Agenda and minutes

Apologies for absence were received from Councillors D P Bond (West Lindsey District Council), J Kirk (City of Lincoln Council) and T Boston (North Kesteven District Council).

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor M Wilson to the Committee in place of Councillor J Kirk (City of Lincoln Council) for this meeting only.

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

In relation to Item 5 – Children and Adolescent Mental Health Services, Councillor Mrs J M Renshaw asked the Committee to note that she had a grandchild who benefitted from Children's Services in prevention.

The Chairman welcomed everyone to the Committee and reported, with sadness, that Lynne Moody (Director of Quality and Executive Nurse for South Lincolnshire CCG) had announced she would be retiring in March 2016.  The Chairman went on to make the following announcements:-

i)             United Lincolnshire Hospitals NHS Trust – Retirement of Chairman

On 27 November 2015, the Chairman of United Lincolnshire Hospitals NHS Trust, Ron Buchanan, announced his retirement in March 2016 following two years in the role.  A replacement Chairman was being sought and a requirement for the successful candidate was to have "experience of leading organisational change to achieve improvement, proven governance and financial skills, and an understanding of the challenges facing NHS healthcare providers".  The Chairman felt that this would be a challenging role and looked forward to the appointment of the new Chairman.

ii)            United Lincolnshire Hospitals NHS Trust – Meetings

On 27 November 2015, the Chairman met with Kevin Turner in his role as Acting Chief Executive of United Lincolnshire Hospitals NHS Trust.  This was the final meeting with Kevin Turner in his role as acting Chief Executive as Jan Sobieraj formally took up the appointment as substantive Chief Executive of the Trust on 7 December 2015.

Kevin took on the Acting Chief Executive role in July 2015, following the retirement of Jane Lewington.  The Chairman intended to write to Kevin to formally thank him, on behalf of the Committee, for his contributions to the work of the Committee over the last few months, in particular for his candour and openness at meetings of the Committee.

On 10 December 2015, the Chairman met with Jan Sobieraj, Chief Executive of the Trust, where a number of issues were discussed, including recruitment and retention of staff, the financial position of the Trust and the importance of providing services to patients.

iii)          Treatment for Anxiety and Depression in Lincolnshire

A report by the Health and Social Care Information Centre was released on 7 December 2015, entitled the Psychological Therapies Annual Report, which highlighted the fact in Lincolnshire the improvement rate for anxiety and depression was far higher than the national average of 60.8%.  The services provided in the Grantham and Sleaford areas had seen a treatment improvement rate of 76.8% which was the highest in the country.  These therapy services were provided by Lincolnshire Partnership NHS Foundation Trust and it was positive to see Lincolnshire recording the highest figure in the country.

iv)          East Midlands Congenital Heart Centre

The Chairman was pleased to report that the East Midlands Congenital Heart Centre had continued to develop its services in line with NHS England's commissioning standards, following the New Congenital Heart Disease Review.

A Consultant Congenital Cardiac Surgeon had been newly appointed to replace a surgeon who had recently left the Centre.  This Consultant would be working alongside two existing Congenital Cardiac Surgeons bringing the Centre's complement of surgeons to three.   Additionally, two Paediatric Cardiology Consultant posts had been filled, specialising in intervention and MRI respectively.  ...  view the full minutes text for item 64.

RESOLVED

          That the minutes of the meeting held on 18 November 2015 be approved and signed by the Chairman as a correct record.

(To receive a report from Andrew McLean (Children's Services Manager for Commissioning) which provides an overview of the commissioning of the Child and Adolescent Mental Health Service (CAMHS), including funding, performance monitoring, local need and delivery against national benchmarking.  The report also includes the proposed revised model of delivery following successful application for Local Transformation Planning NHS England Funds)

A report by Andrew McLean (Children's Services Manager for Commissioning) was considered which described the overview of the commissioning of the Child and Adolescent Mental Health Service (CAMHS).  This included funding, performance monitoring, local need and delivery against national benchmarking.  The report also included the proposed revised model of delivery following successful application for Local Transformation Planning NHS England Funds.

Jonas Gibson (Commissioning Manager and Contract Lead for CAMHS – Lincolnshire County Council), Catherine Southcott (Commissioning Officer – Lincolnshire County Council) and Amanda Newman (CAMHS Team Leader – Lincolnshire Partnership NHS Foundation Trust) were all in attendance for this item of business.

Members were given an overview of the report which included the background to Children's and Adolescent Mental Health Service (CAMHS).  The service provided highly specialist mental health services delivered by clinical experts from Lincolnshire Partnership NHS Foundation Trust (LPFT) and was funded by Lincolnshire County Council and the four Clinical Commissioning Groups (CCGs).

The structure of CAMHS was on a four tier basis with Tier 1 being access to universal support services through to Tier 4 which supported inpatient specialist, acute needs.

