Agenda and minutes

Apologies for absence had been received from Councillor Simon Arnold (Councillor Nicola Brightman was present as his substitute), Councillor Kuldeep Lakhmana (Councillor Peter Money was present as her substitute) and Councillor Ali Milani.

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

It was suggested that other Trusts could learn a lot from the good practice demonstrated by Central and North West London NHS Foundation Trust.

It was noted that there were a number of resolutions in these minutes that had not yet been actioned.  It was anticipated that further information on these would be forthcoming at the Committee’s next meeting on 9 July 2019.

RESOLVED:  That the minutes of the meeting held on 30 April 2019 be agreed as a correct record.

RESOLVED:  That the minutes of the meeting held on 1 May 2019 be agreed as a correct record. 

RECOLVED:  That the minutes of the meeting held on 9 May 2019 be agreed as a correct record.

The Chairman welcomed those present to the meeting. 

Ms Claire McDonald, Engagement and Communications Lead, Specialised Commissioning – NHS England (NHSE) London Region, noted that she had last attending a Committee meeting to talk about this issue in 2017.  Congenital Heart Disease (CHD) standards had been consulted upon and agreed by the NHSE Board in 2015.  It had been noted that the Royal Brompton Hospital had not met the standard for paediatric colocation on the Chelsea site as the other specialist children’s services required for hospitals providing children’s CHD were not located on site.  In order to meet the standards, the Royal Brompton Hospital had proposed a partnership with Guys and St Thomas’ Hospital which was compliant with the CHD standards.  The proposal had been to move all paediatric services from the Chelsea site (children’s heart surgery (including CHD and intensive care), children’s respiratory services for children with cystic fibrosis, primary ciliary dyskinesia and other conditions and children who required long term ventilation in hospital and at home) as a ‘joint venture’.

Three proposals had been identified by the following organisations:

1.    Royal Brompton Hospital and Kings Health Partners - move all services from the Royal Brompton Hospital Chelsea site to new buildings on the Guys and St Thomas’ Westminster site as part of a joint venture.  Mr Piers McCleery, Director of Strategy and Planning at Royal Brompton and Harefield NHS Foundation Trust (RBH), advised that this collaborative proposal would not just meet the CHD standards but would also improve things like the estate, rotas and opportunities to fulfil academic potential.  Collaboration would provide RBH, Guys and St Thomas’ and Kings College with the opportunity to improve.  It was anticipated that all proceeds from the sale of the Royal Brompton Hospital would be reinvested in this proposal which would develop a network of care for 15m people.  Mr Nick Hunt, Director of Service Development at RBH, advised that this proposal was fit for mid-21^st century, was network driven and would provide modern care, making it easier to recruit new staff.

2.    Chelsea & Westminster and Imperial College Healthcare – move cystic fibrosis services from the Royal Brompton Chelsea site to the Chelsea & Westminster Hospital, cardiac (not adults or children’s CHD) and other respiratory services to Hammersmith Hospital and CHD and ECMO to Guys and St Thomas’ Hospital.

3.    NHSE – move paediatric CHD from the Royal Brompton site to another compliant CHD provider either in total or split along with adult CHD and associated services.  This had been the original proposition in 2017. 

Mr McCleery suggested that any proposal that sought to pick off services or sub sections of services would not work as well as RBH’s proposal which embraced wider collaboration.  He noted that taking the paediatric CHD services away from RBH would render other services at the Royal Brompton Hospital unsustainable. 

Ms Hazel Fisher, Programme Director Cardiac and Paediatrics Specialised Commissioning – NHSE London Region, advised that none of the proposals would change the services provided at Harefield  ...  view the full minutes text for item 8.

Mr Nick Strouthidis, Medical Director at Moorfields Eye Hospital NHS Foundation Trust (MEH), advised that Moorfields was the oldest and largest centre of its kind in Europe.  It trained approximately half of all eye surgeons in the UK.  The Trust provided excellence in eye care, ground breaking research and comprehensive training. 

The Trust operated from 31 sites with City Road being the main site from which 30% of activity was undertaken.  Moorfields had been located at the City Road site since the 1890s and, since then, the services available and the needs of patients had changed.  As such, the building had some constraints and patient experience was not always acceptable with regard to, for example, way finding. 

Members were advised that 10 of the other 30 sites performed surgery (for example, Ealing Hospital) and the others offered a clinic facility.  They were reassured that the proposed move to St Pancras would not replace any of the services provided from the other 30 locations.  These services were provided in areas where the Trust had been invited by the local CCG and the Trust was actively looking to identify different ways of delivering care. 

It was suggested that a move to a new site would enable the Trust to integrate various strands of expertise (for example, research and education) with the intention of stimulating interaction between clinicians, educators and researchers.  Ms Johanna Moss, Director of Strategy and Development at MEH, advised that the options appraisals had been assessed and had resulted in the proposal to buy two acres of land for a purpose built facility on the St Pancras site.  This move would also help in the regeneration of a deprived area. 

