Agenda and minutes

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

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor B Bilton to the Committee in place of Councillor J Kirk (City of Lincoln Council) and Councillor K Cook in place of Councillor T Boston (North Kesteven District Council) for this meeting only.

Councillor Mrs S Ransome indicated that she would have to leave the meeting at approximately 2.30pm.

The Chairman reminded the Committee that should a Replacement Member be appointed at a meeting they would then be the Member for that meeting.  Should the substantive Member join the meeting at a later time, they would be welcome but as an observer only.

In relation to Item 7 – Cancer Services in Lincolnshire, Councillor G Gregory advised that he was currently serving part of the cancer service (colon cancer) as part of his paid employment with United Lincolnshire Hospitals NHS Trust but felt that this discussion did not relate to his pecuniary interest.

Councillor Mrs P F Watson advised that she was a patient receiving cancer services but would remain for the discussion at Item 7 – Cancer Services in Lincolnshire.

Councillor S L W Palmer declared an interest in Item 7 – Cancer Services in Lincolnshire as a former patient receiving cancer services within the county. 

In relation to Item 5 – East Midlands Ambulance Service (EMAS) – Improvements and Performance and Item 6 – Lincolnshire Integrated Volunteer Emergency Service (LIVES), Councillor S L W Palmer advised that he was a first responder and coordinator of the LIVES Sutton on Sea Group.  When called out, he was active under EMAS.

In relation to Item 7 – Cancer Services in Lincolnshire, the Chairman, Councillor C A Talbot, advised that her daughter had received cancer treatment from United Lincolnshire Hospitals NHS Trust (ULHT) twice within the last ten years and had written with her concerns about the treatment received in 2015. 

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

i)          Norovirus at Lincoln County Hospital

At various times over recent weeks, several wards at Lincoln County Hospital had been closed to new admissions owing to an outbreak of the norovirus.  It was reported that of 15 January 2016, the norovirus outbreak at Lincoln County was declared over as there had not been any associated cases reported for 72 hours.  Although three wards were still affected, these were being cleaned and would be fully open within the next few days.

ii)         Lincolnshire Community Health Services NHS Trust – Meeting

On 11 January 2016, the Chairman met with Elaine Baylis (Chairman) and Andrew Morgan (Chief Executive) of Lincolnshire Community Health Services NHS Trust (LCHS).  Several issues were discussed including progress with the Trust's application for Foundation Trust status.  It was understood that the predicted date for the Trust's authorisation and establishment as a Foundation Trust would be late 2016.

Two changes to senior management had been made at LCHS:  Danni Cecchini had been appointed as the permanent Director of Finance and Lisa Green had been appointed as Director of Nursing and Operations in place of Sue Cousland, who retired in December 2015.

iii)       Healthwatch Lincolnshire – 17 February 2016

The Chief Executive of Healthwatch Lincolnshire, Sarah Fletcher, had contacted the Chairman regarding the content of the item from Healthwatch scheduled for consideration at the Committee on 17 February 2016.  It was suggested that the report be an overall Mental Health Report from Healthwatch rather than having a CAMHS focus and to give consideration to CAMHS later in the year.

iv)       East Midlands Congenital Heart Centre – Stakeholder Meeting

The first local authority stakeholder meeting of the year for the East Midlands Congenital Heart Centre took place on 14 January 2016 at Glenfield Hospital in Leicester.  The Chairman was unable to attend the meeting but advised that NHS England had found overlap in the geographical areas where congenital surgical centres intended to provide a service.  In order to address this, NHS England were to divide the country up into 'parts' and then ask the centres to bid for areas to which they wanted to provide the service.

The East Midlands Congenital Heart Centre continued to work towards the national standards.  For example, they were on track to complete approximately 330 cases in the coming year; to co-locate their congenital heart services with all other children's services by 2019; and to have four surgeons, each undertaking 125 procedures per annum by 2021.  The next stakeholder meeting was scheduled for 17 March 2016.

