Agenda and minutes

Apologies for absence were received from Councillors C J T H Brewis, Gregory, Mrs L A Rollings and T Boston.

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, he had appointed Councillor Mrs K Cook to the Committee in place of Councillor T Boston for this meeting only.

Apologies for absence were also received from Dr B Wookey, Healthwatch, who was replaced by Mr P Keeling.

Liz Ball (Executive Nurse, South Lincolnshire CCG) and Councillor B W Keimach (Executive Support Councillor for NHS Liaison and Community Engagement) also submitted apologies for absence.

In the absence of the Vice-Chairman, Councillor C J T H Brewis, the Chairman requested volunteers for the role of Vice-Chairman for this meeting only.

RESOLVED

          That Councillor T M Trollope-Bellew be appointed as Vice-Chairman for this meeting only.

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.

In relation to Item 8 – East Midlands Ambulance Service Response to the Care Quality Commission Inspection Report, 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 responding on behalf of EMAS.

The Chairman declared, in relation to Item 7 – Cancer Services in Lincolnshire, that due to personal health reasons, she had been a private patient at Park Hospital in Nottingham but was now undergoing treatment as an NHS patient at Queens Medical Centre in Nottingham.

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 Items

Two of the items on this agenda were not expected at the last meeting of the Committee, on 20 July 2016. 

Firstly, on 11 August 2016, United Lincolnshire Hospitals NHS Trust announced that Grantham A&E Department would be temporarily closed overnight.  As a result, the Chairman had urgently sought their attendance at this meeting, which would be considered at Item 5 of the agenda.

Secondly, Lincolnshire West Clinical Commissioning Group announced, on 21 July 2016, that the four surgeries in its area would be under new management from 1 August 2016.  A short paper would be considered at Item 10 of the agenda.

ii)            Congenital Heart Disease Services – East Midlands Congenital Heart Centre

On 20 July 2016, the Committee authorised the Chairman to write to NHS England in relation to the East Midlands Congenital Heart Centre.  The letter dated 22 July 2016 and the response from NHS England dated 9 August 2016 were circulated to the Committee for consideration at Item 9 of the agenda.

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

Following the July meeting of the Health Scrutiny Committee for Lincolnshire, Councillor D Brailsford attended the Annual Public Meeting of Peterborough and Stamford Hospitals NHS Foundation Trust on 28 July 2016.  Councillor Brailsford provided a short report in which he highlighted progress with the MRI scanner at Stamford and Rutland Hospital, where electrical infrastructure and generator works were being undertaken along with redevelopment of the eastern end of the site due to commence during the Autumn.

iv)          Proposed Merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust – Full Business Case for Merger

On 20 September 2016, the full business case for the merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust was published.  At its meeting on 20 July 2016, the Committee reserved the right to make a response on this full business case.  The Chairman proposed to consider the options for responding to the full business case as part of the work programme item.

Several public engagement events were also taking place in the coming weeks on this topic and events local to Lincolnshire included:-

·       6 October 2016, 5.45pm – Stamford Hospital;

·       10 October 2016, 7.00pm –Deepings Community Centre, Market Deeping;

·       11 October 2016, 5.45pm – Peterborough City Hospital; and

·       20 October 2016, 2.00pm – Bourne Corn Exchange, Bourne.

v)            Annual Public Meetings

The Chairman confirmed that this period was where most annual meetings of NHS bodies took place.  On 15 September 2016, Lincolnshire Partnership NHS Foundation Trust held its annual public meeting and Lincolnshire Community Health Services NHS Trust was holding its annual meeting in Boston on 21 September 2016.  The Committee was advised of the forthcoming meetings and volunteers were asked to indicate their attendance to Simon Evans, Health Scrutiny Officer, for South West Lincolnshire CCG, Lincolnshire West CCG  ...  view the full minutes text for item 21.

