Agenda and minutes

Details of the arrangements in case of fire or other events that might require the meeting room or building’s evacuation will be announced.

The Chairman advised all present of the action to be taken in the event of fire or other emergency requiring evacuation of the building.

(if any) – receive.

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

Councillor Steven Kelly was also present.

Officers present:

Lorna Payne, Group Director – Adults and Health, LBH

Neill Moloney, Director of Planning and Performance, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT)

Jackie Doyle, BHRUT

Heather Mullin, NHS North East London and the City (NHS NELC)

Stephanie Dawe, Chief Operating Officer, North East London NHS Foundation Trust (NELFT)

Havering Local Involvement Network (LINk) members present:

Emma Lexton, Vice-Chair

Susan Fey

Joan Smith, Coordinator

Members are invited to disclose any interests in any of the items on the agenda at this point of the meeting. Members may still disclose an interest in an item at any time prior to the consideration of the matter.

There were no disclosures of interest.

To receive the minutes of the meetings held on 4 July 2012 and 6 September 2012 (attached).

In the minutes of the 4 July 2012 meeting, it was noted that the reference to “The Mayor” in item 1 should in fact read “The Chairman”. The minutes were otherwise agreed as a correct record and signed by the Chairman.

The minutes of the meeting held on 6 September 2012 were also agreed as a correct record and signed by the Chairman.

To receive an update from the Chairman on recent health scrutiny developments and meetings attended.

The Chairman advised the Committee that she had held a lot of discussions with the Clinical Commission Group and Heather Mullin regarding the future of NHS services in Havering and plans for St. George’s Hospital. She had also recently attended a Havering LINK event with local pharmacists which had been very productive and wished to take a presentation from a local pharmacist at a future meeting.

It was hoped to visit the new beds at King George Hospital that would take over from those at St. George’s. An invitation had also been received to see the JONAH discharge system in operation at Queen’s Hospital. It was also planned to meet with the new director of midwifery at the hospital.

Update on the work and future plans of the Health and Wellbeing Board.

The Chairman of the Health and Wellbeing Board (Cllr. Kelly) explained that the Board’s overall aim was to ensure an across the borough approach to both health and social care. The Board membership numbered twelve people including four Councillors, the Group Director for Social Services and the Director of Public Health. A representative of the Local Healthwatch for Havering would also join in April. This representative would be appointed by Local Healthwatch themselves and not by the Council. The Clinical Commissioning Group (CCG) was also represented.

No Government funding had been received to set up the Health and Wellbeing Board and other funding had been used to run 19 projects. These covered areas such as the number of rehab beds, falls, telecare, strokes and COPD. Each project was run jointly between the Council and health partners.

The Board also wished to have GP surgeries open, on a rota basis, on Saturdays and Sundays. The CCG would check that savings generated by the projects were reinvested into the brought. Another role of the Health and Wellbeding Board would be to agree the final budget of the CCG although this would be undertaken in partnership with the CCG itself.

The Health and Wellbeing Board also produced the Joint Strategic Needs Assessment and it was hoped to produce local health statistics as this would allow effective pre-emption of health problems in Havering. It was hoped this would reduce both numbers of people going into hospital and rates of readmission.

There were seven priorities for the Health and Wellbeing Board:

1. Early help for vulnerable people to live independently. The Board felt that more work on long-term conditions of the elderly could reduce their need to attend or be admitted to hospital. The development of telehealth would reduce hospital admission and the Board also wished to tackle the isolation of elderly people.

There would be more community based and provision of reablement. Fifteen more beds were opening in Royal Jubilee Court. There would also be a move to allow more initial reablement to take place in people’s homes.

2. Dementia identification and support – It was agreed that this was a growing problem in Havering and the Board wished to change attitudes and ensure that dementia was seen as an acceptable illness. An aim was to reduce the number of people on anti-depressants as this may increase dementia. The Health and Wellbeing Board could direct strategy on this. Better recognition of dementia was also needed by professionals to reduce instances of e.g. urinary tract infections being mistaken for dementia. The Board had also agreed to adapt some allotments units to be used by people with dementia.

