Agenda and minutes

The Chair welcomed Members, guests and the public to the last meeting of the municipal year. She thanked the adviser and colleagues for their contributions and work to support the residents of Harrow.  She also thanked the representatives of the NHS for their regular attendance and contributions during the year.

With the agreement of the Sub-Committee, the Chair varied the order of business to take the agenda items as follows: 12, 10, 8, 9, 11 and 13.

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 at this meeting.

To receive declarations of personal or prejudicial interests, arising from business to be transacted at this meeting, from:

(a)               all Members of the Sub-Committee;

(b)               all other Members present in any part of the room or chamber.

RESOLVED:  To note that the following interests were declared:

Agenda Item: 8 – Full Business Case for Ealing Hospital Trust and North West London Hospitals Trust Merger; Agenda Item: 9 – Quality Account 2011-12; Agenda Item:10 - Review of Paediatric Contracts; Agenda Item: 11- Admiral Nurses Service Update; Agenda Item: 12 – Quality Account 2011-12

Councillor Ann Gate declared a personal interest in the above items in that she was employed by the Pinn Medical Centre.  She would remain in the room whilst these matters were considered and voted upon.

CouncillorMrs Vina Mithani declared a personal interest in the above items in that she was employed by the Health Protection Agency.  She would remain in the room whilst these matters were considered and voted upon.

Agenda Item 9 – Quality Account 2011-12

CouncillorSachin Shah declared a personal interest in that he was employed by Parkinsons UK.  He would remain in the room whilst the matter was considered and voted upon.

That the minutes of the meeting held on 6 December 2011 and of the Special meeting held on 7 February 2012 be taken as read and signed as correct records.

RESOLVED:  That the minutes of the meeting held on 6 December 2011 and of the special meeting held on 7 February 2012 be taken as read and signed as correct records.

To receive questions (if any) from local residents/organisations under the provisions of Committee Procedure Rule 17 (Part 4B of the Constitution).

RESOLVED:  To note that the following public question was received at the meeting under the provisions of Committee Procedure Rule 17:

1.

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 had been received.

To receive deputations (if any) under the provisions of Committee Procedure Rule 16 (Part 4B) of the Constitution.

RESOLVED:  To note that no deputations were received at the meeting under the provisions of Committee Procedure Rule 16.

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

RESOLVED:  To note that no references had been received.

Letter from Ealing Hospital NHS Trust and North West London Hospitals NHS Trust

The Sub-Committee received a letter from Ealing Hospital NHS Trust and the North West London Hospitals Trust (NWLHT) which provided an update on the next steps in relation to the publication of the Full Business Case (FBC) for the proposed merger of the Trusts.  The letter also provided a general update on the merger programme.

The Chair welcomed Peter Coles, Chief Executive NWLHT, David Cheesman, Director of Strategy NWLHT, and Catherine Thorne, Director of Governance NWLHT, to the meeting.  Mr Cheesman reported that NHS London had requested that the Trusts refine the financial elements of the FBC.  The FBC would now be submitted to NHS London on 28 June 2012 which would subsequently put the merger date back to 1 October 2012.  It was hoped that the FBC could be considered by the Health and Social Care Scrutiny Sub?Committee in July.

The Director of Strategy advised that a Transaction Director, David McVittie, had been appointed by NHS London to lead on the merger process.  In terms of the name for the new organisation, he advised that the Department of Health would need to give their final agreement and that the name would need to be relevant locally.  Following consultation with staff, the preferred name was London North West Healthcare NHS Trust.

RESOLVED: That the position be noted.

Report of North West London Hospitals NHS Trust

The Sub-Committee received the Quality Account 2011-12 from the North West London Hospitals NHS Trust which outlined key priorities for quality improvement in the organisation.

The Director of Governance NWLHT introduced the report, advising that data was currently the subject of validation.  The report provided an update on the previous year’s priorities of 1, improving overall patient satisfaction, 2, reducing the number of falls amongst patients whilst they are in hospital and 3, increasing the number of patients discharged on a Chronic Obstructive Pulmonary Disease following an admission with acute exacerbation of their COPD.  In terms of priority 1, the patient survey had not been received as yet but there had only been 5 breaches on mixed sex accommodation.  She reported that reducing the number of patient falls was a challenge for the Trust as the number was already below the national average but that the harm arising from such falls had reduced.  In terms of priority 3, she reported that the unvalidated results for February showed a figure of in the mid 80s.

