Agenda and minutes

Apologies for absence were received from Councillor Mrs E L Ransome.

There were no replacement members in attendance.

Councillor Mrs C A Talbot advised the Committee that she remained a patient of University Hospitals Nottingham but was also under the care of a team of nurses, on a regular basis, at United Lincolnshire Hospitals NHS Trust, which would be discussed under Item 7 – United Lincolnshire Hospitals NHS Trust 2021 Strategy and Change Programme.

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

i)             Wainfleet GP Surgery – Temporary Suspension of Registration

On 10 November 2016, the Care Quality Commission (CQC) temporarily suspended its registration of Wainfleet Surgery for a period of three months due to concerns for patient safety.  The 2,200 patients on the Wainfleet list had been advised to register temporarily with other local GP practices, such as Hawthorn Medical Practice in Skegness.

Lincolnshire East Clinical Commissioning Group had provided support to the Wainfleet Surgery and further information on the role of the CCG in supporting the surgery and its patients would be provided to the Committee as part of Item 8 – Lincolnshire East Clinical Commissioning Group Update.

ii)            Meeting with Lincolnshire West Clinical Commissioning Group

On 8 November 2016, the Chairman met with Richard Childs (Chairman), Dr Sunil Hindocha (Chief Clinical Officer) and Sarah Newton (Chief Operating Officer) of Lincolnshire West Clinical Commissioning Group.  The discussion included the inspection of GP practices by the Care Quality Commission and the CCGs financial position.

iii)       Working Group Meetings

The Chairman thanked eight Members of the Committee who had participated in the two working group meetings in the last month.  On 2 November 2016, Councillors D Brailsford, R L Foulkes and T M Trollope-Bellew attended a working group at Stamford and Rutland Hospital which responded to the full business case for the merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust.

On 10 November 2016, Councillors C J T H Brewis, Mrs R Kaberry-Brown, J Kirk, R C Kirk and Mrs J M Renshaw attended the working group which responded to the Medicines Management Consultation.

The full responses were set out, for information, under Item 11 – Work Programme and Responses to Consultations.

iv)          Final Business Case for the Merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust

Further to the submission from the working group on the Merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust, Board papers for both Trusts had been issued for meetings taking place in the following week and these papers included the Committee's submission.  Each Board was expected to ratify the proposed merger on the basis of the business case.

v)            Sustainability and Transformation Plans

As at 22 November 2016, it was understood that 30 of the 44 Sustainability and Transformation Plans (STPs) had been published.  On 21 November 2016, the Chairman had received a copy of the Cambridgeshire and Peterborough STP which, like the other published STPs, was a five year strategy document rather than a consultation in its own right.  The Cambridgeshire and Peterborough STP contained a commitment for public consultation, where necessary, on substantial variations to services.

The Chairman reported that there was an intention to publish the Lincolnshire STP no earlier than 8 December 2016 (the date of the Sleaford and North Hykeham by-election) and it was expected that an item  ...  view the full minutes text for item 42.

Councillor Mrs J M Renshaw advised that her name had been omitted from the minutes under minute number 37.  Councillor Mrs Renshaw had indicated at the meeting that she would also participate in the working group to formulate a formal response to the Medicines Management Consultation.  It was agreed that the minutes be amended to reflect this addition.

RESOLVED

          That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 26 October 2016, with the amendment noted above, be approved and signed by the Chairman as a correct record.

(To receive a report from Tony McGinty (Interim Director of Public Health) which provides information on current activity to ensure the Health and Wellbeing Board is meeting its statutory duties in respect of developing the new Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS).  David Stacey (Programme Manager – Strategy and Performance) and Alison Christie (Programme Manager – Health and Wellbeing) will be in attendance for this item)

Consideration was given to a report by Tony McGinty (Interim Director of Public Health) which provided information on current activity to ensure that the Health and Wellbeing Board was meeting its statutory duties in respect of developing the new Joint Strategic Needs Assessment (JSNA) and the Joint Health and Wellbeing Board Strategy (JHWS).

