Items
No. |
Item |
1. |
Late Items
To identify items which have been admitted to
the agenda by the Chair for consideration.
(The special circumstances shall be specified
in the minutes.)
Minutes:
The following supplementary information was
submitted to Members prior to the meeting:
Item 8 – JCPCT Update: Additional correspondence
Item 12 – Regional Infant and
Children’s Transport Service: Impact assessment
Item 14 – Additional submission from
LTHT: Bonding and attachment in
CHD babies and young children
Item 16 – Feedback from other
authorities: additional submissions from Rotherham Council, Leeds
City Council and Wakefield Council.
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2. |
Chair's Opening Remarks
Minutes:
The Chair informed the Committee that an
invite had been sent for either Sir Neil McKay or some other
representative from the Joint Committee of Primary Care Trusts
(JCPCT) who would be involved in the
decision making process to attend today’s
meeting. It was reported that this
request had been declined. It was felt
the decision not to attend was unacceptable in the fact that this
was a democratically elected body and was representative of 15
Local Authority areas and a populace of 5.5million. Further concerns raised by the Committee included
the fact that any response to the proposals would not have been
done without opportunity to question the decision makers; it did
not support democratic processes without attendance from the
JCPCT and it was only fair that they
should have attended for what was an evidence based process.
A member of the public was also given
opportunity to address the Committee and reported on her
experiences as a Member of the Leeds Teaching Hospital Trust
Patient and Public Involvement Forum and Children’s Hospital
arrangements in Leeds.
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3. |
Declarations of Interest
To declare any personal/prejudicial interests
for the purpose of Section 81 (3) of the Local Government Act
2000
Minutes:
The following declarations of interest were
made:
- Councillor E Rhodes as a retired
member of UNISON (Health Service)
- Councillor K Wilson as a Governor of
North Lincolnshire and Goole Hospital
- Councillor S Wiseman as a Member of
the York Hospital Foundation Trust
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4. |
Apologies for Absence and Notification of Substitutes
To receive any apologies for absence and
notification of substitutes.
Minutes:
Apologies for absence were submitted on behalf
of Councillors J Bromby (North
Lincolnshire County Council), D Brown (Hull City Council), I
Saunders (Sheffield City Council) and S Worten (Barnsley MBC).
Councillor C Skelton was in attendance as
substitute for Councillor I Saunders.
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5. |
Minutes of the Previous Meeting PDF 80 KB
To approve the minutes of the meeting held on
29 March 2011
Minutes:
RESOLVED – That the
minutes of the meeting held on 20 March 2011 be confirmed as a
correct record.
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6. |
Review of Children's Congenital Heart Services in England: Revised Terms of Reference PDF 68 KB
To receive and consider the attached
report.
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development referred to the need to revise the terms of reference
for the Joint Health Overview and Scrutiny Committee (Yorkshire and
the Humber) and a revised copy was circulated. The revisions referred to the change of membership
and changes to the consultation period.
RESOLVED – That the
revised terms of reference be approved.
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7. |
Review of Children's congenital Heart Services in England: Joint Committee of Primary Care Trusts (JCPCT) Update PDF 71 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development informed Members of the contact that had been made with
the JCPCT and the Safe and Sustainable
Team. As had been previously reported,
there would be no representation from the JCPCT or Safe and Sustainable team at this
meeting.
Cathy Edwards of the Yorkshire and Humber
Specialised Commissioning Group (SCG)
was in attendance for this item and gave the Committee an overview
of some of the work that had been recently published in respect of
the review for children’s congenital heart services, namely
the Health Impact Assessment and the IPSOS Mori public consultation. Further issues reported included the
following:
- All trusts had been asked to report
on capacity planning and any constraints or restraints there would
be from taking n additional work.
- Analysis of how much work Leeds
would take from other areas was now being analysed and would be fed
to the JCPCT in October or
November.
- Work surrounding the Central Cardiac
Audit Database – this gave more up to date figures on the
likely number of procedures to be carried out.
- Work that was currently being
carried out by Price, Waterhouse & Cooper in respect of patient
flow. This looked at 18 postcode areas
nationally, 8 of which were in Yorkshire and the
Humber. This information would be fed
to the JCPCT in November.
- The judicial review relating to
Royal Brompton Hospital – an initial hearing had been held
and there was to be a full hearing in September.