Tier 1 services were available to all children and young people and were provided by Primary Care and universal service professionals, i.e. General Practitioners, Health Visitors and School Nurses and other support groups or helplines.  These services offered general advice and treatment for less severe problems; promoted good mental health; aided the early identification of problems and referred to more targeted or specialist services.  In addition, schools played a vital role at this level.

Lincolnshire County Council Children's Services had the delegated lead responsibility from the CCGs for CAMHS at Tiers 2 and 3 which was agreed in the form of a Section 75 Agreement and due to expire on 31 March 2018.  Services for Tier 2 CAMHS for children and young people experiencing moderately severe mental health problems included:-

·       Primary Mental Health Team offering:-   

o   Free training on understanding mental health concerns for all professionals working with children and young people aged 0-18 in Lincolnshire;

o   Consultation to professionals and families about specific concerns relating to a child;

o   Assessment and treatment for children aged 0-18 with mild to moderate mental health concerns, normally 6-8 sessions.  Maximum waiting time from referral to intervention should be 6 weeks;

·       Looked After Children Team offering:-

o   Training for foster carers, adoptive parents, leaving care workers and residential care staff;

o   Fast track access for assessment and treatment for Looked After Children and care leavers up to age 25.  Maximum waiting time from referral to intervention should be 4 weeks;

·       Therapeutic Services for Children:  Sexually Harmful Behaviours and Victims of Sexual Abuse (including for those with non-diagnosable mental health concerns)

Services for Tier 3 CAMHS for children and young people with more severe complex and persistent mental health needs included:-

·       Community Teams providing treatment via a range of therapies.  Maximum waiting time from referral to intervention was 12 weeks;

·       Forensic Psychology Service providing an assessment of risk and  ...  view the full minutes text for item 66.

(To receive a report from Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provides an update in relation to the activities for Lincolnshire East Clinical Commissioning Group (CCG) including the commissioning activities of the CCG and the wider developments the CCG has been involved in)

A report by Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provided an update in relation to the activities for Lincolnshire East Clinical Commissioning Group (CCG) including the commissioning activities of the CCG and the wider developments the CCG had been involved with.

Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) and Dr Peter Holmes (Chairman – Lincolnshire East Clinical Commissioning Group) were both in attendance for this item.

Members were given an overview of the report which provided information on the development within Lincolnshire East Clinical Commissioning Group.  The CCG currently had 30 member practices which were structured across three localities covering over 1,060 square miles.  The locality structure was fundamental to how the CCG operated and member practices were embedded within the localities and communities which they served.

The CCG covered a population of 243,650 although a greater population growth than the national average had been experienced since the 2001 census.  There had been substantial inward migration into the CCG area of older people from industrial centres from the Midlands and this had influenced the age structure of the populations and the prevalence of long term health conditions.  24.7% of the population were aged 65 years or older in comparison to England as a whole which was 16.9%.  23.7% of the population within Lincolnshire East had a limiting long term illness or disability which was significantly higher than the England average of 17.6%.

A number of areas had been the focus of the CCG, including the following:-

·       Mental Health:  Dementia

·       Care for the Over 75s

·       Neighbourhood Teams

·       Integrated Urgent Care

·       Care Home Projects

·       Community Hospitals

·       Optimising Prescribing in Primary Care

·       C2 Evaluation and Future

·       Caravan Dwellers

The lead commissioning responsibilities included:-

·       United Lincolnshire Hospitals NHS Trust

·       Urgent Care and System Resilience

·       Information Management and Technology

When the CCG was authorised, NHS England had responsibility for commissioning all primary care services including GP services, pharmacies, optician services and dental services.  In 2014/15 NHS England gave CCGs the opportunity to take on the commissioning responsibility for GP services.  The rationale being that the local focus of the CCG would enable a more tailored approach to local commissioning and stronger links between the strategic direction of other services commissioned by CCGs with GP services.  The statutory responsibility for GP services remained with NHS England but these were delegated to CCGs through the co-commissioning arrangements.

Lincolnshire East CCG achieved full delegated responsibility for GP services.  Appropriate governance arrangements had been implemented to manage any conflict of interest.  The CCG also had a Primary Care Commissioning Committee (PCCC) which was a formal committee of the governing body.  No GP's within the Lincolnshire East CCG sat on the PCCC which was composed of Governing Body lay members and CCG officers.  These meetings were held in public.

Priorities for primary care commissioning would be to develop a primary care strategy detailing the direction of travel and models for GP services in the future. 

The delivery of the NHS Constitution standards  ...  view the full minutes text for item 67.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides the proposed draft response, produced by the established working group, for the Committee's approval as part of the stakeholder engagement phase)

A report by Simon Evans (Health Scrutiny Officer) was considered which provided the proposed draft response, produced by the established working group, for the approval of the Committee as part of the stakeholder engagement phase.

