Agenda item

·         NHS NW London – Formal Witnesses

Ø  Anne Rainsberry

Ø  Daniel Elkeles

Ø  Mark Spencer

Ø  Lisa Anderton

 

·         Patient and Public Advisory Group: Trevor Begg

 

·         Overview and Scrutiny Committees Summaries

 

·         Other 

 

The Chair allowed three members of the public to address the Committee briefly before the Committee heard evidence from NHS North West London and the Patient and Public Advisory Group.

 

Robert Sale

 

Robert Sale informed the Committee that he had come to speak at the meeting not only on behalf of Brent Fightback but also as a concerned member of the public who had relied on the NHS his entire life. He stated that he had experienced difficulty in trying to communicate with Mr Blair who was the lead communications contact for the project, as he had been informed that Mr Blair did not have a telephone, and he often did not reply to emails. Mr Sale explained that he had asked Mr Blair for a copy of the risk assessment but had yet to receive it, he then asked if the committee had received this document as he believed the risk assessment was fundamental to consideration of the proposals by NHS North West London.

 

Mr Sale then went onto to reveal his disappointment at the Committee having agreed to a 14 week consultation period when that was only 2 weeks above the legal statutory requirements. He stated that West Sussex had agreed a 20 week consultation period and that Council represented a significantly less number of people than North West London JHOSC did. Mr Sale concluded by urging the Committee to not allow this political driven reform to take place.

 

The Chair thanked Robert Sale for his contribution and acknowledged that there were risks associated with these recommendations and that these had been considered in a risk assessment. NHS North West London informed the Committee that the risk assessment had been sent to members the day before the meeting. NHS North West London agreed that this had not allowed the members enough time to consider the document to date which was unfortunate.

 

Emma Tate

 

Emma Tate addressed the Committee by firstly explaining that she was the Secretary of the Queens Park Area Residents Association, and that the Association had discussed this consultation at its last meeting. She stated that members of the Association had found it very difficult to access the information relating to the consultation, even though they were all fairly well educated. Therefore the consultation was flawed and inadequate as other members of the public may have found it virtually impossible to access the information, especially if they did not have access to a computer or the internet.

 

Emma Tate also explained that the consultation was inadequate as it was being conducted at a very bad time. Firstly it had taken place when a lot of people were on holiday, and it had also taken place at the same time as the Health and Social Care Act was being implemented. She stated that there should not be any changes to hospital provisions until the public could see and be assured that the out of hospital care offered would be fit for purpose. She asked the Committee if they were seriously going to agree to the proposals knowing that there would only be £120 million available over the next three years for out of hospital care which everybody knew would not be anywhere near enough.

 

Emma Tate considered the Committee’s drafted recommendations as weak and inadequate. She reiterated that the Committee should not allow these changes to happen until they were satisfied that there were sufficient alternatives in place. She concluded by echoing Robert Sale’s point of having asked for the risk assessment two weeks prior and still not having received it.

 

Sarah Cox

 

Sarah Cox addressed the Committee by explaining that she was also from the group Brent Fightback and that she had lived in and taught in Harlesden in Brent for a number of years. Sarah Cox informed the Committee that North West London, and the country as a whole faced a growing, ageing population and deep health inequalities. She stated that to tackle these health inequalities, help had to be provided where it was needed most. Sarah Cox explained that there was a great need for help in communities that currently accessed services at Central Middlesex Hospital. These communities faced high birth rates, high incidents of mental ill health, and low life expectancy to name a few of the challenges. Sarah Cox therefore stated that members of the public could not fathom why the Accident and Emergency (A&E) had been closed at Central Middlesex, especially after £62 million was invested into Central Middlesex only 6 years ago for it to provide specialist care for emergencies.

 

Sarah Cox then questioned one of the reasons for the current proposals, as she stated that the vulnerable were far less likely to seek help than the rest of society and that they would be even less likely to access help if it were far away. She stated that public transport did not provide a direct route for many to Northwick Park, and that car ownership was low among the most vulnerable in society. She explained that more people would choose to go to St Mary’s hospital which was in a different Trust and which would likely lead to many problems. She also stated that at present, with NHS staffing levels massively overstretched, visitors provided an invaluable role of providing care to those they visit. However, if people had to travel further to visit patients in hospital, it was likely that the number of people able to visit would decline. Sarah Cox concluded that she would happily support excellent out of hospital care, however it was evident, to her, that this would sadly not be the case.

 

The Chair thanked all three members of the public for their views, and stated that all these issues would be raised by the Committee. The Chair invited the public to remain for the rest of the meeting.

