Agenda and minutes

The Chairman gave details of the arrangements in case of fire or other event requiring the evacuation of the meeting room.

Apologies were received from Councillor Fred Osborne (Councillor Frederick Thompson substituting).

Apologies were also received from Heather Mullin, NHS NELC.

Offices present:

Lorna Payne, Group Director, Adults & Health, London Borough of Havering

Conor Burke, NHS North East London and the City (NHS NELC)

Neill Moloney, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT)

Jacqui van Rossum, North East London Community Services (NELCS)

Fiona Weir, North East London NHS Foundation Trust (NELFT)

A representative of Havering Local Involvement Network (LINk) and a representative of the Press were also present.

There were no disclosures of interest.

The minutes of the meetings held on 3 October and 18 October 2012 were agreed as correct records and signed by the Chairman.

Under matters arising, health officers emphasised that the use of Foxgolve ward at King George Hospital was a temporary measure pending the completion of the outline business case for the St. Gorge’s site and for other non-acute beds for Havering residents.

The Chairman explained that, in conjunction with the Vice-Chairman and a representative of Havering LINk, work had been undertaken to ascertain the welfare of patients formerly treated at St. George’s Hospital. Whilst the care previously offered at St. George’s had been of a good standard, there was a consensus that the facilities on the site left a lot to be desired.

The Chairman and Vice-Chairman had visited both the replacement sites for St. George’s – Brentwood Community Hospital and Greys Court in Dagenham. Members had raised minor queries with health officers which had since been answered satisfactorily. A visit had also been undertaken to Foxglove ward at King George Hospital, shortly before patients moved there from Brentwood.

Future planned visits included a briefing on the JONAH discharge system used at BHRUT, the new midwife led unit at Queen’s Hospital, South Hornchurch Health Centre and a return visit to Foxglove ward. It was also planned to visit Queen’s A&E once the Rapid assessment and Treatment system was in operation.

A Havering Local Involvement Network (LINk) representative added that the LINk had formally requested that discharge meetings for patients treated in the replacement facilities be held within Havering. A health officer clarified that St. George’s had been closed due to the discovery of elevated legionella levels in the hospital’s water supply rather than any outbreak of legionnaire’s disease itself. 

The BHRUT officer explained that there had been a number of new appointments to the Trust Board including to the positions of Medical Director, Director of Nursing and Chairman.

The Queen’s Birthing Centre was now complete and would comprise eight delivery rooms and six post-natal beds. Two open days would be held in December and the unit would be open from 8 January 2013. The unit would gradually expand to a final capacity of 2,500 beds per year.

The development was part of wider commissioner-led changes to maternity arrangements in North East London. Approximately 200 women booked with BHRUT would be transferred to a Barts Health hospital closer to their home. Thirteen midwives would also be transferred to Barts Health under the TUPE regulations.

Officers confirmed that priority would be given to local women who wished to give birth at Queen’s and it was now expected that maternity at King George Hospital would close at the end of March 2013.

The junior endoscopy suite at King George was now in use and a formal opening was planned for December 2012. The Redbridge renal unit was also now open at King George and conversion work on Foxglove ward had now been completed.

The Rapid Assessment and Treatment (RAT-ing) system had now been implemented in Queen’s A&E. Improved streaming of cases had also been introduced including better use of the Urgent Care Centre and more referral of A&E attendees to their GPs. A new medical rota had also been introduced to match the seven-day demand pattern.

Staff development had been improved for nursing staff and more advanced Nurse Practitioner posts had been introduced in A&E who could see some patients independently. Four new A&E consultants had been recruited as well as a new Lead Nurse and additional junior doctors.

As regards other areas of Queen’s Hospital, new professional standards had been introduced for medical cover. There were now weekly performance management meetings as well as the planning and structuring of weekend discharges. There was also continued intensive support for patients who stayed in hospital for longer periods.

The BHRUT officer added that there was now greater clinical engagement with GPs and Social Care in order to reduce instances of inappropriate admissions and delayed discharge. Audits had been carried out with GPs in an attempt to reduce admissions although no drop in attendances had been seen as yet.

The Trust had recently undertaken a travel survey which had shown car parking to be the major complaint for both patients and staff. Work on these issues was ongoing with local representatives of the Greater London Authority and the Trust also enjoyed a good relationship with Council transport planners. The BHRUT staff travel plan would be updated in light of the results of the survey. It was clarified that oncology car park was free for patients receiving radiotherapy and chemotherapy treatment but not for follow up outpatients. This was due to the limited capacity of the car park. Surface  ...  view the full minutes text for item 38.

