Extraordinary Brent CCG meeting on Wednesday to further controversial health plans

There is an Extraordinary Meeting of the Governing Body of the Brent Clinical Commissioning Group at noon-1.30pm on Wednesday 14^th December at the Boardroom Wembley Centre for  Health and Care.  The meeting is open to the public and 30 minutes has been allocated to questions from the public.

The meeting is about the business case for Shaping a Healthier Future and the CCG consider this essential for ‘delivering’  the controversial NW London Sustainability and Transformation Plan. Cllr Krupesh Hirani confirmed in the Brent and Kilburn Times today that Brent Council intends to sign the STP despite the fact that neighbouring Ealing and Hammersmith and Fulham councils have refused to do so.

As usual the documents are massive, jargon ridden and with enough acronyms to fill Wembley Stadium.

Anyone who manages to plough through them AND understand them deserves an honorary degree.

Those who think that the STP, though argued on the  basis of benefits to patients, is really a cover for cuts may be interested in the Strategic Outline Case for investment to eventually save money: 

For trusts under the ‘comparator’ scenario, where no commissioner QIPP is assumed to be delivered and with business-as-usual CIP delivery, all our provider trusts will be in financial deficit, with a combined deficit of £114m at 2024/25. However, if commissioner QIPP were delivered, trusts’ I&E would improve to a combined deficit of £18m as additional CIPs can be achieved (termed the ‘SaHF scenario before reconfiguration). The CCG QIPP delivery is dependent in part on the building of the hubs, which is why it is not included in the ‘comparator’. If we receive the capital funding we are requesting, the trusts’ financial projections demonstrate that all trusts will have a sustainable I&E surplus position of £27.6m at 2024/25, with the reconfiguration contributing a c£50m benefit (termed the ‘SaHF scenario after reconfiguration’). 

Currently the trusts are running in-year deficits which would require an estimated cash support of £1.1bn over the next 10 years (and continue thereafter), which would reduce to £0.5bn under the ‘SaHF scenario before reconfiguration’ (where additional CIPs are delivered, partly due to hub investment to enable QIPP delivery). Under the SOC part 1 option (‘SaHF scenario after reconfiguration’), the cash deficit support in the 10-year period would reduce further to £0.4bn and are eliminated post reconfiguration. 

If the capital investment were funded by loans, two of the trusts would have a below target Financial Sustainability Risk Rating (FSRR) and be unable to meet the loan repayments. As the loan funding scenario is unaffordable from a liquidity perspective, we have explored two further scenarios and have concluded that our preferred option is for Public Dividend Capital (PDC) funding, and an accelerated timeline. 

We have also demonstrated that the case is affordable under a range of scenarios by conducting sensitivity analyses.

Documents

BrentCCG SaHF SOC Part 1 cover sheet 14122016

Shaping a Healthier Future SOC Part 1 Covering Report

14 December GB Agenda

Shaping a Healthier Future - Strategic Outline Case Part 1

This is the Brent Cabinet decision as recorded in the minutes of the October 24th Cabinet meeting:

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 disabled charity threatened as NHS increases rent to market rates

My article on plans for the 'NHS Estate' elicited a comment about the future of Brent Advocacy Concerns LINK who are faced with a possible increase in their rent at Willesden Centre for Health and Care  LINK to market rates as part of the monetisation of NHS property.

BAC is a charity run by disabled people themselves.

John Healy, a South Kilburn resident and volunteer at Brent Advocacy Concerns, has provided further detail about the situation BAC faces:

Today at 12.30pm our landlords have called another 'building users meeting' (5 previous ones so far) but we have never been invited to attend any of them, including that meeting.  I intend to attend it as we have been there since the centre opened and on the previous site in Harlesden Road since 1991 and we are tenants of sorts.  The problem is we were tenants of BADP, a limited company who were dissolved on the 1st March this year. 

We have been surviving on our reserves and without knowing if we can stay in our office, it has been impossible to plan anything.  We are still solvent but have not received any income since the 2011/12 financial year.  We have no waged staff any more and now only use volunteers including myself.  We decided a couple of years ago to have a 'new' website which we now have and we are able to give advice and information to people who email or phone us.  We can no longer provide advocacy itself so we are only a shadow of our former selves.  But if we lose the office, it is more than likely that we will close down.

