Agenda and minutes

Apologies for absence were received from Councillors Mrs R Kayberry-Brown (South Kesteven District Council), R J Kendrick, C Matthews and G Scalese (South Holland District Council).

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

Councillor Mrs S Harrison (East Lindsey District Council) wished it to be noted that in relation to agenda Item 7 – Community Pain Management – Update, she was a patient with Connect Health.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 16 September 2020 be agreed and signed by the Chairman as a correct record.

Further to the Chairman's announcements circulated with the agenda, the Chairman brought to the Committee's attention the supplementary announcements circulated prior to the meeting.

The supplementary announcements provided information on the following:

·       East Midlands Ambulance Services NHS Trust – High Level Winter Briefing;

·       Transitional Protocol between Child and Adolescent Mental Health Services and Adult Mental Health Services; and

·       Lincolnshire Partnership NHS Foundation Trust – Acting Chief Executive.

RESOLVED

That the Supplementary Chairman's announcements and the Chairman's announcements as detailed on pages 17 to 20 of the report pack be noted.

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with the first quarterly review of the Grantham 'green site'.  Senior representatives from ULHT will be in attendance for this item)

The Committee was advised that item 5 could be found on pages 21 to 81 of the agenda pack. 

The Chairman advised the Committee that on 6 October 2020, the Board of United Lincolnshire Hospitals NHS Trust (ULHT) had approved the recommendations as shown on pages 57 and 58 of the agenda pack.

The Chairman invited Mark Brassington, Director of Improvement and Integration and Deputy Chief Executive, ULHT and Simon Evans, Chief Operating Officer, ULHT to present the report, which provided the Committee with first quarterly review following the temporary conversion of Grantham Hospital to a Covid-19 'green site'.

Detailed at Appendix A to the report was a copy of the report which had been considered and approved by ULHT Board of Directors on 6 October 2020.

The Committee was advised that the overarching objective of the proposal was to address the requirements for urgent care in response to Covid-19; and to address the need to re-establish and maintain access to elective care for the benefit of all patients across Lincolnshire.

It was highlighted that the establishment of the 'green site' was one element of the Trust's overall Covid-19 Strategy and recovery plan.  Having the 'green site' had enabled planned surgery to resume to a level which maintained the current waiting list; restore public confidence and reduce the risks to patient's post-operative; and for cancer patients to receive their treatment in a Covid-19 free environment.  Details of the strategic aims and priorities of the 'green site' model were shown on pages 25 and 26 of the report.

The Committee noted that the operating model had minimised hospital transmission of Covid-19, by protecting patients and staff; it had reduced the risks associated with delays in treatment; and had provided extra resilience to the services provided.

It was highlighted that the establishment of two surgical wards at Grantham with fully functioning theatres had helped restore elective surgery for a range of specialities at Grantham. It was noted that theatre capacity would be increasing.

It was highlighted further that the 'green site' had been successful in providing service provision for cancer surgery and for providing chemotherapy treatment for patients across Lincolnshire, with the exception of cases where a patient required acute inpatient care with oncology teams.

The Committee was advised that in addition to the outpatient activity run at Grantham hospital itself, extra capacity had been introduced at the Health Centre and Gonerby Road Health Clinics, which had increased the number of services being offered locally in Grantham.

It was also noted that attendance at the Grantham Urgent Treatment Centre (UTC) was continuing to increase since it had opened.  It was noted further there was now an 8% increase in the number of patients attending the UTC, which indicated that the UTC services had been well received by local residents.

It was noted that to understand the impact of the temporary service change, an initial patient survey (110 responses received) had indicated that patients had confidence in attending the site, and in  ...  view the full minutes text for item 27.

(To receive a report from the NHS Lincolnshire Clinical Commissioning Group (LCCG), which provides the Committee with an update on the Non-Emergency Patient Transport Service (NEPTS). Sarah-Jane Mills, (Chief Operating Officer, LCCG) and Tim Fowler, (Assistant Director of Contracting and Performance, LCCG) will be in attendance for this item) 

The Chairman welcomed Tim Fowler, Assistant Director of Contracting and Performance, Lincolnshire Clinical Commissioning Group (LCCG) to the meeting and invited him to present the report to the Committee. 

The item as detailed on pages 83 – 89 of the agenda pack enabled the Committee to receive an update from NHS LCCG on the Non-Emergency Patient Transport Service (NEPTS).

