Agenda item

(To receive a report from Jan Sobieraj (Chief Executive United Lincolnshire Hospitals NHS Trust), which provides the Committee with background information as to the issues faced by the Children and Young Persons Services)

The Chairman welcomed to the meeting:-

·         Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust;

·         Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust;

·         Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust;

·         Sue Bennion, Head of Midwifery and Nursing – Women and Children's Services, United Lincolnshire Hospitals Trust; and

·         Dr Rao Kollipara, Consultant Paediatrician, United Lincolnshire Hospitals NHS Trust.

The Chief Executive in his introduction advised that a series of circumstances had led to the challenging position currently faced by the children's and young person's department specifically at Pilgrim Hospital, Boston.  It was highlighted that at the moment services were safe, and that the Trust was actively working to recruit staff.  It was reported that the children's services provided at Pilgrim Hospital could not be sustained in their current form beyond July 2018, unless additional middle grade doctors were recruited, in addition to the long standing nursing shortages.

The Medical Director advised that services provided by the children's and young person's department were complex and included:-

·         Acute Children's Inpatient Service;

·         Emergency Children's Assessment;

·         Neonatology;

·         Consultant Led Obstetric Service;

·         Emergency Department;

·         Outpatients Clinics and Procedures;

·         Community Children's Services; and

·         Children's Elective inpatient and Day Case Surgery.

The Committee was advised that the service had over the last three years experienced both medical and nursing staffing challenges, which had been mitigated by temporarily closing beds; increasing the skill mix of staff; and utilising both locum and agency medical staff.   It was highlighted that the Clinical Directorate Team, supported by the Children's Multi-Disciplinary Team at Pilgrim Hospital, Boston had highlighted their concerns that the children's service at Pilgrim Hospital, Boston was currently safe, however, that moving forward the service might struggle to provide safe care if the staffing shortages remained the same.

The Committee was advised that a task and finish group had been established to develop the work required to mitigate the current risks to ensure the safe and sustainable running of children's, obstetrics and neonatal service at United Lincolnshire Hospitals NHS Trust.

It was highlighted that nationally there was a 25% shortage of middle grade doctors for paediatric services.

The Committee was advised that a paper had been presented to the United Lincolnshire Hospitals NHS Trust Board on 27 April 2018, a copy of which was attached at Appendix A to the report presented.  The Committee was advised further that the paper had outlined five options regarding temporary measures that might need to be taken to maintain safe paediatric services at Pilgrim Hospital, Boston.  The United Lincolnshire Hospitals Trust Board had supported the further working up of four of the options; and had requested a further more comprehensive report being presented to the next United Lincolnshire Hospitals Trust Board meeting to be held on 25 May 2018.

In conclusion, the Committee was advised that the Trust felt that Option One was the option the Trust wanted to maintain; and that steps were being undertaken to put together sufficient mitigation to maintain a safe service; but at the same time the Trust was being mindful of the associated risks.  The Committee were invited to provide any feedback to the Trust Board for consideration at its 25 May 2018 meeting.

During discussion, the Committee raised the following issues:-

·         Recruitment – The Committee was presented with extensive evidence surrounding the recruitment process to recruit middle grade paediatric doctors.  The Committee was advised that the Trust was using a specialist recruitment consultant to assist overseas applicants with visa documentation.  It was highlighted that the said consultant was well acquainted with relevant processes and procedures.  Details relating to staffing were shown on pages 41 to 45 of the report presented.  It was felt that if Option One was to be maintained, then efforts needed to be continued to recruit staff.  One member highlighted that the recruitment issue had been a long standing issue, which had not been resolved which had resulted in the current recruitment situation.  Confirmation was given that the Trust operated a whole range of incentives for the benefit of its staff.  The Committee was advised there was a number of staff expected in October through the last round of international recruitment. 

It was also highlighted to the Committee that nationally there were 50,000 nursing vacancies.  It was reported that systems were in place to help with recruitment and that the Trust had managed to recruit 100 nurses since November 2017;

·         The need for the involvement of all Lincolnshire MPs.  The Committee was advised that Matt Warman (Member of Parliament for Boston and Skegness) had raised the matter with the Prime Minister who had been supportive of maintaining services at the Pilgrim Hospital, Boston.  Matt Warman had also met some children's services staff; and was due to meet others at a meeting scheduled for Friday 18 May 2018;

·         Whether help had been sought from other organisations.  Confirmation was given that the Trust was seeking help from other areas;

·         New starters and staff returning from maternity leave.  The Committee was advised that there was an expectation that the new starters and those returning from maternity leave would not be going elsewhere.  Confirmation was also given that the three paediatric nurses who had been assisting in the Emergency Department had now returned back to the wards; as Emergency staff had now completed the necessary training;

·         A question was asked as to why the Trust was unable to retain middle grade doctors.  The Committee was advised that all the Trust's medical staff received training and support to help them develop in their roles. Some medical staff had left for a variety of reasons, some of which were personal reasons, and some for better career development and promotion.  The Committee noted that the Trust was not perfect and that the Trust did not tolerate bullying.  The Trust was endeavouring to employ individuals who had the necessary skill sets and values to deliver the level of care required.  It was further noted that to sustain rotas the Trust had a very active bank shift programme.  The Committee was advised that the Trust's retention rates were good, but that changes to working arrangements might have an impact on personal development and job satisfaction;

