Agenda and minutes

None declared.

The minutes are attached.

RESOLVED:-

that the minutes of the previous meeting held on 27 March 2012 be approved as an accurate record of the meeting.

Recruitment of health visitors in Brent

Councillor Hunter commented that a written answer was awaited in respect of her query concerning domestic violence.  Phil Newby (Director of Strategy, Partnerships and Improvement) replied that he would request that Genny Renard (Head of Community Safety - Integrated Community Safety, Strategy, Partnerships and Improvement) to provide some information.

The report addresses issues raised by the Members on this item at the last committee meeting on 27 March 2012.

Yvonne Leese (Ealing Hospital NHS Trust) introduced this item and advised that there was a shortage of health visitors both locally and nationally.  The Trust was developing a recruitment and retention strategy and some progress was already being made in recruiting health visitors.

Jacinth Jeffers (Community Services Brent, Ealing NHS Trust) then presented the report and advised that a task and finish group had been created in June 2011 to progress the Department of Health paper, ‘health visitor implementation plan – a call to action.’  She referred to the table in the report outlining the vacant health visitor posts over the last two years, which had averaged twelve vacancies consistently despite a recruitment drive.  Jacinth Jeffers advised that the most recent external recruitment exercise had shortlisted six applicants and resulted in five of these accepting job offers.  Community Services Brent had also offered health visitor posts to internal students subject to them qualifying in September 2012.  However, the committee heard that it was not compulsory for students to remain with the Trust once they had qualified, so it was important that students were well supported and encouraged to take up posts in Brent.  In total, ten health visitor posts were due to be filled in September 2012.  However, it was forecast that a further 43 additional health visitors would be required by 2015.

During discussion, Councillor Harrison enquired whether the Trust was limited to the number of students it could recruit each year.  Councillor Hunter asked whether the Trust was confident that it could recruit the number of health visitors required in 2015 and what incentives were in place to encourage recruitment and retention of staff.  Councillor Leaman commented that recruitment of health visitors had been a long standing problem and he asked whether exit interviews were conducted for those leaving and what were the specific problems in Brent.  He also enquired what impact under capacity was having on staff and was it affecting morale. Councillor Daly asked how many health visitors were currently in post and what was the intended total number to recruit for this year and whether the ethnic mix of the staff reflected Brent’s population.  She also asked if there was a gap in service in view that vacancies remained.  Councillor Al-Ebadi sought clarification as to whether back staff had the appropriate qualifications.

The Chair asked whether there were sufficient financial resources to cover the forecast recruitment required in the next few years and was there any kind of guarantee that the students would remain with the Trust once they had qualified.  She also asked if there were an adequate number of practice teachers to train students.

In reply to the issues raised, Jacinth Jeffers advised that funds had been committed this year for the recruitment required, however funding was agreed on an annual basis with the NHS and the Trust had been funded to take on five students this year.  The Trust was currently considering what incentives it could introduce to encourage recruitment and  ...  view the full minutes text for item 4.

North West London Hospitals NHS Trust has been asked to provide a report setting out waiting time performance at the trust. They have also been asked to provide details of ambulance transfer times from Central Middlesex Hospital to Northwick Park, the numbers of transfers and the time they have taken.

Paul Jankowiak (North West London Hospitals NHS Trust) introduced the report which set out Accident and Emergency (A and E) waiting times over the last six months.  He began by advising that the Department of Health’s NHS Performance Management Framework set out a performance indicator that required 95% patients to be seen within four hours.  He referred the table in the report outlining the performance of Central Middlesex Hospital, Northwick Park Hospital and the Trust overall.  Paul Jankowiak advised that the targets were being met consistently since March 2012.

Councillor Daly sought confirmation that Northwick Park hospital received the largest number of A and E visitors and in noting that some patients had been waiting too long in February and March, she asked how they were dealt with.  She also asked for further data with regard to what happened to A and E patients when they arrived, including how many had arrived by ambulance and those who were seriously ill.  Councillor Daly asked if there were specific plans in place in respect of the Olympics.  Councillor Leaman asked for further details about waiting times for those patients who had to wait longer than four hours to be seen.

The Chair enquired why ambulance transfer times had not been provided as this had been the committee’s wish.