Since 2013/14, the Trust had been considering next steps and had been receiving consistent messages regarding the need for accessibility and transport hubs.  Investigations had shown that a move from City Road to St Pancras would make an average difference of 3½ minutes to a patient’s journey time.  The challenge would be how to get patients from the termination of their chosen form of transport to the new site (known as the last half mile).  Currently, it took patients 10 minutes to travel the last half mile; it was likely to take 10-20 minutes for the new site.  Discussions had been undertaken with RNIB and it was likely that extra support would need to be put in place during the transition period which could include the use of volunteers to signpost.  Consideration would also be given to the use of digital technology.  It was suggested that Network Rail, Transport for London (TfL) and the Mayor of London be contacted to consider permanent step free access.  Mr Turkay Mahmoud, Interim Chief Executive Officer at Healthwatch Hillingdon, advised that he would liaise with the other North West London Healthwatch bodies to gain their thoughts on this proposal. 

Concern was expressed that the move to St Pancras might impact on the stability of the Western Ophthalmic Hospital (WOH) as it was located just  ...  view the full minutes text for item 9.

·         Cancer Screening and Diagnostics

·         Service Review at Mount Vernon Cancer Centre

Cancer Screening and Diagnosis

Dr Kathie Binysh, Head of Screening at NHS England (NHSE) and NHS Improvement (NHSI), advised that there were currently three cancer screening programmes running: bowel, breast and cervical.  Concern was expressed that, nationally, there had been a reduction in the number of women participating in cervical screening which was reflected in the local uptake.  In a move to provide improvements to the service and more reliable results, a single laboratory on Euston Road was being established which would provide the new primary HPV screening test for all cervical screening samples in London by March 2020.  100% of GPs in the Borough had signed up for the text service to remind patients to have a cervical smear. 

With regard to breast screening, Hillingdon had performed second worst in the country 25 years ago.  Significant improvements had been made in the interim.

Bowel cancer screening had been introduced in 2015.  A new test (the FIT test) had been introduced from June 2019 which meant that there was no longer any need for three samples to be taken and a 7% increase in coverage was expected as a result.  Hillingdon’s performance with regard to bowel cancer screening was lower than the England average and lower than other outer London boroughs.  There had been historical concerns that the test kits had not been arriving in Hillingdon but this had been addressed when the service transferred to a new provider last year.  It was suggested that consideration be given to enabling patients to order their own tests online for bowel cancer screening.  NHSE was now looking to set ambitious bowel cancer screening targets. 

GPs in Hillingdon would be meeting soon to look at improvements to colorectal (bowel) cancer screening.  Mr Joe Nguyen, Deputy Managing Director at Hillingdon Clinical Commissioning Group (HCCG), advised that a lot of work had already been undertaken with GPs and a patient engagement event in relation to cervical screening had been undertaken with Somali women. 

Hillingdon had been performing well in comparison to the rest of North West London but was below the national average.  Whilst Members acknowledged that the Borough’s performance was adequate, it was clear that there was still more work to do.  Dr Binysh advised that consideration was being given to adopting the text reminder system across the whole of London and national campaigns were being developed to raise awareness.  Thought was also being given to how practices with a low uptake could be targeted and well as how to target those with learning difficulties (LD) or severe mental illness.  A lot of work had already been undertaken to get the message through to those with LD and these would need to be replicated for mental health services.  He noted that HCCG would also be able to help NHSE with ways to increase reach to those with LD.  Consideration could also be given to using Hillingdon Care Partners to help increase uptake.

Dr Stephen Vaughan-Smith, Cancer Lead at Hillingdon Clinical Commissioning Group  ...  view the full minutes text for item 10.

It was noted that, as agreed by Cabinet, letters had been sent to the Ministry of Justice, Secretary of State for Housing, Communities and Local Government and Chairman of the Parliamentary Select Committee on 8 June 2018 with regard to the findings of the Community Sentencing Working Group.  Although a response had been received from the Ministry of Justice, no formal response had been received in relation to the other two letters. 

Members were advised that the evidence gathered by the Council’s Working Group had fed into a larger Government Select Committee review of Community Rehabilitation Companies (CRCs).  This review had resulted in the recent public announcement that the supervision of all offenders on probation in England and Wales would be put back in the public sector after a series of failings following the part-privatisation of the system.

RESOLVED:  That the update be noted.

Consideration was given to the Committee’s Work Programme.  The Committee agreed to continue to undertake lead Member responsibilities for specific Trusts.  Whilst all Members were encouraged to ask questions of all witnesses that attended the Committee meetings, these lead roles had led to more in-depth questioning resulting from more thorough research of the Trusts.  It was agreed that the lead Members for each Trust would be as follows:

·         Councillor June Nelson: Royal Brompton and Harefield NHS Foundation Trust (RBH)

·         Councillors Simon Arnold and Ali Milani: The Hillingdon Hospitals NHS Foundation Trust (THH)

·         Councillors Kuldeep Lakhmana and Devi Radia: Hillingdon Clinical Commissioning Group (HCCG)

·         Councillor Nick Denys: Central and North West London NHS Foundation Trust (CNWL)

·         Councillor Vanessa Hurhangee: London Ambulance Service NHS Trust (LAS)

Following the discussion earlier in the meeting in relation to bowel, cervical and breast screening in the Borough, it was agreed that an additional meeting needed to be arranged that focussed entirely on this issue.  It was also agreed that an additional meeting was likely to be needed in relation to the Mount Vernon Cancer Centre review in due course.

RESOLVED:  That the Work Programme be agreed.