Public Board Meeting of the Lincolnshire Clinical Commissioning Group (CCG)

To be held on Wednesday, 25th August 2021 at 9.30 am

This meeting will be held virtually BOARD MEETING - PUBLIC

DATE Wednesday, 25th August 2021 TIME 9.30 am VENUE To be held virtually as a Live Event

AGENDA

ENCLOSURE ITEM NUMBER ACTION LEAD TIME /VERBAL STANDING ITEMS 1. Welcome and Introduction from the - Verbal All 9.30 CCG Chair - Apologies for Absence - Declarations of pecuniary and non-pecuniary interests and conflict of interests 2. Minutes of the previous meeting held Approve Enclosures All 9.35 on 28th July 2021 - Matters arising - Action Log Receive Enclosure Mr Sean Lyons 3. Update from the CCG Chair and Note Verbal Mr Sean Lyons & 9.40 Chief Executive Mr John Turner 3.1 Petition by Better Health For Note Enclosure Mr Sean Lyons & Mr Stamford (BH4S) regarding primary Turner care services in Stamford

GENERAL ISSUES 4. COVID-19 Pandemic Update 10.00 4.1 Report in relation to the NHS Note Enclosure Mrs Clair Raybould System and CCG response to COVID-19 Pandemic, including the Vaccination Programme 4.2 Public Health update Note Verbal Professor Derek Ward 10.15 4.3 Healthwatch update Note Verbal Mrs Sarah Fletcher 10.25

QUALITY, PERFORMANCE AND PATIENT EXPERIENCE 5. Integrated Performance Report – Note Enclosure Mr Martin Fahy/ 10.35 August 2021 Mr Matt Gaunt BREAK FINANCE 6. CCG and System Finance Report – Consider Enclosure Mr Matt Gaunt 11.05 July 2021 (Month 4) STRATEGY AND PLANNING 7. Update on the White Paper – Note Verbal Mr John Turner 11.15 Innovation and Integration 8. Older Adults Mental Health Services Note Enclosure Mr Andy Rix 11.25 GOVERNANCE No specific items MINUTES FROM COMMITTEES, ESCALATION REPORTS AND TERMS OF REFERENCE No specific items

9. To identify any areas of risk to be Discuss Verbal All 11.35 included on the Risk Register 10. Date and Time of the Next Meeting – Close 29th September 2021 at 9.30 am – to be held as a Live Event via MS Teams

Please send apologies to: Jules Ellis-Fenwick, CCG Board Secretary via email at: [email protected]

Papers are available on the CCG website at www.lincolnshireccg.nhs.uk In case of difficulty accessing the papers, please contact – Jules Ellis-Fenwick, CCG Board Secretary on 07825 938794 or via email as above

Confidential Motion: The Board will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960) Subject to approval by the Board at its next meeting

MINUTES OF THE NHS LINCOLNSHIRE CLINICAL COMMISSIONING GROUP BOARD MEETING HELD VIRTUALLY ON WEDNESDAY, 28th JULY 2021 AT 9.30 AM

PRESENT: Dr Gerry McSorley Non-Executive Director (Chair for the meeting) Dr Majid Akram GP and Clinical Lead, South Locality Dr Dave Baker GP and Clinical Lead, South West Locality Dr David Boldy Secondary Care Doctor Mrs Fenella Chambers Non-Executive Director Mr Jim Connolly Non-Executive Director Mr Martin Fahy Director of Nursing and Quality Mr Graham Felston Non-Executive Director (with effect from 1st July 2021) Mr Matt Gaunt Director of Finance and Contracting Mrs Janet Inman Non-Executive Director Mr Pete Moore Non-Executive Director Dr John Parkin GP and Clinical Lead, West Locality Mr John Turner Chief Executive

N ATTENDANCE: Mr Pete Burnett System Strategy and Planning Director Mrs Jules Ellis-Fenwick CCG Corporate Secretary/Manager Mrs Sarah Fletcher Chief Executive, Healthwatch Mr Andy Fox Consultant in Public Health, Public Health Representative Mrs Sarah-Jane Mills Chief Operating Officer, West Locality Ms Sue Liburd Non-Executive Director Mrs Clair Raybould Director of Operations (lead for South West Locality) – from item 5 onwards) Mr Andy Rix Chief Operating Officer, South Locality Mrs Sandra Williamson Chief Operating Officer, East Locality

APOLOGIES: Dr James Howarth GP and Clinical Lead, East Locality Mr Sean Lyons CCG Chair Professor Derek Ward Director of Public Health Cllr Sue Woolley Chair of the Health and Wellbeing Board

21/249 WELCOME AND INTRODUCTIONS Dr McSorley advised that he would be Chairing the Board meeting on this occasion as Mr Lyons was on annual leave. Dr McSorley welcomed everyone to the Lincolnshire CCG Board meeting, highlighting this was Mr Felston’s first meeting as the new Non-Executive Director, having replaced Mr Murray Macdonald from 1st July 2021.

Dr McSorley advised the meeting was being held via Microsoft Teams as a live event, which included a facility for members of the public to post any questions they wished to submit either through the Question and Answers facility, or alternatively a proforma was available on the CCG website, which should be submitted to Mrs Julie Ellis-Fenwick, CCG Board Secretary.

Dr McSorley emphasised that this is a meeting held in public and not a public meeting. As such any questions submitted would be responded to after the meeting subject to inclusion of name and contact details. Questions will be published on the CCG website in future along with the response in terms of being open and transparent.

1 Subject to approval by the Board at its next meeting The Board Members and those in attendance were asked to remain ‘muted’ until they wished to ask questions which will be monitored throughout the meeting and also asked to ensure they introduced themselves either when presenting items or asking questions.

21/250 DECLARATIONS OF PECUNIARY AND NON PECUNIARY INTERESTS AND CONFLICTS OF INTERESTS Dr McSorley reminded the Board members of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the CCG. Declarations made by members of the Board are listed in the CCG’s Register of Interests. The Register is available either via the CCG Board Secretary or the CCG website

Declaration of Interest from Committees: No items declared.

Declarations of Interest from today’s meeting: Dr David Boldy advised that the Integrated Performance Report included in the pack of papers made reference to the Medical Examiner at United Lincolnshire Hospitals NHS Trust (ULHT); he had previously worked as a part-time Medical Examiner for ULHT during December 2020 and January 2021 as a result of the COVID-19 pandemic and asked that this be noted. Mrs Ellis- Fenwick noted the details for inclusion in the minutes.

The Board agreed to: • Note the interest as declared.

21/251 MINUTES OF THE PREVIOUS MEETING The minutes from the previous meeting held on 30th June 2021 (not the 26th May and 9th June 2021 as stated on the agenda) were presented and the Board agreed to: • Approve the minutes as a true record subject to the following amendment: - Mr Matt Gaunt should be listed under apologies, not present.

21/252 MATTERS ARISING

The Action Log was presented which included three actions; all of which were identified as delivered or the additional information requested had been added to specific reports which were included in the pack of papers for today’s meeting.

The Board agreed to: • Note the Action Log.

21/253 UPDATE FROM THE CHAIR AND CHIEF EXECUTIVE Dr McSorley provided a briefing and highlighted the following:

• Mr Lyons continued to attend the fortnightly Regional Chairs meeting where regional key priorities and performance is discussed. Lincolnshire is performing very well by comparison to other areas, particularly in terms of the vaccination programme, which has been acknowledged by the NHSEI Regional Team. • A specific point of note is that there is an increasing focus on the ‘green’ NHS agenda and initial attention will be given to anaesthetic gases and metered dose inhaler prescribing. • Mr Lyons had recently chaired the Lincolnshire System Leaders Board in the absence of Mrs Elaine Baylis who is the regular Chair. There was a full agenda at the latest meeting including vaccination update, update on the Lincolnshire Strategic Investment Infrastructure Group which is Chaired by Ms Sarah Connery, Acting Chief Executive, Lincolnshire Partnership NHS Foundation Trust (LPFT), planning update and a progress report on the Acute Services Review (ASR).

2 Subject to approval by the Board at its next meeting • There was also a discussion about staff welfare, with an acknowledgement that individuals should continue to be encouraged to ensure they take their annual leave and seek support as and when they feel appropriate. • Mr Turner, Mr Lyons and other CCG Executive colleagues had recently attended an initial meeting with local Dentistry, Optometry, Pharmacists and general practice representatives entitled the ‘Four Pillars of Primary Care’ This was a pre-meeting in preparation for what is anticipated to move from being a delegated commissioning responsibility of the CCG to under the remit of the ICS. There were concerns raised about resourcing in terms of dentistry and optometry specifically. A set of actions have been agreed following that meeting and further meetings are being arranged to take place later in the year. • The monthly Local Outbreak Engagement Board meeting had recently taken place with updates provided on the vaccination programme and the progress to date was commended. There was also a briefing provided on wider operational pressures across the system.

On a final note, Mr Lyons had attended the first meeting of the ICS Development Board which will be called the Better Lives Lincolnshire Development Board going forward. The meeting was attended by NHS Chairs, Mr Turner, Mrs Debbie Barnes, Chief Executive, Lincolnshire County Council and Councillor Sue Woolley and the he Terms of Reference were agreed and the emphasis will be on addressing the health needs of the population and ensuring meaningful consultation as and when required.

Dr McSorley advised that two questions had been submitted prior to the meeting.

The first question raised by Caroline Cakebread, Lincolnshire Community and Voluntary Sector

Question:

In light of the stark findings made by Dame Carol Black regarding substance misuse provision, what are the intentions of the commissioners in addressing this key issue, the effects of which we see throughout our population - whether that be through lost work hours, housing and rough sleeping, dual diagnosis and comorbidity, prison and hospital populations and so many other areas?

Apart from the devastation effects on individuals, families and relationships, the impact on the economy, crime stats anti-social behaviour, mental health and premature death (the figures are shocking in this regard), the situation is escalating year on year with funding having shrunk more and more. There needs to be a clear program to address all aspects of this huge subject and that takes funding; ongoing and sustained funding.

Response:

Mr Turner advised that the issues and points raised were really important in respect of substance misuse services and acknowledged this is an issue for not only Lincolnshire but across the whole of the country. Commissioning responsibility for substance misuse services lies with local government colleagues in the Public Health Team at Lincolnshire County Council who the CCG works very closely with. As such the question will be passed through to the Public Health Team for their response and a request that the CCG is kept informed, noting that Mr Andy Fox was present at the meeting that day as he was representing Professor Derek Ward. Action: Mrs Ellis-Fenwick

Post meeting note: The response from Public Health is attached to the minutes.

3 Subject to approval by the Board at its next meeting The second question had been received from Jody Clark, Member of the Public

Question:

With the government plans for new hospitals, has any representations been made for a new hospital in the South of the county (i.e. Grantham)? If not, why not?

Response:

Mr Turner advised that firstly no representations have been made by the CCG or anyone else in the NHS in Lincolnshire in relation to a new hospital in Grantham. Any new NHS premises require capital monies and it was correct that more capital resources have been made available through the new hospital schemes (of which there are about 40). All of those have been worked up in very significant detail with partners and NHSE over a number of years, including Leicester Royal and have been subject to detailed scrutiny.

Lincolnshire has been successful in attracting more capital into the county over the couple of years in relation to the development of A&E services at Pilgrim Hospital, Boston, Urgent Treatment Centre at Lincoln and for LPFT to eradicate Nightingale wards. There were also numerous capital schemes in primary care and other priorities in the system. The current priority in addition to trying to see through the pandemic was the Acute Services Review, which will be going out to public consultation in the next few months.

In summary, there has been no consideration or detailed discussions at CCG or ULHT level regarding a new hospital in Grantham and Mr Turner did not anticipate this was something which be given priority consideration to in the immediate future.

There were two further questions received as part of the Questions and Answers Facility, both from the same individual and both of which were responded to by Mr Turner.

Mr Stephen Meadows. Member of the Public

Question: With increasing financial pressures in H2 how will this affect prescribing savings programs?

Response: The CCG already has a prescribing savings programme in place, and it will be an important component both of H2, and for 2022/23 financial planning.

Question: Next April will the CCG change its name to Lincolnshire ICS? Response: It will be NHS Lincolnshire ICS

Mr Turner advised that he had several items to highlight to the Board, some of which would be picked up in further detail throughout the meeting.

The following points were highlighted:

• There continued to be intense operational pressures consistently being reported from all NHS organisations across the system for all services generally but particularly in terms of high level service demand for urgent care. This was without a shadow of a doubt the most intense and busiest time the NHS has ever been under. This was completely separate from all of the other issues having to be addressed in relation to the elective care backlog. Lincolnshire was certainly not on its own in relation to these pressures, which were being witnessed up and down the country. The NHSEI Midlands Regional Team has held meetings and discussions with all systems regarding urgent and emergency services.

4 Subject to approval by the Board at its next meeting • The Lincolnshire system meeting took place the previous week and NHSEI Regional Team expressed their appreciation and assurance that everything that could be done was being actioned to address the pressures. However, there had subsequently been a request from NHSEI regarding ‘surge’ planning through the pandemic and concerns about the overall capacity of urgent care and critical care capacity up and down the country. Mrs Raybould was working with ULHT colleagues to respond to that request. • Lincolnshire passed the 1 million vaccination mark the previous week. This was approximately 550,000 first doses and 450,000 second doses. This was truly a remarkable achievement and the CCG Executives have informally offered significant appreciation and gratitude to the team and those involved across the county. The Board was asked to formally note the achievement of that significant milestone and offer their congratulations to the team. • Last Friday there was a media piece on this on ITV. The vaccination team took the opportunity to not only celebrate the achievement but also to reinforce the message about the importance of having the vaccine, specifically to those groups where there had been lower uptake, such as young males aged 20-25. Primary Care and specifically the Primary Care Networks had been very much involved in the delivery of the vaccine programme. • Planning for the autumn booster and flu vaccine campaign was well underway. • From a national perspective Mr Chris Whitty, Chief Medical Officer had recently published his Annual Report; there was a new Secretary of State, namely Mr Sajid Javid. Mr Simon Stevens, the current NHS Chief Executive would be leaving in the next week. The appointment of his replacement was imminent. • The first and second readings of the new ICS legislation have now been through Parliament. The ICS boundary issue, which had previously been mentioned to the Board, was resolved last week. The adverts for the ICS Chairs went live the previous day. 17 ICS Chairs were being recruited to out of 42 ICS areas. Further guidance and information in relation to the ICS legislation was anticipated to be published in the coming weeks and would be made available to the Board when received. • As referred to under Dr McSorley’s update, the first meeting of the Integrated Care System Development Board meeting in Lincolnshire had recently taken place. Mr Turner reiterated the membership and advised that the Joint Strategic Needs Assessment (JSNA) and public engagement exercise on the Acute Services Review would be the cornerstones of the Lincolnshire ICS. • The Joint Working Executive Group (JWEG) held its first Time-Out on 14/15th July, which involved senior leaders from both health and social care across the county. JWEG reflected on the strong partnership working which is already clearly evident in Lincolnshire, achievements to date and agreed the group’s collective priorities and key themes over the next 6-12 months given the population needs of Lincolnshire and the ICS Design Framework. Within that JWEG committed to developing a great health and wellbeing offer for all staff working across the health and care system in Lincolnshire and also push more on some health promotion activities, such as smoking cessation and blood pressure monitoring. • Mrs Sandra Williamson, Chief Operating Officer, East Locality was leading on a piece of work in relation to Integrated Commissioning and Four Pillars of Primary Care in Lincolnshire’s Integrated Care System and, as referred to by Dr McSorley under his update a recent meeting had taken place involving representatives from Dentistry, Optometry, Pharmacy and General Practice. Ms Tracey Latham–Green, who was a previous Lay Member for Lincolnshire East CCG now worked for Community Pharmacy Lincolnshire which is also providing some leadership across this piece of work. • As referred to under the CCG Chair update there is a real and genuine concern regarding staff welfare which had been reinforced under the update on JWEG and the determination to offer the best possible support to staff. • The national pay award of 3% had been announced last week, although the full details were not yet available.

5 Subject to approval by the Board at its next meeting • The CCG virtual staff events had now concluded and the write up of actions and outcomes from those events was currently being pulled together. The feedback on those events had generally been very constructive. The CCG was currently undertaking a CCG staff survey on preferred ways of working going forward which included a potential mixture of home/office working.

On a final note, Mr Turner reinforced the concerns about fatigue in the NHS workforce across the country as well as in Lincolnshire. This clearly needed to be taken into consideration throughout the next 6-9 months and when contemplating the work that needs to be actioned this needs to be done in a way which is supportive for staff.

The Board considered the update and congratulated those involved with the vaccination programme and the achievement of hitting the 1 million milestone, which was a tremendous achievement.

The Board agreed to: • Note the Chair and Chief Executive updates. • Note the questions received and responses. • Note the details would be published on the CCG website for reference. Action: Mrs Ellis-Fenwick

21/254 REPORT IN RELATION TO THE NHS SYSTEM AND CCG RESPONSE TO THE COVID-19 PANDEMIC Mrs Mills advised that she would take the report as read but wished to draw the Board’s attention to specific areas in the report. Firstly, the latest infection rate figures would be covered by Mr Fox as part of his Public Health update so these would not be referred to in detail under this item.

COVID-19 General Update

The Board was advised that the government published a COVID-19 Summer Response paper (Appendix 2 of the report) and has asked that after the 19th July 2021, all health and social care settings continue to operate with existing Infection Prevention Control (IPC) precautions to reduce the risks of transmission of COVID to vulnerable patients and service users in their care. To put that into context it means that health and social care settings will continue to operate under existing precautions which include social distancing, masks, increased cleaning and enhanced Personal Protective Equipment (PPE) and hand hygiene.

As a key system partner and to demonstrate effective leadership, the CCG has aligned with its provider organisations with that recommendation. As a result the CCG has decided to postpone Phase 1 of the return to office plan that was due to commence in August whereby teams of staff were piloting a return to the office a few times in the month and to pause the Phase 2 which was the blended return from October until further guidance is received. The Board will be aware that there were some staff that have and will continue to work from the office due to the nature of their role but the majority of our staff were working from home. Managers continue to support their staff with those arrangements.

‘Ping effect’ national guidance has been issued in respect of exemption from contact isolation for fully vaccinated health and social care staff in exceptional circumstances; the CCG is working through the guidance with partners prior to implementation. The CCG Quality Team has been working to ensure the organisation has the appropriate mechanisms in place to carry out robust risk assessments to maintain the balance of protecting people from risk of exposure to COVID but also being able to access services when required.

6 Subject to approval by the Board at its next meeting There has been a steady increase in COVID hospital admissions in the county in July with the current number of COVID positive patients in Lincolnshire provider hospital beds being 26, 25 at ULHT and one at LPFT and over 50% of the current positive inpatients were unvaccinated. Mrs Mills took the opportunity to really encourage people to have the vaccination.

Emergency Planning, Resilience and Response

On 8 June 2021, NHSEI was issued with a “stop” notice, requiring all its documents to be retained into the response to the COVID-19 pandemic. All NHS organisations have now been advised to start preparing for a public inquiry and NHS leaders are asked to consider “four key areas of action”, which were set out in the paper for information.

As described last month the CCG and system as a whole will be required to undertake a resource intensive piece of work to ensure all documentation relating to decisions made during the COVID response is saved and stored in the event the information is called for as part of the Inquiry. The Board was assured that the CCG has operated a robust records management for the incident and is starting to consider the operational requirements of the stop notice ahead of full details expected during the coming months.

COVID-19 Recovery

Currently, the NHS in Lincolnshire is experiencing very high levels of patient demand across all services, but particularly for urgent and emergency care. Our GP Practices, Urgent Treatment Centres, A&E Departments, and East Midlands Ambulance Service (EMAS) are all reporting exceptional pressures of a nature which is beyond that experienced during the depths of winter. This increase has also being seen in hospitals across the country and is being very closely monitored. In addition, there are concerns that the increase in COVID positive patients in hospitals will impact on the recovery of other NHS services – this is being reported in other parts of the country (e.g. cancelled operations) and whilst this was not currently the case in Lincolnshire, it was a concern.

In Lincolnshire the recovery of services remains a very high priority. The CCC is working on a number of key areas as part of its restore and recovery programme which has progressed positively in line with the planned trajectory over the last month and continuing to restore services that were paused or cancelled during the last year.

Cancer waiting times are continuing to reduce gradually and again largely due to the ‘green site’ at Grantham Hospital where many cancer patients were able to be safely treated over the last year in confidence of a COVID secure environment. The focus is on treating those cancer patients that are clinically urgent - these are Priority 1 patients who need surgery within 72 hours, and Priority 2 patients who need surgery within a month. The CCG currently has no Priority 1 patients waiting, and Priority 2 patients are treated within an average of 4 weeks which is in line with the position across NHS Midlands Region.

In summary, the system as a whole is responding in parallel to an increase in demand for all NHS services, COVID resurgence and this along with seasonal pressures, increasing self- isolation and enhanced Infection Prevention and Control (IPC) measures places an increased strain on all of services and associated pathways of care but continued to work exceptionally well across the services to do the very best for the population and for staff.

The Lincolnshire COVID Vaccination Programme continues to make excellent progress in vaccinating the population across the county. The latest vaccination figure as of 26th July for first dose for the adult population was 84.8% and the CCG team are still encouraging people to come forward to get their vaccinations and continued to carry out innovative work including outreach into communities where individuals need easier access. The current second dose position was at 87.1% for cohorts 1-10, which were those groups of people who were eligible to receive the vaccination. 7 Subject to approval by the Board at its next meeting Looking forward into the autumn, the CCG is in the midst of the planning for Phase Three of the vaccination programme which involved looking at a booster programme and potentially running this in parallel with the annual flu vaccination programme, which will be an enhanced service. The CCG would also continue to offer a ‘green’ programme whereby anyone who has not had the vaccine will be able to do so should they wish. Whilst plans are still in development, Mrs Mills was able to advise that there had been a very positive response from the Primary Care Networks (PCNs) across the county in terms of delivery a system wide programme but with good local access.

The Board considered the report. Dr Boldy advised that in the East Lindsey area the majority of people testing positive for COVID appeared to be predominantly in the 0-59 age group and whether there was any data which indicated whether the majority were in the lower age bracket for that group. Mr Fox advised that the information is available and is published on the Government’s coronavirus website under Lincolnshire. Currently, and indeed throughout the current wave of the pandemic, the majority of people testing positive for COVID were aged 20- 25 at the peak and then secondary school aged children, but this had recently bled through into the older group but the numbers were now declining which was very good news. This clearly evidenced the protection the vaccine provided with onward transmission rates and hospital admissions in the older population in the current wave being very low and was currently non- existent in Care Homes in Lincolnshire.

Dr Boldy advised that he had a supplementary question in respect of page 27 in the pack of papers which related to the forward planning list for booster vaccinations which appeared to be a priority list by age group and asked whether this was correct. Mr Fahy advised that the flu vaccine programme will be running alongside the COVID booster campaign and as in the previous year the intention is to drop the flu vaccine right down to the over 50’s. The detail was currently being worked through and in terms of whether it will be possible to give both vaccines at the same time, although people may not been keen to receive both at the same time. There were also the practicalities to consider in terms of rolling that out, again which were currently being worked through. It was noted that the CCG had the best uptake of the flu vaccine last year and the intention was to replicate that this year.

Mrs Chambers asked whether the CCG was starting to see an impact from holiday travel to the East Coast and also sought clarification on the position in terms of COVID boosters being run alongside the flu vaccine programme and what is happening for young people as they turn 18 in terms of vaccinations. Mr Fox advised that no impact was currently being seen as a result of people travelling to the East Coast; there was also no particular evidence of this the previous year. The highest rates currently were in Boston and Lincoln which had high numbers of young people who were not vaccinated.

Mr Fahy advised that the JCVI had recently issued national guidance in terms of looking at people aged 17 ¾, so three months before they turn 18. Licencing guidance was currently awaited to enable the vaccine to be administered to that age group, but planning was already taking place to be able to do that. Uptake has been very good in Lincolnshire but the position could be improved on and the team continued to emphasise the importance of having the vaccine through numerous communication routes.

Dr McSorley sought clarification that current JCVI guidance was that vaccines were recommended to not be offered to school aged children. Mr Fahy confirmed this was correct with the exception of young people who are clinically vulnerable. However, the majority of young children who do catch COVID have a relatively mild illness.

Public Health Report

Mr Fox presented a verbal update from the Public Health perspective which covered an overall picture in respect of prevalence, incidence around COVID and some key policy matters. The following points were highlighted:

8 Subject to approval by the Board at its next meeting • The number of cases as of that day in Lincolnshire was 253.5 per 100,000 of population over the last seven days which showed a declining position. This mirrored the picture nationally and regionally. Lincolnshire remained below the national average of 473.5 per 100,000. This was being pushed up by higher incidence of prevalence which is currently predominantly in the North East. • The leading hypothesis for the reasons the cases were going down was not clear at this stage as the decrease at this point was not widely predicted with 100,000 cases originally having been predicted a few weeks previously. • At this time it was not possible to confirm with any certainly whether this downward trend will last for days, weeks or months. • There have been some significant changes in population behaviour; the first being that the schools had broken up for the summer holidays and there was therefore less testing taking place. • There had also been a significant reduction in the desire to take a test which appeared to be for a number of reasons, including where individuals were only experiencing mild symptoms and scheduled to go on holiday and also secondary school aged children not taking tests due to the holiday season. • The daily testing figure had reduced from around 25,000 to 15,000 over several weeks. • This in itself would indicate a false indication that numbers were declining was it not for the fact that the number of positive cases had also declined, which had reduced to fewer than 2% over recent weeks.

