Agenda item

The report from the North West London Collaboration of Clinical Commissioning Groups outlines the processes within the Systems Resilience Group and provides an update on the current status.  A presentation is also attached.

The Chair began by stating that this item had been requested to inform the committee what steps were being taken to address the increase in demand for healthcare over the winter period.  On behalf of the committee, he expressed its disappointment that there were no representatives from the London North West Healthcare NHS Trust despite having received earlier confirmation that they would be attending.

Rob Larkman (Chief Officer, Brent, Harrow and Hillingdon Clinical Commissioning Groups) gave a presentation on this item and advised that the Systems Resilience Group (SRG) was a partnership group set up to respond to pressure on health services, not just during winter but also where elective demand rose.  This winter had seen unprecedented pressure on services for the North West London Clinical Commissioning Groups (CCGs) as well as the rest of London and also nationally.  Members heard that the SRG worked as a network and it had been identified that the Accident and Emergency (A and E) Unit at Northwick Park Hospital (NPH) had not been performing at the desired level, where 85% of patients had been seen within four hours, although some A and E units in London had lower rates than this. Rob Larkman advised that the A and E unit was operating safely.  He explained that investment for the winter period had been unpredictable in the past, however now funding for this was allocated nationally and so the SRG could plan and respond to demand accordingly. 

Bernard Quinn (Director of Delivery and Performance, North West London CCGs) then drew members’ attention to the membership of the SRG, which included representatives from NHS commissioners, NHS providers, local authorities, London North West Healthcare NHS Trust, Central and North West London NHS Foundation Trust, London Ambulance Service, NHS England, patient representative and urgent care centres (UCCs).  Members noted the governance arrangements for the SRG and a breakdown of costs for each scheme in tranches one and two.  Bernard Quinn advised that a comprehensive escalation system was now in place and that efforts to improve A and E performance at NPH had increased the proportion of patients seen within four hours to 88%.  He added that the local aim was 93%, whilst the national average was around 95%.

During members’ discussions, a member asked what the total funds were to manage winter pressures and what defined the winter period. Since funds had been received, further information was sought on the SRG’s method for addressing winter pressures and the action plan in respect of London Ambulances not arriving on time, whilst it was also asked what the average wait for an ambulance was in the last week.  Another member asked how many beds would be in Robertson Ward following the funding for three additional beds and for further details in respect of costings for Furness ward and Willow ward.  She also requested if the report on how to improve patient flow could be made available.  In respect of work undertaken by Capita on behalf of hospitals, she enquired what areas this was addressing.  The member also sought clarification on total bed numbers at Central Middlesex Hospital (CMH), including a breakdown of the total beds per ward.  She commented that around 75% of visitors to her councillor surgeries complained about health services and that quality of care was a real issue in the borough.  She felt that the report did not give a clear picture as to how Brent residents are served and that it appeared that changes only happened following a particular incident. 

The committee commented that they had been told at previous meetings that transferring staff from the closed A and E at CMH to NPH would lead to improvements in staffing levels and clarification was sought as to whether this had been demonstrated.  An explanation of the difference between bank and agency staff was requested.  A member asked what the ring fenced grant in respect of delayed transfers of care was specifically for and what was the size of the grant.  He added that he had a positive personal experience when he had needed to visit the A and E at NPH around Christmas time and the service he received was efficient. 

In reply to the issues raised, Rob Larkman advised that the winter period was defined as until the end of the financial year, at the end of March 2015.  The SRG met monthly and worked as a network, escalating action where necessary and looking at capacity across the whole of North West London.  In respect of London ambulances, the target of arriving at the patient’s location within eight minutes of the call being made for cases classified as severe was not being met, with only 60% of ambulances arriving within this time against a target of 75%.  As part of a wider action plan, the CCGs were working with London Ambulances to see if more investment could be made available and consideration of how resources were deployed was being undertaken to improve performance in this area.  Rob Larkman explained that the issue was exacerbated by a shortage of acute beds in hospital beds and winter resilience funds were being used to address this.  A business case was being made for another 66 acute beds and it was hoped that this would be agreed this year and there were also plans to increase the number of community beds and improve patient flow.  Rob Larkman agreed to see if the report from NPH in respect of improving patient flow could be made available to members.  He advised the committee that Capita were involved in an initiative on looking at capacity and demand in respect of shortage of beds and Bernard Quinn was to provide funding details of this.  Rob Larkman also agreed to provide total bed numbers and bed numbers per ward at CMH.  Members noted that funding for delayed transfers of care was for patients who had been discharged and were medically fit. but had nowhere to go.  He added that the CCGs would encourage those who wished to make or forward complaints so that they could learn from these to improve services.

Professor Ursula Gallagher (Director of Quality and Safety, Brent Harrow and Hillingdon CCGs) emphasised that as well as providing additional beds, these needed to be sufficiently staffed and consideration of this was being undertaken across all services.  She felt that staffing levels at NPH had improved and most nurses who had previously been at the A and E at CMH were transferred to NPH with no redundancies and the situation continued to be monitored to ensure the right concentration of staff.  Professor Ursula Gallagher advised that the NPH did set out the difference between bank staff and agency staff and she would seek to provide this information to members, adding that NPH continued its efforts to reduce the number of agency staff.

Christine Gilbert (Chief Executive, Brent Council) advised that £350,000 funding had been allocated for delayed transfers of care.

There was discussion about future health items at Scrutiny Committee meetings and it was noted that submitting questions in advance, particularly if they were of specific nature, was desirable as it would give health colleagues sufficient time to provide responses.  The Chair added that in some reports, the information was provided was not always as clear as it could be and was difficult to explain to residents and he asked that this be taken into account in future reports.  He asked that an update on the SRG be provided at a future meeting.