Agenda item
Palliative and End of Life Care in Brent
This report provides an update for the Overview and Scrutiny Committee on Community Palliative and End of Life Care (EOLC) services in Brent. The report describes demographic data and activity, the current range of local acute and community specialist palliative care services and the CCG’s strategy and commissioning intentions that address some of the challenges in the delivery of EOLC services in Brent
Minutes:
At the invitation of the Chair Rashesh Mehta (Brent CCG) introduced the report on Palliative and End of Life Care services in Brent. The report described End of Life (EOL) service provision in Brent and explained that a recent suspension of in-patient services at the Central London Community Healthcare Trust (CHCLT) Pembridge hospice provided an opportunity to review Brent’s EOL strategy. This review would encompass an evaluation of system capacity and demand for community specialist palliative care services, as well as consideration of whether the Pembridge hospice service was of sufficient quality, was clinically safe and provided good value for money.
Rashesh Mehta further explained that an independent review of the Pembridge hospice service as well as other local services had already been conducted by the commissioner of the service, Central London CCG. The resulting review report detailed a number of options, but recommended the procurement of one lead provider in the community for specialist palliative care services. The review also recommended that that the in-patient provision at Pembridge hospice could be reduced, given that all displaced patients had been accommodated by other hospice providers within existing capacity.
Sheik Auladin (Chief Operating Officer, Brent CCG) advised that since the suspension of services at Pembridge hospice, Brent CCG had been engaging with local providers about potential options moving forward. It was emphasised that currently, Brent CCG paid the full contract sum, despite the suspension of in-patient services at Pembridge hospice. There were three other providers of community specialist palliative care services for Brent patients in North West London, all of whom provided a high standard of service and value for money. If the Pembridge hospice service was permanently decommissioned, this would allow for re-investment in other providers. The committee was therefore asked to comment on potential options as identified in the report for the provision of EOL services in Brent to feed into the Brent CCG review and subsequent further engagement with residents and providers. As Brent CCG was moving towards a single North West London CCG structure and a new collaborative way of working between providers and commissioners, it was highlighted that due consideration needed to be given to the impact on providers across North West London of any proposed service changes in Brent.
The Chair thanked Rashesh Mehta and Sheik Auladin for the introduction to the item and invited questions from the committee.
The committee raised a number of queries regarding the circumstances leading to the suspension of in-patient services at Pembridge hospice and exploring alternative solutions to continuing these services at the site. Members sought assurance that the other three providers of hospice services for Brent patients had sufficient safeguards against similar circumstances. The committee questioned the robustness of conclusions drawn with respect to the capacity of the three remaining providers, seeking particular comment on ability to expand capacity with projected increases in demand. Clarification was sought regarding the option to pursue a tri-borough arrangement, rather than a Brent specific service and noting the intention to expand community based palliative care services, members questioned how fragmentation would be prevented as the nature of the service developed. Further details were sought regarding consultation with service users and their families around arrangements for hospice based palliative care services. Members concluded their questioning by seeking confirmation that if Pembridge hospice were to be decommissioned, the savings by Brent CCG would be re-invested in other providers ensuring the continued provision of such services for Brent residents.
Responding to the queries raised, Sheik Auladin, advised that the specialist palliative care consultant at Pembridge hospice had resigned in late July 2018 and the provider had been unable to recruit to this position. This meant that there was not appropriate specialist palliative care clinical supervision of the in-patient unit and this service had therefore been suspended. There had been no proactive action from the provider to make arrangements for the provision of appropriate clinical supervision since this time. Brent CCG was confident in the resilience of the other three providers, who had staffing support from hospitals with which they were partnered, an arrangement that was absent from the Pembridge hospice contract. Rashesh Mehta explained that Brent CCG was content with the capacity of the existing providers and was confident that the providers would be able to accommodate additional capacity with additional resource, if and when required.
Jonathan Turner (Brent CCG) informed the committee that with the move towards a single North West London CCG and in consideration of patient flows across borough boundaries, any change to commissioned services in Brent would have an effect on service provision to patients in surrounding areas. It was therefore essential that an aligned approach be pursued with neighbouring CCGs to support connectivity in service delivery across North West London.
Dr MC Patel (Chair, Brent CCG) advised that the nature of palliative care services had changed significantly over the past few decades with more conditions treated out in the community, supporting patients to remain in their own homes when desired. However, there remained a very important role for hospices which provided a fantastic service to Brent patients and it was important that the Brent CCG invested in both forms of service delivery.
The committee further heard that there had been a degree of engagement with patients and their families with regard to hospice services in Brent. Four focus groups had been held across all providers to discuss service development and improvement and specific issues relating to Pembridge hospice. Greater engagement was planned pending the Brent review of EOL. All patients and families who had been affected by the suspension of in-patient services at Pembridge had been consulted. Patients had felt saddened at the prospect that the service would not be available going forward but had also felt that the provision of a seamless service across all competencies was an aspiration that should be worked towards.
Sheik Auladin confirmed that if Pembridge hospice were to be decommissioned, the £1.4million currently invested in the provider would be redirected to other hospice provision, whilst at the same time ensuring that services provided had appropriate clinical supervision. It was emphasised that the £1.4m was not considered a saving and did not form part of the CCG’s recovery plan.
The Chair thanked everyone for their contribution to the discussion.
The committee subsequently RECOMMENDED:
That Brent CCG:
i) undertake engagement with Brent residents, stakeholders and existing providers (St Luke’s Hospice, St John’s and Elizabeth Hospice and Marie-curie Hospice Hampstead) regarding the proposal to decommission services at Pembridge hospice and reinvest in the remaining providers, assessing whether there was sufficient capacity to meet local need and projected service demand.
ii) explore a tri-borough arrangement with the relevant CCGs if it was subsequently determined following the engagement recommended at i) that there was insufficient capacity across the three existing providers to meet local need or there was strong objection to the proposal to re-invest in the remaining providers.
That the Cabinet:
iii) review the position with regard to land adjacent to St Luke’s Hospice, with a view to supporting possible expansion of the hospice at a future date.
Supporting documents: