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 receive any apologies for absence.

Apologies for absence were received from Cllr Matt White (Haringey).

To elect the Chair of the Committee for the 2023/24 municipal year.

Councillor Pippa Connor was nominated as the 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 & Scrutiny Committee for the municipal year 2023-24.

To elect the Vice-Chair(s) of the Committee for the 2023/24 municipal year.

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

RESOLVED – That Councillors Tricia Clarke and Larraine Revah be elected as Vice-Chairs of the North Central London Joint Health Overview & Scrutiny Committee for the municipal year 2023-24.

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 13 below).

None.

None.

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 meetings on 20^th March 2023, 6^th June 2023, 7^th June 2023 and 26^th June 2023 as a correct record.

The minutes of the previous four meetings of the North Central London Joint Health Overview and Scrutiny Committee were approved.

RESOLVED – That the minutes of the JHOSC meetings held on 20^th March 2023, 6^th June 2023, 7^th June 2023 and 26^th June 2023 be approved as an accurate record.

To provide a finance update for the NCL including the overall strategic direction of travel, 2023/24 figures for the NCL ICB and for NHS Trusts that provide services to NCL patients.

The report for this item was introduced by Gary Sired, Director of System Financial Planning at NCL ICB, Chris Garner, Assistant Director of Transformation and Community Commissioning at NCL ICB and Anthony Browne, Director of Finance for Strategic Commissioning at NCL ICB.

Referring to the financial position in the previous year, Gary Sired explained that there had been concerns about the risks in the 2022/23 financial plan for the Integrated Care System (ICS) as a whole, including the ten ICS providers. The plan was successfully delivered with a balanced budget, though partly through some non-recurrent technical benefits and, as these were one-off measures, the underlying challenges remained in developing the financial plan for 2023/24. This meant that additional actions were required for providers, such as the stretching of efficiency targets for example. There was currently some in-year adverse variance in the financial plan and the main cause for this was the ongoing industrial action which resulted in a net cost.

Gary Sired, Chris Garner and Anthony Browne then responded to questions from the Committee:

• In response to questions from Cllr Clarke and Cllr Milne about the net financial cost of the industrial action, Gary Sired explained that consultants were hired during these periods to ensure continuity of services and that the cost of doing so outweighed the savings from unpaid wages to staff resulting in significant adverse variance in the budget. In addition, there was an adverse impact on elective work which also had a negative financial impact. Finally, there was a negative knock-on effect to delivering planned efficiency savings.
• Cllr Clarke asked about efforts to stop the strikes and Cllr Chakraborty asked about the potential impact of permanent staff such as junior doctors and consultancy staff striking at the same time. Chris Caldwell, Chief Nursing Officer, said that there were significant ongoing lobbying efforts across the sector to the Government as this was having a significant impact on patients and staff. She added that the upcoming strike action by permanent/agency staff would lead to a period of activity over two weeks and that some surgery would be cancelled because of the risk of not being able to provide intensive support afterwards. There were also now significant restrictions on the use of additional resources to hire agency staff.
• Cllr Connor asked whether consideration had been given to the provision of additional resources outside of the planned budget, given the ongoing financial difficulties caused by the industrial action. Gary Sired explained that the Trusts were paid according to the activity carried out and that the targets had been reduced in April to take into account the impact of the industrial action and so this provided some financial relief. There would need to be further discussions about financial relief given the ongoing situation with the strikes.  
• Asked by Cllr Clarke and Cllr Cohen for further details about the expected 30% budget reduction for the NCL ICB, Anthony Browne explained that the aim of this was to reduce management costs and so the  ...  view the full minutes text for item 23.

To provide an update on coproducing a new mental health day support service based in Camden.

Alice Langley, Managing Director – Camden Division, North London Mental Health Partnership (BEH-MHT and C&I Trust) and Debra Holt, Assistant Director for Integrated Commissioning Mental Health & Learning Disabilities, NCL ICB/London Borough of Camden, introduced the report on this item which related to the co-production of new mental health services in Camden borough. Alice Langley explained that this had been a collaboration between the mental health Trust and the local authority over the past nine months following recent progress on partnership working and integration. The engagement and co-design process had been completed and the focus was now on finalising the service and staffing model with residents involved in ongoing development and the monitoring of the service. She added that the service was an innovation based on research which demonstrated the positive impact of Acute Day Units (ADUs) on service users and their recovery. The provision of ADUs across the country was quite patchy and had historically been quite siloed and so the intention was to ensure that the Camden ADU was well integrated with other services. The new ADU service would initially only be operating in Camden, but there would be a formal evaluation process which could help to inform future service development elsewhere in NCL. Debra Holt explained that the six core areas of feedback were set out in the report, the service specification was being finalised and that this referenced the feedback received so that it was clear how the feedback had been used to develop the service. It was agreed that the service specification would be circulated to the Committee. (ACTION)

