Agenda and minutes

Members are invited to declare 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.

Councillor Sweden declared a personal interest in item 5 as his employment was managed by NELFT.

To approve as a correct record the minutes of the meeting held on 12 July 2011 (attached).

It was noted that Richard Vann was the representative from Barking and Dagenham LINk and that the title of Manisha Madhvadia was in fact Outreach & Development Officer, Barking & Dagenham LINk. Subject to these amendments, the minutes were agreed for accuracy and signed by the Chairman.

The Committee noted that topic group meetings were planned in Havering to scrutinise the report of the Care Quality Commission into the BHRUT and also to consider the Secretary of State’s final decision concerning the Health for North East London proposals. The Chairman confirmed that all members of the Health Overview and Scrutiny Committee were welcome to attend these meetings and the clerk to the Committee would circulate meeting dates in due course.

It was AGREED that Health for North East London would also be placed on the agenda for the next meeting of the Joint Committee.

The Committee noted that the chief executive of St. Francis Hospice was unfortunately unable to attend the meeting and AGREED that a presentation on the hospice’s outreach work should also be placed on the agenda for the next meeting.

As mentioned in the previous minutes, it was noted that Councillor Ryan had circulated dates for scrutiny visits that Redbridge had organised to local health facilities.

Discussion with NHS officers.

A.           Takeover of Outer North East London Community Services (ONELCS)

SD explained that NELFT had a good reputation for working with local communities and that it had already moved Barking & Dagenham Community Services from the bottom to the top 20% of such organisations in the UK. There had already been some early gains seen in Barking & Dagenham Community Health Services with for example there no longer being any health visiting vacancies in the borough. Councillor Salam from Barking & Dagenham had also recently visited the Greys Court facility.

The acquisition of ONELCS was key to NELFT’s strategic gateway as it allowed NELFT entry to the acute care management sector. This allowed the opportunity to move elements of healthcare into a community setting.

SD felt that the key benefits of the ONELCS takeover were that it allowed more efficient local commissioning and gave the opportunity to work with complex care pathways. Synergy and economies of scale could be derived through e.g. integrated care pathway management and it was planned that an increase in mobile working would also deliver economies.

Now that it was combined with Barking & Dagenham Community Health Services, ONELCS would be renamed North East London Community Services (NELCS) and would form a new NELFT directorate along with those for South West Essex and mental health services. The NELFT Constitution and Council of Governors had been changed in order to increase the number of public and staff members of the Trust.

Risk areas of the takeover were seen as being the delivery of financial targets, safeguarding issues for example with health visiting in Waltham Forest and a need to increase recruitment although a full staff establishment had now been reached.

ONELCS had been registered by the Care Quality Commission with no conditions and the higher NHS Litigation Authority insurance rating had been achieved. There were high reported patient outcomes in the service and a stronger than expected performance culture. SD accepted that the financial situation was a challenge but felt that this could be managed.

A member of the public present felt that there was low public awareness of the ONELCS takeover and that there should be higher local representation among the governors. SD confirmed that the number of governors had been changed and accepted that the expanded Trust had to work more effectively with its members.

Councillor Pond asked for further details of the takeover of South West Essex Community Services and SD explained that this had been a similar process to the ONELCS takeover and the South West Essex services had been acquired in June 2011. There were three governors for each ONEL borough as well as members from South West Essex. Meetings were being arranged with the Health Overview and Scrutiny Chairmen in Essex and Thurrock and NELFT had also presented to the Thurrock committee prior to the acquisition.

SD stated that in Redbridge there was a long tradition of working across health and social care including having joint directors shared between the Council and the health  ...  view the full minutes text for item 3.

Presentation from Thomas Pharoah, Implementation Lead Cancer, London Health Programmes (briefing note attached).

TP explained that London Health Programmes, an organisation funded by all London Primary Care Trusts, had been working on the cancer model of care for the last two years. The implementation phase had now commenced following a three-month engagement process on the proposals. In excess of 85% of respondents to the engagement had been supportive of the plans.

Clinical advice was that the principal reason for lower relative cancer survival rates in London was the problem of late diagnosis of cancer conditions. The strategy therefore planned to improve early diagnosis by raising public awareness and ensuring greater access by GPs to diagnostic tests. This work was supported by the Mayor of London’s Shadow Health Improvement Board which prioritised earlier diagnosis of cancer.

Work was now underway with hospital providers to develop integrated cancer systems. In London, this work was covered by the London Cancer Group of hospitals providing cancer services. It was planned for the new model of care to start fully in April 2012 although TP accepted that full in-service plans were not available as yet. When these were available, TP agreed to bring them to the Committee along with representatives from the local Hospital Trusts.

