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 Committee;

(b)               all other Members present.

RESOLVED:  To note that the following interest was declared:

Agenda Item 10 – Information Report: Harrow Carer Champion Project

Councillor Margaret Davine declared a personal interest in that she was a member of the Champion Carer Group.  She would remain in the room whilst the matter was considered and voted upon.

That the minutes of the meeting held on 19 March 2014 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 19 March 2014, be taken as read and signed as a correct record.

To receive any public questions received in accordance with Board Procedure Rule 14.

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, Monday 28 April 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 were put, or petitions or deputations received.

Report of the Director of Public Health.

The Board received a report which set out the main findings from a situational report on tuberculosis in Harrow conducted by the Public Health team.  An officer introduced the report, stating that the recommendations were based on findings from the report, relevant recommendations from NICE guidance and other national policy, and interviews with key stakeholders.

The officer drew attention to the following:

·                    the London TB Control Board had an objective to achieve a 50% reduction in TB rates by 2018;

·                    a draft business case had recently been submitted for informal comment to the CCG by the NWLH NHS Trust highlighting the impact of staffing issues on the control of TB.  Northwick Park Hospital currently had less than the recommended number of TB nurses.  This business case was discussed at a Harrow CCG seminar and comments fed back to NWLHT on 3 December 2014.  To date NWLHT has not resubmitted a revised business case to Harrow and wider CCGs;

·                    the PHAST report found that most GPs across London had limited experience of treating TB;

·                    more consistent screening was required;

·                    the report contained recommendations for the Local Authority, CCG, and NHS England in working with primary care services and other agencies.

The Vice-Chairman informed the Board that TB screening took place at NWL chest clinics and the process for the GP to request screening was complex.  The draft business case mentioned above had been received informally by the CCG but what was required was a seamless process with a multi-disciplinary approach.  This would require a review of the whole issue of TB including prevention and neonatal care and discussion with NWL public health.  He informed the Board that TB drugs were not dispensed by GPs but by specialists, the default rate was high and resistance to the drugs could be built up.

Additional analysis was requested from NWLHT as the draft business case targeted all treated patients at NWLHT, not just Harrow registered.  The draft business case requested that Harrow CCG commissions the total service which is outside of Harrow CCGs commissioning responsibility.

Members of the Board commented that:

·                    it was important to ensure that GPs were trained in early warning of TB, especially for hard to reach groups, in order to arrange screening should there be any suspicion of TB.  Awareness of symptoms should be extended beyond primary care;

·                    the recommendations for the CCG were more applicable to its role as commissioners rather than providers.  The Council was in agreement with the thrust of the report and the Council role identified therein.  The Community Health and Wellbeing department was well placed to ensure housing involvement as indicated;

·                    NHSE would take the opportunity regarding awareness training for GPs and ensure inclusion of  mental health and drug and alcohol needs;

·                    a CCG clinical representative considered the report to be very useful and timely with a depth of information of use to the key provider.  GPs in Harrow were aware of TB as a living disease in the borough;

·                    the NHSE representative undertook to  ...  view the full minutes text for item 76.

Report of the GP Network Lead, Harrow Clinical Commissioning Group.

A report was received that informed the Board with regard to progress in the drafting of a business case to develop a third Primary Care Centre, or hub, in Harrow.  A CCG officer introduced the report, stating that the CCG had been supported by the NWL Transformation Team in the review of current premises capacity and condition to support Shaping a Healthier Future (SaHF) in bringing services out of hospital and close to home.

The Board was informed that phase 1 of the evaluation aimed to advise on:

·                    whether a new primary care centre or ‘hub’ was necessary to deliver Harrow’s ambitious out of hospital programme and SaHF;

·                    which area of Harrow should be prioritised for development;

·                    which sites should be taken forward to the next stage.

It was noted that, of the available options, those that scored most highly in the evaluation by a non-conflicted Estates Panel were a redevelopment of the Belmont Health Centre and a new development on the Kenmore site, the latter being land currently owned by the NHS.  Both sites were being considered as two separate options and were going forward for outline business case with the PID having been submitted to NHSE for comment.

In response to a question with regard to ensuring an affordable rent, the Board was informed that value for money detail had not yet been evaluated as it had yet to be decided whether to demolish, refurbish or make better use of existing premises.  It was envisaged that additional CCG services beyond GP practices would be provided by the hub with some of the funding being for services currently provided in hospital.  A Council officer reported that one of the recent steps in collaboration with the CCG and other partners was to ascertain opportunities in respect to co-locating where it was of benefit to the public and to the estate.

The CCG officer stated that Council input would be welcomed and undertook to liaise with Council departments.  The process would include a review of Alexandra Avenue Health Centre which was currently underused.

