Agenda item

To receive a report on the transfer of community services from LNWHT to CLCH.

Steve Vo (Assistant Director Integration and Delivery – Brent, NWL CCG) introduced the report, which detailed the transfer of Community Services from Central and North West London NHS Foundation Trust (CNWL) to Central London Community Healthcare NHS Trust (CLCH). The transfer was completed in August 2021 and the paper provided an update on the mobilisation and transformation programmes within community services. He detailed the selection and award process, as outlined in the report, with a selection panel involving Brent CCG’s Accountable Officer, the Local Authority Chief Executive, and NWL CCG Chief Financial Officer. Contract award notice had been published to ensure transparency and compliance with the lawful process. There were 2 phases to mobilisation of services – phase 1 being the shifting of existing services, which was complete, and phase 2 being transforming services, which CLCH were now working on. CLCH had identified 3 main priorities for transformation, which were heart failure, respiratory services and diabetes. He finished by highlighted the new Ageing Well Fund, which was an additional fund allocated by the government for 2021-22, and recurring for 2 years with incremental increases. Within those bids, proposals had been submitted to put that additional funding into diabetes, care homes and anticipatory care, all services supported by CLCH.

The Chair thanked Steve Vo for the introduction and invited comments and questions from those present, with the following issues raised:

Regarding the mobilisation of services, the Committee queried how the feedback from patients, service users and carers had been sought and used by the Joint Mobilisation Groups and what learning had been taken from that feedback. Fana Hussain (Borough Lead Director, Brent – NWL CCG) advised that the model was lift and shift, therefore services had not changed for patient facing services and patients should not have seen a difference in the way they were provided. Janet Lewis (Director of Operations, CLCH) advised that the feedback from staff had been very positive, and that it had been a very amicable move of services between partners who had a good working relationship. The Joint Mobilisation Groups had been important to ensure everything went well for the transfer of staff, and that the patients and carers being looked after did not experience any challenges. She highlighted that staff were very happy and settled, and CLCH were working and engaging on how CLCH could work with staff to improve service delivery for the future. Overall the transfer had been seamless but there had been some IT issues due to a move in networks, which had since been resolved.

In relation to what was learned during the mobilisation period, Janet Lewis highlighted that the transfer had been done very quickly. The plan had been to move services in April 2021, but when the Mobilisation Group had convened they had realised that was not safe or feasible, so the transfer was delayed until 1 August 2021 which was felt safe once all the different workstreams had been reviewed. She advised there was a large amount of hard work on everyone’s part to complete the transfer which took place mid-pandemic and felt that the learning was around the timescales that providers set themselves, as well as working together in partnership.

There was a CLCH divisional base at Wembley Centre for Health where the management and leadership team of CLCH were based, although they were usually in the community within Brent most of the week. CLCH provided services in a lot of the big health centres in Brent such as Willesden, Wembley, Hillside and Chalkhill and were starting to work more with primary care directors to help patients remain close to home for neighbourhood level care. CLCH also worked in the Family Wellbeing Centres. Services would be delivered in the same places they had been delivered with the previous provider. CLCH provided some services in Westminster but not Camden, and the leadership team worked across Brent, Harrow and a small bit of Ealing. Dedicated staff were Brent centric and there were separate teams for Harrow and Ealing.

In relation to staff changes for paediatricians, the Committee were advised that 4 paediatricians had been transferred from the previous provider and a further paediatrician had been appointed during the transfer. Staff across the provider remained the same and there had been an increase in the team for children with complex needs in order to bring that service from a 5 to 7 day service. There was also a designated asthma nurse linking between the Acute Trust, schools and community services to co-ordinate provision.

The Committee discussed the Task and Finish Groups for diabetes, heart failure, respiratory services, rehabilitation and reablement, querying how they were going and how the work would transform the offer to the community. Janet Lewis advised that those were the areas identified and prioritised by the Community Services Executive Group for improvement, which was a subgroup of the Integrated Care Partnership (ICP) under the community services priority. She advised that services were already good but this looked to improve them further. The task groups were working with a group of professional staff from the primary care directorate, local authority, and other agencies, along with Healthwatch to see how user perspective could be brought into those groups. For diabetes, there was a NWL specification and CLCH were looking to see how that could be delivered in Brent while maintaining a Brent-centric model. The focus for the groups was on short to medium term changes as well as a longer term piece of work to see what services might look like in the future. Janet Lewis had hoped for changes from the task groups to be in place by 1 April 2022, however, due to the outbreak of the Omicron variant, and the need to implement business continuity measures due to staff shortages, this had been delayed. CLCH were now in a position of standing those transformational Task and Finish Groups back up and hoped to see them making changes early in April 2022. Robyn Doran (Director of the Integrated Care Partnership, NWL) added that this work formed part of the overall integrated working in the Brent place and was one of the 4 ICP priorities overseen by the ICP Exec, which reported to the ICP Board and Health and Wellbeing Board.

