Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership which provides information on the Lincolnshire Urgent and Emergency Care Strategy 2018-2021, and the development of the plan to support the delivery of the strategy.  Sam Milbank (Accountable Officer, Lincolnshire East CCG) and Ruth Cumbers (Urgent Care Programme Director, Lincolnshire East CCG) will be in attendance for this item)

The Chairman welcomed to the meeting Samantha Milbank, Accountable Officer, Lincolnshire East CCG, Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East CCG and Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust.

The Chairman advised that at the previous meeting he had announced that he would be seeking to explore the future options for emergency care in Lincolnshire, which would provide information on how the A & E Consultation options were being developed, particularly in relation to Grantham A & E.

Page 42 of the agenda identified that Grantham A & E was out of scope of the Urgent and Emergency Care Strategy 2018-2021.  The Chairman requested the presenters as part of their introduction to explain the relationship between Urgent and Emergency Care Strategy 2018-2021 and the emergency care consultation elements of the STP.

The Committee was advised that there was no nationally accepted definition for 'urgent care' and 'emergency care'.  It was highlighted that the Lincolnshire Urgent and Emergency Care Strategy 2018-2021 used the following definitions:-

·         Urgent Care - The provision of care for patients who require prompt advice or treatment, but whose condition is not considered life-threatening; and

·         Emergency Care – immediate or life threatening conditions, serious injuries or illnesses.

It was highlighted further that the Lincolnshire Urgent and Emergency Care Strategy 2018-2021 (a copy of which was attached at Appendix A to the report) was a system approach to the development of urgent and emergency care across Lincolnshire.  It was noted that the strategy incorporated national expectations and requirements; and was also aligned to the Lincolnshire Sustainability and Transformation Plan.  The top of page 42 of the report provided details of the service areas that fell under the definitions mentioned above; including those services in scope; and those urgent and emergency care services that were not in scope.

Appendix B to the report provided the Committee with a report on the urgent care streaming service. The Committee was advised of the urgent and emergency care system in Lincolnshire and a broad overview of current care service delivery, which was shown on pages 45/46 of the report presented.

It was confirmed that Grantham A & E was outside of the scope of the strategy; and that significant work was being undertaken to design the substantive urgent and emergency care services that would be offered from the site.  The work being carried out was taking on board the East of England Clinical Senate report; and was being managed in line with the pre-consultation Business Case being produced by the STP operational delivery unit.

Reassurance was given that where proposals for major reconfiguration of services were developed; they would be subject to full public consultation, including the involvement of the Health Scrutiny Committee for Lincolnshire.

During discussion, the Committee raised the following issues:-

·         One member expressed concerns relating to the fact that the report did not provide any clarity concerning Grantham A & E.  The Committee was advised that the purpose of the strategy was to ensure that a fair and equitable service was provided across the county to respond to the appropriate need.  The representatives present understood the frustrations expressed by some of the Committee; and advised that the outcome of the Acute Services Review was not due to be completed until May 2018; 

·         The national requirement for 50% of all NHS 111 calls to result in a patient being passed across to a clinician for advice and guidance.  It was noted that   this target was already being exceeded in Lincolnshire.  Reference was also made to the EMAS 'See and Treat  Assessments';

·         Table 1 on page 34 – One member requested that the number of people who had attended A & E should have been included within the figures, as this would have demonstrated the increased demands on A & E over the three year period.  The Committee was advised that the figures for Lincolnshire did not demonstrate any trends; and that Lincolnshire's growth in A & E attendances was in-line with the national position;

·         One member enquired as to what was the definition of a Neighbourhood Team; and when was the consultation likely to be carried out in respect of Neighbourhood Teams.  The Committee was advised that Integrated Neighbourhood Working would provide care to a defined registered population of between 30,000 and 50,000.  It was highlighted that there was a government mandate in respect of consultation.  It was reported that at the moment work was ongoing looking at the level of demand required; and then consultation would be done relating to the level of need.  It was highlighted that the NHS could not go out for consultation on a matter that was mandatory for them to do.  The Committee was advised that an item concerning Neighbourhood Teams was due to be considered at the 18 April 2018 meeting;  

·         Urgent Treatment Centres – The Committee was advised that under national guidance Urgent Treatment Centres should be developed and co-located at existing Emergency Departments within Lincolnshire.  Their purpose was to provide highly effective patient streaming to relevant specialities minimising the requirement for patients to attend Emergency Departments.  It was highlighted that work was underway to establish what facilities would be available in the county.  It was noted that these would be located in convenient locations, with no-one having to travel more than 20 miles to their nearest Urgent Treatment Centre.  Confirmation was given that the 20 mile limit was a national standard;

·         Estates – The report highlighted that operational efficiency work streams in the STP were reviewing and integrating where possible the estates between all the statutory providers.  Some concern was expressed that if the bids mentioned in Appendix A, Paragraph 6 were unsuccessful, if there was an alternative plan in place.  The Committee was advised that realistically not all the bids put in would be successful, but some would be successful.  It was highlighted that without the money, the NHS would be unable to comply to the necessary requirements;

·         Public perception – The need to ensure that the public were kept well up to date with any changes;

·         Staffing of streaming facilities – It was reported that work was being done looking at new models of care; an example given was GP practices working together.  Confirmation was given that there was a need for GP Practices to be better equipped to meet the needs;

·         The reluctance of ringing 111, when needing an appointment with a GP on the same day;

·         The temporary cessation of elective paediatric inpatient activity at Boston hospital.  The Committee was advised that this had been done as a system approach to ensure the safety of patients.  It was highlighted that this was not a permanent change; it was just a realignment of services to help A & E.  The Committee was advised that with the Medical School in Lincoln it was hoped that Lincolnshire would be able to 'grow its own staff more';

·         Confirmation was given that there was still a debate ongoing as to whether Louth and Skegness would become Urgent Treatment Centres or become Primary Care Hubs.  It was noted that at the moment there was no definite answer.  The Committee was advised that there was an Urgent Care Meeting planned for 21 March, and that any outcomes from the meeting would be passed on to the Chairman to share with members of the Committee; and

·         One member expressed concern regarding the cost of the implementing the Strategy; and to the financial risks associated if the system should fail.

RESOLVED

1.    That the Lincolnshire Urgent and Emergency Care Strategy 2018 - 2021 attached at Appendix A to the report be received.

2.    That the Urgent Care Streaming Service attached at Appendix B to the report in the context of the Lincolnshire Urgent and Emergency Care Strategy 2018 – 2021 be received.

3.    That regular updates be received by the Health Scrutiny Committee for Lincolnshire.

Note: Councillors M A Whittington, Mrs R Kaberry-Brown (South Kesteven District Council) and P Gleeson (Boston Borough Council) wished it to be recorded that they had abstained from voting in respect of this item.