The Group Director explained that an assurance review would take place following the recent major incident at St. George’s Hospital and the terms of reference for this would be considered at the NHC NELC Board meeting this month. All clinical services had now been moved off the site and the CCG offices would be moving temporarily to Mercury House on 23 November.

A strategic outline business case (OBC) for the St. George’s site was being developed and engagement would take place on this with stakeholders including with Members. Officers confirmed that a total of thirty-two services, including support functions had been moved from the St. George’s site. The final two support functions would vacate the site in the next few days. Further discussions would take place around long term solutions for accommodation for clinics etc. within Havering in order to improve access issues to some services. The NELCS chief officer agreed to supply to the Committee Officer an updated list of where former St. George’s services were now located.

It was confirmed that no staff had lost anything financially due to the moves of service locations. A celebration event was also being planned to mark the end of use of the St. George’s site in its current form and it was confirmed the hospital League of Friends group would be involved with this. A total of 15 patients were moved from St. George’s to Brentwood Community Hospital, 11 of whom were later moved again to Foxglove ward at King George. Foxglove ward contained two small day room facilities which was not something that had been available at St. George’s. The move had been conducted over a two-day period and it was confirmed that no late evening transfers had taken place.

Members raised concerns over difficulties in accessing Foxgolve ward within King George Hospital. Whilst it was accepted that maps of the hospital were available, the lack of signage to and from the ward was felt to be an issue, particularly for older people, and the NELCS officer agreed to investigate this.

Commissioners did not expect to need to spot purchase any additional beds as more effective bed management and discharge procedures meant the existing number of beds was considered to be adequate. Contingencies were also available should any extra beds be needed.

Concerns were also raised by the Committee concerning access problems at Grays Court for physiotherapy patients. The NELCS officer responded that patients who required patient transport to attend St. George’s should still have this facility to enable them to get to Grays Court. The NELCS officer agreed to provide details of the number of cancellations of appointments at Grays Court and an indication of whether these were due to problems with getting to the facility. It was accepted that parking was a challenge at Grays Court and the objective was therefore to move back to a facility in Havering in due course. Updates on these plans would be given to the Committee as they developed.

It was clarified  ...  view the full minutes text for item 39.

The NELCS officer explained that the majority of services provided by the North East London NHS Foundation Trust (NELFT) were now community services across North East London and South West Essex. This allowed for a mental health input into services for areas such as stroke, heart disease and chronic obstructive pulmonary disease. Investment was also being made in mobile working such as electronic care records. The Trust and its NELCS subsidiary were also introducing more treatment solutions that could be delivered at home or in community settings.

NELCS provided a number of community services within Havering including district nursing, health visiting and smoking cessation. Service developments had included a new model of integrated case management being introduced from November 2012. This comprised of six clusters across the borough offering support to patients with long term conditions and those who were frequent attendees at hospital.

The continence service could now be offered any qualified provider which increased patient choice. A new falls service had also been launched in April 2012.  

Discussions were in progress between NELCS and BHRUT around sharing resources to provide a pilot of an alternative service to A&E. This service would be available 8 am – 8 pm seven days per week. Support was also being given to extend the service at Queen’s Hospital to facilitate weekend discharges and avoid unnecessary hospital admissions. Phase 1 of the new service – the Community Treatment Team would concentrate on support for frail elderly residents. In the longer term, it was hoped to extend both the numbers of conditions and the age range covered by the service.

Progress made by the new team would be shared with the Committee in due course. The Havering Group Director for Adults and Health emphasised that detailed plans had not yet been agreed but that she did support the principle of more integrated working. The Council was keen to combine treatment and care and supported the overall principles from a commissioning point of view. The Integrated Care Coalition also wished to see more flexible models of care delivered closer to home.

The NELCS officer confirmed that work was being undertaken with the Council’s Social Care directorate. NELCS also employed some social workers directly. The Community Treatment Team would be led medically by Dr. Rob Fowler – a geriatrician and lead on chronic obstructive pulmonary disease. The new team was anticipated to be in place by the end of December.

The Community Treatment Team could be contacted by care home staff should they have concerns over the condition of a resident. The NHS NELC representative added that better coordination of community services may be needed as well as better measurement of outcomes from GPs and district nurses.

Members asked for clarity around the patient pathway, particularly for conditions such as chronic obstructive pulmonary disease. Officers responded that most patients with this sort of condition were referred to community services via their GP. The Community Treatment Team would be able to give referred patients advice over  ...  view the full minutes text for item 40.