Agenda and minutes

An apology for absence was received from Councillor D Rodgers (West Lindsey District Council).

An apology for absence was also received from Councillor S Woolley (Executive Councillor NHS Liaison, Integrated Care System, Registration and Coroners).

Councillor R J Kendrick wished it to be noted that he was one of the Council’s representatives on the Lincolnshire Partnership NHS Foundation Trust – Council of Governors Stakeholders Group.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 14 June 2023 be agreed and signed by the Chairman as a correct record.

Further to the announcements circulated with the agenda, the Chairman brought to the Committee’s attention the supplementary announcements circulated on 18 July 2023.

The supplementary announcements referred to:

·       Membership of the Committee – the Committee noted that Councillor Suzanne Welberry was to be the Boston Borough Council representative on the Committee going forward and Councillor Lina Savickiene was to be the named replacement member;

·       Proposed change of date for the October 2023 meeting – that 11 October 2023 meeting date was to be changed to 4 October 2023; 

·       The Humber Acute Services Programme - pre-consultation business case;

·       Hawthorne Medical Practice, Skegness – Care Quality Commission Report based on an inspection carried out on the 19 April 2023 which was now rated as ‘requires improvement’;

·       Magna House, Sleaford – Care Quality Commission Report rating of ‘inadequate’, following an inspection on 26 and 27 April 2023;

·       Report of the House of Commons Health and Care Select Committee – NHS Dentistry; and

·       Lincolnshire Community Health Services NHS Trust – that Maz Fosh, Chief Executive of Lincolnshire Community Health Services was standing down with effect from 31 July 2023.

During consideration of this item, some members welcomed the report of the House of Commons Health and Care Select Committee concerning NHS Dentistry; some support was recorded for the proposals for the Diana, Princess of Wales Hospital, Grimsby, for it not to be downgraded (as part of the Humber Acute Services Review), as the service provided was welcomed by residents living in the north of the county, a request was made for further information in this regard.  The Committee noted that it was hoped that an item regarding the Humber Acute Services Review would be considered by the Committee at its 13 September 2023 meeting. 

RESOLVED

1.      That the meeting of the Health Scrutiny Committee for Lincolnshire scheduled for 11 October 2023 be rescheduled to Wednesday 4 October at 10.00am.

2.      That the supplementary announcements circulated on 17 July 2023 and the Chairman’s announcements as detailed on pages 15 to 21 of the report pack be noted.

(To receive a report from the NHS Midlands Primary Care Team and NHS Lincolnshire Integrated Care Board (ICB), which provides the Committee with an update on NHS dental services in the county.  Carole Pitcher, Senior Commissioning Manager, Nottingham and Nottinghamshire ICB working on behalf of the Five Integrated Care Boards in the East Midlands and Sandra Williamson, Director of Health Inequalities and Regional Collaboration, NHS Lincolnshire Integrated Care Board, will be in attendance for this item)

Consideration was given to a report from NHS East Midlands Primary Care Team and NHS Lincolnshire Integrated Care Board, which provided the Committee with an update on NHS dental services, covering the following areas: the national NHS dental contract; where dental services were located, including special dentistry and intermediate minor surgery; charges for NHS dental services; access to dental services in Lincolnshire; private dentistry; commissioning and procurement plans; and collaborative working.

The Chairman invited the following representatives to present the item, to the Committee: Sandra Williamson, Director of Health Inequalities and Regional Collaboration, NHS Lincolnshire Integrated Care Board, Carole Pitcher, Senior Commissioning Manager, for the five integrated care boards in the East Midlands and Kenny Hume, Chair of the Lincolnshire Local Dental Committee.

During consideration thereon, some the following comments were noted:

·       Some concern was expressed to the ongoing lack of dentist provision in Lincolnshire;

·       Steps being taken to improve access to dentistry across the east coast, South Holland, North Kesteven and Boston.  Reassurance was given there was a plan and that this was covered in the Lincolnshire Dental Strategy. It was noted that the strategy had developed four key pillars: developing the dental workforce; improving access to dental services; increasing focus on prevention and strengthening the integration of oral health into wider health care services. The Committee was advised that the House of Commons Select Committee had identified the backlog of applications for the Overseas Registration Exam, and that resolving this would provide a short-term increase to the number of dentists working in the NHS, which would then provide more appointments, for patients to access much needed services.  Some members felt that intense overseas recruitment could result in health care in other countries suffering as a result.  The Committee noted that in some parts of south India there were too many dentists and that recruitment from this area would help with the shortages experienced in Lincolnshire;