Councillor Mrs S Woolley (Executive Councillor for NHS Liaison and Community Engagement; and Chairman of the Lincolnshire Health and Wellbeing Board), Alison Christie (Programme Manager – Health and Wellbeing) and David Stacey (Programme Manager – Strategy and Performance) were in attendance for this item.

Under the Health and Social Care Act 2012 Health and Wellbeing Boards (HWB) were required to publish a Joint Strategic Needs Assessment (JSNA) for the local area.  The protocol agreement, signed between the Lincolnshire Health and Wellbeing Board, Health Scrutiny Committee for Lincolnshire and Healthwatch Lincolnshire in December 2014, set out the working relationship and respective roles in delivering the shared ambition of improving health and wellbeing in Lincolnshire.

The Health and Wellbeing Board was established in April 2013 as a strategic forum bringing together key leaders from the health, public health and care systems to work together to improve the health and wellbeing of the people of Lincolnshire. 

The current format of the JSNA had been in place since 2011 and a programme of review was agreed by the Board in March 2015.  The Committee contributed to the engagement exercise by submitting a formal response in December 2015.

Stakeholder feedback received during the review had highlighted a number of weaknesses in JSNA processes in addition to a wide variation in the levels of awareness and use of the JSNA itself.  A number of respondents reported that they were either unaware of the JSNA or had not used the document and buy-in across partners had also been inconsistent as many perceived this as the responsibility of Public Health with little awareness of the statutory nature of the JSNA.

Based on this feedback, the HWB agreed the review approach based around topic expert panels using the current JSNA as the starting point for the fundamental review which began in April 2016.  Expert Panels, made up of appropriate representatives from the County Council, Clinical Commissioning Groups, health providers, District Councils and voluntary and community sectors had been set up to support Topic Leads to undergo a refresh of each of the topics.  A dedicated Data Analyst had supported the process along with the JSNA Support Officer.

In addition, a multi-agency JSNA Strategic Delivery Group (JSNA SDG) had been established by the HWB to steer the review process and approve changes to the JSNA prior to its publish in Spring 2017.  This included a Peer Review process which would ensure that each topic commentary met the agreed set quality standard before approval was given by the JSNA SDG.

The current Joint Health and Wellbeing Strategy (JHWS) was scheduled to end in 2018 and the review of the JSNA was expected to form the basis on which  ...  view the full minutes text for item 44.

(To receive a report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) which provides the Committee with details of the decision made on 2 November 2016, by the Trust Board of United Lincolnshire Hospitals NHS Trust, for the closure of the A&E Department to continue for at least a further three months.  Jan Sobieraj (Chief Executive – ULHT) and Dr Suneil Kapadia (Medical Director – ULHT) will be in attendance for this item)

The Chairman reported the findings of research undertaken prior to the meeting in order to assist the Committee with their consideration of this item:-

·       In 2007, Lincolnshire Primary Care Trust (PCT) held a consultation entitled Shaping Health for Lincolnshire, which included a proposal for a network of two major A&E Departments (Lincoln County and Pilgrim Hospitals) which were to be supported by other A&E Departments and minor injury units.  This proposal was opposed by the Health Scrutiny Committee for Lincolnshire but supported by 88% of respondents to the consultation.  Lincolnshire PCT adopted the proposal in November 2007. It was understood that the main effect was the restriction of stroke admissions at Grantham;

·       A subsequent consultation in 2013 entitled Shaping Health for Mid Kesteven included a commitment to Grantham A&E, but did not put any further restrictions on the types of patients, which may be received at Grantham A&E, other than putting a GP into Grantham A&E, and linking the A&E with the out-of-hours service; and

·       It was understood that patients who required emergency surgery and certain paediatric emergencies had not been treated at Grantham A&E since at least 2002.  One of the key issues to be addressed was the definition of a Level 1 A&E and the difference between a Level 1 and a minor injuries unit.

