Agenda and minutes

Apologies for absence were received from Councillor Morgan and, Ruth Lake - Director of Adult Social Care.

It was noted that Councillor Poland was in attendance as a substitute for Councillor Morgan.

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 interest they may have in the business on the agenda.

Councillor Hack declared an interest in that she worked for Advance Housing and Support in the Housing division providing accommodation and support in the Leicester, Leicestershire and Rutland area for individuals with Learning Disabilities and Mental Health Disabilities.

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

For the purpose of discussion and any decisions being taken they retained an open mind and were not therefore required to withdraw from the meeting.

The minutes of the meeting held on 16^th November 2021 and the special meeting held on 15^th February 2022 are attached and the Committee will be asked to confirm them as a correct record.

It was noted that the minutes of the meeting held Tuesday 16^th November 2021 omitted to include the presence of Councillor Waller and Councillor Pantling who were both present.

It was also noted that the minutes of the meeting held Tuesday 15^th February 2022 omitted to include the presence of Councillor Pantling who was present.

AGREED:

That subject to an amendment to correct attendance of Members as referred to above, the minutes of the meetings held on Tuesday 16^th November 2021 and Tuesday 15^th February 2022 be confirmed as an accurate record.

None outstanding.

The Chair announced a change to the running order of the agenda and agreed to take the Item Re-procurement of the Non-Emergency Patient Transport Service (NEPTS) as the next substantive item of business.

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

Response to ICS Constitution petition to be recevied.

The Chair informed those present that the response to the ICS Constitution petition submitted at the last meeting would be received as part of the substantive item Integrated Care System Update.

Members to receive a presentation that provides details around the re-procurement of the Non-Emergency Patient Transport Service (NEPTS).

Members received a presentation providing details around the re-procurement of the Non-Emergency Patient Transport Service (NEPTS)

Joanne McKenna, Head of Contracts and Procurement, LLR CCG introduced the presentation noting that certain details remained commercially sensitive and drew attention to the following points:

·         Non-emergency patient transport within Leicester, Leicestershire and Rutland was currently provided by Thames Ambulance Service Ltd (TASL) providing around 15000 journeys per year. The current contract was due to end in September 22 but was being extended to enable feedback from stakeholders and to fully consider improvements for the new service.

·         The new procurement was aimed at bringing services together to improve  both quality of service to all patients and flow of patients through the healthcare system.

·         Feedback was being sought from patient and service users as well as by provider engagement using a variety of tools e.g., online surveys, patient QAs, and discussions with service referrers; that feedback would be used to support the service specifications and a complete data report would be produced in April 2022.

·         Internal stakeholder engagement showed there were good and bad experiences with the current system; generally service users had good relations with the drivers however the downside included long waits for journeys, resources not matching peeks in activity; delays in collecting discharges for time critical patients, patient appointments overrunning and the knock on effect of that on other patient services.

·         The new contract would seek to include real-time patient updates to address issues of waiting, journey delay and pick-ups.

·         Local guidance was also being developed to improve the user experience taking account of recently reviewed national guidelines.

Members discussed how the service would change; the improvements for patients; increased flexibility and the eligibility criteria as set out in the presentation.

Members noted the transport provision needed to be reflective of patients’ needs and to progress with them. It was hoped that the frictions and issues experienced previously would be reduced through the long mobilisation phase of the procurement process.  In terms of service change, it was advised response transport would be wrapped into the system such as Emergency Services as well as Outpatient Services, and providers would have to have special awareness and establish their own patient participation groups to understand the proposals, delivery plans, expectations etc.

Concerns were raised about the eligibility criteria: the lack of information/data in that regard; the uncertainty around patients who had transport initially but not later; and ensuring the eligibility criteria was broad and inclusive.

Members were informed that NHS England and NHS Improvement had established a team to review and help standardise the approach in this area and they had developed updated national eligibility criteria following the published outcome of a review into non-emergency patient transport services (NEPTS). That was consulted upon in Autumn 2021 and the criteria was subject to final stages of development before publication of a final report in Spring 2022. Indicators were that the proposed new criteria were broadly consistent with LLR local eligibility criteria. The patient criteria may change,  ...  view the full minutes text for item 59.

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

The following questions have been received:

From Steve Score

Q1 Will the public be consulted on the draft Integrated Care Board constitution before it is finalised?

From Kathryn Jones

Q1 I have been trying unsuccessfully to find the papers taken by the shadow Integrated Care Board meetings in the papers for the CCG governing body meetings and am concerned about the lack of transparency. Please could you tell me where they can be found?

