Agenda and minutes

Apologies for absence were received from Councillor T M Trollope-Bellew.

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor R L Foulkes to the Committee in place of Councillor T M Trollope-Bellew for this meeting only.

Apologies for absence were also received from Gary James, Accountable Officer – Lincolnshire East Clinical Commissioning Group.

The Chairman declared that, due to personal health reasons, she continued to be a private patient with Circle Nottingham, Nottingham NHS Treatment Centre in Nottingham and had also become a private patient with BMI Healthcare at The Park Hospital in Nottingham since the last meeting.

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

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

i)             Agenda Item 5 – Congenital Heart Disease Services – East Midlands Congenital Heart Centre

On 8 July 2016, NHS England made an announcement on the East Midlands Congenital Heart Centre.  As a result of this, a report was prepared for inclusion on the Committee's agenda at short notice.  This item was not on the Committee's work programme but a report had been prepared for the agenda and would be considered at Item 5 of the agenda.

ii)            Item 8 – East Midlands Ambulance Service – Response to the Care Quality Commission (CQC) Comprehensive Inspection Report

The Chairman reported that a decision had been made to withdraw item 8 (East Midlands Ambulance Service – Response to the Care Quality Commission (CQC) Comprehensive Inspection Report) from the agenda.  Mike Naylor (Finance Director – EMAS) and Steve Kennedy (Assistant Divisional Manager – EMAS), had been expected but, following the decision to withdraw the item, Richard Henderson (Acting Chief Executive – EMAS) and Blanche Lentz (newly appointed Lincolnshire Divisional Manager – EMAS) would attend the afternoon session of the Committee meeting scheduled for Wednesday 21 September 2016.

It was agreed, therefore, to consider item 9 immediately following the recess for lunch.

iii)          Lincolnshire Health and Care – Case for Change Document

On 29 June 2016, Lincolnshire Health and Care published the Case for Change document, which identified the main challenges faced by the Lincolnshire Health and Care system, and led to the conclusion that the current system was not sustainable either clinically or financially.

The Case for Change committed to a full consultation on any reconfiguration of services but did not include any firm date for consultation.  This would largely be dependent on the outcomes of the Sustainability and Transformation Plan submitted to NHS England on 30 June 2016.  A copy of the document would be circulated to the Committee with the Chairman's Announcements.

iv)          Community Pharmacy 2016/17 and Beyond

As agreed at the last meeting, the Chairman wrote to the Rt Hon Alistair Burt MP, the Minister of State for Community and Social Care, on 21 June 2016 outlining the concerns about the absence of consultation with health overview and scrutiny committees.  The Chairman reported that a reply had been received, dated 13 July 2016, in which Mr Burt reiterated the vision for a more efficient modern pharmacy system.  The comments regarding consultation had also been noted although Mr Burt stated that many stakeholders had been consulted including patient groups and the Local Government Association.

v)            Peterborough and Stamford Hospitals NHS Foundation Trust – Annual Public Meeting

The Chairman had received an invitation to attend the Annual Public Meeting of Peterborough and Stamford Hospitals NHS Foundation Trust, which would take place at Peterborough City Hospital between 5.15pm and 7.00pm on Thursday 28 July 2016.  The Chairman was unable to attend the meeting and asked if any members could attend on behalf of the Committee.  Councillor  R L Foulkes advised that  ...  view the full minutes text for item 11.

It was noted that Liz Ball (Executive Nurse – South Lincolnshire CCG) had been in attendance at the last meeting but omitted from the attendance list.

RESOLVED

          That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 15 June 2016, with the addition noted above, be approved and signed by the Chairman as a correct record.

(On 8 July 2016, NHS England announced that "subject to consultation with relevant trusts and, if appropriate the wider public" it was decommissioning congenital heart disease surgery ("Level 1 services") from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital).  This report seeks the Committee's view on the next step) 

A report by Richard Wills, the Director responsible for Democratic Services, was considered by the Committee which provided information following the announcement, on 8 July 2016 by NHS England, that "subject to consultation with relevant Trusts and, if appropriate, the wider public", congenital heart disease surgery (Level 1 services) would be decommissioned from the East Midlands Congenital Heart Centre (formerly known as Glenfield Hospital).

