Agenda and minutes

The Chairman welcomed those present to the meeting.  She proposed that item 6 be taken first, followed by items 5, 7, 8 and 9 if there was sufficient time.  This was agreed.

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 Committee;

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

RESOLVED:  To note that the following interest was declared:

Agenda Item 6, 7 and 8 – Main Themes for the Meeting, Progress for Public Consultation, Evidence Required for Future Meetings

Councillor Krishna James declared a disclosable non-pecuniary interest in that she was a former nurse and had worked for the NHS.  She would remain in the room whilst these matters were considered and voted upon.

RESOLVED:  That the minutes of the meeting held on 12 July 2012, be taken as read and signed as a correct record and the minutes of the informal briefing held on 6 July 2012 be taken as read and signed as a correct record, subject to the following amendments:

the final sentence in paragraph 3.1 on page 3 to read:

‘It was reported that doctors understood the proposals of moving to a reduced number of sites.  It was reported that few consultants would not argue for fewer sites.’

the final sentence in paragraph 3.18 on page 6 to read:

‘The Member from H&F reported that financial assessments could be wrong and restated a second request for NHS NWL to consider the split site suggestion and asked NHS NWL to provide a response.’

It was noted that David Clegg’s name throughout the minutes should read David Slegg.

RESOLVED: To note there were no matters arising.

Oral update

The Chairman stated that when the Chairman and Vice-Chairman of JHOSC had been nominated, there had been no Liberal Democrat Member on the Committee.  She asked if Members felt strongly that a second Vice-Chairman should be appointed.  Following brief discussion, the Committee agreed to retain its current membership and chairing arrangements.

RESOLVED:  That the Committee retain its current membership.

Evidence from witnesses:

• David Cockayne – UK Director of Health and Social Care for Tunstall UK
• Professor David Welbourn – Visiting Professor in Health Systems Management, Centre for Health Enterprise at Cass Business School
• Dr Alasdair Honeyman – Associate at the Kings Fund

The Committee were given a presentation by Professor David Welbourn, Visiting Professor in Health Systems Management, Centre for Health Enterprise at Cass Business School relating to the proposals in the Shaping a Healthier Future report, focussing on associated risks and a second presentation by Dr Alasdair Honeyman, Associate at the Kings Fund, about the demographic drivers for the ‘Shaping a Healthier Future’ case for change.

Professor Welbourn made the following points about current  healthcare provision in the UK:

·                     transforming healthcare provision in the UK was not merely about money and resources.  Although the USA spent double what the UK did on healthcare, at least 90,000 people died each year in the US as a result of inadequate healthcare provision;

·                     the Organisation for Economic Cooperation Development (OECD) figures showed that the UK had the fastest growing mortality rate in the West;

·                     the needs of NHS patients had changed dramatically over the last 20 years.  In the past the NHS had focussed on treating infectious diseases.  However, medical advances in recent years had meant that the NHS was now focussing on delivering interventions that enabled patients to survive their illnesses and live longer.  30% of the UK population were living with the consequences of long-term conditions such as diabetes, dementia and heart diseases.  The role of the NHS had changed to helping these sufferers manage their conditions and live with them;

·                     70% of the total UK health budget was spent on the above interventions.  The NHS system was designed to intervene in cases of acute exacerbation of patients symptoms and was not designed to enable patients manage their conditions more proactively. Politicians and healthcare professionals were unwilling to face this reality and emotional attachment to the NHS made rational debate difficult.  Currently, the NHS was not fit for purpose and any proposed changes to the NHS should be based on logical arguments, and not on sentiment;

·                     £300bn was spent annually on the care eco system.  £100bn was spent by the NHS with a further £25m spent on social care and other expenditure related to social welfare.  There were several million voluntary carers in the UK, which meant that the healthcare system was heavily dependant on the goodwill of  these volunteers to function.

Professor Welbourn added that if a healthcare system were to be designed from scratch that took into consideration the current needs of the population, it would need to focus on the following:

·                     to enable the 30% with chronic conditions to live well and manage their conditions;

·                     a coherent approach to urgent care;

·                     engaging the population to look after themselves better and understand the consequences of lifestyle on health;

·                     delivery of healthcare by centres that had extensive experience in providing routine care, and highly specialist care centres for others.

