Monday 25 th June 2012 at 2.30pm Methodist Central Hall, Storey s Gate, Westminster, SW1H 9NH MINUTES OF MEETING

Transcription

1 Joint Committee of Primary Care Trusts (JCPCT) The JCPCT is a joint committee established by NHS Brent, NHS Ealing, NHS Hammersmith & Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS Kensington & Chelsea, NHS Westminster, NHS Camden, NHS Wandsworth and NHS Richmond Monday 25 th June 2012 at 2.30pm Methodist Central Hall, Storey s Gate, Westminster, SW1H 9NH MINUTES OF MEETING Chairman Jeff Zitron Administration Kieran Seale, Corporate Affairs Manager Members Jeff Zitron (JZ) Trish Longdon (TL) Elizabeth Rantzen (ER) Fergus Cass (FC) Sarah Cuthbert (SC) Arif Kamal (AK) Chandresh Somani (CS) Martin Roberts (MR) Denise Chaffer (DC) Daniel Elkeles (DE) Andrew Howe (AH) Anne Rainsberry (AR) Mark Spencer (MSp) David Slegg (DS) Simon Weldon (SW) Stephen Hickey (SH) John Carrier (JC) Marilyn Plant (MP) Chairman Vice Chairman, North West London PCTs Vice Chairman, North West London PCTs Chairman, Audit Committee,, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Director of Nursing, North West London PCTs* Director of Strategy, North West London PCTs Director of Public Health*, North West London PCTs Chief Executive, North West London PCTs Medical Director, North West London PCTs* Director of Finance, North West London PCTs Director of Commissioning & Performance, NW London PCTs Vice Chairman, Wandsworth PCT Vice Chairman, Camden PCT PEC Chair, Richmond PCT* Non Members in attendance Ian Adams (IA) Director of Communications, North West London PCTs Mike Anderson (MA) Medical Director, Chelsea & Westminster Hospital* Liz Knight (LK) Deputy Director of Strategy, North West London PCTs Susan La Brooy (SB) Medical Director, Hillingdon Hospital* Rob Larkman (RL) Chief Executive, Brent PCT and Harrow PCT David Mason (DM) Capsticks Solicitors Alison McLellan (AM) Corporate Services Manager, North West London PCTs Nick Relph (NR) Chief Executive, Hillingdon, Hounslow and Ealing PCTs Thirza Sawtell (TS) Delivery Support Unit Director, North West London PCTs* Lynne Spencer (LS) Head of Corporate Affairs, North West London PCTs Sarah Whiting (SWh) Chief Executive, Kensington & Chelsea, Hammersmith & Fulham and Westminster PCTs Tim Spicer (TS) Chairman Hammersmith & Fulham Clinical Commissioning Group* *denotes clinical personnel Page 1 of 11

2 1. Welcome, Introduction & Apologies 1.1. The Chair, Jeff Zitron, welcomed all to the meeting. He explained that this was a meeting of a joint committee formed by eleven Primary Care Trusts, eight North West London PCTs: NHS Brent, NHS Ealing, NHS Hammersmith & Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS Kensington & Chelsea and NHS Westminster, together with NHS Camden, NHS Wandsworth and NHS Richmond John Muolo gave his apologies From the audience, Andrew Slaughter MP stated that insufficient notice had been given of the meeting and that there had not been sufficient time to read the papers. Jeff Zitron explained that proper notice had been given for the meeting and that the papers had been available on the NWL Cluster website since 21 st June. 2. Declarations of Interest 2.1. Arif Kamal declared that his wife is a medical doctor at North West London Hospitals Trust and works with the London Deanery Mark Spencer declared an interest as a GP in Ealing John Carrier declared an interest as a Council member of Great Ormond Street Hospital and a Governor of University College London Hospital Marilyn Plant declared an interest as a GP in Richmond. 3. Meeting Etiquette 3.1. A paper setting out the approach to be taken to the running of the meeting was noted. 4. Purpose of Consultation 4.1. The Chief Executive (Anne Rainsberry) described the purpose and process of consultation to the Committee. She outlined the work undertaken during the preconsultation phase to engage the public, patient representatives, clinicians and elected representatives. The North West London Public and Patient Advisory Group (comprising the chairs of borough Local Involvement Networks - LINKs) had been extensively involved in the pre-consultation stage. Meetings had also been held with the shadow Joint Health Overview and Scrutiny Committee, representing the relevant local authorities, to brief them on the development of the proposals and the plans for formal consultation. A Clinical Board had been established, made up of the Medical Directors of the hospitals in North West London and representatives of the eight North West London Clinical Commissioning Groups who had reported their views into the Clinical Executive Committee. Well attended North West London wide public engagement events were held on 15 th February, 23 rd March and 15 th May Discussions had also been held with the Shadow Health & Wellbeing Boards and these continued. Action Page 2 of 11

