Agenda and minutes

No apologies for absence were received from members of the Committee.

An apology for absence was received from Councillor Mrs S Woolley (Executive Councillor NHS Liaison and Community Engagement).

Councillor Mrs P F Watson advised the Committee that she was currently a patient of United Lincolnshire Hospitals NHS Trust.

Councillor C J T H Brewis advised the Committee that he had recently received cataract eye surgery from the Anglia Community Eye Service, Wisbech.

Councillor M T Fido advised the Committee that his partner was employed by East Midlands Ambulance Service, as an Emergency Dispatcher for 999 Calls.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 19 July 2017 be approved and signed by the Chairman as a correct record.

Further to the Chairman's announcements contained within the agenda for the meeting, the Chairman made reference to the supplementary information circulated to all members of the Committee in advance of the meeting, which included the following:-

United Lincolnshire Hospitals NHS Trust – Financial Special Measures

That on 1 September 2017, NHS Improvement, the national NHS organisation which oversees all provider trusts, had announced that United Lincolnshire Hospitals NHS Trust had been placed in 'financial special measures'. 

The Committee was advised that the Chairman was due to meet Karen Brown, the Trust's Director of Finance, Procurement and Corporate Affairs later in the day to gain further information on the Trust's deficit and how the special measures would operate.

Chair of United Lincolnshire Hospitals NHS Trust Board

That on 23 August 2017, Dean Fathers, the Chair of United Lincolnshire Hospitals NHS Trust Board, had announced that he was standing down.  The Committee was advised that a recruitment process was underway; and that the Chairman would be attending a stakeholder engagement event on 3 October 2017, to meet and interact with potential candidates.

Re-ablement and Rehabilitation Services for People over 65

It was reported that at its last meeting, the County Council's Adults and Community Wellbeing Scrutiny Committee had considered the performance of re-ablement and rehabilitation services in Lincolnshire for people over 65.

The Scrutiny Committee had noted that in relation to the '91 day' indicator the performance of the provider of re-ablement commissioned by the County Council had exceeded the performance of the provider of intermediate care commissioned by the clinical commissioning groups.  As a result, the Adults and Community Wellbeing Scrutiny Committee had asked for the matter to be considered by the Health Scrutiny Committee for Lincolnshire.

The Chairman drew the Committees attention to pages 15/16 concerning the item relating to Proposed GP Mergers in Louth.  The Committee was invited to comment on how it wished to proceed with this matter.

The representative for East Lindsey District Council advised that in her capacity as the Mayor of Louth, she had had conversations with the practices concerned and from the information received; the Committee should record its support for the proposed mergers.

The Committee agreed that it would not formally respond to the proposed mergers at this stage, but would record its positive support, on the basis that there was no expected negative impact on the ability of patients to access primary care services from their practice.

The Chairman also drew the Committee's attention to the list of Annual General Meetings/Annual Public Meeting detailed on page 17 of the agenda.  The Committee were invited to register any interest in attending the meetings.

The following members indicated that they would be attending the following meetings:-

·         14 September 2017 – Lincolnshire Partnership NHS Foundation Trust – Councillor K Cook;

·         19 September 2017 – South West Lincolnshire CCG – Councillors R J Kendrick;

·         19 September 2017 – Lincolnshire Community Health Services NHS Trust – Councillor J Kirk;

·         22 September 2017 – United  ...  view the full minutes text for item 23.

(To receive a report from Simon Evans (Health Scrutiny Officer), which asks the Committee to consider the determination of the Secretary of State for Health on the overnight closure of the Grantham Accident and Emergency Department; and the latest information from United Lincolnshire Hospitals NHS Trust regarding their staffing levels for emergency care.  Jan Sobieraj (Chief Executive of United Lincolnshire Hospitals NHS Trust) and Dr Neill Hepburn (Trust's Medical Director) will be in attendance for this item)

The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Dr Neil Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust.

The report presented advised the Committee that on 2 August 2017, the Secretary of State for Health had issued his decision on the referral of the overnight closure of Grantham Accident and Emergency Department, which had been submitted by the Health Scrutiny Committee for Lincolnshire in December 2016.  It was reported that the Secretary of State for Health had accepted the advice of the Independent Reconfiguration Panel (IRP) that the referral did not merit a full review and should be resolved locally.

Detailed at Appendix A to the report was a copy of the advice received from the IRP; and Appendix B provided a copy of the letter from the Secretary of State for Health to the Chairman of the Health Scrutiny Committee for Lincolnshire, dated 2 August 2017.

