Agenda and minutes

(i)            To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care & Social Inclusion Policy and Accountability Committee held on 20 January 2015.

(ii)           To note the outstanding actions.

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 Audit, Pensions and Standards Committee.

Councillor Carlebach declared an interest in that he is a trustee of Arthritis Research UK, the second biggest landholder on the Charing Cross site and a non-executive director of the Royal National Orthopaedic Hospital, Stanmore.

The North West London Joint Health Overview & Scrutiny committee met on 16 October 2014 and approved the terms of reference, set out as appendix 1.

On 16 December 2014, England’s Chief Inspector of Hospitals rated the services provided by Imperial College Healthcare NHS Trust (ICHT) as Requires Improvement overall,  following a Care Quality Commission (CQC) inspection in September.

The attached documents set out a summary of the findings of the CQC and the Action Plan put in place by ICHT.

The full CQC reports can be found at http://www.cqc.org.uk/provider/RYJ.

Professor Baker and Dr Krishnamoorthy presented an overview of the Care Quality Commission (CQC) inspection of Imperial College Healthcare NHS Trust (ICHT), which had taken place in September 2014.

The CQC’s new approach focused on five key questions: Is the service safe, effective, caring, responsive and well-led? Eight core services had been identified for NHS acute trusts: A&E, Medical care (including frail elderly), Surgical care (including theatres), Critical care, Maternity and family planning, Children and young people, End of Life care and Outpatients (selected).

Each service was rated on each of the five key questions and overall. There was a four point scale: Outstanding, Good, Requires Improvement and Inadequate.

The overall trust rating for ICHT was Requires Improvement. The key questions in respect of Effective and Caring had been rated as Good.

The presentation provided the individual ratings for the four hospitals (St Mary’s (SMH), Charing Cross (CXH), Hammersmith (HH) and Queen Charlotte and Chelsea, by key question and overall.

SMH urgent and emergency services had been rated as Requires Improvement with the key question ‘well-led’ being rated as Inadequate. There were issues in respect of leadership and cleanliness and infection control in the A&E department.

Outpatients and diagnostic imaging had been rated as Inadequate across the three sites.

Professor Baker commented on the rating of the five key questions:

·         ‘Safe’ had been rated as Requires Improvement, and immediate steps had been taken to improve cleanliness.

·         Clinical outcomes were generally very good, and ‘effective’ had been rated as Good.

·         There was high quality compassionate care, and ‘caring’ had been rated as Good.

·         ‘Responsiveness’ had been rated as Requires Improvement, with outpatients being the most challenging area, and specifically appointment delays and cancellations.

·         ‘Well led’ had been rated as Requires Improvement. The CQC considered that ICHT had a history of unstable leadership and was impressed with the change in leadership, although this had not yet been embedded.

The CQC was impressed with ICHT’s response to the report and the immediate action to address the issues and develop long term plans.

Professor Baker responded to Councillor Carlebach that the Western Eye Hospital provided specialist services and had not been inspected on this occasion.

Professor Baker responded to Mr Naylor that some services had not been rated in the Effective category because of a lack of evidence on which to report.

Mr McVeigh noted that at the November inspection, ICHT, despite making significant improvements since the main inspection in November, had still been rated as Requires Improvement for the Safe category.

Professor Baker confirmed that the new inspections of hospitals were significantly more rigorous. 60% of hospitals had been rated as Requires Improvement. The inspections presented evidence which gave staff more insight into how to improve services.

Councillor Chumnery queried the potential impact of the inspection, if it had been undertaken before the closure of HH A&E. Professor Baker responded that the inspections did not relate to  ...  view the full minutes text for item 54.

There will be an oral update on Accident & Emergency Waiting Times.

Dr Batten stated that whilst there had been some improvement in A&E performance, ICHT was still not achieving the national target of 95% of patients waiting four hours or less. An Action Plan was in place to systematically improve key areas in order to achieve and sustain the 95%, focusing on: the management of patients within the A&E department; the admission process; working closely with partners to streamline the discharge process so that patients could be discharged home or to supported care in the community as soon as they were ready;  moving forward the discharge time for inpatients to before the peak in A&E attendances; and delayed transfers.