3 4.2. The Chief Executive said that the purpose of the consultation process is to get the views of the people of North West London, as well as Camden, Richmond and Wandsworth, on the proposed changes. She stressed that the proposals are still at a formative stage. The consultation would put information into the public domain in order to allow the public to give their views and to comment on the proposals. She said that a Pre-Consultation Business Case has been made available to facilitate this. A free-phone number will be available through which copies can be requested and the information is available on the internet. Discussions with the North West London Public and Patient Advisory Group will continue. She said that the consultation plan had been approved by the shadow Joint Health Overview & Scrutiny Committee on 12 th June Presentation of North West London 5.1. The Medical Director, Dr Mark Spencer, presented the Pre Consultation Business Case (PCBC). He stressed that the programme was clinically led, and that the proposals had been recommended by the North West London Clinical Executive Committee and by the Shaping a Healthier Future Programme Board. He described the vision which is based around improving primary care, and particularly general practice, thus reducing the need for people to go to hospital. He said that doing nothing would result in continuing inequalities, and especially result in those with long-term conditions suffering unnecessary admissions to hospital, hospital trusts being under severe financial pressure, and unnecessary deaths. He described a vision based around: Localising carrying out routine care closer to patients; Centralising more specialist services; Integration of primary care, secondary care and social care. He said that the aim is to provide quality care outside of hospital while radically improving services inside hospitals Turning to delivery, the Medical Director spoke about the various approaches to be taken for each of the eight settings of care: Home, GP Practices, Core Networks, Health Centres, Local Hospitals, Major Hospitals, Elective Hospitals and Specialist Hospitals. He noted the work that is underway by Clinical Commissioning Groups (CCGs) on Out of Hospital strategies, and that the proposal is for there to be fewer Accident and Emergency Departments providing better care than at present The view of the Clinical Board is that there should be five major hospitals in North West London, each with an Accident & Emergency Department, in order to provide sufficient volume of activity to maintain round-the-clock consultant cover and clinical skills. Travel time and access have also been important in the Clinical Board s recommendation on where major hospitals should be, although research has shown that the crucial issue is getting to the right place, rather than how quickly you get there. Due to their location, Hillingdon and Northwick Park are proposed as major hospitals with the other three spread across North West London. That leaves the choices as being between Ealing and West Middlesex, Charing Cross and Chelsea & Westminster, and Hammersmith and St Mary s. The criteria for choosing between the options adopted by the Clinical Board were: Quality of Care Access Value for Money Deliverability Research and Education Page 3 of 11

4 5.4. The Medical Director explained that Hammersmith Hospital is not proposed as an option as a major hospital as there is no room on the site for extra services and because of the presence of the major trauma unit at St Mary s. The maternity unit at Hammersmith (Queen Charlotte s) is, however, proposed to be maintained. Central Middlesex is also not proposed as a major hospital as it is the smallest general hospital in North West London and would therefore require the largest investment to become a major hospital Thus, the Clinical Board, and subsequently the Programme Board, agreed to recommend that under each of the options proposed for consultation Hillingdon, Northwick Park and St Mary s Hospitals should be major hospitals. Thus, three sets of choices remain to be made for the other two major hospitals. Based on the evaluation, these are: Option A West Middlesex and Chelsea & Westminster (with Ealing and Charing Cross becoming local hospitals under this option) Option B West Middlesex and Charing Cross (with Ealing and Chelsea & Westminster becoming local hospitals under this option) Option C Ealing and Chelsea & Westminster. (with Ealing and Charing Cross becoming local hospitals under this option) Of these alternatives, Option A is preferred as it provides better value for money, utilises high quality estate, supports research and education, is easiest to deliver, and is least adversely affected by sensitivity testing of the modelling (i.e. of negative changes in key assumptions) In conclusion, the Medical Director said that changes in Out of Hospital care have been instituted in North West London and elsewhere, and are succeeding in reducing unnecessary hospital admissions. The underlying aim is to have the right care delivered in the right place. He noted that overall the proposals will take at least three years to implement, and that agreed changes in hospital services would not be made until appropriate Out of Hospital alternatives were in place The Medical Director also drew attention to the proposal in the Pre-Consultation Business case to consult on the closure of the Western Eye Hospital and its relocation to St Mary s Hospital, and of the move of the Hyper Acute Stroke Unit from Charing Cross Hospital to St Mary s Hospital The Director of Strategy outlined some minor changes to the Pre-Consultation Business Case that had been circulated to members of the Committee. He said that there were four typographical errors and he circulated an erratum sheet. He confirmed that these changes do not affect the analysis and that the changes are reflected in the documents on the website Members of the Committee were then able to ask questions Arif Kamal asked if the vision had been created in collaboration with the local authorities and was based on evidence of achievements elsewhere. The Medical Director said that they had worked closely with the local authorities and the Clinical Commissioning Groups. He said that the proposals were evidence based, reflecting lessons from Torbay and also from abroad in countries such as Norway, Sweden and the United States Jeff Zitron asked about the implications of integrated care for local authority social care spending. The Medical Director said that the current Integrated Care Pilot was working well and that avoiding emergency admissions reduces the costs of social care as patients remain independent for longer. Page 4 of 11

