Agenda and minutes

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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 Larraine Revah and Cllr John Bevan. Cllr Thayahlan Iyngkaran, a Haringey Councillor, attended the meeting as a substitute for Cllr John Bevan.

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 11 below).

Cllr Pippa Connor informed the Committee that an urgent question had been received from Samantha Gordon and Frances Bradley, governors of Camden and Islington Mental Health Trust. The question concerned the moving of mental health patients from St Pancras Hospital to facilities elsewhere in London due to construction delays to Camden & Islington Foundation Trust’s new Highgate East hospital. The St Pancras site was reportedly due to be used instead by operations transferred from Moorfields Eye Hospital.

Cllr Tricia Clarke explained that there were two parts to the question:

• Why couldn’t Moorfields wait to move their operations to St Pancras so that patients would only need to be moved once (from St Pancras to Highgate East)?
• Why were Camden & Islington Foundation Trust having to pay for the additional costs incurred by temporarily moving patients rather than Moorfields?

Sarah Mansuralli, Chief Development & Population Health officer for NCL ICB, informed the Committee that it had not been possible for anyone from Camden & Islington Foundation Trust to attend the meeting at short notice. She added that the issue had considered by the Camden & Islington Foundation Trust’s Board in detail and so a direct response from the Board to the Committee would be required to answer these questions. Cllr Connor requested that a response to the questions should also be obtained from Moorfields. (ACTION)

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 Thayahlan Iyngkaran declared an interest by virtue of being a fellow of the Royal College of Radiologists.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting held on 15^th July 2022as a correct record.

Cllr Connor advised the Committee that responses to the action points from the previous minutes were expected shortly and would by circulated to Committee Members by email.

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

RESOLVED – That the minutes of the meeting held on Friday 15th July 2022 be approved.

To provide a finance update for NCL including the overall strategic direction of travel, 2022/23 figures for the NCL ICB and for NHS Trusts that provide services to NCL patients.

Gary Sired, Director of System Financial Planning for the NCL ICB, and Anthony Browne, Director of Finance Strategic Commissioning for the NCL ICB, introduced the report on this item. Gary Sired explained that NCL had a complex health and care economy and that the ICB had a duty to lead collaborative working across the Integrated Care System (ICS). The system in NCL was a net importer of activity and there were significant differences in the size of the Trusts. The underlying position of the finances was that there was a recurrent deficit that needed to be recovered and that had been recently managed with non-recurrent solutions to achieve balance. A balanced plan for the ICS for 2022/23 had been developed but it contained a large level of financial risk.

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

• Cllr Iyngkaran noted that a surplus had developed in 2021/22 due to the underspends resulting from the Covid-19 pandemic and asked how the backlog would now be dealt with. Gary Sired acknowledged that this was a challenge but noted that there was a national incentive scheme with funding for elective recovery that Trusts could access when achieving activity of 104% or more of their 2019/20 activity levels. Asked by Cllr Iyngkaran about the progress towards this target, Gary Sired said that some Trusts were on target and some were not, but the target was not yet being achieved overall in NCL. However, it was a tough target and the performance in NCL was above average in London. Asked by Cllr Hutton about the operational issues in achieving the target, Gary Sired noted that there was a moratorium on the 104% target on the first six months which allowed the Trusts more time to adapt.
• Asked by Cllr Cohen about the impact of the non-recurrent solutions to achieve financial balance in previous years, Gary Sired said that these should not affect services and that the changes were largely technical balance sheet adjustments such as releasing reserves. In response to a follow up question from Cllr Atolagbe, he explained that the timeframe for addressing the deficit had not yet been agreed but that a financial plan for recovering a position like this would typically be 3 to 5 years.
• Following up on the previous questions, Sarah Mansuralli provided some further detail on operational issues. The approach to elective recovery involved the Trusts working together, maximising the availability of capacity by moving some patients to other Trusts to have their procedures carried out faster. Underlying efficiency issues were being addressed through the transformation programmes including by reducing duplication and providing more care in the community. Asked by Cllr Milne why the emphasis was on moving patients rather than resources, Sarah Mansuralli clarified that surgeons were operating at different sites as required and that, in dealing with the backlog, further options about moving resources to meet patient needs may need to be considered.
• Cllr Clarke asked about the discrepancy in funding between  ...  view the full minutes text for item 20.

To provide an update on workforce issues in NCL.

Dr Jo Sauvage, Chief Medical Officer at NCL ICB, and Kate Gardiner, Nursing Workforce Programme Director, introduced the report on this item. Dr Sauvage commented that the aim of Integrated Care Partnerships was to manage population health improvement with a focus on outcomes and on inequalities in a way that used resources appropriately and was embedded in local communities. She acknowledged that the NHS had not been as good as it could be on local workforce planning and there was an opportunity to develop different ways of working in the ICS by thinking about transformation and the planning and development of existing staff. There were existing challenges on recruitment, retention, staff wellbeing, agency pay and the impact of the cost of living crisis. There were also issues with the retention of GPs and on recruitment and retention in the care sector.

