PRESENT. Mrs. R. Camamile CC (in the Chair) Leicestershire County Council. Leicester City Council

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1 Minutes of a meeting of the Leicestershire, Leicester and Rutland Health Overview and Scrutiny Committee held at County Hall, Glenfield on Monday, 21 December PRESENT Mrs. R. Camamile CC (in the Chair) Leicestershire County Council Mr. A. D. Bailey CC Dr. S. Hill CC Mr. G. Jones CC Mr. B. L. Pain CC Mrs. C. M. Radford CC Leicester City Council Cllr. A. Bayford Cllr. M. Cooke Cllr. C. Hall Cllr. Mrs. M. Sood MBE LL.D. (Hon) In Attendance. Mr Richard Smith (minute 33 refers) Kate Caston Director, East Midlands Specialised Commissioning Group (minute 39 refers) Kath Murphy Associate Director for Mental Health, East Midlands Specialised Commissioning Group (minute 39 refers) Dr Margaret Oates Consultant Perinatal Psychiatrist and Clinical Director, East Midlands Managed Clinical Network for Perinatal Psychiatry (minute 39 refers) Helen Seth Deputy Director of Strategy, University Hospitals of Leicester (minutes 41 and 43 refer) Abi Tierney Director of Strategy, University Hospitals of Leicester (minute 41, 42 and 43 refer) Deborah Matthews Programme Director Towards Excellence, NHS East Midlands (minute 42 refers) Michael Kaiser Change Manager for Stroke and CVD, NHS Leicestershire County and Rutland (minutes 42 and 43 refer) Dr Doug Skehan Clinical Director, Cardio-Respiratory Services, University Hospitals of Leicester (minute 43 refers) Dr Sean Treadwell Consultant Physician, University Hospitals of Leicester (minute 43 refers) Mr Andrew Brown Consultant in Trauma and Orthopaedics, University Hospitals of Leicester (minute 43 refers) Helen Mather General Manager, Medicine and Emergency Services, University Hospitals of Leicester (minute 43 refers) 32. Minutes. The minutes of the meeting held on 14 September 2009 were taken as read, confirmed and signed. 33. Question Time. Mr Richard Smith, representative of the Leicestershire Local Involvement Network (LINk), asked the Chairman the following question under Standing Order 35:-

2 2 Will the OSC seek a full justification for the refusal of the relevant statutory authorities to extend the route of the Hospital Hopper to include the new Park and Ride hub at St Nicholas Circle on the basis that the communities in the south of the city are significantly disadvantaged by first having to travel into the city to connect with the Hopper service. The opening of the Enderby Park and Ride which will also connect with the St Nicholas Circle hub would make such an extension to the Hopper route even more viable for the south of the county. The Chairman replied as follows:- The Hospital Hopper service was instigated in 2006 by the University Hospitals of Leicester NHS Trust (UHL), in order to provide a controlled transport system between the three UHL sites of Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. The service was introduced to address issues relating to staff transport, to contain the alternative methods of transport between the sites of private car use or taxis. Although the service has been available to members of the public, it should be emphasised that this was not the primary purpose of the service as it is not intended to run in competition with other publicly available bus services. The service route was instigated to have limited stops at key locations, and ensured that medical and nursing students could also utilise the service, having stops convenient for the Charles Frear Nursing School and the University of Leicester. Reviews have been undertaken of the routing and stops continuously and several additional stops have been included in centres of population, to offer opportunities for both staff and public to utilise the service as an alternative to car use. The service operates entirely from funding from the UHL, which currently costs 429,000 per annum for a four bus service. Modest charges are made to members of the public for use of the service, which offsets some of this operating cost, with a charge of 1.50 for a ticket, which is valid all day, enabling members of the public to make multiple trips on the route if necessary for the 1.50 charge. The timetable for the service is registered with the Traffic Commission, to enable the Trust to take fare paying passengers, with the timetable being established to coincide with staff start and finish times, incorporating shift changeovers; the current timetable operates from 6.00am to 6.30pm daily, Monday to Friday. The Trust is currently registering a change to this timetable, which will see the operating times extend from the present 6.30pm finish, to 9.30pm finish. This will be reviewed for use after three months, and is being implemented to assist staff who work with a changeover time of 9.00pm, to utilise the service instead of utilising car transport. Since its introduction, the service has become highly successful, with the current passenger numbers at approximately 12,000 per week, which plays a significant part in reducing congestion on the road system, and also makes a significant contribution to the CO2 emission reductions by eliminating individual car journeys. Opportunities for further reviews of the timetable are now extremely limited, as the service frequency requires the maintenance of a half hour schedule, which

