Agenda and minutes

Apologies for absence were received from Councillors Bajaj, Glover and Singh.

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 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 Chair commented that a response to the petition submitted by Mr Ball in relation to the scrutiny of the Better Care Together Programme was being prepared in accordance with the Council’s Petition Scheme.

The Monitoring Officer to report on the receipt of any questions, representations and statements of case submitted in accordance with the Council’s procedures.

The Monitoring Officer reported that no questions, representations and statements of case had been submitted in accordance with the Council’s procedures.

Michael Wilson, New CHD Review Programme Director and Jon Gulliver, Local Service Specialist, Specialised Commissioning - East Midlands will attend the meeting to provide an update on the Congenital Heart Disease Review and answer members questions.  A copy of a presentation is attached.

Michael Wilson, New Congenital Heart Disease (CHD) Review Programme Director and Jon Gulliver, Local Service Specialist, Specialised Commissioning - East Midlands attended the meeting to provide an update on the Congenital Heart Disease Review and answer members’ questions.  A copy of their presentation was previously circulated to Members with the agenda.

In addition to the comments set out in the presentation notes, Mr Wilson, made the following observations:-

a)         External consultants, Dialogue by Design, had been commissioned by the NHS England to receive the responses to the consultation, analyse the response and produce a report, which had been published on 2 March 2015.

b)       There had been 373 responses, from both organisations and individuals. The responses were mixed with approximately a third disagreeing with the proposals, a third agreeing and a third either not knowing or neutral to the proposals.   Differing views were expressed by organisations to those expressed by individuals.  The responses were currently being analysed to see if these differences in responses could be explained. 

c)         Although the presentation was giving a high level overview; the questions in the consultation had been aimed at testing whether the proposals were appropriate and, if not, what could be done to improve them.

d)         NHS England had not yet formally considered its own view on the outcome of the consultation.

e)         Approximately half of the responses were from patients or families of patients and approximately 20% of responses were from 18 year olds or under.

f)          There were growing numbers of adults with a CHD and these numbers would continue to grow because of the success of the service.  The service would, therefore, need to develop to keep pace with the increase in future demand and the likelihood of more patients requiring complicated forms of treatment as they grew older.

g)         Most of the comments relating to teams of 4 surgeons undertaking 125 operations a year expressed views rather than indicating whether they were for or against the proposed standard.

h)        Concerns about access to other services were also expressed as CHD patients often had other health conditions which required treatment.

i)          In relation to the proposals for co-location, it was understood that it may take time to relocate services and this was reflected in the proposed standards.

j)          After the responses had been analysed, the Clinical Advisory Group would be asked to determine if the standards were appropriate or needed to be revised, whether any new evidence required the standards to be amended and whether any of the comments that didn’t specifically relate to the proposed standards raised any issues which needed to be considered further.

k)         Recommendations would then be made to the NHS England Task and Finish CHD Group and, following this, the proposal would go through an internal assurance process with the aim of the submitting the final proposals to the NHS England Board meeting in July.  If this was not possible, it would be considered at the September Board meeting.

l)          Commissioning models  ...  view the full minutes text for item 107.

Kate Shields, Director of Strategy University Hospitals of Leicester NHS Trust will attend the meeting to discuss this issue.

Kate Shields, Director of Strategy University Hospitals of Leicester NHS Trust (UHL) attended the meeting to discuss the issue of the future provision of Intensive Care Units (ICUs) at UHL.  A background briefing paper was circulated at the meeting and a copy is attached to these minutes.

Before considering the briefing paper, the Chair circulated and extract from the ‘Guidance to support Local Authorities and their partners to deliver effective health scrutiny, published in June 2014’.  This is reproduced below:-

Local Authority Health Scrutiny - Extract from page 24 & 25

4.5 When consultation is not required

4.5.1 The Regulations set out certain proposals on which consultation with health scrutiny is not required.

These are:

a)         Where the relevant NHS body or health service commissioner believes that a decision has to be taken without allowing time for consultation because of a risk to safety or welfare of patients or staff (this might for example cover the situation where a ward needs to close immediately because of a viral outbreak) – in such cases the NHS body or health service provider must notify the local authority that consultation will not take place and the reason for this.

b)         Where there is a proposal to establish or dissolve or vary the constitution of a CCG or establish or dissolve an NHS trust, unless the proposal involves a substantial development or variation.

c)         Where proposals are part of a trusts special administrator’s report or draft report (i.e. when a trust has financial difficulties and is being run by an administration put in place by the Secretary of State) – these are required to be the subject of a separate 30-day community-wide consultation.

Following consideration of the guidance, the Chair commented that the Commission’s role was not to approve the proposals, but to understand them and to fulfil their obligations under the guidance, particularly those relating to paragraph a) above.

