Agenda and minutes

Apologies for absence were received from Councillors Mrs S Harrison (East Lindsey District Council), S R Parkin, G P Scalese (South Holland District Council), and Dr M E Thompson.

The Committee noted that apologies for absence had also been received from Cllr K Rice-Oxley, (as the replacement member for South Kesteven District Council) and Councillor S Woolley (Executive Councillor NHS Liaison, Community Engagement, Registration and Coroners).    

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

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 9 November 2022 be agreed and signed by the Chairman as a correct record, subject to the first sentence of bullet point five on page 6 of the agenda being amended to read “Some concern was expressed that Lincolnshire has the lowest proportion of primary care appointments undertaken by an actual GP.” 

Further to the announcements circulated on 8 December 2022, the Chairman brought to the Committee’s attention the supplementary announcements circulated on the 13 December 2022.  The supplementary announcements referred to:

·       Information requested at the previous meeting relating to the Hawthorn Medical Practice concerning the number of appointments, and a copy of the Action Plan.  The Committee was advised that this information would be circulated once it was available;

·       Hawthorn Medical Practice, Skegness – Listening Clinic on Thursday 5 January 2023 between 10.30am and 12.30pm;

·       Grantham and District Hospital – the provision of two new theatres;

·       An update on the Adult Acute Mental Health Wards at Norton Lea, Boston and the Peter Hodgkinson Centre, Lincoln; and

·       An update on the Humber Acute Services Programme.

During discussion reference was made to:

·       There was a suggestion that health services for Armed forces personnel were considered as part of the development of the Integrated Care System.  Assurance was given by the Executive Support Councillor for NHS Liaison, Community Engagement, Registration and Coroners, as the County Council member representative on the Armed Forces Covenant Board that this matter was being dealt with;

·       One member expressed frustration at the number of missed appointments at GP practices, and asked whether there was anything that could be done to encourage people to attend appointments;

·       There was reference to the quality of the NHS England data relating to GP practices. Members were reminded that NHS England referred to its GP appointment data as ‘experimental’; and

·       Praise was extended by local members to Grantham and District Hospitals opening of two new theatres, and the positive impact they would have for the people of Grantham and for Lincolnshire as a whole.

RESOLVED

That the Chairman’s announcement circulated on the 8 December 2022 and the supplementary announcements circulated on 13 December 2022 be noted.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust, which advises of the temporary closure of the Hartsholme Centre, Lincolnshire’s Male Psychiatric Intensive Care Unit and invites the Committee to review the proposed engagement plan and provides guidance on any additional considerations or activities required. Sarah Connery, Chief Executive, Lincolnshire Partnership Foundation Trust (LPFT) and Chris Higgins, Chief Operating Officer, LPFT will be in attendance for this item) 

Consideration was given to a report from Lincolnshire Partnership NHS Foundation Trust, which advised of the temporary closure of the Hartsholme Centre, Lincolnshire’s Male Psychiatric Intensive Care Unit, and invited the Committee to review the proposed engagement plan as detailed at Appendix A to the report and provide any guidance on any additional considerations or activities required.

The Chairman invited the following representatives to present the item to the Committee: Sarah Connery, Chief Executive Lincolnshire Partnership NHS Foundation Trust (LPFT), Chris Higgins, Director of Operations LPFT and Andy Rix, Chief Operating Officer, Integrated Care Board.

In summary, the Committee was advised that on 18 October 2022 the Trust’s Executive Team had made an emergency decision to temporarily close the adult male Psychiatric Intensive Care Unit (PICU) at the Hartsholme Centre in Lincoln, on the grounds of safety.  It was reported that the PICU had been identified as the preferred option as it was the smallest of Lincolnshire’s inpatient wards, (maximum ten-bed capacity). 

The Committee was advised that this had been an urgent clinically driven decision based on recommendations of senior clinical and operational leaders in the Trust and that further engagement would be taking place with patients, carers, and other local partners to understand the impact and what needed to be in place to allow the Trust to safely reopen as soon as possible. The Committee noted that timeframes for reopening would be dependent on there being sufficient staff to maintain safe and sustainable services across the adult mental health wards, the conditions of which would be determined through current stakeholder, patient, and staff engagement.

It was highlighted that it was the Trust’s intention to continue to provide a psychiatric intensive care service in the county, and that plans would be developed for a female PICU, as women currently travelled out of county for their care.

(Cllr Mangion joined the meeting at 10:19am)

It was reported that during the temporary closure there might be a small number of men, who required this high level of care, needing to travel out of Lincolnshire to access PICU care and treatment, and that the Trust was working closely with neighbouring trusts to minimise any distance travelled, and that these patients would be brought back to Lincolnshire services as soon as needs allowed.

