Agenda and minutes

Apologies for absence were received from Councillors Miss E L Ransome 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 (North Kesteven District Council) for this meeting only.

The Democratic Services Officer reported that, since the last meeting of the Committee, two substantive members had been appointed to the Committee in place of the published vacancies.  Councillor P Howitt-Cowan had been appointed as the representative for West Lindsey District Council and Councillor P Gleeson had been appointed  as the representative for Boston Borough Council.

Councillor Mrs C A Talbot advised the Committee that she continued to be a patient of Nottingham University Hospitals NHS Trust but was also under the care of a team at United Lincolnshire Hospitals NHS Trust, which may be discussed under Item 6 – Lincolnshire Sustainability and Transformation Plan.

Councillor Mrs P F Watson advised the Committee that she was also a patient of United Lincolnshire Hospitals NHS Trust, which may be discussed under item 6 – Lincolnshire Sustainability and Transformation Plan.

Dr B Wookey advised the Committee that he was currently a patient of University Hospitals of Leicester NHS Trust at Glenfield Hospital, which was the base of the service to be discussed at item 7 – Congenital Heart Disease Services.

Councillor S L W Palmer advised the Committee that he was a LIVES First Responder and, when activated, was under the employment of the East Midlands Ambulance Service NHS Trust (EMAS), which may be discussed at item 6 – Lincolnshire Sustainability and Transformation Plan.

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

i)             Membership: Boston Borough Council and West Lindsey District Council

The Chairman referred to the appointment of Councillor Paul Gleeson to the Committee as the representative of Boston Borough Council and welcomed Councillor Gleeson to his first meeting.

The Chairman also referred to the appointment of Councillor Paul Howitt-Cowan to the Committee as the representative of West Lindsey District Council and welcomed Councillor Howitt-Cowan to his second meeting of the Committee.

ii)            Agenda Order

Owing to the availability of NHS colleagues, there had been a change to the agenda order for the meeting.  Items would be considered in the following order:-

·       Congenital Heart Disease Services (Item 7)

·       Lincolnshire West Clinical Commissioning Group Update (Item 5)

·       Lincolnshire STP – Response of the Health Scrutiny Committee (Item 6)

The Chairman confirmed that the afternoon session would run as planned.

iii)          Circulation of Additional Documents

Since the publication of the agenda, four additional documents had been circulated to the Committee via two emails.  The first email enclosed the Draft Response of the Committee to Lincolnshire Sustainability and Transformation Plan.  The second email enclosed the Minutes of the Extraordinary Meeting of the Committee held on 12 January (which would be confirmed at agenda item 4); information from Will Huxter dated 17 January 2017; and information on neighbouring Sustainability and Transformation Plans.

All Members of the Committee confirmed that they were in receipt of these documents.

iv)          Congenital Heart Disease Services – Letter from Will Huxter, 17 January 2017

At the last ordinary meeting of the Committee, on 21 December 2016, the Committee requested the attendance of Will Huxter (Senior Responsible Officer at NHS England) at this meeting to present the additional information requested by the Committee.  Mr Huxter indicated on 4 January 2017 that he was unavailable but would provide the information in writing.  The Chairman wrote to Mr Huxter on 9 January 2017 to express disappointment at his non-attendance and to ask for confirmation of the date of the public consultation, as well as reiterating the request for additional information.

On 17 January 2017, the Chairman received a letter from Mr Huxter with an enclosure which detailed the additional information requested by the Committee on 21 December 2016, which was circulated to the Committee on 17 January.  The Chairman stressed that there was still no confirmation of the public consultation date, although the additional information referred to the Department of Health sanctioning consultation during the Purdah period.

v)            Congenital Heart Disease Services – All-Party Parliamentary Group on Heart Disease and East Midlands Councils

The Chairman was of the understanding that colleagues from University Hospitals of Leicester NHS Trust were to attend a meeting of the All-Party Parliamentary Group on Heart Disease, chaired by Stuart Andrew MP.  The remit of the groups was:-

·       to inform and educate parliamentarians about heart and circulatory disease, the single most common cause of death in the UK;

·       to encourage and promote work undertaken to  ...  view the full minutes text for item 63.

RESOLVED

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

It was noted that Councillor R A Renshaw had been included within the attendance list as an observer of the Committee when, in fact, he had attended as a replacement member for Councillor R C Kirk and should have, therefore, been included under the attendance for Lincolnshire County Council.

