Agenda and minutes

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health and Adult Social Care PAC held on 20 July 2022; and

(b)   To note the outstanding actions.

resolved

That the minutes of the meeting held on 20 July were agreed.

Apologies for absence were received from Councillor Patricia Quigley and Roy Margolis.

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.

None.

This report from Imperial College Healthcare NHS Trust provides an update on Western Eye Hospital and ophthalmology services and a planned £9m building project with additional operating capacity to help tackle the waiting list backlog created by the Covid-19 pandemic.

Councillor Natalia Perez introduced this item by way of reference to the Council’s focus on co-production and the importance of listening to residents voice whose contributions were welcomed and evidenced an inclusive approach.

Prof. Tim Orchard provided a short presentation identifying key highlights from the report.   Historically, the Western Eye hospital had been situated on Marylebone Road in its current building since 1930.  The building was not ideal for delivering 21^st century healthcare and a redevelopment of the facility had been considered for many years.  Imperial as an acute hospital trust was included within the “40 hospitals” development programme but it was recognised that this could not form the entirety of a viable and holistic solution for service delivery at Western Eye, going forward.

Western Eye had coped extremely well in delivering general ophthalmic and tertiary services given the condition of the estate.  Reflecting on the national register of outcomes for, for example, cataract surgeries, the output of the two eye centres based at Central Middlesex and Western Eye, placed them generally first and second, respectively, with the results at Western Eye being particularly impressive having cleared the backlog of cases that had accumulated during the pandemic.  Independent experts had evaluated the site and highlighted concerns about fire safety, precipitating a decision to close it.  Some services had been relocated to other floors and Charing Cross hospital.  Currently, there were no patients who were waiting longer than two years for treatment, and about a 100 people waiting for a year.  In general, the waiting time for a cataracts operation was about two to three weeks but the need to expand outpatient capacity was recognised.

Prof. Orchard confirmed that £9 million in funding had been secured as part of the national Targeted Investment Fund (TIF) as capital spend for a particular project. Site work had commenced and would eventually include an additional operating theatre increasing capacity to three theatres.  Pre-assessment areas would be refurbished as would pre and post operative areas to offer improvements in the patient experience by Spring 2023.

Prof. Orchard acknowledged that the current provision of ophthalmology services in NWL was fragmented and that the variation in rates of avoidable blindness in the different NWL Boroughs was concerning. A key focus in transitioning from the pandemic was to ensure that health inequalities affecting groups with protected characteristics were eliminated. It was acknowledged that patient transport in this context was also a concern, and a potential response would be predicated on building a more responsive, sector wide ophthalmology strategy with a tailored hub and spoke model.  Including optometrists and high street opticians in a digitised network could offer enhanced diagnostic capabilities in secondary and tertiary provision.  Informing this with the patient voice was an important aspect of ensuring that service would be co-designed and help to achieve consistent standards across the system.

Bryan Naylor, a resident, commented that national and local caseloads were likely to increase the need for ophthalmology services, underpinned by improved future techniques.  As the  ...  view the full minutes text for item 4.

This report from Imperial College Healthcare NHS Trust sets out the proposal from the four acute NHS trusts in north west London to deliver routine, inpatient surgeries through an elective orthopaedic hub.

Professor Tim Orchard outlined the need for an elective orthopaedic hub that could efficiently handle a large volume of cases with clinically low complexity. A prioritised waiting list in terms of increasing deterioration of a patient’s condition was in place.  There would be capacity for treating life limiting conditions which could lead to other secondary issues.  A public consultation was ongoing, details of which had been shared with the committee and wider NWL communities.  It was important to recognise that the consultation would inform the process, to both understand and work to alleviate the integral concerns and views of the public.  Operationally, procedures would be undertaken at Central Middlesex Hospital, with follow-up treatment pathways identified locally.  Ensuring transport was a primary factor and an imaginative and sensible approach would be required.  Patients would have a choice as to where their procedures would be carried out, and not choosing the elective hub option would not result in a delay to receiving treatment.

