Transformation of Community Services
To receive a report on the progress of the transformation of community services in Brent.
Steve Vo (Assistant Director Integration and Delivery, NWL CCG – Brent Borough) introduced the report, which focused on waiting times, priorities, the monitoring and measuring of success, and comparatives with other boroughs. The report detailed the Central London Community Healthcare NHS Trust (CLCH) Covid-19 recovery plan in relation to waiting times, with clinical triaging and weekly waiting lists reviewed by clinicians. The report also detailed the transformation programme and key measures of that programme. One of the key projects to help in the transformation work was the change to the EMIS patient record system to align with the system used by GPs, which would alleviate the need to double check data, and increase transparency and fluidity. In relation to Ageing Well, CLCH were working with Central and North West London Foundation Trust (CNWL) to recruit to key posts, although there were recruitment challenges across the sector. The paper also noted the work on patient engagement, which was key for Brent Health Matters (BHM).
The Chair thanked officers for the introduction and invited comments and questions from those present, with the following issues raised:
The Committee were concerned about the number of people on waiting lists, and asked several questions in relation to some specific waiting lists:
- In relation to those waiting for Brent Integrated Diabetes Services, the Committee were advised that this referred to an education programme, meaning that those patients’ care needs were met and no-one was suffering harm, but they were recommended to go through an education programme. The programme had previously been a group learning exercise but it was no longer possible to do that. Some group sessions went ahead virtually but not every patient was able to do that through digital platforms.
- The Pulmonary Respiratory Service waiting list was also backlogged due to patients doing one-to-one rehabilitation where previously this would have been a group class setting. The service supported patients to manage their own condition and had been clinically evidenced to be effective, however there was a very small group of staff running that rehabilitation and this was something that most trusts across the whole of North West London (NWL) had built up a waiting list for. CLCH had looked to buy educational materials for patients to help themselves.
- There were very few waiting for Bladder and Bowel Services but there was a data problem with the waiting lists requiring validation. There was a growing number of patients waiting for reassessment of continence, but there was no risk that their continence pads would cease while they waited for reassessment. Those who may no longer be receiving enough continence pads could contact the service to be prioritised.
- It was confirmed that the NHS still had Covid-19 control guidance issued, which was why many services were not able to deliver group therapies. Despite this, CLCH were still doing one to one service and face to face for the vast majority of services.
In relation to the Brent Health Matters programme, the Committee queried how CLCH would measure the performance. Steve Vo advised the Committee that there were a number of key measures, and was happy to bring back what those were to the Committee. He advised that the work was front and centre in terms of strategic direction, and there were several more clinical measures he could bring back to the Committee. In relation to BHM’s overall aim to reduce health inequalities in Brent, the Committee queried whether Covid-19 had set CLCH back in attaining that goal. Janet Lewis (Director of Operations, CLCH) advised that the team had been affected by Covid-19 in the same way as others. They had benefited from the learning of Covid-19 as they had been very much involved in the vaccination programme, and through that work, liaison with the Brent population had enabled a large amount of learning about what the individual health requirements of different client groups were. CLCH had now fully recruited to that team, which would be a full team the following month.
The Committee asked if the public understood the transformation journey that CLCH and the CCG were trying to take forward. Janet Lewis (Director of Operations, CLCH) felt that they had more to do on engagement. The Integrated Care Partnership (ICP) were working with BHM and the clinical forums they had established as well as through GP forums to engage fully. New forums were not being set up, instead existing forums were being put to use. As a group, it was felt the ICP needed to look at the existing engagement forums and ask what they did well and what they could be better at. Brent Youth Parliament asked how engagement would focus on the final recommendation of the GP Access Task Group – to have more young people involved in patient participation groups. The ICP were working with the Brent Children’s Trust (BCT) in relation to how, as partners, they could work together to encourage each other to get the voice of young people heard.
In relation to referrals for housebound patients and whether there was a backlog, the Committee were advised that CLCH had not seen a decrease in referrals for District Nursing or Rapid Response services and those core services were maintained throughout the pandemic. There was no cause for concern that patients were not being referred appropriately by primary care. Continuing to discuss primary care referrals, the Committee highlighted a common complaint councillors received about receiving no feedback or updates in relation to a patient’s referral and where they stood along the pathway. The Committee were advised that for clinic based services, CLCH could do better communications and were currently trying to contact all patients on waiting lists. CLCH recognised the anxiety a patient might feel if they were unsure where their referral had ended up. Janet Lewis highlighted that the waiting lists were longer than CLCH would want, and CLCH were working with all services to contact people to find out their current needs and whether their situation had changed. The focus would then be on seeing patients as quickly as possible. The reality for some patients would be that their needs were clinically low priority, so it could be some time before they received an appointment. In the meantime, patients would be contacted and supported as best as possible.
Continuing to discuss waiting lists, the Committee queried what work streams currently existed to focus on reducing waiting lists in a tangible, evidenced based way. Steve Vo assured the Committee that his team worked closely with the team at CLCH, with monthly meetings looking at Key Performance Indicators in relation to waiting lists.
The Chair thanked those present for their contributions and brought the discussion to an end. The Committee RESOLVED:
To recommend the following key areas for improvement:
i) For CLCH, alongside the ICP, to review the community engagement plan for the transformation programmes in order to ensure patients and the public understand and support them, and have a clear understanding of how the changes would address local priorities and achieve better health outcomes for patients.
ii) For CLCH, alongside the ICP, to review the communication strategy for patients requiring an appointment with a long wait, ensuring that patients’ care is reviewed and discussed with them on a regular basis.
iii) For CLCH, alongside the ICP, to review the communication mechanisms in place between different NHS organisations and services across Brent when making patient referrals, in order to avoid fragmentation of care.
An information request had also been made during the course of the discussion, recorded as follows:
i) For the Community and Wellbeing Scrutiny Committee to receive further information on how Brent Health Matters monitors and evaluates outcome for patients.