Agenda and minutes

In introducing the minutes, the Chairman noted that the Committee had been due to receive three items from the Royal Free London NHS Foundation Trust, but the Trust had been unable to provide Officers to attend to present the reports.  The Chairman advised the Committee that it had been agreed to postpone the items until the meeting scheduled for 6 July 2015 when the representatives would be able to attend.

The Chairman provided the Committee with an update in relation to parking at Barnet Hospital and advised that she had e-mailed Tony Wright, Head of PFI and Contracts (Estates and Facilities) at the Royal Free London NHS Foundation Trust, asking for a meeting at the hospital site in an attempt to finally resolve the parking issues.  The Committee noted that the Chairman had provided Mr. Wright with photographs evidencing the height of the signs, the inadequate size of the print and the lack of leaflets explaining the new system.

RESOLVED that the minutes of the meeting date 9 February 2015 were agreed as a correct record. 

Apologies for absence were received from Councillor Philip Cohen.

Apologies for absence were received from Councillor Gabriel Rozenberg, who was substituted for by Councillor Shimon Ryde.

Apologies for absence were received from Councillor Amy Trevethan, who was substituted for by Councillor Laurie Williams. 

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

Councillor Caroline Stock declared a non-pecuniary interest by virtue of her husband being an Elected Public Governor on the Council of Governors at the Royal Free London NHS Foundation Trust. 

None.

None. 

The Chairman introduced the minutes of the North Central Sector London Joint Health Overview and Scrutiny Committee (JHOSC).  The Committee noted the following:

·         That during consideration of the Royal Free Acquisition of Barnet and Chase Farm Hospitals NHS Trust, it was reported that in the London Borough of Barnet, GPs had ceased to undertake visits to care homes.  The Chairman informed the Committee that she had expressed her surprise about this at the JHOSC and had asked for confirmation from Barnet CCG.

·         That Deborah Sanders, the Director of Nursing at the Trust had advised that there was now a designated member of staff in place to act as a liaison between the Royal Free Hospital and nursing homes.

A Member of the Committee commented that he was unclear on the timetable of communication in relation to out of hours visits at nursing homes.  

The Chairman introduced the Member’s Item in the name of Councillor Rawlings and noted that the Committee had considered a report from the Barnet Clinical Commissioning Group (CCG) on unscheduled care services at Cricklewood GP Health Centre at their meeting on 9 February 2015. 

The Chairman noted that at that meeting the Committee had unanimously requested that the CCG provide the Committee with a further report in July 2015, with further evidence, including the views expressed by the Patient Participation Group (PPG).  The Chairman suggested that the Committee wait to receive this information at the July meeting prior to making any further recommendations, especially as she had just been informed that the contract had been extended from September 2015 to December 2015. 

Councillor Rawlings agreed that if the Walk in Centre contract had been extended until December 2015, he would be prepared to receive the additional evidence at the July 2015 meeting.  Councillor Rawlings also noted that he wished to convey the message to NHS England and Barnet CCG that he considered Walk in Centres as part of the overall health economy, which needed to fit into the overall strategy for the area. 

A Member suggested that Barndoc Healthcare Ltd., who provide out of hours face to face GP services and had attended the February 2015 meeting also be invited to attend the July meeting.

RESOLVED that the Committee note the Members Item, and request to receive a further report in July 2015, as agreed by the Committee at their meeting on 9 February 2015.

The Chairman invited Joanne Murfitt, the Director of Public Health Commissioning, Health in the Justice System and Military Health, NHS England (London Region) to the table.

The Committee considered the report which provided an update on the work of a Task and Finish Group which was established by NHS England to consider the implementation of an IT system, namely “System One”.

Ms. Murfitt provided the Committee with the following update in relation to the matter:

·           All practices within Barnet are now signed up to “Quality Medical Solutions”, a service which supports commissioners by quickly providing information on primary care performance.

·           That Quarter 3 data was showing an improvement across all key groups, but that performance was still the lowest in North Central London. 

