Agenda and minutes

Apologies for absence were received from Councillors R A Renshaw, P Gleeson (Boston Borough Council), T Boston (North Kesteven District Council).

It was noted that the Chief Executive, having received notice under Regulation 13 of the Local Government (Committee and Political Groups) Regulations 1990, had appointed Councillor R B Parker to replace Councillor R A Renshaw on the Committee until further notice.

It was noted further that Councillors S Woodliffe (Boston Borough Council) and Mrs P Whittaker (North Kesteven District Council) had attended the meeting on behalf of Councillors P Gleeson (Boston Borough Council) and T Boston (North Kesteven District Council) respectively, for this meeting only.

An apology for absence was also received from Councillor Mrs S Woolley, Executive Councillor for 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 Stephen Woodliffe advised the Committee that he was currently a patient of United Lincolnshire Hospitals NHS Trust.

Councillor C J T H Brewis advised the Committee that he was currently a patient of the Anglia Community Eye Service, Wisbech.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 11 October 2017, be approved and signed by the Chairman as a correct record, subject to a grammatical error, bullet point one, fifth sentence, the moving of the word 'in' to the following position in the sentence 'There was recognition that in the present'.

The Chairman advised that further to the announcements circulated as part of the agenda, an additional announcement had been received concerning the Grantham A & E Overnight Closure.

It was reported that at a meeting of the United Lincolnshire Hospitals NHS Trust Board held on 7 November 2017, the Board had decided to support the re-opening of the Grantham A & E 24 hours a day over the winter period.  However, it was highlighted that NHS Improvement (NHSI) had requested that the final decision concerning the opening should be deferred by one month to allow for an independent review of staffing to be carried out.  The Committee was advised that the review would look at the staffing model for all three A & E's, to ensure that before Grantham was reopened overnight, safe staffing levels could be maintained over the busy winter months.  The Committee was advised further that the next Board meeting would be held on 15 December 2017 to consider the review findings. 

The Health Scrutiny Officer advised that a copy of the report had been circulated to all members of the Committee prior to the meeting, but several members requested a hard copy of the report being made available to them at the end of the meeting.

RESOLVED

            That the Chairman's update be noted.

(To receive a report from Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Karen Brown, Director of Finance, United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on the support packages that have been put in place to assist the Trust develop a recovery plan to exit Financial Special Measures)

The Committee gave consideration to a report from United Lincolnshire Hospitals NHS Trust, which provided information on the number of support packages that were in place to assist the Trust in developing a recovery plan to exit Financial Special Measures.  It was reported that a draft recovery plan had been developed and submitted to NHS Improvement (NHSI).  The plan's main aim was based on making current services more efficient and effective.   

The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Karen Brown, Director of Finance, United Lincolnshire Hospitals NHS Trust.

The Committee was reminded that an additional paper entitled Quality and Safety Report for October 2017 had been circulated by email to all members of the Committee on 2 November 2017, a copy of the said document was tabled at the meeting.

The Committee received a joint update from the Chief Executive, United Lincolnshire Hospitals NHS Trust and the Director of Finance United Lincolnshire Hospitals NHS Trust, which brought the Committees attention to the table on page 21, paragraph 2.5 which described the main elements of the Trust's structural deficit of £70m; and provided a breakdown of the £70m as follows:-

·         Duplication of services across multiple hospitals         £30m

·         Use of agency staff                                                                        £13m

·         Loss of elective (planned) work                                       £13m

·         ULHT inefficiencies                                                                       £14m

The Committee noted that the Trust had not achieved             a breakeven position since 2011/12; and that the graph detailed on page 21 identified the levels of deficit since that time.  Reference was made to the increased costs of delivering and investing in services over the Trust's three main sites; and that the large geographical area of Lincolnshire had not assisted the Trust in delivering the national efficiency agenda.  It was noted that the projected budget deficit for 2017/18 of £75m allowed for investment for quality of care in the future.

It was reported that to exit financial special measures three elements were required, which included a robust recovery plan, which needed to be approved by the ULHT Board and NHSI within one month; and also the production of a detailed delivery plan providing evidence of significant efficiencies within a further two months' timescale.  It was highlighted that the NHSI might also require evidence of delivery over a further three month period; and the implementation of further actions as detailed at paragraph 4.2 of the report.  It was highlighted further to the Committee that there was some recognition from the NHS and NHSI that there needed to be a more co-ordinated approach to commissioning services.

During discussion, the Committee raised the following issues:-

·         One member asked for an explanation of the word 'structural deficit'.  It was explained that the term structural deficit referred to a long-term mismatch between income and expenditure.  The Committee was advised that there was a balance between exiting financial special measures and delivering quality; and as a result the recovery plan needed to be balanced so that it did not affect the quality of care  ...  view the full minutes text for item 40.

(To receive a report from Dr Tim Davies from NHS England, which provides details of the local arrangements for the delivery of immunisations to the population.  Also, Tony McGinty, Interim Director of Public Health to provide a presentation to the Committee concerning the Scrutiny of the National Immunisation Programme in Lincolnshire)

Consideration was given to a report from Dr Tim Davies, NHS England Screening and Immunisation Lead, Public Health England, which provided the Committee with details of the local arrangements for the delivery of immunisations to the population of Lincolnshire and its current performance with regard to vaccination programmes.

The Chairman welcome to the meeting Dr Tim Davies, NHS Screening and Immunisation Lead, Public Health England, Dr Jharna Kumbang, Consultant in Communicable Disease Control, Public Health and Tony McGinty, Interim Director of Public Health.

Tony McGinty, the Interim Director of Public Health provided a short presentation, which outlined to the Committee the Lincolnshire Health Protection Assurance Process; and provided details relating to the National Immunisation Programmes in Lincolnshire.

