Agenda and minutes

Apologies for absence were received from Councillors Chaplin, Cleaver, Conde and Fonseca and from Healthwatch Rutland.

Apologies were also received from Mrs Richards C.C. and Mr Harrison C.C. from Leicestershire County Council. Mr Bentley C.C. and Mr Gillard C.C. were their respective substitutes.

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

No declarations of interest were made.

The minutes of the meeting held on 4 September 2018 and the Special Meeting held on 28 September 2018 have been circulated and the Committee is asked to confirm them as correct records.

AGREED:

that the minutes of the previous meetings of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee held 4 September 2018 and the special meeting held 28 September 2018 be confirmed as correct records.

The Chair stated that further to the meeting on 4 September 2018, she had given Members the opportunity to submit additional questions outside of the meeting. The responses to those questions are attached to the back of these minutes.

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, petitions, or statements of case in accordance with the Council’s procedures.

The following questions have been received in accordance with Part 4E: Scrutiny Procedure Rules (Rule 10) of the constitution.

Tom Barker

What actions will the committee be taking to scrutinise the detailed calculations underpinning UHL's decision that no additional hospital beds will be needed for the growing population of Leicester, Leicestershire and Rutland for the coming years even though we already don't have enough beds to meet patient need?

Peter Worrall

What plans have the Joint Health Scrutiny Committee for scrutinising the UHL plans for reconfiguration of acute services and how can the committee ensure UHL follows its recommendations, given that the plans have already been drawn up in detail although these details have not been shared with the public?

Katy Wheatley

Will the joint scrutiny committee be examining whether the capacity planning in UHL’s acute reconfiguration proposals adequately take into consideration the growth plans across Leicester, Leicestershire and Rutland and increased numbers of dwellings and residents in the coming years?

Kathy Reynolds

How does the JHOSC plan to collect the evidence that will assure both the JHOSC and the public that STP/UHL plans for reconfiguration involving a capital bid for £367m will meet the future needs of the Leicester, Leicestershire & Rutland community?  I am particularly concerned that at the recent engagement events it became clear that the UHL Plan was reliant on changes within community and primary care to allow it to deliver. However, the Community / Primary Care Plan is not available nor has the associated engagement has taken place, raising questions about the assumptions behind UHL’s Plan. Does the JHOSC have a work plan or are they planning a programme of work to assure the public and can we be appraised of the arrangements?

Additional questions:

Further questions (as attached)  were submitted in accordance with the Scrutiny Procedure Rules (Part 4E) Rule 10 of the Constitution but were received too late to be included on the agenda.  

The following questions had been received in accordance with Part 4E: Scrutiny Procedure Rules (Rule 10) of the Council’s constitution. The Chair advised that she would respond to the questions collectively.

Tom Barker submitted the following question and advised in advance of the meeting that his representative, Mr Steve Score would ask the question on his behalf.

What actions will the committee be taking to scrutinise the detailed calculations underpinning UHL's decision that no additional hospital beds will be needed for the growing population of Leicester, Leicestershire and Rutland for the coming years even though we already don't have enough beds to meet patient need?

Peter Worrall

What plans have the Joint Health Scrutiny Committee for scrutinising the UHL plans for reconfiguration of acute services and how can the committee ensure UHL follows its recommendations, given that the plans have already been drawn up in detail although these details have not been shared with the public?

Katy Wheatley

Will the joint scrutiny committee be examining whether the capacity planning in UHL’s acute reconfiguration proposals adequately take into consideration the growth plans across Leicester, Leicestershire and Rutland and increased numbers of dwellings and residents in the coming years?

Kathy Reynolds

How does the JHOSC plan to collect the evidence that will assure both the JHOSC and the public that STP/UHL plans for reconfiguration involving a capital bid for £367m will meet the future needs of the Leicester, Leicestershire & Rutland community?  I am particularly concerned that at the recent engagement events it became clear that the UHL Plan was reliant on changes within community and primary care to allow it to deliver. However, the Community / Primary Care Plan is not available nor has the associated engagement has taken place, raising questions about the assumptions behind UHL’s Plan. Does the JHOSC have a work plan or are they planning a programme of work to assure the public and can we be appraised of the arrangements?

The Chair responded to the questions raised as follows:

The Joint Scrutiny Committee was committed to continued scrutiny of the Better Care Together (BCT) Plan. The Scrutiny would take place within their meetings but also, with such a large programme of work, be delegated to the separate Local Authority Health and Wellbeing Scrutiny Commissions.

