Agenda and minutes

 Apologies for absence were received from Councillors Cleaver, Fonseca and Dr Sangster.

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.

Dr Feltham, C.C. declared that he worked for the NHS in Northamptonshire.

Dr Janet Underwood declared that she had made a representation to Councillors, that was independent to her position in Healthwatch Rutland. The representation related to the consolidation of the Level 3 Intensive Care Units.  It was agreed that this did not constitute a declaration of interest that meant she could not continue with the upcoming debate.

The minutes of the meeting held on 27 April 2018 have been circulated and the Committee is asked to confirm them as a correct record.

The Chair stated that there were some minor typographical errors in the minutes but she believed that they did not affect their accuracy.

RESOLVED:

that the minutes of the meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee held 27 April 2018, be confirmed as a correct record.  

Minute item 54 Update on Congenital Heart Disease Services

The Chair stated that it had been agreed to write to Nottingham City Council to provide assurance about the monitoring of targets and to request that they encourage the University Hospitals of Nottingham (UHN) to refer their congenital heart patients to the University Hospitals of Leicester.  It had also been agreed for the minutes of the meeting to be sent to Nottingham City Council. The Chair confirmed that the letter and the minutes had been sent as agreed and they had replied giving assurances that UHN are doing this.

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 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 Chair stated that questions had been received relating to an item that she had agreed to take as Any Other Urgent Business and therefore the questions would be received during that item.

The Chair agreed to take the following item of Any Other Urgent Business in accordance with the Scrutiny Procedure Rules Rule 14 (Part 4E) of the Council’s Constitution.

The Consolidation of Level 3 Intensive Care

The Chair agreed to take the report as urgent on the grounds that it needed to be considered before the next meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee.

The Chair invited the following members of the public to read out their questions which had all been received in accordance with the Scrutiny Procedure Rules Rule 10 (Part 4E) of the constitution.

Ms Jean Burbridge

“The law requires commissioners and providers to involve the public when making changes to the provision of NHS healthcare. NHS bodies discharge this duty by carrying out consultations. There is no legal definition of service change but broadly it encompasses any change to the provision of NHS services, usually involving a change to the range of services available and/or the geographical location from which services are delivered. Not only is a change in service location being proposed in UHL’s full business case, but it is a change in the location of a core service, that is, one on which numerous other service depend and one where change has significant ramifications for the rest of the hospital. Why did UHL consider it possible to proceed without a full public consultation and will the committee ensure that this omission is rectified and recommend that full public consultation takes place?”

Giuliana Foster

"Why has UHL been planning to close level 3 intensive care at the Leicester General Hospital since at least 2015 and yet still not consulted the public?"

Ms E Brenda Worrall

“Given the recent ruling by The High Court (HHJ Jarman QC sitting as a High Court Judge) in quashing a decision by the Corby Clinical Commissioning Group over failure to undertake public consultation, is there a danger that the local NHS could find itself on the wrong side of the law if it proceeds to remove services as important as level 3 intensive care from Leicester General Hospital without full public consultation? A legal challenge will be costly in time, money and reputation. I therefore urge you to recommend full public consultation”.

Ms Warrington

"Why is the NHS undertaking to consult the public on ‘our plans for acute reconfiguration’ (Next Steps to Better Care in Leicester, Leicestershire and Rutland, August 2018 p40) but is not consulting the public on the reconfiguration of intensive care and other services such as kidney services now?"

Mr A Ross

“Although the scrutiny committee does not have the right to impose its views on the local NHS, will it state its desire to see a full public consultation take place in relation to the closure of level 3 intensive care and the consequent downgrading of the Leicester General Hospital?”

The Chair also referred Members to the questions relating to this issue, that had been brought to the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission on 23 August 2018.  These were circulated for reference. The Chair thanked the members of the public for their questions and invited representatives of University Hospital Leicester (UHL) to respond to the issues raised.

Mark Wightman, Director of Strategy and Communications UHL, explained that with regards to the consultation, their response and the clinical risk remained the same as it did  ...  view the full minutes text for item 8.

Members are asked to receive a presentation from the East Midlands Ambulance Service (EMAS) entitled ‘Shaping our Vision’.  A copy of the presentation and supporting papers are attached and the Committee is invited to comment as they see fit and give their views on the key questions as detailed in the presentation.

Mr Richard Lyne, General Manager, East Midlands Ambulance Service (EMAS) gave a powerpoint presentation to the committee. The presentation entitled ‘Shaping our Vision’ was included in the agenda pack. Members were asked to consider three questions as follows:

1)    Did Members feel that the parties listed in the presentation were the right stakeholders for EMAS to engage with on this particular strategic piece of work?

2)    What would Members of the LLR Joint Health Scrutiny Committee like to see within EMAS’ vision for the future?

3)    What feedback did the committee have on the emerging vision?

Members considered the presentation and raised comments and queries which included the following:

·      A Member asked whether all staff were sufficiently trained on mental health issues and Mr Lyne said that there was a plan to roll our mental health training to all staff. 