·       Reference was also made for contracts to be reformed, not only to address the access crisis, but to ensure a more sustainable system was put in place going forward;   

·       Clarification was also sought regarding the potential closure of both Boston and Sleaford’s Bupa clinics.  Reassurance was given that dialogue was on going with new owners for both clinics;

·       How to encourage dentists to stay NHS service providers.  The Committee was advised that dentists were small businesses, operating with a combination of NHS and private patients.  It was highlighted that the private side of most dental practices subsidised the NHS side, and that without private patients, most dental practices would not stay in business;

·       The Committee noted that dental charges were set by the Treasury;

·       The potential development of a Dental School in Lincolnshire.  It was highlighted that work was in progress in this regard and talks were in progress with Suffolk concerning their working template.  It was hoped that being able to provide professional training and support would help encourage newly qualified dentists to stay in Lincolnshire.  The Committee noted that at present  ...  view the full minutes text for item 16.

(To receive a report from Derek Ward, Director of Public Health, Lincolnshire County Council, which advises the Committee of the role fluoride has on oral health, and the transfer of power to initiate, vary or terminate fluoridation schemes, and the current situation with water fluoridation schemes in Lincolnshire. Derek Ward, Director of Public Health and Lucy Gavens, Consultant in Public Health, will be in attendance for this item)

The Committee considered a report from Derek Ward, Director of Public Health, Lincolnshire County Council, which advised the Committee on the role fluoride had on oral health, the transfer of power to initiate, vary or terminate water fluoridation schemes, and the current situation regarding water fluoridation schemes in Lincolnshire. 

The Chairman invited Lucy Gavens, Public Health Consultant to present the item to the Committee.

Appendix A to the report provided a map showing artificially fluoridated areas in Lincolnshire for the Committee to consider.

During discussion thereon, some of the following comments were noted:

·       The need to write to the Secretary of State for Health and Social Care in support of water fluoridation and that a request should be made for new fluoridation schemes to be introduced to address the gaps in provision within Lincolnshire;

·       Confirmation was given that a feasibility study for fluoridation would fall to the Secretary of State to commission one;

·       The Committee noted that no fluoridation schemes had been terminated in the last 12 months.  It was however highlighted that the team in the Department of Health and Social Care had been actively looking into new schemes, following representation from the north east of the country.  It was reported that locally work was ongoing with north, and north east Lincolnshire and Norfolk (areas also covered by Anglian Water) to gain a sense of what needed to be done concerning fluoridation;

·       It was reported that a combination of factors helped with oral health, i.e. regular brushing of teeth; use of fluoride toothpaste; and for those that did not following a regular oral regime, water fluoridation helped to protect teeth; and

·       Some support was extended for the extension of fluoridation across Lincolnshire from district council representatives present.  The Committee was advised that writing to local MP’s would assist in this regard.

The Chairman on behalf of the Committee extended his thanks to the Consultant in Public Health for her presentation.

RESOLVED

1.      That the evidence in relation to water fluoridation and oral health, the changes to the legislation on water fluoridation schemes and the current situation with water fluoridation schemes in Lincolnshire be noted.

2.      That the Chairman write on behalf of the Health Scrutiny Committee for Lincolnshire to the Secretary of State for Health and Social Care to record the Committee’s support for fluoridation of water supplies throughout the county, and to request as a first step the Secretary of State initiate a feasibility study on the potential for its implementation, with support for this action also being sought from:

(a)    the Lincolnshire Members of Parliament who represent constituencies either wholly or partially without fluoridation; and

(b)   from the Lincolnshire district councils, whose areas are either wholly or partially without water fluoridation.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust and NHS Lincolnshire Integrated Care Board, which advises the Committee of the outcome of the mental health rehabilitation consultation to permanently close Ashley House in Grantham and extend the community rehabilitation service to a countywide model.  Chris Higgins, Director of Operations Lincolnshire Partnership NHS Foundation Trust and Pete Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board, will be in attendance for this item) 

Consideration was given to a report from the Lincolnshire NHS Partnership Trust (LPFT) and the NHS Lincolnshire Integrated Care Board, which provided an update on the outcome of the Consultation on Local Mental Health Rehabilitation Services (Ashely House in Grantham).