The Committee was asked to consider the determination of the Secretary of State for Health and consider what next steps should be taken with regard to 'further local action by the NHS with the Council to address the issues raised; and to consider the latest information from United Lincolnshire Hospitals NHS Trust, regarding their staffing levels for emergency care'.

The Chairman also welcomed to the meeting Councillors L Wootten (Grantham East County Councillor) and R Wootten (Grantham North County Councillor), who had made a request to the Chairman to address the Committee regarding this item.

The Chairman advised that he proposed to allocate the two Councillors three minutes each to address the meeting, following which the Committee would receive an address from the Trust.  The Committee was advised further that the Chairman was then proposing to allow one representative from each of the patient groups present three minutes to address the Committee.

Both of the Grantham Councillors in their address to the Committee expressed the concerns of local people in and around Grantham who were furious about the down grading of the Accident and Emergency service they had been receiving, and to the fact that one year on, there was still no plan to reinstate overnight services at the Accident and Emergency Department.  It was felt that the reduced service was causing local people extra stress and was also putting them at risk.  Some concern was also expressed regarding the United Lincolnshire Hospitals NHS Trust being placed in 'financial special measures'.  In conclusion, the Health Scrutiny Committee for Lincolnshire was asked to do all it could to help resolve the situation for Grantham residents.

Some members of the Committee echoed the concerns of the two divisional councillors; and one member felt that there needed to be an open and honest conversation regarding the options for future emergency care delivery at Grantham Hospital; and that wider consultation needed to be undertaken with the Council.

The Chief Executive, United Lincolnshire Hospitals NHS Trust advised that the Independent Reconfiguration Panel report had stated that 'Commissioners must as  ...  view the full minutes text for item 24.

(To receive a report from the Lincolnshire West Clinical Commissioning Group, Lead Commissioner of Emergency Ambulance Services in Lincolnshire, which provides the Committee with an overview on how emergency ambulances are commissioned from the East Midlands Ambulance Service.  Martin Kay (Head of Commissioning, Lincolnshire West Clinical Commissioning Group) will be in attendance for this item)

The Committee gave consideration to a report on behalf of Lincolnshire West Clinical Commissioning Group (CCG), Lead Commissioner of Emergency Ambulance Services in Lincolnshire, which provided an overview on how emergency ambulances were commissioned from the East Midlands Ambulance Service (EMAS) NHS Trust.

The Chairman welcomed to the meeting Martin Kay, Head of Commissioning, Lincolnshire West CCG who provided the Committee with some background information to commissioning arrangements.

The Committee noted that the four CCGs commissioned emergency ambulances as part of a collaborative commissioning arrangement across East Midlands, along with further 18 CCGs, to make 22 CCGs in total.  The emergency ambulances commissioned from East Midlands Ambulance Service covered five counties comprising of Derbyshire, Leicestershire, Lincolnshire, Northamptonshire and Nottinghamshire.  It was noted that the commissioning meetings were held at EMAS Trust level and at divisional level.  For Lincolnshire this involved the four County CCGs; and North and North East Lincolnshire CCG (Six CCGs in total who constituted the EMAS Lincolnshire Division).  Full details as to the meeting arrangements were shown on page 54 of the report presented.

It was reported that there was a single contract across the 22 CCGs and EMAS, which was managed by Hardwick CCG.  It was highlighted that additional local requirements could be added to the contract. 

The Committee was advised that the contract currency with EMAS was activity-based using four counts: calls; hear and treat; see and treat; and see and convey; and that contracted activity was based on a three-year rolling analysis, which was then adjusted for system changes that would have an impact on any of the four counts.  The Committee was advised further that the contract value across the four Lincolnshire County CCGs was £25.5m.

It was brought to the Committees attention that the majority of commissioning decisions were managed at Trust level, as these were largely determined by national requirements, which both local commissioners and the provider were obliged to follow.  Regional application of the contract was determined through meetings between the commissioners (Hardwick CCG and County Leads) and EMAS through negotiation.  In Lincolnshire County decisions involved all CCGs, but at times could be CCG specific.  It was noted that there was clear communication between Lincolnshire West CCG, as the lead commissioner and the other three Lincolnshire County CCGs.  It was noted further that having a local approach was important to identify and meet the needs of local people; and that local working had delivered changes which had benefitted the local population.  An example of this was EMAS being a partner in the Lincolnshire Clinical Assessment Service (CAS).  The CAS provided additional clinical support to paramedic's on-scene, which had reduced the number of people taken to hospital, as these people had been better cared for within other community-based services.