In conclusion, it was highlighted that the impact of the temporary closure would be monitored and that the Trust was fully committed to providing male PICU care in Lincolnshire again as soon as it was safe and sustainable to do so.  It was highlighted further that LPFT had major plans to improve the recruitment of staff and to bolster the current workforce, with additional training in managing severe mental health issues.

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

·       One member who had attended a very helpful engagement event expressed thanks to LPFT staff for their honest presentation of the situation;

·       Clarification was sought as to how long the PICU would be temporarily closed.  The  ...  view the full minutes text for item 24.

(To receive a report for United Lincolnshire Hospitals NHS Trust, which provides the Committee with an overview of the health and social care discharge programme, with a focus on United Lincolnshire Hospitals NHS Trust.  Andrew Morgan, Chief Executive, United Lincolnshire Hospitals NHS Trust (ULHT), Michelle Harris, Deputy Chief Operating, ULHT, and Nikki Pownall, System Flow Director, Lincolnshire Integrated Care System will be in attendance for this item)

The Committee considered a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provided an overview of the health and social care discharge programme, with a focus on ULHT. The report also outlined details of initiatives that had been developed to improve patient flow in Lincolnshire’s acute hospitals

The Chairman invited Andrew Morgan, Chief Executive, ULHT, Michelle Harris, Deputy Chief Operating Officer ULHT and Nikki Pownall, System Flow Director, Lincolnshire Integrated Care System, to present the item.

In guiding the Committee through the report, thanks were extended to colleagues in ULHT and social care for all the work being undertaken to improve discharge and patient flow through acute hospitals.

It was noted that although expansion of capacity in acute hospitals often led to a temporary solution in flow, the fundamental solution to flow and access to emergency care was the timely discharge of patients who did not require acute care into a more appropriate environment.

It was reported that the Secretary of State for Health and Social Care had announced on 18 November 2022, the allocation of a fund of £500 million to help reduce the number of patients in hospitals not requiring acute care and waiting for discharge.  Details of the Lincolnshire Patient Flow Improvement Journey was shown on pages 27 to 31 of the report.

Reference was made to the 60 day “Breaking the Cycle” initiative which had started on 22 November 2022, aimed at delivering improved patient flow through the emergency departments, acute assessment areas and wards, with the initial focus on the introduction of a risk based continuous flow management model as advocated by the NHS national winter improvement collaborative.  It was noted that the new approach had already led to some positive results for patients and for the service.  It was noted further that data had shown a reduction in the average ambulance handover times at hospitals from 52 minutes to 27 minutes, since the Breaking the Cycle initiative had been launched, as well as a significant reduction in the number of ambulances who had waited more than 60 minutes. 

It was highlighted that ‘Breaking the Cycle 2’initiative had gone live on 5 December 2022, which focused on the interface between acute hospitals and the rest of the system.  Its initial aim was to reduce by 24 hours the waits at the end of the pathway (discharge home/community) by maximising existing capacity and the benefit of additional capacity being put in place for winter.

It was highlighted that the next steps would be how best to utilise the additional discharge funding coming into the system to enable more people to be discharged to an appropriate setting with adequate and timely health and social care support.

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

·       Personal experience of a member who had been discharged but had been kept waiting for a prescription for six hours before being able to leave the hospital.  The Committee noted that hospital procedures and processes  ...  view the full minutes text for item 25.

(To receive a report from the Lincolnshire Integrated Care Partnership, which provides the Committee with an update on the process to develop Lincolnshire’s interim integrated care strategy. Michelle Andrews, Assistant Director Corporate Support, Lincolnshire County Council and Peter Burnett, Director of Strategic Planning, Integration and Partnerships, Lincolnshire Integrated Care Board will be in attendance for this item)

Consideration was given to a report from the Lincolnshire Integrated Care Partnership, which advised of the steps and processes taken to develop Lincolnshire’s Interim Integrated Care Strategy.

The Chairman invited Pete Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board and Michelle Andrews, Assistant Director Integrated Care Systems, to present the item to the Committee.

The report presented also provided the Committee with the background relating to the requirement for the Lincolnshire Integrated Care Partnership (ICP) to prepare and publish an interim integrated care strategy in December 2022, to influence the first, five-year NHS Lincolnshire Integrated Care Board forward plan, which needed to be published before April 2023.

It was highlighted that despite time constraints, several engagement opportunities to gather views from stakeholders and partners had been arranged, with particular reference being made to the Planning and Development Workshop held on 2 November 2022, details of which were shown at paragraph 1.2 of the report presented.

The Committee noted that the ambition of the strategy was: ‘for the people of Lincolnshire to have the best possible start in life, and be supported to live, age and die well’; and that the shared aims were to focus on prevention and early intervention; tackle inequalities; deliver transformation; and take collective action on health and wellbeing across a range of organisations.

