Page 125 Agenda Item 7

Please reply to: Mike Ahuja

: Head of Corporate Scrutiny Services : PO Box 50 Rt Hon Andrew Lansley MP : B Block Secretary of State for Health Civic Centre Department of Health Silver Street Richmond House Enfield EN1 3XA 79 Whitehall Tel : 020 8379 5044 Fax: 020 8379 4172 SW1A 2NS E-mail: [email protected] My Ref: MJA/bcc Your Ref: Date: 20 th February 2011

Dear Secretary of State

Referral of Barnet Enfield Haringey Clinical Strategy Review

On Tuesday 1st February 2011 Enfield Health Scrutiny Panel agreed to exercise its power of referral to the Secretary of State for Health pursuant to Section 7 of the Health and Social Care Act 2001.

The decision was taken after careful consideration of the evidence provided by NHS Enfield, GPs, Enfield LINks and members of Enfield’s community.

The Health Scrutiny Panel noted the decision of NHS London at their Board meeting on 26th January 2011 to recommend that the Barnet Enfield and Haringey Clinical Strategy had met the four new tests for reconfiguration based on the BEH Strategic Co-ordination Group’s assessment and that the BEH strategy should recommence.

The Health Scrutiny Panel considers that the four key tests designed to build confidence within the service, with patients and communities have not been met and is referring the matter as the proposed variation to the provision of services is not in the best interests of the residents of Barnet, Enfield and Haringey.

Background

The Health Scrutiny Panel met on 24 th November to discuss the Barnet Enfield Haringey Clinical Strategy Review and consider whether the four tests set by you as Secretary of State for Health have been met.

Corporate Scrutin y Services Enfield Scrutiny – Serving the People

James Rolfe Phone: 020 8379 1000 Director of Finance & Corporate Fax: 020 8379 3819 Resources Textphone: 020 8379

London Borough of Enfield 4419 PO Box 50, Civic Centre, Silver Street DX: 90615 ENFIELD 1 Enfield, Middlesex. EN1 3XA Page 126

Test 1: Engagement and support from GP commissioners

The Health Scrutiny Panel considers that the BEH Strategic Co-ordination Group has failed to demonstrate support from GP commissioners for the reconfiguration proposals. The evidence available to the Scrutiny Panel on this test is attached as Appendix 1 and was sent to Mr Richard Sumray, Chairman of the Strategic Co- ordination Group.

In addition the Health Scrutiny Panel heard from Dr Keating (representing 10 GP practices in Enfield Town, Bush Hill Park and North East Enfield area) of concerns about this review. Dr Keating is also the Chair of the Enfield Local Medical Committee.

Test 2: Strengthened public and patient engagement

The Health Scrutiny Panel considers that the BEH Strategic Co-ordination Group has failed to demonstrate strengthened public and patient engagement. The evidence available to the Scrutiny Panel on this test is in the letter to Mr Richard Sumray, Chairman of the Strategic Co-ordination Group, Appendix 1

Test 3: Clarity on the clinical evidence base

The Health Scrutiny Panel considers that there is insufficient evidence of the clinical need for change. The evidence available to the Scrutiny Panel on this test is in the letter to Mr Richard Sumray, Chairman of the Strategic Co-ordination Group, Appendix 1

In addition the Health Scrutiny Panel have noted, and shares the concerns of GPs regarding the cessation of base obstetric led maternity services at Chase Farm Hospital see page 29/30 of UCL Partners report on Nov 2010. Extract Appendix 2

Test 4: Consistency with current and future patient choice

The Health Scrutiny Panel has concerns that there will be a reduction in patient choice in respect of service location. The evidence available to the Scrutiny Panel on this test is in the letter to Mr Richard Sumray, Chairman of the Strategic Co- ordination Group, Appendix 1

On Friday 26 th November, Enfield’s three MPs; ; and Andy Love, convened a meeting with an invited audience to discuss ‘ Future health care provision in Enfield: Review of BEH Clinical Strategy’. Professor David Kerr the special advisor to Secretary of State for Health also attended. The meeting was independently chaired and was attended by 79 people, including GPs, stakeholders and residents.

