Agenda and minutes

The Chair welcomed those present and led introductions.

The Chair mentioned the following matters:

·         a separate Member briefing on the UHL statement of accounts was to be arranged by virtual means and communicated to Members as soon as possible.

·         the recent report from the Care Quality Commission was to be brought to both City and County scrutiny committees; Members suggested it would be better to come just to this joint committee. Chair agreed to look at arrangement of dates outside this meeting.

Apologies for absence were received from Councillor Bray, Councillor Whittle and Councillor Smith.

It was noted that Councillor Poland was present as a substitute for Councillor Smith.

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 King declared that he was involved with the Carers Centre Leicestershire, a local charity providing help and support for unpaid carers across Leicester, Leicestershire and Rutland.

Councillor Waller declared that she was a Trustee at the Carlton Hayes Mental Health Charity.

Both gave assurance that they retained an open mind for the purpose of discussion and any decisions being taken and were not therefore required to withdraw from the meeting.

The minutes of the meeting held on 13^th September 2021 are attached and the Committee is asked to confirm them as a correct record.

RESOLVED:

That the minutes of the meeting held on 13^th September 2021 be confirmed as an accurate record.

It was noted that health partners had offered a meeting outside this committee to explain responses to Councillor Harveys previous questions on post-partum figures in more detail.

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 Chair agreed to a change in the running order of the agenda to take the item on Dental Services in LLR; NHS England & NHS Improvement Response next.

Members to receive an updated report  on the provision of NHS dental services commissioned in Leicester, Leicestershire and Rutland together with an overview of the ongoing effects of the Covid 19 pandemic and the steps being taken to restore and recover service provisions.

5.50pm The Chair agreed to a short adjournment to resolve technical and audio issues with participants joining the meeting via Zoom for this item.

5.58pm Meeting resumed.

The committee received an updated report in relation to dental services commissioned across Leicester, Leicestershire and Rutland and an overview of the ongoing Covid 19 pandemic effects on those services as well as the steps being taken to restore and recover service provision.

Rose Marie Lynch, Allan Reid, and Catriona Peterson from NHS England were present to provide responses to any points raised.

Rose Marie Lynch, NHS England and NHS Improvement briefly introduced the report summarising key points which included:

·         An overview of the background and clarification as to how NHS dental care was provided;

·         Details of dental contracts in place across Leicester, Leicestershire, and Rutland as wells as extended or out of hours cover and secondary care;

·         NHS dental care access  was routinely at around 50% of the population, and dental practices had a duty to see people who needed treatment, however the number of people attending private services is not known;

·         The timeline for impact upon dentistry of the pandemic was referred to as set out in the report together with the ongoing impact and effects;

·         Significant impacts were largely due to measures introduced around infection prevention control and the national guidance that dental practitioners had to adhere to, e.g., introduction of “downtime” a period where the surgery must be left empty following any aerosol-generating procedure (AGP) i.e., fillings, root canal treatment or surgical extraction.

·         Information about the Urgent Dental Centres (UDC’s) provision and Urgent Care pathway was noted. Four urgent dental care centres (UDC’s) established during pandemic remained in place across Leicester, Leicestershire, and Rutland; their openings offered optimum coverage with a pathway to access through general dental practices or the 111 service.

·         Since the pandemic schemes had been commissioned with purpose of increasing patient provision and to enable additional activity at weekends, this had led to availability of 152 additional sessions for dental treatment. Providers had also been engaged to provide dedicated slots to the 111 service generating an additional 56 appointments each week across LLR for urgent treatment.

·         NHS England were now looking at commissioning a child access team as it was recognised children’s oral health and routine dental care had been impacted by the pandemic.

·         Steps were also being taken to invest in adult oral health and to address oral health inequalities.

Allan Reid, NHS England provided further details regarding oral health in Leicester, Leicestershire, and Rutland during which it was noted that:

·         Based upon the last national survey of 5 year old state school pupils (2021) Leicester City had the 2^nd highest childhood tooth decay levels in the region. Within Rutland, child decay was slightly higher than the regional and national average and in Leicestershire, Charnwood district had the highest tooth decay rates in the county.

·         Charts within the report set out  the prevalence of dental decay in 5 year olds by ward areas and  ...  view the full minutes text for item 37.