The NHSE representative reported that prioritisation of potential business cases for the redevelopment of hubs, together with a review of ongoing problems with existing arrangements, was being undertaken in its capacity as the key funder of GP premises. This included determination on whether proposals represented value for money and would result in some difficult decisions having to be made given the limited budget.

The Vice-Chairman reported that the new development at Northwick Park Hospital had cost £50 million whereas a new hub would cost in the region of £3-4 million.  There was a commitment that services would not be moved out of hospitals until suitable premises were available in the community.  The Alexander Avenue hub, Belmont Health Centre and the Kenmore site did not have adequate public transport connections.  Whilst there was an aspiration for provision in east Harrow, there was also a need to address the lack of provision in central Harrow.  Phase  ...  view the full minutes text for item 77.

Report of the ICP Operations Director, Harrow Clinical Commissioning Group.

The Board received a review of progress on the Integrated Care Programme in 2013/14 together with the priorities and anticipated outcomes for 2014/15, supporting the Whole Systems agenda and the Better Care Fund.

Members of the Board were informed that the Harrow ICP had become the strong platform for health and social care integration and the foundation on which to move forward to whole system integration in 2014/15.  The aim was to set up multidisciplinary groups starting in Harrow, and then in other boroughs, which would provide the foundations to take on care planning, case conferences and ongoing ‘year of care’ provision to the most vulnerable. 100% of the population of GP practices in Harrow had signed up to the ICP from its commencement.  A bespoke patient scheme showed that patients considered that they could discuss the process and speak to GPs.  A key element had been the opportunity to plan new and innovative schemes to reduce unnecessary hospital admissions such as new ways of working in a nursing home and liaison with Age Concern in returning to the community.

It was noted that whole scheme integration aimed to bring health and care together around enablement and innovative projects for which a new model had been produced with the aim of responding to changing patient needs, incorporating ongoing reviews and encouraging monthly multi-disciplinary practice discussions and feedback.

Care plans would be reviewed at key points throughout the year in response to ‘trigger events’.  The new role of the Health and Social Care Navigator will ensure that patient care was co-ordinated and actions were followed up.  In response to a question, it was noted that the involvement of carers, with the consent of the patient, was critical in discussion of the care plan.

RESOLVED:  That the report be noted.

Report of the Director of Legal and Governance.

The Board received a report produced by the Carers’ Champions, a group of carers who had signed up to be part of the Champions Project which aimed to improve awareness of carers’ experiences and the support available.

The Chairman invited Councillor Victoria Silver to present the report to the Board on behalf of the Carer Champions.  Councillor Silver drew the Board’s attention to the following areas of the report:

·                    she urged the Board to consider the inclusion of carers in decision making.  The Board was informed that there were examples of carers who were unable to leave the home for days on end, did not have access to the internet and could not get to services.  She expressed the wish for further capacity in relation to support for carers;

·                    she suggested the creation of a carer charter with carer rights, a study of the treatment of carers during visits to Council premises, a reward scheme for carers, further availability of short breaks, enhanced networks and opportunities for carers to be listened to;

·                    Councillor Silver stated that the report was not an academic document containing expert evidence but was stories from carers giving details of their personal experiences.

The Chairman endorsed the report introduction that carers were one of the most valuable assets within the community, making a vital contribution and undertaking a difficult job in difficult circumstances.  She drew the Board’s attention to the following areas of the report:

·                    the report did not acknowledge the work undertaken by the Council and its partners in support of carers.  An example was the request for the introduction of short respite breaks for carers, provision of which was currently available.  The report mentioned that many carers were not claiming carers allowances, an allowance paid by the DWP to which the Council would help provide the contact details;

·                    the financial information contained in the report was incorrect and there were factual errors;

·                    she acknowledged that carers from BAME groups often experienced isolation.  Whilst it was not possible to provide assistance to all carers, assistance should be available for those who wanted it;

·                    the report was based on the views of a small sample of carers;

·                    she undertook to circulate a list of the provision made for carers;

·                    she sought clarification from Councillor Silver as to whether or not she had any commercial or business interest in the report and its recommendations and findings.

The Portfolio Holder for Health and Wellbeing stated that the role of carers was recognised by the Board and questions from carers had been responded to at previous meetings.  Membership of the Board included Councillor Davine, who was a carer champion, and representatives from Healthwatch and the voluntary and community sector.  Other members present had a responsibility for older people or medical circumstances.

Councillor Davine reported that her involvement in the report process and listening to carers revealed that whilst the service of the Carer Lead was appreciated, if all carers in Harrow registered for the service there would  ...  view the full minutes text for item 79.