To assess whether the proposals outlined in Imperial College Healthcare NHS Trust’s Clinical Strategy aligns with the NHS North West London reconfiguration entitled ‘Shaping a Healthier Future’.
Minutes:
4.1 The Sub-Committee received a presentation from Dr Bill Oldfield, Consultant in Respiratory Medicine at Imperial College Healthcare NHS Trust, which detailed and explained the proposals outlined in the Trust’s recently published Clinical Strategy. As part of his presentation, Dr Oldfield addressed the following key areas:
(i) The Trust’s vision and objectives – to be a world leader in transforming health through innovation in patient care, education and research.
(ii) Drivers for change – transforming clinical services to meet changing demands and expectations, such as a growing population; evolving technologies; increased pressure on public spending and personalisation of health and social care.
(iii) The key features of the Trust currently in respect of being one of the safest in the country, with a long track record of healthcare innovation and pioneering better care (recognised by AHSC status).
(iv) The Trust’s approach to clinical service change as part of the ‘Shaping a Healthier Future’ programme (“Localise, Centralise, Integrate and Personalise”) and the clinical strategy framework.
(v) Service and site plans for Charing Cross Hospital (proposed to be a local hospital), St. Mary’s Hospital (proposed as the major acute centre for the region) and Hammersmith Hospital (proposed to be a specialist centre).
(vi) The proposed scale and shape of the Trust’s estate by 2020 and the steps the Trust will take to realise these ambitions in respect of enabling strategies, clinical transformation and site developments.
4.2 The Sub-Committee sought clarification on the integrated care to be provided at St. Mary’s Hospital and received a detailed explanation of the proposals from Dr Oldfield. He noted that patients would enter St. Mary’s through a GP surgery in order for their treatment needs to be assessed at the outset of their visit and to prevent unnecessary admissions where alternative care could be provided or appropriate referrals recommended.
4.3 Members emphasised the importance of ensuring that the special needs of elderly residents were at the forefront of the Trust’s proposals for change, specifically in respect of how these residents could be treated in their homes as an alternative to a hospital admissions. Members noted that travelling can be extremely difficult for elderly patients, many of whom have complex medical requirements and may therefore be required to travel between different sites for specific types of care. In this respect Members had key concerns around the issue of inter-hospital transfers and requested a written response to address these points.
4.4 Dr Oldfield updated the Sub-Committee on the recent implementation of the Cerner Patient Administration System and confirmed that the roll-out went well overall and continues to be embedded positively, despite some loss of information at the outset. Members were informed that the implementation of the new system will drive further improvements to the Trust’s business processes and systems and encourage greater collaboration and focus on a joined-up working approach across the Trust.
4.5 The Sub-Committee discussed the increasing necessity to focus on methods of prevention and intervention across the arena of integrated health care and home care services, in addition to improving patient experience and achieving greater efficiency and value from health delivery systems. To achieve these aims, Members emphasised the importance of undertaking consultation on how effectively processes are working ‘on the ground’ - from the perspective of patients and health care users. Members voiced key concerns regarding the Trust’s ability to successfully drive forward multi-agency working and suggested that the Council’s Health and Wellbeing Board could be an appropriate body to ensure these objectives and realised.
4.6 Members discussed the Trust’s plans for capital investment and sought reassurance that the Council would be appropriately engaged and consulted, to ensure the best deal for Westminster’s residents is achieved. The Sub-Committee noted that the Trust not only needs to manage a process of clinical transformation but must simultaneously manage a huge programme of planning and engineering change. In this context, Members queried whether the Trust had the right level of expertise to successfully deliver both aspects of transformation? In response, Michelle Dixon, Director of Communications at Imperial Healthcare NHS Trust, assured the Sub-Committee that a clinical transformation office has been established to lead the programme. Ms Dixon emphasised that the change also entail a transformation of behaviours and culture at the Trust, which Members welcomed.
4.7 Ms Dixon recognised that local opposition to the proposals, primarily based upon transport issues, will be a key risk to the programme. The Trust will therefore need to ensure it effectively communicates the benefits to patients of the proposed locations of the three sites and how the changes will minimise transfers between hospitals. The Sub-Committee recommended that an effective means of involving and consulting residents would be to utilise a ‘community champions’ model of engagement which reaches the local community.
4.8 RESOLVED:
(1) That the Sub-Committee endorses the direction of travel outlined in Imperial’s Clinical Strategy, subject to a formal review of the Outline Business Case, which will contain the financial aspects of the plans, before formally endorsing the Strategy itself;
(2) That the Adults, Health and Public Protection Policy and Scrutiny Committee conduct an annual review of the proposals and progress;
(3) That whilst the changes outlined in ‘Shaping a Healthier Future’ were subject to rigorous consultation with patients and the public, the Sub-Committee notes that the Trust’s interpretation of the planned reconfiguration will contain service changes which may have been unanticipated in the Decision Making Business Case. As such the Trust should consult service-users in specialties where there will be a shift in service provision (i.e. changes to Radiotherapy). It is considered that patient feedback will inform how the Trust can safely and effectively implement the plans set out in the Clinical Strategy;
(4) That Imperial College Healthcare NHS Trust provides Westminster’s Adults, Health and Public Protection Policy and Scrutiny Committee with further information and evidence on the modeling assessments undertaken to ascertain patient flow once Central Middlesex Hospital’s A&E department has closed;
(5) That Imperial College Healthcare NHS Trust provides details on the financial modeling undertaken to assess post-implementation revenue streams;
(6) That Imperial College Healthcare NHS Trust works with a small task group of Members of Westminster City Council to review the outcomes of the service moves of renal / haemotology in 2010 / 2011;
(7) That Imperial College Healthcare NHS Trust provides further evidence to Westminster City Council regarding the implementation of new patient administration software; and
(8) That Imperial College Healthcare NHS Trust actively engages local residents through the implementation of a ‘Community Champions’ model of engagement.
Supporting documents: