Agenda and minutes

Apologies for absence were received from Councillor Emma Apthorp, Councillor Ann Rosenberg, and Lucia Boddington.

Victoria Brignell, Jim Grealy, and Merril Hammer joined the meeting remotely.

If a Councillor has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Councillor with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter. The Councillor must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where Members of the public are not allowed to be in attendance and speak, then the Councillor with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Councillors who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Councillors are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Standards Committee.

There were no declarations of interest.

To approve the minutes of the previous meeting as an accurate record and to note any outstanding actions.

The minutes of the meeting held on 26 April 2023 were agreed as an accurate record.

Imperial College Healthcare NHS Trust will provide a verbal update about the delayed rebuilding of St Mary's Hospital and the impact on residents.

Dr Bob Klaber (Director of Strategy, Research and Innovation, Imperial College Healthcare NHS Trust) addressed the Committee and provided a verbal update about the delayed rebuilding of Charing Cross, Hammersmith, and St Mary's Hospitals and the healthcare impacts on residents.

A series of photographs showing run-down areas of St Mary’s Hospital were distributed in the meeting.

Dr Klaber told the Committee that St Mary’s Hospital currently had one ward closed and said there were constant issues across the estate making things difficult for staff and patients. The New Hospital Programme recently announced they were delaying funding for the rebuild beyond 2030, although he noted they had promised funding for a business case for the eventual rebuild.

Dr Klaber said he felt there were opportunities to move further up the list, using a combination of public money and some commercial money from land sales. The Trust calculated they needed around 40% percent of the land for the hospital. He added that Charing Cross and Hammersmith Hospitals could be rebuilt in phases, building on some of the existing good quality infrastructure and replacing the poor infrastructure.

Councillor Amanda Lloyd-Harris noted the refurbishment of Charing Cross was being delayed and asked, if groundwork started in 2024, what the completion date would be. Dr Klaber said he couldn’t give an estimate. He noted the business plan was due to be submitted in the autumn. He added that Charing Cross would be a phased rebuild. The business plan would explore how best to deliver that phasing. He said the clear steer from the programme had been that there was potential to have a significant funding envelope brought forward and the trust was doing everything they could to bring it forward. He hoped that could be done in partnership with local authorities.

Councillor Lloyd-Harris said engaging with commercial enterprises was often contentious locally and asked how the Trust planned to deal with that, and what benefits there might be for patients and staff. Dr Klaber said he understood that some people may have anxieties, but by starting with communities and population need, they were much more likely to get to the right answer. He said it was clear that there were ways to do it to create some competition in an open way, to give taxpayers confidence they were getting value for money. He said, things that kicked it into the long grass would make things worse for patients and ultimately cost more money.

Jim Grealy asked if the deteriorating condition of one of the three hospitals could have wider consequences, pushing services to other places. He also asked what the effects of delaying the necessary rebuild would have on care. Dr Klaber said the current state of the buildings was difficult for staff who wanted to deliver the highest quality care, as well as being difficult for patients. He said the impact of estate failure could have knock-on effects in all sorts of spaces. Running services at very high capacities had serious impacts. He  ...  view the full minutes text for item 4.

This briefing paper provides an update on the progress made by the programme team and seeks the Committee’s support and feedback on engaging on the new model of care before launch.

Dr Lyndsey Williams (NW London GP clinical lead for end of life and care homes) and Ian Jones (CLCH) presented the update on the progress made by the programme team since their previous presentation on 25 January 2023. She said the programme team welcomed the Committee’s feedback on engaging on the new model of care before the engagement process was officially launched.

Councillor Amanda Lloyd-Harris commented that the document was much improved from the version presented in January. She said she was glad to see the service was being extended given how it important it was for residents to be able to contact someone out of hours. Dr Williams said she hoped the new model of care put patients and those around them, and those left behind, at the centre.

