Agenda item

Lincolnshire Sustainability and Transformation Partnership Update

To receive a report from Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership (STP), which provides the Committee with an update on the current position of the STP)


The Chairman welcomed to the meeting John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP), Andrew Morgan, Chief Executive, Lincolnshire Community Services NHS Trust and Sarah Furley, Programme Director, Lincolnshire Sustainability and Transformation Partnership.


In a short introduction, the Chairman advised the Committee that two councillors had made a request to address the Committee on this item in relation to Grantham A & E, which was referred to in the report.  The Chairman highlighted that as the STP was a county-wide issue, there was not an automatic right for local members to speak on this item.  However, on this occasion, the Chairman highlighted that he had decided to allow the councillors to speak, and he urged the Committee to give full consideration to all aspects of the STP report; and not just the Grantham A & E issue.


The Chairman welcomed Councillors Mrs L Wootten and R Wootten to the meeting; and advised the Committee that he proposed to allocate them both three minutes each, and that they would be invited to speak to members of the Committee following officers presenting the report.


The Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP) started his address by advising the Committee that throughout the county on a day to day basis, dedicated NHS staff provided excellent services.  However, stepping back from day to day provision, the NHS in Lincolnshire had some very challenging issues to address.


The Committee was advised that there were significant challenges across the county relating to recruitment of specialist staff; and that agency staff were helping to keep NHS services across the county working.  Other challenges for the NHS included the demographics of Lincolnshire; in particular, it's increasingly ageing population.


It was reported that the current model of NHS provision across Lincolnshire was out of date and inconsistent and that over the years the NHS had been reactive in its planning, rather than being proactive.  The current model clearly was not sustainable and was not suitable for patients, or for staff.  It was highlighted that the Sustainability and Transformation Plan would try and address the challenges and ensure that health services in Lincolnshire were delivered in an efficient and effective way, ensuring that the services provided met the needs of patients.  The Committee noted that many services across the county were working well and that there were no plans to change them.


The Committee was advised that the STP plan was a plan that focussed on progressing seven key priorities, which comprised of:-


·         Mental Health;

·         Neighbourhood Teams;

·         Implementation of GP Forward View;

·         Acute Care Reconfiguration;

·         Urgent and Emergency Care Transformation;

·         Operational Efficiencies; and

·         Planned Care.


Outline details against each of the seven priorities was provided within the report for the Committees consideration.


It was reported that the seven priorities were all supported by a number of enabling work streams such as IT solutions; ensuring that the estate was able to support the delivery of service reconfiguration; the up-skilling of the workforce; delivering financial leadership; and ensuring that robust and meaningful engagement happened with patients, carers and stakeholders to successfully implement the STP.


It was reported further that the Lincolnshire STP had formed a Capital & Estates working group that was collaboratively working together to ascertain future capital and estate requirements, having both scoped short and medium term future needs against current estate.  The STP would ensure more joined up working, and take a more systematic approach to providing a standard, consistent, more local focussed approach to sustainable service provision.


In conclusion, the Committee noted that the NHS faced some big challenges, and that the STP would try to meet those challenges and address them by working in partnership with others, whilst operating within available resources, and ensuring that services were provided in a sustainable way.


Both of the Grantham Councillors in their address to the Committee highlighted that previous engagement as part of the Lincolnshire Health and Care (LHAC) programme hardly represented the views of the residents of Lincolnshire.  It was also highlighted that South Kesteven District Council and Lincolnshire County Council had registered their views against the STP proposals in their current form; and that there was a need for the NHS to act upon the views that emerged from any public consultation.  Concern was expressed to the down grading of the Grantham A & E, despite local residents concerns; and to the prospects for Grantham A & E in the future.  It was highlighted that staff working at the Grantham hospital were very hard working, but were overworked and demoralised, as a result of the uncertainty surrounding Grantham hospital.  Reassurance was sought that the people of Lincolnshire would have the opportunity to have their say concerning the services to be provided in the proposed STP.


During debate, the Committee raised the following issues:-


·         Some concern was expressed to the proposals detailed in the report and to the current financial situation of the United Lincolnshire Hospitals NHS Trust (ULHT).  The Committee was advised that the STP proposed a broad range of activities, some of which had already been taken forward; all of which had had the involvement of staff.  An example given was the changes that had taken place with regard to Learning Disabilities, which was an item to be considered by the Committee later in the agenda.  An acknowledgement was given that there was always more that could be done with regard to engagement.  Reassurance was given that where a service reconfiguration was to take place, the NHS was required to undertake public consultation, in accordance with National Policy;

·         Concern was expressed regarding the current Grantham A & E reduced service; and to the fact that there was a lack of trust from local residents, as a result of the (ULHT) not being open and honest regarding its future plans.  The Committee was advised that at the recent South West Lincolnshire Clinical Commissioning Group AGM meeting, it had been stated that there were significant problems with specialist staffing across the county.  It was noted that two pieces of work were being considered:-


1.    How the limited hours service at Grantham A & E could be improved during the winter period in the short term.  The Committee was advised that once the work was completed, this would be openly shared when the Trust was in a position to do so; and

2.    The long term future for Grantham A & E and, what services would be provided.


There was an appreciation of the lack of trust from members the public, but it was hoped that the steps now being taken would give reassurance to the public.  One member stressed that it was key to get the views of the public on all aspects of the STP;

