Agenda and minutes

RESOLVED

That Councillor C S Macey be elected as the Chairman of the Health Scrutiny Committee for Lincolnshire for 2021/22.

COUNCILLOR C S MACEY IN THE CHAIR

RESOLVED

That Councillor L Wootten be elected as the Vice-Chairman of the Health Scrutiny Committee for Lincolnshire for 2021/22.

Apologies for absence were received from Councillors Mrs S Harrison (East Lindsey District Council) and Mrs R Kayberry-Brown (South Kesteven District Council).

The Committee noted that Councillor M A Whittington (South Kesteven District Council) had replaced Councillor Mrs R Kayberry-Brown (South Kesteven District Council) for this meeting only.

An apology for absence was also received from Councillor 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 16 March 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 on 22 June 2021.  The supplementary announcements made reference to: Covid-19 Data; Integrated Care Systems – Design Framework; and Quality Accounts 2020/21.

The Chairman advised the Committee of his intention to write to Councillor Chris Brewis thanking him for his long service on the Committee, having been the Committee's Vice-Chairman from 2013 to 2021.

RESOLVED

That the Supplementary Chairman's announcements circulated and the Chairman's announcements as detailed on pages 15 to 24 of the report pack be noted.

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with a general update.  Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration and Simon Evans, Chief Operating Officer from 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 general update on its services.

The Chairman invited the following representatives from ULHT to remotely present the report to the Committee: Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration and Simon Evans, Chief Operating Officer.

The Committee received an update on the current position in relation to the services, which made reference to the following:

·       That ULHT currently had one Covid-19 positive in-patient in Pilgrim Hospital, Boston. The Committee noted that to date the Trust had treated over 3,000 Covid-19 patients.  The Deputy Chief Executive and Director of Improvement extended thanks to staff in hospitals and across Lincolnshire for their continued support and commitment throughout the pandemic.  In contrast, it was noted that in Wave One the number of patients receiving treatment had peaked at 104; and in Wave Two the figure had risen to 253 patients being treated;

·       The hospital hub had provided over 41,000 vaccinations to social care staff across Lincolnshire.  It was noted that hospital hub had now closed;

·       That complex clinics continued to operate to accommodate patients with more complex medical conditions who required closer monitoring;

·       That the number of staff absences from work as a result of Covid-19 or having to isolate had reduced back to normal levels, which was a positive step forward for the Trust;

·       There had been an increase in bed occupancy due to an increase in emergency demand, which had also impacted on other partners such as the ambulance service.  It was also highlighted that there had also been an increase in the number of elective patients;  

·       That the Trusts waiting lists were being treated in order of clinical urgency, with clinicians applying priority status: priority one where patients were treated within 72 hours, and the Committee noted that currently there were no patients waiting in this priority group; and priority two where patients were treated within four weeks.  The Committee noted that currently this waiting time was at six weeks.  There was recognition by the Trust that there was more to be done to improve access.  It was highlighted that cancer patients were quickly prioritised and were receiving treatment within four weeks.  It was highlighted further that the waiting list in Lincolnshire during the pandemic had peaked at just over 2,000 patients waiting, and that this figure had now been reduced to 937; and that there was a commitment to reduce the waiting list further; and  

·       That the Grantham restoration was going to plan and that services would be restored to as they were in May 2020 with two additional services: Chemotherapy and additional theatres (it was highlighted that there were currently two additional theatres but one of these was due to be removed).  It was highlighted further that it was the intention to make Grantham Hospital, the principal elective surgery site.

Appended to the report at Appendix 1 was a copy of the Chief Executive's Report to United  ...  view the full minutes text for item 7.

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which invites the Committee to respond to the consultation on hospital urology services.  Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration, Andrew Simpson, Consultant Urologist and Chloe Scruton, General Manager Surgery from ULHT will be in attendance for this item)  

The Chairman invited Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration, Andrew Simpson Consultant Urologist, Chloe Scruton, General Manager Surgery and Anna Richards, Associate Director of Communications and Engagement, to remotely present the report to the Committee.

The Committee was advised that planned urology services were currently delivered from Lincoln County Hospital, Pilgrim Hospital, Boston, Grantham and District Hospital and County Hospital, Louth; and emergency urology admissions at the weekends went through one single site-alternating between Lincoln and Pilgrim hospitals.  It was highlighted that there were emergency admissions at both Lincoln and Pilgrim hospitals during the week.

It was noted that ULHT were consulting patients on a proposal that Lincoln County Hospital in future received all emergency urology admissions seven days per week as they believed that this change would increase ULHT's capacity to perform planned surgery without disruption to patients, better meet the needs of ULHT's emergency cases and allow for more patients to seen and treated.

It was reported that at present, consultants and middle grade doctors within the urology service were required to perform planned surgery and be on-call for urgent surgical requirements at the same time. This was of concern as staff were becoming exhausted as they could be preforming planned surgery in the day and then be called out to perform an emergency surgery; this then impacted on the ability for the service to respond as quickly as it would like to emergency surgical needs; and it also caused the cancellation at short notice of planned surgeries, typically over 1,300 operations per year across ULHT every year for urology related procedures.

