Agenda and minutes

The Chairman of gave details of action in the event of fire or other event that

might require the evacuation of the meeting room.

Apologies were received from Councillors Sanchia Alasia and Syed Ahammad, Barking & Dagenham, Wendy Brice-Thompson, Havering and Chris Pond, Essex County Council. 

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 point prior to the consideration of the matter.

There were no disclosures of pecuniary interests.

To agree as a correct record the minutes of the meeting held on 7 January 2014 (attached).

The Committee considered and approved the minutes of the meeting held on 7 January 2014 as a correct record pending the following amendments:

It was noted that Professor David Fish represented UCL Partners rather than the North East London Commissioning Support Unit.

Item 32, paragraph 2 should note that “Surgeons would form part of the specialist teams working across different sites”.

Item 32, paragraph 2 should read “the future of services at Chelmsford needed to be clarified as would the service covering Essex and Suffolk”.

Item 32, paragraph 5 should read “the Trust CEO had confirmed that there was sufficient capacity for the service at Bart’s Hospital site”.

Item 32, paragraph 7 should read “Officers pointed out that events had been held at different times of the day and at different locations and had offered to run an event in the Loughton area if required”.

1.    To receive an update from North East London Commissioning Support Unit officers on the current review of proposals for services for prostate cancer (presentation attached).

2.    To discuss the open letter from clinicians concerning aspects of the proposals (attached with response letter from Sir David Nicholson, Chief Executive, NHS England).

The Committee received a presentation on the changes to Cancer and Cardiovascular services from a representative of the North East London Commissioning Support Unit who were overseeing the engagement process on behalf of NHS England. 

Neil Kennet-Brown (NKB) of the North East London Commissioning Unit advised members that local services were not organised in a way that gives patients the best care with specialists, technology and research spread across too many sites. In order to address this, clinicians had recommended the following:

·                    Specialist cardiovascular services at The London Chest, The Heart Hospital and St Bartholomew’s Hospital be consolidated to create an integrated cardiovascular centre at St Bartholomew’s

·                    For specialist cancer care, the proposal was to consolidate only some of the specialist elements of five cancers which equated to 1% of all Bart’s Health specialist cancer services and 2% of BHRUT specialist cancer services.

The Committee were asked to note that the majority of care would continue to be provided locally.

Formal support had been received from all Clinical Commissioning Groups bar one and the London Clinical Senate (LCS) was in the process of carrying out an independent clinical assurance exercise. The initial business case was expected to be published in April 2014.  There would be further planning for implementation and engagement until a final business case was agreed in June 2014.

NKB noted the interest around the prostate cancer services at BHRUT and advised that the LCS were currently holding an independent review led by Professor Chris Harrison.  Advice would be sought on the robustness of the clinical process to arrive at recommended options and depth of clinical involvement and support.  In addition, advice would be sought on the future model and locations of radical prostatectomies, specifically:

·                    A comparative analysis of current outcomes data

·                    Which outcome measures should be used to compare radical prostatectomy performance

·                     Implications of recently published NICE prostate guidance

In addition to the Prostate Review, LCS was also carrying out a clinical wide review of the proposed changes using independent experts from the medical profession and lay senate members.  Both the reports were to be concluded prior to April 2014 when the Senate reported to the NHSE.

A Commissioner Programme Board would have final approval of the initial business case. The Board will comprise NHS England representatives and six CCGs who are the majority commissioners for the proposed changes:

For specialist cardiovascular 59% of activity was CCG commissioned. Of this, 70% was commissioned by Haringey, City and Hackney, Enfield, Islington, Camden and Barnet CCGs

For specialised cancer care all the services were commissioned by NHS England, except acute myeloid leukaemia. This would particularly impact Enfield, Barnet, Haringey and Camden CCGs due to the proposed transfer of services to ULCH from other locations

Commissioners, clinicians, providers and the Trust Development Agencies would then commence planning for implementation.

With regards to Trauma Services a meeting was held on 16 December 2013 to identify and address issues.  A further full day clinically-led workshop was held on 16 January 2014. The  ...  view the full minutes text for item 40.

To receive an update from Trust officers on how the Trust is responding to a recent report on its services by the Care Quality Commission.

The Committee received the Barts Health response to the CQC Report.  The inspection was carried out in November 2014 and the subsequent report was published on 14 January 2014. 

In general, there was much to be proud of as staff were commended for providing safe compassionate care in clean surroundings. Management structures around the Clinical Academic Groups and their abilities to implement change were also positively highlighted. 

Since the last CQC inspection, broken equipment had been replaced and improvements made to the complaints handling process, leadership development, risk management/governance and organisational culture.  The issues around bullying and harassment were also being addressed.

The Committee were asked to refer to the detailed action plans accompanying the presentation.

