Agenda and minutes

RESOLVED

That Councillor C S Macey be elected as Chairman of the Health Scrutiny Committee for Lincolnshire for 2018/19.

COUNCILLOR C S MACEY IN THE CHAIR

RESOLVED

That Councillor C J T H Brewis be elected as Vice-Chairman of the Health Scrutiny Committee for Lincolnshire for 2018/19.

Apologies for absence were received from Councillors R J Kendrick, R H Trollope-Bellew and P Gleeson (Boston Borough Council).

It was noted that Councillor S Woodliffe (Boston Borough Council) had attended the meeting on behalf of Councillor P Gleeson (Boston Borough) for this meeting only.

An apology for absence had also been received from Councillor Mrs S Woolley, Executive Councillor for NHS Liaison and Community Engagement.

Councillors Mrs P F Watson and S Woodliffe advised the Committee that they were currently patients of United Lincolnshire Hospitals NHS Trust.

The Committee extended their thanks to Simon Evans, Health Scrutiny Officer and Katrina Cope, Senior Democratic Services Officer for their continuing support to the Committee.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire held on 18 April 2018 be agreed and signed by the Chairman as a correct record.

Further to the Chairman's announcements circulated with the agenda, the Chairman advised that it was proposed in relation to announcement 3, which related to Healthwatch Lincolnshire's report on GP Appointments (pages 18-19 of the agenda pack) that this matter would be discussed as part of the work programme item later on in the agenda.

A paper copy of supplementary Chairman's announcements was circulated at the meeting.

The Chairman advised that Councillor J Kirk had been appointed to the Executive of the City of Lincoln Council, and as a result was now no longer able to be a member of the Committee. The Committee was advised that the City of Lincoln Council had appointed Councillor C Burke as their representative on the Committee, with Councillor B Bilton as their nominated replacement member.

The Committee was advised further that Councillor Dr M E Thompson had been appointed by the Leader of Lincolnshire County Council as the Executive Support Councillor to Councillor S Woolley, Executive Councillor for NHS Liaison and Community Engagement; and that going forward Councillor Thompson would be attending the Committee in that capacity.

The Supplementary announcements also made reference to:-

·         Extended GP Opening Hours – Consultation by Lincolnshire West Clinical Commissioning Group;

·         Joint Ambulance and Fire Station in Sleaford; and

·         Chief Executive of North West Anglia NHS Foundation Trust.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 17 to 20; and the supplementary announcements circulated at the meeting be noted.

(To receive a report from Jan Sobieraj (Chief Executive United Lincolnshire Hospitals NHS Trust), which provides the Committee with background information as to the issues faced by the Children and Young Persons Services)

The Chairman welcomed to the meeting:-

·         Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust;

·         Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust;

·         Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust;

·         Sue Bennion, Head of Midwifery and Nursing – Women and Children's Services, United Lincolnshire Hospitals Trust; and

·         Dr Rao Kollipara, Consultant Paediatrician, United Lincolnshire Hospitals NHS Trust.

The Chief Executive in his introduction advised that a series of circumstances had led to the challenging position currently faced by the children's and young person's department specifically at Pilgrim Hospital, Boston.  It was highlighted that at the moment services were safe, and that the Trust was actively working to recruit staff.  It was reported that the children's services provided at Pilgrim Hospital could not be sustained in their current form beyond July 2018, unless additional middle grade doctors were recruited, in addition to the long standing nursing shortages.

The Medical Director advised that services provided by the children's and young person's department were complex and included:-

·         Acute Children's Inpatient Service;

·         Emergency Children's Assessment;

·         Neonatology;

·         Consultant Led Obstetric Service;

·         Emergency Department;

·         Outpatients Clinics and Procedures;

·         Community Children's Services; and

·         Children's Elective inpatient and Day Case Surgery.

The Committee was advised that the service had over the last three years experienced both medical and nursing staffing challenges, which had been mitigated by temporarily closing beds; increasing the skill mix of staff; and utilising both locum and agency medical staff.   It was highlighted that the Clinical Directorate Team, supported by the Children's Multi-Disciplinary Team at Pilgrim Hospital, Boston had highlighted their concerns that the children's service at Pilgrim Hospital, Boston was currently safe, however, that moving forward the service might struggle to provide safe care if the staffing shortages remained the same.