The Director of Governance reported that the 2012/13 priorities took account of the feedback received and the following were being considered:

1.                  continued development and improvement of the patient journey and experience through accident and emergency (patient pathway);

2.                  further improve the quality of care for our vulnerable residents with dementia;

3.                  improve access to emergency theatres for all specialities.

She reported that there had been 7 unannounced inspections by the Care Quality Commission and the Trust had met their requirements.  The CQC had also identified areas where improvements could be made.

The Chief Executive of NWLHT advised that the document was not yet finalised and therefore any feedback or areas that Members wished to be included should be forwarded to the Trust.  The Director of Governance added that it was necessary to be mindful that the merger with Ealing Hospital Trust may take place during the year and that this may then lead to amendments to priorities.  It should also be noted that there were draft objectives for the new organisation.

Following the presentation, Members made comments and asked questions as follows:

·                    There had been a problem with providing responses to complaints within 25 working days as many complaints referred to a number of different departments/consultants and staff preparing the responses also had to deal with their normal workload.  It had been agreed that the backlog of complaints would be dealt with by bringing in an additional resource.  It was noted that patient expectations were being raised by setting a target of complaints being acknowledged within 3 days of receipt.  The Member also commented that complaints could be viewed as helpful.

·                    Referring to a Member’s comment that some targets appeared to be omitted from the patient experience indicators (page 38 on the agenda), the Director of Governance undertook to include some narrative.

·                    A Member expressed concern at the green indicators in relation to CQUINN performance (Patient experience questions).  The Director of Governance  ...  view the full minutes text for item 95.

Report of NHS Brent and Harrow

The Sub-Committee received a report on the review of paediatric contracts which covered the services of health visiting, school nursing, paediatric community nursing, paediatric therapies and community child health consultant clinics.

Javina Seghal, Borough Director, introduced the report and outlined the financial context. Rebecca Wellburn, Deputy Borough Director NHS Harrow, reported that the review had considered contract specifications so that it was clear as to what was being provided.  Many of the contracts in the review did not have robust specifications.  The first task had been to identify what each service was delivering.  She undertook to provide the appendices that were missing but referred to in her report.

In terms of health visiting, the Deputy Borough Director advised that NHS London were impressed with this service and from the benchmarking done across London, Harrow already met the Government’s targets.  There was, however, a need to better integrate health visiting.

The Deputy Borough Director reported that the school nursing service was not as progressed as health visiting and that there was a tri-borough core service specification for the service.  A re-design of the service had been started but there were some concerns in relation to special schools.

Members were advised that the remaining three services; paediatric community nursing, paediatric therapies and child health consultants were provided by NWLHT.  In terms of paediatric therapies, demand had risen significantly largely due to educational needs.  In relation to child health consultants, much could be achieved in efficiencies and productivity.

A Member sought the views of the Deputy Director on those functions that the local authority should be mindful of when it takes on public health and was advised that work with Children’s Services was already underway.  The Chair of the CCB added a note of caution in that many GPs and health visitors wished to retain their strong relationship as that was how a lot of safeguarding work took place.  The Member stated that it would be helpful if the Council were kept informed of any concerns that arose.

In response to a question in relation to Academies and contracts with school nurses, the Deputy Borough Director advised that these would remain unchanged.  However, school support staff might be able to provide assistance instead of the school nurse in some instances.  The Borough Director added that it had been agreed that where there was a transfer of service, the NHS would not make any decision without discussing it with the local authority.

A Member queried the workload for nurses and health visitors and was advised that according to NHS figures, there was currently the right number of health visitors and making use of administration staff and consideration of skill mix would assist with workloads.  The Deputy Director advised that flexible working did have an effect and there could be issues in matching the needs of the team with the needs of the service.  The Borough Director added that a review carried out the previous year had showed that the patient facing  ...  view the full minutes text for item 96.

Report of NHS Harrow

The Sub-Committee received a report from NHS Harrow which provided a service update on Admiral Nurses.  The Borough Director introduced the report and provided some context and background to the service.

