Apologies were received from Councillors Sheila Knight, Gilli Lewis-Lavender, Lynne Hack and Nick Harrison.  Councillors Andrew Judge and Barbara Mansfield substituted for Councillors Knight and Lewis-Lavender.

To note that the following declarations of interest were made:

·        Councillor Sheila Knight declared a personal interest as an employee of Merton MIND.

·        Councillor Jayne McCoy declared a personal interest as a member of Sutton, Epsom & District Branch of The National Childbirth Trust.

Resolved: To note that the following declarations of interest were made:

Ÿ         Councillor Jayne McCoy declared a personal interest as a member of Sutton, Epsom & District Branch of The National Childbirth Trust.

Minutes of the meeting held on 2 October 2008.

The Minutes of the meeting held on 2 October 2008 were approved as a correct record and signed by the Chair.

The Chair will give a verbal update on communications with the Royal Marsden NHS Foundation Trust.

The Chair explained that Cally Palmer, Chief Executive, Royal Marsden Foundation Trust, had been invited to give evidence at this committee but had declined, at this stage, on the grounds that it was too early in the process to present the hospital’s plans for a polyclinic..

Resolved: To request that officers write to Cally Palmer asking her to indicate when she is likely to be able to attend a meeting to provide evidence and also to seek information on programme management arrangements and likely intentions on consultation.

Shane Degaris, Deputy Chief Executive, Epsom and St Helier NHS Trust, and Stephen Evans, Executive Director for Sutton, will present the report.

Invited witnesses for this item included:

·        Shane Degaris, Director of Operations and Deputy Chief Executive, Epsom and St Helier NHS Trust,

·        Jon Schick, Programme Director Women’s and Children’s services,

·        Stephen Evans, Director Acute Commissioning and Sutton Locality, and

·        Rosemary Najim, Mid Surrey LINks (Local Involvement Networks) and Epsom Hospital Campaign.

Stephen Evans introduced the new permanent director for this project, Jon Schick.  He explained that there were several factors driving this project which included the European Working Time Directive and guidance from the Royal Colleges on improving standards and staffing.  The aim was to have an affordable, safe and sustainable service which was resilient to change.  It was planned to have extended consultant level presence on labour wards - moving to 60 hours per week prospective cover during 2009. 

He explained that Sutton and Merton Primary Care Trust (PCT) wished to continue to commission services from St Helier including a specialist baby unit.  It was decided in October 2008 that St Helier would look towards developing a partnership with St George’s Hospital.  The aim was to explore whether this could mean that better quality services could be achieved.  This project would be ongoing and workshops were being arranged to look at how the two hospitals could work together and draw up some options.  It was expected that Surrey PCT would establish commissioning intentions at Epsom through work between Epsom Hospital and hospitals within Surrey or St George’s to satisfy the needs of Surrey PCT.  

The Joint Cabinet meeting would next meet in February/early March and it was explained that the working groups would report to this cabinet on options for partnership and produce an action plan that would need to be put in place.  Members of the Joint Cabinet included the chief executives and chairs from the trusts, clinical staff and an independent clinical chair, Prof. Ian Lewis, from St James University Hospital, Leeds..

The partnership work Steering Group meeting held on 8 January received feedback on workstreams which helped plan the working groups’ away-day.  Following the away-day a report would be put together for chief executives in the first instance.

It was explained that there was a clear project management process using project management principles, but not using Prince 2 at this stage.  Prince 2 would be put in place when the working groups had finished their work and the Joint Cabinet have agreed the project that needs to be undertaken.  The Chair requested a paper for members explaining the process.

The Chair requested that future reports should be easier for lay people to read, be user friendly with no jargon and acronyms explained. 

There was some discussion around deadlines, as there were no milestones indicated in the report.  It was explained that different projects would have different deadlines but the European Work Time Directive deadline was August 2009. 

The Chair requested further papers on the CNST standards and project details with timelines for decision making deadlines.

