Agenda and minutes

Apologies for absence were received from Councillors S R Parkin and C Morgan (South Kesteven 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 4 October 2023 be approved 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 7 November 2023, which referred to the following:

·       The delayed partial re-opening of the Hartsholme Centre in Lincoln, as a result of legionella bacteria being found in the water system;

·       The Branston and Heighington Family Practice being rated as being ‘Good’ by the Care Quality Commission;

·       That East Midlands Ambulance Service had opened a new base for Non-Emergency Transport in North Hykeham; and

·       An update on from the Centre for Governance and Scrutiny regarding revised Health Scrutiny Regulations and Statutory Guidance.

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

·       Reference was made to the relocation of acute stroke services from Pilgrim Hospital Boston to Lincoln County Hospital. Further details were provided in paragraph 4 on page 12 of the agenda pack.  It was however noted that stroke services formed part of the acute services review, which was to be covered in the next agenda item; and

·       The implications of the revised Health Scrutiny Regulations and Statutory Guidance.  The Committee noted that the new regulations were expected to limit the powers of health and overview and scrutiny committees to make referrals to Secretary of State in instances where a committee disagreed with a proposal from the local NHS for a substantial reconfiguration of NHS services.

RESOLVED

That the supplementary announcements circulated on 7 November 2023 and the Chairman’s announcements as detailed on pages 11 to 13 of the report pack be noted.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the consultation document presented and whether it wishes to make a response to the consultation as a ‘non-statutory’ consultee.  Representatives from the Humber and North Yorkshire Integrated Care Board will be in attendance for this item)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider the consultation documents presented, and to decide whether it wished to make a response to the consultation on proposals affecting acute hospital services at Diana Princess of Wales Hospital in Grimsby and at Scunthorpe General Hospital, as a non-statutory consultee.

Appendix A to the report provided the Committee with an overview of the Humber Acute Services Consultation dated 17 August 2023; and Appendix B provided a copy of the ‘Have your Say’ – Public Consultation information leaflet for the Committee to consider.

The Chairman invited the following representatives to remotely, present the item to the Committee: -

Presenters from the NHS Humber and North Yorkshire Integrated Care Board: Alex Seale, North Lincolnshire Place Director, and Linsay Cunningham, Associate Director of Communications, Humber Acute Programme.

Presenters from Northern Lincolnshire and Goole NHS Foundation Trust: Dr Anwer Qureshi, Consultant Acute Physician and Clinical Lead for Elderly Care, at Scunthorpe General Hospital and Kerry Carroll, Deputy Director of Strategic Development.

The presentation referred to:

·       What was being proposed to provide a better model of care whilst addressing the challenges being faced and minimising the impacts on patients and staff;

·       Services that would remain unchanged, and services that would be changing. It was noted that to improve services, those with the most urgent and complex needs would be brought together at one hospital, the Diana Princess of Wales Hospital, Grimsby, which would ensure a higher quality service, provide access to dedicated services 24 hours a day, seven days a week, help to address critical shortages in the workforce by organising teams more effectively, and by helping patients to be seen and treated sooner;

·       Services changing included: the Trauma unit, Emergency Surgery (overnight), some medical specialties (inpatient) and Paediatric overnight (inpatient) care;

·       The impact for Lincolnshire, based on 2019/20 modelling outputs and how the proposals came to being.  It was noted that the options had been based on strong clinical evidence base and data analysis;

·       Key issues and impacts raised from engagement so far, this included travel and access, discharge from hospital, contingency planning and major incidents, and the impact on Goole; and

·       Ways to get involved in the consultation, timeline, and next steps.

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

·       There were significant capital challenges and a backlog of repairs requiring capital funding.  The Committee noted that a business case for funding Scunthorpe General Hospital as part of the government’s New Hospitals programme had unfortunately been unsuccessful. It was noted further that when looking at the proposals, one of the drivers had been around the centralisation of the most specialist elements of the service to the Diana, Princess of Wales Hospital, Grimsby, as less capital infrastructure was required to deliver the changes within the site and the proposal would have less impact on the population and patient flows;

·       Some of the members who had attended the joint Humber and Lincolnshire Health Overview  ...  view the full minutes text for item 44.

