Agenda and minutes

The Chair welcomed Councillor Clarke to the meeting in his new role as Deputy City Mayor with responsibility for health and wellbeing.

The Chair also congratulated Councillors Dempster and Myers on their recent appointments to Assistant City Mayors.  The Chair had invited them to attend the meeting to contribute to the issues previously considered by the Commission.

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.  No such declarations were made.

The minutes of the meeting held on 23 August 2017 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/ieListMeetings.aspx?CId=737&Year=0

AGREED:

that the minutes of the meeting held on 23 August 2017 be approved as a correct record.

To receive any Chair’s announcements and verbal updates on any 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:-

a)         The questions submitted by Dr Sally Ruane at the last meeting had now received a written response and were printed in the minutes of the last meeting.

b)         The letter on Sexual Health to be sent to Director of Education and Children’s Services had been drafted. The Chair raised the issue of Oftsed picking up these issues with schools with Councillor Russell who had confirmed that Ofsted do consider these types of issues as part of their overall inspection regime but the Council had no control over specific topics to be included in individual inspections.

c)         The City CCG position on the Settings of Care Policy would be submitted to the next meeting in November

d)         The comments and questions raised by Members at the last meeting in relation to the item on General Practice Forward View (Primary Care) had been forwarded to the CCG and a reply was awaited before considering the next steps on the General Practice Forward View and the STP.

e)         A decision on the NHSE Congenital Heart Disease Services Review was expected to be made at NHS England’s Board on 30 November 2017.  The Chair had attended a meeting of the East Midlands Scrutiny Network and the Councils represented there were supportive of the stance taken by the LLR Joint Health Scrutiny Committee and the approach to collaborative working.

f)          Members were invited to a Workshop set up by Councillor Palmer on the updated Health and & Wellbeing Strategy.  The Director of Public Health would submit the draft Strategy to a future meeting of the Commission.

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.

To receive an update on the Mental Health STP Workstream from Dr Peter Miller, Chief Executive, Leicestershire Partnership Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group.

Dr Peter Miller, Chief Executive, Leicestershire Partnership Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group presented an update on the Mental Health STP Work-stream.

The Chair referred to the briefing Members had received the previous week on the Five Year Forward View for Mental Health.  This had been useful to improve Members’ understanding of the issues involved and would be useful in considering mental health as part of the STP.

The Chair had attended the Healthier in Mind event in September which she felt had been a meaningful engagement event.  The Chair also noted that a further update report on CAMHS would be submitted to the Commission in November and that the CQC’s report following their planned re-inspection of LPT would be scheduled into the Commission’s work programme.

Dr Miller and Mr Bosworth in presenting the update stated:-

a)         Service integration underpinned all work-streams in the STP.  The focus in the Mental Health work-stream had been on recovery, prevention and that the care pathways could support people at earlier stages, manage crisis periods effectively and avoid hospital admissions.

b)         It was aimed to improve the access pathways to enable easier access to therapies especially for people with long term physical health issues that were also suffering from mild and moderate mental health disorders.  The target to assess people with a new presentation of psychosis was now 2 weeks and liaison had been improved to provide rapid access wellbeing and recovery hubs if required.  The need to send people out of county for treatment had been reduced from 30 people a year ago to the current level of 5.  The aim was to eliminate the need to send people out of county for treatment.

c)         The Trust were working closely with staff from Northumberland Tyne and Weir NHS Trust who have helped to design a new service process based upon their success of transforming the Trust from being in special measures approximately 5 years ago to a Trust currently rated as Outstanding by the CQC.  The service design process, called Healthier In Mind, had started by engaging patients to provide input into designing services that were attuned to what they wanted to meet their needs.  Having clear and easily understood pathways was also a prime consideration in the design process.