With the approval of the Chair, Councillor Cheese also addressed the committee and commented that the ambulance service would be under additional pressure during the Olympics, especially those ambulances needing to do patient transfers via Wembley and he enquired what steps were in place to address this.  Maurice Hoffman (Brent LINk) also addressed the committee and he enquired whether the average A and E waiting times were in effect being lowered by the Urgent Care Centres (UCC) and did waiting times vary depending on the time of day.

In reply, Paul Jankowiak explained that he thought it was the number of transfers being on target that were of particular interest to the committee and he stated that information could be provided on ambulance transfer times.  Those who were deemed seriously ill received treatment within four hours.  Paul Jankowiak confirmed that waiting times did include those patients treated by the UCCs and waiting times increased in the early hours of the morning and late evening. 

David Cheesman (North West London Hospitals Trust) added that the UCC was effectively part of the same department as A and E and waiting times were also affected depending on the time of year, particularly during winter and capacity was scheduled accordingly.  He advised that Northwick Park hospital had struggled with rising demand initially, however recent improvements in how it handled A and E cases were reflected in a boost to performance.  Nurses would decide whether patients needed to go to A and E or treated at the UCC and patients categorised as ‘type one’ would go to A and E.  David Cheesman explained that the waiting times were calculated from the moment the patient entered the hospital and  ...  view the full minutes text for item 5.

The report provides an update on this item from the last committee meeting on 27 March 2012.

Rob Larkman (Chief Executive, NHS Brent and Harrow) introduced the report and explained that there were two main elements to shaping a healthier future, these being the future hospital-based acute services and developing a strategy for out of hospital services.  Consultation on proposals would continue until October 2012.

Dr Tim Spicer (Shaping a Healthier Future) then presented further detail in the report. Following on from the two main elements of the programme, he referred to the particular challenges for North West London, which included a projected increase in population of 113,000 in the next ten years, whilst the population also continued to age with 31% having long term chronic conditions.  Dr Tim Spice drew Members’ attention to the variations within hospital care and the differing outcomes of patients as set out in the report.  With regard to developing an out of hospital care strategy, this would apply to each of the North West London boroughs and key themes were emerging from these.  There would also be the establishment of four standards to maintain quality of care, these being:-

·         Individual patient empowerment and self care

·         Service access convenience and responsiveness

·         Care planning and multi-disciplinary care delivery through a joined-up approach

·         Standards of information and communication sharing

Dr Tim Spicer advised that the strategy would go public and UK standards would be used to model finances.  Every effort would be made to demonstrate how the drive for changes would be made and it was intended to create coherence and confidence in the service whilst relieving stress on acute services.

Ethie Kong (Clinical Commissioning Group Chair, Brent) added that a borough level view was also being considered with regard to how the strategy would be delivered locally and how the local vision would change in the next three years.

Jo Ohlson (Brent Borough Director, NHS Brent and Harrow) advised that plans for outside of hospital care had been developed in the last two years and she cited the Short Term Assessment, Reablement and Rehabilitation Service (STARRS) as an example and which had achieved high satisfactory rates in providing services in the community.

During discussion by Members, Councillor Harrison commented that access to services was an issue and the reforms proposed placed a lot of focus on the role of GPs.  In some cases, GP practices were not sufficiently organised and she asked what steps would be taken to ensure GPs took the appropriate action so that their practices performed to the levels necessary.  Councillor Daly sought clarification of the term ‘frequent flyers’ as she felt it somewhat inappropriate.  Councillor Leaman commented that the report did not make mention of the need to change the behaviour of the public to help ensure that the new arrangements would be effective and there needed to be measures in place to promote public awareness.  He also asked what information was provided to those who may be first time visitors in accessing health services.  Councillor Hunter welcomed the report overall and enquired when the programme was due to  ...  view the full minutes text for item 6.

NHS Brent has provided an update on three GP practices in Brent. Their report covers three main issues:

·         Willesden Medical Centre – The possibility of relocating the practice to Willesden Centre for Health and Care.

·         Kenton Medical Centre – This centre is to close, and the report highlights the work that has gone on since the GPs gave notice that they intended to retire.

·         Kilburn Medical Centre – On the plans to disperse the patient list for this practice, which is also set to close.