The Committee noted that the separation of duty to enable consultants to be either on-call or scheduled to perform planned surgery, would avoid the requirement to fulfil both duties at the same time.  Full details of what was being proposed were shown on pages 45 to 47 of the report pack and page 52 provided the Committee with a list of the benefits to patients of the proposal.

Detailed at Appendix 1 to the report was a copy of a document entitled   Hospital Urology Services Consultation – Have Your Say (United Lincolnshire Hospitals NHS Trust-2021) for the Committee to consider.  The Committee was advised that the consultation was due to close on 23 July 2021.

During discussion, the Committee raised the following points:

·       Clarification whether the 1,900 cancelled procedures annually related to elective procedures.  Confirmation was given that the figure related to elective procedures;

·       Whether there was sufficient bed capacity to meet the increased demand in elective surgery at Grantham Hospital.  Confirmation was given that there was sufficient bed capacity at Grantham Hospital; as more surgical procedures were planned to be carried out at Grantham Hospital;

·       Operating theatre capacity at Grantham Hospital.  The Committee noted that currently there were two additional mobile theatres at Grantham Hospital, one of which was due to be removed from the site, as the temporary contract for its hire was due to expire.  ...  view the full minutes text for item 8.

(To receive a report from United Lincolnshire Hospitals NHS Trust, (ULHT) which provides the Committee with an update on the current model of the paediatric service at Pilgrim Hospital, Boston and the performance of this model.  Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration and Simon Hallion, Divisional Manager, Family Health Division from ULHT will be in attendance for this item)

The Chairman invited Mark Brassington, Deputy Chief Executive and Director of Improvement and Integration, Simon Hallion, Divisional Manager Family Health and Dr Suganthi Joachim, Divisional Clinical Director for Family Health to remotely present the report to Committee, which provided an update on the Paediatric Service, at Pilgrim Hospital, Boston. 

Detailed at Appendix A to the report was a copy entitled "Proposal for the Next Stage Development of the Paediatric Assessment Unit (PAU) Model at Pilgrim Hospital Boston."

The Committee was reminded of the background to the original model agreed in August 2018, which sought to assess and discharge all children presenting at Boston within a twelve-hour time frame, with children requiring longer inpatient periods being transferred to Rainforest Ward at Lincoln County Hospital, by private ambulance.

It was noted that by the spring of 2019, however, the PAU was not always strictly following the twelve-hour model.  It was noted further that the absence of an immediate High Dependency Unit-level ambulance transfer service meant that sicker children (non-intensive care) needed to receive the early phase of their care at Pilgrim Hospital, Boston.  Over the intervening two-year period, a more sustainable longer-term model of care had been actively developed alongside the successful recruitment into both the medical and nursing teams.

It was reported that the ULHT Trust Board had supported a revised interim model for paediatric care at Pilgrim Hospital, Boston, moving the service towards a Short Stay Paediatric Assessment Unit, with an average length of stay below 24 hours.  The remit of the unit would be to deliver both an assessment and short term observation function, with the option of some children with defined care plans remaining on in the unit beyond 48 hours.

In conclusion, the Committee was advised that the clinical teams believed that the described model delivered a short stay PAU that reflected national best practice and enabled children and young people to receive their full care needs at Pilgrim Hospital, Boston.

It was also highlighted that general public and patient engagement had been ongoing around the Pilgrim Hospital paediatric service over the last three years, including extensive patient involvement in adjustments to the service offer to reflect local need.

The Committee were invited to provide guidance on the level of public engagement required to make the current service model into a more permanent arrangement.

During discussion, the Committee raised the following points:

·       Congratulations and support was extended to the improved service.  The Committee was advised that there had been a high level of consultation with the local population and patients, which had been gratefully received as had the support of staff at Pilgrim Hospital, Boston.  Particular thanks were extended to the SOS Pilgrim Group for the articulate way the needs of the local population had been presented;

·       Whether the model to be adopted at Pilgrim Hospital, Boston would be replicated in other hospitals and by neighbouring hospital trusts.  The Committee was advised that the model had been seen as good practice, and innovative in its  ...  view the full minutes text for item 9.

(To receive a report from Lincolnshire Community Health Services NHS Trust (LCHS), which provides the Committee with a general update.  Maz Fosh, Chief Executive, and Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operations from LCHS will be in attendance for this item)   

The Chairman invited Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operation to remotely present the report to the Committee, which provided an update on the restoration and recovery of services provided by Lincolnshire Community Health Services NHS Trust (LCHS) following the Covid-19 pandemic.

A copy of the report had been circulated to members of the Committee on 19 June 2021.

