Agenda and minutes

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

Apologies were received from the following Councillors:

Barking & Dagenham:

Sanchia Alasia

Danielle Lawrence

Havering:

Nic Dodin (Councillor June Alexander substituting)

Dilip Patel

Waltham Forest:

Stuart Emmerson (Gerry Lyons substituting)

There were no disclosures of pecuniary interest.

To agree as a correct record the minutes of the meeting held on 13 January 2015 and to authorise the Chairman to sign them (attached).

The minutes of the meeting held on 13 January 2015 were agreed as a correct record and signed by the Chairman.

To scrutinise the plans of Barts Health NHS Trust in light of the recent inspection of Whipps Cross Hospital by the Care Quality Commission (CQC).

The Barts Health NHS Trust chief executive explained that an inspection of Whipps Cross hospital by the Care Quality Commission (CQC) had taken place in November 2014 and had revealed significant concerns in a number of areas including A&E patient flow, staffing and bullying. Following the inspection, a risk summit was organised with stakeholders in March 2015 and Barts Health wished to be inclusive with other organisations as part of its improvement plan.

Significant concerns raised by the CQC included issues of staffing, morale & culture, the routine delivery of standards such as keeping to timetables for treatment and the lack of safety policies and embedding of safety etc. The Trust management believed that the public would still get good outcomes and care at Whipps Cross but accepted that patients had been let down. While there were good aspects of care at Whipps Cross, improvements were also required.

The Trust Medical Director explained that immediate recovery action was agreed with the Trust Development Agency, local Clinical Commissioning Group (CCGs) and Healthwatch Waltham Forest.  Significant progress had been made around improving the quality and safety of clinical care. Daily meetings were held where nurses could share any concerns around patient care. The number of medical patients treated on surgical wards had been reduced and the seven-day site presence of senior management had also been improved.

As regards staffing levels, improvements had been made but there was still a reliance on use of agency staff on some wards. The budgeting process for the nursing establishment was currently in progress and the Trust aimed to reduce its need for agency staff. On safeguarding, the introduction of a babytracking system at Whipps Cross maternity had not been concluded and the Trust accepted that this needed to be actioned. Recruitment had taken place to the senior leadership team whose visibility had improved, making it easier for staff to escalate issues if necessary.

The Trust and hospital leadership were keen that staff understood and engaged with the hospital improvement plan. On outpatient issues, the Trust wished to meet waiting time targets, avoid duplication of appointment letters and ensure patient records were available at appointments. In A & E, the objectives were to ensure patients were seen and assessed promptly, admitted to the correct ward and discharged safely.

Trust officers felt that recruitment had improved with the ratio of permanent, agency and bank staff being looked at. A new eight-bed High Dependency Unit was due to open was due to open at Whipps Cross by December. It was accepted that communication around the hospital improvement plan had to be improved both with stakeholders and the general public and also with the hospital’s own staff.

It was also important that staff were engaged in delivering better care and a clinical senate had been established to manage the hospital at a local level. A quality and safety committee would also be set up to allow safety issues and complaints to be dealt with on site at Whipps Cross.

The final  ...  view the full minutes text for item 39.

Discussion with Lucy Hamer, Involvement Team Leader, Care Quality Commission of the hospital inspection process used by the organisation.

Officers from the Care Quality Commission (CQC) explained that the CQC strategy committed the organisation to working closely with scrutiny. The CQC wished to strengthen this relationship further following issues such as those raised by the Francis Report. The CQC had recently produced a new guide for scrutiny committees on working with it. The CQC teams that inspected facilities for health, social care and primary & integrated care each wished to strengthen their relationships with scrutiny.

A new set of CQC standards for care had been introduced with effect from 1 April 2015. If the CQC found that services provided were not good, it needed to decide if the services provided required improvement of if they should be rated as inadequate. Services were also now required to put their CQC rating on public display. Guidance for providers had now been updated and was available on the CQC website.

It was noted that the CQC was responsible for inspecting hospitals, GPS, dentists, mental health facilities, care homes, home care services, children’s care facilities and healthcare within the criminal justice system.

Officers reiterated that the relationship with scrutiny was important to the CQC. The CQC inspection schedule was announced to scrutiny and a representative of the most local scrutiny committee was invited to the quality summit arranged by the CQC following an inspection. Inspection reports were also notified to scrutiny.

The CQC inspection of Whipps Cross had been undertaken in direct response to concerns raised by local stakeholders. Evidence was collected from stakeholders before each inspection and a team of 45 people had been involved in the inspection at Whipps Cross.

Inspections of Newham and the Royal London Hospitals had been undertaken in January 2015 and these reports were currently with the respective Trusts who were allowed to check matters of factual accuracy. The inspection at BHRUT had been dealt with supportively by the Trust and the report on this was due to be compiled by the end of April.   

