Agenda item

The report is attached and includes a presentation that will be given to Members.

Rob Larkman introduced the report and explained that the North West London NHS budget of £3.5bn was under pressure and changes to service provision were required.  Although schemes such as the Short Term Assessment, Rehabilitation and Reablement Service (STARRS) had improved the transition of patients between acute hospital services and community service, more changes were still needed, whilst hospitals in North West London also needed to perform better in a number of areas.  Members noted that health services needed to be localised where possible, centralised where necessary and integrated across health, social care and local authorities where it improved patient care.  Members then noted the timetable for the consultation and that a Joint Health Overview and Scrutiny Committee would be set up to provide external scrutiny.

Dr Mark Spencer added that a pre-cursor to these changes had started two years ago and it was intended to provide a series of quality changes to health provision.

Councillor Daly sought further details with regard to the legislative implications of the changes and commented that when the original Government legislation was approved, it was not envisaged that there would be such wholesale changes to health provision.  She asked that if external consultation was undertaken, to what extent did it take place and she felt that it was important that the individual health overview and scrutiny committees of each borough concerned retained their scrutiny role to oversee the changes.  Concern was expressed that hospital care needed by older persons and diabetics was to be reduced and details were sought as to how the 24% reduction in cost of care for these groups as outlined in the integrated care pilot could be achieved. Councillor Daly requested that the peer review paper for the pilot scheme, the community strategy and costings of the project be supplied and she asked how many hospitals and beds were due to close.

Councillor Hunter also expressed concern that the Joint Health Overview and Scrutiny Committee would be the sole delegated scrutiny body and that there would not be a role for the individual health and overview scrutiny committees.  She stated that it was important to scrutinise on both a local and North West London wide level and she asked whether this arrangement was certain or remained a proposal.  Councillor Colwill sought assurance that proper safeguarding measures were in place.

The Chair referred to paragraph 4.5 in the supplementary report and sought further information with regard to the role of the individual health overview and scrutiny committees.  She commented that most individual health and overview scrutiny committees would wish to provide input regarding proposals within their own borough and asked what the next steps were with regard to the creation of the Joint Health and Overview Scrutiny Committee.  The Chair queried why the Health and Wellbeing Board was not formally involved in the scrutiny process even though the council was to have more public health responsibilities.  Information on the membership of the hospital working groups was also sought.

Dr Mark Spencer advised that NHS North West London comprised of eight primary care trusts working together.  The actual budget reduction for older persons and diabetics acute hospital services was around £1bn over five years, representing approximately 13%.  Where people did not require hospital care, this would help reduce costs, however there would not be a reduction in care services.  With regard to the integrated care pilot, Dr Mark Spencer explained that this was an example of a scheme operating in inner London.  An interim report would be made available in the next six months, however the number of bed/hospital closures were yet to be outlined as modelling of the scheme continued.  It was likely that all sites would remain open, however some services may change at some sites.  The committee noted that the hospitals working group was chaired by a GP and the intention of the group was to consider what standards needed to be set for provision outside hospitals.  Although savings needed to be made, it was intended to improve the quality of care across the whole of health services whilst ensuring the appropriate safeguarding measures were in place.  Detailed information was being requested from the clinical groups to help put together the proposals for changes.  There would also be further discussion on the roles of both the Joint and individual health overview and scrutiny committees at the meeting on 29 February.

Rob Larkman advised that it had been proposed that a Joint Health Overview and Scrutiny Committee undertake an external scrutiny role, however scrutiny activity undertaken by individual health overview and scrutiny committees could be discussed.  Similarly, it was expected that health and wellbeing boards would also provide input and undertake informal scrutiny, however their role could also be discussed further.

Andrew Davies advised that legislation was quite clear in setting out the scrutiny role of a joint health overview and scrutiny committee.  If a joint committee was not created, Members needed to be aware that the individual health and overview scrutiny committees may not retain any formal scrutiny role on this issue and this should be taken into consideration when discussing the role of committees.

Ethie Kong added that a recent example of upskilling GPs included them being trained to administer and monitor insulin use.