Agenda and minutes

Apologies were received from Malcolm Wilders, co-opted member.

Apologies were also noted from Averil Dongworth, BHRUT and Lorna Payne & Joe Coogan, Social Care & Health, London Borough of Havering.

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.

There were no declarations of interest.

To approve as a correct record the minutes of the meeting held on 11 October 2011 (attached) and to authorise the Chairman to sign them.

These were agreed as a correct record and signed by the Chairman.

Matters arising:

St. George’s Hospital, Hornchurch – The H4NEL programme director confirmed that the future of this site would be considered as part of the ONEL-wide estates strategy. Decisions on the strategy would be brought to the Joint Committee for scrutiny.

Essex births at Queen’s Hospital – Councillor Pond reported that the Essex Health Overview and Scrutiny Committee had scrutinised with BHRUT officers the current restriction on mothers from Essex giving birth at Queen’s Hospital in Romford. BHRUT officers had stated this was a decision taken by the commissioners. The H4NEL programme director agreed that this was the case, stating that East of England commissioners had decided to switch births to hospitals other hospitals with the aim of improving quality at Queen’s.

To receive a presentation from Pam Court, Chief Executive Officer, Saint Francis Hospice.

Pam Court, the Chief Executive Officer of St. Francis Hospice thanked the committee for its invitation to speak at the meeting and added that she was happy to attend other meetings or for Members to visit the hospice.

The majority of the hospice’s work consisted of its outreach services. The hospice offered services across Barking & Dagenham, Havering, Redbridge and the Brentwood and Abridge areas of Essex. The hospice ran an education centre specialising in palliative care training and employed a full range of healthcare professionals. Consultant cover could be accessed on a 24:7 basis via Queen’s Hospital. The hospice was a charity run predominantly by volunteers.

Demand for all the hospice’s services had risen with for example use of the telephone triage service having tripled since 2006/07 and demand for bereavement support at the hospice having risen by 25%. The average length of stay in the hospice’s 18-bed inpatient unit was 13 days. While approximately two thirds of patients did die in the hospice, around one third went home after care and treatment.

Referrals were made to the hospice from Queen’s and also Basildon and Broomfield Hospitals. There was also an increasing number of referrals from care homes. The hospice triage team currently operated 9 am – 5 pm Monday to Friday but the hospice wished to make this a 24-hour service. The hospice at home service was also very important as it allowed support for people in the last two weeks of life to die at home. This service was also seeing an increase in demand. The service could be mobilised within one shift. The service did not however currently run in Redbridge.

Key current issues for the hospice included a lack of coordination in community services and a withdrawal of support from Marie Curie nurses. Coordination with the health and social care sectors was also variable and it was felt by the Chief Executive Officer that district nurses needed better training.

The hospice received 38% of its funding from the NHS and fundraised the remaining 62% (approximately £5 million per year). The hospice was seen as a quality provider with an outstanding reputation and the Chief Executive Officer felt that better coordination with other providers was essential as was more educational work on palliative care in care homes.

It was accepted that GPs had mixed knowledge of palliative care and this was a challenge. The hospice’s palliative care consultants could meet with GPs. A breakdown of referrals by area and by diagnosis of patient would be passed to the Committee. It was reiterated that the hospice was open to all groups and cultures and the Chief Executive Officer was happy to meet with hard to reach groups and discuss this. The hospice had rebranded its logo etc. and the Chief Executive Officer would consider a change of the hospice name over the longer term although for example St. Joseph’s Hospice in Hackney was not seen as a religious organisation.

It was explained that, although the  ...  view the full minutes text for item 10.

Scrutiny of the implementation plans for the Health for North East London proposals. Presentation and discussions with Heather Mullin, Health for North East London and Averil Dongworth, Barking, Havering and Redbridge University Hospitals’ NHS Trust. Letter from the Rt Hon Andrew Lanlsey CBE MP, Secretary of State for Health attached.

The Chairman noted that any discussions of the item at the meeting did not preclude individual overview and scrutiny committees from also scrutinising the H4NEL plans.

The H4NEL programme director thanked the Joint Committee for its work on the plans to date and felt that the recommendations of the Independent Reconfiguration Panel were better for the work undertaken by the Committee.

For financial reasons, the Outer and Inner North East London PCT clusters had been combined under a single Chief Executive – Alwen Williams. As regards maternity provision, the Barking Birthing Centre was on target to receive its first delivery by April 2012. The programme director reiterated that the vision for King George Hospital was to provide a range of services on the site.