Corporate Scrutin y Services Enfield Scrutiny – Serving the People The overall conclusion realised was that the 4 tests had not been met and at best James Rolfe Phone: 020 8379 1000 Director of Finance & Corporate Fax: 020 8379 3819 Resources Textphone: 020 8379

London Borough of Enfield 4419 PO Box 50, Civic Centre, Silver Street DX: 90615 ENFIELD 2 Enfield, Middlesex. EN1 3XA Page 127

had been only partially met.

In response to Scrutiny’s view that the 4 tests had not been met -See Appendix 3, 4 and 5 - NHS Enfield and NHS London suggested a meeting with UCL Partners whose reports were not available until 1st December, after the deadline by which Scrutiny and other stakeholders were asked to respond.

On 19 th January the HSP members met informally with UCL Partners and were told that new clinical evidence had been collected between 2007 and 2010 from national and international research reviews. Members raised a number of issues at this meeting including concerns that no prospective research had been undertaken locally. Details of the issues and NHS Enfield’s reply can be seen in Appendix 6 .

Scrutiny remains unconvinced that the tests have been met and considers that there are a number of discrepancies:-

• The GPs abstained in those areas where the patients are most affected by these proposed changes. Scrutiny was told that abstentions could not be judged to be either in support or against the strategy and thus were discounted. From our perspective this is a flaw in the analysis.

• Scrutiny noted that the only public meetings were held in Enfield. Two of the three meetings were in locations hard for the public to reach. Furthermore the times chosen did not encourage public attendance. From our own feedback we found that of the three public meetings held in Enfield, there was a poor attendance and the audience was dominated by NHS staff. The allotted time was taken on presenting the original clinical strategy with no new information, leaving little time for debate and opportunities to explore different ways of delivering services. There was still no clarification of what is urgent care, leaving the public confused over the different types of provision being proposed.

• Scrutiny was advised by Enfield LINks of their response - see Appendix 7 - and are most concerned that this has been interpreted as providing full support. To date LINks have not received a breakdown of what assurances can be offered now and what will need to be addressed in the future.

• Scrutiny maintains that the review should have taken into account what development is required to underpin the potential changes if the proposals go ahead and what impact any changes, such as the introduction of walk-in centres, have had on the level of A&E attendees. It is our view that primary care must be in place and seen to be working before withdrawal or changes occur at the hospital.

Corporate Scrutin y Services Enfield Scrutiny – Serving the People

James Rolfe Phone: 020 8379 1000 Director of Finance & Corporate Fax: 020 8379 3819 Resources Textphone: 020 8379

London Borough of Enfield 4419 PO Box 50, Civic Centre, Silver Street DX: 90615 ENFIELD 3 Enfield, Middlesex. EN1 3XA Page 128

• Scrutiny was disappointed that the Review did not consider possible alternatives nor did it give any consideration to amending the proposals to help the community find a way forward that addresses its needs and wishes. However at the NHS London Trust Board meeting on the 26 th January mention was made that Barnet Chase Farm Hospital Trust had submitted a further option. We have asked for details of this but our request has been refused.

On the basis of this additional information, Enfield Health Scrutiny Panel members remain of the view that the four tests have not been met and that the proposals are not in the best interest of Barnet Enfield and Haringey residents. .

Yours faithfully

Cllr Mike Rye Chairman Cllr Christine Hamilton Vice Chairman Health Scrutiny Panel Health Scrutiny Panel

Copies to:-

Cllr Doug Taylor Leader of Enfield Council Cllr Don McGowen Cabinet lead on Health and Adult Social Care Cllr Michael Lavender Leader of the Opposition Rob Leak Chief Executive of Enfield Council Ray James Director of Health and Adult Social Services Averil Dongworth Chief Executive of Barnet Chase Farm Hospitals NHS Trust Clare Panniker Chief Executive of North Middlesex University NHS Trust Karen Trew Chairman NHS Enfield Nigel Beverley Interim Chief Executive John Lynch Chairman of Enfield Links Ruth Carnall Chief Executive of NHS London Nick de Bois MP Enfield North David Burrows MP Enfield Southgate Andy Love MP Edmonton Charles Walker MP Broxbourne

Corporate Scrutin y Services Enfield Scrutiny – Serving the People

James Rolfe Phone: 020 8379 1000 Director of Finance & Corporate Fax: 020 8379 3819 Resources Textphone: 020 8379

London Borough of Enfield 4419 PO Box 50, Civic Centre, Silver Street DX: 90615 ENFIELD 4 Enfield, Middlesex. EN1 3XA