(To receive a report from NHS Lincolnshire Integrated Care Board, which provides the Committee with an Orthopaedics and Stroke Services Implementation update.  Peter Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board and representatives from United Lincolnshire Hospitals NHS Trust 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 implementation of the changes relating Orthopaedic and Stroke services.

The Chairman invited Pete Burnett, Director of Strategic Planning, Integration and Partnerships NHS Lincolnshire Integrated Care Board and the following representatives from United Lincolnshire Hospitals NHS Trust (ULHT): Dr Sameedha Rich-Mahadvar, Director of Improvement and Integration, Vel Sakthivel, Consultant Orthopaedic Surgeon and Divisional Clinical Director and Rebecca Johnson, Business Case Manager, to present the item to the Committee.

The Committee were reminded that following consultation, on the 25 May 2022, the NHS Lincolnshire Clinical Commissioning Group Board had approved key changes to the reconfiguration of four NHS services, and that the report presented was the second implementation report the Committee had received concerning Orthopaedics and Stroke services, the first one being in December 2022.

Orthopaedics 

The Committee noted:

·       That the service was performing well against its performance indicators, reducing the length of stay for Orthopaedic elective admissions to 1.9 days;

·       The Trust was one of a select few hospitals in the country being able to carry out the specialist SuperPath keyhole procedure, the results of which had seen significantly quicker recovery and a shorter hospital stays;

·       Referral time to treatment for the Trust had been ranked first in terms of performance against its peer hospital trusts, and seventh out of all 132 NHS Trusts;

·       That patient experience had been very positive.  Some comments received from patients were detailed on pages 53 and 54 of the report pack for the Committee to consider.  As a result of the improvement in the Trust’s referral time to treatment, the Trust had been able to provide mutual aid to neighbouring trusts when they had been struggling with their performance;

·       Access to the outpatients services remained across all sites, with all new patients being seen face to face, with follow up appointments being offered virtually;

·       Grantham and District Hospital had delivered 1,110 elective Orthopaedic procedures to patients;

·       Since the orthopaedic pilot started in 2018, only three patients had required post-operative transfers from Granthan and District Hospital to Lincoln County Hospital (as these patients required intervention from other specialities, for example cardiac input was required);

·       Two new theatres had opened at Grantham and District Hospital in November 2022, and that there was a clear plan for continuing improvements to be made.

Stroke

The Committee noted:

·       That stroke provision for patients were being developed to expand the current provision for stroke patients at Lincoln County Hospital, with support from an enhanced Community Rehabilitation Team;

·       A Joint Stroke Board had been set up with community partners and other key partners to look at key processes and to work through the best approach to implementing the remainder of the service proposal within the Acute Service Review public consultation;

·       A number of workshops had taken place to identify what was needed to improve the stroke service and bring down the length of stay for patients;

·       That following the loss of two locum consultants,  ...  view the full minutes text for item 45.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider whether it would wish to make a suggestion for a potential scrutiny review topic to the Overview and Scrutiny Management Board)

The Committee considered a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider whether it wished to make a suggestion for a potential scrutiny review topic to the Overview and Scrutiny Management Board. 

The Committee were reminded that when selecting an item consideration needed to be made to the Scrutiny Prioritisation Toolkit document as detailed at Appendix A to the report.

During discussion, the Committee put forward the following suggestions/comments:

·       Mental Health – It was acknowledged that an in depth look at mental health issues had already been undertaken by the working group, followed by a series of agenda items at the Committee;

·       That support from NHS colleagues for a scrutiny panel might be very limited due to pressures within the NHS;

·       Role of volunteers within the NHS in Lincolnshire, including third sector involvement.  It was agreed that this was an item for the Committee to consider and would be added to the work programme

RESOLVED

That no potential scrutiny review topic be put forward from the Health Scrutiny Committee for Lincoln to the Overview and Scrutiny Management Board for consideration at their meeting on 21 December 2023.

