Agenda and minutes

The Chairman noted minor amendments in the body of the minute text.

RESOLVED that subject to the amendments made at the meeting, the minutes of the meeting of 7 July 2014 were agreed as a correct record. 

None.

The Chairman declared a non-pecuniary interest by virtue of being a Chaplains’ Assistant at Barnet and Chase Farm Hospital.

Councillor Caroline Stock declared a non-pecuniary interest in relation to Agenda Item 10 (Royal Free London NHS Foundation Trust: Update Report Upon the Acquisition of Barnet and Chase Farm Hospitals NHS Trust) and Agenda Item 11 (Royal Free London NHS Foundation Trust: Accident and Emergency Winter Preparations) by virtue of her husband being a Governor at the Royal Free London NHS Foundation Trust.

Councillor Barry Rawlings declared a non-pecuniary interest in relation to Agenda Item 12 (Healthwatch Barnet Enter and View Report) by virtue of the fact that he works for the host organisation of Healthwatch Barnet, CommUnity Barnet.

Councillor Arjun Mittra declared a non-pecuniary interest in relation to Agenda Item 11 (GP Services at Finchley Memorial Hospital) by virtue of being a patient of one of the practices mentioned in the report.

Councillor Phillip Cohen declared a non-pecuniary interest in relation to Agenda Item 11 (GP Services at Finchley Memorial Hospital) by virtue of being a patient of one of the practices mentioned in the report.

None.

None.

RESOLVED that the Committee note the minutes of the North Central Sector London Joint Health Overview and Scrutiny Committee meeting of 19 September 2014.

At the invitation of the Chairman, Councillor Trevethan introduced her Member’s Item.

A Member commented that it would be useful for the Committee to be provided with the following available information from NHS England, as set out in the report:

The current data related to unfilled GP posts in Barnet and their plans to ensure Barnet residents:

a) can register with a local GP

b) are able to obtain a speedy consultation when requested

c) are assured that there will be sufficient GPs to cope with extra demand

d) are assured that plans are in place to ensure increased GP coverage takes account of the expected varied rise in population in different parts of the borough

Please also provide data broken down by constituency and ward as follows:

e) the current GP shortfall, missed targets on appointments and any gaps in cover.

A Member suggested that the available information be requested and circulated electronically to the Committee, allowing the Committee to consider if they wish to receive a full report at a future meeting. 

RESOLVED that:-

1)    The Committee note the Member’s Item;

2)    The Committee request that available information, as set out above, is requested from NHS England and is circulated to the Committee electronically. 

The Chairman introduced the report which provided the Committee with an update from the London Ambulance Service NHS Trust covering the following:

·         The staffing position and delivery of performance of the Trust.

·         An overview of activities taken to improve response times through better staffing levels.

·         Staffing matters.

·         How the Trust is modernising to improve the care delivered to patients.

·         How the Trust is educating people to use appropriate care pathways

The Chairman invited Paul Gates, the Deputy Director of Operations at the London Ambulance Service NHS Foundation Trust to the table.

Mr. Gates advised the Committee that in Barnet the Trust had seen a 7% increase in the number of category A (most seriously ill and injured) calls responded to, when comparing the period 1^st April to 26^th September of both 2013 and 2014.  The number of calls from 1 April to 26 September 2014 was 8129, an increase from 7602 for the same period in 2013. The Committee noted that the delivery of the Category A target of 75% within 8 minutes was a significant challenge for the service in Barnet and the Trust as a whole.

The Committee noted that North Central London had had 21 members of staff leave within the period April to September 2014 and that of those 21, 19 were Paramedics. The Committee noted that the attrition rate had improved significantly from the same period last year when 56 staff had left.

Mr. Gates advised the Committee that London was one of the busiest Ambulance Areas, with the utilisation rate of London at 80 – 95% compared to that nationally of 60-65%.

Responding to a question from a Member, Mr. Gates advised the Committee that the term “Category A” referred to the most dangerously affected patients and could include for example cardiac arrest or difficult breathing. 

A Member questioned if the number of staff leaving the Trust was to do with pay and questioned if the Trust had lobbied the Government on the matter.  Mr. Gates advised that pay was certainly an issue.    

A Member questioned if the Trust had looked overseas to recruit.  Mr. Gates advised that whilst there was a shortage of graduates in the UK, there was a surplus in Australia and New Zealand and that the Trust was looking to make links with universities in those countries.  Denmark was also mentioned as a country which had similar training to the UK and was therefore a compatible recruiting area. 

Responding to a question from a Member, Mr. Gates advised that care homes were the biggest user of ambulances. 

A Member questioned if there were still issues around keeping ambulances well equipped.  Mr. Gates advised that the Trust had a fleet plan and that there would be new ambulances.

The Chairman noted that the North Central London Joint Health Overview and Scrutiny Committee had been advised that, as well as the elderly, a large number of people aged between 29 – 35 years were using ambulances and, when questioned why  ...  view the full minutes text for item 8.

