Agenda and minutes

To confirm that all items marked Part 1 will be considered in public and that any items marked Part 2 will be considered in private

RESOLVED:  That all items be considered in public.

Councillor John Hensley, Chairman of the Health Inequalities Working Group, introduced the Working Group’s draft final report on the effect of overcrowding on educational attainment and children’s development.  Members were advised that the Working Group had been acutely aware that the effects of overcrowding had the greatest impact on the development of children under five.  Councillor Hensley advised that his meeting with a young person whose attainment and development had been hindered by overcrowding had been very emotional.  The report looked at the existing good practice already undertaken and proposed recommendations to build on this work. 

Dr Ellis Friedman was thanked for his considerable contribution to the Working Group meetings. 

It was noted that Councillor Phoday Jarjussey, who had been a Member of the Working Group, had not agreed with recommendation 6 in the draft final report.   

RESOLVED:  That the report of the Health Inequalities Working Group be agreed and submitted to Cabinet for consideration at its meeting on 18 November 2010.

The Chairman welcomed those present to the meeting. 

Cardiovascular and Cancer Services

Mr Tom Pharaoh, Senior Project Officer at Commissioning Support for London, gave a presentation on the work that had been undertaken to develop models of care with regard to cancer and cardiovascular services across London. 

In developing the proposals for cancer services, consideration had been given to early diagnosis, common cancers/general care and rarer cancers/specialist care.  These work areas had been investigated by a project board which had received evidence and information from an expert reference group for each work area, an overarching expert reference panel, a patient panel and experts from outside of London. 

Although there were areas of excellence in London in terms of mortality for all cancers, there were significant inequalities in access and outcomes.  It was noted that later diagnosis had been a major factor in causing poorer relative survival rates.  It had been suggested that specialist surgery be centralised and that common treatments and surgery be localised where possible.  It was also suggested that organisational boundaries should not be a barrier to the strong commissioning that was required for high quality comprehensive care pathways. 

The following recommendations resulted from the work that was undertaken:

• Early diagnosis:

o Direct access to some diagnostic investigations from primary care

o Increase the uptake rates of screening programmes

o Understand and address inequalities to increase awareness and reduce late presentation

• Common cancers/general care:

o Centralisation of some surgical services and localisation of others

o Standardised best practice (day case breast surgery, laparoscopic colorectal surgery, enhanced recovery programmes to minimise lengths of stay)

o High quality, safe local delivery of chemotherapy

o Acute oncology services in emergency departments

o Complement traditional follow-up with bespoke follow-up based on survivorship model

•  Rarer cancers/specialist care:

o Concentration of some rarer cancer services beyond minimum NICE requirements to help ensure high quality experience and outcomes

o Minimum caseloads for specialist oncologists for each rarer tumour type to maintain their specialist expertise

o Consider centralised commissioning of all radiotherapy (to include specialist radiotherapy) to ensure equal access to treatment for all Londoners

In developing proposals for cardiovascular services, the focus had been on emergency and complex hospital care in the following work areas: vascular surgery – surgery on veins and arteries; cardiac surgery – surgery on the heart; and cardiology – less invasive procedures on the heart.   This project had been led by a clinical expert panel for each work area and a patient panel.  It was noted that the proposals that came out of the investigation were in relation to how cardiac surgery was organised rather than where heart bypass surgery was provided. 

Suggestions for improvements included:

• Vascular surgery

o All emergency and elective complex vascular surgery should be centralised into high volume hospitals

o Local hospitals should continue to deliver the bulk of the vascular service: outpatients and diagnostics; varicose vein surgery

• Cardiac surgery

o Concentrate the expertise of surgeons and teams performing mitral valve surgery

o Improve  ...  view the full minutes text for item 15.

RESOLVED:  That the minutes of the meeting held on 14 July 2010 be agreed as a correct record. 

24 November 2010

It was noted that Councillor White would not be present at the Committee’s next meeting on 24 November 2010 and that, should he have any questions in advance of the meeting for the witnesses attending, these would be forwarded to Democratic Services. 

Children’s Self-Harm Working Group

It was agreed that the scrutiny review on children’s self-harm would focus on children/young people up to the age of 18 and vulnerable young people up to the age of 25.  It was anticipated that, although the review would primarily consider physical self-mutilation, it would also touch on other related issues such as anorexia and drug and alcohol abuse. 

A Health Visitor from Hillingdon Hospital would be invited to attend the first witness session.  Other potential witnesses included representatives from Relate, YMCA, Mind, Metropolitan Police Service, Social Services. 

Officers would contact BBC Radio 4 to establish whether it would be possible to obtain a transcript from an item on children’s self-harm that had been broadcast in the last three months. 

It was agreed that the Working Group would include Councillors O’Connor and Kemp.  The appointment of the remaining membership would be delegated to Councillor O’Connor in consultation with the Chief Whips.  The dates of the Working Group meetings would be agreed with Councillor O’Connor in advance of the Committee’s next meeting. 

RESOLVED:  That:

1. Councillor White’s apologies be noted for the meeting on 24 November 2010;
2. officers contact BBC Radio 4 to obtain a transcript of the item on children’s self-harm;
3. the appointment of the remaining membership of the Children’s Self Harm Working Group be delegated to Councillor O’Connor in consultation with the Chief Whips;
4. the dates of the Children’s Self Harm Working Group meetings be agreed with Councillor O’Connor in advance of the Committee’s next meeting; and
5. the Work Programme be agreed subject to the above amendments.