Agenda and minutes

Joint Health Overview & Scrutiny Committee
Tuesday, 2nd October, 2018 4.00 pm

Venue: Barking & Dagenham

Contact: Anthony Clements  Email: anthony.clements@oneSource.co.uk 01708 433065

Items
No. Item

10.

APOLOGIES FOR ABSENCE AND ANNOUNCEMENT OF SUBSTITUTE MEMBERS (if any) - receive.

Minutes:

Apologies were received from Councillors Stuart Bellwood, Redbridge (Muhammed Javed substituting) Nisha Patel, Havering and Catherine Saumarez, Waltham Forest. Apologies were also received from Mike New, Healrthwatch Redbridge.

11.

DISCLOSURE OF INTERESTS

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.

Minutes:

6. HEALTH BASED PLACES OF SAFETY.

 

The following personal interest was disclosed;

 

Councillor Richard Sweden, Personal, managed by, though not employed by, North East London NHS Foundation Trust.

 

12.

MINUTES OF PREVIOUS MEETING pdf icon PDF 140 KB

To agree as a correct record the minutes of the meeting held on 26 July 2018 (attached) and to authorise the Chairman to sign them.

Minutes:

The minutes of the meeting of the Joint Committee held on 26 July 2018 were agreed as a correct record and signed by the Chairman.

13.

BHRUT - IMPROVING CANCER CARE pdf icon PDF 74 KB

Report attached.

Additional documents:

Minutes:

BHRUT officers explained that the Trust provided one of the largest oncology departments in the UK and offered care for patients during the acute phase of treatment as well as beyond this. The Trust had met the national 62 day cancer treatment standard for the last 13 months. Initiatives such as the Enhanced Supportive Care Team and the EMPOWER Programme – a course on dealing with cancer treatment, had been nominated for awards.

 

The Trust also offered a state of the art radiotherapy facility at Queen’s Hospital and the introduction of two halcyon machines had halved treatment times as well as making radiotherapy treatments more accurate. The Trust covered a catchment area of more than one million people and expected a 6% yearly increase in patient numbers.

 

Current treatments offered included radiotherapy at Queen’s, chemotherapy at Queen’s and King George, an inpatient ward at Queen’s and outpatient facilities at both sites. The Trust wished to centralise chemotherapy treatment at Queen’s to improve efficiency, care and experience due to the access to specialised medical cover and the removal of the need to transport chemotherapy drugs between sites. This would allow better access to clinical trials and would offer better outcomes for patients requiring chemotherapy and radiotherapy. Current treatment pathways meant that more complex cases were seen at Queen’s whilst all pre-assessment and clinical trials also took place at Queen’s.

 

Some 600 patients per month were given chemotherapy at the Sunflower Suite at Queen’s (compared to 450 previously) and 150 patients at the Cedar Centre at King George (comparted to 200 previously). More choice of appointment times could be offered at the Queen’s unit which was open six days per week. There was also a dedicated pharmacy production unit at Queen’s whereas chemotherapy had to be transported four times a day to King George. The Trust therefore felt that just having chemotherapy at Queen’s would reduce patient delays. Longer term plans included a phone triage service for chemotherapy patients which would allow those patients needing urgent help to go straight to the cancer unit, rather than wait in A & E.

 

Some 20% of patients receiving chemotherapy at BHRUT would be affected by the proposed change. The expected rise in more complex cases over time (which would be seen at Queen’s) was likely to reduce this figure. It was accepted that some people would experience increased travel times but officers felt that the better patient experience would outweigh this. Hospital transport would continue to be provided as necessary and there remained a dedicated free car park at Queen’s for oncology patients during treatment. Reduced waiting times would mean that car park capacity was unlikely to be an issue.

 

The Trust wished to implement the changes by the end of October and BHRUT officers did not feel that this was a significant change to how services were delivered. Engagement had been undertaken with patient groups and, once the changes were agreed, leaflets about the changes would be distributed across both hospitals and a frequently  ...  view the full minutes text for item 13.

14.

HEALTH BASED PLACES OF SAFETY pdf icon PDF 75 KB

Reports and information attached.