 

Witnesses and Additional Evidence

 

The Chair explained that this part of the meeting would centre on questions that had not been explored so far.  NHS North West London stated that they did not have any presentations to make and they agreed to answer any questions the Committee may have.

 

Dr Anne Rainsberry, Chief Executive, NHS North London

 

Dr Rainsberry responded to the Chair’s point that the Committee had not heard evidence that the strategy relating to the reconfiguration of Accident and Emergency would be a success, which was crucial, by stating that in her extensive experience the proposals put forward responded to the issues that the Committee and public had brought up. She stressed that this was the first time that the NHS had consulted on A&E proposals and that she recognised that there were significant challenges. She stated that she was very aware that the changes they wanted to make to hospitals were very reliant on how the NHS provided out of hospital care, and therefore they knew that they had to deliver out of hospital care successfully. She then informed the Committee that unless hospital care was reformed then health inequalities would remain.

 

The Chair explained to Dr Rainsberry that the Committee had not heard evidence from clinicians who worked within hospitals where significant changes would be made, they had only heard from a small number of GPs, and therefore the Chair wanted to know if there was broad clinician support for these proposals.

 

Dr Rainsberry replied to this point by explaining to the Committee that they had established the Clinical Board to help draw up these proposals. This group comprised the Medical Directors from each of the Trusts, who represented their organisations and had sought the views of their organisations. She stated that the Clinical Board agreed that change needed to happen, however she explained it had been difficult to gain a complete consensus on how this change should be implemented. The Clinical Board had considered the standards required for both in and out of hospital care and how change should be delivered, and therefore Dr Rainsberry was satisfied that these proposals were clinician lead and had the broad support of clinicians. She added that clinicians from outside London had assessed the proposals and scrutinised the report. They had made some important recommendations that had been taken on board but they agreed overall that the proposals were sound and that they would improve health care in North West London. She agreed that there would always be anxiety from clinicians with such major change being recommended.

 

When challenged that these proposals were led by those at the top who hoped to gain support from clinicians as the proposals progressed, rather than the proposals being clinician led, Dr Rainsberry explained that the purpose of having a clinical board was for those who sat on the board to seek and bring along the views of the people they were representing and therefore the NHS could solicit the views of a wide variety of clinicians. She added that there had been a lot of engagement in the process including a number of workshops that had allowed them to harness a wide range of clinical views.

 

In response to a point raised by Councillor Gulaid regarding health inequalities, Dr Rainsberry explained that addressing health inequality was central to the proposals for change. She informed the Committee that the key ways they wanted to address this issue was by improving out of hospital care, and improving hospital care for local areas. She stated that by working through the Health and Wellbeing Boards this would make a difference to the constituents that councillors represented. She also noted that there would be associated strategies relating to the proposals to help reduce inequalities.

 

When asked if the new census figures that had been released would impact on the finances allocated to these proposals, Dr Rainsberry explained that the financial modelling had gone through a vast amount of scrutiny by the Health Authority and Department of Health. She added that there was still work to do regarding detail but that the broad financial plan was in place. Daniel Elkeles informed the committee that the financial modelling had been done based on activity rather than population size and therefore it was not expected that the census data would impact significantly on the finances already identified.

 

A member of the Committee called on NHS North West London to remove their February deadline as such a short space of time would not allow a fully considered outcome

 

Dr Rainsberry informed the Committee that NHS North West London believed that there was enough time to consider the issues that had been raised, however she reassured the Committee that if it was felt that there remained issues to be considered by the February deadline then a decision would be delayed, however she was confident that they would be in a position to make decisions by February.

 

Councillor James raised concerns that services at Central Middlesex were being closed or moved to Northwick Park, which troubled him and his constituents as Central Middlesex had new facilities and he stated that Northwick Park had experienced a worrying mortality rate within the maternity wards. Councillor James also enquired as to how many people had actually attended the road shows that were put on to engage the public.

 

Dr Rainsberry responded by agreeing that the facilities at Central Middlesex were new and that it was hoped to use this hospital to maximum effect. She also stated that she was not aware of Mental Health services transferring out of Central Middlesex but that she would check and report back to the Committee. It was also noted that the NHS did not have to hand the exact figures of the number of people who attended the roadshows but that they could provide this information to the Committee.

 

Councillor Kabir stated that at time of constant change in the NHS it was hard to know what the impact of all these changes, including these proposals, would be for the residents of North West London.

 

Councillor Kapoor stated that it was unacceptable that A&E and maternity would be closed at Ealing hospital. She noted that Urgent Care Centres (UCCs) had become victims of their own success, and rather than supporting services of A&E they were now more of an extension to GPs. She asked if finances could not be redirected into making A&E and maternity departments more effective.