The issues connected to Willesden Medical Centre and Kilburn Medical Centre have been previously considered by the committee. However, Kenton is a new issue. More information on this practice is set out below.

Jo Ohlson introduced the report and confirmed that the lease at Willesden Green Medical Centre expired on 31 August 2012.  The two options being looked at involved either the possibility of relocating the centre and also possibly including Dr Fletcher’s practice to the Willesden Health and Well Being Centre, or Willesden Green Medical Centre and possibly Dr Fletcher’s practice remain at the same premises if the current landlord was able to improve their existing accommodation and provide space for Dr Fletchers’ practice.  Discussions and meetings were taking place in respect of these and the committee would be updated about developments.

In respect of Kilburn Medical Centre that had been operating under a temporary contract, it had been decided to terminate this contract on 30 June 2012.  NHS Brent had undertaken a review as to whether to develop a specification and tender on the open market or to list dispersal of the registered population.  However, as there was no guarantee that a contract would be awarded to a new provider or that the service could remain at the existing site, it was decided to disperse the patient list.  Members noted the results of the health inequalities assessment that had been undertaken as part of coming to this decision.

Rachel Donovan (NHS North West London) confirmed that the two doctors at Kenton Medical Centre were retiring and had tendered their resignation for 30 June 2012 and this would also mean the termination of the Personal Medical Service (PMS) contract.  Two options had been considered, the first enabling patients to register with a GP from existing list of practices in the area and the second inviting applications from providers to take up a PMS contract at Kenton Medical Centre.  Consultation had involved all patients over 16 years of age, local councillors and MPs and this committee.  Following this, it had been recommended to the NHS North West London Board that patients be asked to register with an alternative practice in the area as the list of patients to existing GP practices had capacity to register additional patients and gave patients more choice as to where they would like to register.  The alternative option was not being pursued as the length of time to procure a new practice on the existing site could take up to twelve months.  In addition, the 2,500 patients affected was well below the average practice size.  Should the recommendation be approved, the list of practices would be reviewed to ensure that they were ones closest to where patients lived, as opposed to closeness to Kenton Medical Centre.  Kenton Medical Centre would also be asked to assist in identifying vulnerable patients and helping them re-register and provide assurance that they have re-registered prior to the practice closing.

During discussion, Councillor Leaman enquired whether the letter sent to patients on 5 April 2012 informing them of the retirement of the GPs at Kenton Medical Centre had also been provided in different languages, particularly as the wording used was not especially clear.  ...  view the full minutes text for item 7.

The report is attached.

Jo Ohlson provided an update in respect of a recent serious incident at Central Middlesex Hospital UCC involving patients who had apparently not been discharged from the IT system and therefore it could not be confirmed that those with radiology reports had been reviewed for missed pathology.  She advised that most of the patients affected had been contacted promptly once the problem was discovered, and of the 97 patients that had remained outstanding, 76 had subsequently been contacted, with 48 of these requiring no further action.  Of the others, fifteen had been offered appointments, six had been re-called at the correct time following the initial x-ray, three referred by GPs to another health facility, three advised to contact their GP and one had sought follow up from a different provider.  Of the remaining 21 who had not been contacted, twelve had left no contact details, six had failed to respond.  However, three had subsequently been contacted following information provided by their GP.  Jo Ohlson advised that of those with no contact details, GPs were being asked if they held any records.  A report was due to be published on 6 June to identify how the error had happened.

Councillor Leaman asked how many of the 97 patients involved were children.  He asked when the earliest failure to record a case had happened and why had the lack of discharging from the IT system not been picked up earlier.  He asked whether NHS Brent had any view at this stage with regard to Care UK’s role about the situation.  Councillor Hunter commented that if the build-up of patients who had not been discharged on the IT system had been happening over an extended period of time, then it appeared that there must be a fundamental system failure.  She also enquired what specific action had not been done that had resulted in the incident.  Councillor Daly expressed concern about the incident and felt the number of patients involved was not acceptable.  She felt that NHS Brent had failed to monitor the contract with Care UK properly and she asked what steps were being taken to address this as well as seeking clarification as to who was leading the investigation into the incident.  Further explanation was also sought in respect of lack of patient contact details for those affected by the incident.

Mansukh Raichura (Brent LINk) was also invited to comment and he stated that it was important that all departments of the hospital worked closely together to ensure such incidents did not happen in future.

