Agenda and minutes

The Chair welcomed those present both in person and via Zoom and led introductions.

The Chair confirmed this was a hybrid meeting and explained what that meant for those present.

The Chair mentioned that he had recently met with officers from UHL Hospitals around a Building Better Hospitals update and note there are a number of questions here tonight and hopefully those responses will accord with what was said in the briefing.

The Chair indicated that future standing items to the agenda would include a regular update on Covid 19 and the Vaccination programme as well as an item for Members questions.

Apologies for absence were received and noted from Councillor Aldred, Councillor Bray, Councillor King, Councillor Harvey and Councillor Waller.

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. There were no such declarations.

The minutes of the meeting held on 6^TH July 2021 have been circulated and the Committee is asked to confirm them as a correct record.

NOTE: appended to the minutes are written responses provided outside the meeting to questions raised at the meeting.

RESOLVED:

That the minutes of the meeting held on 6^th July 2021 be confirmed as an accurate record.

To note progress against actions of previous meetings not reported elsewhere on the agenda (if any).

None outstanding.

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 following questions have been received:

From Indira Nath : Q1: “According to the Health Service Journal (29^th July 2021) the New Hospital Programme Team requested the following documents of Trusts who are “pathfinder trusts” in the government’s hospital building programme.

·         An option costing no more than £400 million;

·         The Trust’s preferred option, at the cost they are currently expecting; and

·         A phased approach to delivery of the preferred option.

So, in relation to the Building Better Hospitals for the Future scheme, when will the documents sent to the new hospital programme team on these options be made publicly available? Are they available now? If not available, why not?

Q2: “ICS Chair David Sissling stated at the Leicester City Health and Wellbeing Scrutiny Commission that the local NHS needs to become more adept at engaging the public. What do you think have been the weaknesses in NHS engagement with the public and what will becoming more adept at public engagement involve? Please can you also explain the relationship between the main ICS NHS Board and the ICS Health and Care Partnership Board, and tell me what each will focus on and the balance of power between them?

From Sally Ruane: Q1: “Following information requested by the New Hospital Programme Team, what changes were made to the Building Better Hospitals for the Future scheme in order to submit a version of the scheme which costs £400m or less? And what elements of the scheme were taken out to reach this lower maximum spend?

Q2: “My question to the Joint Health Scrutiny meeting in July asked about an ‘Impartiality Clause’ voluntary organisations were required to sign by CCGs if they wished to promote the Building Better Hospitals for the Future consultation in exchange for modest payment. Unfortunately, neither the oral nor the written responses fully addressed this question. Please can I ask again whether the Impartiality Agreement was legal, whether it is seen as good practice and what dangers were considered in deciding to proceed with these agreements; and what steps the CCGs took to ensure that organisations under contract informed their members/followers in any engagement they (the organisations) had with their members/followers that they were working under a service level agreement which contained an “impartiality clause”.

Q3: “There is little in the government’s legislation about the accountability of integrated care systems to the local public and local communities. How will the integrated care board be accountable to the public? Its precursor, the System Leadership Team, has not met in public or even, apart from the minutes, made its papers available to the public. The CCGs have moved from monthly to bi-monthly governing body meetings; UHL has moved from monthly to bi-monthly boards and does not permit members of the public to be present at the board to ask questions. How will the integrated care Board provide accountability to  ...  view the full agenda text for item 21.

The Monitoring Officer reported that several questions had been submitted by members of the public as set out on the agenda.

The Chair outlined the procedure for the meeting and advised that there was a wide amount of overlap in the questions which had therefore been put into three groups to be taken together with the opportunity for each questioner to ask a supplemental question.

·         Health Service Journal report

From Indira Nath: Q1:“According to the Health Service Journal(29thJuly 2021) the New Hospital ProgrammeTeam requestedthe followingdocuments of Trusts who are “pathfinder trusts” in the government’s hospitalbuilding programme.

·         An option costing nomore than £400million;

·         The Trust’s preferredoption, atthe costthey are currentlyexpecting; and

·         A phased approach to deliveryof the preferred option.

So, in relation tothe BuildingBetter Hospitals for the Future scheme, when will thedocuments sent tothe newhospital programmeteam on these optionsbe made publicly available?Are theyavailable now? If not available, whynot?