 

Dr Rainsberry responded to this point by stating that it was evident that the care provided by hospitals needed to be reviewed to ensure a satisfactory level of care was being offered to those who were seriously ill and she stated that currently she could not assure the Committee that the NHS provided this care consistently. She added that there were three options to review the way critical health care was offered and that they were consulting on these options. It was evident that Ealing supported option C, however she explained that clinicians agreed that option A would be the best option and would offer results quicker.

 

Councillor Vaughan referred to the out of hospital strategy and asked that, given the reconfiguration depended on the success of the out of hospital programme, what criteria would measure success.  He asked when would Clinical Commissioning Groups (CCGs) be able to indicate that they were satisfied with the out of hospital strategy in each borough so that the programme could go ahead.  He asked what would happen if the success criteria was not met at the same time in all of the boroughs. 

 

Dr Rainsberry replied that the process of creating CCGs would culminate in their establishment on 1 April 2013.  Before then the NHS Commissioning Board would be established on 1 October 2012 and would be responsible for authorising CCGs.  There would be an extensive process for CCGs to go through.  They would be required to produce a strategic plan and then site visits would be undertaken so that the Board could be satisfied that adequate plans were in place.  The Board would have the power not to authorise CCGs or impose conditions on them.  However, Dr Rainsberry was confident that the CCGs would be able to successfully go through this process.  The out of hospital strategy for the first time established standards of care.  It was expected that CCGs would work to implement the out of hospital strategy and this would be done around establishing systems of care, with providers also ensuring safe systems were in place and these would be reflected in the implementation plan.

 

Councillor D’Souza stated that these proposals had a critical dependence on the out of hospital care strategy being a success and therefore she wanted to know how the out of hospital care was progressing and how they would ensure the continued success of out of hospital care.

 

Dr Rainsberry stated that the NHS had already engaged with a number of stake holders and that they would continue too after the strategy had been put into place. The Health and Wellbeing Boards and NHS Commissioning Board would also scrutinise the decisions that had been and would be made and they could intervene if they disagreed with what was happening. Dr Rainsberry reassured the Committee there would be a number of checks and balances surrounding the out of hospital care strategy.

 

Councillor Fisher informed the Committee that he agreed with the case for change however he was worried that the finances would not be there to fully support the out of hospital care strategy. He also enquired what had been done to engage the public with the proposals and he then asked Dr Rainsberry to define urgent care, as the Committee had yet to receive a definition.

 

Dr Rainsberry firstly stated that she believed that you could never do enough to engage people; however they had tried to engage different groups by holding a number of workshops. She also explained that Health and Wellbeing Boards would be a route for people in North West London to guide and shape the proposal as these Boards would have the ability to do that. She also added that the Health and Wellbeing Board would determine how money would be spent in the future, which should give the strategy the best possible start. However Dr Rainsberry added that the reality was that the NHS’ budget was not expanding.

 

Dr Mark Spencer, Clinical Director, NHS North West London

 

Councillor Fisher asked for reassurance that the financial deficit that Hounslow PCT currently faced would not be transferred to the CCG. Dr Spencer replied by stating that the current budget would transfer, however he was optimistic that Hounslow PCT would be able to make improvements in their budget before it was transferred in April 2013. 

 

The Chair asked Dr Spencer if the UCCs would have the diagnostic resources and knowledge to function sufficiently. Dr Spencer answered by explaining that currently standards did vary across different UCCs. However, a review was currently under way to develop a clear set of standards for all UCCS and therefore what would be provided in the future would be very different. He also added that currently there were a number of examples of UCCs successfully delivering services with a full range of diagnostic resources available.

 

Councillor Collins asked the NHS to assure the Committee that there would be a consistent standard of care for acute services, such as mental health and that there would be joined up working to ensure that vulnerable people received consistency in their care.

 

Dr Spencer gave a practical example of mental health services being provided in a more collaborative way. He detailed that it became very apparent very quickly that there was lack of psychotherapy at A&E and therefore they had allocated finances to ensure this service was available at A&E. He stated that this was already having a positive impact. He also added that in North West London they had improved integrated care for those over the age of 75, those who had diabetes, and were now looking at how to make mental health care more integrated.

 

Councillor Gulaid commented that he did not believe that there was practical evidence that this strategy would work. He stated that £128 million was not enough to support out of hospital care in North West London over the next three years.

 

Councillor Hector stated that she believed that there should be a survey given to all GPs to assess what they felt about these strategies. She also added that given the level of violent crime in the south of Brent it did not make sense to have the health care provision in the north of the borough.

