Agenda and minutes

In December 2006, the National Health Service (NHS) London commissioned Professor Lord Ara Darzi, an eminent figure in the field of healthcare to carry out a review of London’s healthcare.  Professor Darzi’s recommendations were published in July 2007 in a report ‘Healthcare for London: A Framework for Action’, also known as the Darzi Review.

Your Committee, having considered a report on the Darzi Review, noted that the framework for consultation from NHS London proposed a first?stage pan?London formal consultation on the models of care set out in the Review.  The consultation would be carried out through a pan?London Joint Overview and Scrutiny Committee (JOSC), which, unlike individual boroughs, would have the powers to request information relating to Healthcare for London.

Having agreed that Harrow’s participation in the pan?London JOSC was essential in light of the revolutionary changes in healthcare proposed by the Darzi Review, and having nominated Members to represent the Council in the pan?London Committee, your Committee

Resolved to RECOMMEND:  (to Council)

That Councillor Mrs Myra Michael (Adult Health and Social Care Policy Lead Member for Scrutiny) be appointed, as the Council’s representative, to serve on the pan?London Joint Overview and Scrutiny Committee and that Councillors Mrs Rekha Shah (Adult Health and Social Care Performance Lead Member for Scrutiny) and Mrs Margaret Davine (Children and Young People Policy Lead Member for Scrutiny) be appointed as 1^st and 2^nd Reserves, respectively.

(See also Minute 200).

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 the attendance at this meeting of the following duly appointed Reserve Members:-

To receive declarations of personal or prejudicial interests, arising from business to be transacted at this meeting, from:

(a)               all Members of the Committee, Sub Committee, Panel or Forum;

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

RESOLVED:  To note that the following interests were declared:

Agenda Item 10 – Brent Birthing Centre – Future Services

The following Members indicated personal interests set out below and remained in the room to participate in the discussion and decision relating to this item and ask questions on the presentation received at the meeting:-

(i)                   Councillor Anthony Seymour stated that his relative had received treatment at Northwick Park Hospital.  He too had received treatment at the Hospital.

(ii)                 Councillor B E Gate stated that he had been a patient at Northwick Park Hospital, and that his wife, who worked for a GP surgery, was employed by Harrow PCT.

(iii)                Councillor Rekha Shah stated that she had been a patient at Northwick Park Hospital, and that she worked for Brent Council.

(iv)                Councillor Stanley Sheinwald stated that he had been a patient at Northwick Park Hospital.

To consider whether any of the items listed on the agenda should be considered with the press and public excluded on the grounds that it is thought likely, in view of the nature of the business to be transacted, that there would be disclosure of confidential information in breach of an obligation of confidence or of exempt information as defined in Part 1 of Schedule 12A to the Local Government Act 1972.

The Chairman re-ordered the agenda at the meeting. For clarity, business is recorded in the order set out in the agenda.

RESOLVED:  That all items be considered with the press and public present.

That the minutes of the meeting held on 6 September 2007 be deferred until printed in the next Council Bound Minute Book.

RESOLVED:  That the minutes of the meeting held on 6 September 2007 be deferred until printed in the next Council Bound Minute Volume.

[Note:  A couple of Members enquired why the minutes had not been circulated with the agenda in order to allow their consideration at the meeting.  A Member made a number of comments, which the Democratic Services Officer undertook to take back to her Directorate].

To receive questions (if any) from local residents/organisations under the provisions of Overview and Scrutiny Procedure Rule 8.

RESOLVED:  To note that no public questions were put at the meeting under the provisions of Overview and Scrutiny Procedure Rule 8.

To receive petitions (if any) submitted by members of the public/Councillors under the provisions of Overview and Scrutiny Procedure Rule 9.

RESOLVED:  To note that no petitions were received at the meeting under the provisions of Overview and Scrutiny Procedure Rule 9.

