Agenda item

The Chairman invited to the table:

• Will Huxter - Director of Strategy, North Central London Clinical Commissioning Groups (CCGs)

The Chairman thanked Mr Huxter for his slides, which had been circulated with the agenda, and included details of how the changes to adult elective orthopaedic services could affect Barnet.

Mr Huxter reported that the Joint Health Overview and Scrutiny Committee (JHOSC) would be invited to consider the proposals in early 2020 with a final decision to be made in the summer. The clinically-led services review had involved five Councils, Healthwatchs and residents. The two proposed models of care were outlined in the slides. Emergency orthopaedics would not change but elective orthopaedics would be delivered by two partnerships across North Central London (NCL) involving five boroughs.

Pre- and post-operative care would continue to be provided at local hospitals with in-patient services being provided at Chase Farm Hospital. For most Barnet residents there will be no change to the current provision with elective orthopaedic surgical services accessed at Barnet, Chase Farm and the Royal Free Hospitals. Patients would benefit from additional choice with the ability to access the other elective centre delivered by the partnership of UCLH and Whittington Health. There would also be ring-fenced beds and dedicated theatre space which should result in reduced waiting times and fewer cancellations.

A Member asked about the evaluation of the consultation and whether an organisation had yet been identified to carry this out. Mr Huxter responded that the process had not yet reached this stage, but this would be decided shortly.

A Member asked whether there had been a reduction in the number of procedures being cancelled as she had read that this was currently 10% of procedures. Mr Huxter responded that the aim was to virtually eliminate cancellations, but there had been no reduction yet as the changes had not happened. Often cancellations were caused by a lack of beds, particularly when emergency and elective work was carried out on the same site. Evidence from other parts of the country demonstrated that having dedicated beds for theatre worked well. The model would also help with workload and training. Currently surgeons could be called from their elective work to travel to a different site to carry out emergency work. The new rotas would have dedicated days for planned and emergency work and would also help to expose trainees to the full range of procedures. This was popular with staff who had been consulted and was more efficient overall.

Mr Huxter added that patients would only need to travel further for inpatient admissions as other services would continue to be more local. Transport had been the biggest concern raised, so the services review would make sure that there was a focus on local delivery of care as much as possible. A workshop had been held with patients and Healthwatchs to discuss transport options that could be put in place.

A Member asked what the current average waiting times were and how much they were expected to improve. Mr Huxter responded that national targets required patients to be treated within 18 weeks of referral. There was a backlog, but this should reduce with the new model. Also, it would provide guaranteed capacity which was one was of reasons for the review.

A Member asked how this model of separating elective and emergency was helpful and where the additional emergency beds came from. Mr Huxter responded that in the current model staff were taken out of the elective list when there was an emergency admission. There would be an overall increase in capacity and, despite a bed cap for elective work, a staff team dedicated to orthopaedics on the correct ward had been shown to be more efficient, even with the same number of beds. Length of stay was also known to be reduced.

A Member asked whether the demand for emergency care was predictable enough to have surgeons on standby specifically for this. Mr Huxter responded that there was some predictability, with a standard number of patients who typically need to be admitted, but sometimes this still peaked causing long waits at A&E.

A Member asked about Barnet’s relationship with the private hospitals and whether this was a higher cost service to provide. Mr Huxter responded that the national tariffs were set at the same rate for the NHS as the private sector. The NHS was preferable from the perspective of training, development and use of capacity. 8-10% of current activity was commissioned in the private sector.

The Chairman asked about the membership of the Joint Commissioning Committee which would make the final decision on the proposals. Mr Huxter responded that this had been set up when the five CCGs merged and would have lay representation, two Healthwatch Chairmen and observers from each of the five Boroughs. Mainly acute hospital services were jointly commissioned. The Director of Public Health noted that she attended the meetings as well as several elected Members.

A Member asked about the consultation phase and how patient representatives were selected. Mr Huxter responded that mostly they were sourced through Healthwatch but also through advertisements.

The Chairman thanked Mr Huxter for his presentation. She invited him to the meeting of the HOSC in May or July 2020, depending on progress, so that he could update the Committee after the consultation process had finished.

RESOLVED that the Committee noted the report.