This report will follow.
Minutes:
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 been shared with the committee, the Medical Director and Chief Executive of NHS London should be formally contacted. Dr Spicer stated that substantial capital investment was required for North West London and therefore the support of NHS London was needed.
Councillor Brown queried the position in respect of the Central Middlesex Elective Surgery Centre. Ms Parker responded that ICHT would not be responsible for the PFI, responsibility would remain with the Trust. The Centre provided elective surgery for a number of trusts, providing better outcomes and safer facilities.
Councillor Brown requested clarification of the additional consultants and other staff in the A&E departments at CXH and HH.
Action: Imperial College Healthcare NHS Trust
The Chair proposed and it was agreed by the committee that the guillotine be extended to 10.15pm.
A member of the public queried the percentage of patients attending A&E compared with previous years. ICHT did not have this information.
The member of the public then commented on a recent press article in respect of telemedicine. Dr McGoldrick responded that three years previously the CCG had received funding to identify, in conjunction with ICHT, where telemedicine could be helpful. There had also been a number of national pilot sites. The evidence at that time indicated that telemedicine could be effective for patients living in more rural areas, but not so much for densely packed inner cities. There had been no consequent funding. The CCG had not seen a role for telemedicine at that point in time.
Dr Spicer responded to the member of the public’s comments in respect of reductions in A&E demand by highlighting the whole systems work which was addressing the integration of acute and community care.
Mr Naylor emphasised that A&E needed back up beds and that the residents of the borough needed to be told what would be available at CXH. Dr Spicer agreed that there would always need to be beds, but the percentage and how arranged could change. There would be more consultants in A&E for more hours. There was evidence that consultant involvement earlier in the pathway resulted in improved decisions and reduced investigations, and patients being more likely to be discharged rather than admitted. Some beds were currently blocked by people who were medically fit.
Mr McVeigh commented on the difference between the A&E figures reported on by the CQC and those provided by ICHT. Professor Sigsworth responded that the CQC inspection had been in September and they had looked at figures retrospectively, and had used a range of qualitative indicators. The graphs provided by ICHT had a quantitative basis, representing a range of service standards on which fundamental clinical decisions were made.
Councillor Chumnery referred to information which had previously been provided in response to her concerns in respect of communication of the Shaping a Healthier Future changes. Of the 257 groups listed, only 11 groups were based in Hammersmith & Fulham and had received communication in the form of leaflets. In addition, face to face meetings had been very limited.
Councillor Chumnery noted that there was a lot more work to do in respect of communication and that better communication was required going forward.
Action: H&F CCG to contact Councillor Chumnery to clarify communications.
Councillor Vaughan concluded the discussion by emphasising the committee’s frustration at the lack of a clear business case for CXH and decision making process.
Councillor Vaughan thanked H&F Clinical Commissioning Group and Imperial College Healthcare NHS Trust for attending the meeting.