Agenda item

(To receive a report from Simon Evans, Health Scrutiny Officer, which advises the Committee on the plans for the 'restoration' phase for NHS Services.  Senior Management representatives from the NHS Organisations in Lincolnshire will be  attending the meeting)

The Chairman highlighted to the Committee that information pertaining to this item was shown on pages 23 to 144 of the agenda pack.  The Chairman advised also that the Committee should note the correction to page 141 of the agenda pack, which had been covered in the supplementary chairman's announcements considered earlier on the agenda.

The Chairman advised the Committee that there were four contributors present for this item who were:  John Turner, Chief Executive, Lincolnshire CCG, Andrew Morgan, Chief Executive, United Lincolnshire Hospitals NHS Trust, Maz Fosh, Chief Executive, Lincolnshire Community Health Services NHS Trust and Tracy Pilcher, Director of Nursing, Lincolnshire Community Health Services NHS Trust.

Attached to the report presented were the following Appendices:

·         Appendix A – Report to the Lincolnshire Clinical Commissioning Board (27 May 2020) – NHS response to the Management of Covid-19 Pandemic; and included:

Appendix 1 - Daily Update Covid-19 – (as at 20/05)

Appendix 2 - Letter of 29 April from Simon Stevens and Amanda Pritchard 'Second Phase on NHS Response to Covid-19'

Appendix 3 – Slides – Second Phase Lincolnshire Response

·         Appendix B – Report to United Lincolnshire Hospitals NHS Trust Board (2 June 2020) – ULHT Covid-19 Restore Phase Plan- Executive Summary

·         Appendix C – Report to United Lincolnshire Hospitals NHS Trust Board (12 June 2020) – temporary Service Changes as a response to Covid-19, including:

Appendix 1 IPC Assurance Framework

Appendix 2 Green Site Clinical Model

Appendix 3 Quality Impact Assessment

Appendix 4 Equality Impact Assessment

The Committee noted that a copy of the letter of instruction for action for the second phase of the NHS response to Covid-19, as discussed in the previous item was detailed at Appendix 2 on pages 31 to 39 of the report pack. The Committee was advised further that the letter had instructed all NHS local systems and organisations working with regional colleagues to step up on all non-Covid-19 urgent services as soon as possible.  Annex A provided a list the services included: urgent & routine surgery & care; cancer; cardiovascular disease; maternity; primary care; community services; mental health & learning disabilities services; and screening and immunisations. 

Appendix 3 to the report provided the Committee with details of the Systems Covid-19 Phase 2 Response.  Appendix C provided the Committee with details of the Trusts temporary services changes, in response to Covid-19.

The Chief Executive of Lincolnshire Clinical Commissioning Group highlighted that the changes which United Lincolnshire Hospitals NHS Trust (ULHT) had announced in relation to service changes at Grantham Hospital were for a temporary period.  Confirmation was given that the ULHT only had authority to make such changes in an emergency, and only for a temporary basis.  The Committee was advised that only a CCG could make amendments to service reconfiguration; and only then after a period of public consultation.

The Committee was advised that the CCG supported the position ULHT had taken in respect of Grantham Hospital and that the CCG highlighted they had significant concerns regarding the treatment of cancer patients in Lincolnshire, as patients not receiving operations and other treatments in a timely way.  There was recognition of the concerns raised in relation to 'temporary', and reassurance was given that the proposed service changes were for a temporary period to ensure that hundreds of Lincolnshire's patients received the care they needed and that these changes were the best arrangements for the residents of Lincolnshire in the current situation.

During discussion, the following points were raised:

·         Clarification was sought that as the proposed changes to Grantham Hospital were planned until the end of March 2021, whether these changes could be classed as temporary; and assurance was sort that any permanent changes proposed would go out to full public consultation.  The Committee was reassured that the proposed changes to services at Grantham Hospital were temporary. There was recognition of the frustration of Grantham residents; and that Healthy Conversation had captured those frustrations.  However, due to the current Covid-19 situation, changes had been necessary to enable the NHS to get back to dealing with non-Covid-19 patients in a safe environment.  The Committee was reassured that any significant change to service provision, would be by the authority of the CCG, and that this would be subject to mandatory public consultation;

