Brent Stop the War will join Kashmir protest outside Downing Street on Sunday

Brent Stop the War has issued the following clarification regarding Sunday's Kashmir demonstration:

A well-attended 14th October meeting on PEACE & JUSTICE FOR KASHMIR in the Community Hall at the Cricklewood Mosque, was co-sponsored by Brent Mosque and Brent Stop the War. It was supported by Brent Central Labour Party and Brent & Harrow Palestine Solidarity Campaign. 

We agreed to have the Brent Stop the War banner on the demonstration in support of Kashmir on this Sunday (October 27th) assembling outside Downing St from 12.00 noon. There has been some public controversy over this demonstration, its purpose and its destination.

Our meeting heard how the Modi government in India had withdrawn the (limited) autonomy of Kashmir and violently repressed the opposition, ignoring longstanding UN resolutions. It was also made clear that this is neither a Pakistan vs India dispute nor a Hindu/Muslim one, but the right of Kashmiris to self-determination and for a just and peaceful solution to the dispute.

Kashmiris have long protested on October 27th, the date the Indian military entered Kashmir in 1947. In the UK, this is marked with a protest each year outside the Indian High Commission.

With the Hindu festival of Diwali falling on Sunday 27th, some have expressed the view that it would be inappropriate to hold the demonstration. Other claims that the demonstration will cause communal conflict because it coincides with Diwali 2019, could be seen as promoting a view of the Indian High Commission as a Hindu institution, when in fact the Diwali religious festival is not exclusive to India and the country defines itself as secular.

Although It is perfectly normal in a democratic society to protest outside the embassy of a government which breaks international law, out of respect for the celebration of Diwali we will not be going on to the High Commission. 

We will join the protest outside 10 Downing St, which has raised no criticism of the actions of the Modi Government.

Brent to devise a strategy for universal free school meals for primary pupils

Free school meals for all primary pupils in Islington - so why not in Brent?

Leader of Brent Council, Muhammed Butt, told a recent meeting of Brent Central Constituency Labour Party that council officers have been instructed to prepare a comprehensive strategy to provide free school meals for the 13,000 Brent primary pupils who do not currently receive them.

The strategy will draw on the experience of four London boroughs who already provide  free school meals to all primary children and will investigate a number of possible funding streams.

Graham Durham, a Brent CLP supporter of the proposal, has requested that the strategy and implementation dates be set out before the November CLP meetings.

Universal Free School Meals directly address issues of hunger and poor nutrition in children of low income families but also serve to remove any lingering social stigma associated with 'free dinners.' They ensure a steady income stream for school caterers and remove the school's administrative burden of collecting 'dinner money' and chasing up debts. The provision of a hot nutritious daily meal also aids a pupil's concentration in class contributing to closing the gap between the educational attainment of poor and better off pupils.

An  Islington Council paper setting out the issues can be found HERE

Brent Council announces convening of a Climate Assembly

Press release from Brent Council

A new Climate Assembly will be convened to channel residents’ voices, views and ideas as Brent responds to the climate emergency. 50 residents will be recruited by independent experts to reflect a cross-section of the population in Brent. Young people have spearheaded the climate emergency movement, so 16 and 17 year olds will also be included in the Climate Assembly.

Brent’s Climate Assembly will take part in a series of workshops through November and December. During these sessions, they will discuss exciting and innovative ideas for tackling the climate crisis at a local level. At the end of the process, they will make recommendations to the council which will be considered by Cabinet in the new year.

The process will be run by Traverse, an independent research and engagement consultancy. They will use random selection methods to recruit the Assembly members and make sure that the group reflects the diverse make-up of the borough.

Brent Youth Parliament will also be holding their own event on 26 October to discuss action that can be taken at a local level to tackle the climate emergency. Their recommendations will be fed into the process.

