Agenda and minutes

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

The Chair thanked Members for their contributions towards the agenda; items for consideration included suggestions from both the Leicestershire and the Rutland County Councils. Officers were also thanked for their collaboration in compiling the agenda.

The Chair reminded everyone that the primary purpose of the meeting was to consider items that were relevant across all three authorities to prevent duplication and to come to a shared position on particular items.

Apologies for absence were received from:

Councillor Fonseca                                     Leicester City Council

Mrs Fryer C.C.                                  Leicestershire County Council

Dr Hill C.C.                                        Leicestershire County Council

Councillor Waddington                  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 might have in the business on the agenda.

Councillor Chaplin declared that she was a patient of the Leicestershire Partnership Trust in the Mental Health Services.

The minutes of the meeting held on 27 June 2017 have been circulated and the Committee is asked to confirm them as a correct record.

AGREED:

that the minutes of the meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee held 27 June 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 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, representations or statements of case had been submitted in accordance with the Council’s procedures.

Members are asked to agree the revised draft working arrangements and terms of reference for the Committee.

Members were asked to agree the revised working arrangements and Terms of Reference for the Committee.  Members heard that the main change related to the plan to rotate the Chair every two years.  The City Council would nominate the Chair for the period May 2018 to May 2019 and the County Council and the City Council would then rotate the position of Chair and Vice Chair in each two year cycle afterwards.

RESOLVED:

that the Revised Working Arrangements and Terms of Reference for the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee be agreed.

Dr Peter Miller, Chief Executive of the Leicestershire Partnership (NHS) Trust submits a report that outlines a summary of the Care Quality Commission’s (CQC) latest key findings and details the Trust’s processes for delivering assurance against the CQC inspection action plan.

The update report and the inspection report with other supporting information are included as follows:

Update report (Appendix B1)

CQC inspection action plan (Appendix B2)

Supporting information:

·         CQC inspection report published in January 2018 (Appendix B3)

·         Report of the CQC considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission 7 March 2018 (Appendix B4)

·         Draft minute extract of the meeting of the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission held 7 March 2018 (Appendix B5)

·         Minute extract of the meeting of the Leicestershire County Council Health Overview and Scrutiny Committee held 28 February in relation to the consideration of the Child and Adolescent Mental Health Services (CAMHS). (Appendix B6)

Supplementary information:

Dr. Anne Scott, Acting Chief Nurse, East Leicestershire and Rutland Clinical Commissioning Group, submits the following papers as supporting information in respect of the above item of business.

a)    East Leicestershire and Rutland Clinical Commissioning Group - briefing paper   (Appendix B7)

b)    East Leicestershire and Rutland Clinical Commissioning Group  - power-point presentation: Commissioner monitoring and supporting quality and safety improvements (Appendix B8)

The Chair introduced the item and explained that a report of the Leicestershire Partnership NHS Trust (LPT) on the Care Quality Commission (CQC) Inspection 2017 had been considered by Leicester City Council’s Health and Wellbeing Scrutiny Commission on 7 March 2018. That report was attached at appendix B4 of the agenda. At the meeting, Members had requested further information on the inspection and also for the Clinical Commissioning Group (CCG) to provide an update from their perspective on the inspection and the LPTs response.  The Chair added that she was pleased that areas inspected had moved from an ‘inadequate’ rating to ‘requiring improvement’.

Dr Peter Miller, Chief Executive of the Leicestershire Partnership (NHS) Trust presented a report that outlined a summary of the CQC’s latest key findings as well as details of the Trust’s processes for delivering assurance against the CQC inspection action plan. Members heard that Dr Miller was pleased with the improvement in the five services that had been inspected. While he wanted the services to be ‘Good’, the CQC’s findings demonstrated that the trust was on a positive trajectory. 

Members were asked to note that the CQC inspection had taken place at a specific point in time and it did not reflect the pressures that the Trust were under; including pressures in Children and Adolescents’ Mental Health Service (CAMHS) and Adult Mental Health Services.

Dr Anne Scott, Acting Chief Nurse, East Leicestershire and Rutland Clinical Commissioning Group presented a briefing paper, as previously circulated, which provided an update on the commissioners’ processes for monitoring the progress against the action plan. 

During the ensuing discussion, a number of questions were raised. Those questions and their responses included the following:

·      Dr Miller was asked if the outcome of the inspection would have been different if there had been a full complement of staff. The theme in the inspection report was that the Trust was under-resourced. Dr Miller responded that staffing and the workforce was the biggest risk on their risk register but there were monthly safer staffing reports and he was confident that there was adequate staffing at all times on all of the wards to maintain safe levels; however there were at times significant numbers of bank and agency staff to maintain those levels. Dr Miller did state though that bank staff are often existing staff members and that they knew the service well.  Across the Trust there should be about 1600 band 5 and 6 qualified nurses but there were currently about 220 vacancies. There should be 150 registered nurses on the Bradgate Unit, but there were regularly vacancies of 40-50 nurses so the challenges were to deliver consistency of care. Bank staff were subject to the Trust’s training and support which resulted in greater compliance to the Trust’s policies. Agency staff may be new to the ward and there was less likelihood of compliance. Dr Miller did therefore believe that a full complement of staff would have led to a better inspection outcome.

