Agenda and minutes

The Chair welcomed those present and led introductions.

Apologies for absence were received and accepted from Councillor Harrison, Councillor Ghattoraya, Councillor Ainsley and Councillor Charlesworth.

Noted that Councillor Bannister was present as a substitute for Councillor Harrison.

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

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

Councillor Newton declared that her daughter was employed in the NHS as a nurse.

Councillor Bannister declared that his wife was employed by University Hospitals Leicester.

Councillor Hills declared an interest in the Dental Services item as he worked as a dentist.

Councillor Waller declared that she had an interest in the Dental Services item as she would be referring to her own dental practitioners.

Each gave assurance that they retained an open mind for the purpose of discussion and were not therefore required to withdraw from the meeting.

The minutes of the meeting held on 28^th March 2022 are attached and the Committee will be asked to confirm them as a correct record.

RESOLVED:

That the minutes of the meeting held on 28^th March 2022 be confirmed as an accurate record.

No actions outstanding.

Members are asked to note the membership of the committee for 2022-23 to note as follows:

City Council representatives

Cllr Elaine Pantling (Chair)

Cllr Gary O’Donnell

Cllr Teresa Aldred

Cllr  Shahid Khan

Cllr Vandeviji Pandya

Cllr Dr Deborah Sangster

Cllr Paul Westley

County Council representatives

Mr Jonathan Morgan (Vice Chair)

Mr Phil King                         

Mr Fula (Kamal) Ghattoraya

Mr Ross Hills

Mr Dan Harrison

Mrs Betty Newton

Mr Michael Charlesworth

Rutland County Council representatives

Cllr Gale Waller                   

Cllr Paul Ainsley

RESOLVED:

That the membership of the LLR Joint Health Scrutiny Committee for 2022-23 be noted.

Members are asked to note the Terms of Reference and working arrangements for the Committee as attached at Appendix B.

RESOLVED:

That the Terms of Reference and working arrangements for the Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee be noted.

Members are asked to note the dates of meetings for 2022-23 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

Dates of meetings for 2022-23 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

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

The Monitoring Officer reported that no petitions had been received.

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

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

Members to receive a report and presentation updating on Dental Services across Leicester, Leicestershire and Rutland to include coverage; access and recovery following the impact of Covid 19 along with data on tooth decay rates.

Members received a report containing an update on NHS Dental services commissioned in Leicester, Leicestershire and Rutland and an update on the impact of Covid 19 upon those services.

Rose Lynch, Commissioning Manager, Primary Care Dental Services presented an update on dental service coverage across Leicester, Leicestershire, and Rutland, referring to the challenges arising from deprivation issues, areas of deprivation with a comparison of deprivation levels, the location and volume of dental services across the area as well as the recovery of services following the impact of Covid 19 and ongoing steps to improve.

Members were reminded that there were challenges in accessing dental services prior to the Covid 19 pandemic and that Leicester City was rated 11^th highest  for deprivation issues.

During the presentation reference was made to the NHS contracts in primary and community dental care as well as the dental services offered, including out of hours service and secondary care.

Adam Morby, Regional Chief Dentist NHS England highlighted issues around oral health and dental decay in young people; this included a comparison of tooth decay rates for 5 year old children and discussion about the effectiveness of water fluoridation as a safe public health measure to reduce dental decay.

Members were asked to support the Health & Social Care Bill and the fluoridation of water across the area to help improve dental decay levels.

Members noted there were currently no water fluoridation schemes across Leicester, Leicestershire, and Rutland and were concerned about the committee being asked to lobby fluoridation of water without being presented with all the facts and evidence. Members noted that dental decay was not just related to fluoridation of water and other aspects needed addressing. Members commented that dental decay leads to more serious disease that will put other pressures on NHS Services.

Adam Morby responded that fluoridation reduced decay by 63% in areas where there was decay. It was also reiterated that there was close work with other partners to educate people, encourage brushing regimes, promote healthy eating and low sugar diets and to promote oral health.

Members commented that it was increasingly difficult to access an NHS dentist or affordable dental services and queried the lack of detail within the report, such as levels of people entitled to free dental services who were currently not receiving it and what more was being done to encourage dentists to take more NHS patients. Concerns were expressed that not enough information was given about what was being done to secure dental services for those in areas who were unable to access services particularly across challenging rural areas.

Members were advised that dental practices were independent businesses who made their own decisions about how much NHS provision they gave. Most NHS dentists had a mix of NHS and private patients and that percentage varied. General dentistry was provided through an annual contract and the Golden Hello was a scheme for dentists that provided £15k to target and encourage dentists to particular areas for a period of  ...  view the full minutes text for item 10.

An update will be provided to the meeting on the UHL Finances and Accounts for the financial period 2019-20 following the UHL process in approving the 19-20 accounts at their separate Board meetings recently.

Members received an update on the UHL Finances and Accounts for the financial period 2019 to 2020 following the UHL process in approving the 2019-20 accounts at their separate Board meetings recently.