Both the council and the NHS have both been saying they are finding it difficult to reach 'marginalised groups' like disabled people but they have never contacted us, even though we are in the council's own directory.  We also help people with The Care Act 2014 in providing some disabled people with information they may need to understand it. Now our work is limited by the uncertainty about our future.

Just to conclude, there are approximately 50,000 disabled and people with a long term illness in Brent (refer to borough's diversity plan 2015-19 which is in The Wellbeing & Scrutiny Committee and the 2011 census) but we are the only disabled charity left.  The council might argue that is not the case but all the other services are companies first, with a charitable part to their business.  There are other charities as well but they cater for specific ethnic groups.

Brent NHS Clinical Commissioning for 2014-15 (Draft)

NHS Brent Clinical Commissioning Group has published its Draft Intentions for 2014/15 which can be found in the document below:

Brent Council shrinks from outright opposition to Central Middlesex A&E closure

The Brent Health Partnerships Overview and Scrutiny Committee last night approved a response to 'Shaping a Healthier Future' which fell far short of outright opposition to the proposals which will mean the closure of Central Middlesex Accident and Emergency.

Although the response contains many reservations about Urgent Care Centres,  community care and transport issues the overall conclusions are anodyne:

Overall conclusions

5.1 The Brent Health Partnerships Overview and Scrutiny Committee believes a strong clinical case for change has been made by NHS North West London and that health services need to be reconfigured to secure better outcomes for patients. This will mean that difficult decisions will need to be taken, but to “do nothing” is not an option and it is in everyone’s interests to ensure that services in London have a sustainable future.

5.2 That said, we urge the Joint Committee of PCTs to consider the following points when making its decisions regarding Shaping a Healthier Future:

(i). Efforts need to be focused on successful implementation of the borough’s Out of Hospital Care Strategy and ensuring this is properly resourced before the reconfiguration of acute services.  Changes to the acute sector are dependent on this – cost shunting, or under resourcing out of hospital care would not be acceptable to the council and will lead to a worse service for patients escalating costs in the acute sector.

(ii). That services to be provided from Central Middlesex Hospital are confirmed as soon as possible. Work should begin with local communities to spell out what the future is for the site so they can be reassured their health and wellbeing won’t be adversely affected by the changes.

(iii). That Shaping a Healthier Future emphasises to TfL the conclusions relating to

transport set out in paragraph 4.11 above.

Earlier in the meeting committee members had subjected Care UK to a grilling regarding the loss of x-rays  and child protection procedures at the Central Middlesex UCC and the time they had taken to answer complaints.  Care UK told them that the problems had been caused by high staff turnover, a large number of interim staff and a failure to recognise the importance of the issues. Cllr Helga Gladbaum stressed the importance of safeguarding children in the brough with its history of cases such as Victoria Climbie, Care UK said that staffing was being stabilised, protocols were in place and there was robust auditing and monitoring. Cllr Sandra Kabir said it was astounding that Brent had not ended up with a terrible disaster on its hands. Dr Sarah Basham, representing the Brent Clinical Commissioning Group said that they had found Care UK willing to listen and learn from each other and they had been open and willing to meet. GPs ere aware of the situation and a feedback mechanism was in place.

There was a lively debate, mainly conducted at a comradely level between councillors apart from a tetchy spat between Cllr Gladbaum and deputy leader Cllr Ruth Moher, on public health. Local councils have now taken over public health functions from the NHS and a proposal had been made to appoint a Director of Health to be shared with the London Borough of Hounslow. The proposal goes before the Executive on Monday.

Phil Newby,  Director of Strategy, Partnerships and Improvement, moved a report advocating such an appointment in a long speech rich in rhetoric but short on substance. He wanted an evangelical leader to drive policy and change. Questioning revealed that the Director would have no budget and would not be part of the Corporate Management Team. Simon Bowen from Brent NHS addressing the committee said that such a 'part-time'  post-holder would be weak and marginalised and it would be hard to recruit to the post. The post was statutory and subject to guidelines. He said that Brent had been transformed in the last 5 years while Hounslow was 5 years behind it. Brent's gains would be put at risk by such an appointment.

Newby defended his report saying that the current Hounslow post-holder had just been given a new job in Croydon and that innovative strategies would be welcomed.

The Committee agreed to recommend to the executive that while they supported mainstreaming public health in the body of the Council that they had serious concerns over sharing a Director with another borough.