Agenda and minutes

Venue: Committee Room One, County Offices, Newland, Lincoln LN1 1YL

Contact: Katrina Cope  Senior Democratic Services Officer

Items
No. Item

53.

Apologies for Absence/Replacement Members

Minutes:

There were no apologies for absence or replacement members.

54.

Declarations of Members' Interest

Minutes:

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

 

There were no other declarations of Members' interests at this point of the proceedings.

55.

Minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 13 December 2017 pdf icon PDF 197 KB

Minutes:

Councillor M A Whittington asked that page six of the agenda pack, at minute number 47 (Chairman's Announcements), under the section "The Next Steps" be amended to include 'the East of England Clinical Senate' as follows:-

 

"In addition to representation from ULHT at that meeting, representatives from the CCGs, NHS Improvement and the East of England Clinical Senate would also be invited to attend."

 

The Chairman highlighted the following errors within the minutes:-

 

·       The final paragraph on Page 11 of the agenda pack should read poseand not posed; and

·       Paragraph two on page 12 of the agenda pack should read "voluntary car scheme" and not voluntary care scheme"

 

RESOLVED

 

          That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire, held on 8 November 2017, with the amendments noted above, be agreed and signed by the Chairman as a correct record.

56.

Chairman's Announcements pdf icon PDF 86 KB

Minutes:

The Chairman referred to the announcements circulated within the agenda pack which included the following areas:-

·       United Lincolnshire Hospitals NHS Trust – Appointment of Interim Chair of the Board;

·       Winter Pressure Funding for Lincolnshire;

·       Psychiatric Clinical Decisions Unit – Lincoln County Hospital; and

·       Non-Emergency Patient Transport Service

 

In relation to the Psychiatric Clinical Decisions Unit at Lincoln County Hospital, Councillor Mrs K Cook advised that she had attended the official opening and had been impressed by the unit and thought this would provide a good service for the county.

 

RESOLVED

 

          That the Chairman's Announcements be noted.

57.

Lincolnshire Sustainability and Transformation Partnership Update pdf icon PDF 143 KB

(To receive a joint report from John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership and Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership, which provides information on the development of the Lincolnshire Sustainability and Transformation Partnership (STP) and the current position of the STP)

Minutes:

Consideration was given to a report on behalf of the Lincolnshire Sustainability and Transformation Partnership (STP) which provided the Committee with information on the development of the Lincolnshire STP and the current position.

 

John Turner (Senior Responsible Officer, Lincolnshire STP) and Sarah Furley (Programme Director, Lincolnshire STP) introduced the report and advised that good progress had been made on key areas of the STP.  It was also noted that the STPs had evolved over the last nine months from 'plans' to 'partnerships' with current thinking nationally describing STPs as working at a health and care system level.

 

There remained a strong case for change which was shared by the collective leadership, partner organisations and stakeholders in Lincolnshire.  The Case for Change was published in June 2016 and, despite the excellent dedication and commitment of staff, the NHS in Lincolnshire remained severely challenged in the following areas:-

·       Deteriorating Quality;

·       Significant Staffing Challenges; and

·       Deteriorating Finances.

 

The Committee was advised that the system deficit was anticipated to reach £100m and not £70m as noted within the report. 

 

As part of the STP as a plan (rather than a partnership or system), Lincolnshire had been focussing on seven key priorities since April 2017, all of which were now starting to deliver real change for people accessing care and support across the county.  The seven key priorities were noted:-

·       Mental Health;

·       Integrated Neighbourhood Working;

·       Implementation of GP Forward View;

·       Urgent and Emergency Care Transformation;

·       Operational Efficiencies;

·       Planned Care; and

·       Acute Care Reconfiguration/Acute Service Review

 

The Committee was advised that there was a specific challenge within mental health as there were too many Lincolnshire residents being treated out-of-county for mental health care.

 

In relation to Operational Efficiencies it was noted that integrated working for back office functions would be essential in the future and could, potentially, provide a saving of £60m over five years.

