Agenda item

The covering and main report are both attached.

With the agreement of the Chair, Irwin Van Colle (Chair, Kingsbury Patient Participation Group) addressed the committee.  Irwin Van Colle began by stating that overall the Equalities, Diversity and Engagement (EDEN) Committee was a highly successful organisation and that in Kingsbury, most of the GP practices sent delegates to the Patient Participation Group meetings.  Members heard that Brent CCG were in consultation with the EDEN Committee over constitutional matters, and whilst there had been some agreement, such as in complaints, differences of opinion remained in respect of commissioning.  In particular, the EDEN Committee was against any proposals for their abolition as apparently had been suggested by the CCG on 25 September 2013 and there were competing views as to how consultation should be undertaken.   EDEN Committee members also felt that the CCG was sometimes simply informing them of their intentions rather than consulting fully with them.  Irwin Van Colle advised that the EDEN Committee was requesting than an open, borough-wide conference involving the CCG, the council, the EDEN Committee and patient participation groups be undertaken on extending public and patient engagement and the committee was asked to help facilitate the creation of this conference.

With the agreement of the Chair, Julia Kirk (Co-Founder, CMH Rheumatology Patient’s Support Group) addressed the committee.  Julia Kirk stated that she was a rheumatology patient at CMH and attended the hospital every two months.  Members heard that the Support Group was dismayed that Brent CCG had not consulted anyone before issuing a decommissioning notice on 28 March 2013 to North West London Hospitals Trust (NWLHT) confirming that musculoskeletal (MSK) services including rheumatology would cease on 1 October 2013.  Upon the Support Group hearing of this in August 2013, Julia Kirk stated that she had sent a letter of complaint to Brent CCG detailing the lack of consultation and indicating that they wished the CMH rheumatology clinic and other services to continue at the Trust.  Brent CCG had responded by stating that a consultation was not required and as a result, she had sent a complaint to the Health Ombudsman at stage two of the complaints procedure.  She was aware that at least 50 other Support Group members had submitted their complaints to Brent and Harrow CCGs respectively.  Julia Kirk outlined the details of the complaints as set out in her written statement and requested that Brent CCG withdraw the decommissioning notice on 28 March 2013, stop the tendering process, request active dialogue between Brent CCG, NWLHT and patients to help design services based on patient needs and ensure that future services continue to operate at CMH and Northwick Park Hospital (NPH).

The Chair then invited Sarah Mansuralli to introduce the report.  Sarah Mansuralli advised that Brent CCG’s intention to commission new pathways for outpatient specialities stemmed from the Commissioning Strategy Plan for 2009-2014.  CCG’s key intentions included commissioning of services to improve the health and wellbeing of its patients, secure sustainable care to receive up to date, high quality, cost effective care and ensure these services were effectively commissioned within CCG’s financial resource limits. However, these aims faced a number of challenges, including a growing population in Brent and the need for more planned care as the current model was not affordable to meet future demand.   There was also a need to transform care at primary, community and social levels.   Sarah Mansuralli drew members’ attention to the next steps as set out in the report.  She stated that the concerns of patients over commissioning was understood and action would be taken to reassure them.  She advised that an integrated impact assessment and full consultation would be undertaken and regular feedback would be provided to the Health Partnerships Overview and Scrutiny Committee and the EDEN Committee and there would be patient representation during the procurement process.  Members heard that the CCG would respond to Julia Kirk’s complaint and patients and the public would be encouraged to participate in the consultation. 

During discussion by members, it was commented that patients tended to prefer that the same service provider remained as continuity offered the advantages of retaining familiarity and providing assurance.  It was noted that there had been a change of provider for cardiology services and concerns were expressed with regard to consultation.  A member commented that the change of provider to the Royal Free Hospital for cardiology services would impact upon out patient services.  She added that there were also issues in respect of CCG’s interpretation of communication as evidenced by the disagreement with regard to the EDEN Committee and its future.  Another member enquired whether TUPE arrangements for staff applied where there was a change of provider.  It was asked whether the driver for commissioning of services was due to changes to the model of care.  A description of the current rheumatology service and its financial budget, including details of the different levels of service, was sought and what aspects of this service were subject to commissioning.  In addition, an explanation of the criteria used to decide what was suitable for commissioning was requested and it was asked whether the current provider had submitted a bid. 

