Agenda and minutes

Apologies for absence were received from Councillors B Bilton (City of Lincoln Council) and S R Parkin.

It was noted that Councillor Calum Watt (City of Lincoln Council) had replaced B Bilton (City of Lincoln Council) for this meeting only.

No declarations of members’ interest were received at this stage of the proceedings.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 16 March 2022 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 Committees attention the supplementary announcements circulated on 12 April 2022.  The supplementary announcements referred to:

·       Covid-19 Update, Appendix A to the supplementary announcements provided weekly briefing information prepared by Lincolnshire County Council Public Health;

·       Further information on the Lincoln County Hospital major incident, with reference being made to the collaborative working of all staff and system partners involved in the incident; and

·       Further to paragraph 4 of the announcements circulated with the agenda, further information was provided regarding the progress of the Health and Care Bill.

Some reference was made to the report on NHS Backlogs and Waiting Times in England, and the need for this to be raised with local MPs.

RESOLVED

That the Supplementary Chairman’s announcements circulated on 12 April 2022 and the Chairman’s announcements as detailed on pages 13 to 19 of the report pack be noted. 

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides an update to the Committee on the activities of LPFT. Sarah Connery, Chief Executive LPFT and Chris Higgins, Director of Operations LPFT will be in attendance for this item)

Consideration was given to a report from Lincolnshire Partnership NHS Foundation Trust, (LPFT) which provided the Committee with an update on the activities of LPFT.

The Chairman invited the following representatives from LPFT: Sarah Connery, Chief Executive and Chris Higgins, Chief Operating Officer, to remotely, present the item to the Committee.

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

·       The challenges during the last 12 months for the NHS and the local community, with the continued impact of the Covid-19 pandemic, rising demand for mental health services and the increasing cost of living;

(Councillor M A Whittington joined the meeting at 10:12)

·       The Trust’s Covid-19 response, it was noted that there had been temporary changes to ward-based services in response to unprecedented staffing pressures, these changes were listed on page 22 of the report.  Reference was made to the temporary closure of Ashley House, Grantham.  The Committee noted that prior to its temporary closure, the service had been operating below its 100% occupancy since 2018; and that an alternative open rehabilitation provision remained available at Maple Lodge in Boston, with other rehabilitation care also being available at Discovery House in Lincoln.  It was noted further that for the three-years prior to the temporary closure, Ashley House had 52 admissions, of which 14 had been from Grantham and the surrounding area.  The closure had therefore not had a direct adverse effect on any one geographic population.  It was also highlighted that the Trust, had on occasion, had to make use of out of area bed placements.  It was highlighted further that this was being closely monitored and was only used when absolutely necessary;

·       Changes to services, it was noted that the Trust continued to utilise the learning from delivering services in a different way during the pandemic, details of which were shown on pages 23 to 25 of the report;

·       The Mental Health and Wellbeing Transformation Programme;

·       The new Acute Mental Health Wards;

·       Increased crisis support;

·       The increasing demand on services.  It was highlighted that nationally there had been an increase in the number of people needing to access mental health services.  The Committee noted that during the last two years, there had been notable increases in the following services: children and young people services, in particular young people experiencing an eating disorder; adult autism diagnostic assessments; early intervention in psychosis; chronic fatigue; and talking therapies.  It was reported that despite the increased demand the Trust continued to perform well against nationally set waiting times for most services, with only the children and young people services currently being an outlier compared to national expectations;

·       Suicides.  It was reported that the Trust had a local suicide prevention strategy, which strived to achieve zero suicides for those people known to the service. It was highlighted that on average only 20 percent of suicide deaths in the county were known to mental health services.  It was reported further that the Trust worked closely with public health colleagues at Lincolnshire County Council  ...  view the full minutes text for item 90.

(To receive a report from the Lincolnshire Local Medical Committee (LMC), which provides the Committee with an update on access to general practice services.  Dr Kieran Sharrock, Former Medical Director Lincolnshire Local Medical Committee and Deputy Chair of the BMA Practitioner Committee England will be in attendance for this item)

The Committee considered a report from the Lincolnshire Local Medical Committee (LMC), which provided a report on access to general practice services.

The Chairman invited Dr Kieran Sharrock, former Medical Director of Lincolnshire Local Medical Committee and Deputy Chair of the British Medical Association (BMA) Practitioner Committee for England, to remotely, present the item to the Committee.

The Committee was advised that nationally the demand for general practice appointments was higher than it had ever been, but the workforce in general practice was declining.  It was reported that this mismatch had led to practices not having the capacity to provide the access which patients that the system would like.

It was reported that general practices had a backlog of care caused by the pandemic, and that hospital trusts also had long waiting lists due to the pandemic, which was impacting on general practice, as patients were seeking further support with their increased health needs which were unable to be managed by secondary care.

The report advised that as of January 2022, in England there were 1,608 fewer fully qualified full-time GPs compared to 2015.  It was highlighted that to compensate for the reduced number of GPs and nurses, practices, and Primary Care Networks (PCNs) now employed other health professionals to manage patients’ conditions.  These professionals were qualified to manage conditions in their sphere of practice but did not have the holistic skills of a GP.

The Committee was advised of the Lincolnshire position, with reference being made to Lincolnshire having a deficit of available professionals; practices in rural and coastal communities being less able to recruit; and that the additional roles funding was limited by national pay scales, which was a disadvantage to PCNs.  Details on page 46 of the report provided the Committee with the number of total appointments and face to face appointments conducted by Lincolnshire’s general practices for December 2019 and December 2021.  The figures highlighted that despite a reduced workforce, Lincolnshire’s general practices had increased their appointments by 6% since pre-pandemic.

