Agenda and minutes

Apologies for absence were received from Councillor Ian Edwards.  Councillor Peter Davis was present as a substitute.

Members were advised that the Committee's response to the London Ambulance Service Quality Account report 2013/2014 had been submitted on 23 June 2014. 

With regard to the reviews being undertaken by the Committee during this municipal year, Members were advised that the scoping reports were in the process of being drafted.  These would be included on the agenda for consideration by the Committee at its meeting on 18 September 2014.

Although Members had requested that they receive an update on developments relating to Shaping a healthier future at the meeting on 15 July 2014, this item had been moved to 18 November 2014.  The Committee would instead be receiving an update on the proposal to withdraw the walk in service at Hayes Town Medical Centre. 

It was noted that Councillor Michael Markham's apologies had been omitted from the minutes of the last meeting. 

RESOLVED:  That, subject to the amendment detailed above, the minutes of the meeting held on 18 June 2014 be agreed.

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

The Chairman welcomed those present to the meeting.  He advised that he and Councillors Corthorne and Edwards had recently met with representatives from the Hillingdon Clinical Commissioning Group (CCG) and North West London Commissioning Support Unit (NWL CSU) in relation to the proposal to allow the contract for the walk-in service at the Hayes Town Medical Centre (HTMC) to lapse when the contract ended at the end of September.  The walk in service at HTMC had originally been provided with a view to reducing the number of Accident and Emergency (A&E) attendances.  However, during the period that it had been open, attendance at A&E had increased, with a slow decline noted recently in attendances at the Walk in service.  As such, there was no evidence to suggest that the walk in provision was fulfilling a service need. 

Dr Ian Goodman, Chair of the Hillingdon CCG, advised that the HTMC had been established in 2009 on a fixed term contract and that 8k patients had registered with the GP surgery since it opened.  The proposal to withdraw the walk in service from HTMC (and the 12 week consultation exercise associated with this proposal) had been discussed with Members at the External Services Scrutiny Committee meeting on 17 July 2012.  Since the consultation had ended, there had been significant changes to the provision of health services including introduction of the 111 service and a new 24/7 Urgent Care Centre at the front of Hillingdon A&E.

Members were advised that, although NHS England (NHSE) was responsible for the adequate provision of primary care services (including the GP surgery at HTMC), the walk in service at HTMC was the CCGs responsibility.  It was noted that the contract for the walk in service at HTMC was due to expire on 30 September 2014.  Dr Goodman was clear that there were no proposals to close the GP surgery at HTMC and that an enhanced contract for this service was currently being negotiated by NHSE to include extended opening. 

It was noted that the patients who experienced the most difficulty with regard to access were not the ones that were using the walk in facility at HTMC.  The patients using the walk in service tended to be younger, had access to vehicles, were from Hayes and were already registered with the GP surgery at the Centre.  The most common reason for attendance at the walk in were respiratory problems (mainly coughs and colds) followed by rashes, UTIs and medication issues. 

The CCG had looked at the impact of the withdrawal of walk in services elsewhere.  Dr Goodman advised that the withdrawal in Hounslow had resulted in only 10% of the patients previously seen by the walk in service going to the UCC.  Erring on the side of caution, Hillingdon CCG had planned for 20% (which would equate to approximately 10 additional patients being seen by the UCC per day).  It was noted that capacity at the UCC would easily be able to absorb this  ...  view the full minutes text for item 13.

Central and North West London NHS Foundation Trust (CNWL)

Ms Maria O'Brien, Divisional Director of Operations at CNWL, advised that there were two main elements to the service that the organisation provided: mental health services and community physical health services.  Approximately 37% (100,000) of Hillingdon residents of all ages used one of these services in one way or another.  With regard to the Hillingdon service user demographics and the costs associated with each of the services provided in the Borough, Ms O'Brien would forward a breakdown to the Democratic Services Manager.

Members were advised that the Northwood and Pinner Rehab unit had moved to the CNWL Woodlands Centre on the Hillingdon Hospital campus in October 2013 and was now known as the Hawthorne intermediate care unit.  This move had been well received by service users and had enabled the service to be better aligned with hospital services. 

With regard to older adult mental health services, it was noted that a specialist memory service had been commissioned from CNWL in April 2013.  Although the demand for the dementia service had grown, the assessment waiting time was now 2-3 weeks.  Members were also advised that the savings made through the reduction in older adults mental health beds had been reinvested in physical and mental health services. 

It was noted that CNWL was commissioned by the Clinical Commissioning Group (CCG) to provide services for residents that would help them stay at home including the Rapid Response service which prevented unnecessary hospital admission.  These services had helped reduce the financial implications for social services.  Individuals could be referred to the Rapid Response service by their GP, A&E or LAS and referrals were monitored to track the effectiveness of the service and identify how many patients were readmitted.  A breakdown of the costs and patient numbers would be forwarded to the Democratic Services Manager for circulation to the Committee. 

A consultant-led falls clinic (providing therapy and medical support) had been established jointly with Hillingdon Hospital in 2013 as part of work to enable early and safe discharge from hospital to home.  Funding for this clinic had been secured for the next year.  

CNWL itself was committed to making planned savings and was looking at the implementation of technology to improve processes and reduce administration which would then free up resources that could be invested in front line services. 

Hillingdon Child and Adolescent Mental Health Services (CAMHS) provided community mental health services to children and young people up to the age of 18.  It was noted that the types of difficulties dealt with by CNWL were predominantly what would be described as Tier 3 (complex and severe) CAMHS services, with a limited service provided at Tier 2 (mild/moderate) due to resourcing issues.  Tier 4 services were provided by a number of providers that were commissioned by NHS England (NHSE). 

It was recognised that there had been a number of commissioning gaps in the CAMHS service provided in the Borough.  Ms O'Brien advised that work  ...  view the full minutes text for item 14.

Consideration was given to the Committee's Work Programme for 2014/2015.  As there had been a new directive requiring local authorities to meet a 26 week timescale for adoptions, an additional meeting would be set up to scrutinise the issue and review potential external barriers that might hinder their progression through the Family Court.  Members agreed that Lord Justice James Munby be contacted and that a meeting be scheduled around his availability.

Members were keen to ensure that they received regular statistical information and analysis from the local Trusts in relation to outcomes, costs and numbers of patients.  The Democratic Services Manager would contact each organisation to request that this information was provided.

It was noted that, although mention had been made during the meeting about the air quality health implications, the health challenges presented by Heathrow in terms of foreign nationals being unwell when they arrived at the airport.  Members agreed that this was an issue about which they would like further information at a future meeting. 

RESOLVED:  That:

1.    the Democratic Services Manager contact Lord Justice Munby to organise an additional Committee meeting to review potential external barriers that hinder the progression of adoptions through the Family Court;

2.    the Democratic Services Manager request that each Trust provide the Committee with regular statistical information;

3.    further information be sought at a future meeting in relation to the health challenges presented by foreign nationals being unwell when they arrived Heathrow airport; and 

4.    the amended Work Programme be noted.