In summary there is a reasonable hypothesis that COVID is genuinely declining currently but the data will need to be analysed and understood in more detail. It was likely there would be some fluctuations with the full effect of the ending of lockdown restrictions from the 19th July not yet being fully seen; the impact was usually about three weeks behind and could potentially see a further increase with the change in population behaviours as a result of the Euros football tournament.

On a cautious note, the country could be behind the worst of the pandemic but this would depend on whether the declining position continued or there was an increase in positive cases in the coming weeks; difficult to predict at the current time.

Mr Fox added that of the cases sequenced in the last seven days 100% of those were the Delta variant which clearly remained the dominant one. The highest numbers were being seen in the 20-25 age group where the vaccinated rates were at their lowest.

In terms of policy, provisions for exemption from self- isolation requirements have been made for health and social care staff. The Government has now expanded that for critical roles and various sectors including the food industry whereby companies can contact relevant Government departures for an exemption certificate where appropriate.

Dr McSorley thanked Mr Fox for his informative and useful update.

Healthwatch Report

Mrs Fletcher provided a verbal update and highlighted some of the feedback and key themes of patient experience shared with Healthwatch during June 2021.

• A number of patients have expressed their concerns about ULHT and the number of cancelled appointments – the majority do not specify which service this related to but there were a couple that referred to cancer and urology. • There were also a number of Did Not Attends (DNAs) reported. If this continued to increase then Healthwatch could provide support in terms of getting messages out, which they had actioned in the past.

9 Subject to approval by the Board at its next meeting • Healthwatch is currently looking to arrange a meeting with ULHT to discuss concerns relating to waiting times, Did Not Attend (DNAs), urology and cancer services and understand the issues. This details/message can then be conveyed to patients. • Primary Care Access continued to be an area of concern, although it was acknowledged that the high demand in Lincolnshire was not helping the situation. Healthwatch was working with primary care partners to look at the work being done to support access. A meeting was being arranged with the CCG to take this piece of work forward. • Patients are feeling surgeries need to be getting back to 'normal' as other services are, plus a view that surgeries are not open, and a general observation that GPs/practice staff do not appear to care. Healthwatch have been seeking clarification on what patients regard as ‘normal’. • Dental - patients are frustrated they are unable to access basic dental care. Those that were not on a 'list' previously and looking for NHS Dental care are unable to be placed on a list (lists closed). • Patients are unclear of the difference between NHS & private dental care. • Healthwatch had recently submitted an outline plan that supports the CCG with regard to the development of the ICS and involvement of the public and look forward to receiving a response on how that might be taken forward. • Healthwatch will be supporting the CCG with the draft Acute Services Review documentation, which will be considered by their Readers Panel.

Dr McSorley thanked Mrs Fletcher for her informative update and advised that he had recently had sight of the Healthwatch July report and asked that Mrs Ellis-Fenwick circulate this to the Board Members for information, which was duly noted for action. Action: Mrs Ellis-Fenwick

The Board considered the update, noting the important issues raised and general point on patient perceptions on the current state of access to services. Dr McSorley invited Mr Turner and GP colleagues to make some comments on the points raised. Mr Turner noted the important points raised, some of which would need to be worked through and he welcomed input from Board Clinical Leads with primary care across the county reporting it has never been as busy in terms of demand from patients for their services. There are number of challenges in terms of capacity and digital access, patients’ wants and needs, all of which come under regular consideration by the CCG’s clinical colleagues and Executives. However, it was essential to understand the specifics so that Healthwatch can receive the support it needs from the CCG in ensuring the right messages are given to patients and the public so they better understand their options and they access the right service.

Mr Turner advised that dental services were not a direct responsibility for the CCG at the moment but would be for the incoming ICS and will require significant attention. The Local Dental Committee and dentists in Lincolnshire are acutely aware of the demand for dental services and are frustrated with the inability to meet those demands at the current time.

On a final note, Mr Turner expressed his appreciation for the continued input from Healthwatch in terms of how the CCG shapes engagement with the public.

Dr Baker referred to the comments in respect of practices and face to face appointments and advised that practices are offering face to face but it is significantly less than in the past; that said there is a misperception about digital services being introduced as a result of the pandemic, which was not the case. A significant number of practices have been using digital services since before the pandemic, including online triage tools. As referred to by Mr Turner demand in general practice was 50% higher than it was pre-pandemic, although there had been a slight decrease seen in the last 10 days. Dr Baker advised that he would encourage patients to look at alternatives and options available.

10 Subject to approval by the Board at its next meeting Mrs Fletcher advised that Healthwatch has reinforced the options available and the position in relation to obtaining clinical advice but unfortunately there were a number of patients who were used to previous practices/ways of working and that is what they class as normal, but in reality it was not clear what that actually means. Healthwatch do have shared experiences from patients that support Dr Baker’s comments regarding access and the use of digital services.

Following further discussion on consistency in respect of statements being conveyed to patients it was agreed that the points raised by Mrs Fletcher need to be considered by primary care colleagues and Mrs Mills as the CCG lead for primary care.

Mrs Mills advised that the CCG does receive feedback from Healthwatch regarding specific practices and any concerns flagged are followed up so that the team can better understand the issues.

The Board considered the update and agreed to: • Note the COVID-19 report. • Note the verbal update from Public Health • Note the verbal update from Healthwatch.

21/255 INTEGRATED PERFORMANCE REPORT Mr Gaunt presented the Integrated Performance Report.This report provided the Board with information on achievement against the CCG’s key performance targets and quality standards and this was the third month of presenting it in the new format.

It was noted that the full version of this report is considered by the Quality and Patient Experience Committee. The Board received the full range of dashboards and the report presented highlighted a number of areas for additional focus; some of which were summarised and others contained more detail.

The Board was advised that the report included information on both CCG and system performance and in comparison to the previous month there were no particular shifts in trends that were a particular cause for concern. The focus areas highlighted in the front sheet of the report were largely the same as per the previous month and were predominantly those which had already been covered earlier in the meeting, such as COVID-19 related pressures, cancer performance and waiting lists.

Mr Gaunt advised that in terms of elective activity progress continued to be made in terms of addressing the backlog but the current operational pressures across the system put that position at risk. The Board was advised that as of that day the number of Lincolnshire patients waiting over 52 weeks for treatment is more than 2,600, which was significantly higher than pre COVID- 19 when the number was 7. There were also a number of patients waiting over 40 weeks.

Mr Gaunt handed over to Mr Fahy at this stage. Mr Fahy advised that there were several points to highlight from the quality section of the report but in the first instance it was important to make the Board aware that one of the key challenges in patient flow across all services was the requirement by all teams in having to engage in enhanced infection control procedures in line with COVID requirements, which in itself impacts on capacity and was causing delays as this takes time e.g. having to wipe equipment down in between patients.

Mr Fahy highlighted the following points:

• There had been one increase in the number of E.coli cases, although the numbers were well below the expected level. • There had also been a slight increase in the number of people with a Learning Disability who had received in-patient care, which was two people and there was an overall downward trend.

11 Subject to approval by the Board at its next meeting • Standard Hospital Mortality Index (SHMI) – the details for all the CCG’s main providers were included on page 15 of the report, and they were all slightly above Band 1. NWAFT and ULHT remained in the ‘higher than expected’ ranges, although NWAFT was on an improving trend. The ULHT SHMI score was 1.125.The intention was to try and get all providers below that level. It was emphasised that SHMI acts as a potential highlight to identify that there may be an issue, but that is not for definite. Since the last Board meeting a considerable amount of work had been carried out involving the CCG Patient Safety Team and ULHT Quality Team to understand the SHMI at ULHT. The outcome highlighted that the rolling average internal Trust crude mortality actually identified a reduction of 0.25% when considering this over a longer time frame. The increase in ULHT SHMI did coincide with the reporting period just after Christmas when there was a significant increase in levels of activity across the acute sector and there was an associated increase with the number of deaths which were in part due to COVID. A deep dive had also been carried out into data recording which had shown that ULHT was reporting an average number of 4.1% of people being coded against COVID or COVID related deaths. Similar acute Trusts across the East Midlands region were reporting 4.5%. Mr Fahy emphasised he was not stating that the figures were related to a coding issue, but that there was clearly more work to be done. Mitigation actions to review the position were set out in the report. • Primary Care Quality – the report identified that there were two out of the CCG’s 85 practices which were rated as Requires Improvement by the Care Quality Commission (CQC). Both practices were being supported by the CCG Primary Care Support Team and both were making good progress and would hopefully improve on their rating when they are re-inspected in August. Sleaford Medical Group which had previously been rated as Requires Improvement had now improved to an overall Good position. • The Care Quality Commission report into the inspection at Lakeside, Stamford was due to be published the first week of August. • Care Homes – the position was largely unchanged and there was no significant deterioration in performance. • The CQC report into St Andrew’s Healthcare had recently been published. There were a number of patients from Lincolnshire placed in that unit and the CCG was currently working through the details with NHSEI colleagues in relation to the quality and also potential safety concerns. • The report into the review of Healthlinks hospital had now been published and identified an ‘Inadequate’ rating. There were currently no patients from Lincolnshire in that unit. • Serious Incident Reporting – the overall position was largely the same as the previous month. There had been a slight increase in incidents reported by both LPFT and ULHT which had not yet been investigated.

The Board considered the contents of the report. Dr Boldy advised that he had one question and one comment; the first related to NWAFT and whether the CCG was aware of any outcome from the Cambridge review and whether that was in fact now complete. Secondly, on page 69 of the performance report, the number of follow up appointments was above plan which was positive and clearly reflective of the catch-up following the pandemic but as referred to by Mrs Fletcher the number of cancelled appointments was a concern; every effort should be made to avoid these where possible.

Mr Fahy advised that the CCG had not received the report on the outcome from the Cambridge review of NWAFT but would look to ensure a copy was obtained and presented to the next meeting of the Quality and Patient Experience Committee (QPEC). Action: Mr Fahy

Mrs Raybould advised that the number of follow-up appointments was above plan and indeed so were the out-patient first appointments when you add in advice and guidance; the issue is around how this has been incorporated as this was not been used in the same way in 20219/20 as it is currently. Mrs Raybould advised that she was happy to pick up any concerns around cancelled operations outside of the meeting with Mrs Fletcher if that was considered helpful. 12 Subject to approval by the Board at its next meeting Mr Connolly referred to A&E challenges and capacity issues because of the infection control procedures which need to be followed, and whether this was related purely to front of house and whether the providers had started to implement any of the usual winter pressure measures.

Mr Fahy advised that there were in essence multiple factors contributing to the position and as referred to by colleagues earlier during the meeting, the level of demand on services at the current time was unprecedented. However, Mr Fahy was confident that all the measures that should be taking place such as discharge flow cells, exception approach particularly with Continuing Health Care and rapid discharge processes and increasing patient flow were in place and working relatively well. Discussions were also taking place with Mrs Tracy Pilcher, Chief Nurse, Lincolnshire Community Health Services (LCHS) who was the system lead for urgent and emergency care about standing up the frequency of the Discharge Flow Cell.

Mr Connolly referred to the numbers of health checks for people with severe mental illness which was currently off track and sought clarification on what actions were in place to recover that position. Mrs Mills advised that this area was a very important piece of work which the team remained very focused on and the intention was to build on the success of last year in terms of the health checks for patients with learning disabilities. A similar approach was therefore being adopted with focus on three specific areas: continue to maintain and improve on the LD health checks, to make sure there is a similar trajectory for people with severe mental illness although it is a slightly more complex service arrangement as LPFT is responsible for carrying out the assessments for those patients who are receiving treatment from them, but CCG team is closely working with LPFT to make sure both elements get improved. The third area is in relation to the diagnosis of dementia for people where performance had previously been only satisfactory. Those three areas have been brought together and have a small amount of non-recurrent funding which was being invested and worked through with the PCNs. Mr Nick Blake, Head of Transforming Care who had led on the Learning Disabilities Health Checks piece of work last year was overseeing this piece of work

Mr Rix added that a paper was due to be considered by the CCG Executive Team at their meeting taking place the following day on the proposed plans for Dementia, Physical Health Checks, Learning Disabilities and Transforming Care..

The Board agreed to: • Note the Integrated Performance Report.

The Board meeting adjourned at 11.16 and reconvened at 11.25.

21/256 FINANCIAL REPORT

Mr Gaunt presented the finance report which demonstrated the CCG’s position as reported at the end of month three (end of June) and forecast position to the end of month six (end of September). The headline position was largely unchanged with no significant shift in the financial regime the CCG has been operating under, and with an expectation that this will continue into the second half of the year. There is no change in the expected position which is for the system to achieve a breakeven for the CCG and a £2 million surplus across the system.

The Board was advised that the CCG received allocations of £723.0m for months one to six. During month three additional allocations were received totaling £1.7m to provide a total allocation of £724.7m for the period M01-M06 for the first half of the year. This was in respect of the COVID-19 expenditure and Hospital Discharge Programme.

The report for the first time included a table on efficiency which sets out where the CCG is in terms of the efficiency programme. The detail of the table in the executive summary demonstrated a £4.1m shortfall to date at month three against programme expenditure, which was driven from an identified gap at the beginning of the year.

13 Subject to approval by the Board at its next meeting Other areas to highlight from the report were as follows:

• The year to date total prescribing spend is under budget and therefore efficiencies have been delivered. • A reduction in the number of external placements for patients with acute complex mental health needs by providing care with LPFT (particularly for patients who can now receive care at Ash Villa) has seen a reduction in expenditure of £0.7 million year to date, which was slightly less than the planned reduction of £0.9m. • There was currently a year to date shortfall of £1.3 million but this was being mitigated by the Elective Recovery Fund (ERF).

Mr Gaunt reminded the Board that if the CCG exceeded its planned levels of activity then it will receive an additional allocation and as at month three this had already been achieved against the position included as part of the planning process at the beginning of the year. However, continued pressure to deliver elective activity and address the backlog will have consequences in the second half of the year.

The Board considered the report. Dr Boldy asked whether firstly Mr Gaunt was confident that the capital allocation will be spent effectively and in year and secondly the capital allocation for LPFT seemed particularly high and sought clarification on the reasons for this. Mr Gaunt advised that the level of allocation received this year was quite substantial, although it was acknowledged it was someway off the actual resource required. Having said that, Mr Gaunt was confident the capital allocation would be spent in year due to the level of planning which had taken place at the beginning of the year. In terms of LPFT, this related to the removal of mixed sex accommodation and the costs associated with that which were fairly significant.

Mr Turner added that as referred to by Mr Gaunt the second half of the financial year was likely to be a different discipline to the first half and there were numerous discussions taking place at a national level on how this will shape up. There was a real risk in Lincolnshire, which was currently being worked on collaboratively and being discussed later that day at the Chief Executive’s meeting, in terms of the ways in which the system can meet the financial challenge, which will require significant clinical input. It will be challenging for this to be carried out comprehensively given the already noted pressures there are and in anticipation of the next six months and going forward.

Mr Rix advised that he had a briefing paper on the LPFT capital allocation which could be shared with the Board members for information. Action: Mr Rix

The Board agreed to: • Not the Finance Report for month three.

21/257 UPDATE ON THE DEVELOPMENT OF THE ICS

Mr Turner advised that there was a clear determination at a national level to get the statutory ICS arrangements established from the 1st April 2022. Since the Board had last met the second reading of the legislation (draft Health and Social Care Bill) had been through the House of Commons. The next stages of the parliamentary process ahead were outlined for information and it was acknowledged that whilst it was clearly not possible to predict the outcome of that, CCGs and systems had been asked to work on the basis of the intent to put ICSs on a statutory footing from April next year.

At the same time there was an understanding and appreciation at a national level of the significant operational service challenges and demands the NHS is currently under and will be under for the rest of the financial year. Therefore a de minimis approach was being adopted.

14 Subject to approval by the Board at its next meeting In summary that means that the 1st April 2022 should be seen as the beginning of the statutory ICS arrangements and CCGs need to take a minimal approach to ensure they arrive in a safe and legal way on that date. In doing so, the CCG will need to protect its resources as much as possible to deal with the demands of operational delivery.

The Board was advised that the 42 ICSs in the country are different in that they will exist in a local context, both in terms of health needs and local dynamics. It was clear there is a genuine willingness to make the Bill, for the most part, flexible and permissive from a local perspective, which is key in terms of ensuring that health and care organisations are not restricted by overly prescriptive and rigid guidance. This approach had not been seen before with the introduction of new legislation and was very much welcomed, e.g. Lincolnshire is only one of three systems in the country that is a ‘one place’ system and the only one in the whole of the East Midlands region that currently has a single Health and Wellbeing Board. These were really important factors in terms of designing locally the details and approach that the CCG/ICS feels will best serve the population of Lincolnshire.

The advert for the Chair of the ICS had been issued the day before and had been shared with colleagues for information. There were 17 Chair roles to be appointed to. The appointment process for the recruitment of the Chief Executive positions was likely to follow in the next three to four weeks. There was also likely to be further clarification and guidance coming out on the other Board Member roles on the ICS statutory Body, although there were no specific timescales identified at this time.

As mentioned at last months’ Board meeting, development of additional resources and guidance would be forthcoming in relation to four key areas: ICS Constitution, Provider collaboratives and provider governance, System Clinical Leadership and broader Health and Care Partnership arrangements which was being developed by the Local Government Association and Department of Health and Social Care.

The CCG has a clear responsibility in terms of its staff below Board level in supporting and engaging them comprehensively in the evolution of the ICS, notably as the CCG will cease to exist on the 31st March and all of its current responsibilities will transfer to the ICS. Staff below Board level will simply ‘lift and shift’ into the ICS. The CCG had recently held a number of virtual staff events and ICS development formed the core focus of the discussions. As referred to previously NHSEI had issued guidance last month on the employment commitment for CCG staff which provided a level of security and clear intent to make the move from a CCG to an ICS as easy as possible. The intention is to maintain minimal distraction for the CCG staff as they continue to concentrate on the response to the COVID-19 pandemic, vaccination programme, restoration and recovery and significant operational demands and pressures across the system.

The Board considered the update and agreed to: • Note the verbal update.

21/258 MEMBERS’ FORUM ANNUAL REPORT 2020/21 The paper included in the pack was produced to brief the CCG Board on the work of the Members’ Forum during 2020/21. The CCG Members’ Forum forms part of overall governance and oversight of the CCG. Its key role is to represent the Members and hold the CCG to account in terms of delivery of all of its workstreams.

There are 25 members of the Forum who represent the views of the CCG’s 84 practices and include individuals from each of the four Localities – East, West, South and South West (currently there are 22 out of 25 representatives identified) – a gap in West and one in East.

The four Locality leads who sit on the CCG Board may not also fulfil the role of one of the Locality Representatives on the CCG-wide Members Forum.

15 Subject to approval by the Board at its next meeting The Members’ Forum usually meets no less than four times a year in private. However, in light of the COVID-19 pandemic the first meeting of the Members’ Forum did not take place until 17th September 2020.

The Members’ Forum has since met in December 2020 and March 2021 - representing a total of three times in 2020/21 with 82% attendance from member practices.

The first two meetings of the Members’ Forum were Chaired by Dr Sunil Hindocha. At the December meeting it was proposed and agreed that Dr Elton Pardoe be elected as the Chair of the Members’ Forum going forward.

The CCG Chair, Chief Executive and Board Secretary regularly attend the meetings. Other relevant CCG Officers have attended meetings during the year in relation to the presentation of specific reports.

In 2020/21 the Members’ Forum has considered a number of items which were set out in the report.

The Board is asked to note the Members’ Forum Annual Report 2020/21 and Self-Assessment which was presented to and approved by the Members’ Forum at their June meeting.

The Board agreed to: • Note the Members’ Forum Annual Report 2020/21.

21/259 MEMBERS’ FORUM REPORT Mrs Ellis-Fenwick presented the Members’ Forum report which highlighted the items discussed at the latest meeting of the Members’ Forum, which was held on 11th June 2021.

As per the previous item the Members’ Forum approved their Annual Report 2020/21 for submission to the Board for information and also approved the changes to the CCG Constitution in relation to the Stackyard Surgery for submission to NHSEI – which was submitted two weeks ago. We are currently awaiting sign-off.

The next meeting of the Members’ Forum is schedule to take place on 9th September 2021.

The Board is asked to note the report from the latest meeting of the Members’ Forum.

The Board agreed to: • Note the report.

21/260 QUALITY AND PATIENT EXPERIENCE REPORT Dr McSorley advised that in Mr Connolly’s absence he had Chaired the Quality and Patient Experience Committee meeting held on 7th July 2021. The report from the meeting was included in the pack of papers and highlighted the key items discussed. There were three specific areas the Committee wished to bring to the Board’s attention:

• The CCG Research Team attended the meeting to present their Annual Report which summarised research activities that had taken place during 2020/21. The presentation was really interesting and informative. The Research Annual Report will be shared with the CCG and a quarterly report detailing the research activities for GP Practices will be produced and shared with Mr Fahy for review and dissemination. • Integrated Quality update – it was noted that with the restoration and recovery of services discussions are ongoing regarding restructuring the regular performance and contracting meetings with providers, which was very welcomed by the Committee and appreciation expressed to Mr Fahy and the Quality Team for picking this up.

16 Subject to approval by the Board at its next meeting • The LeDeR (Learning Disability Mortality Reviews) Annual Report was presented. The key themes relate to the Mental Capacity Act and the application of it when people lack capacity. The Committee commended the excellent work and progress made.

The Board considered the report and agreed to: • Note the report and key areas highlighted.

21/261 AREAS OF RISK TO BE INCLUDED ON THE RISK REGISTER The Board considered whether there were any new areas of risk to be included on the Corporate Risk Register. There were no new items identified.

Mr Connolly advised that the Board had agreed its strategic objectives following a piece of development work which had recently been completed with Oaks Consultancy and sought clarification on when the details would be presented to the Board as part of a Board Assurance Framework (BAF).

Mr Turner advised that outcome of the Oaks work was being actively managed and progressed and formed the bedrock of the CCG’s six strategic objectives for the forthcoming year. Lead Executives have been identified for each of the six overarching objectives to progress the specific actions identified as part of each one. Progress will be reviewed with each Executive Lead in the next few months.

In parallel with that piece of work the broader aspects of the Oaks work have already been included into the overall evolution of ICS development in the county and will continue to do so for some time.

Mr Gaunt added the Board had been presented with the Board Assurance Framework previously on a several occasions. The BAF had been formed into four key themes: Finance, Quality, Transformation and Leadership/Reputation. However, it was acknowledged this had been preceding the conclusion of the Oaks work. Should the review by Mr Turner identify any areas which were off track then this would need to be considered in the context of the effect of the six strategic objectives as this could create risks under the framing of the four themes identified. The next review of the BAF will take place by the Audit and Risk Committee at its September meeting. An update will then be presented to the Board.

The Board agreed to: • Note the verbal update.

21/262 DATE AND TIME OF THE NEXT MEETING The next meeting is scheduled to take place on Wednesday, 25th August 2021 at 9.30 am. The meeting will be held as a live event via Microsoft Teams.

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Chair Signature Date

17 Not Delivered In Progress On Track to Deliver Delivered ACTION LOG - PUBLIC

Date of Meeting: Wednesday, 25th August 2021

Agenda Item: 2

Reporting Officer: Mr Sean Lyons, CCG Chair

Date of Minute Item Action Lead Due Date Progress Meeting Number

28/07/21 21/253 Question from a To publish the questions received Mrs Ellis- August Delivered. Member of the from members of the public Fenwick 2021 Public including the CCG and LCC response. 28/07/21 21/254 Healthwatch To circulate the July Healthwatch Mrs Ellis- August Delivered. Update Report to the Board. Fenwick 2021

28/07/21 21/256 Finance Report To circulate a report detailing the Mr Andy Rix August Delivered. LPFT capital allocation. 2021 BOARD MEETING – PUBLIC

Date of Meeting: 25th August 2021 Agenda item: 3.1

Title of Report: Petition by Better Health For Stamford (BH4S) regarding Primary Care Services in Stamford Report Author and Mr John Turner, Chief Executive Title: Mrs Julie Ellis-Fenwick, CCG Board Secretary Appendices: Appendix 1 – Covering Letter Appendix 2 – Online Petition List Appendix 3 – BH4S Petition

1. Purpose of the Report (including link to objectives)

The purpose of this report is to inform the Board of a petition received by the CCG from Better Health for Stamford (BH4S) on the 11th August 2021 in relation to Primary Care Services in Stamford.

2. Recommendations

The Board is requested to note the petition which is for information purposes only.

3. Executive Summary A petition represents the expression of the views of the people who sign it and petitions are an important mechanism for the expression of community views and the public voice. Petitions should not be viewed in isolation but as important evidence and information which contributes to an overall picture.

The Board is asked to note that the CCG has received a petition from BH4S as attached.

The petition was received on 11th August 2021 and the Board will note there are in excess of 3,100 signatures.

In line with the CCG Standing Orders, which form part of the CCG Constitution, all petitions have to be presented to the Board by the CCG Chair for noting.

The CCG’s Primary Care Commissioning Committee as part of its responsibilities relating to Primary Care across Lincolnshire, is currently considering matters relating to the future structure and configuration of services in Stamford. Following noting of the petition by the Board there will be further analysis undertaken by the CCG Engagement Team. This analysis will be fed through to the CCG’s Primary Care Commissioning Committee which will review the analysis as part of its considerations.

The immediate focus of the CCG is to support the Practice and to liaise with the Care Quality Commission (CQC) to ensure that the shortcomings identified in the recent CQC report are addressed as a priority.

The Board will be kept informed of developments. 4. Management of Conflicts of Interest No direct implications

5. Finance, QIPP and Resource Implications Not applicable.

6. Legal/NHS Constitution Considerations

Where the CCG receives a petition it is to be considered formally in line with the CCG’s Constitution.

7. Analysis of Risk including Assessments

This section should identify known or potential risks and how these are being mitigated, including conflicts of interest.