A discussion ensued, from which the Committee raised the following issues:-

·         In response to a question on emergency ambulance cost adjustments, it was confirmed that any adjustment in national funding would be passed to the CCGs in the first  ...  view the full minutes text for item 25.

(To receive a report from Simon Evans (Health Scrutiny Officer), which invites the Committee to consider information from the East Midlands Ambulance Service, following the publication of the Inspection report by the Care Quality Commission; and to also consider information relating to the Ambulance Response Programme.  Richard Henderson (Chief Executive of the East Midlands Ambulance Service) and David Williams (General Manager of the East Midlands Ambulance Service will be in attendance for this item)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider information from the East Midlands Ambulance Service, following the publication of the inspection report by the Care Quality Commission; and to also consider information relating to the Ambulance Response Programme.

The Chairman welcomed to the meeting Richard Henderson, Acting Chief Executive, EMAS, David Williams, Interim General Manager for Lincolnshire Division of EMAS and Neil Scott, Service Manager, EMAS.

Appended to the report were the following Appendices:-

            Appendix A – EMAS Lincolnshire Division Update;

Appendix B – Information relating to Ambulance Response Programme Pilot; and

Appendix C – EMAS – Lincolnshire Overview and Scrutiny Committee Briefing Paper.

The Committee was advised that on 13 June 2017, the Care Quality Commission (CQC) had published its report on the East Midlands Service NHS Trust, following inspection visits conducted between 21 - 23 February 2017; and on 3 March 2017.  The overall finding for the Trust was "Requires Improvement" for both emergency and urgent care services".  Details of the CQCs key finding were shown on pages 58 to 60 of the report presented.

Appendix A provided the Committee with an update concerning EMAS and Lincolnshire Division with regard to improvements to ratings applicable to:-

·         Safe – It was highlighted that enhanced arrangements would be put in place to ensure that lessons learnt were captured and addressed. There would be better integration of complaints and investigations teams; and better effective leadership of resolution of hospital handover delays, delivering system-wide changes and improvement;

·         Effective – There would be a revised Capacity Management Plan focussing on patient safety and patient acuity; there would be continued improvement of Medicines Management; a roll-out of pre-hospital antibiotics for Sepsis patients; improvement to survival to discharge from cardiac arrest from 5.9 to 6.9%; and direct access to Primary Percutaneous Coronary Intervention laboratories for stroke patients;

·         Well-led – The Committee was advised that leadership would be strengthened and stabilised; Vision and strategic objectives would be realigned; investment in frontline staffing and equipment; reviewing of long term activity, price and strategic reviews with commissioners; and engagement with the broader health community including A & E Delivery and Escalation Boards and Sustainability Transformation Partnership;

·         Caring – Ensuring best practice in staff support and wellbeing; reducing sickness absence; improving appraisal rates; improving statutory and mandatory training rates; improving staff engagement; and being sector lead in metal health training; and

·         Responsive – Continue to recruit staff; improve skill mix of frontline staff; reduce staff turnover for 11% to 9%; ensure career progression opportunities are offered; review and strengthened emergency resilience, following the devastating and tragic attacks in Manchester and London; financial stability allowing for long-term investment; provision of 57 double crewed ambulances; provision of 164 new defibrillators on vehicles in 2016/17 and a further 127 for coming year; introduction of new electronic patient report from solution (ePRF); and to agree plans with commissioners for long-term strategic review to support greater care focus  ...  view the full minutes text for item 26.

(To receive a report from Simon Evans (Health Scrutiny Officer), which invites the Committee to consider and comment on its work programme).

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which enabled the Committee to consider and comment on the content of its work programme to ensure that scrutiny activity was focussed where it could be of greatest benefit.

Appendix A to the report provided the work programme from 13 September 2017 to April 2018 for the Committee's consideration.

The Committee was invited to highlight any additional scrutiny activity which could be included for consideration in the work programme.

One item suggested was to include as an item for a future agenda United Lincolnshire Hospitals NHS Trust – Progress in Response to Special Measures.

RESOLVED

That the work programme as detailed in Appendix A be received, subject to the inclusion of United Lincolnshire Hospitals NHS Trust – Progress in Response to Special Measures as an item on the agenda for the next meeting.