The Chairman made a statement reminding all present that the purpose of the Committee was to scrutinise NHS Healthcare; and the Health and Wellbeing Board and their services and outcomes and not for the Committee to criticise individuals to stray in to matters which were the proper remit of other organisations, such as employment issues.

In accordance with the County Council's Constitution, the following local Councillors expressed their wish to speak:-

·       Councillor D C Morgan (Grantham South);

·       Councillor R Wootten (Grantham North);

·       Councillor R G Davies (Grantham North West); and

·       Councillor L Wootten (Grantham East).

A request was made to the Chairman, by Councillor R G Davies, to allow a spokesperson from the "Fighting 4 Grantham Hospital" campaign group to address the Committee also.  The Chairman granted the request and invited Melissa Darcey to join the meeting.

Following the accepted convention, local members and the member of the public would be allowed to speak for up to three minutes.

The Chairman then invited Councillor D C Morgan to address the Committee, during which the following points were noted:-

·       In addition to her role as a local member for Grantham, Councillor Morgan confirmed that she was also the Chair of SOS Grantham Hospital and, in total, represented approximately 6000 residents in Grantham town centre area;

·       Immediate reinstatement of 24/7 services at Grantham A&E Department was sought;

·       A request was made that the Committee scrutinise the reasons given by United Lincolnshire Hospitals NHS Trust to close Grantham A&E Department overnight;

·       A review in to the information submitted to NHS Improvement for approval of this temporary closure was requested; and

·       In relation to the impact  ...  view the full minutes text for item 45.

(To receive a report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) which provides an update on the development of United Lincolnshire Hospitals NHS Trust's 2021 Strategy and Change Programme to deliver the strategy.  Jan Sobieraj (Chief Executive – ULHT) and Dr Suneil Kapadia (Medical Director – ULHT) will be in attendance for this item)

A report by Jan Sobieraj (Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)) was considered which provided an update on the development of United Lincolnshire Hospitals NHS Trust's 2021 Strategy and Change Programme to deliver the strategy.

Kevin Turner (Deputy Chief Executive – United Lincolnshire Hospitals NHS Trust (ULHT)), Jan Sobieraj (Chief Executive – United Lincolnshire Hosptials NHS Trust (ULHT)) and Dr Suneil Kapadia (Medical Director – United Lincolnshire Hospitals NHS Trust (ULHT)) were in attendance for this item.

Due to the significant service and financial challenges faced by many NHS Trusts, United Lincolnshire Hospitals NHS Trust was in the process of developing a five year strategy which would align to Lincolnshire's Sustainability and Transformation Plan (STP).  It was agreed that this strategy would be managed by the 2021 Programme Board, led by the Chief Executive.

Work had been undertaken to ensure that the development of the five year strategy was in line with the STP.  Following initial consultation and engagement with key stakeholders the ambitions noted below were agreed:-

·       Our Services will:-

o   Be Centres of Excellence;

o   Be secure in Lincolnshire where possible; and

o   Get things right first time, valuing patient's time.

·       Our Patients will:-

o   Want to choose us for their care and be our advocates; and

o   Shape how our services run.

·       Our Staff will:-

o   Be proud to work at ULHT;

o   Always strive for excellence and continuous learning and improvement; and

o   Challenge convention and improve care.

It was reported that these ambitions would be realised through the delivery of key priorities which were being developed into improvement programmes.  These programmes would be managed by the 2021 Change Programme and would provide the transformational change platform to enable the organisations to achieve future sustainability.  The programmes include:-

·       Redesign of clinical services to extend future sustainability;

·       Productive Hospital to improve Market Share seeing and treating more patients currently accessing elective care outside ULHT;

·       Review of the workforce to address future gaps, design new roles and develop more flexible models of delivery;

·       Improve productivity, efficiency and Estates;

·       Improve staff engagement – delivering safer and better outcomes for patients; and

·       Targeting quality improvement.

Development and delivery of the Five Year Strategy would be underpinned by communication, engagement and consultation, plans for which were being finalised.