Members were given an overview of the report, following the meeting of the Task & Finish Group on 11 November 2015.  It was reported that some factual amendments were required.  This information would be circulated to the Committee with the relevant amendments included as track changes to enable the changes to be clearly seen.  These amendments have been noted below:-

1.    Introduction – second sentence to read – The Health Scrutiny Committee for Lincolnshire understands that there will be further opportunities for the Committee to contribute, for example during a further engagement phase on the interpretation of the JSNA and suggestions for priorities for inclusion in the Joint Health and Wellbeing Strategy in 2017.

2.    Introduction – third sentence to read – The Committee also acknowledges that the JSNA is a key evidence base in the development of the Joint Health and Wellbeing Strategy.

3.    Involvement in Stakeholders – third sentence to read – The Committee suggests that to further emphasise this importance, the CCG Council, which comprises the senior management representatives of each of the four CCGs, should be specifically engaged in the continued maintenance and interpretation of the JSNA.

4.    Involvement in Stakeholders – second paragraph to read – The Health Scrutiny Committee believes that the views of the voluntary sector must be taken in to account, as these organisations see services from a different viewpoint.  They may also have data that could inform the JSNA.

5.    Data and Specific Topics – first bullet point to read – neurological conditions, where there is a need for adequate evidence to establish whether services in Lincolnshire meet need and to ensure that commissioning decisions fully take account of the needs of people with such conditions.

6.    Data and Specific Topics – second bullet point to read – cancer, where there should be more evidence to support an emphasis on prevention and the appropriate funding for such services as the early prevention and detection of cancer.

7.    Data and Specific Topics – third bullet point to read – childhood obesity, where more evidence is required on how existing services can impact on the number of overweight or obese children, as this is a topic where the Health Scrutiny Committee would like to see further action.

8.    Data and Specific Topics – fourth bullet point to read – rural isolation, where contextual intelligence could be better integrated into the JSNA and used to support improved implementation of services.

9.    Data and Specific Topics – final paragraph – The Committee also supports the intention for the restructuring of the JSNA to provide a more flexible approach to the existing 35 topic commentaries.

Members were given the opportunity to ask questions during which the following points were noted:-

At this point of the meeting, the Chairman declared an interest due  ...  view the full minutes text for item 68.

(To receive a report from Simon Evans (Health Scrutiny Officer) which presents the joint response of the Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire submitted to Lincolnshire Partnership NHS Foundation Trust (LPFT) on their Draft Priorities)

A report by Simon Evans (Health Scrutiny Officer) was considered which presented the joint response of the Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire, submitted to Lincolnshire Partnership NHS Foundation Trust (LPFT) on their Draft Priorities.

Members were advised that a working group to review the draft priorities of Lincolnshire Partnership NHS Foundation Trust was established and met on 12 November 2015.  The final statement was submitted to the Trust on 26 November 2015 on behalf of the Committee and Healthwatch Lincolnshire.

The report which the Committee considered on 21 October 2015 listed seven draft priorities (noted below) which the working group further considered.  The working group involved Councillors Mrs C A Talbot and S W L Palmer and Sarah Fletcher, Chief Executive of Healthwatch Lincolnshire.

1.    Maintain compliance with the Care Quality Commission (CQC) Fundamental Standards of Care;

2.    Ensure long-term sustainability for the Trust;

3.    Improve access to our services;

4.    Provide better support for people who are discharged or waiting for services;

5.    Supporting our people to be the best they can be;

6.    Increase service user and carer involvement in all aspects of service design and delivery; and

7.    Support the Lincolnshire Health and Care (LHAC) programme and promote service integration.

The Committee did not make any additional comments on the draft response.

RESOLVED

1.    That the joint statement, at Appendix A to Agenda Item 8, of the Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire to the Draft Priorities of Lincolnshire Partnership NHS Foundation Trust submitted to the Trust on 26 November 2015 be noted; and

2.    That a further opportunity for the Committee to comment on the content of the clinical strategy of Lincolnshire Partnership NHS Foundation Trust be presented to the Health Scrutiny Committee for Lincolnshire in February 2016.

(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 forthcoming meetings.

The Health Scrutiny Officer advised that the meeting in January would be all day with the afternoon session including contributions from the Trust Development Authority (TDA) and NHS England – Midlands and East (Central Midlands) on the Lincolnshire Recovery Programme Board.

The Chairman noted that a Cancer Summit had taken place in February 2015 prior to Sarah-Jane Mills (Director of Planned Care and Cancer Services – Lincolnshire West Clinical Commissioning Group), the former Chief Executive of St Barnabas, being appointed.

It was reported that an enquiry had been made by a member of the public in relation to the Men Behaving Badly initiative.  Following discussion, it was agreed that this query be referred to Public Health as it was within their remit.

RESOLVED

          That the contents of the work programme be approved.

The Chairman took the opportunity to wish the Committee a very happy Christmas and a peaceful New Year.