Agenda and minutes

Apologies for absence were received from Councillors R H Trollope-Bellew, Mrs P F Watson (East Lindsey District Council) and P Howitt-Cowan (West Lindsey District Council).

It was noted that Councillor William Gray (East Lindsey District Council) had attended the meeting on behalf of Councillor Mrs P F Watson (East Lindsey District Council) 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 K Cook advised the Committee that in respect of agenda item 4, she was a Lincolnshire Partnership NHS Foundation Trust Governor; and a Lincolnshire NHS Foundation Trust service user.

RESOLVED

That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 21 February 2018 be agreed and signed by the Chairman as a correct record.

The Chairman brought to the Committee's attention the Supplementary Announcements that had been tabled at the meeting.  The Chairman highlighted to the Committee two of the supplementary announcements.  These were that on the 20 March 2018, the University of Nottingham had announced the establishment of a new University of Nottingham Lincolnshire Medical School.  It was noted that students would be studying for a University of Nottingham medical degree at the University of Lincoln site.  The second item highlighted was that TASL was holding a Voluntary Car Driver Open Forum Workshop on Tuesday 3 April at 5.30pm at the TASL Headquarters in Lincoln and that members of the Committee were invited to attend the said workshop. 

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 17 to 20; and the Supplementary Chairman's Announcements tabled at the meeting be received.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership (STP) which provides information on the operational efficiency aspects of the Lincolnshire STP.  Andrew Morgan (Chief Executive, Lincolnshire Community Health Services NHS Trust) and Darren Steel (Portfolio Director (Operational Efficiency) will be in attendance for this item)

The Chairman welcomed to the meeting Andrew Morgan, Chief Executive, Lincolnshire Community Health Services NHS Trust, Darren Steel, Portfolio Director (Operational Efficiency), STP System Delivery Unit and Kerryn Marriott, CCG Prescribing Programme Lead.

The report provided information on the operational efficiency aspects of the Lincolnshire Sustainability and Transformation Partnership (STP).  The report also provided details of the main efficiency schemes undertaken on a system-wide basis as well as reference to those managed individually within organisations.

The Committee was advised that the system approach to the efficiency agenda was focussed around areas developed in the original STP and variations highlighted in the Carter Report and the NHS RightCare initiative.  Details relating to the Carter Efficiency Schemes were detailed on pages 25 to 27 of the report; and information relating to a number of schemes that had been implemented to address variations in prescribing costs and implement the efficient management of drugs alongside a number of other prescribing initiatives was shown on pages 27/28.

It was highlighted that the 2018/19 priorities currently under development were:-

·         A focus on shared service of back-office functions;

·         Temporary workforce solutions;

·         Countywide prescribing initiatives;

·         Estates rationalisation; and

·         Pharmacy and prescribing.

In conclusion, the Committee was advised that the more collective approach for 2018/19 should lead to better system management across Lincolnshire NHS, collective performance monitoring and clearer reporting of system savings.  It was highlighted that the system efficiency target remained challenging and that further work was required to continue to develop and implement new specific schemes.

During discussion, the Committee raised the following issues:-

·         Efficiency savings – The report presented advised that the original five year STP had outlined an operational efficiency requirement for the Lincolnshire NHS of just over £60m by 2020/21.  The Committee was advised that the Operational Efficiency strand was just one element of the STP.  Other elements of the STP included clinical service redesign.  There was an aim that the Lincolnshire health system would be in financial balance by 2021;

·         The impact of patients going out of county for treatment – It was noted that patients were entitled to exercise choice and for many patients an out of county provider would be their nearest provider; CCGs would aim for the best outcomes for patients within the money available to them;

·         The importance of ensuring that individuals get registered with a GP as resources followed registration;

·         Consultation – Some concern was expressed as to the lack of formal consultation been undertaken to date in respect of the STP.  The Committee was reassured that consultation was not being bypassed, but that operational efficiencies were things that the NHS was getting on with day to day, as any other organisations would do with internal efficiencies.  In respect of any proposals for Clinical Services redesign, these would be subject to public consultation once finalised;

·         Shared low level procurement – Confirmation was given that there was already collaboration between the three provider trusts; which would see a reduction in management fees;

·         Some members welcomed  ...  view the full minutes text for item 76.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership which provides information on the Lincolnshire Urgent and Emergency Care Strategy 2018-2021, and the development of the plan to support the delivery of the strategy.  Sam Milbank (Accountable Officer, Lincolnshire East CCG) and Ruth Cumbers (Urgent Care Programme Director, Lincolnshire East CCG) will be in attendance for this item)

The Chairman welcomed to the meeting Samantha Milbank, Accountable Officer, Lincolnshire East CCG, Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East CCG and Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust.

The Chairman advised that at the previous meeting he had announced that he would be seeking to explore the future options for emergency care in Lincolnshire, which would provide information on how the A & E Consultation options were being developed, particularly in relation to Grantham A & E.

Page 42 of the agenda identified that Grantham A & E was out of scope of the Urgent and Emergency Care Strategy 2018-2021.  The Chairman requested the presenters as part of their introduction to explain the relationship between Urgent and Emergency Care Strategy 2018-2021 and the emergency care consultation elements of the STP.

