Agenda and minutes

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

RESOLVED:  To note the attendance at this meeting of the following duly appointed Reserve Members:-

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from all Members present.

RESOLVED:  To note that the declaration of interests, which had been published on the Council website, be taken as read and that no further declarations were made during the course of the meeting.

That the minutes of the meeting held on 29 November 2022 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 29 November 2022, be taken as read and signed as a correct record.

To note any public questions received.

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, 16 February 2023. Questions should be sent to publicquestions@harrow.gov.uk   

No person may submit more than one question].

RESOLVED:  To note that no public questions had been received.

To receive petitions (if any) submitted by members of the public/Councillors.

RESOLVED:  To note that no petitions had been received.

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

RESOLVED: To note that no references from Council or other committees/Panels had been received.

Report of the Harrow Borough Director, North West London Integrated Care Board.

Members received a presentation on the report fromIsha Coombs,Harrow Borough Director, North West London Integrated Care Board, which described the purpose and the approach to the North West London Integrated Care Board’s review of community outpatient services within the context of all outpatient services in Harrow with the following highlights:

·                 A key priority for the review and provision of future services was to ensure that all patients/residents in Harrow had access to an equitable provision of service, no matter where they lived in the borough, or which GP practice they were registered with.

·                 Harrow CCG had become part of NHS North West London during the duration of a 10 year contract with Harrow Health Community Interest Company (HHCIC) for the provision of outpatient services.  As part of the forward planning for these services, some were being reviewed and would be procured across North West London while others would be reviewed locally.  The services being reviewed were detailed in the report.

·                 NHS NW London was committed to ensuring that the quality and waiting times for all services, in hospitals and the community, were equally scrutinised and inequitable waiting times were addressed.  This review was to ensure that access to services was simplified for GPs to use and provides the same level of access and provision for all patients in Harrow and NW London.

·                 A public survey was open until 25 February (four weeks) for feedback on ENT, gastroenterology, paediatrics and neurology services and as at 9 February, approximately 182 survey responses/comments had been received

·                 The survey was to ensure people had an opportunity to share their views on the current services and to gather their feedback on future service provision.  The feedback would be used to inform the service reviews and would form part of the recommendations.

·                 For each community outpatient service, the review would assess several options for the future provision of services to patients and a final decision on the preferred option would be made by the NWL ICB Executive by the 31 March 2023.

Members asked the following questions:

·                 A member asked if the on the response to the consultation was specific to Harrow residents, if it showed if they were services users and the success (or lack) of the various engagement channels used.  The Borough Director, NWL ICB explained that it was agreed that the consultation and methodology used, should not be analysed until after the closing date 25 February 2023 so as not to unduly influence the outcome of the consultation.

A Member asked why the consultation response (182 responses) was low given the size of the borough.  The officer explained that the services being reviewed had only 2000 appointments in the last year and the response was considered one of the highest received on surveys undertaken across North West London.

A Member asked if the results of the two reviews would be merged and brought to the committee and given that the contract for the provision of outpatient services would be expiring in  ...  view the full minutes text for item 28.

Report of the Acting Director of Operations (Outer North West Division), Central London Community Healthcare NHS Trust.

Members received a report from Jackie Allain, the Acting Director of Operations NHS CLC and Samantha Howard, Divisional Director of Nursing and Therapies which provided an overview of the CQC’s findings following their inspection of the Community Nursing service in Harrow in October 2022, report of their findings published in December 2022 and the Trust’s planned action to meet the required areas for improvement.  The report had the following highlights:

.

Positive Findings

·                 Statutory and mandatory training uptake was high

·                 Staff were trained how to protect patients from abuse

·                 Infection risk was well managed and appropriate controls were in place

·                 Clinical waste was managed well by staff

·                 Staff took precautions and actions to protect themselves and patients

·                 Medicine storage and prescription systems/processes were in place

·                 Staff knew how and when to report patient safety incidents

·                 Managers investigated incidents and shared lessons learned

·                 When things went wrong staff apologised and gave suitable support

·                 Actions from patient safety alerts were implemented and monitored

Areas for Improvement

·                 The service did not have enough nursing staff

·                 All locality teams had high vacancies which put staff under pressure [CQC noted that staffing levels had recently been increased and that there was an active recruitment campaign]

·                 Records not always completed with enough detail

·                 Some handover meetings were brief and lacking in detail.

·                 Lack of leadership oversight on a case of neglect [which should have been reported to the local authority]

·                 Audits and supervised visits were not occurring regularly

·                 Capacity decisions were not consistently documented

·                 Referrals for potential neglect not always made to the local authority

Inspection Outcome

·                 The rating in the ‘Safe’ domain for Community health services for adults had changed from ‘Good’ to ‘Required Improvement’

·                 The overall rating for the core service remained ‘Good’

·                 The overall rating for the Trust remained ‘Good’

·                 The full report can be viewed at: https://www.cqc.org.uk/provider/RYX/inspection-summary#chsadults

CQC Recommendation Plans

Must Do

·                 ensure that clinical documentation was completed in sufficient detail in the Harrow community nursing teams

·                 ensure that clinical documentation was completed in sufficient detail in the Harrow community nursing teams

Should Do

·                 ensure that all handovers include all necessary key information to keep patients safe.

·                 ensure that formal assessments of patients’ capacity were appropriately recorded.

·                 ensure staff report safeguarding concerns to the local authority when they were required to do so.

Members asked the following questions:

A Member asked about the challenge with “handovers” and why comprehensive information was not being handed at the end of a shift.

The director explained that it was due to staff shortages.  A Member advised that in addition to a verbal handover, staff could check the notes to ensure that vital information was not missed out during the handover process.  The director explained that a template had now been given to staff to ensure that the information needed is captured and handed over at the end of a shift.

A Member asked about current vacancies and staff shortages.  The director explained that some teams had up to 40% vacancy on training nurses.  There  ...  view the full minutes text for item 29.

Members received a verbal update on Child Immunisations Review.  The role of the public health department and the DPH was to provide scrutiny on the process around childhood immunisation particularly the zero to five vaccination schedule.  The officer informed Members that there was a downward trajectory on child immunisation in Harrow compared to other boroughs in North West London.

At the informal review, effect of demographic factors on the uptake of immunisation was considered and it was concluded that work should be done on engagement with identified communities to communicate the effectiveness of vaccinations.  This was a huge area of work and officers had met with challenges such as behavioural factors were often difficult to influence.

Another factor considered at the review, in addition to promotion, was the existing mechanisms to invite children informally and their parents for immunisation.   It was the responsibility of NHS England to provide the assurance that these existing mechanisms were of good quality.  The responsibility was soon passed to the ICS.  A review was held on 2 February 2023, but this area could not really be explored very thoroughly and the officer recommended that NHS England be invited to attend a future meeting of the sub-committee to address the existence and quality of these systematic measures and procedures and to assist primary care officers in improving the uptake of childhood immunisations within Harrow.

Members asked the following questions:

A Member asked if any efforts were being made to benefit and build on the work done with communities and community leaders during COVID vaccination.  What challenges or barriers had been encountered and if they were specific to Harrow.  An officer explained that there were partners involvedin the demographic and behavioural aspects to vaccination, ICS had made available a grant and had also involved with their engagement team.

A Member suggested that engagement of the identified communities could be done through partnership with the embassies of their respective countries.  An officer agreed with the suggestion.

Members asked if the downward trajectory was specific to any immunisation or vaccine.  The officer responded that it had affected all vaccines but specially the MMR because of its history.

RESOLVED:  That the report be noted.