·      Concerns about fridge  ...  view the full minutes text for item 53.

Alison Poole, Senior Manager Special Projects, University Hospitals of Leicester (UHL) NHS Trust submits a briefing paper that provides the committee with an update on the Congenital Heart Disease (CHD) services in the East Midlands and progress of the national reviews on Paediatric Intensive Care (PICU) and Extra Corporeal Membrane Oxygenation (ECMO) services in England. 

The report follows on from the decision of the NHS England National Board made on 30 November 2017 to continue to commission University Hospitals of Leicester NHS Trust to provide level 1 CHD services, conditional on achieving full compliance with the standards in line with their own plan to do so and demonstrating convincing progress along the way.

Dr Frances Bu’Lock, Honorary Associate Professor in Congenital and Paediatric Cardiology presented a briefing paper that provided the committee with an update on the Congenital Heart Disease (CHD) services in the East Midlands and progress of the national reviews on Paediatric Intensive Care (PICU) and Extra Corporeal Membrane Oxygenation (ECMO) services in England.

The Chair stated that the committee was very pleased that the NHS England National Board had agreed to continue to commission the UHL NHS Trust to provide Level 1 CHD services, and that a fair and achievable target had been set. She thanked members of the committee and officers for capturing the intricacies of discussions in such detail, and while many people had been involved in the campaign, she felt that the contribution of the committee could not be underestimated. Dr Bu’Lock also expressed her appreciation for the rigour with which the committee had challenged NHS England.

Dr Bu’Lock explained that many of the targets were similar to those in the other centres, with the main exception being that they had to move the paediatric part of the service to co-locate with the children’s services. The Chair stated that if the capital funds were available, the paediatric service would move into the Kensington building, but if capital was not made available, the service would locate in the Balmoral building and she questioned how long the service could wait for a decision regarding funding before opting for the Balmoral.  Members heard that there was some flexibility in awaiting the decision.  Dr Bu’Lock commented that that the NHS did not have the funding so this was dependent on the outcome of discussions with NHS Improvement and the funding for the Sustainability Transformation Plan.

Members heard that while no adult surgical cases were completed for three to four weeks because of winter pressures and the demand for respiratory beds; the Trust put in measures to prioritise paediatric cases where beds in the High Dependency Unit were sufficient as opposed to beds in Intensive Care. The overall target for surgical procedures was met but issues around winter pressures could impact on future targets.

The Chair stated that she and the Vice Chair had received a letter from Nottingham City Council seeking assurances that the committee would continue to monitor performance against targets set by NHS England. The Chair said that they would write to Nottingham to give them those assurances.    Dr Bu’Lock expressed concerns that the University Hospitals of Nottingham were carrying out congenital cardiac intervention procedures on patients, although they were no longer supposed to be doing this. Concerns were expressed that this was placing patients at risk. It was also noted that this impacted on the numbers of patients undergoing surgical procedures in Leicester. Dr Bu’Lock added that it would be very helpful if the committee would write to Nottingham City Council to encourage them to ask the University Hospitals of Nottingham to refer all of their congenital heart work to the UHL.  It was agreed that this would  ...  view the full minutes text for item 54.

Sharron Hotson, Director of Clinical Quality submits a report and power-point presentation that provides the Committee with an overview of the outcome of the Care Quality Commission’s (CQC) inspection of the University Hospitals of Leicester (UHL) NHS Trust in November and December 2017 and their well-led review in January 2018. 

The report, presentation and supporting information are attached as follows: 

Report of the UHL’s CQC inspection (Appendix D1)

UHL Power-point Presentation (Appendix D2)

Supporting information:

·         CQC inspection report of the UHL (Appendix D3)

Sharron Hotson, Director of Clinical Quality, University Hospitals of Leicester (NHS) Trust (UHL) submitted a report that provided the committee with an overview of the outcome of the Care Quality Commission’s (CQC) inspection of the UHL that took place in November and December 2017 and their Well Led review which took place in January 2018.

The Chair noted that within the inspection report, there was praise in some areas including the care of patients with sepsis. Some areas required improvement and Improvement Notices had been served in relation to insulin management.

Sharron Hotson presented the report and explained that the inspection report had been published in March and the action plan had been very recently submitted to the Quality Outcome Committee. There was also a separate action plan which related to insulin management and was subject to weekly monitoring and monthly reporting to the Board. Ms Hotson commented that it would take time to embed the new practices for insulin management; as every patient on every ward was affected.

