Agenda and minutes

Apologies for absence were received from Councillors Bajaj, Shelton and Westley, Members of the Heritage, Culture, Leisure and Sport Scrutiny Commission who had been invited to participate in the consideration of  Agenda Item 7: Integrated Lifestyle Services Review – Final Proposals.

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 5 July 2018 have been circulated and the Commission is asked to confirm them as a correct record.

The Chair announced that she had asked for some amendments to the minutes of the previous meeting held 5 July 2018, and therefore these would be brought back to the next meeting for approval. 

The Chair read out a statement in relation to the proposals to move the Intensive Care Unit (ICU) from the Leicester General Hospital (LGH) to either the Leicester Royal Infirmary (LRI) or the Glenfield Hospital.  The Chair thanked everyone for coming out to support the protest against the proposal and said that campaigners had clearly demonstrated the level of interest and strength of feeling.

The Chair provided a background to the situation and made the following points:

·         An announcement was made in the Leicester Mercury on 25 July 2018 regarding the University Hospital of Leicester’s intention to move a number of ICU beds to the LRI or Glenfield and the intention was to do so without any formal consultation. It was understandable that people had interpreted this as an attempt to close the LGH by stealth.

·         While Scrutiny had a good relationship with the local NHS partners; the fact remained that there had been a significant lack of information in the public domain regarding the Sustainable Transformation Plans (STPs) and plans to reconfigure the University Hospitals of Leicester.

·         The Chair did not feel that it was a coincidence that today the STP’s Next Step document had been published. She understood that it had been at the printers for a number if weeks but it appeared that it had been pushed through ahead of this meeting now taking place.

·         The discussion to move the ICU beds was last held in public scrutiny in Leicester in March 2015 when senior NHS officers brought a paper to the Health and Wellbeing Scrutiny Commission. At that time the commission heard a compelling case for immediate closure for intensive care beds at the LGH which was based on clinical evidence that the current way of operation over three sites was unsustainable and unsafe.

·         The Chair asked people to note for the sake of clarity, that scrutiny did not approve the decision as it was not scrutiny’s role to approve or grant permission. 

·         At that time, scrutiny was assured that the proposal was not associated with delivering the Better Care Together Programme but was concerned with continuing to provide a service.

·         The Chair stated that the facts surrounding the announcement were as follows:

1.    There was a lack of information regarding the draft STP and Next Steps documents, with delays of over 12 month.

2.    There was an inconsistency in delivering the information.

3.    There were ongoing accusations about the lack of transparency – the Chair added that the public needed to be better informed.

4.    The timeline was constantly slipping.

5.    To date, there had been no assurances that a full consultation would go ahead or what this might look like.

The Chair said that she had met with senior NHS officers and explained how Scrutiny would respond to the concerns expressed because of the announcement. She believed that it was a serious oversight by the NHS in failing to recognise the significance of the announcement and the resulting public opinion. The Chair believed  ...  view the full minutes text for item 19.

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 following question has been submitted from Mr Robert Ball:

Moving the Intensive Care Unit from the Leicester General Hospital to the LRI 

University Hospital Leicester (UHL) presented a case to the Scrutiny Commission stating that the intensive care unit (ICU) needed to be closed down at the Leicester General Hospital and moved to the Leicester Royal Infirmary and Glenfield Hospital. Because this was considered an urgent matter with closure required within months for reasons of patient safety, the scrutiny commission at the time approved the move without public consultation. 

Clearly, however, closure was not urgent nor required in 2015 as the ICU at the General Hospital continues in place. As its governing body's approval of the full business case indicates (Ref 1), UHL appear to be assuming they can proceed three years later (commencement of construction by October 2018) with no public consultation, despite the fact that this represents a major change in service delivery. 

This is a question for the Health and Wellbeing Scrutiny Commission: what action will the scrutiny commission be taking to ensure this does not occur? 

The effective closure of ICU at LGH will require the removal of other services, making the long-promised STP consultation on the three to two strategy virtually a meaningless exercise.

The following question has been received from Mr Stephen Score:

University hospitals of Leicester want to close the General as an acute hospital and concentrate their services onto two sites only (the Royal Infirmary and the Glenfield). However, there has been no public consultation on this. Despite that, they are planning to move ITU out of the General, which will make it very difficult to keep other services there. Effectively they are moving from three to two hospitals by stealth and without public consultation. Will the Scrutiny Commission ensure consultation happens?

The following question has been received from Mr Peter Worrall:

It's my understanding the Scrutiny Committee approved the closure of intensive care at the General Hospital in 2015 without formal public consultation because it was informed by University Hospitals of Leicester that the matter was urgent and needed to be dealt with swiftly for patient safety reasons. As ITU still functions at the General can we assume that formal consultation will now be required? And furthermore will the Scrutiny Committee make clear whether it wishes to see proper consultation now take place?