While residents won’t be able to volunteer to take part in the Assembly, their voices will also be heard. A new website will act as a hub for members of the community or local organisations wanting to share their own ideas for reducing Brent’s carbon emissions. These contributions will then be presented to the Assembly to reflect on and consider.

Cllr Krupa Sheth, Lead Member for Environment at Brent Council, said:

Global heating is predicted to have devastating consequences for all of us. That’s why it’s crucial that we create spaces for the voices of residents to be heard as we try to find solutions to this crisis. Now is the time to be bold. So I’m delighted to announce this Citizens Assembly and I’m especially pleased that young people will have the opportunity to share their ideas and suggestions.

Terry Parker, Chief Executive at Traverse, said: 

We at Traverse believe that the best policy is made together with the people it affects, so we’re delighted to be working with Brent Council in this pioneering action to hear from citizens how they want to address the climate emergency.

In July, the Council joined more than 200 other local authorities in declaring a Climate Emergency and pledged to do all in its gift to strive for carbon neutrality by 2030.

The local authority has spearheaded numerous green initiatives in recent years. These include introducing a diesel levy on parking permits to incentivise greener transport, creating a seven-mile bee corridor to boost biodiversity, and helping businesses to think about their impact through the Plastic Free Wembley initiative. Brent’s Civic Centre has been recognised as one of the greenest public buildings in the UK.

Have your say on the Brent Climate Assembly website.

How should we be discussing the new Relationship and Sex Education requirements in Brent?

I was rather surprised to see that a presentation on Relationship and Sex Education  (RSE) at Tuesday's meeting of Brent senior officers and school governors is to be given by Sophie Taylor, who is Deputy Director for Due Diligence and Counter Extremism at the Department for Education. The new requirements and guidance on RESE come into effect in September 2020.

I assume that the agenda is connected with events in Birmingham where some parents have protested outside a primary school about its teaching on these issues LINK.  However to make an explicit connection between 'Extremism' and concerns about RSE in the Brent context seems to run counter to commonsense when retaining the confidence of the community and parents in our schools and working with them should be our priority.

The issue came up in the July Council meeting and these are the relevant Minutes:

Question from Cllr Daniel Kennelly to Cllr Amer Agha, Lead Member for Schools, Employment and Skills: 

Can the Lead Member for Schools, Employment and Skills set out the measures that the Department for Education published in its statutory guidance on the teaching of Relationships Education? 

The Department for Education has announced that from 2020, relationships education will be compulsory for all primary school children and relationships and sex education will be compulsory for all secondary school children. The Department for Education published on the 25th February 2019 draft regulations and statutory guidance on Relationships Education, Relationships and Sex Education and Health Education, setting out what the requirements will be from 2020. This statutory guidance sets out what schools should do and sets out the legal duties with which schools must comply when teaching Relationships Education, Relationships and Sex Education (RSE) and Health Education. 

This comes 20 years after the government last made changes to health, relationships and sex education and is in the context of a world that looks significantly different to children from 20 years ago, with significant changes for how children develop their relationships, including understanding the risks for children online and the development of social media as a key feature in the majority of children's lives. 

The guidance states that from September 2020 all schools must have in place a written policy for Relationships Education and Relationships and Sex Education. Schools must consult parents in developing and reviewing their policy. Schools should ensure that the policy meets the needs of pupils and parents and reflects the community they serve. The policy should set out the subject content, how it is taught, who is responsible for teaching it and how the subject is monitored and evaluated. 

For primary education, the Policy should define Relationships Education and include information to clarify why parents do not have a right to withdraw their child. For secondary education, the policy should define Relationships and Sex Education and include information about a parent’s right to request that their child be excused from sex education within RSE only. 

The guidance sets out what by the end of primary school pupils should know about under the headings “families and people who care for me”, “caring friendships”, “respectful relationships,” “online relationships” and “being safe.” The guidance also sets out what in addition pupils should know by the end of secondary school under the headings “families”, “respectful relationships”, “online and media”, “being safe” and “intimate and sexual relationships including sexual health”. 

