The Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee met to discuss NHS transformation, a digital pilot project by the East Midlands Ambulance Service (EMAS), and shared care records. The committee noted the NHS transformation plans and requested more information on key performance indicators (KPIs) and GP access. The committee also heard about a digital pilot project from EMAS and a presentation on shared care records from the Leicestershire Partnership NHS Trust (LPT).

NHS Transformation and Financial Challenges

The committee received an update on the financial position of the NHS in Leicester, Leicestershire and Rutland (LLR), where the local NHS budget is approximately £2 billion. The NHS has been tasked with making £190 million in efficiency savings this year, building on £150 million saved the previous year.

Rachna Patel, Senior Communications & Public Affairs Lead for Communications and Engagement team at NHS Leicester, Leicestershire and Rutland, explained that the savings would be achieved through:

• Reducing duplication of services
• Relocating services
• Providing more care closer to patients' homes

Councillor Zuffar Haq questioned how the NHS would achieve another 10% in savings, and Councillor Phil King voiced concerns that the same message about making efficiencies is delivered every year without clear evidence of achievements.

Patel offered to provide a year-end report to the committee, detailing progress made across health and care in LLR. She highlighted the opening of 26 mental health wellbeing cafes and improvements in learning disability health checks as examples of progress.

Councillor Melissa March raised concerns about potential job losses within the Integrated Care Board (ICB) and the impact on staff morale. Patel acknowledged the difficulty of the situation, explaining that the government is asking every level of the NHS to become more efficient and reduce duplication. She said that the Department of Health and Social Care and NHS England would eventually merge, requiring ICBs to revert to a strategic commissioner role.

Councillor Liz Sahu asked about recruitment, and Patel clarified that there has been a recruitment freeze, with internal staff being moved to fill critical roles.

Councillor James Poland questioned at what point efficiencies would negatively affect patients, particularly regarding GP services. Patel responded that there isn't an official national number for GP-to-patient ratio, but the local medical committee is working towards a clinical contact of 75 per thousand population.

Councillor Karen Pickering asked what steps were being taken to reduce reliance on agency and bank staff. Representatives from LPT and University Hospitals of Leicester (UHL) outlined measures to manage the workforce, increase substantive recruitment, and stabilise staffing on wards.

King asked about the quantum of running costs and the KPIs for measuring efficiency. Patel clarified that the £190 million savings target was separate from the 33% reduction in ICB running costs, which amount to approximately £10 million out of a £30 million budget. Pete Biddex explained that the system executive group uses an operational plan with agreed KPIs to track progress, and that a review would be brought to the committee at the end of each year.

Janet Underwood asked for a breakdown of primary care appointments with doctors versus other professionals. Patel stated that 60% of appointments are with GPs and 40% with other staff. She offered an in-depth session on general practice.

Councillor Nags Agath asked what kind of staff the ICB was looking to reduce. Patel clarified that the reductions would be in non-patient-facing roles such as strategy, finance, and contracting.

Councillor Samantha Harvey asked whether increased GP appointments had reduced presentations at secondary care settings. Patel responded that there were still 211 to 250 patients presenting at the emergency department who could have been seen elsewhere, indicating a need for a primary care stream on that site.

Patel confirmed that safeguarding services were earmarked for transfer, but that no services would be moved without the receiver being ready and the transfer being safe. She also stated that local authorities and voluntary sector partners were being engaged in shaping and delivering the transformation plans, but that the ICB was waiting for more information from the Department of Health and Social Care.

Councillor Lucy Stephenson asked what the transformation meant for patients and how residents would be reassured. A representative responded that there would be no changes to public services and that communication channels would be used to reinforce this message.

King raised concerns about the postcode lottery of access to minor injuries units and the potential impact of local government reorganisation on service transfers. Patel acknowledged the uncertainty and reiterated that safety would be the primary concern.

Digital Stroke Triage Project

Mark Dixon, Senior Manager for Quality for East Midlands Ambulance Service (EMAS), presented a digital initiative piloting stroke video triage with a stroke consultant.

