Agenda and minutes

Please note this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method.  Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on.  By entering the ‘meeting room’, you are consenting to being filmed and to the possible use of those images and sound recordings.

The Chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual, or may lead to the breach of a legal obligation by the Council.

The Chair referred Members present to agenda Item 1 as shown on the agenda in respect of filming at this meeting, and Members noted the information contained therein’.

To elect the Chair of the Committee for the 2022/23 municipal year.

Councillor Pippa Connor was nominated as Chair of the Committee. There were no other nominations.

RESOLVED – That Councillor Pippa Connor be elected as Chair of the North Central London Joint Health Overview and Scrutiny Committee for the municipal year 2022-23.

To elect the Vice-Chair(s) of the Committee for the 2022/23 municipal year.

Councillors Larraine Revah and Tricia Clarke were nominated as Vice-Chairs of the Committee. There were no other nominations.

RESOLVED – That Councillors Larraine Revah and Tricia Clarke be elected as Vice-Chairs of the North Central London Joint Health Overview and Scrutiny Committee for the municipal year 2022-23.

To receive any apologies for absence.

Apologies for absence were received from Cllr Jilani Chowdhury (Islington), and Cllr Tricia Clarke (Islington).

The Chair will consider the admission of any late items of Urgent Business.  (Late items will be considered under the agenda item where they appear.  New items will be dealt with under item 14 below).

None.

Cllr Pippa Connor declared an interest by virtue of her membership of the Royal College of Nursing.

Cllr Pippa Connor declared an interest by virtue of her sister working as a GP in Tottenham.

Cllr Kate Anolue declared an interest by virtue of her membership of the Royal College of Midwives.

To consider any requests received in accordance with Part 4, Section B, paragraph 29 of the Council’s constitution.

None.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 18^th March 2022as a correct record.

The minutes of the previous meeting of the Committee were approved.

RESOLVED – That the minutes of the meeting held on Friday 18^th March 2022 be approved.

Report to follow.

Anna Stewart, Programme Director for the Start Well programme, introduced the report for the item on Start Well, which was a long-term change programme focusing on children & young people’s and maternity & neonatal services in a hospital context across North Central London. This covered hospital services at the North Middlesex, UCLH, Royal Free, Barnet, Chase Farm and Whittington Health as well as pathways with specialist providers such as Great Ormond Street. The project had started in November 2021 and the first phase had been looking at how services worked at the moment, how they compared to best practice and international standards, and identifying opportunities for improvement. This phase had now been completed with the Case for Change findings published.

Dr Emma Whicher, Medical Director for North Middlesex University Hospital and SRO (Senior Responsible Owner) for the Start Well programme, provided further detail to the Committee about the themes that had been identified. She said that there were good examples of outstanding care provided to children & young people and pregnant women but opportunities for improvement were found. These included:

• Health inequalities with variations in stillbirth rates between boroughs and the babies of black women twice as likely to be admitted to a neonatal unit after birth compared to those of white women.
• The sustainability of staffing was recognised as a challenge with agency staff being used to fill shifts in many instances. In neonatal services there was a need to match care capacity with demand and the provision of community support was variable between boroughs.
• With regards to children and young people’s services there had been an increase in the number of children presenting to A&E with minor/moderate health issues suggesting that these could be dealt with in alternative settings. Children and young people with long-term health conditions who lived in the most deprived areas were more likely to be admitted to hospital. Pathways for children waiting for treatment was variable between and within hospitals depending on the skills of the surgeons.

Chloe Morales Oyarce, Head of Communications and Engagement for NCL ICB, spoke about the engagement process outlining a 10-week period of consultation running from 4^th July to 9^th September which would seek views from staff, patients, stakeholders and the public about the Case for Change findings. The patient and public engagement process had been developed with partners including Councils and the voluntary and community sector. This would include online discussion events, interactive workshops, a questionnaire, drop-in events and specialist engagement with children and young people. A report would subsequently be published on the feedback received and this would be used to inform the next stages of the programme.

Angie Belanor, Head of Maternity & Neo-natal Commissioning for NCL ICB, reported that a piece of work was ongoing to improve midwifery workforce issues including by looking at ways of attracting staff and supporting staff health and wellbeing to improve retention and reduce sickness rates.

Anna Stewart and her colleagues then responded to questions from Committee Members:

• Asked by Cllr  ...  view the full minutes text for item 9.

Report to follow.

Vanessa Piper, Assistant Director of Primary Care Contracts and Commissioning for NCL, provided an overview on quality and performance monitoring of GP practices. The NCL Integrated Care Board (ICB) had responsibility for monitoring the contracts of 180 GP practices in the NCL area in line with national primary care regulations and policy guidance produced by NHS England.

Vanessa Piper explained that there were clear processes in place for any quality or performance issues that were identified and the ICB’s Primary Care Contracts team and Quality team worked together to respond to any trigger indicating quality concerns or underperformance. This could include from a patient complaint, infection control issue or an adverse rating from the CQC. While CQC reports were carefully scrutinised, any ICB investigation was carried out independently from the CQC and examined a range of quality data over three or four financial years. They would also then speak to the Practice about any specific concerns or challenges that they may be facing. The ICB Primary Care Contracts team meets with the CQC and the NHS England Medical Directorate on a fortnightly basis to discuss cases and share relevant information. Recommendations are then taken to the Primary Care Contracts Committee which meets on a bi-monthly basis and is attended by HealthWatch, local councillors and community representatives. The recommendations can include improvement action plans for individual practices or more formal contractual action.

Vanessa Piper then addressed concerns that had previously been raised by the Committee relating to reporting by the BBC Panorama programme about physician associates and the GP/patient ratio at a London GP practice. Although this practice was not in the NCL area, the ICB had started to scrutinise GP FTE workforce ratios in NCL. The current figures indicated that the ratio was too low in some practices, but it was also the case that a number of practices had not recently logged onto the National Workforce Reporting System meaning that the data was not accurate in some cases. The primary care team was therefore working with practices to improve reporting. They would also work closely with practices over the supervision and training of physician associates through the core primary care contract. In addition, the CQC looked at employment and training records through its regulatory inspections.

Vanessa Piper then responded to questions from the Committee:

• Cllr Connor referred to the concerns about the GP practice in south London that was covered by the BBC Panorama programme and asked how the monitoring practices in the NCL area would prevent a similar issue from occurring. Vanessa Piper noted that the detail of the GP practice would not be known until the CQC report was published. She added that, while ICBs had monitoring processes in place, some practices could get into a pressured position which could lead to quality and performance concerns. On top of the process described in the report there was also an annual contract review process on all primary care contracts which included questions on clinical governance and issues  ...  view the full minutes text for item 10.

To receive an update on upcoming national changes to ‘enhanced access’ to general practice – the additional provision of appointments outside of core hours.

Clare Henderson, Director of Integration in Islington at the NCL ICB, introduced the report for this item by explaining the changes that would result from the proposals on enhanced access to General Practice from October. This related to access to services outside of the core hours which were 8:00am to 6:30pm on Mondays to Fridays. At present, the enhanced access hours were offered at ‘hubs’ from 6:30pm to 8:00pm on Mondays to Fridays and 8:00am to 8:00pm at weekends or bank holidays. This was part of a national specification and the services were generally provided in the NCL area through GP Federations or other primary care providers. Some GP practices also offered ‘extended hours’ which involved longer opening hours funded through a contract.

The new proposals involved bringing these two types of services outside of the core hours into one single specification delivered through Primary Care Networks (PCNs). The timescales for implementation had been tight with the national specification released in March 2022, draft plans to be developed by PCNs by the end of July and the delivery of the new service by the beginning of October 2022. The new national specification required the additional opening hours from 6:30pm to 8:00pm on Mondays to Fridays but only from 9:00am to 5:00pm on Saturdays with no requirement for services on Sundays or Bank Holidays. There was also no longer a requirement for ring-fenced slots for NHS 111 to book into.

In the NCL area there had therefore been engagement with PCNs with a view to commissioning services on Sundays and Bank Holidays so as not to lose the 7-day access. Engagement had been based on existing patient feedback and from HealthWatch and partners in the voluntary and community sector. A survey had also been developed to support PCN engagement. However, due to the timescales, it had not been a long engagement process and the scope had been limited. An Equality Impact Assessment had been developed and, while it was expected that there would be additional capacity overall, it was also recognised that there was a high level of demand on services at present.

