Agenda and minutes

The minutes of the meeting held on 24 January 2020 were taken as read, confirmed and signed.

The Chief Executive reported that six questions had been received under Standing Order 7(3) and 7(5).

1.        Question by Mrs Jean Burbridge

Did out breaks of Covid-19 occur in Care Homes in LLR to which patients with Covid had been discharged from UHL?

Reply by the Chairman:

The three Councils across Leicester, Leicestershire and Rutland (LLR) have worked closely with University Hospitals of Leicester NHS Trust (UHL) and Leicestershire Partnership NHS Trust (LPT) to implement Government Guidance to ensure the safe and timely discharge of patients from hospital. Where appropriate, this has included ensuring that patients recovering from Covid can be discharged on a long or short term basis to care homes. Since March 2020 around a third of care homes in LLR have had a Covid outbreak although a lessor number in Rutland. This means that it is inevitable that some homes with outbreaks also admitted people discharged from hospital. Some of these infections are likely to be linked to these discharged patients, but others will have been as a result of community infection, often through asymptomatic care staff which has been shown through national and international research to be significant. In this respect Leicester, Leicestershire and Rutland is no different to other parts of the region and lower than the all England average

The number of new infections in care homes has declined significantly, and the number of new outbreaks has been very low in the last 2 weeks.

2.        Question by Mrs Jean Burbridge:

From what date were patients tested for the Coronavirus before being discharged from Hospitals to Care Homes?

Reply by the Chairman:

I have received the following answer to the question from University Hospitals of Leicester NHS Trust:

“National COVID-19 hospital discharge service requirements were first published on 19th March – these set out the actions to be taken immediately to enhance discharge arrangements. There was no mandate to test patients being discharged to care homes. At this time most patients were discharged to care homes with no test unless;

•       they had been symptomatic, as the directive at this time was to test only symptomatic patients;

•       the receiving care home refused to take the patient without a test  result.

The “Admission and Care of Residents during COVID-19 Incident in Care Home” guidelines were published on the 2nd April highlighting the need for care homes to isolate patients – this included no details regarding additional testing prior to discharge.

The UHL approach to the guidance was to share with care homes our view that, ‘Hospitals are a high risk environment and there is a case for considering isolation in a care home on admission from secondary care. Trusted Assessors and Discharge Co-ordinators will be able to support care homes with the most up to date information on the individual patients and relevant guidance.’

In other words our advice to care homes was to be cautious and isolate patients discharged from hospital.

The “Coronavirus (COVID-19): Adult Social Care Action Plan” was published on the 15th April and for the first time the need to test patients prior to discharge to a care home was recommended. With the Government stating “we can now confirm we will move to institute a policy of testing all residents prior to admission to care homes. This will begin with all those being discharged from hospital”

The guidance was very clear stating that ‘where a test result is still awaited, the patient will be discharged and pending the result, isolated in the same way as a COVID-positive patient will be’.

Thus from the 15th April – all care home discharges  ...  view the full minutes text for item 23.

Mrs Amanda Hack CC asked the following question of the Chairman:

Please could we receive an update on the support for 2017 Student Nurses, who put their studies and lives to one side to assist the NHS with the Covid response. There had been reports of student nurses having their 6 month contracts reduced by 2 months, whilst it looks like the 6 month contracts will now be honoured, is this the correct position?

How many 2017 cohort student nurses do we have across our sites and how are our hospitals going to support these student nurses through the next 2 months.

Reply by the Chairman:

I have sought an answer to the question from University Hospitals of Leicester NHS Trust and received the following response:

“Across UHL, we have approximately 100 finalist student nurses and midwives from the 2017 cohort who volunteered to become an aspirant nurse at the beginning of the COVID-19 outbreak in England. Some of the Aspirants are from other universities across England who have chosen to complete their training in Leicester to be nearer to their families during the pandemic. All Aspirant nurses are being paid a Band 4 salary.