P lease state if the risk is on the CCG Risk Register. Yes  No

8. Outline engagement – clinical, stakeholder and public/patient

As identified the CCG Engagement Team will carry out a review of the petition and the outcome will be considered by the Primary Care Commissioning Committee as part of the wider determinants in terms of primary care provision in Stamford.

9. Outcome of Impact Assessments

Not applicable.

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process: Finance Clinical Leads Commissioning Quality Contracting Safeguarding Medicines Optimisation Other 

11. Report previously presented at:

Not applicable.

12. For further information or for any enquiries relating to this report, please contact Jules Ellis-Fenwick, CCG Board Secretary – [email protected] We care about healthcare www.BH4S.net

10 August 2021

Mr John Turner Lincolnshire Clinical Commissioning Group Bridge House Lions Way Sleaford Lincs NG34 8GG

Dear John

Re: Petition by BH4S to end Lakeside’s GP provision monopoly in Stamford

As part of our campaign to secure accessible, choice-based GP services for patients in Stamford and to break the monopoly of the Lakeside Healthcare Group, we present the results of our patient-led petition, which is the culmination of three month’s work. During this time, we collected signatures on paper and online. We have met and spoken to hundreds of patients and heard countless stories, bearing out the findings of the CQC’s report.

You will note from our online petition that our stated aims were to “petition those responsible for commissioning GP services in Stamford and the surrounding area” to:

• End Lakeside Healthcare’s monopoly of the provision of GP services in the Stamford area and instead provide the area's residents with a permanent choice between well-resourced and reliable GP service providers.

• Make recommendations to regulators and legislators on how local authorities and NHS commissioning bodies can be empowered to act quickly and decisively where GP service providers lose the confidence and support of the public they serve and/or fall short of the high standards of partnership and co-operation expected between them and their NHS commissioning bodies."

You will note that the total number of signatures (moderated downwards by 5%, to account for duplications and additional signatures of those not effected) is in access of 3,100. This accounts for a full 20% of the adult population of Stamford and 10% of Lakeside’s total patient list. We are sure that you will be as concerned as we are about the strength of feeling shown and that you will now seriously consider our request for the CCG/ICS to make it possible for another group of GPs to operate in Stamford.

We can say in all sincerity that it gives us at BH4S no pleasure to be presenting this petition. However, we believe that the situation should never have been allowed to become so serious, and that patients’ welfare should never have been sacrificed for what has developed into a lamentable and failed tenure by Lakeside in Stamford.

Before 2016, it would have been extremely difficult to find anybody with a serious complaint to make about whichever of the three GP surgeries they used in our town. If they were unhappy, they did, at least have the choice of moving to a different GP provider. Unfortunately, as with most monopolistic situations, when the competition reduced, so did the service provided. We are determined to maintain our efforts to urge you to allow another GP provider in the town, as we are concerned that the CCG appears to favour maintaining the status quo and speaks of “supporting” Lakeside in their efforts. We beg to differ. We do not believe that, after all that has happened, the chances they have been given and their complete inertia in even considering making changes to the senior management team (notwithstanding the problem of the same managers bringing in more of the same failing management techniques). Today’s announcement about Mr Harris’ resignation does little to assuage our concerns, whilst the rest of the Corby team remain. We echo the request made in MP Gareth Davies’ letter of 2nd August, for the CCG to confirm what action they intend to take to bring about swift action and significant change, within the six-month measures imposed by the CQC.

Better Healthcare for Stamford will continue to campaign for Lakeside’s long-suffering patients until commissioning bodies take seriously the appalling and totally undeserved treatment they have received, since long before the Covid pandemic. This issue now appears to provide a cynical excuse for the lack of care, when we know there is clear evidence of other surgeries in the surrounding regions providing far better care for, and towards, their patients. We know you are aware that up to 1,000 patients have, in an unprecedented move, chosen to leave the practice in the past year, creating longer lists and waiting times in surrounding practices.

In further support of our case, we offer below a selection of some comments we have collected from patients via our website, social media and our online petition, which the CCG can access here: http://chng.it/McSyv6ZZ

• “It's impossible to even speak to reception now. It's an absolute disgrace what Lakeside has done to the once great service provided by St Mary's. Enough is enough”.

• “Our worst fears have been realised. Huge difficulty even getting through to reception on the telephone, no continuity of appointments or even conversations with doctors, dreadful administration generally, low staffing ratio, low morale of many staff encountered, plus so much more. How can we rid ourselves of this terrible company?”

• “I have had appointments cancelled without being told, turned away with a baby who was constipated, and told that my complaint can't be dealt with because the practice manager was living too far away! Shocking!”

• “My mother was under Lakeside healthcare; they failed to find her cancer sooner even though she had all the symptoms… She can’t sign this petition for herself as she passed in May 2021 - 10 months after diagnosis. She spent literally hours on the phone in a morning only to be told there were no appointments and to try again the next day. In the last year of her life she managed to see a doctor once”.

Finally, we were extremely disappointed to see, tellingly, that there was not a single word of apology in Lakeside’s press statement, following publication of the CQC report, to their patients. Rather, a defence of their position, despite all of the evidence and a completely untrue assertion about telephones being answered in 2-4 minutes. As you can imagine, this did not go down well with patients, all of whom know it to be a fallacy.

Changing this unacceptable situation is within your gift. Please use the power you have to give residents of Stamford and its surrounding villages the healthcare they deserve, expect and pay for. Four new proposed developments mean the population is due to swell by around 8,000 over the next decade, so our cause is urgent.