- There was an expectation of
responses from Overview and Scrutiny Committee’s to submit
responses by 5 October to be fed into the JCPCT meetings in October and November.
- The Clinical Advisory Group was to
meet in September and would be looking at Children’s Cardiac
Services and Co-location.
In response to Members comments and questions,
the following issues were discussed:
- The JCPCT was due to meet on 25 October and 17 November
when the final decision on the options was exected.
- It was felt to be unacceptable that
the scrutiny responses had to be submitted by 5 October when
information such as the patient flow analysis had not yet been
completed. An interim report on this
was due in the last week of September.
- The review of the impact on other
services at Royal Brompton was being carried out due to the
judicial review and to look at the overall sustainability of the
hospital.
- The results of the patient flow
analysis were critical to the Yorkshire and Humber region as all
the other options would increase travelling time for the majority
of residents. It was felt that to not
have this information this was against the interest of open and
accountable decision making.
- If the Judicial Review ruled in
favour of Royal Brompton Hospital it was likely that the whole
process would have to be reconsidered.
- It was felt that the process was
flawed when information such as the patient flow analysis was not
available. This could have
...
view the full minutes text for item 7.
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8. |
Review of Children's Congenital Heart Services in England: Health Impact PDF 57 KB
To receive and consider the attached
report
Additional documents:
Minutes:
This item was deferred to be considered in
conjunction with Agenda Item 13, Impact Assessment for Yorkshire
and the Humber.
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9. |
Review of Children's Congenital Heart Services in England: Report on the Public Consultation PDF 58 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development referred to the Safe and Sustainable Review of
Children’s Congenital Heart Services in England: Report on
the Public Consultation produced by Ipsos MORI. The full
report on the consultation was included with the agenda along with
a press release from the Safe and Sustainable team.
In response to the consultation, the following
issues were discussed:
- A large response was received from
the East Midlands area which gave an obvious preference to the
options that favoured that area.
- There was no weighting given to
petitions which had seen a high response in the Yorkshire and
Humber region.
- Questions should have been included
that related to the 5 key principles.
- There should have been questions
based on travel time.
- Absence of information on the
patient flow analysis – this would have been beneficial to
the consultation.
- No reference to motions passed by
Local Authorities.
- It was felt that the consultation
exercise asked leading questions to get the answers required to
support the decision makers and that vital considerations such as
patient flow and travel times should have been included.
RESOLVED – That the
report and discussion be noted.
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10. |
Review of Children's Congenital Heart Services in England: Feedback from Yorkshire and the Humber Congenital Cardiac Network PDF 70 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development introduced the Regional Congenital Cardiac Network
Strategy which had been developed by the Yorkshire and the Humber
Regional Congenital Cardiac Network Board. A copy of the strategy was attached to the report
along with the Network’s response to the Safe and Sustainable
Consultation Document: A new vision for Children’s Congenital
Heart Services in England.
Ruth Lund, Yorkshire and Humber Congenital
Cardiac Network Manager was in attendance for this item along with
Cathy Edwards.
The Committee was informed that the Yorkshire
and the Humber Regional Congenital Cardiac Network was established
in 2005 and supported those with heart defects right through from
detection of problems at the foetal stage to children’s and
adults heart surgery and care. It was
the only network of its kind in the country and their work was
recognised nationally. The Strategy
prepared set out the local position for the next two years and had
consultation had taken place with all key stakeholders. Key points of the strategy included the
following:
- Effectiveness of the service and the
reliance of early identification of problems.
- Commitment to ongoing support for
patients and their parents.
- Support given to the regional
centre, Leeds Teaching Hospitals Trust, and support during the
national review.
In response to Members comments and questions,
the following issues were discussed:
- Early diagnosis and the ability to
arrange delivery of babies at a specialist centre.
- Issues surrounding early births and
time to get to specialist care and emergency transfers.
- The outcome of the whole review
would place a reliance on these kind of networks and the model in
Yorkshire and Humber would be suitable for whatever
option was chosen although different
network arrangements would have to be put in place.
- One of the SCG concerns was whether there would be a dilution
of outreach services in the area. 17
outreach services were currently in operation and there was concern
whether these could be maintained if Leeds was not selected.
- Issues relating to co-location of
services.
- Scotland was not included in the
review. Members felt that Glasgow could
have been used as an alternative option to Newcastle particularly
to reach target numbers. It was
reported that Scotland would have its own review.
