Agenda and minutes

Apologies for absence were received from Councillor Sangster and Councillor Palmer.

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 25 May 2016 have been circulated and the Commission will be asked to confirm them as a correct record.

The minutes can be found on the Council’s website at the following link:-

http://www.cabinet.leicester.gov.uk:8071/ieListDocuments.aspx?CId=737&MId=7366&Ver=4

RESOLVED:

that the minutes of the meeting held on 25 May 2016 be approved as a correct record subject to “The impact on looked after children of the reduced budget be assessed” be added to Minute No 9 in paragraph a) of the members comments and observations.

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, 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.

The Chair commented that she had received a full response from the Monitoring Officer in relation to the issue of the requirement for questions from the public to be received 5 clear days before the meeting.  This provision was intended to allow members of the public the opportunity to raise health issues of concern to them but was not intended to specifically receive questions on the published agenda.  To allow this to happen would require a change to the Council’s Constitution.        

To receive the Care Quality Commission’s (CQC) report, issues in April 2016, of their unannounced inspection of the Emergency Department at the Leicester Royal Infirmary on the evening of 30 November 2016.  Following the inspection an urgent Notice of Decision was issued to the Trust on 4 December 2015.

A copy of the University Hospitals of Leicester NHS Trust’s presentation to their response to Notice of Decision is attached at Appendix A1 (Page ???).  Mark Wightman, Director of Marketing and Communications, University of Hospitals Leicester NHS Trust will be present at the meeting.

Members received the Care Quality Commission’s (CQC) report, issued in April 2016, of their unannounced inspection of the Emergency Department at the Leicester Royal Infirmary on the evening of 30 November 2016.  Following the inspection an urgent Notice of Decision was issued to the Trust on 4 December 2015.

Mark Wightman, Director of Marketing and Communications, University of Hospitals Leicester NHS Trust (UHL) gave a presentation on UHL’s response to the Notice of Decision.

During the presentation it was noted that:-

a)         The CQC report had highlighted 3 areas where conditions were imposed on the Trust’s registration as a service provider.  These were

·         Patient Assessment

·         Emergency Department Staffing

·         Sepsis Management

b)         The Trust had been aware of these issues prior to the inspection.  It was well known that the A&E department was the busiest single A&E site in the country and had originally been built to accommodate 100,000 attendances per year but the attendances between November 2014 and October 2015 were 217,832.  The large attendances at A&E in recent years had prompted the building of new Emergency Department to improve the operation and efficiency of the A&E unit.

c)         The Trust had taken the following actions in response to the CQC’s Notice of Decision:-

            Patient Assessment   

Additional staff resources were taken from hospital wards to work in the assessment area in the A&E unit to improve the performance of patients being assessed within 15 minutes of arriving in the Emergency Department.  At the time of the inspection the actual performance was 55%-60% against the standard of 90%.  Following the inspection, performance was significantly improved and performance during the last 6 months had fluctuated between 85%-95%. A graph showing the performance was circulated with the agenda.

Emergency Department Staffing

A graph showing the performance was circulated with the agenda and indicated the improvement in performance that had been achieved in staffing levels.  The CQC had been concerned with the number of staff and the skills mix of staff dealing with the poorliest patients. Additional senior nurses had been moved into these areas and more consistent levels of performance were now being achieved. 

Sepsis Management    

Sepsis was a life threatening condition that can occur when the whole body reacts to an infection.  The symptoms of sepsis are similar to the symptoms for a number of ailments and if not spotted quickly, the patient can deteriorate very quickly.  The performance was improved but was not yet consistent.  The national standard was for 90% of patients who presented with sepsis to receive their medication within 1 hour of arriving at the Emergency Department.  Patients with symptoms of sepsis may not always present themselves within the A&E, major injuries or resuscitation units and additional education and training was being rolled out across all staff to assist them in identifying patients with sepsis.

Following comments and questions from Members the following responses were noted:-

a)         The peaks and troughs in patient assessment performance were mainly related to the varying numbers  ...  view the full minutes text for item 20.