The CQC had the remit to look at how integrated services were and information was shared between the different sector CQC teams. The CQC also undertook thematic reviews looking at for example care and services for older people.

Members expressed disappointment at the lack of an invitation to Redbridge to the quality summit re Whipps Cross and the CQC officers accepted that it was important to identify correctly which overview and scrutiny sub-committee should be invited. This was also a challenge where hospitals treated patients from across several different Local Authority areas. Members also recorded their thanks to the CQC for an excellent report on Whipps Cross.

A member of the public asked why the CQC had not picked up concerns about Whipps Cross at an earlier stage. Officers responded that the CQC did have a database of evidence on Whipps Cross. Barts Health had been inspected in December 2013 by a team of 90. When it became clear that action plans were not being worked towards, the CQC announced a new inspection  ...  view the full minutes text for item 40.

Scrutiny of the new co-commissioning landscape operated by NHS England and Clinical Commissioning Groups.

The chief operation officer of Havering Clinical Commissioning Group (CCG) explained that NHS England wished for the commissioning of GP practices to be decided at a more local level. All four CCGs in ONEL wished to have full delegation in this area as this would allow the CCGs to drive integrated care. Delegation would relate to CCGs commissioning GP practices, performance managing practices as a whole and being involved when deciding on closures of practices.

It was hoped that delegation would allow improved care by GPs for people with long-term conditions. It was accepted that there were also risks to delegation such as to the reputation of CCGs as well as a potential conflict of interest as GP practices were themselves members of CCGs.

The CCGs were currently consulting their members on this issues, Full delegated commissioning responsibility had been approved for the four ONEL CCGs with effect from 1 April 2015. Governance arrangements were currently being considered and a primary care committee was being established to take on these responsibilities. The local Healthwatch organisations, Health and Wellbeing Boards and Councils would be non-voting members of the committee, which would meet in public. There would also be a wider reference group including BHRUT and other providers.

It was planned that the primary care committee would be established over the next two months and an update could be given to a future meeting of the Joint Committee. The position would be checked as regards whether non-voting members would be able to remain present during confidential part 2 discussions at the primary care committee.

The Joint Committee AGREED to recommend that non-voting members of the primary care committee should be present at discussions regarding the distribution of resources.

The CCG officer accepted that GP recruitment and retirement was a major issue and felt that workforce issues would be a key work stream of the primary care improvement programme.  NHS England would continue to performance manage individual clinicians but the CCGs would undertake wider performance management on issues such as access to GPs. Funding received in Barking & Dagenham, Havering and Redbridge from the Prime Minister’s Challenge Fund had been used to establish GP access hubs.

The Committee NOTED the position.

Update on the position with the urgent care reprocurement process from a representative of local Clinical Commissioning Groups.

The Committee was addressed briefly by a Waltham Forest resident and member of the Waltham Forest CCG steering group. The member of the public noted that the urgent care procurement process was now paused but the member of the public felt there had not been sufficient involvement of patients and the public in the process. If there was to be a single of services such as NHS 111 and the out of hours GP service across the four boroughs, the member of the public wished to establish how the different demographics of the four boroughs would be taken into account and also what risk assessment had been undertaken.

The Havering CCG chief operating officer, on behalf of the four ONEL CCGs explained that the original competitive dialogue evaluation had left only one viable provider and the CCGs had therefore decided not to continue with that process. It was accepted that patient and public involvement could have been better and the new procurement process would commence with an urgent care conference in June 2015. This would involve the Joint Committee, Healthwatch, local Health and Wellbeing Boards as well as other stakeholders. The conference would aim to develop a high level specification for an urgent care pathway.

The CCGs wished to generate more interest in the urgent care procurement from a range of different providers. Next steps in the procurement would be considered after the urgent care conference had been held. It was uncertain at this stage if any potential change of Government following the General Election would have any impact on the process.

The Committee NOTED the position.  

To receive a report from Healthwatch Barking and Dagenham on a recent enter & view visit to Fern ward, King George Hospital. Healthwatch report and action plan from Barking, Havering and Redbridge University Hospitals’ NHS Trust attached.

In view of the length of the meeting, it was AGREED that this item be deferred to the next meeting of the Joint Committee.

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 should be considered at the meeting as a matter of urgency.

The schedule of meetings for the JOINT Committee for 2015/16 was AGREED as follows:

Tuesday 21 July 2015, 2 pm, Barking & Dagenham

Tuesday 20 October 2015, 2 pm, Havering

Tuesday 19 January 2016, 2 pm, Redbridge

Tuesday 19 April 2016, 2 pm, Waltham Forest