Agenda and minutes

Apologies for absence were received from Dr S Hill CC (Vice Chair of the Committee) and Mrs B Newton CC. 

Leicestershire County Council had nominated Mrs J A Dickinson CC as Vice Chair for the meeting and Mr S Sheahan CC was attending as a substitute for Mrs B Newton CC

Members were asked to declare any interests they might have in the business on the agenda. 

Councillor Cassidy declared an Other Disclosable Interest as a trustee of Carlton Hayes Mental Health Trust.

Dr R K A Feltham CC declared an Other Disclosable Interest as a hospital manager at Northampton General Hospital.

In accordance with the Council’s Code of Conduct the interests were not considered so significant that it was likely to prejudice either Councillor Cassidy’s or Dr Feltham’s judgement of the public interest.  Councillor Cassidy and Dr Feltham were not therefore required to withdraw from the meeting during consideration and discussion relating to NHS England’s proposals for the future provision of congenital heart disease services.

The Terms of Reference and Working Arrangements of the Joint Health Scrutiny Committee are attached for information. 

Members noted the Terms of Reference and Working Arrangements of the Joint Health Scrutiny Committee which had been previously circulated with the agenda.

In response to a Member’s question it was noted that the Joint Committee was the appropriate body to be consulted by NHS England on the proposals in accordance with Regulation 30 of the Local Authority (Public Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.  The regulation provides that where the appropriate person (NHS England) has any proposals for a substantial development or variation of a health service in an area they must consult the local authority.  Where the consultation affects more than one local authority in an area, the local authorities are required to appoint a Joint Committee to comment upon the proposal and to require a member or employee of the responsible person to attend its meeting and respond to questions in connection with the consultation.

It was also noted that this did not prevent constituent Councils of the Joint Committee considering the issues separately; but it was the responsibility of the Joint Committee to formally respond to the consultation process.

The Regulations also provided that a Council may refer a proposal to the Secretary of State where:-

·         it not satisfied that the consultation has been adequate in relation to content or time;

·         it is not satisfied with the reasons given for the change in services; or

·         it is not satisfied that that the proposal would be in the interests of the health service in its area.

This referral must be made by the full Council unless the Council has delegated the function to a Committee of the Council.  Currently, only the City Council had delegated the powers to refer the NHS proposals to the Secretary of State. Leicestershire County Council and Rutland County Council would need to approve any referral at their respective Council meetings.

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 submitted in accordance with the Council’s procedures.

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

The Monitoring Officer reported that no questions, petitions, or statements of case had been received in accordance with the Council’s procedures.

To consider NHS England’s proposals for the future provision of congenital heart disease services with particular reference to University Hospitals of Leicester NHS Trust.

Following the publication of NHS England’s proposals on 8 July 2016 Leicester City Council and Leicestershire County Council considered the issue and extract of their decisions at attached at Appendix B (Page 5). 

Rutland County Council’s Health and Wellbeing Board will consider the issue at its meeting on 27 September 2016.

The City Council’s Health and Wellbeing Board received a report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL) at their meeting on 18 August 2016.  A copy of the minutes are attached at Appendix B1 (Page 9) for information.

            Supporting information to the Minutes

a)         Report of NHS England and their Assessment of UHL submitted to the Board and updated to reflect the subsequent meeting held with UHL on 16 September 2016 and the revised high level timetable for the consultation and decision making process. Appendix B2 (Page 29)

b)         Letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board. Appendix B3 (Page 45)

c)         Evidence base for new standards & specifications in relation to the 125 cases per surgeon that was requested by the Health and Wellbeing Board.  Appendix B4 (Page 49)

NHS England were invited to attend the meeting and were originally available to attend but are now unable to send a representative as they are all now required to attend a national oversight meeting for all of specialised commissioning that was subsequently arranged for the same day. They have sent a revised report at Appendix B2 above and have stated that they would welcome the opportunity to attend a future meeting of the Committee.