The Committee was reminded that the last update from NEPTS had been considered at the February 2020 meeting.

The report presented covered the key period of Covid-19, including the period of 'lockdown' and the start from September 2020 of the restoration of NHS Services to pre-Covid-19 levels.

The Committee was advised that Covid-19 had caused a significant number of issues for patient transport services.  It was noted that the approach to managing Covid-19 in Lincolnshire had resulted in much closer working between TASL, hospitals, the CCG and other transport providers.  It was noted additional support from Ambicorp to support discharges at Boston Pilgrim and Lincoln County Hospitals had continued during the peak Covid-19 period, and as with TASL had generally worked well.

The Committee noted that as a result of the restoration of elective services, there had been an increase in journey distances for patients travelling from across Lincolnshire, for example to receive their treatment at Grantham Hospital.  It was noted that to support this, the CCG had put in place additional elective patient transport arrangements to and from Grantham outside of the TASL contract.

Appendix A to the report provided the Committee with a summary of the Activity and Key Performance Indicator (KPI) position for the TASL Contract for the period to August 2020.  It was highlighted that TASL had achieved contracted level of performance for 2 out of 15 KPIs.  The Committee noted that the report also included three new KPIs relating to 're-beds' and the timeliness of return journeys for outpatients.

The Committee noted that the CCG was starting to work up options and planning for the patient transport service once the current TASL contract ended.  The Committee was advised that the current contract had been let on an initial term of five years to 30 June 2022, with an option for a two year extension to 20 June 2024.  The Committee was advised further that the option to extend the contract with TASL would not be exercised.  Details of the proposed outline planning and procurement timeline was set out on page 86 of the report.

In conclusion, the Committee noted that TASL had generally responded well during the peak of Covid-19.  However, the KPI performance for TASL had continued to be below contracted levels

The Committee noted further that the assessment of risk of termination on the contract remained as previously reported.

During discussion, the Committee raised the following issues:

·         Changes to the eligibility criteria – The Committee was advised that the CCG was not aware of any changes to the eligibility criteria and agreed to look into a particular case outside of the meeting;

·         What  ...  view the full minutes text for item 28.

(To receive a report from the NHS Lincolnshire Clinical Commissioning Group (LCCG), which provides the Committee with an update on the Community Pain Management Service.  Sarah-Jane Mills, (Chief Operating Officer, LCCG) and Tim Fowler, (Assistant Director of Contracting and Performance, LCCG) will be in attendance for this item)

The Chairman invited Tim Fowler, Assistant Director of Contracting and Performance, Lincolnshire CCG and Sarah-Jane Mills, Chief Operating Officer (West Locality), Lincolnshire CCG to update the Committee on the Community Pain Management Service. 

The report for the item was shown on pages 91 to 95 of the report pack.

The Committee was reminded that the service had been awarded in November 2018 to Connect Health and that the service had commenced on 1 April 2019.  The service was commissioned as an end to end chronic pain management service throughout the pain pathway from GP referral through assessment and treatment to discharge.  It was highlighted that in accordance with best practice the service had also moved away from a traditional model of pain management largely focussed around injections to a 'holistic bio psychosocial' model of care.

The Committee noted that Covid-19 had presented a significant number of challenges to the pain management service. These challenges were generally well responded to and a number of actions had been put in place to allow the service to continue during Covid-19 i.e. virtual appointments.

The Committee noted further that the most significant issue had been the suspension of hospital based elective pain management treatment, which during Covid-19 had been largely cancelled in line with national guidance.  It was highlighted that patient's whose assessment or treatment had been cancelled were being kept under review by Connect Health.

It was reported that Connect Health had now restored all services and were working to reduce the backlog of assessments and treatments, and that plans were in place to have normalised waiting times to those pre-Covid-19 by the end of December 2020.

The Committee noted that patient satisfaction with the service had been largely positive; and that comments received from patients whether positive or negative had been reviewed with Connect Health.  Some negative comments received were contained on page 93 of the report.

Appendix A to the report provided the Committee with a KPI Performance Summary - April 2020 to August 2020.  It was noted that performance across the KPIs was variable, with some indicators showing good performance despite Covid-19 impact.  Reassurance was given that action was being taken to consistently improve performance where below target levels.