There are a number of myths being circulated regarding the 2020 changes. The first is that schools will from 2020 be required to teach concepts and values that are contradictory to some religious beliefs. This is not the case. Schools are required to comply with relevant requirements of the Equality Act 2010 and the Public Sector Equality Duty, which means, in making decisions, having due regard to the need to eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act, and to advance equality of opportunity and foster good relations between people who share a relevant protected characteristic and people who do not share it. The guidance states that “the religious background of all pupils must be taken into account when planning teaching.” 

A second myth is that these changes will conflict or compromise parents’ ability to educate their children according to their own religious or philosophical beliefs. How this curriculum will be taught will be a matter for individual schools, who will consult with parents before the introduction of the new relationships education and will listen to their views. 

Governing Boards, which will include parent Governors as members, will then work with their teaching staff to deliver the most age appropriate elements of the new curriculum to the pupils. Schools will have the ability to amend their approach if they believe it is necessary to support pupils and families at the school. 

Brent is home to one of the most diverse communities in the UK and this is one of our strengths. We strive to be an inclusive society and to ensure that everyone in the borough feels welcome and included. This means embracing the modern world we live in, and understanding and celebrating our various differences and addressing the context in which our children are growing up.

Councillor Kennelly thanked Councillor Agha (Lead Member for Schools, Employment and Skills) for his response in relation to the Department for Education (DfE) guidance on the teaching of Relationship Education. Before moving on to his supplementary question he took the opportunity, following on from the Mayor’s Announcements, to also pay tribute to Pride and the LGBTQ+ community and to express his support for the Armed Forces community in recognition of Armed Forces Day.

In terms of a supplementary question, whilst recognising that the Lead Member had acknowledged the challenges faced in addressing the myths surrounding the DfE guidance, Councillor Kennelly asked what further assurance could be provided in terms of the support being made available for schools in order to address any concerns or difficulties experienced.

In response, Councillor Agha advised that the Council was using a number of different strategies and methods such as the Brent School Partnership, the Schools Forum and the Annual School Governors Conference to disseminate advice and guidance and provide support to schools and their governors to assist them in complying with the statutory guidance. He felt it was important to remember, however, that the way in which the curriculum was taught would be a matter for individual schools and their Governing Bodies. Whilst expected to consult with parents prior to its introduction, schools and their Governing Bodies would have the ability to amend their final approach, if felt necessary, in order to support pupils and families at the school. He therefore reminded members of the importance of Governing Bodies and encouraged any members not already involved to consider becoming school governors in order to be able to individually offer their help and support.

Councillor S.Choudhary sought further details on the teaching of relationship education in schools, particularly given concerns around parents seeking to withdraw their children from relationship and sex education as a result of cultural and religious beliefs. He asked the Lead Member for his views on what more could be done to inform and educate parents on the new guidance in order to dispel the myths identified relating to its introduction and impact.

In response, Councillor Agha (Lead Member for Education, Employment andSkills) advised that it was important to recognise that the Council could not issue any direction in this matter and that it would be up to individual schools and their Governing Bodies to decide how they would teach the curriculum and implement the guidance from the Department of Education. He pointed out that the introduction of the new guidance would need to be undertaken in consultation with parents, taking account of the religious background of all pupils as part of the planning process, with the Council offering support and guidance, as required, in order to ensure schools were complying with the necessary requirements.

The approach outlined in the replies with its emphasis on working with parents seems sensible.  Successful RSE will depend on an open and transparent relationship between school staff, governors and parents. Anything that suggests a hidden agenda or stereotyping of communities is likely to cause distrust.

Relationship, Sex and Health Education - What schools need to know 

Scrutiny ask for Urgent Care Centre reduction in hours to be reviewed and put out to public consultation

Brent Community and Wellbeing Scrutiny Committee tonight asked Brent Clinical Commissioning Group (CCG) to use its statutory right to ask North West London NHS to reconsider the abolition of overnight hours at Central Middlesex Hospital Urgent Care Centre and to put the issue out to public consultation.