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:

From Robert Ball

1.    What provider collaboratives are under development or being anticipated?

2.    Can ISC leads confirm that commercial providers will be excluded from these provider collaboratives?

From Jean Burbridge

1.    At the least meeting ICS leads were asked “How will the Integrated Care Board improve the current reduced accountability and transparency?” but this was not answered. Are the ICS leads now able to answer this question?

2.    In the last meeting David Sissling stated that the local NHS is currently making no use of private companies to assist it in moving towards an ICS. Please could you clarify whether any companies have been used in recent years to assist in the transition to an ICS and, is so, which they were.

From Giuliana Foster

1.    Has a decision been made by the Treasury or Department of Health regarding the funding of the UHL reconfiguration scheme. If so, what is the decision? If not, when is this decision expected?

2.    University Hospitals of Leicester judges that a) some of the information in the templates returned to the National Hospital Programme team setting out alternative versions of the Building Better Hospitals for the Future Scheme was commercially sensitive and b) that it is not in the interest of the public to have this information. What type of information was provided in the templates returned to the National Hospital Programme team which was considered commercially sensitive?

These questions will be considered in accordance with Rule 10 of the Scrutiny Procedure rules of the Council’s Constitution.

The Chair explained the procedure to be followed for taking questions from the public and indicated that questions relating to the Integrated Care System could be taken under that item on the agenda.

The Chair took public questions as follows:

From Giuliana Foster

1.    Has a decision been made by the Treasury or Dept of Health regarding the funding of the UHL reconfiguration scheme. If so, what is the decision? If not, when is this decision expected?

2.    University Hospitals of Leicester judges that a) some of the information in the templates returned to the National Hospital Programme team setting out alternative versions of the Building Better Hospitals for the Future Scheme was commercially sensitive and b) that it is not in the interest of the public to have this information. What type of information was provided in the templates retuned to the National Hospital Programme team which was considered commercially sensitive?

It was noted that a representative of UHL was not present who could provide a response to these questions.

The Chair expressed dissatisfaction that a response wasn’t available for the meeting and asked for written responses to be provided before the next meeting.

Responses provided post meeting:

Q1 Answer – The plans are currently at the pre-outline business case stage and what we have submitted is being reviewed nationally. Details of the way forward, and timeframes, will be released once this has been agreed with the New Hospital Programme.

Q2 Answer – We have submitted plans which illustrate what can be achieved within the original funding allocation, our preferred option and a phased approach which would deliver the preferred option, albeit over a longer time scale. The Trust considers that this information is exempt from disclosure on the grounds of commercial interests and has applied the Public Interest Test as required.

From Jean Burbridge:

1.    At the last meeting ICS leads were asked “How will the Integrated Care Board improve the current reduced accountability and transparency?” but this was not answered. Are the ICS leads now able to answer this question?

2.    In the last meeting David Sissling stated that the local NHS is currently making no use of private companies to assist it in moving towards an ICS. Please could you clarify whether any companies have been used in recent years to assist in th transition to an ICS and, if so, which they were?

Andy Williams, Chief Executive ICS responded that:

 Q1. The Integrated Care Board (ICB) will hold meetings in public between 6 to 10 times per year, the exact configuration of those meetings was still to be determined by the board. There would typically be an annual meeting held in public. The ICS was still subject to the Act of Parliament being finalised and that would establish the board. The ICB would expect to undertake extensive engagement and it was envisaged that would be transparent.

Q2. This query related to the previous system when the STP linked with big companies. It was clarified that  ...  view the full minutes text for item 38.

Members to receive an update on the Covid 19 and Autumn/Winter vaccination programmes.

Caroline Trevithick, and Kay Darby, both of Leicester, Leicestershire and Rutland CCGs provided a presentation update on the ongoing situation with Covid 19 and the Autumn/Winter Vaccination programme including recent data and vaccination patterns across Leicester, Leicestershire, and Rutland.

Members noted that:

·         The vaccination programmes changed weekly and had now moved into the under 50 year old category, this meant the number of eligible people changed too.

·         There continued to be several ways to access vaccinations and details were updated regularly online.

·         Although there was data around vaccination take up the situation remained fluid and data changed regularly.

Members raised various concerns about the 3^rd dose and booster doses and the confusion amongst people around that. It was advised that the 3^rd dose and the booster were different. The 3^rd dose was for very vulnerable people, and they would still be called to have a booster. It was acknowledged there was confusion around those 2 terms and further clarity was needed especially when booking through GP surgeries to avoid people who were eligible being turned away.  The CCGs were taking steps to ensure that the right messages were sent out in relation to 3^rd doses and boosters.