The Committee was advised that increasing workload was causing GPs and other clinical staff to leave the profession early, and that from a recent poll, one third of GPs had reported they were suffering from depression, burn out or mental distress.  Further details relating to a recent poll of GPs was shown on page 47 of the report for the Committees consideration.  It was also highlighted that a lack of workforce planning, and other factors had resulted in GPs feeling that the health service was now unsafe for patients and practitioners.

During consideration of this item, the Committee raised some of the following comments:

·       The frustrations and problems encountered by patients not being able to get an appointment with a GP. The Committee noted that receptionists were designated as care navigators trained to identify a patients need and direct them to the most appropriate person.  It was highlighted that unfortunately there were not enough professional people to deal with the demand, and that patients tended  ...  view the full minutes text for item 91.

(To receive a report from the Lincolnshire Clinical Commissioning Group, which advises the Committee of the current service provision by general practice across the county.  Sarah-Jane Mills, Chief Operating Officer (West Locality) Lincolnshire Clinical Commissioning Group will be in attendance for this item)

Consideration was given to a report from the Lincolnshire Clinical Commissioning Group, which provided the Committee with an update on the current service provision by general practice across the county.

The Chairman invited Sarah Jane Mills, Chief Operating Officer, (West Locality) Lincolnshire Clinical Commissioning Group, to present the item to the Committee.

An acknowledgement was given to the outstanding contributions of GP colleagues across the county who had continued to provide local primary care services throughout the pandemic, in addition, to working with Primary Care Networks (PCNs) in delivering the Covid-19 vaccination programme to people living in their local communities.  It was however recognised that there were continued challenges associated with increased demand and workforce availability, which meant that the model of primary care service provision would need to change and evolve in the coming years to meet the required need.

There was recognition that there were problems accessing GP services, and that data had shown when compared to the same period pre-Covid in 2019/20, GP colleagues were providing on average 20% more appointments.  It was highlighted that the ‘Ask my GP’ App had seen an increase of 5% in same day appointments and a 4% increase in appointments being provided between 1 – 6 days.

It was reported that practices were mindful that new ways of accessing primary care services had been welcomed by some patients, whilst others felt the new arrangements did not meet their personal needs.  As a result, practices were working hard to understand these issues, to be able to refine their processes and enable the continued development of local access arrangements.  It was noted that in the coming year, the CCG along with GP colleagues and other partner organisations would be continuing to develop arrangements to improve access to primary care services, which would include developing services for a timelier access for people with minor illnesses, which would then enable the GP to develop local arrangements to create time to support more vulnerable people and those with more complex health needs.

(Councillor Mrs L Hagues left the meeting at 12:37)

It was reported that although the CCG continued to work closely with practices to ensure and help facilitate continuous improvement, the assessment of the Care Quality Commission (CQC) was relied on to provide an independent assurance of the quality of GP service provision.  Current CQC rating details were provided within the report which indicated that Lincolnshire practices were in a good position, with 80 practices being rated good or outstanding.

The Committee noted that the makeup of GP teams had changed and developed in recent years; and those practices independently of Primary Care Networks (PCNs) had introduced new roles to provide additional capacity and professional support to help treat each patient’s individual needs.

Although Lincolnshire had a slightly lower than the national average number of GPs, the number of clinical staff working in primary care compared favourably.  Details of the current position relating to GPs compared to the national average were shown on page 52  ...  view the full minutes text for item 92.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to finalise its response to the consultation by United Lincolnshire Hospitals NHS Trusts on its nuclear medicine service)

The Chairman invited Simon Evans, Health Scrutiny Officer, to present the item, which invited the Committee to finalise its response to the consultation by United Lincolnshire Hospitals NHS Trust on its nuclear medicine.

A further copy of the draft response document had been circulated to Member of the Committee for their consideration in advance of the meeting.

Some concern was expressed that the proposals were again seeing services being eroded from Grantham and District Hospital and Pilgrim Hospital, Boston and services being centralised at Lincoln County Hospital.

The Committee extended their support to the draft response document circulated.

The Chairman extended thanks on behalf of the Committee to the Health Scrutiny Officer for preparing the response document.

RESOLVED

That the Committee’s final response to the consultation by United Lincolnshire Hospitals NHS Trust on its nuclear medicine service be approved.

(To consider 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 94 to 96 of the report pack.

The Committee was advised that the Lincolnshire Acute Services Review – Decision by Lincolnshire Clinical Commissioning Group scheduled for the 18 May 2022 meeting was to be re-scheduled to the 15 June 2022 meeting.

During discussion of this item, the following suggestions/comments were put forward:

·       Future commissioning arrangements for dental services, ophthalmology and pharmaceutical services – whether this item currently in the list of items to be programmed could be brought forward to the 15 June 2022 meeting; and

·       Membership of the working group to look at mental health provision and suicide prevention.  The following members put their names forward: Councillors C S Macey, S R Parkin, T J N Smith, Mrs A White and M A Whittington.

RESOLVED

1.      That the Committee’s work programme as detailed on pages 94 – 96 of the report pack be received, subject to the comments/suggestions made above and the items agreed at minute numbers 90(2), 91(2) and 92(2).

2.      That the working group to look at mental health provision and suicide prevention be comprised of the following Committee members: Councillors C S Macey, S R Parkin, T J N Smith, Mrs A White and M A  Whittington.