Agenda and minutes

Councillor Ketan Sheth declared an interest as the Vice Chair of Central and North West London NHS Foundation Trust, however he did not view this as a prejudicial interest and remained present to consider all items on the agenda.

The minutes are attached.

RESOLVED:-

that the minutes of the previous meeting held on 19 March 2013 be approved as an accurate record of the meeting, subject to the following amendments:-

-       page 2, last paragraph, second line, add ‘not’ after ‘could’.

-       page 5, last paragraph, third line, replace ‘LES’ with ‘LAS’.

-       page 6, second paragraph, sixth line, add ‘hospital’ before ‘care’.

None.

The Health Partnerships Overview and Scrutiny Committee were presented with an interim report on the incidents that had occurred with pathology results provided to GPs in Brent and Harrow.  Following completion of the investigation, members of the committee have since received a copy of the Root Cause Analysis Investigation report.  The report now being presented to the committee is an update on the actions being taken to address the issues identified and the recommendations in the Root Cause Analysis.

Jo Ohlson (Brent CCG Chief Operating Officer) introduced the final report in respect of the incidents and subsequent investigation for pathology services in Brent and Harrow.  Pauline Johnson (Interim Head of Quality and Safety, Brent CCG) then drew Members’ attention to the six actions listed in the resulting action plan as set out in the report.  Dr Patel, chair of the Root Cause Analysis (RCA), was also present to respond to members’ questions. 

Members then discussed the item and raised a number of issues.  One member commented that the incidents may not have happened had there been more staff with the necessary expertise and the number of consultants available was queried.  Further comments were sought in respect of the reference in the report to GPs not attending working group meetings and were steps being taken to ensure that they did.  It was acknowledged that there had clearly been communication issues, in particular a lack of cascading information down to staff at all levels, with CROs not sure who was responsible for ensuring this was happening and it was asked whether this had now been addressed.  An update on the communications strategy was also sought.  In relation to transportation of samples, it was enquired why it had not been specified in the service specification that samples be transported at room temperature, despite clinical opinion stating they should.  Information was sought with regard to future arrangements for risk assessments and would this include involvement from GPs.  The committee asked for an explanation of the process for when laboratories presently issued tests.  A member commented that  the incident and the RCA had flagged up issues that were also national ones and it was asked whether there had been a formal response to this.

A member acknowledged that one of the main reasons the pathology contract had undergone a procurement exercise was to test if the market could produce potential savings.  However, although this was necessary, there was no evidence to suggest that a proper risk assessment had been undertaken and it was asked what had been learnt from this.  It was enquired whether both the previous and current provider of pathology services was clinically accredited and what date had they been confirmed as being so.  It was commented that in the Francis report, it had been stated that consultants had been commissioned to advise hospitals as opposed to CCGs and it was asked how expert advice had been sought during the procurement.  Members asked what the total costs of the incident had been and what steps were being taken to address management and leadership issues in respect of the CCG and Central Middlesex Hospital. It was commented that the procurement of the pathology contract had been undertaken without the knowledge of GPs and she asked what steps were being taken to keep them informed. 

In reply to the issues raised, Pauline Johnson advised that although consultants were being used at around the time the incident happened, some of them had not been able  ...  view the full minutes text for item 4.

This report outlines the key current problems, notably with meeting the four hour waiting time targets.  It cites issues such as increased pressure at Northwick Park Hospital, where Emergency Department attendances have decreased but combined Emergency Department and Urgent Care Centre attendances continue to increase; it also cites issues around long stays in beds and delays in discharge causing a blockage in the emergency pathway.  Attendance at Central Middlesex continues to decline.

Tina Benson presented the report and stated that the North West London Hospitals (NWLH) Trust had held a number of discussions, including a risk summit, with staff and other stakeholders to explore ways of reorganising emergency services across both Central Middlesex Hospital (CMH) and Northwick Park Hospital (NPH), to make best use of staff and other resources.  A project board had been created and set up three workstreams underpinned by a number of projects, which will require the support of all key health and social care partners to deliver:-

·         Increasing bed capacity at NPH

·         Maximising capacity at CMH

·         Moving more orthopaedic work to CMH

Tina Benson explained that for CMH, the changes in particular focused on moving recovery and rehabilitation care to the hospital for patients who had received surgery for hip fractures.  It was also proposed to have an enhanced recovery programme.  CMH would sustain an acute medical intake to treat patients with a medical problem, whether they arrived by ambulance or through GP referral, at any time day or night.  Currently ambulance arrivals were not accepted out of hours, but this was being discussed with the London Ambulance Service.  With regard to NPH, additional bed space on existing wards, including a short term change of 11 private beds on Sainsbury Ward to NHS beds would be undertaken.  It was also intended to expand the ambulatory care unit and surgical assessment unit on Fletcher Ward to include the STARRS assessment lounge to accommodate a further 10 to 15 patients a day and move STARRS to focus on the Emergency Department to prevent unnecessary admissions.  Other measures included patients in need of a surgical assessment not necessarily having to be assessed in the Emergency Department first and being referred directly to the relevant consultant depending on their condition.  Work had also started on a new Emergency Department and state-of-the-art operating theatres at NPH. 

