Agenda item

(To receive a report from the Sustainability and Transformation Partnership (STP), which enables the Committee to consider the final report on the Healthy Conversation 2019 engagement exercise and the next steps for the local NHS. Senior representatives from the STP and Lincolnshire Clinical Commissioning Group will be in attendance for this item)

The Vice-Chairman welcomed John Turner, Chief Executive, Lincolnshire Clinical Commissioning Group to the meeting and invited him to present the report to the Committee.

The item as detailed on pages 71-178 of the agenda report pack enabled the Committee to consider the final report on the Healthy Conversation 2019 engagement exercise; and to receive a progress update on the next steps to be taken by local NHS in developing plans for public consultation relating to elements of the Lincolnshire Acute Services Review.

It was reported that the Healthy Conversation 2019 engagement had identified some key messages from the people of Lincolnshire.  A copy of the final report was attached at Appendix B, together with five further supporting appendices:

·         B1 - Purpose and Activities;

·         B2 - Engagement Feedback;

·         B3 - Workshop Frequently Asked Questions;

·         B4 - Acute Services Review Survey Report;

·         B5 - The People’s Partnership Acute Services Review - Engagement with; and

·         Hidden and Hard to Reach Communities (Executive Summary).

A summary of the Committee's response relating to engagement was detailed on pages 73 and 74 of the report pack.

Also, detailed at Appendix A to report was a copy of the Health Scrutiny Committee for Lincolnshire – Responses to Specific Topics in the Healthy Conversation 2019 Engagement Exercise (pages 76 to 86 of the report pack).

The Committee was reminded that the Healthy Conversation 2019 engagement exercise had been launched in March 2019 and had concluded on 31 October 2019.  Healthy Conversation 2019 had enabled the NHS in Lincolnshire to have open engagement with residents of Lincolnshire to help shape how health care was taken forward in Lincolnshire.  The overarching campaign messages had been that the NHS needed to continue to change, improve quality and attract staff in order to be fit for purpose and for the future; and to review the way residents use its services.  

The Committee noted that all feedback received from the Healthy Conversation 2019 engagement exercise had helped shape the Long Term Plan (LTP) for the NHS in Lincolnshire.

Recognition was expressed that the whole process had taken a long time, but there had been external factors that had impacted on the process, not least the Covid-19 pandemic.  Confirmation was given that joint working was continuing with partners and the care home sector in light of Covid-19, and that it was hoped to refresh the Lincolnshire LTP over the next six months; and that it was hoped to publish the LTP in the spring of 2021.

The Committee was advised that consultation on the following four elements of the acute services review would take place first as they did not require significant capital funding:

·         Medical Services / Acute Medicine (Grantham and District Hospital);

·         Stroke Services;

·         Trauma and Orthopaedic Services (Centre of excellence); and

·         Urgent and Emergency Care Services.

The Committee noted that the remaining elements of the acute services review requiring significant capital funding, consultation would take place when funding was available:

·         Breast Services;

·         General Surgery Services;

·         Haematology and Oncology Services; and

·         Women’s and Children’s Services.

Reassurance was also given to the Committee that the temporary changes currently in operation at Grantham Hospital were temporary, and that any re-configuration of services at Grantham Hospital would be subject to a consultation exercise, which the CCG would be responsible for.

The Committee was advised that the CCG was progressing with the Pre-Consultation Business Case with NHS England/Improvement (NHSE/I).  The Committee was advised further that no further progress could be made until a determination had been made by NHSE/I; and as such, no definitive timescale could be given for when the process would move into public consultation stage.

