Agenda and minutes

To note the attendance at this meeting of any duly appointed Reserve Members.

RESOLVED:  To note the attendance at this meeting of the following duly appointed Reserve Member: -

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from all Members present.

RESOLVED:  To note that there were no declarations of interests made by Members.

That the minutes of the meeting held on 29 July 2024 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 29 July 2024, be taken as read and signed as a correct record.

RESOLVED:  To appoint Marie Pate as a non-voting adviser to the Health and Social Care Scrutiny Sub-Committee for the 2024/2025 Municipal Year.

To note any public questions received.

Questions will be asked in the order in which they were received.  There will be a time limit of 15 minutes for the asking and answering of public questions.

[The deadline for receipt of public questions is 3.00 pm, 5 December 2024.  Questions should be sent to publicquestions@harrow.gov.uk  

No person may submit more than one question].

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

To receive any references from Council and/or other Committees or Panels.

RESOLVED:  To note that no references were received.

Report from the Head of Partnerships and Engagement, NHS England.

The Head of Partnership and Engagement NHS England (East of England) provided a comprehensive overview of the proposed changes to the Mount Vernon Cancer Centre.

The 2019 Review was initiated due to clinicians' concerns about service sustainability at Mount Vernon Cancer Centre.

The aim of the review was to provide a modern cancer centre offering specialist treatments, access to the latest trials, and improved patient care for populations across Harrow, Hertfordshire, Bedfordshire, and Northwest London.

The Key findings of the review were set out for Members, and it was noted that:

·                 The centre lacked the co-located services required for modern cancer care, such as critical care.

·                 Emergency patient transfers to other hospitals were seen to disrupt treatment and restrict admission options for at-risk patients.

·                 Services were required to be modernised to provide cutting-edge cancer care, clinical trials and specialist treatments going forwards.

As a result of the review, there were a number of key proposals recommended and these were as follows:

·                 The main centre should be relocated to Watford General Hospital, an acute hospital with better access to critical services.

·                 Additional chemotherapy services were proposed at Northwick Park Hospital as this was closer to home.

·                 University College London Hospitals (UCLH) were identified as the preferred provider to manage the centre; however, the consultation would focus on patient care and relocation, not UCLH's formal takeover.

The Officer then went onto provide Members with an update on the current challenges and it was noted that:

·                 Progress was slowed by the COVID-19 Pandemic and a failed bid for capital funding through the New Hospitals Programme.

·                 Despite no confirmed capital funding, NHS England plans to consult on the proposals in the first half of next year due to the current site becoming untenable.

·                 The need for relocation is urgent due to the current site’s limitations, which have made operations increasingly untenable.

Hertfordshire County Council, which has the largest patient cohort, led the development of a Joint Scrutiny Committee involving ten local authorities, including Harrow.

A site visit to Mount Vernon was conducted for scrutiny chairs, nominated members, and officers to review the proposals and draft terms of reference.

The Joint Scrutiny Committee was formally approved following a unanimous vote by Hertfordshire County Council.

The committee's first meeting was scheduled for December 16, 2024.

The impact for Harrow was then set out in detail as follows:

·                 Harrow’s population relies significantly on Mount Vernon Cancer Centre services.

·                 Proposals aim to address gaps in care and improve outcomes for patients in the borough.

Members asked whether sufficient transport options had been considered for Harrow residents who lack access to a car, particularly compared to the current availability of affordable public transport, such as the H11 bus route to Mount Vernon.  The Head of Partnership advised that a transport and access group had been set up to address these concerns.  Initial work included gathering patient transport data, conducting surveys, and consulting stakeholders to understand accessibility challenges.  They acknowledged the gaps in public transport options to Watford and confirmed  ...  view the full minutes text for item 74.

Presentation by the Strategic Director for Adults and Public Health.

The Strategic Director of Adult Social Care and Public Health provided an overview of the recent Care Quality Commission (CQC) inspection of Harrow’s adult social care services.

Harrow was among the first local authorities to be inspected under the new framework.

The inspection resulted in a "Requires Improvement" rating.  It was noted that a slight improvement in one subcategory could have elevated the rating to "Good."

While the inspection report highlighted many examples of good practice in Harrow, it also identified several significant areas for development.

The current adult social care strategy had expired.  A new strategy was being developed to address the findings from the CQC report.

The strategy would be co-produced with residents and brought forward for approval next year.

In the meantime, several improvement actions were already underway, focusing on the key priorities outlined in the CQC report:

Safeguarding: 

Work was ongoing to establish a multi-agency safeguarding hub for adults, modelled on the approach used in children's safeguarding, to enhance collaboration between social care and partner agencies.