- The impact on services for adults if
Leeds was not included in the preferred option. There was a separate workstream associated with services for adults and
although the same surgeons were usually involved, adult services
were carried out by different cardiology teams.
- Provision of services for those with
multiple health needs. It was
acknowledged that co-located services in Leeds were exemplary and
something to aspire to. This was taken
into account during the preparation of the options but it was felt
it was not given enough weighting.
- Greater weighting was given to
issues such as ECMO provision than
co-location or the network service. The
SCG had stressed the need of
co-location and the value of the network at a national level to the
JCPCT.
RESOLVED – That
...
view the full minutes text for item 10.
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11. |
Review of Children's Congenital Heart Services in England: Impact Assessment on the Regional Infant and Children's Transport Service PDF 59 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development informed the Committee of the role of Embrace, which
was the country’s first combined infant and children’s
transport service. The service provided
neo-natal transfers and paediatric
retrievals across Yorkshire and the Humber and the Committee was
provided with an impact assessment of the service
following the key issues surrounding
the Safe and Sustainable Children’s Review.
The following were in attendance for this
item:
- Dr Derek Burke (Medical Director)
– Sheffield Children’s NHS Foundation Trust
- Dr Steve Hancock (Lead Paediatric
Consultant) – Embrace, Sheffield Children’s NHS
Foundation Trust
- Liz Murch (Clinical Nurse Manager) – Embrace and
Paediatric Critical Care at Sheffield Children’s NHS
Foundation Trust
The Committee was given an overview of the
services provided by Embrace and it was reported that the impact
assessment carried out showed that there would be a four fold
increase in cardiac activity should option A, B or C be
chosen. Embrace had recommended that
further work be carried out on transport options nationally and
also the financial implications of this under the Safe and
Sustainable review.
In response to Members comments and questions,
the following issues were discussed:
- Journey times were considered in the
impact assessment.
- A financial assessment had not been
done as to what the alternative options would cost, there would
need to be at least provision for another dedicated team and this
could not be established under current staffing and financial
arrangements.
- The medical impacts due to increased
time to transfer patients.
- Embrace had not been consulted
regarding the Price. Waterhouse and Cooper Patient Flow
Analysis.
- Potential effects of adverse weather
conditions.
- At present, approximately 10% of
Embrace’s work involved travelling out of the Yorkshire and
Humber region.
- There was concern over the increased
distance to be travelled for those with critical problems and the
knock on for other services provided by Embrace such as emergency
calls.
- Members requested information on
retrieval and transfer times between the different hospitals
involved in the options.
- Concern that transport arrangements
had not been given full consideration
in the Safe and Sustainable review.
RESOLVED – That the
report be noted
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12. |
Review of Children's Congenital Heart Services in England: Impact Assessment for Yorkshire and the Humber PDF 58 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development referred to the impact assessment on the proposed
reconfiguration models for Children’s Congenital Heart
Services that was produced by the Specialised Commissioning Group
(Yorkshire and the Humber) and also included activity data for
Leeds Teaching Hospitals NHS Trust (LTHT).
The SCG had
considered all information that had fed into the review and had
provided the impact assessment, although this was not part of the
formal consultation. A number of issues
were highlighted including the following:
- Clarification on multiple health
issues on a national basis.
- Provision of outreach services.
- Future sustainability of
children’s cardiology services in Yorkshire and the
Humber
- Retrieval services
In response to Members comments and questions,
the following issues were discussed:
- 75% of patients with congenital
heart disease had other health needs and this should be considered
along with the issue of co-location.
- There were significant levels of
outreach service in Yorkshire and the Humber which was well
supported by a network.
- It was anticipated that the chosen
option would be implemented in 2013-14.
- Further concern that full
consideration had not been given to the following issues
o
Impact on transport networks
o
Patients expectations
o
Population density
o
Accessibility
o
Accommodation for families
o
Co-location
RESOLVED – That the
report and discussion be noted.
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13. |
Review of Children's Congenital Heart Services in England: Submission from Leeds Teaching Hospitals NHS Foundation Trust PDF 72 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development referred to submissions made by Leeds Teaching
Hospitals NHS Trust (LTHT) in response
to the Safe and Sustainable Review.
The following were in attendance for this
item.
- Stacey Hunter –divisional
General Manager, Children’s Services, LTHT
- Karl Milner – Director of
Communications, LTHT
Stacey Hunter gave the Committee an overview
of the position with regards to LTHT. The following
issues were highlighted:
- Disappointment that Leeds was only
included in one of the four options.