The Chairman invited the following representatives to remotely, present the item to the Committee: Chris Higgins, Director of Operations, LPFT and Pete Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board.

The Committee were reminded that in February 2023, as part of its response to the consultation, had accepted the arguments in support of the community rehabilitation model and the permanent closure of Ashley House.  It was also noted that the Committee had commented on the importance of continuing to monitor the level of need for inpatient services; but wanted to be advised of any plans as to the future use of the Ashley House premises.

Attached to the report, were the following Appendices for the Committee’s consideration:

·       Appendix A – Copy of the consultation document previously presented to the Health Scrutiny Committee on 18 January 2023;

·       Appendix B – A summary of Consultation Activity and Findings;

·       Appendix C – Patient, Carer and Public Concerns Raised and Actions Being Taken;

·       Appendix D – Staff Concerns and Actions Being Taken; and 

·       Appendix E – East Midlands Clinical Senate Recommendations and Action Being Taken.

During consideration of this item, the following comments were noted:

·       Clarification was given that prior to its closure, the unit cared for patients with severe and enduring mental illness who would have been likely to have had significant periods in hospital to help manage their symptoms.  It was noted that the unit had provided additional rehabilitation support in the patient’s recovery before moving back into their community to live.  It was noted that patients requiring dependency rehabilitation were now being treated at Maple Lodge in Boston, or by the community rehabilitation service;

·       Confirmation was given that there was enough provision to support levels of demand;

·       Support was extended to the Community rehabilitation service;

·       Reassurance was provided that out of hours provision was catered for in the community rehabilitation service; and

·       Confirmation was given that a low number of staff had responded to the consultation.  It was however noted that in response to some of the feedback received during the consultation, the Trust would be discussing the matter further with all staff that had previously worked at the unit.

The Chairman on behalf of the Committee extended thanks to the presenters.

RESOLVED

1.      That the outcome of the mental health rehabilitation consultation, conducted between 16 January 2023 and 31 March 2023 be noted.

2.      That the decision by Lincolnshire Partnership NHS Foundation Trust, with support from NHS Lincolnshire Integrated Care Board to permanently close Ashley House in Grantham and extend the Community rehabilitation service to a countywide model be noted.

3.      That an update be requested in one year’s time on the implementation of the community rehabilitation service model, including monitoring of out of area  ...  view the full minutes text for item 18.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides the Committee with an update on adult mental health services in Lincolnshire.  Chris Higgins, Director of Operations LPFT, Nick Harwood, Associate Director of Operations for Adult Community Division LPFT and Paula Jelly, Associate Director of Operations for Adult Inpatient and Urgent Care Division LPFT, will be in attendance for this item)

The Committee considered a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provided an update on Adult Mental Health Services in Lincolnshire.

The Committee were reminded that in the previous year, the Committee had held a working group, which had considered various aspects of mental health provision, and as a result had requested an outline of the various new developments.  It was highlighted that at the 13 September 2023 meeting, the Committee would be continuing this theme, considering mental health services for children and young people, and for older adults. 

The Chairman invited the following representatives from LPFT to remotely, present the item to the Committee: Chris Higgins, Director of Operations, Nick Harwood Associate Director of Operations, Adult Community Division and Paula Jelly, Associate Director of Operations, Adult Inpatient and Urgent Care Division.

During consideration of this item, the following comments were noted:

·       The Trust were commended for the two new wards at the Peter Hodgkinson Centre, Lincoln, and the improved facilities they provided;

·       A request was made for the pathway for urgent care to include young people (16-18) pre-transition to adults ;

·       The Committee noted that anyone attending A & E at either Lincoln or Boston could be seen by a member of the mental health team and that this was available 24/7.  The Committee noted that the team would aim to see emergency referrals in A & E in one hour against a target of 80%, and that the team generally met this target 93% of the time.  From members personal experience, concerns were highlighted that this was not the case.  There was recognition that there had been some pressure on the east coast, and that steps were being taken to strengthen that provision;

·       That information would be provided to members of the Committee relating to the location of Night Light Cafés. The Committee was advised that all volunteers received training and support;

·       Confirmation was given that there was a system wide group that dealt with patients with a dual diagnosis, and there was recognition that there was more to do in this regard;

·       The Committee was advised that 75% of patients accessed talking therapies for anxiety and depression within 6 weeks and 95% of patients within 18weeks.  It was noted that where people were waiting for treatment, they were provided with a range of resources to help with self-care and any workbooks that might help them.  Information was also provided advising them of what to do if needs changed and they were in crisis, or if they needed help urgently, and that this included information about the county’s 24-hour mental health helpline;

·       It was reported that resources were being built up to support communities, which would then link into the crisis team;

·       The Committee noted that suicide prevention was high on the agenda of both public health and mental health teams.  It was however highlighted that not all suicide cases had been in contact with mental health services.  It was also recognised that support for those requiring mental  ...  view the full minutes text for item 19.

