Agenda and minutes

(a)  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 Monday, 17^th September 2018; and

(b)  To note the outstanding actions.

RESOLVED

That the minutes of the previous meeting be agreed as an accurate record.

There were no apologies for absence.

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 Amanda Lloyd-Harris declared an interest as a former Chair of Hammersmith and Fulham MIND.

The Committee is asked to agree the new appointment of the following co-opted member for 2018-19:

Jennifer Nightingale

The Committee considered the nomination of a new co-optee.  This was proposed by the Chair, Councillor Lucy Richardson and seconded by the Vice-Chair, Councillor Bora Kwon.

RESOLVED

That Jennifer Nightingale be appointed as a co-optee to the Committee for the municipal year 2018/19.

This report provides an overview of the work undertaken by Healthwatch; raises awareness about local health issues; and the concerns of Hammersmith and Fulham residents.

Olivia Clymer presented a brief update on current priorities, the key points of which were addressed in the report.  There were concerns around The Pembridge Hospice, about the handling of communications about the temporary closure and the way in which people had been informed of this, which had been reported to H&F CCG and the Royal Borough of Kensington and Chelsea (RBKC).  The future for the provision of services from the Royal Brompton Hospital were highlighted as of interest to the wider community.  Healthwatch had received briefings and initial observations were that that there needed to be greater consultations with specialist groups.  Healthwatch commended H&F CCG for the recent finance workshops they had facilitated, recognising that they were operating under increasingly difficult financial pressure. 

RESOLVED

That the update from Healthwatch be noted.

This report aims to outline circumstances that led to a decision to suspend all admissions into the in-patient beds of Pembridge Hospice, describe the service that is currently provided and to provide an update on the current situation.

The Chair welcomed Andrew Ridley, and Dr Joanne Medhurst, from CLCH, supported by Janet Cree.  Mr Ridley briefly explained the circumstances that had led to a decision to suspend all admissions into the in-patient beds of The Pembridge Hospice.  Staffing levels at the Hospice had been maintained and provision for day patients had continued, so it remained open in all other respects.

Co-optee Victoria Brignell asked about the wider context and whether other hospices had experienced similar difficulties.  Dr Medhurst reported that she had spoken to several other hospices in the London area, all of which had reported difficulties in recruitment.  It was confirmed that this was also a national experience.  CLCH had tried to offer improved remuneration and had made informal enquiries through medical and professional networks.  One application had been received but this had been unsuitable, and a review commissioned by the CCG.  Dr Medhurst commented that the model of care outside of London was nursing led, by contrast to the model operated at Pembridge, which was consultant led, which indicated a need for more creative solutions.  In response to a follow up question, Dr Medhurst confirmed that the issue had been escalated to the Department of Health and that she had been unaware of the recent private members bill to improve palliative care. 

Co-optee Jim Grealy commented that a member of his family had received palliative care and that this was an issue that would not be resolved quickly or easily.  It was a strain on family members to have loved ones placed in hospices located outside their boroughs.  Janet Cree confirmed that the CCG had no intention to reduce the provision of palliative care from a commissioning perspective but needed to ensure that the provision remained clinically safe.  Dr Medhurst added that the Pembridge was not just a hospice but also included day and community units. The community service aspect of the whole provision was very important.  Many people hope to end their lives peacefully, in their own homes.  The Trust had redeployed hospice staff and reconfigured services around community focused provision. 

Dr Medhurst expressed her concern about the possible loss of highly valued and skilled nursing staff, who may choose to leave the service, because of the temporary closure.  They would have to consider the clinical strategy and look at staff models.  The impact on the wider system was that patients had been transferred to St Johns and that The Pembridge was closed to new admissions.  Patients had been diverted elsewhere to minimise the number of transfers, and this was currently being managed.  Ms Cree reported that she was not aware of patients experiencing delays in care, but recognised that there had been increased flow. It was acknowledged that the demand for palliative care could be variable, which had been included in the forecast of projected need.

Co-optee Bryan Naylor enquired about the anticipated length of the temporary closure. Dr Medhurst replied that the Trust will re-advertise the New year and were working with provider  ...  view the full minutes text for item 213.

