Agenda and minutes

Apologies for absence were received from Councillors R P H Reid, R Kayberry-Brown (South Kesteven District Council) and Dr B Wookey (Healthwatch Lincolnshire).

It was noted that the Chief Executive, having received notice under Regulation 13 of the Local Government (Committee and Political Groups) Regulations 1990, had appointed Councillor M A Whittington to replace Councillor R P H Reid for this meeting only.

It was also noted that Dr Maria Prior (Healthwatch Lincolnshire) had replaced Dr B Wookey (Healthwatch Lincolnshire) for this meeting only.

The Committee was advised that an apology had also been received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison, Community Engagement, Registration and Coroners).  

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 13 October 2021 be agreed and signed by the Chairman as a correct record.

Further to the Chairman’s announcements circulated with the agenda, the Chairman brough to the Committee’s attention the supplementary announcements circulated on 9 November 2021.  The supplementary announcements referred to:

·       The most recent Covid-19 data, compiled by Lincolnshire County Council Public Health Division;

·       Care Quality Commission (CQC) Inspection of United Lincolnshire Hospitals NHS Trust made between the 5 and 8 October 2021.  It was noted that the CQC was following these inspections with a ‘Well Led Review’ of United Lincolnshire Hospitals NHS Trust between 9 and 11 November, the results of which were not expected to be published until early 2022; and

·       The Lincolnshire Community Health Services NHS Trust (LCHS) launch of the Lincolnshire Urgent Community Response Service (4 October 2021), which aimed to care for people at home through an urgent crisis response service within two hours.

During a short discussion, the Committee raised the following comments:

·       Concern was expressed relating to the Covid-19 data, and to the increase in the number of cases in Lincolnshire, with particular reference being made to the rise in the number of positive cases in the South Kesteven District Council area;

·       Some concern was also expressed regarding the number of NHS vacancies at Pilgrim Hospital, Boston; and to the reducing number of GPs across Lincolnshire;

·       Whether the new Urgent Community Response Service was a Countywide service.  The Scrutiny Officer agreed to seek a response to this question; and

·       One member enquired whether details had been made available relating to the financial impact of the Acute Services review.  The Scrutiny Officer agreed to follow up after the meeting.

RESOLVED

That the supplementary Chairman’s announcements circulated on 9 November 2021 and the Chairman’s announcements as detailed on pages 17 to 28 of the report pack be received.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the details provided on the Lincolnshire Acute Services Review of Stroke Services; and to highlight any areas which the Committee’s working group might wish to explore in further detail. Senior representatives from United Lincolnshire Hospitals NHS Trust will be in attendance for this item)  

Councillor S R Parkin joined the meeting at 10.08am.

The Chairman invited Dr Abdul Elmarimi, Consultant in Stroke Medicine, United Lincolnshire Hospitals NHS Trust and Charley Blyth, Director of Communications and Engagement, Lincolnshire Clinical Commissioning Group, to remotely, present the item to the Committee.

In his introduction, Dr Abdul Elmarimi provided an introduction for Committee regarding the impact of a stroke on a patient; the services required to treat the three main levels of stroke within certain timescales, and the rehabilitation period required for a patient to recover from a stroke.

It was reported that Hyper-Acute and Acute stroke services were provided by highly trained and skilled doctors, nurses and therapists who specialised in looking after people who had had a stroke.

It was highlighted that there were two key hospital services for the treatment of strokes which were, firstly thrombolysis, a ‘clot busting drug’ which was used to treat strokes caused by blood clots.  The use of this treatment was time critical and had to be administered within 4.5 hours of the stroke’s onset; and the second treatment was mechanical thrombectomy or ‘clot retrieval’.  It was noted that this was a relatively new procedure and was only available in a small number of hospitals; the nearest for Lincolnshire was the Queen’s Medical Centre, Nottingham.

Appendix A to the report provide the Committee with further details relating to how services were currently organised at ULHTs hospitals (pre-Covid).