During discussion, the Committee raised the following points:

·       Patient expectations not being met. The Committee noted that this was a complicated issue as to what meets the needs of an individual.  The contracted service was the nationally recommended approach to help people manage their pain; and for a significant number of people that approach helped; and enabled some patients to come off their medication.  However, there were some individuals who needed their medication, and the service provided a person centred approach;

·       Some concern was expressed that the transfer of some patients to the service had not been managed as well as it could have been and that going forward there needed to be reassurance that patients' needs were dealt with in a sympathetic way.  The Committee noted the service was all  ...  view the full minutes text for item 29.

(To receive a report from the NHS Lincolnshire Clinical Commissioning Group (LCCG), which advises the Committee of an engagement exercise by Lakeside Healthcare at Stamford on its proposal to permanently close one of its two premises in Stamford from 1 December 2020.  Sarah-Jane Mills (Chief Operating Officer, LCCG) will be in attendance for this item) 

The Chairman advised the Committee that the item could be found on pages 97 to 108 of the agenda pack.

The Committee was advised that the Chairman had received three requests from members of the public to speak regarding the item; and that these would be heard first prior to the presentation, and that each speaker would be given three minutes.

The Chairman invited the first speaker to address the Committee: Mr Andrew Nebel, Chairman of Lakeside Healthcare at Stamford Patient Participation Group (PPG).

Mr Nebel advised the Committee that the proposed closure of St Mary's Medical Centre on the 1 December 2020 had not been communicated to patients or to the PPG and had only been confirmed by Lakeside when the PPG learnt of it on 26 August 2020.

The Committee was advised that patients had been disadvantaged by a lack of openness and poor communication; and that the practice had not worked with the PPG.

Concern was expressed that a full consultation process had not taken place prior to the decision to close the surgery and to whether a statutory Equality Impact Assessment had been completed.

The Committee was advised that based on the significant feedback received from patients the PPG opposed the closure.

In conclusion, the Committee was advised that PPG believed that is was possible to negotiate an affordable extension of the lease at St Mary's, which would allow for a review of the town and surrounding villages' growing primary care needs.

The Chairman invited Mr William Turner, Mayor of Stamford to address the Committee:

Mr Turner echoed the concerns of the previous speaker with regard to lack of consultation, and whether an Equality Impact Assessment had been completed.

Concern was also expressed to the parking provision at the Sheepmarket Surgery and to time consuming telephony system currently operated by the surgery.

The Chairman invited Councillor Gloria Johnson, South Kesteven District Council and Deputy Mayor of Stamford Town Council to address the Committee.

Councillor Johnson provided the Committee with her personal patient perspective of the St Mary's Surgery.

The Committee was advised that Councillor Johnson had been a patient at the surgery for some forty years; and that the service provided to patients had deteriorated when Lakeside had taken over the surgery.  Reference was also made to time taken get through to the surgery by phone (an average of 45 minutes); and patients not being able to get a face to face appointments.  Concern was also expressed whether the Sheepmarket Surgery would be able to accommodate the patients from St Mary's.

The Chairman extended his thanks to the three members of the public for their input.

The Chairman advised that the following presenters were in attendance for the item.  They were: Adam Cocks, Chief Operating Officer, Lakeside Healthcare, Andy Rix, Chief Operating Officer (South West Locality) Lincolnshire CCG and Sarah-Jane Mills, Chief Operating Officer (West Locality) Lincolnshire CCG.

The Committee was advised that the St Mary's Medical Centre had been closed to patients since  ...  view the full minutes text for item 30.

(To receive a report from NHS Lincolnshire Clinical Commissioning Group (LCCG), which advises the Committee of an engagement exercise by Vale Medical Group on its proposal to permanently close its branch surgery in Woolsthorpe.  Sarah-Jane Mill (Chief Operating Officer, LCCG) will be in attendance for this item)

The Chairman invited Clair Raybould, Chief Operating Officer (South Locality) Lincolnshire CCG, Shona Brewster Head of Transformation & Delivery (South West Locality) Lincolnshire CCG and Sarah- Jane Mills, Chief Operating Officer (West Locality), Lincolnshire CCG to present the item to the Committee.

The Committee noted that this item could be found on pages 109 to 118 of the report pack.

The Committee was advised that the Vale Medical Group was undertaking an engagement exercise on its proposal to permanently close its branch surgery in Woolsthorpe.  It was noted that the engagement exercise was due to close on 27 October 2020.