To receive deputations (if any) under the provisions of Overview and Scrutiny Procedure Rule 10.

RESOLVED:  To note that no deputations were received at the meeting under the provisions of Overview and Scrutiny Procedure Rule 10.

(if any).

RESOLVED: To note that there were no references from Cabinet or Council.

The Committee received a report from the Director of People, Performance and Policy, which set out issues considered by the Scrutiny Policy and Performance Leads at their quarterly briefing meetings.  Members noted that the Lead Members for Adult Health and Social Care and Safer and Stronger Communities would be meeting in October 2007.

The Scrutiny Policy Lead for Children and Young People reported that the White Paper on ‘Care Matters’ would build on ‘Every Child Matters’ and introduce new statutory responsibilities for Councils in respect of Children Looked After.  Consultation on the White Paper had taken place and it was essential that this matter was included in the work programme.  It was noted that a summary of the White Paper would be circulated to Members.

The Scrutiny Performance Lead Member for Corporate Effectiveness and Finance reported that focus would be on staff morale/culture in line with the administration’s desire for change in the culture of the organisation.  Residents’ satisfaction was another priority.

It was noted that a specific meeting of the Overview and Scrutiny Committee, to consider matters relating to Sustainable Development and Enterprise, might be needed.

The Scrutiny Manager undertook to include the names of the Lead Members for Scrutiny in future reports.  The Performance Lead Member for Corporate Effectiveness and Finance stated that the profile of scrutiny and that of the Lead Members ought to be raised through Harrow People so that the residents of Harrow were aware of the work being carried out by them.

RESOLVED:  That the report from the Policy and Performance Lead Members for Scrutiny and their recommendations be noted.

Paper submitted by the Chief Executive of the North West London Hospitals NHS Trust

[There will be a presentation on this item].

The Chairman welcomed Fiona Wise, Chief Executive for the North West London Hospitals NHS Trust, Sarah Thompson, Interim Director of Strategic Commissioning at Brent PCT and Angie Woods, Commissioner for Women, Children and CAMHS (Children and Adolescent Mental Health Services) at Harrow PCT to the meeting.

The Chief Executive for the North West London Hospitals Trust gave a presentation on the proposed changes to the Brent Birthing Centre at Central Middlesex Hospital in Park Royal and outlined the benefits.  She stated that the Overview and Scrutiny Committee’s initial views on the proposals would be welcomed. Formal consultation would follow.

Following the presentation, Members asked questions on the following areas:-

·                    timing of the proposals and the length of the consultation period;

·                    which organisations and user groups would be consulted on the proposals and the need to consult widely.  Publicity was essential, particularly in GP surgeries;

·                    benefits of the proposals to Harrow residents and their impact on the residents of Brent;

·                    costs associated with the proposals;

·                    availability of adequate staffing resources.  It was noted that the levels of staff employed at Birthing Centres was governed by safety legislation rather than the number of users;

·                    use of Birthing Centres that had been re-located;

·                    value for money.

A Member was disappointed that a business case had not been made available and commented that an analysis on the impact of the proposals would have assisted Members. It was suggested that the capacity of Northwick Park Hospital to accommodate the additional maternity numbers, particularly in the light of the poor performance of maternity services at the hospital should be investigated as part of the work programme of Performance and Finance Sub-Committee. The Chairman of the Performance and Finance Scrutiny Sub?Committee agreed to discuss these matters further with the Vice?Chairman with a view to their inclusion in the work programme.  It was noted that the matters raised by the Member fell under the remit of the Sub?Committee.

Fiona Wise stated that the deficit of running the current service at a loss was not shared across all NHS Trusts but was the responsibility of the North West London Hospitals Trust alone.  She added that she operated an organisation that was transparent and policies were in place for staff to bring issues to her attention. The Trust’s preferred option was Option 4, which was to transfer inpatient (delivery) maternity care to a new dedicated midwifery led unit within Northwick Park Hospital’s Maternity Unit and to keep antenatal services at Central Middlesex Hospital but not in the Brent Birthing Centre.  This would offer choice to users whilst ensuring immediate access to obstetric care should the need arise.  Members noted that the Brent PCT had, in principle, supported Option 4.  Some Members also expressed support for Option 4.

