Agenda and minutes

Apologies for absence were received from Councillor T M Trollope-Bellew and Dr B Wookey.

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

Councillor Mrs S M Wray advised the Committee that she was one of the founders of the Butterfly Hospice which was to be considered by the Committee at Agenda Item 6 – The Butterfly Hospice, Boston.

Mr P Keeling, Healthwatch representative, advised the Committee that he was a former Chairman of the Butterfly Hospice which was to be considered by the Committee at Agenda Item 6 – The Butterfly Hospice, Boston.

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), both of whom would be addressing the Committee at Agenda Item 5 – East Midlands Ambulance Service Update and Performance and Agenda Item 8 – LIVES (Lincolnshire Integrated Volunteer Emergency Services) Status Report and Update.

Councillor Mrs C A Talbot advised the Committee that she continued to be a patient of Nottingham University Hospitals NHS Trust but also under the care of a team at United Lincolnshire Hospitals NHS Trust.

Councillor Mrs P F Watson advised the Committee that she continued to be a patient of United Lincolnshire Hospitals NHS Trust.

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

i)             Congenital Heart Disease – Launch of Consultation

On 9 February 2017, NHS England launched the national consultation on Congenital Heart Disease services.  The consultation would continue through the local government purdah period to 5 June 2017.  The Chairman intended to discuss the arrangements for the Committee's response to the consultation as part of the Work Programme item.  The overall length of the NHS England consultation materials was in excess of 200 pages.

The Chairman also reported that the General Meeting of the East Midlands Councils was considering this item at its meeting on 15 February 2017 which included a recommendation that all health overview and scrutiny committees in the East Midlands also make a robust response to the consultation.

It was noted that only two health scrutiny committees in the East Midlands had not provided a response therefore it was important that there was a united voice on this issue across the region. 

The Chairman confirmed that no response had been received, from the Secretary of State for Health, to the letter asking why the Department had allowed a consultation during Purdah.

ii)            East Midlands Ambulance Service  - Care Quality Commission Inspection

The Care Quality Commission (CQC) had undertaken an inspection of East Midlands Ambulance Service (EMAS) in November 2015.  For three days from 21 February 2017, the CQC would carry out a follow-up inspection to review areas of concern identified during their last inspection.  The inspection would concentrate on those areas where the CQC had identified concerns including the Warning Notices, which had sought improvement in areas such as staff resourcing; response times; and hospital handover delays.

Progress with recommendations in the November 2015 CQC inspection was not covered in detail in the report at item 5 which would focus on response times in Lincolnshire.

iii)          Louth Ambulance and Fire Station

Lincolnshire Fire and Rescue and the East Midlands Ambulance Service had decided to share an operational base on Eastfield Road in Louth from August 2017.  A new ambulance and fire station would be located on the site of the existing fire station.  This was a good example of collaboration between two blue light services.

iv)          West Lindsey District Council Health Commission

The Chairman referred to a letter dated 26 January 2017, from Councillor Sheila Bibb, Chairman of West Lindsey District Council's Health Commission, and Manjeet Gill, Chief Executive of West Lindsey District Council.  The letter explained the role of the West Lindsey Health Commission.  The Chairman confirmed that the letter had been acknowledged and an explanation of the role of the Health Scrutiny Committee for Lincolnshire included.  This also emphasised the importance of each district council representative on the Committee.

v)            Referral to the Secretary of State – Grantham and District Hospital

On 10 February 2017, the Chairman wrote to the Rt Hon Jeremy Hunt MP, Secretary of State for Health, to pursue a response to the Committee's referral in relation  ...  view the full minutes text for item 72.

RESOLVED

          That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 18 January 2017 be approved and signed by the Chairman as a correct record.

(To receive a report from Blanche Lentz (Lincolnshire Divisional Manager, East Midlands Ambulance Service (EMAS)) which summarises the key areas of demand and performance within East Midlands Ambulance Service with particular reference to the Lincolnshire Division.  Blanche Lentz (Lincolnshire Divisional Manager) and Neil Scott (Lincolnshire Assistant Divisional Manager) will be in attendance for this item)

Consideration was given to a report by Blanche Lentz (Lincolnshire Divisional Manager, East Midlands Ambulance Service NHS Trust) which summarised the key areas of demand and performance within East Midlands Ambulance Service with particular reference to the Lincolnshire Division.