·         Some members expressed concerns relating to the similarities surrounding the reduction of paediatric services at Pilgrim Hospital, Boston to the overnight closure of Grantham Hospital's A & E department overnight; and to the implications of the Sustainability and Transformation Partnership (STP).  Reassurance was given that no decision had been made to withdraw any services on a permanent basis.  The Trust advised that they had the patient's best interests at heart and providing a safe and sustainable service was paramount; and that they would continue to recruit to the vacant positions to mitigate the risks.  One member highlighted that the uncertainty was as a result of members of the public in Boston being frightened by the impending changes to the services; as a result of the potential travelling distance to Lincoln Hospital.  Some members of the Committee felt that as there was uncertainty, the need for better communication was paramount;

·         Options - The Committee was advised that options two and three referred to between one and two children per day being transferred by ambulance from Pilgrim Hospital, Boston to Lincoln County for an in-patient bed.  The Trust advised that further work was being done on the possibility of commissioning a separate ambulance service to make the inter-hospital transfers, as EMAS was unlikely to offer this service in every instance.  One member suggested the use of an air ambulance in these circumstances.  One member enquired as to why the five options that had been presented to the Trust Board had not been worked up properly.  Details of the five options were shown on pages 56 to 62 of the report presented.  The Committee was advised that the options had come from the clinical teams; and then discussed by the task and finish group and the wider health community.  The Trust Board had at their meeting on 27 April looked at the options and requested that further work should be done on four of the options.   

Some discussion was had as to the effect option three would have on maternity provision and patient choice.  The Committee was advised that choices of a home-birth, midwifery led unit or consultant-led unit should be offered as a part of the principle of patient choice.  It was noted that for 1,650 mothers the choice of consultant-led birth at their preferred local hospital might be removed if option three was adopted.  It was also noted that with this option 1,650 mothers would now be expected to travel further to give birth.  Confirmation was given that the midwifery- led model was a national model; and that women wanted choice and options.  The most important factor was that the right service was delivered for women and children.  One question was asked concerning the number of home births in the Polish community. The Committee was advised that this data would be circulated to members of the Committee.  One member felt that offering so much choice to mothers in the current poor recruitment climate might put extra pressure on services provided; particular reference was made to provision for home births.  The Committee was reassured that home births would be the better option for resources in this instance.

It was highlighted that in addition to the patient transfer arrangements for options two and three, there would be further impacts on travelling time for parents and families.  The Committee was advised that the Trust's preferred option was option one;

·         The role of Health Education England and the General Medical Council – It was stated that the Trust was in discussion with Health Education England's regional deanery on ensuring tier 1 and tier 2 trainees would continue to receive training in Lincolnshire; as the General Medical Council was applying strict standards on the expected content of training;

·         One member highlighted there was a need to build on existing partnerships to ensure that correct facts were circulated to all, to help alleviate the fears members of the public were having;

·         Themes arising from engagement relating to the children's and young people's service, details of which were shown on page 101 of the report presented.  It was noted that in relation to an emergency very few parents had called 111 and followed the process; or had tried to get an appointment with a GP.  The Committee was advised that the process of streaming prior to the A & E would help to ensure that children could be seen by an appropriate professional; and

·         The role of the Clinical Senate.  The Committee was advised that the Clinical Senate had been commissioned by NHS England; and that the Clinical Senate was brought in to offer advice and assurance.  Confirmation was given that the Trust was obliged to listen to the advice and guidance provided by the Clinical Senate.  The Committee was advised further that there were 12 Clinical Senates across England, and that they were introduced as part of the Health and Social Care Act 2012.  The Clinical Senate comprised of professionals as well as patients to look at clinical service issues independently.  Confirmation was given that the Clinical Senate had no remit for finance related matters.

In conclusion, the Chairman expressed thanks on behalf of the Committee for the Trust representative's attendance and for their openness; and to the staff that had, and were still continuing to provide women's and children's services at Pilgrim Hospital, Boston.  In view of the concerns raised by the Committee, it was agreed that a further update on children's services at Pilgrim Hospital, Boston should be presented to the 13 June 2018 Health Scrutiny Committee for Lincolnshire meeting; and that a letter should be sent from the Chairman, on behalf of the Committee to Jan Sobieraj, Chief Executive United Lincolnshire Hospitals NHS Trust detailing the Committee's comments so that they could be passed on to the Board of ULHT in readiness for them making their decision regarding the future options for children's services.  The Committee highlighted the need to also write to all Lincolnshire MP's to ask for their support regarding this matter.

RESOLVED

1.    That the report concerning Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust – Risk to the Safety of the Service be received.

2.    That a further update on Children's and Young People's Services be presented to the Health Scrutiny Committee for Lincolnshire at the 13 June 2018 meeting; at which the frequency of future updates going forward relating to children's and young people's services would be determined.

3.    That a letter be sent from the Chairman of the Health Scrutiny Committee for Lincolnshire to United Lincolnshire Hospitals NHS Trust outlining the Committee's comments concerning the four options for the provision of children's and young people's services.

4.      That the letter sent from the Chairman of the Health Scrutiny Committee for Lincolnshire to United Lincolnshire Hospitals NHS Trust be copied to all Lincolnshire MP's asking for their support concerning the provision of children's and young people's services.