Agenda and minutes

Apologies for absence were received from Councillors Mrs C A Talbot (Lincolnshire County Council) (LCC), Mrs S Ransome (LCC), Mrs P F Watson (East Lindsey District Council), T Boston (North Kesteven District Council) and Mrs L A Rollings (West Lindsey District Council).

The Chief Executive reported that under the Local Government (Committee and Political Groups) Regulations 1990, Councillors C E D Mair (LCC), N Jones (East Lindsey District Council) and Mrs A White (West Lindsey District Council) had been appointed to replace Councillors Mrs S Ransome (LCC), Mrs P F Watson (East Lindsey District Council), and Mrs L A Rollings (West Lindsey District Council) respectively, for this meeting only.

It was noted further that Councillor C E D Mair had submitted his apologies for the meeting.

Councillor S L W Palmer declared a prejudicial interest in item 7 – Lincolnshire Medicines Management Consultation due to his wife being a coeliac, and that the proposed changes would have an effect on them financially.  Councillor S L W Palmer further advised that as a result, he would be leaving the meeting during consideration of the item.

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

a)            Message from the Chairman, Councillor Mrs Christine Talbot

The Vice-Chairman read out a statement from the Chairman Mrs C A Talbot which thanked those members who had sent 'Get Well' messages, and for all the support received prior to her operation.  The Committee was advised that Councillor Mrs Talbot was now at home recovering from her operation.

b)            Revised Agenda

That a revised agenda had been issued on Friday, to contain the report relating to the Annual General Meetings and Public Meetings, which was detailed at item 9 of the revised agenda. 

Thanks were extended to Councillors T Boston, J Kirk, and S L W Palmer, who had each attended one of the annual meetings, and whose reports were contained as part of item 9.

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

Following the last meeting and in accordance with Minute 27, the Chairman had sent a letter to Will Huxter on 29 September 2016, which had included an invitation for him to attend the Committee on 21 December 2016.  It was highlighted that to date, no response had been received however, two further developments had occurred, one was that a briefing paper from NHS England dated 1 September 2016, had come to light on 10 October 2016.  The Committee noted that NHS England had not sent the briefing paper directly to local authority overview and scrutiny committees, but had relied on a third party.  The Committee noted further that the briefing paper contained a commitment from NHS England to undertake a full public consultation; and a copy of the Chairman's announcements would be forwarded on to members of the Committee after the meeting.

The second development was that on 19 October 2016, there had been a thirty-minute debate in Westminster Hall concerning the Glenfield Hospital.  Philip Dunne, the Minister of State at the Department of Health had responded to debate on behalf of the Government, and it had been confirmed that there was an intention for a three-month public consultation by NHS England, which would conclude in the spring of 2017.

d)                 Community Pharmacy 2016/17 and Beyond: Final Package

The Committee was reminded that consultation by the Government earlier in the year on 'Community Pharmacy 2016/17 and Beyond', to which the Chairman had responded on behalf of the Committee on 27 April 2016.  The Government had on 20 October 2016 announced that there would be an overall funding reduction of £113 million, or 4% in the current financial year 2016/17, which would then be followed by a further reduction of 3.4% in 2017/18.

The Government had also announced that it would be removing the basic establishment payment of £23,000, paid to each pharmacy, but would be introducing a Pharmacy Access Scheme to protect pharmacies in rural areas.  The scheme would apply to a pharmacy which was more than a mile away from its nearest pharmacy; and the pharmacy was not in  ...  view the full minutes text for item 33.

RESOLVED

That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 21 September 2016 be approved and signed by the Chairman as a correct record.

(To receive a report by Gary James (Accountable Officer – Lincolnshire East CCG) which provides an update on the planning for Winter Pressures across the Health and Care Economy in Lincolnshire.  Gary James (Accountable Officer – Lincolnshire East CCG) and Ruth Cumbers (Director of Urgent Care – Lincolnshire East CCG) will be in attendance for this item).

The Chairman welcomed to the meeting Gary James, Accountable Officer, Lincolnshire East Clinical Commissioning Group and Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group.

The purpose of the report was to update the Committee on planning for Winter Pressures across the Health and Care Economy in Lincolnshire.