Councillor Holder queried if there was any reason why SMH rates improved and CXH worsened at the time of the CQC visit. Dr Batten responded that the two departments were run separately, and the reasons for changes in performance would be different underlying causes.

Further measures to increase capacity were being put in place. At SMH, extra space was being created for more serious emergency cases by moving the UCC treatment rooms out of the middle of A&E to a new unit nearby. In addition, there were more senior staff and clinicians working until later times. Additional capacity at CXH would be in place by late February.

Councillor Chumnery queried how ICHT intended to manage seasonal trends with the current low level of resources. Dr Batten responded that the recruitment process for further additional consultants had already commenced. An action plan was in place to sustain performance. Until recently, ICHT has consistently achieved good performance of 94%. In  the last few months, there had been greater volatility of attendances and acuteness. The low spikes at CXH corresponded with the virus outbreak, at which time beds had been closed.

Councillor Barlow queried why some domains has been rated Good when targets had been missed. ICHT was unable to respond in respect of the CQC rating system.

Councillor Lukey queried whether ICHT had conveyed the problems to people in higher levels of the NHS. Dr Batten responded that ICHT felt extremely well supported by the NHS Trust Development Authority, the CCGs and NHSE.

ICHT was working with the CCGs to provide more appropriate care in more appropriate settings.

Councillor Vaughan concluded the discussion, stating that the committee welcomed the re-assurance that ICHT was working to achieve and sustain the 95% target. It would be helpful for the committee to be provided with the statistics on a monthly basis.

Action: Imperial College Healthcare NHS Trust

This report will follow.

Dr Tim Spicer updated on the current position in respect of Shaping a Healthier Future (SaHF). There was an integrated site strategy for the different ICHT sites. SMH had been designated a major hospital and major trauma centre. HH had been designated as a specialist hospital with an emergency heart attack centre and a 24/7 UCC. CXH was a local hospital, designed to meet the needs of the local population to remain independent. Services provided at CXH included; support for carers; a range of outpatient  services; a one-stop shop to reflect the fact that many patients had multiple conditions; and specialist rapid access clinics for frail and elderly people. CXH was part of an integrated approach to healthcare.

There were GP hubs in the north and south of the borough, comprising 31 practices, all working from a single IT platform.

It was expected that the Keogh Review would transform Urgent and Emergency Care in the NHS.

Workforce was an issue throughout North West London and the whole of London. A key role was the development of training to enable staff to work within hospitals and the community.

An Implementation Business Case (ImBC) collated all the outline business cases (OBC) across North West London (including eight CCGs and nine acute trusts). The ImBC would be submitted to NHSE in mid-March. The process would involve the NHS, Department of Health and the Treasury. It was believed that completion would be from 2016/2017 until 2020/2021.

Councillor Vaughan queried the details in respect of CXH, and emergency facilities in particular. Ms Parker confirmed that these details would have been included in ICHT’s business case, but this was still a draft and confidential. Dr Spicer added that the CCG would ask NHS London/NHE when the details could be revealed.  

Action: H&F Clinical Commissioning Group

Councillor Lukey stated that it was deeply frustrating that there had been no information since the Independent Review and endorsement by Jeremy Hunt. There had subsequently been timetable slippage, the CQC report and ICHT not proceeding with foundation trust status application.

Councillor Lukey queried how public money would be sought for investment in the plans. Dr Spicer responded that CCGs could not raise capital and therefore the OBCs had to be handed over to an organisation which could raise capital. Ms Parker confirmed that implementation had slipped. The different OBCs had to be reconciled to ensure that no activity had been duplicated or missed.

Dr Batten responded that ICHT had to receive a CQC rating of Good or Outstanding to proceed with its foundation trust application, after which it would take approximately 12 months to achieve. Following approval of the ImBC, each trust would have to submit a final business case providing a detailed level of planning across the sites. This was likely to take 12 months to complete. There would then be a three/four year timescale for the capital programme.

Councillor Carlebach considered that as a draft had not  ...  view the full minutes text for item 56.

The Committee is asked to consider its work programme for the remainder of the municipal year.

The work programme was received.

Wednesday 4 February 2015

Monday 9 March 2015

Monday 13 April 2015

9 March 2015

13 April 2015