Agenda and minutes

None.

RESOLVED:-

that the minutes of the previous meeting held on 8 October 2013 be approved as an accurate record of the meeting.

Rob Larkman (Chief Officer Brent, Ealing Harrow and Hillingdon Clinical Commissioning Groups (CCGs)) provided a brief update on the procurement of cardiology services. He advised that the procurement process which had identified the preferred bidder had been referred to the system regulator for review and formal enquiries were in process. A decision would be issued by February or March 2014 an the contract would not now be able to be awarded in line with the expected timetable.

The Health Partnerships Overview and Scrutiny committee may remember that last winter (2012/13) North West London Hospitals Trust’s Accident and Emergency Departments struggled to cope with the additional pressures traditionally felt during the winter months.  Brent CCG and NWLHT have therefore both been asked to provide the committee with details of their plans to cope with the forthcoming winter pressures.

The committee considered reports from the Brent Clinical Commissioning Group (CCG) and the North West London Hospitals Trust (NWLHT) on their plans to cope with the anticipated pressure on services over the winter period. The reports were presented by Jo Ohlson (Chief Operating Officer, Brent CCG) and Tina Benson (Director of Operations, NWLHT) respectively.

In summarising her report, Jo Ohlson clarified that Brent CCG was responsible for ensuring that there were sufficient services to meet demand over the winter but did not commission General Practitioner (GP) services; this latter task lay with the National Health Service England (NHSE). A briefing had been provided by NHSE on the relevant activity undertaken by the organisation and this would be circulated to the committee.

Outlining the work of Brent CCG, Jo Ohlson explained that £6.4m funding had been secured via winter bid plans to support a range of schemes across the local Brent-Harrow health economy, with a further £6.6m provided by Brent CCG. Schemes included the Short Term Assessment, Reablement and Rehabilitation Services (STARRS), an Integrated Care Pilot aimed at those most at risk of hospital admission, and increasing access to GPs via extended opening hours, including Saturday appointments. With reference to this latter project, it was noted that there was a need to promote these expanded opening times and work was being undertaken to explore possibilities of direct appointment bookings via the 111 service. Members’ attention was drawn to the table setting out the creation of additional bed capacity across several sites and an update was provided. In addition to those reported, a further 6 mental health beds would be provided on the Northwick Park Hospital (NPH) site. Members were advised that NWLHT was using capacity at both NPH and Central Middlesex Hospital (CMH) to ensure all available beds were used for suitable patients. It was anticipated that from December onwards there would be sufficient beds in the system. However, risks of a surge in demand on services remained.

Jo Ohlson set out the planned work to reduce Delayed Transfers of Care (DTOCs) from hospital to community settings. Principal causes of DTOC included patients awaiting either health or social care assessments or  appropriate residential or nursing home placements, and a lack of appropriate / accurate information on potential discharges. A series of actions had been agreed to address these issues including increasing capacity within the NWLHT discharge team and creating a further 6 reablement beds. An escalation process had also been established to ensure appropriate overview of the process.

Tina Benson outlined the actions being taken by the NWLHT to address anticipated difficulties, such as excessive patient waiting times in Accident and Emergency (A&E) departments, during the winter period. These actions sought to increase bed capacity, improve flow through the emergency pathways and embed seven-day working. The report also set out performance against the four-hour emergency target, which required that those attending A&E must be seen, treated, admitted or discharged in under four hours. It was emphasised that the  ...  view the full minutes text for item 4.

Brent Clinical Commissioning Group is about to undertake "Wave 2" of its procurement plans.  The CCG will be using consultants Mott MacDonald to undertake both an impact assessment and the statutory consultation for this procurement and the proposals for both of these are now being presented to the committee.

Sarah Mansuralli (Assistant Chief Operating Officer, Brent Clinical Commissioning Group) introduced  a report to the committee regarding Wave 2 of the procurement plans of  Brent Clinical Commissioning Group (CCG). Wave 2 procurement covered the re-procurement of musculoskeletal services, trauma and orthopaedics, rheumatology and gynaecology. Members were advised that Brent CCG had awarded a contract in December to consultants Mott MacDonald to undertake an impact assessment and a formal consultation in relation to the  procurement. Action plans for these two components had been drawn up by Mott MacDonald and were attached for the committee’s information. The impact assessment would cover four key areas: a health impact assessment, an quality impact assessment, a travel and access impact assessment and an organisational impact assessment. The consultation would primarily comprise several consultation events, an online survey and focus groups with key patient and hard to reach groups. A consultation booklet would also be produced. It was emphasised that a further consultation on the proposed service specifications would be held subsequently. Sarah Mansuralli introduced representatives of Mott Macdonald and advised that  they were in attendance to address any queries the committee might have.  

Members’ sought clarity on the purpose of the formal consultation and discussed the importance of there being a good understanding by those conducting the consultation of Brent’s diverse communities and how to best engage those communities. Rob Larkman (Chief Officer for Brent, Ealing, Harrow and Hillingdon CCGs) explained that the formal consultation was aimed at involving local people in the re-design of the services and was not a statutory consultation. The representatives from Mott MacDonald advised  that they had been involved in a number of London service reconfigurations. They were currently undertaking activities to better understand the providers and had been engaging with the Council for Voluntary Services (CVS) Brent. They would be talking to those who would be affected by the service plan and would make use of the equality and engagement database of Brent CCG. For those for whom English was a second language, community groups and translators would be made use of. David Cheeseman (Director of Strategy, North West London NHS Hospitals Trust commented that he had welcomed the opportunity to talk to someone independent of Brent CCG regarding the impact on the services concerned.

RESOLVED:

That the report on Wave 2 of the procurement plans of  Brent Clinical Commissioning Group (CCG) be noted.