(To receive a report from NHS Lincolnshire Integrated Care Board (ICB), which advises the Committee on ICB and partner processes to quality assure General Practice and where quality concerns are identified, the support provided to enable quality improvement within and across General Practices. Nick Blake, Programme Director – Primary Care NHS Lincolnshire ICB and Wendy Martin, Associate Director of Nursing and Quality NHS Lincolnshire ICB  will be in attendance for this item)

Consideration was given to a report from the NHS Lincolnshire Integrated Care Board (ICB), which advised the Committee on the ICB and partner processes to quality assure General Practices and where quality concerns were identified, the support provided to enable quality improvement within and across General Practices.

The Chairman invited the following presenters from the NHS Lincolnshire Integrated Care Board to remotely, present the item to the Committee, Nick Blake, Programme Director – Primary Care and Wendy Martin, Associate Director, Nursing and Quality.

The Committee was advised of the general levels of support available to General Practices, details of which provided in the report presented.  It was also highlighted that the ICB had well established and effective processes, working with relevant partners including the Local Medical Committee, Healthwatch and the Care Quality Commission, to identify quality concerns for Lincolnshire’s General Practices and to support practices to make any required quality improvements.  The Committee noted that these processes were further enhanced with the implementation of the Primary Care Access Recovery Plan and the associated Support Level Framework and the General Practice Improvement Plan.

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

·       The Committee was advised that there were three locality, Quality Assurance Oversight Groups, a west group, east group and a south and southwest group.  The Committee noted that the groups comprised of members of the quality team, ICB Primary Care Team members, GP clinical leads and performance and information team members.  It was reported that the groups looked at some of the following: performance data; the overview of quality of practices, GP workforce and non-GP workforce;

·       It was reported that the level of support to practices was dependent on the level of support, and the actions required.  It was noted that the ICB would be looking for the practice to deliver the actions using the resource they had at their disposal.  For example, if the GP practice had a dispensing issue, a talk on medicine optimisation would be provided and any additional support needed, but the delivery action would be the responsibility of the practice;

·       It was reported that currently there were 10 practices that were medium to higher risk rating and approximately three/four at very high-risk rating.  It was highlighted that levels of support matched the risk ratings accordingly;

·       The Committee noted that monitoring would be picked up through the county level, Quality Assurance and Oversight Group, and that lessons learned would be picked up through local Quality Assurance Oversight Groups

·       It was reported that if a practice was having intensive support, they would be receiving regular visits, an action plan would be formulated from which the practice would be measured against their actions for achievement and that actions were driving forward improvements.  Confirmation was given that any general learning points highlighted for practices would be cascaded through clinical forum to all practices or through the regular primary care newsletter;

·       That quality surveillance, outcomes and performance information and metrics about each practice helped inform  ...  view the full minutes text for item 47.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on the content of 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 70 to 72 of the report pack.

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

The Health Scrutiny Officer briefed the Committee on the items for consideration at the 6 December 2023 meeting.

(Note: Councillor Mrs L Hagues (North Kesteven District Council) left the meeting at 12:36pm).

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

·       The Committee was advised that primary care for the 2,000 asylum seekers due to be accommodated at the former RAF site in Scampton would be provided by a separate contract.  However, the Committee asked that a report on the impact on secondary care, 111 and A &E services be brought forward to the Committee as a priority.  The Committee was advised that on 6 December 2023 the item on GP Provision in Lincolnshire would be able to provide an update on this matter;

·       An update concerning Local Strategic Planning of Integrated Health Provision; and

·       111 out of hours provision affected by the Rutland/Stamford border.

RESOLVED

That the work programme presented on pages 70 to 72 of the report pack be agreed, subject to the inclusion of the suggestions put forward by the Committee above and the requests made at minute 44 and 45.