FromSally Ruane: Q1:“Following informationrequested bythe New Hospital Programme Team,what changes were made tothe BuildingBetter Hospitals for theFuture scheme in order to submita version of the scheme which costs £400mor less? And whatelements of thescheme were taken out to reachthis lower maximum spend?

FromTom Barker: Q1“The government is indicatingthat theymay nownot fullyfund trusts’ preferrednew hospitalschemes, despite previous assurances. Botha phased approach anda cheaper, £400mscheme will impactthe delivery ofcare significantly as bothwill require changes to workflow. This would especially affect peoplein Leicester, Leicestershire andRutland as the UHL reconfigurationplans have limited newbuild (the Glenfield TreatmentCentre and theLRI Maternity Hospital)and involve a lot of emptyingand reconfiguration ofworking buildings. Droppinga project ordelaying it could veryeasily createa situation where necessaryadjacencies are lostetc. What willbe the impacton patientexperience of boththe £400mversion of the project andthe phasedapproach?

Q2“With regard toBuilding Better Hospitalsfor the Future, what are therevised costings as ofAugust 2021 for thefull (and preferred) scheme including local scope/national policychanges as requested bythe New Hospital Programme?”

FromJennifer Foxon: “Re thehospital reconfiguration plans inLLR, howwould a phased approach change thefinal organisation of hospital services when comparedwith current plans?”

Rebecca Brown, Acting Chief Executive UHL, responded that in terms of the reconfiguration, as one of the 8 national New Hospital Programme (NHP), Pathfinder schemes UHL had been asked to look at a range of approaches on how to go about building new hospitals in Leicester. Three scenarios were being considered:

–     An option that fits the Trust’s initial capital allocation of £450m in 2019

–     The Trust’s preferred option

–     A phased approach to delivery of the preferred option

The Leicester scheme had remained  ...  view the full minutes text for item 21.

Members to receive a report providing an overview of NHS dental services commissioned in Leicester, Leicestershire and Rutland and an update on the impact of the ongoing COVID19 pandemic on those services.

The committee received a report containing an overview of NHS dental services commissioned in Leicester, Leicestershire, and Rutland and an update on the impact of the ongoing Covid 19 pandemic on those services.

The Chair noted that Tom Bailey, Senior Commissioning Manager, NHS England had to leave the meeting early and there was no-one else at the meeting to present this report or respond to questions.

The Chair was disappointed that the report contained insufficient information about the recommencement of services across the City, County or Rutland. The Chair noted it was the responsibility of the committee to scrutinise this and therefore a fully updated report with more detail and data would be sought for  the next meeting.

Mukesh Barot from Healthwatch welcomed the response noting however the concerns of the public and the issues raised about people for SEN were not fully answered. He indicated that Healthwatch were intending to do further research into dentistry issues as a special project. The Chair suggested it would be helpful to do that collaboratively and to press for data on dentistry to come to this committee.

Dr Janet Underwood from Healthwatch commented that there were mixed messages that needed clarification. Some practices were not accepting NHS patients but would if they paid privately; children were not being seen regularly and some patients were waiting up to 3 years for orthodontal treatment.

It was suggested that the updated report should also include information about dental services for children in the care of local authorities too.

The Chair confirmed that the item would be brought as a priority to the next meeting where the debate could be extended then.

AGREED:

That a fully updated report with data and including information on dental services for children in care of local authorities be provided  for the next meeting.

Members will receive a presentation detailing progress on the transition of Children’s services from the Glenfield Hospital to the Kensington Building at Leicester Royal Infirmary.

Rebecca Brown, Acting Chief Executive gave a presentation detailing progress on the transition of children’s services from the Glenfield Hospital to the Kensington building at Leicester Royal Infirmary.

Background details of the East Midlands Congenital Heart Centre and NHS Standards were given, and Members were reminded of the decision taken in September 2019 to move the paediatric congenital heart service to the Leicester Royal Infirmary in order to meet the co-location standard.

It was noted that:

·         The project comprised a 12 bed intensive care unit, 17 bed cardiac ward, a cardiac theatre and catheter lab as well as an outpatient and cardiac physiology dept.

·         Phase 1 had completed with the Kensington building being attractively refurbished

·         The move from Glenfield to Kensington building took place from 5^th – 8^th August 2021 with the support of other providers during the transition to ensure that emergency services for children remained available.