In reply to the issues raised, Jo Ohlson advised that of the 97 patients, four of these were children and it was understood that these had been contacted.  The earliest failure to record a case had occurred sometime after the UCC had opened in 2011, although the red cases which were of more concern were much more recent.  At this stage, it was no possible to pinpoint the specific reasons for the failure whilst the  ...  view the full minutes text for item 8.

NHS Brent has provided a report updating members on the progress of the procurement of community cardiology and ophthalmology services in the borough. Members requested this update at their meeting in March 2012.

Although the update is essentially for noting, previously members have had questions about the consultation plan for the service procurement and the consultancy costs associated with the procurement. These are addressed in the paper.

Jo Ohlson gave a brief introduction to the report that was before Members updating them on the public consultation of the procurement of the new community cardiology and ophthalmology services.

Councillor Daly enquired what action would be taken following the consultation.  Councillor Hunter stated that she had not seen any consultation letters to date and she enquired why consultation on cardiology and ophthalmology services were being undertaken together as they were two significantly different kinds of services.

The Chair suggested that there should be separate consultation questionnaires for cardiology services and ophthalmology services and she enquired what patient groups were being consulted.  She also sought confirmation as to what body would make the final decision.

Maurice Hoffman was invited to address the committee and he commented that Brent LINk were still awaiting responses to two letters they had sent NHS Brent with regard to this issue.  He queried why the consultation was being undertaken simultaneously for both cardiology and ophthalmology services as there were no obvious connection between the two.  He felt that patients and stakeholders had not been adequately consulted, whilst a request to postpone consultation in order to increase public involvement had not been responded to.

In response, Jo Ohlson advised that the consultation was with regard to service specification which had been under consideration for some time and no service was to be de-commissioned.  Jo Ohlson indicated that she would take on board comments made with regard to how the consultation should be undertaken and respond accordingly.  Members noted that following consideration of the consultation and a response to it, recommendations would be made to the Clinical Commissioning Group’s Executive and then on to the NHS Brent Board before a final decision was made.

Members will receive a verbal update on this item.

Ethie Kong confirmed that Rob Larkman had been appointed the Chief Executive of the North West London CCG, whilst Ethie Kong was to chair the Shadow CCG Board which also included two lay members including a lay vice chair.  A timetable of public meetings would be advertised in local newspapers and the CCG would consist of five localities.  Work was under way to develop the CCG constitution and the first draft had gone to GP practices for consultation.  There would also be consultation with patient user groups and the CCG was working with Brent LINk to ensure that they had the relevant contact details.  Ethie Kong confirmed that the CCG had been delegated its budget as of April 2012.

Councillor Leaman enquired whether details of a who’s who could be provided of the CCG and how many public meetings were scheduled to take place.  Councillor Daly stressed the need for the committee to see the relevant reports so that it could undertake proper scrutiny. 

The Chair confirmed that the committee would like to receive progress reports in future and also a report on the CCG meeting that had happened on 30 May.  In response to comments from Brent LINk representatives, she also requested that information be made more transparent in future.

Ethie Kong confirmed that two public meetings of the CCG were presently scheduled

Andrew Davies commented that verbal updates had been provided up to now as it was felt that this was the most appropriate way of informing Members, however reports would be provided in future.

Members will receive a verbal update on this item.

Andrew Davies updated Members regarding Health and Wellbeing Board (HWB) developments, reporting that the Shadow HWB May meeting had discussed the direction of travel with regard to the public health transfer.  In respect of the Joint Strategic Needs Assessment that was feeding into the HWB strategy, working groups had been created to cover a range of areas following feedback received from the consultation.  Consultation on the HWB strategy would take place over the summer of 2012.  Andrew Davies advised that he would provide reports at future meetings for this item.

The work programme is attached.

Members noted the suggested work programme for 2012-13.

The next meeting of the Health Partnerships Overview and Scrutiny Committee is scheduled to take place at 7.00 pm on Wednesday, 18 July 2012.

It was noted that the next meeting of the Health Partnerships Overview and Scrutiny Committee was scheduled for Wednesday, 18 July 2012 at 7.00 pm.  Andrew Davies advised that a pre-meeting would take place at 6.15 pm.

None.