The Independent Reconfiguration Panel was pleased with the level of clinical support and leadership at H4NEL. It had also recommended that the scrutiny of the plans carried out by the LINks and People’s Platform should continue. The Secretary of State had however stated that the H4NEL plans could not be implemented until quality issues at Queen’s Hospital had been addressed. A programme board (not covering Waltham Forest) including the Clinical Commissioning Groups had been formed to monitor this improvement.

It was planned to deliver the H4NEL proposals over a two-year period from February 2012. The programme board would work with local LINks and the People’s Platform to develop commissioning and engagement strategies. A more detailed action plan and timelines were being developed. It was also planned to continue to involve the Joint Committee in this work.

BHRUT officers accepted that it was a large challenge to create sufficient bed capacity at Queen’s to accommodate the additional work from King George. There was a however now a high level of clinical engagement and officers were confident that this could be delivered.

It was accepted that H4NEL impacted on all the North East London boroughs including for example the extra capacity the changes would require at Whipps Cross. Only the programme board would be restricted to the BHRUT area. The H4NEL executive, chaired by the programme director, would include Waltham Forest representatives including from the Waltham Forest Clinical Commissioning Group. The consultation did give a clear articulation of what services needed to be on the Whipps Cross site and the programme director reiterated that Waltham Forest would continue to be part of the user engagement strategy and that she did not wish to exclude Waltham Forest from any discussions.

The programme director agreed that changes such as the moving of maternity services from King George to Queen’s could not proceed until the relevant assurances had been received. This would be covered in the composite action plan for the project.  

The programme director explained that the H4NEL governance structure was now more sophisticated and she would provide to the Committee slides illustrating this. The effect of H4NEL on the estates strategy would be considered as part of the decision making business case and plans for the estate would  ...  view the full minutes text for item 11.

Scrutiny of BHRUT response to report of Care Quality Commission. Discussion with Averil Dongworth, BHRUT.

The Director of Planning and Performance at BHRUT confirmed that the Trust took the findings of the Care Quality Commission (CQC) report extremely seriously. Some actions were already underway but the Trust was keen to speed up the pace of change. The latest action plan in response to the CQC recommendations had been circulated to the Committee.

Management of the maternity department had been strengthened with the recruitment of a new director of midwifery who was due to start in three months. The Trust was now operating a 1:29 midwives to women ratio, one of the highest in London.

The diversion of planned caesarean section deliveries to the Homerton Hospital was intended to be for a period of eight weeks but it had been decided to continue this until the end of the current financial year. It was then planned to move deliveries of this type to King George Hospital.

A study of staff behaviour in maternity had been undertaken as well as a large exercise in staff engagement. A zero tolerance approach was now being taken to poor staff behaviour. A new complaints system had also been introduced. The details of the co-located Midwife Led Unit at Queen’s were currently being worked on.

Emergency care had also been raised by the CQC and the JONAH computer system had recently been implemented to facilitate A&E patients’ journeies through the whole of the health sector, not just the acute hospital. It was planned to expand the majors, resuscitation and intensive care sections of Queen’s A&E in light of the extra work expected when the A&E at King George was closed.

Officers accepted that, given the large size of the maternity unit, some serious incidents would still unfortunately occur. A recently publicised case was reported promptly as a serious incident and the midwife concerned was not a Trust employee. The Trust was only able to respond publicly to such cases when the family involved chose to put the matter in the public domain. The Trust action plan in response to the CQC report was available on its website and there had been a lot of positive work undertaken with both Councillors and the Local Involvement Networks. It was agreed that any incident notifications that were able to be shared publicly would be passed to the clerk to the Committee for forwarding on to Members. Maternity reports to the Trust board were also available to view on the website.

It was confirmed that Essex women with due dates of 1 April 2012 onwards were now able to again book deliveries at Queen’s if they wished. Trust officers agreed that the behaviour of drunks in A & E continued to cause problems. A recent incident was reported quite quickly but it was accepted that reception staff should have reported this at an earlier stage.

Replacing hospital signage was an expensive project but officers accepted that a solution needed to be found on an interim basis. This issue had also been  ...  view the full minutes text for item 12.

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.

There was no urgent business.

The next meeting would be held on 10 April 2012 at 3.30 pm at the Lopping Hall Loughton (since changed to Waltham Forest Town Hall, Walthamstow).