It was agreed that a working group be established to provide the initial views on the strategy with a view to holding one meeting in early/mid-December and it was also agreed that the Health Scrutiny Officer would seek nominations from the Committee.  It was agreed also that Healthwatch Lincolnshire would nominate a representative for the working group.

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

·       It was suggested that more positive press coverage was required to counteract the negative media currently surrounding ULHT.  Staff within the Trust worked extremely hard to provide excellent patient care but it was acknowledged that, despite good news stories being shared with the press, the focus was inevitably on the  ...  view the full minutes text for item 46.

(To receive a report by Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provides an update on the activities of Lincolnshire East Clinical Commissioning Group (LECCG) and includes information on the lead commissioning arrangements undertaken by LECCG.  Gary James (Accountable Officer – LECCG) will be in attendance for this item)

The Chairman invited Tracy Pilcher (Chief Nurse – Lincolnshire East CCG) to provide an update on the announcement of the temporary closure of the Wainfleet Surgery.

During an inspection of 30 GP practices, the Care Quality Commission (CQC) had identified significant concern within this practice.  An action plan was developed and implemented however a follow-up inspection by the CQC identified that sufficient progress had not been made which resulted in the practice being placed in a high risk category.  As a result, the following action was taken:-

·       A suspension was placed on the practice from 8.00am on 10 November 2016;

·       Discussions with the nearby Hawthorn practice resulted in an agreement to temporarily transfer all 2200 patients from the Wainfleet practice;

·       Patients were given the option to register with other practices on a permanent basis;

·       All high risk patients registered with the Wainfleet practice were considered to ensure access to appropriate services was maintained;

·       Communication was being undertaken to advise all concerned of a helpline;

·       Additional non-emergency transport for Wainfleet patients to attend Hawthorn Practice had been deployed on a short term basis; and

·       Practice boundaries were being redrawn in line with patient lists to ensure access to primary care services for all residents.

The Committee was invited to ask questions, during which the following points were noted:-

·       CQC registration had been suspended although payment for the GMS contract had continued to ensure the running of the surgery whilst the necessary changes were made;

·       A risk assessment had been undertaken by the CQC to enable a decision to be made.  Some of the data presented suggested to the CQC that patients were not being assessed safely with one minute appointments being held;

·       Temporary home services had been put in place for patients unable to travel to the temporary practice;

·       It was reported that the Hawthorn practice had 10k patients registered currently.  A telephone line in to the Wainfleet practice was currently transferred to a staff member at the Hawthorn practice dedicated to taking calls from Wainfleet patients only.

The Committee congratulated Lincolnshire East CCG on the actions taken to deal with this issue.

A report by Gary James (Accountable Officer – Lincolnshire East CCG) was considered which provided an update on the activities of Lincolnshire East CCG (LECCG) and included information on the lead commissioning arrangements undertaken by LECCG.

Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) and Dr Peter Holmes (Chairman – Lincolnshire East Clinical Commissioning Group) were in attendance for this item.

Lincolnshire East CCG was in its fourth year of commissioning services for a population of 245,000 patients with the last twelve months facing unprecedented demands for services across the NHS as a whole.  It was clear that there was a requirement for the NHS to change and adapt in order to meet the needs of patients and to become more effective and efficient.

The report presented key facts and figures for LECCG:-

·       Coverage of three localities;

·       244,907 people looked after;

·       Approximately 296,800 outpatient attendances;

·       802,000  ...  view the full minutes text for item 47.

(To receive a report by Jane Green (NHS England) which provides an overview of the NHS dental services commissioned in Lincolnshire and an update on the new Special Care Dentistry Service arrangements from 1 December 2016.  Jane Green (NHS England) will be in attendance for this item)

A report by NHS England (Central Midlands) was considered which provided an overview of the NHS dental services commissioned in Lincolnshire and an update on the new Special Care Dentistry Service arrangements from 1 December 2016.

Jane Green (Assistant Contract Manager for Dental and Optometry – NHS England (Midlands and East (Central Midlands))) and Jason Wong (Local Dental Network Chair – NHS England) were in attendance for this item.

