Agenda and minutes
Venue: Boardroom - Brent Civic Centre, Engineers Way, Wembley, HA9 0FJ. View directions
Contact: Toby Howes, Senior Democratic Services Officer 020 8937 1307, Email: toby.howes@brent.gov.uk
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Declarations of personal and prejudicial interests Members are invited to declare at this stage of the meeting, any relevant financial or other interest in the items on this agenda. Minutes: None declared. |
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Minutes of the previous meeting held on 4 December 2013 PDF 104 KB The minutes are attached. Minutes: RESOLVED:-
that the minutes of the previous meeting held on 4 December 2013 be approved as an accurate record of the meeting. |
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Matters arising (if any) Minutes: None. |
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Diabetes Services in Brent PDF 55 KB The report covers services currently provided, including; healthy eating and physical programmes, awareness and health checks, primary care measures through the Quality and Outcomes Framework; GP insulin scheme, community and secondary care provisions and diabetic eye screening services. Additional documents: Minutes: Melanie Smith (Director of Public Health) presented the report that had been jointly produced by the council’s Public Health Team, Brent Clinical Commissioning Group (CCG) and NHS England. Members were aware that diabetes was of particular concern in the borough and noted that 22,097 people were on GP diabetes registers in Brent. Diabetes UK had estimated a diabetes prevalence rate of 10.5% overall in Brent in October 2013, although rates varied across the borough. It is estimated that one in four people with diabetes in London are undiagnosed and are at high risk of developing long term complications. The committee heard that there had been a 38% increase in diabetes rates for NHS Brent between 2008/09 and 2012/13. Melanie Smith informed members that those with diabetes in Brent were more likely to develop complications arising from their condition than the general population, including heart disease, stroke, foot disease that may necessitate amputation, kidney disease and loss of sight. However, early diagnosis, good diabetic care and self management could all be effective in preventing complications from arising. Melanie Smith referred to the findings from the 2011/12 National Diabetes Audit that identified that people with diabetes in Brent were less likely to suffer complications than the national average of those with diabetes, despite the borough’s relatively high levels of deprivation. This served as evidence that both health services and residents were responding well once diabetes was diagnosed.
Isha Coombes (Manager, Brent CCG) then summarised the current diabetes services currently operating in the borough. A total budget of £9.493m had been set for diabetes services for 2013/14 and it included a range of services. This included health promotion and prevention of diabetes schemes run in conjunction with the CCG and the council, including physical activity programmes, healthy eating, diabetes awareness raising, risk assessment and health checks and the Moving Away from the Pre-diabetes programme. The council commissions the NHS Health Check programme offered by Brent GPs aimed to prevent diabetes as well as heart disease, stroke, kidney disease and certain types of dementia. The council was also working with Diabetes UK through a community engagement programme, using community champions to promote awareness of diabetes for the high risk groups in the borough. Isha Coombes advised that diabetic patients were currently managed in primary care under the standard General Medical Services (GMS)/Personal Medical Services (PMS) contract, including additional health checks under the Quality and Outcomes Framework (QOF), a voluntary scheme which all Brent practices participated in. Other schemes to tackle diabetes included the Brent GP insulin initiation scheme, which had been rolled out across Brent in April 2012 and the Ealing Integrated Care (ICO) Organisation service that helped patients with type II diabetes, secondary care services and the Brent diabetic eye screening service. The latter is commissioned by NHS England from Ealing ICO. Those patients with positive screening tests would subsequently be referred to ophthalmology services at Central Middlesex Hospital (CMH).
Isha Coombes then outlined the proposals for the diabetes service redesign commencing in ... view the full minutes text for item 4. |
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Brent Clinical Commissioning Group finances PDF 55 KB The report outlines Brent’s current position, with a surplus of £26m in 2013/14, and an overview of the key areas and their current spends. Also outlined are 2013/14 QIPPs and investment plans and an overview of the approach to 2014/15 QIPPs and investment plans. Additional documents: Minutes: Jonathan Wise (Chief Finance Officer, Brent CCG) introduced the report and outlined Brent CCG’s finances in the context of the national financial framework, explaining that NHS England would be responsible for allocating funding to CCGs for the next two years. Members heard that CCGs’ statutory functions were more restrictive than they had been for primary care trusts. Hospitals received most of their income from CCGs, as well as NHS England and local authorities, through national tariffs. Jonathan Wise drew members’ attention to Brent CCG’s financial position, which was relatively healthy and a surplus budget of £26m had been agreed for 2013/14. Brent CCG had also agreed to be part of two pan-CCG financial arrangements, the first to support the Shaping a Healthier Future implementation and the second an agreement with Harrow and Hillingdon CCGs to be part of an in-year risk share arrangements. Jonathan Wise advised that the supplementary paper circulated prior to the meeting provided an explanation of the process of how risk share arrangement would operate. He informed members that Brent CCG had been awarded the minimum level of growth in 2014/15 and 2015/16 as it had been assessed as being overfunded in 2014/15. He advised that the uplift of 2.14% for 2014/15 and 1.7% in 2015/16 would not keep pace with the estimated 3.4% per annum increase in cost pressures that were expected due to local demand and cost growth.
