The Adult Social Care & Health Select Committee met to scrutinise the quality accounts of Chelsea and Westminster Hospital NHS Foundation Trust and to discuss and prioritise items for their work programme for the upcoming year. Key discussions included the hospital's performance, its engagement with the new Integrated Care Board, and the development of neighbourhood health services.

Chelsea and Westminster Hospital NHS Foundation Trust Quality Accounts

The committee reviewed the draft Quality Accounts for Chelsea and Westminster Hospital NHS Foundation Trust, hearing from Robert Bleasdale, Chief Nursing Officer, and Laura Bewick, Managing Director of the Chelsea site. The Trust was ranked eighth nationally and first among teaching hospitals in the latest NHS acute trust league table. While improvements have been made in elective and emergency care, the Trust acknowledged it was still short of constitutional standards, with plans in place to meet these by 2028-29.

During the discussion, the committee raised several points:

• Integrated Care Board (ICB) Engagement: The committee sought clarity on how the Trust was working with the newly formed West and North London ICB to ensure Kensington and Chelsea received adequate funding. The Trust stated they had a three-year funding plan agreed with the ICB and maintained regular communication with the ICB's chief nurse.
• Integrated Neighbourhood Teams (INTs): The Trust explained that the bi-borough area of Kensington and Chelsea and Westminster had been selected as an accelerator site for INTs, with a focus on community-based care to manage increasing patient numbers. Scrutiny of services within the INT model would be overseen by the Care Quality Commission (CQC).
• Service Provision: Questions were raised about the proportion of services provided in-house versus outsourced and their respective costs. The Trust offered to provide further details on this, noting that they contract with both private and other NHS providers.
• Digital Transformation and Patient Communication: The committee heard about the Trust's efforts to improve digital communication with patients, including plans for patient-led appointment booking and rescheduling, and enhancements to hospital signage. The Trust is also working with the national NHS team to integrate data systems for better continuity of care.
• Health Inequalities: The committee enquired how the Trust measured differences in outcomes for patients from ethnic minority backgrounds, those living in deprivation, and patients with disabilities. The Trust acknowledged challenges in this area across the four North West London trusts and outlined ongoing work to improve monitoring, including prioritising maternity services for women from ethnic minority backgrounds.
• Workforce Shortages and Safety: The Trust reported a year-on-year decrease in nursing, midwifery, and allied health professional vacancies and turnover, with a vacancy rate below 5%. They also detailed how lessons learned from incidents are shared across departments and trusts through various bulletins and governance days.
• Accident and Emergency (A&E) Performance: The committee discussed the increasing demand in A&E and the impact of patients unable to be discharged. The Trust outlined plans to improve performance through workforce reviews, point-of-care testing, and enhanced waiting environments. They also discussed improving A&E triage and redirecting patients to alternative care providers, acknowledging the need to strengthen links with pharmacies and out-of-hours services.
• Infection Prevention and Control: The committee received an update on site-specific improvements to reduce C. difficile and MRSA infections. This included a collaborative improvement programme across four North West London trusts, focusing on shared electronic patient records, enhanced cleaning, and improved handling of medical lines. The Trust also reported improving E.coli rates.
• Artificial Intelligence (AI) in Triage: The Trust indicated an openness to adopting AI and digital tools to support triage, but noted that AI was not currently used for clinical decision-making in triage, citing significant clinical safety considerations.
• Constitutional Standards and Waiting Times: The Trust confirmed they were on track to improve in three out of four constitutional standards (A&E, Cancer, Referral to Treatment) for the current year, with Diagnostics being an area needing further improvement. Surgical specialties, particularly ENT, plastic surgery, and orthopaedics, continue to experience the longest Referral to Treatment wait times due to pandemic-related backlogs. The Trust aims to eliminate waits of over 52 weeks by the end of the year.
• Learning from Deaths: The committee sought clarification on the screening of deaths mentioned in the report, and the Trust offered to provide further details. They also explained how learning from deaths is shared across North West London trusts through a combined report.

The committee thanked the Trust representatives and indicated that a letter would be sent outlining their reflections and conclusions.

Select Committee Work Programme 2026/2027

The committee discussed potential items for their work programme for the upcoming municipal year. The committee agreed that a detailed work programme be developed with the following priorities in mind:

• North West London Integrated Care Board (ICB): The committee discussed the reorganisation of the ICB. It was agreed that this item should be raised at the next Full Council meeting for discussion, citing ongoing concerns about clarity regarding its practical implications for patients, residents, and the local authority.
• Neighbourhood Health and Care Services: This was identified as a priority area for scrutiny, with a focus on the shift of services into the community and ensuring that those not currently being served by existing community services, such as mental health and support for isolated individuals, are identified and supported. The integration of homecare mobilisation into this item was discussed.
• Mental Health and Neurodiversity: The committee discussed the significant issues surrounding ADHD diagnosis and treatment, and the broader impact of mental health challenges, anxiety, and depression, particularly among young people. This was noted as a priority area for the work programme.
• Palliative Care Services: This was noted as a priority area for the work programme, with ongoing discussion regarding the implementation of compassionate care for all and the provision of end-of-life care beds.
• Children's Hospital Services: The relocation of specialist children's services from Royal Brompton Hospital to Evelina London Children's Hospital was noted as a priority area for the work programme.
• Public Health: This was noted as a priority area for the work programme, with a focus on health inequalities and the impact of high street provisions on residents' health.
• Other areas for consideration included Adult Social Care Services, Transitions, Budget and Resources, and NHS and health services.

The committee also discussed the potential for working groups, site visits, and raising issues at Full Council as methods to enhance their scrutiny function. The committee agreed that a detailed work programme be developed based on these priorities.