The Chairman introduced the report which provided the historical background of the reviews undertaken of this service over the last eight years including two full public consultations, the most recent of which was held in September 2013.  This review listed the following aims:-

·       Securing the best outcomes for all patients;

·       Tackling variation; and

·       Improving patient experience.

The review also referred to three levels of service:-

·       Level 1 – Specialist Surgical Centres;

·       Level 2 – Specialist Cardiology Centres; and

·       Level 3 – Local Cardiology Centre

In response to the consultation, on 14 December 2014, the Health Scrutiny Committee for Lincolnshire had provided three particular issues for consideration:-

·       The number of surgeons at each centre – whether a one-in-three or a one-in-four was appropriate;

·       The minimum number of operations undertaken by each surgeon each year, with 125 operations proposed in the consultation averaged over a three year period; and

·       The co-location of congenital heart services with other paediatric services, which would mean Glenfield Hospital having to move its heart surgery services from Glenfield Hospital to Leicester Royal Infirmary.

The NHS England Board received the report from the review on 23 July 2015, where approximately two hundred new standards and service specifications were approved, which providers were expected to meet from April 2016, with a five-year trajectory to full compliance.  The following excerpt was taken from the announcement issued by NHS England on 8 July 2016, pertinent to the University Hospitals of Leicester NHS Trust:-

          "Subject to consultation with relevant Trusts and, if appropriate, the wider public, NHS England will also work with University Hospitals of Leicester NHS Trust and Royal Brompton & Harefield NHS Foundation Trust to safely transfer CHD surgical and interventional cardiology services to appropriate alternative hospitals.  Neither University Hospitals Leicester or the Royal Brompton Trusts meet the standards and are extremely unlikely to be able to do so.  Specialist medical services may be retained in Leicester."

Prior to this statement, NHS England had written to the Chief Executive of University Hospitals of Leicester NHS Trust advising that the East Midlands Congenital Heart Centre did not meet all the April 2016 requirements and was unlikely to do so.  As a result, NHS England were minded to cease commissioning of Level 1 (Specialist Surgical Services - congenital heart disease) from the Trust.  The Trust responded to NHS England on 5 July 2016, setting out the excellent progress made during the previous 18 months.

The Chairman further explained that there had been some developments since the agenda pack had been published and asked the Committee to note the following:-

·       On 15 July 2016, NHS England published a series  ...  view the full minutes text for item 13.

(This report provides an update to the Health Scrutiny Committee for Lincolnshire on the proposed merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust.

This report covers the engagement phase of the proposed merger programme and also provides an update on the redevelopment work at Stamford and Rutland Hospital. Stephen Graves, Chief Executive, and Caroline Walker, Deputy Chief Executive and Finance Director, from Peterborough and Stamford Hospitals NHS Foundation Trust, will be in attendance)

Consideration was given to a report from Stephen Graves (Chief Executive – Peterborough and Stamford Hospitals NHS Foundation Trust) which provided information on the proposed merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust.  The report included the engagement phase of the proposed merger programme as well as an update on the redevelopment work at Stamford and Rutland Hospital.

Stephen Graves (Chief Executive – Peterborough and Stamford Hospitals NHS Foundation Trust) and Caroline Walker (Deputy Chief Executive and Finance Officer – Peterborough and Stamford Hospitals NHS Foundation Trust) were in attendance for this item of business.

The Committee was advised that Councillor R L Foulkes was electronically recording the presentation and subsequent discussion.  Councillor Foulkes confirmed that this was for his use only and would act as an aide memoir to brief fellow division members.