In relation to waiting times, the Committee queried whether there were any targets or timelines in place to reduce the waiting times. For many services that were not rapid or urgent care, the current waiting time was in excess of 20 weeks, and CLCH were working closely with the acute trust to reduce that. Community nurses and rapid response had no waiting lists but there was a variety of different services that had different waiting lists and times. Anyone requiring urgent care, for example diabetes patients requiring podiatry, would be seen with a priority as patients were being carefully and clinically triaged. Specifically in relation to the longest waiting lists for paediatric services, it was confirmed that this was for treatment following initial assessment for those with an Autism Spectrum Disorder, which was around a 6 month wait. CLCH had recruited a locum doctor for additional capacity in that service to reduce that time. CLCH were keen to start working on the longer waiting lists as it entered another recovery phase following the further outbreak of the pandemic, and were working through those lists to ascertain whether any additional resources might be required.  The provider were also waiting for funding information for the following year to be received to know whether there would be any additional resource they could put towards reducing waiting times. The provider could then ascertain a trajectory for how long it would take to get those lists to the correct level.

The Committee queried whether the provider needed more money in order to reduce waiting times. Janet Lewis felt that there was not a need for more money currently but for more staff into the workforce. She highlighted that staff were tired as a result of the pandemic and were not always willing to do additional shifts, and that their health and wellbeing was essential to support. Fana Hussain agreed that CLCH were experiencing workforce number issues like the majority of the NHS system. She advised the system was struggling with recruitment and retention and many GPs and nurses were due to retire. As a result, the workforce was being moved around the system and there was a focus on training, education, and upskilling of existing staff. One example of that taking place was the upskilling of Health Care Assistants into nursing roles through on- the-job accredited training. Robyn Doran agreed to provide information to the Committee in 2 months’ time which included the waiting list baselines and clear trajectories, once the funding for the following year was clear, to establish and distinguish whether there were any issues caused by shortages of staff or shortages of financial resource.

In relation to the impact of Covid-19 on staff, Janet Lewis advised that it had been particularly challenging over Christmas and New Year but the provider was now moving out of that phase. The sickness rates were still around the 6% mark, but only 3% of that was related to Covid-19 currently and they were seeing improvements in Covid-19 related sickness rates. Where possible, staff were able to work from home through the virtual model, ensuring any digitally excluded patients were not disadvantaged.

The Ageing Well fund was discussed, and Robyn Doran highlighted that the ICP wanted to lever as much new money into Brent as it could to target the areas that they knew had been underfunded in the past. Considering the Ageing Well Fund areas of diabetes, care homes, and St Luke’s Hospital, those areas had been stipulated by central government and included a national specification for delivery. Providers had worked together as a partnership to ensure the money would enhance Brent services, targeting where they felt the gaps were e.g. podiatry and mental health in diabetes. In terms of measuring outcomes to understand whether the Ageing Well money had led to improved outcomes, Janet Lewis advised that there were set metrics monitored across all areas that would show whether CLCH were achieving good health outcomes and reduced health inequalities.

The Committee highlighted the increase in the Ageing population, including increases in mobility difficulties, dementia and Parkinson’s, and wanted to understand how that was being addressed. CLCH were revisiting their frailty pathway for people in those categories. There were a lot of small services provided by CLCH, and Janet Lewis felt it was possible to rearrange them together for a ward type model with patients in their own homes and communities.

In terms of performance overall, the Committee queried how that would be monitored and reported going forward. Robyn Doran advised that the ICP had some expectations on performance and could include this in the report being provided to the Committee in 2 months’ time. Janet Lewis advised that, currently, CLCH were trying to regroup with the Patient Experience Group and were looking at patient stories, Friends and Family Test, Complaints and Compliments, for a wide range of qualitative metrics to share with commissioners as well as quantitative data and metrics.

The Chair thanked those present for their contributions and brought the discussion to an end. The Committee RESOLVED:

i)              To receive a report on the progress of the transformation programme at the Community and Wellbeing Scrutiny Committee to be held on 14 March 2022. This report should include:

a)    Comparative data on community waiting lists across North West London and action being taken to address long / hidden waiting times in Brent

b)    Monitoring and evaluation processes for transformation proposals

c)    Timescales and checkpoints for transformation proposals

d)    Information on the community services provided for infants, children and young people.