Agenda and minutes

RESOLVED:

That Councillor Colwill be appointed  as Vice Chair of the Scrutiny Committee for the 2014/15 municipal year.

None declared.

The purpose of this report is to update the Scrutiny Committee on the Brent CCG’s assurance process for the closure of the A&E unit at central Middlesex Hospital and Brent changes to related services to ensure a high quality of health care is accessible to residents.

The Chair briefly introduced the item and advised that members had requested a number of supporting documents from colleagues at NHS Brent Clinical Commissioning group (CCG) to assist the committee in undertaking detailed scrutiny of the assurance process for the closure of the A&E unit at Central Middlesex Hospital (CMH). The Chair expressed his disappointment that these documents had not yet been provided to the committee and received confirmation that they would be provided following the meeting.

Councillor Daly asserted that she could not support the plans to close Central Middlesex Hospital Accident and Emergency Department as she been provided with inadequate evidence to make a decision[1]. The Chair reminded the committee that the item related to the robustness of the assurance process for the closure of the A&E at CMH.

David McVittie, Chief Executive of North West London Hospitals Trust (NWLHT), was then invited to present the report to the committee. He advised that the plan to close the A&E unit at CMH pre-dated the Shaping a Healthier Future programme and had related to the under-utilisation of the site, which in turn had reduced opportunities for doctors to develop their skills and had driven recruitment difficulties. It was emphasised that at no time had CMH been unsafe and that average attendances for the A&E unit at CMH was far below that of Northwick Park Hospital (NPH) at 35 per day compared to 250. Admissions at CMH were also significantly lower and could have been reduced further if patients had been treated at NPH where there were additional facilities. Concerns regarding the historic performance of NPH A&E were acknowledged and the meeting was advised that there had been targeted investment in emergency physicians; for example the number of A&E consultants had been doubled to 14 over the past 18 months and two full time emergency surgery consultants had been recruited.

During the subsequent discussion, the committee questioned why the closure of the A&E unit at CMH had not been scheduled to coincide with the opening of the new A&E department at NPH. Members queried when the A&E unit at Ealing Hospital was due to close and sought comment on the recent Care Quality Commission (CQC) inspections of NPH and Ealing Hospital.  Noting the challenges that NPH had previously faced, it was further queried how NPH would maintain and enhance performance and service quality. The committee noted that the closure of CMH would result in a loss of £3.5million and it was queried how this would be recovered. It was also queried whether there was an existing, successful model for a hospital to have a stand-alone Urgent Care Centre.

The committee further questioned whether the figures quoted for average attendances at CMH reflected A&E usage following the implementation of restricted opening hours. Members queried why there were recruitment difficulties at CMH but not at NPH.  Noting that the number of A&E consultants had been increased to 14,  ...  view the full minutes text for item 3.

This report sets out Brent CCG’s plans to transform the way health care is provided in Brent. The context for this proposal is the need to deliver care at a reduced cost while still achieving better patient outcomes. These plans are reflected in the CCG’s five year draft strategy which is intended to put in place more integrated and locally available services and reduce dependance on acute services.

A report updating members on Brent CCG’s plans to transform the way that healthcare was provided in Brent was presented to the committee by Jo Ohlson (Chief Operating Officer, Brent CCG). Members were advised that there were three major transformational programmes which were closely interlinked and formed part of an overarching five year strategy. The first of these,  Shaping a Healthier Future (SsHF) involved the reconfiguration of hospital services and in particular, the development of long term plans for Central Middlesex Hospital (CMH). Jo Ohlson drew members’ attention to the list of proposed services for CMH set out in the report. She emphasised that planning for CMH was at an early stage and that an Outline Business Case was being developed to further explore and refine the proposals. The second programme, Primary Care transformation, aimed to improve access to GPs and make more treatments available in a community setting. Brent CCG, together with North West London CCGs had secured funding via the Prime Minister’s Challenge Fund in April 2014.  This funding would be used to assist GPs in developing their networks in order to provide extended opening hours, weekend opening and better use of technology.

The third programme, whole systems integrated care (WSIC), involved the joining together of health and social care services. Phil Porter (Strategic Director of Adult Social Services) advised that the Brent Early Adopter, WSIC project formed part of the Brent Better Care Fund Plan and was also one of fourteen Pioneer sites for WSIC in England. He emphasised WSIC was underpinned by a holistic vision which focussed on people, their wellbeing and their quality of life, rather than simply a patient’s health needs or a service user’s social care needs. WSIC placed people at the centre of the care that they received and ensured that providers worked together to provide an individualised and seamless service. The primary objective was to improve outcomes for people, for example feeling safe and secure. The Early Adopter project would initially deliver WSIC on a pilot basis for over 75s with one or more long-term conditions who were registered with a Harness or Kilburn GP. A fundamental part of the Early Adopter process was the idea of a ‘capitated budget’, which would enable a locality to know know how much money it has to spend on its population across all services, and decide where to spend money, and which services and support would make the greatest difference.

The committee raised several queries in the subsequent discussion. Members asked what support would be provided to GPs to assist them in carrying out their additional responsibilities. Further information was sought on the development of GP networks and the accessibility of a patient’s named GP to  other medical professionals treating the patient. It was queried whether the £4m from the GPs commissioning funds that had been directed to improving GP networks and interconnectivity was drawn from monies  allocated for the commissioning of hospital services. The committee also sought clarification of how the  ...  view the full minutes text for item 4.

Decisions made by the Cabinet on 21 July 2014 in respect of the following report below were called in for consideration by the Scrutiny Committee in accordance with Standing Orders.

