Agenda item

To consider and provide a formal response to the procurement plans for Planned Care Services across Central and West London and the development of the CCG’s joint procurement approach as part of the Tri-borough strategic objectives, in accordance with Section 244 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012).

3.1      The Sub-Committee received the report which detailed the procurement plans for Planned Care Services across Central and West London and the development of the Clinical Commissioning Group’s (CCGs) joint procurement approach as part of the Tri-borough strategic objectives. The Sub-Committee considered the report in order to provide a formal response on behalf of the City Council, in accordance with Section 244 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012).

3.2      Mona Hayat, Head of Planned Care for Central London CCG, introduced the report and informed Members that the NHS Central London and West London Clinical Commissioning Groups were commencing the service review, re-design and procurement of 9 and 6 (respectively) end-to-end Planned Care Services in 2014/15. Ms Hayat detailed that, in the planning stages of the 2014/5 NHS Central London and West London CCG’s Commissioning Intentions, it was identified that a procurement programme to address the gaps in planned care (outpatient services) community provision would be required. This was to be significantly aligned to the Out of Hospital Strategy 2012-15 and the successful delivery of planned care which includes more patient self-management, preventative care, more home based care and an extended range of services available in primary care to prevent the need for more specialist treatment. 

3.3      The Sub-Committee noted that a proposed programme of procurement for planned care had been presented and ratified by the City Council’s Health and Wellbeing Board between July and September 2013. Subsequently, Central London have undertaken a programme to review and redesign specific outpatient services to ensure that patients receive simple, timely, convenient and effective planned care with seamless transitions across primary and secondary care, which are supported by a set of consistent protocols and guidelines for referrals and the use of diagnostics. Ms Hayat provided Members with an overview of the robust approach taken to service redesign, which included data analysis of incident and prevalence rates in 7 key areas, extensive benchmarking; and work with external clinicians to support the plans, seeking expertise from the University of Leicester in respect of cardiology and respiratory.

3.5      Davey Thomason, Head of Planned Care for West London CCG, explained that, by reviewing and redesigning community planned care provision, NHS Central London and West London CCG’s aims to undertake a process of simplifying planned care pathways. Mr Thomason noted the ambitious nature of the plans but emphasised the importance of commissioning community services which provide intermediate outpatient services in a community setting, which crucially prevents the need for patients to attend hospital clinics for diagnosis and treatment where it is unnecessary. Mr Thomason provided Members with an overview of the first phase of the programme and the planned care services which would be re-procured during 2014 – 2016.

3.6      The Sub-Committee reviewed the proposed governance framework which intends to provide accountability and quality assurance around the programme, but noted that the structure focused on ‘groups’ and provided no detail in respect responsible officers. Members therefore sought clarification of the mechanisms by which issues and potential risks would be raised, resolved and/or mitigated. The Sub-Committee were informed that the Heads of Planned Care would be responsible for highlighting issues to the Governing Body and for providing regular updates on emerging risks. Mr Thomason explained that this good governance practice is already undertaken through a regular reporting requirement to the hospital committees – where risks are highlighted and the Heads of Planned Care, as the ‘responsible officers’, ensure mitigating actions are agreed. In this context Ms Hayat evidenced a recent example where it emerged that due diligence had not been followed during the course of a wheelchair procurement. Ms Hayat subsequently raised her concerns to the North West London Collaborative Senior Management Team concerning the matter and recommended that the procurement be terminated to allow the issues to be resolved and to ensure due process was followed.

3.7      The Sub-Committee discussed the stakeholder/patient engagement and consultation plans detailed in the report and raised the fundamental issue of mobility, in respect of how both patients and staff will travel between different clinical sites. Members emphasised that the issue of mobility will be crucial to informing reconfiguration and must be at the forefront of location planning.

3.8      Members highlighted the forthcoming providers survey into how often patients raise transport as a barrier in accessing health appointments and activities, and enquired as to whether other methods of engagement and information gathering had been utilised, such as the GLA or working with the local community directly? Ms Hayat explained that transport issues had been a key focus for the CCGs and, as such, transport boards had been created at both the North West London Collaborative and Tri-Borough, which are directly aligned to the procurements. The CCGs have also received feedback from a TfL survey into how services could be effectively delivered in the community. Members requested to be provided with the results of the aforementioned TfL survey.

3.9      In response to a suggestion from the Sub-Committee in respect of how Healthwatch could provide effective critical friend challenge to the procurement proposals, Ms Hayat confirmed that Healthwatch had previously been commissioned to undertake a wheelchair review which subsequently informed the procurement. The CCGs are also commissioning Healthwatch to undertake a review of dermatology.

3.10    The Sub-Committee discussed the policy of ‘patient choice’ and sought comments on firstly, why this should be an important consideration and secondly, whether many patients actually exercise this choice or simply utilise services on the basis of locality and ease of access? Louise Proctor, Managing Director of West London CCG, explained that there is an emerging population of patients who are internet savvy and who actively choose to select consultants and other clinical providers on the basis of a wide range of information and according to a number of factors. Some of these factors are clinical (such as reputation, quality of facilities or waiting times) and others are practical (such as car parking space or proximity). Ms Proctor agreed with Members that many patients may find this element of choice superfluous, or even confusing. However, many patients feel a greater sense of independence and ownership over their treatment when they are given the option to choose. KiranChauhan, Deputy Managing Director of Central London CCG, further explained that in modern treatment is a two-way partnership between the doctor and patient and should be encouraged and facilitated.

3.11    The Sub-Committee noted and welcomed the wider approach to encouraging Small and Medium Enterprises (SMEs) to participate in tender processes for public sector contracts and the work undertaken by the CCG’s to ensure that tenders are open to SMEs, such as providing tender opportunities as “lots” which divide up tenders and contracts in to clinically safe, patient focused components that SMEs will be able to take on in a sustainable manner.

3.12    RESOLVED:

(1)    That the West London and Central London CCGs plans to address the gaps in outpatient services and community provision be conditionally endorsed.

(2)    That a formal response from the Health Urgency Sub-Committee, to both phases of consultation and the plans, be provided to the West London and Central London CCGs on the grounds that the plans are considered to constitute a ‘substantial variation’ to services in Westminster.

(3)    That  it be recommended that Healthwatch Central West London be directly solicited to provide an input at both phases of the consultation; and

(4)    That the CCGs ensure the Westminster Adults, Health and Public Protection Policy and Scrutiny Committee are regularly updated on the progress of the procurements and that Members be alerted to any proposed changes when these are fully known.