·         The Kensington building was fully up and running with all equipment and clinical teams in place.

Images of the new Kensington building were viewed and noted.

Rebecca Brown, Acting Chief Executive explained the next phase, Phase II envisioned the creation of East Midlands first dedicated standalone Children’s Hospital to ensure all children could be cared for on one dedicated site and would see the move of all children’s services into the Kensington building.

Members of the Commission welcomed the presentation, expressing positive comments about the smooth transition and commented on how good the building and unit looked. Members asked that their thanks be passed on to the staff who made this happen and everyone involved in save Glenfield should be assured seeing everything transitioned across so well.

The ensuing discussion included the following points:

In relation to specialist children’s services it was noted that UHL consultants were recognised nationally and regionally as experts. Clinical teams worked with networks across Northamptonshire, Lincolnshire to expand the region and be experts for all those areas too. National recognition for clinical outcomes showed UHL was up in top three.

Regarding space, the Kensington building was very spacious with room for growth and had been very well designed for children and adolescents with

dedicated play therapists and support staff to help children with special needs.

Nicky Topham, Programme Director of Reconfiguration confirmed the new build and existing Kensington building interior had been extended too including down into lower floors.

Phase II would be looking to move services from the Balmoral building and there would be a combined ICU. At moment it had not been prioritised when services would be moved as UHL were still waiting for maternity hospital to be completed that area in the Kensington building decanted and then consider which children services go in and where.

In terms of lessons learnt it was always good practice to review what had been done well and what could be done better and feed into new projects, this process had been started and one such lesson learnt was to give selves more time to move in  ...  view the full minutes text for item 23.

Members will receive a verbal update on the Covid 19 and Autumn/Winter vaccination programmes including recent data and vaccination patterns across Leicester, Leicestershire and Rutland.

The Chair reminded those present that since the situation around Covid was fluid written reports were not provided as the data changed daily.

Caroline Trevithick and Kay Darby of Leicester City CCG, gave a presentation and verbal update on the Covid 19 and Autumn/Winter vaccination programmes including recent data and vaccination patterns across Leicester, Leicestershire and Rutland latest plans

It was noted that:

·         The City compared favourably with other similar cities in terms of vaccination uptake.

·         Vaccination rates had fallen significantly so CCG partners were reviewing that and looking at what next steps could be taken to boost uptake.

·         Leicester, Leicestershire and Rutland had published vaccination data that showed the lowest uptake was amongst the under 29 year old age category.

·         In relation to 12-15 year olds, the vaccination programme was due to roll out across secondary schools from next week.

·         A third primary dose vaccination had been approved and recommended for vulnerable people; this was not to be confused with a booster. Work was ongoing to look at which people might benefit from this vaccination.

Expanding the points around low uptake, there were some patterns which included particular areas heavily populated by students, so work was being done to deliver key messages and target people across campuses. Various pop up vaccination clinics were also planned.

In terms of younger people: 16 – 17 year olds were averaging 51.8% uptake, 12-15 year olds currently only had crude numbers however it was known there were 3,034 people in at risk cohorts within this age group waiting for vaccination.

Regarding the vaccination programme for 12-15 years olds and the issue of parental consent, it would be an opt in programme that followed tried and tested practice for other vaccination programmes. However, because it was Covid there was more contention and so there was work around that in terms of parental consent and whether children who are conscient may be able to consent for themselves.

Regarding logistics, it was noted that children in year 7 were a mixture of ages with some not yet 12 years old however the age cut off was 12 years so only those 12 years and above would be vaccinated. Clarity on those arising 11-12 was still awaited. At the moment this was a one dose vaccine, being administered using existing programmes to deliver logistically to schools across LLR.

In terms of encouraging uptake, each school would be visited and given information, some parents/children would need more information and take longer to reach a decision on whether their child should be vaccinated so there would need to be consideration of how those not ready when teams were at school could then have it if they changed their minds. 

The Covid Booster vaccination programme would commence from September.

The seasonal Flu cohort’s vaccination had now started and there was also talk of the Flu programme being wrapped into a combined offer although this would be subject to supply. Additional community pharmacy capacity was also being targeted at hard to  ...  view the full minutes text for item 24.

