Agenda and minutes

Apologies for absence were received from Councillor O’Donnell, Councillor Morgan, David Williams- NHS and Dr Janet Underwood – Healthwatch.

Members are asked to declare any interests they may have in the business on the agenda.

Members were asked to declare any pecuniary or other interests they may have in the business on the agenda.

Councillor Newton declared that her son worked in the NHS and her daughter was employed as a clinical commissioning nurse and assured that she retained an open mind for the purpose of discussion and was not therefore required to withdraw from the meeting.

The minutes of the meeting held on 22^nd November 2022 have been circulated and the Committee is asked to confirm them as a correct record.

It was clarified that Councillor Dan Harrison was present at the last meeting as a member of the committee and not as a substitute as mistakenly recorded.

It was noted that in terms of actions arising from the UHL financial accounts item, further detail had been provided to members immediately following the last meeting. Future reports about the UHL financial recovery had been scheduled to the work programme.

In relation to the Corporate Complaints Procedure report the Chair had requested a fuller report to a future meeting and this was reflected on the future work programme.

RESOLVED:

That subject to the correction referred to above the minutes of the meeting held on 16^th November 2022 be confirmed as an accurate record.

The Monitoring Officer to report on the receipt of any petitions submitted in accordance with the Council’s procedures

The Monitoring Officer reported that no petitions had been received.

The Monitoring Officer to report on the receipt of any questions, representations, or statements of case in accordance with the Council’s procedures.

The Monitoring Officer reported that no questions, representations or statements of case had been received.

The Chair noted that Richard Mitchell CEO UHL and David Sissling Chair Integrated Care Board had to leave the meeting early and therefore agreed to a change in the running order of the agenda to take items on the agenda that they were talking to first.

Members to receive a report providing an update on the reconfiguration proposals for University Hospitals Leicester.

Members will also receive a report providing an overview of the planned move of the elective Dermatology service from Leicester Royal Infirmary (LRI) to the St Peter’s Health Centre.

Members received a report providing an update on the reconfiguration proposals for University Hospitals Leicester.

Richard Mitchell, Chief Executive Officer, UHL introduced the report reminding members that funding was initially confirmed for the programme in September 2019 with full consultation taking place thereafter. He went on to provide a recap of the interim reconfiguration project and the delays that had arisen due to the covid pandemic which had led to changes around how prevention of infection was looked at, alongside changes in policy such as achieving carbon net zero and the greater significance of digital transformation.

Richard Mitchell advised that whilst there were some delays UHL had still made progress, and went on to give an overview of the current status of the main reconfiguration programme; impact of the development of the programmatic business by the New Hospital Programme and how that affected the position in terms of the Trust being told of its final capital envelope and delivery programme.

Members were concerned about the uncertainty of the final capital figure. Assurance was given that it had been confirmed in 2019 there would be £450m capital and the ongoing conversation was not questioning whether plans would happen but were about how much more could be added to account for the cost increases that had occurred since.

Members referred to the current economic climate, rising costs and effect of inflation and were disappointed by the lack of clarity about what would happen if there was no subsequent funding uplift to account for rising costs.

Richard Mitchell advised that he had taken on ownership of the reconfiguration plans and collectively the board were making sure that they were building for the best services. He reiterated that conversations were taking place about the increased costs/inflation and how that could be covered. UHL were also looking beyond plans for money coming only from the treasury and were exploring the feasibility of working with long term partners to generate money. It was accepted that the costs base had increased but it was hoped that UHL would receive an increase in funding in a few months. It was emphasised that UHL were committed to delivering, primarily on good health services, and if it became necessary they would revisit plans in terms of design features to reduce costs.

Members discussed the standardised buildings approach and how that impacted on the reconfiguration. It was explained that the standardised approach was similar to what had been seen in education in that there would be an expectation of a standard approach in new buildings however not all of the reconfiguration involved new build and there would be continued flexibility locally in terms of those works.

Members suggested that modern methods of construction should be easier, faster and cheaper to build than 5 years ago, and that logic should be checked when taking forward the next design development.

In terms of steps being taken towards meeting climate/carbon emissions policies there was a greater focus on being carbon net zero and transition  ...  view the full minutes text for item 37.

Members to receive a report providing details of the recent Care Quality Commission (CQC) Well-Led inspection at University Hospitals Leicester (UHL).

Members received a report providing details of the recent Care Quality Commission (CQC) Well-Led inspection at University Hospitals Leicester (UHL).

Becky Cassidy, Director of Corporate and Legal Affairs, UHL introduced the report explaining that the well-led inspection took place in September 2022, the outcomes of that inspection were received in December 2022 with the overall rating reduced to “requires improvement”. UHL believed the report was fair and balanced, and as a board UHL were not expecting to have a well-led inspection at that time. It was notable that there were no actions required as “must do’s” but there were eight “should do’s” which were being followed up internally.

Members considered the report and inspection outcomes which included the following comments:

It was felt this was a disappointing report although it was recognised the leadership at UHL was reasonably new. Members queried if inspectors were to come in now whether they would see any difference to September.

