Agenda and minutes

Councillor Rekha Shah welcomed members to the London Borough of Harrow.

Apologies for absence were received from Councillor David Harvey (Westminster), Dr Sheila D’Souza (Westminster), Councillor Will Pascal (Kensington & Chelsea), Councillor Theresa Mullins (Ealing), Councillor Myra Savin (Hounslow).

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 Joint Committee;

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

Agenda Item 6 – Shaping a Healthier Future Update

Councillor Mel Collins declared a non-pecuniary interest in that he was involved with the Willesden Centre for Health and Care.

That the minutes of the meeting held on 16 June 2015 be taken as read and signed as a correct record.

The Assistant Director of Communications, CCG commented that the minutes from the meeting held on 16 June 2015 had indicated that a wide ranging consultation would be taking place with communities, patients and local authorities on the development of Charing Cross and Ealing Hospitals into Local Hospitals.  He commented that this had not been stated at the meeting.

The Committee were advised that the business case for the proposal was required to go through internal governance processes before a workshop event was conducted with partners, stakeholders etc.

The Committee believed that the minutes were a correct record but the clarification provided was noted.

RESOLVED:  That the minutes of the previous meeting of the Committee held on 16 June 2015 be taken as read and signed as a correct record.

A presentation was conducted for the Committee by representatives from the London Ambulance Service NHS Trust (LAS).  They made a number of points as follows:

·                     London had been divided into 7 sections for the operation of the LAS;

·                     The LAS had undergone a service transformation which had included a management restructure.  A new Chief Executive of the service had also been appointed;

·                     A new set of purposes and values had been adopted by the LAS to modernise the Trust;

·                     Demand for the LAS increased year on year. In 2014/15 over 1.7 million requests were received;

·                     The operating budget for the LAS was £316 million;

·                     The LAS had about 5,000 staff. Approximately 71% of these staff operated on frontline services;

·                     There were 70 Ambulance stations across London;

·                     Retention of staff had been a big challenge for the LAS.  Opportunities for paramedics outside the NHS had increased dramatically;

·                     The LAS were focusing on national and international recruitment drives;

·                     The contract for the LAS included 9 Commissioning for Quality and Innovation schemes (CQUIN).  These were a contractual requirement for NHS providers and offered financial incentives to the innovative development of services;

·                     The LAS produced a suite of reports as a requirement of the commissioning contract;

·                     The LAS and the NHS faced a number of financial challenges.  The LAS income was dependent of demand and performance.  Money was being spent on private ambulances and overtime payments but the LAS were striving for value for money;

·                     There were three major challenges for the LAS which related to staffing, demand and culture;

·                     There was an increased emphasis from the LAS to make it a better place to work.  This involved the launch of a LAS academy, filling all front line vacancies, creating 500 band six senior paramedics and continuing with VIP awards;

·                     The LAS were not achieving the 75% target response rate.  However reports and reviews undertaken had demonstrated that a safe service was being provided;

·                     A detailed improvement programme had been developed.  Some of the actions identified were the reduction of absences from front line staff relating to sickness and reducing the out of service hours relating to people and vehicles;

·                     In relation to front line recruitment of staff, processes had been redesigned to include revised training and supervision to allow staff to work on the front line as safely and quickly as possible.  University places had increased and a media campaign had been launched;

·                     There was closer work being undertaken with Emergency Department leads to improve Hospital handover processes;

·                     There was greater work being done on standardising referral pathways.

Councillor Filson queried what was being done regarding vehicle utilisation which was currently at 85%.  This provided very little flexibility for the LAS.  Councillor Filson also asked whether vehicle serving and maintenance facilities could be shared with the Fire Services. Councillor Filson also asked whether filling vacancies only up to 95% created extra stress for staff.  Additionally was the level of training being proposed from October 2016 realistic given that proportionally it was small.

The  ...  view the full minutes text for item 5.

The Committee were advised that there were separate papers for different topics relating to these items.

Paper 1 – Out of Hospital Update

The Medical Director – Shaping a Healthier Future Programme introduced the report and explained that there was a great deal of hospital activity taking place and a number of common themes across the 8 boroughs.  This included the following:

·                         Extended GP opening hours would be been introduced;

·                         There was visible progress toward hubs;

·                         Far less difference between out of hospital and in hospital care;

·                         Rapid access to service change on assessments;

·                         Lots of partnership working with other organisations like the London Ambulance Service;

·                         There was a great amount of work being conducted in moving to a co-ordinated service in and out of hospital.

The Chair – Harrow CCG reported to the Committee that there had been a lot of work taking place on supported living to help promote independent lives.

Councillor Filson stated that the Scrutiny Committee at Brent Council had recently conducted a review into extended GP hours and it was hoped that the recommendations made would be adopted by the relevant CCGs.

Councillor Filson also raised an issue where a community organisation (Brent Bereavement Service) had its rent increased on a property owned by the NHS despite it providing a service to which the NHS signposted residents to.  This organisation received no financial assistance yet provided a valuable service to residents.  It was queried why this was allowed to happen and whether the CCG had an input into these issues.

It was responded that the CCG did not own estates.  However the issue raised would be investigated.

Councillor Mithani queried how the 2 walk in centres in Harrow had helped to ease the pressure on the Accident and Emergency Department at Northwick Park Hospital.

It was responded that there had been a change in the attendance at Accident and Emergency as a result of the 2 walk in clinics.   It was also being proposed that a walk in clinic be established on the east side of Harrow.  It was hoped that this would be operational from 2016 although the exact site was still to be determined.

Councillor Vaughan queried how availability for the out of hours GP service was being communicated and whether the services provided would be consistent across the 8 boroughs.  Councillor Vaughan also queried when the business case for the implementation of out of hospital care would be made available

In relation to the extended opening for GP practices, there was a real issue to determine whether the same model should be used across North West London.  It was important to assess the patterns that were faced and the size of each facility.

It was also responded that not all out of hospital would be exactly the same.  These could be different depending on the building used.  Services that could have been offered locally in a hospital can now be offered closer to patients’ homes.

Councillor Collins queried whether the proposals for  ...  view the full minutes text for item 6.

Verbal Report.

The Committee were advised that there had been indications at the last meeting that it consider a more specific item in relation to mental health.  The Committee had previously made a commitment to focusing on the ‘Shaping a Healthier Future Initiative’ so any consideration would be made with this context in mind.

Members of the Committee felt that at this point it would be better focusing  on the ‘Shaping a Healthier Future’ item.

RESOLVED:  That the Committee does not consider an item on mental health at this stage.

Verbal Report.

The Committee were advised that a report of the Healthcare Commission had not yet been published.  It was expected that the report would be published towards the end of November 2015 and a briefing session for the Committee would be arranged as soon as possible after that.

RESOLVED:  That the item be noted.

The Chair advised that at the next meeting of the Committee there would be consideration of a new Chair and Vice Chair.  It was also agreed that the next Committee meeting should be arranged after the Implementation Business Case had been published in January / February 2016.