Agenda and minutes

The minutes of the meeting held on 23 September 2020 were taken as read confirmed and signed.

The minutes of the meeting held on 14 December 2020 were taken as read confirmed and signed.

The Chairman reported that no questions had been received from the public under Standing Order 34.

The Chairman reported that no questions had been received from members under Standing Order 7.

Mrs. S. Harvey CC reminded the Chairman that she had still not received an answer to the supplementary questions that she asked at the Committee meeting on 14 December 2020. The Chairman advised that answers to those questions would again be requested from the Clinical Commissioning Groups.

There were no urgent items for consideration.

Mrs. A. Hack CC declared a personal interest in agenda item 9: Covid-19 Vaccination Programme as she worked for an organisation that dealt with people with learning disabilities.

Mr. T. Parton CC declared that he was the paid employee of a mental health charity though stated that this declaration was not in relation to a specific agenda item.

The Chairman reported that no petitions had been received under Standing Order 35.

The Committee considered a report of the Leicester, Leicestershire and Rutland (LLR) Health and Care System which informed of how the NHS system had managed Covid-19 and the extra pressures over winter 2021/21. A copy of the report marked ‘Agenda Item 8’, is filed with these minutes.

The Committee welcomed to the meeting for this item Andy Williams, Chief Executive, LLR Clinical Commissioning Groups (CCGs), Tamsin Hooton, Assistant Director of Urgent and Emergency Care, LLR CCGs, Caroline Trevithick, Chief Nurse, WLCCG and Rebecca Brown, Acting Chief Executive, University Hospitals of Leicester NHS Trust (UHL).

Arising from discussions the following points were noted:

(i)          The winter pressures plan was led by the Urgent and Emergency Care Group whereas the Covid-19 pandemic resilience arrangements were overseen by the Local Resilience Forum arrangements working alongside the Health Economy Strategic Co-ordinating Group and supporting sub-groups. It was agreed that after the meeting a flow diagram would be circulated to members to show how all these groups interlinked with each other.

(ii)         In the early days of the Covid-19 pandemic there had been concern on behalf of the NHS that some people were not attending Emergency Departments due to Covid related concerns even when they had a genuine medical emergency which required attendance at the Emergency Department. Since then attendances at Emergency Departments had risen as messages had been publicised encouraging people to still attend Emergency Departments if they had a genuine need for the service. However, the mix of patients seen in Emergency Departments had now changed. The amount of patients being seen in Majors was the same as before the Covid-19 pandemic whereas the number of patients with minor injuries was lower. The reduction in minor injuries was believed to be because due to the lockdown restrictions people were being less active and not getting involved in risky outdoor activities.

(iii)       During the pandemic initiatives had been put in place to enable EMAS staff to better provide clinical advice and enable patients to access alternative care pathways. This resulted in fewer than 50% of patients seen by EMAS being taken to hospital. These initiatives would continue after the Covid-19 pandemic had ended in order to keep Emergency Department attendances low.

(iv)       Due to the Covid-19 pandemic there had been less face to face appointments at GP Practices and members suggested that this could have resulted in an increase in attendance at the Emergency Department. It was also queried whether the lack of face to face appointments could have resulted in underlying health issues being missed by GPs whose only contact with patients was over the telephone. In response it was explained that there had been some positive effects of the additional telephone appointments in that GPs had been able to spend more time talking to patients and therefore were able to identify a patient’s needs better. However, the members’ concerns were acknowledged by the CCGs and reassurance was given that a large amount of work had gone into addressing the issues arising from less face to face appointments. The CCGs and UHL were aware that whilst some performance targets were being met there could be a hidden backlog of patients that had not come forward for treatment and so work was taking place to assess the possible hidden harm resulting from the pandemic.

(v)        During the Covid-19 pandemic there had been a drop in the requirement for social care, wrap around and reablement services but it was expected that demand would increase again as the impacts of the pandemic abated.

(vi)       In response to concerns raised by members regarding the amount of elected  ...  view the full minutes text for item 40.

The Committee considered a report of Leicester, Leicestershire and Rutland Clinical Commissioning Groups (LLR CCGs) which provided an update on the progress of the Covid-19 vaccination programme in LLR. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

The Committee welcomed to the meeting for this item Andy Williams, Chief Executive, LLR CCGs, and Caroline Trevithick, Executive Director of Nursing, Quality and Performance, West Leicestershire CCG.

Arising from discussions the following points were noted.

(i)          The vaccine programme was progressing rapidly and currently people in cohort 7 (aged 60-65) were being vaccinated. Whilst overall the programme was going well certain areas of LLR had seen significantly lower take-up of the Covid-19 vaccine than the rest of LLR. In Leicester City these areas were St Matthews, Spinney Hill, Northfield, Crown Hills and St Saviours, in the County they were North West Leicestershire, Charnwood and Thorpe Astley, and in Rutland they were Market Overton, Cottesmore, and Empingham. Investigations were taking place to try and understand the reasons for the lack of take-up in those areas but at the moment it was not clear. Staff from the Public Health department at Leicestershire County Council were assisting with the investigation. Engagement would take place with the local members for those areas when the investigation was complete. 