It was agreed at the meeting on 28 September 2018 that the BCT plan would remain a standing item on the agenda and updates are anticipated at every meeting.

The Committee would continue to pursue work around the proposals for UHL reconfiguring and agreed as to the importance of looking at capacity planning alongside population growth plans and forecasts of future health needs both within the UHL reconfiguration plans and the broader BCT plan. She had no doubt that public engagement would be a priority for the CCGs and other NHS services going forward and the Committee would continue to push for assurances that this would remain.

Scrutiny would also fulfil its role as it had been doing in the interests of all  ...  view the full minutes text for item 23.

The Committee will be asked to consider a report that provides an update on progress with proposals to appoint a joint accountable officer and management team across the three Clinical Commissioning Groups (CCGs) in Leicester, Leicestershire and Rutland (LLR) – NHS West Leicestershire CCG, NHS East Leicestershire and Rutland CCG and NHS Leicester City CCG. The report includes a link to an additional paper that provides background information, and that additional paper is also attached for Members’ convenience.

Caroline Trevithick, the Interim Accountable Officer, West Leicestershire CCG presented a report that provided an update on the West Leicestershire CCG, the East Leicestershire CCG and the Rutland CCG Management Structure.

Members considered the report and the ensuring comments and queries included the following:

·      Some Members commented that the plans for the management structure were very welcome as there was an overlap across the three CCG areas. It was noted that there was a trend for this happening across the country. Comments were made that new structure would lead to more efficient decision making.

·      Some concerns were expressed as to how the new management structure would work and that the Joint Accountable Officer would have immense responsibility.

The Interim Accountable Officer responded that the individual appointed to the post of Joint Accountable Officer would be working to three governing bodies and would be supported by a joint management team.

A Member expressed a concern about the governance issues and that having three governing bodies would make it difficult to performance manage that individual.

The Interim Accountable Officer said that the appointment process was very important (as it would be across the country) and the job description for the post would be based on a national job description for Accountable Officers.  A Member asked whether the Scrutiny Committee Members could be included in the interview process and heard that the process was not something that the CCGs could shape but this request would be reported back.

·      A concern was raised as to whether Leicester would continue to have the same scope for development and resources, as the City had very different demands compared to Leicestershire and Rutland, Members heard that the discussions had started by considering how there could be a more unified commissioning view whilst also acknowledging that each area had different needs.

·      It was noted that there was a requirement to reduce running costs by 20% by 2020/21 and a Member said that this need to save money should have been clearly set out. In response, Members heard that the process on the management structure had already started before the requirement to make that saving was known.  The proposals therefore were not driven by the need to save money; however, the CCGs tried to ensure that resources were used in the best way. A Member commented that there was no indication as to how much the proposals would save; information which she would have expected for proposals such as this.

·      Concern was expressed that limited progress was being made in the 13 Integrated locality teams across the LLR, and much more progress was needed if the whole process was going to work.

·      Concerns were expressed about the impact on staff including churn and redundancies and the Interim Accountable Officer explained that each of the individual CCGs were working with their staff. They had not seen a wholesale movement of staff and were trying to ensure that staff were supported through what was acknowledged to be a difficult time.

·      The  ...  view the full minutes text for item 24.

The Committee will be asked to receive a report that describes the activities undertaken in October and November 2018 to engage with communities in Leicester, Leicestershire and Rutland on Better Care Together. The report also describes the ongoing activities which will take place between January and March 2019.

The Committee is asked to note the outcome of the Better Care Together engagement work and the work to be undertaken early in 2019.

The Committee received a report relating to Better Care Together Engagement and Involvement that described the activities undertaken in October and November 2018 to engage with communities in Leicester, Leicestershire and Rutland (LLR) and the ongoing activities to take place between January and March 2019. 

Mr Richard Morris, the Director of Operations and Corporate Affairs, Leicester City CCG presented the report which was considered by Members.

During the ensuing discussion, Members raised comments and queries which included the following:

·      A concern was raised that there appeared to be no reference to the Stamford and Rutland Mercury being used to publicise engagement events. A member commented that not everyone used social media and even if they did, they did not necessarily have the time to ‘surf the net’ looking for interesting information.

The Director of Operations explained that there was a detailed communication plan and their social media work was part of a multi-disciplined approach which included the use of newspapers. He could confirm that the Stamford and Rutland Mercury had been used to publicise the local engagement events.  

