Agenda and minutes

Apologies for absence had been received from Councillor Ali Milani. 

There were no declarations of interest in matters coming before this meeting.

RESOLVED:  That all items of business be considered in public.

RESOLVED:  That the minutes of the meeting held on 23 March 2021 be agreed as a correct record. 

The Chairman welcomed those present to the meeting.  Ms Jessamy Kinghorn, Head of Partnerships and Engagement at NHS England (NHSE) and NHS Improvement (NHSI) – East of England, advised that she had continued to work on plans following the independent clinical review of cancer services at Mount Vernon Cancer Centre (MVCC) that had been undertaken in 2019.

The MVCC review programme had been paused in 2020 to enable clinical and operational teams to focus on responding to the pandemic.  Following this pause, several key pieces of work had been undertaken with a medium to long term focus. 

It was noted that patients attending MVCC came from a wide geographical area which included: Herts Valley CCG (28%), East and North Herts CCG (16%), Hillingdon CCG (14%), Harrow CCG (9%), Bedfordshire CCG (6%), Buckinghamshire CCG (6%), Luton CCG (5%), Brent CCG (4%), East Berkshire CCG (3%), Ealing CCG (3%) and Barnet CCG (2%).  Given the large area covered, it would be important to find a solution that everyone could support.  Over the next couple of months, it would be important to identify the source of any capital funding that would be needed to implement any resultant recommendations before any consultation could be undertaken.  This would mean that consultation would only be undertaken if the funding was in place to deliver an outcome. 

If capital funding was not forthcoming from the NHS, Members queried whether private financing would be sought.  Members also asked if consideration had been given to building the cancer centre into the new Hillingdon Hospital redevelopment if full funding was not secured.  Ms Derrett advised that alternative potential sources of funding had not yet been investigated.  NHSE/I had been working closely with health colleagues (including Hillingdon Hospital) but no conversations had yet been held in relation to what would happen if full funding was not secured.  The Committee would be updated as progress was made. 

Ms Kinghorn noted that the review was not just looking at the buildings but also at the lack of acute services on the site and the inability to respond to new developments and treatments.  Staff had continued to do a good job in providing high quality treatment and ensuring patient safety, despite these conditions. 

Members were advised that two options that had been considered were: full reprovision; and reprovision with ambulatory hub.  Fewer patients were currently going to MVCC.  This had proved somewhat frustrating at times for clinicians who were having to care for patients remotely, but had also meant that there had been fewer emergency transfers to acute facilities. 

The Programme Board had met in December 2020 to consider the views and feedback already received and to discuss areas of concern around cancer outcomes and health inequalities.  As only one of the sites considered met the criteria that had been set in full, the Board recommended that work be undertaken to develop proposals for a full relocation of MVCC to the Watford Hospital site, with enhanced local access to services where possible.  For example,  ...  view the full minutes text for item 46.

Mr Jason Seez, Hillingdon Hospital Redevelopment Programme SRO, Deputy Chief Executive and Director of Strategy at The Hillingdon Hospitals NHS Foundation Trust (THH), noted that the Committee had last been provided with an update on the hospital redevelopment at its meeting on 8 September 2020. 

In terms of the process for delivering a new hospital, the Trust needed to follow the HM Treasury’s Green Book business case process to show that all options had been considered and that the best option had been progressed.  This was a three stage process: Strategic Outline Case (SOC); Outline Business Case (OBC); and Full Business Case (FBC).  The SOC had received approval from the Department of Health and Social Care (DoH&SC) and NHS England / Improvement (NHSE/I) Joint Investment Committee on 5 October 2020 (subject to conditions being met in the OBC) and the OBC was currently being worked on.  Designs were being progressed at pace and place-based work was underway with Hillingdon Health and Care Partners (HHCP) and the North West London Integrated Care System (NWL ICS).

Ms Rachel Benton, Programme Director, advised that a team had been put in place to take forward the development of the business case in partnership with the local system.  She noted that investment in new hospitals was managed centrally by the DoH&SC and NHSE/I jointly through the New Hospital Programme team who regularly reviewed the work undertaken on the Hillingdon Hospital development. 