It was noted that there were instances of people having 2 vaccinations and still catching covid and queried how the booster worked to promote immunisation and whether people had a natural immunity if they had covid. It was advised that where people had been vaccinated and then caught covid they were not usually as poorly as they might have been, but it was also important to note that immunity receded over time. It was likely anyone who had covid did have more immunity, but the levels of immunity were not known as there weren’t the resources to investigate that yet.

There was unease at the level of take up among young people, those of school age and children in care and it was queried how the vaccination programme had been developed since the last meeting to increase uptake in these groups and also among those living and working in care homes.

In relation to mandatory care home vaccination the CCGs had worked closely with local authorities to mitigate the risk of there not being enough staff to care for people. There were 3 homes in the city and 3 homes in the County with concerns and plans in place to work with them to ensure proper staffing. It was noted that the mandatory vaccination of clinical staff was most likely to affect unregistered staff nationally and CCGs were looking at steps to encourage and increase uptake of the vaccination amongst those. Campaigns were focused on convenience, confidence and addressing complacency and there was work with staff to support them in their choices.

Responding further on the comments regarding vaccination uptake Members were informed that:

·         The care homes team had now visited 90% of care homes and there was a 64% uptake of vaccinations across the residents; 18 care homes  ...  view the full minutes text for item 39.

Members to receive a report on black maternal healthcare and mortality, including details of what the local maternity and neonatal system is doing to address health inequalities and poor outcomes for women of a black and minority ethnic background.

The Committee received a report on black maternal healthcare and mortality, including details of what the local maternity and neonatal system was doing to address health inequalities and poor outcomes for women of a black or minority ethnic background.

Elaine Broughton, Head of Midwifery introduced the report and drew attention to the following points:

This report followed on from the work of MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) which continued to highlight multiple and complex problems that affect women who die in pregnancy, these could be a combination of social, physical and mental or just one of these factors alone. The Covid pandemic had also highlighted even more disparity.

During the Covid pandemic MBRRACE published a rapid report following a review over a 3 month period from 1^st March 2020 to 31^st May 2020 which included several key messages. During that period 10 women died, the majority being from black/ethnic minority backgrounds and the report went on to identify existing guidance that needed improvement and recommendations that needed implementation.

Following that report the NHS had developed a long term plan and recommendations to be implemented as part of their Equity and Equality: Guidance for Local Maternity Systems and on the back of this a piece of work was being done by LLR health colleagues around equality analysis. That would be used to inform an action plan and would be reported to the committee in due course.

Members discussed the report which included the following comments:

The in depth summary was welcomed and it was acknowledged this was a very difficult subject.

In terms of lessons learnt, all deaths were investigated by an external H&S branch set up by the government, that involved extensive investigation and a comprehensive report of findings, and this had been in place locally for over 2 years so there was confidence that the service was addressing lessons to be learnt.

It was noted that one of the issues raised concerned black and ethnic minority women’s voices not being heard and it was asked how the service were taking that forward. Floretta Cox, Midwifery Matron advised that they were developing a dashboard with key performance indicators to look at issues such as this. There was a joint healthcare review of the issues that black and ethnic women had and an action plan would be drawn from that. Leicester, Leicestershire and Rutland were the only area in UK doing that as the demographics and diversity of the area were well recognised. As an example of the steps being taken, the Covid action plan was shared with Sharma and other women’s groups and feedback from them informed that plan was pitched right. In another example antenatal services during Covid were moved online with peer supporters and steps taken to get the same ethnic mix/language among peers.

It was queried whether the ethnicity of midwives working across LLR reflected the demographics of the area as a whole and any steps being taken  ...  view the full minutes text for item 40.

Members to receive a report providing an overview of the LLR Integrated Care System taking into account recent guidance issued by NHS England and the Health and Care Bill.

The Chair invited Robert Ball to put his questions.

From Robert Ball:

Q1: What provider collaboratives are under development or being anticipated?

Q2: Can ISC leads confirm that commercial providers will be excluded from these provider collaboratives?

Andy Williams, Chief Executive ICS responded that they were looking at collaboratives based on care areas. The focus would be on care areas such as elective care, learning, disabilities, children services etc. ICS were keen to progress the first two care areas then set up other collaboratives over the next 12 to 18 months

In relation to the second question, the government had not placed any commercial providers in governance although it was unavoidable there would be some involvement in the collaboratives as it was an integral part of service delivery.

