Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on the Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust)

The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust, Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust, and Mark Brassington, Chief Operating, United Lincolnshire Hospitals NHS Trust.

Pursuant to minute number 15 from the Health Scrutiny for Lincolnshire meeting held on 13 June 2018, the Committee received an update concerning children and young person's services at United Lincolnshire Hospitals NHS Trust. 

The Committee was advised that a proposed workable model of care had been worked up and presented to the ULHT Trust Board on 29 June 2018.  Details of the proposed model were shown in Appendix 1 on pages 34 and 35 of the report presented. 

The Committee was advised further that the service at Pilgrim Hospital, Boston, was still very fragile, but actions were being taken to help mitigate the situation and a proposed model of care was being developed for the future.

It was reported that Health Education East Midlands was continuing to place trainee junior doctors in ULHT and that they would be based at Lincoln County Hospital, however, agreement had been reached that the junior doctors could undertake some duties at Pilgrim Hospital, Boston when a consultant was present for support and teaching. 

The Committee noted that a new Trust wide rota was being developed and discussed with the consultant body; and that work was continuing with medical agencies, irrespective of financial cost, to find agency and locum medical staff to support the rota at Pilgrim Hospital, Boston, in order to keep children's services running safely.

During consideration of the proposed model of care, it was reported that there would be an eight-bed paediatric assessment unit open 24 hrs, which would be co-located with the neonatal unit; paediatric outpatients provision; the re-instatement of four day surgery beds; neonatal services would be managed from 34 weeks gestation; consultant led maternity unit provision; and a 24 hour In Patient Gynaecology Ward. 

The Committee was advised that the proposed model of care would mean that 98% of children who were seen and managed at Pilgrim Hospital, Boston on a daily basis would continue to receive care there.  The Committee was advised further that the modelling indicated that two children each day might require transferring for an inpatient stay in Lincoln; and that two additional expectant mothers would need transferring to Lincoln each week to deliver a premature baby.  Representatives from ULHT appreciated the concerns raised in respect of travelling.  It was highlighted that with existing provision, mothers, young babies and children were currently being transferred to Lincoln and out of county.  The Committee noted that transport options were being examined.

During discussion, the Committee raised the following points:-

·         Paediatric Assessment Unit - Whether the nursing team would be 24/7 and multi-skilled; when the service would be introduced and whether the service would be made countywide.  The Committee was advised that at the moment the focus was on Pilgrim Hospital, Boston, and that some work was already being done to look at the way nurses worked; and that the proposals were still at early stage and therefore all the details were not yet available;

·         Ongoing staffing issues – The Committee was advised that recruitment of staff had been an ongoing issue for a number of years, and that the Women and Children Clinical Directorate had been managing the significant medical and nursing staff vacancies for a number of years within paediatrics.  It was highlighted that following conversations with staff regarding their personal development and future plans at the beginning of the year, it had become apparent that there would be a shortage of middle grade doctors; and nursing staff at Pilgrim Hospital, Boston.  It was highlighted that previously there had been a 'pipeline' of replacement staff available.  However, in this instance it was not the case.  Reassurance was given that Lincoln County Hospital had the capacity to cope with any patients being transferred, as they already had Paediatric, Neonatal. Obstetrics and Gynaecology services; and that consideration would be taken to the issues raised in relation to transportation.  One member asked whether there was any inducement to encourage locums to take on substantive positions.  Confirmation was given that there were financial incentives in place.  It was also highlighted that there were training posts in place which offered a path to develop into a consultant role.  One drawback of this was that once in a consultant role, staff then tended to move to larger hospitals to gain more knowledge and experience.  Confirmation was also given that Pilgrim Hospital, Boston were utilising agency nurses;

·         One member enquired whether the proposed changes in relation to neonatal cases had been discussed with service users.  The Committee was advised that to help mitigate risks Pilgrim Hospital, Boston would manage low risk neonates above 34 weeks; and that this proposal had been covered in the recent survey.  It was noted that there had also been visits to local mother and toddler groups; and that discussions had also been undertaken with lobby groups in Boston.  It was highlighted that further information events were planned during July/August 2018.  Confirmation was also given that expectant mothers would continue to have a choice.  The Committee noted that a percentage of expectant mothers chose to go to Peterborough, or Grimsby; and that Boston and Lincoln sites only looked after a proportion of Lincolnshire mums.  One member asked how many mums would be affected by the proposed change to the gestation threshold for neonatal services.  The Committee was advised that between 60 and 80 women per year would be affected; but support would be provided to them elsewhere.  Reference was also made to the potential for an extra three hours travelling time; and to the lack of public transport available.  Confirmation was given that a mother would not be moved during labour; and that a mother could have a Caesarean Section at Pilgrim Hospital, Boston if it was required; and then be transferred to Lincoln if necessary.  The Committee received confirmation that currently risks were managed on a daily basis; 