- When the consultation commenced the
JCPCT declined to consider other
options. LTHT had formulated another feasible option.
- Yorkshire and the Humber had a
significant population density that was different to other regions
and there were well documented reasons that surgical provision
should remain
- The issue of co-location was not
reflected appropriately in the options to the public.
- There was no evidence to support the
fact that a centre that could provide 400 procedures a year would
provide better care.
- Concern that Adult Services
weren’t part of the review.
- Further consideration should have
been given to the impact on families, especially for mothers to
bond with newborn babies.
In response to Members comments and questions,
the following issues were discussed:
- Matters of factual accuracy and
consistency as outlined in the report – LTHT had raised these concerns on a number of
occasions without response.
- LTHT
would consider options available to them following the Jucial Review regarding Royal Brompton.
- Black and Minority Ethnic Groups and
vulnerable people – LTHT
supported these groups successfully and there would be concern over
accessibility, travel and the effect on family life if Leeds
wasn’t a chosen option. The
questionnaire from the JCPCT had not
been made available in other languages.
- If Adult Services had been included
in the review, a model that supported up to 9 centres across
England and Wales would have been feasible.
- Other services not provided at Leeds
such as ECMO and transplants – it
was reported that services would be transferred to the centres
supported in the options of the Safe and Sustainable review.
- Concern that other centres did not
have maternity and cardiac services close together.
- Further details regarding how the
weighting had been applied in the development of the options had
not been released due to the ongoing consultation. Freedom of Information requests had been
sent. This would also be requested on
behalf of the Committee.
RESOLVED – That the report and
discussion be noted.
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14. |
Review of Children's Congenital Heart Services in England: Feedback from Other Key Stakeholders PDF 91 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development presented the Committee with details of a range of
views expressed by other key stakeholders including Hospital
Trusts, BME communities and the general
public.
The following were in attendance for this
item:
- Judith Huntley
– Cardiac Nurse, LTHT
- Elspeth Brown –
Consultant Cardiologist, LTHT
- Kevin Watterson
– Paediatric Cardiac Surgeon, LTHT and Children’s Heart Surgery Fund
(CHSF) Trustee
- Lois Brown –
Parent
The following key issues were raised:
- Leeds could carry out
the 400 required procedures now, but would require another
surgeon. Recruitment was not possible
whilst the review was ongoing.
- The role and work of
the CHSF.
- Leeds was one of only
2 centres in the country with fully co-located services.
- Mrs Brown gave the
Committee an overview of her experiences and the difficulties she
would face and would have faced if there was no provision in
Leeds.
- The potential impact
on cardiac services if cardiac surgery was carried out
elsewhere.
- The loss of continual
services from childhood through to adulthood as currently available
in Leeds.
In response to Members comments and questions,
the following issues were discussed:
- The figure for 400
procedures was based on having a centre with 4 surgeons.
- It was felt the
findings of the Ipsos/MORI survey were
predictable due to the nature of the questions and the complicated
nature of the survey.
- Lasting effects when
mothers and babies are separated at birth.
- Cost effects on
families having to make long journeys – CHSF did make contributions in some cases, the
reality often meant less visiting.
- All networks across
the country were given the same score in the proposed options even
though Leeds was classed as exemplary.
- Further concern that
the decisions were taken by a non-democratic process. The JCPCT did not
represent the people concerned.
RESOLVED – That the report and
discussion be noted.
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15. |
Review of Children's Congenital Heart Services in England: Feedback from other Authorities PDF 88 KB
To receive and consider the attached
report
Additional documents:
Minutes:
The report of the Head of Scrutiny and Member
Development presented the Committee with details of ranges and
views/findings identified by individual Health Overview and
Scrutiny Committees with regards to the proposed reconfiguration of
Children’s congenital Heart Services in England.
Members discussed the issues identified and
also made reference to motions made by their respective Councils
and other responses made. It was agreed
that all this information be collated.
RESOLVED – That the report and
discussion be noted.
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16. |
Date and Time of Next Meeting
To be confirmed – 29 September 2011 at
10.00 a.m.
Minutes:
To be confirmed.
Subsequent to the meeting, the date was
confirmed for Monday, 19 September at 10.00 a.m. Meeting to be held in the Civic Hall, Leeds with a
9.30 a.m. pre-meeting for all Members.
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