The reports from North West London Hospitals highlights the fact that, in February this year, it was identified that 60% of patients on the waiting lists did not have an open care pathway, meaning that waiting times had been wrongly recorded and that, as a result, large number of patients had been waiting longer than 18 weeks and there was an unmanageable number of cases on the waiting list that could not be addressed through normal channels.

Tina Benson (Director of Operations NWLHT) presented the report to the committee on an incident resulting in lack of compliance with the 18 week referral to treatment target (RTT). This target related to patients’ right to receive consultant led treatment within 18 weeks of referral. Members were advised that in February 2013 it was identified that 60 per cent of patients on the waiting lists did not have an open care pathway which meant that waiting times had been wrongly recorded. As a result, approximately 2700 patients had been waiting longer than 18 weeks of which approximately 560 were Brent residents. In response to this, action had been taken which ensured that all those waiting over 18 weeks received offers of treatment, with agreed dates.

Tina Benson explained that following an internal review, NHS Interim Management and Support (IMAS)  had been invited to review processes and pathways underlying the RTT. The review found that systems and processes had not been sufficiently robust, there had been a gap between increased service demand and capacity, and staff-culture had resulted in some staff members feeling under pressure to undertake actions which resulted in incorrect records of patients waiting times. Since the findings of the review were made available, considerable progress had been made and a comprehensive action plan had been produced, with input from CCGs. The action plan included updating policies, staff training, enhanced monitoring and auditing of data recording and reporting and establishing additional outpatient clinics. Additional capacity would also be outsourced to alternative NHS providers and private providers of patients’ choice.

During member discussion, the committee sought assurance that patients would be appropriately tracked. Further details were sought on plans to monitor and audit patients’ care pathway ‘clocks’. An update was requested on post-op care and  clarity was sought on the demand and capacity issue identified by the IMAS review. A member raised a query regarding communication with patients. 

Tina Benson replied to the queries raised and explained that outsourced projects were frequently managed; patients were kept on a separate spreadsheet which was updated twice-weekly following information exchange between NWLHT and the provider in question. Efforts were made to ensure that a shared record was maintained which meant for instance that on the day of surgery records from both organisations were available for reference. There was also a good set of performance indicators which had been established by Brent CCG.  Members were advised that additional capacity was being resourced at NWLHT in order to support routine auditing of data. It was now possible to monitor on a weekly basis the numbers of patients who had had their care pathway ‘clocks’ stopped and/or who had been added to the elective waiting list.

Addressing questions of capacity, Tina Benson explained that additional therapists had been employed for post-op care and additional STARRS support had also been agreed. It was acknowledged that the commissioning plan did not reflect the current level of activity and discussions were now being held to ensue a robust plan  ...  view the full minutes text for item 6.

Brent CCG, in conjunction with the North West London Collaboration of CCGs, has been asked to provide an update on the plans for Central Middlesex Hospital which will now follow as a direct consequence of the Shaping a Healthier Future plans.

Rob Larkman (Chief Officer – Brent, Ealing, Harrow and Hillingdon Clinical Commissioning Groups (CCGs)) provided an update to the committee on the plans for Central Middlesex Hospital (CMH) under the Shaping a Healthier Future (SaHF) programme. He advised that colleagues from SaHF, Daniel Elkeles (North West London CCGs) and Dr Mark Spencer, were also present to address any queries from the committee.

Rob Larkman reminded the committee that Ealing Council had referred the SaHF plans to the  Secretary of State for Health and had made an application for Judicial Review (JR). The JR had been declined and in October 2013, the Secretary of State for Health had given his broad approval to the SaHF proposals including that CMH become a Local Hospital and Elective Centre.  The Secretary of State for Health had also recommended that the changes to A&E at CMH take place as soon as practicable after winter. It was emphasised that the current restricted opening hours of the A&E service at CMH were not a result of the SaHF proposals but instead were related to clinical safety issues.

Members were advised by Rob Larkman that the plans for CMH created potential for significant investment in the site. Work was currently being undertaken to build a long term sustainable model for the site. Working groups had been established which would complete evaluations of clinical and financial factors as well as exploring the impact on patients of moving existing services to CMH. An Equalities Impact Assessment would also be completed to explore how protected patient groups would be affected by any proposals. Weekly meetings were being held to oversea the progress of the work streams. Members attention was drawn to the list of options under consideration, set out in the report. In response to a query it was clarified that this list represented the core elements of the portfolio of services being considered for CMH. It was emphasised that there would be full and meaningful engagement with local residents and other stakeholders. In line with this, an engagement plan was being developed. Rob Larkman concluded by noting that a final report setting out proposals for CMH would be presented to the Partnership Board and Implementation Programme Board on 6 February 2014.  Approval would then be required to be sought through several decision making bodies including the Clinical Commissioning Groups, National Health Service England (NHSE), Trusts and the NHS Trust Development Body (NTDA). 

In the subsequent discussion, the committee raised a number of issues. A member queried the percentage of the CMH site currently in use and sought an explanation for the figure provided. In response, David Cheesman (Director of Strategy NWLHT) advised that approximately 65 per cent of CMH was currently being used and at present the A&E service was closed overnight for reasons of clinical safety. Additional elective work had been transferred to CMH from Northwick Park Hospital (NPH) but without a 24 hour A&E service this would only be temporary. Daniel  ...  view the full minutes text for item 7.

The work programme is attached.

The committee reviewed the work programme, noting the items that were scheduled for the forthcoming meeting in January 2014.

RESOLVED:

That the work programme be noted.

The next scheduled meeting of the Committee is on 28 January 2014.

The committee noted that the next meeting was scheduled for 28 January 2014.

None.