It was reported that nationally that there was recognition of an increase in demand on urgent and emergency services across the winter months.  It was however highlighted that generally the system was under pressure all year round.  It was noted that the whole health and social care system was running "hot" with the usual expected easing of pressures during the summer no longer being experienced.  It was noted further that the acute sector escalation beds had remained largely open all year rather than as originally planned just for winter only.  It was reported that the A & E performance across Lincolnshire was below the national standard with Lincoln County and Boston Pilgrim consistently underperforming against the 95% four hour treatment target.

The Committee was advised that the Lincolnshire 2016/17 Winter Plan had been produced by the Urgent Care Team with contributions from partners across the health and care community.  The Plan had then been reviewed by key partner organisations to ensure its robustness.  It was highlighted that there was an expectation from NHS England and the NHS Improvement that a robust system wide plan was in place for each winter.  The A & E Delivery Board also had to have assurance that all commissioner and provider plans evidenced both individual organisation and system wide congruence and resilience.

In summary, the Committee was advised that the plan described how the system was aiming to manage pressures by:-

·         Improvements in acute hospitals concerning bed flow processes; Emergency Department efficiency and to fully implement ambulatory emergency care and SAFER (Senior review: that All patients have discharge date, Flow, Early discharge; Review);

·         That community services and the local authority would be focussing on enhancing capacity and reablement to avoid admissions and speed up complex discharges;

·         That commissioners would be focussing on driving greater throughput at treatment centres; and ensuring that demand management schemes were effective in reducing Emergency Department attendance; and

·         That there would be a collective effort focused on managing complex medically fit patients within a fewer number of days; and that there would be improvement's to support, and divert greater number of the over 75 year of patients outside of the acute hospital.

The Committee noted that Delayed Transfers of Care had shown some improvement; however, there had been a slight increase in the figures for August. 

It was reported that both the Surge Plan and Escalation Plan and the Winter Plan had recently been updated.  It was highlighted that unlike in previous years, there had not been any additional central government funding for winter pressures, as the sums had been included in each CCG's base allocations.  As a result investment in the system had been agreed through  ...  view the full minutes text for item 35.

(To receive a report by Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) which seeks to provide assurance to the Committee that Lincolnshire Partnership NHS Foundation Trust (LPFT) continues to make good progress with the implementation of the action plan resulting from the Care Quality Commission (CQC) Comprehensive Inspection (30 November to 4 December 2014.  Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Anne-Maria Olphert (Director of Nursing and Quality – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

The Chairman welcomed two colleagues from The Lincolnshire Partnership NHS Foundation Trust, Ian Jerams, Director of Operations and Anne-Maria Olphert, Director of Nursing and Quality.

The Director of Operations advised that the purpose of the report was to provide assurance to the Committee that the Lincolnshire Partnership NHS Foundation Trust (LPFT) had continued to make good progress with the implementation of the action plan resulting from the Care Quality Commission (CQC) Comprehensive Inspection held from 30 November to 4 December 2015.

Appendix A to the report provided a summary of the CQC ratings for LPFT in the Comprehensive Inspection; and Appendix B provided the Committee with a copy of the latest version of the Action Plan for their consideration.  It was reported that the CQC Action Plan was updated monthly, and was presented in a public meeting to the Board of Director each month.

The Committee noted that 74% of the 'sub-actions' were now complete; and that 46 of the sub actions were now on track to be delivered by the agreed date.  Progress was also being made to complete the remaining actions and to transfer any remaining actions into a Quality Improvement Plan to support the continuous quality improvement objectives of the organisation.

Discussion ensued, from which the Committee raised the following points:-

·         Chart 1.2 – page 5 of the report presented.  The Committee was advised that work was now complete and a protocol was now in place; and

·         Page 74 – Community Learning Disabilities and Autism – One member enquired as to whether the problem relating to data had been resolved.  The Committee was advised that this had been completed; and that there was now only the historic data to be migrated.  It was highlighted the system was a good news story; however, the Committee noted that varying systems were still not able talk to each other.

Overall, the Committee felt that the report was a good news story and looked forward to receiving a further update in due course.

RESOLVED

1.    That the Committee record its assurance that the work being undertaken by Lincolnshire Partnership NHS Foundation Trust to meet the actions set out by the Care Quality Commission (CQC) was progressing.

2.    That the Committee record its assurance that Lincolnshire Partnership NHS Partnership Trust would be focussing on continuous quality improvement once the CQC Action Plan was complete.

3.    That the Committee record its assurance that the Care Quality Commission, NHS Improvement and NHS England, as well as local Clinical Commissioning Groups, were receiving progress updates.