The Chair explained that three questions had been received from Mr Robert Ball, Mr Stephen Score and Mr Peter Worrall and had been included in the agenda.  The questions related to the plans to move the Intensive Care Unit from the Leicester General Hospital to the Leicester Royal Infirmary and the Glenfield Hospitals. At the invitation of the Chair, the questions were read out as follows:

Mr Robert Ball:

Moving the Intensive Care Unit from the Leicester General Hospital to the LRI 

University Hospital Leicester (UHL) presented a case to the Scrutiny Commission stating that the intensive care unit (ICU) needed to be closed down at the Leicester General Hospital and moved to the Leicester Royal Infirmary and Glenfield Hospital. Because this was considered an urgent matter with closure required within months for reasons of patient safety, the scrutiny commission at the time approved the move without public consultation. 

Clearly, however, closure was not urgent nor required in 2015 as the ICU at the General Hospital continues in place. As its governing body's approval of the full business case indicates (Ref 1), UHL appear to be assuming they can proceed three years later (commencement of construction by October 2018) with no public consultation, despite the fact that this represents a major change in service delivery. 

This is a question for the Health and Wellbeing Scrutiny Commission: what action will the scrutiny commission be taking to ensure this does not occur? 

The effective closure of ICU at LGH will require the removal of other services, making the long-promised STP consultation on the three to two strategy virtually a meaningless exercise.

Mr Stephen Score:

University hospitals of Leicester want to close the General as an acute hospital and concentrate their services onto two sites only (the Royal Infirmary and the Glenfield). However, there has been no public consultation on this. Despite that, they are planning to move ITU out of the General, which will make it very difficult to keep other services there. Effectively they are moving from three to two hospitals by stealth and without public consultation. Will the Scrutiny Commission ensure consultation happens?

Mr Peter Worrall:

It's my understanding the Scrutiny Committee approved the closure of intensive care at the General Hospital in 2015 without formal public consultation because it was informed by University Hospitals of Leicester that the matter was urgent and needed to be dealt with swiftly for patient safety reasons. As ITU still functions at the General can we assume that formal consultation will now be required? And furthermore will the Scrutiny Committee make clear whether it wishes to see proper consultation now take place?

The Chair expressed her thanks for the questions and stated that they would be referred to the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee where the issue would be discussed.

The Director of Public Health submits a report that presents a final proposal for a new model of delivery for lifestyle services in Leicester City. Scrutiny Commission members are asked to note the recommended new model and feedback comments on the proposed model to the Executive.

Members of the Heritage, Culture, Leisure and Sport Scrutiny Commission have received an invitation to attend and participate in the consideration of this item.

The Director of Public Health submitted a report that presented a final proposal for a new model of delivery for lifestyle services in Leicester City. Jo Atkinson, Consultant in Public Health delivered a power point presentation on the final proposals, a copy of which is attached to the back of these minutes.

The Chair thanked officers for the report stating that the information presented was more detailed than in the previous report and it provided better understanding. The Equality Impact Assessment was also much improved.

Members considered the report and during the ensuing discussion, a number of points were made including the following:

·      Councillor Cleaver expressed a little disappointment that the review did not promote gardening in general or include information about the initiatives taking place in Eyres Monsell and the Featherstone Orchard which promoted gardening and healthy eating with the added benefit of saving money.

·      A suggestion was made that funding could be sought from the Lottery or Ward Community Budget to help those people who would have to pay for support to promote a healthy lifestyle after their initial 12- week (free) period had lapsed.

·      Reference was made to conversations with people currently volunteering who were concerned about a lack of support. It was acknowledged that volunteering could be exhausting.  The consultant acknowledged that volunteering was an on-going issue and that consideration was being given to appointing a Volunteer Co-ordinator, which would be a paid position to train and support volunteers. They were aware that in some areas of Leicester, it was very difficult to recruit volunteers.

·      Concerns were expressed that there was too much reliance on volunteers and the Deputy City Mayor responded that volunteering was an element of the new model. However, if it was not possible to recruit the volunteers the programme would continue.

·      The meeting heard that there were 16 volunteers leading walks and it was hoped to increase this to 25. It was also hoped to recruit volunteers to help people access gyms.

·      Reference was made to walking groups led by volunteers and a concern was raised as to how those walking groups and services would be delivered in areas where there were busy roads or no accessible or convenient areas to walk. A Member stressed the need to give consideration as to how to help people safely get to those parks or suitable areas. 

·      In response to a question about staffing and volunteers, the meeting heard that consultations had taken place with the unions, staff, service users and focus groups.  The Director of Public Health added that volunteers were not a substitute for paid staff, but would help to expand what was being delivered.

·      In response to a question relating to the proposed savings targets, Councillor Clarke, the Deputy City Mayor with responsibility for Environment, Public Health and Health Integration stated that they were as confident as they could be that the savings target could be achieved without compromising health.