It was highlighted that as a result of concerns raised by the Lincolnshire Health and Wellbeing Board, the information provided to the Committee focussed on the vaccination programme for those under the age of five years of age.

Dr Tim Davis, NHS Screening and Immunisation Lead, Public Health England advised the Committee that immunisation programmes for children up to the age of five had uptake targets of 95%.  It was noted that this uptake target needed to be high with diseases such as measles to ensure a good level of immunity. 

Details pertaining to the routine immunisation schedule along with selective immunisation programmes; and additional vaccines for high risk individuals was detailed in Appendix A to the report.  It was highlighted that NHS England was responsible for the commissioning and system management of the routine immunisation programme through its local offices.  It was highlighted further that local authorities through their Director of Public Health (DPH) had a duty to provide advice and advocacy to protect the population of Lincolnshire; and that NHS Clinical Commissioning Groups (CCGs) had delegated authority for co-commissioning primary care; and also needed to have oversight and scrutiny of the routine vaccination programmes.

Table one on page 31 of the report provided information relating to the uptake of immunisations by age group for 2015/16, 2016/17 and quarter one for 2017/18.  The table highlighted that generally the performance of childhood immunisations measured at one year was good, with an uptake at or around the 95% target.  The Committee noted that the uptake of vaccines at age two years and five years were areas where improvement could be made.

Figure 1 - Trend in the uptake of MMR by CCG - on page 32 of the report identified that Lincolnshire East CCG had had the lowest uptake.  It was highlighted that this pattern was reflected in all of the under 5 vaccination programmes.  It was noted further that in figure 3 - Uptake of immunisations at 1 year compared to peers and national average for 2013/14 and 2016/17 and figure 4 – Uptake of immunisations at 5 years compared to peers and national average for 2013/14 to 2016/17, Lincolnshire's performance was above the national average.

The Committee noted that immunisation was a parental choice; and that nationally there was  ...  view the full minutes text for item 41.

(To receive a report from Chris Weston, Public Health Consultant, which invites the Committee to receive the project plan timelines from the 'Lincolnshire Pharmaceutical Needs Assessment Steering Group' and to initiate a working group to comment on the draft Pharmaceutical Needs Assessment during the 60-day public consultation)  

Consideration was given to a report from Chris Weston, Public Health Consultant, which asked the Committee to consider the project plan timelines from the 'Lincolnshire Pharmaceutical Needs Steering Group' on the production of the 2018 Lincolnshire Pharmaceutical Needs Assessment (PNA).  The report also asked if the Committee wished to initiate a working group to comment on the draft Pharmaceutical Needs Assessment during the 60-day public consultation.

In guiding the Committee through the report presented, the Committee was advised that the Health and Social Care Act 2012 had transferred responsibility for developing and updating PNAs to Health and Wellbeing Boards (HWB).  It was noted that the first PNA had been completed on behalf of Lincolnshire HWB and had been submitted to NHS England by the 1 April 2015, and the next PNA was due to be submitted to NHS England by 1 April 2018.

Appendix A to the report provided the Project Plan for Lincolnshire 2018 PNA for the Committee's consideration.

It was reported that a public questionnaire had been produced by the PNA Steering Group to seek views and comments on current pharmaceutical service provision.  A total of 1145 responses had been received from all age groups above the age of 16 years.  A summary of the responses received was detailed in Appendix B to the report presented.  The Committee was advised that the next stage of the process was a 60-day mandatory consultation on the findings of the draft PNA, which would be approved by the Lincolnshire Health and Wellbeing Board at their 5 December 2017 meeting.  The Committee was advised further that the planned dates for the consultation were from 11 December 2017 to 11 February 2018.  The results of the consultation would then be considered by the Steering Group at its meeting on 27 February 2018.  A final PNA would then be produced with a recommendation for the Lincolnshire Health and Wellbeing Board to publish, at its meeting on 27 March 2018.  It was noted that the final PNA had to be published no later than 31 March 2018.

It was highlighted that regulations listed a range of stakeholders who needed to be consulted.  The Health Scrutiny Committee was invited therefore to initiate a working group during the consultation period to feed into the consultation of the draft PNA.

The Committee was also advised that Regulation 9 of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations required that Joint Health and Wellbeing Strategies, when carrying out assessments for the purpose of PNAs, had to have regard to:-

·         The number of people in its area who require pharmaceutical services;

·         The demography of its area; and

·         The risks to the health or wellbeing of people in its area.

A short discussion ensued from which the following points were raised:-

·         One member enquired in accordance with Regulation 9, whether the issue of Pharmacists being open seven days a week along the coast had been taken on board as part of the Strategy.  Confirmation  ...  view the full minutes text for item 42.

(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 December 2017 to 16 May 2017.

The Health Scrutiny Officer enquired as to when the Committee wished to consider the previously identified four priorities from the Lincolnshire Sustainability and Transformation Partnership.  It was agreed that the Committee would be consulted via email.

The items the Committee agreed should be considered at future meetings were highlighted as:-

·         An update concerning Paediatric Nurses;

·         Quarterly Update from United Lincolnshire Hospitals NHS Trust;

·         Adult Immunisation; and

·         Update on the Grantham A & E

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

One member requested whether the item concerning EMAS scheduled for the 21 February 2018 could be brought forward to an earlier meeting, due to information received that East Midlands Ambulance Service was withdrawing ambulances from ambulance stations in the West Lindsey area.  The Chairman agreed to look into the matter and report back to members of the Committee.

RESOLVED

That the work programme as detailed in Appendix A be received, subject to the inclusion of the items listed above.