Agenda item

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the details provided on the Lincolnshire Acute Services Review of Urgent and Emergency Care; and to highlight any areas which the Committee’s working group might wish to explore in further detail.  Dr Dave Baker, South West Lincolnshire Locality Clinical Lead, Lincolnshire Commissioning Group and Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust will be in attendance for this item)

The Committee considered a report, which provided details on the Lincolnshire Acute Services Review of Urgent Emergency Care.

The Chairman invited Dr Dave Baker, South West Lincolnshire Locality Clinical Lead, Lincolnshire Clinical Commissioning Group, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust and Charley Blyth, Director of Communications and Engagement, Lincolnshire Clinical Commissioning Group, to remotely present the item to the Committee.

Appendix A to the report provided an extract of the Lincolnshire NHS Public Consultation Document relating to four of Lincolnshire’s NHS Services – Urgent and Emergency Care at Grantham and District Hospital; and Appendix B provided a copy of the Pre-Consultation Business Case for the Lincolnshire Acute Services Review for the Committee’s consideration.

The Committee were reminded of the background relating to Grantham and District Hospital since 2007/08.  It was highlighted that the A & E had only dealt with a limited range of emergency conditions, due its small size and its limited availability of specialist staff and limited range of 24/7 support services to support very ill patients after they left the A & E department.

It was reported that most patients treated at Grantham and District Hospital A & E department could be safely treated at an Urgent Treatment Centre (UTC).

The Committee was advised that if a patients presented themselves at Grantham and District Hospital A & E department with conditions that the hospital was not able to deal with, the skills and experience were there to manage the patient whilst a transfer was quickly arranged to a more specialist unit for the appropriate treatment.

Summary details relating to the current provision at United Lincolnshire NHS Hospital Trust’s A & E departments were shown on page 64 of the report. It was noted that in addition to the three A & E departments, six UTCs were provided by Lincolnshire Community Health Services NHS Trust (LCHS).

The Committee was advised that the proposal was to establish a 24/7 Walk in Urgent Treatment Centre at Grantham and District Hospital, in place of the current A & E.  It was highlighted that the multi-disciplinary workforce would have the ability to manage all presentations, and that it was anticipated that the change would affect around 3% of patients currently attending Grantham and District Hospital.  This was equivalent to two patients a day on average being transferred for immediate specialist care.

Page 67 of the report pack provided a summary of the level of stakeholder and public support for the change proposal.

During consideration of this item. The Committee raised the following comments:

·       Some concern was expressed regarding challenges being experienced by LCHS in providing staffing cover at other UTCs.  Reassurance was given that services had not been impacted and that LCHS had to be constructive with its staffing to maintain services.  It was noted that this was a temporary issue, and was one that was being felt across all health services, mainly due to Covid-19;

·       One member expressed concern that the report did not express the views of the people of Grantham.  Reassurance was given that the views of the people of Grantham were being listened to, an example given was the change to the proposal, which had been set out in the Healthy Conversation engagement exercise, to make the service a 24/7 walk in service, rather than an 8am to 80m service. It was highlighted that every comment would be captured and analysed during the consultation process.  The Committee was advised that Grantham had a very limited provision of specialist services to provide support for A & E.  For example Grantham had none of the following services: paediatrics; gynaecology; obstetrics; acute surgery; acute orthopaedics; ear, nose and throat; stroke medicine; and acute interventionalist cardiology.  Thus, it was not possible to provide A & E Services at Grantham and District Hospital;

·       The success of UTCs in other areas of the County and the role they played in taking the pressures of A & E’s; and the realisation that there were not the resources available within the County to enable the continuation of A & E Services at Grantham and District Hospital;

·       Some concern was expressed regarding transport costs when a patient was transferred from Grantham to another hospital for specialist treatment; but not admitted and then had to return to Grantham.  One member felt that the Council had a role to play in this regard, as an enabler of public transport;

·       Concern was expressed to the waiting times encountered before patients were seen in A & E, some even having to wait in ambulances outside of the hospital.  The Committee was advised that the four-hour target was still in place, and that all A & E’s and UTCs were measured against the four-hour target.  The Committee noted that the delays were not just in Lincolnshire, but across the country.  It was reported that Lincoln and Boston had both seen increased activity and that UTC’s on those sites were managing the extra activity including ambulance patients.  It was reported further UTCs were treating 95% of their patients within the four-hour target, despite the increased activity.  The Committee was advised that the delay in ambulance handovers was due to lack of flow through the hospitals and bed availability. The Committee was advised further that as the Grantham A & E dealt with less complex cases, they were meeting the four-hour target and reassurance was given that this would continue to be met if Grantham Hospital became a UTC;

·       Conflicting messages to the public, paragraph 10.2.9 on page 74 of the report pack advised that the UTC would be open 24 hours a day, seven days a week, and then the next sentence advised that the preferred route of access for the service should be via NHS 111.  Reassurance was given that the proposal was for 24/7 access.  The reason the message says to ring 111 was to make sure that any treatment required would not be unnecessarily delayed.  If a patient was able to wait, then they should ring 111, which provided them with the ability to book an appointment for later in the day;

·       Clarification was sought on the terminology of: a level 3 A & E and a UTC Plus.  The Committee was advised that the term level 3 A & E had in effect ceased, and that the term UTC had replaced it;

·       Further concern was expressed that the general public were unaware of how to access treatment; as services were being changed, and that better communication was needed to help alleviate patients concerns;

·       Pages 74 and 81 of the report pack provided workforce details for the proposed UTC, a further question asked was what was in place for medical cover arrangements overnight.  Reassurance was given that a doctor would be on site overnight supported by two ACP Nurses.  It was also noted that doctors, when possible, would also assist the clinical assessment service;

·       Reference was made to paragraph 10.6.19, which referred to moderate capital investment being required for expansion into adjoining departments, a request was made as to how much capital funding would be required; and

·       How the extension of Pilgrim Hospital A & E affected the overall staffing needs for urgent and emergency care in Lincolnshire.  The Committee noted that the main reason for the expansion was to provide extra accommodation for people visiting the A & E and to revamp the layout to provide a more usable space.  The Committee was advised that the expansion would not result in the need for more staff.

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

RESOLVED

1.      That the details presented on the Lincolnshire Acute Services review of Urgent and Emergency care be noted.

2.     That the Committee’s initial findings on the proposal be considered by the Committee’s working group.