A full report would be circulated to the Committee.

v)         Lincolnshire Integrated Volunteer Emergency Service (LIVES) – Appointment of Chief Executive

Lincolnshire Integrated Volunteer Emergency Service (LIVES) had announced the appointment of their first full-time Chief Executive Officer.  Nikki Silver would take up the position with effect from 2 April 2016.  Nikki was previously the Deputy Director of Operations, Family and Healthy Lifestyle and Urgent Care at Lincolnshire  ...  view the full minutes text for item 73.

RESOLVED

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

(To receive a report from Sue Noyes (Chief Executive of East Midlands Ambulance Service NHS Trust), which outlines the key areas of performance within the East Midlands Ambulance Service (EMAS) and, in particular, the Lincolnshire Division.  The report also includes an update on the work and ongoing projects being carried out to enhance and support performance.  Andy Hill (Lincolnshire Divisional Manager – EMAS) will be in attendance for this item)

A report by Sue Noyes (Chief Executive of East Midlands Ambulance Service NHS Trust) was considered which outlined the key areas of performance within the East Midlands Ambulance Service (EMAS) and, in particular, the Lincolnshire Division.  The report included an update on the work and ongoing projects being carried out to enhance and support performance.

Andy Hill (Lincolnshire Divisional Manager – EMAS) and Steve Kennedy (Divisional Support Manager – EMAS) were in attendance for this item of business.

Members were given an overview of the report which provided Quarter Two Performance Data (July, August and September 2015).  It was also reported that the Care Quality Commission (CQC) had inspected EMAS in November 2015, the outcomes of which were expected in early 2016.

It was reported that the Lincolnshire Division had achieved the Red 1 target for the quarter (76.56%).  This had been challenging with the Division falling short of the required target by 1.44%.  Handover delays at hospitals were detailed in Table 2 of the report but it was stressed that these figures were subject to validation.  Overall activity in comparison to Quarter Two in 2014/15 had increased by 6%

EMAS had noted that inter facility transfers (IFTs) from Grantham and District Hospital had increased by 23% compared to 2014/15.  In order to establish the reason for the increase a review was being undertaken.  The review would also identify what actions would be required to mitigate impact on performance in the South Lincolnshire and South West Lincolnshire CCG areas.  Once the review was complete, the findings would be made available to the Committee.

Close working with United Lincolnshire Hospitals NHS Trust (ULHT) had resulted in proactive management of handover delays although this remained an ongoing issue which was being reviewed as part of the Recovery Plan for ULHT.  December 2015 saw the deployment of a clinical navigator by the Division to Pilgrim Hospital which was to liaise with ULHT staff to efficiently signpost patients thereby freeing up EMAS resources to respond to other calls.  The impact of this initiative would be reported to the Committee once available.  It was confirmed that Hospital Ambulance Liaison Officers (HALOs) would also continue to be deployed to all sites where pressures were identified.

An EMAS Healthwatch Task Group had been formed between the Trust and Healthwatch Lincolnshire to consider and act upon initiatives in response to local need.  Engagement with both System Resilience Groups (SRGs) and Urgent Care Working Groups was well established with representation and participation being regular and inclusive.  Unique initiatives with partner organisations, including CCGs, Integration Executive, Local Resilience Forum (LRF) and others were congoing in support of the improvements necessary for the wider Lincolnshire health economy. 

The following initiatives had been developed to improve service and performance:-

·       Mental Health Car Initiative;

·       Mobile Incident Unit, Butlins – Skegness;

·       Clinical Assessment Car Initiative;

·       South Lincolnshire Investments/Initiatives;

·       Joint Ambulance Conveyance Project (JACP) – Stamford, Woodhall Spa and Long Sutton;

·       Clinical Navigator role at Pilgrim Hospital, Boston; and

·       Addressing patient handover delays within  ...  view the full minutes text for item 75.

