The North West London Joint Health Overview and Scrutiny Committee (NWL JHOSC) met to discuss community-based specialist palliative care, the Mount Vernon Cancer Centre, and NHS involvement strategies. The committee heard that a decision had been made not to reopen beds at the Gordon Hospital. Members expressed concerns about the closure of the Pembridge unit, travel costs for low-income families, and the need for culturally competent care.

Gordon Hospital Update

Claire Murdoch, Graham Cole and Rose Graves from Central and North West London NHS Foundation Trust (CNWL) provided an update on the services at Gordon Hospital. They confirmed that the Integrated Care Board (ICB) had made a formal decision on 8 April to support the proposal not to reopen the beds.

Claire Murdoch stated that the ICB and Westminster City Council are working on joint funding for potential further provision of crisis and step-down beds, but a location and operating model are still needed.

Ross and Graham added that the decision was part of a larger transformation programme, including the Northwest London mental health strategy and CNWL's transformation. They welcomed the commitment to creating further crisis and step-down beds.

Councillor Concia Albert reiterated the importance of engaging in a way that leads to a better place, but was unsure if they were there yet.

In response to a question from Councillor Lucy Knight about the location of the six inpatient and six step-down beds, Graham Cole said that a proposed solution for crisis beds was in place, and progress was being made on a location for step-down beds in South Westminster, but nothing was 100% confirmed yet.

Community-Based Specialist Palliative Care

Dr. Lindsay Williams and Robin Duran led a discussion on community-based specialist palliative care, focusing on the consultation that closed on 15 May. The aim is to deliver a consistent, equitable, high-quality, culturally competent service across all boroughs.

The consultation tested support for two options:

• Option One (preferred): Delivering the new model of care, including 46 new enhanced end-of-life care beds, without reopening the Pembridge inpatient unit, costing $27.6 million.
• Option Two: Delivering the model of care and reopening the Pembridge unit, which would lead to a reduction in the number of beds in other hospices, costing $29.7 million.

Dr. Lindsay Williams highlighted the importance of equity of service, cultural competency, and keeping people at home. The new model includes:

• Increased community specialist palliative care teams (12 hours a day)
• New enhanced end-of-life care beds (total of 54)
• 24/7 telephone advice
• Hospice at home
• Outpatient appointments and psychology support

Cathy Walker discussed local delivery and the Pembridge update, noting that CLCH has been offering enhanced hospice at home provision. She stated that Pembridge is an option for the enhanced end-of-life care beds.

Dr. Samantha Lund spoke about the role of hospices, emphasising the importance of stabilising the community offer.

During questions, Councillor Lucy Knight raised concerns about the location of the enhanced end-of-life beds for RBKC, specialist consultant input, and whether existing care home beds would be repurposed. She also asked about the future of the Pembridge facility and whether the new model would meet future demand.

Dr. Lindsay Williams clarified that the enhanced beds would have a weekly consultant specialist palliative care ward round and 24/7 care by nurses with specialist knowledge. Navneet Willoughby added that existing NHS estate was being looked at, and Pembridge was an option.

Catherine Shaw, chief executive of Healthwatch, noted concerns about the closure of the Pembridge and the move of services away from a central hub.

Leslie Watts, chief executive of Chelsea and Westminster in Hillingdon, supported the paper, noting that it addresses the issue of patients dying in acute units. She also highlighted the need to ensure specialist care is available for all patients.

In response to concerns about travel access and support, Melissa Mellett said that some hospices provide free transport based on criteria, and free parking is available at all hospices.

Councillor Chetna Halai raised concerns about whether there would be enough beds for the ageing population in Harrow and other boroughs. She also asked about mechanisms for culturally competent care.

Councillor Natalia Perez questioned how closing the NHS bedded unit at Pembridge could be considered levelling up, and whether the enhanced beds would add to pressures for care beds within local authority areas. She also asked if workforce was a concern.

Councillor Concia Albert asked about staffing at the Pembridge and what would happen to the beds going forward. She also asked what was unstable about option B.

Councillor Andy Hale echoed concerns about the ageing population and transport costs.

Councillor Lucy Knight asked whether the council was in a comfortable position to meet the demand for elderly people with dementia, which was expected to double by 2040.