It was confirmed that the 19/20 accounts had been approved and this reflected a significant amount of work done over last 2 years, that process was now completed, and everyone involved was thanked. Members noted that the accounts were now formally adopted by the Trust Board and papers were available to see on the Trust website.

Members also noted that the Trust were keen to finalise the 20-21 accounts and that UHL continued to be in recovery support programme and were keen to show they were spending public money effectively.

Richard Mitchell, Chief Executive UHL advised that in relation to being in special measures it was hoped to provide the appropriate evidence to satisfy those measures and be out by November 22 or shortly thereafter.

The Chair indicated that as this was public money it was important there was proper scrutiny and the committee required assurance that lessons had been learnt. The Chair asked that both sets of the accounts referred to be brought to scrutiny in November 2022 to fully appreciate what had been done.

AGREED:

That the UHL financial accounts for the financial years 2019-21 and 2021-22 be brought for scrutiny at the November meeting of this committee.

Members to receive a report providing an update following the Health and Care Act receiving Royal Assent on progress with the transition of organisational arrangements before the implementation date of 1^st July 2022.

Members received a report updating on the Leicester Leicestershire and Rutland Integrated Care System (ICS) and its Transition Programme.

Andy Williams CEO introduced the report and gave an overview of the background to the establishment of the LLR ICS Transition Programme, system preparedness, committee appointments to the Integrated Care Board (ICB), the Executive Management structure and governance arrangements for the ICB and ICS.

Members were reminded that the new Health and Care Act 2022 had received Royal Assent in April 2022 and the new Integrated Care Board (ICB) would be created from 1 July 2022 and will assume responsibilities for delivery of NHS care.

Andy Williams clarified the acronyms Integrated Care System (ICS);  Integrated Care Board (ICB) and Integrated Care Partnership (ICP) all as set out in the Act.

Members noted that progress towards establishing the ICB was going well, and the 3 CCG’s would meet on 28^th June 2022, the formal AGM had been brought forward to present accounts in public domain and then those CCGs would be closed down.

In terms of the ICB membership it was noted that David Sissling, Chair of ICB had exercised the remit to widen board where possible to give better representation.

Members commented that the information set out in the report was complex and confusing and should be further considered to show who was making decisions.

Andy Williams clarified that the role of ICB was to facilitate NHS working together. Decisions around the NHS and the way it responds to national government guidance would be predominantly through the ICB.  The ICB was the statutory body of ICS with discretion to do ICP too. The ICP would be an equal partnership and nominations for membership of that had been requested.

Strong concerns were raised about the accessibility of documents which for some were impenetrable. The public were unaware of who was responsible for what in terms of communications and the ICS needed to better understand what the receiver was going to receive. Online solutions were not always helpful, and it was suggested that having straight forward documentation that people could refer to would be helpful.

David Sissling, Chair of ICB commented that the material produced was required to show governance and constitutional arrangements, and one of the ICS first tasks will be to ensure accessibility.

Andy Williams confirmed that they would be working on making documents accessible and had received that feedback from others too.

In relation to the Health and Wellbeing partnership referred to at page 64 of the report it was advised that there was currently a small core membership to ensure they could orchestrate the wider membership described otherwise it would be too unwieldy at outset. The small core group would meet to initiate matters, and this would involve partnership with the 3 Health and Wellbeing Boards so there would be broader engagement. As far as where Healthwatch sits, Healthwatch were engaged automatically by the Health & Wellbeing Boards. It was confirmed that Healthwatch would be represented on the  ...  view the full minutes text for item 12.

Members to receive a verbal update on the status of the Covid 19 vaccination programme.

Members received a presentation update on the ongoing situation with Covid 19 vaccination programme and plans for Autumn/Winter.

Caroline Trevithick and Kay Darby of Leicester Leicestershire and Rutland CCG’s presented the update on the Covid 19 vaccination programme.

In relation to the completion of the spring booster campaign:

·         Boosters had been available since March 2022 and all eligible cohorts had been invited to take up vaccination by end June 2022,

·         A downsized summer plan had been put in place to continue vaccination until end August 2022 to allow for preparation of an integrated Autumn/Winter campaign.

·         It was recognised vaccination rates had dropped and campaigns for other vaccines had been affected.

·         Catch up campaigns for other vaccines were being organised and local commissioners had been asked to consider how these could be supported throughout the summer.

Regarding the Integrated Autumn/Winter campaign:

·         Currently 65+ and at risk cohorts would be invited.

·         Flu planning guidance had been in place from April 2022.

·         Contingency planning was taking place for rapid deployment in the event of any surge. Surge plans were aimed at limiting the effect on primary care providers.

Members discussed the update which included the following points:

As far as the future vaccination and immunisation strategy was concerned health partners were building on the successes of the Covid-19 programme in partnership with public health colleagues.

As for uptake of the vaccine, 5-11 year olds were still increasing as a new cohort but uptake had been slower. The Spring campaign had an uptake of 4.1% and would continue to focus on groups through summer where needed.

