Agenda and minutes

The Chairman introduced the minutes of the last meeting and noted that at that meeting, the Committee had considered a report on health tourism.  The Committee noted that they had subsequently requested to be provided with the final amount invoiced to non-British patients for the financial year of 2015 – 2016.  She mentioned that the figures provided by the Royal Free London NHS Foundation Trust had been circulated to the Committee that afternoon and that the data had be broken down into:

1.     What had been invoiced: £2,347,219

2.     What had been paid: £508,447

3.     If the payment had been received, was it i) on the spot or ii) afterwards:   no figure received

The Chairman expressed shock at the huge amount of nearly £2 million relating to outstanding invoices.  The Committee had requested a further report on health tourism from the Royal Free London NHS Foundation Trust to be bought to their meeting in either July or October 2016.

The Chairman commented that the Governance Service had arranged a site visit at the Barnet, Enfield and Haringey Mental Health Trust.  The Chairman noted that one Member who had expressed an interest was unable to make the agreed date and requested that the Governance Service see if another date was available to accommodate all Members wishing to attend.

The Chairman noted that, following consideration of The Annual Report of the Director of Public Health, the Committee had requested to be provided with additional information regarding the provision of psychological therapies within Barnet.  The Chairman advised that this information had been circulated to Committee Members via e-mail on 10 May 2016.

Referring to the issue of car parking at Barnet Hospital, the Chairman informed the Committee that she had attended a site visit with Councillor Stock and Councillor Zinken, who is on the Board of Governors at the Royal Free, and had made some suggestions to the Officer in attendance about urgently increasing the number of parking spaces. 

RESOLVED that the minutes of the meeting dated 8 February 2016 be agreed as a correct record.

None.

Councillor Caroline Stock declared a non-pecuniary interest in relation to Agenda Item 9 (NHS Trust Quality Accounts) by virtue of her husband being an Elected Public Governor of the Council of Governors at the Royal Free London NHS Foundation Trust.

None.

None.

The Chairman paid tribute to Amy Trevethan, who had resigned as a Councillor and had previously been a Member of the Health Overview and Scrutiny Committee.  The Chairman noted the work and contribution of former Councillor Amy Trevethan on the Committee.  The Chairman noted that she had been in correspondence with Ms. Trevethan regarding the report scheduled on the agenda on Children’s Mental Health and Eating Disorders, which had arisen as a result of a Member’s Item in Councillor Trevethan’s name.

The Chairman informed the Committee that she wished to bring an urgent item to the attention of the Committee following a referral from Barnet’s Health and Wellbeing Board on the issue of poor childhood immunisation rates in Barnet. 

The Chairman noted that Barnet Council’s Director of Children’s Services, the Clinical Commissioning Group Chairman and the Director of Public Health had sent a joint letter to NHS England on 1 April 2016 expressing their concern and frustration in relation to this issue but that they had not received a response.

The Chairman invited Councillor Helena Hart, Chairman of Barnet Health and Wellbeing Board (HWBB), Mr. Chris Munday, Director of Children’s Services and Dr. Andrew Howe, Director of Public Health (Barnet and Harrow Councils), to the table.

The Committee noted that the issue of immunisation rates for Barnet had previously been referred from the HWBB to the Health Overview and Scrutiny Committee in December 2014, when, at the time, NHS England had given assurance that reported childhood immunisation rates in Barnet were not an accurate reflection of immunisation uptake in the Borough.  The Committee were informed by NHS England that a Task and Finish Group had been established to ensure the transfer or immunisation data to the new data system, “System One”

The Chairman informed the Committee that when considering that item, the Committee had amended a recommendation as set out in the report considered by the Committee on the evening, as below:

Recommendation 3: That the Committee will continue to seek assurance is satisfied that appropriate governance arrangements are in place within NHS England in relation to immunisations to protect the health of people in Barnet and to this effect requests an update report in March 2015 to inform on the progress of the Task and Finish Group

The Committee noted that the above amendment was carried and became the substantive item, which was then subsequently approved by the Committee. 