The Chair commented that this would be the first of a series of meetings to consider NHS England’s proposals for the future provision of congenital heart disease services (CHD) with particular reference to University Hospitals of Leicester NHS Trust.  It was not intended to cover every aspect of the proposals during the meeting; particularly as the process was currently in the pre-consultation engagement stage.  There would be further opportunities at a later date to discuss the issues once the formal consultation process had started.

Members had received the following information prior to the meeting:-

a)     Extracts of decisions taken by Leicester City Council and Leicestershire County Council following the publication of NHS England’s proposals on 8 July 2016.

b)     Rutland County Council’s Health and Wellbeing Board considered the issue at its meeting on 27 September 2016.

c)     Minutes of the City Council’s Health and Wellbeing Board meeting held on 18^th August which received a report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL).  The minutes were supported by the following documents:-

i)       A report of NHS England and their Assessment of UHL submitted to the Board which had been updated to reflect the subsequent meeting held with UHL on 16 September 2016. It also included the revised high level timetable for the consultation and decision making process.

ii)      A letter to the City Council’s Deputy City Mayor from NHS England in response to questions asked at the Health and Wellbeing Board.

iii)     NHS England’s evidence base for new standards & specifications in relation to the 125 cases per surgeon that had been requested by the Health and Wellbeing Board.

NHS England had been invited to attend the meeting and had originally indicated that they were available to attend, however, a national oversight meeting for all of specialised commissioning had subsequently been arranged for the same day as the Joint Committee.  Consequently, NHS England staff involved in the review were now unable to attend or send a representative as they were all required to attend the national oversight meeting. They had, however, submitted a revised report and had stated they would welcome the opportunity to attend a future meeting of the Committee.

Councillor Conde reported that the leader and portfolio holder for health at Rutland County Council had both issued strong statements in support of retaining current CHD services at Glenfield Hospital.

In response to a question relating to the outcomes envisaged for the Joint Committee meeting, the Chair stated that she hoped the Joint Committee would be able to support a strong message to NHS England that, having considered the information supplied to them and also taking into account the views of UHL and the public, the proposals should be abandoned now to avoid wasting any further public funds.  If that was not possible and the consultation process went ahead, then the Joint Committee should agree to meet again; with NHS England representatives present to explain their proposals.

The Chair invited Members  ...  view the full minutes text for item 6.

A representative from UHL will attend the meeting to present their initial view on proposals from NHS England.

Mark Wightman, Director of Communications, University Hospital of Leicester NHS Trust (UHL) attended the meeting to present UHL’s initial view on proposals from NHS England.  He introduced Aidan Bolger, Paediatric Cardiologist and Head of Service for East Midlands Childrens’ Heart Centre (EMCHC) and Claire Westrope, Consultant in Paediatric Intensive Care and Clinical Lead for Paediatric Intensive Care Unit who could provide clinical responses if required.

UHL were grateful for the support of the Joint Committee and the opportunity to provide evidence to enable the Joint Committee to make a qualified and evidence based decision.  UHL had always maintained that if the EMCHC had given them cause for concern or was not providing its patients with excellent outcomes they would have a different viewpoint on the proposals. However, they felt that the proposed changes were not right for their patients.

UHL’s initial views on the proposals included the following:-

a)         The proposal to conduct the consultation process on a national basis was of concern to UHL as the local perspective could become diluted since other areas of the country were unlikely to comment upon the proposals because they would not have any particular interest in the issues affecting the East Midlands.  There was a concern that NHS England would use the national consultation to suggest that both the Glenfield and the Royal Brompton Hospitals should cease to provide Level 1 CHD services because there would be no overwhelming support in the national consultation to support them continuing.

b)         The proposals also raised concerns relating to the knock on effect upon other services such as ECMO and paediatric intensive care services in the East Midlands.  There was also concern that NHS England had subsequently announced they were fast tracking two national reviews on ECMO and Paediatric PICU provision to inform the review of CHD services.  There was a strong view that these reviews should have undertaken before the CHD proposals were announced and not as an apparent afterthought.