5 5.12. John Carrier asked about consultation outside the North West London area. The Medical Director said that Clinical Commissioning Groups and clinicians in other areas will be involved during the consultation process and beyond Trish Longdon asked about relationship between the implementation of the Out of Hospital strategy and these proposals. The Medical Director said that the implementation of the changes to hospital services would be phased with the implementation of the Out of Hospital strategies; hospital services would not be withdrawn unless appropriate Out of Hospital care is in place Chandresh Somani asked how the recommendations from the National Clinical Advisory Team and the Equality Impact Assessment will be implemented. The Medical Director said that an action plan has been drawn up following the National Clinical Advisory Team visit and that they will return to do a further review. The Director of Strategy said that an Equalities Action Plan is being developed as recommended in the Equality Impact Assessment Fergus Cass asked about the robustness of the data and assumptions used in the modelling. The Medical Director said that the travel issues had been looked at in detail, including by local authority representatives and that staffing assumptions had been discussed with the Deanery. With regards to financial issues, the Director of Finance (David Slegg) said that a group of commissioner and provider Finance Directors had discussed and agreed the assumptions between them The Director of Public Health (Andrew Howe) asked about how these proposals would address the gap in life expectancy across North West London. The Medical Director of said that disadvantaged groups have most to benefit from the proposals as they were the greatest users of services, as the Equality Impact Assessment had identified Marilyn Plant asked if the proposals were consistent with those made in the previous consultation on stroke services. The Medical Director confirmed that this was the case Elizabeth Rantzen asked whether the Out of Hospital strategies could be delivered on time and on budget. The Medical Director said that he believed it would be as the record of delivery of this sort of measure was improving and that Clinical Commissioning Groups are now working together to roll out investments more quickly. She also asked about the impact of the proposals on those hospitals that were losing services, particularly with regard to staff morale. The Medical Director said that this issue was being discussed with Trusts and solutions were being developed. The activity undertaken by many staff would not be reducing; rather it would be being undertaken in the community, and support and training would be needed to help staff work in a new setting Elizabeth Rantzen went on to ask about the impact of the proposals on the London Ambulance Service. The Medical Director said that they had worked closely with the London Ambulance Service using a travel tool. The London Ambulance Service is looking at what the impact of the proposals will be on them in terms of additional ambulances and journey times. Page 5 of 11

6 5.20. Sarah Cuthbert asked about the best model for Urgent Care Centres and the impact of the proposals on maternity highlighted by the National Clinical Advisory Team, which implied that a smaller number of Maternity Units than proposed by the Clinical Board would be better. The Medical Director said that clinicians were examining both these issues. With regards to the Urgent Care Centres, a consistent baseline specification for a high quality service is being developed. For maternity, the National Clinical Advisory Team had suggested fewer high quality maternity units, but the Clinical Board, and the North West London obstetricians, believe the proposed model to be safe and reflective of access needs. Work on maternity services continues, and the Medical Director confirmed that information from this work would be made publically available Fergus Cass asked about the sensitivity of the financial assumptions and therefore the level of risk they implied and what actions were being taken to mitigate any risks. The Medical Director said that there was a bigger financial risk if these proposals were not to be implemented, although he accepted that there were transition risks, which would be kept under review. The Finance Director said that financial sensitivities had been modelled and were part of the Pre-Consultation Business Case. The sensitivity testing showed each of the three options was viable, although Option A, the preferred option, was most robust Stephen Hickey stressed the importance of dialogue with South West London. He asked about Chelsea & Westminster s comment that they would not be viable if their A&E was closed. The Medical Director responded that their view was that it would not be viable as a major hospital without an A&E; Chelsea & Westminster would under Option B have to be restructured as a local hospital Martin Roberts said that quality of care is used as an evaluation criterion, and asked for clarification of how this was evaluated. The Medical Director said that the issue of quality had been given most consideration in developing the proposals. Overall, the Clinical Board had concluded that the agreed quality criteria for major hospitals could be achieved under any of the eight original options as they were all based on achieving the clinical staffing levels and volumes needed to provide a clinically sustainable service. The practicalities of achieving those levels and volumes varied substantially, as reflected in the other criteria. Also, he said that it would also be impractical to use quality as a criterion to chose between each of the three pairings for major hospitals as individual services vary across Trusts, and quality comparisons for individual hospitals within multi-site trusts (e.g. between St Marys and Charing Cross for Imperial) are not available. 6. Quality Assurance & Stakeholder Engagement 6.1. The Director of Strategy outlined the engagement that had happened so far. He said that there had been engagement with providers, commissioners, staff, the public, the Department of Health, Overview and Scrutiny Committees and emergent Health & Wellbeing Boards. A broad range of activities had been carried out including open forum events, focus groups and liaison with providers. The Public & Patient Advisory Group (PPAG) has had a substantial involvement in the pre-consultation work and they are represented on all the programme committees. The contribution of PPAG and other LINKs members has been extremely valuable. Page 6 of 11

