Agenda and minutes

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

The Chair reminded everyone that the primary purpose of the meeting was to hear from patients’ and stakeholders about their experiences and for them to give their views on NHS England’s proposals.  The level of frustration expressed by the public in relation to accessing the consultation process was well understood by Members.  Although the meeting was open to the public to attend it was not a ‘public meeting’ as such and only those that had registered to speak would be allowed to do so.  It would not be possible, therefore, to hear comments from the other Members of the public who were in attendance at the meeting.  NHS England had arranged a public consultation meeting at Glenfield Hospital for Saturday 1 July 2017 and that would be the opportunity for the public to participate in the process.

The Chair also welcomed Michael Wilson, Programme Director for CHD, NHS England and Catherine O'Connell, Regional Director Specialised Commissioning - Midlands and East who were attending the meeting to hear the submissions by the public and stakeholders.

Apologies for absence were received from:-

Councillor Corrall                Leicester City Council

Councillor Fonseca             Leicester City Council

Dr S Hill CC                          Leicestershire County Council

Councillor Sangster                        Leicester City Council

Councillor Stephenson      Rutland County 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 might have in the business on the agenda.  No such declarations were made.

The minutes of the meeting held on 14 March 2017 are attached and the Committee is asked to confirm them as a correct record.

RESOLVED:-

That the minutes of the meeting held on 14 March 2017 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 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 in accordance with the Council’s procedures.

The Chair to welcome new members of the Joint Committee and to recap on the Committee’s previous consideration of NHS England’s proposals for Congenital Heart Disease Services.

Background Information

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

This consultation period was originally intended to end on Monday 5 June, but was subsequently extended to close on Monday 17 July 2017 as a result of the recent Parliamentary Election.

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 Joint Committee first met on 29 September 2016 and received the following supporting documents:-

·         NHS England’s proposals published on 8 July 2016.

·         Extracts of decisions taken by Leicester City Council and Leicestershire County Council’s Cabinet in response to NHS England’s proposals.

·         A report from NHS England and a submission from the University Hospitals of Leicester NHS Trust (UHL) submitted to the City Council’s Health and Wellbeing Board at their meeting on 18 August 2016, together with the Minutes of the Meeting.

·         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.

·         A letter to the City Council’s Deputy City Mayor from NHS England in response to questions  ...  view the full agenda text for item 40.

The Chair stated that given there were a number of new members on the Committee and the Programme Director for the CHD was attending his first meeting of the Committee; she felt it would be useful to set the scene and recap on the points raised at the previous meeting of the Committee. 

The Chair mentioned the following points:-

NHS England stated that it wasn’t for them to mandate to patients where to have surgery at a particular centre and that it was for parents/patients to determine where they wished to receive treatment.

·         UHL disputed this stating that it was NHS England’s responsibility to organise these services and whilst they did not choose where a patient was treated, these proposals were seeking to determine where they would not be treated.

The outstanding issue with regards to Glenfield hospital’s plans from NHS England’s perspective related to their ability to reach 375 operations (125 each for 3 surgeons) per year.

·         UHL also argued that small adjustments to the catchment area would enable them to meet the required number of operations.

·         Members commented that the destabilising effect of the ongoing proposals may also be having a negative effect and would no doubt influence patient choice if they thought the centre may close whilst not realising the high quality of care that they would receive.

·         There was anecdotal evidence that people in Northampton were being directed further south when Glenfield was a much closer option.

It was debated as to whether the figure of 125 surgeries had been applied fairly across all CHD sites in the consultation proposals; given that Newcastle, in particular, had been given no time frame within which to reach the standards.

·         UHL argued that if it was safe for Newcastle to continue providing Level 1 services whilst providing considerably less surgeries than Glenfield; then why should it be unsustainable for Glenfield to continue with higher levels of surgeries and still also provide the National ECMO service.

·         NHS England stated they would revisit Newcastle if they couldn’t meet the required number of surgeries in an agreed timeframe; although no timeframe had been agreed.  Also, Newcastle were being treated separately, as they also undertook heart transplant services, the only centre to do so one outside of Great Ormond Street Hospital to perform them and it would be unsafe to only have that service on one site.

·         Committee members argued that given the 125 surgeries was not backed by any real scientific evidence for it to be an absolute criteria to provide a resilient service and, given that Newcastle were being given an indefinite time period to meet the required number of surgeries, Leicester should also been given extra time.  If, like Newcastle, they subsequently didn’t meet the required number of surgeries in an equal timeframe, then NHS England should review the situation at that time.

·         UHL’s CHD unit was rated as ‘outstanding’ by the CQC; the only one in the country and this should not go unrecognised.

·         Also, the fact that there  ...  view the full minutes text for item 40.

Representatives from UHL will attend the meeting to present their current view on the proposals.  A copy of presentation is attached.

The Chair welcomed the following representatives of University Hospitals of Leicester NHS Trust (UHL) to the meeting:-

John Adler, Chief Executive.

Dr Aidan Bolger, Consultant Cardiologist & Honorary Senior Lecturer and Head of Service East Midlands Congenital Heart Centre.

Mark Wightman, Director of Communications Integration and Engagement.

Alison Poole, Senior Manager Special Projects.

