Agenda and minutes

To receive apologies from members of the Committee unable to attend.

Apologies were received from Councillor Jones, London Borough of Richmond upon Thames and Councillor McCabe, London Borough of Merton.

Councillor Jones was substituted by Councillor Jaeger, LBRuT.

To receive declarations of interest from councillors pertaining to items on the agenda.

Councillor Burstow declared a personal non-prejudicial interest in matters for discussion by virtue of her marriage to a Minister for the Department of Health.

To receive the minutes of the previous meeting of the Committee, held on 22 February 2012, and seek approval for signature by the Chairman.

The minutes of the previous meeting, held on 22 February 2012 were agreed as an accurate record and the chairman authorised to sign them.

To receive any updates pertaining to the membership of the Committee, and to receive nominations and elect a Vice-Chairman.

Members were asked to report any changes to membership.

Councillor Mark Thomas reported that he had been formally appointed to the Committee and that Councillor Randall would now be his named substitute.

Councillor Jaeger reported that she had been appointed as named substitute for Councillor Jones, London Borough of Richmond upon Thames.

Nominations were again sought for a Vice Chairman to the Committee.  No nominations were received.

To receive a short presentation from Michael Bailey, Acute Medical Director for the BSBV programme. 

The presentation will report progress made in the Better Services, Better Value Programme since the 22^nd February JHOSC meeting, to include:

o    Publication of final Clinical Reports

o    London Health Programmes: Implementation of Emergency Standards

o    Adjustments to the Scoring Day arrangements

o    Update on communications and engagement strategy

o    Integrated Impact Assessment

In addition there will be an update given on the review of the Scoring Day arrangements on the non-financial evaluation criteria. 

The team will also provide information on the London Health Programme which has particular focus on emergency care standards and their implementation across London.  This provides further context for the Urgent Care and Paediatric model of care.

Mike Bailey, Acute Medical Director, NHS SWL and Lucie Waters were in attendance to present to the Committee information relating to the progress of the Better Services, Better Value (BSBV) review.

In particular they referred to the following information during their presentation:

• That the clinically driven nature of the review continued and that 5 of the 6 clinical reports had now been written and published.  The clinical report for Children’s Services remained unpublished as deliberations continued on the content and recommendations.
• That Maternity and A&E units continued to be aligned as the needs of both were similar, in terms of resources.
• That in response to comments received at the last meeting of the JHOSC, the plans to release potential options prior to the financial appraisal, and prior to the Purdah period associated with the GLA elections, had been changed.  The Scoring panel had now been rearranged to the 9^th May and the timeline for the review was being adjusted accordingly. 
• The financial appraisal would be conducted separately as planned and the results combined to generate a ranked shortlist.
• That legal advice received suggested that Councillors from Surrey County Council should be invited to join the Committee.
• That an impact assessment would be carried out alongside the scoring panel and options appraisal, and would be used by the programme executives to inform the formal decision making process. Separately an impact assessment of the preferred option would be carried out – the outcome of this would inform plans for implementation.
• This assessment would be facilitated by an independently chaired steering group which would meet for the first time in March 2012 and a chairman was currently being sought by various means.
• An Integrated Impact Assessment (IIA) would be undertaken in parallel with the BSBV public consultation, some of the data would be publicly available, but not complete before the start of consultation. 

In response to questions raised and comments made the Committee heard the following further information from the Acute Medical Director:

• That the Clinical Reports from each group had been cross referenced via the Clinical Strategy Group and the Programme Board.
• That the number of planned care beds had been set at 150 based on modelling work conducted by 2020 Delivery over the last year
  [Note by NHS SWL (17/04/12): Latest modelling suggests it will be in a bed range of 80-120, which allows for differences between the candidate sites, reduction in ALOS (~15%) and the fact that some activity from Surrey will be retained at SWLEOC.  This work is ongoing]
  This number represented the number of patients who would be able to be treated at the planned care centre. This included beds for the Elective Orthopaedic Centre (EOC) to be relocated onto the planned care site.
• That a 150 bed site was smaller than the other sites currently in operation and those that might be created through the BSBV programme.
• That the suggested 150 beds were for overnight patients.  There would be additional in patient beds available,  ...  view the full minutes text for item 12.

In response to resolutions of the February meeting of the JHOSC, Hardev Virdee Director of Strategic Finance NHS South West London and Tim Thomas from 2020 Delivery, the Committee will receive a presentation containing further detail on the Options Appraisal process.  The particular focus will be on the financial criteria which will be used and how these criteria will be applied to the process.

[Presentation slides to follow]

Tim Thomas, Associate, 2020 Delivery and Hardev Virdee, Director of Strategic Financial Planning were in attendance to present to the committee information it had requested at its previous meeting regarding the financial criteria in relation to the options appraisal.

During the presentation they particularly referred to the following information:

• That the financial criteria applied to the option evaluation had been agreed as a result of guidance from NHS London and fell into three categories, namely:
  • Commissioner sustainability – CCG’s projected to be in financial balance
  • Provider sustainability – organisations projected to meet required financial targets.
  • Deliverability – financial criteria associated with transition satisfied.
• Within these three categories, eight financial criteria had been agreed and these were assessed by hurdle, or score criteria or both.  Simplified, these could be represented by  a single test and a financial measure.
• That oversight of, and active participation in, the financial evaluation benefits from broad representation in order to ensure the overall integrity of the process.
• The governance groups involved were the:
  • Programme Board
  • CWGs / CSG
  • Finance and Activity Group
  • Workforce Group
  • Estates Group
• That whilst the BSBV review was clinically led it was important to understand the financial implications and constraints of various models of care that may come out of the options appraisal.
• That the applications for Foundation Trust status would continue to run alongside the BSBV review.  It was thought that as both processes were working to the same aim that they could dovetail.  Foundation Trusts would have to establish their robustness, so those nearing the end of the process would be largely unaffected.  Those at the beginning were being given advice in order that BSBV was included in the plans produced.
• That at present none of the hospitals met the required standards and ability to meet demand that was clinically recommended and required for the future.

In response to questions raised and comments made by the Committee the following further information was provided by officers in attendance:

·         That an Impact Assessment would run alongside the consultation process.  It would assess the impact of different options for implementation and propose mitigating actions.  It would be publically available at the same time as the consultation and might be used to influence the final decision alongside the results of the consultation.    A potential outcome could be that the preferred option is substantially modified or discarded

·         That patient representatives and a Local authority member were present on the Programme Board.

·         That the options to be assessed had been shortlisted more quickly than had been anticipated and therefore the impact assessment steering group was not ready immediately.  The committee heard that the delay would not be detrimental to the BSBV process.

·         That the site that was designated to host the Planned Care Centre would have the capacity to do this and more by virtue of the A&E related beds having been removed.

The Committee made the following comments in response to further information received:

• That the impact assessment being utilised after the results  ...  view the full minutes text for item 13.

To discuss objectives and deadlines for the JHOSC in light of information received under items 5 and 6.

Following a brief discussion it was RESOLVED that

At the next meeting of the Committee, the Impact Assessment element of the review be considered

That information pertaining to the key stages of the BSBV be provided by NHSSWL, for distribution.

To agree a date or dates for future meeting(s) of the Committee.

It was RESOLVED:

That the dates of the next meetings of the JHOSC be agreed on receipt of the key stage information from NHSSWL.