Changes to Recycling and Green Waste Collections

The attached report sets out the decisions of the Cabinet and the call in details. Also attached is the original report that went to Cabinet, together with a supplementary report.

Decisions made by the Cabinet on 21 July 2014 in respect of the following report were called-in for consideration by the Scrutiny Committee in accordance with Standing Order 20.

Changes to Recycling and Green Waste Collections

The decisions made by the Cabinet on 21 July 2014 were:

RESOLVED:

(i)         that approval be given to increasing the frequency of the dry recycling service to a weekly service;

(ii)        that approval be given to the extension of the separate food waste collection service to all street level properties;

(iii)       that approval be given to the introduction of a chargeable garden waste collection service as the means of facilitating these improvements as set out and detailed in section 4 of the report;

(iv)       that the financial and non-financial benefits that will accrue from these changes be noted;

(v)        that approval be given to the amendment to the Public Realm Contract and the minor changes to the contract targets to allow these proposals to go ahead.

The reasons for the call in are:

Whilst not opposing the principle of charging for garden waste, members consider that the system proposed could be improved on.

There was concern at the absence of crucial information in the report including:

o   a proper analysis of options available to the council

o   consideration of up front payment (covering collection and disposal) for recycling bags rather than an annual charge

o   clear financial information regarding risk/gain to Brent Council and Veolia 

o   information about market research undertaken with residents on options likely to achieve good recycling rates

o   how Brent can seek reciprocal arrangements with neighbouring authorities so increasing drop off points. The only site proposed in the report is at Abbey Road

o   learning from other local authorities

o   contamination of dry recycling/kitchen waste

o   monitoring and enforcement

o   communication with residents.

An outline of the suggested course of action of the Scrutiny Committee is to:

o   seek a report responding to the concerns outlined above

o   question lead member and senior officers and the leader

o   if necessary, set up a very brief task finish group to examine these issues in more depth.

Additionally, reference was made to residents’ concerns about the charge and the implications. Further clarification was requested on:

o   the way the decision was made

o   what would have changed within a year of a new contract, to justify such big change or adjustment

o   the framework is in place for monitoring and reporting

o   the financial implications for the council in relation to the scheme.

Whilst not opposing the principle of charging for garden waste, additional concerns were expressed at the absence of crucial information in the report including the failure to:

o   demonstrate VFM (value for money)

o   show financial information containing savings from decommissioning existing garden waste service

o   give financial information regarding risk/gain to Brent Council and Veolia

o   model other alternatives, available to the Brent Council and consider their financial and environmental impact.

Scrutiny Committee is asked to:

o   seek  ...  view the full minutes text for item 5.

This report sets out the proposed scope for the Scrutiny task group on Promoting Electoral Engagement.

The Chair drew members attention to the report setting out the proposed scope for the Scrutiny task group on Promoting Electoral Engagement. The task group had been requested by Members in response to the introduction of individual electoral registration (IER). The task group would focus on proposed actions to promote electoral registration and target those groups who may be adversely affected by the changes and as a consequence could lose their right to vote. The Chair advised that it was proposed that Councillor Nerva would Chair the task group and the remaining membership would be determined subsequently.

RESOLVED:

That the scope and timeline for the task group on Promoting Electoral Engagement as set out in Appendix A to the report be agreed.

This paper sets out the proposed terms of reference for the Budget Scrutiny Panel. The Panel will be responsible for providing scrutiny of the council’s budget proposals as they are developed for the financial year 2015/16 and beyond.

Cathy Tyson (Head of Policy and Scrutiny) presented a report to the committee setting out the proposed terms of reference for the annual Budget Scrutiny Panel. The Panel would be responsible for providing scrutiny of the council’s budget proposals as they were developed for the financial year 2015/16 and beyond. The panel would meet from September 2014 through to March 2015 to review the council’s emerging budget proposals and provide feedback to the Cabinet. A final report would be produced by the Panel reflecting their discussions and findings and submitted to the Cabinet and to Full Council in March 2015.

The Chair noted that a member of the public, Mr Kaye had indicated that he wished to ask a question on this item. Mr Kaye advised that the meetings of the Budget Scrutiny Panel would not be open to the public. He stated that the Panel would be established in place of the former Budget and Finance Overview Scrutiny Committee, the meetings of which had, in contrast, been open to the public. He felt that this had adversely affected the budget setting process and undermined the role of Scrutiny in maintaining the democratic process. Mr Kaye raised a concern that there was no longer a Scrutiny Committee dedicated to scrutinising the One Council Programme[1]. Mr Kaye concluded by requesting that the committee vary the proposed terms of reference to make the meetings of the Panel open to the public.

Cathy Tyson clarified that the Budget Scrutiny Panel had been established annually for several years to support the budget setting process. It pre-dated the new Scrutiny arrangements and did not replace the former Budget and Finance Overview and Scrutiny Committee. The Budget Scrutiny Panel had always been conducted in the same manner and involved meeting with lead members and directors of the council. The findings of the Panel would be reported back to meetings open to the public. Cathy Tyson also explained that the Scrutiny Committee would continue to scrutinise the One Council Programme.[2]

RESOLVED:

That the terms of reference for the Budget Scrutiny Panel as set out in Appendix A to the report be agreed.

Membrs noted the committee’s forward plan for 2014/15.

The next scheduled meeting of the Scrutiny Committee will take place on 9 September 2014.

It was noted that the next meeting of the committee was scheduled for 9 September 2014.  

None.