Members made the following comments and observations:-

a)         LPT were to be congratulated on signing up to the Armed Forces Covenant as many servicemen and ex-servicemen suffered from mental health issues

b)         There were references to VCS involvement in service delivery in the Plan and, as a number of VCS organisations had recently closed or had their funding reduced, had these been taken into account when preparing the Plan.

c)         The Plan should include more details of the pathways for engaging with services and contain more details of the services that would be available in the hubs.

In response to Members’ questions the following responses were received:-

a)         The CCG were working with the provider  ...  view the full minutes text for item 33.

Will Legge, EMAS Director of Strategy and Transformation and Richard Lyne, EMAS LLR Service Delivery Manager will attend the meeting to present a briefing paper on the Ambulance Response Programme and Handovers to the Emergency Department at Leicester Royal Infirmary.     

Will Legge, EMAS Director of Strategy and Transformation and Richard Lyne, EMAS LLR Service Delivery Manager, attended the meeting to present a briefing paper on the Ambulance Response Programme and Handovers to the Emergency Department at Leicester Royal Infirmary.

It was noted during the presentation of the report that:-

a)         The presentation to the East Midlands Health Scrutiny Network, appended to the report, gave details of the improvement journey that the Trust had undertaken since CQC published its last Inspection Report in May 2016.

b)         The CQC had carried out a follow-up inspection February 2017 when significant improvements had been recognised. This had resulted in the ‘safe’ element of the inspection process moving from the previous rating of ‘inadequate’ to ‘requires improvement’.  The CQC commented upon a number of good examples of best practice; such as the procedures for dealing with sepsis.  No new areas of concern had been identified.  Both staff and patients had made positive comments about changes which already been made under the Quality Improvement Plan.

c)         A new Quality Improvement Plan had been produced in response to the February 2017 inspection and this was being monitored by an internal Improvement Board and the EMAS Board.

d)         Handovers had improved since the new Emergency Department had opened as a result of joint work between EMAS and UHL to address the known issues.  There had been some initial teething issues in the first month as the new arrangements had bedded down.  Since September 2016 to September this year there had been a 77% reduction in waiting hours by EMAS crews.  There had also been a bigger reduction in instances where the handover of the patient from arrival to being offloaded to the ED took more than an hour.  In 2016 more than third of arrivals at the ED had waited more than an hour and now this had been reduced to 7%. 

e)         EMAS had worked with UHL on many aspects to see if the improvements were sustainable; especially in relation to the winter plan. EMAS felt that they had a strong relationship with UHL which enabled robust discussions to take place when needed.

f)          EMAS staff had been involved in the design of the new ambulance fleet and the new fleet had made a difference to the clinical care and environment for staff.  The design of the new fleet had been highlighted as an example of good ambulance design and a number of Trusts are trialing the new EMAS fleet design.   The new design allowed crews to have quicker access to lifesaving and key equipment coupled with a more accessible treatment area that allowed crews to treat a patient more effectively en-route to a hospital rather than at the scene. 

g)         The ambulance response targets, which had been used since 1994, were felt to be somewhat outdated as they did not reflect the huge changes in the social care system or the increased levels of demand that had occurred since then.  In addition,  ...  view the full minutes text for item 34.

To receive a report from the University Hospitals of Leicester providing an update on the current state of play since the move to the new Emergency Department.

John Adler, Chief Executive, University Hospitals of Leicester NHS Trust provided an update on the current state of play since the move to the new Emergency Department.

The Chair commented that she had attended the preview tour of the new Emergency Department and had been impressed with the facilities it provided.

