Agenda and minutes

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

It was noted that requests for further information were not always being dealt with promptly.  As such, the Democratic Services Manager was asked to contact all regular witnesses accordingly.

It had been agreed that the issue of LAC offenders be reviewed at the Committee's meeting on 14 September 2017 as there were concerns about the vagueness of the information provided.  The Chairman and Labour Lead for the Corporate Parenting Board and the Children, Young People and Learning Policy Overview Committee would also be invited to attend this single meeting review.  The findings of this review would be forwarded to Cabinet in a formal report. 

Members agreed that the Committee would undertake a single meeting review of the provision of GP services in Heathrow Villages. 

RESOLVED:  That:

1.    the Democratic Services Manager contact regular witnesses to request that information requests be dealt with promptly;

2.    the Chairman and Labour Lead for the Corporate Parenting Board and the Children, Young People and Learning Policy Overview Committee be invited to take part in a single meeting review of LAC offenders;

3.    the Committee undertake a single meeting review of GP provision in Heathrow Villages; and

4.    the minutes of the meeting held on 14 June 2017 be agreed as a correct record. 

Members expressed concern that there appeared to be no good reason for NHS England's (NHSE) proposal to stop commissioning congenital heart disease (CHD) services from Royal Brompton and Harefield NHS Foundation Trust (RBH).  It was suggested that a representative from NHSE be invited to attend a meeting with the External Services Scrutiny Committee to establish the reasoning behind the proposals.  Mr Nick Hunt, Director of Service Development at Royal Brompton and Harefield NHS Foundation Trust, agreed to provide the Democratic Services Manager with the details of the most appropriate NHSE representative/s to invite to the meeting.

Mr Hunt advised that the NHSE consultation would end on 17 July 2017 and that the results would not be reported until Christmas at the earliest.  RBH had received a lot of support from, amongst others, MPs.  He noted that there had been regular personnel changes at NHSE.  It was suggested that the proposals could have arisen for a number of reasons such as: the process could not be stopped without NHSE losing face; and the possible realisation of the estate value.  Members were keen to test the assertions made in the consultation document with NHSE representatives. 

Mr Hunt stated that the Hillingdon Medical Director had highlighted the impact that closure of RBH CHD services would have on Hillingdon patients, especially those using the maternity services.  Concern was expressed that, if the RBH Paediatric Intensive Care Unit (PICU) closed, there was no capital investment available to bolster the service in other hospitals to cope with the resultant increase in demand.  It was suggested that the exercise was more about the cost of care rather than the quality of care.  Furthermore, NHSE was seemingly under the misconception that, if the proposals went ahead, RBH staff would just move to a different Trust.  The reality was that RBH staff had been recruited from all over the world and it was likely that they would return to their country of origin and the UK would lose this expertise completely.  If implemented, the proposals would be hindered by a lack of funding and would result in a lack of expertise in the remaining centres. 

Although RBH was still able to recruit medical staff, the proposals had impacted on the recruitment of nurses.  This had resulted in an increase in agency staff costs which was now being brought under control. 

Mr Hunt acknowledged that RBH did not have an in-house gastroenterologist.  However, this service was contracted with the Chelsea and Westminster Hospital NHS Foundation Trust which was located next to the Royal Brompton Hospital.  This arrangement worked seamlessly. 

Members were advised that 80% of RBH work was cardiothoracic and 20% was complex respiratory.  The proposals would result in the withdrawal of PICU and CHD services and would impact on the transplant service at Harefield Hospital.  The foetal echo service at Hillingdon Hospital would be withdrawn and the training provided for Hillingdon Hospital staff by RBH would also be damaged, resulting  ...  view the full minutes text for item 12.

The Hillingdon Hospitals NHS Foundation Trust (THH)

Mr Imran Devji, Director of Operational Performance at THH, advised that the Trust's regulators had revised its 4 hour A&E access target to 88%.  The Trust had achieved 87.5% in June 2017, missing its target by just 0.5%.  Type 1 performance (the highest acuity) was at 69.7% which was the Trust's best performance for the last 15 months.  It was noted that this target was proving to be a challenge nationally.  Type 3 patients (lowest acuity) were seen in the UCC and could be dealt with more quickly.

With regard to referral to treatment times, THH had delivered 92.2% in June 2017, meeting the 92% target for the fifth successive month.  However, it was noted that referral to treatment times for planned care (GP referrals) was not without its challenges. 

Members were advised that THH had sustained performance by achieving all cancer standards in May 2017 - the June 2017 position was awaited.  With regard to infection control, Ms Vanessa Saunders, THH's Deputy Director of Nursing and Patient Experience, noted that there had been one case of MRSA and 2 cases of C. diff in the year to date.  Root cause analyses had been undertaken and had shown that these cases had not been as a result of a lapse in care.  The C. diff cases had been linked to age and comorbidities. 

Patients were asked to respond to the Friends and Family Test (FFT) when they were discharged from hospital.  In the last year, 33,000 individuals had completed the survey and the results had reflected the challenges experienced in A&E.  The FFT included the ability to include comments (free text) and quarterly analysis of this information had shown that communication and the provision of information were recurring issues, e.g., the need to tell patients how long their wait would be. 

Mr Devji advised that the Trust's £12.9m deficit in 2016/2017 had been offset by £11.3m of accounting benefits which had then enabled THH to gain £6.8m in Sustainability and Transformation Funding (STF), thus resulting in a £5.2m reported surplus for the year.  It was noted that the realisation of accounting benefits was a short term tool to enable THH to access additional funding to offset the deficit.  As it was not something that could be routinely undertaken, Members queried how the Trust would be able to balance its accounts in 2017/2018.  Mr Devji agreed to liaise with the THH Director of Finance to establish when the Trust's planned £8.8m deficit in 2017/2018 would become a surplus.

THH was looking to improve the control of its finances to enable it to deliver on its ambitious plans and to continue to provide patients with a good level of care.  The Financial Improvement Programme (FIP) was a national programme that provided Trusts with expert financial and operational improvement skills.  Hillingdon had been selected as one of 12 Trusts that would be  ...  view the full minutes text for item 13.

Consideration was given to the Committee's Work Programme 2017/2018.  It was agreed that the next meeting of the External Services Scrutiny Committee would look at LAC offenders. 

Consideration was given to the draft comments and queries that the Democratic Services Manager had put together in response to the CQC consultation. 

With regard to the NHS England (NHSE) consultation on proposals to implement standards for congenital heart disease services for children and adults in England, it was agreed that the Committee would submit a holding response.  This response would advise that there was currently insufficient evidence available and further information was being sought to establish the rationale behind the proposals.  A full response would be submitted in due course.  The Committee expressed grave concerns about the reasoning for the review, which were not apparent. 

It was noted that there were 9 Paediatric Intensive Care Units in England and that the number of patients seen at each was not such that it could sustain the level of expertise needed in each.  It was thought that, by reducing the number of centres, the work would be concentrated and therefore increase the level of expertise at each.  It was suggested that the Director of Specialised Services at NHSE would be able to address most of the Committee's concerns and queries. 

RESOLVED:  That:

1.    LAC offending be considered at the Committee's next meeting on 14 September 2017;

2.    a holding response be submitted in relation to the NHSE consultation on proposals to implement standards for congenital heart disease services for children and adults in England; and

3.    the Work Programme be noted.