In response it was noted that there were a number of fundamental issues, long term that needed to be addressed, some of that related to culture which needed to strengthen and UHL were able to demonstrate some improvements, however at this point in time there was a need to embed new practices and so inspectors might not see a great deal of difference but that would change over time. The inspection report was fully accepted and there would be full reflection of where the organisation was and noting that UHL was still in financial special measures.

Richard Mitchell, CEO UHL, commented that this was an accurate report at a point in time and not necessarily disappointing. The previous CQC well-led inspection had taken place 31 months before this one, in between that time there was considerable change, and an earlier inspection may have seen more deterioration. In context with other university hospitals, the majority had done worse than “requires improvement”. It was suggested that if inspectors came back today then at a high level, not a lot would have changed, however it was hoped the CQC would come back later in the calendar year and would hopefully see improvement in the well-led rating.

Members commented upon the level of operational leadership and accountability and lack of awareness amongst staff of the Trust strategy and how that aligns to their divisions and work.

Richard Mitchell responded that the report was not indicative of a deterioration in the organisation, an awful lot had occurred over the 3 year period since the last well-led inspection visit, when the inspectors came in there was no strategy and the inspectors were told that, the UHL board had subsequently begun the process of determining the direction of travel for UHL for next 5-10 years, and staff and stakeholders views had been sought about that with over 10k interactions received within 2 weeks.

A key engager was the staff survey, as of this year 48% of the staff had engaged and completed that which was a 15% increase on the previous  ...  view the full minutes text for item 38.

Members to receive a verbal update on the organisational progress of the Leicester, Leicestershire and Rutland Integrated Care Systems.

David Sissling, Chair of the Integrated Care Board provided a verbal update on the organisation progress of the Leicester, Leicestershire, and Rutland Integrated Care System (ICS).

Members were reminded of the background to the introduction of the Integrated Care System and how that reflected movement in health and care towards collaboration and partnership. It was advised that collaboration and partnership were very much at the centre of the integrated care system and the aim was to bring the best out of central services, and to have broader focus to include inequity and inequality.

Members noted that over the past 8 months the foundations for the new ICS had been put in place and those were being developed at pace.

Sarah Prema, Chief Strategy Officer for the Leicester, Leicestershire & Rutland Integrated Care Board (ICB) reminded Members that the ICB was established on 1st July 2022 as part of the ICS and was the ICB that planned and co-ordinated delivery across LLR.

Members were advised there was also a Health & Wellbeing partnership, that was co-chaired by the Health & Wellbeing Board Chairs with members drawn from Health & Wellbeing Boards across the Local Authority areas. The Health & Wellbeing Partnership had met several times looking at focused areas and were developing the integrated care strategy, the draft strategy would be presented to Health & Wellbeing Boards for consideration before going through a period of consultation. The aim was to have the integrated care strategy in place for Autumn 2023.

Members were informed that the ICB was also required to produce a delivery plan which would be called the 5 years forward view plan, this was required to be finalised by June 2023 and would set out how services will be delivered and how they would deliver on the needs of populations. The 5 years forward view plan was in process of drafting and engagement would take place in similar timescales as for the integrated care strategy.

Sarah went on to inform members that there would be a change in integrated care commissioning responsibilities from April 2023, and the establishment of sets of services called pods, e.g., pharmacy, optometry and dental which would be within the remit of the ICB going forward with responsibility for delivery of services at a local level. In relation to specialist services, it was advised circa 60 (out of 169) specialist services would come within the ICB remit over the next year with ongoing dialogue about whether other specialist services would transition later in 2024.

Members appreciated the verbal update but indicated it would be more helpful in future to receive written reports so that they could absorb the content and formulate questions for a proper discussion to take place.

Members asked that a further written update report be provided from the Integrated Care Board after May 2023 to provide more understanding of what was actually taking place and how services were being commissioned rather than theoretical updates of what was planned to be done.

The Chair thanked David and Sarah for  ...  view the full minutes text for item 39.

Members to receive an update report on the work being done in partnership to improve the outcomes for people with a Learning Disability or Neuro-developmental need.

Members will be asked to note the successes and challenges within LLR and to champion joint focus on people who need support and the importance of supporting all people across LLR.

Members received a report giving an update on the work being done in partnership to improve the outcomes for people with a learning disability or neuro-developmental need.

Mark Roberts, Asst. Director Leicestershire Partnership Trust (LPT) introduced the report giving an overview of the aims of the programme, details of the collaborative formalised between the ICB and LPT and the close work with local authority colleagues as well as the significant improvements in the services provided and priorities moving forward.

Members were advised this work took forward the successes of the Transforming Care Programme from 2021-22 and sought to address inequalities in a fundamental way whilst also reviewing the delegated duties from NHS England to local systems too.

Attention was drawn to the key target areas namely: reducing the need for inpatient care; learning from the lives and deaths of people with a learning disability;  and Annual Health Checks for people with a learning disability along with the successes, challenges and opportunities in those areas.