Melissa Mellett stressed that the $2.1 million was an investment, not a saving.

Councillor Chetna Halai recommended having a plan or strategy, maybe borough by borough, with graphics or stats, and the impact of all the decisions.

Councillor Ketan Sheth suggested ensuring there is opportunity for parking at the locations, and better comms or engagement with residents.

Mount Vernon Cancer Centre

Jessamice Battersby, Head of Partnerships and Engagement at NHS England, and Leslie Watts provided an update on the Mount Vernon Cancer Centre (MVCC).

Jessamice Battersby explained that the clinicians had expressed concerns about the long-term sustainability of the service. An independent clinical review recommended immediate actions, a change in management to UCLH, and reprovision on an acute hospital site.

The proposal is to relocate to Watford General Hospital, with additional chemotherapy services at Hillingdon Hospital and Northwick Park Hospital. A transport working group has been set up.

Leslie Watts stated that the way care is currently provided at Mount Vernon is not acceptable. She asked for the committee's support to get a decision made and capital allocated.

During questions, Councillor Ben Wesson asked for an update on securing capital funding and how to show support. He also asked about consultation events and addressing travel issues.

Jessamice Battersby said that they did not have an update on finances, but were confident they had support to fund the move. She added that the consultation planning was going well, and they were looking to do more pre-consultation engagement.

Councillor Chetna Halai expressed disappointment at the delays and stressed the need to push the plans along. She asked about figures for additional chemotherapy services and benchmark figures for engagement.

Catherine Shaw asked how Healthwatch would be engaged.

Leslie Watts challenged what was actually being consulted on, as the choice of continuing services at Mount Vernon was not an option.

Councillor Chetna Halai said that what she was hearing was ultimately death if provisions were not put in place.

Councillor Concia Albert asked about the radiotherapy department and if the closest one was still in Luton-Stevenage.

Councillor Andy Hale echoed the commentary about ageing and transport costs.

Councillor Lucy Knight asked if the council was in a comfortable position for the demand for elderly people with dementia.

Sam said that dementia is a core component of specialist palliative care provision.

Melissa Mellett reiterated that the $2.1 million was an investment, not a saving.

Councillor Chetna Halai recommended having some sort of plan or strategy, maybe borough by borough, and the impact of all the decisions.

Councillor Ketan Sheth suggested ensuring there is opportunity for parking at the locations.

Jessamice Battersby said that they were looking for a date in June for the next Joint Scrutiny Committee for Mount Vernon.

NHS Involvement Strategy

Rory Hegarty presented the NHS involvement strategy, explaining that it was based on talking to people to find out their experiences. The strategy includes an involvement charter and focuses on reaching excluded communities.

The strategy includes:

• In-reach programme
• Co-design advisory body
• Quarterly residents' forum
• Resident voices on programmes
• Citizens panel
• Commissioning VCS organisations

During questions, Councillor Ben Wesson asked about the approach moving forward given the changes, and resources for supporting ongoing work.

Rob Hurd said that there would be a reduction in people involved in involvement, and they would need to work closely with local authorities and provider partners.

Councillor Chetna Halai wanted to make sure that each individual council's priorities were taken into consideration.

Councillor Natalia Perez asked how recommendations around working more closely with local authorities to deliver messaging about accessing the ambulance service were being taken forward.

Councillor Chetna Halai asked to see proposals for partnership working.

ICB Landscape Update

Rob Hurd provided an update on the ICB landscape, noting that the ICB delivered on its key performance targets at the end of March. However, there is a need to radically reduce support staff. He said that the ICB currently employs 700 people, likely going down to around 350.

Leslie Watts added that the cuts would mean changing the way services are provided.

Councillor Concia Albert suggested having a written update before the meeting.

Councillor Ketan Sheth suggested having a committee briefing to understand what is being proposed, and what is on the forward plan of the providers and the ICB.

Councillor Chetna Halai asked what was being done on the other committee and if there were any dates in place.

Councillor Ketan Sheth asked Rob Hurd to extend the committee's gratitude to all the individual colleagues for their work.

The committee then moved on to the work programme tracker.