The Chairman noted that on March 2015, the Committee received the requested report from NHS England on the work of the Task and Finish Group and that NHS England advised that the recent data on immunisations was more positive, although there was more work to be done around immunisations, particularly in relation to five year olds for MMR.

Councillor Helena Hart addressed the Committee.  Councillor Hart expressed her thanks to the Chairman for taking the referral as an urgent item and commented that the issue of childhood immunisations had warranted concerted action at the Health and Wellbeing Board.  The Committee noted that there had been continual low reporting rates of child immunisations and that the issue had been going on for two years. 

The Committee noted that the HWBB had a discussion on the issue at their meeting on 10 March 2016 and that they had requested a full report and action plan from NHS England.  Councillor Hart noted that the Officers from NHSE in attendance at the Health and Wellbeing Board had commented that there was no need for concern  ...  view the full minutes text for item 6.

The Chairman invited the following Officers to the table:

·                     Chris Munday – Commissioning Director for Children and Young People and Statutory Director for Children’s Services

·                      Eamann Devlin – Children and Adolescent Mental Health Services Joint Commissioning Manager (interim), Barnet CCG

·                     Dr Mark Berelowitz, Lead Clinician for the Eating Disorder Service at the Royal Free London NHS Foundation Trust

·                     Dr Andrew Howe, Director of Public Health (Harrow and Barnet Councils)

·                     Ruth Ouzia, Senior Consultation Manager

The Chairman noted that the report had arisen as a result of a Member’s Item in the name of Councillor Amy Trevethan.  The Chairman commented that as Councillor Trevethan was particularly interested in this matter, she had been in touch with her following her resignation as a Councillor in order to put forward any questions on her behalf. 

Referring to the report, the Chairman noted that an allocation of £198,000 was made available to Barnet and that the decision was made to place £100,000 against development of the existing service, with the remainder being invested in Out of Hours and Crisis Care related works.  The Chairman questioned if the £100,000 was just going to crisis care, or if it would include self harm care as well.  Dr. Berelowitz informed the Committee that the £100,000 was being invested in order was to reduce waiting times. The remaining £98,000 would be used for out of hours and crisis care including suicide and self-harm.  Ms. Ruth Ouzia commented that extra recruitment was underway to appoint more specialist staff members to the existing team.

The Chairman noted that the report stated that: “As part of the Transformation Plan Barnet will roll out training for all eating disorder staff as part of the “Improving access to Psychological Therapies for children” (CYP-IAPT), provide outreach education training for eating disorders and provide telephone support for General Practitioners.”  The Chairman questioned who was included in the outreach education and whether GPs could access the telephone support line during as well as after a consultation.  Mr. Devlin informed the Committee that feedback had been obtained from many Headteachers to the effect that teachers often found it hard to have conversations with pupils or even identify the signs and symptoms of eating disorders.  The Committee noted that a training session had recently been held  so that staff would know what to do if they were worried about a child.  The Committee also noted that GPs could access the telephone line either during a consultation of afterwards. 

Mr. Devlin informed the Committee that there is less stigma than there used to be about eating disorders although stigma is a much bigger issue for boys than girls. 

The Committee noted that The Royal Free London CAMHS eating disorder service covered the five North Central London Boroughs plus the London Borough of Brent.  The Committee noted that Brent did not commission the Royal Free Hospital’s “intensive service” but they buy-in when they need to. 

The Committee commented that the Psychiatry reviews that were being undertaken by service being very  ...  view the full minutes text for item 7.

The Chairman introduced the report, which provided the Committee with an update on the North West London, Barnet and Brent Wheelchair Service redesign. 

The Chairman invited Garrett Turbett, Senior Business Planning & Commissioning Manager (Interim) at Barnet CCG, to the table.

Mr. Turbett informed the Committee that following the award of the contract to ADM Healthcare, the contract was now moving into mobilisation.  The Committee noted that the service re-design had involved service users, clinical advisors and the independent standards body for disability equipment and wheelchair services. 

