Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Women's and Children's Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from Healthy Conversation 2019. Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operations, Lincolnshire Community Health Services NHS Trust and Penny Snowden, Deputy Chief Nurse, United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Women's and Children's Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from Healthy Conversation 2019.

The Chairman welcomed to the meeting:-

·         Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operations. Lincolnshire Community Health Services NHS Trust; and

·         Simon Hallion, Managing Director Family Health, United Lincolnshire NHS Hospitals Trust.

The report presented provided the Committee with background information relating to the Healthy Conversation 2019 engagement exercise; the case for change for Women's and Children's Services; and the reasons why there needed to be changes.

The Committee was reminded of the significant hospital staffing issues, particularly at the Pilgrim Hospital, Boston, which had an on-going problem of not being able to recruit middle grade doctors and nursing staff.  It was highlighted that the shortage of medical and nursing staff had also meant there was reduced ability to support junior doctors; as the support and training required could not be provided.  However, since August 2018, as a result of safety concerns, the following temporary changes had been introduced:-

·         The closure of the paediatric in-patient beds; and the opening of a paediatric assessment ward at Pilgrim Hospital with any child requiring a non-elective admission needing to stay 23 hours, or have planned elective care being treated at Lincoln Hospital; and

·         Any babies' pre 24 weeks at Pilgrim Hospital being transferred to the Lincoln Hospital site, where staff were able to deal with their needs.

The Committee was advised of the two 'Emerging Options', details of which were shown on page 23 of the report.  The Committee was advised further that the NHS's preferred emerging option was number one as it would provide the following services at the two hospital sites:-

Pilgrim Site

·         To continue with a consultant led obstetric service with the addition of a co-located midwife-led unit;

·         The Boston special care baby unit currently cares for babies born from 34 weeks, this is the interim position.  Prior to August 2018, it cared for babies from 30 weeks;

·         To have short stay paediatric assessment ward for children needing up to 23 hours of care;

·         To have low acuity paediatric in-patient beds overnight; and

·         To have paediatric day case surgery.

Lincoln Hospital

·         To continue with a consultant led obstetric service with the addition of a co-located midwife-led unit;

·         To continue with a neonatal unit caring for babies born from 27 weeks;

·         To have a short stay paediatric assessment ward;

·         To have paediatric in-patient beds;

·         To have paediatric day case and planned surgery;

·         The wish to keep gynaecology services the same as now on both Lincoln and Pilgrim Hospital site with clinicians; and

·         Working as one team across the two sites.

The Committee noted that the second emerging option was to have a consultant obstetric, neonatal and paediatric services at Lincoln Hospital and a midwife-led unit and short stay paediatric assessment ward at Pilgrim Hospital.  It was noted further that in this option the hospitals would have midwifery-led units, at Lincoln, this would be co-located to the consultant unit, and at Pilgrim Hospital the unit would be a stand-alone midwifery-led unit.  The Committee was advised that this was not the NHS's preferred option.

The report highlighted the key activities that were currently taking place across Lincolnshire to support the development and transformation of the services.  These were shown on pages 24 and 25 of the report.

The Committee was advised that there was an understanding that women's maternity care should be personalised to meet their needs, and those of their baby and family. The Committee noted that integral to delivering this ambition across Lincolnshire was the development of community hubs, which enabled women and families to access care closer to home.  It was highlighted that there were now six community hubs operating across the county, with a further two hubs proposed.  A list of services being delivered at the community hubs were shown on page 26 of the report.

The Committee was also advised that there was an ambition that women should have continuity of the person looking after them during their maternity journey, before, during and after the birth.  It was highlighted that the first Continuity of Carer Team had been launched on 30 April 2019 in Gainsborough. 

A further ambition highlighted was to improve mental health services for women, as about half of all cases of perinatal depression and anxiety were currently undetected.  It was noted further that the Lincolnshire Partnership Foundation Trust (LPFT) had been successful in obtaining Wave 2 National Perinatal Mental Health Funding which had enabled Lincolnshire to offer a service for women with high perinatal mental health needs, and that this had been launched in December 2018.