From Kathy Reynolds

Q1 At a previous meeting the LLR ICS explained that councillors were explicitly banned from sitting on integrated care boards. In the House of Lords on 9^th February Health Minister Lord Kamall, announced that NHS England will revise its draft guidance to remove the proposed blanket exclusion of councillors sitting on integrated care boards. What does this mean for the membership of the LLR ICS Board?

Q2 We know that the Designate CEO and Designate Chair have been appointed, have any other Designate Members been appointed and how will the selection process for board members change to allow selection of councillors?

From Jean Burbridge:

Q1 At the January meeting of the Leicester City Health Overview and Scrutiny Committee, I asked the question whether social enterprises would sit on the Integrated Care Board and/or ICS Partnership. I have since discovered that there is already a social enterprise (namely DHU Health Care) represented on the shadow Integrated Care Board, but I was not given this information in the response to my question. Please could you let me know if there are plans to include other social enterprises or “independent organisations” on the Integrated Care Board in either shadow or full form?

From Sally Ruane

Q1 Will the ICS Chair guarantee that the Integrated Care Board or any other local commissioner will pay for the emergency health care, including ambulance services, required by all people in its geographical area even if some of those individuals are visiting from other parts of the country?

Q2 The Health and Care Bill makes reference to “the group of people for whom each [Integrated Care Board] has core responsibility” (emphasis added). Will the ICS Chair pledge that the Integrated Care System in Leicester, Leicestershire and Rutland will abide by the principles of comprehensive and universal health care?

From Godfrey Jennings

Q1 Please could you tell me why the draft Integrated Care Board Constitution has not been to the joint health overview and scrutiny committee as is happening in several other parts of the country where good practice is being observed. When will the draft be brought to this committee before it is finalised?

The Chair explained the procedure to be followed and took public questions as follows:

From Steve Score: Will the public be consulted on the draft integrated care board constitution before it is finalised?

From Sally Ruane on behalf of Kathryn Jones: I have been trying unsuccessfully to find the papers taken by the shadow Integrated Care Board meetings in the papers for the CCG governing body meetings and am concerned about the lack of transparency. Please could you tell me where they can be found?

From Sally Ruane: Will the ICS Chair guarantee that the Integrated Care Board or any other local commissioner will pay for the emergency health care, including ambulance services, required by all people in its geographical area even if some of those individuals are visiting from other parts of the country?

The Health and Care Bill makes reference to the group of people for whom each integrated Care Board has core responsibility. Will the ICS Chair pledge that the Integrated Care System in Leicester Leicestershire and Rutland will abide by the principles of comprehensive and universal health care?

From Kathy Reynolds (read by the Chair on her behalf): At a previous meeting the LLR ICS explained that councillors were explicitly banned from sitting on integrated care boards. In the House of Lords on 9^th February Health Minister Lord Kamall, announced that NHS England will revise its draft guidance to remove the proposed blanket exclusion of councillors sitting on integrated care boards. What does this mean for the membership of the LLR ICS Board?

We know that the Designate CEO and Designate Chair have been appointed, have any other Designate Members been appointed and how will the selection process for board members change to allow selection of councillors?

From Godfrey Jennings: Please could you tell me why the draft integrated care board Constitution has not been to the joint health overview and scrutiny committee as is happening in several other parts of the country where good practice is being observed. When will the draft be brought to this committee before it is finalised?

From Jean Burbridge: At the January meeting of the Leicester City Health & wellbeing Scrutiny Committee, I asked the question whether social enterprises would sit on the Integrated Care Board and/or ICS Partnership. I have since discovered that there is already a social enterprise (namely DHU Health Care) represented on the shadow integrated care board, but I was not given this information in the response to my question. Please could you let me know if there are plans to include other social enterprises or “independent organisations” on the Integrated Care Board in either shadow or full form?

Andy Williams Designate CEO, ICS responded to the public questions as follows:

The LLR ICB constitution was based upon the national model and was still being developed. The national model was available on the NHS website and the only substantive change suggested to that was to broaden membership so it could include availability for local government representatives  ...  view the full minutes text for item 60.

Members to receive a report that provides an update on progress towards the establishment of the Leicester, Leicestershire, and Rutland Integrated Care Board.

Members received a report providing an update on progress towards the Leicester, Leicestershire and Rutland Integrated Care Board.

