Agenda and minutes

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.

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.

All Agenda Items

Councillor Michael Borio declared a non-pecuniary interest in that he was employed by Independent Age.  He would remain in the room whilst the matters were considered and voted upon.

Councillor Mrs Vina Mithani declared a non-pecuniary interest in that she was employed by Public Health England.  She would remain in the room whilst the matters were considered and voted upon.

Councillor Chris Mote declared a non-pecuniary interest in that his daughter was employed by Northwick Park Hospital.  He would remain in the room whilst the matters were considered and voted upon.

That the minutes of the meeting held on 7 July 2014 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 7 July 2014 be taken as read and signed as a correct record.

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 notice of them was received and there be a time limit of 15 minutes.

[The deadline for receipt of public questions is 3.00 pm, 1 September 2014.  Questions should be sent to publicquestions@harrow.gov.uk  

No person may submit more than one question].

RESOLVED:  To note that no public questions or petitions were received at this meeting.

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

RESOLVED:  To note that none were received.

Report of the Director of Legal and Governance Services.

The Sub-committee received a report of the Director of Legal and Governance Services, which set out details of nominations for the position of non-voting adviser to the Sub-Committee 2014/15. 

An officer advised that the nomination from HealthWatch Harrow had been withdrawn after the agenda had been published.  HealthWatch Harrow would be contacted for a replacement nomination, which would be agreed at the next meeting. 

The Sub-Committee agreed the nomination from the Local Medical Committee.

Resolved to RECOMMEND: 

That Dr Nizar Merali, of the Local Medical Committee, be appointed as a non?voting adviser to the Sub-Committee for 2014/15.

Report of the Director of Public Health.

The Sub-Committee received a report of the Director of Public Health which set out the work and experience of the Joint Public Health Service in its first year of operation from 1 April 2013 to 31 March 2014.

The Director stated that the Joint Public Health Service, which was in its first year of operation, worked for Barnet and Harrow Councils and had the following key areas of responsibility:

·                    leading health improvement and reducing health inequalities;

·                    health protection and ensuring appropriate plans are in place;

·                    public health support to health service commissioning and joint commissioning;

·                    providing public health knowledge and intelligence.

He added that the team worked with both councils and organisations within the NHS, eg, the Clinical Commissioning Groups, NHS England and Public Health England.  It had formal links to all of these organisations in order to fulfil statutory requirements and to ensure effective health provision for both boroughs.

Members made the following comments and asked the following questions:

·                    What new services and initiatives had been funded with the new investment totalling £1.65m across the two councils?

The Director advised that the following initiatives had been funded with the investment:

·                    £350,000 of new investment was deployed to support work on childhood obesity, a review of the school nursing service in preparation for health visitors joining the Council in April 2015 (to ensure a joined up preventive health support for Children 0?19 is in place), warmer homes, work to improve the older peoples health and social care pathway (undertaken by Adults Services).  Harrow Childhood obesity, Alcohol brief advice in pharmacies, and healthy eating in schools and Children’s Centres.

·                    How would childhood obesity be tackled and healthy eating among school children be promoted? What could be done about the proliferation of fast food outlets in our local high streets and in the vicinity of schools?

The Director advised that schools in Barnet and Harrow had engaged well with the Healthy Schools programme, which was part of the Mayor of London’s initiative.  Healthy eating, emotional wellbeing, stopping smoking  along with the sexual health programme, and services provided as part of the Early Years’ services and Children’s Centres were key elements of the programme.

He added that Tower Hamlets had looked at introducing new by-laws to regulate fast food outlets and there the government was considering a proposal to tax fizzy drinks.  The Environmental Health team at Harrow was working with schools on healthy catering options.

·                    Why was the ring fenced grant a higher amount for Barnet than for Harrow?

The Director advised that PCTs in Barnet and Harrow and other outer London authorities had historically received low allocations.  Furthermore, the population of Barnet was almost double that of Harrow and the two boroughs had one of the smallest allocations in England, per head of population.  The grant amount was based on indices such as deprivation and age and though the two boroughs shared services, they did not share the funding.  The residents of both boroughs were considered to be  ...  view the full minutes text for item 16.

Report of the Care Quality Commission.

The Sub-Committee received a report of the Care Quality Commission (CQC) which set out its findings following its recent inspection of  the North West London Hospitals NHS Trust (NWLHT).

Following a brief overview of the report by the Interim Medical Director at NWLHT, Members asked the following questions:

·                    What was the Trust’s reaction to the report?  Did the Trust agree with the report’s conclusions?  Did the report highlight areas that the Trust was already aware of or were they a surprise, if so, which ones had come as a surprise?

·                    Critical care at Northwick Park Hospital had been rated ‘Inadequate’.  What was being done to address this, when would detailed improvement plans be made available to the Sub-Committee?  When was the service expected to improve and to which CQC standard?

The Interim Medical Director stated that in his view, the report was measured and appropriate.  The Trust was obliged to submit a Compliance Action Plan in response to the CQC report.  The Action Plan was almost complete and the Trust was in the process of producing a Quality Improvement Plan with its partners and the CQC.  The report had highlighted the fact that National Audit requirements for critical care had not been taken into account by the Trust, and consequently, critical care units at Northwick Park Hospital had discharged patients too soon, which had led to an increase in re-admission rates for these patients.

A representative from Harrow’s Clinical Commissioning Group (CCG) added that the Improvement Plan was owned by Barnet and Harrow CCGs, which had joint monitoring responsibility.

·                    Would the enhanced A&E services at Northwick Park have the capacity to deal with an increased and more complex workload as a result of the planned closures of the daytime A&E facility at Central Middlesex and Hammersmith being replaced by an urgent care facility?  How would this work in practice and would Harrow residents experience increased delays in accessing A&E?

·                    Why were A&E services at Central Middlesex and Hammersmith being closed despite the anticipated delay in implementing the changes at Northwick Park?  Why had the changes not been implemented in phases?

·                    What effect would the changeover have on staff management and morale?

The Interim Medical Director advised that the Shaping a Healthier Future report had made a number of recommendations regarding North West London hospitals, which had been taken on board by the Trust. A&E facilities at Hammersmith Hospital and Central Middlesex Hospital would be closing the following week.  Modelling had suggested that significant numbers of patients would opt to go to access A&E services at either St Mary’s or Charing Cross Hospitals following the closures.  Furthermore, Central Middlesex already referred its patient overflow to Northwick Park Hospital.  He anticipated that there would be an additional 9-12 patients visiting the re-vamped A&E unit at Northwick Park Hospital on weekdays and that this figure would be lower on weekends. 

He added that the following measures were being implemented at Northwick Park.  ...  view the full minutes text for item 17.