Agenda and minutes

Venue: Redbridge Town Hall

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

Items
No. Item

25.

CHAIRMAN'S ANNOUNCEMENTS pdf icon PDF 294 KB

The Chairman will announce details of the arrangements in case of fire or other events that might require the meeting room or building’s evacuation. Directions to the building are attached.

Minutes:

The Chairman gave details of the action to be taken in case of fire or other event requiring the evacuation of the meeting room.

26.

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

Minutes:

Apologies for absence were received from Councillors Sanchia Alasia and Eileen Keller (Barking & Dagenham) and Dilip Patel (Havering). Apologies were also received from Alli Anthony (Healthwatch Waltham Forest) and Richard Vann (Healthwatch Barking & Dagenham).

27.

DISCLOSURE OF PECUNIARY 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:

There were no disclosures of interest.  

28.

MINUTES OF PREVIOUS MEETING pdf icon PDF 89 KB

To agree as a correct record the minutes of the meeting of the joint committee held on 14 October 2014 (attached).

Minutes:

The minutes of the meeting held on 14 October 2014 were agreed as a correct record and signed by the Chairman.

29.

PHARMACY ARRANGEMENTS

To receive a presentation from a local pharmacist on the relationship between pharmacists and GPs in the Essex area.

Minutes:

The Committee was addressed by a community pharmacist from the Loughton area. The pharmacist had created a template to allow more effective communication between pharmacists and GPs. It was felt that advice given by pharmacists was not currently communicated directly to GPs. Equally, pharmacists were not currently able to access GP patient records. The template had therefore been created to show on patient records what interventions a pharmacist had undertaken with patients.

 

The pharmacist stated that 95% of patients he had assisted would otherwise have gone to the GP and pharmacy alone had therefore produced a £62,000 saving to the NHS. He felt however that the template project needed funding in order to maximise the benefits of interventions by pharmacists.

 

The project had been discussed with the pharmacist’s local Clinical Commissioning Group – West Essex CCG NHS England and the Royal Pharmaceutical Society. While most pharmacies currently operated a paper-based system, the form that had been developed could be completed on a Tablet device. Patients using the pharmacy system had to consent to their information being transmitted to their GP. The pharmacy form had been developed in cooperation with stakeholders over a three year period. It was hoped to also develop an I-phone based system with different levels of security.

 

It was noted that a co-director of Healthwatch Havering was the secretary of the North East London Local Pharmaceutical Committee.

 

It was emphasised that the template could be used by any pharmacies, whether independent or part of a large chain.

 

The Committee felt that any initiative that reduces pressure on A&E and GPs should be supported and it was AGREED that the local CCGs should be asked to support the project.  

 

 

 

 

30.

GREAT ORMOND STREET HOSPITAL

To scrutinise services provided by Great Ormond Street Hospital for Children NHS Foundation Trust.

Minutes:

The Director of Planning and Information at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) explained that GOSH was a specialist children’s hospital, founded in 1885. The hospital had a small number of beds (350) but high staff number (approximately 4,000) and turnover. Nearly half of the hospital’s beds dealt with complex care and there had been an 80% increase in the number of patients seen over the last 8 years. The hospital also ran the second largest private hospital service in the UK.

 

GOSH offered all children’s services except burns treatment. GOSH dealt with 25% of children’s heart surgery in the UK as well as 33% of bone marrow transplants and 75% of children’s epilepsy surgery. 1There were a total of 19 specialist children’s services offered by the hospital and these were not commissioned by CCGs but by NHS England in most cases. Forty-eight per cent of GOSH patients were from London with a further 24% from Hertfordshire, Essex and Bedfordshire. 11.5% of admissions were from Essex with the ONEL boroughs each accounting for 1.6 – 3.2%. Redbridge for example had seen 1,210 admissions in the last year. One per cent were overseas patients funded by the NHS under reciprocal agreements.

 

There was no A & E department at GOSH and the hospital did not generally take referrals from GPs. Referrals were usually made by consultants in other hospitals. The Trust’s vision was for GOSH to be the leading children’s hospital in the world for patient experience, outcomes and research.

 

A major Challenge for GOSH was the planned in NHS commissioning arrangements for specialist services which could have an impact of £20 million on the Trust’s finances, The ability to recruit and retain key staff was also a challenge. The Trust also wished to make patient records digital and transferrable.

 

Opportunities for the Trust included the hospital’s strong brand name which allowed it to diversify its income base. The hospital’s new clinical building was due to open in 2017. GOSH was also at the forefront of genomic medicine such as the development of a non-invasive pregnancy testing service.

 

The greatest clinical pressures at GOSH related to end of life care. GOSH was often the hospital of last resort and families were often reluctant to agree to the ceasing of intervention. Some patients incurred extremely high treatment costs with the 125 most complex cases seeing £12.5 million more being spent on treatment than GOSH had received from commissioners for these patients. 

 

The private patient wing at GOSH was operated separately from the rest of the hospital and funds from this were being used to support NHS services and research.

 

The Liverpool Care Pathway had never been used at GOSH and the UK’s only dedicated paediatric palliative care team was based at GOSH. Digital records were in the process of being rolled out to different departments at GOSH. It was hoped to also develop a portal system to be used by other hospitals around the UK.

 

GOSH did make use  ...  view the full minutes text for item 30.

31.

MATERNITY SERVICES

To receive updates from health officers and patient representatives on maternity services at local hospitals.

Minutes:

A.   Whipps Cross

 

The head of midwifery for Whipps Cross advised that 4,800 babies had been born at the hospital in 2013/14. Services available through Barts Health included community midwives for home births and other specialist services including bereavement services. There were also specialist teams available for e.g. pregnant women with mental health needs.