RESOLVED

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

In light of the recent announcement on A&E Services at Grantham and District Hospital, this item has been brought to the Committee as a matter of urgency by the Chairman, Councillor Mrs C A Talbot

(To receive a report from Dr Suneil Kapadia (Medical Director – United Lincolnshire Hospitals NHS Trust) which provides an update in relation to the provision of emergency care at United Lincolnshire Hospitals NHS Trust and the next steps to ensure continued patient safety and public engagement.  Dr Suneil Kapadia (Medial Director – United Lincolnshire Hospitals NHS Trust) will be in attendance for this item)

Prior to the consideration of this item, the Chairman welcomed Councillor D C Morgan and asked her to confirm her request to address the Committee as a Local member for Grantham.  Councillor Morgan indicated that she did not want to speak but had expected a paper which she had prepared to be made available to the Committee.  The Committee indicated that they were not in receipt of the document and, in order to clarify the best way forward, the Chairman adjourned the meeting at 10.25am whilst legal advice was sought.

At 10.35am, the meeting was reconvened where the following statement was made by the Chairman:-

          "I would like to remind everyone here that the purpose of this Committee is to scrutinise NHS Healthcare; and the Health and Wellbeing Board and their services and outcomes.

          It is essential that we respect this remit.  It is not for this Committee to criticise individuals or stray into matters that are the proper remit of other organisations, such as employment issues.

          Our job is to consider NHS healthcare services and their outcomes.  To that end we have invited a number of people to attend this morning's meeting to report on matters that are relevant to our work.

          It is not the convention of this Committee to allow members of the public to address this Committee unless they have been specifically invited to do so in advance.

          We have a very long agenda and it is important that Committee members have sufficient time to contribute to the discussion and take into account the comments of those people reporting to the Committee this morning.  I shall therefore not allow members of the public to speak.

          In accordance with Part 4 of the Council's Constitution, local Councillors have a right to speak at any Committee on a matter affecting their division and adjoining divisions.  I shall allow three minutes for a local member to speak.  This duration is consistent with the time allowed for councillors to speak in Full Council and for those who address the Planning Committee.  Statements will, therefore, need to be succinct and relevant."

Having sought legal advice during the adjournment, the Chairman invited Councillor D C Morgan to speak for three minutes to address the Committee on this item.

Councillor D C Morgan thanked the Chairman and indicated that she had not prepared an address but would highlight the main issues for Grantham residents, as noted below:-

·       Up until 14 August 2016, a patient in need of resuscitation was able to present at Grantham A&E at any time during a 24 hour period;

·       In the Grantham area, it was reported that there were 40 villages and 120k people, all of whom would no longer have access to emergency care overnight at Grantham A&E;

·       The situation had been monitored locally and it was alleged that at least three people had died in transit to other hospitals.  Although it was acknowledged that these patients may have died anyway, the Committee was advised that  ...  view the full minutes text for item 23.

(To receive a report from Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group (CCG)) which provides the Committee with an update on urgent care services within Lincolnshire.  Gary James (Accountable Officer – Lincolnshire East CCG) will be in attendance for this item)

A report by Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group (CCG)) was considered which provided an update on urgent care services within Lincolnshire.

Gary James (Accountable Officer – Lincolnshire East CCG) and Ruth Cumbers (Urgent Care Programme Director – Lincolnshire East CCG) were in attendance for this item.

At 12.07pm, the Chairman temporarily left the meeting and handed the Chair to the Vice-Chairman, Councillor T M Trollope-Bellew.

The NHS constitution set out that a minimum of 95% of patients attending an A&E department in England must be seen, treated and admitted or discharged in under four hours ("the four hour A&E standard").  The target was originally introduced at 98% in 2004.  More recently all types of departments had seen the number of attendances increase.

The national context was further explained with the impact on winter performance showing an increase in older patients presenting at A&E who then were admitted as an emergency.  These patients were found to wait longer in A&E than other patients due to their complex needs and multiple illnesses which increased the chance of the four hour target being breached.

Local context in relation to A&E attendances and performance in Lincolnshire noted that the four hour A&E standard had been falling since the winter of 2014/15 and that the overall performance delivered at the end of 2015/16 was 86.0% compared with 90.2% in 2014/15.

As part of the 2016/17 planning and contract round, local systems were expected, by NHS England and NHS Improvement, to agree sensible trajectories for the Q4 performance at year end (March 2017).  This regulatory decision reflected the number of systems failing to meet the 95% target across the country.

