Agenda and minutes
Venue: Committee Rooms 1 and 2, Brent Town Hall, Forty Lane, Wembley, HA9 9HD. View directions
Contact: Elly Marks, Democratic Services Officer, 0208 937 1358, Email: Elly.Marks@brent.gov.uk
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Declarations of personal and prejudicial interests Members are invited to declare at this stage of the meeting, any relevant financial or other interest in the items on this agenda. Minutes: None declared |
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Minutes of the previous meeting PDF 86 KB Minutes: RESOLVED:-
that the minutes of the previous meeting held on 15th July 2009 be approved as an accurate record of the meeting. |
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Matters arising (if any) Minutes: None |
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Deputations (if any) Minutes: None |
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Audit Commission Review of addressing Health Inequalities in Brent PDF 66 KB The Audit Commission has completed a report into Health Inequalities in Brent. This will be presented to the Health Select Committee for comments. Additional documents: Minutes:
Cathy Tyson (Assistant Director of Policy and Regeneration) introduced a report, written by the Audit Commission, which documented the findings of the Audit Commission’s review into how health inequalities were being tackled by the Council and its partners. She informed the committee that the Audit Commission project was composed of two stages. This review, she explained, had been the first stage of the project. She commented that whilst at borough level the overall health of the population was consistent with the national average, there were areas in the borough where residents were experiencing significant health inequalities.
Cathy Tyson highlighted the key strengths that were identified in the Audit Commission’s review, which included the commitment of partners to tackling health inequalities, the quality of the joint strategic needs assessment and the high level of commitment to performance managing health inequalities. She also brought to the committee’s attention the key areas of development that had been identified by the Audit Commission.
Cathy Tyson informed the committee that the second stage of the project was to carry out development work on an agreed local priority. She stated that, following discussion with the Audit Commission, partners had agreed that the local priority would be how to increase the levels of physical activity in adults. She explained that there had been a big improvement in getting young people involved in physical activity, but that more work was needed to be done to improve the participation of adults.
In the discussion which followed, it was noted that whilst there were a lot of positive aspects to the report, there were areas which needed to improve. The committee asked whether there were lessons Brent could learn from other areas in the country. In response, Neil Sands (Audit Commission) explained that as health inequalities were caused by a multitude of factors, it was difficult to find one area which was doing everything successfully. Instead, he argued that they had discovered that there were pockets of good practice and that there were many ways to be successful. He added that it was important that the Audit Commission was not too prescriptive because of the importance of local circumstances. He empathised that there was a need to ensure that a strong, sustainable and consistent approach was used to tackle health inequalities.
It was noted by the committee that one of the areas for development, identified in the review, was to ensure that the Health Select Committee maintained the effective consideration of health inequalities. It was asked, therefore, whether the committee’s work programme would reflect this. In response, Cathy Tyson stated that the committee’s work programme would reflect this. Neil Sands commented that it was important for scrutiny to look at key indicators to ensure that a focus on the key areas was maintained.
Following on from an enquiry as to what would happen next, Cathy Tyson explained that the next part of the project would be to look at improving the level of physical activity in adults. She stated that ... view the full minutes text for item 5. |
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GP Access Survey Results PDF 63 KB Results of the GP access survey for 2008/09 will be presented to the committee to give members an indication of how satisfied members of the public are with GP access in the borough. GP access is an issue that has been of concern to the Health Select Committee in the past and so members are likely to be interested in these results and how NHS Brent and GPs are responding to improve patient satisfaction.
Additional documents: Minutes: Mark Easton (Chief Executive NHS Brent) introduced a report which set out the results of the GP Access Survey for 2008-2009. He informed the committee that patient satisfaction with GP access in Brent had decreased compared to the 2007-2008 results. He explained that this decrease in performance was in line with both national and London averages. He informed the committee that there had been a significant decrease in Brent’s response rate, but that this decrease was also in line with the national and London averages.
Mark Easton informed the committee that, as a result of NHS Brent’s overall performance in the survey, an Access Improvement Transformation Programme would be undertaken. He added that the programme would be carried out internally and that a senior GP had been appointed to lead on the programme. He explained that the programme would use a best practice/shared learning methodology. He informed the committee that there were 27 practices in Brent which had scored below the Brent average and that the programme would begin with these practices, starting with the 10 lowest performing surgeries. He noted that the programme would run until the end of March 2010.
