Agenda and minutes

No apologies for absence were received from Committee members.

An apology for absence was 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 20 January 2021 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.

The supplementary announcements provided information on the following:

·       Vaccination update;

·       Approval by the Lincolnshire Clinical Commissioning Group's Primary Care Commissioning Committee of the closure of the Woolsthorpe Branch Surgery and the transfer of the Stackyard surgery to East Leicestershire and Rutland Clinical Commissioning Group;

·       The temporary closure of Ashley House, Grantham and the redeployment of staff to Ash Villa and Community Rehabilitation; and

·       Information concerning Integration and Innovation: Working Together to Improve Health and Social Care for all.  Appendix A to the supplementary announcements provided an executive summary of the health and social care white paper.

The local electoral division member wished it to be recorded that he disapproved of the decision taken by the Primary Care Commissioning Committee with regard to the closure of the Woolsthorpe Branch Surgery.

The Chairman extended his thanks on behalf of the Committee for all NHS colleagues and volunteers for their dedication and hard work in achieving the target set for vaccinations by the Joint Committee on Vaccination and Immunisation.

RESOLVED

1.    That the Supplementary Chairman's announcements circulated prior to the meeting and the Chairman's announcements detailed on pages 13 to 16 of the report pack be noted.

2.    That thanks be extended by the Committee to all NHS colleagues and volunteers for their dedication and hard work in delivering the vaccination programme across Lincolnshire.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides the Committee with an update on the LPFT Child Adolescent Mental Health Service proposed service change to move to a permanent Intensive Home Treatment Team service.  Senior management representatives from NHS England and NHS Improvement; and LPFT will be in attendance for this item)  

The Committee gave consideration to a report which provided an update on the Lincolnshire Partnership NHS Foundation Trust (LPFT) Child and Adolescent Mental Health Service (CAMHS) and the proposed service change from in-patient care to a permanent Intensive Home Treatment Team service.

The Chairman invited Jane Marshall, Director of Strategy, Planning and Partnership and Andrew Horton, Lead Commissioner, NHS England and NHS Improvement – Specialised Commissioning (Midlands) to present the report, which was detailed on pages 17 to 22 of the report pack.

It was highlighted that on 22 July 2020; the Committee had given consideration to a report, which had advised of the impact of the new model of care in place in Lincolnshire.  At the aforementioned meeting, the Committee had asked that engagement should take place with the Lincolnshire public, to seek their views as to whether the new model of care should be a permanent change.

It was highlighted further that the report, which had been considered by the Committee on 22 July 2020, had demonstrated that the service was meeting all key indicators of quality, and the new model of care was delivering improved care to meet the needs of Lincolnshire children and young people, in the absence of a General Adolescent Unit in the county.

The Committee was advised that NHS England had embarked on targeted engagement activity to assess views and feedback on the new community model of care compared to in-patient care.  Some examples of the statements received were shown on page 18 of the report.

The Committee noted that the most recent engagement exercise was designed to assess the views on the pilot and also on in-patient care in Lincolnshire.  A copy of the letter and questionnaire sent to service users was set out in Appendix A, for the Committee's consideration.  It was noted further that a copy of the engagement letter and questionnaire had been circulated to patient representative groups, counsellors and case workers, young people and their carers, all of whom either had experience of in-patient care, or the community pilot, as well as charities who worked with young people and mental health.  The Committee was advised that the engagement activity was due to close on 19 February 2021.

During discussion, the Committee raised the following comments:

·       Response rate so far to the engagement.  The Committee was advised that to date there had not been a large number of responses to the current engagement exercise.  The Committee was reminded that a lot of engagement had already happened prior to the current engagement exercise  The Committee was advised that details of pre-engagement feedback; and results of the current engagement exercise feedback would be shared with the Committee at a future meeting;

·       The current vacancy rates for CAMHS.  The Committee was advised that although working through the pandemic had brought challenges to the team.  The team overall were managing to cope due to their multi-disciplinary roles.  It was noted however, that there was a shortage of Band 5 nursing staff;

·       When  ...  view the full minutes text for item 63.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides the Committee with a general update.  Senior management representatives from LPFT will be in attendance for this item)

The Chairman invited Jane Marshall, Director of Strategy, Planning and Partnerships, Lincolnshire Partnership NHS Foundation Trust, to present the report to the Committee, which provided a general update from LPFT and also its response to the Covid-19 pandemic.

Detailed at Appendix A was a copy of a report by the Acting Chief Executive to the Lincolnshire Partnership NHS Foundation Trust Board of Directors (28 January 2021) for the Committee's consideration.

