Agenda and minutes

The Chair welcomed everyone to the meeting and asked those present to introduce themselves.

Apologies for absence were received from:-

Karen Chouhan                   Chair, Healthwatch Leicester

Councillor Conde                Rutland County Council

Councillor D Sangster        Leicester City Council

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

Members were asked to declare any interests they may have in the business on the agenda.  No such declarations were made.

The minutes of the meeting held on 14 December 2016 are attached and the Committee is asked to confirm them as a correct record.

AGREED:

That the minutes of the meeting held on 14 December 2016 be confirmed as a correct record.

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.

NHS England launched a national consultation on its proposals for the future commissioning of Congenital Heart Disease services on 9 February 2017. 

This consultation will run until Monday 5 June, closing at 23.59. Extra time has been added to the usual 12 week consultation period to allow those involved in local government elections to have a full opportunity to contribute to the consultation.

The “Proposals to Implement Standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Document” is attached at Appendix B1 – Page 1.

This Joint Committee is 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.

The Regulation does not prevent constituent Councils of the Joint Committee considering the issues separately; but it is the responsibility of the Joint Committee to formally respond to the consultation process.

The Regulations also provide 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.

Supporting Information

The following supporting information is supplied to assist the Joint Committee to comment upon the proposals in the Consultation Document.

a)         Minutes of the Meeting of the Joint Committee held on 29 September 2016 when the Joint Committee considered the proposals in the pre-consultation engagement stage. Appendix B2 (Page 75)

b)         Letter from Will Huxter responding to issues raised by the Joint Committee on 29 September 2017.  Appendix B3 (Page 87)

c)         Proposals to implement standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Summary. Appendix B4 (Page 91)

d)         Congenital Heart Disease Equality and Health Inequalities Analysis – Draft for consultation.  Appendix B5  ...  view the full agenda text for item 27.

The Joint Committee received NHS England’s proposals for the future provision of Congenital Heart Disease Services with particular reference to University Hospitals of Leicester NHS Trust.

NHS England had launched a national consultation on its proposals for the future commissioning of Congenital Heart Disease services on 9 February 2017.  This consultation would run until Monday 5 June, closing at 23.59. Extra time has been added to the usual 12 week consultation period to allow those involved in local government elections to have a full opportunity to contribute to the consultation.

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 provided that where the appropriate person (NHS England) had 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 were 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.

The Regulation 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 following information was supplied to the Joint Committee prior to the meeting to assist it comment upon the proposals in the Consultation Document.

a)         The “Proposals to Implement Standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Document”.

b)         Minutes of the Meeting of the Joint Committee held on 29 September 2016 when the Joint Committee considered the proposals in the pre-consultation engagement stage.

c)         Letter from Will Huxter responding to issues raised by the Joint Committee on 29 September 2017. 

d)         Proposals to implement standards for Congenital Heart Disease Services for Children and Adults in England - Consultation Summary.

e)         Congenital Heart Disease Equality and Health Inequalities Analysis – Draft for consultation. 

f)          Congenital Heart Disease Provider Impact Assessment: National Panel Report.  ...  view the full minutes text for item 27.

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

The Joint Committee had received a report from UHL presenting their initial view of NHS England’s proposals.

The Chair welcomed John Adler, Chief Executive, UHL Trust and Claire Westrope, Consultant Paediatric Intensive, UHL Trust, who were attending the meeting to outline UHL’s views on the proposals and to answer Members’ questions.

The Chair invited Mr Adler invited to make an introductory statement during which he made the following comments:-

a)         UHL still disagreed with the original intention to decommission congenital heart disease surgical services from the Trust and the reasons were set out in Appendix C previously circulated to the Joint Committee members.

b)         The Trust’s responses to the questions in the consultation paper had also been circulated to the Joint Committee.

c)         The Trust had no difficulty with the motivation behind the review and agreed that there should be a good high quality service for children who were seriously ill with a congenital heart disease.  The Trust felt, however, that the changes being proposed were misguided and appeared to be a solution looking for a problem.  There were good Congenital Heart Disease outcomes in Britain when compared globally and the Glenfield Unit had good outcomes compared to the rest of country.

d)         Mr Huxter’s comments on the progress made by the Trust were welcomed and NHS England’s participation in the public meeting had been appreciated.

e)         It was pleasing that the issue of co-location and the concerns NHS England had on locums had been discussed and sorted out.  All that remained unresolved with NHS England was the number of operations per surgeon.  UHL were not in dispute with proposed standards per se but did disagree with the way in which they had been applied retrospectively by NHS England.