During discussion, clarification was sought in respect of acute medical intake at CMH and whether staff numbers would be increased in order that it could remain open at night and was there the budget to be able to do this.  Moreover, would the hours be extended at CMH in the event of additional staff being recruited in any case and what was the recruitment policy for the hospitals.  Comments were sought as to whether the patient footfall remained low at CMH and was this an attributable reason for the difficulty in recruiting staff there.  Members also noted the concerns of residents to the ongoing evening closure of the Accident and Emergency (A and E) department at CMH and it was enquired what was being done to improve communication with residents in the area to keep them informed of services available at the hospital. It was also asked if A and E targets at CMH were being met and were residents in the area visiting A and E less, and if so, where were those who were in a serious condition being treated.  Furthermore, was there an increase  ...  view the full minutes text for item 5.

The report outlines some of the key issues that have affected the 111 telephone service and delayed its’ full roll out.

Jo Ohlson presented the report and confirmed that the 111 service went live on 26 February 2013, its launch being delayed as a result of the findings of the risk assessment.  The launch in February was a ‘soft launch’, meaning the service was only available for patients contacting GPs on the out of hours telephone line.  Since the launch, there had been some performance concerns, particularly in respect of performance over the Easter Bank Holiday weekend, both locally and nationally.  This had led to a performance notice being issued to the contractor, Harmoni, and a remedial action plan had been put in place. Since Easter, performance had improved with performance meeting or being very close to the required standard of answering calls in 60 seconds and call abandonment.  However, Jo Ohlson added that the performance indicator of call backs to patients within ten minutes of their initial call remained a challenging one, and actions such as queue prioritisation were put in place whilst underlying issues in respect of staff numbers and rotas were addressed.  Any call backs talking longer than an hour were investigated.  There had also been deemed to be a lack of professionals to transfer the calls to which had led to the number of call backs required increasing.  Jo Ohlson advised that NHS London would decide when the full service would be launched in London, although 111 performance was better than the national average.

During discussion, Members sought clarification with regard to the differences between the 111 service and 999 service and what issues presently remained unresolved with the 111 service.

In reply, Richard Penney (111 Project Manager for North West London) advised that the 999 service was for life-threatening situations, whilst the 111 service was for all other urgent and non life-threatening situations.  The 111 service helped direct callers where they were not sure who to contact and there was also direct access between 111 and 999 and vice versa. Richard Penney added that a protocol had been agreed between the 111 service and the London Ambulance Service.  He advised that the problems the 111 service had experienced were not to do with how the service operated, but in meeting a whole range of standards and issues such as a lack of professional advisers had affected the ability to meet some of these.  However, following the problems experienced during the Easter Bank Holiday weekend, meetings with providers had led to a recovery plan and the introduction of a number of measures to address these issues.  Richard Penney explained that the call back target was a particular problem at national level and there still remained challenges to overcome, however Harmoni were addressing these and were also recruiting new staff.

The Chair requested details of the training programme for 111 service advisers, the remedial action plan and progress with regard to the key indicators performance at the next meeting on 24 July 2013.

Members will receive a verbal update on this item.

David Cheesman advised that there were no changes to the timescale of the merger since the last update to the committee.  He confirmed that the financial aspects of the business case were to be finalised.

The Health Partnerships Overview and Scrutiny Committee were advised by the Northwest London Hospital Trust, at the meeting in March, that the Colposcopy Service at Central Middlesex Hospital had been suspended after a member of staff had left.  The trust had had problems recruiting a replacement, and this left insufficient staff to ensure a service that complied with waiting times criteria and clinical standards.

This report provides an update on the situation, including details of problems with a high number of “did not attend” instances prior to the colposcopy service closing at Central Middlesex and plans to train a gynaecological nurse to replace the member of staff that has left.