In guiding members of the Committee through the report, mention was made to:

·       That all services had now been restored and were all back to pre-Covid-19 levels of performance; that Louth and Skegness Urgent Treatment Centres (UTCs) were now open 24/7, and that Gainsborough and Spalding had been restored as UTCs, providing a greater range of services;

·       Same Day Primary Care Appointments; LCHS was currently working with system partners on a short-term proof of concept to support two GP surgeries; in Gainsborough and Lincoln.  Details relating to the proof of concept were shown on page 4 of the report.  The Committee was advised that activity was increasing across all UTCs and that the Skegness activity was continuing to increase as in previous years.  The biggest demand being from 8am to 10pm with minimal activity overnight.  A breakdown for each UTC for restoration and recovery was shown on pages 5 to 8 of the report;

·       Community Hospitals – It was noted that as part of the restore programme a number of developments had been identified, including the piloting of an e-observation platform, further development of the direct admissions pathways for community hospital, as well as a review of the workforce models for community hospitals to support the wider out of hospital programmes of care.  The Committee noted that 67% of services had been partially restored;

·       LCHS Outpatient Services – This activity would be restored on the LCHS sites during June and July 2021;

·       Butterfly Hospice – The service had been restored and was providing significant contribution to the palliative and end of life pathway for patients within Boston and surrounding area;

·       Community Nursing – The Community nursing service was now fully restored; and that work was now ongoing in relation to embedding the new pathways of care, as well as supporting the increased number of patients with complex needs being cared for in the community.  Full details of referrals and discharges were shown on page 11 of the report;

·       Allied Health Professionals and Children's Services - It was highlighted that there had been challenges to fully restoring the services due to many of the Allied Health Professional services being stepped down during the first phase of Covid-19, in line with national policy, and staff being redeployed to support the wider organisational response;

·       Specialist Services – The Committee noted that 62% of services had been restored;

·       Post-Covid Syndrome Service – It was highlighted that since the commencement of this service , there had been 438 referrals, with 312 open referrals and 126 patients being discharged from the service; and

·       Covid-19 Vaccination Programme – It was highlighted that  ...  view the full minutes text for item 10.

(To receive a report from Derek Ward, Director of Public Health, which provides the Committee with information on the National General Practice Data for Planning and Research (GDPR) data collection and local risks. Katy Thomas, Head of Health Intelligence will also be in attendance at the meeting)

The Chairman invited Derek Ward, Director of Public Health and Katy Thomas, Head of Intelligence to remotely present the report to the Committee, which provided information on the National General Practice Data for Planning and Research (GDPR) data collection and local risks.

The Committee was advised that NHS Digital was changing the way it collected data from GP sites.  It was noted that although the changes were predominantly around the process that was to be used, the issue had caused some concern.  It was highlighted that the implementation date for the new process had been moved from 1 July to 1 September 2021.

The Committee was advised further that disruption to the national programme or substantial number of patients 'opting out' of data sharing with NHS Digital locally would hamper the national data flows for primary care.  This would mean that data would be unusable for understating needs, fair and effective service provision and outcomes for the residents of Lincolnshire.  It was noted that this would have implications for Lincolnshire County Council and the Director of Public Health in fulfilling their statutory duties to their best abilities; and for the Clinical Commissioning Group to commission and providers to provide high quality, appropriate and effective services for all, making the best use of collective resources.  It was also highlighted that the increasing concern over data sharing might impact engagement with local programmes and agreements.

The report provided information on governance and safeguards; what was changing; what data was shared; and how data was shared by NHS Digital.  It was highlighted that patients' names, addresses were not shared and all other data that could directly identify patients (such as NHS number, date of birth, full postcode) would not be included and would be replaced by unique codes before the data was shared with NHS Digital, which would ensure that patients could not be identified directly to the data.

It was further reported that data shared by NHS Digital was subject to robust rules relating to privacy, security and confidentiality; and that organisations using the data also had to have a clear legal basis to do so.

Dr B Wookey left the meeting at 12.41pm.

Councillor M G Allan left the meeting at 12.43pm.

During discussion, the Committee raised the following points:

·       What level of patients opting out of data sharing would compromise the data collected.  The Committee was advised that there was not a figure identified in this regard.  To obtain complete data sets, the fewer patients that opted out the better the data would be;

·       Whether anything could be done to encourage patients not to opt out.  The Committee was advised that work was already ongoing with general practices to try and provide reassurances; and that more would need to be done nationally to alleviate any misunderstandings; and

·       Support was extended by some members of the Committee for the need to be able to access the data to ensure that Lincolnshire had all the information required to do the best for  ...  view the full minutes text for item 11.

(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 report, which invited the Committee to consider and comment on its work programme as detailed on pages 68-70 of the report.

Potential items suggested included:

·       Dentistry;

·       G P Services;

·       Mental Health Issues as a result of Covid-19;

·       Acute Services Review;

·       North West Anglian NHS Foundation Trust – Update; and

·       Non-Emergency Patient Transport – Update.

RESOLVED

That the work programme presented be agreed, subject to inclusion/consideration of the items listed above.