NHS England had been responsible for commissioning primary and secondary care dental services since April 2013 and a commitment made to oral health and dentistry.

NHS England's clinical aim for each dental practice was to deliver high quality NHS clinical services were defined as:-

          "patient-centred and value for money primary care dental services, delivered in a safe and effective manner, through a learning environment, which includes the continuing professional development of dentists and other dental professionals"

The Central Midlands Local Officer was responsible for commissioning NHS primary, community and secondary care dental services and had two locality teams who managed dental and optometry commissioning.  Within the Central Midlands region, Lincolnshire formed part of the North Locality which also covered Leicestershire and Rutland. 

Within Lincolnshire 69 practices delivered 76 contracts including:-

·       49 practices providing general dental services (10 restricts contracts);

·       1 pilot contract to provide general dental services;

·       15 practices providing general dental and orthodontic services;

·       5 contractors providing orthodontic services;

·       5 contractors providing minor oral surgery services; and

·       1 Special Care Dentistry Service contractor.

NHS dental contractors were transferred to the new NHS Dental contract in April 2006 which monitored units of dental activity (UDA) target for general dental practice and units of orthodontic activity (UOA) for orthodontic contracts.

Patient charges were changed with the introduction of the new contract which was simplified in to three treatment bands ranging from £19.70 to £233.70.

An Oral Health Needs Assessment (OHNA) for the North Locality was developed by Public Health England in conjunction with NHS England Central Midlands Local Office.  The document had been submitted for gateway approval and would be published once received.

The OHNA reviewed the demographics of the resident population, provision of services, access to NHS dental services and also made recommendations for consideration by commissioners.  The review identified that the access rate in the following Local Authority areas was similar to, or above, the NHS England and Leicestershire and Lincolnshire averages:-

·       West Lindsey (for children and adults);

·       North Kesteven (for children);

·       South Kesteven (for children and adults); and

·       East Lindsey (for children and adults).

The access rate in the following areas was below the NHS England and Leicestershire and Lincolnshire average:-

·       Boston (for children and adults);

·       Lincoln (for children and adults);

·       South Holland (for children and adults); and

·       North Kesteven (for adults).

The Local Office also reviewed the outcomes of the draft OHNA along with other intelligence in order to develop the dental commissioning intentions and it had been agreed to commission new dental contract to improve access in priority areas within the resource envelope available:-

·       Boston;

·       Lincoln;

·       Sleaford  ...  view the full minutes text for item 48.

(To receive a report by Simon Evans (Health Scrutiny Officer) which invites the Health Scrutiny Committee for Lincolnshire to consider the next steps for its review and scrutiny of delayed transfers of care)

Consideration was given to a report from the Director Responsible for Democratic Services which asked the Committee to consider the next steps for its review and scrutiny of delayed transfers of care (DTOC).

Simon Evans (Health Scrutiny Officer) introduced the report which confirmed that the issue had been considered by the Health Scrutiny Committee for Lincolnshire who made a request for the Adults Scrutiny Committee to also consider this.  The Adults Scrutiny Committee accepted this request and the item was considered at the following meetings of the committee:-

·       6 April 2016;

·       7 September 2016; and

·       19 October 2016.

In the meantime, reference had been made to delayed transfers of care within three reports to the Health Scrutiny Committee for Lincolnshire.

The request for consideration by the Adults Scrutiny Committee was made on the basis that this committee was the lead for the scrutiny of the Better Care Fund (BCF) which, for 2016/17, included the reduction of delayed transfers of care as a key measurement.

The Adults Scrutiny Committee had considered two reports where delayed transfers of care formed a substantial element.  Firstly, as part of an item on Seasonal Resilience of Adult Care in April 2016; secondly, in October 2016, when it considered Adult Care Acute Delayed Transfers of Care; and also within the detailed performance information as part of the Quarter 1 Performance Monitoring Report on the Better Care Fund in September 2016.