The background of the proposed merger was explained to the Committee.  In October 2015 Monitor developed a strategic outline case which suggested that savings in the region of £10m may be achieved from closer collaboration between Peterborough and Stamford Hospitals NHS Foundation Trust and Hinchingbrooke Health Care NHS Trust.  In November 2015, both Trusts agreed to explore four levels of collaboration:-

·       Option 1 – do nothing for now;

·       Option 2 – shared back office function – leading an integrated back office;

·       Option 3 – as per option 2, plus two boards, one executive team and one operational organisation;

·       Option 4 – merger in to one organisation

A project management board had been established with engagement between both trust boards followed by the development of an Outline Business Case for the proposed merger of the two trusts.  The boards agreed to the recommendations set out within the Outline Business Case in order to sustain and improve clinical services for patients and value for money for the taxpayer in Huntingdonshire, Greater Peterborough and South Lincolnshire and benefit both trusts by working as one organisation in the future.

Preparation of a Full Business Case commenced in June 2016 to be considered by both boards in September 2016 and final approved planned for November 2016 in readiness for a full merger on 1 April 2017.

Engagement of staff and members of the public had commenced in May 2016 during board meetings and would continue throughout July, August and September as part of a dedicated engagement plan.  Views of residents, GPs, commissioners and service providers in South Lincolnshire would also be sought as key stakeholders within the engagement plan.

A further period of engagement would be held following a review of the Full Business Case by both boards prior to the final approval in November 2016.

Doctors and clinicians across the local health and social care economy had been engaged as part of the Cambridgeshire and Peterborough Sustainability Transformation Plan.

The Outline Business Case included details on the populations served by each trust, turnover and surplus figures, number of sites and beds, staffing levels, overall rating of the CQC and national performance standards for  ...  view the full minutes text for item 14.

(The purpose of this report is to provide the Health Scrutiny Committee for Lincolnshire with assurance that Lincolnshire Partnership NHS Foundation Trust (LPFT) is making progress with implementation of the action plan arising from the Care Quality Commission (CQC) Comprehensive Inspection, which took place between 30 November and 4 December 2015)

Consideration was given to a report from Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) which sought to provide assurance to the Committee that Lincolnshire Partnership NHS Foundation Trust was making progress with the implementation of the action plan arising from the Care Quality Commission (CQC) Comprehensive Inspection which took place between 30 November and 4 December 2015.

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust), Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) and Anne-Maria Olphert (Director of Nursing and Quality – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item.

The report provided background to the inspection by the Care Quality Commission (CQC) which looked at eleven service areas of Lincolnshire Partnership NHS Foundation Trust following which, on 23 April 2016, a detailed report was published giving the findings.

Overall the organisation had been rated as "Requires Improvement" with a "Good" rating for caring in all services inspected and an "Outstanding" rating for community based Child and Adolescent Mental Health Services (CAMHS).  The rating for "safe" was "Inadequate" due to concerns raised about potential risk associated with Mixed Sex Accommodation and Points of Ligature.

It was reported that the vast majority of the findings were consistent with the Trust's own assessment of its areas for improvement, as presented to the CQC on the first day of the inspection.  The Trust deemed that the concerns raised in relation to the "safe" key line of enquiry conflicted with the interpretation by the Trust regarding anti-ligature and same sex accommodation guidance.  As such, the Trust had responded proactively to the assessment of the CQC in respect of these areas of risk and had also challenged the same sex accommodation assessment for the Ash Villa Child and Adolescent Mental Health inpatient unit to which a response was awaited.

Following the publication of the report, the Trust was required to submit an action plan covering the five CQC domains and to address the issues raised.  This action plan was submitted to the CQC in early June 2016 in line with the deadline given.  This was a key plan and could be found on the Trust's website at www.lpft.nhs.uk/get-involved/meeting-dates-and-minutes/board-of-directors-meetings/30-june-2016-bod-meeting-papers

The action plan was developed immediately following the inspection to address the initial feedback during the visit itself.  This included the breaches in Mixed Sex Accommodation and Point of Ligature.  A safety fence had been erected at the Ash Villa Unit to create a safe outside area due to the trees providing possible ligature points.

The action plan was updated further following the publication of the CQC report and included a list of the immediate actions identified.  The action plan included approximately 100 actions and noted against each an accountable person along with the evidence of progress made and key milestones for each.  This action plan formed part of the overall Quality Improvement Plan.  Internal monitoring of the plan was led by the Director of Operations who liaised on a regular basis with Clinical  ...  view the full minutes text for item 15.

