The Chair welcomed members to the meeting. Apologies were noted.

The minutes of the previous meeting were approved as an accurate record of proceedings subject the insertion in page one of a declaration of interest from Councillor Mammat.

There were no matters arising.

Ms LeBrooy explained that she had been working with the North West London cluster and helping to take Shaping a Healthier Future to consultation. Shaping a Healthier Future came from a need for change and was driven by the Clinical Commissioning Groups in North West London including board level clinical leads. 

She explained that the options were put before the PCT board and they agreed to go to consultation.  The programme aims to improve access and ensure high quality hospitals by providing clinical leads with the tools to achieve these objectives. 

The changes would involve 2 million people, 8 clinical commissioning groups and lots of specialist hospitals. Ms LeBrooy outlined the main issues:

1.      Aging population

2.      Differential life expectancies

3.      Requirement to deliver savings of 4% a year

She added that there was also an imperative to have a more senior and specialist skills set.  

Ms LeBrooy explained that if nothing was done then there would be no clinical quality improvement. She highlighted the importance of reshaping services and investment. She also reported that the Clinical Commissioning Groups were making changes to ensure that patients are not going to hospital if it would be worse for them in the long run. She said they also have to be able to manage money and improve mortality rates. 

Ms Lebrooy reported that their response to these challenges was to localise, centralise and integrate services. She explained that integration is an important element which is helped by their work in the community, such as end of life care schemes.

Quality improvement

Ms LeBrooy outlined the various elements of quality improvement:

i.                    Independent empowerment and self care

ii.                  Access

iii.                Multidisciplinary care 

Ms LeBrooy explained that, because a variety of different organisations need to work together and share information, communications was very important.  Patients will have access to care records and they will be able give their consent to share their records with healthcare professionals.  This will help ensure that patients only stay in hospital for the correct length of time.

Ms LeBrooy reported that the focus will be on improving choice, quality and access to emergency departments, maternity and childcare services. There will be more senior specialist decision making with the result that risks to patients will be reduced, care improved and lives saved.  

Implementation

Ms LeBrooy explained that the vast majority of cases are dealt with by accident and emergency and outpatients departments and it is envisaged that in the future hospitals will manage 70% of what they do now. There will be elective hospitals but specialist hospitals are not considered in the consultation.

Urgent care centres will be available for dealing with minor injuries in different boroughs and there will be different arrangements with private providers. If the case cannot be dealt with there must be a safe mechanism for managing it.  

Ms LeBrooy explained that they were looking at what could be done without disturbing the whole system. Five hospitals would be changed slightly to meet demand for  ...  view the full minutes text for item 3.

 Ms Jeffers explained that since April 2012 Hounslow Clinical Commissioning Group (CCG) was led by 12 local GPs and since election in June this number had been reduced to 9 plus lay members, LINKS and nurse members. Procedures had been changed in response for their application to become a statutory organisation. Members will be on the board for 3 years, 2 years or go to election the next year.

The Board will meet in public and Councillors are welcome to attend. There will be local authority representation through the Assistant Director of Joint Commissioning and the Chief Executive.  Ms Jeffers explained how the money the CCG is responsible for is used. There will be a 360 degree review that will feed into the authorisation process.  The Accountable Officer will be Daniel Elkeles, NHS Hounslow Director of Strategy and the Finance Officer is yet to be recruited.  

The CCG has worked hard on the hospital strategy and spent a lot of time rolling it out, including stakeholder events and opportunities for residents to meet board members.

Commissioning priorities

Ms Jeffers provided an update on commissioning priorities. She reported that commissioning institutions were all working well together and progressing well, for example a mental health integrated health care pilot and ensuring that clinical guidance is clear and consistent with regards to triage. Ms Jeffers added that it was important to make sure that there was a secondary care consultant to help and support GPs.

Planned care

Ms Jeffers reported that the CCG had developed a communications and engagement strategy and that there was a clear vision; multi-professional staff working together to provide care in the community as effectively as in hospital and all consultant led services.  The out of hospital strategy has 5 key areas with a focus on working together.

Cllr Todd noted that GPs will be responsible for commissioning hundreds of millions of pounds of services and questioned how well they are equipped to deal with the commercial pressure and ensure value for money.

Ms Jeffers responded that GPs are accustomed to running their own businesses but will also have a team around them to advise on issues such as finance. There is also a Council of Members involving local GPs that will have monthly meetings and statutory responsibilities.

Six practices will have a relationship manager and there will be a programme of mentoring.  The finance team will divide the budget into practice based budgets based on factors such as deprivation to ensure an appropriate budget for patients in that practice and GPs will be mentored to stay on budget.  GPs have been brought into the procurement side allowing a fusion of management and clinical knowledge.

Responding to members questions on mental health services at Feltham Young Offenders Institution and back up services for bereavement in end of life care Ms Jeffers said that bids to provide an integrated mental health service at FYOI came in on the day of the meeting and confirmed that there will be a  ...  view the full minutes text for item 4.

The Chair asked Deepa Patel, Scrutiny Officer, to update the committee and asked what the Committee would like to prioritise.  Members were advised to pick two areas but to prioritise one.

o       Cllr Fisher – Disability

o       Cllr Reid – Infectious diseases

o       Cllr Mammat – Day centres

Members requested that Scrutiny schedule more meetings but were advised that the meeting calendar had been reduced to five meetings a year. Members said that it was possible to ask for additional meetings to cover issues such as the NHS consultation. The committee could have formal meetings as scheduled and then have extra meetings to deal with specific issues.

Members commented that the limited meeting schedule is preventing the committee from exercising its scrutiny function.  Members agreed that the reduction in meetings will have an impact but should wait until the new Panel membership is established and discuss this issue further.

There were no other matters.

The date of the next meeting was noted.