The summary of services pre-Covid was:

Lincoln County: Hyper-acute stroke services including Thrombolysis; Acute stroke Services and Transient Ischaemic Attack (TIA) mini stroke clinics; and

Pilgrim Hospital:  Hyper-acute stroke services including Thrombolysis; Acute stroke Services and Transient Ischaemic Attack (TIA) mini stroke clinics.

The Committee was advised of the challenges and opportunities for stroke services and what was hoped to be achieved by making the changes. It was highlighted that national best practice was that hyper-acute stroke units should admit a minimum of 600 patients a year, below this level doctors and nurses in hospital stroke services risked becoming deskilled.  The Committee was advised that Lincoln County Hospital admitted 670 stroke patients a year and Pilgrim Hospital, Boston around 500 stroke patients a year.  It was noted that even when considering growth in the size of the ageing population over the next five years, Pilgrim Hospital Boston, was unlikely to admit 600 stroke patients each year.

It was reported that more doctors, nurses, and therapists were needed to deliver the existing hospital stroke services and that there was a shortage of such staff locally and nationally. Locally, this was causing problems as there had already been a temporary closure of some of the stroke services as there was not enough doctors and nurses available.  As a result of this, both Lincoln County and Pilgrim Hospital Boston had struggled to consistently perform well in the national audit of service quality and performance, despite the skills and dedication of staff.

It was highlighted that feedback from engagement, particularly through the Healthy Conversation 2019 had  ...  view the full minutes text for item 46.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the details provided on the Lincolnshire Acute Services Review of Urgent and Emergency Care; and to highlight any areas which the Committee’s working group might wish to explore in further detail.  Dr Dave Baker, South West Lincolnshire Locality Clinical Lead, Lincolnshire Commissioning Group and Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust will be in attendance for this item)

The Committee considered a report, which provided details on the Lincolnshire Acute Services Review of Urgent Emergency Care.

The Chairman invited Dr Dave Baker, South West Lincolnshire Locality Clinical Lead, Lincolnshire Clinical Commissioning Group, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust and Charley Blyth, Director of Communications and Engagement, Lincolnshire Clinical Commissioning Group, to remotely present the item to the Committee.

Appendix A to the report provided an extract of the Lincolnshire NHS Public Consultation Document relating to four of Lincolnshire’s NHS Services – Urgent and Emergency Care at Grantham and District Hospital; and Appendix B provided a copy of the Pre-Consultation Business Case for the Lincolnshire Acute Services Review for the Committee’s consideration.

The Committee were reminded of the background relating to Grantham and District Hospital since 2007/08.  It was highlighted that the A & E had only dealt with a limited range of emergency conditions, due its small size and its limited availability of specialist staff and limited range of 24/7 support services to support very ill patients after they left the A & E department.

It was reported that most patients treated at Grantham and District Hospital A & E department could be safely treated at an Urgent Treatment Centre (UTC).

The Committee was advised that if a patients presented themselves at Grantham and District Hospital A & E department with conditions that the hospital was not able to deal with, the skills and experience were there to manage the patient whilst a transfer was quickly arranged to a more specialist unit for the appropriate treatment.

Summary details relating to the current provision at United Lincolnshire NHS Hospital Trust’s A & E departments were shown on page 64 of the report. It was noted that in addition to the three A & E departments, six UTCs were provided by Lincolnshire Community Health Services NHS Trust (LCHS).

The Committee was advised that the proposal was to establish a 24/7 Walk in Urgent Treatment Centre at Grantham and District Hospital, in place of the current A & E.  It was highlighted that the multi-disciplinary workforce would have the ability to manage all presentations, and that it was anticipated that the change would affect around 3% of patients currently attending Grantham and District Hospital.  This was equivalent to two patients a day on average being transferred for immediate specialist care.

Page 67 of the report pack provided a summary of the level of stakeholder and public support for the change proposal.