The Borough Director advised that there had been dialogue between the Chief Executives, CNWL and NHS Harrow and the work on Admiral Nurses would be included as part of the modernisation board.  Having met with resident leading the lobbying for the re-establishment of the service and others, she now had a clearer understanding as to what had happened in the past.  However, to fund a service in an ad hoc way when it was not clear where any future funding would come from would not be helpful.

The Borough Director reported that considerable work had been done on the dementia pathway.  In addition, NHS Harrow had received £42,000 funding and there were discussions underway with CNWL to establish what resources were available in block contracts.  The current view was that the service could be delivered in an integrated way.

In response to a Member’s question, the Borough Director advised that Admiral Nurses could be funded from a range of sources and options were being explored.  She stated that she had looked to the CNWL, ICO and the acute Trusts to see what could be provided although match funding may be required.

The Borough Director confirmed that whilst there would be a role for Admiral Nurses she was not able to make a commitment at this stage due to the process that had to be gone through.  The Chair of the Harrow CCB added that dementia was a priority and there was a commitment to this from the CCG.

The Chair thanked the representatives for their presentation and responses.

RESOLVED:  That the report be noted.

Report of Central North West London NHS Foundation Trust

The Sub-Committee received Central and North West London (CNWL) NHS Foundation Trust draft Quality Account 2011/12.  The Chair welcomed Robyn Doran, Director of Operations and Partnership, Ela Pathak-Sen, Associate Director for Quality and Service Improvement and Matt Malherbe, Quality Assurance Manager, to the meeting.

The Sub-Committee received a detailed presentation on the Quality Account and were advised that there was little flexibility in the structure of the account but that it would include a statement from the Auditor.  The presentation provided an overview of CNWL including Vital Signs MR, Monitor target performance, a look back at performance against last year’s Quality Priorities and a look forward to Quality Priorities 2012-13 (including stakeholder involvement and principles).  The presentation also highlighted the next steps.  The presentation is available to view on the Council’s website.

Following the presentation, Members made comments and asked a series of questions as follows:

·                    Referring to page 111 and the table detailing service user experience, a Member queried the copy of care plan target and was advised that it was measured if a care plan had been offered.  It was clear, however, that staff had a different view to that of the service users.  Users were asked if they understood the content of their care plan.  Care plans were prepared by professionals and were now written so that service users could better understand them.

·                    A Member questioned what plans were in place to improve Harrow’s performance in the percentage number of service users who called the crisis number getting the help they wanted.  The Director of Operations and Partnership reported that work was being done with staff and mystery shoppers were being used.  She added that crisis cards for carers would also be provided and reported on.

·                    The Quality Assurance Manager confirmed that there were 38 questions in the 2011 national NHS staff survey.  A Member expressed the view that 10% was an indication of nearly achieving a target as opposed to 20% and this was acknowledged as a fair point.

·                    A Member expressed concern that Harrow’s performance was worse than the Trust’s and was advised that 7 targets had been achieved and that performance related to resources.  Harrow PCT had overspent by £1.1m and the other PCTs were picking up the cost.  Overall, the Trust had not overspent.  Work was being done with the Borough Director and the Chair of the CCB in order to improve performance.

·                    It did not matter where you lived, as an acute inpatient you would receive the same minimum standard of care.  The Director of Operations and Partnership reported that patients in Harrow probably had the best environment.  In addition, the surplus had been reinvested in Northwick Park Hospital.

·                    The majority of service users wanted to be involved in their care plan but some were more able than others.  If a service user did not want to be involved this was reflected in the figures and was a negative for the Trust.

·                    The issue in relation to hand washing was  ...  view the full minutes text for item 98.

Report of the Divisional Director of Partnership Development and Performance considered by the Overview and Scrutiny Committee on 3 April 2012

The Sub-Committee received an information report which outlined the issues for consideration by the Overview and Scrutiny Committee at their meeting on 3 April 2012 and the recommendation to Council that Harrow participate in a Joint Overview and Scrutiny Committee (JOSC).  The JOSC would be formed to consider ‘Shaping a Healthier Future’ NHS North West London’s programme to improve care for North West London and the consultation process.

RESOLVED:  That the report be noted.

Members thanked the Chair of the Sub-Committee for her work during the 2011/12 municipal year.