Agenda item

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider the Clinical Board’s decision and its rationale for making the decision in relation to the reconfiguration of four NHS Services in Lincolnshire: Orthopaedics; Urgent and Emergency Care; Acute Medicine and Stroke Services. Pete Burnett, System Strategy and Planning Director, NHS Lincolnshire Clinical Commissioning Group will be in attendance for this item)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider the Board of Lincolnshire Clinical Commissioning Group’s (CCG) decision, and its rationale for making the decision in relation to the reconfiguration of four NHS Services in Lincolnshire: Orthopaedics; Urgent and Emergency Care; Acute Medicine and Stroke Services.

The Chairman highlighted to the Committee the motion agreed at the South Kesteven District Council Extraordinary Council meeting held on 14 June 2022 concerning Grantham and District Hospital.  A copy of which had been circulated to all members of the Committee prior to the meeting. 

The Chairman invited the following presenters from the NHS Lincolnshire Clinical Commissioning Group: Pete Burnett, System Strategy and Planning Director and Tom Diamond, Associate Director of Strategy, to remotely present the item to the Committee.

In guiding the Committee through the report, reference was made to: the decision of Lincolnshire Clinical Commissioning Group, which approved changes to the four NHS Services in Lincolnshire; the consultation process; feedback received; assessment by the Clinical Directorate and NHS Lincolnshire Clinical Policies Sub-Group; endorsement by the Quality and Patient Experience Committee; extensive clinical engagement in Lincolnshire and the East Midlands Clinical Senate; and support regionally and nationally for the Board’s decision being in-line with best practice.

During consideration of the item, some of the following comments were raised:

·       Some opposition was received to the proposed changes for Grantham and District Hospital A & E becoming a 24/7 Urgent Treatment Centre (UTC); and to the fact that 700 people per year would now have to travel to Lincoln.  One member provided details of their personal experience of having to waiting thirteen hours in Lincoln County Hospital before being admitted.  The Committee was appraised of the situation concerning Grantham A & E and to the services provided by the UTC and to the fact that the services to be provided at Grantham and District Hospital’s UTC would be enhanced, compared to other UTC’s;

·       Some concern was expressed regarding transport plans and who would be responsible for these.  A request was made for a copy of the completed document to be shared with the Committee.  The Committee noted that engagement was taking place with the county council in this regard, as was looking at voluntary car services and increasing the commissioning capacity of the East Midlands Ambulance Service (EMAS).  It was also highlighted that with the rising cost of fuel; some patients would not be able to afford to attend appointments;

·       One member queried who the service provider would be for the Grantham UTC.  The Committee was advised that the aim was to have an integrated model , including United Lincolnshire NHS Hospitals Trust;

·       Problems encountered across all major sites in Lincolnshire when accessing services. It was reported that patients were willing to travel for specialised services and that best practice was to centralise services, as this provided better outcomes and better recovery for patients;

·       Staffing shortages.  It was noted that there were staffing shortages nationally as well as locally, and that Lincolnshire was taking steps with the Lincoln Medical School, apprenticeships and growing existing staff to help bridge some of the gaps in Lincolnshire;

·       Some concern was expressed to ambulance poor response times in Lincolnshire, and to the fact that the Fire Service was being asked to do more in this regard.  It was highlighted that joint working arrangements happened in other areas around the country.  It was highlighted further that the ambulance service had improved, but the current level of demand was beyond anything ever seen before.  Some concern was also raised that (EMAS) were not meeting their Key Performance Indicators (KPIs);

·       The need for lifestyle changes to alleviate pressures on the NHS and that more preventative measures needed to be considered;

·       Assurance was sought that access to Grantham UTC would be 24/7, when other UTC sites in the county were having to close their doors, for example, due to staff shortages.  Reassurance was given that the integrated service being provided at Grantham would ensure 24/7 opening, as it was not just a community provider.  One member stressed that 24/7 healthcare was vital at Grantham;

·       The need for a Communication Strategy to ensure that the public were aware of the changes and the conditions that could be treated at the Grantham UTC due to the changes;

·       Whether potential housing growth had been factored into the service changes.  Reassurance was given that consideration had been taken to future growth.  The Committee was advised that every year a detailed plan was compiled concerning service modelling and that the figures provided were nowhere near a critical mass situation;

·       The usefulness of UTCs in front of A & E departments and whether they were actually making a difference.  Unfortunately, the presenter was unable to comment, as this was a matter for United Lincolnshire NHS Hospitals Trust (ULHT);

·       Extended waiting times in A & E departments, it was felt that some of the congestion could be prevented if GPs continued to make contact with specific specialist units, if some action was required;