7 6.2. Trevor Begg, Chairman of Hillingdon LINk and the Patient & Public Advisory Group, said that his role was to ensure that the information in the public domain is sufficient to make a decision. He said that he had been given unparalleled access to information. PPAG had written to the Chairman of the JCPCT recording its views on the pre-consultation process and the substantive issues. He said that Committee members had already raised all the points of concern to PPAG except for the impact of the proposals on carers. He asked for this issue also to be considered further during the consultation phase The Director of Strategy said that genuine options were being presented to the public and concerns that are raised will be considered. The impact on carers will be the subject of work carried out during the consultation. The Medical Director expressed his thanks to Trevor Begg for this work, saying that his challenge had been invaluable. Jeff Zitron added his thanks for the time and effort that LINks members have put in to the process Daniel Elkeles described the quality assurance processes which included review by: NHS London; An external clinical panel (made up of clinicians from provider organisations and Clinical Commissioning Group chairs); Office of Government Commerce who reviewed the process and approved it as sound to go to public consultation; Joint Health Overview and Scrutiny Committee this met in shadow form and will meet formally next month. The shadow committee agreed to the consultation period and the consultation plan; National Clinical Advisory Team who reviewed the Clinical proposals and support them in principle. He said that a full equalities impact assessment can only be carried out when proposals are finalized and therefore this work is on-going, but those who are in the groups protected by the Equality Act stand to gain most from the proposals. More work is being done to understand the public transport implications of the options and a detailed impact assessment will be produced. He drew attention to the report on the impact of the proposals on patient choice and competition, and on the carbon assessment. The letters of support to the consultation process from Clinical Commissioning Groups and provider Trusts were also noted by the Committee The Committee raised the following issues in response to the Equalities Impact Assessment report: Chandresh Somani said that the report referred to a significant impact as a result of longer journey times and asked for this to be analysed in further detail; Stephen Hickey stressed the need for the Equality Impact Assessment to look across geographical boundaries; Trish Longdon welcomed the fact that the recommendation to develop an Equalities Action Plan had been accepted. She said that it was important that all the recommendations are addressed. The Director of Strategy said that all these points would be addressed and brought back to the Joint Committee when there is a final decision to be made. Page 7 of 11

8 7. Questions from the Public 7.1. Councillor Julian Bell (Leader of Ealing Council) said that none of the three options involved an A&E at Central Middlesex and stated that therefore there was no real consultation. He said that deliverability was part of the assessment, but that support from patients, public and elected representatives should also be a criteria. He also said that the areas around the proposed major hospitals suffered from the worse congestion in London and asked if this was considered in the evaluation The Medical Director responded to the question about Central Middlesex. He said that the hospital had a very limited A&E role and noted that the training doctors had been withdrawn by the Deanery and therefore there was insufficient workforce to staff an A&E. Nevertheless, he said that the public would be asked specifically to comment on this issue in the consultation Regarding deliverability and public acceptance, the Director of Strategy said that this was hard to use as a criteria in choosing options as any option was likely to generate political and public support in some areas but not in others. Turning to congestion, he said that this was less of an issue for ambulances than for normal traffic and work was being undertaken with the Ambulance Service as previously noted Ms Maureen McGinn said that there was qualified support for the proposals but a lack of specificity in the Out of Hospital strategy and that more detail was needed. She asked when this would be available. She also asked about how these proposals reflected the borough Joint Needs Assessments. Dr Tim Spicer responded to this question. He said that each of the Clinical Commissioning Groups was developing its Out of Hospital Strategy and the results would be published during consultation. He said that work would be done by the Health & Wellbeing Boards on ensuring the link between the Joint Strategic Needs Assessment, Out of Hospital Strategy and delivery. Discussions had already been held, but more work remains to be done. He said that the Out of Hospital strategy has had an impact on unscheduled admissions within the Integrated Care Pilot and success has also been demonstrated elsewhere, e.g. in Torbay. There needs to be a change in culture from practitioners as no-one wants unscheduled admissions Andrew Slaughter MP began by asking for a meeting to discuss the proposals. He then asked the following: a) Hammersmith A&E closes under all the options. Do the public have any say on that issue?; b) If Charing Cross did not have an A&E department what is planned for the rest of the site, and how much detail on this is available?; c) He wished to see more and detailed information on travel time assumptions; d) He asked whether the London Ambulance Service had been consulted The Chief Executive confirmed that she was happy to meet Mr Slaughter. She said that retaining an A&E at Hammersmith was not recommended by the Clinical Board or Clinical Executive. Page 8 of 11