The Chairman introduced a report which provided the Committee with an update on A&E preparations for the coming winter and presented the lessons learned from last year in relation to Barnet and Chase Farm Hospital.

Deborah Sanders, the Director of Nursing at the Royal Free London NHS Foundation Trust, advised the Committee that the Trust was working closely with the Clinical Commissioning Group (CCG) and their partners for winter planning.  The Committee noted that in doing so, the Trust had looked at surge and bed modelling.  The Committee noted that the Trust had a number of different schemes in place for winter which included extending the hours of the urgent care provision, extra bed capacity at the Royal Free, as well as increasing hours for PACE and TREAT. 

Fiona Jackson, the Director of Chase Farm Hospital, advised the Committee that they were providing training for care homes and were developing links with care homes for TREAT.  Responding to a question from the Chairman, Ms. Jackson advised the Committee that care homes with the highest hospital admissions were able to access training. 

At the invitation of the Chairman, Dr. Debbie Frost, the Chairman of the Barnet Clinical Commissioning Group, came to the table.  Dr. Frost advised the Committee that the CCG was focussing on how agencies and partners could work together to avoid hospital admission where appropriate.

A Member questioned the role of carers in the community when it came to trying to reduce hospital admissions. Ms. Jackson advised that there was work to be done on working with carers when trying to reduce hospital admissions during the winter.

Responding to a question from a Member, Mr. Kim Flemming, the Director of Planning at The Royal Free London NHS Foundation Trust, advised the Committee that certain diseases were more prevalent during winter and that the demographic of an area also had an impact on Accident and Emergency.  Mr. Flemming advised the Committee of the importance of keeping people healthy at home wherever possible.   

A Member commented that Dr. Frost’s practice had been doing a piece of work on encouraging pneumonia vaccinations and questioned if this was Borough-wide.  Dr. Frost advised that it was.

The Chairman requested that the Royal Free London NHS Foundation Trust provide an update report on ambulances to the Committee at their meeting in March 2015.

RESOLVED that:-

1)    The Committee note the report

2)    The Committee request to be provided with an update report from the Royal Free London NHS Foundation Trust provide an update report on the topic of Ambulances at their meeting in March 2015.

The Chairman introduced the report which provided the Committee with an update from the Royal Free London NHS Foundation following the Acquisition of the Barnet and Chase Farm Hospitals NHS Trust.

Referring to the report, Mr. Flemming advised the Committee that one of the most important determinants of success for the acquisition was the extent to which the working relationships with partners can be improved and how those partners work together on commonly agreed priorities.  Mr. Flemming noted the importance of having strategic leadership. 

Referring to emergency flows, Mr. Flemming advised the committee that Barnet Hospital is a busy emergency and maternity hospital.  Mr. Flemming noted the significance of demographic pressures on demand.

The Chairman questioned if Mr. Flemming felt that the three hospitals were pulling together following the acquisition.  Mr. Flemming advised that it is early days for the Trust and that, as the acquisition had only been in place for about around 100 days, he would be hesitant to make any premature judgements. 

A Member referred to the cases of Clostridum Difficile attributed to each hospital, as set out in the report, and noted that the number of cases at Barnet and Chase Farm had fallen. 

A Member questioned if the Trust had received many comments on signage at Chase Farm Hospital.  Ms. Sanders advised the Committee that the hospital had considered signage recently and had put in additional signs, but did not consider that enough had been done.  The Committee noted that staff at the hospital were being encouraged to actively help people to find their way around the site.  A Member suggested that the hospital could publish a site map on their website.  A Member questioned if the hospital needed funding to improve signage on site.  The Committee noted that the hospital had received approval for a specialist consultant on signs.

A Member of the Committee asked if the Trust held any figures about the number of people accessing A&E Services in Barnet from outside the Borough.  Mr. Flemming advised the Committee that the Trust was currently looking into ways to measure the postcode area that patients came from. 

The Chairman requested that the Royal Free London Hospital NHS Foundation Trust provide the Committee with another report on the acquisition at their December meeting to cover:-

·         A financial update on the Trust as a whole a service update for Barnet hospital.

·          The Planning Application for the Chase Farm Hospital site which had been submitted to the London Borough of Enfield.

·          Dementia and Alzheimer’s training. 

RESOLVED that:-

1)    The Committee note the report

2)    The Committee request to be provided with a further update from the Royal Free London NHS Foundation Trust as set out above.

The Chairman introduced the item which contained an update report from NHS England on the proposed relocation of two GP practices within Barnet (Squires Lane and Cornwall House) to the Finchley Memorial Hospital site.

The Chairman invited Fiona Erne, the Deputy Head of Primary Care (North Central and East London) at NHS England, to the table.

Ms. Erne advised the Committee that NHS England had been working with the two practices for the last twelve months and that the issues faced in the relocation of the GP practices on site revolved around lease negotiations.  The Committee noted that in June 2014, Barnet Clinical Commissioning Group (CCG) had advised that they were unable to continue with funding and that they would take the matter to a meeting of the Barnet CCG Funding Board in August 2014.

