Agenda and minutes

None declared.

RESOLVED:-

that the minutes of the previous meeting held on 3 November 2014 be approved as an accurate record of the meeting.

None.

The attached report from London North West Healthcare sets out their progress in responding to the findings and recommendations of the Care Quality Commission (CQC) inspection of Northwick Park Hospital.

The Chair advised that the London North West Hospital Trust (LNWHT) had been subject to an inspection by the Care Quality Commission (CQC) in late May 2014. The subsequent report published by the CQC on 20 August 2014 had identified a number of areas where the LNWHT and Northwick Park Hospital (NPH) were found to require improvement. The findings in relation to the A&E service at NPH were particularly concerning and in recent months the length of wait times at the unit had been amongst the worse in the country. The reports before the committee updated members on the progress achieved by LNWHT against the CQC Compliance Improvement Plan and the development of the Trust Quality Improvement Plan. Representatives of the LNWHT were present to address the committee’s queries.

Carol Flowers (Chief Nurse, LNWHT) introduced the Compliance Improvement Plan and advised that the recommendations of the CQC had been grouped into actions that had to be completed within three months and those that should be taken with a longer time frame. It was emphasised that the ‘must do’ actions had all either been completed or were on track to be completed by the deadlines set.  This included the creation of a new database to capture information on the safety and quality of care and treatment provided within critical care and the appointment of a lead clinical officer to oversee this. A series of actions had been undertaken in response to concerns that the maternity service did not actively seek women’s feedback including the appointment of a designated Patient Experience and Quality Improvement Lead and the development of a Women’s Feedback Plan. The Trust Quality Improvement Plan would be made available to the committee following its circulation to the CQC in the coming week. The Plan had been submitted to the LNWHT Board earlier that day and included actions such as increasing compliance with mandatory training rates and integrating policies and procedures across the Trust. It had been agreed with CQC that monthly meetings would be held to monitor improvement at the Trust and provide assurance to providers and stakeholders. A compliance manager would be appointed to sustain this work. In concluding the presentation, Carol Flowers advised that the issues raised by CQC regarding the A&E unit at NPH had principally related to the need to appoint permanent staff into several posts. These issues had largely been addressed by the transfer of staff from CMH A&E to the unit at NPH.

In the subsequent discussion, a member queried how many reports had been received as a result of the ‘see something say something campaign’ which had been launched to encourage staff to raise their concerns. It was further queried how the campaign worked in practice and to whom staff were asked to report their concerns. Comment was sought on the findings relating to the maternity service. A question was raised regarding whether LNWHT had been challenged on their Whistleblowing Policy. An update was sought on the low levels  ...  view the full minutes text for item 4.

In February 2013 the North West London joint committee of Primary Care Trusts approved implementation of the Shaping a Healthier Future Programme.  The reconfiguration commenced with the closures of the A&E units at Central Middlesex Hospital and Hammersmith and Fulham Hospital on 10 September 2014.  The next stage of implementation is the planned changes to maternity services at Ealing Hospital.  This report from Brent Clinical Commissioning Group sets out the anticipated impact that the changes to maternity, neonatal, paediatric and gynaecology services at Ealing Hospital will have on Brent Residents.

Dr Susan LaBrooy (Medical Director, SaHF) introduced a report detailing the process by which approval was granted for the consolidation of inpatient paediatric services and maternity and neonatal services in North West London, and outlining the anticipated impact of these changes on Brent residents. Encompassed within these changes was the cessation of the interdependent maternity and paediatric services at Ealing Hospital. It was explained that the decision to consolidate these services had been clinically driven and had been approved by the Secretary of State in 2013. The maternity service at Ealing Hospital had been declining and the hospital was only able to achieve 60 hours of consultant presence on the labour ward; this did not provide enough activity to allow medical professionals to remain validated as practitioners and was therefore unsustainable without significant further investment.

Dr Susan LaBrooy further explained that in 2013/14 only 1 per cent of Brent women chose to use maternity services at Ealing Hospital. The majority of Brent women chose to North West London Hospitals (43 per cent) or Imperial College Healthcare (41 percent), both of which had sufficient capacity to accommodate the additional numbers of births following the closure of the service at Ealing Hospital. Modelling conducted regarding usage of maternity services following the proposed closure at Ealing Hospital had identified that West Middlesex and Hillingdon Hospitals would receive the greatest increase in use of their maternity services. Further modelling was underway with data being collected from expectant and new mothers via GPs and Children’s Centres. This data would inform the decision of the Ealing Clinical Commissioning Group as to when the transfer of services would take place, as would evidence from site visits conducted by NHS England and the NHS Trust Development Authority to assess the assurance provided. Members were further advised that a North West London maternity booking service had been commissioned which would allow women to choose their preferred hospital and would ensure that priority was given to local women. This booking service would provide valuable monitoring information for maternity services.

During members’ discussion, the committee sought confirmation that NPH would be able to cope with additional pressure on their maternity services, given the findings of the recent Care Quality Commission (CQC) inspection and the high birth rate in Ealing. Further information was sought regarding the capacity of Imperial College Healthcare to accommodate additional deliveries. A query was raised regarding the number of consultant hours on the maternity ward at NPH and how this compared to the recommended figure.  The committee questioned what contingency plans were in place if it was found that the proposals were not feasible or appropriate. It was questioned whether similar modelling had been undertaken regarding the anticipated dispersal of service pressures for A&E units following the closure of the unit at Central Middlesex Hospital (CMH).