Yours sincerely Encl: Online petition list - link Paper petition - PDF cc: Gareth Davies, MP Alicia Kearns, MP Tom Pusglove, MP Shailesh Vara, MP Cllr. Susan Woolley Cllr. Carl Macey Sarah Fletcher Caroline Tyrrell-Jones Cllr. Kelham Cooke Cllr. Richard Cleaver (Lincs Healthwatch) (Cambs Healthwatch) Name City State Postal Code Signed On Richard Cleaver Stamford England 09/06/2021 Andrew Nebel Stamford PE9 11/06/2021 Geoff Freestone Stamford PE9 11/06/2021 Barbara Cornish stamford England pe92fb 11/06/2021 Rick Wilson Essendine PE9 4EH 11/06/2021 James Parker Stamford PE9 2HN 11/06/2021 Mel Turner stamford pe9 2gx 11/06/2021 Suzie Harvey Stamford PE9 1SR 11/06/2021 Melanie Loder Nottingham NG7 11/06/2021 Shalini Austin Stamford PE9 11/06/2021 Alex Baker Stamford PE9 11/06/2021 Jill Szymanski Stamford England PE9 1DP 11/06/2021 LJ Poll Spalding PE11 11/06/2021 Linda Giddings Uppingham LE15 11/06/2021 Fiona Stimpson Ryhall PE9 4ER 11/06/2021 sophie apter Aylesbury HP19 11/06/2021 Paul Overton Camberley GU15 11/06/2021 Hollie Danyluk Birmingham B11 11/06/2021 James Dalton Stamford England PE91DJ 11/06/2021 Janet Smith Stamford PE9 11/06/2021 Yvette Díaz-Muñoz Nottingham NG9 11/06/2021 Stephen Cardwell Knutsford wa16 8le 11/06/2021 Amo Gill Peterborough PE6 11/06/2021 Duncan Lingard Stamford PE9 1QU 11/06/2021 Jenna Holliday Stamford PE9 11/06/2021 Marilyn Bell Stamford PE9 11/06/2021 Hannah Kinkade Stamford PE9 11/06/2021 Anne Farrer Stamford Pe9 11/06/2021 John Cilia Woodhall Spa LN10 11/06/2021 Christopher Barkes Peterborough PE9 11/06/2021 graham wale Stamford PE9 11/06/2021 Hazel Watson Clitheroe bb72qd 11/06/2021 sarah rutledge enniskillen BT74, 11/06/2021 Faizan Nadeem Peterborough PE1 5lj 11/06/2021 Helen Lovelace Stamford PE9 11/06/2021 Evie Price Stamford pe91au 11/06/2021 marie pilkington Stamford pe9 1sj 11/06/2021 Sandra Allison London EC4N 11/06/2021 Nicola Younger Stamford PE9 11/06/2021 Vheryl Hinton Stamford England PE91SD 11/06/2021 Oleen Dias stamford pe91ut 11/06/2021 Charlene Mason Stamford PE9 11/06/2021 Amy Neve Stamford PE9 11/06/2021 Phoebe Holliday Stamford PE9 11/06/2021 rebecca palmer Stamford PE9 4JL 11/06/2021 Heather Cooke Stamford PE9 11/06/2021 Richard Murmann Stamford PE9 2EG 11/06/2021 Juliamycka Mycka Stamford Pe9 2nu 11/06/2021 Michelle Crisp Peterborough PE9 11/06/2021 Emma McHugh Loughborough England LE12 11/06/2021 Gerald Heathershaw Stamford England PE91DS 11/06/2021 Rebecca Linnell Stamford England Pe94er 11/06/2021 Neville Short Stamford England PE9 2HN 11/06/2021 Karen Meadows Stamford PE9 11/06/2021 Ruth Few Stamford PE9 11/06/2021 Kim Downs Stamford PE9 2TG 11/06/2021 Helen Mulcahy Stamford England Pe91fh 11/06/2021 Kay Roberts 11/06/2021 Gabriela Kvasnovska Stamford PE9 11/06/2021 Jesse Beaumont Coventry CV1 11/06/2021 Kevin n Rippin Stamford England PE9 2UN 11/06/2021 Andrew Harwood Spalding PE11 11/06/2021 Paula Fountain Stamford PE9 11/06/2021 Colin Osborn Stamford PE9 11/06/2021 Dianne Rose Stamford PE9 11/06/2021 j c London sw12 11/06/2021 Brian Wisdom Stamford PE9 11/06/2021 Lauren Williams King's Lynn PE30 11/06/2021 Amanda Wheeler Stamford PE9 2DJ 11/06/2021 Margaret Emerson Stamford PE9 11/06/2021 Karon Stretton Stamford PE9 1SG 11/06/2021 Kieran Wade Stamford PE9 11/06/2021 Kirstie Clifford Lechlade GL7 11/06/2021 Glynis Chalkley Lincs Pe9 2yr 11/06/2021 Katy Longworth Stamford PE9 11/06/2021 Jeremy Ball Stamford PE9 1FJ 11/06/2021 Jonathan Cook Oakham England LE15 11/06/2021 Antonia Dowell Stamford PE9 11/06/2021 Jill Bemrose Stamford PE9 11/06/2021 Alan Richardson Leicester England LE18 11/06/2021 Colin Murray Stamford PE9 11/06/2021 Zoe Belford Lincoln LN2 11/06/2021 Marion Cutforth Market Deeping PE6 11/06/2021 LIZ GODBER Llanelli SA14 11/06/2021 Richard White Stamford PE9 11/06/2021 Helen Peebles Stamford PE9 11/06/2021 Ros Nicol Stamford PE9 11/06/2021 Robert alan Wallace Stamford PE9 11/06/2021 Donna Dunseath Stamford England PE9 2RN 11/06/2021 Anja Davies Stamford PE9 1HS 11/06/2021 Marie Cooper Peterborough PE6 11/06/2021 Julia Peyser Stamford PE9 1du 11/06/2021 Bettina Hewitt Stamford Lincs 11/06/2021 Alison Ford Stamford PE9 11/06/2021 Mark Martin Stamford PE9 11/06/2021 Ruth Jamieson Peterborough PE2 11/06/2021 Shelley Simone Stamford PE9 11/06/2021 Cherie Diovisalvi Stamford PE9 11/06/2021 Shaun Woods Easton on the hill England Pe93ly 11/06/2021 peter helm Stamford England pe9 2jg 11/06/2021 Denise Norman King's Lynn PE30 11/06/2021 Daniel Hobbs Stamford PE9 11/06/2021 Karen Gregory Stamford PE9 11/06/2021 Andrianna Curtis Stamford PE9 11/06/2021 Jennifer Marples Stamford PE9 11/06/2021 Paul Cracknell Stamford PE9 11/06/2021 Sarah-Jayne Dodman Stamford PE9 11/06/2021 Agnes Butler Stamford England PE9 1uh 11/06/2021 Victor Woodward Stamford England PE9 2SQ 11/06/2021 TERRY BUXTON Stamford England PE9 1LJ 11/06/2021 Duncan Brown Stamford England PE92XA 11/06/2021 Rowena Freeman Stamford PE9 11/06/2021 Chris Fellingham Stamford PE9 11/06/2021 ✰ maz ✰ Poplar E14 11/06/2021 Peter Finn Stockport SK3 11/06/2021 Emma Holyoake Leicester LE4 9NA 11/06/2021 Julie Parker Peterborough PE7 11/06/2021 Robert Cleveland Stamford PE9 11/06/2021 One-Up Gaming 11/06/2021 Laura Dodwell Stamford PE9 11/06/2021 Bartosz Dembowski Leeds LS9 8PD 11/06/2021 Janice Hobbs Stamford PE9 11/06/2021 David Cadogan Stamford England PE9 1SJ 11/06/2021 jonty meyer Stamford PE9 11/06/2021 Leanne Weathers LUTON MK42 9bx 11/06/2021 Suzanne Cerfontyne Minworth B76 1YD 11/06/2021 Sophia Bragan Stamford Pe9 11/06/2021 Brianna Johnson Lewisham N9 8RU 11/06/2021 Michael Hallam Market Deeping PE6 11/06/2021 Dawn Stride-Burrows 11/06/2021 Georgi Nikolov 11/06/2021 Joshua Curphey Peterborough PE7 11/06/2021 Doug Marshall Stamford PE92JB 11/06/2021 Dilshad Chang Stockport SK6 11/06/2021 Anne-Marie Hamill Stamford PE9 2UX 11/06/2021 Catherine Harris Stamford PE9 11/06/2021 Julian Lambert Peterborough PE6 11/06/2021 Nicola Grimer Sleaford England NG34 11/06/2021 patricia brudenell Biggleswade sg18 8ll 11/06/2021 Jane Phillips Stamford England PE9 1SP 11/06/2021 Mick Chiverton Stamford Pe91qs 11/06/2021 Louise Downs Scunthorpe DN16 11/06/2021 Leo Marsh Stamford PE9 1QE 11/06/2021 Marie Dalton Stamford PE9 11/06/2021 Sue Prior Peterborough PE6 11/06/2021 Steve Hutchins Stamford Pe9 11/06/2021 Emma Dimbleby King's Lynn PE9 3PX 11/06/2021 Stephen Lilley Peterborough PE2 11/06/2021 Alun Thomas Stamford PE9 11/06/2021 Sheila Kelly Stamford PE9 11/06/2021 Catherine Wriggt Stamford Pe94bu 11/06/2021 Steven Sander Manchester M40 11/06/2021 Adam Kaye Stamford Pe92db 11/06/2021 Ilona Brzozowska Stamford Pe9 1LQ 11/06/2021 Bob Moss Stamford PE9 11/06/2021 Sara jane Baker Stamford PE9 11/06/2021 Robert Cornforth Stamford PE9 1UU 11/06/2021 Niki Barry Newark England NG24 1FR 11/06/2021 fiona neal Stamford pe9 1sa 11/06/2021 Pete Taylor Croydon CRO 2EF 11/06/2021 Shaun Oliver Stamford England PE9 1AQ 11/06/2021 David Barkhouse Stamford England PE9 2EB 11/06/2021 Tim Walmsley Stamford PE9 11/06/2021 Rachel Forsyth Peterborough PE7 11/06/2021 Richard Palmer Stamford PE9 11/06/2021 Eva Wisenbeck Norwich NR3 11/06/2021 Lindsay Hudson 11/06/2021 Lynne Loder Oakham England LE15 11/06/2021 Peter lambert Stamford PE9 11/06/2021 Muhammed Kayani Solihull B90 11/06/2021 Nicola Thorne Stamford PE9 11/06/2021 Julian Cooper Wittering PE8 11/06/2021 Melody Hudson Wisbech PE13 11/06/2021 Nicholas Lazarus London W2 3PE 11/06/2021 Anthony Clynes Stamford PE9 11/06/2021 Nalini Appadoo Leicester LE5 11/06/2021 Kerris Hartley-Brown Bristol BS15 1bt 11/06/2021 Carol Popple Stamford Lincs PE92PR 11/06/2021 Marius Cox Lynden L0r 1t0 11/06/2021 Catherine Harries Stamford PE9 11/06/2021 Sharon Long Stamford PE9 11/06/2021 Stephen Demagalski Stamford PE9 4SN 11/06/2021 Lorna Bohea Stamford PE9 1JB 11/06/2021 Anthony Baker London E1 11/06/2021 Emma Woodcock Leicester LE18 11/06/2021 Linda Wadley Pershore WR10 1AT 11/06/2021 Lindsay Ford Peterborough PE6 11/06/2021 Phil holliday Stamford England pe91ag 11/06/2021 Paul Plant Stamford England PE9 2PB 11/06/2021 Christine Leigh Stamford England PE91EA 11/06/2021 Lynne Kemp Stamford Pe92zf 11/06/2021 Tracey Regis Stamford PE9 11/06/2021 Ann-Veronica Cole Stamford PE9 11/06/2021 Olivia Dutton London HA6 2NL 11/06/2021 Naomi Ticehurst Stamford England PE9 1SJ 11/06/2021 Neil Watson Newbury RG12 11/06/2021 Roger Gibbons London EC2V 11/06/2021 Alex Yu Glasgow G775UE 11/06/2021 Sally Freestone Stamford PE9 11/06/2021 alison groves stamford pe9 2wx 11/06/2021 Jean Cunnington Stamford PE9 11/06/2021 William Bales Stamford PE9 11/06/2021 Natalie Giddings Stamford PE9 11/06/2021 Janet Rhys-Davies Helpston PE6 11/06/2021 Paul Bull Scunthorpe DN16 11/06/2021 Valerie Hopkins Peterborough PE3 11/06/2021 Charlene Giddings Stamford PE9 11/06/2021 virginia bray Stamfo 11/06/2021 John Spooner Stamford PE9 11/06/2021 Zoey Brunton Stamford PE9 11/06/2021 Nick Saunders Bedford England Mk43 11/06/2021 Graham Clark Stamford Pe91sx 11/06/2021 Jennifer Turner Stamford PE9 11/06/2021 philip Atkin stamford pe9 1hu 11/06/2021 Irene Hooper Stamford PE9 11/06/2021 Edward Skellett Ketton Pe93sq 11/06/2021 Jill Norfolk Stamford PE9 11/06/2021 Simon Rudd Norwich NR3 11/06/2021 Baron Sharpe Stamford England PE9 4hr 11/06/2021 Sarah Pattinson Stamford PE9 11/06/2021 Paul Coxon Stamford PE92JB 11/06/2021 Keith Hooper Stamford PE9 11/06/2021 Ben Southwood Stamford PE92ND 11/06/2021 Kerri Graham Lincoln LN5 11/06/2021 Michael Gamblin Ketton PE9 11/06/2021 Sarah Francis Easton, Grantham England NG33 5AP 11/06/2021 Margaret Thompson Stamford PE9 11/06/2021 Margaret Durrant Peterborough England PE9 1HZ 11/06/2021 Jill Unsworth Stamford PE9 11/06/2021 Abbie Houghton Spalding England PE11 11/06/2021 Linda Cross Stamford PE9 11/06/2021 Laura Parham Stamford PE9 11/06/2021 Rachel Parry arch stamford PE91qs 11/06/2021 Mandy Fox Stamford PE9 11/06/2021 Holly France Stamford PE9 1hf 11/06/2021 Kevin Thurlby Stamford England PE9 1UF 11/06/2021 Kyrina Dyer Islington N7 11/06/2021 Richard Halliday-Pegg Ascot RG42 11/06/2021 Brett Middleton Stamford Pe9 11/06/2021 Jackie Stevenson Bourne PE10 11/06/2021 Bev Lewis Stamford PE9 11/06/2021 Valerie Harlow Hampstead NW6 11/06/2021 Wendy Marx Warrington WA3 11/06/2021 Stevie Borowik Lincoln LN5 11/06/2021 Emma Creasey Stamford PE9 11/06/2021 Julia Gray Stamford PE9 11/06/2021 Samia Ferozedean Streatham SW16 11/06/2021 martin adeshokan Croydon CR0 11/06/2021 Rosemary Stimpson Stamford England PE9 1BZ 11/06/2021 Maddison Cartwright Cumbria Ca110HN 11/06/2021 Deborah Campbell Terrington Saint ClementEngland PE34 4JX 11/06/2021 Helena Cutforth Stamford England PE9 3PA 11/06/2021 k radford grantham ng319ds 11/06/2021 Jeanette Gibson Peterborough PE1 11/06/2021 Donna Brown Stamford PE92TG 11/06/2021 Madeline Davies Ryhall PE94EU 11/06/2021 Andrew Butt Market Deeping PE6 11/06/2021 Anna Breen Stamford Pe93rh 11/06/2021 Stephen Brunton Wisbech PE13 2QA 11/06/2021 David Terry Leicester LE3 11/06/2021 kevin little london ls129pe 11/06/2021 Mary Bremner Peterborough PE6 11/06/2021 Mikala Theodore Stamford PE9 11/06/2021 Catherine Barlow Stamford PE9 11/06/2021 Pete Richardson Stamford PE9 11/06/2021 Barry Penman Stamford Pe9 11/06/2021 Tracey Jones Spalding PE11 11/06/2021 Lydia Morgan Sedbergh England LA10 11/06/2021 Julia Cunnington Wittering PE8 11/06/2021 Catherine Thompson Stamford PE9 11/06/2021 Lorraine Helm Stamford England PE9 2JG 11/06/2021 Sharon Moore Stamford PE9 11/06/2021 Tina Richardson Stamford PE9 11/06/2021 Serena James Stamford PE9 11/06/2021 Dominic Lambert STAMFORD ENGLANDEngland PE9 2SU 11/06/2021 Anna Gilbert Wittering PE8 11/06/2021 Jenny Hall Stamford PE9 11/06/2021 Barry Devereux Stamford PE91QE 11/06/2021 Lisa Wyllie Stamford PE9 11/06/2021 Gemma Heathershaw Peterborough PE6 11/06/2021 Melvyn Palmer Stamford PE9 11/06/2021 Jane Williams Stamford PE9 2WN 11/06/2021 Melanie Sharpe Stamford PE9 2YT 11/06/2021 Michelle Feasey Greatford Pe9 4qf 11/06/2021 Michelle Sawdon-Brown Lincs PE9 11/06/2021 John Swanston Stamford PE9 11/06/2021 Paul Wild Ketton Pe9 3Rs 11/06/2021 Margery Nicholls Stamford PE91QZ 11/06/2021 Dawn Barrett Peterborough PE1 11/06/2021 Elisa Fullick Stamford Pe91fh 11/06/2021 Peter Gilman Stamford PE9 11/06/2021 Pete Robinson Stamford England PE9 1SN 11/06/2021 Bridget Coxon Stamford PE92JB 11/06/2021 Maggie Edwards Bourne England PE10 11/06/2021 Craig Huntbatch Ryhall PE94EY 11/06/2021 martin yallop Stamford PE9 2NX 11/06/2021 Duncan Ford Witney OX29 11/06/2021 Wendy Phillips Stamford PE9 2SQ 11/06/2021 pat juggins stamford pe9 1el 11/06/2021 chris dixon Market Deeping pe68au 11/06/2021 Cheryl Allibone Scunthorpe DN16 11/06/2021 cheryl williams Stamford pe91hd 11/06/2021 Duncan Warwick Peterborough England PE8 6EQ 11/06/2021 Jacob Smith Grandborough England CV23 11/06/2021 Sharon Diamond Stamford PE9 11/06/2021 Claire Johnson Spalding PE12 11/06/2021 Sam Cooper Stamford PE9 11/06/2021 Adrian Heathershaw Stamford PE9 11/06/2021 Charlotte Smith Stamford Pe9 11/06/2021 Charlotte Bristow Stamford PE9 11/06/2021 Dave Austin Stamford England pe91hj 11/06/2021 Allison Alexander Barnack England PE9 3EQ 11/06/2021 Gareth Bell Stamford PE9 11/06/2021 Nicky Gibson 11/06/2021 Stephen Coburn Stamford PE9 11/06/2021 Catherine Talbot Stamford PE9 1BH 11/06/2021 Sharon Stancer Stamford PE9 1FG 11/06/2021 Carolyn Tyers Peterborough PE4 11/06/2021 Margaret Engel Stamford PE9 11/06/2021 Tracy Wallace Wisbech PE13 11/06/2021 Erin Rome Market Deeping PE6 11/06/2021 Craig Hawksworth Stamford PE9 1bh 11/06/2021 Gillian Bell Stamford Pe9 11/06/2021 Graham Town London EC2V 11/06/2021 Julie Harwin Wisbech England PE13 11/06/2021 Tom Lambert Stamford PE9 11/06/2021 Brian Newbon Stamford PE9 11/06/2021 Alex Engel Stamford England Pe9 4ar 11/06/2021 David Longstaff Sandiacre England NG105da 11/06/2021 michael hardy Stamford PE9 11/06/2021 Nicki Townsend London W9 11/06/2021 sylvia batho 11/06/2021 Louise Rawlings Camden Town NW1 11/06/2021 Jan Bee Amersham HP6 11/06/2021 Inderjit khaira Birmingham B31 11/06/2021 Tracey King Nottingham NG8 11/06/2021 Katie McGuire Glasgow G44 11/06/2021 Martina Harvey London N17 6TQ 11/06/2021 Joanne Sinclair Stevenage sg1 5el 11/06/2021 Kate Gorman Uffington PE9 4SW 12/06/2021 Rachel Thorne Stamford PE9 2XY 12/06/2021 Anna Williams Perth 6065 12/06/2021 Lisa McCormick Stamford PE9 12/06/2021 Susan Maleszka 2767 12/06/2021 Sarah Tipler Lincolnshire PE9 12/06/2021 Jess Calver Peterborough PE4 12/06/2021 Peter Burke Leicester LE1 12/06/2021 Tamsin Sheldrake Stamford PE9 12/06/2021 Deborah Rollings Stamford PE9 12/06/2021 Amanda Mcculloch Stamford PE9 12/06/2021 Sarah Vallack Stamford Pe9 12/06/2021 Eddy Montgomery Stamford PE9 12/06/2021 Martin Webster Manchester England M20 12/06/2021 Tracey Fitzpatrick Market Deeping PE6 12/06/2021 Victoria Abbott Manchester M20 12/06/2021 Susan Heatherington Woodhall Spa England LN10 12/06/2021 Sarah Jane Nichols Stamford PE9 12/06/2021 Brett Caines Stamford PE9 12/06/2021 Jimmy Mcavoy London da14 6pu 12/06/2021 Sarah Roads Stamford PE9 12/06/2021 Anita Sephton Wigan WN1 12/06/2021 Shabana mushtaq Romford Rm70na 12/06/2021 Lynda Griffin Stamford PE9 12/06/2021 Keith Bellamy Alcester B50 12/06/2021 Lily Skinner Cranbrook 0 12/06/2021 Lynda Lowe Stamford PE9 12/06/2021 Vikki Gregory Huntingdon PE26 12/06/2021 Sheila Jackson King’s Cliffe, PeterboroughEngland PE8 6XH 12/06/2021 Isabel Robson Carlby PE9 4Nq 12/06/2021 Tony Johnson-Veale Peterborough PE2 12/06/2021 Cecil Woodruff Mayfair W1K 12/06/2021 Paul Van-herring Stamford PE9 12/06/2021 Imogen Beech King's Lynn England PE30 12/06/2021 Barbara Narey Stamford PE9 12/06/2021 Caroline Croxton Stamford PE9 12/06/2021 Sonia Sunner Spalding England PE11 12/06/2021 Wendy Curtis Stamford PE9 12/06/2021 Elizabeth Laundon Chelmsford CM29LG 12/06/2021 Sophie Wilson Stamford PE9 12/06/2021 Simon Tee Peterborough Pe86ej 12/06/2021 Carol Phillips Stamford PE9 12/06/2021 Christopher Johnston Northampton NN3 12/06/2021 Jayne Bagshaw Market Deeping PE6 12/06/2021 Jane Knight Stamford PE9 12/06/2021 John Courtney 12/06/2021 Anne Thompson Stamford PE9 12/06/2021 Tonya Orvis Peterborough PE10 12/06/2021 Franciszek Oleksow Stamford PE9 12/06/2021 Val Harvey Stamford PE9 2ZD 12/06/2021 Jess Scott Peterborough PE6 12/06/2021 Janet Tindall Stamford PE9 12/06/2021 Dean Hall London SW8 12/06/2021 Nicky Wilkinson Rutland PE9 12/06/2021 Hannah Palmer Stamford PE9 12/06/2021 Peter Devlin London EC4N 12/06/2021 Brendan Hayes Melbourne 3001 12/06/2021 Anna O'Connor Stamford PE9 3RH 12/06/2021 Bernard Simcock Stamford PE9 12/06/2021 Paul Johnson Leeds England LS20 12/06/2021 ALISON SQUIRES Bourne PE10 12/06/2021 Paul Reeson Pontefract WF9 12/06/2021 Stephen Baker Stamford PE9 1JN 12/06/2021 Sarah Crudge Stamford PE9 12/06/2021 Mark Sharman Bath Ba2 2aD 12/06/2021 Michael Steinberg Golders Green England NW11 12/06/2021 June Headley Leicester LE2 12/06/2021 Sally Park Stamford PE9 1DT 12/06/2021 Roger Jardine Liverpool England WA11 12/06/2021 Jayne T Jones Stamford PE9 1SD 12/06/2021 Elisabeth Slater Stoke-on-trent ST3 12/06/2021 Chris Edwards Lincoln LN1 12/06/2021 Kay Taylor Stamford PE9 12/06/2021 Ian Hall Stamford PE9 12/06/2021 Tony Johnson Stamford Pe91su 12/06/2021 Rebecca Brackpool Peterborough PE86EN 12/06/2021 Paul Gordon Stamford England PE9 1PJ 12/06/2021 Rita Downs Stamford PE9 12/06/2021 Daniel Ledger Stamford England PE9 1BE 12/06/2021 Joan Carter Stamford PE9 12/06/2021 Bridget Green Grantham NG31 12/06/2021 Sam Hayden Stamford PE9 3PA 12/06/2021 Matt Stanley Stamford England pe9 2yt 12/06/2021 Patricia Nebel Stamford PE9 12/06/2021 Rachel Woodman Stamford PE9 12/06/2021 Martin Holmes Stamford PE9 12/06/2021 Austin Carter Easton on the Hill England PE93LS 12/06/2021 Stephen Gates Stamford England PE9 2HN 12/06/2021 S Taylor Stamford PE9 12/06/2021 Malcolm Griggs Stamford PE9 2UL 12/06/2021 Sarah Baxter Stamford PE9 12/06/2021 Sarah Lofthouse Stamford PE9 12/06/2021 Karis Steinborn-Busse Oakham England LE15 12/06/2021 Gianni Cafano Stamford PE9 12/06/2021 Glenys Eastman Stamford PE9 12/06/2021 David Watson Stockport SK3 12/06/2021 Andy Orvis Bourne England PE10 0BU 12/06/2021 Sylvia Wood Ilford IG3 9ET 12/06/2021 Chloe Hawkins Manchester SK4 12/06/2021 Chloe Harley Stamford PE9 12/06/2021 Anne Wragg Loughton IG10 3BG 12/06/2021 Carly Long Romford RM3 0FR 12/06/2021 Kerry Glynn Wigan WN2 12/06/2021 David Braithwaite Burton-on-trent DE13 9JU 12/06/2021 Zara-lee Ocak 12/06/2021 Stan Watson Stamford PE9 12/06/2021 Karen Forrest Great Casterton PE9 12/06/2021 Ruth Dickens Hungerford England RG17 12/06/2021 Caroline Hawksworth Salisbury England SP2 8EH 12/06/2021 michelle Harker Barkisland hx4 0hd 12/06/2021 Nicholas Clarke Bourne England PE10 12/06/2021 Trevor Vernon Mansfield NG19 12/06/2021 colin smith Wallasey CH45 12/06/2021 Kelly Manifold Congleton CW123EP 12/06/2021 Stephen Suckling Edinburgh eh8 7dt 12/06/2021 Stephen Brennan Brentwood Cm150tn 12/06/2021 Ian Lucas Whitehaven England CA28 12/06/2021 Fiona P Finchley N2 12/06/2021 Cheryl Tulloch London Sw6 5ab 12/06/2021 Shane Robinson Derby De22 2jq 12/06/2021 Garry Hallam Leicester LE3 12/06/2021 Matthew Stainsby Stamford PE9 12/06/2021 Vaughan Melzer London N89NX 12/06/2021 Michael Grover London SW4 6LT 12/06/2021 Jill campbell Glasgow G42 12/06/2021 Joe Blocksidge Telford Tf4 12/06/2021 James McIver Stamford PE9 12/06/2021 Joseph Gawley Easton On The Hill PE9 12/06/2021 sheila gowans Stamford PE9 12/06/2021 Evan Davies Bourne England Pe109ly 12/06/2021 Miss kathryne Miller Peterborough PE9 12/06/2021 Sharon Dobbs Easton on the Hill PE9 3NU 12/06/2021 Anne-Marie Evans Wittering PE8 12/06/2021 Ian Jeffries Stamford PE9 12/06/2021 Daivd Rose Stamford PE92LW 12/06/2021 Fiona angel Grantham ng31 8 eg 12/06/2021 Kenneth Cole Leicester LE3 12/06/2021 Debbie Gibbons Stamford PE9 12/06/2021 Darren Russon King's Lynn England PE30 12/06/2021 Stuart Britten Grantham NG33 5RR 12/06/2021 BARRIE CHURCH Stamford pe9 4u3 12/06/2021 Chantelle Tyers Bristol BS1 12/06/2021 Jessie Edwards Stamford PE9 12/06/2021 Nick Wright Lincoln 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Miranda Drage Stamford CR0 12/06/2021 Colin Edwards Stamford Pe9 1ff 12/06/2021 Steven Mocklow Stamford PE9 12/06/2021 Robert Meadows Peterborough PE8 6YJ 12/06/2021 richard epton Rainworth ng21 0fp 12/06/2021 josephine fountain Stamford England pe91bh 12/06/2021 Gareth Dyer Oakham England LE15 12/06/2021 Anna Bentley King's Lynn PE34 12/06/2021 Adam Baxter Stamford 12/06/2021 Viv Middlebrook Wittering PE8 12/06/2021 Gurjit Sunner Stamford PE9 12/06/2021 Nathan Rigby Wisbech England PE13 12/06/2021 Paula Cooper Stamford PE9 12/06/2021 Chris Greaves Stamford PE9 3SE 12/06/2021 Liz Morgan Stamford PE9 12/06/2021 Kate Cadby Brown Candover SO24 12/06/2021 Ellen Edmans Spalding PE11 12/06/2021 Scott Whiteside King's Lynn PE9 12/06/2021 Ranvir Sunner Stamford England PE91bn 12/06/2021 Eileen Martin 12/06/2021 Craig Elliott Stamford PE9 12/06/2021 Caroline La Niece Bury BL8 12/06/2021 Angela Grainger Stamford England PE9 4EL 12/06/2021 Andrew Sims Bourne England Pe109bj 12/06/2021 Zoey Wurfel 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12/06/2021 Adele Stainsby Abbess Roding CM5 12/06/2021 Nicola Wileman Stamford PE9 12/06/2021 Joanne Price Stamford England Pe91bp 12/06/2021 Jonathan Burley Stamford PE9 12/06/2021 Gayle Hunter Peterborough PE7 12/06/2021 Richard Spall Stamford England Pe94bx 12/06/2021 Coleen Thomas London N18 1XF 12/06/2021 Tarquin Taylor Nottingham DE7 12/06/2021 Natalie Hampson Stamford PE9 12/06/2021 Ann Johnstone Doncaster DN7 12/06/2021 Joe Andrews Spalding England PE9 2EA 12/06/2021 Anne Hewitt Stamford England PE91ER 12/06/2021 Clare Burnell Stamford PE9 2ta 12/06/2021 Mary Hanna Wittering PE8 12/06/2021 Paul Muskett . . 