c)         UHL felt they had now reassured NHS England on the colocation of all services in one building and had explained the plans in place to move to 24/7 access to services.  UHL were confident that they could give the necessary assurances to NHS England on this.

d)         The remaining issue for UHL was the arbitrary figure of 125 operations per surgeon per year.  The advisor to NHS England had never indicated a minimum or maximum number of operations and NHS England had determined the number of 125 operations per surgeon.

e)         If all patients in the East Midlands area were treated at Glenfield, then the 500 operations per year could be achieved.  There were currently 502 cases in the East Midlands but a number were treated out of the area. NHS England promoted ‘patient choice’ as being enshrined in the NHS constitution but, in reality, it was the referring clinician that was leading the ‘patient choice’ to go to other centres.  It was felt that NHS England could provide stronger leadership in requiring  ...  view the full minutes text for item 7.

The following gives further information and viewpoints on NHS England’s proposals and are submitted for the Committee to consider:-

a)         NHS England’s press announcement of its proposals. 

            Appendix C (Page 57)

b)         Report of NHS England’s National Panel on Paediatric Cardiac and Adult Congenital Heart Disease Standards.

Appendix C1 (Page 63)

c)         Questions and Answers from NHS England’s website on the decision making process.

            Appendix C2 (Page 79)

d)        Copy of Will Huxter’s blog on the Congenital Heart Disease Implementation Programme issued on 13 September 2016. 

           Appendix C3 (Page 85)

Will Huxter is the NHS England Senior Responsible Officer for the Congenital Heart Disease Review and his blog can be found at the following link:-

https://www.england.nhs.uk/2016/09/will-huxter-15/

The bog will be used to keep everyone up-to-date with activities during the pre-consultation and consultation period on our proposals for meeting the national standards on CHD, and anyone can request to receive it by e-mailing  england.congenitalheart@nhs.net

e)         The Leicester City Health and Wellbeing Board also requested the assessments of every other centre currently providing CHD Services.  NHS England has published these on their website at the following link:-

            https://www.england.nhs.uk/commissioning/spec-services/npc-crg/chd/

            The link above also has details of the New CHD Review’s report, including around two hundred new standards and service specifications which providers of CHD services should meet.  These standards came into effect in April 2016.  

Members received the following information and viewpoints on NHS England’s proposals:-

a)         NHS England’s press announcement of its proposals dated 8 July 2016. 

b)         The report of NHS England’s National Panel on Paediatric Cardiac and Adult Congenital Heart Disease Standards.

c)         Questions and Answers from NHS England’s website on the decision making process.

d)        A copy of Will Huxter’s blog on the Congenital Heart Disease Implementation Programme issued on 13 September 2016. 

Note: Will Huxter is the NHS England Senior Responsible Officer for the Congenital Heart Disease Review and his blog can be found at the following link:-

https://www.england.nhs.uk/2016/09/will-huxter-15/

The blog would be used to keep everyone up-to-date with activities during the pre-consultation and consultation period on NHS England’s proposals for meeting the national standards on CHD, and anyone can request to receive it by e-mailing  england.congenitalheart@nhs.net

e)         Leicester City’s Health and Wellbeing Board had also requested the assessments of every other centre currently providing CHD Services.  NHS England had subsequently published these on their website at the following link:-

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/chd/

Note: The link above also has details of the New CHD Review’s report, including around two hundred new standards and service specifications which providers of CHD services should meet.  These standards came into effect in April 2016.

The Committee is asked to consider when the consultation of proposals will be launched and at what stages scrutiny involvement is appropriate.

The Committee considered this item during discussion of previous agenda items.  

The Committee is asked to consider the next steps in taking the review forward.

The Committee considered the next steps in taking the review forward during discussion of previous agenda items. 

There were no items of Any Other Urgent Business to be discussed.  

The Chair declared the meeting closed at 4.00pm