We also have 80 x 3rd year finalist students who chose not to be an aspirant nurse or midwife but wanted to have an extended paid placement in UHL. They are being paid a Band 3 salary. At the beginning of the COVID outbreak, Health Education England (HEE), believed that the extended paid placement initiative would be for six months and this was communicated to universities and students. However in UHL we gave all of our students (and all the NHS Bring Back Scheme volunteers) a three month fixed term employment contract in UHL that would end on July 31st 2020. This was a pragmatic decision because of the unpredictable nature of COVID. It is always easier to have a shorter contract that can be extended rather than bringing a longer contract to an end with little notice to an individual (which may be the case elsewhere in the UK). However, HEE announced on Friday 26th June that these paid placements could now continue for six months as per their original decision. Locally, we will now extend contracts until the 31st August so as of the 1st September the students will revert back to full supernumerary status in order to complete their training. Our finalist students at DMU should complete their training on the 20th September and many have secured jobs in UHL so we will make sure they are supported to complete their programme in the best way possible.

HEE and NHSI/E agreed that students who chose to continue their placements during the pandemic should have an NHS contract and be reimbursed for their time working on wards. This is because as an NHS employee, students would benefit from the COVID legislation around statutory sick pay which would give them the same protection as existing NHS employees should they contract COVID whilst working in the NHS and as a result, become very ill (or in the worst case scenario, die as a result of COVID so, family becoming eligible to receive death in service payment). The salaries for students are being paid for by NHSI/E. Many students across the UK may have given up part-time employment thinking they would be receiving a band 4 salary for six months and this has caused distress to the students. This is not the case we believe, in LLR. However, when the contract ends on August 31st the students will no longer be an NHS employee or be  ...  view the full minutes text for item 24.

There were no urgent items for consideration.

The Chairman invited members who wished to do so to declare any interest in respect of items on the agenda for the meeting.

No declarations were made.

The Chief Executive reported that no petitions had been received under Standing Order 36.

The Committee considered a joint report of Leicester and Leicestershire Clinical Commissioning Groups (CCGs), University Hospitals of Leicester NHS Trust (UHL) and Leicestershire Partnership NHS Trust (LPT) which set out how the local NHS had responded to the spread of the Covid-19 virus. A copy of the report, marked ‘Agenda Item 7’, is filed with these minutes.

The Committee welcomed to the meeting for this item Andy Williams, Chief Executive LLR Clinical Commissioning Groups, Rebecca Brown, Acting Chief Executive, UHL, Angela Hillery, Chief Executive of LPT, Rachel Bilsborough, Director - Community Health Services, LPT and John Edwards, Associate Director of Transformation, LPT.

Statement from the Director of Public Health for Leicestershire.

Prior to the presentation of the NHS report, the Chairman asked the Director of Public Health for Leicestershire to make a statement on the health protection restrictions which were in place in Leicester and parts of Leicestershire. The Director of Public Health informed that a data sharing agreement was now in place with Public Health England and post code level data on positive Covid-19 cases in LLR had now been received. The data indicated that the numbers of Covid-19 cases had stabilised in Leicester City, and in Leicestershire there were less cases of Covid-19 than in the City though the public should not be complacent. The areas of Oadby and Hinckley were higher than the rest of Leicestershire, though not as high as Leicester City. Close working was taking place between Leicester City Council and Leicestershire County Council to manage the spread of the virus and communication strategies and community engagement was in place, particularly in those areas of Leicestershire that were part of the restriction zone.

Arising from the statement the following points were discussed:

(i)          Members suggested that the communications strategy should take into account the ethnic and cultural diversity of the residents of Leicester and Leicestershire and messages should be disseminated in different languages using paper leaflets as well as digital methods because not everybody had access to social media technology. The Director of Public Health supported this approach and stated that some of the money received from the Government for the extended public health restrictions locally would be used to improve communications to all communities in Leicester and Leicestershire.

(ii)         The Public Health England report entitled ‘Preliminary investigation into COVID-19 exceedances in Leicester (June 2020)’ only covered Leicester City and not the parts of Leicestershire that had been included in the restriction zone. The Director of Public Health was not aware of any plans to produce an updated version of the report to include the parts of Leicestershire which had been included in the Leicester restriction zone. Data would be published soon regarding Leicestershire but it would not be broken down into ethnicity.

