Agenda and draft minutes

Whittington Hospital Patient and Public Involvement Forum

The Chair will consider the admission of any late items of urgent business.  Late items will be considered under the agenda items where they appear.  New items will be dealt with at item 8 below. 

None.

A member with a personal interest in a matter who attends a meeting of the authority at which the matter is considered must disclose to that meeting the existence and nature of that interest at the commencement of that consideration, or when the interest becomes apparent.

A member with a personal interest in a matter also has a prejudicial interest in that matter if the interest is one which a member of the public with knowledge of the relevant facts would reasonably regard as so significant that it is likely to prejudice the member’s judgement of the public interest.

None.

To approve scope and terms of reference for the review.

A number of initial observations were made by the Panel:

·        There was concern at the number of consultations being undertaken locally and the impact that this may have on local health services and their patients.  In addition to the Whittington Foundation Trust application, it was reported that consultations were also being undertaken by Haringey PCT (Primary Care Strategy) and Barnet, Enfield and Haringey (Clinical Strategy).  Impending consultations were also noted to include the London NHS Strategy (Framework for Action) and further Foundation Trust status applications from Barnet, Enfield & Haringey Mental Health Trust and North Middlesex Hospital.

·        The Panel noted that equalities issues were very important in the Whittington Hospital’s application for Foundation Trust (FT) status, especially how this may impact on other local health services and the people that use them.

·        The Panel were keen to understand what impact the review of London NHS services (Framework for Action) would have on health services provided at the Whittington.  In particular, Panel Members required further clarification on what were the implications of the independent status of Whittington Hospital Foundation Trust and its involvement in the London review consultation (i.e. what role would the Whittington have in the review process once being independent of NHS control?).

·        In this scrutiny review the Panel would be seeking to assess why the Whittington has applied for FT status, how the Whittington would use new freedoms allowed under Foundation Trust status, the impact Foundation Trust status will have upon Haringey services and the people that use them and consider the adequacy of planned consultation process by the Whittington.

Agreed: The Panel agreed that the aims and terms of reference as set out in the documentation be approved.

Attached: Whittington Hospital Foundation Trust Consultation Document.

The Panel will hear evidence from Officers:

• Susan Sorensen, Director of Strategy & Performance and Deputy Chief Executive
• Siobhan Harrington, Director of Primary Care

Susan Sorensen, Director of Strategy & Performance and Deputy Chief Executive and Siobhan Harrington Director of Primary Care presented an overview of the Whittington’s Hospital application for Foundation Trust status and responded to Panel questions.  A summary of the discussions that subsequently took place is provided below:

Background to application

·        The Whittington was told it could apply for FT status in the 2006/7 business planning cycle having met the required standards.  The Whittington Hospital will therefore be part of the 7^th wave of applications for FT status.  The decision to seek FT status was unanimous among current Whittington Board.

·        The acute sector must continually ‘horizon scan’ to ensure that business plans recognise and respond to anticipated events.  In this context, the Whittington had been required to make some tentative assumptions about the outcome of the London review of NHS services.

·        It was emphasised that this was a genuine application which would be thoroughly assessed by the scrutinising body (Monitor).  It was noted that not all NHS trusts had been successful in their applications for FT status, indeed, some had been deferred for further developmental work before they can resubmit their application.

Local Health Economy

·        The Whittington Hospital indicated that it was aware of the issues that may arise with many local health agencies in transformation at the same time.  It was reported that there is ongoing dialogue with both Haringey PCT and NHS London to ensure that local and regional developments are planned coherently and that services do not fragment.

·        The Whittington indicated that it was committed to maintaining a strong network of local health care provision.  Even though the Whittington will be independent of NHS control once acquiring FT status, it will retain a strong interest in maintaining clinical networks which naturally extend over many acute sector sites (such as the North Middlesex Hospital).  Similarly, under the London NHS review (Darzi), emphasis will be on developing effective care pathways which will maintain links between acute sector sites.

·        It was pointed out that the Whittington was particularly keen to maintain links with the primary care sector, hence the development of the innovative post of Director of Primary Care at the hospital.  This role will help the Whittington to maintain an awareness of community developments and provide a focus for ongoing consultation processes between the two sectors.

·        The Whittington sought to reassure the Panel about private sector provision from the site under FT status.  It was indicated that there would be no benefit from incorporating private sector health care provision (i.e. treatment centre) within the hospital business model, as the FT would have a much tighter business case for all services provided in the future. 

London NHS Reconfiguration

·        Concerns were raised about the future of the Whittington Hospital in the context of the review of NHS services in London.  There was a general indication that Primary Care Trusts (as commissioners of services) would lead the way in shaping the nature and level of acute sector provision across London (subject to  ...  view the full minutes text for item 5.

The Panel will hear evidence from Joy Tweed, independent adviser to the Panel.

Joy Tweed, is a member of the Health Scrutiny Support Programme (at the Centre for Public Scrutiny) and an Associate Lecturer at University of Westminster.  A brief summary of the main points that were discussed with the Panel are summarised below:

·        To date 73 NHS Trusts have acquired FT status.  Although the stated policy of ensuring that all acute sector NHS trusts become FT’s is still in place, it is unlikely that this will be achieved by the target date of 2008.   

·        The Governor role will be critical in the new governance arrangements for the FT, particularly in developing links with different stakeholder groups.  As Governors may be from a wide range of lay communities, there will need to be an explicit commitment to train and develop those elected to Governor Role to ensure that they can fulfil these duties effectively.

·        Further information is required as to how the Whittington planned to develop the Membership of the FT.  In particular, details of how patients and members of the public are to be engaged and recruited into the Membership.  This was important as this is the mechanism for ensuring that local people are adequately represented in the Membership and subsequent election to the Council.

·        The Darzi review (of London NHS services) will have important implications for FT’s and the wider acute sector, especially as to how new commissioning arrangements will work (practice based commissioning).  It was noted that there is a t need to develop such commissioning capacity.

·        With the creation of FT’s, it has been inevitable local disputes have arisen between commissioners and providers concerning variations in the nature and level services provided.  With the right of appeal to the Secretary of State no longer available, Monitor has assumed this regulatory role.  It was noted however, that Monitor appeared unwilling to get involved in such local disputes, instead recommending local dialogue as a solution. 

·        The Panel indicated that it would like to learn more about the experiences of other FT’s, particularly in relation to 1) governance issues -  the work of the Membership Council and relationship with the Board 2) financial position – costs of recruiting Membership and maintaining Membership Council 3) benefits that have been derived from new freedoms conferred through FT status.  The Panel asked the independent adviser if some further information could be obtained from 2 or 3 FT’s in relation to these areas. 

Agreed: Independent adviser to obtain information from other FT’s in respect of governance, benefits of new freedoms and finances.

·        The Panel indicated that a visit to the Whittington Hospital would be helpful to guide and inform decision making. 

Agreed: Panel visit to Whittington Hospital be arranged before the next meeting (4^th October). 

A representative from the Whittington Hospital PPI Forum was not able to attend.  This Forum is meeting on the 18^th September to develop a written response to Whittington Hospital consultation, which the Review Panel will also receive.

Agreed: Whittington PPI Forum be invited to attend the next meeting (4^th October, 7.00 p.m.

None.

To confirm date of next meeting.

Agreed: Thursday 4^th October 7.00pm Haringey Civic Centre (Committee Room 1)