During discussion, the Committee raised the following points:

·         Whether residents' views had been taken into consideration.  Reassurance was given that the views of residents had been collated from the exercise and were reflected in the report;

·         The Healthy Conversation 2019 engagement exercise, whether it actually reflected the views of the residents of Lincolnshire, as the response only reflected the views of a minority of residents.  The Committee noted that the exercise had been conducted for a six month period, and that it had been published as a countywide exercise.  Reassurance was given that the team had worked hard to capture the view of residents, including Grantham residents.  It highlighted that the CCG was unable to consult publicly until it had received confirmation from NHSE/I that they were able to do so.  Acknowledgement was given to the frustration of Grantham residents.  Some members stressed that Grantham Hospital needed to be returned to being an A & E.  A question raised was whether there were plans to build a new hospital for Grantham on another site.  The Committee noted that this was not part of the NHS plan at the moment, nor was it the NHS policy plan.  It was highlighted that there were no proposals to move services from the current site; 

·         Some support was extended for the report; and to the extensive engagement that had taken place;

·         Some concern was expressed relating to the development of secondary care. The Committee was advised that capital funding was short in the NHS; and that was why a decision had been made to progress with four elements of the acute services review, as they did not require significant capital funding; 

·         The need to re-engage residents in the process.  One member suggested that a mailshot should be delivered to all resident in Lincolnshire for the public consultation exercise.  The Committee was advised that the need to update the public was valid and be timed and linked into the launch of the public consultation.  On a more general note, the Committee noted that a public announcement campaign encouraging residents to take care of themselves; who they should contact should they require a GP, or have an urgent care concern.  Reference was made to the  'Talk Before You Walk' initiative; and the need for encouraging residents to have the flu vaccination;

·         Digital appointments – It was reported that GPs in Lincolnshire were being encouraged to work digitally where they can and that this was being supported by NHSE/I.  One member advised that there needed to be a balance between face to face and digital appointments. Also, it was highlighted that some patients were having difficulty accessing a GP by the new processes. One member highlighted a particular issue with contacting a GP surgery and it was agreed that this would be looked at outside of the meeting. The Chief Executive of Lincolnshire CCG welcomed the feedback and agreed to look into the matter further;  

·         Some concern was expressed as to what plan was currently being worked on.  It was reported that the LTP had been updated in the autumn of 2019 from feedback from the Healthy Conversation 2019, and advice and support from partners.  It was highlighted that a lot of the content was relevant, but some areas needed refreshing and this was currently in the process of being done with health care partners; 

·         The need to encourage people to be more responsible for themselves and their health, which would then ultimately help to save NHS time.  Particular reference was made to smoking, drinking and healthy eating.  The Committee noted that GPs in their role continually strived to encourage individuals to look after themselves.  The Committee noted that there were various public health initiatives in place to tackle the issues raised; and that the Lincolnshire Health and Wellbeing Board were also involved in promoting health and wellbeing in Lincolnshire.  Particular reference was made for the need for more to be done to reduce obesity in Lincolnshire;  

·         Services available for those with mental health issues.  The Committee noted that a lot work had been done by Lincolnshire Partnership Foundation Trust (LPFT) regarding mental health issues in Lincolnshire.  The Committee was advised that a mental health liaison service operated alongside A & E Departments; and that crisis mental health teams were available to people across the county.  It was suggested that further information could be obtained from LPFT regarding this matter; 

·         Role of Primary Care Networks and Neighbourhood Teams.  It was noted that there were lots of services and different ways of working in place within a Primary Care Network.  The Networks provided structure and funding for services to be developed locally in response to the needs of the patients they serve.  The Networks also worked very closely with Neighbourhood Teams on a local integrated level;  

·         Concern was expressed on the delays attributed with the public consultation, which was having a negative impact with members of the public, leaving them frustrated and confused; and

·         One member enquired as to why it had been difficult to recruit staff to work at Pilgrim Hospital, Boston.  The Committee was advised that the assessment of the hospital and evidence submitted was that the hospital did not provide as much training as some others.  It was noted that ULHT were looking to address this matter. It was highlighted that there was a shortage of NHS staff nationally, as well as in Lincolnshire.  It was suggested that having exit interviews might highlight the positives and negatives of working for the NHS, and that it was an issue that needed to be solved for Pilgrim Hospital, Boston.

In conclusion, the Committee agreed that the item should be considered by the Committee again in three months' time.

RESOLVED

1.    That the Committee's concerns over reach and methods of the Healthy Conversation 2019 engagement exercise be reiterated.

2.    That an update report be received on Healthy Conversation 2019 and Next Steps at the 16 December 2020 meeting; and then quarterly thereafter.