Agenda and minutes

Apologies for absence were received from Councillors Cassidy and Chaplin.

Members of the Adults Scrutiny Commission and Children Young People and Schools Scrutiny Commission had been invited to attend and apologies for absence had been received from Councillors Aldred, Cole, Hunter, Riyait, Moore, Senior and Willmott.  

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 received.

The Chair stated that there would be further meetings of the Commission to consider various aspects of the STP and a further meeting of the Commission would take place on 29 April 2017 to hear the views of public, patient groups and other interested community organisations on the draft STP prior to the formal consultation process.  There would also be a further meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee to submit a formal response on behalf of the three local authorities within the LLR.

To receive the Care Quality Commission’s (CQC) Quality Report of the inspection of the Leicestershire Partnership NHS Trust (LPT) in November 2016.  The report was published on 8 February 2017. (Appendix A1)

The Chief Executive of LPT also submits a report which summarises the CQC’s key findings and the Trust’s initial response ahead of the production of a full action plan. (Appendix A2)

The Commission received the Care Quality Commission’s (CQC) Quality Report of the inspection of the Leicestershire Partnership NHS Trust (LPT) in November 2016.  The report was published on 8 February 2017. The Chief Executive of LPT also submitted a report that summarised the CQC’s key findings and the Trust’s initial response ahead of the production of a full action plan.

The Chief Executive LPT introduced the report and stated that:-

a)         The Trust had received a ‘Requires Improvement’ rating following the initial inspection in March 2015.  The follow up inspection in November 2016, involving 86 inspectors across 15 core service lines, had also resulted in an overall rating of ‘Requires Improvement’; although the Safe Services rating had improved from ‘Inadequate’ to ‘Requires Improvement’.  The individual ratings for Effective, Caring and Well Led Services were still rated as ‘Requires Improvement’; although it had been acknowledged that many improvements had been made since the initial inspection. The rating for a Caring Service remained unchanged as ‘Good’.   CAMHS Inpatient ward had received a ‘Good’ rating and progress had been made in adult mental health services.

b)         Although disappointing, the overall CQC rating was considered a fair assessment of the improvement journey since the initial inspection and the Trust remained confident that they were moving in the right direction.      

c)         There was still work to be done to improve the physical environment within the estate.  The Trust was in the process of changing 180 doors within the initial budget of £3m for improvements.  The Trust had been planning to re-build the place of safety unit for some time following the publication of the Mental Health Crisis Care Concordat which meant that it was no longer adequate for the new requirements in the concordat.  The Trust had consequently programmed the rebuilding of the unit but this could not be achieved between the initial and follow up inspections.  Rebuilding the unit was currently underway and it would reopen as all age facility, with separate entrances, in early June 2017.    

d)         Two central themes in the review were around staffing and the use of agency staff and the out of county pathway.

e)         CAMHS had been rated ‘Inadequate’ overall in relation to safety and being responsive in the initial inspection.  The focus since then had been to improve the waiting times for young people improving the initial triage service and introducing a new access model and additional resources for the team.  As a result no one was now waiting longer than 13 weeks for an initial assessment.  However, 640 young people were currently waiting for treatment and initiatives were being introduced to reduce this.  The Trust, as part of the Future in Mind initiative was working with the CCG to provide a programme of measures to improve eating disorders, and provide crisis intervention.  £1m of funding had been provided from 1 April 2017 for dealing with instances of unscheduled crisis.  There had been a 20% increase in demand in the previous year on top of the 10%  ...  view the full minutes text for item 64.

At 6.30 pm the Chair adjourned the meeting for 10 minutes to allow those Councillors, officers and members of the public who had attended for the previous item to leave the meeting.

At 6.40 pm the meeting reconvened with Councillors Dempster, Fonseca, Cleaver, Sangster and Unsworth present.  

To receive a report from UHL on their intention within the STP to consolidate maternity care onto the Leicester Royal Infirmary site with the potential for a midwifery led birthing centre at the Leicester General Hospital, subject to formal public consultation.

Members received a report from UHL on their intention within the STP to consolidate maternity care onto the Leicester Royal Infirmary site, with the potential for a midwifery led birthing centre at the Leicester General Hospital, subject to formal public consultation.

The Chair stated that there would be a further meeting of the Commission on 29 March 2017 to hear submissions from the public and interested organisations on their views of the proposals in the draft STP.    There would also be a further meeting of the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee to consider the STP once the formal consultation process had started.

