Bid for £513m for NW London CCGs to be submitted to implement STP

Just after the Kilburn Times LINK published a story about the potential impact of the Sustainability and Transformation Plan (STP) on Brent, the NHS Brent Clinical Commissioning Group held an extraordinary Governing Body meeting at lunchtime today. The Times story pointed to a difference in emphasis on the STP from Cllr Krupesh Hirani, lead member for community wellbeing who said he would sign up to the STP, and Carolyn Downs, Brent CEO who has led on the STP, who repeated the caveats made at Brent's October Cabinet meeting*. The STP got very little detailed mention at today's meeting.  Ealing and Hammersmith and Fulham boroughs have refused to sign the STP at present.

The chair said that in seeking £513m investment the area CCGs were following through the controversial Shaping a Healthier Future  (SaHF) and the Sustainability and Transformation Plan . The investment was necessary to deliver these plans and the meeting considered the Strategic Outline Case (Soc 1) for the investment. 

The majority of the funding (£304)  would go to acute hospitals, most of it to Ealing Hospital. £69m to improving GP practices, and £141m to out of hospital hubs.

 

The £304m hospital share would:

• support Ealing's changes to become an excellent local hospital
• expand A& E and provide more beds at West Middlesex Hospital
• expand A & E and maternity at Hillingdon Hospital
• provide more primary and community care services at Central Middlesex Hospital
• provide more post-op recovery and critical care beds at Northwick Park Hospital and improve some existing buildings

The £69m GP practices share would:

• make it easier for patients to physically get in and out of practices
• make better waiting rooms and more consulting rooms across all 8 boroughs

The £141m allocated to Out of Hospital Hubs would:

• modernise 11 existing community hubs
• build 7 new ones
• increase capacity and enable people who have multiple health and care needs to have those dealt with in one place 

The overall aim was better health care and preventing unnecessary hospitalisation.

At the public question time Robin Sharp speaking for Brent Patient Voice said:

I thank the Governing Body for making 30 minutes available for public comments or questions during this session. I am afraid that the rest of what I have to say will be more critical.

Sadly we are presented with yet another example of flawed procedure and a flawed case for change on the part of our NHS.

To begin with procedures, it is farcical that the Governing Body are set to approve a complex 250-page submission only 8 days after it was put into the public domain. Doctors on the Governing Body are very busy people with important clinical jobs. How can they have had time to read and understand these proposals?

It is also disgraceful that 7 out of the 8 NW London Healthwatches which make up the PPRG (Patient and Public Representative Group) for SaHF have offered quasi-endorsement for the document even though they admit that the public they are supposed to represent have not seen it.

We are told there will be public engagement in future, but is not this the wrong way round? Engagement should have been before the document goes to the Treasury.

Turning to the clinical case for change, it has been over 3 years since the “Better Care Closer to Home” strategy set out in SaHF was launched. It was supposed to be all in place by 2015. Where is the assessment to show that more care in the community has stopped people being admitted to hospital and reduced the need for acute beds?  It is certainly not in the NW London STP (Sustainability and Transformation Plan). “If Better Care Closer to Home” works why are our A&Es among the most challenged in England. Why are Referral to Treatment (RTT) times on a downward trend?

We were told in the slide presentation that 27 Hubs across NW London are at the heart of this Business Case and that St Charles off Ladbroke Grove is an example of a fully functioning “Hub”. Can we please see a paper giving details of how this is working? As a patient of a nearby Brent practice who uses the Urgent Care Centre at St Charles I have to say that the existence of a Hub is a well kept secret. No-one has told me or my Practice PPG about it.

Maurice Hoffman asked if only a limited amount of the monies claimed was available how would it be distributed?  He asked if  a 'local A & E' would meet London standards. He was told that the CCG had made it clear to the NHS that all the proposals were inter-connected and they were pitching for the full amount.  He was told that a Charing Cross A & E would not take 'blue light' case and NW London CCGs were looking at what services for the frail and elderly could be best placed there.  He was assured that 'until we have the capacity we will not change anything.'