Tina Benson presented the report which outlined the reasons for relocating the colposcopy service at CMH to NPH on a temporary basis from 1 April 2013.  This had been done as there had remained only one colposcopist at CMH following the retirement of their colleague and so the relocation was necessary in order that they had retained support and to not be left working in isolation, which would be against the national screening programme’s statutory clinical guidelines.  Members noted that the Trust was in the process of training one of its gynaecology specialist nurses to take over the vacant colposcopist position and they would be appointed to this post, subject to meeting the required competencies. 

During discussion, a member commented that their spouse had received good service at NPH.  Another member commented that the Did Not Attend rates were high and were they getting worse. She also noted that a four week wait to be seen following a smear test result was long and what steps were being taken to reduce this.

In reply, Tina Benson advised that a lot of work was being focused on explaining to patients of the importance of taking smear tests to identify conditions such as cancer and to explain the procedures involved in the test.  Members heard that the waiting times for smear test results were nationally set standards and four weeks was only the target, however if the smear test had conclusively identified cancer, patients would be seen within two weeks.

This report summarises for the Health Partnerships Overview and Scrutiny Committee the position relating to the transfer of public health services from NHS Brent to Brent Council which formally took place on 1 April 2013. The transition project has come to an end and it is important that remaining activity related to the transfer passes to departments in order to “mainstream” the public health function within the local authority.

Imran Choudhury (Interim Director of Public Health) confirmed that there had been a successful transfer of staff from the NHS to the council and staff were in the process of being embedded and getting used to the new working culture.

Members commented of the need to receive regular reports on how public health services were working. 

Phil Porter (Interim Director of Adult Social Services) added that the first meeting of the Health and Wellbeing Board would be responsible for overseeing the response to the broader issues involved in improving public health services.

This report summarises for the Health Partnerships Overview and Scrutiny Committee the Sexual Health and Reproductive Services which have transferred across to Brent Council as a result of the transfer of public health services from NHS Brent to Brent Council which formally took place on 1 April 2013.  The report briefing highlights the current provision of sexual health services in Brent, an outline of the council’s role in relation to the commissioning and co-ordinating of services in the borough and the key challenges for the future commissioning landscape.  

Members had before them a report on sexual and reproductive health services in Brent.  A member commented that the mention of sexual health prevention in the report was perhaps inappropriate and misleading and should be re-termed.  It was also enquired whether there was any risk to the contracts for the pan-London HIV prevention services.

In reply, Imran Choudhary advised that pan-London HIV prevention services were not at risk, however there had been some concerns with regard to the robustness of these services so these were being reviewed by the London Borough of Lambeth, the lead borough on this matter.  He acknowledged the need to reconsider the term sexual health prevention. 

The work programme is attached.

The Chair drew members’ attention to the committee’s work programme.  In respect of commissioning intentions for the 24 July 2013 meeting, she stated that issues concerning CCG procurement, such as how they operated, the main principles and priorities and who was consulted, be explained.  In addition, the current procurement programme should also be outlined and explained in the context of the Francis report, the needs of services and the community.  The Chair also advised that a report on how Health Watch was working would also be put to the committee.

Dismissal of Deputy Borough Director for Brent NHS

Rob Larkman updated members in respect of the recent dismissal of the Deputy Borough Director for Brent NHS, Craig Alexander, following the revelation that he had a previous conviction for armed robbery.  Members heard that he had been recruited through an agency, who were not required to undertake Criminal Records Bureau/Disclosure and Barring Service checks.  Craig Alexander had  not disclosed the criminal offences during his application and he had provided satisfactory references, whilst his work performance had also been satisfactory.  Rob Larkman explained that as soon as the criminal offences were known, an immediate review was undertaken and Craig Alexander was swiftly dismissed.  A report had also subsequently gone to the Governing Body making various recommendations in respect of employing agency staff.  The recommendations would be reported in a public meeting.

The committee enquired whether the police had provided any advice in respect of the case and could assurances be given to the person who had bought Craig Alexander’s background to the attention of Brent NHS.

In reply, Jo Ohlson advised that NHS Protect were involved in the case and were advising other bodies accordingly.  She gave her assurances in respect of the member of staff who had first highlighted the case.

The Chair requested that the number of agency staff in the CCG and the total expenditure on them be provided at the next meeting of the committee on 24 July 2013.

The next meeting of the Health Partnerships Overview and Scrutiny Committee is scheduled for Wednesday, 24 July 2013 at 7.00 pm.

It was noted that the next meeting of the Health Partnerships Overview and Scrutiny Committee was scheduled to take place on Wednesday, 24 July 2013 at 7.00 pm.