The briefing paper outlined the proposal to reduce the current three ICUs at each of the three hospital sites into two ‘super’ ICUs at the Royal Infirmary and Glenfield Hospital.  There was not enough capacity at the Royal Infirmary and Glenfield Hospital to provide level 3 care, whilst there was over capacity at the General Hospital.  Difficulties in recruiting staff for level 3 care had been difficult as the trust was no longer able to provide training and the volume and mix of cases at each site was not attractive to potential staff.  In addition, 3 consultants had given notice to retire in the near future.  The details of the proposal were being subjected to external review to validate that the proposal was safe and sustainable.  It was intended to have the two level 3 care units in place by December 2015.  The General Hospital would become a High Dependency Unit providing a higher level of care than a ward but not as specialised as a level 3 care ward (ICU).

In response to members’ questions the following responses were noted:-

a)  ...  view the full minutes text for item 108.

East Midlands Ambulance Trust wish to discuss a number of key strategies to help them to achieve their long term plans, allowing them to give people the right care, with the right resources, in the right place, at the right time.

The strategies are being developed together and in line with the strategic objectives contained in their Better Patient Care and draft five year plans, so that the full set will support what they wish to do.

The strategies are:

•           Clinical and Quality Strategy

•           Workforce Strategy

•           Fleet Strategy

•           Information Management and Technology (IM&T) Strategy

•           Estates Strategy

The final strategies will then be presented to the EMAS Executive Board and they would then wish to come back at a later date to discuss future developments.

A copy of a report is attached at Appendix B, a briefing at Appendix B1 and a presentation at Appendix B2.

East Midlands Ambulance NHS Trust attended the meeting to discuss a number of key strategies to help them to achieve their long term plans, allowing them to give people the right care, with the right resources, in the right place, at the right time.

The strategies were being developed together and in line with the strategic objectives contained in their Better Patient Care and draft five year plans, so that the full set will support what they wish to do.

The strategies were:

•      Clinical and Quality Strategy

•      Workforce Strategy

•      Fleet Strategy

•      Information Management and Technology (IM&T) Strategy

•      Estates Strategy

The final strategies would then be presented to the EMAS Executive Board and they would then wish to come back at a later date to discuss future developments.

A copy of a report, a briefing and a presentation had previously been circulated to Members with the agenda.

RESOLVED:

That EMAS be thanked for their presentation and it was pleasing to see that the new management structure was providing improvements and allowing the service to move forward in responding to the current challenges.

To consider a report on the outcomes of the consultation carried out on the Pharmaceutical Needs Assessment (PNA) which was carried out from 29 September 2014 to 12 December 2014.  The Report is being submitted to the Health and Wellbeing Board at its meeting on 26 March 2015.  The final PNA which is being submitted to the Board for approval is also attached.

The Commissions views on the report and the final PNA are requested.

The Commission received a report on the outcomes of the consultation carried out on the Pharmaceutical Needs Assessment (PNA) which was carried out from 29 September 2014 to 12 December 2014.  The Report was also being submitted to the Health and Wellbeing Board at its meeting on 26 March 2015 requesting approval of the final PNA Assessment.  The final PNA Assessment for approval had previously been circulated to Members.

The Commissions views on the report and the final PNA are requested.

In response to questions, it was noted that:-

a)         The final PNA was a based on a prescribed format to comply with legislative requirements.

b)         Although there were adequate pharmacies for the needs of the total population, not all areas of the city received the same level of service.

c)         The PNA would be available for Commissioners to use when services were commissioned.

d)         NHS England commissioned pharmacy services and the Council would request additional services be provided by pharmacies in different areas of the city that reflect each area’s health needs.

e)         The number of pharmacies in a ward did not necessarily mean better health outcomes in the ward. Commissioning different services from pharmacies according to local health needs could potentially have an effect on health outcomes.  Pharmacies were also required to report on the usage of various services through the commissioning arrangements.  

RESOLVED:

That the Commission supports the Recommendations to the Health and Wellbeing Board to:-

a)         Approve the final PNA for publication.

b)         Note the need to update the PNA by March 2018, as set out in the Pharmaceutical Regulations.

c)         Note and approve the ongoing responsibilities with respect to the publication of an up-to-date map of all pharmacy provision and the arrangements that have been proposed to ensure that this takes place.

The draft report was considered at the Commission’s meeting on 10 March 2015.  Comments have now been received and the 2^nd Draft final report is submitted for approval. Any comments received after the publication of the agenda will be reported at the meeting.

The Commission received a 2^nd Draft final report for approval.  The first draft was originally considered at the Commission’s meeting on 10 March 2015. 

The Chair reported that a response had been received from NHS England to the report’s recommendations and these were incorporated under paragraph 4.3.

RESOLVED:

1)         That the 2^nd draft report be received and approved for final issue including the response made by NHS England.

The draft report was considered at the Commission’s meeting on 10 March 2015.  A copy of the latest draft is attached.  Any further comments received will be reported at the meeting. 

Following discussion at the lasts meeting it was agreed that LAMP would provide further evidence at the meeting.

The Commission received a 2^nd Draft final report for approval. The first draft was originally considered at the Commission’s meeting on 10 March 2015. Comments received since the meeting had been incorporated into the 2^nd draft report.