12/06/2021 Robert Harvey Bourne England PE10 9RZ 12/06/2021 Tim O'Keefe Peterborough PE2 12/06/2021 Victoria Wilson Newcastle Upon Tyne NE4 12/06/2021 Janet Bennett Liverpool L8 9RY 12/06/2021 Melanie Sockett Stamford PE9 2EE 12/06/2021 rosie ward Stamford PE9 12/06/2021 Charles Louth Stamford PE9 12/06/2021 michael baumber Barnack PE9 12/06/2021 May Xu Stamford PE9 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6TR 13/06/2021 Jasmine Smith Stamford PE9 13/06/2021 Jennifer Green Peterborough PE6 13/06/2021 Robyn Russell Stamford PE9 13/06/2021 Sophie Bonami Westgate on Sea CT8 8DE 13/06/2021 Linda Bryan Stamford PE9 13/06/2021 Jennie Widdop Stamford PE9 13/06/2021 Graham Bryan Stamford PE9 13/06/2021 Sean Aspill Peterborough PE6 13/06/2021 Fiona West Stamford England PE30 13/06/2021 Alan Byrne Stamford PE9 13/06/2021 Katie Webb Stamford PE9 13/06/2021 Averil Campbell Stamford PE9 2FJ 13/06/2021 Tamsin Davis Stamford PE9 13/06/2021 Terry Baker Keswick England CA12 13/06/2021 Philip Worrall Stamford PE9 13/06/2021 Sharon Carr Abingdon OX13 13/06/2021 Martyn Neve Stamford PE9 13/06/2021 Vanessa Kimberley Stamford England PE9 4SN 13/06/2021 VINCENT O’Shea Stamford PE9 13/06/2021 Laura Upson Stamford PE9 13/06/2021 Adriana Davies Ketton PE9 3RH 13/06/2021 Keziah Chance Stamford PE9 13/06/2021 Sarah Woolf Stamford PE9 13/06/2021 Joan Wade Stamford PE9 13/06/2021 Iris Nolan Stamford Pe9 13/06/2021 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PE9 2XB 13/06/2021 V H 13/06/2021 Peter Stean Stamford PE9 13/06/2021 Dixon Adams Stamford PE9 4SX 13/06/2021 Karen Booth Stamford PE9 13/06/2021 Ruchard Taylor Cardiff CF5 3QP 13/06/2021 Julie Aylmer Stamford England PE9 1XB 13/06/2021 Ann Hunter Stamford England PE9 1JW 13/06/2021 Rob Holmes Stamford PE9 13/06/2021 Nicki Parr Stamford PE9 2TB 13/06/2021 Paul Barker Crewe CW2 13/06/2021 Susie Lewis Peterborough PE6 13/06/2021 Megan Garwood Stamford Pe9 13/06/2021 Neil Hoy Gloucester GL2 13/06/2021 Craig Harrison Morpeth NE61 2YR 13/06/2021 Debra Asher Stamford PE9 13/06/2021 Ian Page Stamford Pe9 13/06/2021 Helen Quinn Quinn Paisley PA2 13/06/2021 Lynda Purnell Warwickshire England CV10 0FS 13/06/2021 Jacqueline Cockerill Ketton England PE9 3RJ 13/06/2021 Alexander Richard Rylance Stamford PE9 13/06/2021 Jem Allaway Cullompton EX15 13/06/2021 Simon Copley Central District 13/06/2021 Jane Wilson Casewick PE9 4RX 13/06/2021 Tim Parr Stamford PE9 13/06/2021 Jean Boxall Cardiff Cf34ed 13/06/2021 Margaaret Campbell Near Stamford PE9 3BB 13/06/2021 Malcolm Bishop Stamford PE9 13/06/2021 Kenneth Court Stamford PE9 13/06/2021 PATRICIA BULL Stamford PE9 13/06/2021 John Burcham Parson Drove PE13 13/06/2021 Kerri Edwards Stamford PE91GB 13/06/2021 Hannah Shone Peterborough PE9 1HJ 13/06/2021 Frank Kelly Newport np20 3bn 13/06/2021 Denise Chen Stamford PE9 13/06/2021 Ross Cameron Stamford PE9 13/06/2021 Ben Rudman Alfreton England DE55 13/06/2021 Janice Nye Penwortham PR1 9PJ 13/06/2021 Eileen Vincent Leicester LE2 13/06/2021 Surinder Gill Scunthorpe DN15 7DB 13/06/2021 Clare Walker Leicester LE6 13/06/2021 Anne Mcculloch Spalding England PE11 13/06/2021 Mary Gates Peterborough PE6 13/06/2021 Martina Dooley Glasgow G73 13/06/2021 Rachel Andrews-Ingram Peterborough PE6 13/06/2021 Marie Hughes Stamford PE9 13/06/2021 Kira Vale Dunoon PA23 7PD 13/06/2021 Frances Nishihara Stamford PE9 2EN 13/06/2021 James Cannings Stamford PE9 13/06/2021 Jason Lindsay Peterborough PE1 13/06/2021 John Nicholls Stamford PE9 13/06/2021 Ann Hayward Bourne PE10 13/06/2021 Mike Hayward Bourne PE10 13/06/2021 Ann Hughes Bourne PE10 13/06/2021 marc antony Ilford IG1 13/06/2021 Patrick Allen Farnham GU9 13/06/2021 Janet Beardsley Skegness PE25 13/06/2021 nina brittain Stamford PE9 13/06/2021 sue stevens cheltenham England gl50 1ul 13/06/2021 Sharon Gooding South Molton, northEngland devon ex36 4el 13/06/2021 Paula Dunkley Stamford PE9 13/06/2021 Anne Egglestone London EC2V 13/06/2021 Gary Rickett Stamford PE9 13/06/2021 Eva Khedhri Spalding England PE11 13/06/2021 Audrey Sawyer Stamford PE9 13/06/2021 Maureen Carter Stamford PE9 13/06/2021 Kerry Cunnington Stamford PE9 13/06/2021 Tony Mcallister Easton PE93NA 13/06/2021 Martyn Wann Stamford PE9 2WP 13/06/2021 John Myers Harlow CM20 13/06/2021 Peter Vacara Stroud GL5 3SB 13/06/2021 Glynis Berry Barnsley S73 13/06/2021 marion weston Leuchars KY160EF 13/06/2021 Alison Butler Peterborough PE7 13/06/2021 Louise Magrath Stamford PE9 13/06/2021 Martin Gem Wallington SM6 8PY 13/06/2021 David Mackenzie Newcastle upon Tyne NE65HJ 13/06/2021 Peter Ambrose Stamford PE9 13/06/2021 Rosemary Stone Spalding PE11 13/06/2021 Max Brown Bracknell RG12 13/06/2021 Mary Worrick Lincoln LN6 13/06/2021 Tracy Salter London EC4N 13/06/2021 Stuart Morrison Forres Iv36 1dd 13/06/2021 Carol Warters Ketton, Rutland England PE13 13/06/2021 Emma Towers Stamford PE9 13/06/2021 Josephine Keys Edinburgh EH4 1NG 13/06/2021 Shirley Bray Stamford PE9 13/06/2021 Susan Sandall Stamford PE9 2FL 13/06/2021 Lynn Chambers Scunthorpe DN17 13/06/2021 Terence Padmore Stamford PE9 13/06/2021 Lucy Asprey Stamford PE9 3JG 13/06/2021 Marjorie Kavanagh Stamford PE9 13/06/2021 Natalie Chiverton Peterborough PE1 13/06/2021 David Webb Eastleigh SO509BU 13/06/2021 Kevin Whitchelo Stamford PE9 13/06/2021 Shelley Sim Winwick WA2 13/06/2021 Judy Baxter Leicester LE5 13/06/2021 Peggy King Bourne PE10 9TS 13/06/2021 Fiona Tuck Stamford PE9 3RH 13/06/2021 Jenine Carrington Stoke-on-trent ST7 13/06/2021 Joanne Goldsmith Bristol BS1 13/06/2021 Philip Long Stamford England Pe93rz 13/06/2021 Angela Stubley Nottingham NG7 13/06/2021 Ewelina Oleksyk Stamford PE9 1LG 13/06/2021 Allan Thompson Norwich NR13 13/06/2021 Kirby Bothamley Stamford PE9 13/06/2021 Nicholas Lewis Stamford PE9 13/06/2021 Norah Ramsay Stamford PE9 2NJ 13/06/2021 Tosh Nishihara Stamford PE9 13/06/2021 Gemma Suffling Manchester England M40 13/06/2021 Zoey Taylor Luton LU3 13/06/2021 Joanne Saltfleet Cardiff Cf24 1rn 13/06/2021 Becky Gilbey Leicester LE3 13/06/2021 Kelly Haworth Chester-le-street DH2 13/06/2021 diehardsteven diehardsteven Falmouth TR11 13/06/2021 Fiona Thomas Bothwell Scotland G71 13/06/2021 Lorna Mallen Stamford England PE9 2JB 13/06/2021 Iwan Powell Leicester LE3 13/06/2021 Amy Roadhouse Stamford PE9 13/06/2021 Sarah Sharman Stamford England PE9 3 LA 13/06/2021 Peter Shough Northwich CW9 13/06/2021 Christine Blaine Stamford PE9 2YX 13/06/2021 Susan Arthur Stamford PE9 13/06/2021 Sarah Norman Stamford England Pe9 1au 13/06/2021 Christine Aspill Stamford PE9 13/06/2021 John Bowie Chryston Scotland G69 9AT 13/06/2021 Tamsin Sawyer Market Deeping PE6 13/06/2021 Emily Smith Edinburgh EH7 14/06/2021 Rachel Nicholls Stamford PE9 14/06/2021 Sharon Eastman Market Deeping PE6 14/06/2021 Anne Mance Manchester M40 14/06/2021 Frances Swann Stamford PE9 14/06/2021 Kim Hughes Stamford PE9 14/06/2021 Adam Cairn Ashford TN23 14/06/2021 Emily Hanley Cardiff CF14 14/06/2021 sylvia lewis Manchester M40 14/06/2021 Adrian Morrell Oban PA34 14/06/2021 Susan Robertson Smith Northwood HA6 14/06/2021 Alex Rodway Stamford PE9 14/06/2021 CRAIG BENSON STAMFORD England PE9 2DE 14/06/2021 Pollyanna McIntosh 14/06/2021 Sandra Allen Stamford PE9 14/06/2021 Susan Porter King's Lynn England PE30 14/06/2021 E M 14/06/2021 Teresa Jude Careby PE4 14/06/2021 Diane Mills Stamford England PE9 2YL 14/06/2021 Diane Mills Stamford England PE9 2YL 14/06/2021 Michelle Jones Stamford England PE9 2nh 14/06/2021 Wendie Rowett Long Sutton PE12 14/06/2021 Kerry Cutts Scunthorpe England DN16 14/06/2021 Patsy Burke Stamford England PE9 2JF 14/06/2021 Adrian Wilkinson London England W11 14/06/2021 Robert Mciver Glasgow Metropolitan Area G78 1BF 14/06/2021 Tracy Shields Harpurhey m9 14/06/2021 Linda Huckerby Hungerford England RG17 14/06/2021 Sam Stephens Solihull b913ly 14/06/2021 Clare Landon Flookburgh LA11 7JR 14/06/2021 Abi Wright Brentwood CM13 14/06/2021 barry wilcox Salford M6 14/06/2021 Amelia Stead Stamford Pe92td 14/06/2021 Karen Burrows Bourne PE10 0UB 14/06/2021 martin engel Stamford PE9 14/06/2021 Iain Rowett Long Sutton England PE12 14/06/2021 Darren Kennelly Bourne PE10 14/06/2021 John Collier Stamford PE9 14/06/2021 Tracey Barford Stamford Lincolnshire PE9 3LU 14/06/2021 Bryony Hurst Stamford PE9 14/06/2021 Michael Adams Peterborough PE2 14/06/2021 Kim McGuire Austin Texas 78748 14/06/2021 Lisa Holmes Bourne England PE109DB 14/06/2021 Bethany Dams Stamford PE9 14/06/2021 Caroline Quigley Leicester LE2 6HF 14/06/2021 Rachel Butler Stamford PE9 4BU 14/06/2021 Christine Power Stamford PE9 14/06/2021 Bill Anderson Stamford PE9 2EN 14/06/2021 Helen Warner Stamford PE9 2YL 14/06/2021 David Conlon Ketton Rutland PE9 3RN 14/06/2021 Jessica Lambe Stamford PE9 14/06/2021 Tony Power Stamford PE9 14/06/2021 Robert Riley Gloucester GL3 14/06/2021 Jillian Dickson Alfreton England DE55 14/06/2021 Alison Ohr Bingley BD16 1EQ 14/06/2021 Kerry Seery Enfield En3 6TR 14/06/2021 Sibeal Butler Brighton BN2 14/06/2021 Natalie Orme Stamford PE9 14/06/2021 Jessica Cordery Stamford PE9 14/06/2021 June Brean Stamford PE9 14/06/2021 Alison Warrick Stamford PE9 14/06/2021 Stephanie Lewis Brighton CA2 14/06/2021 Eileen Paul Stamford PE9 14/06/2021 Gemma Hodson Stamford England PE9 4BL 14/06/2021 Barry Frake Stamford PE9 14/06/2021 William Orme Stamford PE9 14/06/2021 Emma Stafford Stamford England PE9 2JF 14/06/2021 Sharon Pizzey Stamford PE9 14/06/2021 Karen Reid Stamford PE9 14/06/2021 Cathy Jarvis Stamford PE9 14/06/2021 Louise Clinch Stamford PE9 14/06/2021 Tracy Neal Ryhall PE9 4EL 14/06/2021 Ria Watford London SW6 14/06/2021 Nicola Kent Stamford, PE9 4rx 14/06/2021 Saiyed Hanif Wembley HA0 1tz 15/06/2021 Melanie Denton Grimsby DN32 15/06/2021 Clare Neal Lincoln LN1 15/06/2021 Mrs S L Spurdens Stamford PE9 15/06/2021 Beverley O’Shea Stamford PE9 15/06/2021 Julie Cutts Peterborough PE6 15/06/2021 Dan Lezano Stamford PE9 15/06/2021 Edwin Raymen Stamford England PE9 2NF 15/06/2021 Elizabeth Gonzalez malaga Stamford PE9 15/06/2021 Allyson Percival-Carter Market Deeping PE6 15/06/2021 Christopher Collins Teignmouth TQ14 15/06/2021 John Fox Stamford PE9 2Sq 15/06/2021 Ross Kalwa Cheadle SK8 1EX 15/06/2021 Denise Watkinson London E17 15/06/2021 Eunice Heather Peterborough PE6 15/06/2021 Amy Nebel Stamford PE9 15/06/2021 Gerald Brean Stamford PE9 15/06/2021 Faye Aspill Stretton England LE15 7RL 15/06/2021 Mark Lewis Uffington England PE9 4UD 15/06/2021 John Smith Klaipeda 15/06/2021 Ben Lewis Stamford PE9 15/06/2021 Kevin Burgh Great Yarmouth NR319PU 15/06/2021 Laura Jones Hungerford England RG17 15/06/2021 Gary Heath Nottingham NG5 15/06/2021 Daniel Aycinena Haslemere 15/06/2021 Anni Stephens Birmingham B13 15/06/2021 Kenneth Burke Stamford PE9 15/06/2021 Ellie Whitefield Stamford England PE9 1LB 15/06/2021 Kaye Griffin Stamford PE9 15/06/2021 Richard Hiblin Nicosia Ammóchostos PE1 1GY 15/06/2021 Tina Witt Poole BH12 15/06/2021 Lauren May Glasgow G5 15/06/2021 Anna Almond Wisbech PE14 15/06/2021 Lydia Cahill Wisbech England PE9 3wl 15/06/2021 Amelia Topley Stamford PE9 15/06/2021 Celia Inglis Stamford PE9 1JD 15/06/2021 Cheryl Buttress Wittering PE8 6AJ 15/06/2021 Trevor Gwinnett Stamford PE9 15/06/2021 kerry williams Southport PR8 15/06/2021 Fiona Shepherd Stamford England Pe9 1LG 15/06/2021 Patricia Furnival Fleetwood Fy78qg 15/06/2021 Nuala Forsey Stamford England PE91HA 15/06/2021 David Flynn Manchester England M40 15/06/2021 Robert Campbell Wittering England PE86BZ 15/06/2021 Anne Burroughs Stamford PE9 15/06/2021 Jennifer Lillistone Stamford PE9 15/06/2021 Richard Goode Nuneaton CV 10 7ER 16/06/2021 Franziska Schwahn 72250 16/06/2021 Sarah Butler Oakham England PE9 4HE 16/06/2021 Simon Battey Stamford PE9 16/06/2021 Rebecca Smith Stamford PE9 16/06/2021 Erin Downs Stamford PE9 16/06/2021 Paul CREGOR Stamford Pe9 2SS 16/06/2021 Andrew Cleaver Stamford PE9 1FG 16/06/2021 stella Davies Stamford England PE9 1FH 16/06/2021 Ramona Morrison Stamford PE9 16/06/2021 Joanne Milnes Stamford PE9 16/06/2021 Francesca Allen Stamford PE9 16/06/2021 Sophie Cornish Uffington Pe9 16/06/2021 Carly Pearson Stamford PE9 16/06/2021 Ellie Lewis Milton Keynes MK19 16/06/2021 Andrew Matthews Stamford PE9 16/06/2021 Aaron Cornish Tonbridge, Paddock EnglandWood TN12 6QH 16/06/2021 Jane Vaughan Whitechapel E1 16/06/2021 paul barber stamford England pe91bp 16/06/2021 Louis Sivers Gibraltar 16/06/2021 Janhavi Purswani Bhopal 462101 16/06/2021 Gail Genever Stamford PE9 16/06/2021 Mry Wilkes Tewkesbury GL20 6EG 16/06/2021 Softie Demon Shah Alam 16/06/2021 Stacey Mann Wolverhampton WV3 16/06/2021 子 冰 Ipoh 31450 16/06/2021 Helga Slater Stamford PE9 16/06/2021 Jack Loombe Norwich NR3 16/06/2021 Ruth Dickens Stamford Pe91hb 16/06/2021 Terri-Leigh Kelly Mansfield NG19 16/06/2021 Matthew Tarrant Stamford England PE9 2UY 16/06/2021 Kate Everitt Spalding PE11 16/06/2021 Julie Flint Stamford PE9 16/06/2021 Barry Scott Holmfirth HD9 16/06/2021 Riddhi Agrawal Indore 16/06/2021 Adam Haykal Kuala Lumpur 16/06/2021 Katherine Parker Tinja Donja 16/06/2021 Raymond Williamson Lisburn BT282XL 16/06/2021 Rachael twinley Stamford PE9 16/06/2021 Krish Agrawal Bhopal 462010 16/06/2021 Meriem Belal Oxford OX4 16/06/2021 Rebecca Lee Stamford PE9 2YY 16/06/2021 Marion Smith Lincoln LN5 16/06/2021 Sophie Hyde Newcastle Upon Tyne NE6 16/06/2021 Katie Body Stamford PE9 16/06/2021 Matt Munro Stamford England PE9 3LN 16/06/2021 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4HZ 30/06/2021 d Whitworth Newcastle Upon Tyne NE29 0bw 30/06/2021 Julie Witherow Londonderry BT47 6EN 30/06/2021 aidan merryweathera London SE15 30/06/2021 Luca Dahse Ashtead KT21 1HN 30/06/2021 Tony Baker Swansea SA1 30/06/2021 Patricia Arling Leicester England LE18 30/06/2021 Robert Reader Bath BA2 30/06/2021 Tim Nicol Stamford PE9 30/06/2021 Nialls Guinness Stamford PE9 30/06/2021 Meledy Martin King's Lynn PE30 30/06/2021 Mark Mellor Stamford PE9 30/06/2021 Michael Simpson Easton on the Hill England PE9 3LL 30/06/2021 Victoria Middleton Peterborough PE1 30/06/2021 Jim Ward Wisbech PE13 30/06/2021 James Bryden Stamford England PE9 1JD 30/06/2021 Sallyann Brown Stamford PE91SP 01/07/2021 Graham Templeton Stamford PE9 01/07/2021 Susan Scammell Stamford PE9 01/07/2021 David Taylor Stamford PE9 01/07/2021 Diane Jibb Stamford PE9 01/07/2021 Evie Martin Bristol BS8 01/07/2021 Rachel Stafford Stamford PE9 2YU 01/07/2021 Stella Rawson Stamford PE9 01/07/2021 Lisa Bowkley Stamford PE9 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Hayden Wembley HA0 02/07/2021 Sandra Jones Stamford PE9 2TH 02/07/2021 Camila Ferreira Stamford PE9 02/07/2021 Philip Murphy Oakham LE15 02/07/2021 Barry Bawden Stamford PE9 02/07/2021 Sarah Harrington Stamford PE9 02/07/2021 Heather Campbell Stamford PE9 02/07/2021 Verity Murphy Stamford Pe91ea 02/07/2021 Jon Hare Stamford PE9 2YT 02/07/2021 Moira Moore Stamford PE9 02/07/2021 Colin Peachey Peterborough PE7 02/07/2021 Stephen Lilley Bourne PE9 02/07/2021 Tony Fox Stamford PE9 03/07/2021 Frank Hatfull Stamford PE9 3LL 03/07/2021 nigel woodford Stamford PE9 03/07/2021 Richard Weir Stamford PE9 03/07/2021 Samantha Armstrong Stamford PE9 03/07/2021 Louisa Simpson Stamford England PE9 3LZ 03/07/2021 Sally D Stamford England PE9 4HD 03/07/2021 Penny Orvis Stamford PE94LA 03/07/2021 Nicola Saunders Stamford PE9 03/07/2021 Barbara Drinkall Stamford PE9 03/07/2021 Molly Parkinson Stamford PE9 03/07/2021 Linda Pearson Newbury RG20 03/07/2021 Shona Rickard Stamford Pe9 3du 03/07/2021 David 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Jane Boyd 14/07/2021 Janet Duff Stamford PE9 14/07/2021 Robert Warren Wittering England PE86BH 14/07/2021 Katy Harrison Stamford PE9 14/07/2021 Paul Middlebrook Stamford PE9 14/07/2021 Patrick Hynes Kensington W14 14/07/2021 Joan Richardson Stamford Pe9 14/07/2021 Patricia Colley Stamford Pe9 14/07/2021 Alan Hayes Stamford PE9 14/07/2021 Maggie Doust Bourne England PE10 14/07/2021 Jason White Stamford England PE9 4RG 14/07/2021 Rosemary Fraser Stamford PE9 2LW 14/07/2021 Beverley Wrigley-Pheasant Kingham PE9 4LA 14/07/2021 Stuart Brown Essendine Pe94ur 14/07/2021 Louise Davies Stamford PE9 14/07/2021 Ian Fraser March PE15 14/07/2021 SHIRLEY GREAVES STAMFORD LINCOLNSHIREEngland PE9 1UP 14/07/2021 Simon Cunliffe Stamford PE9 14/07/2021 Cunliffe Janice Stamford PE9 14/07/2021 Anne wilcock Stamford PE9 14/07/2021 Veronica Sutton Stamford PE9 14/07/2021 Sean Barratt Birmingham B1 14/07/2021 Michael Sharpe Stamford PE9 14/07/2021 Linda Bowskill King's Lynn England PE30 14/07/2021 Alan HUDSON 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Peterborough England PE57AZ 14/07/2021 Daphne Summerfield Peterborough PE91UR 14/07/2021 Kate Singer Stamford PE8 14/07/2021 PAUL GALLOWAY Market Deeping PE6 14/07/2021 Michael Challis King's Lynn PE34 14/07/2021 Jennifer Woolway Stamford England PE9 2SD 14/07/2021 Sue Sykes King's Lynn PE30 14/07/2021 Hilary Mcneillie Stamford PE9 14/07/2021 Jean Smith Stamford PE9 2LY 14/07/2021 Y P FAIRBAIRN Stamford PE9 14/07/2021 Mrs A M Durno Leicester LE3 14/07/2021 John Hope Redditch B98 14/07/2021 Jo Dawkins Stamford PE9 14/07/2021 Graham Barks Stamford PE9 2RY 14/07/2021 Tim Skilton Stamford England Pe92NP 15/07/2021 Michael Smith Chorzow 41-500 15/07/2021 Susan Duggan Kent Me1 1uT 15/07/2021 mia churm Carmarthen SA31 15/07/2021 Laura Dyson York YO31 15/07/2021 Alan Blakemore Stamford PE9 15/07/2021 Susan Pearce London EC4N 15/07/2021 David Hibbs Stamford PE9 15/07/2021 Rachel Bartlett-Ward Stamford PE9 1DT 15/07/2021 Paul Dunseath Stamford PE9 15/07/2021 Conan Lewis Carlby England PE9 4NN 15/07/2021 Bryan Hackney Stamford England PE92ET 15/07/2021 Vivienne Burke Stamford PE9 15/07/2021 Alison Foster Plymouth Pl36pj 15/07/2021 Tracey Bridges Woodford Green IG8 15/07/2021 Sebastian Veremundo London EC4N 15/07/2021 Kaye Fisher Cadishead M44 5BU 15/07/2021 Stephanie Hynes Leeds LS10 15/07/2021 Talia Cummins Birmingham B63 15/07/2021 Graham Fletcher Bainton Stamford Pe9 15/07/2021 Ann-Marie Fountain Stamford PE9 15/07/2021 Richard Harris Stamford PE9 15/07/2021 Margaret Hewerdine Stamford PE94NQ 15/07/2021 Jacquie Barry Chelmsford CM1 15/07/2021 Dennis Rayment Locks Heath So316tb 15/07/2021 Jenny Flaxman Harleston IP20 9PY 15/07/2021 Gillian Johns Stamford PE9 15/07/2021 marie-therese widger Brigg DN20 15/07/2021 Rita Pirouet Summerhill LL11 4TT 15/07/2021 Mervyn Thorpe Stamford PE9 15/07/2021 Zoe Garner Stamford England PE91SH 15/07/2021 Jo Smith Stamford England PE9 1SF 15/07/2021 loraine rose Easton on the Hill PE9 3LY 15/07/2021 Christine Warren Wittering PE86BH 15/07/2021 Emma Howlett King's Lynn England PE30 16/07/2021 Ifigenia Quesada Stamford PE9 16/07/2021 Martin Hewitt Stamford PE9 16/07/2021 Robert Winstanley Sandbank Scotland Pa23 8nz 16/07/2021 Lisa Scott March PE15 16/07/2021 Jeanette Dupree Essendine Pe94la 16/07/2021 Monica Walsh Stamford PE9 16/07/2021 Sandra clark Stamford England Pe9 1ef 16/07/2021 Louise Barker Stamford England PE9 4LP 16/07/2021 Bob Emmett Caythorpe Ng32 3eg 17/07/2021 Claire Flint Belmesthorpe PE9 4JQ 17/07/2021 John Hughes Stamford PE9 17/07/2021 Bridget Palmer Easton on the Hill England PE9 3LZ 17/07/2021 Stewart Hird Stamford Pe92nx 17/07/2021 Tony Diovisalvi Stamford PE9 17/07/2021 Richard Featherstone Kelvedon CO5 17/07/2021 Patricia Naylor Stamford PE9 17/07/2021 Neil Mcivor Stamford Pe91jw 17/07/2021 Graeme Humphrey Carlton On Trent NG23 17/07/2021 Alexander Guthrie Stamford PE9 17/07/2021 Carole Griffiths Peterborough PE2 17/07/2021 Sarah Jones Peterborough PE6 9AD 17/07/2021 Nina Van Dyck Stamford PE9 17/07/2021 Geoffrey Hull Bourne PE10 18/07/2021 Jess Dane Stamford PE92JG 18/07/2021 Alexandra Borg Stamford PE9 18/07/2021 JR Fenn Stamford PE9 18/07/2021 Anca Pascut Tallington PE9 18/07/2021 Sara Parry Stamford PE9 18/07/2021 Sharon Pentland Oakham England LE15 18/07/2021 Chantal Wellavize Sowerby Bridge HX6 18/07/2021 Lorna Hutchinson Huddersfield Hd7 5nx 18/07/2021 Rod Howitt Stamford England Pe92xn 18/07/2021 Charles Tyers Stamford PE9 1SN 18/07/2021 Kenneth Rawlins Stamford England PE9 2SQ 18/07/2021 Paul Simmonds Stamford PE9 18/07/2021 Jennifer Gardner Stamford PE9 2sf 19/07/2021 Denise Wade Derby England DE22 19/07/2021 Kevin White Stamford PE9 19/07/2021 wendy burkitt Ryhall pe94eu 19/07/2021 Jessica Birch Wisbech England PE13 19/07/2021 E Jane Vallis Glen Parva England LE2 9NJ 19/07/2021 Richard Gregory March England PE15 20/07/2021 Vera Jones Stamford PE9 20/07/2021 Fattaneh Farzad Stamford PE9 20/07/2021 Nicholas Turner Stamford PE9 20/07/2021 A S Stamford PE9 20/07/2021 Niamh Shiggins King's Lynn England PE30 20/07/2021 Heather Hooper Stamford PE9 21/07/2021 Les Gardner Swaffham England PE37 21/07/2021 Cathal O'Sullivan Stamford England PE9 2SU 21/07/2021 Nicholas Farka Stamford England PE92DN 21/07/2021 claire, sophie stafford-swithenbankLeicester LE4 21/07/2021 Johanna Parr Stamford PE9 21/07/2021 Nicole Richardson Peterborough PE8 6EN 21/07/2021 Irena Cornwell Reading RG8 22/07/2021 Barbara Rauchfliesch Stamford PE9 22/07/2021 Andrew Milner Peterborough Pe2 24/07/2021 Tracy Fox Spalding England PE9 4BU 24/07/2021 Simon Gamble Stamford Pe9 24/07/2021 Jade Barker Stamford England Pe9 2dd 24/07/2021 Sue Baxter Manchester M1 24/07/2021 Sarah Iveson March England PE15 24/07/2021 Jen buckle Stamford PE9 24/07/2021 Trevor Latimer Stamford PE9 24/07/2021 Cristina Fernández Hierro Stamford UK and Santander PE9 2XP 24/07/2021 Peter Chitauro Stamford PE9 24/07/2021 Linda Beckett Stamford PE9 24/07/2021 Edwina Hawkridge Stamford PE9 24/07/2021 Jorge Diaz-Munoz Market Deeping PE9 24/07/2021 Nicky Wayling Stamford PE92QF 24/07/2021 Patricia Neal Stamford England PE9 2RX 24/07/2021 Jess Woodcock Stamford PE9 24/07/2021 Julia Elliott Stamford PE9 2RU 24/07/2021 Jennifer Duffy Stamford PE9 24/07/2021 Helen Langman Bourne, LincolnshireEngland PE10 24/07/2021 Jon Whowell Stamford PE9 4HS 25/07/2021 Gillian Newbold Peterborough PE6 25/07/2021 Sarah Markwell-Cook Stamford PE9 25/07/2021 Carl Allan Stamford PE9 25/07/2021 Vanessa Swatheridge Peterborough PE8 25/07/2021 Henry Fenn Stamford England PE9 1EE 25/07/2021 Frances Hall Daventry NN11 25/07/2021 Katrina Vorster Peterborough PE6 25/07/2021 Patricia Freeman Watford WD17 25/07/2021 Mike Beckwith Stamford England PE9 1SQ 25/07/2021 Paul Gosling Stamford PE9 25/07/2021 Mike Almond Islington N1 25/07/2021 Anthony Woods Boston PE227LU 25/07/2021 David Holmes Stamford PE9 25/07/2021 Katarzyna Luczak Clapham England mk416dy 25/07/2021 Miss Jenny Watson Stamford PE9 25/07/2021 Helen Blythe Stamford PE9 25/07/2021 Rob Headland Stamford PE9 25/07/2021 paul waterfield Lincoln LN2 25/07/2021 Nicola Laud Bourne England PE10 25/07/2021 Michelle Dixon Stamford England PE91BQ 25/07/2021 Emma-Louise Duncan Stamford PE15 25/07/2021 Alan Chamberlain Brigg England DN20 25/07/2021 Lauren Seamer Stamford PE9 25/07/2021 Caroline Dawson Stamford PE9 25/07/2021 Leona Selby Stamford PE9 25/07/2021 Annette Ferguson Solihull England B92 25/07/2021 Polly Hurst Stamford England Pe9 1ey 25/07/2021 Bret Allibone Stamford England PE9 2UB 25/07/2021 Anna Sirigannagari Stamford England PE9 2XT 25/07/2021 Rachel Friend Grantham England NG33 4SL 25/07/2021 Melissa O'Neill Dublin 25/07/2021 Mark Buttress Stamford PE9 25/07/2021 Steve Saunders Stamford PE9 25/07/2021 Suzanna Aldous Stamford PE9 25/07/2021 Michael Aldous Stamford PE9 25/07/2021 Tracey Crawford Stamford PE9 25/07/2021 Helen Giddings Stamford PE9 25/07/2021 Jack Proudley Gloucestershire England GL12 26/07/2021 Jade Adams Bradford BD5 26/07/2021 Thomas Bell Stamford Pe9 26/07/2021 Hannah McIlfatrick Stamford PE9 26/07/2021 Caroline Burley Stamford PE9 26/07/2021 Valerie Baddeley Stamford PE9 26/07/2021 Beverley Meader Spalding England PE11 26/07/2021 Louise Gamble Stamford PE9 26/07/2021 Christine Owen Langtoft England PE6 9RB 26/07/2021 Diane Park Stamford England PE92RN 26/07/2021 Patricia Saunders Stamford PE9 26/07/2021 Justin Cullinan Enfield EN1 26/07/2021 Gary McIlfatrick Stamford PE9 26/07/2021 Elizabeth Putterill Wittering PE8 26/07/2021 Anne Chuter Stamford Pe9 26/07/2021 Patrick Freer Stamford PE9 26/07/2021 Mark Roberts King's Lynn England PE30 26/07/2021 Martin Ballard Stamford PE9 27/07/2021 Lindsay Attrill Norwich NR5 27/07/2021 Martin Edmonds Stamford England PE9 2SG 27/07/2021 Michael Bullard Stamford England PE9 2SD 27/07/2021 Hannah Lingard Stamford England PE9 3NB 27/07/2021 Suzanne Joyce Lincolnshire England LN10 27/07/2021 Vanessa Anderson Spalding PE9 2wn 27/07/2021 David Wadkin Stamford PE9 27/07/2021 Jackeline Joyce Lincolnshire England LN10 27/07/2021 Tricia Porter Nottingham England NG10 27/07/2021 Kirk Morgan Stamford PE9 27/07/2021 Imogen Hesford Stamford Pe9 28/07/2021 Jon Moore Sleaford England NG34 28/07/2021 Heather Owen Stamford PE9 28/07/2021 Liz Heesom Stamford PE9 2DN 28/07/2021 Vivien Turner Wittering PE8 28/07/2021 Maria Nowak-Swatowska Stamford PE9 28/07/2021 Lucy Warner Stamford PE9 28/07/2021 Karen Parsons Stamford PE9 28/07/2021 Beverley Bullard King's Lynn England PE30 28/07/2021 Eamonn Treanor Stamford PE9 28/07/2021 Margaret McCabe crumlin dublin 12 29/07/2021 Laura Smith Stamford PE9 29/07/2021 Tim Allan Stamford England PE9 3UD 29/07/2021 alan hart Stamford PE9 30/07/2021 Kylie Monsma Southampton England SO18 01/08/2021 Ellen Cadman Stamford PE9 01/08/2021 Valerie Allen Melton Mowbray England LE13 02/08/2021 Rachael Ogunlaja Ryhall, Stamford PE9 4HH 02/08/2021 Robert Smith Oakham England LE15 02/08/2021 Georgina Iveson Stamford Pe9 4 be 02/08/2021 John Kelly Bourne England PE10 02/08/2021 Louis Mcallister Peterborough PE8 02/08/2021 Lee Daffern Stamford PE9 02/08/2021 Lindsay Oconnell Stamford England PE9 2JF 02/08/2021 Lesley Moore Torpoint PL10 02/08/2021 Joanne Wild Peterborough PE1 02/08/2021 Nicola Wilson Stamford PE9 02/08/2021 Sally Coombes Stamford PE9 02/08/2021 Peter Foot London WC1H 02/08/2021 Peter Symonds Stamford PE9 02/08/2021 Colleen Garrod Stamford England PE9 2YQ 02/08/2021 Unity Guinness Stamford England Pe9 2qq 02/08/2021 Nadia Clifford-Brazier Stamford PE9 02/08/2021 Corrine Storey Peterborough PE6 02/08/2021 Sarah Trigg Lincoln LN6 02/08/2021 Robert King Stamford England Pe92sd 02/08/2021 Chloe Brewer Stamford PE9 02/08/2021 Norma Needham Stamford PE9 02/08/2021 Emma Green Grantham England NG31 02/08/2021 Ola Sandom Stamford WC1H 02/08/2021 PAUL ROBINSON Stamford England PE9 2NS 02/08/2021 Elisabeth Beckett Bourne England PE10 02/08/2021 Lauren Feerick Stamford PE9 02/08/2021 Hayley Ashberry Stamford England Pe9 1qr 02/08/2021 Fran Manoussakis Stamford England PE9 1qd 03/08/2021 John Steward Wincanton BA9 03/08/2021 Steve Mackiewicz Wisbech England PE13 03/08/2021 Gary Moat Stamford England Pe92xs 03/08/2021 Rachael Young Stamford PE9 03/08/2021 Elaine Jones London SE1 3XB 03/08/2021 Toby de Havilland Barholm England PE9 4RQ 03/08/2021 Joan Brocklebank Stamford PE9 03/08/2021 Wendy Bradshaw Lincs England Pe93py 03/08/2021 Chris Burke Stamford England Pe9 1fh 03/08/2021 Cheryl-Ann Burrows Stamford PE9 03/08/2021 Jane Stilwell Essendine PE9 04/08/2021 Janet King King's Lynn England PE30 04/08/2021 Nick Harris Wittering England PE8 6EN 04/08/2021 M Lynn Culf Stamford PE9 2EW 04/08/2021 Patricia Lipton Stamford PE9 04/08/2021 Susan Ruff Guildford GU2 04/08/2021 Annie Cooke Stamford PE9 05/08/2021 Paul Houghton Stamford PE9 05/08/2021 Peter Rowbotham Stamford PE9 05/08/2021 Martin Cliff Stamford England PE92EG 05/08/2021 Sam Dyer Stamford PE9 05/08/2021 Alan Wells Birmingham England B10 05/08/2021 Andy Turner Stamford PE9 06/08/2021 suzie dell Stamford PE9 06/08/2021 Stephen Hoskins Stamford Pe9 06/08/2021 Lia Clayton Bourne Pe10 9ln 06/08/2021 Dr Alison Maxwell Sale England M33 06/08/2021 Kevin Clayton Bourne England PE10 06/08/2021 Michael Pring Stamford PE9 06/08/2021 Richard Smith Stamford PE9 06/08/2021 Michaela Eccles Stamford PE9 06/08/2021 Rebecca Lee Stamford PE9 07/08/2021 Sarah sparkes Market Deeping England Pe6 8na 07/08/2021 Margaret Cummings Wisbech England PE14 07/08/2021 Carl Roberts Stamford England PE9 1BP 07/08/2021 Kim Roberts Stamford, Lincolnshire.England PE9 1BP 07/08/2021 Margaret Leyton Market Deeping England PE6 8JD 07/08/2021 Claire Kerr Peterborough PE6 08/08/2021 Sharon Bradshaw Nottingham England NG15 08/08/2021 Nanny penman Taylor Stamford PE9 08/08/2021 Anne Robinson Stamford PE9 08/08/2021 Galina Goodman Warrington WA5 09/08/2021

