Agenda and minutes
Venue: London Borough of Tower Hamlets, First Floor, Town Hall, Mulberry Place, 5 Clove Crescent, London, E14 2BG
Contact: Tahir Alam, Strategy, Policy & Performance Team 0207 364 5064
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WELCOME AND INTRODUCTIONS PDF 357 KB Minutes: 1.1 Introductions were made and the Chair welcomed to the meeting Dr Somen Bannerjee (Interim Director of Public Health, Tower Hamlets Council).
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APOLOGIES FOR ABSENCE PDF 42 KB To receive any apologies for absence.
Minutes: 2.1 Apologies for absence were received from Cllrs Vaughan, Walls and McAlmont. The Chair sent the Committee’s best wishes to Cllr Vaughan who was in hospital.
2.2 An apology was also received from Mr Neil Kennett-Brown (Programme Director – Transformational Change, NHS NEL CSU) for item 6.
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URGENT ITEMS / ORDER OF BUSINESS Minutes: 3.1 There were no urgent items and the order of business was as on the agenda.
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DECLARATIONS OF INTEREST Any Member of the Committee or any other Member present in the meeting room, having any personal or prejudicial interest in any item before the meeting is reminded to make the appropriate oral declaration at the start of proceedings. At meetings where the public are allowed to be in attendance and with permission speak, any Member with a prejudicial interest may also make representations, answer questions or give evidence but must then withdraw from the meeting room before the matter is discussed and before any vote is taken.
Minutes: 4.1 There were none.
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MINUTES OF THE PREVIOUS MEETING AND MATTERS ARISING PDF 75 KB Additional documents:
Minutes: 5.1 The minutes of the meeting held on 11 September 2014 were agreed as a correct record subject to the following amendment:
Page 8, point 4 referring to Cllr Hayhurst "...by virtue of a conflict of interest arising from his career as a barrister, and undertook to leave the room…" to read "by virtue of having met with those conducting the judicial review with a view to assisting them, and undertook to leave the room…"
5.2 Under matters arising the Committee noted the response from Neil Roberts of NHSE to the Chair’s letter to them concerning the MPIG issue. The Chair added that she has asked NHSE London to keep the Committee informed when the new Carr-Hill funding formula would be agreed.
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IMPROVING SPECIALIST CANCER AND CARDIOVASCULAR SERVICES - UPDATE ON IMPLEMENTATION PDF 69 KB Additional documents:
Minutes: 6.1 Members gave consideration to a report providing an update on the implementation of the changes to specialist cancer and cardiovascular services which had been requested by the Chair. The Committee had given consideration to this formal case for change proposal on 20 November 2013 and NHS North East London Commissioning Support Unit had been invited back to present a short update.
6.2 The Chair welcomed to the meeting Sarah Mcilwaine (Senior Consultant, NHS NEL CSU) who took Members through the report. Ms Mcilwaine added that the Commissioners would only give final sign-off on the moves when all the services involved were deemed safe and quality assured.
6.3 Ms Mcilwaine and Dr Steve Ryan (Medical Director, Barts) responded to detailed questions from Members and in the responses the following points were noted:
(i) The three JHOSCS who considered the Case for Change were all broadly supportive of the proposal. Issues had been raised for example by clinicians on the impact on clinician training. Dr Ryan pointed out that at Barts they had engaged with ‘The Deanery’ on updating the curriculum for their brain-cancer surgeon training to take account of the changes.
(ii) Dr Ryan pointed out that concerns by neuro-surgeons about sufficient cover at the Trauma Centre at the Royal London (following movement of brain cancer surgeons to Queen’s Square) were one of the many quality assurance issues taken on by Barts’ Unification Board, which had the job of implementing the changes within their Trust. This Board had senior cancer surgeons on it and checks were made on all treatment gateways and ensuring that trauma services were safe. No moves would be signed off until the Operational Steering Group, led by senior clinicians, were assured that all systems remained safe.
(iii) In relation to the metrics being set to judge the performance of the new system, Dr Ryan pointed out that for Barts these would include the results from the National Cancer Survey, reductions in waiting times and reaching the benchmarks for England, Europe and the World on outcomes.
(iv) Across all the changes ‘gateway 6’ would be the key milestone and it would assess how long after the switch round could benefits be realised. The focus here would be on the whole pathway not just on trauma. The key focus overall was to reduce late diagnosis of cancer and CVD.
(v) The changes were cost neutral but resources would move around within the system. The vast majority of care would remain where it was currently provided. In terms of Barts own Cancer Centre, this represented a large investment and there would be analyses of when a surplus could be made on that long term investment.
(vi) The claims made for how the changes would impact on early diagnosis and prevention related to the fact that in large trusts such as Barts, the whole pathway was being looked at. The organisation was called ‘Barts Health’ not ‘Barts Hospitals’ and the focus was in saving lives ... view the full minutes text for item 6. |
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IMPROVING QUALITY AT BARTS. HEALTH NHS TRUST PDF 48 KB Additional documents: Minutes:
7.1 The Chair stated that Barts Health issues generally came to INEL because their services crossed all of the 4 boroughs as well as Waltham Forest. She stated that there were ongoing concerns about quality issues at the Trust and reminded Members that City and Hackney CCG had written to the Trust during the summer raising serious concerns about quality standards and since then there has been the publication of the National Cancer Patient Survey where the Trust did not do well.
7.2 Members gave consideration to the “Update Report from Barts Health” and the Chair welcomed to the meeting Dr Steve Ryan (Medical Director), Ms Karen Breen (Director of Delivery and Improvement) and Mr Mark Graver (Head of Stakeholders Relations and Engagement).
7.3 Dr Ryan and colleagues took Members through their report. It was noted that Ms Breen was the new COO for the Trust and that improving data and IT system would be an important priority for her.
7.4 Dr Ryan and colleagues replied to detailed questions from the Members and during the discussion the following points were noted:
Problems with appointment systems
(i) The Clinical Support Services CAG in the Trust had taken on the outpatient quality issues. Issues of concern ranged from the appointment follow-up system, multiple letters being issued, patients being booked in to sites on days when a clinic wasn’t operating, or patients receiving two appointments on the same day at different sites. The processing time for patients was at 14 days and reducing as were the number of missed appointments and the phone waiting times. At Royal London the out-patients service had been successfully moved to a new building which had also helped.
(ii) Major problems experienced at Whipps Cross over the summer, when a serious incident had to be declared, were now being addressed in the new ‘Millennium’ IT system. The quality of the estate at Whipps for out patients also needed addressing and a lot more work needed to be done.
(iii) The problem of multiple letters arose from lack of sufficient staff training on the new system and the need to respond robustly when patients changed their appointment times more than once. The Chair commented that it appeared that sufficient testing did not appear to have been carried out on the new system before it had gone live. It was agreed that the new problem was a transformational change one and not just an IT issue.
National Surgical Audit Results
(iv) In relation to the issue of some surgeons not carrying out optimal numbers of particular surgical procedures, the Trust now had fewer vascular surgeons, going down from 13 to 5, who were highly specialised clinicians and the outcomes had improved significantly. With stroke patients for example surgeons could now intervene at an earlier stage of a clot and thus prevent the stroke from developing. This team were also working on this issue with clinicians at the Homerton.
Concerns from C&H CCG on quality
(v) Dr Ryan had ... view the full minutes text for item 7. |
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