Agenda and minutes

To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on 29 April 2015.

The minutes of the meeting held on 29 April 2015 were approved as an accurate record and signed by the Chair.

Councillor Andrew Brown offered retrospective apologies for the 29 April 2015, when he had been on paternity leave.

Apologies for absence were received from Debbie Domb and Bryan Naylor.

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 is a trustee of Arthritis Research UK, an ambassador for Mencap, a non-executive director of the Royal National Orthopaedic Hospital and he has served with the Chair of the Trust Development Agency on the Court of Newcastle University.

The Committee is asked to appoint a Vice-chair for the 2015/2016 municipal year.

Councillor Vaughan stated that bi-partisan working had broken down on the key issue of health, and therefore he was nominating Councillor Hannah Barlow as Vice-chair.

Councillor Brown responded that the nomination breached the long standing convention of appointing a member of the Opposition as Vice-chair, and could be to the detriment of the PAC. Councillor Carlebach endorsed this.

RESOLVED THAT:

Councillor Hannah Barlow be appointed as Vice-chair.

The Committee is asked to agree the re-appointment of the following co-opted members:

Debbie Domb, HAFCAC

Patrick McVeigh, Action on Disability

Bryan Naylor, Age UK

RESOLVED THAT:

The following co-opted members be re-appointed for the municipal year 2015/2016:

Debbie Domb, HAFCAC

Patrick McVeigh, Action on Disability

Bryan Naylor, Age UK

This report highlights the challenges and opportunities for vulnerable young people in this borough regarding transition from Children’s Services to Adult Social Care and provides a number of options moving forward.

Councillor Vaughan commented that the report on transition from Children’s Services to Adult Services was an important item in the Administration’s manifesto. Transition should be a seamless process, led by professionals. The offer going forward should include health, education and adult social care. There should be person centred seamless provision of care for the young person and their families.

Liz Bruce introduced the report, which highlighted the challenges and opportunities for vulnerable young people in the borough regarding transition from Children’s Services to Adult Services. The new ‘Transition Service’ would provide choice and control for the young person and their family, not available in the current provision.

Should a child have a Statement of special educational needs (SEN) or an Education, Health and Care Plan (EHC), it was good practice for the planning process to begin at age 14.

Mrs Bruce stated that there was limited provision within Hammersmith & Fulham. There was a narrow interpretation of who should be supported, largely young people with learning disabilities. The report set out the scope of the service and the current transition offer. Feedback from families was not very good.

The Children and Families Act, which was enacted in September 2014, had extended the age range of eligibility for a formal assessment and support plan for Education, Health and Care needs from 0-16 to 0-25 years.

In respect of Health, young people with complex needs would transfer from specific paediatric support to their local GP at age 18.

The report set out the key imperatives to improve and develop the transition experience for young people and their families and friends.

Ian Heggs stated that the replacement of a SEN with an EHC was a big change and the joint assessment needed to be co-ordinated in a more efficient way. Young people and their families had the right of referral to a tribunal.

There was now a requirement on local authorities to provide a high quality offer of specific courses and support for young people up to the age of 25 years. There was a need to develop and expand provision for young people 16-25 years. However, the budget remained the same.

Mr Heggs noted the development of provision at Queensmill Special School specifically for young people with autism.

Mr Heggs emphasised the importance of local services and supported housing. The Council was focused on taking on board the views of young people and their families and a person centred approach. The EHC assessment would take longer, in the region of 42 hours.

Mrs Bruce stated that there remained challenges in respect of the different services not working in silos and ensuring that the planning process with young people and their families was not an administrative process.

Nandini Ganesh stated in reference to the creation of a consultative forum, that Parentsactive existed. They had not been included in any of the surveys. Mr Heggs agreed that Parentsactive should be included and this would be addressed.

Alison Farmer stated that the work of  ...  view the full minutes text for item 6.

Chelsea and Westminster Hospital NHS Foundation Trust has provided the attached report.

Professor Janice Sigsworth presented the update on Imperial College Healthcare NHS Trust’s (ICHT) implementation of the recommendations from the Francis Report. Of the 290 recommendations, some 50/60 had been applicable to ICHT.

There had been some quite fundamental changes arising from the Francis Inquiry, which had been embedded as part of the existing work streams. In addition, these  changes had been reflected in the recent CQC inspection.

In the first year, 44 actions had been completed. The report set out the four areas where ICHT wanted to do more work: feedback and learning from complaints; nurses/midwives to be in a supervisory capacity; clinical audit, mortality and efficacy of treatment; and feedback from students and trainees.

Ms Vanessa Sloane presented the update on Chelsea and Westminster Hospital NHS Foundation Trust, which set out the responses to the recommendations.

Councillor Carlebach considered that there had been a significant improvement in communications at ICHT but that there continued to be a lack of response from the executive team at Chelsea & Westminster Hospital. A response to correspondence initially sent on the 28 April in respect of a Changing Place remained outstanding, despite being chased.

Councillor Carlebach referred to the comments made by the CQC in respect of the Lead Nurse for Learning Disabilities not being  a specialist, and additional time not being allocated for this work. In addition there were issues in respect of easy to read leaflets; ‘Consent to Treatment’ leaflets not being available; and care for people with Learning Disabilities not being audited.  The web site did not name the Board Level Lead for Learning Disabilities.