Leadership would therefore be through the ICB, and collaboratives would be through public sector but would involve the independent sector in collaboration work.

The Chair invited Andy Williams to continue that discussion with Robert Ball outside this meeting.

Sarah Prema, Executive Director of Strategy and Planning briefly reminded members of the situation around ICS which had already been discussed in detail at independent Health Scrutiny Commissions of local authorities across LLR.

Members noted that the process to develop ICS was 2 fold; the legal process to close existing CCG’s and importantly improving experience and outcomes. The statutory footing of ICB and ICS provided the facility to remove barriers and enable faster co-ordination of care across pathways and increase improvement of outcomes for patients.

Sarah Prema presented details of the approach for LLR, examples of what was being done to integrate services, the priorities for integration and transformation in LLR, the overview of the ICS infrastructure, the high level responsibilities of each place group and draft place based governance.

Members noted the progress and next steps which included:

·         A designated Chair (David Sissling) in place and appointment of Andy Williams as Chief Executive.

·         Recruitment processes and ICP governance arrangements to be finalised.

·         Due diligence to complete in closing CCG’s establishing the Board.

·         Finalising leadership arrangements.

Members discussed the presentation which included the following comments:

·         It was clarified that Andy Williams had been appointed by the Chair as designate CEO and through NHS England. In due course the ICB would become the statutory board and that would be the legal employer. ICB would be the board whereas the ICP would be the partnership body in between.

·         In relation to governance arrangements, equal partnership and involvement of local government, it was clarified that both upper and lower tiers would be engaged however it would be for the Health and Wellbeing Board to determine that involvement. The board (ICB) would advocate 3 places around the table from local government and that could include officers. The board would be subject to scrutiny at all levels and there was no attempt to differentiate between place and system scrutiny.

·         With regards to maintaining patient care during the transition arrangements there was a long history of re-organisation and with support  ...  view the full minutes text for item 41.

Councillor Samantha Harvey submits the following question:

Following a negative patient experience at LRI last month, and the difficulty faced trying to navigate the LRI site, can our UHL colleagues comment on the following:

-          Why does the website contain incorrect information that is years out-of-date? The receptionist, at the incorrect location, explained the web site information has been incorrect for ages and the correct location was at the other end of the campus.

-          Why is the website so difficult to navigate and makes it almost impossible to find any useful patient information?

-          Why is the signposting to campus so very poor? Circling the site, in search of the correct entrance is not good for a calm state of mind or for patient wellbeing.

-          Internal signage is poor and there was no sight of the usual cheery volunteers or porters to point or lead the way.

-          Why are there no maps of the campus and car parks available on-line?

Councillor Samantha Harvey submitted the following questions:

Following a negative patient experience at LRI last month, and the difficulty faced trying to navigate the LRI site, can our UHL colleagues’ comment on the following:

·         Why does the website contain incorrect information that is years out of date? The receptionist, at the incorrect location, explained the web site information has been incorrect for ages and the correct location was at the other end of the campus.

·         Why is the website so difficult to navigate and makes it almost impossible to find any useful patient information?

·         Why is the signposting to campus so very poor? Circling the site, in search of the correct entrance is not good for a calm state of mind or patient wellbeing.

·         Internal signage is poor and there was no sight of the usual cheery volunteers or porters to point or lead the way.

·         Why are there no maps of the campus and car parks available online?

Response received post meeting:

Maria O’Brien, Head of Communications replied that:

“Our website is tabled for improvements next year. Given the scale of the project, it has not been possible to update the site until this time.

We are aware of search issues and whilst we provide as much via homepage links as possible, we know this can be improved and will be a critical part of our website development plan.

Whilst there are maps of the sites, we know these are out of fate. We are currently in the middle of an improvement project looking at all of these in light of continued development work at all of our sites.”

Answers to the remaining questions will be sent as soon as possible.

Members will be asked to consider the Work Programme and make any comments and/or suggestions for inclusion as it considers necessary.

The contents of the work programme were noted and additional items mentioned during Chairs announcements to be updated.

AOUB 1

UHL Finance and misstatement of accounts.

None.

28^th March 2022 at 5.30pm

The next scheduled meeting to take place on: 28^th March 2022 at 5pm

Any special or extraordinary meetings before then will be notified separately.

There being no further business the meeting closed at 9.10pm.