Agenda and minutes

The Vice-Chairman, Councillor C J T H Brewis, welcomed the Committee and advised that the Chairman would not be in attendance at the meeting and that he would, therefore, be in the Chair.  Councillor Brewis had requested that Councillor T M Trollope-Bellew act as Assistant to the Chairman for this meeting only.

Apologies for absence were received from Councillors Miss E L Ransome (Lincolnshire County Council), Mrs C A Talbot (Lincolnshire County Council) and Mrs S M Wray (Lincolnshire County Council).

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor C E D Mair to the Committee in place of Councillor Miss E L Ransome.

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

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

i)          United Lincolnshire Hospitals NHS Trust – Appointment of Chairman

Councillor Mrs C A Talbot had attended a Stakeholder Event at Pilgrim Hospital in Boston on 21 January 2016 to meet candidates seeking to become the new Chairman of United Lincolnshire Hospitals NHS Trust (ULHT).  It was understood that the formal interviews took place on 28 January 2016 and an announcement was expected shortly.

ii)         New Maternity and Gynaecology Unit – Pilgrim Hospital Boston

On 9 February 2016, United Lincolnshire Hospitals NHS Trust (ULHT) announced that a new purpose-built modular maternity and gynaecology unit would be 'arriving' at Pilgrim Hospital in Boston this week.  ULHT had invested £5.2 million in to Pilgrim Hospital for creation of new wards to replace the existing maternity and gynaecology wards.

The new unit would be an extension to the main hospital and had been built at a factory near Beverley, Yorkshire and would take approximately 10 days to construct on site.  This innovative method of construction was an off-site build to reduce the construction time and disruption to patients.

iii)       Britain Imbalanced – Why Now is the Time to Tackle Obesity in Britain

The Chairman referred members to a report authored by Olympic rower, James Cracknell, which was published on 10 February 2016 by the Policy Exchange Thinktank and which received some national media attention.  The report, entitled Britain Imbalanced – Why Now is the Time to Tackle Obesity in Britain, made a number of recommendations including the introduction of a tax on sugary drinks.  Additionally, the report recommended that children aged 4-11 should be measured although the report argued against issuing "fat-shaming" letters to parents as these were often counter-productive.  The emphasis, therefore, should be on improvements to a child's wellbeing and reduced portion sizes. The Chairman looked forward to further developments in the national debate on reducing obesity.

iv)       Sue Noyes, Chief Executive – East Midlands Ambulance Service NHS Trust (EMAS)

On 15 February 2016 it was announced that the Chief Executive of the East Midlands Ambulance Service (EMAS), Sue Noyes, would be leaving EMAS later this year.  The decision had been made due to personal and family reasons but Sue had been requested to stay until June 2016 to continue to lead EMAS through the introduction of phase three of its quality improvement programme, Better Patient Care – Driving Forward for 2016.

The Chairman of EMAS, Pauline Tagg, would be discussing the future leadership arrangements with the EMAS Board and the NHS Trust Development Authority (TDA).

v)         East Midlands Health Scrutiny Network – 17 February 2016

A meeting of the East Midlands Health Scrutiny Network was taking place at Leicester City Hall at the same time as this Committee.  The Chairman advised that the meeting was to cover the approaches of health scrutiny committees in the region to topics such as health inequalities; the integration of health and social care; and commissioning and reconfiguration.

It  ...  view the full minutes text for item 83.

The Committee asked that formal thanks to the Democratic Services Officer for the clear, concise and detailed minutes of the last meeting be recorded.

RESOLVED

          That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 20 January 2016 be approved and signed by the Chairman as a correct record.

(To receive a report from Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) which  sets out the Lincolnshire Partnership NHS Foundation Trust (LPFT) Draft Clinical Strategy 2016-2021.  Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) and Chris Higgins (Deputy Director of Strategy and Business Planning, Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

A report by Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust (LPFT)) was considered which set out the Lincolnshire Partnership NHS Foundation Trust (LPFT) Draft Clinical Strategy 2016-2021. 

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust), Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust (LPFT) and Chris Higgins (Deputy Director of Strategy – Lincolnshire Partnership NHS Foundation Trust (LPFT) were in attendance for this item.

Members were given an overview of the draft clinical strategy, which was intended to translate the organisation's Mission into the deliverable objectives and actions through a series of agreed priorities and would sit centrally to the governance framework, informing the development of Divisional plans, dependent sub-strategies and the Trust's overarching Integrated Business Plan.

The Strategy was the result of work completed since the summer of 2015 during which time staff, patients and carers, commissioners, partners, Governors and the public had been consulted about their views on what should be done to improve clinical services.  The aim was to implement a new clinical strategy for 2016/17 and beyond which reflected the ambition to provide the best possible care but also a strategy co-created with service users but which remained aligned to national policy and best available evidence.