The decision was one of several made after an exhaustive discussion of the North West London NHS Recovery Plan and the proposal to merge the various CCGs in North West London into one 'Super CCG'.

Dawn Butler MP was unable to attend the Committee due to pressing duties in the House of Commons but her speech was read out for her by Cllr Colacicco. Butler said that the Recovery Plan was coded language for cuts in NHS services.  She said that the cuts fell disproportionately on the south of Brent affecting the poorest areas  in Stonebridge and Harlesden where life expectancy was 13 years lower than in the north of the borough.

When the A& E at Central Middlesex was closed it was on the basis that the Urgent Care Centre at the hospital would be provided on a 24 hour basis. It had now been shut at night with no public consultation. She said that a whistle blower had informed her that this was a 'closure by design' and was part of a plan that could lead to eventual closure of the hospital.

I understand that Dawn Butler and Barry Gardiner MP will meet the CCG tomorrow to discuss their concerns.

Addressing the Committee Cllr Mary Daly refuted claims that the Recovery Plan did not relate to patient care. It aimed to cut referrals to consultants by GPs - 'there was not enough money to treat Brent patients' - by scaring them.  GPs would not be allowed to refer patients more than once and if a consultant decided a patient needed to be referred to a consultant in a different discipline the request would first have to go back to the GP. Emergency A&E patients would not be admitted to hospital and patients would have to pay for over the counter medicines themselves.

Cllr Nerva introduced himself as a former non-Executive Director in the NHS and said that as things had developed there was now a lack of democratic accountability in the NHS. The proposal that patients should choose hospitals within The NW London NHS Trust, in order for it to enjoy the 30% in-house cost reduction, would provide an incentive to limit choice. These were toxic cuts and there should have been officer input to the Committee for members to consider.

Cllr Colacicco and Cllr Ann Clarke (Labour, Barnet, Childs Hill ward) both concentrated on the proposed closure of the walk-in Cricklewood Health Centre. Colacicco criticised the consultation for not enabling people to state that they wanted the Centre kept open. Clarke said the Centre had been under threat before, in 2014, and had been saved then. New developments, including that at Brent Cross, meant there would be many new homes in the area in the future and the Centre would be needed. She was also concerned with the suggestion that extended GP hours would increase local capacity when the Centre closed.

Cllr Thomas Stephens proved to be the most incisive and persistent member of the Committee when cross examining NHS and CCG officers. Most questions were fielded by Mark Easton, Accountable Officer for the NHS North West London Collaboration of Clinical Commissioning Groups (the shadow Super CCG),  He attributed the financial crisis to population increase, an ageing population, cost increases caused by new treatments with costs going up 18% and population 5%.  Units costs were increasing faster than numbers treated.  Regulators recognised that the planned deficit could not be wiped out in one year so a three year programme had been introduced.

He said patients would be allowed to go into hospital but that some GPs were not aware of community services that would keep patients out of hospital. The CCG were visiting GPs who may have referred more than 3 times as many patients as other GPs to make them aware of community services.

He said that hospitals inside the NW London NHS area were as good as those outside and had the advantage of being 30% cheaper, although patients could still choose to go outside.

Patients paying for over the counter medicines rather than through prescriptions was already policy and it was just a matter of ensuring compliance by GPs.  Eligibility criteria were based on evidence from NICE.

Adherence to the NHS Constitution would ensure that the changes would not affect the quality and safety of health services.

Scrutiny adopted a number of recommendations including that the NHS should ensure that local services were sufficient for the needs of local residents, there should be a full Equality  Impact Assessment of proposed changes in referral behaviour, review the impact on Primary Care which is already low quality in comparison with the rest of London, review the impact of changes after the Winter.

