Agenda item
Shaping a Healthier Future
The report summarises the services that each of the affected hospitals is intended to provide once the changes are implemented and how the changes affect different areas.
Minutes:
Rob Larkham gave a presentation highlighting the background to the shaping a healthier future initiative and the proposals that were currently being consulted upon. He drew members’ attention to the vision to localise care, integrate care and a centralised consistent access to senior doctors and for specialist skills to be accessible and developed with the ultimate vision to save lives. He continued to highlight previous concerns highlighted by the Committee such as; the low satisfaction levels of primary care services; acute services being closed before alternative provision was successfully up and running; and that service provision could not remain as it was and should be reconfigured to secure a better, sustainable future for patients. The programme of change would take three to five years with option A receiving the most support and least opposition. As a result of the feedback received several changes had been made including; development of the out of hospital strategies, a developed vision, governance process and pathways for urgent care centres; and a review and re-run of the financial, estates and capital investment analysis. Rob Larkham highlighted the specifications for urgent care centres and the types of problems they would treat. The decisions of the Joint Committee of Primary Care Trusts (JCPCT) on the 19 February were explained and how they intended to move beyond the core offering of services. The future configuration of major and local hospitals were clarified with Northwick Park being a major hospital offering A&E provision and central Middlesex being classified as a local hospital addressing urgent care, outpatients and diagnosis.
The proposed governance structure to oversee implementation was highlighted although it was confirmed that Ealing Borough Council had referred the plans back to the secretary of state which would delay the overall process whilst the independent review panel reconsidered the proposals. A clearly laid out process would be followed for key decision making before any changes were implemented. He continued to highlight the activities for the out of hospital programme, where community facilities could potentially be based and the work carried out by CCGs to deliver the out of hospital programme.
Rob Larkham explained that there was a £28m backlog of maintenance investment and a further £20m investment required at Northwick Park hospital to enable a 20% increase in maternity births, 15% increase maternity general, 23% increase neonatal activity and 33% increase in critical care activity. A capital programme of works including expansion of the A&E department, refurbishing of existing theatres as well as creating four new theatres and a new 10 bed ITU extension was required to enable the capacity increases outlined. Central Middlesex hospital would be a local and elective hospital with a £9m investment required. Rob Larkham concluded that all changes would be subject to the litmus test of whether change of services would be safer than the current provision.
Members noted the high level of detail included within the presentation and report. Members queried whether urgent care was currently being provide on a 24/7 basis due to the difficulties in recruitment. It was clarified that the provision of urgent care was reduced due to the positions not being attractive to experienced GPs and being more desirable to younger doctors who had not yet chosen an area in which to settle and develop their own practices. Members queried the extended journey times to major hospitals amongst plans to reduce the ambulance service. It was noted that the ambulance service was critical in enabling the plans and in response to anecdotal evidence provided by Councillor Cheese regarding lack of porters and ambulance staff, Rob Larkham informed the Committee that a £20m investment in the ambulance service was proposed to increase capacity and remodel the service to improve efficiency. Following queries it was explained that the greater the delay, the greater the risk to being able to sustain the correct level of surgical expertise at smaller sites and potential for services becoming unfit in the future. Members asked what controls were in place to ensure all changes did not have a detrimental effect during implementation. Rob Larkham reassured members that each decision would be mapped out against the key decision process and safety must be satisfied at each stage with work between existing and new providers taking place to enable an improved NHS and not a privatised service. Following queries regarding the timeline, it was noted that this had not been fully agreed due to the finalisation of proposals being required and investments to be confirmed, it was however hoped that investments in the out of hospital service would start later in the year. Jo Ohlson explained that closer working relationships with CCGs, social services and voluntary organisations was needed to offer out of hospital services to reduce the pressure on Northwick Park hospital for patients who did not necessarily need hospitalisation. Members queried whether there was adequate staffing to support the primary care hubs throughout the borough. Jo Ohlson stated that a pilot would commence in April where a central hub would provide additional appointments following a £1m investment for six months, with the intention of a further £4m and the intention of six hubs being created overall, including a proposed site in Kingsbury.
Councillor Hector proposed the following motion:
“It is arguable that closing A&E at local hospitals could be appropriate if the ambulance service had been expanded so that people could be taken direct to the relevant specialist hospital. I understand that the cuts to the ambulance service that began 2 years ago are continuing. This is unacceptable. We cannot agree to this. We are therefore referring back the report ‘Shaping a Healthier Future’ to the Secretary of State.”
Councillor Hector reiterated her concerns that the directions of the changes were heading towards privatisation and that the ambulance service should be invested in rather than cut.
The following alternative motion was proposed:
“Brent Council’s Health Partnerships Overview and Scrutiny Committee notes that the London Borough of Ealing has already referred Shaping a Healthier Future to the Secretary of State. Given the scale of the changes, it is right that these proposals are thoroughly examined by the Secretary of State along with the Department for Health. The Committee wishes to further raise our concerns with current A&E capacity regardless of future changes to services and seeks assurances that services will not be reduced or closed unless changes in infrastructure prove to deliver successful outcomes for residents.”
The original motion was not seconded and failed, with the alternative motion being seconded and carried.
RESOLVED:-
Members noted the report
Supporting documents: