Agenda item

The report provides an update on this item from the last committee meeting on 27 March 2012.

Rob Larkman (Chief Executive, NHS Brent and Harrow) introduced the report and explained that there were two main elements to shaping a healthier future, these being the future hospital-based acute services and developing a strategy for out of hospital services.  Consultation on proposals would continue until October 2012.

Dr Tim Spicer (Shaping a Healthier Future) then presented further detail in the report. Following on from the two main elements of the programme, he referred to the particular challenges for North West London, which included a projected increase in population of 113,000 in the next ten years, whilst the population also continued to age with 31% having long term chronic conditions.  Dr Tim Spice drew Members’ attention to the variations within hospital care and the differing outcomes of patients as set out in the report.  With regard to developing an out of hospital care strategy, this would apply to each of the North West London boroughs and key themes were emerging from these.  There would also be the establishment of four standards to maintain quality of care, these being:-

·         Individual patient empowerment and self care

·         Service access convenience and responsiveness

·         Care planning and multi-disciplinary care delivery through a joined-up approach

·         Standards of information and communication sharing

Dr Tim Spicer advised that the strategy would go public and UK standards would be used to model finances.  Every effort would be made to demonstrate how the drive for changes would be made and it was intended to create coherence and confidence in the service whilst relieving stress on acute services.

Ethie Kong (Clinical Commissioning Group Chair, Brent) added that a borough level view was also being considered with regard to how the strategy would be delivered locally and how the local vision would change in the next three years.

Jo Ohlson (Brent Borough Director, NHS Brent and Harrow) advised that plans for outside of hospital care had been developed in the last two years and she cited the Short Term Assessment, Reablement and Rehabilitation Service (STARRS) as an example and which had achieved high satisfactory rates in providing services in the community.

During discussion by Members, Councillor Harrison commented that access to services was an issue and the reforms proposed placed a lot of focus on the role of GPs.  In some cases, GP practices were not sufficiently organised and she asked what steps would be taken to ensure GPs took the appropriate action so that their practices performed to the levels necessary.  Councillor Daly sought clarification of the term ‘frequent flyers’ as she felt it somewhat inappropriate.  Councillor Leaman commented that the report did not make mention of the need to change the behaviour of the public to help ensure that the new arrangements would be effective and there needed to be measures in place to promote public awareness.  He also asked what information was provided to those who may be first time visitors in accessing health services.  Councillor Hunter welcomed the report overall and enquired when the programme was due to go live, however she enquired how confident were the NHS that funding from acute providers would be released to community services.  She also sought more information with regard to what consultation would be undertaken and when.  Councillor Al-Ebadi noted the present different outcomes for patients as set out in the report and he enquired what steps were being taken to improve these, particularly for groups who currently have poorer outcomes than others.

The Chair commented that Members were putting together a separate list of questions to forward to NHS colleagues with a view to arranging a meeting with them to discuss the issues raised.

With the approval of the Chair, some non-member councillors addressed the committee.  Councillor Hashmi commented that in view of the financial pressures, how would savings be achieved.  Councillor Cheese stated that disorganised services could result in patients losing confidence.

In reply to the issues raised, Dr Tim Spicer advised that GPs were required to undertake what they were contracted to do, however more attention was needed as to how they should work with other services.  It was intended to provide access to coordinated care services and linking up with social care.  Dr Tim Spicer advised that GPs could produce core plans to help achieve better outcomes, whilst the health economy was moving in the direction to reduce hospitalisation and provide more appropriate care where applicable.  This also involved a more planned and coordinated approach in providing services in the community.  Members heard that patients that had made unnecessary visits to the UCCs were contacted to identify the reasons why they had done so and sign posted as to what would be the most appropriate services to access.

Jo Ohlson advised that ‘frequent flyer’ was an NHS term for patients who were frequent visitors to A and E and such patients would be identified and steps taken to see if they could be treated more effectively in a different way.  It was proposed to improve access to GPs in Brent and with the other North West London boroughs and provide patients with more choice and the focus was in providing the most appropriate care.  Investment in staff for community services would improve such services and help reduce hospital admissions and therefore costs in this area.

Ethie Kong commented that changes in how GP services could be accessed were being pursued, including providing appropriate sign posting and a joined up approach with the appropriate organisations was required.  She stated that self care was also an important factor in improving outcomes.  With regard to unnecessary visits to UCCs, Ethie Kong explained that there was a process of re-direction then education of the patient concerned.  She acknowledged that the scheduling of the consultation was of particular importance in order to provide user groups sufficient time to provide feedback, including Brent LINk, and a timetable of consultation would be publicised.

Rob Larkman added that the programme was intended to improve care and provide a sustainable basis whilst also making financial efficiencies.

The Chair requested that information with regard to how the consultation be undertaken, including the timetable, be provided and that any questions Members wished to be forwarded to NHS colleagues to answer at the separate meeting be sent to Andrew Davies.