9 7.7. The Director of Strategy said that respondents would be asked in the consultation document to express their view on the proposal that Hammersmith Hospital should not be a major hospital. On Charing Cross, he said that its future of the site was being considered, and that the documentation set out the implications for the site of it being a local hospital. Turning to travel time information, he said that a summary had been published up to now and that the full information would be published if the consultation is goes ahead. He confirmed that the London Ambulance Service had been consulted Councillor Ranjit Dheer of Ealing Council commented that the vision was just vague words. He asked how closing the A&E at Ealing hospital will help to localise services, particularly given congestion on the A40. The Medical Director responded that there is a balance to be struck between localisation and centralisation if clinical quality and patient safety are the main aims, and referred to the on-going work on transport An Ealing councillor asked how many Overview & Scrutiny Committees were consulted, and whether Ealing was amongst them. The Director of Strategy said that he had visited all the Overview & Scrutiny Committees twice and that the Joint Overview & Scrutiny Committee had met a number of times. He pointed out that the role of the Joint Overview & Scrutiny Committee was to comment on the processes and scrutinise consultation, but not to make decisions Councillor Jasbir Anand of Ealing Council made the following points: a) She was not happy with the proposed Ealing/Northwick Park merger. She asked if the travel times were accurate and realistic; b) She asked about the impact on residents from Black and Minority Ethnic communities in Ealing. c) She noted that two of the Non-Executive Directors were from Black and Minority Ethnic backgrounds and asked whether they had voting rights The Chairman confirmed all Non-Executive Directors had voting rights and these were the same for all Committee members The Director of Strategy stressed that this meeting was not about the Ealing/Northwick Park merger, which is a separate issue for consultation. Significant work on travel times has been undertaken and will continue. He said that the Equality Impact Assessment will be used to help the programme ensure that the Equality duty is met and that the impact on residents from Black and Minority Ethnic communities is fully understood Mr Colin Standfield pointed out that there were a large number of caveats in the National Clinical Advisory Team report. He also asked for clarity on the definition of Urgent Care Centres. He stated that his prior enquiry on the services offered by Urgent Care Centres had not been adequately answered. The Medical Director said that each Urgent Care Centre had a specific specification to fit the locality with criteria of what services to include and not include Mr Mike Phelan asked about the views of hospital doctors on the proposals. Mike Anderson, the Medial Director of Chelsea & Westminster Hospital Trust responded that the size of clinical teams was a major part of the driver for change. Susan La Brooy, Medical Director, Hillingdon Hospital said that most clinicians want to improve care, but that changes were needed to achieve that. She said that there needs to be a concentration of specialists to delivery good care, as had been shown by the stroke consultation. Page 9 of 11

10 7.15. Councillor Abdullah Gulaid of Ealing Council also expressed concerns about transport issues. He said that fully open consultation was needed and expressed the view that cuts in community services would hamper the delivery of the Out of Hospital strategy. He queried the relevance of experience from Torbay and Sweden and the cost of tele-health Councillor Peter Graham of Hammersmith & Fulham Council said that the Council was wholly sceptical and deeply worried by the proposals. He was concerned about the impact of congestion on travel times. He also asked that information on the deficits of Trust should be released and asked if the proposals were a solution to Imperial s financial difficulties. He asked who decided who the National Clinical Advisory Team met. The Finance Director said the financial modelling showed that only one trust in North West London would be in surplus if nothing was to be done and that the proposals aimed at building a sustainable model. The Medical Director said that the National Clinical Advisory Team had asked all hospitals to nominate people to attend and that a representative from Imperial had been invited and had participated Bringing the questions to a close, the Chair said that sheets were available for members of the public to put any further questions in writing which would all be responded to. 8. North West London Reconfiguration Options 8.1. Jeff Zitron noted that there is a preferred option in the proposals. He asked if the alternative options are therefore realistic i.e. whether they are deliverable. The Chief Executive of NHS North West London said that the Cluster Board, Programme Board and Clinical Executive Committee had narrowed the options for major hospitals down to three. She said that the various benefits of each option were set out in the papers, and confirmed that all are implementable. She said that one option is better than the others in terms of ease of implementation and value for money, but all were realistic options. She stressed that these options represented current thinking, but could be changed by consultation Chandresh Somani asked about how the responses would be used to evaluate the options. The Chief Executive said that there would be three to four months analysis of the consultation and revised options may well be generated at that stage The Joint Committee of PCTs considered the proposed resolutions and unanimously agreed to: a) approve the Pre-Consultation Business Case; b) confirm acceptance of the proposed options for change (options A, B and C); and c) confirm that Option A is the preferred option. The Committee then unanimously confirmed that it was content to commence public consultation on the proposed service changes described in the Pre- Consultation Business Case. 9. Decisions on plans for public consultation 9.1. The Director of Strategy referred to the consultation plan that had previously been circulated. He said that it would be added to in the light of the comments made at this meeting. He noted that the programme will include 19 road shows, including three outside North West London (in Richmond, Wandsworth and Camden). He said that the consultation was planned to begin on 2 nd July and run for 14 weeks. He suggested that the Chair and Chief Executive be delegated the authority to sign off the consultation document. Page 10 of 11

11 9.2. Elizabeth Rantzen asked if in the light of the comments made today, it was still realistic to begin the consultation on 2 nd July. The Director of Strategy said that he was confident that they would be ready by that date. The Chief Executive said that the Consultation Plan would be updated and circulated to Committee members and to the Joint Overview & Scrutiny Committee The Committee agreed unanimously to : a) approve the plans for public consultation including a consultation start date of 2 July 2012; and b) to delegate sign off of the consultation document to the Chair of the Joint Committee of PCTs and the Chief Executive of NHS North West London. 10. Close of Meeting DE Jeff Zitron thanked everyone for the work they had done on developing the proposals before the Committee and all those who had given their views through the consultation process. He noted that this was just the start of the process. Finally he thanked all those present at the meeting for their courtesy and their contributions. All queries regarding the NHS North West London Cluster Board meetings please contact: Lynne Spencer, Head of Corporate Affairs, Chief Executive s office or lynne.spencer@london.nhs.uk Page 11 of 11