RESOLVED

          That the minutes of the extraordinary meeting of the Health Scrutiny Committee for Lincolnshire held on 12 January 2017, with the amendment noted above, be approved and signed by the Chairman as a correct record.

(To consider a report by Simon Evans (Health Scrutiny Officer) which provides the Committee with some points of clarification from University Hospitals of Leicester NHS Trust, including a letter from the Trust's Chief Executive, following the last meeting.  Representatives from University Hospitals of Leicester NHS Trust will be in attendance)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer) which provided some points of clarification to the Committee from University Hospitals of Leicester NHS Trust, including a letter from the Trust's Chief Executive, following the last meeting.

Dr Frances Bu'Lock (Honorary Associate Professor in Congenital and Paediatric Cardiology – East Midlands Congenital Heart Centre) and Jon Currington (Head of Partnerships, University Hospitals of Leicester NHS Trust) were in attendance for this item.

On 21 December 2016, Will Huxter (Regional Director of Specialised Commissioning, NHS England (London Region)) and Dr Geraldine Linehan (Regional Clinical Director of Specialised Commissioning, NHS England (Midlands and East Region)) attended the Committee to provide information on NHS England's reasoning for indicating that the East Midlands Congenital Heart Centre (EMCHC) would not meet the required standards for congenital heart disease surgery with a view to decommissioning those services from the EMCHC.

Both Mr Huxter and Dr Linehan were requested to attend this meeting to provide additional information and further points of clarification requested by the Committee.  However, they had indicated that they would be unable to attend in person but would provide the information in writing.  The information had been received and circulated to the Committee prior to the meeting.

The view of University Hospitals of Leicester NHS Trust had been included within the report by way of a letter dated 1 January 2017 from John Adler (Chief Executive) to the Chairman.  The Chairman had also written to NHS England to request dates for the formal public consultation and it was noted that the response from Mr Huxter confirmed that permission had been granted by the Department of Health to run the consultation during Purdah. 

Dr Bu'Lock addressed the Committee and noted the following responses to the statements made by NHS England at the last meeting:-

·       Point 1 (a) – 375 cases this year – this was not a requirement of the new cardiac review standards – the actual standard stated 375 cases were required, averaged over three years from April 2016.  East Midlands Congenital Heart Centre would achieve this standard in the required timescales;

·       Point 1 (b) – 500 cases by 2020 – a growth plan had been provided to NHS England on 7 November 2016 which showed that East Midlands Congenital Heart Centre would achieve the required 500 cases by 2020;

·       Point 1 (c) – surgeons – the standards did not require surgeons to be employed in a substantive role and other centres also had consultants on locum contracts.  It was usual practice to offer locum contracts to allow overseas consultants time to register with the GMC specialist register (a pre-requisite for a substantive post). On 2 December 2016 an appointment for a new substantive consultant was made as well as an additional appointment from those interviews to allow service development and succession planning.  Despite the adverse climate, there were nine high quality applicants for this particular post;

·       Point 2 (a) – network and out of area referral were purely patient choice  ...  view the full minutes text for item 65.

(To receive a report from Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group) which provides an update on the activities of Lincolnshire West Clinical Commissioning Group (LWCCG) and includes information on the lead commissioning arrangements undertaken by LWCCG; APMS (Alternative Provider of Medical Services) practices, financial and performance information; and patient engagement activity.  Sarah Newton (Chief Operating Officer, LWCCG) and Dr Sunil Hindocha (Chief Clinical Officer, LWCCG) will be in attendance for this item)

Consideration was given to a report by Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group) which provided an update on the activities of Lincolnshire West Clinical Commissioning Group (LWCCG) and included information on the lead commissioning arrangements undertaken by LWCCG; APMS (Alternative Provider of Medical Services) practices, financial and performance information; and patient engagement activity.

Sarah Newton (Chief Operating Officer, LWCCG), Dr Sunil Hindocha (Clinical Chief Officer, LWCCG) and Richard Childs (Lay Chair, LWCCG) were all in attendance for this item.

Lincolnshire West CCG had a registered population of 234,594 patients, was in its fourth year of commissioning health services and was experiencing increased demand for healthcare, prescribing and hospital services.  The CCG had fully delegated authority for Primary Medical (General Practice) services, the commissioning of which was managed through the Primary Care Co-commissioning Committee (PCCC), constituted to minimise any conflict of interest with GPs as members of the CCG.  The PCCC also included representatives from Healthwatch Lincolnshire and the Health and Wellbeing Committee as observers. 