The Committee was advised that a task and finish group had been established to develop the work required to mitigate the current risks to ensure the safe and sustainable running of children's, obstetrics and neonatal service at United Lincolnshire Hospitals NHS Trust.

It was highlighted that nationally there was a 25% shortage of middle grade doctors for paediatric services.

The Committee was advised that a paper had been presented to the United Lincolnshire Hospitals NHS Trust Board on 27 April 2018, a copy of which was attached at Appendix A to the report presented.  The Committee was advised further that the paper had outlined five options regarding temporary measures that might need to be taken to maintain safe paediatric services at Pilgrim Hospital, Boston.  The United Lincolnshire Hospitals Trust Board had supported the further working up of four of the options; and had requested a further more comprehensive report being presented to the next United Lincolnshire Hospitals Trust Board meeting to be held on 25 May 2018.

In conclusion, the Committee was advised that the Trust felt that Option One was the option the Trust wanted to maintain; and that steps were being undertaken to put together sufficient mitigation to maintain a safe service; but  ...  view the full minutes text for item 7.

(To receive a joint report from Sarah-Jane Mills (Chief Operating Officer, Lincolnshire West CCG) and Wendy Martin (Chief Nurse, Lincolnshire West CCG), which provides an update to the Committee on the development of primary care services to meet the patient need following the closure of the Lincoln Walk-in Centre on Monks Road)

Consideration was given to a report from the Lincolnshire West Clinical Commissioning Group, which provided the Committee with an update on the development of primary care services to meet the needs following the closure of the Lincoln Walk-in Centre.

Detailed to the report for the Committees consideration were the following Appendices:-

·         Appendix 1 - Alternative Provision Plan;

·         Appendix 1A -  Alternative Provisions Description;

·         Appendix 1B -  Alternative Provision Engagement Plan;

·         Appendix 1C - Alternative Provision Communications Review;

·         Appendix 2 - GP  Practice Impact Review;

·         Appendix 3  – A & E Attendance Impact Review; and

·         Appendix 4 – NHS 111 Lincolnshire Calls.

The Chairman welcomed to the meeting Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning Group (LWCCG), Sarah-Jane Mills, Chief Operating Officer, LWCCG; and Wendy Martin, Executive Lead Nurse and Midwife, Quality and Governance, LWCCG.

The Chief Clinical Officer introduced the report and advised that the LWCCG had as a result of the requests for information raised by the Committee at the February meeting had in the report been able to provide an update relating to the following issues:-

·         Abbey Medical Practice – the Committee had requested further information regarding the impact on this practice following the closure of the Walk-in Centre;

·         GP Practices List Sizes – a question had been raised as to whether there was capacity to meet the demand;

·         GP Appointments/Primary Care Access; and

·         Reception Staff Training.

The Chief Operating Officer, LWCCG advised the Committee that in relating to the Abbey Medical Practice, an additional GP, practice nurse and clinical pharmacist had been recruited to manage presenting demand following the closure of the Arboretum Surgery and the Walk-in Centre.  It was also highlighted that a plan was being developed with a business case, for approval by the Primary Care Commissioning Committee to enable the practice to consolidate their services on to one site.  The Committee was advised that the additional staffing had provided capacity to meet demand; and that work would continue to secure the development of services to one site.  

It was reported that the majority of patients who had attended the Walk-in Centre over the last two years had been registered with GP practices located in the LWCCG.  It was noted that only 3.3% of patients who had attended the Walk-in Centre had been unregistered.

The Committee was advised that the provision of additional resources and better use of existing resources at GP practices had enabled GPs to manage presenting demand.  Appendix 2 to the report provided the Committee with responses from the eight GP practices.

Reference was also made to the fact that the Lincoln University GP practice had actively promoted registration to increase their GP list size to manage their demand, which had resulted in additional registrations and increased daily appointment demand.

In relation to access to pre-bookable and same day appointments, the Committee was advised that any impact had been managed through extended triage, clinics and additional resources or better use of existing resources.  It was noted  ...  view the full minutes text for item 8.

(To receive a report from Ruth Cumbers (Urgent Care Programme Director and Senior Responsible Officer, STP Urgent Care Programme) and Simon Evans (Director of Operations, United Lincolnshire Hospitals NHS Trust) which provides the Committee with an update on the system resilience during Winter 2017/18)

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

The purpose of the report was to update the Committee on system resilience during the Winter 2017/18.