It was reported that Covid-19 had been a challenge for LPFT, but Trust staff had responded brilliantly.  Staff had managed outbreaks well, ensuring that patients and staff had been kept safe. Despite the extra challenge of Covid-19, the Trust had still managed to make progress on transformation work.

The Committee noted that the Trust had undertaken its annual flu vaccination campaign for staff with an aim of achieving 90% take-up of the vaccine.  The Committee noted further that the response by the Trust staff had been exceptional resulting in the Trust achieving 92% take-up, which had resulted in LPFT being cited as the top performer in the midlands region, and the country.

The Trust had been a key player in supporting the county-wide Covid-19 vaccination programme.

The Committee was advised that the Trust had been awarded £37 million to eradicate dormitory accommodation across adult acute wards in Lincoln and Boston.  This was excellent news for the Trust and for the Lincolnshire health and care system. 

It was reported that the Trust remained committed to having zero inappropriate out of area adult and older adult Acute and PICU placements by April 2021.  Details of the work currently underway on two specific schemes to build in-patient capacity were shown on page 27 of the report pack.  These were: repurposing Ash Villa into a 15 bed acute ward for women; and repurposing the Wolds Ward at Discovery House, Lincoln, from long-stay rehabilitation to a short-stay reablement service.

The Committee was advised that as the Trust had encountered difficulties in recruiting Band 5 registered nursing staff and current operational pressures faced by the Trust, linked to the Covid-19 pandemic; a decision had been taken to temporarily close Ashley House in Grantham.  It was noted that Ashley House was one of two long-stay intensity mental health rehabilitation wards, which was currently operating at 50% capacity.  The Committee was advised that patients at the unit would be moved to Maple Lodge, Boston, which was a Care Quality Commission compliant setting for mixed genders. The temporary closure would then release staff from Ashley House to enable Ash Villa to open; and also expand the existing Community Rehabilitation Team to support more rehabilitation patients in the community, and provide greater resilience to the in-patient workforce.  It was noted further that that the temporary change had been necessary in order to provide much needed resilience to essential services and to maximise treatment outcomes for patients.  The Committee noted that the situation would be kept under review.

Reference was made to the publication of the Independent Safeguarding Adults Review –  ...  view the full minutes text for item 64.

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on Covid-19.   Andrew Morgan, Chief Executive of ULHT and Simon Evans, Chief Operating Officer, ULHT will be in attendance for this item)

The Committee gave consideration to a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provided a Covid-19 update.

The Chairman invited Andrew Morgan, Chief Executive of ULHT and Simon Evans, Chief Operating Officer, ULHT, to present the report to the Committee.

Attached as Appendix A to the report was a copy of a report to United Lincolnshire Hospitals NHS Trust Board of Directors (2 February 2021) from their Chief Executive for the Committee to consider.

The Committee was advised that since the start of the Covid-19 pandemic, nearly a year ago, the Trust had dealt with 2,754 Covid-19 positive in-patients, and as of 16 February 2021, 1,874 in-patients had been discharged home and 748 patients had died. 

It was reported that currently, the NHS was continuing to operate at level 4 and was governed by national direction.

The Committee noted that currently the Trust was looking after 85 Covid-19 positive in-patients, 56 in-patients at Lincoln County Hospital and 29 in-patients at Pilgrim Hospital, Boston. 

The Committee noted further that the number of Covid-19 positive in-patients was starting to decline; and that the Trust was also seeing staff absences reducing from 14% to 7%, which was an improving positive position for the Trust.

It was highlighted that hospitals remained busy, with bed occupancy levels at 90%.  The Committee noted that the Trust had to ensure that Covid-19 positive in-patients were kept separate from non Covid-19 in-patients and as a result some beds had to be kept vacant, this then had an impact on bed occupancy figures.  It was reported that intensive care had been very busy and that a rise in activity had been mirrored across the country.  As a result of the increase in activity, staff had been moved around hospital sites to support intensive care units (ICUs), which was then having an effect on other hospital services.

The Committee noted that the Trust was making progress with recruitment; and had been successful in making job offers to over 200 health care support workers and over 200 overseas recruits.  Details of the measures in place to keep staff safe and well was shown on pages 39 and 40 of the report pack.

During discussion, the Committee raised the following comments:

·       A question was asked whether Lincolnshire had experienced any issues procuring PPE in Lincolnshire, with particular reference to fraudulent suppliers.  The Committee was advised that there had not been any problems in Lincolnshire in this regard;

·       The Committee extended their thanks to all NHS staff for their hard work;

·       Clarification was sought as to when the Acute Services Review would be finalised.  The Committee was advised that the Trust was just about to submit a revised pre-consultation business case to NHS England/Improvement, and that there was no confirmed date for its consideration;

·       The effectiveness of the Winter Plan model – The Committee was advised that the Winter Plan had worked; but there had been significant  pressures as a result of the increase in Covid-19 inpatients; which had impacted on  ...  view the full minutes text for item 65.