 

Lisa Anderton, NHS North West London

 

Councillor Kabir stated that transport was one of the most critical issues in terms of the proposals to reconfigure services; however the Committee had yet to receive sufficient information on the support that patients would receive to help them get to hospital. Councillor Kabir added that without having this information it made it very difficult to agree to the reconfiguration whilst being accountable to their constituents. 

 

Lisa Anderton responded by informing the Committee that the Transport Advisory Group was beginning to identify these issues and she accepted that the detail regarding transport was lagging behind the rest of the strategy. She explained that the Travel Advisory Group was now starting to look at the detail behind the proposals and these would take into account all the views that had been gathered throughout the consultation. However, she stated that more information regarding travel had been sent to members the previous day but acknowledged that this did not give the Committee any significant time to consider it. She explained that there was no significant difference in the impact on transport between the three different options that had been proposed. She also stated that car parking at hospitals had been identified as a key area and they would be looking to increase car parks although this would be very challenging.

 

Councillor Collins asked if there would be a uniform extended bus service between one A&E and another department throughout the eight boroughs. It was also stated that the Committee needed certainties not probabilities on the impact that this strategy would have on ambulance times.

 

Lisa Anderton explained that the impact on ambulance travel times would be minimal as currently travel time on average was 11.4 minutes, and this would only increase to 12 minutes. Also that the patients care would begin from the moment that the patient was placed into the ambulance.

 

Councillor James asked NHS North West London if they were aware that none of the three stations closest to Central Middlesex Hospital were mobility friendly. Lisa Anderton replied that they were aware that there was a lack of step free access, and this would be raised at the Transport Advisory Group.

 

The Chair commented that very little evidence had been provided on patient transport and therefore the Committee would find it hard to make a decision given the absence of information.

 

Trevor Begg, Patient and Public Advisory Group

 

Trevor Begg addressed the Committee, firstly by stating that patient transport was a key issue for the Patient and Public Advisory Group (PPAG) as well. He stated that all of the questions that he had heard raised by the Committee were similar to questions that he and PPAG had raised as well.

 

He then explained to the Committee that he had been involved in the review of emergency care standards that Dr Spencer had mentioned earlier, and it had been evident from this research that there were huge variations in the care provided across different Trusts. He added that this piece of work reinforced the case for change and the urgency for change in how emergency care was delivered.  He stated that in the current financial climate, health inequalities would remain unless the way health care was delivered was reformed.

 

Trevor Begg then discussed one of the key issues regarding the reconfiguration of services which was the provision of the workforce. He stated that after reviewing evidence from a number of Royal Colleges there were likely to be significant challenges in maintaining and securing a skilled workforce. He explained that there would be no quick way to change this situation as this problem had a historical context that could not be reversed. He concluded this point by stating that this issue potentially posed the possibility of increasing health inequality for patients.

 

Trevor Begg then concluded by informing the Committee that he agreed that current health provisions could not be maintained. However he stated that, looking at the issue of finance, he was concerned that there were risks associated with the speed of the savings proposed and this could impact on the quality of care given.

 

The Chair asked if Trevor Begg had formed a view regarding the impact that travel would have on people accessing services. He replied by explaining that one of the major issues was the lack of definition of ‘emergency care’ and he stated that he hadn’t really seen enough information to truly understand what the impact would be. He added that he was quite concerned about transport between hospitals and car park provision and that he really hoped that these issues would be detailed in the final business case. He then said that he would want to see checks and balances applied to the process over the next few months to ensure these issues were dealt with sufficiently.

 

The Chair then asked Trevor Begg what he believed would be the likely success of the out of hospital care proposals. Trevor Begg answered by explaining that he believed that the success would be variable. He expanded on this by stating that in boroughs where there were fewer financial burdens the chances of success would be higher. He also stated that it would depend on the level of support by the Local Commissioning Boards.

 

In response to a point made by Councillor Gulaid, Lisa Anderton explained that NHS North West London did not believe that it needed to extended the consultation period as they were satisfied that they had had satisfactory dialogue with all stake holders. However the Committee was informed that if it proved necessary to submit their report after the end of the consultation deadline NHS North West London would still accept it.

 

The Chair thanked NHS North West London for all of the information they had provided and stated that the Committee still aimed to submit its report within the designated deadline, however she stated that the Committee would still appreciate receiving the information that had been promised to them today.

 

The Chair concluded the morning by informing the Committee that the views from all the borough’s Overview and Scrutiny Committees had now been submitted and that the only thing to note was that they were all very different.

 

The Committee then broke for a working lunch.