The Chair invited Members comments which included the following points:

Concerns were expressed about accessibility of documents, and the impact of that, for example limiting the opportunity for disabled people to respond to consultations/engagements so losing a valuable voice. A request was also made to ensure that all future reports and documents submitted to this committee were fully accessible not just easy read.

Andy Williams Designate CEO of ICS apologised for the difficulties with accessibility of all documents and agreed to investigate this issue as the ICS was keen to avoid disenfranchising any groups.

Concerns about how the voluntary sector would be engaged considering the gap in voluntary sector emerging across LLR were noted and the ICS would reflect further as to whether there was more, they could do to strengthen that.

In relation to engagement with non-public bodies, the ethos was to move towards integrated care systems and away from tendering/market based procurement however, for a variety of reasons there was a lot of important involvement with organisations, and they tried to do that appropriately. Relations with all partners were important to deliver services, including with private sector, and there would be times when the ICS needed to work in active partnership with non-public bodies, but they wanted to be very transparent around that and it was not envisioned there would be any non-public body involved in governance or as part of the ICB, that included any it’s sub-committees. In respect of service delivery or bringing something back within public delivery that was a possibility for ICS, but it had to be what was in interest of the public, and the ICS would have greater discretion moving forward.

In terms of councillors being able to sit on ICB, the board was being formed to include local authority membership and the three local authorities (Leicester, Leicestershire, and Rutland) would determine their own nominations whether that be councillors or a specific role/officer.

Andy Williams confirmed that it was intended for the Healthwatch Chairs across LLR to be invited to ICB meetings as non-voting members.

The Chair thanked Andy Williams for the update.

AGREED:

That the contents of the report be noted.

Members to receive a verbal update on the current position around Covid 19 and the ongoing vaccination programmes.

Caroline Trevithick of LLR CCG provided an update on the ongoing situation with Covid 19 and the vaccination programme including recent data and emerging patterns across Leicester, Leicestershire, and Rutland.

Members noted that:

·         Uptake had slowed considerably and focus was on progressing vaccination uptake among those in population that haven’t had any vaccination; steps taken included opening more drive through centres i.e., at County Hall and across parts of the city and districts to make vaccination process more accessible.

·         Roll out of the 2^nd booster (4^th dose) to over 75 years had started and those clinically vulnerable who had 3^rd dose were now eligible for a 4^th.

·         Planning for Autumn was underway as well as for roll out of boosters should that be required.

·         There were still some high numbers of covid patients in hospital and people being tested positive in hospital as a secondary issue.

·         Uptake among 5-11 year olds was proving difficult as there was a lower willingness for parents to allow children to be vaccinated.

·         81% of population of LLR had now received a 1^st dose and care home uptake was the best in region for boosters however, there were significant differences spread across LLR and it was agreed to share data by CCG cohorts for City, County East and West.

The Chair noted that there had already been significant discussion on this topic at the recent Leicester Health & Wellbeing Scrutiny Committee and invited Members questions and comments which included the following points:

Concerns were expressed at the low uptake levels among younger age groups, the lack of information being provided to parents to help them make informed choices about the pros and cons of the vaccination and the scarce details around immunity e.g., in younger people that had already had Covid or for those that had a vaccination some time ago.

In response it was advised as regards the 5-11 year old group there was national recognition that delivery of vaccination in schools puts lots of pressure on small immunisation teams and stops parents getting their child vaccinated when they want so there was a different model being applied. There remained a vaccination programme in secondary schools and for any 11-12 years that missed the 1^st programme details were on CCG websites about catch up vaccinations. As for pros/cons of vaccinating the main message remained that vaccination helped reduce the spread and severity of the illness particularly amongst those more vulnerable.

In terms of immunity, the understanding was that for those over 75 years immunity does wain at around 6 months and so boosters were encouraged.

It was acknowledged that messages around Covid had gone quiet nationally and locally and the CCG were looking to fill the communications gap. There was a large amount of concern about anti-vaxing and the impact of that on other vaccine programmes across the country and CCG were also looking at systematic targeted approaches to address that.

The Chair thanked health partners for the update  ...  view the full minutes text for item 62.

Members to receive a verbal update on general activities regarding University Hospitals Leicester (UHL).

Richard Mitchell, Chief Executive Officer at university Hospitals Leicester (UHL) was introduced to the Committee as the Chief Executive in post since October 2021.

Richard Mitchell provided a verbal update around 5 themes which included the following points:

Covid

There were currently 210 patients in UHL across 10 wards, of these 85% were presenting with Covid as a secondary diagnosis. As for staff, 10% were currently off with Covid too.

