Agenda item

Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust - Update

To receive a report from United Lincolnshire Hospitals NHS Trust on the latest position on the interim model of paediatric care, which has been operating at Pilgrim Hospital, Boston, since 6 August 2018.  The report, which was written by Dr Neill Hepburn the Trust's Medical Director, will be presented by senior managers from the Trust.  The report also makes reference to the contingency arrangements if the interim model of care should fail. 


The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust.


As agreed at the 12 September 2018 meeting, the Committee received an update on Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust. 


The Committee were reminded of the temporary model of care that had been implemented on 6 August 2018; which included an enhanced paediatric presence in the Pilgrim Hospital Emergency Department; and an acute paediatric assessment unit with a twelve-hour length of stay.  Attached to the report were the following Appendices:-


·         Appendix A - Children & Young Persons Services at United Lincolnshire Hospitals NHS Trust (ULHT) – Risk to the sustainability of the Service (26 October 2018);

·         Appendix B – Contingency Plan – Proposed Relocation Plan;

·         Appendix C – Health Scrutiny Committee – Questions on Contingency Plan – September 2018; and

·         Appendix D – Communications and Engagement Plan Update – United Lincolnshire Hospitals NHS Trust (29 October 2018).


The Committee was advised that the interim service model remained in place and that services were still fragile.  The Committee was advised further that the workforce was still heavily dependent on locums and agency doctors; and that there was now one substantive middle grade doctor and six agency locum middle grade doctors within the current rota.  It was highlighted that the Women's and Children's Clinical Directorate were continuing with national and international recruitment.  Other areas reported on included:-


·         The Committee was advised that following the analysis of the first six weeks' data, the dedicated transport provision that began with two ambulances being available 24 hours a day had now been reduced; and the contract had been extended until 31 December 2018; 

·         It was also reported that in the first six weeks of operation up to 31 October 2018, 674 patients had been seen in the Paediatric Assessment Unit; with 99 children being transferred.  It was highlighted that no issues had been experienced or reported, however, there was an acknowledgment that the transfers of patients had caused some disruption to the patients and their families.  It was noted that each transfer direct from Pilgrim Hospital, Boston to Lincoln County Hospital had taken on average 90 minutes;

·         The Committee was also advised that there had been six in-utero transfers of pregnant ladies during the period up to the end of October 2018;

·         The Committee was advised that the risks would continue to be managed through the project risk register.  It was highlighted that no incidents of patient harm had been reported;

·         The Committee was advised that if needed the contingency plan would be to centralise paediatric services from the Pilgrim site onto the Lincoln County Hospital site, if services could not be maintained at the Pilgrim site.  Details of the proposed Relocation were shown in Appendix B to the report.  The report highlighted the Trust's three incremental plans for the next six months.  These were detailed on page 22 of the report; and

·         Feedback from Engagement Events and the Communications Plan – Further to the Committee's request at the September meeting, a summary of responses received on each of the three themes were shown on page 23 of the report.  It was highlighted that full feedback notes had been shared with the Trust's Women's and Children's Managers, and that this feedback would be used in the development of the service going forward to ensure that current and future service models were able to meet the needs of the patients. 


During discussion, the Committee raised the following points:-


·         One member highlighted a recent British Medical Association report, which made reference to bullying with regard to medical training and how this impacted on ULHT staff.  The Trust reassured the Committee that bullying was not acceptable and would not be tolerated.  It was accepted that bullying could occur as a result of poor training; and that this was an issue the Trust was working on to ensure that staff were adequately trained and supported.  It was also highlighted that on occasions change could be perceived as bullying; and that this was a further area that the Trust was aware needed improvement;

·         Page 23 – Higher Level Neonatal Unit at Pilgrim Hospital, Boston – The Committee was advised that the Trust did not determine what was provided, that was the responsibility of the commissioners.  It was highlighted that provision of such a unit would be balanced between actually staffing the unit; and to whether staff would be kept busy enough to maintain their skill levels.  It was highlighted further that babies with a higher need than that provided at Lincoln had always been transported to Nottingham;

·         Page 24 - Births - The report highlighted that three babies from the Pilgrim Hospital, Boston area (Under the 34 week's gestation) had been born in Lincoln County Hospital.  A question was asked as to whether any of these women had been transported mid-labour.  Confirmation was given that no woman would be transferred in labour.  Confirmation was given that all transfer journeys took around 90 minutes from ward to ward;

·         Page 44(8) - A question was asked as to whether women were getting a full range of choices at Pilgrim Hospital Boston.  An explanation was given that choice was a discussion that was had between the doctor and the patient, to best meet the needs of the patient.  It was highlighted that there were benefits to having a mid-wifery unit  and that this was an alternative it was hoped would be developed at a later date;

·         Ambulance provision – Confirmation was given that the ambulances used for patient transfers was by a private provider, and that EMAS had been approached but unfortunately did not have the capacity to provide the service;

·         Shortage of staff at the Lincoln and Boston site – The Committee was advised that that there had been long term recruitment issues which were starting to be addressed.  The Committee was advised that young people looking for careers seemed to gravitate to large cities; whereas some more mature staff seemed to prefer Lincolnshire for a better quality of life;

·         Bullying – One member highlighted to the Committee that he had been saddened whilst waiting in the A & E at Pilgrim Hospital Boston recently to hear bullying language being used by a doctor to a nurse.  The Committee was advised that the Trust had been working very hard with the medical team to improve behaviour.  The Trust staff were also saddened to hear of the incident;

·         Page 23 – Children's Ward/Paediatric Assessment Unit – A question was asked whether children would be able to stay longer than the twelve hours.  The Committee was reassured that the time frame was for guidance only;  

·         Page 29 - Progress of the STP -   Confirmation was given that the plan was moving forward; and that the plan would be out for consultation in the new year;

·         The need to look for initiatives to get people into the NHS; and the need for the creation of a centre of excellence.  The Committee was advised that relationships between doctors and senior nurses were changing so that there was a more blended workforce;

·         A question was as asked as to whether NHS Improvement (NHSI) was still providing assistance to ULHT.  The Committee was advised that they were still receiving support from NHSI; and that quarterly meetings were still taking place;

·         Whether the interim model was adding an additional cost on an already constrained budget, and whether there was confidence that finances would remain in place. It was noted that the interim model was costing extra and that there was a worsening of the deficit position.




1.    That the update by United Lincolnshire Hospitals NHS Trust on Children and Young Persons Services be noted.


2.    That a further update on Children and Young Persons Services be received at 23 January 2019 meeting.


3.    That consideration be given by the Committee to a report by the Royal College of Paediatrics on the Trust's women and children's services.   

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