3 3 now has only three to four minutes of turnaround time for each bus, eliminating the options for introducing additional stops so as to be able to maintain the scheduled times required. Since the inception of the Enderby Park and Ride scheme, discussions have been undertaken with the County Council Transport Department, as to the opportunities to incorporate stops at the Leicester Royal Infirmary on the routing. Leicester City Council has also requested opportunities for this service to be complimentary for its staff needs. The route planners have taken these requests into consideration and the service has incorporated into it a route which travels directly to St Nicholas Circle, which acts as the central hub stop. The bus then continues on an inner circle, which has stops incorporated at the City Council Offices and the Leicester Royal Infirmary going then back to St Nicholas Circle hub and continuing to Enderby car park. Therefore, users of the service remain on the park and ride bus from Enderby until they get to the Leicester Royal Infirmary stop, where they can gain direct access to the Leicester Royal Infirmary, or from the same stop gain access to the Hopper service, which has a service in both directions, one to the Glenfield Hospital and the second to the Leicester General Hospital, therefore, acting as the changeover point between the Enderby service and the Hospital Hopper service from existing routing and stops. The County Council is also working on the development of a Birstall Park and Ride scheme and consideration will, again, be given to making arrangements for buses to travel direct to the Leicester Royal Infirmary. This provision commenced on 16 November 2009, with the commencement of the Enderby Park and Ride, and was well publicised before this. At a meeting held on 6 November 2009 involving representatives of the Trust, this was explained to Mr Z. Haq, Co-Chair of the Leicester LINk. 34. Questions asked by Members under Standing Order 7(3) and 7(5). The Chief Executive reported that no questions had been received under Standing Order 7(3) and 7(5). 35. Urgent Items. There were no urgent items for consideration. 36. Declarations of interest in respect of items on the agenda. The Chairman invited members who wished to do so to declare any interest in respect of items on the agenda for this meeting. The following members declared personal non-prejudicial interests in all items on the agenda:- Mr A D Bailey CC, as his son was an employee of Leicestershire Partnership NHS Trust

4 4 Cllr C Hall, as he was a member of Leicestershire Partnership NHS Trust and University Hospitals of Leicester NHS Trust Cllr M Sood MBE LL.D (Hon) as she was a trustee of CLASP and the Chair of the Leicester Council of Faiths. 37. Declarations of the Party Whip in accordance with Overview and Scrutiny Procedure Rule 16. There were no declarations of the party whip. 38. Presentation of Petitions under Standing Order 36. The Chief Executive reported that no petitions had been received under Standing Order Mother and Baby Mental Health Work Stream: Next Stage Review The Committee considered a report and presentation from the East Midlands Specialised Commissioning Group (EMSCG) which provided an update on regional work being undertaken in the East Midlands to improve specialised mother and baby mental health services as part of the Towards Excellence (Next Stage Review) priorities. A copy of the report, marked B, and the slides forming the presentation is filed with these minutes. The Chairman welcomed Kate Caston, Director and Kath Murphy, Associate Director of Mental Health from EMSCG and Dr Margaret Oates, Consultant Perinatal Psychiatrist and Clinical Director for the East Midlands Managed Clinical Network for Perinatal Psychiatry to the meeting for this item. Arising from discussion, the following points were raised:- (i) (ii) (iii) Specialist mother and baby mental health services were available for up to a year after the baby was born. However, most signs of illness became apparent within three months of the baby being born. Many of the illnesses were predictable, preventable and treatable. If there was specialist community team for mother and baby mental health services in each of the five Mental Health Trusts in the East Midlands, women would only be admitted to the specialist in-patient unit when necessary and would be able to be discharged as soon as possible. Therefore, only thirteen or fourteen in-patient beds would be needed across the East Midlands. Dr Oates indicated her personal view was that, as a minimum, two small units would be the most effective way of delivering the service; larger units tended to be less successful. However, this still needed further work and discussion. The sites for the units had not yet been identified. An external agency had been commissioned to work with PCTs on current expenditure and modelling costs. This was because EMSCG was following the same approach as other workstreams across the Next Stage Review of seeking external assurance for their proposals. It was not yet clear whether changes to the service would result in any additional expenditure.

