Agenda item

A debate facilitated by the Chairman and the Committee’s Lead Officer, Andy Fisher (Assistant Director – Assets) and the following guests:

 

·         John Turner, Chief Executive, Lincolnshire Clinical Commissioning Group (LCCG)

·         Sandra Williamson, Chief Operating Officer, East Locality, Lincolnshire Clinical Commissioning Group (LCCG)

·         Simon Evans, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust (ULHT)

 

 

 

 

The Chief Executive of the CCG addressed the meeting to give an overview of the current situation.

 

Structure, operation and funding

 

The CCG received approximately £1.3bn per ann from the Government with which it planned, organised and commissioned the health services in the best interests of the people of Lincolnshire. 

 

There were a number of provider organisations in the county, i.e. 3 NHS trusts, including United Lincolnshire Hospital NHS Trust, responsible for Pilgrim Hospital; the Lincolnshire Partnership Foundation Trust, which provided mental health services; and the Community Health Trust, responsible for all community services, such as community nurses, community hospitals and therapy services.  In addition, there were the ambulance service, 85 general practices, plus pharmacists, optometrists etc.  The vast majority of NHS staff provided direct health care to the population and the CCG was responsible for co-ordinating those services following Government guidance and was managed by NHS England. 

 

It was crucial for all these to work together as one Lincolnshire NHS team with available resources to serve the population as well as possible.  There had previously been 4 CCGs in Lincolnshire and these had been merged into one.  It was believed a single CCG would prevent duplication and provide a better opportunity to deliver co-ordinated care, and to work closely with partners across the county, including local authorities, care and voluntary sectors.

 

The NHS was on the journey to “integrated” care, to provide more joined up care for people.

 

The Government was restructuring the NHS and it was expected that a new body would be formed from 1^st April 2022, the Integrated Care NHS Board, which would take on all roles and responsibilities of the CCGs, which would then cease to exist. 

 

Day to day care

 

The last 18 months had been a traatic and difficult period generally and for the NHS in particular.  The opening up of society was welcomed and they were proud of their role within the vaccination programme, but the pandemic was still very prevalent and would continue to have a considerable affect for the next 6-9 months and probably for years to come.

 

Colleagues had done an amazing job, but were fatigued and everything was being done to support services as they advanced into what would be a very difficult winter.

 

The Trust still had Covid-19 patients, 61 at that moment in time, and 5 had died since 1^st September 2021. 

 

The Urgent & Emergency Care service was literallly ‘on its knees’ due to demand and had been on the highest level of alert for the last few weeks.  The ambulance services were waiting for long periods to discharge patients to A&E and A&E patients were more regularly waiting over 12 hours, which was a rare occurrence before the pandemic.  Demand for urgent day to day care was huge.

 

Elective operations

 

There had been regular cancellations of elective operations across the county.  ULHT had cancelled a few, but generally, was working well to hold to their commitments. 

 

There were 61,000 Lincolnshire people on waiting lists in July 2020.  There were 81,000 in July 2021.  Prior to the pandemic, virtually no one had to wait longer than 1 year.  Now, 2,200 had waited over 1 year and some had waited longer than 2 years. 

It was an extremely difficult situation. 

 

Grantham Hospital had performed comparatively well due to special arrangements put in place to protect provision of cancer care and elective care and were just about meeting targets for urgent cases.  Although numbers were “dreadful”, they compared well to most other parts of the country. 

 

Mental Health

 

Demand for mental health services had increased, but not significantly as yet; excellent services were in place and were well prepared.  There was significant concern about mental health issues in children and young people that were yet to manifest themselves. 

 

Vaccinations

 

The vaccination programme had been extremely successful in Lincolnshire and was consistently exceeding targets.  It had progressed well into the 16/17 year old band, and 61% of the population had been vaccinated compared to 53% nationally.  The Trust had been amongst the first to offer vaccinations to care homes.

 

GP Services

 

GP practices were under immense pressure.  They had never been busier, which led to public frustration regarding access to services, and it was a difficult situation. 

 

Winter period

 

The flu vaccination programme had begun, but there was much concern about the forthcoming winter months and worry that flu might be even more significant than Covid-19 due to loss of immunity. 

 

Configuration of Hospital Services

 

They had been looking at the configuration of hospital services for a number of years.  A pubic consultation was imminent regarding some services and this would appear in the media soon. 

 

Questions and Answers

 

All four guests then responded to a range of questions and concerns raised by Members, some of which they had submitted in advance.  These included situations relating to the prescription of medication following hospital discharge, delays in obtaining face-to-face appointments with GPs, and difficulties experienced by some non-English speaking patients.  Answers provided also covered the allocation of funding, the long-standing shortage of doctors and nurses, and expenditure on agency staff and locum cover. 

 

Answers to key concerns were answered as follows, in summary.

 

Pilgrim Hospital was regarded as a vital asset for the NHS, Lincolnshire and local people, and the NHS authorities were fully committed to it.  This was demonstrated by the intention to redevelop the A&E department.  Detailed work on this was currently taking place and local capital resources were being added to the funding provided by the Government.  This would be the largest ever investment in a single ULHT project.