Clare Henderson then responded to questions from the Committee and was joined by John McGrath, a GP in Islington and interim Clinical Lead on the ICB:

• Referred to the proposals to buy provision of services in the NCL area from outside of the hours required by the national recommendations, Cllr Connor queried whether this would involve new providers and, if so, how the service provision would be monitored. Clare Henderson clarified that the new national specification required broadly the same number of appointments but in a shorter timescale within the week. Therefore, by buying the Sundays and Bank Holidays services within the NCL area, there would be no loss of capacity. The arrangements would be for PCNs to ensure the delivery of services and some would work with the same GP Federations that provided the existing services.
• Cllr Connor expressed concerns that, if new providers for enhanced access  ...  view the full minutes text for item 11.

Report to follow.

John McGrath introduced the report on this item, noting that this provided an update on previous reports that had been brought to the Committee on this policy review. He informed the Committee that the new policy was now expected to go live in the NCL area from 25^th July 2022. The aim of the approach was to introduce a single fertility policy across the NCL area, thereby removing the postcode lottery variation that previously existed. This related to eligibility of funding for IUI treatments as well as IVF, including for same sex couples and single women, and also on extended fertility preservation issues. A Readers Panel had been involved with the development of the policy document to improve inclusivity of the language used.

Penny Mitchell, Director for Population Health Commissioning at NCL ICB, highlighted some key points around the implementation of the policy. A principle of no disbenefit was being applied to people who were already part-way through their treatment so that if the previous policy was more favourable to them then this would still be applied. A full communications engagement plan had been developed to support the implementation of the policy including with a range of core materials, easy read documents, translation information, a response feedback document, FAQs on the NCL ICB website and updates to GP practice websites. A surge of inquiries was anticipated by the team and a dedicated email address had been made available for this.

Cllr Connor welcomed the update and commented that she had been impressed by the work that had gone into this policy and how robust the engagement process had been. She noted that the Committee had not seen the leaflets but emphasised the importance of them being clear and accessible and asked for further detail about the availability of translations. Penny Mitchell clarified that text on the back of the leaflets was provided in six or seven languages to explain that full translations could be made available upon request and how to get in contact by email. This was in line with NCL ICB policy. Cllr Hutton suggested that the provision of a telephone number as well as an email address could be helpful.

Cllr Anolue highlighted the translation services provided by LanguageLine. John McGrath agreed that LanguageLine provided valuable tools in this area. He added that the review had highlighted how sensitive this issue was for some communities and that printed material was not the only or necessarily the best way of engaging. Other methods of engagement, such as through community meetings, was included as part of the communications plan. There also needed to be a nuanced difference with this policy compared to some other areas of health policy due to the specific target demographic.

Cllr Connor suggested that a further update on the implementation of the policy and the demographic data on who had successfully accessed the services could be brought back to the Committee at a later date. Penny Mitchell commented that thought was being given to  ...  view the full minutes text for item 12.

This paper provides an outline of the 2022-23 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

Cllr Connor summarised the work programme for the Committee noting that the next meeting on 30^th September would include a detailed finance update and a workforce update. The meeting on 25^th November was due to receive an update on the Estates Strategy and there was currently space for additional agenda items. No agenda items had yet been scheduled for the 3^rd February 2023 and 17^th March 2023 meetings. Dominic O’Brien, Scrutiny Officer, added that the previous meeting held on 18^th March 2022 had included items on the Mental Health Services Review and the Community Health Services Review and that updates on these issues would need to be scheduled in the 2022/23 work programme.

Committee Members then discussed possible issues that could potentially be added to the 2022/23 work programme including:

• Ambulance waiting times and pressures across the system including A&E Departments. (Cllr Revah)
• Pediatric service review. (Cllr Revah)
• Primary care commissioning and the monitoring of private corporations operating in this area. (Cllr Revah)
• The efficacy of online GP consultations, how the disconnect between the public and the medical profession could be addressed, how the public could be reassured that outcomes would be equally as high as face-to-face consultations and how capacity can be improved in this way. (Cllr Milne)
• Health inequalities and the impact of cuts to public health budgets. (Cllr Cohen) Health inequalities could also be scrutinised as part of Mental Health Services Review and the Community Health Services Review. (Cllrs Connor/Hutton/Cohen)
• Increases in number of people being charged for services that they were previously able to access free of charge through the NHS (e.g. dentistry/ear wax syringing) (Cllr Revah)
• Update on funding for NHS dentistry for both adults and children. (Cllr Connor)

To note the dates of future meetings:

·         30^th September 2022 (10am)

·         25^th November 2022 (10am)

·         3^rd February 2023 (10am)

·         17^th March 2023 (10am)

·         25^th November 2022 (10am)

·         3^rd February 2023 (10am)

·         17^th March 2023 (10am)