·      In response to a comment that the Better Care Newsletter had not been received by some of the Committee Members, the Director of Operations expressed some surprise and said that he would look into this as the intention was for it to be sent to all the Councillors on the committee.

·      A Member cautioned that care was needed to use appropriate venues when carrying out cross border events.

·      Concerns were expressed that the engagement that had taken place was weak and that if the CCGs were only attracting the same people, they needed to engage in a different way to get a broader view. Members heard that as part of the engagement exercises, rather than asking people to come to them, the CCGs would now be going out to existing groups and forums and thus make it make it easier for more people to give their views.

·      Comments were made that people were generally less interested in participating in engagement sessions as they did not provide the public with information as to what would happen next, whereas consultations were more about the outcome.   Mr John Adler, the Chief Executive of the University Hospitals Leicester (UHL) acknowledged the point made but said that the NHS had reiterated that consultations could not be carried out until funding had been approved in principle. He stated that final approval had now been received for work on the Intensive Care Unit but there had not been any announcements on monies over £100m but as soon as any news arose he would inform the Committee.

The Chair drew the discussion to a close and said that the engagement events, were extremely important even though they only attracted about 350 responses. The Chair was also pleased that as part of the engagement, the CCGs had started to use social media and on-line newsletters which showed that they were still there and busy and to help myth bust. The previous  ...  view the full minutes text for item 25.

The Committee will be asked to receive a report from the three Clinical Commissioning Groups (CCGs) in Leicester, Leicestershire and Rutland that provides an overview of the Community Services Redesign project which looks at the future model of community health.

The Committee is asked to note the progress to date in redesigning  community health services and the next stage of the work.

Ms Tamsin Hooton, Director Lead for Community Services presented a report relating to Better Care Together, Community Health Services Redesign.  Members heard that the Redesign project was led by the three Clinical Commissioning Groups (CCGs) in Leicester, Leicestershire and Rutland which looked at the future model of community health. Members heard that the CCGs were about to commence engagement exercises and the Director said that she took on board the comments made by Members about the need to feed those comments into the process going forward.

Members considered the report and during the ensuing discussion, the comments and queries raised included the following:

·      A Member stressed the importance of working with Adult Social Care services in the three authorities across the LLR. In the past, he had expressed concerns that in relation to the STP there had not been enough joint working. The Director confirmed that they had been working with officers in each of the social care teams in the three different authorities.

·      In the report, there appeared to be issues regarding a general lack of confidence expressed by members of the public in the services and a Member asked as to how this could be restored. The Director responded that the CCGs recognised that there had been insufficient capacity around the neighbourhood nursing teams.  They wanted to restore that confidence and restore capacity to enable as far as possible, patients’ management by the GP teams. It was only through those teams working better together at a local level, that people’s confidence would be restored.

·      It was noted that the LLR had approximately half the number of community physio and occupational therapists compared to the national average. In addition, there had been reports earlier of a shortage of district nurses and a Member commented this impacted on discharges from hospital. The Member welcomed the fact that it was recognised that services were not working as well as they should.

·      It was noted that Neighbourhood Community Nursing, as part of the integrated locality teams would work closely with social care and primary care neighbourhoods. These would have approximately 30,000 – 50,000 patients and some surprise and concern was expressed at the size of these neighbourhoods.

·      A Member commented that the approach set out in the report made sense, particularly in relation to Home First services as many people preferred to remain in their own home. However, she had concerns as to how this would be managed on such a large level as there was a view that the Home First service and services around community and district nursing system was not working as well as it should.

Officers explained that the primary care networks provided an opportunity to join services such as primary care, district nurses and social cared together in a locality, where there would be a clinical director with a contract for delivering those services. This was part of the national direction of travel and the CCGs response to stop people staying in hospital who should not be  ...  view the full minutes text for item 26.

The Scrutiny Policy Officer submits a document that outlines the Leicestershire, Leicester and Rutland Health Scrutiny Committee Work Programme for 2018/19. The Committee is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Chair announced that the next meeting of the LLLR Joint Health Scrutiny Committee would take place on Tuesday 19 March at 10.00am.  The Chair said that she also hoped that an informal meeting of the Committee would be held before then to discuss the Better Care Together programme. In addition, for the agenda, the LPT had had another inspection and she anticipated that the CQC report would be available then for the Committee to discuss.

The Chair thanked officers for the quality of the reports they had brought to the Committee.

The Chair closed the meeting at 3.51 pm.