Ms Erne advised the Committee that, upon consideration of this matter, the CCG Funding Board had advised that they were unable to provide support but that they would approach the partners in order to seek a five year arrangement.  Ms. Erne informed the Committee that she believed that this idea had been rejected. 

The Committee were informed that the CCG were now looking to use the space reserved for the GP Practices for alternative primary care purposes. 

The Chairman invited Dr. Debbie Frost, the Chair of the Barnet Clinical Commissioning Group Board, to the table.  Dr. Frost advised the Committee that the CCG was looking into the possibility of locating a “health village” on the Finchley Memorial Hospital site.

A Member of the Committee expressed concern over the length of time that it was taking for decisions to be made.  The Member also expressed concern that money that was intended for patient treatment and support could be used to fund matters arising from estate management.  Dr. Frost commented that the issue had been going on for a long time but that the CCG were keen for the project to be mobilised within the next eighteen months to two years.

Responding to a question from a Member, Dr. Frost advised that the proposals surrounding the “health village” would include GPs.

In response to a question from a Member, Ms. Erne advised the Committee there had been dialogue with Community Health Partnerships, the site landlords, to advise them that they considered it unfair to apportion costs on square footage alone, as services are consumed at different rates.  Ms. Erne also noted that NHS England had been in dialogue with Community Health Partnerships about negotiating issues such as cleaning in order to reduce costs. 

The Vice Chairman suggested that the Committee receive an update on the issue from both NHS England and Barnet CCG at their meeting in March 2015. 

The Committee noted that the Clinical Commissioning Group were working on their draft objectives for the “health village” proposal. 

A Member questioned if it would be preferable to relocate a GP into the hospital and run at a reduced loss, rather than to have the site empty.  Ms.  ...  view the full minutes text for item 11.

Julie Pal, the Chief Executive of Community Barnet, provided the Committee with an update on the activities of Healthwatch Barnet.

The Committee noted that Healthwatch Barnet had been working with the Royal Free London NHS Foundation Trust on 18 Week Referral to Treatment.

Ms. Pal advised the Committee that Healthwatch Barnet had noted concerns of patients in getting GP appointments and mentioned that it would be helpful to receive the information requested in Cllr. Trevethan’s Members’ Item from NHS England.

The Committee noted the work that Healthwatch Barnet had been undertaking in relation to reducing hospital admissions for care home patients. 

Referring to key Healthwatch activity, Ms. Pal advised the Committee that “Enter and View” visits were continuing and that a number of wards had been visited at Barnet Hospital.  Ms. Pal advised that the reports, which would come to a future meeting of the Committee, would cover the availability of hot food at breakfast time and protected mealtimes.

The Committee noted that the “Enter and View” team had undertaken a training session for volunteers who are involved in mental health visits.

A Member of the Committee noted that it would be helpful to have a report appended to that of Healthwatch to enable the Committee to scrutinise the report in advance.

RESOLVED that the Committee note the update from Healthwatch Barnet. 

RESOLVED that the Committee note the work programme. 

The Chairman invited Dr. Howe, the Director of Public Health at Barnet and Harrow Councils, and Councillor Helena Hart, the Chairman of the Health and Wellbeing Board, to the table.

At the request of the Chairman, Dr. Howe provided the Committee with a update on the Winter Well campaign.  The Committee noted that the Public Health team had been working with the Barnet Clinical Commissioning Group to distribute leaflets and thermometer cards.

At the invitation of the Chairman, the Committee received an update from Councillor Hart.  She advised the Committee that the Board had been dissatisfied with incomplete data on cancer screening and immunisation in Barnet and that the Health and Wellbeing Board had therefore decided to refer it to the Barnet Health Overview and Scrutiny Committee.  The Committee noted that they would be inviting NHS England to attend their next meeting.  Cllr. Hart advised that the Health Overview and Scrutiny Committee had the power to refer matters to the Secretary of State.

Cllr. Hart noted that screening was an effective tool and that a second “Get to Know Cancer” Pop Up Shop had taken place in Edgware which 1557 people had attended.  The Committee noted that 150 referrals to GPs had been made as a result of the Pop Up Shop.

A Member questioned if it would be possible to have a Pop Up Shop in Finchley.  Councillor Hart advised the Committee that there were no immediate plans to do so.  The two previous Pop up Shops had been located in shopping centres with the management of the centres assisting with finance.   Councillor Hart noted that Brent Cross would be an effective venue but that a cross-borough approach would need to be taken. 

Councillor Hart advised the Committee that the Children’s Trust Board was not continuing in its previous form and that the Board would now be meeting on a bi-annual basis at half day conference sessions to review progress on the Children and Young People’s Plan and to refresh priorities.

The Director for Public Health, Dr. Andrew Howe advised the Committee that Members should not panic about the Ebola crisis and that Barnet had been attending workshops on the matter.

RESOLVED that the Committee note the update from the Chairman of the Health and Wellbeing Board and the Director of Public Health.