Regarding the merger of local CCGs into one NW London body Scrutiny recommended that the CCG guarantee that the new structure will include local government representatives and lay people, before a final decision is made on the super CCG that they should come back to Scrutiny with the full financial implications and assessment of the shadow structure currently in operation, if a single CCG is formed it should more adequately integrate medical and social care.

The Fight for the Environment is International - Brent Resident Behind Environmental Campaign In Ghana

Ghanaian-born barrister Awula Serwah, who is a Brent Community Champion and founder of the local Taking A Stand Against Littering and Fly-tipping initiative, recently presented a petition signed by over 3,500 supporters from Ghana and beyond to Ghanaian President Nana Akufo-Addo through Ghana's Deputy High Commissioner in London H.E. Rita Tani Iddi.

Serwah, who lives in Neasden, leads the Eco-Conscious Citizens (ECC) group, which has been campaigning against a Ghanaian government ministry felling trees on Parks And Gardens lands in the Ghanaian capital Accra, to make way for building a multi-storey office complex.

With climate change in the news and activists, including Extinction Rebellion, demanding that world leaders take environmental issues seriously, ECC are hoping that President Akufo-Addo will respond positively to the petition.

ECC are asking the President to use his good offices to ensure that Parks And Gardens lands are kept exclusively for the green economy - that is sustainable environmental, horticultural or botanical use, and that:

1. There are no further attempts to re-zone any portion of Parks And Gardens land to exclusively Civic, so that a multi-purpose office complex can be built on the land.

2. The Department of Parks And Gardens is resourced to deliver the remit for which it was set up.

“The multi-purpose office complex should be located elsewhere,” says ECC co-ordinator Awula Serwah. “It is vital that we preserve our parks and open spaces, and that Parks And Gardens land is kept for environmental purposes.”

Kilburn Times calls for system change to tackle climate crisis

This week's Brent and Kilburn Times is a special green edition - both in design and content. The North West London group editor , Ramzy Alwakeel, explains why in a rare editorial:

Tackling climate change isn't about shaming your neighbours for not separating their plastic recycling properly. Everyone has different amounts of energy, money, time; none of us should judge anyone else. We are all working within an economic and political system that promotes and rewards selfishness, and that has left many people with very little to survive on.

But we won't recycle our way out of the climate crisis: we need system change. Government inaction, corporate unaccountability and collective denial mean all of us have inherited responsibility for something that really shouldn't be our problem. It is wrong that a handful of big businesses are responsible for the majority of the world's toxic emissions. It is wrong that a Swedish schoolgirl has become the face of a campaign to treat our planet better.

But the crisis is now so bad that we must all play a part in fixing a problem that isn't our fault. I hope this week's Times makes that clear - and gives you some ideas.

Dawn Butler to join protest tonight as Scrutiny examine NW London NHS cuts & their impact on patients

The NW London NHS Financial Recovery Plan will come under close scrutiny at the Community and Wellbeing Scrutiny Committee on Wednesday. The plan aims to tackle the deficit in a variety of ways but the fear is that it will impact on patients.

The full document with the financial background and overall strategy can be found HERE but of most importance for residents will be the actions that are planned that will affect patients. Committee members will need to look beyond the jargon and probe deeply to find out what the real implications are for patients.

Dawn Butler will lead a protest outside the Civic Centre against the cuts, the ending of an overnight service at Central Middlesex Urgent Care Centre, and the closure of Cricklewood Walk-In Centre. She will be speaking at Scrutiny. Butler has also issued a video challenge to Brent CCG to join her on the overnight bus from Central Middlesex Hospital to Ealing Hospital to show how difficult the journey is for residents seeking urgent treatment.

Cllr Mary Daly has provided a commentary on theRecovery Plan proposals via Twitter:

Cllr Mary Daly

@CllrDaly

The managers bemoan the increased use of emergency service doesn’t seem able to link it to cuts to out of hours primary care across the area or CMH urgent care centre. There is no plan for primary or community care.