(To receive a report from Lincolnshire Integrated Volunteer Emergency Service (LIVES) which provides information on the emergency response service, provided by trained volunteers, to medical emergencies throughout Lincolnshire.  The service supported the service provided by the East Midlands Ambulance Service as the statutory ambulance service provider.  Dr Simon Topham (Clinical Director – LIVES), David Hickman (Training Manager – LIVES) and Stephen Hyde, Marketing and Fundraising Manager – LIVES) would be in attendance for this item)

A report by Lincolnshire Integrated Volunteer Emergency Service (LIVES) was considered which gave information on the emergency response service, provided by trained volunteers, to medical emergencies throughout Lincolnshire.  The service supported the services provided by the East Midlands Ambulance Service as the statutory ambulance service provider.

Dr Simon Topham (Clinical Director – LIVES) and Stephen Hyde (Marketing and Fundraising Manager – LIVES) were both in attendance for this item.

Dr Topham gave a presentation to the Committee which included the following slides:-

·       Who are we?;

·       Charitable Aims;

·       What does this look like?;

·       Activity and Performance;

·       LIVES Calls (Making a Difference);

·       So you short up EMAS then?;

·       Finance;

·       Clinical Governance;

·       LIVES New in the Last Year;

·       LIVES The Future;

·       Challenges;

·       Summary.

The charitable objectives of LIVES were:-

          To provide Immediate Medical Care to any person injured in an accident or involved in any medical emergency in the area of Lincolnshire, North East Lincolnshire or any area reasonably close to.  To advance the principle of Pre-Hospital Emergency Care on a national basis; providing advice and guidance in all aspects of such care, including the delivery of training and provision of approved emergency equipment.

There were over 160 responder groups across Lincolnshire, with approximately 700 active LIVES Community First Responders (CFRs) and LIVES Medics. 

LIVES Medics may attend the following incidents:-

·       Life-threatening medical emergencies;

·       Cardiac arrest;

·       Paediatric emergencies;

·       Road traffic collisions;

·       Major trauma;

·       Major incidents;

·       Responding to requests for on-scene advanced clinical support.

LIVES medics offered skills appropriate to their level of professional. The highest level medic members were able to offer some, or all, of the following skill sets:-

·       Advanced airway management and management of the difficult airway including pre-hospital emergency anaesthesia ("medically induced coma");

·       Advanced ventilatory strategies;

·       Advanced vascular access techniques;

·       Sedation and advanced analgesia;

·       Senior clinical support and decision making;

·       Major incident management; and

·       Further critical care interventions.

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

·       Congratulations were given to LIVES for the successful defibrillation rates;

·       LIVES had not needed to recruit actively over the last three years as numbers had been maintained.  There was a cost to recruitment and funds were limited so could only expand the service when funds allowed.  In relation to medics, volunteers were only accepted who were in certain areas of needs to ensure better coverage;

·       The resilience of individuals within their own home was not necessarily what happened within an acute situation.  Having shadowed a paramedic, it was found that repeat visits were made to the same house for the same reason therefore an acknowledgement that services need to increase communications to ensure better utilisation of resources;

·       A suggestion that District Councils may be able to support recruitment of volunteers in their own areas was welcomed.  It was reported that the south of the county was a particularly challenging area where new responders were needed;

·       During the presentation, LIVES reported that they had responded to 9.3% of all EMAS Red1 calls in Lincolnshire which contradicted  ...  view the full minutes text for item 76.

(To receive a report from Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) which invites the Committee to consider and comment on the progress with regards to the development of Cancer services throughout Lincolnshire.  Sarah-Jane Mills (Director of Planned Care and Cancer Services – Lincolnshire West Clinical Commissioning Group) will be in attendance for this item)

A report by Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) was considered which invited the Committee to comment on the progress with regards to the development of Cancer Services throughout Lincolnshire.

Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group) and Mark Brassington (Chief Operating Officer – United Lincolnshire Hospitals NHS Trust (ULHT) were in attendance for this item of business.

The Chairman reminded the Committee that Theme 3 of the Joint Health and Wellbeing Strategy focussed on Delivering High Quality Systematic Care for Major Cause of Ill Health and Disability.  A key priority in this theme was to reduce mortality rates from cancer and improve the take-up of screening programmes.