BOARD MEETING – PUBLIC

Date of Meeting: 25th August 2021 Agenda item: 4.1

Update – NHS Lincolnshire Response to and Management of COVID-19 Title of Report: Pandemic Report Author and Clair Raybould – Director of Operations Title: Appendices: 1. Appendix 1 - Daily Update – COVID-19 in Lincolnshire as at 18/08/21

1. Purpose of the Report (including link to objectives)

The purpose of this paper is to provide assurance to the CCG Board in relation to:

i. The latest position in terms of the COVID-19 pandemic in Lincolnshire ii. Update on Emergency Preparedness Resilience and Response (EPRR) iii. Covid Recovery headlines iv. Update on Covid Vaccination Programme

2. Recommendations

The Board is asked to note and consider all of the information in this report and the actions being undertaken.

3. Executive Summary

In Lincolnshire we are seeing an increase in Coronavirus infections as in other parts of the country along with high levels of Urgent and Emergency care. The links between serious illness and infections have been weakened as a result of excellent progress in the vaccination programme but we are now seeing an increase in Covid admissions including critical care and we are advised to expect this to continue to increase in the coming weeks.

We are pressing ahead with our recovery trajectory but are cognisant of the current pressures and the impact the pandemic this far has had on the system, our people and their health and wellbeing of our staff.

The report details the position for Lincolnshire of Covid, current pressures, Vaccination and EU Exit, all of which the Board are aware are managed under a Single Incident Operating Model nationally, regionally and locally.

4. Management of Conflicts of Interest

N/A

5. Finance, QIPP and Resource Implications

Workforce shortages as a result of Covid have had an impact on the use of bank and agency staff across providers.

6. Legal/NHS Constitution Considerations Any considerations will be identified in the main part of the paper. 7. Analysis of Risk including Assessments

Please state if the risk is on the CCG Risk Register. Yes x No

8. Outline engagement – clinical, stakeholder and public/patient On-going clinical and stakeholder engagement during the pandemic and public communications are undertaken with a particular focus on health inequalities.

9. Outcome of Impact Assessments Not applicable to this paper.

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance x Commissioning x Contracting x Medicines Optimisation x Clinical Leads x Quality x Safeguarding x Other x

11. Report previously presented at: A previous update was presented to the July Board meeting.

12. For further information or for any enquiries relating to this report, please contact

Clair Raybould – Director of Operations

[email protected]

Appendix 1

1. Covid 19 General Update

i. Since the July Board meeting COVID19 prevalence has risen sharply across the County. The increase in prevalence relates primarily to the Delta variant and reflects the upward surge in cases seen across the Country and the East Midlands region.

ii. Lincolnshire currently tracks higher than the England average at 353.1 per 100,000 compared with the national average of 306.1 per 100,000. There are signs the upward curve has started to flatten in the past 7 days. Cases recorded over the past 7 days (per 100,000 rate) to 16th August are shown below with a consistent rate during the past 4 weeks (with slight deviation w/c 2nd August). Increase in positive tests are attributed to the night time economy reopening with c60% cases linked with night clubs and extended opening hours in pubs.

Cases - Last Seven Days as at 16/08/21

Location 26/07/2021 02/08/2021 09/08/2021 16/08/2021 Rates per (Rates per (Rates per (Rates per 100,000) 100,000) 100,000) 100,000) England 532.1 305.1 283.9 306.1 Lincolnshire 358.4 264.8 351.2 353.1 Boston 441.8 309.2 258.3 331.7 East Lindsey 393 255.4 285.9 345.7 Lincoln 421 459.2 732.6 528.7 North Kesteven 282.3 272 433.4 387.6 South Holland 318.9 145.2 182.6 244.1 South Kesteven 336.3 207.8 259.7 329.6 West Lindsey 346 239.4 322.3 298.4

iii. Despite the continued rise in cases, on August 16th people in England who have had two COVID vaccine doses no longer have to isolate if they come into contact with someone who has tested positive for the virus. Instead of having to quarantine for 10 days, people are advised to take a PCR test, however this is not compulsory. Further advice is that face masks should be worn in enclosed spaces and to limit contact with others. This guidance applies to under 18s too.

iv. In the UK 89.4% of adults have had one vaccine dose while 76.7% have had both doses.

v. The number of staff contacted by the NHS test and trace App increased significantly during July and August which impacted on service delivery across the system. At its peak, the number of self- isolation alerts sent in England and Wales in a week was just below 700,000. The changes to self- isolation rules are anticipated will reduce staff absence. People who are contacted will be advised to take a PCR test. Those who test positive, or begin to show symptoms, will still be required, by law, to self-isolate for 10 days.

vi. Some extra safeguards are in place for those working with vulnerable people, particularly health and social care staff, including a risk assessment and daily lateral flow tests.

vii. There has been a steady increase in Covid hospital admissions in the county this month with the current number of Covid positive patients in Lincolnshire provider hospital beds is 64, 60 at ULHT, 3 at LCHS and 1 at LPFT. (August 16th data)

viii. The current R rate in England is between 0.8% and 1%; in the Midlands is it between 0.8% and 1%.

Experimental map from gov.uk available here: https://coronavirus.data.gov.uk/details/interactive-map

July and August maps included for comparison below:

2. Emergency Planning, Resilience and Response.

i. On 12 May 2021 the Prime Minister confirmed in a statement made to the House of Commons that the UK Government will establish an independent public inquiry into the response to the COVID-19 pandemic. The inquiry is anticipated to start during Spring 2022, however, it was clarified that preparatory work, such as appointing the chair and setting the terms of reference, will take place prior to Spring 2022.

ii. As described last month the CCG and system as a whole will be required to undertake a resource intensive piece of work to ensure all documentation relating to decisions made during the COVID response is saved and stored in the event the information is called for as part of the Inquiry. The board can be assured that the CCG has operated a robust records management for the incident and are starting to consider the operational requirements of the stop notice ahead of full details expected during the coming months.

iii. The Local Resilience Forum

The Local Resilience Forum formally stepped down from a Major Incident on June 24 as planned. The Strategic Co-ordination Group (SCG) has now handed over to the Recovery Strategic Co- ordination Group (RSCG) which will oversee the delivery of a local Recovery Roadmap. The RSCG has representation from the local authority, district councils, the police, NHS, EMAS as well as national bodies such as the Armed Forces, Ministry for Housing, Communities and Local Government which advices the LRF as to the national direction of travel, policies and procedure. The RSCG is led by Lincolnshire County Council.

Ruth Cumbers, Programme Director for Urgent Care will represent the CCG at the RSCG and the CCG continues to attend all LRF meetings as planned.

3. Covid 19 Recovery

i. The NHS in Lincolnshire is continuing to experience very high levels of patient demand, particularly for urgent and emergency care. Our GP Practices, Urgent Treatment Centres, A&E Departments, and East Midlands Ambulance Service are all reporting sustained pressures of a nature which is beyond that experienced during the depths of winter. This increase has also being seen in hospitals across the country and is being very closely monitored. In addition, there are concerns that the increase in Covid positive patients in hospitals will impact on the recovery of other NHS services. Extensive system planning for a wave 3 has taken place which includes the need to retain as much time critical surgery as possible.

ii. In Lincolnshire the recovery of services remains a very high priority for us. We are working on a number of key areas as part of our restore and recovery programme which has progressed positively in line with our planned trajectory over the last month and we are continuing to restore services that were paused or cancelled during the last year. Despite the non-elective pressures and increases in Covid positive patients, time critical surgery is continuing to take place along with outpatient appointments and diagnostics. Challenges within our main acute provider are increasing, particularly around workforce availability, and so with system support ULHT have implemented some key actions including reinstating response cells and increasing resilience in their Incident Command Centre as mitigation.

iii. With regard to elective operations, in June 2021 the total waiting list size for Lincolnshire patients at all hospitals was circa 75,000 people. This compares to 52,000 in June 2020. Treating so many COVID patients over the past year, along with additional safety measures, has inevitably had a knock-on effect on non-emergency care:

a. Prior to the pandemic Lincolnshire only had 7 patients waiting longer than 52 weeks for an elective procedure, all of which was for a specialist operation out of county. Today the number of Lincolnshire patients waiting over 52 weeks is more than 2,200 which is a reduction from last month.

b. Grantham Hospital continues to provide ring-fenced surgical capacity and the system is supported by the Independent Sector to maximise the number of patients able to be treated. Clinical prioritisation is in place to ensure the most urgent patients are seen as quickly as possible.

v. The backlog remains unchanged within Cancer recovery. The largest backlogs remain within the surgical specialities Colorectal, Head & Neck, Urology and Gynaecology.

vi. The numbers of patients waiting over 104+ days has risen with the majority being in Head and Neck, Urology and Colorectal pathways across all providers.

vii. Almost half the patients waiting over 62 days are on a Colorectal pathway, however all patients on a Colorectal pathway with a diagnosis over 62 days have a date for treatment.

viii. Grantham has restarted Level 1 colorectal surgery and theatres on the Lincoln, Pilgrim and Grantham sites have reopened.

ix. Delays exist with tertiary referrals for Urology patients to Leicester. With wait times at 3-4 months for robotic surgery. ULHT and the CCG are working together to build a business case to bring a surgical robot to Lincolnshire. It is hoped that if approved a robot could be in place by January. In the meantime Coventry is providing aid to Leicester to undertake this surgery.

x. Within mental health care we have established two 24/7 mental health helplines (one for adults, and one for children) which are available to our population across the county. In addition, within Mental Health, Learning Disabilities and Autism services we are receiving additional funding which we are using to introduce a range of new initiatives which will significantly enhance provision for our patients and service users and support the Covid recovery programme.

xi. Respiratory Syncytial Virus (RSV) - The Board will be aware from previous reports that the system is prepared with plans in place for any possible increase in admissions linked an increase in childhood respiratory illness over the winter period. Surge planning has been undertaken Acute Trusts and further work is being carried out to prepare for increased prevalence in Primary and Community Care, and options for community based referral and assessment are underway. This will be underpinned by an education and training plan for teachers and parents that supports an understanding of symptoms and when health care is required along with effective communications. Plans will be in place to deliver a community based model for RSV in September.

Summary

The system as a whole is responding in parallel to an increase in demand for all NHS services, Covid resurgence and this along with seasonal pressures, increasing self-isolation and IPC measures places an increased strain on all of our services and associated pathways of care but we continue to work exceptionally well across the services to do the very best we can for our population and our staff.

4. COVID Vaccination Programme

Performance

i. The Lincolnshire Covid-19 Vaccination Programme continues to perform well and the regional team have commended the work and achievements to date. Lincolnshire remains as the third top performing system in midlands region for overall vaccine uptake.

ii. The system has met the 2 targets to achieve 85% uptake of second doses for cohorts 1 -10, and the target to achieve 85% first dose uptake for cohorts 1-12 .In Lincolnshire we have vaccinated in excess of one million people for both their first and second doses,

The programme remains focussed upon continuing to improve uptake amongst eligible groups through the evergreen offer, and promoting uptake specifically in cohorts 11 and 12 in pursuit of the first dose target. Uptake is increasing across all cohorts and the numbers of 18 to 21 years olds is increasing albeit slowly.

iii. Significant focus has been given to reaching out to and ‘mopping up’ those people in Lincolnshire who have been offered but not yet taken up their vaccine. This proactive approach is being progressed with the support of colleagues in local government to ensure that people in ‘seldom heard’ groups are not left out.

Cohort uptake dated 22nd August 2021 is detailed within the table below.

1st Dose 1st Dose 2nd Dose 2nd Dose Cohort (#) (%) (#) (%) 2a: 80+ 43,793 97.5% 42,620 94.8% 2b: HSCW 16,791 95.6% 15,964 90.8% 3: 75-79 36,482 97.5% 35,936 96.0% 4a: 70-74 48,863 96.7% 48,317 95.7% 4b: CEV (16 - 69) 15,890 95.2% 15,500 92.9% 5: 65-69 41,177 95.3% 40,706 94.2% 6: At Risk 77,522 89.6% 73,946 85.4% Carers - DWP 10,194 85.6% 9,576 80.4% Carers - LA 8,622 83.4% 7,832 75.7% 7: 60-64 26,057 92.3% 25,627 90.8% 8: 55-59 31,987 90.3% 31,362 88.6% 9: 50-54 32,506 88.2% 31,661 85.9% 10: 40-49 53,208 80.6% 50,378 76.3% 11: 30-39 50,563 69.0% 40,993 56.0% 12: 18-29 64,301 69.7% 32,770 35.5%

Children and Young People i. As the Covid19 vaccination programme progresses, attention is now being given to children and young people aged under 18. There are a number of sub categories sit within this cohort and the approaches being taken to vaccinate this programme is outlined below.

Rising 18s – this is 17 year olds who are within 3 months of their 18th birthday. This group will be able to book onto the National Booking System imminently. This group can be vaccinated at any site and the newly published update of the National Protocol enables vaccination at the Mass Vaccination Centres.

16 and 17 year olds who are clinically extremely vulnerable, have underlying health conditions making them at higher risk from Covid19, live with someone who is clinically vulnerable, carers and health and social care workers have been eligible from phase 1 of the programme. As Astra Zeneca is not approved for under 18s, only sites that were running Pfizer could offer vaccination to this age group. Mass Vaccination Sites can now offer this due to using Pfizer and eligible individuals can book on the National Booking System. Despite the challenge with regards being able to confirm eligibility the decision was taken to restrict walk-in’s for the over 18s and only support booked appointments for clinically vulnerable young adults of 16 and 17. This group could also access any of the LVS that are using Pfizer.

16 and 17 year olds who are not clinically vulnerable have been advised to have 1 dose of Pfizer only. On Friday 13th August the National Protocol was published this enabled this cohort to receive their vaccination both at the LVS and VCs across Lincolnshire. Whilst the national booking system was not open both VCs offered walk in vaccinations over the weekend. Although the announcement regarding this being available was only made on Friday evening there was a good uptake over the weekend.

Forward planning and capacity modelling

Looking forward into the autumn, we have received direction from NHS EI to prepare for an Autumn booster campaign based upon the interim JCVI guidance, where pragmatic this will be run as part of, or in parallel to, the annual flu vaccination programme. However it is imperative that neither vaccination programmes are slowed so therefore where dual administration is possible and sensible such as for those who are housebound or live in care homes this is an approach that will be championed, careful consideration will need to be given for other groups to ensure maximum and timely protection. The influenza programme will be extended during 2021/22 to include all adults over the age of 50 years and also all children up to the age of 15 years (year 11). Current interim advice from JCVI indicates that the following groups will be eligible for a Covid booster vaccination:

o Immunocompromised individuals 16 years and over o Older adults living in care homes o All adults aged 70 and over o Clinically Extremely vulnerable aged over 16 years old & health and social care workers o All adults aged 50 years and over o At risk adults aged 16 – 49 o Housebound contacts of immunocompromised

Service quality

There have been no significant quality concerns in relation to the delivery of the vaccination services since inception and the services have received external validation and continued triangulation of assurance. Services benchmark positively against other regional services. Themes continue to be monitored and lessons learnt shared across the Programme

Patient feedback continues to be is captured as part of the programme, which demonstrates a high level of patient satisfaction,

As with phase 2, specific guidance is not yet available to enable detailed planning for phase 3, however the renewed contracting framework for our PCNs and Community pharmacies has been released and we are working closely with them to understand their intentions in relation to future service delivery. An estate review is also being conducted to ensure the programme continues to offer value for money and that accessibility for the population is based upon feedback and learning from the phase one and phase two programme.

The Vaccination team are now fully engaged in the planning for Phase 3. This phase of the vaccination programme will support the provision of the Covid vaccination boosters and an extended flu vaccination programme.

The arrangements for the delivery of the programme will include the re-opening of the Hospital hubs for health staff, the continuation of the Vaccination centres at the Lincoln showground and PRSA, Local vaccination services and Community Pharmacies.

In light of the national position, and the concerns relating to increased case numbers in England, we in Lincolnshire are continuing to push hard to maximise vaccination rates across the county and to build on our already strong performance position.

In conclusion, the Vaccination Programme in the county and the country has been a significant success to date, and we are grateful for the hard work of all of our staff, partners and volunteers for their contribution.

Equity and Inclusion

The Inclusion and Health Equality team comprising of CCG staff and neighbourhood team staff are collaborating to optimise uptake of COVID-19 vaccinations in communities susceptible to health inequalities & vaccine hesitation. On-going & increasing connections with and reach out to community leads and facilitators to better understand and respond to the concerns and needs of communities continues.

5. EU Exit Update

The NHS System locally continues to report no issues as a result of the agreement reached in December 2020 and with extended border controls neither are there any national concerns that affect Lincolnshire.

DAILY COVID-19 SUMMARY – 18th August 2021

Date No. of No. of COVID No. of COVID Cumulative COVID 19 19 cases in 19 Deaths in Lincs cases in hospital (ULHT, Lincolnshire Hospitals Lincolnshire LCHS, LPFT) Hospitals COVID 19 discharges st Sun 1 Aug 53,130 33 866 2,318 nd Mon 2 Aug 53,508 36 866 2,322 Tue 3rd August 53,872 43 866 2,324 Wed 4th August 54,144 44 867 2,330 Thu 5th August 54,583 39 867 2,338 Fri 6th August 54,988 39 867 2,343 Sat 7th August 55,452 41 868 2,349 Sun 8th August 55,862 49 868 2,350 Mon 9th August 56,246 50 868 2,356 Tue 10th August 56,577 54 869 2,361 Wed 11th August 56,871 52 871 2,367 Thu 12th August 57,277 56 872* 2,369 Fri 13th August 57,704 62 873** 2,374 th Sat 14 August 58,077 61 876*** 2,379 th Sun 15 August 58,454 62 877**** 2,382 th Mon 16 August 58,803 64 877**** 2,384 Tues 17th August 59,176 60 877**** 2,391 Weds 18th August 59,508 62 877**** 2,397 i. There has been a steady increase in Covid hospital admissions in the county this month with the current number of Covid positive patients in Lincolnshire provider hospital beds being 62.

 57 at ULHT  4 at LCHS  1 at LPFT

BOARD MEETING – PUBLIC

Date of Meeting: 25th August 2021 Agenda item: 5.

Title of Report: Integrated Performance Report – August 2021 Report Author and Tim Fowler, Associate Director of Contracting and Performance Title: Appendices: Integrated Performance Report

1. Purpose of the Report (including link to objectives)

This report provides the Board with information on achievement against the CCG’s key performance targets and quality standards This report includes: • A performance overview dashboard setting out the position for key performance metrics; • A more detailed summary of performance achievement and actions in place for a number of the performance metrics; • A summary of elective activity recovery against the CCG plan.

2. Recommendations

The Board is asked to note this report and consider the actions underway.

3. Executive Summary The report is presented for discussion and feedback. The approach has been to incorporate targets presented in the Quality Performance report, into a single Integrated Performance Report for the CCG.

This report shows information of normal variation, trends and shifts in performance over time for key metrics and measures across a number of areas of CCG delivery. It also highlights those areas where there is an immediate cause for concern. The report is designed to provide assurance to the Board that there full understanding of the drivers for performance and that actions are in place to address off track performance and quality in areas that are likely to have the most significant impact for patients.

The format of the report from last month is largely unchanged. The full dashboards are presented as usual and the focus areas largely follow up from last month featuring cancer performance, waiting lists, urgent care and mortality index.. There are no additional areas of focus as a result of a deterioration in performance from the previous month

Summary Hospital Level Mortality Indicator (SHMI) - NWAFT and ULHT remain in the ‘higher than expected range’ for their SHMII rates the CCG quality team is working with both providers to understand the factors that are contributing to this upward trend

Cancer Suspected cancer referrals seen within 14 days - Two week wait (2WW) referrals from a GP for suspected cancers remains higher than pre COVID levels in a number of tumour sites, 2WW performance decreasing slightly and but in line with pre-COVID performance levels.

Urgent Care - High demand continues for urgent care services both in the community and at the acute sites impacting on A&E and Ambulance performance

Total waiting list size - RTT waiting list increased by 4,553 to 78,552 in June with the vast majority of the growth being new additions to the list from provider ASI. 52 week waiters fell to 2,263.

4. Management of Conflicts of Interest

No conflicts of interest have been declared by individuals involved in the development of this report.

5. Finance, QIPP and Resource Implications

Finance, QIPP and resource implications directly associated with the issues outlined in this report are set out in the body of the report.

6. Legal/NHS Constitution Considerations

Not applicable.

7. Analysis of Risk including Assessments

Risks to the achievement of performance standards are outlined in the body of this report.

Please state if the risk is on the CCG Risk Register. Yes No X

8. Outline engagement – clinical, stakeholder and public/patient

Not Applicable

9. Outcome of Impact Assessments Not Applicable

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance Commissioning Contracting Medicines Optimisation Clinical Leads Quality Safeguarding Other

11. Report previously presented at:

A draft version of the Performance Report shared with the CCG Executive Committee on 13 May 2021. The Report has subsequently been updated and develpoed to reflect the latest available data.

12. For further information or for any enquiries relating to this report, please contact

Tim Fowler Associate Director of Contracting and Performance e-mail: [email protected] telephone: 07810 770476

James Singleton Performance/Assurance Manager e-mail: [email protected]

Integrated Performance Report (Board)

August 2021

1 Contents

1. Executive Summary Page 3 2. Key to Run Charts Page 4 3. Performance Overview (Dashboard) Page 5 4. Cancer Page 8 5. Planned Care Page 12 6. Quality Page 15 7. Elective Recovery Page 21

2 Executive Summary Overview The August integrated performance report incorporating constitutional standards, quality and safety measures and elective recovery activity, presents CCG and system performance updated to July where available. The focus areas continue as Cancer, SHMI, Elective treatment backlog and long waiters, and quality of patient treatment within primary care and care homes. There are no additional areas of focus from last month.

COVID vaccination The programme has commenced vaccinating the 16-17 year olds cohort and advanced planning is in place for the 12–15 year olds with specific underlying health conditions that put them at risk of severe COVID-19. The ambition for this cohort is to enable vaccination before school term starts in September.

Hospital Mortality NWAFT and ULHT remain in the ‘higher than expected range’ for their SHMII rates the CCG quality team is working with both providers to understand the factors that are contributing to this upward trend. The team continue to work closely with the medical examiners and the trust’s patient safety teams to ensure the required actions, learning and mitigations arising from the mortality reviews are in place. CCG representatives are in attendance at the ULHT quality forums and also sit as peers on their mortality reviews. The CCG DDoN will raise SHMI at the next NWAFT QAC on the 31st August.

Urgent Care High demand continues for urgent care services both in the community and at the acute sites; mirroring national trends. This is impacting on Ambulance and A&E performance. A&E 4 hour performance down to 74.9% in July with 9 patients breaching 12 hours. The County has witnessed its predicted swell in visitor numbers predominantly in the East, on both a semi-permanent and day basis during the school holidays. On-going increases in both COVID and non COVID related absence is causing significant challenges across the NHS and social care. This is affecting ambulance handover delays and patient flows through the hospital's. Ambulance handover delays over 2 hours increasing to 42 at Lincoln and 142 at Boston in July.

Waiting List The overall RTT waiting list increased by 4,553 to 78,552 in June with the vast majority of the growth being new additions to the list from provider ASI. The number of patients waiting over 52 weeks fell by 339 to 2,263 and now accounts for 2.9% of waiters (national average 5.6%). A greater national focus is now on clearing 104 week (2 year) waiters and Lincolnshire had a slight increase in numbers to 28 in June. It is important to view and read this in the context of the current National Covid Restore Agenda and the move away from a focus on constitutional standards to the expectation of focus upon cancer and clinical urgency. This means there is a clinical risk based patient selection process has been introduced as opposed to selection based upon the longest waits.