 

As part of the STP, the future configuration of acute services was being given greater consideration.  The Acute Service Review would also include all hospitals in neighbouring counties attended by Lincolnshire residents.  The review would focus on the following question:-

          What is the optimum configuration of ULHT services and the role of neighbouring  acute trusts, in order to achieve a thriving acute hospital service in Lincolnshire and for the population as a whole and to deliver clinical, staffing and financial sustainability across the Lincolnshire NHS health economy?

 

The first part of the review would engage with senior clinicians and the second part would look at the analytics of 32 specialities and how these could be configured to allow the best quality of care to be delivered whilst retaining the right level of staff.  Initial proposals would be identified by the end of February 2018, following which the proposals would be subject to the standard NHS England assurance processes.  All this would take place prior to any formal public consultation.

 

The STP accepted that more engagement, communication and information was required from the public, council, district council, patient groups, etc.

 

There was  ...  view the full minutes text for item 57.

58.

Grantham and District Hospital Accident and Emergency Department pdf icon PDF 110 KB

(To receive a report on Grantham and District Hospital Accident and Emergency Department which invites the Committee to consider the implications of the report by the East of England Clinical Senate. Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust; Dr Neil Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust; John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership, will be in attendance)

Additional documents:

Minutes:

Consideration was given to a report by the Health Scrutiny Officer which invited the Committee to consider the implications of the report by the East of England Clinical Senate on the Review of Accident and Emergency Services at Grantham and District Hospital (United Lincolnshire Hospitals NHS Trust).

 

The Chairman welcomed Jan Sobieraj (Chief Executive, United Lincolnshire Hospitals, NHS Trust (ULHT)), Dr Neill Hepburn (Medical Director, ULHT), John Turner (Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP)) and Jeff Worrall (NHS Improvement).

 

The report by the East of England Clinical Senate contained five recommendations as précised below:-

·       Recommendation 1;

o   The Panel did not support the reopening of the 24/7 A&E department at Grantham Hospital on the grounds of potential adverse impact on patient safety at A&E Departments at all three ULHT hospitals;

o   The Panel strongly recommended on the grounds of patient safety, that ULHT Trust Board reconsider the proposal to extend the current A&E service opening hours at Grantham and District Hospital; and

o   The Panel recommended that the Trust continue to provide an A&E service at Grantham and District Hospital on the current opening hours;

·       Recommendation 2;

o   The Panel recommended that in order to make it clear for patients and the public the type of service available at Grantham and District Hospital A&E Department, the Trust consider relabelling or renaming the department and ensure that it communicates this message widely.  It was also recommended that 'A&E Centre' not be applied to Grantham and District Hospital in any further model;

·       Recommendation 3;

o   The Panel recommended that the Trust should move to a single A&E team with a focus on standardised clinical pathways and processes across the three sites;

·       Recommendation 4; and

o   The Panel recommended that the Trust and CCG have clear alignment with the Lincolnshire STP, developing a system approach to urgent and emergency care, and planned care for patient and the public.  The Trust and STP should move to public consultation on an agreed future model as quickly as possible;

·       Recommendation 5;

o   The Panel recommended that ULHT work with the local CCG and STP to develop an enhanced communication and engagement strategy to ensure that all stakeholders, public, patients and locally elected representatives were given the opportunity to input on the development and decision regarding the final model for urgent and emergency care across the Trust's three sites;

o   The Panel recommended that the communication and engagement strategy develop plans to ensure that any changes to the designation, opening times and pathways related to emergency care provision were clearly communicated with the public, patients, stakeholders and staff both within the STP footprint and with surrounding STP footprints.

 

Jan Sobieraj (Chief Executive, ULHT) confirmed that the ULHT Board had considered the report by the Clinical Senate on 15 December 2017 and resolved to heed the expert advice and accept the key recommendations to maintain the current hours at Grantham A&E.

