Agenda and minutes

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

RESOLVED:  That the minutes of the meeting held on 30 September 2015 be agreed as a correct record.

RESOLVED:  That the minutes of the meeting held on 8 October 2015 be agreed as a correct record.

Dr Cherry Armstrong advised that Shaping a healthier future (SaHF), which had been launched in 2012, was an acute reconfiguration programme and formed part of a wider transformation programme.  She noted that the maternity unit at Ealing Hospital had closed in July 2015 and the neonatal unit had closed in June 2015.  No negative feedback had been received in relation to the transfer of care and 95% of respondents had advised that they would recommend or strongly recommend the service at Hillingdon Hospital.

Dr Abbas Khakoo, Medical Director at The Hillingdon Hospitals NHS Foundation Trust (THH), advised that, during the transition, there had been 15-18 local expectant mothers that had been unable to give birth in Hillingdon as out of area bookings were being made at that time (arrangements had been made for these women to have their babies in their second choice hospital).  Since then, the introduction of the Central Booking System had improved the situation and all GPs in North West London (NWL) had been briefed on the bookings protocol.  These bookings were monitored fortnightly by the SaHF Programme Board. 

Significant work had been undertaken at Hillingdon Hospital to increase capacity to match the increase in demand and, so far, progress had been positive.  Antenatal bookings were now done through the Central Booking System and antenatal and postnatal clinics were being held in the community to provide a higher quality and continuity of care for patients.  In addition to the maternity staff that had transferred from Ealing Hospital, Hillingdon had recruited 13 new midwives. 

A robust assurance process had been undertaken prior to the transfer which would have taken account of the changing demographics in the Borough.  It was noted that this transfer was the first phase of the transition which would take the number of births at Hillingdon Hospital up to 5,000.  Any further increase in the number of births at the site would require further investment. 

Since the transfer, a booklet (Giving Birth in North West London) had been produced to provide expectant parents with information about their options.  In addition, regular monthly reports were produced to identify the effect on quality and safety of the service.  Although the midwife to birth ratio had improved (1:32), work was underway to improve this further with the recruitment of additional staff anticipated to bring this down to 1:3.  Furthermore, there were now two middle grade doctors covering at night and the 12 week booking rate had also improved.  It was noted that this was still short of the 130 hours cover in obstetrics units suggested in the independent review undertaken by the Secretary of State in 2013.

The number of unbooked deliveries at Hillingdon had increased in July and August 2015.  Hillingdon Hospital had accommodated these births and it was though that this increase was an anomaly.  There had also been an increase in the rate of postpartum haemorrhage which was being closely monitored.  Dr Khakoo advised that, although the data included on page 48 of  ...  view the full minutes text for item 34.

Royal Brompton and Harefield NHS Foundation Trust (RB&H)

Mr Richard Connett, Director of Performance and Trust Secretary at RB&H, advised that the Trust's finances had been rated as 2* by Monitor (it had previously been rated as 3* or 4*) and it was planning for a £10m deficit this year.  However, at month 6 there was a £6.5m deficit against the £8.6m plan.  It was noted that the 2016/2017 tariff would be key to the Trust's future financial situation. 

With regard to improvements projects, Mr Connett advised that £6m capital investment was expected at Harefield Hospital before the end of 2016 in relation to intensive care beds and imaging.  The cost of the modular build had increased and, as such, the Trust was looking to refurbish G Floor instead. 

Members were advised that RB&H was meeting its infection targets: there had been no cases of MRSA to date and, although there had been a number of Clostridium difficile infections identified, none of these had been as a result of a lapse in care.  In addition, the Trust had met its 'time to treatment' targets in the last quarter and its 14 and 31 day cancer access targets.  However, action was being taken to identify the reasons behind the Trust not meeting its 62 day target regarding lung cancer (referrals were not always being made expediently).  To this end, Mr Connett stated that the Trust was holding an event on 30 November 2015 at Harefield Hospital to bring together clinical staff from the Trust and clinical representatives from referring centres to identify possible improvements.  In addition, radiologists from Harefield Hospital had offered to provide training to referral centres. 

It was noted that RB&H had not yet been inspected by the CQC.  As the inspection of all specialist trusts would need to be completed by 30 June 2016, an inspection of the Trust was likely to be announced in the near future. 

Ms Joy Godden, Director of Nursing and Clinical Governance at RB&H, advised that the Trust looked at serious incidents in great detail and would forward further details to the Democratic Services Manager for circulation to the Committee.  It was noted that there tended not to be particular recurring issues and that the Trust focussed on training and the safety culture.  Members requested that each trust provide the Committee with 3/6 monthly updates in relation to serious incidents. 

The Hillingdon Hospitals NHS Foundation Trust (THH)

Mr Shane DeGaris, THH Chief Executive, advised that, although there was a £1.1m deficit at the end of quarter 2 (Q2), the Trust was looking to achieve a financial breakeven this year in the face of increased demand.  As type 1 A&E attendances had increased by 3% to date over 2014, the Trust had not met its Q2 four hour A&E target and was working with Hillingdon Clinical Commissioning Group (HCCG) to identify the reasons for this increase when other Trusts were experiencing decreases.  A review of A&E  ...  view the full minutes text for item 35.

Consideration was given to the draft final report of the Working Group's review into alcohol related A&E admissions amongst those aged under 18.  The Committee noted that, although the subject matter of the review did not involve huge number of young people, it was still a serious issue. 

Dr Steve Hajioff, the Council's Director of Public Health, advised that Ms Sharon Daye, Consultant in Public Health, had already made some progress with regard to this issue which, it was anticipated, would add value to the process.  The Working Group was congratulated for addressing the important issue of alcohol abuse which impacted on the NHS. 

RESOLVED:  That the Working Group report be presented to Cabinet for consideration at its meeting on 17 December 2015.

Consideration was given to the Committee's Work Programme.  It was agreed that the following additional items be considered at the next meeting scheduled for 12 January 2016:

·         HCCG provide the Committee with further information in relation to levels of postpartum haemorrhage and puerperal sepsis in Hillingdon in comparison to neighbouring boroughs;

·         HCCG provide the Committee with detailed information in relation to the services in Hillingdon that had been affected by SaHF over the last two years, how successful they had been and whether they had created capacity and/or delivered savings;

·         HCCG provide the Committee with revenue and capital costs associated with SaHF and further information in relation to the impact on budgets and financial savings;

·         CNWL provide the Committee with further information in relation to adult and child mental health services; and   

·         HCCG provide the Committee with a primary care co-commissioning update.

Members agreed the GP Pressures scoping report and it was noted that the Working Group would comprise Councillors Chapman, East, Edwards, Lakhmana and Riley.

RESOLVED:  That:

1.    the GP Pressures scoping report and the Working Group membership be agreed; and

2.    the Work Programme, as amended, be agreed.