Ms Hotson referred Members to the ratings table contained within the report and explained that some of the ratings related to a previous inspection. Those ratings could not be changed until the CQC re-inspected those areas. Members heard that there were no inadequate ratings from the most recent inspection.

A Member expressed concern that targets for some areas of staff training and appraisals were not being met.  The value of the staff was emphasised and Ms Hotson was asked what the UHL were doing to address those concerns.  Ms Hotson responded that there had been a problem with delivering training with the pressures during the winter months but Members were also asked to note that the data had not portrayed the correct information. The system had now been improved and targets were being monitored.

It was noted that St Mary’s Birth Centre had received a ‘good’ rating on all aspects and in response to a question, Ms Hotson confirmed that the centre was one that Sustainability Transformation Plan was proposing to close.

A Member asked about the ‘Red to Green’ process for the discharge of patients. Ms Hotson explained that this was a tool that was used to ensure there was a timely discharge. If there were delays, there was need to understand what those delays were and what action could be taken. The Red to Green had added transparency to the process. Ms Hotson was asked whether some discharges took place too soon resulting in the patient being readmitted. Members heard that discussions about discharging the patient and the situation at home often occurred prior to operations taking place but it could be very difficult to manage expectations.  The Chair stated that there needed to be a culture shift; Members at the Leicester City Council Health and Wellbeing Scrutiny Commission meeting had heard that patients, through patient choice, opted to remain in hospital longer rather than going into a community hospital.

A Member referred to leadership and questioned whether improvements  ...  view the full minutes text for item 55.

Richard Lyne, General Manager of the East Midlands Ambulance Service (EMAS) submits a report explaining progress made since the Care Quality Commission’s (CQC) inspection in February 2017 and outlining the key areas for improvement in the Trust Quality Improvement Plan. 

The report and supporting papers are attached as follows:

Report:  Quality Improvement Plan Update (Appendix E1)

Supporting information:

·         EMAS – Response time and handover:  considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission  4 October 2017 (Appendix E2)

·         EMAS – Ambulance Response Programme – Pilot: considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny commission 4 October 2017 (Appendix E3)

·         EMAS – Presentation: considered at the East Midlands Health Scrutiny Network 27 June 2017  (Appendix E4)

·         The CQC Inspection report of EMAS can be found on the following link:

• http://www.cqc.org.uk/sites/default/files/new_reports/AAAG3547.pdf

Richard Lyne, General Manager of the East Midlands Ambulance Service (EMAS) submitted a report that provided an update on the Quality Improvement Plan that arose following their CQC inspection.

The Chair introduced the item and explained that the Leicester City Council’s Health and Wellbeing Scrutiny Commission had considered EMAS and the hand-over time at the Leicester Royal Infirmary at their meeting on 4 October 2017. The Committee had been given assurances that the new Emergency Department (ED) would increase capacity and the ability to deal with pressure surges from EMAS.   However there had been winter pressures since and reports of ambulances stacking up and delays in transferring patients into the ED; all of which impacted on the rest of the county. The Chair had also heard that EMAS had requested an additional £10m funding over the next two years and then £20m which represented a 12% increase in their annual budget. This was requested in order to meet the national target which included a seven minute response time (this was currently at 9%).

Mr Lyne presented the report and explained that since the last meeting they were now in a position to address some of the ‘could do’ actions arising from the inspection as the key actions had been addressed.   Points made included the following:

1)  Leicester was now the second county in the East Midlands region to adopt the pre-hospital treatment antibiotic therapy. The therapy had been rolled out earlier that month and was a very important development in managing life threatening sepsis.

2)   A leadership development programme had been put in place across all of EMAS’ leaders regardless of their level of management.

3)  Duty of Candour was now fully embedded which ensured that an acknowledgement and appropriate response was given when the service fell below the standard that was expected.

4)  A training needs analysis was now in place for all of the paramedics. Paramedics had been upgraded from a Band 5 to a Band 6 and a requirement of that upgrade was for all paramedics to have a training needs analysis.

5)  There had been a capacity and demand review which had identified a gap between demand and in what EMAS could provide, hence the request for investment to fund more front line clinicians and ambulances. In respect of this; negotiations with the CCG were currently taking place.

6)  There had been a very challenging winter with activity 6% higher than anticipated between December 2017 and March 2018. There had also been an increase in acuity with approximately 12 % of the calls involving life threatening conditions. Given the increase in calls, the delays at the Leicester Royal Infirmary were significantly lower than the previous year. The average handover time during that winter period was approximately 26-27 minutes compared to 31 minutes the year before.

A Member commented that she was pleased to hear about the improvements and questioned what determined the response target; whether it was the condition or the individual concerned. The meeting heard  ...  view the full minutes text for item 56.

The meeting closed at 12.30 pm.