Rosemary Najim was invited to  ...  view the full minutes text for item 5.

Shane Degaris, Deputy Chief Executive, Epsom and St Helier NHS Trust, will be attending.

Shane Degaris updated the committee on progress and reported that an event for consultants had been arranged for 23 January at the Epsom racecourse.  Other events would be arranged for staff.  Local Members of Parliament were calling for the demerger and their letters would be included in the review.  By spring of 2009 it was aimed to review the conclusions and consult as appropriate.

Shane Degaris responded to members questions as follows:

(i) Why has it taken so long to get this off the ground?

It has taken a while to get a Project Director in place and getting the various bodies to sign up to the terms of reference. Spring 2009 has always been agreed as the outline timetable for the review to be completed.

(ii) How many consultants will be attending the event in January and what is the cost of Epsom racecourse?

All Consultants in the Trust were invited to the event. The costs will be confirmed.

(iii) Where will the other events be held?

We are trying to arrange them around the patch but more answers will be available after the Board meeting on 22 January.

(iv) When is spring?

Spring 2009 has always been agreed as the outline timetable for the review to be completed.

            Resolved: (i) To thank Shane Degaris for attending.

(ii) To request that Shane Degaris provides a project management paper showing how the LNLH programme will be taken forward.

Stephen Evans, Executive Director, will present the report.

Stephen Evans and Dr Martyn Wake responded to members questions on this item.

Stephen Evans made reference to the figures relating to the number of patients transferred on page 18 of his report and explained that it had been agreed to extend the pilot for a full year because of the low numbers involved.  This meant that the project was due to finish at the end of February.

In response to general questions it was reported that:

·        Questions as to why one patients address was not recorded or why one patients PCT was not known, could not be answered at the meeting but Stephen Evans would provide a response.

·        In response to a question, regarding outcomes now and before the pilot and had it proved beneficial to patients to go to St George’s, it was explained that the aim of the pilot was not to compare sites but rather how different organisations work together.

·        Evidence from the Health Commission for London showed that specialist centres were beneficial for patients.

·        One member reported seeing figures that Sutton and Merton have the highest number of incidences of stroke and therefore St George’s may not be the right location for a specialist centre, but presumed that work on locations would come later.  Dr Wake explained that plans were far more radical in that it was being considered to having only two acute units per sector within London: London had five sectors.  It was reported that the PCT would be holding a public meeting very soon as part of a wider London consultation on Stroke and Trauma services.

Responses to more specific questions from members:

(i) If there were increasing numbers of patients needing out of hours care would this impact on the model of care?

Dr Wake responded that Out of Hours included all weekends, and nights from 5pm to 9am, and therefore covered a longer period than Monday- Friday 9-5, so care should be taken about comparing numbers treated in-hours, and numbers treated out of hours.  He also commented that strokes suffered at night could be more complicated especially if the patient is asleep and may not wake up within the 3hr period for thrombolysis treatment.

(ii) Would patients expect to get better treatment at St George’s?

Dr Wake responded that currently this was the case but that thrombolysis was only a small part of stroke care and that many patients did not get to a stroke unit.  He explained that there was a disparity of stroke care services across London and that St George’s and St Helier Hospitals were in the top 10 hospitals in London as shown in the Sentinel’s audit last year, as was the Mayday Hospital.  National Sentinel Audit for Stroke is funded by the Healthcare Commission, and carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physicians' Clinical Effectiveness and Evaluation Unit, and covers 100% of eligible hospitals in England and Wales.  ...  view the full minutes text for item 7.

There were no urgent items.

The next meeting will be held on Thursday 19 March 2009.

Resolved: (i) To note that the next meeting would be held on 19 March, 7.30pm, venue to be confirmed.

(ii) To request an update on Better Healthcare Closer to Home programme at the next meeting of this committee.

(iii) To request a report on local care centres for a meeting after the March meeting of this committee.