This item is to discuss a proposed joint bid for Royal Brompton Hospital by Imperial College Healthcare NHS Trust, and, Chelsea and Westminster Hospital NHS Foundation Trust.

Professor Tim Orchard briefly explained the background to the report, which had considered options at a meeting in September.  Proposals had been submitted by Kings Health partners, which proposed to move most of the services from the Royal Brompton Trust (RBH) to a site on the St Thomas hospital campus (part of Guys and St Thomas NHS Foundation Trust).  This would be an expensive proposal, involving the transfer of congenital paediatric heart surgery services.  Professor Orchard explained that the proposed joint bid (Imperial College Healthcare NHS Trust; and Chelsea and Westminster Hospital NHS Foundation Trust) would provide similar services, without moving them out of the NW London area, building on existing networks, utilising local expertise in both Imperial, and Chelsea and Westminster.  High level documents had been produced which set out how these services could be provided more efficiently.  The proposal had been submitted to NHS England, which would be meeting next week to discuss the joint bid.  Professor Orchard indicated that when they had first approached NHS England, their preferred option had been for services not to be removed from RBH, however, they would aim to work as a collective of providers, to ensure that services remained local.  Professor Orchard made the following points:

·        An adult cardio-respiratory unit on the Du Cane Road site would be established.  There was currently an empty block, available and this had been submitted as part of the proposal to NHS England.  An in-patient care facility would also have to be built;

·        New cardio service on Chelsea site;

·        National heart and lung service would become part of the Hammersmith hospital; and

·        Combined paediatric services, to maintain a unified approach.

Professor Orchard considered that this was the beginning of the process and further consideration as to how this would fit in with the options for public consultation, was required.  He was hopeful that the first response from NHS England would indicate what proposals could be consulted upon.  This would also offer an opportunity to further discuss with other providers.

Councillor Kwon asked if there was capacity at St Thomas’s to accommodate services moving from RBH and the possible impact on their reputation.  Professor Orchard explained that there would be a new build and confirmed that there would be capacity at St Thomas’s. He speculated that there would be some reputational impact on RBH services moving to another NHS trust.

Councillor Caleb-Landy asked about the possible timeline for the transfer of services and what the plans were for consulting Hammersmith & Fulham residents about the changes.  Professor Orchard confirmed that this was a significant decision and that there would be a special remit for consultation, which was complex.  As most of work at RBH was commissioned by NHS England, there needed to be a mechanism for the whole the service to be consulted on.  It was critical to get the right input. 

In a response to a question from a member of the public, Professor Orchard confirmed that co-operation between Imperial, Chelsea and Westminster and St Thomas’s  ...  view the full minutes text for item 214.

This paper from Hammersmith and Fulham CCG looks at the urgent care and out of hours primary care provision in the borough and makes proposals about the hours of those services. This includes the case for change, the current usage of the two urgent care centres and the out of hours services as well as the public and stakeholder engagement to date and plans for consultation.

Councillor Richardson welcomed Janet Cree, Dr James Cavanagh, Rory Hegarty and Vanessa Andreae, who would jointly speak to the report.  Ms Cree explained that that the report outlined primary care and urgent care centre (UCC) proposed changes.  It also addressed the implementation of digital plans, the offer of increased choice, responding to patients to match demand.  Ms Cree referred to details in the report about UCC, focusing on Hammersmith Care Centre, where just under 8% of usage occurred between midnight and 8am.  Commonly, five people attended the centre overnight, most of whom were discharged without further treatment.  Routine data indicated that around six patients would be discharged, and one transferred to A&E.  Clinically, only two patients per night were treated.  There was no proposal to change the UCC at Charing Cross Hospital.

In H&F, 765 additional GP appointments were currently commissioned weekly through two schemes, extended hours and weekend plus.  Demand was met across the 29 practices in total; 19 practices were locally commissioned and 5 delivered in accordance with the national criteria.  The CCG had met with NHS London Clinical Senate on 20 November 2018, and had outlined proposals and presented the clinical data that they hoped to consult upon. The Clinical Senate had sought further details about the transfer of patients to Charing Cross and about how consultation would take place.  The Clinical Senate had confirmed that the proposals were clinically safe, compared to the current model, and that changes would not impact on the provision of primary care services.  Chapter 5 set out an overview of the consultation and presented feedback, responding to some of the questions raised. 

