Agenda and draft minutes

Joint Health Overview & Scrutiny Committee - Tuesday, 28th January, 2020 4.00 pm

Contact: Anthony Clements  Email: 01708 433065

No. Item



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 venue are attached.



Apologies for absence have been received from Ian Buckmaster, Healthwatch Havering.


Apologies were received from Councillors, Nisha Patel & Ciaran White (Havering) Stuart Bellwood (Redbridge – Hannah Chaudhry substituting) Umar Alli (Waltham Forest – Richard Sweden substituting) and Chris Pond (Essex).


Apologies were also received from co-opted members Ian Buckmaster (Healthwatch Havering) and Mike New (Healthwatch Redbridge).



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 disclosures of interest.



To agree as a correct record the minutes of the meetings held on 15 October 2019 and 6 November 2019 (attached).

Additional documents:


Subject to the clarification that Jilly Szymanski was Scrutiny Co-Ordinator at London Borough of Redbridge, the minutes of the meeting of the Committee held on 15 October 2019 were agreed as a correct record and signed by the Chairman.


The minutes of the meeting of the Committee held on 6 November 2019 were also agreed as a correct record and signed by the Chairman.



Report attached.

Additional documents:


The Committee was addressed by a member of North East London Save Our NHS (NELSON) – an umbrella organisation representing a number of NHS campaigning groups in North East London. It was noted that the Committee had not had the opportunity to scrutinise the NHS Long Term plan before the draft was submitted to NHS England on 15 November. 


The NELSON group had a number of concerns regarding the plan including a lack of information about resources available for specific plans and a lack of detail about how services could be delivered in the community. Issues such as difficulties that the elderly or people with dementia may have in accessing hospitals had also not been considered sufficiently. Other concerns raised including an apparent lack of training opportunities for staff and moves towards an integrated care provider meaning there was a risk of contracts going to private companies.


Members noted the concerns raised and agreed that there was an absence of much numerical data in the published plan.


A member of the public questioned the accuracy of data supplied in the agenda papers concerning the meeting of four hour A & E targets at Queens and King George Hospitals. BHRUT officers responded that the emergency departments at the two hospitals were different and could not be directly compared. It was accepted that there was significant room for improvement in performance in this area and that data could also be presented with more context around it. Admission rates from A & E had lowered recently which was an improvement in performance.


It was agreed that a draft policy on public speaking would be presented at the next for meeting for discussion.


A representative of the local CCGs explained the revised policy showed the final proposed list of procedures to be funded. A consultation exercise in May 2019 had produced around 600 responses and had resulted in the removal from the policy of a number of procedures including hip & knee replacements, elective caesarean sections and treatment for cluster headaches. Some procedures had also been added to the policy including split earlobe repair and certain procedures relating to skin pigmentation issues.


The policy had commenced in November 2019 and would be subject to six monthly reviews which would take into account any updates in National Institute for Clinical Excellence Guidance. Exceptional clinical need cases would still be funded and this would be decided by a panel including clinicians, Council representatives and members of the public. Each case would be taken on its merits with for example a condition affecting a patient’s ability to work likely to be considered as exceptional clinical need. Whilst private providers would be expected to adhere to the same policy as local NHS Trusts, it was accepted that there was nothing to stop clinicians offering such procedures on a private basis.   


It was agreed that an update on how the new policy had been operating should be brought to the Committee in approximately 9 months time.






Previous correspondence from Healthwatch Redbridge to BHRUT attached. Healthwatch Redbridge officers will update on the latest position.


The Committee was addressed by a Redbridge residents whose husband was receiving chemotherapy and undergone a very poor experience with lengthy delays at when attending A & E at Queen’s Hospital. Whilst certain staff and aspects of care were praised, the ‘red card’ system to give priority at triage to chemotherapy patients had not worked in this case.


A representative of Healthwatch Barking & Dagenham thanked the resident for relating her experiences and explained that the three local Healthwatch organisations had made recommendations to BHRUT on cancer services but had been unhappy with the response from the Trust and had made further comments to BHRUT. The formal written response received from the Trust had not yet been discussed by the Trust.