Concerns were raised that drop in centres were not easily accessible for elderly or those who can’t travel, and that the vaccine was not available at all GP surgeries.

Regarding availability at GP surgeries, it was noted the vaccine was available at some GP surgeries and as primary care was returning to business as usual there was a wider network becoming available for vaccinations as well as the community pharmacy network. Gaps in provision would continue to be targeted with pop up or proactive events such as at the Horse Fayre, Carnival and Pride.

In relation to the flu vaccine, booking teams and GP surgeries should contact those eligible for vaccines. There was still some work to do on logistics of administering the flu and covid vaccines together as not all GP surgeries were administering the covid vaccine. There was no obligation for people to have both or at the same time and people could elect which one they have or not.

Efficacy of the vaccine was queried, and concern raised that if it lasted only 6 months those receiving boosters at beginning of year would have waning immunity and having to wait until Autumn was a risk that might lead to a surge. Members noted that the clinical effectiveness and booster programmes were subject to national guidance which guided there being a minimum gap between vaccination of 91 days.

Members noted that from Autumn a planned national  ...  view the full minutes text for item 13.

Members to receive a report providing assurance that the LLR Local Maternity and Neonatal System (LMNS) have addressed the immediate and essential actions in relation to the Interim Ockenden Report published in December 2020 (Part 1).

The Committee received a report updating on maternal healthcare and services across Leicester, Leicestershire and Rutland and details of how the LLR Local Maternity and Neonatal System (LMNS) had addressed the immediate and essential actions in relation to the Interim Ockenden Report published in December 2020 (Part 1).

Julie Hogg Chief Nurse, Leicester Hospitals, introduced the report, briefly referring to the background that led to this point and gave an overview of the findings from the report and the immediate actions required following the independent review.

Elaine Broughton, Head of Midwifery at UHL highlighted the 7 immediate and essential actions to improve care and safety in maternity services as set out in the report namely: Enhanced Safety; Listening to Women; Staff Training and working together; Managing Complex Pregnancy; Risk assessment through pregnancy; Monitoring foetal wellbeing and Informed Consent. There were all considered to be important and pertinent to the services UHL provided.

It was noted that maternity services across LLR had met a number of the actions prior to the interim Ockenden report and had embedded and introduced further actions. Regular monitoring of the actions introduced was taking place through audit and spot checks and a maternity services self-assessment had been completed against the final plan whilst the final Ockenden report was awaited.

Members expressed some concern at the number of Trusts where maternity services were not what they should be.

Working across 2 sites continued to be challenging however as both were very large covering Leicester, Leicestershire and Rutland and provided acute services too. Both sites were well covered at the moment, but UHL was aware of the risk of coming under pressure.

Members noted that in terms of addressing challenges such as midwife shortages a lot of work had been done around recruitment and working on retention of midwives. This was a national issue which NHS England had provided money to address the situation going forward and Leicester was in a better position as a university hospital in that it was able to provide qualified midwives.

There was the option for qualified nurses to go on to undertake midwifery training, but some people were put off having to pay additional 2 years university fees, the Health Education funding being made available would support Band 5 pay and the fees during that training period so that was being promoted. There were 7 nurses re-training in the current cohort and more coming forward.

UHL were also going out to international midwives and provided a robust programme to support them which also helped with addressing culture too.

Members noted that nationally there was a lot being done to train, recruit and attract people into the midwifery service. Unfortunately, it was often the case when a report such as Ockenden published that some people left.

UHL were investing time and resource into developing their own midwives, providing support for health and wellbeing and improving culture. The effects were being felt positively and improvements could be seen.

Members welcomed the report and  ...  view the full minutes text for item 14.

None notified.

The Chair indicated that no members questions had been received in advance.

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

The contents of the work programme were noted.

Members expressed concerns that there were high numbers of complaints being sent to councillors from their local constituents who were still unable to obtain appointments to see GP’s face to face and the perception that GP surgeries were hiding behind Covid. Members suggested the system was broken and wanted to know what was being done to address this issue. It was noted that a review undertaken with the public across Rutland also showed there was a lot of disquiet about access to GP services.

David Sissling Chair ICS observed that accessing GP appointments and services was a priority issue and one of the first that the newly established ICB would be giving attention to, however an evidence based approach was essential. The scale of the issue was acknowledged, and it was indicated that the ICB would be willing to provide updates and timeframes for improvements once it had opportunity to consider those issues.

The Chair and Vice Chair noted that this issue was already being taken up by prospective individual scrutiny committees for the City, County and Rutland and it would be better to leave it there so that each committee could focus from their own local authority perspective rather than add to the joint committees work programme which was already heavy.

The Vice Chair requested that additional meetings to those already scheduled be avoided as it was difficult to secure Member attendance. The Chair acknowledged that request and was keen to avoid undue pressure on Members who all had other commitments.

It was suggested that future consideration be given to the number of meetings held over the year and whether the Terms of Reference held sufficient flexibility to call an extra meeting for an urgent item.

None notified.

There being no further business the meeting closed at 20.19 hours.