(To receive a report from NHS Lincolnshire Integrated Care Board, which provides the Committee with an update on the implementation of the changes relating to urgent & emergency care, and acute medicine. Pete Burnett, Director of Strategic Planning, Integration and Partnerships, will be in attendance for this item)

Note: Apologies for absence were received from Councillors M G Allan, S Welberry (Boston Borough Council), L Hagues (North Kesteven District Council), and M Geaney (South Holland District Council), for the afternoon part of the meeting.

The Committee considered a report from the NHS Lincolnshire Integrated Care Board, which provided an update on the implementation of the changes relating to urgent & emergency care; acute medicine; and the implementation of changes being taken forward over three phases of work.

The Chairman invited Pete Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Board, to remotely, present the report to the Committee:

During consideration thereon, the following comments were noted:

·       Grantham and District Hospital’s designation as an Urgent Treatment Centre (UTC) and the service model expected.  It was reported UTC services and community medical wards would be staffed by local providers United Lincolnshire Hospitals NHS Trust (ULHT) and Lincolnshire Community Health Services NHS Trust (LCHS), full details of the three-stage implementation plan of services were shown within the report presented.  Reassurance was given that the service would meet the needs of the population of Grantham and surrounding area.  The Committee were also reminded of the process followed concerning the Acute Services Review, and to the outcome of the Clinical Senate regarding UTC designation;

·       Some concern was expressed to the lack of detail presented in the report, with particular mention being made to the number of beds being provided; the need for an A & E in Grantham; and the need for better communication regarding the services to be provided at Grantham and District hospital going forward;

·       Reassurance was given that pathways were in place to ensure that patients had the right care at the right time, and at the right place.  It was noted that some patients would be transferred back, following stays in other hospitals to Grantham Hospital for their care, to prevent families having to travel;

·       The Committee was advised that further details regarding the opening of the UTC would be known in the autumn of 2023;

·       One member expressed concern that information received as part of a Freedom of Information request had indicated that Grantham had been a full A & E prior to 2016; (Note: for clarity regarding this point, information has been received that the exclusion criteria have been in place for Grantham A & E since 2008 and that this has been confirmed in two independent reports by the Independent Reconfiguration Panel and the East Midlands Clinical Senate which both outline the department has not been a full ED since 2008);

·       The lack of information pertaining to proposed specific services;

·       The Committee noted that services would be provided by middle grade doctors and that GPs would continue to be involved.  It was noted that the out of hours service would allow for both bookable appointments through the 111 service and for walk-in access; and that every measure would be taken to ensure that services were delivered in an integrated way; and

·       When an update on orthopaedics and  ...  view the full minutes text for item 20.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the draft response (attached at Appendix A) to the consultation on the Paediatric Service at Pilgrim Hospital, Boston)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider the draft response as attached at Appendix A to the report, and subject to any further amendment, approve the draft as the Committee’s final response to the consultation on the Pilgrim Hospital Paediatric Service, being undertaken by United Lincolnshire Hospitals NHS Trust.

The Chairman on behalf of the Committee extended thanks to the Health Scrutiny Officer for a well written response.

RESOLVED

That the draft response (attached at Appendix A) be approved as the Committee’ s final response to the consultation on Pilgrim Hospital Paediatric Service, being undertaken by United Lincolnshire Hospitals NHS Trust.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on the content 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 144 to 146 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 details of planned work for the coming months.

During consideration of this item, the following suggestions were put forward for additions to the current Committee’s work programme.

·       North West Anglia NHS Foundation Trust update for January/February 2024

·       Minor Injuries Unit at Stamford; and

·       Growth plans across the county and how they will impact on health services.  The Health Scrutiny Officer agreed to investigate the matter further as a possible overview report.

RESOLVED

That the work programme presented on pages 144 to 146 of the report pack be agreed, subject to the inclusion of the suggestions put forward by the committee and the items put forward for further consideration at Minute numbers 16 (2) and 18 (3).