Five of the 37 practices were operated under APMS when the CCG took over delegated responsibility in April 2015.  Since then the company running the University Practice APMS contract went into liquidation in March 2016.  Following a successful procurement process, the contract to run this practice was awarded to the Nottingham University Health Service, rated by the Care Quality Commissioning (CQC) as Outstanding. 

In July 2016, the CCG was given one month's notice of an intent to apply for voluntary liquidation by Universal Health, who held the remaining four APMS contracts (Burton Road Surgery, Lincoln; Pottergate Surgery, Gainsborough; Arboretum Practice, Lincoln; and Metheringham Surgery).  The services of a Caretaker Manager for these practices, whilst undergoing a consultation process for an alternative provider, was sought and, despite a number of expressions of interest, only one single bid was received for three practices.  Pottergate Surgery received two bids.  The bids were independently evaluated and a determination made that neither bidder met the minimum criteria to make a contract award.  It was therefore decided by the PCCC to close the practices.

The four surgeries formally closed to patients on 13 January 2017 and all patients who had not registered with an alternative practice by 6 January 2017 had been contacted to advise automatic registration with the GP practice closest to their existing provider.

In addition to the content of the report, the Committee was advised that the closure was not as a result of finances but the lack of a suitable provider to take over the contracts.  It had, however, cost over £50k per month over the baseline funding to keep these surgeries open whilst a new provider was sought.  Universal Health also went into liquidation owing a considerable sum to the CCG.  Disappointment at the failure of the private sector to be held to account was expressed as some of these contracts had been inherited from NHS England and not awarded by the CCG.

Lead commissioning arrangements of all CCGs had also been reviewed  ...  view the full minutes text for item 66.

(To receive a report from Simon Evans (Health Scrutiny Officer) which invites the Committee to consider the draft statement prepared following the discussions of the Committee at the extraordinary meeting held on 12 January 2017.  The draft statement, prepared on behalf of the Committee, will be circulated prior to the meeting)

Consideration was given to a report by Simon Evans (Health Scrutiny Officer) which invited the Committee to consider the draft statement prepared following the discussions of the Committee at the extraordinary meeting held on 12 January 2017.

At 12.25pm, Councillor R C Kirk left the meeting and did not return.

The draft statement was circulated to the Committee on 17 January 2017 for information.  The Committee made the following comments:-

·       Information on the number of births to Lincolnshire mothers at Lincoln County Hospital and Pilgrim Hospital, Boston, was asked to be included;

·       To include a paragraph calling for consideration to the balance between increased specialisation and the provision of services locally;

·       To make reference to the Lincolnshire Workforce Advisory Board under "Workforce"; and

·       To add a paragraph within the conclusion to clearly state the Committee's view that the case for change had been partially demonstrated but reserved the right to consider and respond to proposals for substantial change as part of the forthcoming consultations.

In order for the Final Statement to be prepared for approval by the Committee, the Chairman adjourned the meeting for lunch at 12.45pm and asked the Committee to reconvene at 2.00pm. 

NOTE:   At 2.00pm, the Chairman reconvened the meeting.  On return, the following Members and Officers were in attendance:-

Lincolnshire County Council

Councillors S L W Palmer, Mrs S Ransome, Mrs J M Renshaw, Mrs C A Talbot (Chairman), T M Trollope-Bellew and Mrs S M Wray.

Lincolnshire District Councils

Councillors P Gleeson (Boston Borough Council), Mrs P F Watson (East Lindsey District Council), J Kirk (City of Lincoln Council), Mrs K Cook (North Kesteven District Council), C J T H Brewis (South Holland District Council (Vice-Chairman)), Mrs R Kaberry-Brown (South Kesteven District Council) and P Howitt-Cowan (West Lindsey District Council)

Also in attendance

Liz Ball (Executive Nurse, South Lincolnshire CCG), Andrea Brown (Democratic Services Officer), Dr Kakoli Choudhury (Consultant in Public Health), Simon Evans (Health Scrutiny Officer), Gary James (Accountable Officer, Lincolnshire East CCG) and Steve Mosley (Chief Officer, Lincolnshire Local Pharmaceutical Committee)

County Councillors R A Renshaw and M A Whittington attended the meeting as observers.

