Agenda item

Presentation by Allan Kitt and Gary Thompson.

The Chairman introduced Allan Kitt, the Chief Officer of the South West Lincolnshire Clinical Commissioning Group (CCG), who had been invited to give a presentation on the Lincolnshire Health Sustainability Review. Mr Kitt began his presentation by offering the apologies of Gary Thompson (the Chief Officer of the South Lincolnshire CCG) who had been detained at another meeting.

The presentation began with a summary of the drivers behind the review, which included the Frances and Keogh reports that challenged quality, the ageing population, improving technology, the emerging health and care gap, opportunities to improve outcomes and use of resources, and integration with social care.

Key work-streams of the review were: proactive care, urgent care, planned care and women and children’s care. The key message coming from the review recognised that improving proactive care was the main solution. Emphasis was placed on opportunities to provide services close to home and creating a system where health and care were easy to get with reduced duplication. The review also identified benefits in providing more specialist care at fewer places but making it easier to access and integrating commissioning and provision.

Mr Kitt explained the input from the south of the county. Both south and south-west CCGs were part of the programme board and had put forward the case for patients and the population in south Lincolnshire. Members were informed that GPs and medical staff had been involved in setting the vision for the programme, as had the local health watch. The south-west CCG also brought forward its experiences from the Shaping Health for Mid-Kesteven project, which, Members were informed, complemented the sustainability review. Mr Kitt added that GPs in the south and south-west supported the plans that had emerged from the review.

A number of anticipated outcomes for the county were identified including improvements in quality, clinically sustainable services, long-term financial stability, becoming a leader in development, reshaping commissioning and service provision and significantly increasing value while significantly reducing cost.

A summary of the integration of Lincolnshire councils with health services in Lincolnshire was provided. There was strong engagement between councils and the health and well-being board while a strong partnership was growing with the CCG. A joint commissioning framework had been developed and joint teams and projects were emerging. Reference was made to single assessment systems, shared by health and social care with one outcome being the use of personalised budgets. It was hoped that a Pooled Better Care Fund covering £53m by 2017 would prove to be a key driver for joined-up local services.

Phase two of the project would take place from February to September 2014, when detailed service design would be undertaken together with public consultation, the development of relevant specifications and procurement. Phase three was the implementation of the model, which was likely to begin in the late winter and spring with a number of pilot projects and non-consultation actions. Further work on the project would review which services were delivered at all sites, what could be done centrally and where there were opportunities presented by hospital downsizing in favour of community upsizing.

A brief update was given on the Shaping Health for Mid-Kesteven programme: from 6 February 2014 the birthing unit would relocate to Lincoln. The Kingfisher Unit was scheduled to be reshaped in April 2014 while ambulatory care had started and plans for a new day surgery unit were being finalised. A project that was a national first: hospice in hospital, was due to open in July. Accident and emergency conversion work would begin after April 2014 and Councillors were advised that fewer people were using A&E facilities for minor issues.

Members of the Council were given the opportunity to ask questions of Mr Kitt. A number of Members spoke, demonstrating great strength of feeling about the importance of Grantham hospital and the impact of changes on residents across the district. The subjects of questions included:

·         The proximity of Grantham to the A1 and east coast mainline railway and the potential impact of any major accident

·         United Lincolnshire Hospitals Trust’s increasing deficit

·         The number of reviews that health services had undergone

·         Staffing arrangements (including the need to recruit more nurses, the impact of budget cuts on front line nursing staff and the impact of the withdrawal of military health personnel from local hospitals)

·         Patient choice about the hospital to which they would be admitted

·         The weight that would be given to the outcome of public consultation

·         Whether the population could trust that the needs of patients would be put first

·         Whether the quality of community-based treatment could be effectively monitored

·         The future shape of accident and emergency services

·         Using education to proactively influence the health of young people

·         Safeguarding mothers’ welfare and choices about where they have their baby

·         The population growth that was expected in South Kesteven

A summary of the responses given is listed below:

·         For procedures to be their safest and most effective they should be carried out by staff who specialised in that type of treatment, for example following a major accident on the A1 patients with critical injuries would be taken to Nottingham, which was a teaching hospital with a  trauma centre and neurosurgery specialists on site. There was not the critical mass of people in Lincolnshire to warrant such specialist services. Even with the projected population growth, there would not be sufficient people to provide the necessary critical mass

·         Views collected in consultation would be important in developing the detailed service proposals that supported the high-level vision and ensuring those services reflected the needs of the population. Members were also reminded that local GPs supported the vision for health services in Lincolnshire.

·         The increasing deficit was attributed to the high number of agency staff and duplication of functions across different sites. It was hoped that the proposals arising from the review would begin to tackle the growing deficit leading to services that were sustainable in the long-term

·         In respect of longevity, it was hoped that the Health Sustainability Review would provide a model for services for the next ten years however future reviews could be necessitated  by changes to patient needs, technological developments and politicians both locally and nationally

·         For patients in the south of the county, Peterborough would be the preferred hospital. The drive to increase community based provision, particularly in the South of the county was recognised

·         The reduction in the number of nurses training began 10 to 15 years ago when fewer cohorts were being trained. A new nursing school had opened at the University of Lincoln, which was developing hundreds of new nurses. Reference was also made to the difficulty of retaining staff in Lincolnshire

·         It would be difficult to predict what A&E services would look like in the future however it was anticipated services would include professionals from a range of organisations including health and social care professionals together with representatives from different charities

·         Local midwives were working well and encouraged women to make choices. One reason the maternity unit at Grantham had been under-utilised was attributed to mothers who chose to give birth in Nottingham

Mr Kitt added that he would look into the question on the withdrawal of military healthcare personnel and feed back through the Chief Executive.

The Chairman thanked Mr Kitt for his presentation and answering the questions of Members. Councillors showed their appreciation with a round of applause.