In summary it was noted there were fewer local adults with a learning disability or neuro-developmental need requiring care in hospital, although there had been an increase to the number of children with a learning disability or neuro-developmental need being in hospital than previously; in terms of learning this was developing well and the learning about aspiration pneumonia had gathered interest at a national level. As regards health checks it was hoped there would be more progress on completion of annual health checks for those with a learning disability.

Members welcomed the report although there was some disappointment that the number of children with a learning disability or neuro-developmental need in hospital had risen, and it was suggested there should be more emphasis on the work around children and exploring the reasons for that.

In relation to the annual health checks members enquired about the definition of a person with a learning disability or neuro-developmental need and how those that should be health checked were being captured in the data.

Responding to the points made it was advised that annual health checks were focused on those with a learning disability and the definition was a certain level of IQ, this was relatively easy to define in the community, however autism was more challenging to identify, and a formal diagnosis defined whether someone was autistic.

As far as people engaging with primary care networks, it was advised that the collaborative had stimulated some improvements, such as in North West Leicestershire where a hub was being developed, however some people had more significant needs that made the annual health check more challenging to undertake. The team had commissioned some additional capacity to address the 200 people without a health check last year and who hadn’t one this year either and those were being targeted through GP’s to make sure they had a health check.

Members noted that other areas of the East Midlands hade turned towards a more centralised process for the annual health checks, but the team  ...  view the full minutes text for item 40.

Members to receive a report updating on the current priorities and opportunities in Primary Medical Care across Leicester, Leicestershire and Rutland as well as a summary on the Primary Care Network (PCN) Enhanced Access services delivered by Primary Care Networks across Leicester, Leicestershire and Rutland.

Members received an update reporting on the current priorities and opportunities in Primary Medical Care across Leicester, Leicestershire and Rutland as well as a summary on the Primary Care Network (PCN) Enhanced Access services delivered by Primary Care Networks across Leicester, Leicestershire and Rutland.

Yasmin Sidyot introduced the report and drew attention to the LLR Primary Care Plan update which concentrated on four key points:- Access, Workforce, Quality, and Delivery on key Long-Term Conditions.

It was noted that:

·         In terms of Access, more appointments were now being delivered across 132 practices compared to April 2019 and there had been sustained increase in face to face appointments being given across LLR from January to October 2022.

·         Enhanced access had been implemented and that came online 1^st October 2022, this meant primary care networks were delivering additional appointment capacity to that stated above, this additional provision was available Mon – Fri 6.30 pm to 8.30pm and on Saturdays  9am to 5pm

·         Outcomes of data showed some areas of significant improvements, such as the percentage of patients being treated on anti-coagulation treatment; hypertension patients being detected and treated earlier, although there was still some inequity across PCN’s with areas of further requirement to improve such as diabetic and respiratory patients but overall seeing shift towards better service provision.

·         Workforce continued to be challenging in general practice, and there was discrepancy between what workforce growth looks like across LLR. Improvements were being seen in the uptake of additional roles brought in through primary care networks such as social prescribers, pharmacists etc and there was growth in those but that was overlaid with the challenges to recruit and retain GP’s, nurses, and an administrative work force too.

The Chair invited members to comment on the report which included the following:

·         PCN contracts  were a concern, although overall things looked to be going well underneath there were still serious issues such as around recruitment and retention of appropriate staff to general practices.

·         OPEL status report was about the operating pressures and escalation level, this reporting was introduced with General Practices this year (2022-23) and is a very operational process that provides good intelligence of what GPs are facing.

·         The OPEL status report showed a deterioration from November 2022 to December 2022 of the number of GP practices at Level 3, this was because of increasing winter pressures  and the visible reporting enabled additional support to be put into acute respiratory services in January 2023, as well as enabling specific targeted work with practices.

·         In terms of patient groups there were currently 51 active participation groups and officers were working with them to ensure consistency in how they operate and also to connect with each other and work more collaboratively around patient experiences. General Practices were also being engaged to re-establish and refresh patient groups that had stopped.

Members raised concerns about the inaccessibility of phone systems that most general practices still used and the huge variation of quality of messages within those systems. Members were  ...  view the full minutes text for item 41.

Members to receive and note the current work programme and consider any future items for inclusion.

It was noted that a formal work programme was not set as this was the last meeting of  the current municipal year, outstanding items and those raised during the course of discussion today will be added to the work programme for future meetings.

None notified.

To note that the administration of this joint committee is due to transfer to Leicestershire County Council for the start of the new municipal year 2023/24 and dates of future meetings will be circulated in due course.

Noted that the administration of the Joint Health Scrutiny Committee will transfer to the Leicestershire County Council for the new municipal year and dates of future meetings to be confirmed in due course.

The Chair thanked committee members for their contributions to these meetings. Councillor Waller extended thanks to the Chair for chairing the meetings in a gracious manner.

There being no further business the meeting closed at 2.48pm.