Keith Mallinson welcomed the report. He noted that he had been on a panel at Trinity Hospice recently looking at end of life provision for the LGBT community. The takeaway was around how to make it more personalised. Dr Williams said the LGBTQ+ community was one of the cohorts that they had engaged with members on, and undertaken literature reviews looking at cultural sensitivities. She said she could share more of the work they had done in that area. Dr Williams said holistic assessment and being aware of cultural sensitivities was part of the underlying principle for the new model of care and said perhaps that needed to be clarified in the engagement documents.

Jim Grealy said he welcomed the extension of hours, he felt it needed to be a 24-hour service to be comprehensive. But he said the report lacked the necessary data to make judgements and felt it was too generalised. Dr Williams said the document presented to the Committee was not the complete model of care document with all the detail and data. The item on the agenda was a progress update on that work. She said it was almost finished and was scheduled to go out for engagement at the end of the month. The initial engagement would be on the ‘what’, not the ‘how’ – which would come later. The goal was to ensure they were identifying any unmet needs. She said the proposed model of care would be published at the end of the month.

Jim Grealy said he was concerned about an engagement exercise over the summer and felt many people would miss out on their chance to provide feedback. Sue Roostan acknowledged that summer was not an ideal time for the engagement and said they would look at extending the engagement period if the response rate was below expectations. Councillor Lloyd-Harris said she thought it was essential to extend the engagement period to the end of September or early October. Sue Roostan said they would consider it.

Dr Nicola Lang (Director of Public Health) discussed how important it was for the service to operate 24-7. Dr Williams said there was a 24-7 advice line and they intended for that to continue and  ...  view the full minutes text for item 5.

This item gives an overview of the post-Covid service offer in North West London.

Melissa Mellett (AD, Local Care programme, NW London ICB) presented the update on the post-Covid service offer in North West London. She noted that a new service was due to open at Charing Cross Hospital in September. The goal of the new service was to reduce the waiting list to a maximum of 6 weeks for those waiting for the acute service. The recommended approach was to move to a community first model which would mean patients were seen quickly and then referred to the Post-Covid Acute Service if necessary. She also noted the post Covid population statistics and said there was a health inequalities programme focused on ensuring those numbers represented the entire population.

Councillor Amanda Lloyd-Harris asked how they planned to actively increase GP referrals and asked why they did not believe the current figures were reflective of the community. She also asked about the impact of isolation and asked if there had been a concerted effort to see those people face-to-face as it might be better for their mental health. Melissa Mellett said some GP’s had been referring at higher rates than others, and population health reviews suggested there were inequalities. Regarding face-to-face assessments – she said triage was done by clinicians and they would try to pick the best solution, while also considering patient need.

Councillor Lloyd-Harris noted the inclusion of digital tools and resources and asked what considerations there were for people who didn’t have access to them. Melissa Mellett said it was just one aspect of the service, people could still go to their GP.

Councillor Genevieve Nwaogbe noted that 127 patient referrals were accepted but 125 were returned to their GP. Melissa Mellett said in the beginning there were significant challenges with referrals from primary care settings. The digital record had key information missing so had to be sent back, but each of those cases was carefully managed and followed back into the service.

Councillor Nwaogbe asked if there was a breakdown of those rejected for further support by ethnicity. Melissa Mellett said the figures in the briefing showed both accepted and rejected together.

Keith Mallinson noted it seemed as though older people were not coming forward and asked if the service would be working with organisations like Age Concern to encourage participation. Melissa Mellett said each borough was running different engagement activities to get underrepresented cohorts to come forward.

Jim Grealy asked how the ICS was informing the public of the condition. He had concerns that poorer people were not being referred and there could be a need going unaddressed. Melissa Mellett said they were trying to ensure information about it was made widely available.

Merril Hammer raised concerns that some people had not been taken seriously by GPs at an early stage and would be reluctant to come back now. She asked how the service planned to reach those people. Melissa Mellett said she didn’t believe GPs hadn’t taken people seriously, but rather the symptoms presented could fit into multiple categories.  ...  view the full minutes text for item 6.

To note the following dates of future meetings:

·       15 November 2023

·       31 January 2024

·       27 March 2024

The following dates of future meetings were noted:

• 15 November 2023
• 31 January 2024
• 27 March 2024