In Lincolnshire the agreed Q4 position for 2016/17 was 89% and, of the nine systems within the Central Midlands locality, three had a trajectory which delivered 95%.  Regulators were satisfied that 89% represented a sustainable position within the local system despite being 6% below the constitutional standard.  The report provided the figures for each month and confirmed that the agreed trajectory was achieved overall in Q1.

Bed Occupancy rates for hospitals were context dependent and varied between organisations.  In recent years, there had been a national increase in the intensity with which beds were being used (this was measured by bed occupancy).  For the year to date, United Lincolnshire Hospitals NHS Trust bed occupancy rate was 91.7% compared with 92.5%.  However, the number of weekly acute beds open had fallen from 1005 in 2015/16 to a current average of 994 which demonstrated an overall improved position.

In relation to Delayed Transfers of Care (DTOC), Lincolnshire DTOC rates had fallen over the first quarter of 2016/17 with performance in June delivering  3.6% of bed days lost.  The system was on track to achieve the target of 3.2% by the required date of October 2016.

Lincolnshire Community Health Services (LCHS) NHS Trust had experienced significant DTOCs through the first quarter of 2016/17 although these  ...  view the full minutes text for item 24.

(To receive a report from Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group (CCG)) which provides an update on performance of cancer services across Lincolnshire and gives details of the progress made on specific improvement projects, previously described.  Sarah-Jane Mills (Director of Development and Service Delivery – Lincolnshire West Clinical Commissioning Group CCG) will be in attendance for this item)

The Committee considered a report by Sarah-Jane Mills, the Director of Development and Service Delivery, at Lincolnshire West Clinical Commissioning Group, which was the lead Clinical Commissioning Group (CCG) in Lincolnshire for commissioning cancer services. 

The report to the Committee made reference to the incidence of cancer across Lincolnshire, with the highest number of new cases recorded in the South Lincolnshire CCG and South West Lincolnshire CCG areas.  Nationally, there had been a steady increase in the diagnosis of new cancers since 2009.  The report also referred to the importance of early detection, and the role of screening as part of this, in particular screening for breast cancer; cervical cancer; and bowel cancer.  In this regard, the support of the County Council's Public Health Department was emphasised in the presentation to the Committee. Overall, the early diagnosis of cancer was lower in comparison to the national averages.

The report referred to survival rates in relation to which it was reported that one-year survival rates for all cancers across Lincolnshire were comparable to the national average; only in the South Lincolnshire CCG area did one-year survival rates exceed the national average.  However, one-year survival rates for lung cancer were much lower in Lincolnshire, ranging from 30.5% to 39.4%. 

The Committee was advised in the report of the performance of four local hospital trusts in quarter 1 against two of the national cancer standards: (1) the two week wait – the percentage of patients seen by a specialist within 14 days of referral; and (2) the 62 day treatment measure – the percentage of patients receiving treatment within 62 days.  In relation to (2), United Lincolnshire Hospitals treated 71.4% of patients within 62 days. 

Progress with the Lincolnshire Cancer Improvement Plan was reported to the Committee, which had focused on United Lincolnshire Hospitals NHS Trust (ULHT).  This was because towards the end of 2015, the trajectory for cancer performance at ULHT had been improving month on month.  Performance at ULHT had dipped from January 2016 onwards, which had been expected.  However, the Trust's performance had not returned to the 2015 levels.  A review to explore the reasons for this had found that there were increased demand for diagnostic tests early in the cancer pathway; reporting issues relating to software; and most importantly workforce availability.

In relation to workforce, the Committee was advised that there had been vacancies in the Oncology Team at ULHT between January and July 2016, which had affected performance and all these vacancies had now been filled.  Similarly, there had been issues with staff vacancies in Chemotherapy, and these had now been addressed.  Over the last two months the two week wait performance had further deteriorated at ULHT, owing to reduced radiology capacity in the Breast Service.  Workforce availability remained the greatest risk to the service.  

Further mitigation measures had taken place at ULHT which included patient tracking to ensure the waiting time standards were met; and a bid for national funding to support capacity in CT. 

The Committee  ...  view the full minutes text for item 25.

(To receive a report from Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust (EMAS) which provides the Committee with a copy of the Quality Improvement Plan produced in response to the inspection findings of the Care Quality Commission (CQC).  Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust and Blanche Lentz (Lincolnshire Divisional Manager – East Midlands Ambulance Service NHS Trust) will be in attendance for this item)

Consideration was given to a report from Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust (EMAS)) which provided a copy of the Quality Improvement Plan produced in response to the inspection findings of the Care Quality Commission (CQC).

Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service (EMAS)) and Blanche Lentz (Lincolnshire Divisional Manager – East Midlands Ambulance Service NHS Trust (EMAS)) were in attendance for this item.

The Committee received a presentation which highlighted relevant areas for consideration from the report of the CQC.  These included:-

1.    CQC rating following November 2015 inspection;

2.    Key themes from the inspection report – frontline staffing support, leadership and training; vehicles and equipment; medicines management and record keeping; serious incident reporting and learning; complaints reporting and learning; and hospital handover delays;

3.    Progress and action going forward – 2016/17 contract settlement;

4.    Progress and action going forward – frontline staff, support, leadership and training;

5.    Progress and action going forward – vehicles and equipment;

6.    Progress and action going forward – learning from serious incidents and complaints;

7.    Turnaround – Total Lost Hours;

8.    Working together to improve patient safety – Health Education England (HEE), workforce development; Hospital handover delays; and improved system-wide demand management;

9.    Summary – action taken and improvements made were being delivered with support from commissioners and regulators.

Three core services had been inspected by the CQC which included the Emergency Operations Centre; Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance; and Patient Transport Services.

Overall the Trust had been rated as 'requires improvement'.

The EMAS Board considered its response to the CQC Inspection on 5 July 2016 and developed an action plan to respond to the issues identified in the CQCs report.  This action plan formed part of the Trust's overall Quality Improvement Plan.  A key element in the action plan was the commissioning of a Strategic Demand, Capacity and Price Review, which was also supported by the commissioners.

A Regional Scrutiny Briefing had been held on 5 July 2016 which representatives from all eleven health overview and scrutiny committees in the EMAS region had been invited.  A number of points were raised during that meeting but, due to the absence of a requirement for EMAS to deliver national response time standards as part of its contract for 2016/17 (including the absence of any requirement for EMAS to deliver these standards at Clinical Commissioning Group level) the Committee was requested to consider how best to scrutinise the response time performance of EMAS at future meetings.  For example, the provision of response time information at Divisional for CCG level would be indicative.

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

·       It was noted that community defibrillators were fit for purpose and suitable for communities but defibrillators used on ambulance vehicles were more advanced and gave the paramedic more relevant information to enable suitable treatment of the patient;

·       Although disappointing to receive  ...  view the full minutes text for item 26.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides the Committee with the content of the Chairman's letter to NHS England, seeking a commitment to a full public consultation and the response received from NHS England)

Consideration was given to a report from Simon Evans (Health Scrutiny Officer) which provided the content of the Chairman's letter to NHS England, seeking a commitment to a full public consultation and the response received from NHS England.

The Committee was referred to page 175 of the report and an update provided on the outcome of other Health Scrutiny Committees in the region in relation to this item.

Nottingham City and Nottinghamshire Joint Health Scrutiny Committee had decided more information was required in order to consider whether the decommissioning of this service would be a substantial variation.

Derbyshire County Council's Health Scrutiny Committee had sought assurance for a consultation and also detail of the alternatives for Level 1 services.

The Committee was advised that the Joint Health Scrutiny Committee for Leicester, Leicestershire and Rutland was due to meet on 29 September 2016 and not 21 September as indicated in the report.

The Chairman expressed her disappointment at the response received and asked the Committee's views on writing again to Will Huxter, seeking details on what NHS England would be including in the consultation and making reference to the report of the Independent Reconfiguration Panel in 2013.

At 4.00pm, Mr P Keeling left the meeting and did not return.

RESOLVED

          That the proposal that the Chairman write again to Will Huxter, Senior Officer, NHS England to ask what would be the focus of the consultation be unanimously agreed.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides the Committee with an update on the interim management arrangements introduced at four GP practices within Lincolnshire from 1 August 2016)

Consideration was given to a report from Simon Evans (Health Scrutiny Officer) which provided an update on the interim management arrangements introduced at four GP practices within Lincolnshire from 1 August 2016.