There appears to be no equalities impact assessment. No meaningful consultation with residents and certainly no contact with local councillors. yet we are told £98.9m.....

£8m saved by denying brent residents over the counter medicines. This affects the most vulnerable refugees, low income residents. this is not to improve the service but to save money...,

£6m saving by stopping new and follow up outpatient appointments denying specialist to thousands......

Admit fewer emergency patients including those with pulmonary embolus and pneumonia no reference to community services social care ......

£4.6m saved by refusing referral for elective surgery if the money runs out unless you are waiting more than a year YES a year

This is the pertinent section of the report:

6. How These Changes Will Affect Brent Patients 

6.1.The section below provides further detail on how specific recovery schemes are likely to affect Brent patients, as requested by the Community Wellbeing Scrutiny Committee. 

6.2.Elective hospital services and bringing some elective hospital services back to local North West London providers 

This programme will focus on “repatriating” elective procedures begin referred by General Practitioners and Trusts to providers outside North West London back into the North West London sector. The project aims to change referral patterns where NWL GPs consider using NW London providers and only refer outside of the sector if there is no capacity or if the patient requires intervention provided by specialist centres out of area. 

North West London NHS has an agreement with local NHS Trusts that specific quantities of activity will be delivered in each trust. Any activity above a set threshold is paid at 70% of the Payment by Results Tariff. This means that if more activity is referred to North West London providers, then approximately 30% of the tariff will be saved on each procedure. This is not true of providers external to North West London or to private sector providers.
The total amount of activity that we could bring back into the sector amounts to around 15% of all secondary care activity. 

For Brent patients, they should see no change in the healthcare that they receive, except that they are more likely to be referred to a local provider rather than a provider external to the North West London health economy such as Royal Free Hospitals NHS Trust, for example. This is likely to be a benefit to patients in not having to travel longer distances across the city. 

It should be noted that patients and GPs will always retain the right under the NHS Constitution to be referred to a provider of their choice and that GP retain the right to make decisions for the wellbeing of their patients. 

6.3. Outpatient services and changes to outpatient appointments 

NWL CCGs have reached agreement with providers that all activity in Quarters 3 and 4 of 2019/20 will be at contracted (planned) levels of activity, unless this puts waiting list commitments at risk. It was agreed that there will be no rise in 52 week waiters.
Additionally, our providers have agreed to adhere an existing consultant to consultant referral policy. The key principle behind this is that referrals relating to the original complaint can be referred on directly to another consultant. However, if an entirely different complaint comes to the attention of the consultant (unrelated to the original referral) this should be referred back to the patient’s GP first. 

We have an outpatient transformation programme in North West London which has developed standardised referral guidelines. Consultants are currently triaging GP referrals against these guidelines when the referrals arrive at the hospital. Any referrals which do not adhere to the guidelines will be sent back to the referring GP with advice. In this way, unnecessary outpatient appointments can be avoided and patients may receive their care from their local GP practice. 

6.4. Reducing spending on over the counter medicine prescriptions

Using the NHS London published guidance, we are working with secondary and primary care to reduce the volume of over the counter medication (for example paracetamol or ibuprofen) prescribed to patients. We have in place a communication plan for clinicians, patients and the wider public to support roll out. We will work with secondary care colleagues to support the programme and ensure that advice to patients is consistent across primary and secondary care.
Patients who are considered to be particularly vulnerable and are in receipt of free prescriptions may still receive these over the counter medications on prescription, at the discretion of their GP. 

6.5. Standardising assessments for patient transport 

This programme involves the renegotiation of the price on the LNWHT patient transport contract and a consistent application of current eligibility criteria. Discussions are currently underway with LNWHT with regard to the first element of the programme. Patient care will not be affected and those patients who require patient transport will still be able to receive it. 

