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 Board;

(b)               all other Members present.

RESOLVED:  To note that the following interests were declared:

Agenda Item 7.  CQC Inspection Report on NWLH and Action Plan; 8. Update on Pressures at Northwick Park Hospital A&E; 9. Director of Public Health’s Annual Report; 10. Draft Council Budget; 11. Better Care Fund.

Councillor Simon Brown declared a non-pecuniary interest in that his daughter was employed by the CNWL NHS Foundation Trust.  He would remain in the room whilst the matter was considered and voted upon.

Councillor Janet Mote declared a non-pecuniary interest in that her daughter was employed as a nurse at Northwick Park Hospital.  She would remain in the room whilst the matter was considered and voted upon.

Agenda Item 10.  Draft Council Budget

Councillor Anne Whitehead declared a non-pecuniary interest in that she was Chair of the Law Centre which was in receipt of a grant from Harrow Council.  She would remain in the room whilst the matter was considered and voted upon.

That the minutes of the meeting held on 6 November 2014 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 6 November 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 5 January 2015.  Questions should be sent to publicquestions@harrow.gov.uk  

No person may submit more than one question].

RESOLVED:  To note that no public questions, deputations or petitions had been received.

Report of the Chief Nurse, London North West Healthcare NHS Trust.

The Board received an update on the achievement of the CQC Compliance Improvement Plan and progress on the implementation of the Trust Quality Improvement Plan.

It was reported that the majority of key actions from the Compliance Plan had been completed or were on track for delivery.  The three main areas of work to be progressed in 2015 were: the provision of additional beds as part of the remodelling in order to increase capacity particularly for winter pressures, the reconfiguration of Jack’s Place regarding visibility and the Shaping a Healthier Future budget.

In response to questions from Board Members, representatives of the North West Healthcare London NHS Trusty reported that:

·                     the redesign of paediatrics as part of the Shaping a Healthier Future initiative was taking place and options for the provision of an increase in beds for children from A&E were under consideration;

·                     a team to deal specifically with recruitment had been formed and a number of initiatives were taking place including revision of bank rates  and staff being encouraged to work additional hours for the Trust instead of an agency, with such additional hours being monitored.   Rates for bank staff were the same as for permanent staff, the same uniform was worn and they were considered to be part of the workforce;

·                     bank services were being merged to encourage staff to work at other sites if a shift was not available at their usual workplace.  Work with neighbouring trusts aimed to prevent salary inflation, such as doctors in A&E;

·                     ongoing international recruitment was taking place in Scotland and London, and attendance at university recruitment events was undertaken several times a year;

·                     the Healthwatch representative welcomed the proposal for a  presentation to the organisation by the Trust on the action plan;

·                     a Member suggested that an investigation take place regarding the number of patients who missed their appointments and therefore wasted the time of doctors etc;

·                     with regard to monitoring and assurance, a CQC Compliance Lead had been appointed to oversee the action plan. Monthly reports would be submitted to the division committees, management teams, and the sub-Trust committees.  Reports would be submitted to the Trust Development Authority (TDA) and Commissioners (CCG);

·                     the aim was that the detailed work and plans would be available thus ensuring that the public were aware that the Trust was working to improve the patient experience.

The Chair suggested the submission of a report back to the Board in 6 months which would allow for a lead in time to obtain results and bed in improvements.  The work being undertaken needed to provide the public with a sense of vision to enable them to be proud of their local hospital, whereas in recent years the public reaction to Northwick Park Hospital had been negative, for example mothers choosing to give birth at other hospitals.  The appointment of a new Trust Chief Executive provided an opportunity to move forward and she proposed that arrangements be made for the Board to meet the new  ...  view the full minutes text for item 47.

Report of the Chief Nurse, London North West Healthcare NHS Trust.

The Divisional General Manager for Emergency and Specialist Medicine for the London North West Healthcare (NWLH) NHS Trust provided an update on the Trust’s emergency pathway and the action being undertaken to address the current under performance of the core A&E performance targets.  The officer stated that it had been unfortunate that the move to the new A&E department had had to take place during a period when the Trust had been struggling to deal with the high demand.

The Board were advised that the three main factors that had affected A&E performance were ambulance conveyances, bed capacity and workforce and that the following initiatives were taking place:

·                     Northwick Park Hospital was receiving approximately 100 ambulances a day, of which about 20 were blue light emergencies.  It was estimated that the merger of A&E departments would result in an additional 20 ambulances per day.  The implementation of Intelligent Conveyancing enabled ambulances to be diverted to hospitals with capacity;

·                     with regard to bed capacity, it had recently been agreed to go out to tender for an additional 63 bedded modular unit that was likely to be in operation around December 2015.  It had been calculated that in excess of 100 additional beds were required and there were some local plans to increase the bed space whenever possible;

·                     all A&E staff from Central Middlesex Hospital had been consolidated onto the Northwick Park Hospital site.  A reduction in the number of locums and agency staff was being sought by increasing bank staff.  A restructured rota aimed to ensure that capacity was available during the peak A&E demand of 7.00 pm to midnight.

