Agenda and minutes

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

There were no disclosures of interest.

To agree as a correct record the minutes of the meetings held on 23 January 2014 (joint meeting re Council budget) and 6 February 2014 and to authorise the Chairman to sign them (attached).

The minutes of the meetings held on 23 January 2014 (joint meeting re Council budget) and 6 February 2014 were agreed as a correct record and signed by the Chairman.

To receive an update on issues facing the Trust from Stephen Burgess, Medical Director, BHRUT.

The BHRUT medical director explained that a wide ranging Care Quality Commission (CQC) inspection of both Queens and King George Hospitals had taken place in October 2013. The CQC report, received in December 2013, had recognised some improvements in e.g. nursing care. Issues concerning the emergency pathway and reconfiguration etc had however led to the Trust being put in special measures. The Medical Director accepted that more needed to be done concerning A&E, outpatients and Trust governance etc.

A capability review of the Trust had been undertaken, the report from which would be submitted to the National Trust Development Authority (NTDA). An Improvement Director had been appointed who had worked in a special measures Trust in South London, as had the new Director of Finance. A Buddy Trust – a well performing Trust of similar size to BHRUT, was also due to be announced.

The Medical Director emphasised that work was underway with staff and partners to move the Trust forward. A reinspection by the CQC was expected in the next 18 months. The NTDA would also expect to see progress over this period.

The Trust improvement plan was due to be submitted to the NTDA within the next week and an overview document could also be produced. As regards workforce issues, it was accepted that there were major staffing problems in A&E as well as in acute medicine and gastroenterology. This applied to both consultants and middle grade staff. Some recruitment problems were due to perceptions of the Trust and local area being poor.

The Medical Director felt that the entire emergency system was a problem including the wards and discharge procedures. He felt however that the major issues related to patient flows and finance. The maternity department had however improved significantly.

There remained a number of issues regarding transferring patients and notes and the Trust was seeking to institute a better system of governance. It was accepted that there had also been a lot of complaints about outpatient appointments and waiting times although these were issues in many hospitals. The Trust executive team wished to be more visible but there was often not enough time for this.

The Trust improvement plan was expected to be finalised by the end of March and would be published on the BHRUT and NHS Choices websites.

There were now some text reminders of outpatient appointments but the Trust needed to do more of this. There had been some problems with the installation at the Trust of the new Medway computer system. There was also a working group looking at outpatient issues.

It was not expected that the Trust would receive any further resources for this work other than perhaps a small amount of transition money. The Trust overspend was predicted to be £38 million for the next year. Five per cent efficiency savings were also required which would be in the region of £20 million.

It was confirmed that the Trust improvement plan would contain a section on health records.  ...  view the full minutes text for item 46.

The Chairman confirmed that a letter had been sent on behalf of the Outer North East London Joint Health Overview and Scrutiny Committee giving the Committee’s support for the planned move by Moorfields Eye Hospital to a new location.

Members had recently undertaken a useful site visit to Harold Wood walk-in centre. The Chief Operating Officer for Havering Clinical Commissioning Group (CCG) explained that the current contract for the centre, running until April 2016, was held by NHS England. The CCG would however be looking to manage the services it had responsibility for from April 2015.

Members were pleased that a number of issues previously raised by the Committee had been rectified by the walk-in centre provider – Hurley Group. The car park at the centre was due to be repaired following damage caused by the breast cancer screening wagon. The Chairman was also pleased that more of the building was now being used for clinical purposes. It was however disappointing that the scanning machine in the building was not being used. The CCG Chief Operating Officer agreed to investigate this.

The patient discharge topic group had recently met and considerable improvements had been made to discharge processes. There was however still some confusion over medication and gaps seen in some communications. Duplication of medicine for care homes remained a problem as well as delays in receiving medication from the hospital. The Chairman felt that patients could be sent home with prescriptions, given that many pharmacies were now open longer hours. It was confirmed that discharge issues were covered in the BHRUT improvement plan. The Committee recommended that scrutiny of discharge issues should continue in the new Council term.

The Joint Committee had also recently written to the Commissioning Support Unit giving its views on the cancer and cardiac proposals. The Committee broadly supported the proposals although felt it was essential that scrutiny should continue as the plans were implemented.

The Chairman expressed a wish that the CCG would continue to keep the Committee updated on developments.

Work on scrutinising children’s health issues had been in progress and the Committee recommended that this should continue in the new Council term.

To receive an update from senior NELFT officers on plans for services in Havering.

The Integrated Care Director at North East London NHS Foundation Trust explained that, following the closure of the child development centre at St George’s Hospital, services for children with complex needs were currently being provided from 13 different locations. The London Road site was originally planned to be used for corporate services but, following the closure of St George’s, had to be used as clinical space.