4.      That further updates be requested in relation to safe care – the requirements of single sex accommodation guidance and assessing /managing the risks of points of ligature in and around the buildings in which patients are receiving mental health services.

(To receive a report which presents the Lincolnshire Medicines Management Consultation which takes place 4 October – 18 November 2016 following which the results will be reported to all four CCG Governing Bodies on 30 November/1 December 2016)

Councillor S L W Palmer left the meeting.

Consideration was given to a report on behalf of the Lincolnshire Clinical Commissioning Groups (CCGs), which presented the Lincolnshire Medicines Management Consultation for the Committee's consideration.  It was reported that the consultation was taking place between 4 October and 18 November 2016; with the results being reported back to all the four CCG Governing Bodies on 30 November to 1 December 2016.

Gary James, Accountable Officer, Lincolnshire East Clinical Commissioning Group presented the report and explained to the Committee that the rationale behind the proposals was that the four CCGs had a substantial financial challenge to meet in the short term; and that currently £38m was being spent over the existing budget.  As a result of this it was felt that money spent on items that were readily available over the counter might be better spent on treatments, staff and essential services to benefit patients.

The four CCGs were asking for comments from the Committee on their proposals to restrict the prescribing of over the counter/minor ailment medicines used for short-term, self-limiting conditions, the prescription of gluten-free products, baby milk (including specialist infant formula) and oral nutritional supplements.  Attached at Appendix A to the report provided a copy of the Medicines Management Consultation document and survey.

Page 92 to 96 of the report provided the Committee with background information as to what was planned against each of the four areas.

During consideration of the item, the Committee raised the following issues:-

·         One member enquired as to where one could obtain a copy of the consultation form.  The Committee was advised that the form had been made available in GPs surgeries, pharmacies, social media, Facebook; website; engagement events, Parish Councils etc.  Some members expressed concern that they were not aware of the consultation.  A further member asked whether a copy of the consultation document should have been put through everyone's letter box.  The Committee was advised that this would have cost at least £500,000; and evidence had suggested that leaflet drops always resulted in a poor return; except if there was an incentive for people to complete.  The Committee also noted that there had been good representation from patients groups such as the Coeliac Society;

·         Some members express their support to the proposal but expressed some concern for the more vulnerable people who for instance needed large amounts of paracetamol for arthritis pain, or who were on lower incomes.  The Committee was reassured that the changes would only be applied to minor conditions; and that someone requiring painkillers in large amounts would still be able to have them on prescription; and that GPs would not restrict prescriptions to vulnerable people.  Some members also felt that the proposal was well overdue, and particular reference was made to coeliac disease, where it was highlighted there was now an extensive range of gluten free products available in shops and supermarkets.  It was highlighted that someone on a low income who was a coeliac, or would be  ...  view the full minutes text for item 37.

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

Councillor S L W Palmer re-joined the meeting.

The Committee considered its work programme for forthcoming meetings.

Simon Evans, Health Scrutiny Officer confirmed that the item concerning United Lincolnshire Hospitals Trust – Pharmacy Services had been moved from the 23 November 2016 meeting to the 18 January 2017 meeting.  It was also highlighted that the last two items on the agenda for the 23 November 2016 meeting were for 'information only'. 

One member referred to the 'Reducing Obesity in Adults and Children' on the 'Items to be Programmed List' and requested for it to be included on a future agenda, as it was felt that this issue needed to be considered sooner, rather than later.  It was also requested that when discussing such a topic, the Committee needed to be mindful of the feelings of others and discuss the item in a more sympathetic manner.  It was agreed that the request for 'Reducing Obesity in Adults and Children' would be raised at the next agenda planning meeting scheduled to be held on 9 November 2016.

RESOLVED

That the contents of the work programme presented be approved, subject to the inclusion/deletion of the amendments detailed above.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides reports, prepared by Committee members who attended the Annual Public Meetings of Clinical Commissioning Groups and Annual General Meetings of NHS Provider Trusts)

The Committee gave consideration to a report, which provided the Committee with a series of reports from individual members of the Committee who had attended various Clinical Commissioning Groups, NHS Trusts and NHS Foundation Trusts Annual Meetings.

The Chairman on behalf of the Committee, expressed thanks to Councillors T Boston, J Kirk, S L W Palmer for their involvement.

RESOLVED

            That the report be noted.