Agenda and minutes

Apologies were received from Councillor John Getgood and Councillor Peter Fookes attended as alternate. Apologies were also received from both Lynne Powrie representing Carers Bromley and her alternate Maureen Falloon.

Councillor David Jefferys declared a personal interest as Vice President of a major pharmaceutical company.  

In accordance with the Council’s Constitution, questions to this Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5pm on Thursday 5^th July.

There were no questions.

Members commented on the previous minutes and it was noted that apologies for absence should have been recorded for Councillor Robert Evans and that the word “fiancés” at paragraph 8 of minute 22 replaced with

”finances”. It was also highlighted that the start of the fourth sentence at Minute 16 should read “Angela Clayton-Turner”.

Democratic Services Note: the minutes published with the agenda were an early draft not reflecting subsequent amendments. As such, arrangements will be made for the correct version of minutes to be agreed by email with the Committee and Co-opted Members. When agreed, these minutes will be published on the Council’s website via the following link:

http://cds.bromley.gov.uk/ieListMeetings.aspx?CId=445&Year=2012

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There were no comments on this item.

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Subject to final approval by NHS London and sign off by the PCT Chair and Clinical Commissioners Chair, formal consultation on the future of Orpington health services was scheduled to begin on 16th July 2012.

A presentation on the proposals (i.e. what people would be consulted on) was given by the Project Director, Orpington Health Services Project and a confidential draft consultation document was tabled. A copy of the PowerPoint Presentation is attached at Appendix A.

A Pre-Consultation Business Case, agreed by the local Clinical Commissioners on 5^th July 2012,had been developed to demonstrate a robust, evidence- based, clinical case for change and to outline the future proposals.

The Project Director’s report to Members set out how it was believed the four tests for reconfiguration proposals (under the revision to the NHS operating framework in England 2010/11) had been met prior to consultation.

Support from GP commissioners - engagement with GP commissioners and the broader GP community had been continuous throughout the lifetime of the Project, with GP commissioners being central to the project. The project had ensured that emerging proposals are also aligned with the emerging local CCG strategy. Engagement had taken place between August 2011 and June 2012, and would continue through consultation and implementation.

The Orpington GP cluster had also been engaged in shaping the emerging picture at each of their meetings.

Strengthened public and patient engagement - the Project had engaged and captured the views and feedback of a wide range of people e.g. Bromley and Orpington residents, patient advocacy groups, Orpington hospital staff, GPs, Clinical Commissioning leads, Bromley LINks, Bromley OSC, NHS London, Bromley MPs and Councillors. Engagement took place between September 2011 and June 2012 and would continue through consultation. Engagement had been undertaken in an open and transparent process and was found by the Health Gateway Review team to be well managed, inclusive and effective.

Clarity on clinical evidence base - there had been strong clinical leadership throughout the Project. Various clinicians such as SLHT clinical leads, Clinical Commissioners and GPs had been involved in the project and had assisted with assessing the needs of the population currently requiring services from Orpington Hospital e.g. long-term conditions such as diabetes. The clinicians had assisted in identifying opportunities to improve the services delivered to the population e.g. co-location with specialist services, improving primary care estates, increasing independence.

The information and evidence collected showed a strong clinical case for a new model of care for services currently delivered from Orpington Hospital and opportunities to further integrate services to meet wider health and wellbeing needs of the local population. 

Consistency with current and perspective patient choice - all recommended approaches for consultation would result in services currently delivered on the Orpington Hospital site being transferred to alternative locations. Accessibility and patient choice had been key considerations in developing viable options for delivering services to meet local population needs.

Information and evidence collected indicated that the proposed changes would not  ...  view the full minutes text for item 6.

A presentation was given by Tracy Pidgeon, Ambulance Operations Manager for A&E Operations Bromley, Beckenham and Forest Hill and David Gibson-Stark, Duty Station Officer at Bromley Ambulance Station. A copy of information handed to Committee Members and Co-opted Members is at Appendix B.

In addition to information in the handout, a number of comments were made by the Ambulance representatives including those summarised below.

• On standards for patient waiting times, Category A includes cases regarded as life threatening.

• The Category A standard (75% within eight minutes) is difficult to achieve as it also takes account of the call.

• Categories C1 and C2 are not cases for immediate response.

• Category C3 and C4 telephone assessments are within 60 minutes and 20 minutes respectively.

• On data related to Bromley Patient Waiting Times April 2011 – March 2012 (page 2 of handout), Category A19 cases relate to occasions where an ambulance backs up.

• The total demand from April 2011 to March 2012 at 35,588 relates to the Bromley, Beckenham and Forest Hill A&E Operations area.

• The illnesses categories at the top of page 3 of the handout represented the ten most frequent requiring an ambulance response.

• The Cardiac Arrest Survival Rate (London) is expected to be at 30% when new figures are published.

• Bromley figures concerning Patient Return of Spontaneous Circulation at 41% for April and 21% for May (i.e. people getting to hospital after a cardiac arrest) are good given the extent of Bromley’s elderly population.

In discussion it was indicated that Bromley Town Centre to Kings College Hospital could take some 25 minutes on an emergency “blue light” journey. 

Referring to the Urgent Care Network of which all LAS services were a part, the Director of Public Health indicated that work was ongoing with LAS services on alternative pathways outside of A&E e.g. taking patients to Urgent Treatment Centres. It was necessary for people to be taken to the right place.

