Agenda item

Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust - Risk to the Safety of the Service

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update concerning the situation in relation to Children and Young Persons Services at United Lincolnshire Hospitals (ULHT) NHS Trust. Jan Sobieraj, Chief Executive, Kevin Turner, Deputy Chief Executive, Michelle Rhodes, Director of Nursing, and Dr Neill Hepburn, Medical Director from United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

Minutes:

The Chairman welcomed to the meeting presenters from United Lincolnshire Hospitals NHS Trust:-

 

·         Kevin Turner, Deputy Chief Executive, United Lincolnshire Hospitals NHS Trust;

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

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

 

Pursuant to minute number 7(2) from the 16 May 2018 meeting, the Committee had requested a monthly update from representatives from the United Lincolnshire Hospitals NHS Trust concerning Children and Young Persons Services at Pilgrim Hospital Boston.

 

Attached to the report were the following appendices for the Committees consideration:-

 

·         Appendix A – A copy of the United Lincolnshire Hospitals NHS Trust (ULHT) Board papers from the 25 May 2018;

·         Appendix A1 – Appendix 5 – to the United Lincolnshire Hospitals NHS Trust Board paper for 25 May 2018; and

·         Appendix A2 – Appendix 6 – to the United Lincolnshire Hospitals NHS Trust Board paper for 25 May 2018.

 

The Committee was advised that on 25 May 2018, the Trust Board had directed that work was to continue to maintain current services at Pilgrim Hospital, Boston; and that work should continue on a contingency plan for the implementation of co-location of paediatric and obstetric services to Lincoln, in the event of the current service model at Pilgrim Hospital, Boston not being sustainable.

 

It was reported that since the last meeting the Trust had been successful in attracting some agency locum middle grade doctors to the posts.  As a result of concerns raised by the medical team around safety relating to a potential medical rota where 7 wte out of the establishment of 8 wte were going to be locum/agency doctors.  To address the issues raised the Trust had appointed two additional locum consultants to support the middle grade doctors; and work was ongoing to explore alternative ways of working to mitigate the concerns raised.

 

The Committee was also advised that Health Education England were now planning to remove Tier 1 (junior doctor) trainees from paediatrics at Pilgrim Hospital, Boston.  This move would make staffing the paediatric unit very difficult as the unit was run on an eight doctor rota of which six posts would normally be filled by such doctors.

 

It was reported that nursing staff numbers had also improved, which had allowed an increase to inpatients beds from eight to twelve at Pilgrim; and had also allowed paediatric surgery to be restarted.

 

The Committee was also advised that the proposed Clinical Senate Review, which had been commissioned by NHS England and NHS Improvement, had been stood down.  The Committee was advised further that ULHT had asked the Royal College of Paediatrics and Child Health to undertake a review of children's and young persons' services, which would be commencing on 14 June 2018; and that the Trust Board would be reviewing the matter at their meeting on 29 June 2018; that the task and finish group in consultation with health partners would continue to develop contingency plans; and that a detailed communications and engagement plan was being further developed to inform and engage communities as proposals evolved.

 

During discussion, the Committee raised the following issues:-

 

·         Visa Delays – The Committee was advised that there had not been any significant delays with emergency medicine and paediatrics as these two areas were classed as being exempt;

·         Some concern was expressed to the proposal by Health Education England to remove all trainee doctors in paediatrics, which included tier one, which would make the situation at Pilgrim Hospital, Boston very challenging.  The Committee was advised that the tier one posts were not attractive to a trainee; and therefore the Trust was working to create a model to get junior doctors to work with the Trust.  The Committee was advised that recognised training would need to have senior input to ensure that the training was of a high enough standard.  It was highlighted that the Trust was exploring alternative ways to provide a service, for example by using nurse practitioners rather than junior doctors; 

·         Preferred Option – Clarification was given that Option One was the preferred option for the Trust.  Some concern was expressed at the lack of information and costings relating to the alternative option (Option Three), and to the risks associated with the problems with junior doctors.  The Committee was advised that the preferred option would not be based on cost but on the health and safety of patients.  It was highlighted that the preferred model might even be a hybrid of the two options;

·         Some concern was expressed to the uncertainty of residents in the East Lindsey area surrounding the provision of services at Pilgrim Hospital, Boston.  The Committee was advised that the staffing issues at Pilgrim Hospital, Boston were an ever changing picture; and that the Trust was doing everything it could to explore ways of attracting staff to work for the Trust  in order to maintain the preferred option;

·         Communication – It was noted that the Trust was working on a Community and Engagement Plan as part of the system approach and that this would provide messages to alleviate members of the public's  concerns;

·         Confirmation was given that the Clinical Senate review, commissioned by NHS England had been stood down, because it was felt that sufficient progress had been made; and that the Clinical Senate would not have offered any added value in this instance to the service review;

·         One member enquired as to when the Trust would know whether the service would be continuing beyond August 2018; and also concerns were expressed concerning the implications of Option Three, if it was to be implemented.  The Committee was advised that the healthcare system was being proactively canvassed for support at the highest level, and that a Health System-Wide Risk Summit was to be held in July 2018.  It highlighted that more would be known following the Summit meeting, which would be in approximately one months' time.  In the meantime, work would be continuing to look for solutions to keep the service running; and to contingency options, should the preferred option be found not to be sustainable;

·         Incentives for doctors.  The Committee was advised that the Trust operated a whole range of incentives for the benefit of its staff;

·         One member asked if data requested at the previous meeting relating to the number on home births in the Polish community could be forwarded onto members of the Committee.  Trust representatives agreed that this information would be forwarded onto the Health Scrutiny Officer; and

·         Some members of the Committee extended their congratulations to the Trust for the progress made since the last meeting, which had been reassuring news to hear.  The Trust reiterated that the intention was to find solutions to mitigate the health and safety risks; and that this was still work in progress.

 

In conclusion, the Chairman expressed thanks on behalf of the Committee for the Trust representative's attendance and for their honest update.  In view of the concerns raised by the Committee it was agreed that some progress had been made since the last meeting.  However, there was a consensus that more information was needed to be made available to the Committee relating to Option Three.  Particular reference was made for further information relating to the associated financial costs, transportation issues; and whether Lincoln County Hospital would be able handle the additional 650 births per annum, and whether out of County hospitals had the capacity to handle an additional 1,000 births per year.  The Committee also agreed that a letter should be sent to all Lincolnshire MPs urging them to continue to be vigilant on this matter.

 

RESOLVED

 

1.    That the update report concerning Children's 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 next Health Scrutiny Committee for Lincolnshire meeting to be held on 11 July 2018; and that the update should also include information relating to the impacts of Option 3.

 

3.    That a letter be sent to all Lincolnshire MPs urging them to continue to be vigilant on the issues relating to Children's and Young Persons' Services at United Lincolnshire Hospitals NHS Trust.

Supporting documents:

 

 
 
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