12 Joint Committee of Primary Care Trusts (JCPCT) The JCPCT is a joint committee established by NHS Brent, NHS Ealing, NHS Hammersmith & Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS Kensington & Chelsea, NHS Westminster, NHS Camden, NHS Wandsworth and NHS Richmond Thursday 6 December 2012 at 4pm-6.30pm Methodist Central Hall, Storey s Gate, Westminster, SW1H 9NH MINUTES OF MEETING Chairman Jeff Zitron Administration Alison McLellan, Corporate Affairs Manager Members Jeff Zitron Trish Longdon Elizabeth Rantzen Fergus Cass Sarah Cuthbert Arif Kamal Chandresh Somani Martin Roberts Daniel Elkeles Andrew Howe Rob Larkman Anne Rainsberry Mark Spencer David Slegg Clare Parker Marilyn Plant Jonathan Wise Jonathan Webster Chairman Vice Chairman, North West London PCTs Vice Chairman, North West London PCTs Chairman, Audit Committee,, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Non Executive Director, North West London PCTs Chief Officer, CWHH Collaboration of CCGs (Hammersmith & Fulham, Hounslow, Kensington & Chelsea, Westminster) & Director of Strategy, North West London PCTs Director of Public Health*, North West London PCTs Chief Officer designate BEHH Federation of CCGs (Brent, Ealing, Harrow and Hillingdon) Chief Executive, North West London PCTs Medical Director, North West London PCTs* Director of Finance, North West London PCTs Chief Financial Officer, CWHH Collaboration of CCGs (Hammersmith & Fulham, Hounslow, Kensington & Chelsea, Westminster) PEC Chair, Richmond PCT* Chief Financial Officer, BEHH Federation of CCGs (Brent, Ealing, Harrow, Hillingdon) Acting Director of Nursing and Quality Non Members in attendance Ian Adams Director of Communications, North West London PCTs Lisa Anderton Assistant Director, Shaping a Healthier Future Nicola Burbidge GP, Clinical Commissioning Group Chair for Hounslow* Mike Anderson Medical Director, Chelsea & Westminster Hospital* Karen Clinton Director, Primary Care, North West London PCTs Councillor Lucy Ivimy Chairman, Joint Health and Overview Scrutiny Committee Amol Kelshiker GP, Chair, Harrow Clinical Commissioning Group * Ethelreda Kong GP, Chair, Brent Clinical Commissioning Group * Page 1 of 14

13 Don Neame Communications Lead, Shaping a Healtheir Future Jonathan Nicholls Head of Health Research, Ipsos Mori David Mason Capsticks Solicitors Alison McLellan Corporate Services Manager, North West London PCTs Andrew Pike Head of Communications, NHS North West London Mohini Parmer GP, Chair, Ealing Clinical Commissioning Group * Thirza Sawtell Delivery Support Unit Director, North West London PCTs* Lynne Spencer Head of Corporate Affairs, North West London PCTs Sarah Whiting Managing Director designate, Commissioning Support Unit Mark Sweeney GP, Chair, West London Clinical Commissioning Group * Tim Spicer GP, Chair, Hammersmith & Fulham Clinical Commissioning Group* Kate Woolland Programme Management Office, Shaping a Healthier Future *denotes clinical personnel 1. Welcome, Introduction & Apologies 1.1. The Chair welcomed those attending to the second meeting of the Joint Committee of the eleven Primary Care Trusts set up to oversee the consultation on proposal for the future of health services in North West London Apologies were received from: JCPCT members: Richard Mendall and Stephen Hickey. Other apologies: Trevor Begg (Chairman of Hillingdon LINk), Dr Ruth O Hare (Chair, Central London Clinical Commissioning Group), Dr Susan Labrooy (Programme Medical Director, Shaping a Healthier Future), Dr Nicola Jones (Chair, Wandsworth Clinical Commissioning Group) and Vicky Scott, Associate Board member of NWL Cluster The Chairman explained that since the last JCPCT, staff structure changes at NWL Cluster meant that there were several changes to the membership of the JCPCT: David Slegg and Simon Weldon had joined the National Commissioning Board and had stepped down from NWL Cluster Board and JCPCT as of 1 October David Slegg had been replaced on the NWL Cluster Board and the JCPCT by the Directors of Finance, Jonathan Wise and Clare Parker. Rob Larkman, Chief Operating Officer for BEHH Federation of CCGs had now joined the NWL Cluster Board and the JCPCT. John Carrier, JCPCT member for Camden PCT had been replaced by Richard Mendall, elected GP representative. 2. Declarations of Interest 2.1. Arif Kamal declared that his wife is a medical doctor at North West London Hospitals Trust and works with the London Deanery Sarah Cuthbert declared that her husband is a partner at Deloittes and currently engaged on work with McKinseys Mark Spencer declared that he owned a single share in Harmonii related to the Ealing Out of Hours service co-operative. 3. Report from the Chairman 3.1. The Chairman introduced his report which summarised the purpose of the meeting. The report also reminded the JCPCT of the functions of the consultation process and the duties of the JCPCT. He explained that the purpose of the meeting was to receive formally the results of the consultation, but this was not a decision-making meeting. The feedback would come in three forms: A summary of the Consultation process A report from Councillor Ivimy who chaired the Joint Health Overview and Scrutiny Committee which oversaw the consultation on these proposals The independent analysis of the results by Ipsos MORI. Action Page 2 of 14

