnshire Clinical Commissioning Group, covering urgent care, planned care, primary care and commissioning support in addition to information on mental health and learning disabilities for which South West Lincolnshire CCG is the lead commissioner)

A report by Allan Kitt (Chief Officer – South West Lincolnshire Clinical Commissioning Group) was considered which provided an update on the activities within South West Lincolnshire Clinical Commissioning Group covering urgent care, planned care, primary care and commissioning support in addition to information on mental health and learning disabilities for which South West Lincolnshire CCG was the lead commissioner.

Allan Kitt (Chief Officer – South West Lincolnshire CCG), Dr Vindi Bhandal (GP Chair) and Clair Raybould (Chief Commissioning Manager) were all in attendance for this item of business.

Members were given a brief overview of the report, the aim of which was to update the Committee on developments with South West Lincolnshire CCG.  The CCG covered a population of approximately 130,000 and was centred around the market towns of Grantham and Sleaford.  Although there was only one practice area within the CCG's area where deprivation was above the national average, the prevalence of disease was significantly higher than the national average.  This included cardiovascular disease, diabetes and respiratory disease.  Cancer mortality was improving overall with mortality for breast, lung and gastrointestinal better than the national average.  Overall, cancer survival rates were worse than the national average despite steady improvement.

The CCG's Strategic Plan had been underpinned by the work consulted on and shared with the Scrutiny Committee and of the Shaping Health for Mid Kesteven Programme.  The work had focussed on the following key areas:-

·       Urgent Care

o   The Hospice in Hospital was a joint venture between local GPs, St Barnabas Hospice, ULHT and the CCG.  It was fully operational at Grantham and District Hospital and was, for the first time, providing local inpatient palliative care;

o   Fifteen new intermediate care beds had been commissioned in partnership with Lincolnshire County Council, Lincolnshire Community Health Services and local GPs.  This provided an alternative to hospital admission as well as a means to avoiding unnecessary hospital stays.  In order to manage the inevitable winter pressures, it was planned to expand these bed numbers;

o   Close working with ULHT and Lincolnshire Community Health Services had enabled a single integrated reception area to open where Out of Hours, the GP in A&E and the Emergency Assessment Unit (EAU) team worked in partnership;

o   Ambulatory emergency care at Grantham Hospital was now complete and was being made operational for the winter enabling a robust alternative to admission to ensure more patients received a diagnosis and urgent treatment without unnecessary hospital stays;

o   Non-elective admissions across all providers within South West Lincolnshire CCG, including ULHT, Nottingham University Hospitals NHS Trust, Sherwood Forest NHS Foundation Trust, fell by 7% in 2014/15.  The CCG's non-elective admissions had fallen between 6% and 7% each year for the past three years and it was not expected that, in light of the aging population and high disease burden, that this would continue;

o   Emergency admission rates for the CCG were significantly lower than the national average although it was reported that admission rates for all Lincolnshire CCG's were lower  ...  view the full minutes text for item 59.

(To receive a report by Simon Evan (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 but asked the Committee to note that the meetings in December 2015 and January 2016 would be all day.

Councillor E L Ransome asked that her apologies for the December meeting be noted.

Further to comments at the last meeting of the Committee, Councillor T M Trollope-Bellew advised that the consultation in relation to Stamford car parking charges closed on 19 November 2015.  Following discussion, it was agreed that a representation should be submitted on behalf of the Committee.  It was agreed, therefore, that the submission from Stamford Town Council to Peterborough and Stamford NHS Foundation Trust be sought on the Trust's proposals to introduce parking charges at Stamford and Rutland Hospital, with a view to a response being made to the Trust on behalf of the Committee, setting out the Committees opposition to the introduction of parking charges.

RESOLVED

1.    That the contents of the work programme be approved; and

2.    That the submission from Stamford Town Council to Peterborough and Stamford NHS Foundation Trust be sought on the Trust's proposals to introduce parking charges at Stamford and Rutland Hospital, with a view to a response being made to the Trust on behalf of the Committee, setting out the Committee's opposition to the introduction of parking charges.

(To receive a report from Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) and Sarah Furley (Urgent Care Programme Director – Lincolnshire East Clinical Commissioning Group), which provides information on the Constitutional Standards recover plan for urgent care and the winter plans)

The Chairman explained that the paper had been presented to the agenda planning meeting on 5 November 2015 where it was requested that the fines and penalties, noted on page 42 of the report, be defined further.  In addition to that, the Chairman asked that the Committee note the following points prior to consideration of this item:-

·       Tabled 2 on page 40 of the report provided statistics in relation to United Lincolnshire Hospitals NHS Trust.  It was confirmed that the table was accurate and the Chairman expected that the figures for 'patients' and 'days' would be further clarified during the presentation;

·       A full range of data was readily available on the NHS England website regarding delayed transfers of care, which recorded delays for each NHS Trust, by local authority, as well as by the cause of delay.

Consideration was given to a report from Gary James (Accountable Officer – Lincolnshire East CCG) and Sarah Furley (Urgent Care Programme Director – Lincolnshire East CCG) which provided information on the Constitutional Standards recovery plan for urgent care and the winter plans.

Gary James (Accountable Officer – Lincolnshire East CCG) and Sarah Furley (Urgent Care Programme Director – Lincolnshire East CCG) were both in attendance and provided members with a detailed overview of the report.

As set out in the NHS Constitution, a minimum of 95% of patients attending at an A&E department in England should be seen, treated and either admitted or discharged within four hours.  Recent evidence had shown that there was an increased risk of harm to patients should the four hour A&E standard fall below 90%.

National Context

During Quarter 3 2014/15 (winter 2014) the four hour A&E standard declined to a lower level than at the end of the same period the previous year which had been a sharp decline nationally.  Since winter 2014-15, work had been undertaken to identify the factors driving the sudden decline in A&E performance in order to take action and prevent it from recurring this year.

Analysis from a report from Monitor in September 2015 (A&E Delays:  Why did patients wait longer last winter?) indicated that half of the decline in A&E performance against the four hour target in winter 2014 could be explained by factors such as each hospitals inability to accommodate the increase in A&E attendance.  Monitor findings had advocated that measures taken by hospitals and urgent care system to improve patient flow through hospital departments other than A&E may be highly effective in avoiding another sharp decline in performance.

Local Context

Although there had been an improvement nationally in the four hour A&E standard since winter 2014, Lincolnshire had not recovered to the same extent.  Figures indicated that England were 94.32%, the East Midlands 94.70% and Lincolnshire at 89.9%.

It was reported that Pilgrim Hospital was running with a higher bed occupancy than other sites and it was acknowledged that medical beds had a higher bed occupancy than surgical  ...  view the full minutes text for item 61.