Agenda and minutes

An apology for absence was received from Councillor S Barker-Milan (North Kesteven District Council).

The Committee noted that Councillor Mrs L Hagues (North Kesteven District Council) had replaced Councillor S Barker-Milan (North Kesteven District Council) for this meeting only.

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

No declarations of members' interest were made at this stage of the proceedings.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 14 October 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:

·         NHS response to Covid-19 – Return to Incident Level 4;

·         Lincolnshire CCG's Primary Care Commissioning Committee – 11 November 2020;

·         Grantham Hospital – Correspondence with the Minister of State for Health;

·         Planning Application for Urgent Treatment Centre at Lincoln County Hospital; and

·         Continuing Healthcare: Getting It Right First Time.

RESOLVED

That the Supplementary Chairman's announcements circulated and the Chairman's announcements as detailed on pages 19 to 27 of the report pack be noted.

(To receive a report from Lincolnshire Community Health Services NHS Trust (LCHS), which provides the Committee with an update on LCHS's urgent care services.  Maz Fosh, (Chief Executive, Lincolnshire Community Health Services NHS Trust) and Tracy Pilcher, (Director of Nursing and Deputy Chief Executive, Lincolnshire Community Health Services NHS Trust) will be in attendance for this item)

The Chairman invited Maz Fosh, Chief Executive, Lincolnshire Community Health Services NHS Trust (LCHS) and Tracy Pilcher, Director of Nursing and Deputy Chief Executive, LCHS to present the report, which provided the Committee with an update on LCHC's urgent care services.  The report as detailed on pages 29 to 36 focussed on the Clinical Assessment Service (CAS), the urgent treatment centres (UTCs), and minor injuries units (MIUs) provided by LCHS.

The Committee was provided with an overview of the latest position in relation to Covid-19 second surge.  It was noted that as of Tuesday 10 November 2020, United Lincolnshire Hospitals NHS Trust (ULHT) had 117 Covid-19 positive in-patients in their acute hospitals; and LCHS had 13 Covid-19 positive in-patients in their community hospitals.  It was noted further that LCHS were also caring for 532 patients in the community.

It was also highlighted that Covid-19 was having an impact on workforce availability, and that currently ULHT had 272 staff absences as a result of Covid-19.  This figure included staff who were self-isolating, or waiting for test results.  The Committee was advised that out of the 98 absences LCHS had, 34 were as a result of Covid-19.

It was reported that LCHS were taking all the necessary steps to meet the requirements of the government's guidance and as a result patients were being encouraged to ring 111; and that 'Talk Before You Walk', was being promoted to protect patients and staff.

The Committee were reminded that urgent care included services where treatment required was not life threatening, but was required on the same day for patient wellbeing, satisfaction and quality of life.  It was highlighted that urgent care differed from emergency care, where the need was more acute or life-threatening and this was provided by accident and emergency departments.

It was reported that when Lincolnshire patients called NHS 111, and their call was categorised as being suitable for LCHS services, the calls were transferred to the Clinical Assessment Service (CAS).  It was noted that the CAS was well established and operated 24/7, 365 days a year, providing phone-based clinical advice and guidance.

Pages 30 and 31 of the report provided the Committee with details of the number of cases handled, call-back times, cases closed by CAS, and monthly performance information. 

It was noted that between 1 February 2020 and 20 October 2020 a total of 83,757 cases had been handled, representing an average of 9,306 cases per month, which had peaked at 11,018 in March 2020.

The Committee was advised that the average call-back wait time in the past 30 days had reduced to 19 minutes for interim cases and 17 minutes for emergency cases.

The Committee was advised further that the figure for the number of cases closed by the CAS had increased to 67%, with no referral to any other service.  It was also noted that the proportion of cases closed without being referred to emergency care remained at 90%.

It was reported that since July 2020, there  ...  view the full minutes text for item 38.