In further discussion, it was confirmed to Councillor Catherine Rideout that a triage could be undertaken by telephone and if appropriate urgent assistance provided by motor cycle with ambulance backup.

In response to a question from Councillor Fookes, it was indicated that highest demand was at the weekend, peaking from Thursday to Friday. In response to a further question, it was indicated to Councillor Fookes that an independent analysis of demand is undertaken and a prediction made of where calls for an ambulance are most likely to be made. The location of ambulances would then be fixed according to the predicted demand. If a crew was unavailable, the next nearest crew is sent out. Depending on the location, this could be a crew from a neighbouring A&E Operations area such as Greenwich.

Concerning hoax calls, it was explained that some might dial the emergency number out of panic and others might dial the number through lack of education.

Councillor Ruth Bennett felt that the cardiac survival rate was impressive; she suggested that it  ...  view the full minutes text for item 7.

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All NHS organisations are required to develop a Quality, Innovation, Productivity and Prevention (QIPP) Plan describing how major national drivers towards shifts in the settings of care, improved quality of care, and greater productivity would be delivered locally. For Bromley this enabled resources to be identified and released which could be reinvested in innovation and improved quality.

To inform development of its QIPP Plan, Bromley Clinical Commissioning had undertaken a review of its strategy for the coming three years - the process being informed by the Joint Strategic Needs Assessment (JSNA), Health and Well Being Board priorities, Health Outcomes, and local provider risks and opportunities. A vision and Integrated Plan for the organisation had been developed defining strategic goals and strategic objectives.

To implement the strategic objectives, the following programmes of work had been formed:

·  Planned Care  

·  Urgent Care 

·  Primary Care 

·  Long Term Conditions 

·  Women & Children 

·  Mental Health 

·  Corporate 

The strategic programmes included the schemes set out in the QIPP Plan.

The QIPP programme for the current year at £9.24m was mainly predicated upon the Clinical Commissioning Group’s (CCG) ability to make contractual changes through activity shifts out of secondary care, moving care into the community where appropriate or through efficiency savings (e.g. reduction in follow up outpatient appointments). This presented the CCG’s main challenge and effective management of its acute contracts in the current financial year would be one of its main priorities.

Additionally, a number of new initiatives had been identified which would deliver improvements in clinical quality across a range of pathways, along with improved efficiency, and shifting care closer to home for many patients.

Work continued with the CCG’s planned care programmes on shifting activity to more community based settings – for example, in Dermatology, Gynaecology and Musculoskeletal – and other pathways continued to be identified through work with stakeholder groups.

Bromley CCG’s QIPP programme also described longer term measures which would become deliverable throughout the planning period described in the Integrated Plan, and which would demonstrate real improvements in patient outcome measures for Bromley residents. Some of the longer term plans would include the more transformational programmes, such as the CCG’s ProMISE programme (Proactive Management and Integrated Services for the Elderly) which, when fully rolled out across the Bromley area, would, it was anticipated, contribute to high level savings through avoiding unplanned admissions for vulnerable and elderly patients. By working with Bexley and Greenwich colleagues additional synergy could be created which would help deliver some of the more challenging aspects of QIPP in the medium to long term e.g. redesign of patient pathways into more community based settings and decommissioning activity from acute providers. The Bromley, Bexley and Greenwich (BBG) Programme Board would continue to own and develop larger transformational QIPP programmes, specifically in planned and urgent care, and for some schemes within Long Term Conditions and other programmes.

A table was provided in the Director’s report showing the 2012/13 QIPP Plan with identified schemes, their 2012/13 values and a short description of each  ...  view the full minutes text for item 8.

Jennie Hall CEO and Chief Nurse, South London Health Trust will address the committee.  

In providing an update on outstanding issues, the Deputy Chief Executive of the South London Health Trust (SLHT) addressed the Sub-Committee.

She advised on matters related to the provision of patient medication and prescriptions. Concerning delays, it was hoped to be able to provide prescriptions/medications to patients on ward rounds. Reference was made to being clear on what is prescribed and getting this to the patient as soon as possible. Sometimes A&E would dispense what is prescribed on discharge. A dossit box could take some time and for people such as the elderly, it was quite a prescriptive and complex process. The Deputy Chief Executive was comfortable that progress was being made although there was further work to be done.

A question was asked on the extent to which the Discharge Lounge was used by patients. It was indicated that the Lounge was a location where a patient could stay whilst waiting for an ambulance. It was a comfortable place to be and a bed was not being blocked. It was confirmed that the Lounge was not operative overnight. It was further explained that if a family provided a private car for transport, the patient could leave directly from the ward.

Concerning eye care, reference was made to implementing the largest NHS programme for change. Timescales were outlined for moving to the new system and receiving its full benefit.

Brief comments were also provided on matters associated with the SLHT’s financial position and an anticipated announcement the next day that the Secretary of State for Health will have decided to put the Trust into administration. Members were advised that pressures for the Trust were around its financial position and not around the quality of service - infection control rates were three times less than the national average. Councillor Ruth Bennett suggested that the Sub-Committee hold a special meeting to consider the Trust.

In closing, the Chairman thanked the Deputy Chief Executive.

Please refer to attached pack.

Please refer to attached pack.