Agenda and minutes

In accordance with the Council’s Constitution, Members are asked to declare any interest they may have in any matter which is to be considered at this meeting.

Councillor C Rice stated that he was a member of North East London Foundation (NELFT) Trust’s governing body.

The minutes of the meeting held on 25 March 2019 were agreed.

The Chief Finance Officer for the Barking, Havering and Redbridge University Hospitals Trust (BHRUT) delivered a presentation updating the Committee on its financial recovery.

Members noted from the presentation that:

·  There was no material or structural reason why the Trust should be making losses;

·  A large part of the deficit (around £30m) was driven by inadequate local health infrastructure;

·  The Trust would save around £60m if it could become as efficient as the top 25% of trusts in the country, by focusing on improving quality and reducing waste which would be better for patients;

·  Key ‘deficit drivers’ were the historic local health economy and the excess cost of employing temporary staff;

·  The Trust was implementing ‘The PRIDE Way’ which was a quality improvement method, used by the Virginia Mason Hospital in Seattle, that focussed on improving quality and reducing waste;

·  The Trust had big ambitions to become among the best integrated care systems and was working with its partners to achieve this; and

·  The Trust would be refreshing its Clinical Strategy this year which would provide a renewed focus on achieving high quality and efficiency.

In response to questions, Dr Smith, Chief Medical Officer for BHRUT stated that:

·  Whilst it was true that the Trust had a long history of high usage of temporary and agency staff, it was continually working to make progress on this; for example, the Trust had changed its offer in relation to its emergency care consultant vacancies and developed an Academy of Emergency Medicine in relation to junior positions in the Emergency Department, both which had been very successful. It had taken a similar approach to recruitment to its surgical team which had helped to fill 23 of its hard to recruit to vacancies and was now replicating this for recruitment into some acute care specialities. The Trust had also developed other clinicians to take on advanced roles and produced a Nursing Workforce Strategy. Nevertheless, the high usage of temporary and agency staff was still a big challenge for the Trust and it would continue to work hard to find ways to manage this. The Trust was not alone in facing recruitment challenges - there were approximately 50 GP vacancies which was a huge strain on the system. All key local partners, including the Council, should be working together imaginatively to make working in this part of London more attractive;

·  With regards to reducing waiting times, one of the main challenges was to reduce demand which was a health-system wide issue. The adoption of the PRIDE way had helped the Trust to look at the processes and pathways in great detail and eliminate waste, which included patient waiting times.  Much of this work related to what the Trust termed ‘reducing waste in system’; for example, it used to be the case that when a patient suffered a fracture, they would be required to come to the fracture clinic, sent away for tests, and then return to the clinic and referred for treatment  ...  view the full minutes text for item 3.

Dr Smith delivered a presentation explaining the findings of Health Education England (HEE) in relation to the standards of staff training and medical education, and the actions taken by the Trust in response to HEE’s report.

Members noted from the presentation that;

·  BHRUT hosted a large number of doctors in training. As part of the monitoring service for feedback from trainees, HEE, along with the General Medical Council (GMC), undertook reviews on the quality of the trainee experience. In addition, HEE undertook a risk-based trainee focus group visit to the Trust on the 2 April 2019, which was planned following the release of the GMC National Training Survey 2018 results. During this visit, some concerns were raised in relation to the acute medical on-call rota, clinical supervision, the relationships between the higher medical trainees and the Emergency Medicine department;

·  As a result of the visit, HEE issued nine mandatory improvement requirements to the Trust and this led to the GMC placing Acute Medicine into enhanced monitoring, due to the potential for patient harm (no harm had actually occurred); and

·  Dr Smith and the Director of Medical Education took these concerns very seriously and were leading the improvement work plan. The Trust continued to work the HEE and GMC and had provided evidence of progress in line with the HEE Quality Visit Action Plan.

Dr Smith took members through the nine mandatory improvement actions the Trust was progressing in detail.

Whilst members were pleased that there were now more individuals that trainees could report issues to, they expressed concern that it had taken a HEE visit for the Trust to become aware that it had a problem. Members also expressed concern that the problems faced by doctors in training could be similar to those faced by other professionals in the Trust, such as nurses. The Trust’s ICE assured members that it was confident that trainees in other professions did not face a similar experience as the management and accountability structure was clearer and the supervision requirements were more developed. The ICE accepted that the Trust needed to work very hard with regards to the culture around doctors in training to ensure all colleagues knew the value of working together. It had already started this work, using the PRIDE way’s ‘Respect for People’ framework to establish high standards; however, it would take a number of years to achieve this.

Members expressed concern that some of the required actions identified by the HEE were basic, such as providing evidence that the consultant on-call was clearly identified and providing supervision and support to medical trainees. Dr Smith accepted that this was the case and added that sometimes organisations needed a mirror held up to them to see where poor practice was occurring. The Trust had a long journey ahead to get to the standards required and telling all staff to listen first would be her ‘mantra’ going forward.

Members asked how consultants were held accountable in terms of their management of staff.  Dr  ...  view the full minutes text for item 4.

The Chair asked members to note a report on the Joint Health and Overview Committee (JHOSC), which, as well as providing information on local joint health scrutiny arrangements between the borough and other boroughs, asked the Committee to confirm the appointment of three of its members to the JHOSC.

The Committee agreed to appoint Councillors E. Keller, P. Robinson and M. Khan to the JHOSC for the 2019-20 municipal year.

The Committee is asked to discuss the draft Work Programme for 2019/20 and agree any changes.

The Chair, having explained that the Work Programme was a flexible document, in order to be able to reflect changing local priorities, asked members to review the Committee’s draft Work Programme and welcomed suggestions for other items for consideration by the Committee.

The Committee agreed the Work Programme.