Carers’ Support: 

A review of Harrow’s carers’ offer is underway, addressing one of the key areas for improvement identified in the report.  The council was working closely with the Carers’ Centre and other stakeholders to implement changes swiftly.

The Director also emphasised that the ultimate goal was to improve the experience and outcomes for residents who rely on adult social care services.

Members asked the following questions in relation to presentation and the report attached to the agenda.

Consistency and Communication in Service Delivery:

Members asked why some residents experienced quick resolutions while others faced delays in accessing services.  They queried what was being done to ensure a more consistent approach in service delivery, particularly in terms of response times.  The Strategic Director advised that processes were being standardised across teams.

Members queried how the council intended to improve communication with residents regarding waiting times and manage their expectations.  The Strategic Director responded that the teams were working to improve communication.

Prioritisation and Waiting Times:

Members queried how the triaging process for urgent and non-urgent cases worked, and how the council ensured that less urgent cases did not face excessively long delays.  The Strategic Director explained that it was important that cases were assessed for risk and allocated accordingly.

Members asked what steps were being taken to reduce the backlog and ensure timely delivery of essential equipment and assessments.  The Strategic Director advised that temporary staff had also been hired to provide immediate support while long-term solutions were developed.

Tangible Improvements and Timelines:

Members asked what improvements residents could expect to see and how the council would ensure progress was visible.  The Strategic Director explained that some aspects of the improvement plan would result in practical changes within six months whilst other things would take longer.  Quarterly performance updates are presented to committee.

Addressing Capacity and Resource Constraints:

Members raised concerns about the growing demand for services and queried whether the council had sufficient capacity within teams to meet residents'  ...  view the full minutes text for item 75.

Presentation by the Planned Care Associate Director, North West London Intergrated Care Board.

This item was deferred till the next meeting.

Presentation from the Borough Director, Harrow. NW London Integrated Care Board.

The Borough Director, Harrow, North West London Integrated Care Board presented a high-level summary of the report on GP access across the eight North West London boroughs, with a particular focus on Harrow, which are served by 31 GP practices and five primary care networks (PCNs).  The report provided an overview of the response rates, early findings, and next steps from the engagement process.

Engagement Programme:

The Northwest London Integrated Care Board (ICB) launched an engagement programme on GP access on 14 October 2024.

The aim was to collect feedback from staff and patients to inform local and system-wide improvements.

Engagement included:

·                 Patient and staff surveys.

·                 PCN-led events (online and in-person).

·                 Community outreach initiatives.

Findings from Engagement and Surveys:

Initial findings indicated:

·                 General satisfaction with GP access.

·                 Demand for more training on using the NHS app for tasks such as accessing medical records, booking appointments, and viewing test results.

·                 Mixed satisfaction with online platforms, with some patients requesting training for better usability.

·                 Challenges with capacity, with some practices receiving over 200 online consultation requests per day.

Areas for improvement were identified, including callback systems, increased staffing, and enhanced online booking options.

Improvement Initiatives:

As a follow-up, PCNs were asked to submit detailed improvement plans, including baseline data and targets for a 10% uplift in activity.

The ICB emphasised the need for plans to demonstrate value for money and address broader system pressures, such as those in urgent care and emergency departments.

Next Steps:

1.              Findings from the surveys and engagement events will be compiled into a final report.

2.              A final findings eventis scheduled for 25 January 2025, where outcomes and recommendations will be shared.

3.              The ICB aims to develop a sustainable, resilient general practice model that incorporates digitalisation, preventive care, and community-based services.

Members raised several queries and concerns regarding the survey report on GP access and its findings.

Members expressed doubts about the survey's representation of residents' experiences.  Members noted significant disparities between the report's findings and feedback from residents, particularly on issues like accessing GP appointments and lengthy call wait times.  Members questioned how the survey process could be improved to capture more accurate and comprehensive feedback.  The Borough Director clarified that over 12,000 individual responses were received for the survey and the initial findings reported are directly attributed to the responses received.  The response rate  is considered positive, with some PCNs achieving above a 5% response rate. However, efforts to improve the participation rate, particularly in areas with lower engagement, were being encouraged.

Members raised concerns about the "system limitations" referenced in the report, specifically around advanced booking appointments.  Members sought clarification on whether these limitations pertained to technology or clinician availability. The Borough Director confirmed the limitations primarily related to clinician availability rather than digital systems.  Efforts to address these challenges included improving triage systems and increasing staffing on high-demand days, such as Mondays.

Members raised concerns about inconsistencies in appointment booking processes across surgeries.  Members highlighted reports of patients  ...  view the full minutes text for item 77.