Agenda and minutes

The Chairman gave details of the action to be taken in the event of fire or other emergency requiring the evacuation of the meeting room.

Apologies were received from Councillors Tariq Saeed, Barking and Dagenham, Hugh Cleaver, Redbridge, Filly Maravala, Redbridge and Sheree Rackham, Waltham Forest.

Apologies were also received from Mike New, Healthwatch Redbridge (Lorraine Silver substituting).

Other Healthwatch Members present:

Ian Buckmaster, Havering

Jaime Walsh, Waltham Forest

Scrutiny officers present:

Glen Oldfield, Barking & Dagenham

Anthony Clements, Havering (clerk to the Committee)

Jilly Szymanski, Redbridge

Corinna Young, Waltham Forest

Farhana Zia, Waltham Forest

Health Officers present:

Wendy Matthews, BHRUT

Imogen Shillito, BHRUT

Wendy Matthews, Barts Health

Mark Graver, Barts Health

Neil Kennnett-Brown, NELCSU

Ilse Mogensen, NELCSU

Dr Richard Burack

Jacqui Niner, Partnership of East London Cooperatives

Three London Borough of Barking & Dagenham officers and one member of the public were also present.

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 point prior to the consideration of the matter.

There were no disclosures of interests.

To agree the minutes of the meeting held on 9 April 2013 (attached).

The minutes of the meeting held on 9 April 2013 were agreed as a correct record and signed by the Chairman.

To receive an update from Barking, Havering and Redbridge University Hospitals NHS Trust and from Barts Health NHS Trust on maternity services in Outer North East London.

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

Officers explained that there had been a lot of commissioner led changes to maternity services including the transfer of some births from BHRUT to Newham and Whipps Cross hospitals. A fortnightly teleconference was held to look at birth numbers across the five local hospitals.

Deliveries at King George Hospital had closed in March 2013 but scans, ante-natal clinics etc still took place there. The Queen’s birthing centre had opened on 8 January 2013 and there had been a total of 375 births at the facility to date. Of these, 65% had been water births and natural methods of pain relief were used at the centre.

Numbers of mothers using the birthing centre at Queen’s Hospital were increasing in line with the planned trajectory. It was hoped to increase the proportion of Queen’s Hospital births taking place at the birthing centre to 15% and then 20%.

Numbers of birth bookings were continually reviewed and busy times were planned ahead for at each hospital. Officers felt there was still capacity in the system for future growth in birth numbers. An unannounced Care Quality Commission (CQC) visit in December 2012 had given a good report on Queen’s maternity and the unit had also been audited in May 2013 by the Local Supervisory Authority.

Numbers of complaints concerning BHRUT maternity had decreased from 118 to 1 in the last two years and there had also been a rise in compliments received. There was a total of 98 hours per week of consultant presence on the labour ward covering the period 8 am to 12 pm, 7 days per week. The Trust wished to increase this to full 24:7 consultant cover. Maternity nurses and a matron had recently won BHRUT wards and the maternity domestic violence and bereavement teams had won national awards.

Feedback on maternity services was received from PALS and from the Maternity Services Liaison Committee. The Directors of Nursing and Midwifery also regularly walked the wards. All women who delivered were given a survey to complete prior to discharge. There was still some negative feedback recorded on women being left alone and not giving wards the ‘very clean’ rating. From 1 July, all maternity users would be asked for their views at 36 weeks pregnant, before discharge and once they were back home in the community. The questions in the survey were based on the CQC national survey although it was possible these could be revised once the results of the latest CQC inspection had been published. It was the case that several results in the survey had plateaued but results remained above the national average.

All women were given a choice of where to have their baby and asked for first, second and third choices of venue when booking their births. Any instances where preferences could not be met would be discussed with individual mothers. Any mothers making serious complaints would be visited personally by the Director of Midwifery.

BHRUT was funded  ...  view the full minutes text for item 5.

To scrutinise with Health Service officers the operation of the NHS 111 telephone service since its introduction in Outer North East London.

The NHS 111 telephone line had taken over from the former NHS Direct service and this was provided in Outer North East London by the Partnership of East London Cooperatives (PELC). All advisers working on NHS 111 were fully trained having undergone six weeks training. The training was very robust and staff were backed up by experienced clinicians.

