Agenda item

The Chairman invited Doctor Hannah Western, Deborah Sanders, Director of Nursing, and Tony Wright, PFI and Contracts Manager, all from the Royal Free London NHS Foundation Trust to introduce the report.

Ms. Sanders noted the Committee’s interest in 18 Week Referral to Treatment and commented that there had been performance issues in relation to this at Chase Farm Hospital.  Ms Sanders informed the Committee that work had been done to data- cleanse the waiting list.

The Committee noted that work had been on-going at the Trust in relation to national reporting and that data would be publicly available within the next fortnight.

Ms. Sanders provided the Committee with an update in relation to the Acquisition.  The Committee noted the following:

The Redevelopment of Chase Farm Hospital

• That on 12 March Enfield Council granted outline planning permission for the redevelopment, subject to signing off a section 106 agreement and a further application to deal with reserved matters later in the summer.
• That subject to approval of the final business case, the Trust expect to commence the main construction works in early 2016, with the new hospital due to open in April 2018.
• Enabling works started this April to the medical block, where various services will be relocated over the summer to enable construction of the new hospital building to begin. The services due to move include the Older Person’s Assessment Unit (OAPU) in July and the urgent care centre in August.
• A public meeting had taken place on 30 June 2015 to update the public and local stakeholders about the redevelopment.

Winter Pressures

• That pressures were being faced nationally at A&E Units.
• Barnet Hospital and the Royal Free Hospital experienced a significant increase in demand over the winter which placed considerable additional pressure on accident and emergency services.  December was particularly busy and attendances at Barnet Hospital were 13% higher in December 2014 compared with December 2013.  Pressure on A&E was further increased by Delayed Transfers of Care. 
• The Trust has commenced building work at A&E at the Royal Free site which was originally built for 60,000 attendances a year, but is being redesigned for 120,000 attendances a year.  The Trust intend to provide a full A&E service whilst building is in progress, but there is a process in place to stop work if it becomes too noisy for patients. 

Ambulance Handover Delays

• Barnet Hospital has had the highest number of ambulance conveyances in London, with high numbers coming from the West.
• The communication between different Ambulance Services does not always work effectively.
• At Barnet Hospital there were 115 ambulance journeys where there was a handover delay of 30/60 minutes or more in April and May 2015. However, these numbers were the lowest since November 2014. Delays of over an hour have been significantly reduced from an average of 27 per month between December 2014 and March 2015 to three in April and zero in May 2015. 
• That data for the Royal Free Hospital is less complete. There were seven journeys where the handover was delayed by over an hour in May 2015.

The Chairman invited Jon Dickinson, Assistant Director, Adult Social Car, to the table and requested that he provide the Committee with an update on Delayed Transfer of Care (DToC) from the point of view of the London Borough of Barnet.  Mr. Dickinson commented that there were some very good working relationships between acute hospitals and Barnet Council.  Mr. Dickinson expressed the need to meet the challenge of Delayed Transfer of Care and noted that the London Borough of Barnet provided a seven day social care service across both hospital sites. 

Mr. Dickinson informed the Committee that, comparing the month of March over the last three years, Adult Social Care received 168 (2013) / 216 (2014) / 265 (2015) referrals from Barnet & Chase Farm acute hospitals. The Committee noted that this correlated with the rise in admissions of older people with complex needs who require community support.

The Committee noted that the Adults and Communities Delivery Unit were seeing a significant staffing challenge in order to meet demand. 

Referring to Appendix A of the report, Mr. Dickinson noted that on 11 June 2015, the Trust had reported a total of 113 patients who were medically fit but whose transfer had either been formally delayed (DToC) or were medically fit but still in process.  Mr. Dickinson informed the Committee that 36 of these 113 people were recorded as a delayed transfer of care, with 10 of these from Barnet, with 14 from Herts Valley, 5 from Haringey, 3 from Enfield, and 1 from East and North Herts NHS Trust, Brent, Camden and ‘other’ areas. The Committee noted that, of these 10 in Barnet, only 3 were attributed to delays in Adult Social Care. 