ACTION: CCG to provide information about patient transfers to Charing Cross, and, how the consultation would take place.  CCG to forward this information to the Strategic Director of ASC and PSR.

Lisa Redfern expressed concern, and contextualised the impact of the proposed changes on residents.  The commentary provided, in her view, a complex and inadequate narrative and appeared to be trying to achieve too much, in a short period.  The intention to reduce services and, simultaneously introduce changes, was hugely challenging and would have a major impact. Ms Redfern recognised that there was logic in the proposals for reducing UCC services, but there was no compelling argument for the parallel reduction in GP out of hours provision.  This, together with the reduction in practice hubs, held little logic.  The introduction of digital based services such as GP at Hand, was also difficult to understand.  Drawing a comparison with mobile banking services, Ms Redfern cautioned that the CCG were trying to phase in a significant change over a short timeframe, against a backdrop of additional, significant primary care service variations. The process also failed to recognise that while part of the population would be able to adapt, other groups would need longer to adjust.  Any consultation questions would need to be set in this context.  A final concern was the fact that these reductions in services had all  ...  view the full minutes text for item 215.

This paper provides a briefing to the Committee on the 2018/19 financial position of the Hammersmith and Fulham Clinical Commissioning Group.

The Committee had requested a report from the CCG setting out the current financial position.  It provided detailed information about months 6 and 7, 2018/19.  The paper had also been presented to the governing body of the CCG.  This set out how the CCG would manage its financial recovery, and targets for expenditure reduction.  Ms Cree confirmed that they had not had notice of funding for 2019/20, and, any impact from the implementation of NHS long term plans would not be known until after Brexit.

The aim for the 2018/19 plan was to deliver reduction, and targets were factored to allow for any slippage. The H&F CCG allocation had remained either the same or had been cut and historically, had been overallocated.  The month 6 position indicated a release of all the reserves available to the CCG and it was likely that by the end of the financial year, there would be a £5 million overspend.  Ms Cree confirmed that she had received an assurance that NHS England would help mitigate.

Ms Redfern referred to section 6.3 of the report, page 86. The cuts being proposed were brutal and not clearly discernible from the report. The report did not offer a clear narrative about the local priorities.  It was critical that a local commentary should clearly explain the proposals, and that this should be set out strategically.  Ms Redfern stated that it was incumbent upon the CCG to clearly set out the detail, which was absent from the scenario outlined in page 86. 

Ms Redfern pointed out that that there was a critical piece of information that was missing, and referred to a letter that had been sent to the Council by the CCG, which had advised that £1.25 million was being withheld from the Council. This would impact on services delivered through Adult Social Care. Ms Redfern challenged the legality of this, given that there was no formal notice given of the decision to withhold funds, and that the issue had not been discussed by the Health and Wellbeing Board.          

RESOLVED

That the meeting be extended by a further thirty minutes.

Councillor Kwon asked what the risk was of driving up demand for services across the Borough; what was the cost of making cuts and whether these were sustainable. Ms Cree referred to section 6.3 of the report, and explained that the proposals will be used as a basis for the review, which would then be followed by an impact equalities assessment.  The detail was absent from the report as this had not yet been determined. Ms Cree said that there was a framework that would be followed and it was confirmed that some services might be downgraded and rationalised, and that non-statutory duties would cease.

Mr Grealy expressed disappointment that the CCG was unable to provide a list of services to be discussed and the impact of reducing these.  Section 6.3 referred to only statutory provision.  It was clear that all planned investment would stop and funding  ...  view the full minutes text for item 216.

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

The Committee considered the Work Programme and noted that an additional meeting had been included in mid-January. 

RESOLVED

That the Work Programme be noted.

Tuesday 15 January 2018 (additional meeting date)

Monday, 11 February 2019

Tuesday, 26 March 2019

The next meeting of the Committee was noted as Tuesday, 15 January 2019.