In respect of paragraph 5.4 in the report concerning Any Qualified Provider (AQP) and competitive tendering, a member sought clarification as to whether an existing provider could be considered as first choice where the contract was working well.  Where there was to be a change of provider, information on the viability of the existing service was needed.  Another member commented that retaining the same service and provider was not necessarily always beneficial and she acknowledged that the current model of care could not meet future demand and there needed to be more planned care.  In respect of the consultation, she sought comments on what steps would be taken to ensure that a fair representation of the different points of view were reflected in the feedback recorded.

Councillor Hirani (Lead Member for Adults and Health) addressed the committee and enquired whether continuity of service contributed to the criteria during the commissioning process.  He added that changes may lead to local providers no longer being used and also service integration could be compromised by having different providers for in an out of hospital patient care.  Councillor Hirani also sought clarification with regard to CCG’s level of engagement with the EDEN Committee.

In response to the issues raised, Sarah Mansuralli confirmed that the awarding of cardiology services to the Royal Free Hospital had been subject to full procurement procedures and patient representatives had been on the Procurement Panel overseeing this.  The outcome of the procurement had identified the Royal Free Hospital as being capable of providing the best service overall.  Sarah Mansuralli stated that a report on consultation concerning cardiology services had been to a previous meeting of the Health Partnerships Overview and Scrutiny Committee.  Consultation on the second wave of commissioning was yet to formally proceed, however Brent CCG was committed to consult thoroughly and to undertake an impact assessment.  An independent provider would be appointed to organise the consultation.  It was noted that there had also been some initial engagement with stakeholders and more details of the consultation were to follow. 

Sarah Mansuralli advised that rheumatology services was an acute service operated collectively by the North West London Hospitals Trust, the Imperial Hospital and the Royal Free Hospital, with the location of where patients were treated determined by GP referral.  Members noted that both out and in patient care was provided, although spend details were currently unavailable.  Sarah Mansuralli informed the committee that commissioning of rheumatology services was only taking place in respect of the out patients service and would involve consultation with both providers and patients.  She added that commissioning was being undertaken because of the changes to the model of care required due to the rise in demand that the current arrangements would not be able to cope with in future.  Commissioning would also ensure that the quality of care provided was sufficient and it was intended to create an integrated service for MSK services with trauma and orthopaedics, rheumatology and gynaecology services in order to improve quality of care and outcomes, reduce duplication and streamline services.  There was evidence nationally that integrating such services improved outcomes for MSK and examples in Thurrock and Basildon were cited.  Sarah Mansuralli advised that the awarding of an organisation to undertake the integrated impact assessment would be completed by the end of October 2013.

Jo Ohlson advised that consideration would be given as to what services would be appropriate to be provided in out of hospitals settings and what should remain in hospitals.  Members heard that cardiology services would remain in hospitals and quite possibly the more complicated of rheumatology services too.  There would also be discussion of ensuring smooth transitions where there were changes to the way services were operated.  Jo Ohlson informed the committee that there had been discussions with the North West London NHS Hospitals Trust in continuing to provide rheumatology services, however ultimately an agreement could not be reached.  In respect of the procurement process, she emphasised the importance in treating all potential providers equally and if undue importance was attached to continuity this would unfairly favour the current provider.  The selection criteria would also be discussed with patients groups and the way in which potential providers interacted with partners when surgery was required and what level of choice they offered would also be assessed.  Jo Ohlson stressed that NPH would remain a fully functional hospital whilst the future role of CMH would be subject to the shaping a healthier future programme.  Jo Ohlson advised that there was a full commitment to engage with the EDEN Committee and the objective was to increase engagement with patients and the public.  Retention of a Brent-wide group was desired and it was important that this group was representative.  Jo Ohlson advised that this did not necessarily mean that the EDEN Committee would not continue and future arrangements were still being discussed.

David Cheesman (Director of Strategy, North West London NHS Hospitals Trust) advised that North West London NHS Hospitals Trust had lost out in the commissioning process to provide cardiology services by one point and he questioned why this provided sufficient basis for the service to be transferred to a different provider.

Mark Creelman (Brent Customer Account Director) added that where services were under review, this tended to facilitate moves towards a procurement exercise and by doing so this would stimulate competition through competitive dialogue.

The Chair requested that an update be provided to the committee at a future meeting concerning rheumatology services, including budget details that would incorporate budget information on the different levels of service.  She also requested more information in respect of best practice and that representatives responsible for ensuring this be invited to a future meeting to respond to members’ questions.  Furthermore, the Chair asked that details of risk assessments that had been undertaken or would happen be provided and information on the viability of existing services where there was a change of provider.  The Chair also requested information on the costs of commissioning and de-commissioning of services in respect of cardiology.