5 5 (iv) There was no specific service for BME communities. The Committee was assured that mother and baby mental health services were accessible to communities from the Indian Subcontinent. It was important for all staff to have equality training, which should include cultural differences around child rearing. RESOLVED: (a) (b) That the report and presentation be welcomed; That officers be requested to provide an update on provision of mother and baby mental health services in the East Midlands to a future meeting of the Committee. 40. Change to the Order of Business. The Chairman sought and obtained the consent of the Committee to vary the order of business from that set out in the agenda. 41. Application for NHS Foundation Trust Status. The Committee considered a presentation from the University Hospitals of Leicester NHS Trust (UHL) which provided an update on the Trust s application for NHS Foundation Trust status. A copy of the slides forming the presentation is filed with these minutes. The Chairman welcomed Abi Tierney, Director of Strategy and Helen Seth, Deputy Director of Strategy at UHL, to the meeting for this item. It was noted that the public consultation on UHL s application for NHS Foundation Trust status would commence on 11 January 2010, subject to approval by UHL s Trust Board. Arising from discussion the following points were raised:- (i) (ii) (iii) Concern was expressed that the governance structure for Foundation Trusts did not provide sufficient evidence of public accountability and engagement. However, the Committee was assured that Foundation Trust status would provide members of the public with the opportunity for engagement with UHL on a day-to-day basis. Details about the proposed governance structure would be included in the consultation documents. UHL was working with external partners including Leicestershire County Council and Leicester City Council to identify cost and service improvement plans. This would enable UHL to consider local examples of best practice. There was an engagement plan for the public consultation on Foundation Trust status. It included circulating the documents to all stakeholders, making a link available on UHL s website and working with community groups that had wider links across Leicester, Leicestershire and Rutland.

6 6 (iv) There were examples of both Foundation Trust and non-foundation Trust hospitals where performance had been poor. However, the overall evidence suggested that Foundation Trust hospitals had higher performance ratings. The standard of performance had to be high for hospitals to become Foundation Trusts. It was also thought that the freedom to reinvest surpluses improved the performance of Foundation trust hospitals. RESOLVED: (a) (b) (c) That the report and presentation be noted; That officers be requested to circulate the plan for public engagement during the consultation on Foundation trust status and a comprehensive list of UHL s stakeholders to all members of the Committee for their comments; That the public consultation on the application for Foundation Trust status be considered by the Committee at the meeting on 22 March Better Stroke and Heart Attack Care for the East Midlands. The Committee consider a report and presentation from NHS East Midlands which set out the case for changing heart attack and stroke services, how the proposals will affect quality and access to care and the process and timescale for the proposed service redesign. A copy of the report marked C, and the slides forming the presentation, is filed with these minutes. The Chairman welcomed Deborah Matthews, Programme Director for Towards Excellence at NHS East Midlands, Abi Tierney, Director of Strategy at UHL and Michael Kaiser from NHS Leicestershire County and Rutland to the meeting for this item. Arising from discussion the following points were raised:- Proposals for Better Care for Heart Attack and Chest Pain (i) (ii) The proposed new pathway for treating heart attacks would improve communication and co-operation between services to ensure that no time was wasted. Paramedics would be trained and would have the technology in their ambulances to identify whether the heart attack could be treated by Primary Percutaneous Coronary Intervention (PPCI) or not. They would then act accordingly. It was possible that this would require additional investment in the East Midlands Ambulance Service. However, heart attack care had been agreed as a regional priority so PCTs would be expected to meet any additional costs. It was not appropriate for every hospital to provide specialist services to treat heart attacks as there were not sufficient numbers of patients. A higher volume of cases would result in better outcomes for the patients. The service was not being redesigned to cut costs but to save lives. A number of hospitals across the East Midlands, including the Glenfield Hospital, had applied to be specialist PPCI centres and were currently

