Agenda item

(To receive a report from South West Lincolnshire Clinical Commissioning Group, which provides the Committee with information on the review of the Minor Injury Nurse Pilot incorporated into the Grantham Out of Hours base. John Turner, Chief Officer, South West Lincolnshire CCG and Dave Baker, Chairman of the South West Lincolnshire CCG will be in attendance at the meeting)

Pursuant to minute number 19 (1) (2) of the meeting held on 13 June 2018, the Committee had requested that an update be received concerning the Minor Injury Nursing Service Trial at Grantham Hospital.

The Committee welcomed to the meeting:-

·         John Turner, Chief Officer, South West Lincolnshire Clinical Commissioning Group (SWLCCG);

·         Dr Dave Baker, GP Chair, South West Lincolnshire Clinical Commissioning Group (SWLCCG); and

·         Andrew Morgan, Chief Executive, Lincolnshire Community Health Services NHS Trust.

The Chairman advised that the Chief Officer SWLCCG, and GP Chair SWLCCG were only able to attend the meeting for 30 minutes, as they had to return to a Clinical Senate meeting.  Due to the time constraints, the Committee had been asked to submit questions in advance and the said questions and responses were tabled at the meeting.

The Chairman requested that the Committee proceed directly to questions,

During discussion, the Committee raised the following questions:-

·         The back ground to the trial - The Committee was advised that the trial had started in September 2016, and was operated by Lincolnshire Community Health Services NHS Trust as part of the Out of Hours Services based on the Kingfisher Unit at Grantham Hospital.  The Committee noted that for 2017 the service had operated for 1,875 hours and had seen 65 patients.  One member asked whether there was any evidence of people going elsewhere.  The Committee was advised that the numbers were low and that a further piece of work needed to be done to see where people were going;

·         Consultation – The Committee was advised that the CCG was not conducting a formal consultation exercise in relation to the Minor Injury Nurse Trial as it was only a trial service, but the trial had undergone a well-publicised four week survey to gain patient feedback; and the CCG had also written to a number of stakeholders requesting their feedback.  The Committee was advised that 304 responses had been received to the CCG survey.  One member highlighted that a local survey by a pressure group had found that over 370 people had not been aware of the service.  The Committee noted that the responses to the CCG's survey were currently being analysed, the results of which would then be reported back to the Governing Body.  The Committee noted that the key themes emerging were that the respondents did not know about the existence of the service, and that it was available as a walk in service; and respondents were also claiming that NHS 111 did not offer the service as an option.  Confirmation was given to the Committee that the availability of the service was cited on the NHS 111;

·         Continuation of the service at Grantham Hospital – One member highlighted that as the cost for the service was minimal (£130,000.00), would the Trust consider extending the service until the Sustainability Transformation Plan was introduced.  The Committee was advised that the Governing Body at the end of the month would take into consideration the letter from the Committee and the response letter from the Accountable Officer, and that the Governing Body was aware of the concerns raised by Grantham in relation to the A & E.  The Committee was advised that an audit of the last six weeks on the usage of the service had identified that all injuries had been minor injuries i.e. cuts, bruises, splints etc.  The Committee was advised that for the calendar year 2017, only 65 patients had been seen.  The cost of the service was £130,000.00, so the average cost per attendance was therefore £2000, which was clearly not good value for money.  One member highlighted that the importance of the service could not be underestimated, and the situation in question was not dis-similar to that previously received from a cottage hospital.  A suggestion was made for a nurse to be employed to cover such provision, but having a substantive post elsewhere in the hospital;

·         Some concern was raised to the fact that people were clearly not using the NHS 111.  It was highlighted that there needed to be more publicity and signage promoting the NHS 111 Service.  Some members felt that people needed to be re-educated on how good the NHS 111 service actually was; and

·         One member advised from personal experience that from Sleaford they had been advised to go to Lincoln and not to Grantham.  A further question was asked as to how the service had been advertised to the residents of Sleaford.  The service had clearly been underutilised due poor publicity.  The Committee was advised that the service was part of the NHS 111 directory of services; and that when the trial of the service was being launched it was publicised within the Grantham Journal, on the Lincolnshire Community Health Services NHS Trust website as an Out of Hours Service; and also on the South West Lincolnshire CCG website.  The Committee was further advised that the minor injury nurse was also advertised through waiting room screens within South West Lincolnshire CCG practices.

The Chairman advised that having received a response to his letter from the Accountable Officer South West Lincolnshire CCG (as detailed at Appendix B to the report) and having heard what the Committee had raised during discussion of this item, it had become apparent that the service had been set up to fail, as there had been poor promotion, lack of signage and no mention of the service in the "Your Health Service Directory".  This lack of publicity had led to the residents of Grantham and surrounding areas not being aware of the service. 

In conclusion, the Committee agreed to the Chairman writing to the South West Lincolnshire CCG asking them to defer their decision to close the service and to request that the CCG ensure better publicity is undertaken in the future.

RESOLVED

That the Chairman should write a letter to the South West Lincolnshire CCG on behalf of the Committee, requesting that:

(a)  the South West Lincolnshire CCG defer its decision to close the Minor Injury Nursing Service until a decision is made around the future services on offer at Grantham Hospital; and

(b)  the South West Lincolnshire CCG insure that full promotion and signposting is undertaken, so that when a decision is made in the future this will be a balanced and fair set of facts and figures for the Health Scrutiny Committee for Lincolnshire to scrutinise.