Mark Wightman, Director of Communications, University Hospital of Leicester NHS Trust (UHL), Ms Melanie Thwaites, Associate Director, Children and Young People Services, East Leicestershire & Rutland Clinical Commissioning Group, and Ian Scudamore, Clinical Director for Women’s & Children’s Services attended the meeting to present the report and answer Members’ questions.

The details of the proposals were:-

•           Women’s services currently located on the LGH site would be consolidated to the LRI; where a new Women’s Hospital would be developed. The Women’s Hospital would include:

o          Maternity (the proposed Standalone Birth Centre at the LGH would remain when other maternity services are re-located)

o          Neonates – new-born babies needing care

o          Gynaecology

o          Clinical Genetics

·                    Antenatal and postnatal services will continue to be provided in the community, as they always have been

·                     Where clinically appropriate, women will still be able to choose from the following four birth options:

o          Home births

o          Standalone Birth Centre at the LGH (if this is the outcome from consultation)

o          Alongside Birth Centre at the LRI

o          Combined Care Unit at the LRI

The proposals had arisen from the Trust experiencing capacity issues in fully staffing all the existing units over recent years and having to temporality close some units for short periods.   Providing all the maternity services on one site was considered to be safer, more efficient and would provide a sustainable service for women and families; as well as offering a choice of services.

Members, in discussing the proposals, received the following responses to their questions and comments:-

a)         The recent CQC inspection report on Maternity Services would be submitted to the Commission in due course.

b)         The number of births at Melton had been reducing in recent years and now averaged 1 birth every two and half days, which made the unit expensive to run as it was fully staffed by midwives.  There were no specialist obstetricians at Melton in the event of difficulties and many expectant mothers chose to use the existing midwife lead facilities at the General and the Royal Infirmary as a result.  If the midwife lead services were moved to the General Hospital this should increase the choice to use midwife led services as specialist services would be available in the event of difficulties.

c)         The number of home births was declining because more expectant mothers wanted a midwife led service in a safe hospital  ...  view the full minutes text for item 66.

To receive a report from UHL on their intention within the STP to consolidate acute care onto two acute hospital sites, subject to formal public consultation.

Members received a report from UHL on their intention within the STP to consolidate acute care onto two acute hospital sites, subject to formal public consultation.

John Adler, Chief Executive, University Hospitals of Leicester NHS Trust (UHL) attended the meeting to introduce the report and respond to Members questions and comments.

It was noted that:-

a)            The proposal to reduce the number of acute sites from three to two sites was dependent upon the proposals in the wider STP because the reconfiguration of the acute service provision could only happen if other reconfigurations in the STP were in place.

b)            The direction of travel for the acute services provision was first announced in the summer of 2014 and there was some frustration that it had taken so long to progress the plans which had previously been discussed with the Commission and the County Council’s Health Scrutiny Committee.  Nothing had materially changed in recent months within the overall plan to concentrate acute services at the Royal Infirmary and the Glenfield Hospital sites.

c)            The projected numbers of acute bed numbers in the STP, whilst only being one part of equation, was nevertheless an important component; especially in the eyes of the public.  The reduction of the number of acute beds in the STP from 1,940 to 1,647 was still ‘work in progress’.  The Trust was learning from the good practices of the vanguard Trusts around the country.  It was envisaged that the next update would include a revised figure for acute beds.  This reflected a modification of the scale of change that was feasible.

d)            The proposals would also be dependent upon capital funding within the national capital programme available in the NHS.  Part of the capital provision would come from the NHS and other parts from PF2 initiatives.  PF2 had retained the better elements of the previous PFI and eliminated those elements that did not work in the interests of the NHS.  The NHS felt this was a pragmatic approach to provide a combination of funding of £114m of public funding by the NHS and the remainder through PF2 funding streams.  UHL’s request for its capital funding programme was known to be towards the top of the regional programme within the Midlands and East; which was one of the four national areas along with the north, the south and London.  The outcomes of the national funding awards were expected to be announced in the next few months.  Any public consultation on proposals within the STP would be delayed until it was known that capital funding was available to deliver the proposals.  If the UHL were successful in receiving a capital allocation from the NHS prioritisation process, it would then begin the process of going through the pre-consultation preparation process.

Members commented that:-

a)            It was difficult to comment effectively on proposals that were dependent upon other elements of change and was reliant upon capital allocations that may or may not be available.

b)            The proposals for the acute  ...  view the full minutes text for item 67.

The meeting closed at 8.35 pm.