·      The Deputy City Mayor was asked whether the Information Technology staff in  ...  view the full minutes text for item 22.

The Director of Urgent and Emergency Care, submits a report that provides an overview of the ongoing work to prepare for the 2018/19 winter period across the Leicester City, Leicestershire and Rutland (LLR) Urgent and Emergency Care system. The Commission is asked to note and comment on the report as it sees fit.

The Commission received a report on ongoing work to prepare for the 2018/19 winter period across the Leicester City, Leicestershire and Rutland (LLR) Urgent and Emergency Care system. The report was presented by Mike Ryan, Director of Urgent Care (LLR Clinical Commissioning Groups (CCGs) and Sue Lock, Accountable Officer (Leicester City CCG). Members were asked to note that a more detailed report with an outline plan would be brought to the Health and Wellbeing Board at their meeting in September. The Chair asked for the winter care plan be brought to the Commission before the start of the winter period and for the more detailed report that was going to the Board,be brought for noting, to the next meeting of the Health and Wellbeing Scrutiny Commission.

Members considered the report and during the ensuring discussion, comments and questions were raised which included the following:

·      The Chair noted that at a previous meeting of the Health and Wellbeing Board when the Winter Care Plan was considered, Sue Lock had stressed the importance of communication. The Chair asked how effective communication could be ensured this time.

·      It was noted that in relation to delayed transfers of care, the number of cases in the city were down and the improving situation was welcomed.  Members heard however, that there were still many patients who could be discharged earlier and a lot of work was taking place to make further improvements.  Members heard that information on the work being undertaken to facilitate an earlier discharge, could be included in the next report. Comments were made that it was also important to discuss patients’ expectations because their experience often plummeted where expectations were not achieved.

·      Concerns were raised that the report referred to effective communication breaking down as the winter pressures increased, though previously Members had been told that communication was good.

·      A Member referred to the flu jab and questioned whether a more pro-active approach could be undertaken to encourage people to have the flu jab earlier rather than later.

·      The introduction of the ‘Red Bag scheme’ was noted and a request was made that this should include both the regular and emergency medication.

·      A Member asked for the CCG to ensure that patients who needed assessments for an ongoing medical condition, would be able to attend a different clinic if it was not possible to have that assessment at their usual clinic. There was concern that medication would be withheld if they could not have an assessment. The meeting heard that practice nurses were trained to carry out certain assessments and most people with a chronic condition would have an Advanced Care Plan as GPs could not be available 365 days of the year. There was also a system for obtaining repeat prescriptions. The Director of Urgent Care said he would want to know if medication was being held because no appointments were available. Members also heard that investment was being made in the Primary Care Hubs and there was capacity there; they would  ...  view the full minutes text for item 23.

The Head of Medicines Optimisation, Leicester City Clinical Commissioning Group (CCG) submits a report that relates to the proposed changes to the prescribing of medicines for minor ailments. The Commission is asked to note and comment on the proposed changes as it sees fit.

Lesley Gant, Head of Medicines Optimisation (Leicester City CCG) and Sarah Prema, Director of Strategy and Planning (Leicester City CCG) presented a report that related to the proposed changes to the prescribing of medicines for minor ailments.

The Chair asked that the Executive be given full sight of the consultation that had taken place and stated that the proposals had implications for children and people within adult social care.

During the ensuing discussion, comments and questions were raised which included the following:

·         A Member stressed the need to talk to those patients where their ability to manage their own care was considered to be compromised because of their medical, mental health or wellbeing or significant social vulnerability.

·         It was questioned as to how people in poverty, or significant social vulnerability would be identified, and whether an Equality Impact Assessment had been carried out.

·         The Head of Medicines Optimisation explained that the proposals were about informing patients and helping them to manage their own ailments. The Chair responded that while she thought there was general support for a scheme to help people self-care, there were people in real poverty. Some products such as head lice treatments were expensive and cheaper treatments were not effective.  The Chair asked for details as to how people in a certain socio-economic group could be supported. The Head of Medicines Optimisation explained that issues relating to headlice and the treatment of thread worms had already been identified and it was acknowledged that such issues affected a child’s confidence and social interaction.

·         A concern was raised that while the proposals were supported in principle, people might have a condition whereby they needed to see a doctor but did not make an appointment.

The Chair drew the discussion to a close with the recommendation that the report with an Equality Impact Assessment be sent to the Executive so that they were aware of the consultation. The Chair added that there was a need to consider those patients with barriers to treatment, for example those in certain social economic groups.

AGREED:

that the Health and Wellbeing Scrutiny Commission recommend that the report with an Equality Impact Assessment be sent to the Executive.

The Director of Public Health presents the draft Joint Health and Wellbeing Strategy.  The Commission is asked to note the content of the proposed strategy and feed in any additional comments on it as part of the consultation process.