(To receive a report from the Lincolnshire Clinical Commissioning Group, which provides the Committee with information on primary care services.  Sarah-Jane Mills, (Chief Operating Officer, Lincolnshire Clinical Commissioning Group) will be in attendance for this item)

The Chairman welcomed Sarah-Jane Mills, Chief Operating Officer, Lincolnshire Clinical Commissioning Group to the meeting and invited her to present the report to the Committee.

The item as detailed on pages 37 to 77 of the agenda pack provided the Committee with information of GP primary care services in Lincolnshire.  The report also provided an overview of the national requirements from primary care during Phases 1, 2 and 3 of the responses to Covid-19; the current arrangements and plans for continuing to ensure local people can access primary care services; and the future development of primary care services as part of the wider integrated care offer from health and care.

Attached to the report were the following Appendices for the Committee to consider:

·       Appendix 1 – A copy of the Lincolnshire Primary Care Network Alliance

– Annual Report 2019-20;

·       Appendix 2 – Primary Care Access Arrangements; and

·       Appendix 3 – Case Study regarding the introduction of Ask my GP.

The Committee was advised that since 5 November 2020, the NHS had returned to Incident Level 4.  This meant the NHS had moved from regionally-managed, but nationally supported Incident Level 3 to one that was co-ordinated nationally.

The Committee was advised that the most significant changes patients had experienced in recent months had been the introduction of remote consultation.  Appendix 2 to the report provided the Committee with a list of all practices and the arrangements that had been adopted to facilitate remote consultation.  It was highlighted that there were three methods being used by GP practices across Lincolnshire, these were: Telephone consultation; E-Consult; and Ask My GP (Appendix 3 to the report provided details of a case study of Ask My GP).

It was reported that one of the core services provided by GPs was to support patients who were vulnerable.  The type of additional support provided included the review of care/treatment plans; remote consultations and home visits when necessary; home delivery of medications; and outreach contacts from wellbeing services and volunteers.

The Committee noted that when the NHS had declared a national level four incident, the Clinical Commissioning Group had established a Primary Care Cell.  It was noted further that the role of the Primary Care Cell was to provided direct support to GPs and primary care colleagues; co-ordinate a response to the national request; and assist teams and managers to manage local issues and integrate with the wider system.  

Page 45 of the report pack provided the Committee with details of the on-going development of primary care services.  It was noted that Primary Care Teams would continue to provide support to GP practices, as they worked together as Primary Care Networks and other agencies to develop service provision arrangements. 

In conclusion, the Committee was advised that primary care services were and would continue to be available to people across Lincolnshire.  There was recognition however, that the accelerated introduction of remote consultations had not, in some instances given time for practices and their patients to understand how best to  ...  view the full minutes text for item 39.

(To receive a report from Derek Ward, (Director of Public Health, Lincolnshire County Council), which provides the Committee with a summary of the outbreak management arrangements in Lincolnshire. An overview of the latest Covid-19 data for Lincolnshire will be provided at the meeting)

The Chairman invited Derek Ward, Director of Public Health, to provide the Committee with an update relating Covid-19.  Pages 91 – 92 of the report pack advised the Committee of the role of the County Council, as the lead public health authority in Lincolnshire; and provided a summary of the outbreak management arrangements in Lincolnshire.

The Committee was advised that Lincolnshire continued to see a lower than average England rate, although there was some variation across the districts.

It was noted that Lincolnshire was seeing an upward trend of Covid-19 cases, but it was hoped that this would see a levelling out by the end of the new restrictions.  It was noted further that if at the end of the new restrictions on 2 December 2020 there was a downward trend, this would be expected to continue for a period of 10 days and then there was an expectation that the rate would increase again.

