Agenda and minutes

None declared.

RESOLVED:-

that the minutes of the previous meeting held on 18 July 2012 be approved as an accurate record of the meeting, subject to the following amendment:-

Paragraph 6, page 7, replace all mentions of ‘Alison’ with ‘Amanda’.

Brent Tobacco Control Service – progress report

Members noted that the recommendations agreed at the previous meeting on this item would now be considered by the Brent Pension Fund Sub-Committee at the meeting taking place on 20 November 2012.

This item was deferred from the meeting in July 2012 because Care UK were not in attendance and because the report provided focussed on safeguarding issues rather than an explanation of what caused the problems at the UCC and how they have been addressed. A further report now attached, has been provided by NHS Brent and Care UK representatives will be present at the committee meeting on the 9 October for this item.

Ian Winstanley (NHS Brent) introduced the report that provided further details of the findings of the investigation carried out in the wake of the serious incident at the Care UK Urgent Care Centre (UCC) at Central Middlesex Hospital (CMH) identified in March 2012.  The report included the findings of the root cause analysis, the recommendations that followed and subsequent action taken to implement these recommendations and monitoring of their success.  Ian Winstanley advised that NHS Brent was satisfied that Care UK had undertaken all action required following the Governing Body meeting on 3 October.

During discussion, Councillor Hunter sought an explanation as to why sufficient action had not initially been taken despite concerns being raised on five separate occasions that radiology procedures were not being followed.   An update was also requested on the nine patients who had required onward referrals regarding the outcome of their cases.  Councillor Hunter enquired whether the incident had prompted Care UK to look at how they operate nationally and whether they would be subject to any financial penalties if there were any further breaches of contract.  Councillor Gladbaum asked why staff turnover had been high at the UCC and could the incident be partly attributable to an over reliance on agency staff.  She also enquired why there had not been a robust protocol for staff with regard to procedures previously and she emphasised the importance of ensuring high standards for the safeguarding of children.  Councillor Harrison sought assurance that the necessary measures would be in place to ensure that staff had read and understood the protocol.

The Chair enquired if NHS Brent was satisfied to date with the implementation of the recommendations made as a result of the Root Cause Analysis investigation and sought clarification with regard to the issuing of a remedial notice to Care UK under Section 57.

In reply to the issues raised, Dr Titus Bradley (Care UK) acknowledged that the incident should have been noticed and escalated appropriately at an earlier stage.  This had been partly attributable to rapid staff turnover, failure to communicate clearly and insufficient induction of new staff.  Dr Titus Bradley advised that during the time of the incident, there was a significant number of interim staff and the high staff turnover was due to staff changing jobs, doctors taking up post overseas and a number of other reasons.  Since then, there had been much effort to increase the number of permanent staff and the workforce now was considerably more stable and dedicated to CMH.  A number of other measures had also been undertaken following the Root Cause Analysis investigation and all new staff undertook a robust induction that required them to sign a declaration that they understood what they had been told and all staff needed to adhere to the new protocol in place.  Members heard that the previous protocol had been less robust and had not been policed and enforced sufficiently.  Furthermore, managers were available on a 24/7 basis to be contacted if staff were unsure  ...  view the full minutes text for item 4.

This report from North West London NHS Hospitals Trust provides information to members of the Health Partnerships Overview and Scrutiny Committee on the position regarding A&E services for their consideration and comment.

Tina Benson (North West London Hospitals NHS Trust) introduced the report and advised that recruitment of staff, in particular doctors, to Accident and Emergency (A and E) services remained difficult, whilst the number of patients attending had now reduced to around 30 a day.  A number of efforts had been made with regard to recruitment and although 15 applicants were invited to interview for middle grade or junior doctor posts, none were thought suitable following the interview and clinical workstation assessments.  However, since publication of the report, a further 10 applications had been received. In view of the above, Tina Benson advised that it was recommended that the interim overnight closure of the A and E remain in place for a further year with a review of arrangements taking place in six months’ time. 