The Director of Public Health submitted the Revised Joint Health and Wellbeing Strategy. Ivan Browne, Consultant in Public Health introduced the report and referred to the Action Plan to support the strategy.

Members considered the report and raised comments and queries which included the following:

·      The strategy was welcomed but a concern was raised that people sometimes experienced stress and illness because of their job, bad management or poor working conditions. A Member commented that she would have liked to see more emphasis on this in the report. The Consultant in Public Health explained that they had been working with the Highcross and looking at mental health at work. He said that there was a need to change the culture as people were often unwilling to admit that they had mental health issues. The Member responded that there was a need to talk to the managers as the emphasis should not be on the person who was ill but on those who were managing their staff.

·      It was noted that the Joint Health and Wellbeing Strategy was a statutory duty of the Health and Wellbeing Board. In response to a question, Members heard that local businesses were not represented on the Board, although efforts were being made to change that. The work however that was being undertaken with the Highcross was critical.

·      A Member referred to the ambitions set out in the strategy, one of which was to ensure decent homes for everyone. She said there were some very sad situations in the city and she expressed concerns as to whether this was achievable. 

·      Views were expressed that the Revised Joint Strategy should be discussed with other Councillors as it was a significant document that cut across everything the council delivered. The Chair suggested that the findings of the consultation should be brought to the Overview Select Committee.

·      The Chair said that the strategy referred to a grass roots approach working with individuals and community groups, and expressed concerns that with pressure of those community groups, there was a limit as to what they could provide.

AGREED:

that the findings following the consultation on the Revised Joint Health and Wellbeing Strategy, be brought to the Health and Wellbeing Scrutiny Commission and the Overview Select Committee as appropriate.

The Commission will receive a verbal update on the new Integrated Sexual Health Services.

The Director of Public Health delivered a verbal update on the Integrated Sexual Health Services in the Haymarket Centre. Members heard that work in the building was progressing well.  A design competition had been held with students from the De Montfort University and the winning entry chosen.

The Chair commented that officers had picked up the comments and concerns previously raised relating to the design and layout of the entrance to the centre and were in regular discussions around other developments in the Haymarket. 

AGREED:

                   that the Health and Wellbeing Scrutiny Commission note the update.

The following items are not for discussion in the meeting but for the Commission to consider if further information is required.

1.  To note that the Leicestershire Partnership NHS Trust has requested a letter of support relating to the re-location of the Child and Adolescent Mental Health (CAMHS) in-patient facility.

2.   To note a briefing paper from the University Hospitals Leicester, NHS Trust that provides information on the process and service development to re-provide and expand renal dialysis services for the population of Lincolnshire and Leicestershire and Rutland (LLR). 

3.  To note the Annual Report 2017/18 Healthwatch, Leicester

4.  To note an update report on oral health in Leicester.

Members were referred to the items for noting and the following comments were made:

Letter regarding the relocation of the Child and Adolescent Mental Health (CAMHS) in patient facility

Councillor Chaplin expressed her reluctance to support the relocation of the in- patient facility without discussing the issue first, as numerous concerns had been expressed in the past.

The Chair responded that a Joint Health and Wellbeing / Children, Young People and Schools / Adult Social Care Scrutiny Commission had been scheduled and she would be happy to discuss the issue with Councillor Chaplin before that meeting, and have a report on the issue. The Chair added however that she as reluctant to delay the process.

The Chair recommended that the Commission submitted a letter of support in principle for the re-location of the CAMHS unit, prior to the issue being discussed in more detail.

AGREED:

                   that the Health and Wellbeing Scrutiny Commission submit a letter to support in principle the re-location of CAMHS, prior to the issue being discussed in more detail.

Renal Dialysis Services

                   A Member asked whether the report related to the re-location of the Renal Services to the Leicester Royal Infirmary. Richard Morris, the Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group responded that he was unsure but would find out.

Update Report on Oral Health

It was noted that it had previously been stated that a letter was going to be sent to schools to encourage them to participate in the oral health scheme. The Director of Public Health was asked to ascertain whether the letter had been sent.

The Scrutiny Policy Officer submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2018/19. 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 2018/19. 

The Commission’s work programme was noted.

The Chair continued with the update on progress with matters considered at a previous meeting;

Leicester Royal Infirmary Signage

A review of the signage, including internal signage, external car parking and highway signage had previously been requested and an update on this would be brought to a future meeting.

Bursaries for nurses

A letter was being drafted to support the provision of bursaries for nurses. This would be sent to the Secretary of State for Health.

Site visit to the LRI Emergency Department

Suitable dates were being checked and details would be circulated as soon as possible.

Leicester City Clinical Commissioning Group (CCG)

The CCG had responded to questions raised at the previous meeting and the responses had been circulated to Members.

The meeting closed at 9.00 pm