The provision of a comprehensive range of services to promote improved outcomes for people affected by Cancer remained a priority for Lincolnshire.  The prevalence and outcomes for local residents were in line with the national average and development of local services was coordinated by Lincolnshire West Clinical Commissioning Group.  The strategic framework for the development of local services reflected the recommendations of the National Cancer Strategy and had been developed to reflect local priorities, challenges and the outcomes of the Cancer Summit in February 2015.

The Lincolnshire Health and Care System remained committed to driving the continued improvement of cancer services and had established a network with key stakeholders, coordinated by Lincolnshire West CCG, to further promote the development of services for local people.

Overall patient experience had a national average of 88% and it was reported that Lincolnshire East CCG scored 83%, Lincolnshire West CCG 88%, South Lincolnshire CCG 89% and South West Lincolnshire 82%. 

United Lincolnshire Hospitals NHS Trust (ULHT) were the primary provider of Cancer Services for Lincolnshire and, on the basis of the number of patients treated, was in the top ten list of cancer treatment providers in England.

To further support the Improvement Plan, ULHT invited the National Intensive Support Team and secured additional service improvement capacity from the East Midlands Strategic Clinical Network.  The key themes of the improvement plan were:-

·       Improve access within 14 days;

·       Improve access to diagnostic tests;

·       Review and refresh systems and processes to facilitate efficient management of patients on a cancer pathway; and

·       Recruit to the Lead Cancer Nurse post

The national End of Life Care Strategy built on the recommendations outlined in NICE guidance for Supportive and Palliative Care. As a result,  a dedicated palliative and end of life care strategic development group had been established to support the continued improvement of services for people in Lincolnshire.  The work programme had included:-

·       Redesign of community service provision to provide 24 hour access to specialist support;

·       Introduction of EPaCCS (Electronical Palliative Care Coordination Systems) – an IT solution to support access to patients' advanced care plan in all settings;

·       Continued provision of education to staff in all settings;

·       Contributed to the development of a countywide/cross organisational Do Not Attempt Resuscitation Policy;

·       Developing arrangements to facilitate  ...  view the full minutes text for item 77.

(To receive a report from Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) which asks the Committee to consider and comment on the content of the report and, in particular, focus on the extent of the positive outcomes of the Lincolnshire Recovery Board to-date.  Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) will be in attendance for this item)

A report by Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Jeff Worrall (Portfolio Director – Trust Development Authority) was considered which asked the Committee to consider and comment on the content and, in particular, focus on the extent of the positive outcomes of the Lincolnshire Recovery Board to-date.

Jim Heys (Locality Director (Midlands and East (Central Midlands) – NHS England) and Ian Hall (Senior Delivery and Development Manager – Trust Development Authority) were in attendance for this item.

The Lincolnshire Recovery Programme (LRP) was developed to provide a senior level coordinating programme structure, which supported performance improvement and the further development of a clinically safe and financially sustainable health and care model, across Lincolnshire.  The aims of the LRP were to:-

·       Improve the performance of United Lincolnshire Hospitals NHS Trust (ULHT) against the NHS Constitutional standards so that all required targets were achieved;

·       Continue to improve quality within ULHT and across the health community;

·       Develop a financial strategy and plan to deliver improvements to the financial position across Lincolnshire; and

·       Design an underpinning workforce/Organisational Development strategy and plan.

The Lincolnshire Recovery Programme Board was jointly chaired by NHS England and the Trust Development Authority. 

With effect from April 2016, the TDA would merge with Monitor whose role included regulation and performance management of NHS Foundation Trusts.  This new organisation would be known as NHS Improvement.