3. Early detection of cancer – Early cancer detection rates in Havering were very low. If diagnosed barky, survival rates were good but there was a need to have doctors recognise the symptoms. The cancer department at Queen’s was good but the Board felt the screening programme needed to be better.

4. Tackling obesity – A priority was to increase  ...  view the full minutes text for item 21.

To receive an update on developments at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) from a senior Trust officer.

A number of new appointments had been made to the BHRUT management team. This included a new Director of Nursing – Flo Pannell-Coates who had started with the Trust that week. A number of new clinical directors had also been recruited.

Targets had been met by BHRUT for cancer waiting times and infection control. Complaint response times had also improved. Other achievements included receiving good or excellent ratings in recent PEAT inspections and lobbying for extra bus links to Queen’s Hospital. Further work was underway on areas including the emergency care pathway, ensuring a better patient experience, staff culture, attitudes and behaviour.

The Trust was undertaking a large programme of staff engagement and had recently joined UCL partners with the aim of strengthening areas such as training and innovation. Several Clinical Fellows had also recently been recruited to BHRUT as had a new Director of Infection Control.

All but eight of the recommendations made in the Care Quality Commission (CQC) had now been met or partly met by the Trust. A follow up inspection was held in September 2012 and all conditions imposed by the CQC on BHRUT’s registration had now been lifted. As regards cancer services, 99.5% of patients were seen within two weeks with even many of the remaining 0.5% being offered appointments within this period but being unable to attend. The hospital mortality ratio at the Trust had improved to 94 against a London benchmark of 100.

The Trust had the best midwife to births ratio in London and also offered a high level of senior doctor cover in maternity. Building on the Queen’s birth centre was due to be completed in October 2012 and the unit would comprise eight delivery rooms and four post-natal beds. Figures for numbers of births at BHRUT in the coming years were as follows:

2011-12 10,300 births across Queen’s and King George

2012-13 9,200 births at Queen’s, 1,900 at King George

2013-14 8,000 births at Queen’s obstetrics and midwife-led unit only (this would include approximately 500 births from the Essex area).

Having mothers would normally be allowed to have their deliveries at Queen’s. Births that were expected to be more straightforward would be handled at the Midwife-Led Unit but this would still be on site at Queen’s.

There were now four new emergency consultants at Queen’s and the Deanery had also agreed the provision of additional junior doctor cover in A&E. The RESET programme was looking at discharge issue and the provision of additional capacity at Queen’s A&E and Critical Care Unit.

The Trust had recorded a £49 million deficit last year and planned to improve this by £10 million this year. A £40 million deficit control target had been agreed for 2012-13. Patient activity had shown a shift between elective and day cases and the BHRUT officer agreed to separate out activity figures for Queen’s Hospital alone.

Approximately £15 million had been invested in the last year in facilities such as the Midwife-Led Unit at Queen’s and the  ...  view the full minutes text for item 22.

Discussion with the project director on latest developments concerning hospital reconfiguration and integrated care in North East London.

The NHS NELC officer thanked the Committee Chairman, Cabinet portfolio holder and Group Director for their assistance with the options appraisal process in relation to St. George’s Hospital. It was emphasised that there was no immediate problem with the hospital boiler and heating for the building would continue. There were however breaches of health and safety rules that would be addressed.

The officer felt that St. George’s was not suitable as a rehab facility due to a lack of toilets, showers, laundry facilities and space on the wards. Immediate action needed to be taken due to the service being isolated and vulnerable. The provider board (NELFT) therefore had to decide if it could continue to run services safely from the site and had concluded that it could not. The changes were considered to be temporary and so could be implemented without public consultation. Four options for the relocation of rehab beds had been considered and Foxgolve ward at King George had been assessed as the best temporary option for the frail elderly beds at St. George’s.

All other facilities would be staying on the St. George’s site for the present and 24:7 security and boiler cover had been brought in. In the longer term, future plans for care were being considered as part of the Health and Wellbeing Strategy. Options for the longer term future of services would be brought both to the Committee and the Health and Wellbeing Board.

The ten stroke beds at St. George’s would be replaced by seven beds at Greys Court in Dagenham – a centre of excellence for stroke services. This would allow NELFT to invest more in temporary community services. What services would be based at St. George’s in the future was currently being considered. A new GP surgery was one possibility.