14 3.2. The Chairman noted that at this meeting the JCPCT needs to confirm the issues that should be addressed in the report to the anticipated 19 February 2013 meeting. However, there will be no attempt to come to conclusions on the proposals themselves at the present meeting. 4. Activities Undertaken during Consultation 4.1. Don Neame presented a summary of activities undertaken during the consultation. A full report of these was included in the JCPCT meeting papers. He highlighted the following activities: The full consultation document was available on line from 2 July 2012 and was printed copies were subsequently dispatched to the stakeholders listed in the report, and on request to enquirers, The summary consultation documents and postcards were distributed to ensure the public had access to information in order to be able to comment. These documents were made available to LINks, libraries, GP practices and provider trusts. Regular newsletters were circulated widely including to stakeholders such as LINks and Councils. Queries were responded to throughout the course of the dissemination activities. Road shows took place in each of the eleven boroughs and these comprised presentation material, with staff available to provide assistance, and one or two question and answer sessions. Focus groups, with membership recruited by a market research agency to a specific quota sample, were also held. Questions and comments from the road shows were fed back to Ipsos MORI for analysis JCPCT members were invited to ask questions Trish Longdon asked what assurance could be given to the JCPCT that the consultation process was adequate given the complaints made by some residents, groups and political representatives. In response, Don Neame said that, in his experience of running NHS consultations, there had been a relatively large number of events, press releases and other engagement activities as listed in the report. The key purpose of a consultation is to provide an opportunity for those potentially affected by proposals to comment. When speaking with the press, the team consistently reinforced the message that the principal aim was to generate comment from the public, and details were provided on how this could be done The Chairman asked about the reference in the report to the Consultation Institute and asked what the position was on the certificate of compliance referred to in the report. Don Neame said he was meeting with this body the next day. It had attended events and reviewed all the paperwork in order to assess their adequacy. It was hoped that the certificate of compliance would be issued shortly and this would mean that the Institute regarded the consultation process as having met their quality standards. The Chairman asked for the results of the Consultation Institute s assessment to be posted on the website and Don Neame confirmed this would be done. 5. Consultation Findings DN 5.1 Joint Health Overview Scrutiny Committee (JHOSC) Formal Consultation Response The Chairman welcomed Councillor Lucy Ivimy, Chairman of the JHOSC and thanked her both for the report of the JHOSC and for her presentation of this at the public engagement event on 28 November Page 3 of 14

15 5.1.2 Councillor Ivimy noted that the JHOSC was set up initially in shadow form then became formally operative from July, with a dual remit to consider the consultation arrangements and to respond to the Shaping a Healthier Future proposals She noted that the Committee members represented a wide range of political views and diversity in terms of the potential impact of the proposals on their residents. The focus of the Committee was on the substance of what was being proposed and whether the process for carrying out the consultation was appropriate Councillor Ivimy said that they had received a significant amount of evidence of varying levels of technical complexity on clinical, financial and other issues.. The JHOSC, with the exception of one borough, had agreed that the case for change had been made and that the clinical case for reconfiguring Accident & Emergency Centres had also been made. It also supported the rationale for the out of hospital strategy However, a number of serious concerns had been raised, notably: There should be no attempt to act prematurely by closing hospital services, Accident & Emergencies departments or beds before the out of hospital strategy could be demonstrated to be working and before it was demonstrated that the Urgent Care Centres were able to take on the assumed workload currently undertaken by A&E departments. Forecasts of activity may by undermined by the rapidly rising population of North West London. The demand on A&E was rising and hospitals were at capacity. In this geographical area there was a transient population profile, for example, of new arrivals and working people, who did not use GP services and instead went to A&E as a matter of course. People were not familiar with the concept of Urgent Care Centres, although Councillor Ivimy considered that this may change quickly when the public saw their implementation. There was concern that the triage of serious cases by Urgent Care Centres may fail to work smoothly. There is a lack of practical detail and evidence of how elements of the new system would work in practice. Would financial pressures in the health economy jeopardise the investment necessary for major changes to be properly funded and implemented. What would be the impact of these changes on the NHS workforce. The term reconfiguration of A&Es conceals a significant reduction in hospital services in those hospitals downgraded to local hospital status which gives rise to serious local concerns among residents. While significant work had been undertaken to assess the impact of A&E closures on ambulance journeys, the non-urgent transport implications of the changes have not been properly considered.. Elderly and vulnerable people largely use public transport to reach hospitals and the planned downsizing gives rise to serious concerns and lack of public confidence. There appeared to be no borough level analysis of the impact of these reductions, particularly with regard to the impact on vulnerable communities. Residents in the areas most affected by the changes may not have confidence in the feasibility of the proposals. The JOHSC questioned whether sufficient had been done to contact hard to reach groups, particular given the late translation of consultation documents. Road shows had been poorly publicised and poorly attended Limited choices had been given to respondents, and the programme s name made it psychologically difficult for people to disagree with. Page 4 of 14

