Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on the Grantham 'green site'. Andrew Morgan, Chief Executive of ULHT and Simon Evans, Chief Operating Officer, ULHT will be in attendance for this item)  

The Chairman invited Andrew Morgan, Chief Executive, ULHT and Simon Evans, Chief Operating Officer, ULHT to present the report, which provided an update from the Trust on the Grantham 'green site' arrangements.

Attached at Appendix A was a copy of a report presented to United Lincolnshire Hospitals NHS Trust Board of Directors (2 February 2021) – Second Quarterly Review following Temporary Conversion of Grantham Hospital to a Covid-19 Green Site Model for the Committee to consider.

Note: Councillor R J Kendrick left the meeting at 12.03pm.

The Committee had considered a report from United Lincolnshire Hospitals NHS Trust on 14 October 2020 on its first quarterly review of the 'green site' arrangements at Grantham Hospital.

In guiding the Committee through the significant quarterly report the Chief Operating Officer made reference to: that the primary aims of the Grantham 'green site' model had been maintained, which were: Infection prevention control (IPC) excellence, capacity to deliver at scale; and future service resilience.  It was noted that at the quarterly review all three aims had been achieved.  From the thousands of patients treated at the site, no patient receiving elective surgery had contracted Covid-19 whilst in Grantham Hospital.  It was noted further although the site had not been entirely absent of Covid-19, investigations had supported that no patient had contracted Covid-19 as an inpatient through failure of IPC excellence, which was credit to all the staff involved.  

It was highlighted that the review report reviewed whether circumstances were different or whether the overriding criteria needed changing.  The Committee was advised that the ULHT Board had determined that there were not sufficient grounds for changing the current temporary arrangements; and that the action was reinforced by the national Covid-19 alert level 5; and the need to continue to protect the most vulnerable patients.  It was noted that the Board did not approve what would be happening on the temporary arrangements for the Grantham 'green site' after 31 March 2021.

During discussion, the Committee raised the following comments:

·       The number of outpatients using the Gonerby Road site and the suggestion that these would only be available for a further three months after the 1 April 2021.  Clarification was also sought as to whether the two additional theatres were permanent or temporary.  The Committee was advised that at the moment there were no plans to close the Gonerby Road site or the two additional theatres or to keep them, and a further assessment of the risk factors would need to be completed before a decision was made;

·       Extended waiting times at the Urgent Treatment Centre and that the referral of 1,024 patients to A & E warranted the return of an A & E back in Grantham.  The Committee were reminded that the measures currently in place were temporary and specific to Covid-19, and that when those arrangements ceased, the arrangements would be returned to the model that was in place previously.  The Committee noted that a proportion of patients seen at Grantham had always been transferred to either Lincoln or Boston, due their specialisms.  The Committee noted that across the Trust between 7am and 7pm, more patients had been seen and assessed within 15 minutes; and that substantial improvements had been made to the number of patients being seen within 60 minutes.  It was noted further that when patients required admission, delays were occurring;

·       One member enquired how likely was the Trust to revert back to the pre Covid-19 model in April, and whether the proposed extension of three months would be extended further, and whether by then as the arrangements would have been in place for a full twelve months whether this arrangement could then still be classed as temporary? The Committee noted that the second report had put suggestions to the Board which had not yet been agreed, and that the proposal to extend for an extra three months was to provide a greater level of capacity and access to services.  Clarification was given that there was a presumption that the Board at an extraordinary meeting on 16 March 2021 would revert the temporary arrangement back to the June 2020 position; and that planning was already underway to ensure that this could be implemented on the 1 April 2021;

·       Clarification regarding wording in the first report relating to the 'green site' model (page 79) October 2021.  Reassurance was give that this date should read October 2020;

·       The success of outpatient services for the residents of Grantham;

·       The success of the 'green site' for cancer patients across Lincolnshire;

·       The need for better terminology and clarification in relation to A & E and Emergency Departments (ED);

·       Lower response rate relating to the Grantham Health Centre.  The Committee was advised that the lower response rating could be as a result of the health centre not having a full range of services unlike the Kingfisher Unit; as there were shared facilities with other services, and it tended to become overcrowded;

·       Data contained on pages 67 to 70 of the report pack relating to the Urgent Treatment Centre figures for 2019, a suggestion was made for some clarity to be provided as to what was being compared.  The Committee was advised that the figures compared the pre Covid-19 model (A & E with reduced hours) with the post Covid-19 model;

·       The use of terminology, particular reference was made to ED and A & E, and the need to ensure that some clarity was provided for members of the public.  Reassurance was given that future reports would provide a glossary to help explain the difference between the two models;

·       The number of patients who when visiting the Lincoln and Boston hospital green site had contracted Covid-19.  Clarification was given that one patient at Grantham during recovery had contracted Covid-19 as a result of transit from one site to the other.  The Committee noted that no patient on the surgical pathway had contracted Covid-19 at the Grantham 'green site';

·       Clarity regarding Covid-19 positive and non Covid-19 wards.  The Committee noted that for twelve months the Trust had Covid-19 positive wards, wards where Covid-19 was suspected; wards where patients had come into contact with someone Covid-19; and then non Covid-19 wards;

·       The NHS definition of word 'temporary'.  The Committee was reassured that the NHS definition was as said temporary.  The Committee noted that there was recognition that the Acute Services Review had taken too long and as a result had put the whole process in disrepute, and that arrangements would revert back to those that had been in place in June 2020;

·       Cost of the 'green site' provision – The Committee was reminded that the 'green site', had significantly reduced harm to thousands of patients and had saved lives.  The Committee was advised that the cost of changes at multiple sites in response to Covid-19 was £1.6m;

·       24 hour ward access.  The Committee noted that the new model had restricted the access of visitors to wards.  It was reported that the out of hours provision at the hospital was provided by the Lincolnshire Community Health Services with enhanced primary care interventions; and that this would be maintained as services were restored as part of the front of house A & E.  A request was made for the 24/7 availability to be publicised better to the public and to ambulance services, so that they had the option to take patients to Grantham;

·       How much elective surgery had been cancelled at Grantham and whether these cancellations were likely to reduce in the coming weeks?  It was noted that elective surgery had reduced to 60%, with 40% being cancelled, to enable more support to be given to Intensive Care Units (ICUs); and that this surgery was now being carried out and that this figure would soon be back to 100% as and when the number of ICU in-patients reduced;

·       How many staff had been redeployed from the 'green site' to Pilgrim Hospital, Boston and Lincoln County Hospital, due to the increased Covid-19 pressures; and what area of care have these staff been transferred from?  It was noted that at times the number of staff redeployed had been low, but in recent weeks, the number redeployed would match those mentioned above relating to elective surgery;

·       Under the current plan, would the x-ray and fracture clinic be brought back within the site?  It was reported that plans being pursued as per recommendation 4 of the report was to put all services back in the ED, which would provide a greater offer of services within that suite; and

·       How many staff were currently off sick from Grantham hospital and how was staff morale?  The Committee was advised that morale was mixed; and that the re-deployment of staff to ICUs had put extra pressure on staff, which had affected their morale.  The Committee was advised that staff were being supported through this difficult time.  The Committee noted that currently 56 staff at Grantham were off sick and that of the 56, 12 members of staff were off as a result of Covid-19 related issues.

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

RESOLVED

1.    That the information presented by United Lincolnshire Hospitals NHS Trust on the second quarterly review of the 'green site' at Grantham Hospital be noted.

2.    That a further update be received from the United Lincolnshire Hospitals NHS Trust on this topic be received at the June 2021 meeting.