Agenda and minutes

Venue: Committee Room One, County Offices, Newland, Lincoln LN1 1YL

Contact: Andrea Brown  Democratic Services Officer

Items
No. Item

110.

Apologies for Absence/Replacement Members

Minutes:

Apologies for absence were received from Councillors Mrs S Ransome (Lincolnshire County Council), Councillor G Gregory (Boston Borough Council), Councillor D P Bond (West Lindsey District Council) and Dr B Wookey (Healthwatch Lincolnshire).

 

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 Councillors Mrs S Ransome.

 

Mr J Rose attended the meeting in place of Dr B Wookey (Healthwatch Lincolnshire).

111.

Declarations of Members' Interests

Minutes:

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

 

Prior to the discussions at Agenda Item 5 – East Midlands Ambulance Service (EMAS) – Improvements and Performance, Councillor S L W Palmer advised the Committee that he was an active member of LIVES.

112.

Chairman's Announcements

Minutes:

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

 

i)          Membership

Following the recent elections and the subsequent annual meeting at the City of Lincoln Council, which took place on 17 May 2016, the Chairman confirmed that Councillor Jackie Kirk would continue on the Committee as the City of Lincoln representative.  Councillor Jane Loffhagen had been appointed as a substitute member for Councillor Kirk.

 

ii)         Lincolnshire Partnership NHS Foundation Trust (LPFT) – Care Quality Commission (CQC) Report

On 21 April 2016, the Care Quality Commission published its report on Lincolnshire Partnership NHS Foundation Trust.  The overall finding from the CQC was that the Trust 'required improvement'.  The CQC's report would be considered at Agenda Item 6 together with an initial response from LPFT.

 

iii)       East Midlands Ambulance Service (EMAS) – Care Quality Commission Inspection

On 10 May 2016, the Care Quality Commission (CQC) published its report on the East Midlands Ambulance Service (EMAS).  The overall finding from the CQC was that EMAS 'required improvement'.  As the report was published on the same day as the Committee's agenda was issued, the Chairman advised that the report from EMAS at Agenda Item 5 did not reflect the CQCs findings.

The CQC found that EMAS was 'inadequate' for safety, stating that there were "insufficient staff numbers of appropriately trained staff with the necessary skill-mix" and "excessively long handover times at some acute hospitals were exacerbating the trust's resource ability".  As part of its initial response, EMAS stated that the 22 clinical commissioning groups within the region, who commissioned the service, acknowledged that EMAS would not be able to meet the national performance standards with its current level of funding (£152.5 million).  This would also leave a deficit of around £12 million at the end of 2016/17.  EMAS stated that an independent Strategic Demand, Capacity and Price Review would be held to consider the level of staff and vehicles required.  The Clinical Commissioning Groups were committed to this review.

On a positive note, several examples of outstanding practice in Lincolnshire were highlighted in the report.  These included the mental health fast response vehicle; mental health triage care; and the Joint Ambulance Conveyance Project with Lincolnshire Fire and Rescue.

Although EMAS Improvements and Performance was to be considered at Agenda Item 5, the Chairman advised the Committee that focus would not be on the content of the CQC report, however some of the issues included within that report such as ambulance response times and handover delays at hospitals would be discussed.  The focus would also be on Lincolnshire rather than region-wide.

 

iv)       East Midlands Ambulance Service (EMAS) -  Regional Scrutiny Activity

It was reported that eleven health overview and scrutiny committee covered the EMAS region and that colleagues in other local authorities within the region had started to explore the possibility of a joint session.  This would involve the Chairman from each of the eleven committees and would focus on EMAS's response to the CQC report.

In addition to representatives from  ...  view the full minutes text for item 112.

113.