During members’ discussion, it was queried whether the national tariffs influenced clinical decisions in any way and was there any possibility of local tariffs being applied. In respect of Brent CCG’s agreement with Harrow and Hillingdon CCGs, it was commented that their financial situation was not particularly healthy and why was there no mention of Brent CCG having an agreement with Ealing CCG whose financial position was stronger. An enquiry was made as to whether community and out of hospital services were subject to national tariffs. It was commented that there were significant costs involved that did not actually include costs of commissioning services and treating patients, such as contingency costs, and a further explanation of this was sought. Moreover, it was asked how end of life services would continue to be provided in view that funding on this had been reduced. A member commented that if more patients wished to see out their lives at home rather than hospital, this would impact on resources in social care. Members also queried why NHS England did not fund GP’s IT equipment. In respect of Shaping a Healthier Future, it was asked whether Brent CCG had allocated 2% headroom funding for last year as well as 2013/14 and did other CCGs do the same. Turning to investments, the committee queried whether these would contribute towards primary care network development and achieving better GP outcomes and improving primary care hub access. It was also commented that the proportion of spending on GPs was considerable and what steps were being taken by NHS England to raise GP standards. A member also ... view the full minutes text for item 5. |
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Brent Clinical Commissioning Group commissioning intentions 2014/15 PDF 52 KB Brent Clinical Commissioning Group (CCG) is presenting the Health Partnerships Overview and Scrutiny Committee with its commissioning intentions for 2014/15 for the committee’s comments. The report provides an overview of the CCG’s commissioning aims along with a more detailed appendix of their plans for 2014/15. Additional documents:
Minutes: Sarah Mansuralli (Deputy Chief Operating Officer, Brent Clinical Commissioning Group) presented the report that outlined the key aims and desired outcomes of Brent CCG’s commissioning intentions. The main intention was to help fulfil the improvements identified as necessary and provide more community provision. The committee noted that the providers shared the CCG’s intentions and the aims would be achieved through collaborative working between the CCG, service providers, patients and the public. The CCG had undertaken benchmarking exercise across four nationally defined domains, however data had not been available for the fifth domain in relation to treating and caring for people in a safe environment and protecting them from avoidable harm, so local data was being obtained. Members heard that CCG’s commissioning intentions had been supported at draft stage by the EDEN Committee and the final proposals would be reported to the EDEN Committee on 29 January, following which their feedback would be available. Sarah Mansuralli emphasised the importance of producing clear commissioning intentions as these were instrumental in shaping the CCG’s investment plans. The CCG’s intentions were both broad and ambitious and aimed to maximise patient outcomes and experience.
During members’ discussion, a member queried whether the proportion of acute contracts making up 73% of the Brent CCG contract was what the CCG had intended. In noting the intention for providers to work collaboratively towards electronic records, she noted that such initiatives had not worked in the past and she enquired what steps would be put in place to ensure that this was more successful this time. She expressed her approval of proposals with regard to the assessment tariff, mental health and elderly care and added that the conference on dementia in December 2013 that had included the attendance of Dr Ethie Kong and some Members of Parliament had been a worthwhile exercise. In view of this, she queried why dementia had not been explicitly included in the report. Another member welcomed the overall purposes of the CCG commissioning intentions, however she felt that they lacked specificity and in view of the financial constraints, she enquired what areas would be focused on and what consultation had been undertaken with patients. A member asked if podiatry services would be available, especially as some diabetic patients would benefit from this. In respect of dementia, he enquired how the quality of assessments would improve to ensure they got the appropriate level of care.