(This item will enable the Committee to consider the issues arising from the inspection of the East Midlands Ambulance Service, which was undertaken by the Care Quality Commission in November 2015) 

Further to the announcement made by the Chairman at the start of the meeting, it was confirmed that this item had been withdrawn from the agenda and would be considered at the meeting of the Health Scrutiny Committee for Lincolnshire scheduled for Wednesday 21 September 2016.

(This item provides an update on the Lincolnshire Recovery Programme, the purpose of is to oversee the delivery of the NHS Constitutional Standards; improvements in the quality of care; and actions to address financial balance within the Lincolnshire health economy.  The reports lists the outcomes from Programme over the last year. 

Jim Heys, Locality Director, Midlands and East (Central Midlands) NHS England, and Ian Hall, Senior Delivery and Development Manager, NHS Improvement, will be in attendance)

Consideration was given to a joint report by NHS England and NHS Improvement which provided an update on the Lincolnshire Recovery Programme, the purpose of which was to oversee the delivery of the NHS Constitutional Standards; improvements in quality of care; and actions to address financial balance within the Lincolnshire health economy.  The report included outcomes from the Programme over the last year.

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

The context of the Lincolnshire Recovery Board, jointly chaired by NHS England and NHS Improvement, was explained for the benefit of the Committee by providing the background.  The Lincolnshire Recovery Programme (LRP) had been developed to provide a senior level coordinating programme structure which supported performance improvement and further development of a clinically safe and financially sustainable health and care model across Lincolnshire.

The aims of the Lincolnshire Recovery Programme were noted:-

·       Improve United Lincolnshire Hospitals NHS Trust's (ULHT's) performance 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.

It was reported that no regulatory action had been necessary over the last 12 months and that the relationship and dialogue between commissioners and providers was much improved.  The group membership had also evolved and included only accountable officers and Chief Executives.  Although it had been agreed that the Lincolnshire Recovery Board would oversee the Lincolnshire Health and Care (LHAC) plan, this had now expanded to include the Sustainability and Transformation Plan (STP). 

The current view was to continue with the Lincolnshire Recovery Board and consider strategic operational progress in addition to financial performance.

NHS England led the National Health Service (NHS) in England, setting the priorities and direction including strategies such as the Five Year Forward View.  NHS England was organised into four regional teams, each providing support to Clinical Commissioning Groups (CCGs) in areas such as healthcare commissioning and delivery.  Additionally, they provided professional leadership on finance, specialised commissioning, human resources and organisational development and worked closely with local authorities, health and wellbeing boards and GP practices.

Since the last meeting it was explained that the Trust Development Agency and Monitor had integrated to become one operational model known as NHS Improvement.  NHS Improvement also included Patient Safety, the National Reporting and Learning System, the Advancing Change Team and the Intensive Support Teams.  NHS Improvement was responsible for overseeing foundation trusts, NHS trusts and independent providers.

Chief Executives from the seven NHS organisations had undergone a Lincolnshire Leadership Programme facilitated by an external body.  The benefit of the programme was to gain a sense of joint ownership and understanding of the issues and had been successful in the cessation of silo working.

The purpose of the Lincolnshire Recovery  ...  view the full minutes text for item 17.

(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.

Tracy Johnson (Senior Scrutiny Officer) confirmed that there had been four changes to the work programme:-

1.    21 September 2016 – to add an item entitled East Midlands Ambulance Service (EMAS) – Response to the Care Quality Commission (CQC) Report

2.    26 October 2016 – to add an item entitled Lincolnshire Partnership NHS Foundation Trust – Response to the Care Quality Commission (CQC) Comprehensive Inspection - Update

3.    23 November 2016 – to add an item entitled Joint Health and Wellbeing Strategy – Annual Assurance Report

4.    18 January 2017 – to add an item entitled Lincolnshire Recovery Programme - Update

The Chairman urged the Committee to ensure that they allocate a full day in their calendars for these meetings.  The work programme was particularly busy over the coming months and the Chairman stressed that full, regular, attendance was essential to ensure consistency of discussions.

RESOLVED

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