Agenda and minutes

Apologies for absence were received from Councillors Chaplin, Cleaver and Conde.

An apology for absence was also received from Mrs Hack C.C. but it arrived too late to be announced at the meeting.

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

No declarations of interest were made.

The minutes of the meeting held on 21 January 2019 have been circulated and the Committee is asked to confirm them as a correct record.

The minutes can be viewed by clicking onto the following link:

http://www.cabinet.leicester.gov.uk:8071/ieListDocuments.aspx?CId=420&MId=9014&Ver=4

AGREED:

that the minutes of the meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee held 21 January 2019 be confirmed as a correct record.

The Chair announced that the official opening of Haymarket Health in the Haymarket had recently taken place.  The centre offered a range of sexual health and health intervention services which were available to people across Leicester, Leicestershire and Rutland.

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.

The Monitoring Officer to report on the receipt of any questions, representations, 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 received.

To consider a report from the Leicestershire Partnership NHS Trust that sets out their response to an inspection report from the Care Quality Commission (CQC). 

The CQC Inspection was carried out between 19 December 2018 to 13 December 2018 and their inspection report, which is attached in Appendix A1, describes their judgement of the care provided by the Trust.

The Committee received a report from the Leicestershire Partnership NHS Trust (LPT) that summarised the outcome of the Care Quality Commission inspection of the Trust that took place between 19 November 2018 to 13 December 2018. The report also set out the Trust’s response to the inspection. The inspection report had been included in the agenda and showed that the overall rating for the Trust was that it required improvement. 

Dr Peter Miller, Chief Executive Officer LPT, introduced the report and Members heard that while there were some examples of good practice, there were some key themes that required improvement and the CQC had issued the Trust with a Warning Notice. In response to this an action plan had been drawn up to include some immediate actions which needed to be completed by 27 May 2019. Members heard that the CQC had been critical of the pace of improvement following the previous inspection in October / November 2017 where the Trust had also received the same required improvement rating as it had in their two previous inspections prior to 2017.  Members heard that two independent reviews had been carried out to find out why the LPT did not know about the lack of pace regarding the improvements.

Mrs Cathy Ellis, Chair of the Trust Board said that the Board had taken ownership of action plan and that they were all responsible for the outcome of the inspection. A meeting had been held with the CQC who were pleased with the action that the LPT had taken so far. Learning and Leadership from the services that had been rated as ‘good’ were being replicated in other services. Mrs Ellis expressed confidence that the Trust could deliver all the required actions.

The Chair said that Scrutiny had previously looked at the earlier LPT inspections and that in all of them, the overall rating was that the Trust required improvement. Some improvements had been made and these needed to be acknowledged and it was recognised that the CQC had judged that staff were good and caring, but there were strong concerns about the recurring key themes and issues throughout that time. 

During the ensuing discussion, comments from Members and responses from officers included the following:

·      Concerns were expressed that the inspection showed that there were still recurring themes that had not be addressed; including risks relating to ligature points and medicine management. 

·      There were concerns that smoking was not being managed in the Bradgate Unit. Members heard that while the NHS was a smoke free environment, managing this in the Bradgate Unit was challenging where some people were acutely ill.  There was a clear commitment however to their ambition to be smoke free and there was now strong clinical leadership to help staff develop intervention measures. Advice to stop smoking, patches and vapours were all available and there were vapour areas in the garden.

·      A Member commented that she was not reassured by the action plan.  There were not just issues that needed  ...  view the full minutes text for item 35.

To consider a report from Better Care Together (BCT) that describes the activities they have undertaken during 2018/19 to engage with communities in Leicester, Leicestershire and Rutland. The report also outlines the direction of travel and strategic approach to communications and engagement in 2019/20 and discusses the outcome they wish to achieve by adopting a consistent engagement process embedded through all BCT work streams.

A report providing an update on scrutiny work related to the Better Care Together Plan is also attached in Appendix B2.

Members considered a report that described the activities undertaken in relation to Better Care Together engagement and involvement across Leicester, Leicestershire and Rutland. Sue Venables, Head of Communications, Engagement and Involvement (NHS) introduced the report and responded to questions from Members.

Comments and queries, along with responses included the following:

·      The Chair referred to Appendix 1 of the report which had details of current work streams and Ms Venables explained that sub streams sat underneath those work streams. The Chair asked for a complete list of work streams with their sub work streams to aid transparency.

·      Mr Micheal Smith, Manager HealthWatch Leicester and Leicestershire reported that they had been seeking people’s views which would then be fed into Better Care. In a similar vein, HealthWatch had been involved in the Community Redesign Programme and it had been very encouraging to see how people’s views had been fed into that programme. 

·      A Member who said she had been very critical in the past of Better Care Together’s engagement programme, welcomed the work that was now taking place, commenting that it was a big improvement.

·      Members suggested that as there were elections in May, there needed to be briefings in the new municipal year for newly elected councillors. 