As the presentation had mentioned voluntary organisations as providing services in the hubs, I asked how this would work when NHS England and NHS Estates were saying that market rents had to be paid. There was a momentary silence while the governing body members looked at each other and then Sarah Mansurali replied that they were looking at giving grants to voluntary sector organisations so they could afford the rent, offering sessional space or try to integrate voluntary organisations into new models of care.

The Governing Body noted the scope of the SOC and approved Part 1 for submission to NHSE and NHSI for approval and asked for the following points to be considered prior to approving subsequent related Outline Business cases (OBCs):

• further public involvement is undertaken where appropriate
• the OBCs continue to justify the capital requirement set out in SOC part 1
• opportunities to accelerate the delivery of the benefits are explored
• opportunities to further improve the income and expenditure position of proposals are explored

It is worth noting that this meeting took place during the day on a weekday so opportunities for the public to attend were clearly limited.  

*Cabinet Minutes October 24th 2016:

1.     Cabinet noted the STP submission for North West London. 


2.     Cabinet welcomed the principles adopted within the STP of prevention, out  of hospital care, dealing with the social care funding gap and the need to work across the public sector to maximise benefits from changes to the NHS and other public sector estate. 


3.     Cabinet noted that the STP will need formal sign off by the end of December and that between October and December the following issues need to be clarified both within the submission and through other NHS processes, in 
 order for the council to give full support for the plan:

a.     That the IMBC on which delivery area 5 is based is released, debated and understood; 


b.     That the flow of monies from acute to out of hospital settings are clarified; 


c.      That the specification for out of hospital settings, in particular social care, are clarified
based on an agreed model of out of hospital care; 


d.     That a full risk assessment for the plan and relevant mitigations are included.

Brent NHS CCG takes its toys away

Guest blog by Nan Tewari

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In the most extraordinary spectacle I have ever witnessed in over 40 years of attending public meetings and meetings of public bodies (two different things) on Wednesday evening, Brent NHS Clinical Commissioning Group (CCG) fell out spectacularly with its patient representatives. In short, the CCG refused a perfectly reasonable, unanimous patient request to change the order of the agenda items of the patient engagement meeting and in the face of patient disapproval, decided to close the meeting with no business having been transacted. The badly run meetings (by a CCG public appointee) had failed consistently to run on accepted lines, namely, apologies, approval of minutes. matters arising etc. and as a result, minutes of meetings held in November 2013, March 2014 and May 2014 have never been approved and therefore cannot be put onto the CCG website for the benefit of the public at large.

The law requires CCGs to consult with patients and the public on proposed changes to the delivery of health services.   Failure to comply with the requirement can be serious with the CCG being challenged by providers as well as by individual patients and groups of patients who perceive changes as being detrimental.  Even if the CCG is confident that it is making the best decision, it still needs to go through a proper and proportionate public engagement process.

In order to meets these legal obligations, the CCG set up a committee of its Governing Body called the Equality, Diversity and Engagement (EDEN) Committee to provide itself with assurance that its public involvement activity in the multiplicity of proposed service changes was as robust as it should be.

My fellow patient reps and I (some, appointed by the CCG and others, elected by fellow patients) worked really hard to help the CCG and pointed out where it could be open to challenge.  We take the view that we are neither a rubber stamp nor nodding donkeys, and it is our duty to withhold the desired assurances if patient involvement is unsatisfactory.  The CCG did not appreciate this one little bit and started a smear campaign against patient reps saying that we were failing in our duties.

The CCG is effectively rewriting the rules to tell patient reps how they must act. In the course of doing so, they are also breaching all of the accepted rules of public body committee procedure and have stated that their particular public body (the CCG) does not have to act in accordance with these norms.

I have taken up this guest blog spot, courtesy of Martin Francis, because there is nowhere officially in Brent CCG for patients to air their views on matters of public involvement in proposed changes to local health services as is required by s14Z2 of the NHS Act 2006 as amended by the Health and Social Care Act 2012. It would be interesting to hear what others patients and members of the public have to say.