Cancer Two week wait (2WW) referrals from a GP for suspected cancers remains higher than pre COVID levels in a number of tumour sites, 2WW performance decreasing slightly to 80.6%, but in line with pre-COVID performance levels. A “spike” in referral numbers have been seen in Head & Neck, Skin, Upper GI and lung pathways. The backlog in the breast pathway continues to impact significantly on ULHTs 2WW performance, patients are still waiting 193 days for first appointment. Run Charts Key Run charts are displays of time-series data shown in graph form and are very useful tools for improvement work – particularly in terms of how you understand and communicate variation in a process. Being able to analyse and understand current system variation is key to being able to make changes that improve processes and systems. Immediate cause For concern

Normal Variation

A Trend (upward or downward trend)

A Shift (a run above or below the mean) 4 Performance Overview Constitutional Standards Further Indicator Standard Period Performance Midlands England Trend Detail A&E admission, transfer, discharge within 4 95% Jul-21 74.5% 70.1% 77.7%  - hours % Suspected Cancer Referrals First Seen Within 93% Jun-21 80.6% 81.1% 84.9%  Page 8 14 Days (LCCG) Patients receiving treatment for cancer within 62 85% Jun-21 66.7% 66.3% 73.3%  Page 9 days of an urgent GP referral (LCCG)

RTT: % of incomplete pathways within 18 weeks 92% Jun-21 64.7% 64.3% 68.8%  -

Percentage waiting six weeks or less for a 99% Jun-21 68.4% 75.4% 77.6%  Page 12 diagnostic test

Urgent Care Further Indicator Standard Period Performance Midlands England Trend Detail A&E attendances- patients waiting over 12 hours 0 Jul-21 9 40 N/A  - (LCCG) A&E attendances- time to first clinical assessment - Jun-21 57.8% 41.6% 40.8%  - within 60 minutes (ULHT) Ambulance response times - Mean response time- 00:07:00 Jul-21 00:09:07 00:08:23 00:08:33  - Category 1 (LCCG patients) Ambulance response times - Mean response time- 00:18:00 Jul-21 00:51:51 00:40:05 00:41:04  - Category 2 (LCCG patients) Ambulance handover times - number of handover Jul-21 42 - -  - delays of > 2 hours (Lincoln) - Ambulance handover times - number of handover Jul-21 142 - -  - delays of > 2 hours (Pilgrim) - 5 Cancer Further Indicator Standard Period Performance Midlands England Trend Detail

Total 62 Day Backlog - Jun-21 269 - -  Page 10

Total 104 Day Backlog - Jun-21 74 - -  Page 11

Planned Care Further Indicator Standard Period Performance Midlands England Trend Detail

Total waiting list size - Jun-21 78,512 - -  Page 13

Patients waiting over 52 weeks for treatment 0% Jun-21 2.9% 6.7% 5.6%  Page 14 (% of total waiting list size)

Patients waiting over 104 weeks for treatment 0 Jun-21 28 - - 

Mental Health Further Indicator Standard Period Performance Midlands England Trend Detail IAPT access - people that enter treatment against 2.1% May-21 1.68% - 1.68%  - the level of need in the general population

IAPT recovery rate - people who complete 50% May-21 51.6% - 52.2%  - treatment who are moving to recovery

Inappropriate Out of Area Placements (OAPs) in mental health services for adults in non-specialist 0 May-21 32.0 126.1 131.3  - acute inpatient care per 100,000 population

Estimated diagnosis rate for people with 66.7% Jun-21 61.8% 61.4% 61.9%  - dementia People experiencing first episode psychosis or ARMS that wait two weeks or less to start a NICE 50% Jun-21 58% 72.8% 66.4%  - recommended package of care Severe Mental Illness- people with SMI who have received the complete list of physical health 60% 21/22 Q1 12.5% - -  - checks in the preceding 12 months 6 (Quarterly) Quality Further Indicator Standard Period Performance Midlands England Trend Detail

Never events (ULHT) 0 Jun-21 0 - -  -

Never events (NLAG) 0 Jun-21 0 - -  -

Never events (NWAFT) 0 Jun-21 0 - -  -

Summary Hospital Level Mortality Indicator 1.000 Mar-21 1.1288 1.0322 0.9978  Page 15-16 (SHMI) (ULHT) Summary Hospital Level Mortality Indicator 1.000 Mar-21 1.0878 1.0322 0.9978  - (SHMI) (NLAG) Summary Hospital Level Mortality Indicator 1.000 Mar-21 1.1516 1.0322 0.9978  Page 17 (SHMI) (NWAFT) Hospital Standardised Mortality Ratio (HSMR) 100.00 May-21 117.08 - -  - (ULHT) MRSA Cases- 12 month rate per 100,000 bed days 0 Jun-21 1.1 0.0 1.2  - (LCCG) C. Difficile Cases- 12 month rate per 100,000 bed 0 Jun-21 21.2 22.4 23.4  - days (LCCG) E-Coli Cases- 12 month rate per 100,000 bed days 0 Jun-21 70.5 69.3 67.6  - (LCCG) Last minute elective operations cancelled for non 0% Mar-21 0.8% - -  - clinical reasons (ULHT) Rate of people with a learning disability receiving 0 Jun-21 54 - 43  - inpatient care (LCCG) Cumulative Learning Disability Healthchecks 80% 20/21 Q4 84.7% - -  - (LCCG) Primary Care Quality ------Page 18 Care Home Quality ------Page 19 Serious Incidents ------Page 20

7 Indicator % Suspected Cancer Referrals First Seen Within 14 Days (LCCG) Standard 93% Period Jun-21 LCCG 80.6% England 84.9% Trend

Description Cause Actions To Recover • The volume of two week wait (2WW) referrals remains • ULHT & LCCG contracting teams are working together to roll out two higher than pre COVID levels in a number of tumour sites, additional Spot Clinics on in Skegness and one in Grantham both are numbers have dropped off in the last few weeks which is expected to commence next month. Additional ERF funding of normal during the summer holidays. £27,000 has been agreed to support this roll out. • Higher referral numbers have been seen in Head & • LCCG are working together with ULHT & NWAFT to implement a Neck, Skin, Upper GI and lung has also seen a significant breast pain pathway at both Trusts which should reduce 2ww spike in referrals. referrals into this pathway by 10-20%. It is thought this will take • The backlog in the breast pathway continues to impact around 3 months to implement. significantly on ULHTs 2WW performance, patients are • Additional clinics are being run by the Breast team at ULHT to still waiting 19 days for first appointment. recover the 2ww backlog. The team are on track with their recovery • Delays in the 2ww pathway at ULHT for gynaecology are trajectory .Inbound referral numbers have returned to pre-COVID also beginning to impact on the 2ww performance, with levels around 135 per week. % Suspected Cancer Referrals First wait times for 2ww appointments currently at 4-6 weeks. • Head & Neck have had a new consultant start on the 5th July which Seen Within 14 Days (LCCG) This is due to long term staff sickness, staff isolating and has improved performance significantly. difficulty recruiting additional staff. • Gynaecology at ULHT have struggled to secure locum cover it is • NWAFT are struggling to meet their 2ww performance in hoped that a new locum will commence next week, established skin due to staff sickness and isolation. consultants are also providing ad-hoc cover where they can. A • Delays are still being caused by swabbing and isolating dedicated Band 7 nurse to focus on hysteroscopy and PMB should regimes required before certain diagnostic procedures, GO out to recruitment next week. Once recruited, they expect to see until infection prevention and control measures change an increase in capacity and a subsequent reduction in PMB waits. this will continue to be an issue. This work is supported by a successful SDF bid of £147,840. • The workforce is very fragile due to ongoing pressures, • NWAFT have requested mutual aid from neighbouring Trusts, ULHT staff sickness levels are increasing and some areas are currently considering whether or not they have capacity to reliant on agency staffing. Many Trusts around the repatriate the Lincolnshire patients in the backlog at NWAFT. We8 are country are paying very high rates of pay to agency staff awaiting confirmation of patient numbers in order to make a hi h ld l d t f th f ilit t ULHT d i i thi t d t d Indicator Patients receiving treatment for cancer within 62 days of an urgent GP referral (LCCG) Standard 85% Period Jun-21 LCCG 66.7% England 73.3% Trend

Description Cause Actions To Recover • Demand for surgery has continued to rise throughout • Trusts continue to clinically prioritise patients. the pandemic, the recovery of this is ongoing. • The Business Units are working closely with theatres, • The largest backlogs remain within the surgical anaesthetics and critical care (TACC) to gain access to specialities colorectal, head & neck, urology where they sufficient theatre capacity and HDU post op care via also have experienced a significant loss in operational weekly meetings. The situation is improving however still management due to staff leaving and retirement. not fully resolved. • The gynaecology backlog is also growing this is due to • All theatres on the Lincoln, Pilgrim and Grantham sites long term staff sickness and difficulties in recruiting. have reopened. • Patients delayed due to poor two week wait • All patients on a colorectal pathway with a diagnosis performance at the beginning of the pathway has had a over 62 days have a date for treatment. knock on effect. • Grantham has restarted Level 1 colorectal surgery. Patients receiving treatment for • One vanguard theatre at Grantham has been removed by • Recruitment is underway within the surgical division to cancer within 62 days of an urgent Vanguard. replace some members of the operational management GP referral (LCCG) • Almost half the patients waiting over 62 days are on a teams. colorectal pathway. • ULHT are putting in place two replacement theatres for • Teams are describing a “hangover effect” where the the Vanguard units at Grantham however this is unlikely backlogs are so large they are very difficult to manage. to occur until early 2022. • Cancellation of surgery due to capacity issues in • ULHT & LCCG are working together to build a business HDU/ITU. case to bring a surgical robot to Lincolnshire. It is hoped • Significant delays exist with tertiary referrals for that if approved a robot could be in place by January. In Urology patients to Leicester. With wait times at 3-4 the meantime Coventry are providing aid to Leicester to months for robotic surgery. undertake this surgery. • Lack of pre-operative assessment capacity at ULHT • A project team at ULHT are working with pre op leading to underutilisation of some theatre time. assessment to improve capacity. 9 • Capacity of management and clinical staff due to ongoing pressures at all Trusts Indicator

Total 62 Day Backlog

Standard - Period Jun-21 LCCG 269 England - Trend

Indicator Standard Period Performance Midlands England Trend

Total 62 Day Backlog - Jun-21 269 - - 

10 Indicator

Total 104 Day Backlog

Standard - Period Jun-21 LCCG 74 England - Trend

Description Cause Actions To Recover • The numbers of patients waiting over 104+ days is • Trusts continue to clinically prioritise patients awaiting treatment. beginning to rise again with the majority being in H&N, • ULHT have opened up more surgical capacity at Lincoln, Pilgrim urology and colorectal pathways in line with what we are and Grantham. seeing in the 62 day performance. • Cancer Nurse Specialists continue to support patients with more • Theatre capacity for diagnostics especially in H&N is complex needs through regular contact, a number of the longest proving challenging. waiters have been removed from the backlog due to this ongoing • The number of undiagnosed patients over 104+ days is work. Funding has been provided from the SDF for an additional significantly higher than those diagnosed due to patient nurse specialist to support ULHT as they work through the backlog. choice and/or the number of diagnostics. • ULHT & LCCG are working together to build a business case to bring • Those requiring an HDU/ITU bed post-surgery are still a surgical robot to Lincolnshire. It is hoped that if approved a robot facing delays with a number of cancellations reported. could be in place by January. In the meantime Coventry are providing • Significant delays exist with tertiary referrals for aid to Leicester to undertake this surgery. Urology patients to Leicester. With wait times at 3-4 • Grantham has restarted Level 1 colorectal surgery. months for robotic surgery. • The Business Units are working closely with theatres, anaesthetics Total 104 Day Backlog • Operational staffing issues within the surgical division and critical care (TACC) to gain access to sufficient theatre capacity are having a significant impact on the amount of time and HDU post op care via weekly meetings. The situation is and effort that can be focussed on these patients made improving however still not fully resolved. more difficult by the sheer size of the backlogs. • All theatres on the Lincoln, Pilgrim and Grantham sites have • Lack of pre-operative assessment capacity at ULHT reopened. leading to underutilisation of some theatre time. • All patients on a colorectal pathway with a diagnosis over 62 days • Capacity of management and clinical staff due to have a date for treatment. ongoing pressures at all Trusts. • Grantham has restarted Level 1 colorectal surgery. • Recruitment is underway within the surgical division to replace some members of the operational management teams. • ULHT are putting in place two replacement theatres for the Vanguard units at Grantham however this is unlikely to occur until early 2022. • A project team at ULHT are working with pre op assessment11 to improve capacity. Indicator Percentage waiting six weeks or less for a diagnostic test Standard 99% Period Jun-21 LCCG 68.4% England 77.6% Trend

Description Cause Actions To Recover • Capacity within diagnostic services has been altered to • Some modalities have been able to increase capacity over and above reflect the infection control requirements and available what was available last year and routine backlogs continue to reduce workforce resources in most modalities. • Increased time to book diagnostics with patients due to • ULHT and NWAFT’s largest backlog concern is in cardiac COVID requirements (for Endoscopy it has increased diagnostics. The division are continually developing action plans and from 6 mins to 16 mins per patient) can add to patient the system have identified community providers that may be able to anxiety and reluctance to attend support. • Patient engagement in diagnostic process (reluctance • NWAFT has two temporary staffed MRI scanners on site which has to visit hospitals during COVID-19) enabled existing staff to focus on CT • Location of capacity does not always match patients • NWAFT has received mutual aid to assist in clearing their endoscopy expectation i.e. patients unwilling to travel backlogs and have multiple providers supporting this Percentage waiting six weeks or • Patient acceptance & compliance with swabbing and • A business case for a Community Diagnostics Hub was submitted on less for a diagnostic test self-isolating requirements resulting in cancelled tests 7 July to NHSEI. CDH1 is planned to be based at Moy Park in and wasted resource Grantham and will provide Cardiac Echo, Plain Film and Non- obstetric U/S. Current timescales for this to be operational is towards the end of 2021. • Additional community diagnostic hubs that will look to address areas of health inequalities in the county are also in the planning phase and financial information has been submitted to regional NHSEI to include in the Autumn spending review. • The BMI in Lincoln are offering additional x-ray capacity to support the volume of requests currently being experienced. 12 Indicator

Total Waiting List Size

Standard - Period Jun-21 LCCG 78,512 England - Trend

Indicator Standard Period Performance Midlands England Trend

Total waiting list size - Jun-21 78,512 - - 

13 Indicator Patients waiting over 52 weeks for treatment (% of total waiting list size) Standard - Period Jun-21 LCCG 2.9% England 5.6% Trend

Description Cause Actions To Recover ● The CCG and ULHT continue to perform better than the ● National RTT reports only show patients as waiting over national average when viewed as the percentage of the 52 weeks, however locally we have developed informal waiting list are waiting over 52 weeks for treatment; reporting processes to get more granular detail with our numbers have reduced for the third month running. main providers. This enables us to be fully sighted on the length patients are waiting above 52 weeks and to work Patients waiting over 52 weeks with these providers. Progress for ULHT is also picked up for treatment on a weekly call to ensure action plans are in place for (% of total waiting list size) patients. ● Harm review and risk stratification processes is ongoing at all our main acute providers to ensure clinically urgent patients are prioritised. All patients waiting over 52 weeks are required to have a harm 14 review completed Indicator Summary Hospital Level Mortality Indicator (SHMI) (ULHT) Neighbouring Trusts ULHT: 1.1288 NLAG: 1.0878 NWAFT: 1.1516 NUH: 1.0115 QEH: 1.0480 England 0.9978 Trend

Indicator Standard Period Performance Midlands England Trend

Summary Hospital Level Mortality Indicator 1.000 Mar-21 1.1288 1.0322 0.9978  (SHMI) (ULHT)

15 Description Cause Actions To Recover ● Due to the 6-month time lag with SHMI data, the alerts have already been reviewed by ULHT when they have alerted within their HSMR data which has a time lag of 3 months. ULHT's Learning from Deaths policy states that ● ULHT SHMI is 112.88 (April any alerts alerting for 3 months a case note review is undertaken, however, all alerts are reviewed by the Deputy 2020 – March 2021); which Medical Director and depending on the alert, they may complete a high level diagnostic review using the Dr Foster places the Trust in Band 1 with data and grading from mortality reviews to identify if there are any concerns prior to the 3 months. The case note a ‘Higher than expected SHMI’. reviews for the alerts involve the most appropriate clinician and the Head of Clinical Coding. SHMI includes both deaths in- ● From the reviews completed, there is a consistent theme around documentation. NHSE/I are running a hospital and within 30 days of Capturing Care workshop for ULHT reviewing the importance and impact that documentation has on mortality discharge data. ULHT are also reinstating a Clinical Coding Masterclass which discusses the impact of documentation on ● However, the rolling average mortality data. internal Trust crude mortality ● Forty clinicians participated in the Structured Judgement Review training during February and March 2021 in Jun-21 was 1.65% (down provided by the Royal College of Physicians. 0.25% from May-21) against a ● In August 2020 ULHT opened a full time Medical Examiner Service that reviews all of the deaths that occur at target of 1.8%. the Trust. From August 2020 to May 2021, the Trust had 2,443 deaths and the Medical Examiner’s Office has Summary Hospital Level Mortality ● The SHMI reporting period reviewed 2,433 (99.6%) of the Trust deaths. Any concerns identified by the Medical Examiner are subject to a Indicator (SHMI) (ULHT) covers the peak of the COVID- Structured Judgement Review, Speciality Discussion or Rapid Review (scoping for a potential SI). ULHT also has a 19 pandemic at the Trust; from list of priority, policy mandated, structure judgement reviews that are completed irrespective if the Medical December 2020 to February Examiner identifies any concerns, these are; Learning Disabilities, Severe Mental Health diagnoses, Unexpected 2021, when the Trust Deaths, Children and Younger People, Inquests. experienced significant covid ● The Trust is currently planning with system partners the roll out of the Medical Examiner Service for community 19 outbreaks and more deaths deaths. This will be invaluable in learning from deaths within 30 days of discharge. than anticipated ● When reviewing SHMI for in hospital deaths versus outside hospital, ULHT percentages are as follows; in ● An extract from NHS Digital hospital 62%, outside hospital 38%. shows that 4.1% of spells (2755 ● The Trust also hosts the Lincolnshire Mortality Collaborative which meets 6-weekly with system partners to spells), have been excluded share learning. The Collaborative has identified ongoing issues with completion of ReSPECT and advanced care due COVID-19 coding. The planning, and the CCG has fed back on the work they are doing to in respect of the Palliative/end of life Care national average is 4.5%. Programme, which includes a focus on improvements for the completion of ReSPECT and advanced care planning. • CCG Executives received an analysis paper on SHMI for ULHT in August 2021 and this will be tabled at QPEC in September

16 Indicator Summary Hospital Level Mortality Indicator (SHMI) (NWAFT)

Standard 1.000 Period Mar-21 NWAFT 1.1516 England 0.9978 Trend

Description Cause Actions To Recover • The July Quality Report was presented at the • The Mortality Rate Improvement Plan continues to be delivered and July Quality Assurance Committee of the trust is monitored by the Quality Assurance Committee the reported the following “No change since • Consideration of local clinical coding agreements relating to last month – no new report issued due to NHS comorbidities & key diagnoses Digital data issue” • NWAFT to co-produce a draft “Clinical Coding Improvement Plan” • A review of the organisations website has • Clinical Coding Masterclasses undertaken identified the following in the Quality • Collaborative working agreement to be made regarding clinical Committee summary report submitted to the coding validation and standardisation Board meeting on the 12th August “HSMR was • Trust wide rollout of mandatory online ‘Primary Mortality discussed in the Quality Report and BAF Reviews’ agenda items. The Trust wide HSMR is • Coding validation process being standardised across x 2 main Summary Hospital Level Mortality currently 113.4 having risen from 112.8 last sites (Peterborough Hospital is the outlier) Indicator (SHMI) (NWAFT) month and remains statistically significantly • Ongoing Review of any alerting diagnoses & regular liaison with high. For PCH the HSMR has increased from Dr Foster to reconcile any rate differentials 118.4 to 120.2. For Hinchingbrooke Hospital • Training with clinicians to improve documentation the HSMR has decreased from 104.2 to 102.5. • Collaborative Review Sessions between Secondary Care and QAC discussed this at length and felt the BAF General Practice to review deaths within 48hrs of admission . assurance rating should be changed from • Structured Judgement Review training will be rolled out across the substantial to reasonable assurance as there organisation by March 2021 (methodology used for mortality continued to be no reduction in Trust HSMR. clinical reviews) This will be reviewed monthly” • Dissemination of learning from mortality reviews across the relevant Division and the wider Trust 17 Primary Care Quality Practices Rated Inadequate: 1 Practices Rated 'Requires Improvement: 2 Inspection Practice Locality Date Beacon Medical Practice 04/02/2021 East Holbeach Medical Centre 07/01/2020 South New Reports Publication Overall Previous Practice Locality Date Rating Rating

Lakeside Medical Centre 02/08/2021 South Inadequate Good

Beacon Medical Practice has recently been re-inspected by the CQC (Aug 2021), initial indications from the CQC are positive as to the outcome of that inspection.

Lakeside Medical Centre have a full action plan to address the improvements required post their CQC inspection (June 2021). Achievement of this is reported fortnightly to the CQC and regularly to the CCG. The CCG have met with the Practice to seek assurances on actions and to provide support. Current support areas have been with communications through the PPG, safeguarding and infection prevention and control.

18 Care Home Quality

The CCG Safeguarding Leads (Head of Safeguarding Adults & Continuing Health Care Safeguarding Lead) have with Lincolnshire County Council (LCC) colleagues undertaken assurance visits in July / August 2021 to the following providers. Homes identified as high risk according to the risk matrix are discussed at the monthly Service Quality Review meetings, led by LCC.

Safeguarding assurance visits: 12.07.201 & 13.08.2021 – Joint visit with LCC to Glenholme Care Home following safeguarding concerns in respect of tissue viability and body mapping. All actions met on the improvement plan. New electronic care planning to be embedded to ensure care is accurately recorded requiring a follow up visit. 16.07.2021 – Joint meeting with LCC and CCG’s in respect of Healthlincs Hospital. Provider held to account regarding the Section 42 enquiries in respect of patient safety. LCCG continue to oversee the quality of the service provision. 03.08.2021 – Roman Wharf- x3 recent safeguarding concerns in respect of care delivery and controlled drugs. Strategy meeting held and unannounced visit carried out by CCG and LCC. Support strategies put in place. 04.08.2021 – Bassingham Care Centre – site visit planned by LCC and CCG but cancelled due to Covid-19, therefore virtual meeting held to obtain assurances around tissue viability and communication. Neighbourhood team to provide support. 09.08.2021 - PJ Care – safeguarding managed by Peterborough County Council – strategy meeting and site visit completed, omissions in some record keeping identified. 12.08.2021 – St Andrews – site visit with LCC and CHC - manager resigned with immediate affect, quality concerns raised by the GP practice. Care Homes with high risk issues – under enhanced level of surveillance via CCG/LCC officers: x7 providers one of which includes Kisimul – national concerns as well as locally, monitoring by MH/LD CCG commissioning team. Suspensions in place by Health and Lincolnshire County Council: Lifeways – Autism care – there are also concerns of other out of county Lifeways Homes , staffing levels remains the main concern with a high use of agency staff. LCC and CCG continue to closely monitor. Qu’appelle – quality of care delivery, management response and governance. Site visit needed by both LCC and Fire and Rescue however the home is currently in outbreak. Regular contact for assurance being maintained by LCC. CHC have one fully funded patient at the home. 19 Maple Leaf – voluntary suspension by provider to ensure opportunity to address improvement plan. Serious Incidents

Actions To Recover • There have been a total of 45 serious incidents reported 13 July 2021 – 10 August 2021. This represents a reduction when compared to last month’s data (n=59). It is noted that there has been reduced serious incident reporting by LCHS and ULHT this month. • The focus of serious incident reporting in Lincolnshire remains pressure ulcers (n=20), by LCHS. There has been a slight decrease in reporting when compared to last month (n=24). Scrutiny of pressure ulcers reported continues to be undertaken within the Trust Quality and Risk Meetings; Clinical Safety and Effectiveness Group and the Quality Assurance Groups. • There has been consistent reporting of serious incidents by LPFT this month (n=8) compared to last month (n=9). The focus of reporting continues to be apparent/actual/suspected self inflicted harm (n=5). • As referenced above, there has been a reduction in the number of serious incidents reported by ULHT this month (n=6); in comparison to last month (n=19). To add context, it is noted that last month, there had been a number of maternity service incidents reported (n=6), which had increased last month’s reporting figures. This month, it is noted that there has been no diagnostic incidents or surgical incidents reported. Whilst the focus of serious incidents reported by ULHT remains treatment delays, this month reporting equated to (n=2) compared to (n=4) last month. There has also been a further single* maternity service serious incident reported. To note there has been 2 never events reported by ULHT in relation to administration of medication and positioning of naso gastric tube. • There has been an increase in reporting by NWAFT (n=6) this month, in comparison to (n=3) last month. There is a consistent level of diagnostic 20 incidents reported (n=2). It is noted that there have been 2 maternity service incidents reported by NWAFT this month. Elective Recovery Elective Recovery Indicator Period Plan LCCG Trend

First Outpatient Attendances Jun-21 19,592 20,911 

F/up outpatient attendances Jun-21 30,755 34,959 

Total elective spells Jun-21 8,789 9,241 

Diagnostics- Magnetic Jun-21 4,761 4,861  Resonance Imaging Diagnostics- Computed Jun-21 8,755 9,918  Tomography Diagnostics- Non-Obstetric Jun-21 8,770 8,827  Ultrasound

Diagnostics- Colonoscopy Jun-21 628 799 

Diagnostics- Flexi Jun-21 432 422  Sigmoidoscopy

Diagnostics- Gastroscopy Jun-21 642 681 

Diagnostics- Jun-21 1,511 1,499  Echocardiography

21 Indicator Total elective spells Period Jun-21 Plan 8,789 LCCG 9,241 Trend

Indicator Period Plan LCCG Trend Variance

Total elective spells Jun-21 8,789 9,241  Activity remains above plan

22

BOARD MEETING – PUBLIC

Date of Meeting: 25th August 2021 Agenda item: 6.

Title of Report: Financial Management Report July 2021 (M04) Report Author and Title: Emma Frost, Assistant Director of Finance Appendices: None.

1. Purpose of the Report (including link to objectives)

This is a standing report to the Board setting out the financial position of Lincolnshire CCG (LCCG) in the context of the financial position for the Lincolnshire STP.

2. Recommendations

The Board is asked to consider and note the reported financial position of LCCG.

3. Executive Summary

The Lincolnshire CCG has had confirmed allocations for the period 1 April 2021 to 30 September 2021 (M01-M06) and as yet there are no confirmed allocations for the second half of the year. The CCG has planned for a half year surplus of £0.2m agreed with NHS England. This position includes anticipated additional allocations of £6.9m in respect of forecast costs for COVID-19 Hospital Discharge Programme, COVID-19 Vaccination Programme and the Acute Commissioning Elective Recovery Fund.

Allocations The CCG received allocations of £723.0m for M01-M06. This includes £11.0m of agreed SDF funding, £25.1m Covid-19 funding and £5.8m CCG growth funding for the same period. Additional allocations were received of £1.7m in M03 and £10.0m in M04 to give a total allocation of £734.7m for the period M01-M06. This includes £4.3m initial allocation for Elective Recovery Fund and £4.6m for Covid-19 expenditure in the first quarter of the year.

Summary M04 Financial position Details are shown in Table 1 below.

Overall Year to Date At 31 July 2021 (M04), the CCG is reporting a £0.1m surplus against its allocation of £491.8m, and anticipated reimbursements of £1.2m. This is in line with the resubmitted plan agreed with NHS England and Improvement.

Forecast Outturn The forecast M01-M06 position reported is to deliver a £0.2m surplus against allocation of £734.7 and retrospective reimbursements of £6.9m, at 30 September 2021 (M06) – again in line with the latest agreed plan.

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Table 1: summary financial position at M04 including anticipated reimbursements

Year To Date (M04) Full Year (M06) Programme Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m

Allocations

In Year Allocations 493.0 493.0 0.0 741.6 741.6 0.0 Prior Year Allocations b/f 0.0 0.0 0.0 0.0 0.0 0.0 Total Allocations 493.0 493.0 0.0 741.6 741.6 0.0

Expenditure

Acute Commissioning Services 261.1 260.4 0.6 393.4 390.2 3.2 Community Health Services 43.8 43.9 -0.0 66.4 66.4 -0.1 Mental Health Services 51.7 50.1 1.5 77.8 76.6 1.2 Continuing Care Services 21.6 19.8 1.8 32.1 29.6 2.6 Primary Care Services 105.7 104.5 1.2 158.3 156.8 1.5 Other Programme Services 4.2 9.2 -5.0 6.4 14.6 -8.2 Running Costs 4.9 4.9 0.0 7.3 7.3 -0.0

Total Expenditure 493.0 492.9 0.1 741.6 741.4 0.2

In Year Surplus (+) / Deficit (-) 0.0 0.1 0.1 0.0 0.2 0.2

The current financial position is a net position after expected retrospective allocations and reimbursement as detailed in Table 2 below.