The Board expressed appreciation for the hard work by staff during the Christmas period and recognised the pressure they were working under.

In response to questions, the Board was advised that:

·                     the number of acute cases had increased by 20% and the public were encouraged to use alternative services as appropriate, for example ringing 111, GPs, pharmacies, and urgent care centres;

·                     it was important to ensure that patients were guided appropriately through triage and then divided into either walk-in major attendances or bed based attendances.  If the bed base became compromised, it was important to maintain the walk-in flow to continue to treat patients who could often be cared for within the 4 hour period.  An internal hospital task force was examining patient flows to make improvements in this regard;

·                     the introduction of side rooms had successfully changed the dynamics with regard to patients disturbing others and moving between cubicles. The introduction of a dedicated mental health room and separate drop off for ambulances had been successfully implemented and after the health care had been addressed the patient was moved to dedicated mental health lounges;

·                     the officer undertook to ascertain whether a doctor other than the allocated doctor could sign discharge papers and therefore reduce delays.

A CCG representative referred to the significant investment in the STARS service to support patients outside of hospital.  Work  ...  view the full minutes text for item 48.

Report of the Director of Public Health.

The Director of Public Health presented his Annual Report for 2014.  The report gave a timeline for each of the topics and the Board noted that the issues arising would be taken forward in the Joint Health and Wellbeing Strategy.

With regard to the strategy for a healthy life expectancy, it was noted that there had been some success through the Healthy Schools Award for which most schools had registered.  The London Health Commission report included recommendations on food labelling and that no fast food be sold within a certain distance from schools.  The Chair undertook to discuss with the planning officers the possibility of implementing planning controls to restrict the number of fast food outlets in an area.

RESOLVED:  That the report be noted.

Report of the Interim Head of Paid Service.

The Interim Head of Paid Service introduced the report which detailed Harrow Council’s Draft Revenue Budget 2015/16 and MTFS 2015/16 to 2018/19, as reported to the Council’s Cabinet on 11 December 2014.  It was noted that the budget would return to the Council’s Cabinet in February 2015 for final approval and recommendation to Council.

The Board was informed of the large amount of feedback received in response to the Take Part consultation campaign which had been undertaken with regard to the need to address the budget gap for 2015-19 of £75m.

It was noted that £32m of savings would take place primarily in Year 1, 70?80% would not affect front line services. 

RESOLVED:  That the report be noted.

Report of the Interim Head of Paid Service and Chief Officer BHH CCG

The Board agreed to the Harrow Better Care Fund plan being tabled at the meeting for discussion, given the deadline for a joint submission between the Council and CCG being 9 January 2015.

Following an adjournment to enable discussion between the parties on the Plan detail, the Interim Head of Paid Service reported that substantial progress had been made, resulting in a total planned revenue investment of £14,373m across the Health and Social Care Economy.  In addition to approving the documentation and allocation the Board was informed of the following:

1.                  subsequent to the agreement of the Better Care Fund bid by the Board in January, the CCG had a lot of work to do to reach a balanced budget and the Council had produced a draft budget.  A review process was agreed to ensure that the further protection of social care could be considered as part of the allocation of any health care resource available to the economy;

2.                  financial support for the emergency winter pressures for 2015/16 and the enhanced discharge scheme were not funded within the Better Care Fund and further conversations would be necessary as part of the overall planning and joint discussions;

3.                  the original 2015/16 Council draft budget allocation of £6.5m towards the protection of social care (including funding for the Care Act) for the Better Care Fund had been scaled back in the circulated Plan.  The Council would assume in its planning for 2016/17 that £6.5m would be the minimum transfer under the BCF and this would be the starting point for discussion in future financial years.

The Accountable Officer, Harrow Clinical Commissioning Group, indicated support for the continual review of the Better Care Fund and that winter pressures would be the subject of separate discussions on how best to use the available resources.  Whilst agreeable to the Council making the £6.5m the starting point for future year, the CCG could not make such a commitment given the need to manage uncertainty.

The Leader of Harrow Council stated that it was an excellent piece of work, resulting from continued partnership working to produce something that was acceptable to all parties.

RESOLVED:  That the Harrow Better Care Fund Plan, as circulated at the meeting, be agreed and submitted to NHS England.

Which the Chairman has decided is urgent and cannot otherwise be dealt with.

The Vice-Chair advised that an item would be submitted to the next Board meeting on the proposal that Harrow CCG collaborate with 7 other CCGs for commissioning primary care.  The information was considered to be urgent as the CCG had to register an interest in participating by 9 January 2016.

RESOLVED:  That the information be noted.