In the discussion which followed, it was asked why performance had declined in some areas. It was also asked whether premium based numbers were a national or a local problem. In response to the first enquiry, Mark Easton explained that he did not want to speculate on the reasons why public satisfaction had declined. With regards to the premium based numbers enquiry, Mark Easton explained that it was a national problem. Following an enquiry about the worst performing surgeries, Mark Easton explained that there was a significant amount of variation between surgeries. He stated that a full analysis, which showed those surgeries that performed the worst, was publically available on the internet. A concern was raised by a member of the committee that the results suggested that there were some GPs who did not care about their patients.
Mark Easton noted that there were a number of GPs who would question the methodology used for the survey as there was such a low response rate. Dr Helen Clark (Chair of Brent Local Medical Committee) explained that she was concerned by the significantly low response rate of the survey and the effect that this could have on the results of the survey. She added that she welcomed the fact that the improvement programme was to be run internally rather than by external consultants and she emphasised that steps were already being taken to improve access for patients. Mark Easton commented that the areas which scored the best tended to be those areas which had the most participants in the survey. It was noted by the committee that it was unfortunate that the results did not reflect the success of the extended hours initiative which had helped improve access for patients.
It was asked whether the survey could also capture qualitative as well as quantitative feedback. In response, Mark ... view the full minutes text for item 6. |
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The Health Select Committee has asked for an update on the smoking cessation service in Brent. The Health Select Committee has agreed previously to monitor progress of the smoking cessation programme because of its importance to the health of people in Brent. NHS Brent has provided a brief update on the performance of the service in the first half of 2009/10.
Additional documents: Minutes: Mark Easton (Chief Executive NHS Brent) provided the committee with an update on the progress of the smoking cessation service in Brent. He explained that a briefing note had been provided to the committee which summarised the performance of the service in the first half of 2009/2010. He stated that Brent PCT had, over the last couple of years, invested a lot of money into smoking cessation and that whilst this was having some impact, it had not had the impact which had been hoped for. He explained that whilst the numbers who had stopped smoking had doubled, the numbers had been very small to begin with.
Mark Easton informed the committee that they had been running an incentive scheme whereby a financial reward was provided, to those who had delivered the stop smoking service, when the client registered with the service and once the client had quit for a certain period of time. He explained that whilst they had thought that a generous scheme would raise the number of quitters, it had not reached the numbers that they had expected it would. Mark Easton stated that the more successful PCTs had been those which had used their Smoking Cessation Teams to proactively reach out and target communities. He stated that consideration needed to be given as to whether the emphasis should be switched from individual pharmacists and GPs to this approach. He added there was currently an under-spend in the smoking cessation budget which could be used for this.
In the discussion which followed, an enquiry was made as to who had been delivering the stop smoking service. It was also asked how long it would be until Brent PCT started to consider a move away from the rewards based system. In response to the first enquiry, Mark Easton explained that it was GPs and Pharmacists who had been delivering the service. In response to the second enquiry, Mark Easton explained that it may be that they would keep using the reward based scheme but that the remaining resources would be used to commission other services to support the current approach. He added that he would not want to dis-incentivise those GPs and pharmacists who were helping people to quit.
Cathy Tyson (Assistant Director of Policy and Regeneration), following an enquiry, explained that smoking cessation remained a local priority in the LAA but was not one of the basket of indicators which was linked to the reward grant. Mark Easton commented that smoking cessation was one of the best ways to decrease health inequalities. Cathy Tyson highlighted that there was huge variation on smoking rates in the borough, but that smoking was generally more prevalent in the borough’s deprived areas.
Following a query about using dentists and opticians, Mark Easton explained that interested opticians and dentists had recently been invited to become providers of the stop smoking service. With regards to community groups, he stated that other PCTs were targeting community groups successfully and whilst it was not ... view the full minutes text for item 7. |
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Acute Services Review PDF 58 KB The Health Select Committee has received reports on the acute services review at its previous meetings and members have also attended a briefing at the Harrow Overview and Scrutiny Committee on plans for paediatric and emergency surgery services at North West London Hospitals Trust. Officers from NHS Brent and North West London Hospitals Trust will attend the committee to update members on the project and also to give a pre-consultation presentation.
Since the committee met last an independent clinical review has taken place on the provision of emergency surgery services during the day at Central Middlesex Hospital. Further information on this development is included in a letter to Councillor Chris Leaman, included as an appendix to this report.
In addition, the chair of the committee had asked for the views of the Local Medical Committee on the acute services review. A letter from Dr Helen Clark, chair of the Brent LMC is also included as an appendix to this report. Additional documents:
Minutes: Fiona Wise (North West London NHS Hospitals Trust) provided the committee with an update on the reconfiguration of emergency surgery and paediatric services across Brent and Harrow as part of the Acute Services Review.