A representative of LAMP attending the meeting and submitted the following comments based upon her experiences:-

a)         Young black British Men could start to face isolation and mental health issues in earlier school life, through unintentional institutional racism, through a mixture of lack of resources and training for professionals who were not aware of the isolation and social issues faced by different cultures.

b)         Children from mixed race marriages could face social isolation as they could feel that they were not fully accepted or felt able to fully integrated into either of their mixed races. This could make them vulnerable to mental health issues in their later life.

c)         Often young black British pupils were underachieving as a result of their isolation issues, but there were no specific initiatives to address this. Often, pupils were more likely to be seen as obstructive and troublesome and, as a result, they were more likely to be excluded either form lessons or from school, which further increased their isolation. Exclusion from lessons did not count towards the formal figures for ‘excluded pupils’ but often had the same effects of isolation for the individuals concerned.

d)         There was an under representation of African-Caribbean teachers in the workforce.

e)         There was a need for a young peoples’ specialist advocacy service in Leicester for mental health for all young people and not just for one specific community.

The Chair commented that, whilst a number of the comments were outside the specific narrow terms of the review, he recognised that the impact of the issues raised could have a later impact upon the group that were the subject of the review. He also recognised that interventions at an early stage may have had an effect upon the current picture.

It was noted that the Royal College of Paediatrics and Child Health had an on-line educational resource called ‘MindEd’ which provides practical e-learning sessions when and wherever they’re needed, quickly building knowledge and confidence to identify an issue, act swiftly and improve outcomes for children and young people. The resource can be found at the following link:-

http://www.rcpch.ac.uk/minded

The project were working with schools to give them have the resources and tools to recognise mental health issues at an early stage. A similar resource for parents was also being developed.

The importance of having a service such as CAMHS was also recognised.

RESOLVED:

1)         That the 2^nd draft report be received and that the comments made at the meeting be noted.

2)         That the Chair revisits the recommendations in the report to make them more robust and ‘active’ clearly indicating individuals or organisation which should take action to address them. The revised recommendations be sent to the Commission Members for comment before the final report is  ...  view the full minutes text for item 112.

The Scrutiny Policy Officer submits a document that lists suggestions for future health scrutiny. 

The Scrutiny Support Officer submitted a document that listed suggestions for future health scrutiny.

The Chair commented that Members could suggest further items by e-mailing the Scrutiny Support Officer if they wished.

RESOLVED:

That the list of suggested items for future health scrutiny be received and Members be invited to e-mail any further suggestions to the Scrutiny Policy Officer.

The Acting Director of Public Health to provide an update on the proposed funding changes to GPs Primary Medical Services contracts and the implications this may have for health care in the City.

The Acting Director of Public Health provided an update on the proposed funding changes to GPs Primary Medical Services contracts and the implications this might have for health care in the City.

It was noted that:-

a)         There were currently 17 GP practices in the City with a Primary Medical Services contact.  This represented approximately 26% of GP practices in the City on this type of contract compared to 40% of GP practices nationally.  A growing number of GP practices in the City were converting to General Medical Services Contracts.

b)         The average financial loss to GPs with a Primary Medical Services contract as a result of the funding changes is estimated at approximately £10,000 per annum per practice.  The money saved by these changes would be retained within the health economy and it was intended to redistribute them to GPs practices that needed additional resources.  These payments had been made previously to all Primary Medical Services GP practices, some of which would have been in more affluent areas and would not have needed the extra support.

c)         The Minimum Practice Income Guarantee, which was used to top up practices core funding, had also been removed.  This could have a further impact upon some City GP practices.

d)         NHS England would be expected to redistribute the monies through the new co-commissioning arrangements with the CCG.

RESOLVED:

That the report be noted and the Acting Director of Public Health undertake further work to determine the impact upon each GP practice in the City affected by these proposals and report back to a future meeting.

To receive updates on the following matters that were considered at previous meetings of the Commission.

The Commission received an update on the following items that had been considered at a previous meeting:-

It was noted that:-

a)         Healthwatch Leicester were still on target to be established as an independent body.

b)         No formal individual apology had yet been issued to the Directors of Healthwatch who had previously resigned, following VAL’s refusal to novate the contract to Healthwatch Leicester.

A Healthier Future for the East Midlands

To receive for information, a copy of a report issued by the East Midlands Councils which examined a number of issues of importance when reviewing health outcomes and practice in the East Midlands Region.  Four priority areas were highlighted as set out below:-

            Inequalities ii Health outcomes.

            Inequalities in funding for health care.

            Recruitment and retention of the health workforce.

            The need for collective leadership.

The report makes a number of recommendations to support further work between councils and MPs, the NHS , Public Health England and wider health partners.

In a review of

A Healthier Future for the East Midlands

A copy of a report issued by the East Midlands Councils which examined a number of issues of importance when reviewing health outcomes and practice in the East Midlands Region.  Four priority areas were highlighted as set out below:-

Inequalities ii Health outcomes.

Inequalities in funding for health care.

Recruitment and retention of the health workforce.

The need for collective leadership.

The report made a number of recommendations to support further work between councils and MPs, the NHS, Public Health England and wider health partners.

RESOLVED:

                        That the report be noted.

The Chair declared the meeting closed at 8.05 pm.