The Chairman agreed that the Healthwatch review of cancer services requested by the Committee had identified the issue of cancer patients not being fast tracked when attending A & E. Experiences such as that related by the resident at the meeting had led Members to question whether the system was safe.


Members of the Committee had recently visited the Sunflowers chemotherapy suite at Queen’s Hospital and had agreed with the lead clinician that an audit would be carried out. Whilst specific details needed to be agreed, this was likely to cover outcomes for chemotherapy patients attending with sepsis, future demand for chemotherapy and ethnicity issues.


In response, BHRUT officers confirmed that the case related to the Committee was being taken very seriously by the Trust and the specific issues raised were currently being investigated. There had been no indications that services as a whole were unsafe and these areas had recently been inspected by the Care Quality Commission. If any similar experiences to those described by the resident were to be found, remedial action would be taken.


Members raised concerns that the ethnicity data supplied by the Trust meant that the service was not meeting the needs of the diverse population of e.g. Redbridge. BHRUT officers responded that the Trust could only treat people referred to them and that all people referred did have equal access to services. Members remained concerned that there was insufficient access for minority groups to information about Trust services. These issues could be considered via the planned audit.


In conclusion, The Chairman remained concerned at a perceived resistance at BHRUT to accepting the recommendations of outside bodies and that the Committee did wish to help the Trust.





Report attached.

Additional documents:


A programme to improve the financial position at BHRUT was under way with a target of £28m savings in the current financial year. It was anticipated that approximately half of this would be achieved on schedule. Work to reduce costs included improving the planned flow of elective procedures so that the current 50-60% use of theatres was increased to 85-90%. Achievement of this target would generate financial improvement of around £25m.


Work was also in progress to reduce outpatient activities of which the trust saw around 2,000 each day at Queen’s Hospital alone. It was felt that up to half of outpatients could be treated in other ways including by phone or in primary care. There was a target to reduce outpatient numbers at the Trust by 30% over the next three years. Reducing spend on agency staff would also save as much as £12m.


The Trust was continuing to fail to meet targets for the ‘four hour rule’ in A & E although the Trust had seen a 10.2% rise in attendances over the last year. The Trust saw up to 1,100 A & E patients per day as well as up to 200 ambulance transfers. Internal processes and systems at A & E were being reviewed although there were also space constraints on the department.


Initiatives to improve performance had included recruitment of Advanced Care Practitioners and the Red2Green system to allow clinical staff to highlight delays in patient care. A new frail elderly unit had been opened at King George Hospital to support winter pressures as well as new short stay elderly care beds. 


Referrals for hospital treatment had grown in recent years and BHRUT was working with the CCGs to better understand referral patterns. The longest waiting patients were reviewed on a twice weekly basis. Improvement work was also focussing on improving booking processes and clinic utilisation.


The Trust had struggled recently to meet targets for starting cancer treatment for some specialities within 62 days. A cancer services recovery plan was in place with a target to return the Trust to compliance by March 2020. Standards for diagnostics had been met in October & November 2019 and waiting lists, which would continue to be monitored, had reduced from 14,000 to 8,000.


Net recruitment to the Trust had increased and officers were pleased that there had been an increase in the response rate at the Trust to the NHS Staff Survey. The establishment of an Academy of Surgery had shortened the time to recruit and a senior intern programme had improved nursing retention rates.


Patient experience scores for maternity were still below target although ratings for both inpatients and the Emergency Department were both exceeding targets. Uniforms had recently been introduced for hospital volunteers and work was in progress to improve accessibility for deaf and blind patients. Changing Places toilet facilities were scheduled to be installed at both Trust hospitals.

A Care Quality Commission inspection had taken place between September and November 2019 and the Trust had been rated as good  ...  view the full minutes text for item 28.



The Joint Committee is asked to suggest any items for scrutiny at future meetings.


It was noted that further discussion of the Healthwatch cancer services report as well as an item on digital transformation of NHS services were due to be dealt with at the next meeting of the Sub-Committee. Other issues for future meetings could include primary care networks and results from the CCG survey of GP patients. Whilst the NHS Long Term Plan was due to be scrutinised at the next meeting, it was suggested that the social care aspects of the plan could also be considered.