The committee was made aware of the letter from Mark Easton (NHS Brent) to Councillor Leaman which set out the reasons for the decision, following the independent clinical review by the National Clinical Advisory Team, to stop emergency surgery at Central Middlesex Hospital. Fiona Wise explained that the London Ambulance Service would instead be taking patients to Northwick Park Hospital or another major acute hospital if closer than Northwick Park Hospital. The cessation of emergency surgery services at Central Middlesex Hospital would result in 7-10 patients per week requiring transfer from Central Middlesex Hospital to Northwick Park Hospital. She emphasised that high risk surgical work had already been moved to Northwick Park Hospital. She commented that Central Middlesex Hospital would remain a busy local hospital. This, she added, was all due to commence in December 2009.
Fiona Wise informed the committee of the implementation plan which was in place to ensure that the process ran smoothly. She explained that work had been carried out which looked at what was needed at Northwick Park Hospital not just to support the extra 7-10 patients per week but also how to support surgery generally. She concluded by providing the committee with some of the quality indicators that had been agreed between the PCTs. She added that this was subject to weekly reviews in the first instance.
In the discussion which followed around emergency surgery, it was asked whether the establishment of a new stroke unit at Northwick Park Hospital would have an effect on things, particularly capacity at the hospital. It was also asked what would happen with emergency surgery on children. Furthermore, an enquiry was made as to how these changes were to be communicated to people as consultation had not taken place. In response to the first question, Fiona Wise explained that the stroke unit would not affect things as there were separate plans in place for this. With regards to the second question, Fiona Wise explained that emergency surgery on children did not currently take place at Central Middlesex Hospital anyway. In response to the third issue, she explained that a draft communication plan was in place. Mark Easton added that it was important to ensure that the GP community were fully involved in the process and that they understood the new service. It was also important, he added, that people were reassured that the changes did not undermine Central Middlesex Hospital as an acute site. Fiona Wise also reiterated, following a question about the role of the ambulance service, that the ambulance service would decide where the closest place was to take a patient.
Fiona Wise then went on to update the committee about the proposed paediatric services reconfiguration. This she explained was a piece of work which was still being undertaken. She began by ... view the full minutes text for item 8. |
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Major Trauma and Stroke Services - Update on final report of the Joint Overview and Scrutiny Committee and decisions from Joint Committee of PCTs Andrew Davies, Policy and Performance Officer, will provide a verbal update on the outcome of the Joint Committee of PCTs meeting on 20th July 2009 where decisions were made on the future of major trauma services and stroke services in London. The decisions that will have the biggest impact on Brent residents was confirmation that a major trauma centre will be located at St Mary's Hospital and a Hyper Acute Stroke Unit will be located at Northwick Park Hospital. Further details will be provided at the meeting.
Minutes: Fiona Wise (North West London NHS Hospitals Trust) updated the committee on the service reconfiguration across Brent & Harrow with regards to stroke services. She informed the committee that, following the outcome of the Joint Committee of PCT’s meeting on the 20th July 2009, North West London Hospitals Trust had been designated as one of London’s 8 Hyper Acute Stoke and 24 stroke units. She explained that there would be 16 hyper acute stroke unit beds and 34 stoke beds established at Northwick Park Hospital. She noted that major ward refurbishment was required and would be completed by 1st February 2010. She also stated that 10 stoke beds would be decommissioned at Central Middlesex Hospital by 31 March 2010. She provided the committee with the detailed timetable of these activities.
Fiona Wise also provided the committee with an update on the recruitment required for the service reconfiguration. This included the fact that a stoke consultant had been appointed last week and that interviews for a second post would take place in December this year. She commented that the service reconfiguration would lead to the trust being able to offer an enhanced level of service for stoke patients.
Andrew Davies (Policy and Performance Officer) updated the committee on the service reconfiguration across Brent & Harrow with regards to major trauma. He stated that, following the outcome of the Joint Committee of PCT’s meeting, a major trauma centre was to be commissioned at St Mary’s Hospital by April 2012. He explained that the joint Overview and Scrutiny committee would be hearing more on the proposed trauma service at its meeting on 28th October 2009.
RESOLVED:-
that the verbal updates on major trauma and stroke services be noted.
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NHS Brent has provided the Health Select Committee with an overview of progress in implementing Healthcare for London, which forms a major part of its strategic planning of health services in the borough. The report covers progress in refreshing the organisations Commissioning Strategy Plan, developed in 2008/09, as it needs to be amended to reflect the changing economic situation in the country. It also has to align with wider health priorities in North West London and to reflect the Healthcare for London's care pathways.