Alice Langley and Debra Holt then responded to questions from the Committee:

• Asked by Cllr Revah about timescales and the locations of the services, Alice Langley said that the current aim was for the service to go live in April and that this was currently on track. She explained that there had been mixed feedback about the Greenwood Centre with some preferring services to be located in one place while others preferred a choice of locations across the borough. They were therefore currently looking at supplementing the Greenwood Centre with some other locations. However, it would be necessary to consider carefully what this would mean for individual service users in being able to access all of the right services for their needs.
• Asked by Cllr Revah about the length of the service provided to service users with acute needs, Alice Langley said that this had been a key theme of the engagement work. She noted that there were other existing services for service users with acute needs but it was felt that the ADU would address a gap between community and inpatient services by providing more intensive support outside of a hospital setting. Alice Langley clarified that existing day support services may support people for anything from 6 weeks to 1-2 years. There had been useful challenging conversations in the engagement process about how long services were available for, and the consensus was that there needed  ...  view the full minutes text for item 24.

To provide an overview of the planning for winter resilience in NCL for 2023/24 and on actions to improve ambulance response and handover times.  

Elizabeth Ogunoye, Director of System Flow & Resilience, introduced the report on this item noting that it provided an overview of the experience of Winter 2022/23, with challenges including flu/respiratory illness and industrial action. The learning from this review process would contribute towards the winter planning process for 2023/24 which involved a joined-up approach, reflecting work in all areas of health and social care, overseen by a Strategic Board and supported by a partnership all-systems group called the NHS Flow Operations Group.

Elizabeth Ogunoye highlighted the timescales for the Winter 2023/24 planning process set out on page 93 of the agenda pack, the end result of which would be a draft plan produced later in September. She added that the population health strategy in NCL would continue alongside this work with workstreams focused on higher risk groups for ill-health, there would also be proactive management of high-risk patients with long-term conditions and work to increase the vaccination take-up rate.

In terms of ambulance handover times, Elizabeth Ogunoye highlighted the pilot for new handover protocols set out on page 95 of the agenda pack which would be evaluated in readiness for Winter 2023/24.

Elizabeth Ogunoye concluded by setting out the next steps which would include working with local authority partners to plan for capacity and demand, including with a refreshed Better Care Fund (BCF) planning process by October. There was also a joint programme on the sustainability of discharge services across NCL.

Elizabeth Ogunoye then responded to questions from the Committee:

• Cllr Connor asked for further details about the learning from Winter 2022/23, particularly in terms of bed capacity and workforce. Elizabeth Ogunoye said that key learning was around joint working with health and social care on bed capacity and maximising flow, hospital discharge and care packages. Another part was on same day emergency care to avoid overnight stays where possible and maximise bed capacity. Avoiding infection was also a key piece of work including increasing the uptake of vaccination. Improvements in the proactive case management of people with long-term conditions was also part of the planning process. She added that the planning process had included modelling of various scenarios (including covid scenarios) and they were confident that sufficient bed and workforce capacity would be in place to respond.
• Asked by Cllr Atolagbe about the physical space for beds, Elizabeth Ogunoye acknowledged that physical space was always a challenge but that this had been taken into account in the long-term estates planning.
• Cllr Revah raised the issue of discharge from hospital and commented that information about the specific arrangements for discharge was not always shared well with the families which could make the post-discharge period more difficult. Elizabeth Ogunoye responded that the joint piece of work on sustainable discharge aimed to address what could be done better including communication, the flow of information and ensuring that patients were well supported at home. Elizabeth Ogunoye agreed to take these comments back for further consideration. (ACTION)
• Cllr Revah added that she was particularly  ...  view the full minutes text for item 25.

This paper provides an outline of the 2023-24 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

Cllr Connor noted that it had been necessary to move some of the proposed agenda items to different dates and that the next meeting date had been changed to Mon 30^th Oct. This information was all provided in the work plan on pages 105-107 of the agenda pack.

Cllr Revah said that the March 2022 item meeting on mental health had been successful in the engagement with local community groups and suggested that a similar approach could be taken for a future meeting on a different policy issue. It was agreed that this could be considered as part of the work programme for 2024/25. (ACTION) Cllr Cohen noted that the use of a community venue had been another positive part of this approach.

Cllr Chakraborty proposed a future agenda item on healthcare data and technology, including the balance between the use of data for healthcare analytics and patient privacy/control of their data. This would be added to the work plan as a possible future item. (ACTION)

To note the dates of future meetings:

·         30^th October 2023 (10am) - Camden

·         29^th January 2024 (10am)

·         18^th March 2024 (10am)

Please note that the meeting originally scheduled for 13^th Nov 2023 will now take place instead on 30^th Oct 2023. 

• 30^th October 2023 (10am)
• 29^th January 2024 (10am)
• 18^th March 2024 (10am)