On the 19 October 2016, the Adults Scrutiny Committee resolved to note the information presented and, as part of the discussion, suggested that the Health Scrutiny Committee for Lincolnshire take the lead on scrutinising this issue in the future.  It was further suggested that a joint meeting or working group be established to give further consideration to the topic.

The Health Scrutiny Committee had continued to receive information on DTOC as part of its regular consideration of Urgent Care Updates and the inclusion of this information had reflected the importance of 'patient flow' to ensure the effective operation of the urgent care system.

The Health Scrutiny Committee could continue in its role of scrutinising DTOC as part of its role with focus on NHS organisations and their efforts to reduce delays.  Similarly, the Adults Scrutiny Committee would continue to receive quarterly performance information on the Better Care Fund which included extensive detail on DTOC performance.

In order to consolidate and enhance the individual scrutiny activity of each committee, it was suggested that a joint informal meeting or working group be established.  Outcomes would then be reported to each committee.

The Committee was invited to ask questions, during which the following points were noted:-

·       Members who also served on the Adults Scrutiny Committee indicated that consideration of this item at that committee had not led to satisfactory outcomes and they would support a joint approach to the topic;

·       The Committee concluded that joint working between the two committees was essential for this issue as it overlapped both Health and Social Care;

·       As a member of the Health  ...  view the full minutes text for item 49.

(To receive a report by Simon Evans (Health Scrutiny Officer) which invites the Committee to consider its' work programme for the coming months.  The report also sets out the Committee's final responses to two consultations)

Consideration was given to a report by the Health Scrutiny Committee for Lincolnshire which gave the Committee the opportunity to consider its work programme for the coming months and also provided the Committee's final response to two consultations.

The consultations referred to were in relation to the merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust; and the Medicines Management Consultation.

In relation to the merger of Peterborough and Stamford Hospitals NHS Foundation Trust with Hinchingbrooke Health Care NHS Trust, the Committee established a working group, on 21 September 2016, to draft and finalise the response of the Committee to the Full Business Case.  The deadline for the response was 7 November 2016 and the response of the Committee would be reported to both Trust Boards at their meetings in November 2016.

On the basis of the information received, the Committee supported the full business case for the merger and was reassured that the outcome of the merger would not impact directly on Lincolnshire patients.  In addition, in the event of a significant change of service in the future, the Committee would seek to be involved in any consultation on service change, led by the appropriate commissioners.

The full response of the Committee could be found at Appendix B to Agenda Item 11 on pages 113/114 of the agenda pack.

A working group was also established, on 26 October 2016 to draft and finalise the response of the Committee to the Medicines Management Consultation which was being undertaken by the four clinical commissioning groups in Lincolnshire.  The response of the Committee on the proposals put forward are noted below:-

·       Proposal 1 – To restrict providing over the counter/minor ailment medicines for short term, self-limiting conditions – the Committee supported the principle of self-care for very minor ailments but noted that some medicines, such as paracetamol or ibuprofen were cheap and widely available in supermarkets, etc.  Some over the counter medicines, including cough syrups, thrush creams or child paracetamol, however, were not as cheap nor readily available.  The Committee recorded its concerns that this may have an impact on low income families;

·       Proposal 2 – To restrict the prescription of gluten-free foods – the Committee supported the proposal to limit prescribing of gluten-free foods to loaves of bread, bread-flour and bread mixes (in accordance with Coeliac UK's recommended quantities).  However, GP's should be advised to take account of the impact of these arrangements on particular individuals and allow discretion in exception circumstances to prescribe additional products;

·       Proposal 3 – To restrict prescribing of baby milks and specialist infant formula – the Committee noted that specialist baby milks and infant formulas may cost up to four times as much as standard milk and formulas.  The Committee expressed concern about the potential impact on low income families and believed that GPs should be allowed to use discretion in these circumstances;

·       Proposal 4 – To restrict prescribing oral nutritional supplements -  the Committee strongly supported the "food first  ...  view the full minutes text for item 50.