The Committee was advised that the Vale Medical Group's Stackyard Surgery (in Croxton Kerrial) had approximately 3,370 registered patients (as of 1 September 2020); and this included approximately 1,648 patients based in Woolsthorpe.  It was noted that the Vale Medical Group was also proposing to make an administrative change, moving Stackyard Surgery from Lincolnshire Clinical Commissioning Group (CCG) into East Leicestershire and Rutland CC.  It was noted further that this was a separate issue on which East Leicestershire and Rutland would be leading.

It was reported that from the beginning of the Covid-19 pandemic, Woolsthorpe Surgery including its dispensary had been temporarily closed, with all face to face consultations taking place at the Stackyard Surgery.  This was because it had not been possible to maintain social distancing at the Woolsthorpe Surgery.

Attached at Appendix A to the report was a copy of the letter sent from the Vale Medical Group to patients; and Appendix B provided details of frequently asked questions for the Committee to consider.

That Committee was advised that to date 120 surveys had so far been returned, which had provided a range of feedback.  The Committee was advised further that on the 27 October 2020 the Lincolnshire CCG would start analysing the responses received.  The Committee noted that the matter would then be considered by the Lincolnshire CCG's Primary Care Commissioning Committee.

During discussion, the following comments were raised:

·   Concern was expressed on the proposed closure as a lot of residents attending the Woolsthorpe Branch Surgery were elderly; and did not have access to public transport to the Stackyard Surgery; especially when patient transport did not cover GP appointments.  The Committee was advised that during the pandemic safer and more efficient ways of delivering primary care had been introduced, which had included internet, telephone and video consultations, therefore a larger number of patients had been dealt with virtually; and those needing face to face appointments had been seen by a GP.  For those patients with a genuine medical need, a home visiting service was still in place;

·       Would patients continue to receive same medications/procedures with East Leicestershire and Rutland CCG.  Reassurance was given that medications and procedures would remain the same;

·   Had the proposed closure had an equality impact assessment?  Confirmation was given that a equality impact assessment had been undertaken, as had a demand and capacity modelling exercise and that this information would  ...  view the full minutes text for item 31.

(To receive a report from Simon Evans, (Health Scrutiny Officer), which updates the Committee on the launch of a patient survey on an extension to the temporary closure of Louth and Skegness Urgent Treatment Centres (UTCs) between 10pm and 8am)

The Chairman invited Simon Evans, Health Scrutiny Officer to present the item to the Committee.  The Committee noted that the report was detailed on pages 119 to 121 of the report pack.

The Committee was advised that a patient survey had been launched on the continuation of the temporary closure of Louth and Skegness Urgent Treatment Centres between 10pm and 8am until at least 31 March 2021.

The Committee was advised further that at the next meeting there would be an update from Lincolnshire Community Health Services NHS Trust (LCHS) on integrated urgent care.  It was proposed that the Committee should make arrangements to respond to the survey, which was due to close on 13 November 2020.

Some concern was expressed regarding the continuing closure, especially when caravan sites along the east coast were remaining open over the winter period.  This was also accentuated by the fact that in both Skegness and Louth residents were visiting UTCs, as it was easier than getting a GP appointment.  It was also highlighted that the Committee had pushed for 24/7 walk-in access to both Skegness and Louth UTCs in response to the Healthy Conversation engagement.

The Committee extended their support for the need to respond to the patient survey and that the LCHS should be encouraged to publicise the survey as widely as possible, so that residents of Louth and Skegness had the opportunity to respond.

RESOLVED

1.    That arrangement be made at the Committee's next meeting on 11 November 2020, for responding to the patient survey by Lincolnshire Community Health Services NHS Trust, on an extension of the temporary closure of Louth and Skegness Urgent Treatment Centres (UTCs) between 10.00pm and 8.00am until 31 March 2021.

2.    That Lincolnshire Community Health Services NHS Trust be urged to make every effort to publicise the patient survey, so that as many residents of Louth, Skegness and the surrounding areas as possible respond.

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

The Chairman invited Simon Evans, Health Scrutiny Officer to present the item to the Committee.  The item was detailed on pages 123 to 131 of the report presented.

The Committee requested that an explanation should be sought regarding the local NHS's proposals for managing winter.

RESOLVED

          That the Work Programme as presented be agreed.