The Health and Social Care Scrutiny Sub-Committee met on Tuesday 10 December 2024 to discuss the proposed changes to the Mount Vernon Cancer Centre, the improvement of adult social care services in Harrow following a Care Quality Commission (CQC) inspection, and the findings of a GP access survey across North West London. The committee endorsed the plans for public consultation on the Mount Vernon Cancer Centre proposals and provided suggestions for a more effective consultation process in Harrow. They also reviewed the approach to improving adult social care services and noted the findings of the GP access survey.

Mount Vernon Cancer Centre Briefing

The committee received a comprehensive overview of proposed changes to the Mount Vernon Cancer Centre, initiated due to concerns about service sustainability. The review aims to create a modern cancer centre with specialist treatments and access to clinical trials for populations across Harrow, Hertfordshire, Bedfordshire, and Northwest London. Key findings indicated a lack of co-located services, such as critical care, at the current site, and that emergency patient transfers disrupted treatment.

Proposals include relocating the main centre to Watford General Hospital, which is an acute hospital with better access to critical services. Additional chemotherapy services are proposed at Northwick Park Hospital, which is closer to Harrow residents. University College London Hospitals (UCLH) has been identified as the preferred provider to manage the centre, though the consultation will focus on patient care and relocation, not UCLH's formal takeover.

Challenges to progress include delays caused by the COVID-19 pandemic and a failed bid for capital funding. Despite this, NHS England plans to consult on the proposals in the first half of next year due to the current site becoming increasingly untenable. A Joint Scrutiny Committee, involving ten local authorities including Harrow, has been established to scrutinise the proposals.

Members raised concerns about transport options for Harrow residents, particularly those without cars, and the Head of Partnership advised that a transport and access group is addressing these issues. The sustainability of funding the relocation, estimated at £400-450 million, was questioned, with acknowledgement of current NHS resource pressures. The decision to select Watford over closer locations like Hillingdon or Northwick Park was explained by extensive travel analysis showing Watford as the only site meeting all criteria. Issues with sharing patient records between Mount Vernon Cancer Centre and Northwest London systems are being addressed. Plans for expanding chemotherapy services at Northwick Park and other local sites were outlined, with the aim of reducing travel for Harrow patients. The committee resolved to note the developing plans for public consultation and provide advice for a more effective consultation in Harrow.

Improving Adult Social Care Services in Harrow

The Strategic Director of Adult Social Care and Public Health presented an overview of the recent Care Quality Commission (CQC) inspection of Harrow's adult social care services, which resulted in a Requires Improvement rating. While many examples of good practice were identified, significant areas for development were highlighted, including information for carers, communication between health and social care services, senior management team instability, and a relatively low uptake of Direct Payments.

Improvement actions are underway, focusing on key priorities:

• Safeguarding: A multi-agency safeguarding hub for adults is being established, modelled on the children's safeguarding approach.
• Carers' Support: A review of Harrow's carers' offer is in progress, with a new carers' strategy being co-produced with residents and partners.

Members questioned the consistency of service delivery, waiting times, and the triaging process for urgent and non-urgent cases. The Strategic Director assured that processes are being standardised, communication is being improved, and temporary staff have been hired to address backlogs. The ultimate goal is to improve the experience and outcomes for residents relying on adult social care services. The committee resolved to review and scrutinise the approach to improvement and the priorities outlined in the paper.

Primary Care (GP) Access Survey

The Borough Director, Harrow, North West London Integrated Care Board, presented a summary of a GP access survey conducted across eight North West London boroughs, with a focus on Harrow. The engagement programme, which included patient and staff surveys, PCN-led events, and community outreach, aimed to gather feedback to inform improvements.

Initial findings indicated general satisfaction with GP access, but also a demand for more training on using the NHS app and mixed satisfaction with online platforms. Challenges with capacity were noted, with some practices receiving over 200 online consultation requests daily. Areas for improvement identified include callback systems, increased staffing, and enhanced online booking options.

Primary Care Networks (PCNs) have been asked to submit detailed improvement plans. The committee noted the patient survey results, the response rate for Harrow, and the proposed next steps, which include compiling a final report and holding a findings event in January 2025. Members raised concerns about the survey's representation of residents' experiences, particularly regarding appointment access and wait times, and queried the system limitations mentioned. The Borough Director clarified that limitations primarily relate to clinician availability and that efforts are underway to improve triage systems and staffing. The need for a Patient Rights Charter was suggested, and the importance of face-to-face appointments for complex issues was highlighted. The committee resolved to note the survey findings and proposed next steps.