The best method to achieve the above would be through engagement with the public, building trust and a non-emotional approach to the issue of healthcare provision.  He said that the NW London proposals are very logical but he expressed concern  ...  view the full minutes text for item 6c

Oral report

A Member from Hounslow stated that attendance at the first consultation session in Hounslow had been poor and few people in the borough seemed to be aware of the proposals.  She had not received any information through her post and asked when the summary booklet would be distributed, how consultation events would be advertised and how public engagement would be ensured.

Dr Spencer responded that:

·                     there had been 300 attendees at 8 roadshow events in the 8 core boroughs in North West London.  These events had been widely publicised, with the first wave taking place in July, and the second wave being planned in the form of door to door leafleting.  His team had been looking at value for money.  The summary booklet would be sent out to the 8 core and 3 neighbouring boroughs shortly;

·                     reports from the 8 focus group meetings had been circulated, with an additional 11 focus group sessions planned;

·                     with regard to hard to reach groups, an estimated 30 groups and 800 people had been contacted.

Mr Blair added that:

·                     Q&A sessions were planned to take place at 14 hospital sites;

·                     consultation via the website had received more responses than hard copy consultation documents;

·                     50 thousand leaflets had been distributed to date across the 8 core and 3 additional boroughs.

A Member from Brent asked who would be dealing with care within the community.  Dr Spencer responded that there was a single commissioning strategy across North West London and GPs were being consulted. Mr Elkeles added that the out of hospital strategy was being actively implemented in each borough.

A Member from Ealing stated that money was being spent in the community without a coherent funding strategy.  He asked how the proposals were being costed.  He added that the budget aspect of the proposals had not been consulted on. He understood that the proposals affected approximately 2 million people and the 300 attendees at the focus groups and 800 people contacted were disappointingly low figures. Mr Elkeles stated that the budget figure was in the region of £138m, which had been based on a series of business cases.  Mr Blair stated that, historically, attendance at consultation road shows were low.  He added that half a million leaflets would be distributed across the 11 boroughs, but it had been difficult to persuade the public to attend consultation events.

A Member from Ealing asked what the feedback from the community at consultation had been.  He added that, in his experience, people at the road shows had generally been against the proposals.  Mr Blair stated that his team had tried to gather evidence from potential high users of NHS services at the road shows, and in his experience, once the drivers behind the proposals were explained to the attendees, they had been in favour of the proposals.  The Chairman stated that focus groups sometimes got it wrong, and it depended on how they were led.  The Chairman requested further data from the other consultation exercises be  ...  view the full minutes text for item 7.

Oral report from Peter Molyneux and Mark Butler, consultants for JHOSC

The Committee was advised that two further evidence-gathering meetings of the Committee were planned to take place during September 2012 (on 4 and 6 September).  The Committee requested that future reports focus on answering the following questions:

·                     how the proposed changes would impact local populations and the equalities impact of these changes;

·                      

·                     what it means for a local population to shift from having an A&E to having an Urgent Care Centre;

·                     the case for concentrating care to fewer hospital sites;

·                     whether the level of clinical and community engagement was sufficient;

·                     whether local hospitals and community services would be able to cope with proposed increases in demand.

·                     The Committee also requested that witnesses from both in and outside of the NW London region from the following fields be invited to give evidence at a including those from adult social care, transport, and clinicians. This would be a combination of written and verbal evidence.

The Committee also requested that the minutes of previous Scrutiny meetings within each borough where Shaping a Healthier Future had been discussed be circulated to Committee Members and the following information be provided at a future meeting:

·                     benchmarked data from hospitals looking at excellence in provision (A&E, maternity and paediatric services), as well as viability and sustainability;

·                     risk-assessment of implementing the proposals;

·                     a summary of which hospital sites would be sold off and which would be retained and any figures relating to these.

The Committee also requested that a site visit to the Chelsea and Westminster Hospital Trust be arranged.

RESOLVED:  That the above requests be noted and incorporated into the Committee’s work programme as appropriate.