With regard to intentions for outpatients’ services, it was queried how these would be delivered in view that the CCG’s Quality, Innovation, Productivity and Prevention (QIPP) investment plan for 2014/15 was subject to a 3% budget reduction. In respect of community health services and pathways, information was sought in respect of plans, including the budget allocated for it and a timetable for implementation. It was commented that intentions for community paediatrics lacked detail and further information was sought, particularly in respect of services for children with acute diabetes. Further details were also sought in respect of proposals for mental health ... view the full minutes text for item 6. |
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18 Weeks Referral To Treatment Incident and Urology Serious Incident PDF 59 KB The report restates the plans to expand some areas of capacity including theatres and to commission external providers in order to cope with the additional capacity required to deal with the large volume of affected patients with some additional details. Also highlighted is a different, more recently identified, incident that has occurred in urology, where patients booked on a planned waiting list for diagnostic/cystoscopy procedures had not been offered an appointment. Additional documents: Minutes: David Cheesman presented this item and began by referring to the Northwest London Hospitals Trust (NWLHT) capacity paper. He stated that the NWLHT continued to carry out waiting lists initiatives and following the review of demand and capacity, the NWLHT had planned an increase in internal capacity with the majority of work being carried out by CMH. In addition, the CCGs within the NWLHT had agreed to fund additional capacity through outsourcing and as a result of this, the BMI Healthcare Group, the Hillingdon Hospitals Trust and the Royal National Throat, Nose and Ear Hospital had been selected as providers.
Turning to the urology serious incident, David Cheesman advised that a review of urology patients on the planned waiting list in October 2013 had identified that 196 patients had waited over ten weeks for a flexible cystoscopy appointment. This had resulted in an investigation to see if any patient’s safety had been affected and results would be reported to the NWLHT Board in March. David Cheesman added that to date, the investigation had not identified any patients who may be at risk of harm, however the seriousness of the incident could not be underplayed.
During members’ discussions, a member queried whether Brent was funding the whole exercise when only 20% of patients were from Brent. She referred to a national audit report that had stated that 58 out of 100 hospitals had problems with waiting lists and asked if a fundamental flaw was responsible for the system not working properly. Further observations were sought with regard to review of mortality rates whilst on the waiting list and what were the plans to meet the needs of patients requiring routine surgery in future. It was also asked whether there was any data available on the additional time patients had waited on top of the 18 weeks that they had been on the waiting list.
In reply to the issues raised, David Cheesman advised that Brent CCG was only funding its patients’ treatment and not from the whole waiting list. He emphasised the need for sound data to evaluate ways to ensure that the 18 weeks referral to treatment could be achieved and external organisations were being used to help with this. In addition, effective management of waiting lists was also necessary. He advised that investigations continued in respect of review of mortality rates for those patients on waiting lists, including assessing whether the condition of patients had worsened. In respect of routine surgery, steps were in place to increase capacity both internally and through external sites, however this would need time to be achieved. Members noted that there were sufficient staff to operate clinics and operational theatres. David Cheesman advised that data was not yet available concerning how long patients had waited in addition to the 18 weeks they had already remained on the waiting list, although efforts would be made to provide this.
The Chair requested an update on this item at a future meeting. |
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Plans for Central Middlesex Hospital PDF 62 KB The report is attached. Additional documents:
Minutes: In noting the report provided, the Chair advised that members wished to defer this item to the meeting on 18 March to allow more time to consider this matter and also to consider it in the context of mental health and the paper on Shaping a Healthier Future. |
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Health Partnerships Overview and Scrutiny Committee work programme 2013/2014 PDF 49 KB The work programme is attached. Minutes: The Chair requested that the mental health services paper be included as part of the plans for CMH report at the meeting on 18 March, whilst sexual health was to be deferred to a future meeting. In respect of public health, this should be placed on the agenda for meetings as more detail and important developments emerge. |
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Any other urgent business Notice of items to be raised under this heading must be given in writing to the Democratic Services Manager or his representative before the meeting in accordance with Standing Order 64. Minutes: In noting that this would be David Cheesman’s last meeting before he joined a hospitals’ trust in South London, members placed on record their thanks for his contributions at the committee meetings and wished him all the best for the future. |
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Date of next meeting The next meeting of the Health Partnerships Overview and Scrutiny Committee is scheduled to take place on Tuesday, 18 March 2014 at 7.00 pm. Minutes: It was noted that the next meeting of the Health Partnerships Overview and Scrutiny Committee was scheduled to take place on Tuesday, 18 March 2014 at 7.00 pm. |