·      A Member referred to the co-location of blue light services and Mr Lyne commented that this was a high priority in terms of their vision as there were numerous benefits. It could be seen to be operating well in Market Harborough.

·      A concern was raised that there was a ‘mismatch’ between public expectation and what could be delivered. A Member asked how this gap between expectation and delivery could be addressed; how EMAS could convey to people what the ambulance service was about and what alternatives there were. It was also noted that there was an aim to treat more people at home and a Member asked for more information as to how this could work.

Mr Lyne responded that health care was very different now than it had been a few years ago and the public’s expectations of the ambulance service were also very different. Very often people who called 999 did not need to go to hospital. To address this a working group was being established across the LLR with all partners with the aim to reduce conveyance by looking at new pathways, using existing pathways better and managing public expectation better.  This might involve transporting the patient to an urgent care centre instead of a hospital but if the hospital was considerably closer, they would aim to go there instead. The service would try to balance the clinical need and keep people in their local area where possible.

·         Dr Underwood, Healthwatch Rutland referred to the queues of ambulances outside the Emergency Department during the winter of 2017/18 as they waited to deliver their patients. Mr Lyne explained that EMAS were working with the hospital to reduce handover delays, in order that ambulances could be released sooner. One of the high priorities in Leicester was to look at what could be done to reduce those delays.

In summary, the vision document was generally well received but a Member said he would like to have seen information about what had been achieved so far. The Chair commented that the Leicester City Council Health and Wellbeing Scrutiny Commission received regular reports, but she would also like to receive information on  ...  view the full minutes text for item 9.

The Director of Urgent and Emergency Care submits a report that provides an update on the provision of services by Thames Ambulance Services Limited (TASL) to the Leicestershire, Leicester City, and Rutland (LLR) healthcare geography as at August 2018.  The Committee is asked to receive the report and comment as it sees fit.

A minute extract of the meeting of the Leicestershire County Council Health Overview and Scrutiny Committee held 28 February 2018 is also attached.

Mike Ryan, Director of Urgent and Emergency Care, West Leicester Clinical Commissioning Group (WLCCG) presented a report that provided an update on the provision of services by Thames Ambulance Services Ltd (TASL).   Members heard that TASL had been awarded the LLR Non- Emergency Patient Transport Services contract in June 2017 and began providing the services on 1 October 2017. During the first year, TASL had under-performed against expectations in terms of both performance and quality. Whilst performance had slowly improved, there were still concerns in relation to quality and this was being monitored. There were also concerns as to TASL’s long-term financial sustainability as the organisation were operating at a deficit. An independent review was being carried out to ascertain their overarching long-term viability and the report of that independent review was due out shortly.                                                                                                                                                                                                                                     

Members considered the report and raised comments and queries, which included the following:

·      In relation to the procurement exercise, a Member commented that it appeared that the CCG had been aware that TASL had shortcomings but had procured their service anyway. Mr Ryan responded that non- emergency patient transport services were very difficult to procure; they had been aware that there were some shortcomings, but these were considered to be manageable. They had not anticipated that there would be concerns relating to the financial viability of the organisation.  The CCG were working closely with TASL and NHS England to ensure appropriate action was being taken to mitigate any risks associated with their financial pressures and have also established contingency plans with other providers.

·      Comments were raised that reports on TASL had been brought to the Leicestershire County Council Health Overview and Scrutiny Committee twice, though a representative from TASL had not been present.  Concerns relating to TASL’s financial stability had also been raised earlier in the year, and Members were given assurances that the financial issues would be sorted out, but the concerns over financial viability were still there. 

·      In response to a question, Members heard that the current CQC rating for TASL was that the organisation required improvement.

·      Micheal Smith, Healthwatch asked the committee to consider the wider impacts arising from delays with handovers at hospitals and he added that Healthwatch had been working with TASL.

·      A Member commented that the concerns relating to performance and quality were not particular to Leicester, Leicestershire and Rutland alone, and she would be interested to hear how the NHS was working with other counties in relation to TASL’s performance, as some patients crossed boundaries to receive services. A question was asked as to how the NHS was managing those patients. The Chair asked for this question to be noted and to be brought back and addressed in a future meeting.

·      Concerns were raised at the cost incurred in monitoring TASL and Mr Ryan responded that as it was a new contact, it was expected that they would put in more time in monitoring. He believed that it was value for money. Mr Ryan was also asked as  ...  view the full minutes text for item 10.

The Director of Performance and Corporate Affairs, West Leicester Clinical Commissioning Group (WLCCG) submits a report on Planned Care Policies. The report explains that the Planned Care Policies enable the Clinical Commissioning Groups  to prioritise their resources using the best evidence about what is clinically effective and to provide the greatest proven health gain.  The Committee is asked to receive the report and comment as it sees fit.