Minutes of the meeting of the Committee held on 20 April 2016 pdf icon PDF 221 KB

Minutes:

In relation to Minute Number 102 at page 7 of the agenda pack, the Chairman confirmed that the Adult Scrutiny Committee had been requested to have a separate item on to consider Delayed Transfers of Care (DTOC) but was disappointed that there was an intention for this to be monitored through the Better Care Fund rather than as a specific item.  It was suggested that the Chairman of the Health Scrutiny Committee for Lincolnshire contact the Chairman of the Adults Scrutiny Committee directly to reiterate the views of the Committee and the need for further scrutiny of the DTOC issue.

 

Councillors Mrs P F Watson advised that she had not indicated that she would not be in attendance for the Committee meeting, as noted at Minute Number 101 on page 7 of the agenda pack.  She would be only be unable to attend the afternoon briefing session.

 

RESOLVED

 

          That the minutes of the Health Scrutiny Committee for Lincolnshire held on 20 April 2016, with the amendment noted above, be approved and signed by the Chairman as a correct record.

114.

East Midlands Ambulance Service (EMAS) - Improvements and Performance pdf icon PDF 169 KB

(To receive a report from Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service (EMAS)) which provides the Committee with an outline of the key areas of performance within the East Midlands Ambulance Service and, in particular, the Lincolnshire Division.  Andy Hill (Manager – Lincolnshire Division of East Midlands Ambulance Service) will be in attendance for this item)

Minutes:

Consideration was given to a report from Richard Henderson (Acting Chief Executive, East Midlands Ambulance Service (EMAS)) which provided the Committee with an outline of the key areas of performance within the East Midlands Ambulance Service and, in particular, the Lincolnshire Division.

 

Andy Hill (General Manager, Lincolnshire Division, EMAS) and Stephen Kennedy (Assistant General Manager, Lincolnshire Division, EMAS) were in attendance for this item.

 

Members were given an overview of the report and provided with the key points from the report.

 

During both Quarters 3 and 4, the Lincolnshire Division had not achieved the Red 1 performance target nor had they achieved Red 2 performance targets.

 

It was reported that Red 2 performance in Quarter 4 had dropped by 7% in comparison with Quarter 3 which coincided with changes to response criteria and removal of EMAS ability to downgrade red calls.  As a result both EMAS overall and the Lincolnshire Division witnessed an increase in Red 2 calls (29%) which required a response.

 

There were a number of mitigating circumstances for the poor performance which included an increase in activity, the ability to manage in terms of triage, loss of resources in terms of drift and delays and resources held in queues.  It was stressed to the Committee that these were reasons which contributed to the disappointing performance.

 

Under the present contract EMAS were not commissioned to achieve national standards within Lincolnshire alone although commissioners in Lincolnshire did expect to see a continuous improvement towards these standards. EMAS remained active with Healthwatch and an EMAS Healthwatch Task Group had been formed to consider and action initiatives in response to local needs.

 

Engagement with the System Resilience Groups (SRGs) and Urgent Care Working Groups was well established with representation and participation regular and inclusive.

 

Unique initiatives with partner organisations, including the CCGs, Integration Executive and the Local Resilience Forum (LRF) were ongoing in support of the necessary improvements.

 

Proactive work on hospital delays with staff at United Lincolnshire Hospitals NHS Trust (ULHT) had shown improvement although it was acknowledged that more work was required.

 

External expert and consultant support, advice, critique and audit had been sourced and the results of this work, including the findings, would be shared with commissioners to ensure the plan for EMAS was robust and sufficiently focused on delivery of the required outcomes.  To-date commissioner feedback was reported to be very positive and supportive.

 

The following initiatives had also been developed to improve 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;

·       Addressing patient handover delays at the acute trusts;

·       Emergency Care Practitioner utilisation; and

·       Blue Light Collaboration (Estates).

 

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

·       The term 'drift' was explained to the Committee.  This was the terminology used by EMAS when a vehicle responded to a call outside of Lincolnshire, or had conveyed a patient to a  ...  view the full minutes text for item 114.

115.