The Committee noted that the London Borough of Barnet is working closely with colleagues to reduce DToC but that it is a challenging issue.  Mr. Dickinson commented on the importance of dealing with complex needs in a dignified way and noted that did mean that occasionally more time was needed to ensure that the needs of a patient were met properly. 

The Chairman asked Mr. Dickinson if he knew whether there were any particular care homes with Barnet who were slow at reassessing residents waiting to return from hospital.    Mr. Dickinson replied that this could be an issue and, if it was, the Council would communicate the need for faster responses to these homes.

A Member commented on turnover delays and questioned if the Trust was able to provide any statistics on the proportion of ambulances coming into the Trust from the London Ambulance Service.  The Royal Free London NHS Foundation Trust undertook to see if there was any available information on this matter that could be provided to Members.

Referring to the report, the Chairman noted that a recent Citizens Advice Bureau survey of 900,000 people found that 18-34 year olds are more than twice as likely to attend emergency departments or walk-in centres as those aged 55 and over and that they are far less likely than older people to see a GP when they need to.  The Chairman questioned if more action was needed to reduce the number of people attending A&E when there are more suitable care pathways.

A Member commented on the large amount of regeneration that was taking place in the Kings Cross area of London which was attracting a young, mobile demographic and questioned if it would be possible for the Committee to see the age profile of people attending A&E at the Royal Free site.  Officers from the Royal Free London NHS Foundation Trust undertook to provide this information if available. 

Responding to a question from a Member on the number of beds there will be at the redeveloped Chase Farm Hospital site, Ms. Sanders informed the Committee a lot of work had been done on modelling for an appropriate number.

A Member expressed concern that the site approved for the redevelopment is too small for the growth of population that will occur in the area.  Ms. Sanders undertook to pass the Member’s comments onto colleagues.   

The Vice Chairman noted that when the Committee had considered the Trust’s Quality Account at their meeting in May, the Committee had requested to be provided with the available data for Barnet and Chase Farm Hospitals on the 62 day wait target for cancer diagnosis.  The Vice Chairman noted that the Committee had received further information and commented that, to be effective, treatment for cancer needed to be sooner than 18 weeks.  The Vice Chairman requested that the Trust provide further information on performance in relation to the 62 day wait.  Responding to this question, Ms. Sanders informed the Committee that the Trust had had particular issues with diagnostics tests for urology, but a plan was in place to address this and that the current trajectory indicated that the Trust should return to compliance by December.  The Vice Chairman commented that compliance was not good enough and that Britain performs poorly compared to the rest of Europe on Cancer treatment. 

The Chairman asked whether Barnet Hospital was now using the “Forget-Me-Not” scheme for dementia patients instead of the “Butterfly” scheme so that it was consistent with the Royal Free London NHS Foundation Trust.  The reply was affirmative. 

The Chairman invited Mr. Tony Wright, PFI and Contracts Manager, to provide the Committee with an update in relation to the new parking scheme at Barnet Hospital.  The Committee noted the following update:

• That after a visit to the site by Councillor Alison Cornelius and Councillor Laurie Williams and a review with Disability Barnet, a complete signage review had been undertaken.  
• That the Committee could be e-mailed the draft signage plan later in the week to review.
• That the Trust would be changing the signage for the front of the hospital to give people who were driving in more information. 

The Chairman questioned if Members would be able to provide feedback on the draft plan.  Mr. Wright advised the Committee that he would be able to send the plan to the Committee the following day, allowing Members of the Committee to make suggestions on the plan.

Following a question from a Member, Mr. Wright undertook to provide information to the Committee denoting if there had been a fall in the number of parking tickets being given at the hospital.  The Committee noted that the number of parking tickets being disputed by motorists is less than 1%. 

Mr. Wright extended an invitation to Members of the Committee to visit the site at Barnet Hospital in advance of providing feedback on the draft parking plan. 

RESOLVED that:-

1.            The Committee request that the Trust provide further information on performance in relation to the 62 day wait.

2.            The Committee request to be provided with information on the age profile of patients attending A&E at the Royal Free site.

3.            The Committee note the update from the Royal Free London NHS Foundation Trust.