Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which sets out the case for change for medical services at Grantham Hospital and the proposed options for future services as set out in the Acute Services Review; and feedback from the Healthy Conversation 2019.  Dave Baker, Chair, South West Lincolnshire Clinical Commissioning Group, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust, and Sarah Furley, Programme Director, Lincolnshire  STP 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 medical services at Grantham and District Hospital; and the proposed options for future services, as set out within the Acute Services Review; and the feedback to date from the Healthy Conversation 2019.

The Chairman welcomed to the meeting Sarah Furley, Programme Director Lincolnshire Sustainability and Transformation Partnership, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services, Dr Dave Baker, GP Chair, South West Lincolnshire Clinical Commissioning Group, and Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust.

The GP Chair, South West LincoInshire Clinical Commissioning Group presented the report and highlighted to the Committee that the report presented only considered the medical services at Grantham and District Hospital. 

Page 46 of the report provided information relating to the background of the Acute Service Review.  It was noted that the case for change had been established at a Clinical Summit held in February 2018.  It was noted further that the case for change had arisen as a result of significant workforce challenges being experienced by United Lincolnshire Hospitals NHS Trust (ULHT), which had impacted the Trust's ability to deliver safe, quality services.  It was highlighted that a conclusion had been reached that ULHT was operationally unsustainable in its current form and that a current review of healthcare provision for the Lincolnshire population going forward was required.  It was highlighted further that in Grantham there were two primary concerns; the first was the future for the A & E department; and the second, the stability of acute medical services.

Details of the case for change were shown on page 46 of the report.  It was reported that at present there were six substantively employed acute care physicians; and that the remaining ten posts were filled by locum consultants.  The Committee noted that the service was heavily reliant on locum medical staff.

Paragraph 1.3 of the report provided details of the number of non-planned admissions to the three hospital sites for the first four months of 2019; and a chart on page 47 provided the Committee with activity for the Grantham and District Hospital 'front door' for the period from 1 April 2018 to 31 March 2019.

Details of the two emerging options for Medical Services at Grantham Hospital were shown on page 48 of the report. 

It was highlighted that the aim was to have integrated care delivered by the community services, hospital services alongside the recent development of Primary Care Networks.  The Vision for 2021 was shown on page 49 of the report.

The Committee was advised that the response to Healthy Conversation 2019 had been significant; and that a review of the feedback provided by stakeholders had been undertaken which was informing the further refinement of the preferred NHS option for the future of not only Medical Services but also A & E services at Grantham.  It was highlighted that the resounding feedback with regards to a preferred emerging option for Medical Beds was Option 1, to retain medical beds, but under a new community-focussed model.  The table on page 50 provided a summary of the key themes received and the responses published on the Healthy Conversation website.

During discussion, the Committee raised the following issues:-

·         Some concern was expressed relating to how much money the proposed option would cost.  The Committee was advised that the preferred option had been developed by local senior clinicians; and it would involve a change of mind set and a different way of working by all staff.  It was highlighted that the new model would be led by Community Health Services with hospital doctors and hospital services being part of an integrated service with GP services, community health and other local services.  It was highlighted further that the preferred model was a patient focussed service, which would meet the needs of the patient, and would also provide a holistic approach to the care of a patient.  The Committee was advised that the preferred model presented an exciting opportunity for Grantham and District Hospital.  One member felt that it would be useful for the Committee to receive a paper on how the community model of care would work.  One member enquired whether the preferred model at Grantham was a model that might be replicated elsewhere.  Confirmation was given that Grantham was unique, and that all was being done to ensure that Grantham Hospital had a viable future being more community focussed.  It was noted that the model, once trialled might be transferrable to other settings;

·         Preferred Service Model –The Committee was advised that the bed cover was 24/7; and that services would be provided seven days a week; as they were already being provided.  The Committee noted that it was the intention for staff to be working across urgent care and to be more integrated.  Confirmation was given that resuscitation would be offered at Grantham;

·         Staffing.  The Committee was advised that staffing still remained a local; and a national problem, but the development of a multi-skilled workforce would help the situation;

·         Confirmation was sort as to the content of Appendix A – Grantham and District Hospital - Exclusion Protocol – Emergency Care Centre A & E.  The Committee was advised that the document as detailed at Appendix  A outlined what currently happened at Grantham; and that this version of the protocol had been in place for three to four years;

·         Role of Neighbourhood Teams – Confirmation was given that Neighbourhood Teams would be an extension of the hospital and part of the overall system with the integrated working arrangements;

·         Step up/Step down – Confirmation was given that this would still happen; and that the provision would be more integrated to provide continuity of care to the patient;

·         Page 50 – One member asked for further information relating to the following statement "Options for improved support for children and young people being considered".  The Committee advised that this primarily related to the Urgent Care Centre; and that it was hoped that there would be greater scope for poorly children to be seen at Grantham; and

·         Reference was made to paragraph 1.3 which listed current urgent care activity at Grantham over a four month period, which clearly showed lower activity at Grantham Hospital than Pilgrim Hospital Boston and Lincoln County Hospital.  The Committee noted that the public were aware of the opening hours of the department; and that medical admissions were still taken 24/7.  The Committee was advised that information providing details of activity for the twelve months prior to the overnight closure of the Grantham A & E would be made available to the Committee.

The Chairman extended thanks on behalf of the Committee to the representatives in attendance.

RESOLVED

That the Chairman be authorised to provide feedback on behalf of the Committee as part of the Healthy Conversation 2019 engagement exercise on the emerging options for medical beds at Grantham and District Hospital.