The Urgent Care Programme Director advised that the 2017/18 winter had been difficult, both locally and nationally.  Causes of the pressures in Lincolnshire were as a result of a higher level of respiratory illness than expected; higher levels of flu than expected with more people having to be hospitalised; and the loss of bed capacity due to norovirus.

Details of the actions of the Winter Plan for Lincolnshire's health and care system were shown on page 149 of the report presented; along with details of the significant steps taken at national level to improve NHS resilience.

It was noted that despite the preparations there had been a number of continuing difficulties and pressures which had put pressure on the system's ability to cope.  This had included the flu strain; funding pressures; lack of beds; workforce pressures and underlying performance pressures. 

It was highlighted with the acute trusts seeing more people in both worse and frailer conditions, and the National Emergency Planning Panel had recommended to all acute trusts that non urgent operation should be cancelled during January 2018.  It was highlighted that although this was enacted in Lincolnshire it was regularly reviewed; and not all operations were cancelled.  The cancelled operations obviously resulted in less income for the trusts, which was an additional challenge for Lincolnshire which was already under significant pressure to deliver savings; and recover financial targets and assure their sustainability.

The Committee was advised that the normal operating for the Lincolnshire system was Operational Pressures Escalation Level (OPEL) 2; information provided on page 151 of the report showed Lincolnshire as being above average and operating at (OPEL) 3 for the duration of December and January.  It was noted that Level 4 was reported on only 2 occasions (days) this winter during the severe weather conditions in February and March.  The Committee was advised that when the systems were at Level 4, the system was able to manage the threshold and de-escalate.

It was reported that ambulance conveyances on all sites had remained consistent during the winter.  The United Lincolnshire Hospitals NHS Trust had been among the top five poorest performers nationally for the percentage of ambulances delayed over the 30 minute arrival to clear target, in December 2017.  It was noted that additional changes had been made to the patient cohort process.

During discussion, the Committee raised the following points:-

·         A question was asked as to whether the Trust was confident in meeting the Lincolnshire Four Hour Standard Trajectory for 2018/19.  It was reported that a realistic improvement trajectory for 18/19 had been developed and agreed across the urgent and emergency care systems.  The plan was however dependent on a number of system wide actions to improve hospital flow and reduce Delayed Transfers of Care (  ...  view the full minutes text for item 9.

(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 scrutiny activity was focussed where it would be of greatest benefit.

The Committee was also requested to note the activity of the Committee's Quality Accounts Works Group; and to consider a proposal to merge the Committee's STP Operational Efficiency Working Group and the United Lincolnshire Hospitals Financial Special Measures Working Group and to adopt the following terms of reference:-

1.    To consider the financial impacts of the Lincolnshire STP, with particular emphasis on the operational efficiency priority.

2.    To consider financial special measures of United Lincolnshire Hospitals NHS Trust, and any impacts of these financial special measures on the quality of care provided by the Trust.

3.    To submit reports to the Committee as required on its findings, including any recommendations for further activity by the Committee.

The Committee extended their support to the merger of the two working groups and to the adoption of the proposed terms of reference (as detailed above).

During a short discussion, the Committee raised the following items for inclusion on future agendas:-

·         Childhood Obesity/Health Eating – The Committee was advised that these items would be looked at by the Adults and Community Wellbeing Scrutiny Committee; and

·         Climate Change Resilience – The Committee was advised that this would be looked at by the Flood and Water Management Scrutiny Committee.

RESOLVED

1.    That the work programme as presented be agreed subject to the inclusion of the items mentioned at minute numbers 7(2), 8(2), and 9(2).

2.    That the activity of the Committee's Quality Accounts Working Group be noted.

3.    That approval be given to the merger of the Committee's STP Operational Efficiency Working Group and the United Lincolnshire Hospitals Financial Special Measures Working Group; and that the terms of reference as detailed below be adopted:-

·         To consider the financial impacts of the Lincolnshire STP, with particular emphasis on the operational efficiency priority.

·         To consider financial special measures of United Lincolnshire Hospitals NHS Trust, and any impacts of these financial special measures on the quality of care provided by the Trust.

·         To submit reports to the Committee as required on its findings, including any recommendations for further activity by the Committee.