Members will receive a verbal update on the UHL Acute and Maternity Reconfiguration.

Darryn Kerr, Director of Estates UHL  provided an update on the UHL Acute and Maternity Reconfiguration as part of the Building Better Hospitals programme.

Referring to earlier discussion during the public questions item of the meeting he confirmed a key point that UHL were not planning to change any clinical models or pathways.

It was noted the team continued to work up the design brief as well as work on enabling the project and business case to create the space needed. They were also undertaking early works on the decontamination programme and liaising with system colleagues on concepts around sustainability.

The ensuing discussion with Members included the following points:

·         Assurance was given that there would be no change to bed numbers referred to during the consultation process. The issue of single rooms for patients put pressure on space not on the number of beds.

·         In terms of moving services, staff and patients, a lot of consideration was given to this from an early stage in all programmes and clinical service exercises to minimise disruption.

·         Referring to a question asked at the December 2021 meeting clarity was sought on the number of women who delivered out of area and were seen by the community team and not just those that received inpatient care at St Mary’s. Rebecca Brown, Acting Chief Executive UHL agreed to provide more details on that outside this meeting.

·         With regard to back office functions and new ways of working, this was something UHL were considering everyday alongside optimising the best accommodation available. This was being worked through, learning lessons from outside the system. As an example, they had just opened their first agile building and that adopts policy of no-one having their own office. A lot of lessons had been learnt during Covid which were part of ongoing considerations.

AGREED:

That further detail be provided in relation to the response given around post-partum/post-natal care numbers in the County for women who delivered out of area.

The Independent Chair, David Sissling of the Leicester, Leicestershire and Rutland Integrated Care System will address the Commission on his vision for the Integrated Care Systems.

The Chair reminded those present there had already been comprehensive questions and answers around the Integrated Care Systems and opened the item for Member discussion.

David Sissling, Independent Chair, LLR Integrated Care System briefly reintroduced himself and set out the reasons for integrated care systems and their aim to provide new models of care for physical and mental health, reduce inequity, create better workspace, and provide volunteer opportunities. It was noted that emerging issues such as defining goals of ICS and addressing inequality and inequity had been identified, especially around supporting those with frailty and enabling people to have a voice.

A lot of the work was about building in continuity with CCG’s and developing good relations, trust, and openness between partners.

In practical terms work was accelerating towards the formal launch of the Integrated Care Partnership (ICP) next April. Focus was on making critical appointments in key roles, as well as working with local authorities to launch the Integrated Care Partnership.

Responding to enquiries about the vision for how the Integrated Care System would work across Leicestershire, this was partly described in terms of outcomes and remaining focused on the reasons why we were doing this work. There was a lot to learn from local government and the way in which NHS was mobilising itself. One change was to recognise that the NHS was an enormous and major contributor to GDP and contributor to the City and County. In that respect the vision was broad but there is no agenda in terms of the private sector and in time that assurance will be seen.

Andy Williams, Chief Executive Leicester CCG commented that they were moving away from competition philosophy so that the standards of care and pathway should be the same across the County and City and there should be a consistent experience for people. However, there might also be a need for different targeted approaches in areas e.g. to increase uptake of vaccinations and these changes would be aimed at facilitating ability to do both these things consistently.

It was queried what element of choice there was in terms of services across borders, and it was indicated that the current situation seemed to be based on resources and they planned to look to make services more universal in terms of the population.

There was a brief discussion around what the NHS offered and the role of scrutiny to challenge process, as an example it was noted that audiological services were not always available on NHS but could be sought privately, this was an interesting point that came back to statutory obligations. There was also the issue around NHS or private prescriptions and members were informed that although there was a lot of discretion to create the care system appropriate for LLR it was subject to statutory obligations.

Referring to gaps in scrutiny around procurement frameworks, David Sissling advised that the involvement of elected members was critical, and the ICS would have to learn from local government. Meetings were  ...  view the full minutes text for item 26.

There were no other Members questions that had not already been covered elsewhere on the agenda.

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

Work programme received and noted.

To note the next meeting will take place on Tuesday 16^th November 2021 at 5.30pm.

Date of next meeting to be noted on 16^th November 21 at 5.30pm

None notified.

There being no other business the meeting closed at:  8.45pm     .