Table 2: M04 expected allocations and reimbursements included in the net position Year To Date (M01 - 04) Forecast (M01 - 06) Expected Expected reimbursement reimbursement £m £m Covid – Hospital Discharge Programme 0.1 0.3 Covid – Vaccination Programme 0.6 3.0 Elective Recovery Fund 0.5 3.6 1.2 6.9

Programme Level Variances Programme level variances year to date primarily include: • Acute commissioning underspend of £0.6m arising from slippage in expenditure for Cancer and Maternity, offset by additional activity in the independent sector; • Mental Health Services underspend of £1.5m comes from £1.8m underspend as the transformation programme will now be provided in H2, offset by activity increases for section 117 and locked rehabilitation;

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• Continuing Care Services underspend of £1.8m predominately due to prior year benefits and current cost of packages of care being below budgeted levels; • Primary Care Services underspend of £1.2m unchanged from last month; and • Other Programme Services overspend of £5m due to unidentified efficiency savings in addition to costs being higher than plan in respect of NHS Property Services, Patient Transport, AQP programme projects and Nursing & Quality Programme.

Efficiency The H1 plan aims to reduce waste and spend resources in the most efficient way to the value of £5.98m. A core focus has been reducing the number of external placements for patients with acute complex mental health needs by providing care locally with our local NHS provider (particularly for female patients who can now receive care at Ash Villa). The value of the Mental Health reduced out of area spend year to date is £1.1m. The H1 prescribing budget was set to reflect £2m planned spend reduction. The year to date total prescribing spend is under budget by £0.5m, which reflects additional efficiencies above plan. Key areas of reduced prescribing spend is on mental health drugs and drug rebates, and prior year benefits. The year to date shortfall in total efficiency of £1.1m is mitigated in full by the Elective Recovery Fund (ERF). The CCG is on track to deliver its H1 efficiency programme by month 6.

Table 3: Efficiency summary at M04 H1, M01 - M06 YTD, M01 - M04 CCG Waste reduction Plan Plan Actual Variance £'m £'m £'m £'m Mental Health 1.9 1.3 1.1 -0.2 Prescribing 2.0 1.3 1.8 0.5 Unidentified 2.1 1.4 0.0 -1.4 Mitigation - ERF 0.0 0.0 1.1 1.1 Total 6.0 4.0 4.0 0.0

Lincolnshire NHS Healthcare System

At Month 4 the Lincolnshire system is reporting a £0.2m deficit, but this improves to generate a £1.4m surplus by the end of Month 6.

Table 4: Lincolnshire NHS Healthcare System financial position at M04 Surplus / (deficit) ULHT LPFT LCHS CCG Total £'m £'m £'m £'m £'m Year to date (M04) -0.6 0.0 0.3 0.1 -0.2 Forecast (M06) 1.2 0.0 0.0 0.2 1.4

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4. Management of Conflicts of Interest Not considered

5. Finance, QIPP and Resource Implications As indicated in the paper.

6. Legal/NHS Constitution Considerations Not considered

7. Analysis of Risk including Assessments This section should identify known or potential risks and how these are being mitigated, including conflicts of interest.

Please state if the risk is on the CCG Risk Register. Yes No X

8. Outline engagement – clinical, stakeholder and public/patient Not applicable

9. Outcome of Impact Assessments Not applicable

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance X Commissioning Contracting Medicines Optimisation Clinical Leads Quality Safeguarding

Other

11. Report previously presented at:

A Finance Management Report is usually presented to the Board meeting each month.

12. For further information or for any enquiries relating to this report, please contact

Emma Frost, Assistant Director of Finance – [email protected]

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BOARD MEETING – PUBLIC

Date of Meeting: 25th August 2021 Agenda item: 8.

Title of Report: Older Adults Mental Health Services Report Author and Mr Andy Rix, Chief Operating Officer, South Locality and the CCG Title: Mental Health Lead Appendices: Health Scrutiny Committee for Lincolnshire – paper on behalf of Lincolnshire Partnership NHS Foundation Trust (LPFT) Conclusions on LPFT Items

1. Purpose of the Report (including link to objectives)

The purpose of this report is to inform the Board of a paper which was considered by the Health Scrutiny Committee for Lincolnshire at its meeting held on 21 July 2021 in respect of Older Adult Mental Health Services.

2. Recommendations

The Board is requested to note the information presented on the Older Adult Services Home Treatment Team and support the proposed closure of Rochford Ward at Pilgrim Hospital, Boston.

3. Executive Summary The Older Adult Services Home Treatment Team was established in October 2018 as a county-wide pilot providing a community facing service to older adult patients with functional mental illness, who would otherwise have been admitted to Brant Ward, Lincoln, which at that time was being refurbished. Subsequently, when Brant Ward was re-opened, the Home Treatment Team continued, with the service funded by the temporary closure of Rochford Ward at Pilgrim Hospital, which was not fit for purpose and would require capital investment for improvement.

The Health Scrutiny Committee for Lincolnshire received a report at its meeting held on 21 July 2021 on behalf of Lincolnshire Partnership NHS Foundation Trust (LPFT) which included information on the Home Treatment Team as well as engagement and consultation responses on the permanent closure of Rochford Ward, Pilgrim Hospital.

A copy of the report is attached at Appendix One along with a conclusions paper on LPFT key items.

The Health Scrutiny Committee for Lincolnshire discussed the proposals and agreed to:

• To note the information in the evaluation of the pilot CAMHS Crisis and Enhanced Treatment Team. • To support the proposal from Lincolnshire Partnership NHS Foundation Trust to make the closure of Rochford Ward at Pilgrim Hospital permanent, with the continuation of the Home Treatment Service, with a recommendation to the Trust that it continues to monitor the demand for older in-patient beds, particularly from the east of the county.

The Board is asked to note the information presented on the Older Adult Services Home Treatment Team and support the proposed closure of Rochford Ward at Pilgrim Hospital, Boston.

4. Management of Conflicts of Interest No direct implications

5. Finance, QIPP and Resource Implications Not applicable.

6. Legal/NHS Constitution Considerations

7. Analysis of Risk including Assessments

This section should identify known or potential risks and how these are being mitigated, including conflicts of interest.

Please state if the risk is on the CCG Risk Register. Yes No 

8. Outline engagement – clinical, stakeholder and public/patient

As outlined in the paper.

9. Outcome of Impact Assessments

Not applicable.

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance Clinical Leads

Commissioning Quality

Contracting Safeguarding  Medicines Optimisation Other

11. Report previously presented at:

Not applicable.

12. For further information or for any enquiries relating to this report, please contact Mr Andy Rix, Chief Operating Officer, South Locality – [email protected]

Agenda Item 6

THE HEALTH SCRUTINY COMMITTEE FOR LINCOLNSHIRE

East Lindsey District Lincolnshire County Boston Borough Council City of Lincoln Council Council Council North Kesteven District South Holland District South Kesteven West Lindsey District Council Council District Council Council

Open Report on behalf of Lincolnshire Partnership NHS Foundation Trust

Report to Health Scrutiny Committee for Lincolnshire

Date: 21 July 2021

Subject: Older Adult Mental Health Services – Home Treatment Team

Summary:

The Older Adult Services Home Treatment Team was established in October 2018 as a county-wide pilot providing a community facing service to older adult patients with functional mental illness, who would otherwise have been admitted to Brant Ward, Lincoln, which at that time was being refurbished. Subsequently, when Brant Ward was re-opened, the Home Treatment Team continued, with the service funded by the temporary closure of Rochford Ward at Pilgrim Hospital, which was not fit for purpose and would require capital investment for improvement.

This report provides the Committee with information on the Home Treatment Team, as well as engagement and consultation responses on the permanent closure of Rochford Ward.

Actions Requested:

To consider the information presented on the Older Adult Services Home treatment Team and the engagement and consultation responses on the proposed closure of Rochford Ward at Pilgrim Hospital, Boston.

Page 63 1. Background

Older Adult Services – Functional Mental Health

Typically the term Older Adult Services refers to those services provided to patients over 65 years of age. Traditionally, these services have been divided into functional mental health (for example, depression and anxiety) and organic mental health services (for example, dementia). Prior to October 2018, there were two inpatient wards for functional mental health provided by Lincolnshire Partnership NHS Foundation Trust (LPFT). These wards were Brant Ward, Witham Court, Lincoln, and Rochford Ward, Pilgrim Hospital.

Refurbishment of Brant Ward, Witham Court, Lincoln

In October 2018 a project began to upgrade Brant Ward at Witham Court in Lincoln, to create single en-suite bedrooms and improve the ward living spaces. Witham Court is the main centre for older adult mental health in Lincolnshire and has a firm place within the Trust’s future strategy. The work on Brant Ward was considered to be a good investment in order to meet Care Quality Commission standards and to future-proof this valuable service.

The Home Treatment Team was established in October 2018 as a county-wide pilot providing a community facing service to older adult patients with functional mental illness, who would otherwise have been admitted to Brant Ward. Brant Ward was re-opened in February 2020, providing 18 single en-suite bedrooms in a modern, accessible and therapeutic space.

Rochford Ward, Pilgrim Hospital

In February 2020, when Brant Ward was re-opened, the Home Treatment Team continued, with the service funded by the temporary closure of Rochford Ward at Pilgrim Hospital. The reason for this was that Rochford Ward was not fit for purpose, it was on the first floor, which restricted patients access to fresh air. Rochford Ward also had beds in dormitories, which was not conducive to mental health recovery and did not meet the Care Quality Commission standards for care environments, for example it was difficult to protect the privacy and dignity of patients in this setting. Re-provision of Rochford Ward would have required require capital investment and a move to a ward on the ground floor.

The closure of Rochford Ward meant that patients who needed an inpatient bed would need to travel to Lincoln, instead of travelling to Boston. However, the Home treatment Team would continue to work to reduce hospital admissions.

Page 64 Previous Committee Consideration

All the above developments were reported to this Committee, with details available at the links listed:

 17 April 2019 https://lincolnshire.moderngov.co.uk/ieListDocuments.aspx?CId=137&MId=5365&Ver=4

 22 January 2020 https://lincolnshire.moderngov.co.uk/ieListDocuments.aspx?CId=137&MId=5530&Ver=4

 22 July 2020 https://lincolnshire.moderngov.co.uk/ieListDocuments.aspx?CId=137&MId=5536&Ver=4

2. Home Treatment Team Service and Consultation

Over the last three years Lincolnshire Partnership NHS Foundation Trust (LPFT) has carried out several engagement events working with patients, staff, governors, public, partner organisations and clinicians to consider and develop its Older People and Frailty Mental Health Services. This has included activities ranging from the co-production of a Carers Pathway for Older People; and their families using our services to the setting up of an Older People Advisory Group to work with staff and help shape services.

Events have taken place at a variety of locations across Lincolnshire and more lately online due to Covid-19 restrictions. (For a full list of engagement events see Appendix A)

People told us:

 They need to have services that work after 5.00pm and weekends.  They prefer to be treated in their own home.  They wanted us to involve carers and family in pathways of care.  They wanted to avoid out of area admissions.  They wanted us to get on with doing it!

What did we consult on?

We specifically asked for views on the plans for the Home Treatment service to provide a permanent county wide service. This means that Rochford Ward at Pilgrim Hospital will no longer be required. All patients will be cared for in accordance with needs but will have the option of home treatment team support if risks can be managed within a community setting but people will still have access to an inpatient bed if required.

Page 65 What is the Home Treatment Team?

The team provides an alternative to hospital for older people with complex and severe mental health needs who can be managed safely in the community setting with enhanced and intensive bespoke support; available seven days a week. It is made up of a psychiatrist, mental health nurses, occupational therapy, physiotherapist and support workers, who provide practical assistance for people in our care.

What do they do?

They work closely with the patient, their family or carer and other professionals (such as the existing Older Peoples Community Mental Health Teams (CMHTs) to provide intensive support, assessment and treatment during periods of increased need; when the care of the CMHTs alone is not enough. The Home Treatment Team works with and supplements the existing community support to provide more intensive and frequent support, to work with the patient and family in their own home and community; to draw on their strengths and skills to improve and maintain their mental health and independence.

While under their care, patients can access the team seven days a week 8.00am – 8.00pm Monday to Friday and 10.00am – 6.00pm Saturday and Sunday.

The care they provide is short term, intensive and flexible to meet individual needs. The length of time will be agreed with the patient, their family, carers and the community mental health team.

The Home Treatment Teams Aims

The team will help patients manage and resolve this stage of their illness through assessment and treatment in their home as an alternative to hospital admission. They also support people being discharged from psychiatric hospital, helping them to continue their recovery at home.

The Home Treatment Service provides:

 An alternative to hospital for older people with severe and complex mental health needs.  Close monitoring of patient’s mental health.  Support, education and advice for patients and their family/carer.  Help with managing medication management.  Help with personal care if this has been impacted on by the patient’s mental health.  Assessment of activities of daily living.  Support with effective coping strategies.  If the patient has a care team, the Home Treatment Team will work closely with them to make sure the patient has the best possible care.  Where someone is not currently receiving Trust services but requires longer term support, the team will refer them to the most appropriate service(s) to meet their needs.

Page 66 How did the Home Treatment Team begin?

A major refurbishment of one of our older adult mental health wards in Lincoln (Brant Ward), presented the opportunity to pilot a new home treatment model during October 2018 which delivers increased community support, enabling service users to stay at home safely. This has greatly reduced the need for people to be admitted to hospital and the number of beds required; enabling the provision of the enhanced community offer over seven days and extended hours of access. The service has received positive feedback from service users, carers, our partners and clinical staff.

The Home Treatment Team has evidenced that fewer people need to be admitted to hospital and thus we need fewer inpatient beds. For those people where home treatment has not proved effective, we are able to use the best of our inpatient wards for our patients.

Why do we need to make these changes?

Like many NHS organisations up and down the country, we are working hard to transform services so that they are better for patients, deliver the right care, in the right place, first time and improve value for money.

This is a difficult balancing act, especially in a large area such as Lincolnshire where many people’s homes are spread across the countryside and in small villages. The development of increased community support aligns with national, regional and county priorities to provide greater support direct to people’s own homes and communities and reduce the number of people unnecessarily admitted to hospital.

Why do we want to make the Home Treatment Service permanent?

The home treatment service has clearly demonstrated that there is no longer a need for the number of in-patient beds previously provided without the extended community support offered by the home treatment team. This means that the beds previously provided by Rochford Ward are no longer required. Furthermore, Rochford Ward does not meet essential quality standards for mental health wards, because it is based on the first floor and has no access to safe outside space. The ward has dormitory style bedrooms with issues of privacy, dignity and safety for patients. This is something which has also been identified by the Care Quality Commission in various national reports and during their inspection of Trust premises.

Given these outcomes and factors, Lincolnshire Partnership NHS Foundation Trust is proposing that Rochford Ward would no longer be used and instead we would only use the recently refurbished modern, accessible and therapeutic space at Brant Ward as the main older adult mental health unit for those fewer patients who do still need to be admitted to a hospital bed. This consultation gathered public, service user, staff and stakeholder views on this proposal.

Page 67 3. Supporting Information:

Admission Avoidance

Since the commencement of the Older People Home Treatment Team, of the 394 referrals to the team only 28 (7%) of these patients required progression to in-patient admission. This represents a potential 93% of patients being able to be treated in the comfort and familiar surroundings of their own home and family.

Reduction in Out of Area Patients

For the six months prior to the introduction of the Home Treatment Team (April to September 2018) nine patients had to go out of area (an average of 1.3 per month). This compares with the 19-month period following the introduction of the team when only ten patients required access to out of area beds (an average of 0.5 per month).

Before the creation of the Home Treatment Team the average days out of area for older people was 23 days, compared to an average of 14.5 days whilst the team has been operating.

Patient Experience

The patient experience of the Older People Home Treatment Team has been consistently high. Based on the nationally utilised patient experience Friends and Family Test (FFT); the recommendation rate for the team has remained above 95%, within which the recommendations have been either extremely likely or likely to recommend the service (based on 203 responses). There has also been a reduction in the amount of medications required and used and a significant reduction in the number of patient incidents and improved clinical outcomes for patients and carers accessing Older Adult Home Treatment Service.

Consultation feedback from events held online on the 14, 18 and 20 January 2021 captured in common themes.

Carers Support

 Carers need support with signposting – often carers don’t know they are a carer; support with form filling and community groups.  The HTT can support carers alongside the patient - carers interaction is not often enough; carers need intervention as much as the patients.  Support carers to navigate inpatient elements – what happens on the ward and why? Support for carers when visiting the ward; more information.  Carers involvement in care planning and discharges and MDT’s.  Technology support for carers.  Developments in OP services for carers including Carers Leads, Leaflets, Accreditation, Triangle of Care, Co-produced Carers Pathway.

Page 68 Advanced Care Planning & Pathways

 Patients to have a choice of home or hospital treatment.  Receiving home treatment gives continued connections with the community for both patients and carers.  Person centred care.  Patients treated with dignity and respect.  Carers to be involved in care and discharge planning.  Joined up working is key so that patients and carers don’t have to keep retelling their story.

Communication of Services

 There needs to be some mapping to bring all the services together across the county to model what works well to support patients and carers.  Work needs to be done with GP’s, so they are aware of the services in the county.  Carer shared they weren’t aware of Admiral Nurse service or their support.  Within LPFT we now have the Dementia Support Service which is a signposting service to support carers.  Having access about information of who carers can contact and even have support with a call.

Development of a Dementia Home Treatment Team

 DHTT has commenced for a 6-month pilot.  Dementia patients do not recognise the time of day so could effectively need support 24 hours of the day.  For elderly patients the thought of leaving their home and loved ones is very distressing. To be able to stay at home with support and keeping their independence and control through the support of OT’s and physiotherapists helping to adapt to their environments, keeping routines the same through support and taking patients to appointments.  A patient with dementia feels safer at home but unfortunately some carers don’t always feel safe at home.

LPFT working with community partnerships

 Ensuring we are working with our community links and knowing what networks are in the county and how to signpost to them, this will help us to broaden our treatment plans.  Links with community partnerships have improved since the introduction of the HTT.  The ability to still relate to the external world, to continue to pursue things that have meaning and interest.  There needs to be some mapping to bring all the service together across the county to model what works well to support carers.

Page 69 Transport and Technology

 Challenges for rural areas with transport.  People struggle with transport and having to use technology to organise transport for appointments.  Difficult for people with a visual impairment.  Can inhibit people accessing services?  Better connectivity between different transport options to help patients to get to a range of appointments.

PROPOSAL: To extend the Home Treatment service to provide a county wide service. This means that Rochford Ward at Pilgrim Hospital will no longer be required. All patients who would have been admitted here will in future be cared for in their own homes.

Agreement from the majority – no objections.

Feedback positive that people would like the HTT service to continue. No comments received regarding Rochford ward. Ideally you would find a new space to replace Rochford Ward given the number of older people increasing to replace the unit but keep the HTT going as they are delivering fabulous work. I don’t think it is tenable given the increasing aging population in Lincolnshire not to replace the ward eventually and you don’t want the HTT to become a “sticking plaster”.

HTT amazing service – huge well done with all the work you do!!

Online Survey 10 February – 31 March feedback report Extract from full survey response on the proposal question.

9a - 9a. Proposal: For the home treatment service to provide a permanent countywide service. This means that Rochford Ward at Pilgrim Hospital will no longer be required. All patients will be cared for in accordance with their needs but will have the option to be cared for by the home treatment team if their care can be managed within a community setting. People will still have access to an inpatient bed if required.

Strongly Agree 50.00% Agree 42.11% Disagree 0.00% Strongly Disagree 2.63% Don't Know 5.26%

Page 70 9b - 9b. Please tell us why you agreed or disagreed with the proposal and if you have any other suggested proposals. Word Cloud detects common themes from the open text.

9c - 9c. Please indicate below the impact that the proposal may have on you

Positive Impact 36.11% No Impact 30.56% Negative Impact 5.56% Don't Know 27.78%

9d – 9d Please tell us the reason for your answer. Word cloud detects common themes from the open text.

Page 71 4. Conclusion

The Committee is required to consider the information presented on the Older Adult Services Home treatment Team and the engagement and consultation responses on the proposed closure of Rochford Ward at Pilgrim Hospital, Boston.

5. Appendices

These are listed below and attached at the back of the report Appendix A Older People and Frailty Services Engagement Work Plan

6. Background Papers

No background papers within Section 100D of the Local Government Act 1972 were used in the preparation of this report.

This report was written by Jane Marshall, Director of Strategy, People and Partnerships, Lincolnshire Partnership NHS Foundation Trust, who can be contacted via [email protected]

Page 72 APPENDIX A Older People and Frailty Services Engagement Work Plan

Date Delivery Method Audience Activity Engagement Events Focus Group Service users, carers, families, Starting a conversation about 12th December 2017 Having a Conversation providers and interested how to improve services people in Grantham Focus Group Service users, carers, families, Starting a conversation about 14th December 2017 Having a Conversation providers and interested how to improve services people in Skegness Workshop Staff To engage with staff about the 19th December 2017 Page 73 Page potential changes Focus Group Service users, carers, families, Starting a conversation about 3rd January 2018 Having a Conversation providers and interested how to improve services people in Spalding Focus Group Service users, carers, families, Starting a conversation about 8th February 2018 Having a Conversation providers and interested how to improve services people in Lincoln Focus Group Service users, carers, families, Starting a conversation about 14th March 2018 Having a Conversation providers and interested how to improve services people in Boston Focus Group Service users, carers, families, Follow up – requesting a conversation providers and interested 12th April 2018 Starting to shape feedback about next steps and support for a people in Lincoln cross county service.

Date Delivery Method Audience Activity Engagement Events Focus Group Service users, carers, families, Follow up – requesting a conversation providers and interested 8th May 2018 Starting to shape feedback about next steps and support for a people in Grantham cross county service. Focus Group Service users, carers, families, Follow up – requesting a conversation providers and interested 15th May 2018 Starting to shape feedback about next steps and support for a people in Spalding cross county service. 3rd October 2018 Staff Carers Pathway Staff Looking at the Clinical Pathway 3rd Sector Event Providers/Groups Feedback and information 19th October 2018

Page 74 Page sharing Summer 2018 Questionnaire Carers To develop the carers pathway September – December 2018 Newsletters Stakeholders To update Carers Pathway Carers, patients, providers, Making the clinical pathway more 21st November 2018 staff user friendly

Date Delivery Method Audience Activity Conversations about the Home Treatment Team 1st July 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Grantham 2nd July 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Skegness

Date Delivery Method Audience Activity Conversations about the Home Treatment Team 30th July 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Louth 31st July 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Lincoln 8th August 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Boston th Page 75 Page 14 August 2019 Focus Group Service users, carers, families, Feedback and information Having a Conversation providers, staff, third sector sharing and interested people in Spalding

Date Delivery Method Audience Activity Consultation Events 14th January 2021 Consultation Event Service users, carers, families, Feedback on proposal and providers, staff, third sector information sharing and interested people in Older People & Frailty Services 18th January 2021 Consultation Event Service users, carers, families, Feedback on proposal and providers, staff, third sector information sharing and interested people in Older People & Frailty Services 20th January 2021 Consultation Event Service users, carers, families, Feedback on proposal and

Page 76 Page providers, staff, third sector information sharing and interested people in Older People & Frailty Services

Date Delivery Method Audience Activity Older Adult Advisory Group Meetings 11th September 2019 Older People Advisory Group Service users, carers, staff and To act as a critical friend to the third sector Older Adult Service 6th November 2019 Older People Advisory Group Service users, carers, staff and To act as a critical friend to the third sector Older Adult Service 22nd January 2020 Older People Advisory Group Service users, carers, staff and To act as a critical friend to the third sector Older Adult Service The Older Adult Advisory Group meetings were postponed in March 2020 due to COVID-19 restrictions. These will commence again when restrictions have been lifted.

HEALTH SCRUTINY COMMITTEE FOR LINCOLNSHIRE 21 JULY 2021

Conclusions on LPFT Items

Lincolnshire Child and Adolescent Mental Health Services Crisis and Enhanced Treatment Team

(1) To note the information in the evaluation of the pilot CAMHS Crisis and Enhanced Treatment Team.

(2) To request that the Lincolnshire Partnership NHS Foundation Trust provides the Committee with its Three Year Recovery Roadmap and an analysis of complaints and compliments.

(3) To support in principle the proposal that the CAMHS Crisis and Enhanced Treatment Team becomes the permanent model of care in Lincolnshire, with a recommendation to Lincolnshire Partnership NHS Foundation Trust, and NHS England and NHS Improvement that:

(a) they continue to monitor the number of Lincolnshire young people being treated at out-of-county general adolescent units, with particular reference to any increases in demand for places in these units arising from the pandemic; and

(b) they seek to report any significant and sustained increases in demand for out- of-county general adolescent unit to this Committee.

Older Adult Mental Health Services – Home Treatment Team

(1) To note the information presented on the Older Adult Mental Health Services Home Treatment Team.

(2) To support the proposal from Lincolnshire Partnership NHS Foundation Trust to make the closure of Rochford Ward at Pilgrim Hospital permanent, with the continuation of the Home Treatment Service, with a recommendation to the Trust that it continues to monitor the demand for older in-patient beds, particularly from the east of the county.

LPFT General Update

(1) To note the information presented by Lincolnshire Partnership NHS Foundation Trust and thank all the staff at the Trust for their continued efforts during the Covid-19 pandemic.

(2) In future, rather than receive general updates, to focus on specific mental health topics.