Blanche Lentz (Lincolnshire Divisional Manager, EMAS), Neil Scott (Lincolnshire Assistant Divisional Manager (EMAS) and Dr John Stephenson (Associate Medical Director, EMAS) were in attendance for this item.

The national performance standards, set for calls to ambulance services, was explained to the Committee as follows:-

·       Red 1 – immediately life threatening calls – 7 minute response time from call received (target 75%) and 19 minute response time for conveying resource to scene (target 95%);

·       Red 2 – life threatening calls – 8 minute response time from call received (target 75%) and 19 minute response time for conveying resource to scene (target 95%);

·       Green 1 – serious but not life threatening calls – 20 minute response time from call received (target 85%);

·       Green 2 – serious but not life threatening calls with no serious clinical need – 30 minute response time of 30 minutes of call received (target 85%);

·       Green 3 – non-life threatening non-emergency call – telephone assessment within 20 minutes of call received (target 85%);

·       Green 4 – non-life threatening non-emergency call – telephone assessment within 60 minutes of call received (target 85%).

The contractual arrangements for the Trust during 2016-17 provided an expected performance against Red1, Red2 and Red19.  With approval from the Clinical Commissioning Groups in the East Midlands, the contractual targets had been set at a lower level than the national performance standards.    Although EMAS was only required to meet response time performance across the Trust as a whole it was stressed that the local expectation was an increase in performance.

Nationally ambulance services were struggling with performance against the national trajectory and standards set and during quarter 3 of 2016/17, the Lincolnshire Division (including North and North East Lincolnshire) did not meet these standards.  Ambulance Services across England continued to struggle with demand and the ability to meet the nationally set targets.  Future changes set by the Ambulance Response Programme nationally would also impact this position as the service migrated to the new method of coding and response by 2017-18.

In relation to Red Conversion rates for Quarter 3 performance at Clinical Commissioning Group level, the percentage was split between red and green calls.  The Red Conversion rate provided a comparison between calls for the very unwell which necessitate a response within eight minutes, compared to calls for the moderately unwell where a response in excess of eight minutes was accepted.

The expected and forecast level to meet national performance standards was 42% of emergency calls and had an acuity level which necessitated an eight minute response.  The increased red conversion rate above the level was a marker of increased acuity of 999 calls.  The red conversion rate had steadily increased to a level of 58% in December 2016 which was significantly above the expected level for  ...  view the full minutes text for item 74.

(To receive a report from Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services) providing information on the Butterfly Hospice in Boston, which opened to inpatients in 2014, and the planned future developments for the Hospice.  Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services), Clare Credland (Integrated Services Lead, Lincolnshire Community Health Services) and Linda Sanderson (Butterfly Hospice Trust Manager) will be in attendance for this item)

Consideration was given to a report by Lincolnshire Community Health Services NHS Trust and Butterfly Hospice which provided information on the Butterfly Hospice in Boston.  The Hospice opened to patients in 2014 and the report also included information about the planned future developments for the Hospice.

At 11.46am, Councillor J Kirk re-entered the meeting.

Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services NHS Trust), Clare Credland (Integrated Services Lead, Lincolnshire Community Health Services NHS Trust), Linda Sanderson (Butterfly Hospice Trust Manager) and Yvonne Slater (Chair of Trustees, Butterfly Hospice) were in attendance for this item.

Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services NHS Trust) introduced the report which noted that in the Hospice's full year (2015) 106 patients had been admitted.  Admissions had increased to 161 for 2016.

At 11.50am, Councillor Mrs P F Watson re-entered the meeting.

Following a meeting with 600 Boston residents in September 2000 to discuss the need for palliative care in the local area, a Trustee Board was formed for the Butterfly Hospice Trust.  The Trust was now both a registered charity and a private limited company as this status meant that individual Trustees and employees could not be liable for business debts.  Initial fundraising had resulted in £1.2m being raised, which meant the Hospice could be built and, in March 2009, NHS Lincolnshire committed to commission twenty-two additional community inpatient beds across Lincolnshire for service users identified as end of life. The building opened in 2011 and six inpatient beds were commissioned by Lincolnshire East Clinical Commissioning Group (LECCG) and a three year partnership agreement put in place between the Butterfly Hospice and Lincolnshire Community Health Services NHS Trust (LCHS) in August 2014.