The Chairman proposed that agenda item 8 be considered prior to the final sign of the STP Statement as the guest speaker for this item was already in attendance.  This was agreed by the Committee.

Following consideration of agenda item 8, the Final Statement, with the suggested amendments, was circulated to the Committee and read as follows:-

"INITIAL RESPONSE OF THE HEALTH SCRUTINY COMMITTEE FOR LINCOLNSHIRE ON THE LINCOLNSHIRE SUSTAINABILITY AND TRANSFORMATION PLAN

CONTEXT FOR THE COMMITTEE'S INITIAL RESPONSE

Role of the Health Scrutiny Committee for Lincolnshire

The Health Scrutiny Committee would like to emphasise its role reviewing and scrutinising the NHS, in terms of the health services available to and accessed by the Lincolnshire population.   The Committee can seek to influence the decision making within the NHS, but decisions on the provision of NHS services rest with the local NHS, NHS England, and ultimately the Secretary of  ...  view the full minutes text for item 67.

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides information on how the Implementation of "Community Pharmacy in 2016/17 and Beyond:  The Final Package" is impacting on local pharmacies.  Steve Mosley (Chief Officer of the Lincolnshire Local Pharmaceutical Committee (LPC) will be in attendance for this item)

Consideration was given to a report from Simon Evans (Health Scrutiny Officer) which provided information on how the Implementation of "Community Pharmacy in 2016/17 and Beyond:  The Final Package" was impacting on local pharmacies.

Steve Mosley (Chief Officer of the Lincolnshire Local Pharmaceutical Committee) was in attendance for this item.

On 20 October 2017, the Government published Community Pharmacy in 2016/17 and Beyond:  The Final Package which set out the Government's response and decision on its consultation which closed on 26 May 2016 and to which the Health Scrutiny Committee responded on 27 April 2016.

The response from the Local Government Association; National Pharmacy Association; Royal Pharmaceutical Society; and Pharmacy Voice were also included within the report pack for the Committee's information.

The Committee had previously considered this paper and additional information from the Lincolnshire Local Pharmaceutical Committee on 20 April 2016 where it was agreed that a letter be sent to the Secretary of State for Health from the Chairman of the Committee on behalf of the Committee noting the Committee's concerns.

A response to that letter was received from the Rt Hon Alistair Burt MP, Minister of State for Community and Social Care on 10 June 2016 acknowledging the concerns of the Committee and assuring the Chairman that all correspondence had been passed to the relevant officials who were considering the consultation responses.

The Chairman wrote to the Minister of State for Community and Social Care on 21 June 2016 confirming that the Committee had been advised of the Pharmacy Access Scheme referred to in his letter of 10 June 2016.  The Chairman also requested that, in future, local authority overview and scrutiny committees be directly consulted for their views on any such potential change in funding arrangements which could impact on local health provision.  The Chairman reiterated the position that the closure of up to 30 pharmacies in Lincolnshire would constitute a substantial variation in health service provision within the County and would strongly urge the Department of Health to make sure that the Pharmacy Access Scheme ensured that rural areas were not left without community pharmacies.

The announcement by the Secretary of State for Health calling for GPs to open seven days per week would have detrimental impact on pharmacies.  Pharmacies were able to play a key role in making the NHS more efficient and a competitive buying market had driven down medicine prices for the NHS more effectively than a single model had previously. 

The level of rurality meant that this package had impacted less in Lincolnshire than in some other areas as the Pharmacy Access Scheme protected rural communities better than urban areas with high deprivation.  A key driver of healthcare need was demand.  For example, a large GP practice and two pharmacies within 100 yards of each other within Lincoln was due to patient demand rather than commercially driven.

Two judicial reviews were ongoing against the decision of the Department of Health.

Members were invited to ask questions, during which the following points  ...  view the full minutes text for item 68.

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

Consideration was given to a report by the Health Scrutiny Officer which gave the Committee the opportunity to consider its work programme for the coming months.

During consideration the following amendments were proposed:-

·       Add an item to the work programme for a future meeting of the Committee to consider screening programmes for cervical, breast and prostate cancer; and

·       Arrangements for Quality Accounts to be added to the work programme for the meeting of the Committee on 15 February 2017.

RESOLVED

          That the work programme, with the amendments noted above, be agreed.