Councillor Harrison enquired whether the recruitment plans were based on the A and E services re-opening at night in the future.  Councillor Hunter sought reasons as to why none of the candidates had passed the interview stage for middle grade and junior doctor posts and Councillor Sneddon sought clarification as to whether any of these applicants had passed the clinical workstation assessment.  With regard to advertising for these posts for a publication in Eastern Europe, Councillor Gladbaum enquired what consideration there had been with regard to language issues and how would such staff be supported if they were recruited.  Councillor Hossain asked for further information on what steps were being taken to improving the quality of staff at middle grade level.

In reply, Tina Benson advised that it was intended to recruit posts across the whole of the hospital trust and initially to appoint sufficient numbers to operate A and E services on a 24/7 basis, however this no longer looked likely to be achievable.  All staff were now rotated across the trust in order to maintain their skill levels.  Tina Benson stated that it was a surprise that none of the candidates for the middle grade and junior doctor posts passed the interview stage, however the shortage of suitable candidates could be attributed to a shortage of A and E doctors nationally.  This had led to a number of junior doctors applying for more senior posts when they were not yet suitably experienced or qualified in the hope they would be able to secure these posts.  It was noted that only one candidate for middle grade and junior doctor posts had passed the clinical workstation assessment.  With regard to recruiting staff from Eastern Europe, Tina Benson informed Members that the advert and recruitment pack would be translated into the appropriate language and all staff were subject to a checking and sign off process before they were approved to work unsupervised and twice weekly training sessions would also be run.  In efforts to improve the quality of middle grade posts, CMH now worked with only one agency and efforts were being made to address responsibility and managerial roles as well as clinical duties.  CMH was also  ...  view the full minutes text for item 5.

The attached report updates members on the latest position regarding the merger of North West London NHS Hospitals trust and Ealing Hospital Trust which was expected to be completed by January 2013.

David Cheesman introduced this item and confirmed that the Final Business Case had been submitted to NHS London on 10 September.  The document had undergone minor amendments since the last meeting of this committee and the merger was presently at the ‘due and careful enquiry’ stage with some financial aspects being considered.  The Final Business Case would be presented to the Trust Boards on 17 October followed by the NHS London Board on 25 October and it was anticipated that, subject to their approval, the merger would commence in April 2013.

During discussion, the Chair sought further information with regard to financial targets and how the transitional arrangements would be funded.  Councillor Hunter asked for an explanation as to why the projected savings were not presently being met.  Councillor Harrison enquired if the merger would continue if it was ascertained that the savings would not be achieved.

In reply, David Cheesman advised that the financial aspects were not progressing as quickly as hoped and the projected savings were not yet reaching the expected levels.  This was partly attributable to increasing demand and the fact that the use of agencies was costly.  With regard to the transitional costs, David Cheesman stressed that this was a one-off cost and the savings that would be made from the merger in the longer term were more important.  The issue of whether the merger would continue if the savings could not be achieved would be a point of serious discussion, however David Cheesman advised that in essence, the clinical argument for the merger was sound, but the financial aspects needed to be more robust.

The Chair requested that information be provided to Members through Andrew Davies (Policy and Performance Officer, Strategy, Partnerships and Improvement) regarding the outcome of the Board meetings on 17 October and 25 October respectively and that an update be provided at the next meeting on the merger and progress towards achieving the trust’s savings targets.

Members had before them the committee’s draft response to the proposals set out in the Shaping a Healthier Future consultation for further discussion and consideration.

Councillor Gladbaum expressed some concern about the proposals for more out of hospital care provision and potentially vulnerable people being placed in the community.  Councillor Harrison commented on the shortage of GPs in Brent and queried what recruitment measures were being taken to address this.  She sought clarification in respect of paragraph 2.3 of the report concerning underuse of health facilities and did this mean underused staff.  Councillor Harrison felt that concern in relation to the future of CMH, particularly in relation to A and E services and the services to be provided by the UCC, should be emphasised in the committee’s response.  Councillor Sneddon also thought that more clarity should be requested with regard to the future role of the UCC and A and E services at CMH and also that the impact on the community to these changes should be investigated further and this should be reflected in paragraph 3.13 of the report.  Councillor Al-Ebadi expressed concern about the transfer of managerial responsibilities to GPs who may lack the appropriate skills to undertake this. 