·         In response to a request for an executive summary, with other documents cited as background papers, the Committee was advised that on this particular occasion it had been felt that the Committee needed to consider all the documentation in their deliberations;

·         An explanation was sought concerning when Grantham Hospital would be returning back to its normal status. It was highlighted that at the moment it was not known what would happen over the next six to nine months with Covid-19, but what was apparent was there was need to provide treatment and care for cancer patients.  As there were lots of variables, the CCG, ULHT, LCHS and LPFT would be working together to regularly review the situation; and that information concerning restoration would be shared with the Committee as things progressed.  The Committee was advised that following an options appraisal, Grantham Hospital had been identified as being the best place to provide non-Covid services (Green Site).  The Committee noted that patients attending a green site would be asked to self-isolate for 14 days prior to their planned admission date; and they would then be invited to have a test for Covid-19 a couple of days before their appointment.  Reassurance was given that the Urgent Treatment Centre part of the Grantham site would be run separately with different staff and diagnostics.  Reassurance was provided that the measures put in place would be temporary; and that this had been the decision of the Board.  It was highlighted that work would be starting on how the temporary arrangements would be reversed, but at the moment the NHS was waiting to see if there would be a second wave of Covid-19, if this was the case, then capacity would have to be switched to meet that demand.  It was highlighted there was an awareness of the lack of trust from the residents of Grantham, but at the moment due to the unprecedented circumstances, the Trust had to balance the needs of the whole of Lincolnshire against the wishes of the people of Grantham;  

·         Staff Morale – The Committee noted that a staff survey in October 2019 had highlighted there had been an overall improvement in staff morale.  When the proposed changes had been announced, as with any organisation there had been some staff who felt things should not be changed, but there had also been some staff who had been in favour of the changes and had been flexible in their approach to work and this was to be commended.  It was noted that staff had been advised that there would be no job losses; and that they would not be financially impacted;

·         Transportation issues for patients accessing services at Grantham Hospital from other parts of Lincolnshire.  There was an appreciation that additional transport arrangements would have to be put into place;

·         Clarification was sought as to whether ambulatory care would be conducted from the blue part of the Grantham Site.  The Committee was advised that it would be part of the blue site and would be kept separate from the green part of the site, just like the Urgent Treatment Centre.  The Committee also noted that the rehabilitation unit was due to come in to being during September/October for patients with green status.  Confirmation was given that the green site would enable progress to be made in relation to Cancer surgery;

·         Reasons for the higher number of Covid-19 cases in Boston; and whether the reason for this might be due to a large number of houses in multiple occupations in deprived areas; and the number of care homes. The Committee was advised that from the data received as detailed on pages 26 to 27 of the report pack, indications could be that the high number had been as a result of urbanisation and deprivation; but this would have to be investigated further when more data was available.  In relation to care homes, the Committee was advised that the key correlation between Covid-19 and mortality was age; and that it had been expected to see clusters of mortality in the older age group.  The Committee noted that the mortality rates in Lincolnshire care homes were one of the lowest in the country at 10 per 1,000 of the population; and that colleagues in public health would be looking at what happened in Lincolnshire and how that information could help other areas;

·         Change to service provision in Alford.  It was agreed that this would be looked at outside of the meeting; and 

·         When consultation on the Acute Services Review would commence.  The Committee was advised that due to the current pandemic situation, no date could be given at this current time.  However, it was noted the CCG was in contact with NHS England/NHS Improvment regarding authorisation for public consultation; and that the CCG was committed to progressing this matter.

The Chairman extended thanks on behalf of the Committee to the four presenters.

RESOLVED

That the Health Scrutiny Committee for Lincolnshire unanimously agreed to:

1.     Welcome the return of 24/7 access to care at Grantham, along with the elective and planned treatment, but that we also put on record the Committee's concerns that the restoration plan will have a significant impact on patients throughout Lincolnshire in terms of travel from their local to other sites, and the downgrading of Grantham A&E.

2.    Seek regular updates on the progress of the restoration plan for ULHT, including the impacts on patients travelling to different sites.

3.    Record the Committee's view that full public consultation on the Lincolnshire Acute Services Review options should take place as soon as possible and to write to the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, expressing the Committee's concerns, which have been raised today, as an indication of the Committee's position for any action in the future.