6.6.Home Oxygen and Enteral Feeds 

This programme is made up of 3 elements. The first is the benefit of a pricing change following national procurement for home oxygen. The next is a clinical review of patients on home oxygen, prioritising those patients who have not been reviewed in the last 12 months and/or those patients where the data shows they are using less oxygen than prescribed. This review process will ensure that patients are not receiving a higher dosage of oxygen than they need, and that oxygen is not being wasted where it is no longer required. It will not change the criteria for patients to receive oxygen. 

The enteral feeds procurement provides commissioners with a saving by reducing the costs of consumables and securing a better deal with the NHS’s external providers. It does not alter the care pathway and patients will not experience any change. 

6.7.Unscheduled Care 

A&E attendances and unplanned emergency admissions to hospital continue to rise in an unsustainable way. These are one of the biggest drivers of the deficit to the NWL financial system. There are a number of workstreams to address this. These schemes are divided up into “front door demand”, which is about reducing the number of patients turning up at the front door of A&E/ Urgent Care Centres, and “short stay flow”, which is about getting senior level clinician input at the start of patients’ journeys into the A&E department so that they can be turned around more quickly. This in turn means that they are less likely to be admitted to an inpatient bed. 

Clinicians from LNWHUT and Brent and Harrow CCGs are currently participating in a “6As audit”. Emergency admission to hospital is a major event in people’s lives. It should never happen because it is easy to admit or to access services that could be available as an out-patient or to administer treatment that may be available closer to home or to get a specialist opinion. All of these are spurious reasons for an emergency admission. To transform emergency healthcare we need to understand why we put patients through this process when alternatives exist and operate effectively across the country but haven’t been widely implemented.
Emergency admission implies a patient is sick and requires a high level of intervention. As such, all proposed emergency admissions should prompt a clinical conversation between senior doctors, ideally consultants. 

The 6 As audit is about establishing whether patients are currently going to the optimal place, or whether improvements could be made to better utilise community care pathways. The audit involves asking whether the following alternatives could have been used: 

·  Advice - suggest a clinical management plan that allows the patient to be managed in primary care

·  Access to out-patient services - suggest an outpatient referral for specialist assessment

·  Ambulatory Emergency Care - clinically stable patients appropriate for same day discharge

·  Acute Frailty Unit - to provide comprehensive geriatric assessment for frail older patients

·  Acute Assessment Units - to diagnose and stabilise patients likely to need admission

·  Admission to specialty ward directly - for agreed clinical pathways and specialised clinical presentations

Once the conclusions of the audit are received, we will aim to optimise our referral pathways so that patients are seen in the most appropriate service and location. 

6.8. High Intensity Users 

This programme is about pro-active case finding of high intensity users (5 or more A&E attendances or admissions within the last 12 months) and to ensure that members of the frequent attenders forum are fully informed. The forum aims to identify other services and resources that may help the patient address their needs e.g. housing, drug and alcohol treatment programmes,psychological interventions etc. As part of this process, the patient’s GP is consistently informed of their registered patient’s interactions with the ambulance/ hospital/ urgent care services. A care plan is formulated and stored on the Co-ordinate My Care system, which means that it is then accessible to hospital clinicians who need to access it as part of any future re- attendance. The aim of the programme is to reduce future unnecessary re- attendances. It will improve patient care in Brent as patients will receive pro- active care that is better tailored to their needs, rather than turning up in an A&E department, which may not be best suited to the type of expertise that the patient needs. 

6.9.LAS Demand
 
This scheme is about supporting the London Ambulance Service (LAS) to book into extended access hub appointments based in GP practices, where this would be the most appropriate course of action for the patient’s needs.
Where appropriate, the 999 service will also be able to book into the access hub appointments.
To support the LNWUHT system Brent, Harrow, and Ealing CCGs have been selected for rollout in phase 1 of GP in-hours and Extended Access booking from LAS Clinical Hub (known as CHUB). Clinical engagement is underway for opening these slots to the CHUB. 