The Committee was advised that there was no nationally accepted definition for 'urgent care' and 'emergency care'.  It was highlighted that the Lincolnshire Urgent and Emergency Care Strategy 2018-2021 used the following definitions:-

·         Urgent Care - The provision of care for patients who require prompt advice or treatment, but whose condition is not considered life-threatening; and

·         Emergency Care – immediate or life threatening conditions, serious injuries or illnesses.

It was highlighted further that the Lincolnshire Urgent and Emergency Care Strategy 2018-2021 (a copy of which was attached at Appendix A to the report) was a system approach to the development of urgent and emergency care across Lincolnshire.  It was noted that the strategy incorporated national expectations and requirements; and was also aligned to the Lincolnshire Sustainability and Transformation Plan.  The top of page 42 of the report provided details of the service areas that fell under the definitions mentioned above; including those services in scope; and those urgent and emergency care services that were not in scope.

Appendix B to the report provided the Committee with a report on the urgent care streaming service. The Committee was advised of the urgent and emergency care system in Lincolnshire and a broad overview of current care service delivery, which was shown on pages 45/46 of the report presented.

It was confirmed that Grantham A & E was outside of the scope of the strategy; and that significant work was being undertaken to design the substantive urgent and emergency care services that would be offered from the site.  The work being carried out was taking on board the East of England Clinical Senate report; and was being managed in line with the pre-consultation Business Case being produced by the STP operational delivery unit.

Reassurance was given that where proposals for major reconfiguration of services were developed; they would be subject to full public consultation, including the involvement of the Health Scrutiny Committee for Lincolnshire.

During discussion, the Committee raised the following issues:-

·         One member expressed concerns relating to the fact that the report did not provide any clarity concerning Grantham A & E.  The Committee was advised that the purpose of the strategy was to ensure that a fair and equitable  ...  view the full minutes text for item 77.

(To receive a report from Lincolnshire West Clinical Commissioning Group (CCG) which provides a summary of the actions taken by Lincolnshire West CCG in order to seek to secure improvement by Thames Ambulance Service Ltd (TASL).  Performance data for February 2018 will be circulated to the Committee separately in advance of the meeting.  Sarah-Jane Mills (Chief Operating Officer, Lincolnshire West CCG) and Tim Fowler (Director of Commissioning and Contracting, Lincolnshire West CCG) will be in attendance for this item)

Pursuant to Minute number (62) from the 17 January 2018 meeting, the Committee gave consideration to a report from the Lincolnshire West Clinical Commissioning Group, (LWCCG), which provided a summary of the actions taken by Lincolnshire West CCG to seek to secure improvement by Thames Ambulance Service Ltd (TASL).

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West CCG and Tim Fowler, Director of Commissioning and Contracting, Lincolnshire West CCG.

The Committee was advised that hard copies of the Supplementary Report from Lincolnshire West CCG circulated by email during the previous day relating to the February 2018 performance position had been circulated at the meeting for their consideration.  

In guiding the Committee through the report the Director of Commissioning and Contracting extended his thanks to staff from TASL for ensuring that a service was provided during the snowy conditions.

The report provided a step by step commentary from LWCCG.  Since the December 2017 meeting, at which the Health Scrutiny Committee for Lincolnshire had expressed a vote of no confidence, it was reported that for the months of December 2017 and January 2018, TASL had failed to achieve the level of performance improvement they had put forward in their Remedial Action Plan (RAP).  In accordance with the process set out in the Contract, LWCCG had issued formal contractual Exception Notices for December 2017 and January 2018.  These Notices gave TASL 20 operational days from the date of the Notice to meet the performance standard to which the Notice related; and in the absence of the achievement, a penalty of up to 2.0% of the monthly contract value could be retained by the CCG.  The Committee was advised that this penalty had been applied for the December failure and would be reviewed for the January failure once the February performance data was available.

It was highlighted that the LWCCG had advised TASL that it would consider exiting the Contract if the required improvements in the RAP were not reached by the end of March.  The Committee was advised that this decision would not be taken lightly by LWCCG, due to the disruption caused by a potential change in provider.

The Committee was advised that although TASL still had a long way to go to meet the required standards, they were heading in the right direction with invalidated weekly performance data for February and March showing some improvement. 

The Supplementary Report provided the latest performance information up to February 2018.  Details relating to performance were shown on page 2 of the Supplementary Report.

The LWCCG welcomed the reported achievement of the recovery trajectory for 2 KPIs; and the month on month improvement in all KPIs for February 2018.  The Committee was also advised that LWCCG was pleased to note the significant improvement in reported performance for call answering.

The Committee was advised further of the Care Quality Commission Inspection (CQC) of TASL sites in Grimsby, Scunthorpe and Canvey Island in September  ...  view the full minutes text for item 78.