7 7 going through an accreditation process to prove that the standard of care was at the required level. Proposals for Better Stroke Care (iii) Although UHL had applied to be accredited as a Specialist Primary Stroke Centre, neurological intervention would not be provided. The only place in the East Midlands that would offer this was Nottingham. RESOLVED:- (a) (b) That the report and presentation be welcomed; That officers be requested to submit a report providing an update on the proposals for better heart attack and stroke care in the East Midlands to a future meeting of the Committee. 43. Service Improvements. The Committee considered a presentation from UHL which set out the local response to proposals for improving heart attack and stroke care and provided details of how surgical orthopaedic care will be improved at UHL. A copy of the slides forming the presentation is filed with these minutes. The Chairman welcomed Dr Doug Skenhan, Clinical Director for Cardio- Respiratory Services, Dr Sean Treadwell, Consultant Physician, Mr Andrew Brown, Consultant in Trauma and Orthopaedics, Abi Tierney, Director of Strategy, Helen Seth, Deputy Director of Strategy and Helen Mather, General Manager Medicine and Emergency Services, from UHL and Michael Kaiser from NHS Leicestershire County and Rutland to the meeting for this item. Arising from discussion the following points were raised:- Proposals for Better Care for Heart Attack and Chest Pain (i) the service would be provided from a single Coronary Care Unit at Glenfield Hospital, although on-site specialist care would continue to be provided at the Leicester Royal Infirmary for patients who also had other health problems and patients suffering from a heart attack or chest pain who came to the Emergency Department rather than calling an ambulance. There was an investment plan to ensure that the new service would be sustainable. Proposals for Better Stroke Care (ii) It was proposed that the Stroke Unit would move from the General Hospital to the fifth floor of the Leicester Royal Infirmary. This would hopefully shorten the amount of time before patients were treated. Patients would come to the Emergency Department but would follow a different pathway from other patients. They would have a brain scan, the equipment for which was located adjacent to the Emergency Department. They would then use the Emergency Department s lift to get to the third floor for treatment.

8 8 (iii) Some reconfiguration of the hospitals in Leicester was required for the Stroke Unit to be moved. It was intended that more acute services would be provided at Leicester Royal Infirmary and that more rehabilitation and planned care services would move to the General Hospital. Proposals for Better Surgical Orthopaedic Care (iv) (v) There was not currently enough capacity at UHL to provide all planned orthopaedic care. Some patients who wanted to be treated in Leicester were being referred to other hospitals as a result of this. It was hoped that, by increasing the number of operating theatres at the General Hospital, capacity issues would be addressed. The preferred bidder for building the new theatres had been notified. The next stage of the process was to apply for planning permission. It was hoped that the theatres would be completed by October The existing theatres would also be refurbished and the pre-operative centre rebuilt to ensure that the department was fit for purpose. RESOLVED:- That the report and presentation be welcomed. 44. Major Trauma Programme Update. The Committee noted a report from NHS East Midlands which provided an update on the Major Trauma Programme, part of the Next Stage Review. A copy of the report marked D is filed with these minutes. 45. Foundation Trust Proposals. The Committee noted a report from the East Midlands Ambulance Service NHS Trust which provided an update on the Trust s application to be an NHS Foundation Trust. A copy of the report marked E is filed with these minutes. 46. Workforce/Human Resources Strategy: Staffing and Recruitment. The Committee noted a report from the Leicestershire Partnership NHS Trust which provided details of the Workforce/Human Resources Strategy and the programme for its implementation. A copy of the report marked F is filed with these minutes. 47. Date of next Meeting. It was noted that the next meeting would be held at County Hall, Glenfield on Monday 22 March 2010 at 2.30pm pm pm CHAIRMAN 21 December 2009