Kate Gardiner added that, from a clinical perspective, the biggest challenge was on staff retention with a large number of nurses now leaving the profession. Across the NCL area there were now around 200 more nurses than there were in 2021 but this was the result of a large effort on securing pathways into nursing, retention and international recruitment.

Dr Jo Sauvage and Kate Gardiner then responded to questions from the Committee:

• Cllr Connor observed that, from people that she knew in the nursing profession, some key concerns of theirs were that it was too stressful on the wards with not enough staff to cope with demand and also pay issues. She asked what more could be done in these two areas as these were specific concerns driving people to consider leaving the profession. Kate Gardiner responded that one of the issues was that patients on the wards often now had more complex needs when compared to years ago and so, to tackle this, it was important to understand the nursing workforce that was required. Organisations went through a process each year to assess and sign off safe staffing requirements using evidence-based tools about the clinical needs of patients. Over the last couple of years, the delivery of care on the units had changed and so there was an opportunity to reset and make sure that the reviews were in place to understand the workforce that was needed, to fill vacancies and retain staff. This included looking after staff on wards, securing their professional knowledge and qualifications, their enjoyment of coming into work and the teamwork on the wards.
• Cllr Atolagbe said that she received feedback from BAME nursing staff who reported that, despite obtaining training and qualifications as well as relevant experience, they felt that they were not achieving the career progression that they ought to. Kate Gardiner acknowledged that this was a problem across the NHS with a high level of diversity across Bands 1-5 but a reduced level at the higher Bands. There was a drive for diversity on recruitment panels in some organisations. Dr Sauvage added that it was important to ensure that clinical  ...  view the full minutes text for item 21.

To provide an update on the procurement programme for a new NHS 111 Integrated Urgent Care service to commence in October 2023.

Clare Kapoor, an NHS 111 commissioner with the NCL ICB and a nurse by background, introduced the report for this item explaining that the current NHS 111 Integrated Urgent Care Service (IUC) contract had been extended but was due to end in October 2023 which meant there was about a year left to procure and get ready for the new service.

She explained that the procurement for the new contract was overseen by a multi-disciplinary Procurement Steering Group. There were two sub-groups, one of which was clinical and the other for engagement and communications which included residents and patient/user group representatives. The procurement process had recently moved from phase 1 (Planning) to phase 2 (Procurement) and would later be followed by phase 3 (Mobilisation). Bidders would shortly be invited to tender and the timeline was set out in the report.

The existing service included the NHS 111 telephone and online support, urgent GP face-to-face services and a clinical assessment service. The new service would add to this with enhancements including direct booking of patients into services such as primary care appointments or referrals into same day emergency care. There were greater opportunities to treat and manage patients within the service where appropriate, for example by prescribing medication.

In terms of engagement, there had been an online survey carried out, community groups in each of the Boroughs had been contacted and HealthWatch in Enfield had been commissioned to run focus groups and had worked with groups where English was not their first language. The feedback had been used to develop an action plan and to help shape the service specification.

Rod Wells from Haringey Keep Our NHS Public asked why a competitive tendering process was necessary as he understood that this was no longer required under the new Health and Social Care Act. Clare Kapoor clarified that the new rules had not yet come into force and, as there wasn’t much time before the existing contract was due to come to an end, the legal advice received had been to go ahead with the procurement process as outlined in the report. In future, there could be scope to directly award contracts such as this based on certain criteria.

Cllr Atolagbe asked how, with the current contract due to end soon, how there would be continuity in training and how the feedback on accessibility would be addressed. Clare Kapoor explained that training requirements were part of a suite of documents for the procurement on the contract portal which also included the patient feedback and the Equality Impact Assessment. The service specification included a section on accessibility for different patient groups. There had recently been a training video produced for NHS111 on handling callers with a learning disability and also a video produced for the deaf community to explain how they can access the service.

Cllr Clarke asked how much the contract was worth and whether NHS organisations could bid for it. Clare Kapoor said that the current provider, a social enterprise called  ...  view the full minutes text for item 22.

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

Cllr Connor introduced the work programme item noting that the Estates Strategy was scheduled for the next meeting in November which would be a substantial item. There was also space for further items at the November meeting. Cllr Clarke suggested that a verbal update could be provided by Camden & Islington Foundation Trust and Moorfields Eye Hospital regarding the issue with St Pancras Hospital that was discussed earlier in the meeting. Cllr Cohen suggested there should be an item on the current crisis with GP services including the workforce issues and difficulties that patients were experiencing in accessing services. These items were both agreed to be added to the November agenda. (ACTION)

It was noted that updates on the Mental Health Services Review and Community Health Services Review were due later in 2022/23. As discussed earlier in the meeting, a report on health inequalities could also be made available. It was agreed that both of these items could be scheduled for the February 2023 meeting. (ACTION)

• 25^th November 2022 (10am)
• 3^rd February 2023 (10am)
• 17^th March 2023 (10am)

·         23^rd November 2022

·         Feb 2023 (date TBC)

·         Mar 2023 (date TBC)