 

The Chairman advised that, in accordance  ...  view the full minutes text for item 58.

59.

NHS Dental Services Overview for Lincolnshire pdf icon PDF 129 KB

(To receive a report from Jane Green, Assistant Contract Manager, Dental and Optometry, NHS England – Midlands and East (Central Midlands); and Jason Wong, Chair, Dental Local Professional Network, which provides the Committee with an overview of the NHS dental services commissioned in Lincolnshire and update on the current challenges and commissioning intentions to improve NHS dental services and oral health across Lincolnshire)

Minutes:

Consideration was given to a report from NHS England – Midlands and East (Central England) and the Dental Local Professional Network which provided an overview of the NHS Dental Services commissioning in Lincolnshire and an update on the current challenges and commissioning intentions to improve NHS dental services and oral health across Lincolnshire.

 

Jane Green (Assistant Contract Manager, Dental and Optometry, NHS England – Midlands and East (Central Midlands)) and Jason Wong (Chair of the Dental Local Professional Network) introduced the report and explained the local context.

 

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

 

There were currently 72 contracts within Lincolnshire providing NHS dental services, one of whom was piloting a new prototype dental contract to test a new remunerations system.  This blended activity and capitation (patient registration) and aligned to financial and clinical drivers to focus on prevention and continuing care. 

 

The report highlighted that the following Local Authority areas in Lincolnshire had access rates below the NHS England and Leicestershire and Lincolnshire average:-

·       Boston (children and adults);

·       Lincoln (children and adults);

·       South Holland (children and adults); and

·       North Kesteven (adults)

 

These outcomes had been reviewed by the local office in addition to patient engagement and consultation feedback and it was agreed to commission new contracts as part of the dental procurement programme in order to improve access to general dental services in priority areas identified within the resource envelope:-

·       Boston;

·       Lincoln;

·       Sleaford (North Kesteven); and

·       Spalding (South Holland)

 

The Local Office were supporting the Chief Dental Officer Smile for Life initiative and had launched the 'Starting Well' programme in Leicester and Luton.  The learning from this programme would be fed into the Lincolnshire area in due course.

 

During discussion, the following points were noted:-

·       The actual figures of the regional and national averages were not available but would be provided to the Health Scrutiny Officer after the meeting;

·       Access rates rather than waiting lists were used to choose new areas for practices in addition to the population rates;

·       The nearest dental colleges to Lincolnshire were in Birmingham and Sheffield and trainees seemed to return to those areas following training placements in Lincolnshire.  NHS England were also working on foreign recruitment of dentists so this could also be considered in improving retention;

·       Smile for Life had held a launch event with eight sites commencing in Leicester City on 1 February 2018.  There was not a separate dental budget as this formed part of the overall primary care budget and the difficulty had been trying to stress the importance of this initiative.  Due to funding, it was not expected that this initiative would be rolled out in the near future;

·       Some schools in Lincolnshire were running initiatives in dental health and it would be helpful if more could be done to support and promote this.  ...  view the full minutes text for item 59.

60.

Update on Developments at North West Anglia NHS Foundation Trust pdf icon PDF 93 KB

(To receive a report from Caroline Walker, Deputy Chief Executive, North West Anglia NHS Foundation Trust, which provides an update to the Committee on key areas of development at the North East Anglia NHS Foundation Trust since its formation on 1 April 2017)

Minutes:

The Chairman welcomed Caroline Walker, Deputy Chief Executive for the North West Anglia NHS Foundation Trust to the meeting.  The Committee received an update on key areas of development at the North West Anglia NHS Foundation Trust since its formation on 1 April 2017, which oversees the running of Stamford and Rutland Hospital, Peterborough City Hospital (PCH) and Hinchingbrooke Hospital in Huntingdon.

 

The Committee was advised of the following during the update:

·         It was hoped that members were reassured with the developments taking place that Stamford and Rutland Hospital was still key part of the Trust's offer.

