Agenda and minutes

To receive from Members declarations as to disclosable pecuniary or other interests in relation to any Agenda item.

Councillor T Alban declared a non-pecuniary interest in relation to Minute Numbers 40 and 41 as an employee of a company that engages in commercial activities with Peterborough Hospital as well as with Addenbrookes Hospital.

Councillor Mrs P A Jordan declared a non-pecuniary interest in relation to Minute Numbers 40 and 41 as an employee of Cambridgeshire Community Service based at Hinchingbrooke Hospital.

The Panel are to receive the following presentations from the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG):

(a)   Cambridgeshire and Peterborough Clinical Commissioning Group Performance Report

  A representative will be in attendance from the CCG to present the organisation’s performance report.

(b)  Clinical Service Provision at Hinchingbrooke Health Care Trust (HHCT)

  Dr Melanie Clements, Medical Director at HHCT will be in attendance to present the paper.

Tracy Dowling presented the Clinical Commissioning Group (CCG) Performance Report to the Panel. Members noted that the governance of the CCG altered in January 2016 when Dr Modha stepped down from the role of Accountable Officer and steps have been taken to strengthen the governance arrangements. Tracey Dowling has been appointed as the Accountable Officer (known as Chief Officer) and Doctor Howsam is now the Chief Clinical Officer and the Chair of the Governing Body.

The CCG have had a difficult year as a result of the collapse of the UnitingCare contract. In addition some performance targets have not been met.

A number of organisational changes have been made to assist the financial position of the CCG as the group have an underlying deficit position. The main cause of the deficit is the amount and cost of work currently undertaken by the hospitals. Despite the financial position standards are being met. NHS England are working closely with the CCG to turnaround the financial position.

Members noted that the sustainability and transformation plan (STP) is in development which focuses on improving the clinical outcomes for patients but also addressing the system wide financial deficit over the next 5 years. The first draft of the STP was submitted to NHS England on 30th June and the next draft is due to be submitted on 22nd October. Mr David Astley has been appointed as the Independent Chair for the Cambridgeshire and Peterborough STP. Tracey Dowling has offered to return to the Panel and discuss the STP in more detail once it has been finalised.

The CCG has stated that it wants patients to be taken care of at home as opposed to being taken care of in hospital as there is evidence to suggest that being in a hospital bed has a negative impact on rehabilitation. The current delivery of rehabilitation for patients who have had stroke is currently not best practice so different models of care and rehabilitation for stroke patients are being considered.

The Panel were informed that the CCG is undertaking public engagement on how to make the minor injury and outpatient services in East Cambridgeshire and Fenland more sustainable and improve integration with other health care providers.

Tracey Dowling informed Members that regarding the Older People’s and Adult Community Services (OPACS) the CCG is confident that the model of care in place remains the best solution for patients.

In respect to Non-Emergency Patient Transport Services (NEPTS) Members were informed that the service is not yet functioning at the standard expected but ‘teething problems’ are being addressed.

Following a question it was confirmed that QIPP means Quality, Innovation, Productivity and Prevention.

In response to a question regarding the NEPTS, Members were informed that GPs are referring patients to the service and the information is being advertised on the CCG’s website. The East of England Ambulance Service then checks the eligibility of patients.

After a question about the management of Hinchingbrooke Hospital, Tracy Dowling stated that Hinchingbrooke is under good management  ...  view the full minutes text for item 40.

The Panel is to consider the Full Business Case for the merger of Hinchingbrooke Health Care NHS Trust and Peterborough and Stamford Hospitals NHS Foundation Trust. Lance McCarthy, Chief Executive of the Hinchingbrooke Health Care NHS Trust will be in attendance to address Members followed by a public participation session.

The Panel received a presentation from Lance McCarthy, Chief Executive Officer at Hinchingbrooke Healthcare NHS Trust (HHCT) on the Full Business Case for the merger of HHCT with Peterborough and Stamford Hospitals NHS Foundation Trust (PSHFT). This included details of HHCT’s plan for Clinical Service Provision, presented by Dr Melanie Clements, Medical Director at HHCT.

Members were informed of the background to the Full Business Case and the proposal of merger including: HHCT is neither clinically nor financially sustainable in its current form; PSHFT is clinically and operationally sustainable but not financially sustainable and Cambridgeshire and Peterborough is one of the most financially challenged health systems in the country.

The Panel were reminded that the Outline Business Case that was approved at the Trusts’ Board meetings in May 2016 outlined clear clinical and financial benefits for the Trusts working as one organisation. In regards to HHCT a merged organisation would ensure that clinical services are sustained at the Hinchingbrooke site.

Following a series of public engagement events over the summer the Trusts developed the Full Business Case and approved it at their Board meetings in September 2016. There will now be more public engagement events before the Full Business Case is ratified by the Trusts’ Boards at their meetings in November 2016. After this, the Full Business Case will be forwarded onto the NHS regulator who will make its recommendation to the Secretary of State for final approval in March 2017. The merger would then take place on 1st April 2017.

Dr Melanie Clements, Medical Director at HHCT, presented the Trust’s plan for Clinical Service Provision at Hinchingbrooke hospital. The Panel were informed that the hospital is not clinically sustainable in its current form. As an example of this, Members were told that 20 of the 90 consultant staff at Hinchingbrooke are locums.

A merged Trust would cover a larger population, requiring a larger team of consultant staff. This would make consultant positions more attractive for applicants as a larger team would mean a reduction in the amount of unsociable hours a consultant would have to work. Dr Clements explained that this would reduce the need for locums, cutting costs as employing locums is not the best use of money.

It was explained that not all clinical services are currently provided at Hinchingbrooke. For example, trauma (level 2 and 3) patients are taken to Addenbrookes Hospital. However Dr Clements explained that there is a desire for both Trusts to continue to provide emergency services on the Hinchingbrooke site after the merger.

The Panel were informed that one of the reasons why a merged Trust is preferable to an arrangement of sharing consultants is that with a shared working arrangement the other hospital could pull back doctors to cover their own staff shortages.

Members were informed that the following services have been identified for integration first as they face the greatest sustainability risk: stroke, emergency department, diagnostic imaging, cardiology, respiratory medicine and clinical haematology.

Dr Clements explained the wider benefits of  ...  view the full minutes text for item 41.