(iii)       Members raised concerns regarding the Test and Trace system, particularly how difficult the home testing kit was to use and the length of time the courier took to pick the sample up. The Director of Public Health acknowledged that the home testing system was not as easy to use as the drive-through system but reassured that the Test and Trace system was improving and 91% of people tested received their results within 24 hours.

(iv)       In response to a question regarding the difference between pillar 1 and pillar 2 testing and the importance of each, it was explained that pillar 1 testing was prioritised for clinical staff and gave an outline of the spread of Covid-19 in an area, whereas pillar 2 testing gave a more specific idea of the number of cases and was more likely to pick up younger  ...  view the full minutes text for item 28.

The Committee considered a report of University Hospitals of Leicester NHS Trust (UHL) which provided an update regarding a prior year adjustment which had to be made to UHL’s accounts due to a misstatement in the previous year’s final accounts. A copy of the report marked ‘Agenda Item 8’, is filed with these minutes.

The Committee welcomed to the meeting for this item Rebecca Brown, Acting Chief Executive, UHL and Jonathan Shuter, Deputy Chief Financial Officer, UHL.

Arising from discussions the following points were noted:

(i)          The misstatement in the end of year accounts was believed to be the result of an under reporting of expenditure and an over reporting of income but investigations were still ongoing to establish the full reasons for the misstatement. Grant Thornton had been the auditors of UHL for the 2019/20 financial year which was why Pricewaterhouse Coopers (PwC) had been appointed to carry out the investigations. It was not known when PwC would complete their investigations and publish their report. The investigations so far had reviewed the accounts of the previous 3 years and found that the accounts for the previous 2 years required adjusting. Indications were that once the investigations had been completed the prior year adjustment was not likely to be greater than the £46 million which it was currently set at.

(ii)         UHL was not expecting to be fined as a result of the misstatement in the accounts but the Trust was likely to receive increased support and oversight from the regulators.

(iii)       In the meantime measures had been taken to improve the financial governance and controls at UHL, improve the culture around finance by providing training and staff development, and focusing on financial sustainability.

(iv)       In response to concerns raised by a member, reassurance was given that NHS Boards would usually have at least one non-executive member with financial expertise.

RESOLVED:

(a)        That the update regarding the prior year adjustment to University Hospitals of Leicester NHS Trust accounts be noted with concern;

(b)        That University Hospitals of Leicester NHS Trust be requested to provide a further update to the Committee once Pricewaterhouse Coopers have published the report of their investigation into the Trust’s underlying financial position.

There will be a verbal update from University Hospitals of Leicester NHS Trust.

The Committee received an oral update from University Hospitals of Leicester NHS Trust (UHL) regarding the Acute and Maternity Reconfiguration plans.

The Committee welcomed to the meeting for this item Rebecca Brown, Acting Chief Executive, UHL and Mark Wightman, Director of Strategy and Communications, UHL.

Arising from discussions the following points were noted:

(i)          UHL had not yet received the £450 million Government funding which they had been awarded for the reconfiguration plans but were confident that the money was forthcoming. It was hoped that the public consultation on the plans would take place in August/September 2020.

(ii)         The Covid-19 pandemic had reassured UHL that its reconfiguration plans were the correct approach. At the peak of the Covid crisis 82 patients had required a ventilator and having two Intensive Therapy Units in LLR would have meant that demand could have been managed much better. At the start of the pandemic children’s heart surgery had to be transferred from Glenfield Hospital to Birmingham because additional capacity for adults had been required in Leicester, Leicestershire and Rutland (LLR). Had there been a children’s hospital in LLR then the children’s heart surgery would not have been required to move to Birmingham.

(iii)       At the previous Committee meeting a briefing document for the public which summarised all the information already in the public domain regarding the proposals had been requested by members. This document had not yet been put together but would be produced in the near future. Members now asked that the briefing document include any changes made to the reconfiguration proposals as a result of the Covid-19 pandemic.

RESOLVED:

(a)        That the lack of progress regarding the University Hospitals of Leicester NHS Trust acute and maternity reconfiguration plans be noted;

(b)        That University Hospitals of Leicester NHS Trust be requested to attend a future meeting of the Committee as part of the consultation process for the acute and maternity reconfiguration proposals.