Agenda and minutes

The minutes of the meeting held on 18 December 2023 were taken as read, confirmed and signed, subject to the amendment that Harsha Kotecha, Healthwatch Leicester and Leicestershire, and Janet Underwood, Healthwatch Rutland, be added to the attendance list.

The Chairman reported that no questions had been received in accordance with Standing Order 34.

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

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.

Mrs. M. E. Newton CC and Mrs. B. Seaton CC both declared non-registerable interests in all substantive agenda items as they had close relatives that worked for the NHS.

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

The Committee considered a report of University Hospitals of Leicester NHS Trust (UHL) on the performance of UHL’s planned and urgent and emergency care activities during 2023 as well as future plans to continue the improvements achieved to date. A copy of the report, marked ‘Agenda Item 7’, is filed with these minutes.

The Committee welcomed to the meeting for this item Jon Melbourne, Chief Operating Officer, UHL and Rachna Vyas, Chief Operating Officer, NHS Leicester, Leicestershire & Rutland.

Arising from discussions the following points were noted:

(i)           UHL had improved its operational performance in 2023 from a position at the start of the year of being in Tier 1 of the National Support Programme for Urgent and Emergency Care (UEC), cancer and planned care, to being exited from tier 1 support for all three areas in 2023 (moving to tier 2 for cancer and planned care and out of tiering for UEC). A hospital trust could be placed in a support tier for any area of care but UHL had not been on a support programme for any areas apart from UEC, cancer and planned care. UHL acknowledged that further improvements still needed to be made. Committee members welcomed the improvement in UHL’s operational performance particularly the 77% reduction in the number of people across LLR waiting more than a year for elective care, the biggest reduction of any system in England.

(ii)         On 23 January 2024 UHL had declared a critical incident and the Trust had remained in critical incident mode for 52 hours and 3 minutes. Members queried how come the critical incident needed to be declared given the operational improvements that had taken place during 2023, and that the 2023/24 winter had not been particularly severe in terms of the weather. In response it was explained that significant operational pressures had been building up for some months particularly in emergency flow pathways. Whilst UHL held data about why the individual patients had attended the hospital, the University of Leicester had been tasked with carrying out a wider investigation into why demand had been so high during the 2023/24 winter. In response to a question from a member it was clarified that the critical incident was not caused by a lack of staff, and even if UHL had a full compliment of staff, a critical incident would still have had to be declared. To put the incident in context, most of the larger hospital trusts in England had to declare a critical incident at some point over the 2023/24 winter. The previous critical incident at UHL was on 29 December 2022.

(iii)        The System Health Equity Committee had been requested to conduct a ‘deep dive’ into longer waits at both the Emergency Department and patients waiting for ambulances to assess the impact against protected characteristics. Separate reports of the findings would be produced for the Leicester City area, the County Council area and also individual neighbourhoods. The relevant reports would be brought to Health Scrutiny Committees when available.

(iv)       UHL was using a small number of Physician Associates to support clinical staff and reassurance was given that they were only being used where clinically appropriate and they were not replacing staff with more advanced clinical skills such as doctors.

(v)         The graphs in the appendix to the report indicated that the diagnostic waiting list had grown towards the end of 2022, then dropped dramatically in early 2023, before reaching a plateau in mid 2023. In response to a query from a member, UHL gave reassurance that the diagnostic waiting list would continue to decrease. It was noted that  ...  view the full minutes text for item 30.

The Committee considered a report of Leicestershire Partnership NHS Trust (LPT) which provided an update on the Well-Being & Mental Health support available for Children and Young People across Leicester, Leicestershire and Rutland (LLR). A copy of the report, marked ‘Agenda Item 8’, is filed with these minutes.

The Committee welcomed to the meeting for this item Justin Hammond, Associate Director of Mental Health & Learning Disability, Integrated Care Board, and Victoria Evans, Family Service Manager, LPT.

Arising from discussions the following points were noted:

(i)           LPT offered a range of well-being and mental health support services designed to tackle issues early and prevent a patient needing to be referred to Child and Adolescent Mental Health Services (CAMHS). However, the age of children being referred to CAMHS was getting younger.

(ii)         A large number of referrals from GP Practices to CAMHS were being rejected due to a lack of information in the referral. Members suggested that Derbyshire Health United (DHU) who assessed the referrals should request the additional information from the GP Practice rather than rejecting the referral. In response assurance was given that this issue was known about and being investigated by the Integrated Care Board (ICB). CAMHS practitioners were being placed in Primary Care Networks to help the process run more smoothly and support signposting to other mental health services. It was pointed out that it was more useful for DHU to get the information directly from the patient rather than via the GP Practice.

(iii)        In response to a query as to why there had been an increase in demand for mental health services in recent years it was suggested that the Covid-19 pandemic would have had an impact but there were likely to be other factors such as social media.

(iv)       Neurodiversity in patients created additional challenges and complexity when diagnosing mental health issues. LPT had seen an increase in referrals of patients with neurodiversity and this was a national issue. LPT was bidding for additional funding to manage those patients. One bid to the ICB for funding to provide a dedicated service had been successful.

(v)         Support was available to the families of patients who required mental health support. The Solihull Approach to parenting was being used which was an early intervention framework. LPT also linked in with Family Hubs.

(vi)       It was important to make the best use of estate space and undertake capacity planning. However, it was more cost effective to utilise buildings owned by other organisations where possible and this fitted in with the approach of imbedding services in communities. A report on estates was requested for a future meeting.

RESOLVED:

(a)        That the update on the Well-Being & Mental Health support available for Children and Young People be welcomed;

(b)        That officers be requested to provide a report for a future meeting of the Committee regarding NHS estates management.

The Committee considered a report of the Secretariat (Leicestershire County Council) which proposed changes to the Committee’s Terms of Reference, required as a result of new Regulations and guidance from the Department of Health and Social Care relating to the role and powers of Health Scrutiny Committees. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

Members were advised that in conjunction with the Terms of Reference changes a Memorandum of Understanding between the Committee and health system partners would be drafted and circulated.

RESOLVED:

That the amendments to the Committee’s Terms of Reference as set out in the Appendix to the report be approved.