Agenda and minutes

Health and Social Care Scrutiny Sub-Committee - Wednesday 12 June 2019 7.30 pm

Venue: Committee Rooms 1 & 2, Harrow Civic Centre, Station Road, Harrow, HA1 2XY. View directions

Contact: Daksha Ghelani, Senior Democratic Services Officer  Tel: 020 8424 1881 E-mail:

No. Item


Attendance by Reserve Members

To note the attendance at this meeting of any duly appointed Reserve Members.


Reserve Members may attend meetings:-


(i)                 to take the place of an ordinary Member for whom they are a reserve;

(ii)               where the ordinary Member will be absent for the whole of the meeting; and

(iii)             the meeting notes at the start of the meeting at the item ‘Reserves’ that the Reserve Member is or will be attending as a reserve;

(iv)              if a Reserve Member whose intention to attend has been noted arrives after the commencement of the meeting, then that Reserve Member can only act as a Member from the start of the next item of business on the agenda after his/her arrival.


RESOLVED:  To note that there were no Reserve Members in attendance.


Declarations of Interest

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from:


(a)               all Members of the Sub-Committee;

(b)               all other Members present.


RESOLVED:  To note that the following interests were declared:


Agenda Item 13 – Information Report – Public Health Forward Plan


Councillor Vina Mithani, a member of the Sub-Committee, declared a non-pecuniary interest in that she worked for Public Health England.  She would remain in the room whilst the matter was considered and voted upon.


Minutes pdf icon PDF 220 KB

That the minutes of the meeting held on 4 February 2019 be taken as read and signed as a correct record.


RESOLVED:  That the minutes of the meeting held on 4 February 2019, be taken as read and signed as a correct record.


Appointment of Vice Chair

To appoint a Vice-Chair of the Sub-Committee for the 2019/2020 Municipal Year.


RESOLVED:  That Councillor Vina Mithani be appointed as Vice-Chair of the Health and Social Care Scrutiny Sub-Committee for the 2019/2020 Municipal Year.


Appointment of (non-voting) Advisers to the Sub-Committee 2019/20 pdf icon PDF 161 KB

Report of the Director of Legal and Governance Services.


RESOLVED:  That the following nominees be appointed as Advisers to the Sub-Committee for the 2019/20 Municipal Year:


Mr Julian Maw (Healthwatch Harrow)

Dr Nizar Merali (Harrow Local Medical Committee).


Public Questions

To receive any public questions received in accordance with Committee Procedure Rule 17 (Part 4B of the Constitution).


Questions will be asked in the order in which they were received.  There will be a time limit of 15 minutes for the asking and answering of public questions.


[The deadline for receipt of public questions is 3.00 pm, 7 June 2019.  Questions should be sent to  

No person may submit more than one question].


RESOLVED: To note that no public questions were received.



To receive petitions (if any) submitted by members of the public/Councillors under the provisions of Committee Procedure Rule 15 (Part 4B of the Constitution).


RESOLVED:  To note that no petitions were received.


References from Council and Other Committees/Panels

To receive any references from Council and/or other Committees or Panels.


None received.



RNOH Quality Account 2018-19 pdf icon PDF 37 KB

Report of the Director of Nursing, Royal National Orthopaedic Hospital.

Additional documents:


The Sub-Committee received a report of the Director of Nursing, Royal National Orthopaedic Hospital (RNOH) NHS Trust, which set out the Quality Account for the RNOH for 2018-19.  The report set priorities for the RNOH for 2019-20 and identified the progress against the quality priorities set in 2017?18.  It also identified performance against key indicators set by National Health (NH) Improvement.


The representative of the RNOH introduced the report and summarised the progress made against priorities set for 2018/19.  She referred to the quality priorities set for 2019/20 as follows:


-               develop and embed safety hurdles across all in-patient areas;

-               develop and implement a Ward Accreditation Programme

-               procure, develop and roll-out Electronic Prescribing and Medicines.


The representative was pleased to report that the RNOH had been rated ‘good’ by the Care Quality Commission (CQC).


Members of the Sub-Committee asked the following questions which were responded to:


Q -Construction of the new inpatient Stanmore Building was completed and opened for patients in December 2018.  How had the first six months been, were there any emerging issues or improvements needed?  What had been the impact of the new building on the quality of care that could be offered by the Trust?


In terms of the new building, a number of issues with the building needed to be resolved with the contractor.  However, the new building provided a better environment for patients who had given positive feedback.  Staff were settling into the new building.


Q -The Trust had been visited by the Care Quality Commission (CQC) in 2018.  Overall the Trust had improved from a ‘Requires Improvement’ to a ‘Good’ rating.  Had this helped maintain RNOH’s position as the country’s leading specialist musculoskeletal centre?


A – The Trust had improved vastly.  Staff culture and experiences had both been improved but the Trust was not complacent and had recognised that there was room for further improvement.  Staff morale was good and confidence needed to be improved.