To receive a presentation from the Leicester City Clinical Commissioning Group (LCCCG) providing an overview of the Sustainability and Transformation Plan and the next steps and expected milestones.  Sarah Prema, Director Strategy and Implementation, (LCCCG) will be present at the meeting.

The Commission received a presentation from Sarah Prema, Director Strategy and Implementation, Leicester City Clinical Commissioning Group (LCCCG) providing an overview of the Sustainability and Transformation Plan (STP), the next steps and the expected milestones.

It was noted that the STP was a place based plan to accelerate the implementation of the Five Year Forward View required in the NHS Planning Guidance 2016/17 – 2020/21.   The STP covered all areas of CCG and NHS England commissioned services including specialised services and primary medical care.  The plan also covered the better integration with local authority services.  Toby Sanders, Chief Officer, NHS West Leicestershire CCG was the lead officer for STP. 

The Better Care Together programme would form an integral part of the STP and Leicester, Leicestershire and Rutland were ahead of many areas of the country in developing the BCT programme.

In developing the STP each area has to show how they are going to ensure sustainability in the following areas:-

·         Health and Wellbeing

·         Improving care and quality

·         Ensuring financial sustainability (improving productivity and closing the financial gap)

The feedback from NHS England on the initial submission in April had been positive and further work had been undertaken to develop where LLR could go further on the three areas listed above.  A detailed submission has to be submitted to NHS England by 30 June 2016 and this was based upon both the BCT Programme and the STP emerging priorities. 

The emerging priorities for the STP were:-

·         BCT Phase 1 service reconfiguration.

·         Public sector efficiency.

·         Prevention.

·         Urgent and emergency care.

·         Mental Health.

·         Integrated place based community teams.

·         Primary medical care.

·         Digital technology.

·         Public sector estate.

·         Health and care workforce.

·         LLR place based system approach.

These priorities would be developed by the 6 STP work-streams of:-

·         Improving health outcomes and independence.

·         Delivering care in the right place.

·         Making better use of resources.

·         Integrated place based teams.

·         Resilience in primary care.

·         System leadership.

It was expected the STP would not be finally approved until late autumn.  As part of this process the pre-consultation business case for the BCT was being refreshed.  As a consequence, public consultation on BCT could not start until this business case had been approved.

Members made the following comments:-

a)         Place based planning could be a topic for the planned Primary Care Health Summit.

b)         The requirement to prepare the STP was frustrating as it appeared to be yet another strategic plan on top of the BCT which had still not progressed to public consultation after two years of development.

c)         Further details of the financial gap outlined on page 3 of the presentation and the proposals to address this should be made available to the Commission.

d)         Documents made available to the public should be written in a clear non-technical style that was easily understood by non-health professionals.

e)         There were concerns that insufficient resources would be spent on twin tracking of services ant his may not be in the best interests of people living  ...  view the full minutes text for item 21.

To receive a report from the Leicester City Clinical Commissioning Group (LCCCG) informing members of the proposals regarding the promotion and education of self-care for Leicester city patients to maximise the benefits of existing resources. The report includes low priority prescribing in particular: gluten free foods and paracetamol and other items for self-limiting illness.

Richard Morris, Director of Corporate Affairs, LCCG will be present at the meeting.

Members considered a report from the Leicester City Clinical Commissioning Group (LCCCG) informing members of the proposals regarding the promotion and education of self-care for Leicester city patients to maximise the benefits of existing resources. The report included low priority prescribing in particular: gluten free foods and paracetamol and other items for self-limiting illness.

Sara Prema, Director Strategy and Implementation, Leicester City Clinical Commissioning Group (LCCCG) and Lesley Gant, Head of Prescribing LCCCG presented the report to the Commission.

The proposals in the report were to:-

·         either partially or fully cease to prescribe gluten free products for patient with coeliac disease; and

·         support GPs in not prescribing paracetamol and other products for self-limiting illnesses, such as viral infections.

The CCG had a responsibility to provide a reasonable level of care for all patients but was also required to work within the financial resources allocated to them.  The two proposals had been identified as the products involved were now widely available in shops and pharmacies etc at cheaper costs than through prescriptions.  In relation to patients with coeliac disease more than 50% of patients managed their condition with prescriptions for gluten free products.