It was noted that there would be one high level plan covering Trust-wide actions and five site-specific plans covering actions at individual hospitals Trust-wide which included:

•              Ensuring staffing levels meet patients’ needs in medical and surgical wards

•              Ensuring risk registers are managed effectively

•              Improving staff morale, staff engagement and visible leadership

•              Ensuring equipment is readily available when needed

•              Ensuring learning from incidents and near miss events is shared with all staff

•              Providing 24/7 consultant cover

The plans had now been agreed by the CQC, the Trust Development Authority (TDA) and the Board.

In addressing staff morale and engagement, Barts Health had undertaken a recruitment drive to achieve 95% permanent staffing levels by September 2014 thus reducing the need for temporary staff. In addition, an on-call Executive Director would be visiting the wards at weekends to obtain staff and patient feedback.  An anonymous online system had been provided where staff could contact members of the Trust Board direct. Plans were also in hand to make necessary changes in the overall organisational culture.

To improve standards, the following actions had been put in place:

•              Developing monthly reporting of actual staffing levels by shift and ward/department

•              Introducing a new Trust wide e-rostering system to manage shifts, to include a patient acuity indicator to help plan staffing levels

•              Rolling out leadership and skills programme based on the programme we ran last year across older people’s services

•              Developing stronger links between risk registers and the capital programme to target equipment replacement more effectively

•              Multi-disciplinary working with commissioners and partners to develop new patient pathways to support more effective discharge planning

•              Refurbishment work already undertaken in the Margaret Centre at Whipps Cross Hospital

•              Working with Healthwatch, local patients and staff on a new PALS and complaints model

The Chairman remarked on the work that PALS carry out in trying to resolve issues immediately and that they are not a large resource.

A Committee member  was pleased to note that there was an action plan for all Barts Health sites and requested sight of the action plan for Whipps Cross following concerns about maternity and obstetrics. The Barts Health representative agreed to the member’s request that the Redbridge Overview and Scrutiny Committee be invited to visit  ...  view the full minutes text for item 41.

To receive an update from officers of Barking, Havering and Redbridge University Hospitals NHS Trust on how the Trust is responding to a recent Care Quality Commission report on its services.

The Committee received a presentation on the BHRUT response to the CQC inspection from Averil Dongworth, Chief Executive at , BHRUT.

Following the CQC inspection in October 2013 and the subsequent report in December 2013, BHRUT had been put into Special Measures in order to meet the scale of future challenges. The report recognised the good quality of care and the improvements made since the previous inspection, however long standing problems with performance and finance had not been effectively addressed and the Trust were now working with the Trust Development Agency (TDA). 

An executive capability review was being carried out by Sir Ian Carruthers who would report back to the TDA.  The name of a “Buddy Trust” had yet to be announced. A draft improvement plan was in place which had been developed with staff and health partners and an Improvement Director had been appointed. The improvement plan set out the issues with corresponding actions including the five work streams as follows:

Workforce

Recruitment, retention, development and deployment of the right number of permanent staff to provide high quality care 24/7.

Patient flow and emergency pathway

Ensuring patients were assessed and treated promptly and supported to return home as soon as they were medically fit and were cared for in the right environment with the appropriate follow-up care.

Patient care and clinical governance

Supporting care with effective management of patient notes and information systems so that problems were promptly addressed.

Outpatients

To ensure effective management of outpatient services so appointments run on time.

Leadership and organisation

Implementing the right systems, structures, checks and balances  to make sure the Trust was properly managed from Board to ward.

In response to a query regarding A&E, members were advised that further improvements were being made to patient flows by streamlining care. A medical assessment unit was in place and short stay capacity was currently being developed. The Committee were asked to note the appointment of two new Paediatric A&E Consultants, and following a recruitment drive in India, further posts had been filled.  Currently, 9 out of 21 consultant posts were filled and 2 out of 18 junior doctor posts. The Committee AGREED that a written response be forwarded to the Committee Clerk giving a full breakdown of staffing levels in A&E.

It was noted that the draft improvement plan had been forwarded to the CQC and the TDA and that feedback was expected shortly. The plan would be finalised before being presented to the Trust Board for approval by April/May 2014. The plan would be published on the Trust website with regular monthly updates to report on progress. The CQC would revisit the Trust in 12 – 18 months.  It was AGREED that the Committee should have sight of the plan once available.

The Chief Executive acknowledged that it would be a challenge to retain staff particularly whilst under Special Measures.  The Trust had introduced PRIDE workshops for staff looking at issues around culture, attitude and behaviours. 

A member  ...  view the full minutes text for item 42.

To agree the Committee’s response to a proposed change of location for Moorfields Eye Hospital (draft letter attached).

It was noted that the Committee members found their visit to Moorfields Eye Hospital most enjoyable and informative and had concluded that they fully understood the reasons why the hospital wished to move to a new site.

The Committee approved the contents of the letter to be sent on their behalf to the Programme Transformational Director at Moorfields. The letter noted the Committee’s support for the site move and requested that it be kept informed of all proposals and developments including an annual update by a Moorfields representative. 

The Committee AGREED to support the Trust’s relocation plans and authorised the Chairman to sign the letter.

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

No matters were raised.