In response to further questions from Members on the improvements made in the severe infection area and the outcomes of the clinical audits relating to the pharmacy department, the representative from the RNOH agreed to consult her colleagues and provide responses separately.  She explained that audits were carried out with clinicians and with the support of the Corporate Management Team.  Audits were conducted on a regular basis but there was always room for improvement.


Members’ attention was drawn to pages 62 and 63 of the agenda which made reference to the conduct of various local audits, such as ‘audit of anaemia and transfusion in spinal surgery’, ‘audit on the effectiveness of the green bag scheme’ and ‘audit on the pharmacy endorsements on drug charts’.  The representative from the RNOH responded to further questions relating to the audits and reported that audits were carried out on a monthly basis and reported quarterly.  In addition, observational audits were carried out.  She explained that audits were carried out to measure compliance against the national guidance set  ...  view the full minutes text for item 43.


Quality Account Timetable for Imperial College Healthcare NHS Trust pdf icon PDF 174 KB

Report of the Medical Director, Imperial College Healthcare NHS Trust.

Additional documents:


The Sub-Committee received a report of the Medical Director, Imperial College Healthcare NHS Trust, which set out the Quality Account 2018/19 for the Trust. Quality Accounts were annual reports to the public from NHS Healthcare providers about the quality of services they delivered.  Their purpose was to encourage Boards and Leaders of healthcare organisations to demonstrate their commitment to continuous, evidence-based quality improvement, to assess quality across all of the services offered and to explain their progress to the public.


The representative of the Trust (Deputy Medical Director) introduced the report and outlined the vision ‘Better Health for Life” and the values, which were being embedded in everything the Trust did.  He added that the Trust had worked with staff to co-design the vision and values and these had been linked to behaviours expected of all A behaviours framework had been developed which set out how the Trust expected staff to behave in order to put the values – Kind, Expert, Collaborative and Aspirational – into practice.  Overarching strategic goals to create a stronger connection to the delivery of vision had been articulated.


The representative added that staff were encouraged to be curious about what was happening across the country and the world in relation to healthcare.  Many improvements had been made but the Trust was very aware of how much work there was still to do and was on a journey of continuous improvement.  For example, the Trust had launched a flow coaching academy, in partnership with Sheffield Teaching Hospitals NHS Foundation Trust, to improve care which had resulted in improvements for patients in several  pathways, such as Sepsis and Diabetes.  He outlined the work in relation to keeping mortality as low as possible, the establishment of a Strategic Lay Forum to involve patients in the strategic work of the Trust, and supporting improvements in patient care through innovation and by working with and learning from other Trusts.


Members of the Sub-Committee asked the following questions which were responded to:


Q -Was the A&E reaching its targets?


A - The Trust had been through a challenging period during the 2017/18 winter months and had set up a Care Journey and Capacity Collaborative which had helped to make significant improvements.  Despite record numbers of ED attendances, there had been a reduction in ‘black alerts’ by over one third (169 in 2017/18, 11 in 2018/19).  The Trust was also working with the Primary Care sector and nursing homes to improve patient experience.


Q -What were the Trust’s priorities and what challenges was it facing? What improvements had been identified during 2019/20?

A - The Trust had a large number of priorities of which the following were key: continuing to improve patient safety, values and behaviours, improvements in patient flow through A&E, collaboration with other organisations such as GPs and the emerging Primary Care networks.  The creation of an integrated care system, outstanding and sustainable services, learning and innovation were at the heart of the Trust’s three  ...  view the full minutes text for item 44.


London North West University Healthcare NHS Trust - Quality Account 2018 to 2019 pdf icon PDF 2 MB

Report of the NHS Trust.


The Sub-Committee received the Quality Account 2018-19 of the London North West University Healthcare NHS Trust, which had similarities with those of the reports considered at Minutes 43 and 44 in terms of the improvements made in the provision of care.


The representative of the Trust introduced the report and summarised the progress made. He stated that the Trust was placed 10th in the country in terms of mortality rates.  Northwick Park Hospital was the second busiest in London but considered to be the most improved hospital in terms of its performance.


The representative added that the Trust’s Transformation Programme focused on its staff and provided development opportunities.  Staff retention was also key.  The Trust was working towards becoming a digital exemplar and praised the work carried out by Imperial College NHS Trust in this area.  Work on a new electronic patient record was underway and he outlined the progress made in the various priorities of the Trust.  He reported that it was important to ensure improvements were sustainable.


Members of the Sub-Committee asked the following questions which were responded to:


Q -In relation to the development of the workforce, had this been sustainable?