·         Some members appreciated that there was a need for change.  However, it was the way that the changes happened that caused concern.  An example given was the formation of Neighbourhood Teams; as these were being rolled out in some parts of the county, a question was asked whether there had there been any consultation on the introduction of Neighbourhood Teams.  The Committee was advised that in partnership, local issues were being addressed with input from the local community.  It was highlighted that there was a consensus that Neighbourhood Teams were the right thing for Lincolnshire; and that the principle also fitted in with National Policy.  A concern was raised that the principle adopted seemed to indicate that a judgement had been made prior to any consultation.  The Committee was advised further that the development of Neighbourhood Teams would provide joined up integrated services at a community based level, which would move services away from existing fragmented service provision;

·         One member expressed concern as to the frustration raised by members of the public for the time taken to being consultation on any changes, some three/four years after the beginning of the Lincolnshire Health and Care (LHAC) process.  It was highlighted that on several occasions the public had been advised of a forthcoming public consultation as part of the Lincolnshire Health and Care programme.  LHAC had now been subsequently replaced by the STP, which was due to go for public consultation in the Spring of 2018.  The effect of delays and uncertainty was harmful for the process, as members of the public were losing confidence;

·         One member highlighted that the aspirations detailed in the report, should contain more detail of what was planned; especially when a consultation was planned.  It was further highlighted that the continual change to service names caused confusion with members of the public.  It was agreed that it had taken a long time to get to the current position. It was noted that some of the delay had been caused by the timing of national and local elections.  It was highlighted further that any change to NHS services, statute clearly stated that formal public consultation should be undertaken.  There was recognition that the present and in the future the best outcomes would be achieved by working together to make the best from the money and resources available.  An acceptance was given that there was not a lot of detail contained in the report, but more information could be made available if the Committee wished to see it. In summary, the Committee was advised that doing nothing was not an option;

·         One member stressed the importance of the role of a GP within a community.  It was also stressed that there was a need to keep any communication to the general public as simple as possible; this would then avoid any confusion, and help in building up public confidence.  The Committee was advised that GP's would be at the centre of all Neighbourhood Teams; and that GP services were the bedrock of the NHS delivering 90% of all patients' contacts.  The Committee was further advised that how changes were explained was vitally important;

·         The importance of removing misleading highways signage, particular reference was made to signs from Wragby that directed people to the 'A & E' at Louth County Hospital, where A & E services were no longer provided.  It was noted that Louth might be designated as an 'Urgent Treatment Centre' and GP Access Centre;

·         Recruitment of GPs.  The Committee was advised that following an international recruitment drive 26 additional GPs had been recruited, all from Eastern Europe.  It was highlighted that GPs were collaborating to ensure their future resilience.  The Committee noted that a GP Federation was a formal arrangement by which GPs could join together to provide more local services; and

·         The link of the STP with the Joint Strategic Needs Assessment (JSNA); and whether the latest version of the JSNA was being used.  It was confirmed that at each stage of the development of the STP, account had been taken of the JSNA; and the latest version of the JSNA would continue to be used as the STP evolved and developed.


The Chairman asked the Committee if they minded him asking a question from a member of the public.  The Committee agreed.


The Question related to page 21 (Section1.4.1 – Mental Health), the question was whether the enhancement of Crisis Resolution and Home Treatment teams from January 2018 would mean these teams would provide services to older adults (adults over 65).  The Committee was advised that the service was aimed at the 15-65 age range and that the enhancement would not extend into the age range of above 65.  It was reported that the issue of service provision for those over 65 was recognised, and that LPFT was working on developing a plan to see how it could meet the needs of people in specific service gaps.  Reference was also made to the Mental Health Liaison Service 'plugging' the current gaps in service provision.


One member enquired whether a representative from the Gainsborough Neighbourhood Team would be able to attend a future meeting to explain the workings of Neighbourhood Teams, or the Committee having the opportunity to visit the Gainsborough Neighbourhood Team to see how it worked.  The Committee was advised that a representative from the Gainsborough Neighbourhood Team would be able to attend a future meeting of the Committee.


A request was made for an update concerning Grantham Hospital, following the winter pressures.  The Committee was advised that an update from ULHT was already included in the work programme for the 8 November 2017.


The Chairman asked the Committee whether they wished to consider any of the seven priorities in the STP at a forthcoming meeting.  During a short discussion, the Committee suggested the following for priorities:-


·         Mental Health;

·         Neighbourhood Teams;

·         Implementation of the GP Forward View; and

·         Operational Efficiencies (including Finance).


The Committee also agreed to receiving quarterly updates on the STP.


As there was no firm date for the consultation elements of the STP, the Committee agreed that they would like to record their concern at the lack of full, extensive and meaningful consultation on the proposals contained in the STP.




1.     That updates be requested on a quarterly basis (or as required if there is substantial change) on the progress of the Lincolnshire Sustainability and Transformation Partnership.


2.     That of the seven priorities listed in the Lincolnshire Sustainability and      Transformation Plan, more detailed consideration be given by the Committee to the following four priorities:


·         Mental Health

·         Neighbourhood Teams

·         Implementation of the GP Forward View

·         Operational Efficiencies (including Finance)


3.         That it be recorded that the Committee would like to express its serious concern at the lack of full, extensive and meaningful consultation on the proposals contained in the Lincolnshire Sustainability and Transformation Plan, and further expresses its concern that no consultation will be taking place on the Plan before April 2018; the residents of Lincolnshire deserve to be treated better than this and their very serious concerns and reservations about the future direction of health care provided in the county needs to be of paramount importance in the decision making process.

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