Care was delivered with a nurse-led model with GP input.  LCHS provided the nursing care and the Butterfly Hospice Trust agreed to raise the funds to cover all operational and maintenance costs associated with the building.  Chefs and housekeeping staff were also employed and WiFi had also been installed for the benefit of patients and visitors.

Key principles of care were followed by the Hospice to ensure End of Life Care Service Users:-

·       Were treated with dignity and respect at all times;

·       Received effective symptom management whatever the diagnosis;

·       Had choice and control over where they would prefer to die; and

·       Were in the company of people who cared about them when they died.

The expected outcomes of the Hospice were explained:-

·       Increased quality of life for Service Users through the reduction of distressing symptoms;

·       Increased Service User and Carer/family satisfaction of the service;

·       Increased numbers of Service Users who would achieve their Preferred Priorities of Care (PPoC);

·       Increased numbers of Service Users who would achieve their Preferred Priorities of Death (PPoD);

·       An Advanced Care Plan to be in place for all Service Users;

·       Increased numbers of non-cancer Service Users accessing services;

·       Reduced numbers of deaths in acute hospitals; and

·       Reduced strain and anxiety of Carers in the short term.

The referral  ...  view the full minutes text for item 75.

(To receive a report from Jane Marshall (Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust) which provides the Committee with information on proposed options on the future model of Learning Disability Services for the people of Lincolnshire)

Consideration was given to a report from Jane Marshall (Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust (LPFT)) which provided information on the proposed options on the future model of Learning Disability Services for the people of Lincolnshire.

Jane Marshall (Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust), Allan Kitt (Accountable Officer, South West Lincolnshire Clinical Commissioning Group) and Sharon Jeffreys (Chief Commissioning Manager, South West Lincolnshire Clinical Commissioning Group) were in attendance for this item.

Jane Marshall (Director of Strategy and Performance, LPFT) introduced the report by giving the background to the proposed options.  Section 242 of the Health and Social Care Act 2016 was a statutory requirement for NHS bodies to consult with Overview and Scrutiny Committees, patients, public and stakeholders when consideration was given to a proposal for the substantial development of the health service or a substantial variation in the provision of a service.  Prior to 2015, learning disability services in Lincolnshire consisted of Long Leys Court (Lincoln), a unit of 16 beds with eight assessment and treatment beds and eight rehabilitation beds.  Community services included a dispersed range of health professionals located across the county.

In June 2015, Long Leys Court was closed temporarily following safety concerns of the unit.  The decision was taken by Lincolnshire Partnership NHS Foundation Trust (LPFT) with the Clinical Commissioning Group and in partnership with the patients and carers/families of people within the unit at the time.  The temporary closure meant that the progress with the national Transforming Care programme was accelerated to enable a new model of care to be introduced.

Since 1 April 2016, a new fully developed integrated community service had been running effectively which had stopped waiting times between professionals, ensured most patients were treated at home and provided equal services across the county.  The service was delivered across Lincolnshire by a total of five multi-professional teams.  Four community hubs were also aligned with the Clinical Commissioning Groups with satellite bases around the county to reduce travel and to ensure local service delivery.

Following the successful implementation of the new model of care, LPFT believed that there was no longer a requirement for an inpatient unit such as Long Leys Court.  To ensure the best service was available to Lincolnshire residents, a consultation with stakeholders was required on the options for providing inpatient beds for the small number of people who needed that level of care.

The improvements to learning disability services had originally been planned to be part of the Lincolnshire Health and Care public consultation, however due to the successful implementation of the new service model, both the Transforming Care Board and Senior Managers from the service provider felt that it would be appropriate to carry out a focussed consultation with immediate effect.

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

·       The Transforming Care Agenda clearly stated that all patients must undergo a full review to decide if admission to hospital was required and, if  ...  view the full minutes text for item 76.