Dixon explained that stroke is a leading cause of death and disability, and that timely diagnosis and treatment are critical. However, only 31% of patients identified by EMAS as potentially having a stroke actually turn out to have one. The pilot project aims to improve the accuracy of pre-hospital stroke diagnosis and ensure that patients receive the right care in a timely manner.

The pilot involves ambulance clinicians using iPads to conduct video consultations with stroke consultants, who can then help determine the appropriate course of action. Since its launch in January 2024, the project has conducted 293 successful consultations, with 28% of patients not being conveyed to hospital at all. Of those patients who were pre-alerted to the hospital as likely stroke cases, 51% were confirmed as having a stroke.

Dixon noted that the project has faced challenges, including difficulties in getting EMAS and UHL Microsoft Teams systems to communicate with each other. However, these challenges have been largely overcome through the use of Power Automate and Microsoft Power Apps.

The project has also identified health inequalities, with higher numbers of strokes being seen in areas of higher deprivation. EMAS is now working with communities and primary care partners to support stroke prevention efforts.

Councillor Harvey asked about the impact of Wi-Fi connectivity in rural areas. Dixon responded that the iPads can roam across different networks and that crews can move to areas with better signal if necessary.

March asked about the Integrated Stroke Delivery Network (ISDN) and the funding received. Dixon clarified that the ISDN oversees stroke care provision and that the project received £100,000 initially, with an additional £150,000 to expand it to other counties.

A member of the public, Cashboy Arlene, noted that a similar GP hotline scheme had been run 10 years ago and questioned why the corporate memory had been lost. Patel responded that a similar service, Consulting Connect, is now in place, but that there is a need for better communication and coordination of different initiatives.

Councillor Poland asked what the total number of calls was that resulted in the three to four unanswered calls per week. Dixon said that there had been 293 successful consultations.

Councillor Haq raised concerns about the use of private ambulances and the need to train their crews in the video triage process. Dixon responded that EMAS is working to address this issue.

Councillor King declared an interest as his wife works for the Stroke Association. He noted that remote medicine has been used around the world for a long time and that it is important to ensure that patients receive adequate support after a stroke.

Shared Care Records

David Williams, Group Director of Strategy and Partnerships, the Leicestershire Partnership Trust, and Laura Gottschalk, Chief International Officer for the ICB and Digital Strategy Officer for the Leicestershire Partnership Trust, presented an update on the LLR Care Record, a system-wide programme that brings together data from health and social care organisations into one viewable location.

Gottschalk explained that the care record is helping to improve decision-making, collaboration, and patient outcomes. She noted that adult social care teams, who have historically been information-poor, are now able to access information about patients' discharge plans and provide more proactive care.

Currently, approximately 1,100 social care users have access to the care record, with reports of saving an average of 30 minutes per login. Other users include LPT, UHL, GPs, EMAS, pharmacy professionals, and Rainbows Hospice.

March asked who within adult social care has access to the records and how the system ensures that carers have access to up-to-date information about patients' needs. Gottschalk responded that access is currently prioritised for front door teams, mental health workers, learning disabilities teams, and rapid response teams. Care homes and auxiliary care are on the roadmap for future integration.

Harvey raised concerns about the privacy of looked-after children, whose lives are extensively documented in Liquid Logic. Gottschalk reassured the committee that access to the care record is limited to health and social care professionals for direct care purposes only and that role-based access controls are in place.

King expressed disappointment that the update was not a written report and requested a pathway diagram showing how the system works. He also asked whether users can see their shared care record and what measures are in place to ensure GDPR compliance.

Poland asked whether the system included carers. Gottschalk clarified that it included more official people, such as GPs and council staff, but that there were plans to include carers in the future.

Other Business

Harvey raised concerns about the lack of access to NHS dentists in Rutland, particularly for housebound patients. She described the case of a bilateral amputee with facial disfigurement who was unable to access treatment.

The committee agreed to add dentistry, ambulance service and ambulance waits, A&E waits, GP access, out of hours access and CAMHS to the work programme.