Councillor Hunter suggested a revision to paragraph 4.6 and circulated the revised version to Members for their consideration. The revised version commented that A and E patients in the south of the borough were already frequently being directed to St. Mary’s, Royal Free and University College hospitals. It was to be queried whether the ratio of patients from this area going to these Imperial Healthcare hospitals would remain the same, or was one of the consequences of the proposed changes mean that more patients would go to Northwick Park Hospital as this issue needed clarification.  Councillor Hunter added that the last sentence in paragraph 4.6 of the report should be retained.

The Chair commented that it was important that out of hospital care services were properly resourced and acknowledged that the lack of GPs in Brent remained a concern and another issue was difficulties in relation to patient access to primary care services.  She added that every effort should be made to address recruitment issues regarding A and E services at CMH.

Andrew Davies advised that underuse of health facilities referred to some health centres being under-occupied and mention of this term in the report will be re-worded accordingly. 

Members agreed to the amendments to paragraph 4.6 as suggested by Councillor Hunter.  The committee also agreed to add the word ‘clinical’ after ‘strong’ in the first line of paragraph 5.1 of the report as suggested by Councillor Hunter and to the add the words ‘before the reconfiguration of acute services are made’ at the end of the first sentence of paragraph 5.2 (i).

RESOLVED:-

that the response to the Shaping a Healthier Future consultation be agreed subject to the amendments as set out above.

This paper sets out the business case for Brent and Hounslow’s proposal to share a DPH as well as the proposed structure for public health and how staff will be integrated into the current officer structure once it transfers to Brent Council from NHS Brent takes place.

Phil Newby (Director of Strategy, Partnerships and Improvement) presented the item and began by emphasising the importance of making public health services more effective and to complement the needs of the borough’s population.  The two main aims of the proposals were to create a fully integrated structure for commissioning public health services and to focus on illness prevention.  Commissioning would take place jointly between the council and the Clinical Commissioning Groups (CCG) and public health services would be mainstreamed to enable improvements in health and make it a core council activity.  Turning to the role of the Director of Public Health (DPH), the intention was to have a shared DPH with Hounslow whose role would be strategic and dynamic in helping to promote fresh ideas on public health matters and help drive policy.  The council was already sharing some services with other authorities, such as trading standards.  In addition, other local authorities such as the London boroughs (LBs) of Harrow and Barnet were already sharing a DPH.  Phil Newby explained that initial discussions with neighbouring London boroughs had involved the possibility of appointing a West London wide DPH, however councils had since followed the route of pairing up where they had identified compatibility.  In the case of LBs Brent and Hounslow, both shared a vision to place public health back into council services and this was the main reason why they were to work together and the shared intelligence of both authorities would benefit them.

Members then discussed the proposals in detail.  Councillor Harrison sought clarification with regard to the budget available for public health services and whether there was potential for conflict between local authorities and CCGs as to how it would be spent and convincing health professionals to be working within the council.  She enquired whether there was an element of risk in pioneering a new way of public health which had not been tried and tested elsewhere.  Councillor Harrison also felt that it was important that a DPH be able to concentrate solely on the needs of Brent residents.  Councillor Sneddon enquired about the main differences between the LBs Brent and Hounslow partnership as compared to LBs Harrow and Barnet.  He asked whether there was a risk that that the Government would raise issues about  the LBs Brent and Hounslow partnership as guidance from the Department of Health and Local Government Association suggested that councils should already have a shared management team in place or share a boundary with each other.  Councillor Sneddon expressed concern that a lack of direct management responsibility and non ownership of any budget could reduce the influence of the DPH, whilst in turn the postholder’s views could be unduly influenced by other budget holders.

Councillor Gladbaum enquired whether the appointment of a DPH would also entail additional staff being recruited and was the council’s Public Health Intelligence Team already in place.  She stated that a shared DPH would mean they would spend less of their time on each borough and suggested that  ...  view the full minutes text for item 8.

Members noted the committee’s work programme for 2012-13 and agreed to Councillor Gladbaum’s suggestion that items on abortion and teenage pregnancy be added to it.

The next scheduled meeting of the Committee is on 27 November 2012.

It was noted that the next meeting of the Health Partnerships Overview and Scrutiny Committee was scheduled to take place on Tuesday, 27 November 2012 at 7.00 pm.

None.