The North West London Joint Health Overview and Scrutiny Committee met to discuss significant updates on community-based specialist palliative care services and the future of Mount Vernon Cancer Centre. Key decisions included the formal decision to not reopen beds at Gordon Hospital and the ongoing consultation for a new model of community specialist palliative care across North West London.

Gordon Hospital Update

The committee received an update on the situation at Gordon Hospital. Councillor Ketan Sheth, Chair of the committee, noted that the committee had been following services at Gordon Hospital for many years. Claire Murdoch, Graham Cole, and Rose Graves provided an update, confirming that on 8 April, the Integrated Care Board (ICB) made a formal decision to support the proposal to not reopen the beds at Gordon Hospital.

Despite this decision, there is a focus on making Gordon Hospital a really vibrant mental health hub in the south of Westminster. The ICB and Westminster City Council are working on joint funding for potential further provision of crisis and step-down beds. Ross, who provided an update on behalf of the ICB, stated that the decision-making business case sits within a larger programme of transformation for North West London's mental health strategy. A fuller update on the work around step-down and crisis beds is expected at the Inner West London J-Hosk on 22 May.

Community-Based Specialist Palliative Care

A significant portion of the meeting was dedicated to an update on community-based specialist palliative care (CSPC) services across North West London. Robin Duran, SRO for the programme and Director of Transformation for Central and North West London NHS Foundation Trust (CNWL), and Dr. Lyndsey Williams, GP in Brent and GP Clinical Lead for the Last Phase of Life programme for the North West London ICB, presented the findings of an extensive consultation process.

The consultation, which closed on 15 May, aimed to gather views on two options for implementing a new model of care. Option A, the preferred option, involves delivering the new model, including 46 new enhanced end-of-life care beds, without reopening the Pembridge inpatient unit. Option B includes reopening the Pembridge unit, which would lead to a reduction in beds in other hospices.

The new model of care aims to provide consistent, equitable, high-quality, and culturally competent services across all boroughs. Key features include:

• Care in the home: 12-hour, 7-day-a-week community specialist palliative care teams, expanded Hospice at Home services across all boroughs, and a 24/7 specialist telephone advice line.
• Community inpatient setting: 46 new enhanced end-of-life care beds, in addition to the 8 already in Hillingdon, bringing the total to 54 across all boroughs. The existing 57 specialist hospice inpatient beds will be retained.
• Outpatient and wellbeing care: Increased specialist palliative care outpatient clinics, and a consistent pathway for bereavement and psychological support.

The preferred Option A is estimated to cost £27.6 million, while Option B would cost £29.7 million. Option A is considered more financially sustainable and quicker to implement. Concerns were raised by Councillor Lucy Knight and Catherine Shaw from Healthwatch regarding the closure of the Pembridge unit and potential travel distances for residents in deprived areas. However, the presenters emphasised that the new model aims to level up services across all boroughs and that the enhanced beds are new, funded provisions, not repurposed care home beds.

The committee also discussed the workforce strategy, with Lindsay Williams confirming that workforce development is a key enabler for the new model. The funding for the new model is intended to support this training and development.

Update on Mount Vernon Cancer Centre

Jessamie, Head of Partnerships and Engagement for NHS England in the East of England, and Leslie Watts, Chief Executive of Chelsea and Westminster and Hillingdon Hospitals NHS Foundation Trust, provided an update on the Mount Vernon Cancer Centre (MVCC) review. The service is considered fragile, and the long-term sustainability of the current site is a concern due to a lack of essential acute medical support services.

The proposal is to relocate MVCC to a purpose-built cancer centre at Watford General Hospital. This move is intended to improve outcomes, enhance research opportunities, and make access to treatment easier. Additional chemotherapy chairs will be provided at Hillingdon Hospital and Northwick Park Hospital, and radiotherapy capacity will be increased at Hammersmith Hospital.

The committee discussed the challenges of securing capital funding for the relocation and the progress of the public consultation, which is planned for the summer. Ben Wesson, Councillor for Ealing, highlighted the importance of addressing travel issues for patients, particularly those with financial needs. Chetna Halai, Councillor for Harrow, expressed disappointment at the delays in the process, emphasizing the necessity of this work. Leslie Watts stressed the urgency of the situation, stating that the current provision is not okay and that a decision and capital allocation are needed to ensure the best care for patients.

Introduction to a New Involvement Strategy

Rory Hegarty, Executive Director for Communication and Engagement for North West London ICB, presented the new Involvement Strategy. The strategy is based on the principle of engaging with communities to understand their experiences of healthcare, not just when changes are proposed. Key elements include an involvement charter, an in-reach programme with an inequalities focus, a Co-Design Advisory Body, a quarterly Residents' Forum, and resident voices on ICS programmes.

Ben Wesson, Councillor for Ealing, raised concerns about the future relationship with the Joint Health Overview and Scrutiny Committee (JHOSC) and the resources available for ongoing involvement work, given anticipated reductions in staff. Rob Hurd, Chief Executive of NWL ICS, acknowledged that resources would be reduced but stressed that the borough-based partnership approach would remain. Conversations are ongoing with providers and local government to ensure that the valuable insights gained from community engagement are not lost.

Verbal Update from the Chief Executive of NWL ICS

Rob Hurd, Chief Executive of the North West London Integrated Care System (ICS), provided a verbal update on recent developments. He acknowledged the challenging financial position nationally and locally, but confirmed that NW London ICS met its key performance targets at the end of March, including balancing its finances. The strategy remains focused on reducing inequalities, improving outcomes, and achieving better value for money.

Mr Hurd also addressed the anticipated national reduction in back-office and support staff, which is expected to impact the ICB. He stated that a formal announcement on the Model ICB is expected imminently, which will provide more detail on resource implications. He assured the committee that while there will be a reduction in support staff, the focus will remain on borough-based partnerships and resident involvement. Leslie Watts added that these changes will necessitate changes in how services are provided to live within the available means.

North West London Joint Health Overview and Scrutiny Committee Recommendations Tracker

Chatan Popat, Strategy Lead - Scrutiny Officer, presented the latest scrutiny recommendations trackers for 2023/24 and 2024/25. The committee noted the trackers and requested updates on outstanding items.

The meeting concluded with a vote of thanks to all involved, particularly acknowledging the emotional uncertainty faced by staff due to potential workforce changes. The committee also agreed to provide a letter of support for the Mount Vernon Cancer Centre relocation project.