During discussion, the Committee raised the following points:

·       Whether there would be mass testing in Lincolnshire.  The Committee was advised that mass testing would only be considered by the government for areas with a high prevalence of the virus;

·       If a vaccine became available in December, how the vaccine would be distributed to patients.  The Committee noted that roll-out of the vaccine would be led by the NHS and that it was understood that it would be made available to priority groups first.  The Committee noted further that the NHS may have to use other personnel to help with logistics of delivering the vaccine, and that conversations regarding this matter were on-going at the moment;

·       Some concern was expressed to the disregard for Hands, Space, Face.  The Committee was advised that there had been a very active communication programme by the County Council and the Lincolnshire Resilience Forum;

·       Whether wearing a mask reduced transmission rates.  The Committee was advised that evidence was developing as things progressed.  It was highlighted that face masks helped protect others and that was why it was necessary to keep two metres or more from other people, and that all three factors Hands, Face and Space were helping to reduce infection rates; and

·       Take up in Lincolnshire of 'Track and Trace.'  The Committee was advised that as the Track and Trace system was anonymous; there was no record of what the take-up was in Lincolnshire.  It was however noted that a future model might look different after the national restrictions, as this was an issue that was currently out for discussion.  Local track and trace was a suggested option, as Lincolnshire had a Public Protection Team to help with this process.

The Chairman on behalf of the Committee extended his thanks to the Director of Public Health for his update.

RESOLVED

That a further Covid-19 Update be requested for the 20 January 2021 meeting and that an update on the Covid-19 vaccine be received at the 16 December 2020 meeting. 

(To receive a report from Simon Evans, (Health Scrutiny Officer), which enables the Committee to make arrangements for its response to the patient survey, following consideration of the information presented by Lincolnshire Community Health Services NHS Trust on integrated urgent care)

The Chairman invited Simon Evans, Health Scrutiny Officer to present the item to the Committee, which was detailed on pages 83 and 84 of the report pack.

The Committee were reminded at its meeting on 14 October 2020 it had been agreed that the Committee would respond to the patient survey on a continuation of the temporary closure of Louth and Skegness Urgent Treatment Centres between 10pm and 8am; as the temporary overnight closure arrangements were due to remain in place until March 2021. 

The Committee was advised that the survey was due to close on 13 November 2020.

As the Committee had already expressed their concerns regarding the temporary arrangements in item 5 of the agenda. The Committee agreed to respond to the survey.

RESOLVED

That the Chairman be authorised to write to Lincolnshire Community Health Services NHS Trust, expressing the views that the changes to the opening times at Louth and Skegness Urgent Treatment Centres should only be a temporary measure during the Covid-19 pandemic, and there should be an aim to re-open these two centres in the longer term on a 24/7 'walk-in' basis as set out in the Healthy Conversation engagement exercise of 2019.

(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 85 to 94 of the report pack.

The Committee were invited to consider the work programme detailed on pages 86 and 87.

Appendix A to the report set out the previous work undertaken by the Committee.

The Committee noted that following the request from a member of the public referring to the eligibility of a specific case for NHS-funded continuing healthcare (as detailed in paragraph 5 of the report).  The Chairman advised he had responded advising that this was not a matter that the Committee could get directly involved in an individual case, as it was not within the Committees remit.

The Committee was however asked whether it would like to include an item on NHS Continuing Healthcare in its work programme.  Page 89 of the report provided expenditure figures on NHS Continuing Healthcare for 2019/20 for three of the four former Clinical Commissioning Groups for the Committees information. 

Also, the Committee noted that Section 3 of the Chairman's supplementary announcements provided information on a recent publication by the Parliamentary and Health Service Ombudsman on NHS Continuing Healthcare.

During a short discussion, a suggestion was made to the Committee for further consideration on the use of opioids.  The Committee noted that a request would be made for this to be included in the update from the Community Pain Management Service, which was scheduled to be considered by the Committee at the 24 March 2021 meeting.  A further request was made for the inclusion of an item on the potential for UTC provision in the south east of the county.

The Committee also agreed to the inclusion of Continuing Healthcare as a future agenda.

RESOLVED

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