The Chief Operating Officer at NELFT added that an unannounced enter and view visit by Havering LINk had found the standard of care at St. George’s to be of high quality. This would continue at King George and where it was likely many of the same would continue to deliver the service. Staff had been briefed on the location change and it was accepted that some staff may not wish to move to King George. Any surplus travel expenses incurred by NELFT would be covered by NELFT.

There were current 35 frail/elderly beds and 10 stroke beds at Saint George’s and these would be replaced by 30 frail/elderly beds at King George and 7 stroke beds at Greys Court. It was felt that greater flexibility in how the service was provided would mean these lower bed numbers would be sufficient.

As regards the longer term plans for St. George’s, a business case was scheduled to be completed by the end of November 2012. This would detail which services would remain on site and include as outline time line for the changes. It was emphasised that NHS NELC was committed to keeping a health presence on the St.  ...  view the full minutes text for item 23.

To consider developments at the Havering Clinical Commissioning Group (CCG).

The NHS officer explained that people were at the centre of the new healthcare system. The Havering Clinical Commissioning Group (CCG) was working under an interim operating model from 1 October. Lay members of the CCG were currently being recruited as was a nursing representative.

A dummy run for the CCG authorisation process would take place on 24 October with final authorisation in mid-December. The formal decision on CCG authorisation would be received in early 2013. The process would include challenging the CCG on areas in which it appeared to be non-compliant.

The transfer of public health functions to the council was underway and Alwen Williams, chief executive of NHS NELC was leading on the process of closing down the cluster Primary Care Trust on 31 March 2013. Attempts were being made to treat staff sensitively but this was a very large reorganisation.

The suggestion from a Member that a simple guide to the NHS be put in the spring issue of Living magazine would be taken forward by the NHS bodies.

The Committee noted the update.

Representatives of Havering Local Involvement Network (LINk) will give a brief presentation on the organisation’s annual report.

The LINK coordinator introduced the report and gave apologies from the LINK Chairman – Med Buck. The LINk had worked productively during the year with the Committee itself, NHS Havering, the Council’s adult social care section and other providers.

An enter and view visit (undertaken, like all such LINk visits by fully trained staff) had been carried out at Queen’s maternity. The LINk representatives had received a good overall impression of the unit although staff morale had been found to be low.

At the request of the Committee Chairman, the LINK had also visited Sunrise ward at Queen’s Hospital and had found that the red tray system to denote people needing assistance at meal times was not working properly. The LINk had therefore made a number of recommendations to ensure the red tray system was working properly and also covering areas such as the prompt removal of dirty crockery and increasing the number of healthcare assistants.

A follow up visit in April 2012 found that the red tray system was now working better. A meal manager had been appointed and dirty crockery was now removed as a priority. The number of healthcare assistants had doubled and an administrator was now employed on the ward.

Two topic group meetings had been held in conjunction with the Committee looking at the issue of patient discharge from hospital. The report produced by the LINk had been discussed at senior levels during meetings between the Council’s Adult Social Care section and BHRUT. The LINk’s report had also led to improved working between Social Care and NELFT.

During the year the LINK had also arranged for improvement to the ‘quiet room’ at Queen’s Hospital with the installation of e.g. non-denominational pictures. A Care Quality Commission compliance inspector had also recentky praised the work of the LINk.

The LINk looked forward to the forthcoming introduction of Healthwatch and thanks were also recorded to the Council’s Principal Committee Officer for his support of the LINk’s work.

The Committee noted the annual report of Havering LINk.

The Committee is invited to review the list of themes arising from the Ageing Well event (attached) and consider any items that could be added to the Committee’s work programme.

It was agreed that a meeting of Overview and Scrutiny Committee Chairmen and Vice-Chairmen be held in the new year to consider the work in this area that had been undertaken and what further issues concerning the ageing population could be scrutinised. One suggestion was for the relevant committee to consider the impact of housing and associated issues on older people.

To consider any other item of which the Chairman is of the opinion, by means of special circumstances which shall be specified in the minutes, that the item shall be considered at the meeting as a matter of urgency.

There was no urgent business.