(To receive a report from Nikki Silver (Chief Executive Officer, LIVES) which provides the Committee with a status report and update on services provided by Lincolnshire Integrated Volunteer Emergency Services.  Nikki Silver (Chief Executive Officer, LIVES) and Dr Simon Topham (Clinical Director, LIVES) will be in attendance for this item)

Consideration was given to a report from Nikki Silver (Chief Executive Officer, Lincolnshire Integrated Volunteer Emergency Services (LIVES)) which provided a status report and update on services provided by LIVES.

Nikki Silver (Chief Executive Officer, LIVES) and Dr Simon Topham (Clinical Director, LIVES) were in attendance for this item.

Dr Simon Topham (Clinical Director, LIVES) introduced the report which explained that LIVES was a charity in its 48^th year of operation and which held the charitable objectives noted below:-

          To provide Immediate Medical Care to any person injured in an accident involved in any medical emergency in the area of Lincolnshire, North East Lincolnshire, or any area reasonable close to.  To advance the principle of Pre-Hospital Emergency Care on a national basis; providing advice and guidance in all aspects of such care, including the delivery of training and provision of approved emergency equipment.

Responders were organised into operational groups based on a response time of approximately six minutes under normal driving conditions.  There were over 160 responder groups across Lincolnshire with around 700 active LIVES Community First Responders and LIVES Medics.  The service had responded to almost 21,000 emergency calls in 2016 which was an increase of approximately 15% on the previous year.  It was expected that this would continue to increase.

LIVES appointed its first Chief Executive Officer in recognition that the organisation had reached a level where strategic development was required to respond to the ever-growing demand for health and care within a resource-limited NHS.

On receipt of a 999 call within a responder's area, East Midlands Ambulance Service NHS Trust (EMAS) would despatch an emergency ambulance with a response category determined by the AMPDS computer-based triage system.  At the same time, the EMAS Community First Responder (CFR) desk would activate the LIVES responder 'on-duty'.  The responders were dispatched using a response 'isochrones map' determined by an ability to get to the patient within six minutes.  The schema leads to the responder:-

·       Clearing and controlling the airway of an unconscious patient;

·       Providing resuscitation and defibrillation;

·       Giving oxygen therapy;

·       Controlling any bleeding;

·       Taking observations; blood pressure, blood glucose, temperature, respirations and pulse;

·       Being the 'eyes and ears' of the ambulance service and feeding back information to control if the situation is not as initially expected;

·       Making the patient feel more comfortable and at ease; reassuring worried relatives and taking charge of the situation; and

·       Using local knowledge to ensure that the ambulance can find the location quickly.

Responders made the biggest impact on calls coded by the AMPDS system as RED1 or RED2 calls which had been deemed "serious and/or life threatening".  Examples of RED calls were:-

·       Signs of cardiac arrest;

·       Unconsciousness and collapse;

·       Chest pains (for example, heart attack and acute angina);

·       Breathing difficulties (for example, asthma);

·       Diabetic emergencies (for example, hypoglycaemia);

·       Fitting or convulsions (for example epilepsy);

·       Stroke;

·       Anaphylaxis (severe allergic reaction); and

·       Choking.

More experienced volunteers also respond to traumas and some to road traffic collisions and made the early assessment if additional resources  ...  view the full minutes text for item 77.

(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 Committee was also asked to consider the Outcomes of the Delayed Transfers of Care Working Group, which had been circulated to the Committee prior to the meeting. 

The Chairman also invited volunteers for a working group to discuss the planned Consultation by NHS England on Congenital Heart Disease Services prior to the next meeting of the Committee on 15 March 2017.  NHS England would be in attendance at the next meeting, hence the need to hold this meeting in the next two to three weeks.  Councillors J Kirk, C J T H Brewis, S L W Palmer, P Howitt-Cowan, Mrs R Kaberry-Brown agreed to join the Chairman on this working group and a date was agreed for Wednesday 1^st March 2017 at 10.00am.  An appointment and relevant paperwork would be provided in due course.

RESOLVED

1.    That the work programme be agreed;

2.    That the conclusion of the Delayed Transfers of Care Working Group to hold a detailed review in the new council term be supported;

3.    That the Congenital Heart Disease Consultation Working Group, with the Members noted above, be arranged for Wednesday 1^st March 2017 at 10.00am.