The Committee noted the focus on getting the service right going forwards and also, on getting the right equipment at the right time for the user.  The Committee noted that the successful bidder, ADM Healthcare can provide a “Chair in a Day” which can be modified on the spot to make it suitable for the user.

The Committee noted that the contract would also include a breakdown service, so, if a user was out at any time with an issue, for example a puncture, the provider would provide a breakdown service for rescue at no extra charge. 

Mr. Turbett informed the Committee that the contract would go live on 1 July 2016 and that the project was on track. 

The Vice Chairman questioned the timescale for the delivery of the “Chair in a Day”.  Mr Turbett informed the Committee that it would vary because for example, motorised chairs will have a schedule of maintenance and that it wouldn’t be necessary for all service users to be provided with a new chair. 

A Member commented that there could be improvements in technology in future years and questioned if there would be money to pay for it, rather than bulk buying and having to use the same equipment for many years.  Mr. Turbett informed the Committee that the contract was for three years with the option to extend for two years, which is not too long.  Mr. Turbett also noted that it is in the provider’s interests to make sure that they are up to speed with wheelchair technology and that they work their contacts to make the best deals.

Responding to a question from a Member, Mr. Turbett informed the Committee that whilst you might expect a contract to be awarded on the basis of 70% importance on quality and 30% on financial consideration, this contract had been awarded on a basis of 90% quality, and 10% finance. 

RESOLVED that the Committee notes the contents of the report, the proposed direction of travel in relation to awarding the contract to the new provider and the required timescales. 

The Committee scrutinised the Central London Community Healthcare NHS Trust’s Quality Account 2015-16 and wish to put on record the following comments:

·         The Committee were pleased to note that CLCH had appointed Angela Greatley OBE as their new Board Chair and that they were currently recruiting a new Chief Executive. 

·         The Committee congratulated the Trust on being ranked ‘Outstanding’ in the first annual ‘Learning from Mistakes’ league which was published in March 2016 and noted that the Trust is one of only eighteen providers in the country that has achieved this ranking in one of the latest quality initiatives launched by NHS Improvement.

·         The Committee noted that when scrutinising a previous Quality Account, they had requested a response to the patient stories.  The Committee were pleased to note that this had been done in this year’s Quality Account under the heading of “Learning from the Story”.

·         The Committee congratulated the Trust on their “good” rating from the CQC.

·         The Committee welcomed Quality Priority 1 – Positive Patient Experience, Preventing Harm – Developing a Quality Alert Process for Stakeholders.  The Committee were pleased to note that the Trust would develop a mechanism by which clinicians in other organisations will be able to quickly alert CLCH to issues within their service.  The Committee noted that a secure e-mail system would be established to assist with this.  

However:

·         The Committee had expressed their concerns about pressure ulcers to the Trust during the consideration of last year’s Quality Account.  The Committee noted that CLCH was a large Trust, with patients being treated across many areas, both at home and on wards.  The Committee welcomed the new initiative on pressure ulcers which would involve input from nurses and healthcare providers. 

·         The Committee also expressed concern that there were several areas in which CLCH was failing to hit its KPIs in relation to pressure ulcers and that that there was a lack of a specific section on pressure ulcers within the Quality Account.  The Committee noted that the issue of pressure ulcers was an area of concern for the Trust and welcomed the re-launch of another pressure ulcer working group and making pressure ulcers part of staff appraisals.

·         The Committee commented that Graph 17, which showed the proportion of patients who did not have pressure ulcers could be clearer and that it did not match the Key Performance Indicator.

·         The Committee noted that there had been complaints about staff communication which the Trust felt could be down to waiting times at Walk in Centres. 

·         The Committee noted that in October and November 2015, the number of complaints the Trust received had spiked.  The Committee noted that the Trust believed this was down to the onset of the winter season and requested to be provided with further information on this. 

·         The Committee expressed concern at the staff survey results showing the percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months.  The Committee noted that the score for 2015 was 24%,  ...  view the full minutes text for item 9.