In presenting the update, the following comments and statement were noted:-

a)         The new emergency department had transformed privacy and dignity for patients, particularly for the frail and elderly.

b)         There used to be all year round pressures but now the unit had sufficient space to accommodate big surges in attendance.    There had been positive feedback on the design, quality and the build of the new facility. 

c)         The Trust was not consistently improving performance against the 4 hour target and as performance was still somewhat erratic.  The goal was now to achieve 90% of patients being seen within the 4 hour target compared to the previous target of 95%.  Overall all A&E departments in the country were performing at around 87%.

d)         Approximately 35 initiatives had recently been implemented in an attempt to bring about a more consistent improvement and these were outlined in the report.

e)         The Emergency Department was now one of biggest in the country seeing 600-800 patients a day.  One initiative had been to provide improved access to consultants for a trial period during the night so that junior doctors could get guidance on treatment of patients with minimal delay.  More porters had been provided and processes changed to allow quicker access to tests for patients.  This had made improvements and a medium term plan was being developed to provide sufficient medical resources during the evening and overnight periods.  Last week the Trust had been rated as the 107^th performing Trust when previously they had been rated the worst. 

f)          The Trust has been ‘buddied’ with Luton and Dunstable NHS Trust which was one of the top performing trusts in the country.  Although they were smaller in size, their system of operation was the key factor in providing efficiencies and long term improvements.  Staff from Luton had visited Leicester to observe the relationship between specialties departments and the Emergency Department.  UHL Trust were now looking to change practices and embed Luton’s culture in the Emergency Department.   This involved providing additional staff resources in the Emergency Department and changing downstream working and responsibility in departments.

g)         Currently UHL aimed to assess patients within an hour of arrival, devise a treatment plan within 2 hours and determine whether a patient needed to be admitted within 3 hours, and then locate a bed and move the patient to a ward within 4 hours.  The Luton model assessed the patient in the Emergency Department and located a bed within the first hour.  UHL were looking at an electronic bed management process to improve patient flows.

h)        Phase 2 of the Emergency Floor would see the co-location of the specialised assessment units next to the new Emergency  ...  view the full minutes text for item 35.

To receive a joint report from Leicester City CCG, East Leicestershire & Rutland CCG and West Leicestershire CCG of plans to de-commission a number of interventions for lower back pain, with or without sciatica, in line with National Institute for Health and Care Excellence (NICE) guidance published in November 2016.   Dr Umesh Roy Leicester City CCG, Lead Planned Care, Helen Mather, Implementation Lead Planned Care and Danah Cadman, Project Manager Planned Care will be in attendance at the meeting.

Members received a report that outlined Leicester City CCG, East Leicestershire & Rutland CCG and West Leicestershire CCG’s plans to de-commission a number of interventions for lower back pain, with or without sciatica, in line with National Institute for Health and Care Excellence (NICE) guidance published in November 2016.   Dr Umesh Roy, Lead Planned Care, Helen Mather, Implementation Lead Planned Care and Sarah Prema, Director of Strategy and Implementation represented Leicester City CCG at the meeting to present the report and respond to Members’ questions.

It was noted that:-

·         The 3 CCGs were implementing the NICE guidance to streamline the management of treatment so that patients could return back to work earlier.

·         Approximately 20% of the population suffered from back pain and it often led to patients developing mental health issues in the long term if the problem became chronic.  Equally, many people suffering from common back pain regularly got better without any treatment and the guidance promoted self-care as key component of the treatment options for back pain.  Self-care could involve weight reduction or exercise regimes.

·         The proposals were intended to look holistically at how health services managed back pain.

·         360 patients were currently affected by the proposals and this number would reduce in the coming months as each individual period of 12 week treatment ended.  Those already on the 12 week treatment course would have the option to continue to the end of the treatment.

·         The model of treatment would reduce referrals and imaging for low/medium risk patients and focus the activities of specialist services on those at high risk of a poor outcome who would require a more intensive input.   

·         Patients would also be advised of other treatments available in the community if they wished to pursue them at their own expense.

·         The redesign of the physio-therapy service also involved redesigning the website to assist people to access and self- refer to service they required.

AGREED:

That the proposals be noted and that the representatives of the CCG be thanked for attending the meeting and responding to Members’ questions.

The Chair submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2017/18.  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 2017/18.

AGREED:-

That the Work Programme be noted and updated to include the actions arising from the meeting.

The meeting closed at 8.23 pm.