Current clinical priorities had been derived from feedback, local delivery objectives and national policy.  The clinical priorities were:-

·       More people will have good mental health;

·       More people will have a positive experience of care and support;

·       More people with mental health and learning disability problems will have good physical health;

·       People will have better access to services;

·       Support integrated health and social care in Lincolnshire;

·       Fewer people will suffer avoidable harm;

·       Promote recovery and independence;

·       Support our people to be the best they can be;

·       Maximise NHS resources;

·       Ensure our estate is fit for modern healthcare delivery.

Members of the Committee had held a working group on 12 November 2015 to discuss the draft Clinical Strategy following which a joint statement, from the Committee and Healthwatch Lincolnshire, was presented to the Committee at its meeting on 16 December 2015 for approval.  Dr Brewin formally thanked the Committee for their support and input into the strategy.

The Draft Clinical Strategy was expected to be presented to the Board of Directors of Lincolnshire Partnership NHS Foundation Trust in March 2016 for final approval.

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

·       A substantial proportion of the population were likely to suffer some mental health problems at some point in their lives and concern was noted about the isolation of young people as a result of social media;

·       The veteran's service within the LPFT was working with patients to consider expansion in to community services and engagement with communities was broadening to assist with this.  Team models were being considered to provide the right level of support;

·       It was reported that there was a bespoke Ministry of Defence (MOD) unit on one of the  ...  view the full minutes text for item 85.

(To receive a report from Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) which provides an update on the services running at GP Practices recently awarded under contracts from NHS England East to Universal Health Ltd.  Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

A report by Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust (LPFT)) was considered which provided an update on the four GP Practices recently awarded the contracts by NHS England to Universal Health Ltd.

Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust) and Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item of business.

Members were advised that the GP Practices referred to were the Arboretum and Burton Road Surgeries in Lincoln, Pottergate Surgery in Gainsborough and Metheringham Surgery.  Universal Health Ltd, a consortium of Lincolnshire Partnership NHS Foundation Trust (LPFT) and Lincolnshire and District Medical Services (LADMS), were awarded four Alternative Provider Medical Services (APMS) contracts in 2015 with effect from 1^st April 2015 (and from 1^st July 2015 in the case of the Burton Road Surgery).  There were 11,000 registered patients across the four practices.

Both clinical and non-clinical staff teams within the surgeries had ensured that the services offered continued seamlessly during the transfer of the contracts to Universal Health Ltd.  Due to the shortages there were challenges in recruiting nursing and medical staff particularly to the role of General Practitioner (GP) and the costs incurred with using locum medical cover to ensure services continued.  It was reported that this was not uncommon across Lincolnshire as challenges with the ongoing stability of primary care continued.

Universal Health Ltd was a Joint Venture company created by LPFT and LADMS in late 2014 and established a new provider vehicle to transfer, stabilise and transform services.  Any potential profit made by this company would be reinvested in local services.  Universal Health Ltd had a formal Board governance structure with director and non-executive director portfolios and also held separate financial accounts.

The challenges and risk presented for these contracts were:-

·       The recruitment and retention of skilled, primary care trained staff to build resilience and capacity in the system.  The recruitment of these staff was becoming increasingly difficult due to the changing workforce profile, for example a large number of GPs were expected to retire in the coming years.  The medical staff at these particular practices were Salaried Doctors rather than GP Partners.  Innovate options were required to ensure that these staff were supported to stay in general practice;

·       The surgeries were open to new patients who needed to register with a GP.  Those patients who were not currently registered with a GP were being encouraged to choose these surgeries due to the capacity for them to take on new patients onto the registered list;

·       Staff working in the surgeries had been through a period of disruption and change over 12 months as well as future uncertainties.  Priorities for Universal Health Ltd were to retain good staff and offer opportunities for new staff;

·       The service offer would be developed to offer alternative services in primary care for patients.  This would include, for example, including Physiotherapists within the clinical team to assess and  ...  view the full minutes text for item 86.

(To receive a report from Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust) which provides an update on progress against ULHT Improvement Portfolio and gives an overview of action being taken where risks and issues have been identified. The report also describes the governance arrangement which have been put in place.  Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust) will be in attendance for this item)

At this point of the proceedings, Councillor G Gregory advised the Committee that he had rotated to Sherwood Forest Hospitals NHS Trust and was no longer a paid employee of United Lincolnshire Hospitals NHS Trust (ULHT).  He therefore no longer had a pecuniary interest to declare for any item of business relating to the ULHT.

A report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust) was considered which provided an update on progress against the ULHT Improvement Portfolio and gave an overview of action being taken where risk and issues had been identified.  The governance arrangements which had been put in place were also described.

Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust), Mark Brassington (Chief Operating Officer – United Lincolnshire Hospitals NHS Trust) and Liz Ball (Deputy Chief Nurse – United Lincolnshire Hospitals NHS Trust) were all in attendance for this item of business.

Members were advised that the four key recovery work streams included Quality Improvement, Workforce and Organisational Development, Constitutional Standards and Financial Recovery. 