Reference was also made to improving new born care services, as evidence now suggested that separation of mother and baby so soon after birth interrupted the normal bonding process.  The Committee noted that the Better Births Team together with the Neonatal Team at ULHT were looking into this particular work stream.

The Committee noted that as part of the development of different service models for caring for children with complex conditions, a new specialist service was being developed to support disabled children with respiratory conditions, which would help treat their needs.  It was noted further that this service had started in February 2019, and it had helped reduced the number of hospital admissions for children with complex needs by managing them in the community and at home, with help from specialist equipment.

It was highlighted that to date there had been little direct feedback from the Healthy Conversation 2019 in relation to the emerging options for Women and Children's services.

During discussion, the Committee raised the following matters:-

·         The need for more publicity for the Healthy Conversation 2019, as some people were still unaware that engagement events were taking place across the county.  The Committee was advised that a lot of publicity had been undertaken, and that the concerns raised would be considered further.  It was also highlighted that there needed to be on-going connection and engagement with local groups in Boston to ensure that the views of the local community were being taken into consideration with regard to the emerging options and the changes to paediatric services.  Reassurance was given that more would be done to get feedback on the emerging options;

·         Some support was expressed for the need to provide continuity of care, as this was particularly important for first-time mothers.  A request was made for the Committee to be provided with infromation relating to re-admission rates;

·         Some concern was expressed to the fact that the emerging option two was still being considered, due to the amount of travelling time from Boston to Lincoln; and to the fact there was the potential for reduced staffing.  Reassurance was given that there was no suggestion of a reduction in staffing; and that there was still further conversation to take place with regard to this matter;

·         Recruitment – The Committee was advised further that there had been more interest in the recent jobs advertised.  The Committee was advised that at the moment the Trust had not looked into applying a retention premium;

·         Some concern was expressed that services were being lost from the Grantham area.  Reference was made to demise of the midwifery unit; the lack of choice for mothers; and the lack of continuity of care.  Reassurance was given that the proposals would give women choice, continuity of care; and the provision of community hubs.  It was noted that the Sustainability Transformation Partnership was also considering border configuration;

·         Support was expressed for community hubs; and the Committee welcomed the proposal for two further hubs;

·         Transitions – The need to ensure that health care was available to children when they transitioned into adults.  A request was made for a further update regarding this issue;

·         Role of the Health Visitor – Confirmation was given that health visitors would provide care at one of the children's hubs or at home;

·         The need to publicise good news stories more;

·         The need to promote the health service as a career to young people.  Confirmation was given that this was already being done;

·         Support was expressed for the mental health services for women with high perinatal mental health needs;

·         Some concern was expressed regarding the risks associated with implementing the preferred option, particularly with the on-going recruitment issues.  The Committee was advised that recruitment was a national issue and that work was taking place to improve the situation.  The Committee were reminded that the Trust was currently looking at seven candidates for interview; and that this was more of a positive picture than it had been.  One member felt that workforce needed to be looked at as a separate item.  Reassurance was given that risk registers were in place and that these were updated monthly, so that any issues were soon identified;

·         One member enquired whether capital funding would be required to establish a co-located midwife-led maternity unit in Lincoln and Pilgrim.  The Committee was advised that capital funding would be required, and that at the moment the amount required was unknown;

·         Where would the additional hubs be located – The Committee was advised that there would be collaboration with the local authority to identify the most suitable locations for the proposed two new sites;

·         Clarity was sought regarding the lack of information regarding the provision of transport for those who needed to be transported to Lincoln.  The Committee was advised that this issue would be looked at further.  The Committee felt that this matter needed to be included in the Healthy Conversation 2019; and

·         One member requested a list of the dates and locations for the paediatric sessions.  The Committee was advised that a list would be provided.

RESOLVED

1.    That the Women's and Children's Services – Case for Change and Emerging Options be noted.

2.    That the Chairman be authorised to make a written response to the Lincolnshire Sustainability and Transformation Partnership on the case for change and emerging options for Women's and Children's Services.

3.    That the Committee be provided with a list of dates and locations for the paediatric sessions; and information regarding re-admission rates after birth; transitions to adulthood; and additional information regarding the Risk Register.