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on the Grantham 'green site'. Andrew Morgan, Chief Executive of ULHT and Simon Evans, Chief Operating Officer, ULHT will be in attendance for this item)  

The Chairman invited Andrew Morgan, Chief Executive, ULHT and Simon Evans, Chief Operating Officer, ULHT to present the report, which provided an update from the Trust on the Grantham 'green site' arrangements.

Attached at Appendix A was a copy of a report presented to United Lincolnshire Hospitals NHS Trust Board of Directors (2 February 2021) – Second Quarterly Review following Temporary Conversion of Grantham Hospital to a Covid-19 Green Site Model for the Committee to consider.

Note: Councillor R J Kendrick left the meeting at 12.03pm.

The Committee had considered a report from United Lincolnshire Hospitals NHS Trust on 14 October 2020 on its first quarterly review of the 'green site' arrangements at Grantham Hospital.

In guiding the Committee through the significant quarterly report the Chief Operating Officer made reference to: that the primary aims of the Grantham 'green site' model had been maintained, which were: Infection prevention control (IPC) excellence, capacity to deliver at scale; and future service resilience.  It was noted that at the quarterly review all three aims had been achieved.  From the thousands of patients treated at the site, no patient receiving elective surgery had contracted Covid-19 whilst in Grantham Hospital.  It was noted further although the site had not been entirely absent of Covid-19, investigations had supported that no patient had contracted Covid-19 as an inpatient through failure of IPC excellence, which was credit to all the staff involved.  

It was highlighted that the review report reviewed whether circumstances were different or whether the overriding criteria needed changing.  The Committee was advised that the ULHT Board had determined that there were not sufficient grounds for changing the current temporary arrangements; and that the action was reinforced by the national Covid-19 alert level 5; and the need to continue to protect the most vulnerable patients.  It was noted that the Board did not approve what would be happening on the temporary arrangements for the Grantham 'green site' after 31 March 2021.

During discussion, the Committee raised the following comments:

·       The number of outpatients using the Gonerby Road site and the suggestion that these would only be available for a further three months after the 1 April 2021.  Clarification was also sought as to whether the two additional theatres were permanent or temporary.  The Committee was advised that at the moment there were no plans to close the Gonerby Road site or the two additional theatres or to keep them, and a further assessment of the risk factors would need to be completed before a decision was made;

·       Extended waiting times at the Urgent Treatment Centre and that the referral of 1,024 patients to A & E warranted the return of an A & E back in Grantham.  The Committee were reminded that the measures currently in place were temporary and specific to Covid-19, and that when those arrangements ceased, the arrangements would be returned to the model that was in place previously.  The Committee noted that a proportion of patients seen at Grantham had always been transferred to  ...  view the full minutes text for item 66.

(To receive a report from Simon Evans, Health Scrutiny Officer, which sets out the Committee's work programme, with items listed for forthcoming meetings)

The Chairman invited Simon Evans, Health Scrutiny Officer, to present the report to the Committee.

Consideration was given to the work programme and to items listed for forthcoming meetings shown on pages 94 to 95 of the agenda pack.

Appendix A to the report provided details of previous work activity undertaken by the Committee since 2017.

Items highlighted to be included on the work programme were:

·       Update on CAMHS;

·       Provider Collaboratives;

·       Community Transformation Funding;

·       Personality and Complex Trauma Team;

·       Update on the Grantham Green Site Arrangements; and

·       United Lincolnshire Hospitals NHS Trust – Covid-19 Update.

The Chairman advised the Committee that during the meeting he had received an email from the Lincolnshire Clinical Commissioning Group, (CCG) concerning the Woolsthorpe Branch surgery, operated by the Vale Medical Group.  The email had advised that the CCG had become aware that whilst the receipt of a petition had been referenced in the report to the Primary Care Commissioning Committee (PCCC), the petition had not been reviewed in line with the CCG's processes. It had therefore been agreed that the decision made by the PCCC would be paused and that consideration would be given to the petition.  Confirmation was also given that the Vale Medical Group had been made aware of this information.

Thanks were extended to Simon Evans, Health Scrutiny Officer and Katrina Cope, Senior Democratic Services Officer, for all their help and support to the Committee.

RESOLVED

That the work programme presented be received subject to the inclusion of the items listed above.