·           That NHS England were taking a proactive approach with the Child Health Information Service provider and a full review had been undertaken in December 2014. The completed action plan will be used as assurance for NHS England to enable all children’s records to be quality assured.

Responding to a question from a Member about whether the fact that GP Practices continue to perform poorly will be made public, Ms. Murfitt advised that the intention would be to work with any such practices to make improvements. 

A Member questioned if there was any work being undertaken in order to ensure that people get the necessary immunisations at the correct time.  Ms. Murfitt advised the Committee that this was an important point and that NHS England would be keen to work with the Local Authority on this matter to consider solutions to the problem such as the use of health visitors. 

Responding to a question from a Member Ms. Murfitt advised the Committee that there had been an increase in the birth rate within the Borough and that people had become complacent about immunisation against infectious diseases. 

Ms. Murfitt advised the Committee that the recent data on immunisations was more positive, but there was more work to be done around immunisation in five year olds for MMR.  The Committee noted that high mobility rates in London tended to affect the uptake rate of immunisation. 

The Committee noted that a number of organisations could potentially assist in getting people registered for immunisations, such as Children’s Centres and Health Visitors. 

A Member commented that pharmacies had been used to promote the Flu vaccine and questioned if the same approach could be used with other immunisations.  Ms. Murfitt advised the Committee that pharmacies in London had been invited to advertise the Flu vaccine and, whilst the uptake had been good, not as many people have received the vaccine as had been hoped for.

RESOLVED that the Committee note the report.  

The Chairman introduced the report, which provided the Committee with an update from NHS Property Services and NHS England in relation to the East Barnet Health Centre.

The Committee noted that on 23 March 2015 the Governance Service had received a telephone call from NHS Property Services expressing concern about the consideration of this issue during the Purdah period.  The Committee noted that the Governance Service sought legal advice on the matter and advised that they considered that there would be no legal issue concerning their attendance on the evening. 

Upon delivering this news to NHS Property Services, the Committee were advised that the Governance Service had also requested an outline of the rationale behind the proposed non-attendance and that the Governance Service did not hear back until 27 March 2015, when a joint letter from NHS Property Service and NHS England was submitted to the Chairman and the Governance Service. 

The Committee expressed their disappointment that NHS Property Service and NHS England had decided not to attend and noted that they would be invited back to Committee in July 2015 to provide a further update. 

The Chairman read a statement from Katherine Herzmark, the Practice Manager at the East Barnet Health Centre, who had sent her apologies in advance of the meeting.  The statement was as follows:

“The three practices normally based at East Barnet Health Centre have been temporarily relocated at Vale Drive Primary Care Centre since the end of June 2014. As you will be aware, works to remove asbestos containing materials overran and the intended move back date for the practices of September 2014 was delayed. The asbestos removal works caused significant cosmetic damage to the building and meant it was not feasible for the practices to return to the Health Centre in its current state.

NHS Property Services is undertaking a full refurbishment of the health centre, following consultation with the practices, the Patient Participation Group and active members of a Facebook based campaign. I understand that works have now started on site and we are in discussion with the project manager about design specifics. We have been informed that the refurbishment is scheduled for 120 working days and expect to move back to East Barnet in the Autumn of this year. We are aware that the refurbishment and reinstatement of the practices to East Barnet may involve discussions regarding contractual issues and new leases for which we are currently in the process of seeking further legal advice.

We are aware of problems that have been experienced with the telephone system while the practices have been at Vale Drive and apologise to anyone who has experienced difficulty getting through to the surgery. I am pleased to announce that the practices’ own phone system from East Barnet has now been successfully relocated to Vale Drive. This went ‘live’ on Friday 27^th March and we have noticed improvements as a result of this.

Our automatic check in screen has also been installed at Vale Drive  ...  view the full minutes text for item 9.

The Chairman introduced the report which provided the Committee with an update from NHS England and Barnet CCG on the provision of GP Services or a primary care facility at the Finchley Memorial Hospital site. 

The Committee noted that at their meeting on 20 October 2014, NHS England had provided an update on the status of negotiations of the movement of two GP services into the Finchley Memorial Site and the difficulties that had been faced in relation to the financial aspects of the move. 