The Commission’s views were being sought as part of the pre-engagement process and any views would be taken into account before any formal public consultation was carried out on the proposals.  Each of the three CCGs in the Leicester, Leicestershire and Rutland would engage with Patient Participation Groups and work with GPs to contact patients with coeliac disease to make them aware of the consultation process.  A stakeholder event with specialist charity representatives (Coeliac UK) dieticians and coeliac patients had already taken place and a further stakeholder event would be held in relation to paracetamol and other products for self-limiting illnesses.

Commission Members made the following comments and observations:-

a)         There were concerns that the proposals would adversely affect poorer families and the homeless community and their views may be missed in the consultation process.

b)         There should be joint working with children and families teams to see how advice can be disseminated to families in relation to dealing with minor ailments.

c)         The CCG could have used their resources to provide additional training and support to GPs to reduce overprescribing paracetamol for self-limiting illnesses.

d)         There were concerns that other products may be added to the list of products to be removed from being routinely available on prescription.        

In response to Members’ comments and questions it was stated that:-

a)         The CCG’s had links with hard to reach communities and these would be used to ensure that the views of the homeless and homeless services were fed into the consultation process.

b)         Whilst West Leicestershire CCG was taking the lead for the review, Leicester City CCG was still required to approve that the engagement was ‘fit for purpose’ for the City area.

c)         Paracetamol would still be available through prescription for patients that required it for their illness, e.g patients who suffered  ...  view the full minutes text for item 22.

The Director of Public Health to provide a verbal update on the Anchor Recovery Hub.

The Director of Public Health reported that the final options for the location of the Anchor Recovery Hub were expected to be completed the following week.  The current service providers, Inclusion Healthcare, had been included in the discussions during the development of the options.   It was intended to provide a briefing for the Chair and Ward Members on the preferred option before the next meeting of the Commission.

Members of the Commission also asked to be provided with details of the preferred option.

AGREED:

            That the update on the Anchor Recovery Hub be noted. 

To receive the draft report of the Commission’ review of the Leicestershire Partnership NHS Trust – Quality monitoring following the Care Quality Commission Inspection.  The Commission is asked to comment upon the draft report and endorse it to be submitted to the relevant bodies involved.  Councillor Sangster will present the report as the Chair of the Scrutiny Review Group.

The Commission received the draft report of the Commission’ review of the Leicestershire Partnership NHS Trust – Quality monitoring following the Care Quality Commission Inspection.  Members were asked to comment upon the draft report and endorse it to be submitted to the relevant bodies involved. 

The Chair thanked Councillor Sangster for leading this review which had made a number of important recommendations that would be taken forward in in other areas of work.

AGREED:

That draft report be received and approved for final issue and that the relevant bodies and organisations mentioning in the report be asked for their comments on the recommendations.  

To receive the draft scoping report for a proposed scrutiny review on the ‘Child and Adolescent Mental Health

Members are requested to make comments on the draft and approve the terms for the review. 

Members received the draft scoping report for a proposed scrutiny review on the ‘Child and Adolescent Mental Health’ and were asked to comment on the draft and approve the terms for the review. 

Members commented that they welcomed the inclusion in the review of what happens to those children and adolescents that don’t get accepted on the waiting list and whether there is any follow up procedures for those who get an appointment and then don’t attend.

It was noted that there were specific procedures in place for ‘Looked After Children’ and these were considered to be of a good standard. 

AGREED:

That the terms of references in the scoping report be agreed and that they be submitted to the Overview Select Committee for endorsement.

The Scrutiny Policy Officer submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2016/17.  The Commission is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Scrutiny Support Officer submitted a document that outlined the Health and Wellbeing Scrutiny Commission’s Work Programme for 2014/15.

Councillor Chaplin requested that the Health Messaging Scrutiny Review Scoping Document be consider at the next meeting.

AGREED:

That the Work Programme be noted subject to the addition of the Health Messaging Scrutiny Review.   

The meeting closed at 8.05 pm.