At the invitation of the Chairman, Councillor Philip Cohen introduced his Member’s Item on Community Pharmacies.  Councillor Cohen outlined the rationale to his Member’s Item, which included the following points:

·         “The Government wants to reduce total funding for pharmacies amounting to £170 million as part of what it calls ‘efficiency savings’ which is essentially the contribution to the austerity drive in the economy. At the same time it wants to streamline the prescribing system by increasing online ordering of prescriptions and ‘click and collect’ systems as well as home delivery. Other reforms proposed  are to locate more pharmacists in GP practices and other settings like care homes.

·         It seems clear to me (Councillor Cohen) that will be the effect of the cuts ie many smaller pharmacies will face closure. At this point I want to refer to the views of an expert, ie a community pharmacist, Brian Isaacs, who is manager of the Brand Russell Pharmacy in East Barnet Village, in my ward. We have discussed this issue and he wishes to make the following comments:

“The government wants to reduce the number of pharmacies by attrition by reducing their basic establishment payments and their reimbursement costs, thus the weakest go to the wall. That is not the way to reduce costs. The government are intent on reducing costs without appreciating the consequences. There are other ways to reduce spending for instance checking whether patients need all their repeat medication, thereby reducing waste. There are many others.”

·         Pharmacies are ideally placed to reduce the GP workload, due to easy access with no appointment, dealing with minor ailment treatments and influenza vaccinations.”

Councillor Cohen requested that the Committee consider submitting a joint response to the consultation. 

A Member commented that many people were shifting their activities online and that further efficiencies shouldn’t be opposed. 

A Member commented that they had noticed a large number of pharmacies opening up in certain areas in very close proximity to each other in certain areas and expressed concern that this was an over-supply of provision. 

Councillor Cohen expressed his concern that if pharmacists were located in GP practices the public might experience the same problems of access and appointment as they currently face seeing a GP. The Chairman noted that patients often used a GP pharmacy for a one-off prescription following a consultation but would go to a high street chemist to purchase a whole range of non-medicinal and beauty products as well as repeat prescriptions. 

The Vice Chairman noted that there had been an increase of 20% in the number of pharmacies since 2003 and that this had been much higher than the percentage increase in the population.  He considered that it would be important to scrutinise the proposals after the consultation.

Councillor Cohen informed the Committee that the purpose of his Member’s Item was to ask the Committee to:

“Express its concern that the reduction in the overall funding package for pharmacies in 2016-17 could lead to the closure of community pharmacies in  ...  view the full minutes text for item 10.

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

Councillor Hart provided the Committee with an update on the work of the Health and Wellbeing Board.  She drew the Committee’s attention to a long term item on the Board’s agenda, the Strategic Framework for Primary Care for Barnet. 

The Committee noted that proposals would be going to Barnet CCG’s Clinical Cabinet to have an Older Person’s Assessment Unit and a specific GP Practice with an emphasis on the frail elderly based at Finchley Memorial Hospital.  The Committee also noted that a permanent breast screening unit on site was now likely to go ahead.

Dr. Howe informed the Committee that both the Primary Care Strategy and the Sustainability and Transformation Plan would be significant strategies for the provision of healthcare in the Borough.

The Governance Officer in attendance noted that the Committee would receive reports on the following issues at the July 2016 meeting:

·         An update report on the utilisation of space at Finchley Memorial Hospital.

·         An update report on the work of Healthwatch Barnet

·         An update report on the Colindale Health Project

·         An update report on Ear, Nose and Throat (ENT) Adult Audiology and Wax Removal Service Redesign.

The Vice Chairman requested that it be put on record the Committee’s thanks to the Chairman for her superb chairmanship of the Committee.  The Vice Chairman noted that the Chairman always went the extra mile to keep Members of the Committee informed on health issues.

The Chairman thanked the Vice Chairman and the entire Committee for their valuable contributions to the meetings during the past year.  She also thanked the Governance Officer. 

RESOLVED that the Committee notes the Forward Work Programme.