In response to the queries raised, Dr Susan Labrooy advised that the Borough of Ealing had a large birth rate but maternity services were accessed by women at a variety  ...  view the full minutes text for item 5.

The attached report from the Brent Clinical Commissioning Group (CCG) outlines the proposals and processes for deciding the new configuration of health services available from Central Middlesex Hospital.

Rob Larkman (Accountable Officer, Brent, Harrow and Hillingdon CCGs) introduced a report updating members on the work being undertaken to develop Central Middlesex Hospital (CMH), including consultation and engagement activities. It was explained that the plans to develop CMH were underpinned by the acknowledgement that the CMH site had been underutilised for many years. The intention was to provide a range of additional services at CMH to ensure that the site was clinically viable and financially sustainable in the long-term. 

Rob Larkman advised that CMH had been defined as a local and elective hospital under the acute services reconfiguration set out in the Shaping a Healthier Future (SaHF) programme. Amongst the services it would provide would be a 24/7 Urgent Care Centre, outpatient services, diagnostics, elective services and primary care hub. Further work to build on the services to be offered had resulted in the development of a Strategic Outline Case (SOC) in 2013, which had subsequently been agreed by the relevant Boards in 2014. The SOC encompassed a preliminary assessment of costs, benefits, risks and funding in scoping the possible range of services that could be provided at CMH and proposed services such as an Elective orthopaedics centre, Mental health inpatient facility, primary care ‘hub’ and genetics laboratory. An Outline Business Case (OBC) was now being developed which built upon the SOC to further refine and develop proposals. It was anticipated that the OBC would be completed by the end of 2014 and that it could then be taken through the approval procedures to obtain the necessary capital investment. Rob Larkman highlighted that the OBC would no longer include a mental health in-patient facility as the ward configuration and open space required could not be accommodated.

The Chair thanked Rob Larkman for his presentation. The committee requested that the proposals be provided in greater detail, including a financial breakdown of costs and the investment configuration for the proposed services. Members then raised several queries. With reference to the proposal to relocate rehabilitation beds from the Willesden Centre to CMH, a member questioned the implications for Willesden Centre. It was further queried what services were located at the Willesden Centre and a concern was raised regarding the costs to the tax payer of an underutilised site. It was subsequently proposed that the committee undertake a site visit to the Willesden Centre. The committee sought further information regarding the provision of in-patient mental health service at the Park Royal site. Queries were raised regarding the consultation activities undertaken, including the number held and how they were advertised.  Further details were sought regarding the services available in the North of the borough and the procedures in place to deal with large scale health emergencies. A view was put that consultation on changes to primary care had been poor. Councillor Daly requested that details of the number of beds to be removed across North West London under SaHF be provided to her in writing.

In response, Rob Larkman and Ethie Kong  ...  view the full minutes text for item 6.

The report of the Scrutiny Task Group on promoting Electoral Engagement is attached for the committee’s consideration.

Councillor Nerva (Task Group Chair) presented the final report of the Task Group ‘Promoting Electoral Registration’. The Task Group had been established to examine the transition to Individual Electoral Registration (IER), which had been described as the most significant change to the electoral system in the last 100 years. IER went live in June 2014 and was expected to fully supplant the current Household Electoral Registration system on 1st December 2015, with the aim of making the process of registration more convenient and secure. IER differed from the previous system by requiring each person to register individually by providing personal identifiers (National Insurance number and date of birth). Online registration had also been enabled under the new system and had been available since June 2014. It was recognised that IER presented significant challenges for the council, as well as opportunities to improve voter registration across Brent.

Councillor Nerva thanked the members of the task group and the supporting officers for their work. He then highlighted the key findings of the task group. It was emphasised that Brent was an incredibly diverse borough and the task group had identified that even within neighbourhoods and polling districts, there was significant variance in voter registration. It was considered therefore that a bespoke plan to target those most at-risk of not registering was required and efforts needed to be concentrated in the areas most in need to make the best use of communications tactics that target those hardest to reach. Consequently, to achieve a successful transition to IER, a joint effort was needed across council services, local stakeholders, partner agencies and community organisations. In concluding his presentation, Councillor Nerva drew the committee’s attention to the task group’s recommendations detailed in the report, which had been grouped into three broad themes: the need for a comprehensive IER roll-out programme and communications strategy; the need for more effective working of partners including the voluntary and community sector, housing and other statutory and non-statutory partners; and, the need for enhanced civic engagement with the community.

With the permission of the Chair, a member of the public suggested that sixth form pupils at secondary school be engaged directly and that parents of children of all ages be targeted via groups run by schools such as parents’ forums.

Councillor Pavey (Deputy Leader) commended the task group for their work and expressed his commitment to ensuring the recommendations set out in the report were implemented. The committee similarly welcomed the report of the task group and added their thanks to the members and officers responsible.

RESOLVED:

That the recommendations of the ‘Promoting Electoral Registration’ task group as detailed in the report be endorsed.

The Scrutiny Committee’s forward plan is attached for members’ consideration.

Members noted the committee’s forward plan.

None.