On 21 July 2016 it was announced by Lincolnshire West CCG that the interim management arrangements would be introduced in four APMS GP practices in Lincolnshire from 1 August 2016.  It was announced that Lincolnshire Community Health Services NHS Trust (LCHS) would run the surgeries until at least 15 December 2016 on a caretaker basis.  The CCG had undertaken a survey of patients which sought views on the services currently received and what they would like for the future.

A procurement exercise had been launched which would require any provider to operate both morning and afternoon sessions Monday to Friday but could not operate as a branch surgery to an existing GP practice.  Interested providers were required to bid by 14 October 2016.  Should no bids be received to run any, or all, of these surgeries, the CCG would need to consider dispersing the patient lists to alternative GP surgeries.  The interim management arrangements could not continue on a permanent basis.

RESOLVED

          That the report be noted and that a further update be presented to the Committee at its meeting in November 2016.

(To receive a report from Simon Evans (Health Scrutiny Officer) which gives the Committee an opportunity to consider the annual Quality Accounts of local providers during 2015-16)

Consideration was given to a report from Simon Evans (Health Scrutiny Officer) which provided an opportunity for the Committee to consider the annual Quality Accounts of local providers during 2015-16.

The Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire had prepared a joint statement on the following draft quality accounts for the following organisations:-

·       Lincolnshire Community Health Services NHS Trust;

·       Lincolnshire Partnership NSH Foundation Trust;

·       United Lincolnshire Hospitals NHS Trust;

·       Boston West Hospital;

·       East Midlands Ambulance Service NHS Trust;

·       Marie Curie;

·       Northern Lincolnshire and Goole NHS Foundation Trust;

·       Peterborough and Stamford Hospitals NHS Foundation Trust; and

·       St Barnabas Hospital.

The Chairman asked that her personal thanks to the Quality Accounts Working Group be recorded for the contribution made to the preparation of the Quality Accounts.

Formal thanks were also offered, on behalf of the Quality Accounts Working Group, to Simon Evans (Health Scrutiny Officer) for his help and guidance throughout the process.

RESOLVED

          That the report be noted.

(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.

Simon Evans (Health Scrutiny Officer) confirmed that, further to discussion at the meeting today, the following items would be added to the work programme:-

1.    ULHT – Emergency Services Update – November 2016; and

2.    Winter Planning – October 2016.

It was also agreed to add an update from LIVES as an item to be programmed.

RESOLVED

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

Merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust

On 20 September 2016, the full business case for the merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust was published.  This was to be considered by the Peterborough Board on 27 September 2016 followed by the Hinchingbrooke Board on 29 September 2016.

P&SHFT had offered to meet with the Committee or members of the Committee to go through the full business case although they were unable to attend the next meeting of the Committee in October.  It was indicated that the November meeting would be too late.

There had also been an approach from Peterborough City Council and Cambridgeshire County Council, who planned to form a joint health scrutiny committee, to respond to the business case.

The options available to the Committee were:-

1.    No formal response;

2.    Nominate a member to participate in the joint committee as a non-voting member and feed into the joint committee's response;

3.    Nominate a member to participate in the joint committee as a non-voting member and feed into the joint committee's response AND make a separate response on behalf of the Health Scrutiny Committee for Lincolnshire; or

4.    Decide not to nominate a member for the joint committee and make own response to the business case.

RESOLVED

          That Option 4 be agreed and a working group comprising Councillors T M Trollope-Bellew and Mrs S M Wray be established to draft and finalise a response to the Full Business Case, with Councillors D Brailsford, P M Dilks and R L Foulkes being invited to attend as the local members.

Annual Public Meetings

Attendance at the following Annual Public Meetings had been agreed and volunteers requested for those without representation:-

·       22 September – Lincolnshire East CCG (Golf Hotel, Woodhall Spa) – Councillor S L W Palmer to attend;

·       26 September – United Lincolnshire Hospitals NHS Trust (Bishop Grosseteste University, Lincoln) – Councillor C J T H Brewis to attend;

·       27 September – South West Lincolnshire CCG (New Life Centre, Sleaford) – Councillor K Cook to attend;

·       28 September – Lincolnshire West CCG (The Showroom, Lincoln) – Councillor J Kirk to attend;

·       29 September – South Lincolnshire CCG (Springfield Event Centre, Spalding) – volunteer required.