The Committee was advised that as the Lincolnshire Integrated Care System area was coterminous with the Health and Wellbeing Board, the ambition was to align the Integrated Care Strategy and the Joint Health and Wellbeing Strategy (JHWS) as far as possible, which would avoid duplication, or gaps, between the two documents.  The JHWS focusing on “what” the identified needs were, and the integrated care strategy to set out “how” the health and care system would focus integration efforts on a number of key enablers to support delivery of the Health and Wellbeing Strategy and its priorities, and the systems’ s overarching ambition and aims.

It was highlighted that 2022/23 was a transition year and that the strategy would be developed further during 2023.

Reference was made to the five ‘Priority Enablers’ identified as potential areas of focus for the strategy.  These were: Population Health and Prevention; Workforce and Skills; Personalisation and Personalised Care; Community Engagement and Involvement; and Information and Information Systems.

The Committee noted the proposed Governance and Delivery arrangements for both the Health and Wellbeing Strategy and the Integrated Care Strategy, and the timescale and next steps as detailed in slides 10 and 11 of the presentation. 

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

·       The Committee was advised that a further report on the Integrated Care Strategy could be expected in the Autumn of 2023;

·       A question was asked as to what extent the interim strategy, and in future the full strategy would influence the commissioning decisions of the NHS.  The Committee noted that the whole purpose of the strategy was to inform the first five-year NHS Lincolnshire Integrated  ...  view the full minutes text for item 26.

(To receive a report from the NHS Lincolnshire Integrated Care Board, which provides the Committee with an update on the Lincolnshire Acute Service Review implementation.  Peter Burnett, Director of Strategic Planning, Integration and Partnerships, Lincolnshire Integrated Care Board will be in attendance for this item)

The Committee considered a report from the NHS Lincolnshire Integrated Care Board, which provided an update on the Lincolnshire Acute Service Review implementation.

The Chairman invited Pete Burnett, Director of Strategic Planning, Integration and Partnerships, Lincolnshire Integrated Care Board, to present the item.

The Committee received an update on the establishment of the Implementation Oversight Group; Orthopaedics; Urgent and Emergency Care and Acute Medicine; and Stroke Services. An update on each of the four areas was detailed in the report presented.

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

·       24/7 opening of the Grantham Urgent Treatment Centre (UTC).  It was reported that within 12 months the UTC would be opening 24/7 for people to attend, or to book an appointment using 111.  Clarification was given that Grantham & District Hospital would be a UTC, but it would also have other services, not found in a typical UTC;

·       Concern was expressed to the time it was taking to get the Grantham and District UTC open, and to the fact that a procurement process had to be undertaken for the services.  There was recognition that the process was taking time, but it was highlighted that the job specification needed to be drafted appropriately to make sure that the service was right; and that legal advice had initially indicated that a formal procurement process was required;

·       Reassurance was given that staff had been involved in the specification details; and that the public and staff would be updated as the process developed;

·       There was recognition that due to the rural nature of Lincolnshire, transportation was a challenge;

·       Whether the funding required to expand the stroke capability at Lincoln would be achieved.  The Committee was advised that there was confidence that the funding would be achieved, as the system had committed to it;

·       One member enquired whether the single Lincolnshire Stroke Service would look to include other acute providers for Lincolnshire residents.  It was noted that this had not been necessary for the scope of the work; but the ICB needed to work with other hospitals to make sure that patients could be transferred into the integrated team at United Lincolnshire Hospitals NHS Trust or Lincolnshire Community Health Service NHS Trust; and

·       How the overall implementation of the Acute Services Review was being affected by the challenges of recruitment and retention. It was hoped that by making services more attractive, would help with recruitment and retention.

The Chairman on behalf of the Committee extended his thanks to the presenter.

RESOLVED

1.      That the progress with the development of a centre for excellence for orthopaedics at Grantham and District Hospital, including the higher levels of performance; the positive feedback and the two new theatres be welcomed.

2.      That the development of a Single Lincolnshire Stroke Service be noted.

3.      That the Committee be notified of the NHS Lincolnshire Integrated Care Board’s decision on whether there would be a full procurement process for the delivery of the Grantham Urgent Treatment Centre, and the  ...  view the full minutes text for item 27.

(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 46 to 48 of the report pack.

Attached at Appendix A to the report was a schedule of items covered by the Committee since the beginning of the current Council Term May 2021, as well as planned work for the coming months.

RESOLVED

That the work programme presented as detailed on pages 46 to 48 of the report pack be received, subject to the additions from minute numbers 24(2), 25(2), 26(4) and 27(3).