A Schedule of Accommodation had been developed which mapped out the space that would be needed.  This had been discussed at length with partners such as the local authority and the GLA.  The first stage drawings (1:500) showed where the rooms would be in the new development but did not show the detail within each of those rooms (which would be included in the next stage).  It was anticipated that these design layouts would be shared with partners in late May 2021 and feedback would inform the more detailed design layouts (1:200 and 1:50). 

Dr Abbas Khakoo, Clinical Lead for the Hillingdon Hospital redevelopment, advised that the Trust’s Clinical Services Strategy had been signed off by all partners (including Social Care) in April 2020.  Although it was not anticipated that the range of services currently provided would change in the new hospital, there would be a more efficient flow of patients.  The Clinical Services Strategy looked to implement a fully integrated health and care system with a focus on prevention and strengthening primary, community and social care services.  The Strategy also focussed on collaborative working and transformation which would be delivered within the framework of HHCP.  It was anticipated that this would result in more health and social care being provided outside of the hospital setting which would result in better quality emergency and elective care being provided in hospital. 

Over the next year, work would be undertaken to strengthen the care provided by the Hillingdon neighbourhood teams.  The departments at Hillingdon Hospital were currently fragmented with a  ...  view the full minutes text for item 47.

Ms Patricia Wright advised that she had started as Chief Executive of The Hillingdon Hospitals NHS Foundation Trust (THH) in December 2020.  She had previously been Chief Executive of Hounslow and Richmond Community Healthcare Trust, Chief Executive of Kensington and Chelsea PCT and Director of Strategic Commissioning across the eight PCTs in NWL.  Ms Wright noted that, following the CQC inspection in 2015, THH had been rated overall as ‘Requires improvement’ but that the Trust had been rated as ‘Good’ in the caring domain.  Following the 2018 CQC inspection, Hillingdon Hospital had been rated overall as ‘Inadequate’ but maternity services had been rated as ‘Good’. 

The CQC and Health and Safety Executive had undertaken inspections in August/September 2020 following a Covid outbreak in July which had affected staff and found failings in relation to adequate infection prevention and control measures.  NHS England / Improvement (NHSE/I) had subsequently asked Lesley Watts to provide specialist advice to the Board and identify support for the organisation as a whole.  This work had resulted in the implementation of a comprehensive improvement plan. 

Work that was being undertaken in response to the enforcement notices included: a new changing area in A&E; new signage; work around staff protection; and risk assessments around the hospital and in relation to vulnerable staff.  Tighter controls around managing infections had been introduced at Hillingdon Hospital which had resulted the previous week in the Trust being clear of all nosocomial infections for 28 days. 

Ms Wright noted that the improvement plan needed to respond to the issues raised by the CQC but that it also needed to be aspirational.  At a service level, the Trust had been systematically looking at the key lines of enquiry identified by the CQC and picking off quick wins whilst also undertaking more focussed actions.  Staff currently had low morale and would not recommend THH as a place to work.  As such, work needed to be undertaken with staff to get them to identify ways in which their morale could be improved.  Ms Wright advised that THH had not yet requested that the CQC take off the improvement notices as it was recognised that there was still more to do to embed the improvements that had been made.  It was hoped that a lot of the issues raised in the CQC inspection report would have been addressed by September 2021. 

When the Trust had achieved Foundation Trust status in 2011, it had been aspirational.  However, there had been some long standing performance issues and issues around emergency access.  A comprehensive action plan had been put in place, action had been taken in 2018/19 and 2019/20 and big changes had been made to the leadership of the Trust. 

One of the criticisms of the 2018 CQC report had been in relation to the leadership and culture at THH.  In terms of the type of leadership that she would like to embed at the Trust, Ms Wright advised that she had trained as a pharmacist where  ...  view the full minutes text for item 48.

It was noted that the meeting on 29 April 2021 would be the last External Services Select Committee meeting of the 2020/2021 municipal year and would receive updates from health partners.  Work was underway to invite witnesses to the meeting on 16 June 2021 where Members would be reviewing the provision of children’s dental services in Borough. 

RESOLVED:  That the Work Programme be noted.