Mr. David Riddle, a Member of the Barnet CCG Governing Body advised the Committee that the issue had provided an opportunity to see how the site could work more effectively.  The Committee noted that many of the decisions made about Finchley Memorial Hospital would have been made eight or nine years ago. 

Mr Riddle advised the Committee that whilst the CCG had been disappointed that their original vision had not come to fruition, they were excited about the opportunity to maximise the use of the site. 

Dr. Debbie Frost, the Chair of Barnet CCG, advised the Committee that she expected to see the GP Services / Primary Care landscape change in the future to include a seven day working week and stressed the need to maximise the use of space on site. 

Responding to a question from a Member about the possibility of replicating an Older Person’s Assessment Unit (OPAU) on site, Alan Gavurin, a consultant working on the project, advised the Committee that he hoped that an OPAU would be included. 

A Member questioned who was paying the rent for the void space on site.  Mr. Gavurin advised the Committee that the CCG was paying the rent for the space on site.

A Member questioned if it would be possible to buy the site so that the CCG did not have to continue to pay rent.  Mr. Gavurin advised that the rent arrangement had been made through a quasi-Private Finance Initiative and that it might be possible to draft a business case for the concept. 

A Member suggested that in order to increase the space available on site, the space currently used for the mezzanine could be utilised.

The Committee noted that the project was scheduled to develop a series of initial options for review in April 2015, which would then need appraisal and planning in order to work through the commissioning and costing consequences.  The Committee noted that the intention was to identify agreed options by the summer of 2015, with a view to commencing work on implementing the new models of service. 

Responding to a question from a Member, Dr. Frost advised the Committee that the concept of GPs using the building had not been ruled out and that consideration was being given as to how to most effectively use the space. 

Mr. Gavurin advised the Committee that it was the responsibility of NHS England to commission GP services and that the CCG had been working closely with NHS England to  ...  view the full minutes text for item 10.

Maria O’Dwyer, the Director of Integrated Commissioning at Barnet CCG, introduced the report which provided an outline of the current Mental Health Contracts performance and also highlighted developments for local health provision.  The report also highlighted the joint work that was being undertaken with partner organisations in the London Boroughs of Enfield and Haringey in order to deliver the Crisis Concordat Plan. 

The Committee noted that Trust Development Agency (TDA) was working with the Secretary of State for Health to determine the Dalton Review categories for all 93 NHS Trusts in England which are not Foundation Trusts and that at its meeting on 22 January 2015, the TDA outlined its intention to work with NHS Trusts to improve quality and efficiency.

The Committee noted that there are four main areas where the NHS TDA is contributing to, or leading on, implementation of proposed changes.  These are:

·           The development of new models of care in “vanguard” sites.

·           The development of a new regime to create the conditions for success in the most challenged health economies.

·           Consideration of the proposed changes to the transactions process as proposed by the Dalton Review.

·           Contributing to NHS England’s ongoing review of the system’s improvement architecture.

Ms. O’Dwyer advised the Committee that a pilot was currently being considered that would encourage more people with mental health issues to be cared for at GP level.

The Vice Chairman commented that each year the Committee considered the Barnet, Enfield and Haringey Mental Health Trust Quality Accounts and noted that the support given to GPs by the Trust was not always of the best standard and suggested that there should be a network of GPs in addition to a helpline.  Dr. Charlotte Benjamin, a Governing Body member of the Barnet CCG, advised that the advice line had been very successful.  Ms. O’Dwyer advised that there was a need to be innovative about how services were delivered.

Responding to a question from a Member, Melanie Brooks, Assistant Director for Adult Social Care, at the London Borough of Barnet advised that any Section 75 arrangements should be designed to enable closer integration of social care and mental health. 

A Member questioned if any changes would need to be made to the GP Network if the programme was to be rolled out.  Ms. O’Dwyer advised that the earlier they were able to meet the needs of a patient, then the better chance that patient would have of receiving the best support. 

RESOLVED that the Committee note the report. 