The NHS 111 service had gone live on 5 February 2013 and, in the view of officers, had performed well with few problems, even over the Easter bank holiday weekend. Daily situation reports were produced by the provider ad there was a target to achieve a call back by a clinician, where required, within 10 minutes of the original call to NHS 111. The proportion of calls resulting in a transfer to the London Ambulance Service was around 8% compared to the national standard of 12%. The highest number of calls to the service was received at weekends.

A national directory of services was used to find the nearest service to a caller’s address or GP so there were no issues if for example calls came from the border areas with Essex.

Councillors were concerned that they were receiving a lot of complaints about the NHS 111 service including staff responding negatively to callers’ concerns and ringing off. Members were also concerned that the level of staff training was insufficient. The provider’s representative accepted that the service was not 100% perfect and that problems needed to be identified. She was also keen for patients to feed back confidentially on the service.  Calls to the service were also continuously audited to identify problems. A GP representative accepted that the NHS Pathways algorithm used by call handlers was too inflexible but felt it did eventually direct to the best end service. At weekends and between 6.30 pm and 8 am on weekdays, calls requiring a follow up would be referred to the out of hours service (also provided by PELC). Outside of these hours, an e-mail would be sent to the patient’s GP. It was emphasised however that the majority of NHS 111 calls dealt with self-care advice and were hence less urgent in nature.

Members were welcome to visit the NHS 111 call centre and learn how the service worked. It was also confirmed that calls to NHS 111 were analysed to ascertain their impact on the use of A&E, as well as other trends. Around 80% of calls to NHS 111 were received out of hours. Members emphasised however that there was not a doctor on site at the call centre. Officers explained that there was not a statutory requirement that clinicians on site had to be doctors but that the service could call on advice from doctors in the out of hours service.

The Committee NOTED the update.   

Note: This item was accepted with the agreement of the Chairman as an urgent matter pursuant to Section 100B (4) of the Local Government Act 1972.

Officers from the Commissioning Support Unit explained that NHS England had decided that the proposals on changes to services for urological cancer would benefit from a period of formal consultation on this and other proposals for changes to cancer services. As such, there would be no changes to the location of services for urological cancer for the present.

Other areas of cancer services  which would now be consulted on included proposed changes to services for brain, spine, head and neck cancer. Changes to cardiovascular services would also now be included in the consultation. NHS England would be leading the consultation although the Commissioning Support Unit would be supporting this work.

The cancer services changes would cover inner and other North East London as well as North Central London. The cardiovascular changes would cover these areas as well as three West London boroughs. Officers had held some initial discussions on establishing a Joint Committee covering these areas but these were at a very early stage. It was noted that Essex and Hertfordshire County Councils should be invited to participate in any Joint Committee that was established.

A pre-consultation process would take place during August and September and it was anticipated that formal consultation would be launched, subject to the agreement of a business case, in November. This would last for three months, following which the final proposals would be implemented. NHS officers were keen to work with the Overview and Scrutiny Committees and Healthwatch organisations during the consultation process and were also happy to work with the People’s Platform organisation.

The Committee NOTED the update.  

To receive a report on proposed amendments to the Committee’s terms of reference (attached).

It was AGREED that the final sentence of paragraph 4 of the Terms of Reference should be amended to read a follows:

The Councils of the Borough of Brentwood and District of Epping Forest may also each nominate an observing Member.

The Terms of Reference of the Joint Health Overview and Scrutiny Committee were otherwise AGREED as presented and are appended to these minutes.

To agree the work plan of the Committee for the remainder of the municipal year (report attached).

The Committee discussed its work programme for the coming year and AGREED the following:

An update on maternity services and on NHS 111 should be taken in January 2013.

A&E issues should be considered by the Committee in April 2013 or sooner if there were urgent developments.

Reorganisation of stroke services at Whipps Cross should be considered in October 2012 and the redevelopment of Whipps Cross should also be scrutinised, perhaps by way of a site visit to the hospital.

The Committee should consider submitting a response to the document listing emerging principles from the Urgent and Emergency Care Review.

An overall view of GP practices and surveys should be presented to the Committee.

The visit to the NHS 111 call centre should be arranged.

Items on mental health and children’s health services should be considered, perhaps as sub-group meetings separate from the main Committee meetings.

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.