(To consider a report from Richard Henderson (Chief Executive of the East Midlands Ambulance Service NHS Trust (EMAS), on the developments and performance of EMAS in Lincolnshire.  The item will focus on how the national Ambulance Response Programme (ARP), introduced in July 2017, is progressing.  The ARP is introducing a new performance management regime to ambulance services in England)

The Committee gave consideration to a report from the East Midlands Ambulance Service NHS Trust, which provided information from the East Midlands Ambulance Service on:-

·         Response time information by Clinical Commissioning Group area, in accordance with the new Ambulance Response Programme standards;

·         Handover delays at hospitals;

·         The role of Lincolnshire Integrated Voluntary Emergency Services (LIVES);

·         The Ambulance Response programme and its impact on staff rotas and the types of vehicles; and

·         The new Urgent Care Tier (from 1 April 2018).

The Chairman welcomed to the meeting Richard Henderson, Chief Executive, East Midlands Ambulance Service NHS Trust, Ben Holdaway, Director of Operations, East Midlands Ambulance Service NHS Trust, and Mike Naylor, Director of Finance, East Midlands Ambulance Service NHS Trust. 

Appendix A to the report provided the Committee with NHS England Ambulance Response Programme Standards.

The Chief Executive, East Midlands Ambulance Service Trust introduced the report and responded to questions raised, which included the following issues:-

·         Ambulance drift from areas such as Skegness to out of county, how this still impacted on ambulance cover.  The Committee was advised that all efforts were made to hand over patients in a timely manner; at A & E departments, but at times crews were delayed; and that if an ambulance crew was drawn away from its area, another crew would be moved closer to the area to respond to any emergencies;

·         One member felt that there needed to be dedicated ambulance provision along the coastal strip during the summer.  It was reported that the summer months did put pressure on the service; and that to accommodate demand the service worked differently with its partners.  The Committee was advised that there was a specific summer plan and that additional resources for that period had already been booked.  One member felt that it would be useful for the Committee to have sight of the summer plan;

·         Confirmation was given that EMAS worked alongside LIVES and the Fire and Rescue Service;

·         Handover Delays – It was reported that Lincolnshire had some of the highest handover delays in the EMAS region.  A table on page five of the report provided the Committee with a breakdown of handover times, Both Lincoln County and Boston Pilgrim's figures were highlighted as having the highest number of handover delays.  The Committee was advised that the correct figures for Lincoln County should read 300 for 1hr+ losses; and 985 for Total Hrs Lost.  The Committee was advised further that EMAS was working with United Lincolnshire Hospitals NHS Trust (ULHT) to improve the position.  It was highlighted that the handover delays were putting significant pressure on EMAS to respond to patients in the community, which then in turn had an impact on response times.  It was reported that the handover delays were as a result of the non-availability of consultants and nurses.  It was also highlighted that the handover delays were not just a problem for Lincolnshire, it was a national issue as well;

·         Confirmation was given that the Emergency Ambulance Cost  ...  view the full minutes text for item 79.

(To receive a report by Simon Evans (Health Scrutiny Officer) which invites the Committee to consider its approach to the Quality Accounts for 2018 and to identify its preferred option for responding to the draft Quality Accounts which will be shared, by local providers of NHS-funded services, to the Committee)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider its approach to the Quality Accounts for 2018; and to identify its preferred option for responding to the draft Quality Accounts, which would be shared with the Committee, by local providers of NHS-funded services.

Pages 69 and 70 of the report outlined the Options for Handling Quality Accounts in 2018 to be considered.  The Committee agreed that Option 2a should be taken forward for this year only.  Option 2a comprised of the following:-

Option 2A – Lincolnshire Based NHS Providers plus EMAS

·         East Midlands Ambulance Service NHS Trust

·         Lincolnshire Community Health Services NHS Trust

·         Lincolnshire Partnership NHS Foundation Trust

·         United Lincolnshire Hospitals NHS Trust

The Committee agreed to a working group arrangement.  The following members volunteered to be part of the working group: Councillors C J T H Brewis, R J Kendrick, J Kirk, P Gleeson, C S Macey and M A Whittington. 

The Committee also agreed to working with Healthwatch Linolnshire.

The Health Scrutiny Officer agreed to make arrangements for the said working group meetings.

RESOLVED

1.    That Option 2 A from Section 4 of the report presented be adopted as the Committee's approach to Quality accounts for 2018.

2.    That the Committee indicated that it would be pleased to work with Healthwatch Lincolnshire in relation to any of the Quality Accounts.

3.    That the Committee agreed to the establishment of a working group for the Quality Account process for 2018 and that the membership of the said working group be comprised of the following Councillors C J T H Brewis, R J Kendrick, J Kirk, P Gleeson, C S Macey and M A Whittington.  

(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)

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 would be of greatest benefit.

Detailed within the report were populated work programmes up to 11 July 2018.  On page 76 was a list of items to be programmed.  The Health Scrutiny Officer advised that confirmation had not been received from ULHT that they would be attending the 18 April 2018 meeting.

The Committee was advised that the Developer and Planning Contribution for NHS Provision item had been put forward for consideration by the Overview and Scrutiny Management Board as a potential scrutiny review item.

Items put forward from the Committee included the following:-

·         Dental Services;

·         CCG Updates;

·         Staff Survey results; and

·         Prostate Cancer.

RESOLVED

That the work programme as presented be agreed subject to the inclusion of the items mentioned above.