The purpose of the Lincolnshire Recovery Board was:-

1.    To oversee achievement of the programme aims for an initial period of twelve months from July 2015, following which those responsible for health and care system delivery would be in a position to no longer require this level of intervention;

2.    To agree a programme structure which held senior leadership from all represented organisations to account and oversee high level intervention and support;

3.    To ensure that the boards of each organisation represented were signed up to the LRP aims and programme structure;

4.    To accept recommendations from the Operational Programme Group with regards to the scope and expected outcomes from the programme work streams;

5.    To act upon exception reports and items for escalation from the Operational Programme Group in order to ensure the programme aims were achieved;

6.    To ensure that dependency issues between the LRP and the Lincolnshire Health and Care (LHAC) Programme were managed in a manner which avoided duplication between the programmes or adverse impact on either programme; and

7.    To identify the need for additional support to facilitate achievement of the Programme aims and agree approaches to secure the support;

Outcomes of the programme to date included:-

·       The delivery of the Referral to Treatment (RTT) incomplete standard from 92%.  The Department of Health had introduced this operational standard in April 2012.  Incomplete pathways were the waiting times for patients waiting to start treatment at the end of a month and were also often referred to as waiting list waiting times and the volume of incomplete RETT pathways as the size of the RTT waiting  ...  view the full minutes text for item 78.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides information on the NHS publication "Delivering the Forward View:  NHS Planning Guidance 2016/17 – 2020/21" published on 22 December 2015 and intended for Commissioners, NHS trusts and NHS foundation trusts)

A report by Simon Evans (Health Scrutiny Officer) was considered which provided information on the NHS publication "Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21" published on 22 December 2015 and intended for Commissioners, NHS trusts and NHS foundation trusts.

Members were given an overview of the guidance which had been prepared by NHS England, NHS Improvement (Monitor and the Trust Development Authority), the Care Quality Commission, Health Education England, the National Institute of Health and Care Excellence and Public Health England.  Building on the NHS Five Year Forward View required two connected plans from the local NHS:-

·       A five year Sustainability and Transformation Plan (STP)

·       A one year Operational Plan for 2016/17

The guidance also stated that the planning process had been put forward to execute three independent tasks:-

·       Implementing the Five Year Forward View;

·       Restoring and maintaining financial balance; and

·       Delivering core access and quality standards for patients.

The link for the full document was:-

https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf

The nine 'must do's' for 2016/17 for every local system were:-

1.    Develop a high quality and agreed STP, and subsequently achieve what was determined as the most locally critical milestones for accelerating progress in 2016/17 towards achieving the triple aim as set out in the Forward View;

2.    Return the system to aggregate financial balance. This included secondary care providers delivering efficiency savings through actively engaging with the Lord Carter provider productivity work programme and complying with the maximum total agency spend and hourly rates set out by NHS Improvement.  CCGs would additionally be expected to deliver savings by tackling unwarranted variation in demand through implementing the RightCare programme in every locality;

3.    Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues;

4.    Get back on track with access standards for A&E and ambulance waits, ensuring more than 95% of patients wait no more than four hours in A&E, and that all ambulance trusts respond to 75% of Category A calls within eight minutes; including through making progress in implementing the urgent and emergency care review and associated ambulance standard pilots;

5.    Improvement against the maintenance of the NHS Constitution standards that more than 92% of patients on non-emergency pathways should wait no more than 18 weeks from referral to treatment, including offering patient choice;

6.    Deliver the NHS Constitution 62 day cancer waiting standard, including by securing adequate diagnostic capacity; continue to deliver the constitutional two week and 31 day cancer standards and make progress in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage two; and reducing the proportion of cancers diagnosed following an emergency admission;

7.    Achieve and maintain the two new mental health access standards:  more than 50% of people experiencing a first episode of psychosis would commence treatment with a NICE approved care package within two weeks of referral; 75% of people with common mental health conditions referred to the  ...  view the full minutes text for item 79.

(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.

It was anticipated that the CQC would issue their inspection reports in time to be considered at the March meeting of the Committee and it was agreed to add this to the Work Programme.

The Chairman advised that she had been contacted by Sarah Fletcher, Chief Executive of Healthwatch, to gain the views of the Committee in regard to the Mental Health report.  Healthwatch have suggested deferring consideration of the CAMHS item until later in the year and to give focus to the Mental Health overview at the meeting of the Committee in February 2016.  This suggestion was put to the Committee and agreed.

RESOLVED

          That the contents of the work programme, with the amendments noted above, be approved.