Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with the first quarterly review of the Grantham 'green site'.  Senior representatives from ULHT will be in attendance for this item)

The Committee was advised that item 5 could be found on pages 21 to 81 of the agenda pack. 

The Chairman advised the Committee that on 6 October 2020, the Board of United Lincolnshire Hospitals NHS Trust (ULHT) had approved the recommendations as shown on pages 57 and 58 of the agenda pack.

The Chairman invited Mark Brassington, Director of Improvement and Integration and Deputy Chief Executive, ULHT and Simon Evans, Chief Operating Officer, ULHT to present the report, which provided the Committee with first quarterly review following the temporary conversion of Grantham Hospital to a Covid-19 'green site'.

Detailed at Appendix A to the report was a copy of the report which had been considered and approved by ULHT Board of Directors on 6 October 2020.

The Committee was advised that the overarching objective of the proposal was to address the requirements for urgent care in response to Covid-19; and to address the need to re-establish and maintain access to elective care for the benefit of all patients across Lincolnshire.

It was highlighted that the establishment of the 'green site' was one element of the Trust's overall Covid-19 Strategy and recovery plan.  Having the 'green site' had enabled planned surgery to resume to a level which maintained the current waiting list; restore public confidence and reduce the risks to patient's post-operative; and for cancer patients to receive their treatment in a Covid-19 free environment.  Details of the strategic aims and priorities of the 'green site' model were shown on pages 25 and 26 of the report.

The Committee noted that the operating model had minimised hospital transmission of Covid-19, by protecting patients and staff; it had reduced the risks associated with delays in treatment; and had provided extra resilience to the services provided.

It was highlighted that the establishment of two surgical wards at Grantham with fully functioning theatres had helped restore elective surgery for a range of specialities at Grantham. It was noted that theatre capacity would be increasing.

It was highlighted further that the 'green site' had been successful in providing service provision for cancer surgery and for providing chemotherapy treatment for patients across Lincolnshire, with the exception of cases where a patient required acute inpatient care with oncology teams.

The Committee was advised that in addition to the outpatient activity run at Grantham hospital itself, extra capacity had been introduced at the Health Centre and Gonerby Road Health Clinics, which had increased the number of services being offered locally in Grantham.

It was also noted that attendance at the Grantham Urgent Treatment Centre (UTC) was continuing to increase since it had opened.  It was noted further there was now an 8% increase in the number of patients attending the UTC, which indicated that the UTC services had been well received by local residents.

It was noted that to understand the impact of the temporary service change, an initial patient survey (110 responses received) had indicated that patients had confidence in attending the site, and in the service they were receiving.

In conclusion, the Committee was advised that the Trust Board had approved the continuation of the temporary service changes for the duration of Covid-19 to at least 31 March 2021.  It was noted that this timescale would be subject to a system wide review of the full next quarter's activity, which would be available in early January 2021 for the Trust Board's consideration in February 2021.    

During discussion, the following points were raised:

·         Thanks were extended to the ULHT for the quarterly progress report, and to the progress made for the treatment of cancer patients;

·         It was highlighted that the increased activity to the Grantham UTC was because people were unable to get an appointment at their GP surgery.  The Committee was advised that at the present time there was not a definitive answer as to why there had been an increase.  It was noted that there had been an increase in attendance at other UTCs as well; and that this issue was being examined with the Lincolnshire Clinical Commissioning Group to see why this was so;

·         A question was asked why the ophthalmology service at Grantham Hospital was not available, and as a result local residents had to travel to Boston for treatment.  The Committee was advised that a decision had been taken not to operate the service as its use would pose a risk; as the unit was often used by elderly patients, who often required frequent visits; and that this was not compatible for the integrity of the 'green site'.  It was noted that provision had been extended at Louth and Gonerby Road Health Clinics to increase service capacity;

·         Confirmation was sought whether the extra theatres would be mobile.  The Committee was advised that the extra two theatres were mobile.

·         Clarification was also sought as to what level ULHT were currently operating on.  The Committee noted that the ULHT were operating on national response level three.  Some reference was also made to the winter pressure and increasing number of Covid-19 cases. Confirmation was given that winter pressures presented a challenge to the phase three plan, along with managing Covid-19.  Confirmation was given that there was not a separate winter plan.  Reassurance was given that NHSE/I had indicated that the ULHT plans were robust enough to take into account the challenges posed;

·         Testing staff for Covid-19 – Confirmation was given that there would be more regular testing for staff; 

·         A question was asked whether Grantham would remain permanently as a 'green site'.  Whether it was possible to create a 'green site' at either Pilgrim Hospital Boston or the Lincoln County sites in the event of further pandemic challenges.  Confirmation was given that Grantham was not a permanent 'green site'.  The Committee were reminded that this had been a temporary change in place up to 31 March 2021, which would be reviewed quarterly. Depending on what happened with regard to the pandemic, this period maybe required to be extended.  The Committee noted that the configuration at Pilgrim Hospital, Boston or Lincoln County Hospital did not provide for a self-contained zone. Reassurance was given that further pandemic challenges had been evaluated, and if required in the future would be given further consideration;

·         Whether surgery activity levels were likely to increase over the coming months; and whether any increase would impact the timescale for reverting back to normal activities on 31 March 2021.  The Committee was advised that it was expected that surgery levels would increase and that having two additional semi-mobile theatres would increase flexibility, and increase the number of cases on offer at Grantham Hospital.  It was highlighted that some cases were more complex and would need more resource and time.  Also, the level of personal protection equipment (PPE) needed to be worn was also taking more time per day, which increased the downtime for theatres. The Committee was advised that the situation to revert back would be reviewed at that time;

·         Reference was made to page 43 of the report which stated that it had not been possible to quantify the proportion of patients being displaced to other trusts. What measures were being taken to include these and in turn give clearer picture of the situation? Some concern was expressed to the number of patients that had been displaced to Pilgrim Hospital, Boston and Lincoln County.  The Committee was advised that the Trust was in contact with other bordering Trusts on a weekly basis to ensure that any displaced patients were not significant; and if another trust was to become overwhelmed, the temporary model would be reconsidered.  It was highlighted that there was not a significant number of patients going to other trusts. The Committee noted that this data would be included in future reports; and

·         Page 51 and 52 of the report listed the additional expenditure to offer services closer to home due to the current arrangements at the hospital.  In response to a question on funding, the Committee was advised that funding had been secured from a national funding allocation in response to Covid-19.  Confirmation was given that the temporary arrangements would not have any effect when it was time for services to be reinstated.

The Chairman on behalf of the Committee extended thanks to the presenters for their update.

RESOLVED

1.    That the Trust and its staff be commended on the increased number of oncology, haematology, urology and maxilla-facial patients being treated at Grantham Hospital 'green site'.

2.    That the Committee put on record its view that the reviews of the Grantham Hospital 'green site' by the Trust should be more frequent than quarterly, given that the green site is operating 29% below predicted capacity; and also the expected in Covid-19 cases in the coming months.

3.    That future reports to the Committee include information on the displacement of patients to other trusts.