The Committee will be given an overview on the work to develop primary care services in the borough, following on from previous items on the Primary Care Strategy. Members will also have an opportunity to consider the developments at the Stag Lane Clinic, which NHS Brent is to close in the near future. The Committee will be able to discuss this in the wider context of the primary care commissioning plans for Brent.
Additional documents: Minutes: Mark Easton introduced the presentation pack which provided the committee with an overview of the progress made in implementing ‘Healthcare for London’. Mark Easton reminded the committee that in 2008/09 NHS Brent developed its Commissioning Strategy Plan which set out a 5 year investment programme. He noted that it was held by Healthcare for London as being one of the best strategies in London. However, he explained that due to changing circumstances, NHS Brent were having to review the plan to ensure that it was aligned with others across North West London and so that it could still support progress towards delivering the goals and outcomes in the changing economic environment. He stated that because last years plan was so good, NHS Brent was committed to retaining the same goals.
Mark Easton explained that NHS Brent was redefining the Commissioning Strategy Plan to align with the 8 ‘Healthcare for London’ Pathways. The presentation pack, he explained, highlighted the case for change, the progress made to date and the plans for the next stage for each of the pathways. He stressed the importance of the polysystem vision and model as underpinned by the Primary and Community Services Strategy. He explained that the presentation pack showed the emerging polysystem sites and explained future plans. He stated that the overarching Polysystem Implementation Model together with the plan for consultation and implementation would be included in the revised Commissioning Strategy Plan. He stated that the signed-off Commissioning Strategy Plan had to be submitted on the 18th December and that in the meantime a series of engagement activities would be taking place.
Following a request by the committee, Mark Easton took the committee through the financial context in which the commissioning plans would be delivered, as shown from slide 40 onwards in the presentation pack. He brought to the committee’s attention the three possible financial scenarios that were being looked at, which were the ‘base case’, the ‘upside’ and the ‘downside’ scenario. He stated that all three scenarios had been built on a ‘do nothing’ basis from 2010/11, which he explained meant no further investment or savings programme. He commented that all three scenarios indicated that if a do nothing approach was used, there would be a budget deficit. He then set out the level of savings or disinvestment which was required to achieve a sustainable financial position under all three scenarios.
Mark Easton informed the committee of some of the ‘Healthcare for London’ initiatives which could be undertaken to achieve the savings required. He then explained how the slides in the presentation pack showed how the Healthcare for London model had been applied to Brent specifically and the savings that could be made by each initiative. He concluded by explaining that if the Healthcare for London savings were achieved, in all scenarios except the downside scenario, the budget would move back into balance. He stated that additional savings would be needed in the case of the downside scenario in order to reach a ... view the full minutes text for item 10. |
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Health Select Committee Work Programme PDF 109 KB This report sets out a list of items for inclusion in the Health Select Committee work programme in 2009/10 Minutes: Andrew Davies (Policy and Performance Officer) updated members on the committee’s work programme for 2009/10 and informed members to contact himself or the Chair if they had any items that they wanted adding to the programme. He explained that the agenda for the 9th December meeting would be altered to incorporate the issues raised at this meeting.
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Any Other Urgent Business PDF 24 KB Notice of items to be raised under this heading must be given in writing to the Democratic Services Manager or his representative before the meeting in accordance with Standing Order 64. Additional documents: Minutes:
In accordance with Standing Order 64, the Chair introduced a report which set out the proposed changes to service in the provision of shared care services for children with cancer. He explained that, as a committee, they were being asked to consider whether the proposed changes amounted to a substantial variation in service that should be subject to formal consultation. The chair explained that the report was being considered under this item because a decision was required as a matter of urgency.
Andrew Davies (Policy and Performance Officer) informed the committee of the changes being proposed. He highlighted that the number of patients affected, as shown on page 2 of the report, was small. He added that 5 out of the 8 equivalent committees, who had already discussed the changes, had agreed that formal public consultation did not need to be carried out as there would not be a substantial variation in service. In the discussion which followed, an enquiry was made as to whether the consultation, if it was to go ahead, would be carried out on a North West London basis. In response, Andrew Davies stated that he expected it would be done on a North West London basis, but that he would need to check that this was the case.
After consideration the committee decided that as the proposals did not amount to a substantial variation in service and affected only a small number of patients, it would not be necessary to carrying out formal consultation.
RESOLVED:-
the committee agreed that the proposals did not amount to a substantial variation in service and therefore formal consultation was not required.
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Date of Next Meeting The next meeting of the Health Select Committee is scheduled for Wednesday 9th December 2009
Minutes: It was noted that the next meeting of the Health Select Committee was scheduled for Wednesday 9th December.
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