 

Whipps Cross offered the full range of maternity services. Specialist scans could now be done at the Royal London Hospital meaning it was no longer necessary to travel to Great Ormond Street for these. There were a total of 158 midwives at Whipps Cross. There were not any vacancies for midwives at the hospital currently but this situation did vary. A consultant midwife had been appointed to give clinical leadership and a clinical education lead was in the process of being recruited. An infant feeding coordinator was also now in post.

 

Women’s experiences of maternity were very important and the Trust was working with its Maternity Services Liaison Committee. The friends and family test was used and the Trust sought to learn from complaints received. Clinical skills of midwives had been assessed and feedback from local women was also sought via the Trust’s ‘Mum to Mum’ programme.

 

Improvements implemented at Whipps Cross over the last 18 months included opening a new theatre suite in HDU, standardising maternity services and developing a home birth team across Barts Health. A new programme of labour induction had reduced the number of caesarean section required and 1:1 care for maternity was now at 97% - a good safety indicator.

 

The report from the latest CQC inspection of Whipps Cross had not yet been shared but warning notices issued from the previous inspection had since been lifted.

 

B.   BHRUT

 

While all births at BHRUT now took place Queen’s Hospital, maternity outpatients appointments were still provided King George. Community midwifery and home birth teams were also available.

 

There were a total of around 350 midwives at BHRUT including 70 community midwives. A total of 15 midwives including two senior midwives were present on each shift. Electronic patient were used in maternity and all birthing rooms were en suite, There were approximately 20 births per day at Queen’s, making it one of the busiest maternity units in the UK. Consultants were present on the wards from 8 am to midnight and the Trust’s current rate of caesarean sections was 24.8%.

 

BHRUT now had low rates of use of epidurals and of labour induction, both of which were indicators. There were also now very low admissions of mothers to ITU and a very low level of brain damaged babies. There had not been any intra partum still births at BHRUT in the last two years.  

 

Maternity HDU was staffed by midwives and trained nurses. This meant there had only been one admission needed to the hospital’s main intensive care unit so far this year. There had also been fewer post partum hysterectomies needed so far this year.

 

Maternity triage was open 24 hours a  ...  view the full minutes text for item 31.

32.

NHS 111

A representative of the NHS 111 service provider will summarise the key features of the NHS 111 service in Outer North East London.

Minutes:

It was explained that the service provider for NHS 111 as well as of the out of hours GP service for ONEL and Essex was PELC – the Partnership of East London Cooperatives. PELC also operated GP walk-in centres at King George and Whipps Cross Hospitals.

 

The NHS 111 service allowed easier access to urgent care and access to on-site advisers for complex care issues. Ambulances could be dispatched if the telephone assessment deemed this to be necessary and the NHS 111 software had an automated link to the NHS 111 service. NHS 111 would otherwise give a time frame and clinical outcomes to e.g. see a patient’s GP within three working days.

 

NHS 111 used the NHS Pathways system that had been developed by GPs and other clinicians.  Around 30% of calls received were transferred to clinical advisers such as nurses or paramedics if they were thought to be sufficiently complex. Nationally, there were around 500,000 calls to NHS 111 each month.

 

The service used a directory of services that listed all NHS services within England. NHS 111 could was also able to send patient details electronically. Training for health advisers on the services lasted for five weeks including a two weeks initial course that was required to be passed. Ongoing training and support was also available. Updates were added to the system for new issues such as the Ebola outbreak.

 

As regards clinical governance, NHS 111 met on a monthly basis with commissioners and also with patient representatives. Feedback was received via surveys and end to audits with patients. All complaints and incidents were also logged. There had been approximately 21,000 calls to NHS 111 from the ONEL area in December 2014. Around 62% of calls were referred to primary care thought it was accepted that access for patients to GPs remained a problem.

 

The directory of services used by NHS 111 allowed the identification for commissioners of gaps in services and it was felt that NHS 111 had made the NHS as a whole more cost effective. NHS 111 had its dashboard that it used for performance indicators.

 

If calls were referred incorrectly, this was fed back to NHS 111 by the services concerned on occasions but did not always happen. The profile of a service could also be changed on the directory of services if necessary. NHS 111 was keen to receive more feedback on calls that had been misdirected.  Feedback could be given via the PELC website and PELC officers would supply the links to this. There were also mechanisms via the PELC website for health professionals to give feedback. PELC also worked with the local Healthwatch organisations for example in planning resilience. NHS 111 also conducted their own patient surveys.

 

The response time target for the service was to answer 95% of calls within 60 seconds. This indicator had hit 97% over the Christmas period. Targets to limit the number of abandoned calls were also being met. It was noted that around 40% of  ...  view the full minutes text for item 32.

33.

URGENT CARE PROCUREMENT

To receive an update from commissioners on the Urgent Care Procurement Programme.  

Minutes:

The chief operating officer of Havering CCG explained that the four local CCGs were working together to reprocure urgent care. This covered non - A & E services  such as NHS 111, walk-in centres (other than at Barking Hospital) and urgent care centres. The CCGs were keen to engage with patients and the public on this process and had identified key elements for the public such as quick assessments by doctors and good transfer of patient records.

 

The reprocurement process was currently at the stage of ‘competitive dialogue’ and it was planned to award the contract for urgent care services at the end of June 2015. The new service was hoped to start in September 2015.

 

Outline solutions from bidders were currently being evaluated further engagement sessions with patients and the public were being planned. Officers were happy to give an update on the position at the next meeting of the Committee.  

 

Sessions were planned whereby each of the bidders could hold discussions with patient and public engagement representatives. These would not be open session due to the confidential nature of the procurement process.

 

The Committee NOTED the update.

34.

URGENT BUSINESS

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

Minutes:

There was no urgent business raised.