(ii)         GP Practice patient lists were used to make the decisions on who to prioritise for vaccination. If a patient was registered with a GP Practice in a different County to that which they resided then they would be called for vaccination in line with the GP Practice they were registered with. However, patients could book their appointment online irrespective of where they were registered with a GP and the national booking system offered patients vaccine appointments within 45 minutes travel of their home post code therefore it was possible for patients to be vaccinated out of the County they resided in.

(iii)       In response to concerns that the vaccination centres in Loughborough and Lutterworth had been closed over the previous week it was explained that they had not been in operation because of a reduction in the supply of vaccines from the manufacturers however supply from the manufacturers was expected to increase again in the coming weeks. Reassurance was given that the planning assumptions indicated that there would be enough vaccine to administer all the required first and second doses. As the planning assumptions had been correct so far it was expected they would be correct again.

(iv)       In response to concerns from members that the media were reporting people with asthma were not being made a priority to receive the vaccine it was clarified that people with unstable asthma were being made a priority to receive the vaccine whereas people with stable asthma were not. This was because the evidence base indicated that people with stable asthma were not adversely affected by Covid-19.

(v)        The advice from the Joint Committee on Vaccination and Immunisation was that the main risk factor for Covid-19 was age which was why teachers and the fire brigade had not been prioritised to receive a vaccine so far.

(vi)       Adult carers would be vaccinated in cohorts 5 and 6.  Members pointed out that there were many family members carrying out caring duties even though they were not formally registered as carers. The CCG stated that these people were advised to register as carers as soon as possible so that they could be vaccinated.

(vii)      With regards to fictitious messages regarding Covid-19 which were being disseminated on social media a member suggested that community forums could be used  ...  view the full minutes text for item 41.

The Committee considered a report of University Hospitals of Leicester NHS Trust (UHL) which explained the events and background to the UHL Trust Board’s decision not to agree the 2019/20 annual accounts as ‘true and fair’ and set out the actions being taken to address the issue. A copy of the report, marked ‘Agenda Item 10’, is filed with these minutes.

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

Arising from discussions the following points were noted:

(i)          Members expressed disappointment that no Non-Executive members of the UHL Trust Board were present at the meeting to explain how the errors in the accounts had occurred and why action had not been taken earlier. Some members suggested that all the Non-Executive Directors on the UHL Trust Board that were in post at the time the errors in the accounts were made should consider resigning, not just the ones that had stepped down from the Board so far.  In response it was explained that those Non-Executive Directors that had stepped down were the ones that had oversight of finance. The other Non-Executive Directors led on overseeing other areas of the Trust where performance had been better. It was important to strike the right balance between making Board members accountable for failing to identify that errors were occurring, and retaining some continuity on the Board.  The errors in the accounts were very technical therefore any Board members without financial expertise would have found it difficult to identify the problems. To prevent this being an issue in the future the Board now had much more financial expertise and two additional associate Finance Directors had been added to the Board who were both qualified accountants. The new Chair of the Audit Committee was also very experienced in financial matters.

(ii)         UHL submitted that the errors in the accounts were the result of the actions of a few individuals and this should not affect the reputation of UHL as a whole as some excellent work was taking place across the Trust.  UHL provided reassurance that the errors in the accounts could not occur again because the policies and control procedures at UHL had now been changed and strengthened, a training programme for the finance team had been put in place, and an external Finance Improvement Director was now holding UHL to account. Whilst it was hoped that UHL would be taken out of special measures after 12 months, the emphasis was on instigating a real culture change with regard to finance at UHL rather than coming out of special measures as soon as possible, therefore UHL was prepared to remain in special measures for 18 months if that was what it took to make meaningful changes. UHL were confident that by September 2021 an accurate set of accounts would be reported.

(iii)       Members asked that UHL Board members be given training not just to enable them to understand the finances but on how to properly scrutinise the accounts and ask relevant probing questions. Board members should be encouraged to raise any concerns they might have.

(iv)       In response to a concern raised by a member that even when UHL’s external auditors had raised concerns regarding the accounts no action had been taken by UHL management to address the problem, it was explained that at the time faith had initially been placed in the finance team to address the issues raised by the internal auditors, however once it became apparent that the finance team had  ...  view the full minutes text for item 42.

The Chairman confirmed that as per the Terms of Reference of the Committee, from May 2021 Leicester City Council would nominate the Chairman of the Committee for the following two years and the administration of the Committee would be carried out by Leicester City Council as well during that period.