16 5.1.6 Anne Rainsberry asked Councillor Ivimy to clarify the position of Hillingdon borough on the JHOSC. She responded that Hillingdon had declined to take part it could have participated mid-way but chose not to Anne Rainsberry asked for clarification on the concerns over the limited choices given to respondents. Councillor Ivimy responded that during the preconsultation stage many permutations had been discussed with the JOHSC but most were ruled out for clinical or financial reasons. However, the formal proposals comprised only three options for hospital services. The JHOSC had favoured there being a greater choice of options given concerns that the public would feel railroaded into choosing from a limited number of options which were financially driven The Chairman thanked Councillor Ivimy for the work undertaken by the JHOSC,and for her role in chairing the Committee. This had enabled the JHOSC s disparate views to be brought together into a substantial report. He said he would ask about the JHOSC s continuing scrutiny role at the end of the meeting. 5.2 Ipsos MORI Report The Chairman invited Jonathan Nicholls and Don Neame to present the Ipsos MORI Report Don Neame said that the findings of Ipsos MORI s Consultation analysis had already been presented at the public meeting on 28 th November 2012 and had been published on the website. There was also a technical report which provided details on the procedures and process, including coding and how assessment was completed. A press release had been published on the report which was also on the website. Newsletters had been issued to key stakeholders and other contacts to inform them of the work of Ipsos MORI, and stakeholder responses had also been published on the website Don Neame added that the 28 November event included 12 workshops to consider in more detail the issues raised by Ipsos MORI s presentation. The results from these workshops would be issued the following week, circulated to JCPCT members and published on the website Don Neame noted that the slide pack provided to the JCPCT had been offered to all Health and Wellbeing Boards, Overview and Scrutiny Committees, and LINKs so that they could consider further the issues arising from the consultation. Don Neame invited Jonathan Nicholls to explain what Ipsos MORI had been commissioned to undertake. DN Jonathan Nicholls said that it was important to understand that the consultation exercise was not intended to be a representative survey. It was an open and democratic consultation, so the responsibility of Ipsos MORI was to work with NHS North West London on the structure of the consultation document and then to gather, analyse and report on all the consultation responses, be they received on paper or online. Responses from stakeholders and petitions have also been captured and included in the analysis. the data. It is the role of Ipsos MORI to present this data as clearly and openly as possible so that others can make a judgement about the meaning or implications of the feedback The Chairman invited JCPCT members to ask questions to ensure that they fully understood the approach taken and the results. Page 5 of 14

17 5.2.7 Chandresh Somani asked for a response to Councillor Ivimy s main concerns raised in her report. In response Don Neame said that: In relation to the concern around limited choice, Don Neame said this was a decision about the feasibility and deliverability of options rather than the consultation process itself. During the pre-consultation period, the rationale for reducing the number of options was explained to and challenged by the public and others at various events. The concern around hard to reach groups Don Neame said this had been raised throughout the consultation. Specific efforts had been made early on to address the need to connect with these groups. An Equalities Impact Assessment was produced and an action plan developed, and specific groups were identified for engagement work. There were 60 groups contacted comprising all the equalities protected characteristics. Concern about late translations Don Neame acknowledged that these took time as they were produced on demand. There were 421 responses in a language other than English which is almost unprecedented for any health consultation in London. Once the translations were out, a relatively high number of responses was generated so delays appeared not to have had an significant adverse effect. Concern about lack of publicity Don Neame said that all the road shows were well publicised as well as many other public meetings. There were varying levels of attendance but it was interesting to note high response rates from boroughs where few attended road shows and vice versa. There was a range of engagement approaches beyond road shows In response to Arif Kamal s question to Councillor Ivimy as to how she would have liked to see the consultation conducted, she said that: Translations should have been out earlier for the hard to reach groups. Road shows were not well publicised and could have been better organised. She noted that the one in Hammersmith and Fulham had been well attended because of local political interest and promotion by the Council but this contrasted with poor attendance in other boroughs. The format of the consultation was such that it reduced months of detailed expert work to a glossy document for respondent to tick boxes arguably designed to elicit a yes tick Martin Roberts asked whether the consultation was able to address any gaps for Hillingdon residents who were not represented in the JHOSC to ensure they could contribute their views; whether this impacted on the uptake and response; and whether Ipsos MORI had analysed the differential picture which seemed to be reflected In response, Don Neame drew members attention to page 18 which recorded the breakdown of response by boroughs and noted that this could only be recorded where postcodes were provided. The response from Hillingdon residents appeared comparable with other boroughs The Chairman asked if Ipsos MORI considered the level of response to be typical given the size of the population from which views were being sought. Jonathan Nicholls responded that even discounting the responses generated from the Chelsea and Westminster campaign, the response level represented a substantial number when benchmarked against other London health consultations. He added that as some people will only answer parts of the questionnaire, they have recorded percentages as a proportion of the number of people responding to that question. Page 6 of 14