·       Some concern was expressed that despite most respondents living nearest to Grantham Hospital disagreeing with the proposal for Grantham becoming a UTC; the same with those living near to Boston disagreeing with the stroke proposal, the two changes were supported across Lincolnshire as a whole.  Clarification was sought as to what was being done to mitigate this; and a question was asked as to whether feedback had been worthwhile.  The Committee was advised there had been support for both proposals; and confirmation was given that views were considered and not dismissed and that this could be demonstrated in the evidenced feedback provided; and that there had been overwhelming clinical support for the four proposals and that this had informed the Board’s decision;

·       Some clarity was sought regarding stroke services, as the report had stated that a third of staff disagreed with the plan for centralisation. It was noted that people locally were concerned what the changes to services would mean for them.  It was noted further that ULHT would be having ongoing discussions with staff, as part of the implementation process;

·       Clarity was sought regarding the impact of any referral by the Committee to the Secretary of State for Health and Social Care of any proposal, on the overall implementation of the changes.  The Committee was advised that the understanding was that the implementation process would not go ahead until after a decision from the Secretary of State had been received. It was highlighted that the delay caused because of this would be detrimental to the health of the population of Lincolnshire.  The Committee were reminded of the overwhelming clinical support for the proposal and that referral would be going against this expertise.  It was highlighted that the permanent service changes would provide a better future, which would mean staff would be attracted to the area which would help with recruitment, and that there would be certainty in the provision of services.  This, however, would not be possible, if there was a Secretary of State action pending.  Some members expressed concern regarding the impact a referral would have for Lincolnshire; and that the evidence provided indicated that a referral might not be successful.  Some support was shown for referral for some elements of the decision by the CCG Board; and

·       Some clarity was sought regarding the status of Grantham UTC, and whether Grantham would be a ‘UTC plus’.  The Committee was advised that as part of the modelling prior to consultation, the East Midlands Clinical Senate would not accept the term ‘UTC plus’, as this was not the accepted terminology.  It was however reported that the Grantham UTC was planned to have a stronger clinical base than other UTCs, for example with middle grade A & E doctors, GPs and nurses and the ability to admit patients into hospital, to the 70 community beds to support frail and elderly patients.  The level of provision would be higher than other UTCs in the country and that this would provide an excellent service for the population of Lincolnshire.

As a result of the comments raised by the Committee, the Chairman advised the Committee of the options available to them in this regard, to continue to monitor the implementation arrangements; refer all four proposals to the Secretary of State; or just refer one or two elements from the proposals.

It was proposed and seconded that:

(1)          To record the Committee’s disappointment with the CCG Board’s decision on Orthopaedics; Urgent and Emergency Care; and Stroke Services, as these reconfigurations had not been supported by the Committee in its response to the consultation exercise.

(2)          To seek further reports on the implementation arrangements for the four NHS services, with particular emphasis on the arrangements for:

(a)      staffing, including recruitment and retention;

(b)     transport and travel arrangements, including:

·     any new local discretions allowed as part of the national non?emergency patient transport arrangements;

·     the extent to which the £1m contingency allocated to cover the additional demands on the East Midlands Ambulance Service, and the non?emergency patient service is required;

(c)      in relation to Stroke Services:

·     any details on securing the capital investment of £7.5 million to increase capacity at Lincoln County Hospital;

·     any details on how increased stroke patient numbers are managed by Peterborough City Hospital and Queen Elizabeth’s Hospital, King’s Lynn;

(d)      In relation to the Grantham Urgent Treatment Centre:

·     confirmation of the services due to be provided at the Urgent Treatment Centre.

An Amendment was Proposed and Seconded that:

The decision for the accident and emergency department at Grantham and District Hospital becoming an Urgent Treatment Centre be referred to the Secretary of State on the grounds that the decision was based on incorrect population projections.

Upon the Amendment being put to the being put to the vote, it was declared lost.

Upon the substantive motion being put to the vote, it was unanimously carried.

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

RESOLVED

1.      To record the Committee’s disappointment with the CCG Board’s decision on Orthopaedics; Urgent and Emergency Care; and Stroke Services, as these reconfigurations had not been supported by the Committee in its response to the consultation exercise.

2.      To seek further reports on the implementation arrangements for the four NHS services, with particular emphasis on the arrangements for:

(a)    staffing, including recruitment and retention;

(b)   transport and travel arrangements, including:

·     any new local discretions allowed as part of the national non?emergency patient transport arrangements;

·     the extent to which the £1m contingency allocated to cover the additional demands on the East Midlands Ambulance Service, and the non?emergency patient service is required;

(c) in relation to Stroke Services:

·     any details on securing the capital investment of £7.5 million to increase capacity at Lincoln County Hospital;

·     any details on how increased stroke patient numbers are managed by Peterborough City Hospital and Queen Elizabeth’s Hospital, King’s Lynn;

(d) In relation to the Grantham Urgent Treatment Centre:

·     confirmation of the services due to be provided at the Urgent Treatment Centre.