 

The removal of mental health services from Pilgrim Hospital would significantly support the expansion of acute services and help address the challenges of Covid-19.  The contribution lost as a result of moving mental health services was a small amount in the context of the trust’s finances. 

 

All NHS services had reopened; the vast majority had remained open throughout the pandemic.  There had been a separate issue recently with respect to a shortage of bottles for carrying out blood tests.  A number of screening tests had been delayed because of the international shortage of bottles, but blood tests were rising imminently (on 17^th September). 

 

Work was ongoing with a private partner to clear the backlog of work.  This was a national effort and would allow the NHS to catch up but it was not known how long this would take.  Using Grantham Hospital as a hub for elective care had been hugely successful.  There was not as much capacity within the private sector in Lincolnshire, but substantial progress was still being made.  Also, they were working on links with other areas, such as Nottinghamshire and Derbyshire, where there was more capacity.  Despite there being substantial NHS vacancies before the pandemic, significant progress had been made in terms of filling positions in urgent care.  However, the backlog would not be addressed in the short-term.  National and local plans, including timescales, were being worked on and would be released soon. 

 

ULHT’s plan for the future of Pilgrim Hospital was a continued expansion of improved services.  In the next few years, its emergency department would more than double in size, which would require state of the art services behind it.  The 5-year improvement plan aligned services with that in mind. Staffing of the urgent services had increased by 20% already over the past year and the workforce was reviewed annually to match demand.  They worked closely with Lincolnshire Community Health Services, which took care of a significant number of patients who arrived at the emergency department in their at urgent treatment centres. 

 

They were not planning substantial closures of services; however, they would continue to focus on centres of excellence and centralise services where possible to improve outcomes for patients whilst ensuring they did not detract from health equality and access.  It was not certain whether the overall changes and restructures at government level would impact the plan as it currently stood. 

 

Centralisation was quite a different matter to closures. They were not considering full closures of any services and before embarking on any changes to services there was always a long period of debate and consultation to engage and involve the public. 

 

The local implementation of the national drive to centralise cardiac and major trauma services had seen the designation of Lincoln Hospital as the primary cardiac centre and both Lincoln and Boston Hospitals became trauma centres, neither becoming a major trauma centre.  However, Boston continued to operate a cardiac service and still cared for cardiac patients, but what they also had access to specialised expertise 24/7 in a way that could not be delivered at a single site. 

 

With respect to stroke services, hyper-acute patients were taken to Lincoln.  This had been happening throughout the pandemic, and it had improved access for some patients who required the hyper-acute element of the service.  A consultation exercise regarding services would commence in the next weeks and proposals regarding stroke services would be included. 

 

With respect to the death rate of inpatients at Pilgrim Hospital, the “crude death rate”, which did not take account of any changes to the expected death rate, was 2.5% across ULHT and 3.3% at Pilgrim Hospital.  This was very high, but was much less so when standardised hospital indictors specifically used for benchmarking were considered.  There had been substantial improvements in services and this would impact on the mortality rate, but it had been affected by Covid-19.

 

The Trust had been in special measures prior to Covid-19.  They had been working with the Care Quality Commission (CQC) over the last two and a half years and had made a number of substantial improvements, for example, in terms of urgent care; the time taken for in-patient treatment; and a 70% reduction in ambulance delays.  CQC continued their work throughout the pandemic and the feedback received from them confirmed that the measures had all led to positive improvements.  The CQC had removed a number of the conditions that they stipulated as areas of major concerns, one of which was around elements of children's services. 

 

It was hoped to announce shortly that a number of those sections and enforcement elements would be removed reflecting the substantial progress made in terms of improving the quality of services, and that will have an impact on mortality. However, it had to be borne in mind that over the 18 months they had experienced the greatest challenge in the history of the organisation and this had taken a toll on many services and the workforce, and would have an impact for some time to come in terms of their ability to recover. 

 

With respect to the levels of bureaucracy, they wanted to ensure that the bulk of resources went on direct patient care on the frontline and other expenditure to be as low as possible.  With the move from four CCGs to one, expenditure had been cut by 20%.  This was not an additional layer of bureaucracy, however; it added responsibilities going forward as they developed into an integrated care system. 

 

The emergency urology service operated at Lincoln and consultants did often have to travel across county to treat patients.  This model was developed by the urology team after examining how they could most effectively deliver services, getting the best outcomes for patients and improving access, and had been debated in-depth.

 

Criticisms on the Trust’s patient engagement were taken on board in terms of the need to increase publicity and face-to-face contact.  Although a range of engagement measures were used, including surveys and events, which were well publicised in the media and through social media, such feedback was valued in order to make further improvements. 

 

Various other issues of concern were raised, from unacceptable waiting times for ambulances to the poor condition of the hospital car park.  Specific complaints made regarding to communication by, and with, two medical practices in Boston that would be taken up with the practices the following day.  The NHS response to the pandemic was discussed at length. 

 

The Chairman requested that written answers be provided for all other questions submitted by Members that the guests had not had time to address.

 

Members ended the meeting with thanks all NHS staff for their immense and ongoing work and commitment to treating patients during the pandemic.

 

[The full meeting can be viewed at Corporate and Community Committee - YouTube.]