During consideration of this item. The Committee raised the following comments:

·       Some concern was expressed regarding challenges being experienced by LCHS in providing staffing cover at other UTCs.  Reassurance was given that services had not been impacted and that LCHS had to be constructive with its staffing to maintain services.  It was noted that this was a temporary issue, and was one that was being felt across all health services, mainly due to Covid-19;

·       One member expressed concern that the report did not express the views of the people of Grantham.  Reassurance  ...  view the full minutes text for item 47.

(To receive a report from NHS England and NHS Improvement (Midlands), which provides the Committee with an update on the provision of NHS dental services commissioned in Lincolnshire.  Carole Pitcher, Senior Commissioning Manager and Tom Bailey, Senior Commissioning Manager will be in attendance for this item)

The Chairman invited Carole Pitcher, Senior Commissioning Manager, NHS England and NHS Improvement (Midlands), Allan Reid, Consultant in Healthcare Public Health (Oral Health) and Rose Lynch, Commissioning Manager, Primary Care Dental Services, to remotely present the item to the Committee.

The report presented provided an update to the Committee on the provision of NHS dental services commissioned in Lincolnshire and provided an overview of the continuing effect of the Covid pandemic and the steps being taken to restore and recover services.

Whilst guiding the Committee through the report, reference was made to the NHS contracts in primary and community dental care that had been in place since 2006; the dental services offered in Lincolnshire, including out of hours service and secondary care.

The Committee was advised of the impact of the national pandemic upon dentistry and a timeline was available for the Committee to consider, which was detailed on pages 94 to 96 of the report.

The Committee was advised that during April – September 2021 (Q1 & Q2), providers had been required to deliver a minimum of 60% of their pre-Covid contractual activity, to continue to receive 100% payment.  Figure 1 on page 99 provided details of the achievements of the Lincolnshire providers during this period.

The Committee was advised that to ensure that NHS Dental services were at the forefront of the new Integrated Care System, NHS England/Improvement had appointed Kenny Hume as the new Local Dental Network Chair for Lincolnshire.

The issue of oral health in Lincolnshire was highlighted.  The Committee noted that the results of a recent survey had shown that in Lincolnshire average levels of dental decay were higher than the average for England. The report highlighted that children living in Boston had the highest levels of child dental decay in the region.  South Holland, East Lindsey and Lincoln also had child dental decay that placed them in the top ten lower tier local authorities in the region.  It was highlighted there was an east/west divide in childhood decay in Lincolnshire, and that this disparity was because the west of the County’s water supply was fluoridated under an existing fluoridation agreement and that the east of the County did not receive fluoridated water.  It was also highlighted that there were fewer dental services available in the east of the County.  Priorities for tackling child dental decay were shown at paragraph 8.8 of the report.

Note: Councillor S R Parkin left the meeting at 12:50pm.

During consideration of the item, the Committee raised the following points: -

·       Whether an NHS dentist was able to offer private treatment.  The Committee noted that most NHS dentists had a mix of NHS and private patients and that the percentage varied.  The Committee was advised that information was not available relating to private dental practices.  The Committee was advised further that general dentistry was provided through an annual contract;

·       The impact of non-fluoridation in the east of the County and its impact on dental decay in children;

·       Concerns were expressed to  ...  view the full minutes text for item 48.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on its forthcoming work programme  and to extending the activities of the working group, established at the last meeting for the consultation on the Lincolnshire Acute Services Review, to the Humber Acute Services engagement exercise)

The Chairman invited Simon Evans, Health Scrutiny Officer, to present the report, which invited the Committee to consider and comment on its work programme as detailed on pages 110 to 112 of the report pack.

The Committee was advised that the United Lincolnshire Hospitals NHS Trust – Nuclear Medicine item would not be included on the December agenda.

Other items highlighted to be scheduled for the new year were:

·       Dental Services;

·       Lakeside Healthcare Stamford;

·       Non-Emergency Patient Transport;

·       Lincolnshire Clinical Commissioning Group – lessons learnt regarding GP practices.  The Health Scrutiny Officer agreed to speak to CCG colleagues regarding this matter.

The Committee was also advised that dates for the Working Group meetings would be circulated in due course.

RESOLVED

That the work programme presented be received and that the items highlighted above be considered.