John Alder thanked the Committee for the opportunity to address the Committee.  He stated that UHL were opposed to the proposals in NHS England’s Consultation Documents for the Congenital Heart Disease (CHD) Review; particularly as the Trust had made good progress in meeting the standards required and NHS England had formally acknowledged that the only point of issue was the standard for each surgeon to perform 125 procedures a year.  The Trust had submitted a Growth Plan to NHS England, at their request, in May 2017 which had clear and robust plans to meet the target standard specified in standard B10 (L1) and demonstrated that the Trust had already begun to put this plan into place to meet the required target.  It was understood that NHS England had been considering the growth plan since it was submitted and had promised a meeting with UHL during the consultation period to discuss it.  However, no formal response had been received from NHS England.

Dr Bolger gave a presentation on their current view of the proposals and a copy of the presentation is attached to these minutes.

During the presentation the following points were noted:-

a)         The announcement that NHS England were minded to decommission Level 1 services in Leicester was made in July 2016. It was not until February 2017 that the public consultation was launched and in may not be until 2018 that the outcomes will be known.  This was having a destabilising effect on those centres put forward for decommissioning.

b)         This destabilising effect had already impacted upon Level 1 services in Manchester as the unit had recently closed prematurely at short notice. This was the result of senior staff leaving because of the uncertainty over its future and, as the Trust could no longer provide Level 1 congenital heart services. NHS England has had to form a crisis team to manage the situation externally, calling on other Level 1 providers in the North of England and Queen Elizabeth Hospital in Birmingham to provide care for Manchester’s patients.  It was of concern that this had been allowed to happen, particularly as NHS England did not have a contingency plan in place for this eventuality during the consultation process.  This uncertainty remained and there was still a danger that other centres, such as UHL, could be susceptible to the same pressures.  If UHL was forced to close prematurely then patients would be at risk as there were no plans in place to absorb their caseload at short notice.

c)         The national picture in relation to CHD services has transformed immensely since the concerns associated with Bristol in the 1980’s and 1990’s.  At that time, Bristol had a 30 day  ...  view the full minutes text for item 41.

To hear views from public, patients groups and other stakeholders on NHS England’s proposals for Congenital Heart Disease Services.

Leicester University were invited to attend the meeting.  Professor Philip Baker, Pro-Vice Chancellor and Head of College Medicine, Biological Sciences and Psychology is, however, unable to attend but has submitted a representation on behalf of the University.  A copy of the letter is attached.

The Chair stated that the Commission had previously invited members of the public, patients groups and other stakeholders to submit their views on NHS England’s proposals for Congenital Heart Disease Services.  A number of individuals and stakeholders had registered their interest to address the Committee and had submitted written submissions. 

Leicester University had been invited to attend the meeting and although Professor Philip Baker, Pro-Vice Chancellor and Head of College Medicine, Biological Sciences and Psychology was unable to attend, he had submitted a representation on behalf of the University.  A copy of the letter is attached at Appendix A to these minutes.

Lincolnshire Health Scrutiny Committee had submitted their response to NHS England’s Consultation on the Congenital Heart Disease Review and a copy of their submission is at Appendix B to these minutes.

The Chair stated that the primary purpose of people presenting their submission was for the Committee to hear at first hand the views being expressed and, as such there, would be no opportunity for members of the Committee to ask questions on the submissions.  Representatives of NHS England were present but they would not be asked to respond to the submissions. They would, however, consider the submissions as part of the consultation process. 

The Chair stated that each person would be given 5 minutes to present their submission and it would be published with the minutes of the meeting unless the person presenting the submission indicated they did not wish it to be made public.  The submissions could also be included as part of the Committee’s evidence to the Consultation process.  All those who were intending to make a presentation to the Committee were then asked to indicate if they wished their submission to remain private.  No such indications were received and the Chair confirmed that all the submissions would be published with the minutes of the meeting. 

The Chair then invited the following patients and stakeholders to address the Committee for a maximum period of 5 minutes each:-

a)         Shirley Barnes, a parent of child with a congenital heart disease.  A copy of the submission is attached as Appendix C to these minutes.

b)         Olivia Barnes, a parent of child with a congenital heart disease.  A copy of the submission is attached as Appendix D to these minutes.

c)         Jess Whitehouse, a parent of child with a congenital heart disease.  A copy of the submission is attached as Appendix E to these minutes.

d)         Dr Sally Ruane, Health Policy Research Unit, DeMonfort University.  A copy of the submission is attached as Appendix F to these minutes.

e)         Katy Weatley, Leicester Mercury Patient Panel.  A copy of the submission is attached as Appendix G to these minutes

f)          Karen Chouhan, Chair of Healthwatch Leicester, representing Healthwatch Leicestershire and Healthwatch Rutland.  A copy of the submission is attached as Appendix H to these minutes.

g)         Eric Charlesworth submitted a question, a copy of which is attached as Appendix I to these minutes.

            Mr Charlesworth commented that a  ...  view the full minutes text for item 42.

The Joint Committee is asked to consider the next steps it wishes to take in response to the consultation process.

The Chair commented that based on the discussions of this and previous meetings a response to NHS England’s consultation would be prepared.  The consultation response would be shared with the constituent Council’s for comment prior to it being submitted before the deadline on 17 July.

The Chair also commented that the City Council would be writing to the Secretary of State expressing concerns in relation to the inequality of the proposals and the way in which the standards had been determined and applied in the consultation process.  The proposals were also not considered to be in the best interests of health services in Leicester and the wider region. The letter would also indicate that, because of those concerns, a referral would be made to the Secretary of State in the future should Level 1 services no longer be commissioned from UHL.

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

The Chair declared the meeting closed at 7.47 pm.