f)          The other area of difference was how pro-active NHS England should be in assisting the Trust in getting to the required numbers.  NHS England had declined to be pro-active in this and had consistently cited that they don’t choose where patients are treated.  This was essentially for the family and the child and the referring commission to decide.  However, the organisation of these services was the responsibility of NHS England and, whilst NHS England may say that they do not choose where a patient will be treated, they ultimately do determine where a patient will not be able to be treated; and that was what the current proposals sought to do.  UHL’s preferred option was to work with NHS England and other network partners to make relatively small adjustments to UHL’s effective catchment area to enable UHL to meet the required standards in relation to number of operations.  This would allow UHL to continue to offer services to children which were currently highly regarded.  In a recent CQC inspection they had been rated as outstanding, the highest rated service within the Trust.  It would also avoid creating a large geographical gap across the country with no CHD surgical services.  None of the other changes proposed by NHS England would  ...  view the full minutes text for item 28.

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

The East Midlands Councils General Meeting considered a report at its meeting on 15 February 2017.  The report also summarised the activities of the health overview and scrutiny committees in the region since July 2016.

The recommendations were approved and it was also agreed that unless plans were already in place, that all health scrutiny committees across the East Midlands should be encouraged to actively consider NHS England’s proposals relating to UHL Glenfield Hospital; and that the scope and detail of this work be shared to support co-ordination of scrutiny activity and wider lobbying.

The Joint Committee noted that the East Midlands Councils’ General Meeting considered a report on NHS England’s proposals at its meeting on 15 February 2017.  The report which summarised the activities of the health overview and scrutiny committees in the region since July 2016 had been circulated to the Joint Committee prior to the meeting.

It was noted that the recommendations had been approved and it was also agreed that unless plans were already in place, that all health scrutiny committees across the East Midlands should be encouraged to actively consider NHS England’s proposals relating to UHL Glenfield Hospital; and that the scope and detail of this work be shared to support co-ordination of scrutiny activity and wider lobbying.

Members discussed NHS England’s proposals and UHL’s initial response and made the following comments/statements and asked questions (these have been grouped into general themes for ease of reference). NHS England’s response to the comments/statements and questions made during the meeting are shown below each themed area.

The Chair commented that other local authorities across the East Midlands were also extremely concerned about the proposals and were feeling upset and destabilised by these proposals.  This issue was of concern across the whole of the region and not just to the Leicestershire, Leicester and Rutland area.  A petition signed by people all across the region had also been sent to London. 

ISSUES RELATING TO STANDARDS

a)         There was concern about the process by which the standards were fixed and introduced which then resulted in losing a good service that was currently appreciated by everyone and the new system of standards would prevent it from being provided.

b)         It was questioned whether all NHS Trusts currently providing Level 1 CHD services been given the same support by NHS England to reach the new standards and whether any NHS Trusts had been given more time to reach these standards than other NHS Trusts.

c)         Members asked for the evidence base used by NHS England to determine that each surgeon should undertake 125 operations per year.  Members referred to the quote from The School for Health and Related Research in Sheffield, which had stated that “whilst a relationship between volume and outcome exists this is unlikely to be a simple, independent and directly causal relationship, i.e that no cut-off relating to surgical volume and better outcomes was identified.  There was never any indication of the number of minimum or maximum cases which should be done each year by an individual surgeon.”  As such, the figure of 125 was arbitrary and it was questioned why a surgeon carrying out 100 operations a year could not be as good as one carrying out 150 operations per year.

            John Adler clarified that UHL did not dispute the numbers in the                  standards per se but did dispute how they were being applied.  In relation to Newcastle, there appeared to be no evidence to suggest they would ever reach those numbers in the standards but NHS England were prepared to allow them to continue providing Level 1 services because they also undertook transplant services.  UHL felt that, if it was safe for Newcastle to continue providing Level 1 services with numbers considerably smaller than Leicester, then why was it not safe for Glenfield to continue to provide Level 1 services which would also allow them to continue to support the national ECMO service, which they had pioneered and developed.

NHS England responded by indicating that if Newcastle could not meet the numbers in the future in the agreed time frame then it would  be necessary to revisit the issue of commissioning those services.  It was further emphasised that there was no implication in NHS England’s proposals that any current service  ...  view the full minutes text for item 30.

The Joint Committee is asked to consider the next steps it wishes to take in response to the consultation process based upon its consideration of the previous agenda items and the responses it has received during the meeting.

AGREED:-

1)         That a further meeting be held to hear the views of patients, members of the public and stakeholders on the proposals in the consultation document, including representatives of protected characteristic groups that were identified in the NHS England’s Equality Impact Assessment as being affected, to hear how they felt the impacts of the proposals could be mitigated for their particular group. 

2)         That NHS England be requested to be represented at the meeting.

There were no other items of Any Other Urgent Business.

The Chair declared the meeting closed at 3.45pm.