6.10. LAS Walk-In Demand 

The Brent category of the LAS has some of the highest rates of conveyance to A&E of all categories. This may be due to higher than average vacancy rates in the service, and a less experienced cohort of incoming paramedics that may be more risk averse in their assessment of patients. This should improve over time as staff become more experienced, but a programme of shadowing is taking place so that LAS staff understand what is available in the community and can refer patients to community pathways where a conveyance to A&E is not deemed to be required. 

6.11. Same Day Emergency Care (SDEC) 

SDEC is the provision of same day care for emergency patients who would otherwise be admitted to hospital.Under this care model, patients presenting at hospital with relevant conditions can be rapidly assessed, diagnosed and treated without being admitted to a ward, and if clinically safe to do so, will go home the same day their care is provided. 

When a patient comes to hospital, an SDEC service (which may operate under the name of ambulatory emergency care unit) means patients with some medical concerns can be assessed, diagnosed, treated and safely discharged home the same day, rather than being admitted. 

SDEC services treat a wide range of common conditions including headaches, deep vein thrombosis, pulmonary embolus, pneumonia, cellulitis, and diabetes. The types of conditions that can be managed through SDEC will vary depending on the hospital and needs of the local population. 

We aim to expand the usage of SDEC as part of our financial recovery programme, which will reduce overnight non-elective admissions (1-2 days length of stay) and A&E attendances by increasing activity through the SDEC pathways and optimising the ambulatory emergency care units. Shorter lengths of stay attract a lower tariff for the CCGs and therefore reduce costs. 

6.12. Front Door Frailty 

The aim of this programme is to implement proactive frailty services which will avoid admissions by providing a holistic response for frail older people in the community and during time of crisis. Frailty practitioners will screen patients who are 75 or over and for those who have a high score, a consultant geriatrician at the front end of A&E will provide a comprehensive geriatric assessment. This means that we are usually able to turn the patient around more quickly so that they get the care they need and may never need an admission to an inpatient bed. This is safer for the patient, as they are likely to stay more mobile at home and not pick up hospital acquired infections. 

6.13. Admission conversion rates 

This programme is about the rates of which A&E attendances ‘convert’ into unplanned admissions to hospital beds. We are using benchmarking data to compare our local hospitals to national averages and London averages so that hospitals who are above the average try to bring their conversion rates down to the average. This means that more patients will benefit from being able to stay out of hospital and reduce their risk of hospital acquired infections. It is a financial benefit to the system because it means that we are not funding unnecessary numbers of hospital beds or opening new beds. It also allows those patients who are most seriously ill to access a bed when they need it. 

6.14. Demand Management 

We have a comprehensive review programme of primary care variation. Across Brent, the amount of secondary care activity and prescribing spend that are attributed to individual GP practices varies significantly, and this does not always correlate with deprivation levels of the demographics of the GP practice. We intend to reduce this unwarranted variation in practice and to enable GP practices to learn from each other to ensure that best practice care pathways are being followed. 

The programme includes:

·       Reviewing A&E and UCC attendances, and contacting patients within 2 days of discharge where attendance was inappropriate;

·       Practices promoting self-care management and continue to improve patient access. 40 practices currently offering E-consultations with a further going live imminently;

·       Ensuring visible display of GP Access Hub, NHS 111 and Online Services Posters;

·       Conducting internal and external peer reviews with CCG and PCN/network leads;

·       Locum, GP trainees and associates referrals to be triaged by the lead clinician/GP partner

·       Educational sessions for all GPs and clinical staff. Inter-practice referrals optimising skill mix at PCN level

·       Kilburn Locality has a low outpatient referral activity - learning shared with other PCNs (advice and guidance at Imperial and MDT programme)

The meeting begins at 6pm on Thursday 24th October at Brent Civic Centre. The meeting will be in the Conference Hall and is open to the press and public.