London Borough of Harrow Report of the six authority Joint Health Overview & Scrutiny Committee Response to the consultation paper “Investing in Your Health” issued by the Bedfordshire and Hertfordshire Strategic Health Authority as it relates to the future of the non-surgical oncology facility at Mount Vernon Hospital and the related consultation paper from the North West London Strategic Health Authority entitled “Mount Vernon Hospital: The Future of Services for Cancer Patients” MEMBERS OF THE COMMITTEE Cllr David Reedman (Bedfordshire County Council), Cllr Duncan Ross (Bedfordshire County Council), Cllr Pauline Wilkinson (Buckinghamshire County Council), Cllr Jennifer Woolveridge (South Bucks District Council, representing Buckinghamshire Health Scrutiny Committee), Cllr Eric Silver (London Borough of Harrow), Cllr Marie-Louise Nolan (London Borough of Harrow), Cllr Ken Coleman (Hertfordshire County Council), Cllr Roma Mills (Hertfordshire County Council) Cllr Mary O’Connor (London Borough of Hillingdon), Cllr David Horne (London Borough of Hillingdon) – Chairperson Cllr Anna Pederson (Luton Borough Council), Cllr Sian Timoney (Luton Borough Council) September 2003 CONTENTS Introduction ...........................................................................................................................1 Statutory Basis for this Submission ...................................................................................1 Composition of the Joint Committee ..................................................................................1 Table 1: Mount Vernon Patients by District of Residence 2002-2003 ..............................6 Approach Adopted by the Joint Committee.....................................................................10 Election of Chairman .........................................................................................................10 Remit of the Committee.....................................................................................................10 Additional Attendance at the Committee ...........................................................................11 Arrangements for Briefing .................................................................................................11 Arrangements for Taking Evidence ...................................................................................11 Relationship to “Investing in Your Health” ......................................................................12 Consideration of the Evidence ..........................................................................................12 Summary of the evidence received...................................................................................12 Commentary by the Joint Committee ...............................................................................16 Conclusion ..........................................................................................................................21 RECOMMENDATIONS.........................................................................................................22 Appendices Appendix 1 - The Secretary of State’s Direction Appendix 2 - Consultation letter sent out by Local Authorities Appendix 3 - Circulation list inviting evidence for consideration by the Joint Health Scrutiny Committee Appendix 4 - List of Written Submissions of Evidence Appendix 5 - Written Submissions of Evidence Appendix 6 - Response from London Borough of Barnet Council Appendix 7 - Response from Bedfordshire County Council and Luton Borough Council Joint Scrutiny Committee Appendix 8 - Response from Buckinghamshire County Council Appendix 9 - Response from London Borough of Harrow Council Appendix 10 - Response from Hertfordshire County Council Appendix 11 - Response from London Borough of Hillingdon Mount Vernon Report Introduction 1. This report sets out the formal response of the Joint NHS Scrutiny Committee to the consultation document “Investing in Your Health” issued in March 2003 by the Bedfordshire and Hertfordshire Strategic Health Authority (StHA) and the complementary consultation paper “Mount Vernon Hospital: The Future of Services for Cancer Patients” issued by the North West London Strategic Health Authority in June 2002. It is understood that Bedfordshire and Hertfordshire StHA consultation document was prepared on behalf of the Primary Care Trusts on the future of health services in the Strategic Health Authority area. The North West London StHA document was issued on behalf of the Primary Care Trusts of Harrow, Hillingdon and Brent. Statutory Basis for this Submission 2. This study was undertaken as a Regulation 4 study under Statutory Instrument 2002 No. 3048, that is: “where a local NHS body has under consideration any proposal for a substantial development of the health service in the area of a local authority, or for a substantial variation in the provision of such service, it shall consult the overview and scrutiny committee of that authority.” 3. As opposed to a Regulation 2 study, whereby: “An overview and scrutiny committee may review and scrutinise any matter relating to the planning, provision and operation of health services in the area of its local authority” 4. The Joint Committee was established under the terms of a Direction issued by the Secretary of State for Health and dated 17th July 2003. A copy of that Direction is shown as Appendix 1. That Direction requires those local authorities consulted by a local NHS Body to appoint a joint committee for the purposes of responding to the consultation, where that consultation concerns a proposal for a substantial development of the health service or a substantial variation in the provision of a service. It was accepted by all those involved that the consultation proposals as they affected Mount Vernon constituted both a substantial development of services and a substantial variation in the provision of service. Accordingly it was appropriate to proceed by way of a Joint Committee. Composition of the Joint Committee 5. It is important that the mechanisms used to establish the Joint Committee are documented, not only to secure a firm underpinning and legitimacy to its work but also to record the process for those authorities faced with a similar task of establishing a joint committee. This report is probably the first report of a Joint Committee established under the regulations and directions emanating from the local authority NHS Scrutiny powers set out in the Health and Social Care Act 2001. 6. In May 2003, the Department of Health issued policy guidance, “Overview and Scrutiny of Health – Guidance”. Paragraph 10.7 of that document anticipated the issuing of a Direction by the Secretary of State. Local authorities which believed that they might be affected by the Direction met at Harrow Civic Centre on Thursday 10th July 2003. Authorities present at that meeting were Hertfordshire County Council, Bedfordshire County Council (also representing Luton Borough Council), London Boroughs of Barnet, Harrow, Hillingdon and Buckinghamshire County Council. Mount Vernon Report Page 1 of 22 7. At that meeting it was anticipated (mistakenly as it turned out) that the Secretary of State for Health would very shortly issue a Directive to the Bedfordshire and Hertfordshire County Councils, the London Boroughs of Harrow, Hillingdon (and possibly Barnet and Brent) and Luton Borough Council requiring them to establish a joint committee to scrutinise the proposals for the transfer of cancer services away from Mount Vernon Hospital. It was expected that this Direction would be received in the week commencing 14th July 2003. At that meeting it was accepted that each authority could therefore be under an obligation to participate in a joint committee to consider the proposals and respond to the consultations from the two Strategic Health Authorities. 8. While the details of the Secretary of State’s Direction were unknown it was thought that each Authority would still have freedom to respond individually by the 1st September consultation submission deadline to the wider Investing in Your Health document and, it would appear, to the specific proposals for Mount Vernon. Accordingly it was agreed that the joint committee would need to focus on the future proposals for Mount Vernon and not the wider proposals for Bedfordshire and Hertfordshire. 9. At that meeting the following issues were raised: a) Timescale: deep concern was expressed by all over the very short timescale which was available during late July and August to establish the joint committee and to identify the issues and respond to the consultations. The meeting felt that sufficient time should be allowed to consult, consider and respond properly in order to avoid any challenge by judicial review. The process must therefore be transparent and clear and there was a general feeling that it was questionable if this could be done in the timescale available. It was however agreed by all that although the time available was felt to be inadequate, if the StHA decision was delayed by more than a few weeks then they would miss this years bidding round and so delay the whole health improvement process by at least a year. Everyone agreed that this should not be allowed to happen and every effort would therefore be made to meet the consultation deadline. b) Conflicts of interest: the possibility of (a) minority report(s) was accepted and would only be required if the final submitted report did not reflect all the views and concerns