A - The Transformation Programme had helped to ensure the development of staff. Data was being used to compare services.  Retaining staff was an issue but the situation was improving.  Various measures such as health and wellbeing initiatives, effective communication, training and a zero tolerance approach to bullying had helped.  New initiatives such as the introduction of ‘speak up’ guardians had helped to establish trust with staff and to show that they were being listened to.  The Trust continued to use agency/bank staff.  Staffing numbers were reported on a monthly basis.  Safe rostering arrangements had also been put in place.


The Trust was undergoing a journey of continuous improvement and supporting staff to embed a ‘can do’ culture.  Individual Wards were visited to monitor and resolve behavioural issues.


The Trust was experiencing problems when patients remained in the hospital(s) longer than required thereby creating blockages.


Q -Maternity services were flagged by CQC as needing attention.  The Quality Account states that the physical environment in maternity services has improved – what are these changes and what does this mean for women using the service?


A - Another representative of the Trust reported on the provision of maternity services.  She explained that a greater focus on staff working in this area, including their training needs, had to helped deliver improvements in the care provided and there had been an alignment with national standards.


Members were also reminded that the majority of the recommendations in the CQC Inspection Report had related to security, operation of the bleep system and tailgating.  These issues had been addressed and audits were undertaken to ensure that the measures put in place were working.  Compliments and complaints were shared with staff, particularly in relation to ‘after care’.  All complaints were taken seriously and addressed.  The intention was to ensure that staff  ...  view the full minutes text for item 45.


Update on Alexandra Avenue GP Access Centre - June 2019 pdf icon PDF 345 KB

Report of the Assistant Managing Director, NHS Harrow CCG.


Members received a report of the Harrow Clinical Commissioning Group (CCG), which provided a summary of the latest activity at the Alexandra Avenue GP Access Clinic in South Harrow.

Members were disappointed that the CCG had not been represented at the meeting and


RESOLVED:  That consideration of the report be deferred to the next meeting of the Committee.


Information Report: Public Health Forward Plan pdf icon PDF 307 KB

Report of the Director of Public Health.


The Sub-Committee received a report of the Director of Public Health, which set out her Department’s plans for 2019-20 and provided an overview of the budgets and the priority areas of work for the team.


Members were informed that prior to April 2018 (not 2019 as indicated in the report), public health in Harrow was a shared service with Barnet Council.   This changed in April 2018 when the team became two separate teams, with a restructure of the Harrow team also occurring at that time.  With a re?focused Harrow team, the plans and priorities for the coming year were before the Sub-Committee for their information.


The Consultant in Public Health introduced the report and outlined the work areas and priorities, encompassing some strategic work in the following areas:  Joint Strategic Needs Assessment (JSNA), Joint Health and Wellbeing Strategy (JHWS) and Annual Public Health Report (APHR), details of which were set out in the report.  The Consultant reported on other priorities such as public health commissioning, health improvement, wider determinants of health and health care public health.  She referred to table 1 in the report, which set out the use of the public health budget for 2019/20 and referred to the grant which was currently confirmed until 2020.

Q - If from April 2020, the public health national ring-fencing of the budget was lifted, what would that mean in Harrow?

A - The Consultant in Public Health reported that the public health ring fence was due to finish in April 2020 and, thereafter, the government expected public health services to be funded from the retention of business rates.  Councils were lobbying for the ring fence to remain and, if they were unsuccessful, money would have to come from other sources, such as business rates, if the work was to continue.


Q - Given the Sub-Committee’s work on dementia, what progress had been made, such as in the provision of a Dementia Hub?


A - The Consultant in Public Health reported that a new Dementia Hub had been launched in May 2019 and its impact would be monitored. Robust monitoring practices would be put in place and analysed.  Details and data on the parameters set would be provided separately to the Sub-Committee.


The Sub-Committee requested that a report be submitted to its next meeting setting out which recommendations set out in the Scrutiny report on Dementia had been carried forward.


The Consultant added that dementia was a priority area of focus for  integrated care and that the CCG were leading on the Dementia Strategy.


Q - Engagement plans for the Joint Heath and Wellbeing Strategy for 2020-23 and the Obesity Strategy were expected to be refreshed this year.  What would be scrutiny’s input?


A - The Consultant in Public Health reported that the Health and Wellbeing Strategy workshops would be held in July 2019 and members serving on scrutiny bodies would be invited.  Members of the Health and Wellbeing Board would also be invited to help shape the Strategy and decide  ...  view the full minutes text for item 47.


Update from NW London Joint Health Overview and Scrutiny Committee pdf icon PDF 188 KB

Report of the Director of Strategy.


Members received a report of the Director of Strategy which provided an update on discussions held at the meeting of the NW London Joint Health Overview and Scrutiny Committee (JHOSC) on 12 March 2019.


The Chair stated that she would not be able to attend the next meeting of the JHOSC on 21 June 2019.  She referred to the Patient Transport Services and reported that each borough would be required to contribute to the scheme.


RESOLVED:  That the report be noted.