Fiona Wise agreed to provide historical information requested by some Members.

The Chairman thanked Fiona Wise, Sarah Thompson and Angie Wood for the presentation and responses to questions from Members.

RESOLVED:  That (1) the presentation be received and noted;

(2)  ...  view the full minutes text for item 198.

Report of the Director of People, Performance and Policy

The Committee received a report of the Director of People, Performance and Policy, which set out details of activity undertaken by the Standing Scrutiny Review of NHS Finances and the Carers’ Case Study.  Members’ attention was drawn to the recommendations set out on page 29 of the agenda.

The Chairman thanked the Chief Executive for North West London Hospitals NHS Trust for participating in this item.  The Chief Executive commented that the nature of care that people could expect from hospitals was set to evolve, for example, chronic illnesses were likely to be managed more within the community settings, and this would also impact on carers.  This could only be done over a period of time. In response to questions from Members, she acknowledged that relationships between the Councils and the Hospitals in Brent and Harrow needed improving and that tensions were due to the financially challenging positions faced by all.  She was meeting Harrow Council’s Chief Executive to discuss such matters and how best to serve local residents.  Members welcomed this approach.

In welcoming the report, Members commented as follows:-

·                    greater co-ordination/joint appointments between all agencies listed under recommendations 1 and 3 on page 29 of the agenda would help save money, avoid bureaucracy and result in a better outcomes for carers;

·                    the anticipated length of time (1-2 years) for measuring success of some of the recommendations ought to be shortened;

·                    the contribution made by carers, many of whom were children, was immense and valuable.  Respite care was therefore essential, and it was important to provide the best possible service in an efficient way with the support of Partners.

The Scrutiny Manager stated that a final report from the Standing Review would be submitted to the Committee.  She explained that the report would clarify the roles and responsibilities of the Council and the PCT in the context of the statutory obligations and limitations of each agency.

RESOLVED:  That (1) the progress made by the Review be noted;

(2)  the interim report on the Carers Case Study be approved, subject to the comments made in the preamble above;

(3)  the interim report on the Carers Case Study form an appendix to the eventual full report of the Standing Scrutiny Review of NHS Finances;

(4)  the Scrutiny Officer be commended for the report.

Report of the Director of People, Performance and Policy

Further to Recommendation I, Members discussed various aspects of the report of the Director of People, Performance and Policy in this regard.  They noted that only the pan?London Joint Overview and Scrutiny Committee (JOSC) had the statutory powers to request information relating to Healthcare for London.  Individual boroughs would not be able to do this and, moreover,  NHS London was under no duty to respond to any comments submitted by individual Overview and Scrutiny Committees.  JOSC would be able to invite expert witnesses to provide evidence on the Darzi Review.

Having discussed the advantages and disadvantages of participation in a JOSC, Members commented as follows:-

·                    Members of the Overview and Scrutiny Committee should engage in the Review and keep the Council’s Executive briefed on this matter;

·                    relevant Portfolio Holder(s), the Leader and Deputy Leader of the Council, together with the relevant Corporate Director(s), be invited to the 13 November 2007 meeting of the Overview and Scrutiny Committee to participate in the discussion on the Darzi Review;

·                    a working group be set up to familiarise itself with the Darzi Review. This would help ensure an informed debate at the 13 November 2007 meeting of the Committee;

·                    the provision of more healthcare at home, as stated in the Review, required further discussion.

RESOLVED:  That (1) the summary of ‘Healthcare for London:  A Framework for Action’ be noted;

(2)  the merits of Harrow participating in a Pan?London JOSC to consider the models of care and consultation process (first-stage consultation) be noted;

(3)  Harrow participate in the first-stage JOSC;

(4)  participation in the second-stage JOSC(s) on area specific proposals (geographical and clinical areas) be given consideration;

(5)  the Portfolio Holder for Adult Services and the Interim Corporate Director, Adults and Housing be invited to the 13 November 2007 meeting of the Committee to participate in the discussion on the Darzi Review;

(6)  a working group on the Darzi Review be set up to include Councillors Mrs Myra Michael, Mrs Rekha Shah, Mrs Margaret Davine, Barry Macleod-Cullinane and Dinesh Solanki;

(7)  the working group meet before the 13 November 2007 meeting of the Committee.

Report of the Director of People, Performance and Policy

The Scrutiny Manager introduced the report on the potential scope for the Standing Scrutiny Review of the Budget.

A Member commented that the membership of the Review Group needed finalising and pointed out that it currently included Assistant - Support Member(s) to Portfolio Holder(s) who could not participate in the Review.

Another Member was of the view that the Review Group needed to meet soon and that a fixed membership was unnecessary.  Those Members eligible to participate in the Review ought to be allowed to join the Group at any time during the process.  Further discussion could take place if open membership became an issue.  However, it was important that the scope was agreed and a meeting of the Review Group arranged. 

Following further discussion on the membership, it was agreed that an informal reserve membership would be appropriate and that each of the political groups should submit names.  The Scrutiny Manager advised that the Liberal Democrat Group had not decided whether to participate in the review but that they did not wish to be considered for chairing the review.

RESOLVED:  That (1) the initial scope for the Standing Scrutiny Review of the Budget be noted;

(2)  the scope be developed further by Members of the Review Group;

(3)  the final version of the scope be submitted to a future meeting of the Overview and Scrutiny Committee;

(4)  Councillor Stanley Sheinwald, having been nominated and duly seconded, be appointed as Chairman of the Review Group and that Councillor Anthony Seymour be included as a Member of the Review Group.

Report of the Director of People, Performance and Policy

The Scrutiny Manager introduced the report, which set out the protocol for relationships between Scrutiny and the Executive titled ‘Delivering Effective Scrutiny – A Framework of Responsibilities’.  She reported that the purpose of the protocol was to clarify relationships and responsibilities and to maximise Scrutiny’s contribution to service improvement.  The quarterly meetings between the Members and the Chief Executive, as suggested in the protocol, would support this.

The Chairman and other Members asked for aspects of the protocol to be strengthened, which would make it incumbent on Portfolio Holders to attend Scrutiny meetings and ensure that serious consideration was given by the Executive to recommendations from Scrutiny. 

Members highlighted the importance of maintaining a positive relationship between the Executive and Scrutiny and were confident that the proposed training would help ensure the continued development of a positive relationship.  They were of the view that where a Portfolio Holder was unable to attend a Scrutiny meeting, the Assistant (Support Member) would be welcomed.

Members noted that the Portfolio Holder Role Descriptions included a requirement to attend Scrutiny Committees, when requested.  It was essential that the Portfolio Holder provided reasons for non-attendance.  Flexibility was essential.

A Member mentioned that the Council’s Constitution Working Group might want to consider the inclusion of the protocol in the Council’s Constitution.

RESOLVED:  That (1) the Scrutiny/Executive protocol, attached as an appendix to the report, be agreed subject to the changes requested above being approved by the Chairman and Vice?Chairman of the Overview and Scrutiny Committee;

(2)  the revised protocol be submitted to the Cabinet for endorsement;

(3)  the revised protocol be submitted to the Council’s Corporate Strategy Board for information.

In accordance with the provisions of Overview and Scrutiny Procedure Rule 6.7(ii)(b), it was

RESOLVED:  (1)  At 10.00 pm to continue until 10.20 pm;

(2)  at 10.20 pm to continue until 10.30 pm.