Councillor Sweden raised the issue of patient transport which had previously been looked at by the Committee. TP agreed that this was important and added that the patient panel had emphasised the role of transport issues in the proposals. The aim was for as much cancer care as possible to be delivered closer to home.

The performance monitoring of GPs carrying out cancer care was a national issue but TP explained that this was audited by the Royal College of General Practitioners. Information already available, if used in the right way, could be used to monitor GP performance in delivering cancer services. Councillor Sweden felt however that pressure would need to be applied locally in order that standards could be reached in each local area.

TP agreed that incidences of cancer were linked to ethnicity but reported that there was less of a correlation with factors such as levels of social deprivation.

The Committee noted the presentation and thanked TP for his attendance.   

Presentation from NHS ONEL officers.

MP explained the strategy of NHS ONEL to ensure a fit for purpose estate. This was a component of the wider primary care strategy developed by the cluster Primary Care Trust. The Trust accepted that there were currently significant variations in the quality of the estate from which primary care was delivered across Outer North East London and that this needed to be addressed. A five-year strategy was being developed to take into account the current state of premises and options for the future.

A total of 15 GP premises across ONEL required major works and 15 had also been deemed as not fit for purpose. Further problems were that 49 practices did not achieve compliance with statutory standards for GP practices and that there was no agreed economic model to deliver estate improvements. These difficulties did also represent an opportunity to set minimum standards for primary care estate in the ONEL sector. Officers emphasised that the objective was to give equal access to the same quality of GP service across ONEL.

Enabling work on the primary care strategy was being carried out with borough PCTs and the ONEL councils during September and October. Public consultation would start from early November including patient involvement groups and Local Involvement Networks. It was planned that the cluster PCT board would receive the strategy in March 2012.

Councillor Light commented that further polyclinics had been promised for the region but this had not happened. She also felt that further clarity was needed over the plans for St. George’s Hospital and whether part of the site would be sold off. There was also a general lack of confidence in the current performance of GPs. PJ agreed to report back on the St. George’s situation. The term polyclinic was no longer being used but he felt that these types of service hub would be part of the current estate solution. As regards GPs, the GP contract would need a clear demarcation between primary contracting and commissioning. Councillor Light was concerned however that a lack of services such as stitches removal at GPs did not inspire confidence that GPs would be able to successfully take on the commissioning function. PJ responded that the clinical commissioning groups were being given training and support to take on the commissioning role. There would also be a strict authorisation process before any GPs could take over the commissioning function. MP agreed to update on this area at a future meeting of the Committee.

Councillor Sweden asked if more material could be provided on how clinical commissioning groups would be assessed as being suitable for taking on the commissioning role. He wished to be involved in this if possible.

MP clarified, in response to a member of the public, that the issues of GP retention and GPs approaching retirement would also be addressed in the strategy.

The Committee noted the presentation and thanked MP and PJ for their attendance.

To consider any other item in respect of which the Chairman is of the opinion, by reason of special circumstances which shall be specified in the minutes, that the item should be considered at the meeting as a matter of urgency.

Councillor Pond expressed concern at the recent announcement that Essex maternity cases would not be accepted at Queen’s Hospital until April 2012. He felt this was an artificial boundary and that the relevant officers should be asked to attend the next meeting to explain this. MP explained that the Essex arrangements were a temporary measure in response to service concerns. The changes had been discussed with the South West Essex PCTs, NHS London and BHRUT. The measures, including the diversion of planned caesarean section deliveries from Queen’s to Homerton Hospital aimed to ensure safe births. MP appreciated however that this was inconvenient for patients.

Councillor Light felt that future arrangements for South West Essex could be covered at the Joint Committee, once the report of the Care Quality Commission on BHRUT had been published. Councillor Sweden reported that the recent bad publicity over maternity at Queen’s had led to an increase in the number of births at Whipps Cross which had caused some problems. It was agreed that the maternity changes at Queen’s should be put on the agenda for the next meeting.

Councillor Pond clarified that expectant mothers in the Epping Forest area looked more towards giving birth at Whipps Cross whereas those from Stapleford Abbots tended to use Queen’s while those from the Chigwell area often gave birth at King George. Councillor Pond shared the concern expressed by a member of the public over the way the changes were announced.

Councillor Ryan added that she had recently visited the maternity units at both Queen’s and Whipps Cross and all patients spoken to were very satisfied with their treatment.