Waiting Lists

Acknowledged that waiting times had deteriorated and had been worsened during the Covid situation. Some progress had been made over last 6 months to reduce the waiting times for Elective Care although given length time of closures there were still very high volumes and Leicester was amongst worse in country and they were looking to address that.

Emergency care performance had been very challenged at Leicester; Covid was still making it more difficult, and the hospital was focusing on discharge pathways to improve the situation.

In relation to cancer care patients were waiting longer than pre-covid, however waiting times were overall within the safety marker but the hospital was keen to get back to where they were and to improve.

Senior Staffing

There had been a number of changes since October 2021 with Richard Mitchell taking up the CEO role following John Adler’s retirement. Three executive director vacancies had also been recruited to and 4 non-executive directors had joined. The Board chaired by John McDonald were looking to fill other senior appointments over next 3 months.

UHL Finances

The annual accounts for the financial year 2019-202 were still not signed off, although they had now been presented to the audit board and were due to be taken to the public board next week. The annual accounts for financial year 2020-2021 were also due to be taken to the public board next week and the hospital hoped to be exiting the Recovery Support Programme (RSP) around October 2022.

UHL Reconfiguration

As part of national strategy UHL was lucky to be one of eight pathway trusts on the reconfiguration programme. Members were reminded that there were four pillars to the programme, a dedicated Children’s Hospital; restructuring of the Intensive Care Units from three to two due to be completed in May 2022; reconfiguration of Maternity services  to two units; and finally the separation of elective/emergency care, this was awaiting final confirmation around receipt of £37m to help facilitate that.

Members discussed the update which included the following points:

There were concerns that the concentration of services around Glenfield Hospital was problematic for residents in south Leicestershire and it was accepted that access to Glenfield could be difficult, but UHL wanted to work with people to address those issues e.g., through development of a travel plan.

It was commented that despite the reconfiguration plans and the large amount of monies involved that was not addressing the waiting list issues mentioned or the waits for other services e.g., musculoskeletal conditions and assurance was sought that was being addressed. In response it was  ...  view the full minutes text for item 63.

Members to receive a report providing an update on the East Midlands Ambulance Service (EMAS) Clinical Operating Model and introduction of Specialist Practitioners.

Members received a report providing an update on the EMAS Clinical Operating Model and introduction of Specialist Practitioners.

Richard Lines Divisional Director EMAS introduced the report providing insight into the background of the Clinical Operating Model review and the three areas of focus: the clinical model; clinical hub and clinical leadership.

It was noted:

·         one of the outcomes of the review was the introduction of specialist practitioners  to enhance delivery of clinical care;  six were recruited initially in September 2020 with an additional 12 in 2021 allowing for 24/7 cover across the division (Leicester, Leicestershire, and Rutland).

·         alongside clinical outcomes there had been a reduction of burden on emergency departments in Leicestershire as specialist practitioners were mainly focused on chronic patients which avoided admissions into hospital.

·         as fast responders specialist practitioners also dealt with cardiac arrests, their role at cardiac arrest was to lead rather than be hands on, providing clinical leadership for ambulance/paramedic crews with the aim of getting patients to the right care.

Members welcomed the report and the positive outcomes, and the ensuing discussion included the following points:

In relation to any concern that ambulance crews might be waiting for a specialist practitioner to arrive, it was not the case that they would be waiting for a specialist as calls were prioritised and appropriate crews responded e.g., in terms of despatch a cardiac arrest would take priority and where necessary a paramedic would be sent if that gave a quicker response time. Typically, a call in categories 3 or 4 would have a 4-6 hour waiting time.

Specialist practitioners were a specific resource providing additional roles to support the existing provision and there had not been any reduction of other ambulance provision. The number of specialist practitioners was being steadily increased and EMAS were looking at the possibility of different roles within that, i.e., specialists in an area.

Members queried whether there were any increased risks associated with carrying additional end of life drugs by the specialist practitioners. It was advised that all crews carried a range of drugs which were all logged with limited accessibility. There were very few incidents upon staff for purpose of obtaining drugs.

The Chair thanked Richard for the update.

AGREED:

                        That the contents of the report be noted.

Members to receive a report that provides details of the dormitory eradication programme together with a brief update on the LPT response to CQC inspection.

Members received a report providing an update around the dormitory eradication programme.