Ms Sloane stated that work on the  Changing Place would begin that month and a Changing Place would be incorporated in the Accident & Emergency Department development.  

The Lead Nurse for Learning Disabilities now worked full time four days a week in this role, and was working with local police, GPs, families and the voluntary sector.

Ms Sloane stated that an IT solution was needed in respect of the patient audit and accepted the need for a patient leaflet.

300 staff had been recruited. 

There was ongoing work in respect of learning disabilities, around transition and support for young people and their families. There had been a stand at the Open Day, with families participating. Ms Sloane was the Lead Executive for Learning Disabilities

Councillor Brown queried staffing levels, the reliance on agency cover and nurse training across North West London.

Professor Sigsworth responded that ICHT currently had 170 vacancies. A senior nurse for recruitment and retention had been appointed. The Board had approved the recruitment of general nurses in Europe and neo-natal nurses in Australia, for which there was a national shortage. To encourage staff retention, rotation with other hospitals was being offered.

There were a reasonable number of nurses in training, but in North West London they were not coming through quickly enough and generally wanted to move around hospitals. 

Councillor Brown queried whether flexibility in pay was an option. Ms Sloane  ...  view the full minutes text for item 7.

Chelsea and Westminster Hospital NHS Foundation Trust has provided the attached report.

Ms Sloane stated that the overall rating for Chelsea and Westminster had been ‘Requires Improvement’, with 13 areas of outstanding practice recognised. A comprehensive action plan had been put in place including the recruitment of permanent nurses and midwives.

There were two different IT systems in the Trust, which it was planned to integrate as part of the West Middlesex acquisition.

The  Trust was working with Central North West London Trust to place mental health patients within an appropriate environment in a much shorter time.

Access to IT systems had been provided for agency staff.

24 hour senior nurse and consultant cover was being put in place.

A peer review had been undertaken to provide internal assurance and demonstrate progress since the CQC inspection. This had provided some assurance but there was still work to be done.

In addition, the Trust Development Agency had arranged an independent desktop review to gain assurance about processes.

Questions on this item were taken after the following item.

There will be an oral report on integration of Chelsea and Westminster NHSFT with West Middlesex Hospital

Ms Sloane updated on the integration of Chelsea and Westminster with West Middlesex University Hospital NHS Trust, which was expected to be completed on 1 September 2015. There had been a number of meetings with Monitor and the Trust Development Agency (TDA).

The two hospitals were working closely, and had jointly appointed three divisional nurses. Several of the Board directors had worked at or were seconded from Chelsea and Westminster.

Members registered their concerns at the lack of substantive members of staff on the Board.

Ms Sloane stated that transition monies would fund a bespoke Electronic Patient Record (EPR) system which would help drive service integration of the two hospitals, and would provide additional assurance in safety, quality and consistency of services for patients.

Ms Sloane stated that there was good staff engagement. There had been a number of engagement events with members of the public and staff and ‘constituency events’  in the boroughs. In addition, a Clinical Summit had been held in Brentford, focusing on clinical innovation to support patient care.

Both hospitals would remain as major acute hospitals, with Accident & Emergency services being provided on both sites. It was expected that specialist services would be developed in bariatric surgery, ophthalmology, orthopaedics and cardiology.

Councillor Carlebach queried a number of issues; the CQC’s concerns in respect of the security of drugs on wards; the information from recent Trust Board papers that a deficit of £7.5million was forecast for 2015/2016 and that the acquisition of the West Middlesex was important in ensuring the long term financial viability of the Trust; patient safety; staff morale; and the lack of substantive board level post holders at the West Middlesex.

Ms Sloane responded that there was some low morale. There were however significant differences between the hospitals. Whilst staff at the West Middlesex tended to be local and users of the hospital, very few staff at Chelsea and Westminster lived locally. There had been a high turnover at West Middlesex, but there was currently real leadership at the Trust.

Ms Sloane stated that the financial case including the PFI was sound.

Members stated that a full report including the financial aspects was required. Ms Sloane responded that this information was available and agreed to arrange for a report to be provided.

Action: Chelsea and Westminster

Ms Sloane responded to a query that the two hospitals were six miles apart and that there was a shuttle bus.

Councillor Vaughan commented that the EPR system remedy was some time away. Ms Sloane responded that the Emergency Department had moved to ‘SystemOne’, the system used by GP practices. ‘Lastword’ was used trust wide. There remained some paper records and these were being scanned into the digital record. Approximately a quarter had currently been scanned.  A multi-disciplinary group was considering the requirements of a future system.

Councillor Holder emphasised the importance of patient involvement. Ms Sloane responded that patients were being involved, including through the constituency events. She  ...  view the full minutes text for item 9.

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

The work programme was noted. It was agreed that the following items would be included on the agenda for the next meeting:

Hammersmith & Fulham Foodbank: Update

Chelsea and Westminster Hospital acquisition of West Middlesex Hospital

GP Networks and Enhanced Opening Hours

It was agreed to add an item about mental health to the work programme.

7 July 2015

14 September 2015

4 November 2015

2 December 2015

2 February 2106

14 March 2016

18 April 2016

7 July 2015

14 September 2015

4 November 2015

2 December 2015

2 February 2106

14 March 2016

18 April 2016