Agenda and minutes

None made.

RESOLVED:-

that the minutes of the previous meeting held on 5 April 2011 be approved as an accurate record of the meeting.

Fuel Poverty and Health Scrutiny task group

The committee heard that the Fuel Poverty and Health task group reported to the Executive in April 2011 and the recommendations were accepted. The issue would be followed up later in the year.

Access to GP Services in Brent

It was confirmed that Jo Ohlson (Brent Borough Director, NHS Brent and Harrow) had received the satisfaction data which was being validated and should be ready for the July meeting. It was noted that information on changing GPs without changing address had been circulated to members.

IT Systems

The Assistant Director (Community Care) confirmed that problems relating to IT systems incompatibility hindering the exchange of sensitive data between the council and the NHS were being resolved and interim arrangement were in place in the meantime.

The committee agreed to change the order of business so as to take early in the meeting the items relating to NWLH NHS Trust Quality Account and the item of urgent business relating to the GP list validation exercise.

The committee should consider the Quality Account provided by North West London NHS Hospitals Trust (appendix 2) and decide what comments it wants to make in relation to it (assuming members want to comment on the Quality Account). North West London Hospitals have asked for a response to be sent to them by the 14 June and so completion and agreement of the final wording of the committee’s comments should be delegated to the chair of the committee.

Catherine Thorne (Director of Governance, NWLH NHS Trust) in introducing the report advised that every trust was required to produce a Quality Account, which is a statement of quality relating to the services provided by that NHS trust and to allow organisations the opportunity to comment.

The report before members was the account for 2010-2011 and, while welcoming the content, questions were raised on the opportunity to monitor past concerns specifically in relation to maternity services, in the absence of historical information; the lack of improvement in complaints handling. The committee heard that the NHS London review into maternity services would form the basis of a report to the committee in September and would allow the recommendations to be looked at in the context of services. The committee was assured that, the incidence of neo natal death was very low and the link sometimes made between neo natal death and infant death were not correct. On complaints handling, it was accepted that performance should be better. Where complaints involved more than one agency it took longer to gather statements. Many complaints to the trust were complex involving many staff working different duty rotas, which also delayed the production of a formal response. Concern was expressed over the lack of improvement in local patient indicators relative to the national picture in areas relating to nurses, care and treatment. These were worse than the national figures and members felt it would be helpful to have an indication of how far the trust’s performance was from the national average. It was agreed that average figures would be included in future however it was noted with some disappointment that the local response rate was low - only 800 patients responded to the In Patient survey on which the figures were based. Members were pleased to note the good work that had taken place in connection with stroke care.

Members were invited to contribute any further comments to be included in the submission to be prepared in consultation with the chair and vice chair.

RESOLVED:

that the Quality Account provided by North West London NHS Hospitals Trust be noted and authority be delegated to the chair to submit a response by the deadline of 14 June 2011.

Circulated to members in advance of the meeting was a briefing paper prepared by NHS Brent on the GP list validation exercise which was being conducted. There was a difference of over 100,000 between the census population and the registered list in NHS Brent and concern had been expressed that the validation exercise may not have been as fair and effective as it could have been.

Jo Ohlson (Brent Borough Director, NHS Brent and Harrow) advised the committee that list validation was not an unusual exercise. During 2007/10 a list validation exercise had been carried out resulting in some patients being removed. However 118,000 had not responded to letters and these were now subject to a further validation exercise. Ms Ohlson outlined the detail of the correspondence that was subsequently sent out (which included a translation offer) and the level of replies received. 38,000 people  had not responded to letters from the PCT and were due to be removed from GP lists. The gap between registered patients and residents of 100,000 was the highest in the country. Ms Ohlson advised that discussions were taking place on steps to be taken to assist vulnerable people and she assured the committee that practices would not be penalised for reinstating patients.

With the consent of the meeting Mr Irvin Van Colle, chair of the Kingsbury GP Consortium patient and public involvement forum questioned the extent to which the process was open and fair and made reference to one practice that was losing 25% of its patients. He acknowledged the importance of accurate lists but felt that reinstatement of patients would create a huge amount of unnecessary work and suggested that decision should be deferred on any practice that was likely to lose more than 5% of its patients. Mr Van Colle put that there could be many reasons why people had failed to respond to letters including not having English as a first language and that the removals should cease until the methodology had been reviewed.

Rob Larkman (Chief Executive, NHS Brentand Harrow) stressed the importance of accurate patient lists to help ensure that funding was being invested in the right areas. He stated that the methodology used was standard and in recognition of the sensitivities safeguards would be introduced for vulnerable people and those whose first language was not English. Further letters would be sent out. The Chief Executive indicated that practices adversely affected financially would be supported once the process was complete.

Members sought and received assurances that every effort would be employed to avoid removing vulnerable people and that requirements would be waived to reinstate them as easily as possible if necessary. Jo Ohlson offered to report back on the outcome. She advised that approximately £700,000 would be saved so far from the numbers removed accepting that this figure could reduce with re-registration.

Members heard that that there seemed to be some inconsistency between the policy and experience of practices involved in the validation process. Vulnerable patients  ...  view the full minutes text for item 6.