It was noted that

·         In 2018 four specific wards were identified to be changed and £9.2m provided to make those changes to improve safety and ensure dignity of patients, this also helped with infection control especially during the covid pandemic

·         3 out of the 4 wards identified had been completed as highlighted by CQC in their inspection and work on the 4^th had started and would be completed by next year.

Members viewed images of the improvements to the wards noting they were brighter, more attractive and provided patients privacy which also helped improve their mental health. Improvements included the wards being painted throughout, improved Wi-Fi signals, replacing staffing call points, and roll out of wrist bands for patients which was another feature captured in the CQC inspection last year.

It was noted that feedback had been gathered from patients and staff resulting in the latest installation of modern doors using most recent technology which could indicate if someone was looking for a ligature point and also anti-barricade.

Members expressed some concern about the impact of the programme on the  number of bedspaces. It was advised that 27 bed spaces (from a total of 247) had been lost, all but two of those were in older people wards but the plan was to return to the original number of beds and a bid had been made to support that with the outcome expected in July. In terms of impact, the situation was unchanged as it was always a difficulty to get people into beds and the shortage was a national issue. To address the issue there was now more emphasis on community services in first instance and trying to prevent hospitalisation.

As far as the programme of works, scope for slippage had been built into the programmes, although there were risks within projects of this scale and size. The main concerns were around supply chain in general and long lead in times which made it difficult to switch supplier. The current economic situation and rise in inflation was adding to price. Funds for the programme were based on initial costs but that included a small contingency and at the moment the programme was on target and within budget.

Reference was made to discussion at the last meeting which talked about the wider issues arising from the CQC inspection and its findings. As regards the challenge around the Trust being given a Requires Improvement (RI) rating it was important to note the inspection related to only 3 core services out of 15 core services.  It was also noted that the report at this meeting was only in relation to the dormitory programme, although acknowledged that across the wider estate the dormitory programme was a significant reason why the ratings were the way they were. Members were informed that the CQC visit was nearly a year ago and a lot of progress had been made by the Trust since,  ...  view the full minutes text for item 65.

Members to receive a report that provides details of the Transforming Care programme in Leicester, Leicestershire and Rutland - Learning Disabilities update.

Members received a report providing an update on the partnership work across Leicester, Leicestershire and Rutland to deliver improved performance and outcomes for people living with a learning disability or autism.

David Williams Executive Director of Strategy & Partnerships, Leicestershire Partnership Trust introduced the report setting out what had been achieved so far, this included successes e.g., less people in long-term hospital now than in 2015; when working together to avoid a crisis admission was avoided  79% of the time; the culture and improvement journey so far and LPT’s future vision. Attention was also drawn to opportunities over the next 12 months to further develop.

Members commented that conditions such as autism still took a long time to get  a diagnosis and were often missed at schools, although the report had some positive outcome in relation to autism there was still more help needed in the community to better understand these conditions and it was queried whether support to schools was extended to further education and parents of those in further education.

Regarding early identification and support, it was advised the government was investing in mental health in schools, and there was joint funding for LPT, and education being used towards supporting identification; schools and teachers as well as a key programme with Barnados to give families support.

Concern was expressed that the report was lacking in details or data and gave no information about the level of support available during transition from child to adult or once a person with autism reached 18 years old and it was emphasised that this was a lifelong condition but as an adult there was little support especially for those who were more cognitive or able to hold a job.

Members were reminded that this was a joint report of the SRO and there were additional services and launched specialist NHS services available. As regards the points made about employment, this was a whole society issue and required working together, some conversations were taking place about how to make LA health more anchoring and there had been progression, but this was part of a wider improvement journey.

The Chair thanked health partners for the report and indicated it would be helpful to have a more detailed report to a future meeting.

AGREED:

That a further report around Transforming Care in Leicester, Leicestershire and Rutland – Learning Disabilities, to include more information and supporting data be brough to a future meeting.

None received.

None received.

Members will be asked to note the work programme and consider any future items for inclusion.

Members received and noted the current work programme.

Members will be asked to note the dates of future meetings as follows:

·         Monday 27^th  June 2022 at 5.30pm

·         Wednesday 16^th November 2022 at 12 noon

·         Wednesday 12^th April 2023 at 5.30pm

All meetings to take place at City Hall unless otherwise notified.

Future meetings of the committee for the municipal year 2022-23 were noted as follows:

·         Monday 27^th June 2022 at 5.30pm

·         Wednesday 16^th November 2022 at 12 noon

·         Wednesday 12^th April 2023 at 5.30pm

None notified.

There being no further business the meeting closed at 9.20pm.