Ket Chudasama, Director of Performance and Corporate Affairs, West Leicester Clinical Commissioning Group (WLCCG) submitted a report on Planned Care Policies. Mr Chudasama presented the report and explained that the Planned Care Policies enabled the CCGs to prioritise their resources using the best evidence about what is clinically effective and to provide the greatest proven health gain. Following the review, it was agreed that 49 of the existing 51 policies would not be changed, 2 of the existing policies would be changed (Hip and Knee Replacement and Male Circumcision) and 50 new policies would be introduced. The committee heard that a small number of patients who would have received treatment a year ago, would now not receive a procedure, where it was deemed it was not right for them to have it.

The Chair stated that due to time pressures, she would send in some questions after the meeting. Dr Feltham CC also said that he had a detailed question which he would submit by email. The Chair explained that responses to questions would be sent out with the minutes of the meeting and would therefore be in the public domain.

The Chair referred to engagement events and expressed concerns that the one she had attended had been held in a back room and she did not consider such engagement events to be meaningful.

During the ensuing discussion, questions and comments were raised which included the following:

·      Councillor Waller asked what coverage there had been in the press as she had not seen anything in her local newspapers in Rutland.  The Director said that he would check with his CCG colleagues to make sure this was happening in the county and Rutland.

·      It was questioned whether there was still a matter of choice; if so, people would be able to go outside of the area for certain treatments. The Director said that they intended to work with all providers to make it clear what the referral guidelines and thresholds were. There were some clinical reasons why the treatments for certain patients, based on the threshold, had little benefit.

·       The committee heard that strong concerns had been expressed that Ear Wax Removal was listed as one of the new policies being introduced. People who required a hearing aid, needed to have ear wax removed prior to the aid being fitted. Dr Tim Daniel, Public Health Consultant responded that the situation would need to be managed for those people who required a hearing aid.

·      A request was made that the wording of the Gynaecology Policy be changed as the reference to the ‘female parts of the body used to make babies’ was patronising. Mr Chudasama apologised for the wording used and said that this would be looked at.

·      A Member commented that the policy was over complex; there were too many policies and it would be preferable for it to be in smaller more manageable sections. A request was also made for consultations on the policies to take place in those clinics  ...  view the full minutes text for item 11.

The Committee is asked to receive a report from the West Leicester Clinical Commissioning Group that aims to provide an update on Better Care Together (the Sustainability and Transformation Partnership for Leicester, Leicestershire and Rutland), and the work being undertaken by partners to improve the health and wellbeing of people locally. An additional report entitled ‘Next steps to better care in Leicester, Leicestershire and Rutland’ is also attached. The Committee is asked to:

·      Note this update and the work of the Better Care Together partners

·      Note the publication of the Next Steps document

·      Note the on-going work to co-ordinate business cases for acute and maternity reconfiguration, which will be subject to formal public consultation once capital funding is identified

·      Note the on-going work of BCT work streams, and engagement and consultation activities.

The Committee received a report that provided an update on Better Care Together (BCT); the Sustainability and Transformation Partnership (STP) for Leicester, Leicestershire and Rutland (LLR).  The Chair provided a background in relation to the scrutiny that had taken place relating to the BCT (formerly known as the STP). The meeting heard that the draft STP came out in 2016 and was brought to the LLR in December 2016. A refreshed STP was expected but never came and during the last few months, it became known that there would be a BCT Next Steps document instead. This document had just been published.

The Chair said that scrutiny needed to be clear as to what it wanted to focus on. She was aware that some dissatisfaction had been expressed relating to the way both scrutiny and NHS bosses had approached public consultation and reports to scrutiny. However, her research showed that scrutiny had carried out a lot of work on the STP; this just needed to be consolidated and a clear way forward agreed.

Toby Sanders, Managing Director of West Leicester CCG and STP lead for LLR, Richard Morris, Director of Operations, Leicester City CCG and Sarah Prema, Director of Strategy and Planning (Leicester City CCG) introduced themselves to the committee. Mr Sanders presented the report and explained that BCT was a partnership that came together across all health care organisations. The Next Steps document set out the important things that had been done and would be done for local people.

The Chair stated that the committee needed a clear idea as to what would be presented to Members in the future and she suggested that it would be useful to discuss this in an informal meeting. The Chair expressed a view that rather than looking at issues they would have little power to influence, it would be most useful for the committee to focus on what service improvements there would be for patients, and public engagement and consultation.

During the ensuing discussion, comments and queries were raised which included the following:

·      A Member commented that she thought from the earlier debate in the meeting, officers from the NHS would understand the importance the public placed on consultation. Comments had previously been made that the NHS could not consult without the confirmation of funding, but she said it was still possible to communicate with the public. The Member said that they wanted to avoid the situation that had occurred in relation to the consolidation of the ICU.  The Chair added that formal consultation could be about detailed proposals and consultation and engagement exercises on principles rather than details, could still be carried out.

·      Further concerns were raised about the lack of information about the STP during the course of the process. Comments were made that the STP was linked to the consolidation of the ICU and the public had not had the opportunity to engage with the process.  A Member said that local authorities had a duty to consult on the  ...  view the full minutes text for item 12.

The meeting closed at 1.16 pm.