Other child development centres had been visited in order to inform the design of the London Road site. Stakeholder engagement sessions were planned for March and April and meetings had been held with the Council Lead Member and local groups such as ADD Up. Work would start on the building in May and it was planned to open for clients in December 2014.

Children’s services were also being redesigned. Complex disability and mental health services would be integrated and co-located in London Road. It was emphasised however that there were no plans to close the mental health services currently provided at Raphael House in Romford. Neuro-developmental pathways and services for conditions such as ADHD would also be brought together at the London Road site.

The London Road building would have 950 square metres of space but services would continue to be provided from Harold Wood Health Centre and NELFT would also look for a third location within Havering. The changes proposed would provide a more effective and efficient pathway for children. NELFT officers were happy to bring further updates to the Committee and for Members to visit the London Road site.

While the NELFT Director could not say that all the needs of the ADD Up support group had been met, it was felt that London Road was the best location at the time. NELFT were keen to involve stakeholders in the design aspects of the building.

It was confirmed that NELFT were seeing an increasing number of children with mental health needs. The current overall service caseload was approximately 5,300 children and this had gone up by 4-5% over the last two years.

The Committee noted the update and that the children’s health topic group had recently visited Raphael House.   

To receive a presentation from the Chief Operating Officer, Havering CCG on future strategic plans of the CCG.

The CCG Chief Operating Officer explained that the plans of the CCG over the next 2-5 years were driven by the Joint Strategic Needs Assessment  which formed the basis for commissioning decisions. Havering had an older population, many of whom had multiple long-term conditions. Ninety per cent of patients with the most complex health problems accounted for 40% of emergency admissions.

There was poor satisfaction with services including access to primary care. There were also lifestyle problems in Havering such as alcohol, smoking and lack of physical activity. Dealing with the most complex problems would make the whole healthcare system function better.

The CCG felt that improving urgent care was not just about BHRUT but that the rest of the health economy should contribute to this. Improving the urgent care pathway was therefore a priority of the CCG over the next year. The CCG was looking to undertake a reprocurement of some of the key services within the urgent care pathway including NHS 111, GP Out of Hours and Urgent Care Centres. The aim was to encourage providers to innovate and work in a more integrated way. The aim was for services to start in 2015/16.

Use of the weekend GP opening service had increased but had still only reached 50-60% of capacity thus far. Open access to weekend GPs could be operated on a trial basis rather than having referrals solely via the NHS 111 service.

As regards integrated care, the CCG wished to expand the number of conditions covered by the integrated case management system to include dementia and end of life care. More integrated health teams would allow integrated care at a local level. A collect and settle scheme was also being developed for people discharged home from hospital.

The CCG wished to see more care delivered closer to home and to have more outpatient appointments take place locally rather than in a hospital setting. More muscular-skeletal, urology and diabetes outpatient appointments would be delivered in the community from July 2014.

In primary care, the CCG was supporting GPs coming together to share services such as stitch removal within a GP cluster. Havering and Barking & Dagenham GP practices had submitted a bid to the Prime Minister’s Challenge Fund for further investment in local primary care services. A Primary Care Improvement Director had also been appointed to the CCG.

The Committee recommended that further details of the integrated care work should be brought to a future meeting of the Committee.

The Better Care Fund submission and the CCG operating plan could be shared with the Committee. The operating plan would also be available on the CCG website. The CCG was also working with other CCGs, Councils and providers to submit a five-year strategic plan by the start of June 2014.

Members requested more details on the issues considered by the Urgent Care Board and the Chief Operating Officer responded that a summary of the Board’s decisions may be produced. It was noted that the CCG governing body held  ...  view the full minutes text for item 49.

To note that the following Cabinet decision is due for a review of progress under the Council Continuous Improvement Model and to decide whether to take an update at the Committee’s next meeting:

Public Health Transition to Havering Council.

The Committee agreed that an update on the transition of public health into the Council should be taken at the next meeting of the Committee, since this issue was now due for review under the Council Continuous Improvement Model.

Minutes of meeting of Health and Wellbeing Board attached for noting.

There were no comments on the minutes of the meeting of the Health and Wellbeing Board held on 8 January 2014.

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

The Committee considered the response by the North East London Public Pharmacy Partnership to the NHS England Community Pharmacy Call to Action. While the were no specific comments on the document at this stage, it was felt that people should make more use of pharmacies which could prescribe as well as offer medication reviews and health prevention advice. The proposed sale of pharmacies run by the Co-Operative organisation was a potential cause for concern.

As this was the Committee’s final meeting of the Council term, the Chairman thanked her fellow Members and also the representative from Healthwatch Havering with which the Committee had built a good relationship. The Chairman also thanked the health officers present and the clerk to the Committee for their assistance.