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 out of hospital services had factored in that it was anticipated that approximately 50,000 new homes were being proposed to be built across the boroughs. Councillor Collins also queried whether relevant section 106 monies earmarked for health services were being utilised by the CCG.
It was responded that proposed increase in population had been taken into account when developing the out of hospital care proposals. Work had taken place with the Greater London Authority (GLA) project future population estimates and this would be kept up to date. This work did not pre-empt the proposed closure of 2 Accident and Emergency departments within North West London as the work conducted was based on a number of different scenarios. It was important to also understand the impact of the increase in population to determine the correct size of the hospital.
In relation to the section 106 monies the amounts were relatively small. However staffs in the estates department were currently investigating this and were looking to use the funds available.
Paper 2 – NHS 111 / GP Out of Hours Integrated Services
The Accountable Officer – BHH Federation introduced the paper and reported that the 111 service was provided by Care UK and LCW. The contract for the provision of this service in London was due to expire in 2016 and a process had been commenced with the intention of identifying a future provider. These services were subject to a national procurement process by the Department of Health. Communication about the services for 111 needed to be better and it was anticipated that a new provider would be identified by the beginning of 2016.
A vision for urgent care was also being developed based on better understanding of local needs and demands.
Paper 3 – Implementation Business Case Briefing
The Accountable Officer, CWHHE Collaborative introduced the report and explained that within it contained the current status, timescales, overview of the approvals process and the outline and full business case in primary care settings.
It was reported that the paper also highlighted the success criteria that would be utilised. It was also highlighted that there were huge financial challenges and so value for money was a key component. Inflation of the construction industry was also influencing the costs involved.
There would be consultation and workshops on the Implementation Business Case to which the Committee would be invited.
Paper 4 – Maternity Update
It was reported that the Ealing CCG Governing Body had agreed to endorse the transition of the Maternity and Neonatal service at Ealing Hospital with effect from 1 July 2015. At the time 969 women were booked to give birth at Ealing Hospital. Out of these 15 women were not able to be offered their first alternative choice of unit.
All staff had been transitioned to their new units. Extra staff were being recruited. Additionally the issue of travelling to Maternity Services would be reviewed in a formal way to understand how women have found their patient experience on this subject.
The report also contained information on the Quality and System Monitoring Dashboard. This only provided the first month of data following transition and so there were a few gaps. This was being monitored on a regular basis to identify if there were any adverse impacts.
Unbooked deliveries, especially at Hillingdon Hospital, had increased. There had also been an increase in post partum haemorrhages although this increase was due to a change in its definition.
Paper 5 – Paediatrics Update
The Medical Director – Shaping a Healthier Future Programme introduced the report and advised that the changes centered on more consultant cover over the entire week. The benefit of this would be reflected in outcomes such as lower mortality rates and an increase in patient satisfaction.
Paper 6 – Benefits Tracker
The Accountable Officer – CWHHE Collaborative introduced the paper and reported that the North West London Transformation and Benefits Tracker had been created to track improvements across health and care. This would help to promote greater transparency.
The Tracker would be presented on a single page and pick up key measures. The Tracker would then be supplemented with a further series of dashboards to provide a comprehensive and detailed view on transformation and benefits realisation.
Paper 7 – Accident and Emergency (A & E) Data
The Accountable Officer – BHH Federation introduced the report and explained that this represented the performance of A & E departments over the last 12 months. This described the actions being taken to improve performance where appropriate.
North West London was the only sector in London to have achieved the national standard for 3 consecutive months. The report provided information on type 1 performance which was a local measure which described the setting of care.
North West London had more urgent care facilities (10 across 8 CCG catchment areas). Less acute patients were seen and treated in urgent care centres. This meant that the denominator was lower leading to lower type 1 performance. However it was acknowledged performance was not at a standard which was desired.
Members then asked various questions on papers 2 to 7.
Councillor Filson questioned a gap on the Transformation and Benefits Tracker in that it did not identify issues at Northwick Park Hospital in terms of it’s A & E performance. More information was also required on what the interpretation of the figures referred to.
It was responded that the national standards dictated that 95% of patients attending A & E would be seen within 4 hours. Performance at Northwick Park Hospital was not where it was hoped it would be. More beds were expected to be installed at Northwick Park Hospital to provide greater capacity to help to address this issue.
Councillor Vaughan asked in relation to the implementation of the Business Case whether early sign off was expected in early 2016 and whether it would be after this that this could be viewed. Councillor Vaughan also commented that there was work required in educating and signposting the public on how to use the NHS in the correct manner. It was also commented that there needed to be a better reflection of the issues facing A & E Departments within the reports presented.
It was acknowledged that greater work was required in educating the public on using the NHS effectively. This would involve greater work between the NHS and their partners to promote this.
It was also acknowledged that there were issues facing the NHS but clinically the best formats for A & E departments were still being devised. It was important to offer a range of clinical services as close to home as possible.
Councillor Collins queried whether the information provided meant that there would be no further closures of A & E Departments. It was responded that consideration would be given to what services were offered from A & E Departments locally before forming an opinion on future provision.
Councillor Filson expressed concern that the basic principle of A & E departments was being diluted by proposals to offer only certain services. He believed that they should offer specialities in all relevant medical areas.
It was responded that a different model of care was required and for those cases which did not require acute care, these could be dealt with at different centres. There would be special consideration given to those who were frail and elderly.
The Chair thanked all of the representatives in attendance.
RESOLVED: That the report be noted.