Keith Mallinson, co-optee emphasised the importance of face to face consultations in Musculoskeletal (MSK) pathway (virtual fracture clinic for patients with acute bone injuries), with reference to two clients who had not found this approach helpful during recovery.  Professor Orchard confirmed that the MSK pathway was not one that Imperial delivered across the eight boroughs but concurred that effective triaging of patients through a video consultation was an issue.  It was acknowledged that there was variability in delivering the MSK pathway across NWL. An opportunity to address this would ensure a fully integrated pathway and would be welcomed by providers and also the council. Patient transport was fundamental to ensuring that patients were effectively triaged. It was noted that Linda Jackson was planning a letter to MSK on behalf of the council to seek clarification about this issue and how it could be resolved.

Councillor Genevieve Nwaogbe referenced page 20 of the agenda pack enquired about the use of the phrase “completely separated from Emergency Care” and used throughout the report.  The Central Middlesex hub would be used for elective orthopaedic care; however, clarification was sought about an example where a person experienced a non-life threatening accident and how they received their treatment.  Councillor Nwaogbe also sought funding information about the Trusts intention to make the most of digital and other advanced technologies, which although welcome, required significant investment.  A final comment was with regards to the travel cost and transport issues which could negatively impact some individuals and Councillor Nwaogbe asked how the Trust would overcome these.  

Councillor Lloyd-Harris sought clarification about the 4000 cases in NWL that would be treated at the hub facility and what the outcome would be for any additional capacity, once these had been resolved given the potential downtime in terms of capacity, and if these would be offered to other trusts.  Councillor Lloyd-Harris also asked if travel modelling realistically reflected accurate travel times which could vary significantly depending on traffic in a given locality.  Cross borough public transport links were not ideal,  ...  view the full minutes text for item 5.

6.1       Service update following CQC report

Dr Chris Hilton outlined the Trusts current activities in response to the recent Care Quality Commission (CQC) report which had highlighted several areas of concern.  The safety domain had moved from “requires improvement” to “inadequate”, and that the Trust “required improvement” overall.  Positive feedback had been received regarding the Mental Health Integrated Network Team (MINT), details of which were summarised in paragraph 2.6 of the report. He acknowledged the challenges faced by the Trust which had arisen from a difficult and disruptive period during the pandemic.  Dr Hilton indicated that the CQC had not highlighted any concerns that the Trust was not unaware of through its own internal governance procedures. The Trust had previously agreed to keep the committee informed of progress in addressing vacancy rates and waiting times.  Commenting on the negative impact of vacancy rates, Dr Hilton acknowledged that this had hindered the Trust’s delivery of a consistent and high quality service. The CQC report had recorded staff concerns to mitigate risks identified in clinical assessments and the committee had previously also noted the difficulties in achieving waiting time targets resulting in significant delays for patients accessing treatment. 

At the time of the CQC report, Dr Hilton reported that the Trust had decided to migrate from using two patient record systems and consolidate this into a single system which had resulted in added complexities.  In addition, there had been other issues highlighted including lone working practices, and inadequate clinical premises in Ealing and Hounslow, not H&F. Dr Hilton referred to additional information in a slide deck that had been circulated to members of the committee and officers, but these were not received in time for inclusion in the agenda papers (appendix 1). Key elements of this were the implementation of clinical controls with regards to the Trusts risk register system, better integration of business intelligence data, the successful implementation of links between operating systems, a review of standard operating procedures, the establishment of a clinical action group to undertake follow up work with patients who missed appointments to ensure co-ordinated care and simplification of the Trusts patient record system. 

It was confirmed that there were several actions that the Trust was in the process of implementing to address the areas of concern identified in the CQC report, categorised as either suggested or required, and to be in place by March 2023.  The Trust intended to work with the Health and Care Borough Partnership to help address the demand on services.  Dr Hilton thanked the council’s specialist support and independent living social care team and Sobus for their support.

Councillor Genevieve Nwaogbe referred to paragraph 2.6 of the report and enquired what immediate actions were being undertaken taken by the Trust to improve staff safety in relation to lone working, poor supervision breaks and staff feeling unsupported.  Councillor Nwaogbe asked if there were any legal consequences resulting from health and safety breaches. Co-optee Keith Mallinson commented that he welcomed the report, and  ...  view the full minutes text for item 6.

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

The committee noted that the next meeting would focus on the following items (TBC):

• Public Health Update (as per actions raised at the 20 July 2022 meeting)
• Model of Care Working Group (feedback on data analysis)
• Budget – Medium Term Financial Strategy

Wednesday, 25 January, 2023

Wednesday, 22 March, 2023

Wednesday, 25 January 2023.