Lincolnshire Partnership NHS Foundation Trust Response to the Comprehensive Inspection by the Care Quality Commission pdf icon PDF 83 KB

(To receive a report from Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) which presents the Committee with the report of the Care Quality Commission (CQC), following its inspection of Lincolnshire Partnership NHS Foundation Trust (LPFT) between 30 November and 4 December 2015.  Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

Additional documents:

Minutes:

A report by Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) was considered which presented the report of the Care Quality Commission (CQC), following its inspection of Lincolnshire Partnership NHS Foundation Trust (LPFT) between 30 November and 4 December 2015.

 

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item of business.

 

The Committee were taken through the report where the main findings in the CQC's report were highlighted.  It was reported that there were eleven further detailed reports covering particular service areas, each with their own finding.  The overall finding for the Trust was that it 'requires improvement'.  The initial response of LPFT to the CQC report was in the form of a powerpoint presentation:-

·       Introduction;

·       LPFT Challenges – 30 November 2015;

·       Our response;

·       Same-sex Accommodation (deemed to be unsafe);

·       Ward environments;

·       Supervision;

·       Access;

·       Summary; and

·       Questions

 

The Trust believed that the overall rating of the CQC was reasonable and acknowledged that improvements were required.  However, the Trust was disappointed with the 'inadequate rating' for safety.  The areas highlighted as inadequate for safety were further expanded upon:-

 

Same Sex Accommodation – the children and adolescent mental health inpatient unit had been rated as 'inadequate' for safety.  The twelve bed unit had both males and females, who had to share a corridor, for example to use lavatories at night.    Although there was a member of staff stationed on the corridor during the night, the CQC thought that this mitigation was insufficient.  This finding had been explored in detail by the Quality Summit and a challenge to that decision was being considered, which was supported by NHS England.  Possible options to address this finding included the construction of a separate corridor, separating males and females, or designating the unit single sex (the majority of patients were female, but this would result in male patients being sent out of county).  The latter option could lead to the need to construct a separate unit for male patients.  At the present time, the Committee was advised that practice had not changed and a member of staff was stationed in the corridor during the night.

 

Ward Environments – the 'inadequate' rating in this area was in relation to fixed ligature points which patients could use to hang themselves.  It was acknowledged that these ligatures points had been removed during the week of the inspection.

 

It was stressed that no attempts had been made at strangulation or hanging in any facility nor had any concerns from parents and families been raised regarding the shared corridor in the children and adolescent mental health inpatient unit.

 

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

·       The use of plastic covers on all duvets and pillows was highlighted as being uncomfortable for patients.  It was explained that LPFT was constrained by hospital guidelines and must comply with national standards around hygiene,  ...  view the full minutes text for item 115.

116.

South Lincolnshire Clinical Commissioning Group Update pdf icon PDF 96 KB

(To receive a report from South Lincolnshire Clinical Commissioning Group which provides the Committee with an update in relation to the activities for South Lincolnshire Commissioning Group (SLCCG).  The report includes the commissioning activities of the CCG in addition to information on the wider developments which the CCG has had involvement in.  John Turner (Accountable Officer – South Lincolnshire CCG) and Caroline Hall (Chief Finance Officer – South Lincolnshire CCG) will be in attendance for this item)

Minutes:

A report by John Turner (Accountable Officer, South Lincolnshire CCG) was considered which provided an update in relation to the activities for South Lincolnshire Clinical Commissioning Group (CCG).  The Report included the commissioning activities of South Lincolnshire CCG in addition to information on the wider developments which the CCG were involved with.

 

John Turner (Accountable Officer, South Lincolnshire CCG) and Dr Kevin Hill (Chairman, South Lincolnshire CCG) were in attendance for this item of business.

 

The Committee was reminded that South Lincolnshire CCG served a registered population of approximately 162,000 and was made up of fifteen practices across to localities with distinct populations and needs. Seven practices were within the Welland locality which served a mainly affluent population with small pockets of deprivation in larger populated centres.  The locality of South Holland held eight practices and was more deprived with areas of rural poverty and a growing migrant population due to new arrivals from EU accession countries.  Services were commissioned for the populations of Stamford, Bourne, Market Deeping, Spalding, Long Sutton and surrounding areas.