·      A Member asked for engagement information to printed in a large print format for those people with sight impairments and Ms Venables responded that the suggestion would be forwarded onto the appropriate officers.

·      Members heard that engagement had taken place with a wide variety of community groups including youth forums and the traveller community. Ms Venables was urged not to forget about the people in Rutland when carrying out engagement exercises and she responded that useful meetings had been held with HealthWatch Rutland.

·      Dr Underwood, HealthWatch Rutland said that they were grateful for the time that Ms Venables and her colleagues had spent with them. They also felt that their views had been listened to following the Community Redesign engagement in February and Dr Underwood asked for this level of engagement to continue.

·      The Chair said that she welcomed the report and it was clear that improvements had been made regarding the engagement exercise, but the Committee had not yet received confirmation as to what the formal consultation would look like when the anticipated capital funding arrived. The Chair also sought assurances that the creation of Patient and Public Involvement Groups would not weaken the public consultation. The Chair expressed a concern regarding primary care networks and that the Committee needed a better understanding of these and how they would work.  There was a real concern that Better Care funding might be sent through the primary care networks rather than via the current route of clinical commissioning groups to the local authority. The Chair said that there was a briefing note from the Kings Fund giving information about primary care networks and she would circulate this to Members after the meeting.

The Chair thanked Ms Venables for the report; welcomed the fact that more  ...  view the full minutes text for item 36.

To consider a briefing paper that outlines the methodology behind the University Hospitals of Leicester (UHL)  NHS Trust’s bed model and how this compares to expected demand in 2019 / 20.

Mark Wightman, Director of Strategy and Communications, University Hospitals Leicester (UHL) and Samantha Leak, Director of Operational Improvement, UHL presented a briefing paper that outlined the methodology behind the UHL NHS Trust’s bed model and how it compared to expected demand in 2019/20.

Members considered the report and during the ensuing discussion, the comments made and their responses included the following:

·      The complexities around bed modelling were noted. A Member questioned how flexible the UHL could be as even if additional wards were opened, appropriate staff would also be needed. Mr Wightman explained that if there was a spike in admissions for example, the easiest option to create extra capacity was to cancel elective surgery as the UHL had been directed to do the previous year.  It was noted that an extra ward in the Glenfield Hospital and two extra wards in the LRI had opened last year because of the very high demand. Mr Wightman added that staffing was an issue as the UHL were understaffed.

·      It was noted that some treatments could be carried out elsewhere such as in GP practices and Urgent Care Centres which would ease the pressure on hospitals.  A Member commented that if the work around the discharge process and the flow of patients could be improved, bed capacity would no longer be a problem.

·      A Member welcomed the report and that there were plans to increase the number of beds and that the decision had been made following the careful analysis of data. It was noted that a review of bed capacity planning was taking place at least monthly and this was also welcomed.

·      A Member welcomed the efforts that were being made to prevent people from needing to be admitted to hospital and also the work being carried out to prevent them staying longer than necessary. However, robust community services were needed to care for those people outside of the hospital environment. The Member was not convinced that the community health services were robust enough to cope and one of the reasons for her concerns were the staff shortages. The Member added that she was not convinced that there was a change taking place in the culture in health services to attract and retain staff.

Mr Wightman referred to the situation in primary care and the shortages of GPs. Efforts were being made to recruit and retain GPs, but he added that it was not easy being a GP. There were many demands on her / his services and time and patients did not always want to be seen by a practice nurse. However, a five year programme was just starting which would address some of those culture issues.

·      Dr Underwood, HealthWatch Rutland referred to the bed occupancy rates.  The meeting had heard that occupancy rates were at approximately 93%, but Dr Underwood had looked at the NHS statistics which quoted occupancy rates to be at 85 – 90%. Dr Underwood expressed concerns that according to NICE guidelines, patient safety could be  ...  view the full minutes text for item 37.

The Scrutiny Policy Officer submits a document that outlines the Leicestershire, Leicester and Rutland Health Scrutiny Committee Work Programme for 2018/19. The Committee is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Chair said that the work programme for the new municipal year had been re-populated and asked Members to note that for the next two municipal years, the Committee would be chaired by Leicestershire County Council, so this was her last meeting as Chair.  The Chair commented that the Joint Committee across three local authorities resulted in a considerable work load and she paid tribute to Kalvaran Sandhu the Scrutiny Support Manager and Julie Harget, the Democratic Support Officer for their work in supporting the committee.

·         Thames Ambulance Service Limited – Care Quality Commission Report: Appendix E

·         Moorfields Eye Hospital proposed move – letter from NHS Camden Clinical Commissioning Group: Appendix E1

The Chair said that the Care Quality Commission report on the Thames Ambulance Service and the letter relating to the Moorfields Eye Hospital were attached for Members to note.

The Chair expressed her thanks to everyone and closed the meeting at 12.25 pm.