Quality Improvement Programme (Rating – Amber/Green)

An update on the main areas of concern where significant issues were:-

Safeguarding (Amber rating) – Additional safeguarding training had been established to provide sufficient capacity to deliver training to all relevant staff.  Compliance had significantly improved although some clinical areas had experienced difficulty in releasing staff to attend training due to site pressures and demands.  At the end of December 2015 compliance for Safeguarding Level 1 Core Learning was 80% against a trajectory of 95% by 31 March 2016.  Work was ongoing to explore the possibility of providing an e-learning package to complement face to face training.  The RAG [red, amber, green] rating had remained the same since the previous update in October 2015.

Hospital at Night (Green rating) – This model had been implemented to improve care to deteriorating patient during the night.  Focus was now on the implementation of the recommendations from Health Education for East Midlands (HEEM) and phase 2 of the project was being developed to maintain a focus on improving these services further.  The RAG rating had improved from Amber since the previous update in October 2015.

Control of Infection (Amber rating) – A full review of housekeeping, cleaning capability and capacity was commenced in December 2015.  When the findings of this review had been received, a business case would be developed.

A major outbreak of the norovirus was effectively managed during December and January with 199 symptomatic patients affecting 16 wards, 11 of which were closed during the peak.  The RAG rating had remained the same since the previous update in October 2015.

Training and Appraisal (Amber/Green rating) – It was reported that this project had now moved to the Workforce Improvement Programme and would be discussed within that section of the report.

Out-Patients (Amber/Green rating) – Environmental improvements had been made in Lincoln Out-Patient Department with Clinic Room standards being introduced to ensure that all areas were clean, tidy and equipped for use.  The  ...  view the full minutes text for item 87.

(To receive a report from Sarah Fletcher (Chief Executive – Healthwatch Lincolnshire), which sets out the final report from Healthwatch Lincolnshire on Mental Health Services published in November 2015.  The report captures the key themes and promotes the voice of the service user to support the awareness of mental health and the need for improvement of services.  Sarah Fletcher (Chief Executive – Healthwatch Lincolnshire) will be in attendance for this item)

A report by Sarah Fletcher (Chief Executive – Healthwatch Lincolnshire) was considered which set out the final report from Healthwatch Lincolnshire on Mental Health Services published in November 2015.  The report captured the key themes and promoted the voice of the service user to support the awareness of mental health and the need for improvement of services.

Sarah Fletcher (Chief Executive – Healthwatch Lincolnshire) and Dr Brian Wookey (Board Member – Healthwatch Lincolnshire) were in attendance for this item of business.

Members were advised of the process involved which enabled Healthwatch Lincolnshire to produce this report.  The work was carried out in three stages from November 2014 until November 2015 with 345 individuals providing feedback on their experiences and perceptions of mental health services.

A broad piece of work had been undertaken during Spring 2014 which considered individual's views of services and support structures available within mental health.  A small group of 23 people were also asked to complete a paper-based survey.

An in-depth structured survey was also designed and distributed which looked at mental health services from the perspective of current service users in addition to those waiting to enter assessment, diagnosis and treatment pathways.  The questionnaire was circulated to a range of groups including mental health support groups, home start centres and professionals working within mental health and 126 were completed.

During 2015, three mental health organisations were invited to gather the views of their service user groups and asked that these views be shared as part of the Seldom Heard Voices programme.  196 responses to the project were received through a range of surveys and focus group activity.

Based on the feedback received, 25 areas for improvement were summarised in to the report:-

·       CAMHS and Transition to adult services;

·       Understanding and awareness of pathways and support networks;

·       Support and recognition (for mental health conditions);

·       Training (for GP's and other frontline staff);

·       Patient involvement (respecting feedback);

·       General support for patients and carers;

·       In-patient services;

·       Discharge from hospital or care;

·       Missing persons;

·       Out of hours;

·       Self-harm;

·       Waiting times (and referrals);

·       Perception of services; and

·       Complaints.

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

·       Concern was raised about mental health patients being arrested or dealt with by the police as a result of their actions.  The police were not always trained to deal with mental health patients and, for example, should patient possess a weapon with intent to harm themselves only, the police tended to be unaware of the patient's intent and were obliged to remove the weapon and make the area safe.  Unfortunately, in the main instances the individual did not receive the help that they needed, as the police were not always trained to identify and respond to those with mental health issues;

·       The transition of young people to adulthood was a concern to the Committee and it was felt that within the new transition service designs more recognition for additional support was required.  Also the age limit for transition into  ...  view the full minutes text for item 88.

(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.

Members were advised that the meeting scheduled for Wednesday 16^th March 2016 would continue in to the afternoon.

It was agreed to add an item to the work programme for the May or June meeting of the Committee – Lincolnshire Sustainability and Transformation Plan (STP).

The Health Scrutiny Officer would seek to facilitate mental health training, which would be delivered by Lincolnshire Partnership NHS Foundation Trust.

In relation to the request for Members to attend the Seminar on Delayed Transfers of Care at Peterborough and Stamford Hospitals NHS Foundation Trust on 2 March 2016, Councillors J Kirk and Mrs J M Renshaw expressed an interest in attending on behalf of the Committee.

RESOLVED

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