Additional documents:

Minutes:

Offices explained the role of s. 136 health based places of safety which allowed the assessment of people detained with mental health problems to take place in a more appropriate environment. Currently, not all such places of safety were open 24:7 or allowed enough privacy and there were also some shortages of trained staff.

 

It was proposed to close the s. 136 suite at the Royal London Hospital which, being located next to the A & E department, was not considered fit for purpose. Extra staff would be allocated to the suite at the Homerton Hospital and the suite at Goodmayes Hospital (Sunflowers Court) would also retained. The future of the suite at Newham Hospital would be decided after a further year of operation.

 

The lead officer for mental health at the Metropolitan Police stated that police received over 4,000 calls a year relating to mental health issues. The detainment of a person under s. 136 arrangements could police offices for a full shift although it was wholly accepted that mental health issues were a core part of policing. Police currently found difficulties in transferring people to a place of safety and needed confidence that they could take people at any time to well managed and fully staffed suites with less waiting time for police officers.   

 

The Deputy Director of Quality and Nursing at London Ambulance Service (LAS) accepted that patients in a mental health crisis often received a very poor service. The LAS received around 400 calls a day from people in mental health crisis and there were cases of people with a mental health crisis waiting 12-14 hours to access a place of safety. The LAS wished to see a reduction in the number of places of safety but an increase in their capacity, opening hours etc. It was felt there had been a very good consultation on the issue with many people engaged. It was felt that the changes would free up ambulances but would also be better for patients. There would be some increases in travel time but it was noted that people could already often not obtain space in their local units. The LAS therefore supported the proposals.

 

It was felt that a better built environment would offer patients safety, privacy and dignity. The recruitment of more staff in places of safety would lead to reduced waiting times. Department of Health funding had been secured for two more rooms at Homerton and one more room at Goodmayes Hospital. Further modelling would be undertaken with the CCGs around whether to increase staffing at the Goodmayes suite.

 

It was felt that 40-50% of people taken to places of safety were not previously known to mental health services.  There was good cooperation between the police and the NHS and work on assessing the street triage service was continuing both across London and nationally. It was felt however that telephone triage services were more cost effective in many areas. The NELFT mental health helpline was available to patients (and police)  ...  view the full minutes text for item 14.

15.

HEALTHWATCH HAVERING - SERVICES FOR PEOPLE WHO HAVE A VISUAL DISABILITY pdf icon PDF 75 KB

Report attached.

Additional documents:

Minutes:

A director Healthwatch Havering explained that the organisation’s report on services for people with a visual disability focussed on Havering but it was felt that many of the problems and issues scrutinised may well also apply elsewhere in Outer North East London. The report had previously been well received by the North East London eye health group.

 

It was felt that the clinical pathway in Havering fir visual impairment was very confusing with ophthalmologists often being unable to refer patients direct to hospital. In addition the Queen’s Hospital ophthalmology department operated from a very cramped building with poor patient communications often via an electronic board that many patients were unable to see clearly.

 

A Royal National Institute for the Blind eye clinic liaison officer had now been reinstated at Queen’s Hospital as some office accommodation had been made available. Healthwatch had found that fewer Certificates of Visual Impairment, which allowed access to services from the Local Authority etc, had been issued than expected. BHRUT could not however confirm how many certificates had been issued and to which boroughs. Healthwatch Havering was therefore concerned at the lack of data available with which to plan services.

 

It was noted that, since the publication of the report in June 2018, BHRUT had made a bid for capita funding to improve the ophthalmology department at Queen’s Hospital. The Healthwatch director agreed that eye services across London were often somewhat piecemeal in nature. There was no overall plan for eye health services across London although this could of course change in the future.

 

The Joint Committee noted the report by Healthwatch Havering.

16.

JOINT COMMITTEE'S WORK PLAN pdf icon PDF 69 KB

The Joint Committee is asked to suggest any further items for addition to its attached work programme.

Minutes:

It was agreed that a report from NELFT on the street triage service should be brought to a future meeting of the Joint Committee. It was also suggested that a report be taken on the issue of the discharge of patients into community-based settings looking in particular at the issue of for example a patient being discharged to a nursing home when they simply required some reablement.