Decision details

The Committee welcomed Dr Nick Losseff, Medical Director for the Barnet, Enfield and Haringey (BEH) Clinical Strategy, Siobhan Harrington, BEH Programme Director, and Fiona Smith, Director of Operations at Barnet and Chase Farm Hospitals NHS Trust who delivered a presentation on the BEH Clinical Strategy.

Dr Losseff advised the Committee that the BEH Clinical Strategy was a quality and safety programme which would improve standards across Barnet, Chase Farm and North Middlesex hospitals.  Members were advised that Chase Farm hospital would not be closing, adding that a large majority of patients would continue to be treated there.  The Committee were advised that the following services would continue to be provided: planned elective surgery (disaggregated from emergency surgery), outpatients, paediatrics and older people assessment units, blood tests, x-ray and pre and post-natal services.  Chase Farm would have an urgent care centre, with accident and emergency services provided from Barnet Hospital.  Responding to a question, it was clarified that the following services would be transferred from the Chase Farm site: maternity deliveries, accident and emergency, paediatric inpatients and complex operations.  The greater specialisation on planned care at Chase Farm would ensure greater efficiency and less likelihood of cancelled appointments.  The Committee noted that as part of the Clinical Strategy, modelling had been undertaken to assess where the 7,090 accident and emergency patients at Chase Farm would be disbursed to.  It was expected that patients would present at the following hospitals for services instead: Princess Alexandra Harlow, Barnet, North Middlesex and West / North Hertfordshire.  

The Committee were advised that staff consultation on the proposed changes were currently taking place, along with deep dives into clinical workstreams to ensure services were fit for purpose.  The BEH Clinical Strategy Programme Office had been working with NHS England in advance of presenting the final proposals to the Barnet, Enfield and Haringey Clinical Commissioning Groups in September, with implementation taking place in November.

As part of a drive to ensure that patients presented in the correct setting, an urgent care pilot was taking place at Barnet Hospital which was seeking to reduce the 30% of people presenting at accident and emergency incorrectly.  As part of the pilot, audits would be undertaken to assess presentations at accident and emergency and urgent care.  Members were advised that reception areas for accident and emergency and the urgent care centre receptions were now co-located.  Patients would be triaged by staff when they presented at reception and would be referred to accident and emergency or the urgent care centre as appropriate.  It was noted that as part of the pilot, extended GP cover would be provided a peak times to manage demand.  The Committee noted that Barnet Hospital had missed the 95% target for seeing accident and emergency patients within four hours, with current performance at 86%.  Members were informed that this was chiefly on account of the current building works to expand the unit which were scheduled to complete in August 2013.  Fiona Smith acknowledged the issue and emphasised that the pilot scheme was seeking to address this issue.         

The Committee referred to an article in the local media which alleged that a patient an accident and emergency patient at Barnet Hospital had not been seen for 16 hours.  Fiona Smith identified that delays could be attributed to the different assessment phases that needed to be completed.  She added that redesigned pathways and reconfigured services would mean that patients had a much quicker referral to a specialist that would have previously been the case. 

Members commented that accident and emergency presentations could often be attributed to a lack of availability of GPs and noted that a whole systems approach was required to reduce admissions.  The Committee expressed support for the Clinical Strategy and emphasised the importance of effective communications with patients regarding service reconfigurations.  They were advised that an extensive marketing campaign was being planned and that there had already been a bus campaign about the maternity changes.  

In relation to delayed discharge, Fiona Smith reported that there were some systems issues which were being discussed with Barnet and Enfield Clinical Commissioning Groups and social care services which were seeking to reduce the length of stays and ensure that the right staff were in place to support the end of placements.   

The Adults and Communities Director, Dawn Wakeling, updated the Committee on social care services at Barnet and Chase Farm Hospitals.  Members were advised that social care teams from Barnet, Enfield and Hertfordshire were based at the hospital sites, adding Barnet social care has a good track record with hospital discharges.  Members noted that there were approximately 117 discharges per month and during the last 16 months, there had only been 14 delayed discharges from Barnet and Chase Farm hospitals which were attributable to social care delays.  Dawn Wakeling reported that there had been no delayed discharges from the Royal Free Hospital this year and advised the Committee that social services would learn from experiences and apply these practices in Barnet and Chase Farm hospitals. 

RESOLVEDthat:-

1.            The Committee note the update on the implementation of the Barnet, Enfield and Haringey Clinical Strategy as set out in the presentation and as referred to above.

2.            The Committee receive a further update on the Barnet, Enfield and Haringey Clinical Strategy at the next meeting on 4 October 2013.

3.            The Committee receive an update on delayed discharges and the ongoing work of social care services, clinical commissioning groups and NHS trusts as part of the report on Health and Social Care Integration at the next meeting of the Committee on 4 October 2013.