North West London NHS Hospitals Trust and Ealing Hospital Trust have begun working on plans for the future of the two organisations. Both of the trust boards have agreed a Strategic Outline Case for a merger and a series of events are to take place in Brent, Harrow and Ealing over the coming few weeks to begin consulting the public on this issue. Although a formal decision to merge has not yet been taken, this is now being considered as a viable way forward for the two organisations in order to achieve foundation trust status and deliver better quality healthcare.

Simon Crawford (North West London NHS Hospitals Trust) introduced the report which set out progress on the possible merger of North West London NHS Hospitals Trust and Ealing Hospital Trust. Consideration was still being given to the benefits of a merger which it was believed would  provide an opportunity to improve the quality and standard of health care delivered by the trusts.  The eventual aim would be to have larger, more specialised teams, improved efficiency, avoid duplication and spread good practice. Significant financial savings were also anticipated. A Strategic Outline Case had been approved and work had now started on an Outline Business Case and at the same time Clinical Working Groups have been established comprising senior clinicians and GP representatives from the three boroughs to develop the clinical vision for the new organisation and options for configuration. The engagement process would include GPs and other stakeholders including patients, staff and individual groups.

Members raised questions on the impact of the current discussion over government health reforms and sought assurances that changes would be clinically driven and services protected. Simon Crawford assured that quality remained a key consideration, that health and well-being would set the agenda and the intention that the merged organisation would be in a better position to deliver. Questions were also raised on the possibility of improving estate utilisation through private finance initiatives to generate income and the risks involved and assurances were given that there would be full consultation on any proposals. The committee were also advised that an options appraisal had been requested and alternatives to merger would be considered.

Members noted that a further report would be submitted in September and it was suggested that consideration be given to a meeting being convened of the scrutiny committees of the three boroughs concerned to further discuss the proposals.

RESOLVED:

that the report be noted.

The Health Partnerships Overview and Scrutiny Committee has asked for a report on the Brent GP Commissioning Consortia to be included on each of its meeting agendas. Members are keen to be kept informed of the key issues connected to GP commissioning and to be updated on progress as responsibilities and budgets are delegated from the PCT to consortia. NHS Brent has provided reports that address the primary care issues of concern to the committee. The paper on Stag Lane also includes an update on the provision of health services in South Kilburn. Members should consider the reports and question officers from NHS Brent on these issues.

Jo Ohlson (Brent Borough Director, NHS Brent and Harrow) introduced the regular report on GP commissioning. She reminded the committee that GP commissioning consortia have been long established in Brent and was unlikely to be affected by the current ‘pause’ in the government’s Health and Social Care Bill. Ms Ohlson outlined the individual commissioning plans developed by each of the five consortia to implement the Quality, Innovation, Productivity and Prevention Plan in 2011/12.

In discussion, Jo Ohlson emphasised that GP pathfinder consortia had a high level of commitment. The recent government announcements of the formal involvement of nurses in consortia was not a new development in Brent. She acknowledged that there would be difficult decisions ahead with both the council and health service working with reduced resources which emphasised the need for increased partnership working. It was noted that one of the initiatives that GP commissioners were working on was urgent care and ways of offering more choice for patients and families at home during end of life care. Jo Ohlson referred to barriers that would need to be overcome to make progress in this area and the need to up-skill professionals. The committee heard that a more holistic approach was required and agreed on the need to have appropriate care plans in place to avoid unnecessary hospital admissions. Current financial challenges reinforced the need for health care reform and the committee noted that NHS London was pushing for rapid delegation to consortia. Alison Elliott (Assistant Director, Community Care) agreed with the suggestion mental health was an area for joint collaboration and confirmed that work was taking place with the PCT and GP commissioning colleagues to improve the service.

On the future and feasibility of the Stag Lane Clinic, Jo Ohlson reported on the poor state of the buildings and the possibility of savings through the renegotiation of the contract. She would be able to report further towards the end of July.

The Health Partnerships Overview and Scrutiny Committee has agreed to establish a task group to look at the health and social impact of khat in Brent. Members have been nominated to work on this task group and an initial meeting has taken place with members of Brent’s Somali community to discuss the group’s scoping document and the issues associated with khat use.

Councillor Hunter (Chair, Khat task group) advised that the Khat task group had met twice and had also met community workers. A ‘Check before you chew group’ had been established and there had been input from the community at the outset. She drew attention to the task group’s scope appended to the report from the Director of Strategy, Partnerships and Improvement.

RESOLVED:

that the Khat task group’s scoping document be noted and the final report submitted to the September meeting of this committee.

The committee had before it the work programme for 2011/12 for comment which was based on issues that had arisen from previous meetings. The following were suggested for inclusion:

• the role of community pharmacists
• the Shadow Health and Well Being Board
• end of life palliative care and strategy
• mental health care

The next scheduled meeting of the Committee is on XXXXXXX.

It was noted that the next meeting would be taking place on 26 July 2011.

Members’ attention was drawn to a meeting to discuss the NHS taking place at the Town Hall on Sunday 12 June organised by Barry Gardiner, MP.