 

The main hospitals to serve this population were Peterborough and Stamford Hospitals (P&SHFT), Johnson Community Hospital, Queen Elizabeth Hospital (Kings Lynn) and Pilgrim Hospital (Boston).

 

Performance Priority Areas included the following:-

·       Accident and Emergency Four Hour Standard;

·       Cancer Standards; and

·       East Midlands Ambulance Service (EMAS).

 

Full plans for the priority areas were included within the 2016/17 Strategic Operational Plan.

 

The CCG achieved the diagnosis rate during 2015/16 for Dementia and would continue to use the tools previously identified to sustain performance.  Recent procurement of the community services listed below provided patients and carers with the support raised as priority during public consultation. These include:-

 

·       Post Diagnostic Support;

·       Dementia Support Network;

·       Dementia Family Support Service;

·       Dementia Action Alliances; and

·       Integrated Personal Commissioning.

 

In April 2015, the CCG took on full responsibility under delegated commissioning for the commissioning of primary care services.  The CCG worked closely with GP practices and federated groups which had enabled a coherent and consistent approach to the development of systems, processes and the consideration of proposed developments. 

 

Partnership working with South West Lincolnshire CCG had resulted in the CCG becoming the first in the country to successfully access the new national Lead Provider Framework for commissioning support.  This framework gave CCGs a choice of accredited providers for 'back office' functions ranging from payroll to IT support.  Optum, a private company, had been selected as the new provider, following a rigorous selection process, and services had been transitioning from the previous provider since January 2016.

 

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

·       It had been acknowledged that people would continue to present to A&E Departments when their symptoms could be better addressed through primary care.  In order to manage these patients, GP services within A&E Departments were being considered with a trial underway at Peterborough City Hospital;

·       It was acknowledged that delayed transfers of care were a key issue and there was  ...  view the full minutes text for item 116.

117.

Work Programme pdf icon PDF 107 KB

(To receive a report from Simon Evans (Health Scrutiny Officer) which invites the Committee to consider its work programme for the coming months)

Minutes:

The Committee considered its work programme for forthcoming meetings.

 

During the meeting, it had been agreed to add the following items to the Work Programme for 20 July 2016:-

·       East Midlands Ambulance Service (EMAS) Update; and

·       Lincolnshire Partnership NHS Foundation Trust (LPFT) - Response to the Comprehensive Inspection by the CQC.

 

The Committee was advised that Marie Curie had submitted a draft Quality Account, which had been circulated to the working group, whose view was that a statement should be prepared on behalf of the Committee on the Marie Curie draft Quality Account.  The Quality Accounts Working Group asked that formal thanks be given to Simon Evans, Health Scrutiny Officer, for his help and guidance throughout the process of providing the quality accounts.

 

The Committee was requested to consider the content of the item being presented on 20 July by Peterborough and Stamford Hospitals NHS Foundation Trust and was advised that the Trust would be presenting on two items: (1) the merger of the Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke NHS Trust; and (2) the latest position regarding developments at Stamford and Rutland Hospital.  The Committee also identified that it would like information on the Trust's financial position, including the ongoing impact of the Private Finance Initiative. 

 

RESOLVED

1.            That the contents of the work programme be approved, with the following additions for 20 July:

 

·                  East Midlands Ambulance Service (EMAS) Update; and

·        Lincolnshire Partnership NHS Foundation Trust (LPFT) - Response to the Comprehensive Inspection by the CQC

 

2. That the Peterborough and Stamford Hospitals NHS Foundation Trust be requested to present on the following matters: (1) the merger of the Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke NHS Trust; (2) the latest position regarding developments at Stamford and Rutland Hospital; and (3) the Trust's overall financial position, including the ongoing impact of the Private Finance Initiative.

 

 
 
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