·         111 Service – One member expressed concern that Appendix 2 - Paragraph 5 – Summary of Views of Patients and the Public highlighted that in the case of an emergency, the majority of parents would take their children to A & E in Pilgrim Hospital, Boston; very few actually called 111 and followed due process.  It was felt that there was still a lack of clarity from the general public as to how to engage with the NHS.  The Committee was advised that a promotional campaign was due to take place through August concerning signposting, and self-care.  It was also highlighted that some patients still experienced problems getting appointments with GPs.  The Committee noted that ULHT was not responsible for primary care;

·         Some concern was also made to the fact that a large number of women had said that they would not use a midwifery-led unit at Pilgrim.  The Committee was advised that a mid-wife led unit would be new to Lincolnshire; but was not new nationally.  Most midwifery-led units provided levels of care, which was rated good or outstanding, and also offered a variety of choice for women.  It was also highlighted that hubs in the community providing antenatal care had been incredibly successful on the coast.  The Committee noted that the number of homebirths in Lincolnshire was higher than the national average;

·         Expectations of Eastern European expectant mothers.  The report highlighted that Eastern European mothers usually preferred to be admitted to hospital earlier to give birth, have the availability of Caesarean Sections; and with less focus on natural births.  The Committee was advised that ULHT worked very closely with Eastern European expectant mothers;

·         Engagement – Some concern was expressed to the lack of engagement undertaken (only 2,500 people) relating to paediatric and maternity services;

·         Some members felt that overall, there had been some positive achievements made in relation to the Proposed Model of Care.  It was also stressed that communication with the general public regarding proposals were very important moving forward;

·         One member asked a question as to the percentage of women who went from Grantham to either Boston or Lincoln for their births; and to whether a hub existed in Grantham.  The Committee was advised that the exact number of women that had been transferred was not known;

·         One member asked what level of support the ULHT had received from NHS Improvement (NHSI).  The Committee was advised that ULHT had been receiving support from NHSI throughout the process;

·         Contingency Plan – Some concern was expressed to the lack of information and evidence around the 'contingency plan', despite the Committee's request over the last three months. It was reported that currently all efforts were being concentrated on option one; as there was not the professional staff to look at option three.  It was noted that the option one model might change as developments happened over the next few months;

·         Some concern was also expressed to the fact that although a calendar of public engagement events had been provided, many of the dates and times were missing.  A further concern was raised relating to when the communication plan would be ready; and when this would be shared.  The Committee was advised that engagement would continue around maternity and paediatric services county-wide; and that feedback received would help inform communication routes when services changed.  It was reported that there would be a communication plan in place once there was a model; and

·         A question was asked as to whether ULHT had a contingency plan for transportation, given the pressure that the East Midlands Ambulance Services were already under.  The Committee was advised that maternity retrieval was already available; and that discussions were ongoing with EMAS concerning the potential increase in the number of children requiring transport.  The Committee was advised further that private ambulance provision was already in place and being used; and that this was being looked at as well.  Confirmation was given that there were no plans to use an air ambulance.  One member highlighted that the Lincolnshire and Nottinghamshire Air Ambulance was a charity, and as such did not receive any direct financial support.

The Chairman advised that following the last meeting, a letter had been sent to all Lincolnshire MPs asking them to be vigilant in terms of the paediatric service across ULHT.  To date, the Chairman advised further that only one response, from Karen Lee MP, had been received, which had raised several issues including the level of regional and national support being provided to ULHT and the impacts on EMAS.  The Health Scrutiny Officer agreed to forward a copy of the response letter to all members of the Committee.

In conclusion, the Committee agreed that a further update should be received from ULHT for the 12 September 2018 meeting; and that NHSI should be contacted to confirm their level of support and input into the proposed plans moving forward.

RESOLVED

The Committee unanimously agreed

1.    That representatives from United Lincolnshire Hospitals NHS Trust be requested to attend the 12 September 2018 meeting to present to the Committee a comprehensive report concerning their contingency plan to address the Committee's concerns and questions, and to provide an update on the progress made on the proposed model of care in relation to the children and young person's services at United Lincolnshire NHS Trust – Risk to the Safety of the Service.

2.    That the Chairman, on behalf of the Committee, writes to NHS Improvement, recording the Committee's disappointment that NHS Improvement has not been represented at a meeting; and to request that an update be provided on the level of support NHS Improvement has had, or is having towards the plans; and that a formal request be made for a representative from NHS Improvement to attend the 12 September 2018 meeting.