·         A base for the Trust had been created which reconfirmed its commitment to that site so that services were where patients needed them.  It would also be a base for the South Lincolnshire Neighbourhood Team as there was space for everyone to work from Stamford, re-affirming the commitment to treat patients locally.

·         Members were advised that the merger had taken place in April 2017 and there was a 5 – 10 year plan to deliver all the benefits.

·         Staff were working to deliver benefits and one of the main benefits was about maintaining clinical services across all sites.  This was the main focus of a lot of the work, and there had been no deterioration in performance of any of the services as a result of the merger.

·         Some clinical benefits had been delivered already, but some would take longer to deliver.

·         It was reported that the hospital were working together and so some of the services could be integrated.  It was noted that some of the clinical teams had been integrated so that clinicians were moving between sites instead of patients.

·         Members were also advised that workforce remained one of the biggest issues and the Trust was trying to recruit internationally as well as within this country.

·         It was reported that the planned first year savings would be achieved, mainly from efficiencies to the back office function.  There was a commitment to make no savings from clinical services.

 

The Committee was provided with the opportunity to ask questions of the officers present in relation to the information contained in the report and some of the points raised during discussion included the following:

·         In relation to the minor injuries unit, it was queried how well it had performed, and members were advised that it did treat every patient within four hours 100% of the time.

·         In terms of workforce, it was reported that the Trust was approximately 150 nurses short of where it wanted to be (around 2,000 nurses in all) so there was about a 10-15% vacancy rate.  The Committee was reassured that shortfall was being covered through agency staff, bank staff and overtime.  However, this came at a premium in terms of cost.  It was also noted that there were 56 consultant posts vacant.  It was noted that this was not a general shortage, as some areas were fully established, but there were some types of doctors who were difficult to  ...  view the full minutes text for item 60.

61.

Lincolnshire Pharmaceutical Needs Assessment 2018 - Response of the Health Scrutiny Committee pdf icon PDF 79 KB

(To receive a report from Simon Evans, Health Scrutiny Officer, which provides an opportunity for the Committee to consider the responses of the working group to the questions in the Pharmaceutical Needs Assessment which was published on 11 December 2017)

Minutes:

It was reported that on 8 November 2017 the Committee considered a report on the process for developing the Lincolnshire Pharmaceutical Needs Assessment (PNA) and a working group was established to respond to the consultation questions in the draft Lincolnshire PNA.  The consultation draft was published on 11 December 2017 and the Committee's working group met on 19 December 2017.  The working group's responses to the questions were circulated with the agenda for the Committee's consideration.  It was noted that the closing date for the consultation was 11 February 2018.

 

It was highlighted that there was a need to ensure that provision would be able to meet the needs from the growth in housing developments over the next five years.  It was noted that this had been covered in the response.

 

RESOLVED

 

            That the Health Scrutiny Committee for Lincolnshire approves the responses of the Committee's working group (attached at Appendix A of the report), to the questions in the consultation draft of the Lincolnshire Pharmaceutical Needs Assessment.

62.

Health Scrutiny Committee for Lincolnshire - Work Programme pdf icon PDF 172 KB

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

Minutes:

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 focused where it would be of greatest benefit.

 

Appendix A to the report provided the work programme from 21 February 2018 to 16 May 2018.

 

The Committee was advised that the Lincolnshire STP item on 21 February 2018 would be focusing on one of the seven priorities in the document.

 

A discussion took place regarding how frequently the non-emergency patient transport item should be on the Committee's agenda and the approach that should be taken to challenge Thames Ambulance Service, as provider, and Lincolnshire West CCG, as commissioner, on the levels of performance.  The Chairman advised that he would raise the concerns of the Committee on this issue with Lincolnshire West CCG.  It was suggested that a way forward for approaching this issue at future meetings of the Health Scrutiny Committee would be discussed at the next agenda setting meeting.

 

RESOLVED

 

            That the work programme as presented be agreed.

 

 
 
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