The Chairman introduced the item and noted that whilst the Committee had previously considered the Annual Report of the Director of Public Health at their last meeting, she wished the Committee to have a further opportunity to scrutinise the report.

Responding to a question from a Member, Dr. Andrew Howe, the Director of Public Health (Barnet and Harrow Councils), advised the Committee that Tuberculosis (TB) had increased in the UK over the last few years.  Dr. Howe advised that he would be providing the Barnet Health and Wellbeing Board with an update on TB figures for Barnet and that he would be happy to provide the Committee with a report on the issue in the future. 

A Member questioned if there was any evidence to link TB with spitting.  Dr. Howe advised that there was no evidence to support the hypothesis that spitting could transmit TB.   

A Member questioned the effect of antibiotics in the treatment of Tuberculosis and asked if there was a rise in the incidence of TB during the winter.  Dr. Howe advised that everyone was exposed to TB and that most people build up resistance over time but that vulnerable people, such as the homeless, were more likely to be affected by the disease. 

Responding to a question from a Member, Dr. Howe advised that it was difficult to detect if some cases of TB were being brought in from overseas due to high population mobility within the UK.

A Member questioned Dr. Howe for his view on e-cigarettes.  Dr. Howe advised the Committee that he would take a cautious view, whilst noting that initial research so far indicates that e-cigarettes could help people to give up smoking.

A Member referred to a section of the report which noted that one evidence-based intervention for the prevention of heart disease that has been effective in other countries is the regulation and taxation of sugars, salt, saturated fats and trans-fats which are concealed within processed food and sweetened drinks.  Dr. Howe advised that this concept was the moral question of the current time and that it would be useful to consider evidence on the legislative approach through taxation on reducing such health problems. 

A Member of the Committee expressed concern that there was not enough information available for elderly people in relation to Genito-Urinary Medicine. 

A Member commented that a number of reports were highlighting why it was beneficial for the responsibility of Public Health to have been transferred to the Local Authority. 

RESOLVED that:-

1)    The Committee note the report 

2)    The Committee request to be provided with a further report on Tuberculosis from the Director of Public Health (Harrow and Barnet Councils) at their meeting in July 2015.

The Chairman invited Councillor Helena Hart, the Chairman of the Barnet Health and Well-Being Board to the table.  Councillor Hart provided an update in relation to the Council’s activity on the Health and Well-Being Agenda.

Councillor Hart advised the Committee that, at their meeting on 29 January 2015, the Health and Well-Being Board had unanimously agreed to progress the development of a specific Dementia Manifesto for Barnet. 

The Committee were informed by Councillor Hart that the Royal Free London NHS Foundation Trust had been successful in obtaining approval for building works for the new Chase Farm Hospital from the London Borough of Enfield. 

Councillor Hart advised the Committee that the Health and Wellbeing Board would be taking a strategic approach to the issue of obesity and how people who wanted to lose weight could be supported. She pointed out that, as 55% of the population of Barnet was either overweight or obese, it would not be possible to provide support to everyone who wanted to lose weight but rather to concentrate on preventing people who were already severely overweight from actually becoming clinically obese.  

A Member advised that he had read a report which stated that many parents did not know that their children were overweight and questioned if any further information on the matter would be made available to the public.  Dr. Howe advised the Committee that he expected to see more information being released shortly from the Department of Health. 

A Member questioned if Officers from the Council went into schools to talk about healthy eating and exercise.  Dr. Howe noted that the Healthy Schools Programme was a step in the right direction, but that more work needed to be done.  Councillor Hart advised the Committee that she had visited a Children’s Centre in the Borough where the chef showed parents how to make inexpensive, healthy meals and that this would take place in all Children’s Centres in the Borough. 

The Chairman requested that the following items be added to the Work Programme:

·         The Liverpool Care Pathway in Hospitals

·         Dehydration in Care Homes

·         Tuberculosis

·         East Barnet Health Centre

·         GP Services / Primary Care Facility at Finchley Memorial Hospital.

RESOLVED that the Committee note the items contained within the Forward Work Programme and request to receive the reports as set out above.  

None.