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 Larraine Revah (Camden), Cllr Kemi Atolagbe (Camden), Cllr Philip Cohen (Barnet), Cllr Rishikesh Chakraborty (Barnet) and Cllr Jilani Chowdhury (Islington).

The number of apologies given by Members meant that the Committee was not quorate. To be quorate there are two criteria:

a)    For at least four Committee Members to be present. This condition was met.

b)    For Members from at least four of the five NCL boroughs to be present. This condition was not met.

In the circumstances, the meeting continued as a briefing for the Members present. This meant that discussions on the agenda items could continue but any formal decisions made could not be ratified.

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

As this was the first North Central London Joint Health Overview and Scrutiny Committee (NCL JHOSC) meeting of the 2023/24 municipal year, the election of the Chair was required.

The Members present indicated their preference for Cllr Pippa Connor to continue as Chair for 2023/24. It was not possible to ratify this decision as the meeting was inquorate and could only continue as a briefing. This decision would therefore be deferred to the next meeting.

The Members present determined that Cllr Pippa Connor should Chair the briefing.

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

As this was the first JHOSC meeting of the 2023/24 municipal year, the election of the Vice-Chairs was required.

The Members present indicated their preference for Cllr Tricia Clarke and Cllr Larraine Revah to continue as Vice-Chairs for 2023/24. It was not possible to ratify this decision as the meeting was inquorate and could only continue as a briefing. This decision would therefore be deferred to the next meeting.

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.

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

None.

To note the Committee’s terms of reference.

The terms of reference for the NCL JHOSC were noted. 

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 and 7^th June 2023as a correct record.

The minutes from the meetings held on 20^th March 2023, 6^th June 2023 and 7^th June 2023 were discussed.

The following points of accuracy were raised:

• On page 18 of the agenda pack, in the draft minutes for 6^th June 2023 (BEH and C&I Mental Health Trusts), there was a reference to the risk of some patients falling between different types of mental health services. Cllr Connor said that there should be an action recorded to investigate this further. (ACTION) There was also a request in the following paragraph for further details on how the performance of services was monitored which Cllr Connor said should also be recorded as an action and that information about the clinical strategies and deep dives into service delivery should be included in the following year’s Quality Accounts. (ACTION)
• On page 25 of the agenda pack, in the draft minutes for 7^th June 2023 (Whittington NHS Trust), it was noted that more information about the actions being taken in response to the CQC inspection would be useful. Cllr Connor said that there should be an action recorded to provide this information to the Committee. (ACTION)

It was not possible to approve the three sets of minutes as the meeting was inquorate and could only continue as a briefing. This decision would therefore be deferred to the next meeting.

For the Committee to receive an overview of maternity and neonatal services in NCL including Ockenden Review assurance/compliance and the role of the Local Maternity Services Network.

The update on maternity and neonatal services was provided by Rachel Lissauer, Senior Responsible Officer, Chris Caldwell, Chief Nurse for NCL ICB and Executive Lead for Maternity & Neonatal services, David Connor, Group Director of Midwifery at the Royal Free NHS Trust and Co-Chair of the Local Maternity System, Sumayyah Bilal, Head of Maternity Services & Commissioning for NCL, Nicole Callender, Associate Director for Midwifery at NMUH, Barbara Kuypers, interim Divisional Director of Midwifery and Nursing at NMUH, Dhruv Rastogi, Divisional Clinical Director & Consultant Paediatrician at NMUH, and Isabelle Cornet, Director of Midwifery at Whittington Health NHS Trust.

Rachel Lissauer began by explaining that, while accountability for services remained with the NHS Trusts, the Local Maternity and Neonatal Service (LMNS) within the NCL ICB had a role in considering elements such as safety, using data and insights, ensuring a supportive infrastructure for services, using the voices of pregnant women to inform how maternity services were run and equality of outcome and access. The Service worked alongside the Start Well programme which was looking at structural issues in the Case for Change. The role of the LMNS had really changed over the past 3-4 years with stronger role and closer working with Head/Directors of Midwifery, including on staffing, recruitment, training and demand pressures.

David Connor said that the Care Quality Commission (CQC) had been revisiting Trusts across the sector as part of its national response to the Ockenden report. The CQC’s report on the Whittington NHS Trust had been published while the North Middlesex University Hospital (NMUH) and University College London Hospitals NHS Trust (UCLH) had been inspected and the reports were currently being awaited. An inspection of the Royal Free Trust was expected soon. Through the LMNS Board, the action plans from inspections were monitored with feedback and learning shared across the system.

Asked by Cllr Connor whether there were any particular areas of concern as part of this process, David Connor said that triage assessments were an area where improvements could be made and that this was a common issue nationally so best practice models were being looked at.

Sumayyah Bilal provided an overview of the Women’s CQC Survey, which was a national survey that covered all aspects of the maternity journey and was conducted annually. The responses received in NCL were not representative of the diversity of survey users and so further work was planned on reaching those community voices with a recently recruited independent senior advocate, as recommended by the Ockenden report. Area for improvement across NCL including monitoring of mental health in pre and post-natal periods, infant feeding support and the ability of partners to visit in hospital (where there had previously been some restrictions due to Covid).

Sumayyah Bilal also explained that all NCL Trusts were asked to provide assurances to the LMNS Board of how they were implementing the recommendations of the Ockenden report. Ockenden assurance visits were also carried out with all NCL Trusts in 2022 and the feedback was mostly  ...  view the full minutes text for item 10.

For the Committee to consider the development of a Cancer Prevention Plan for NCL.

Ali Malik, Managing Director, and Fanta Bojang, Programme Manager, at NHS North Central London Cancer Alliance, introduced the report on the North Central Prevention, Awareness and Screening strategy and action plan.

Ali Malik said that work had recently been carried out to examine the overarching cancer pathway and the core aims and objectives for the cancer system. At the heart of this was the early diagnosis programme, which supported the national target in the NHS Long Term Plan for 75% of people with cancer to be diagnosed at stage 1 or 2 by 2028.

Fanta Bojang explained that the strategy had initially been drafted in 2019/20 but had been delayed by the Covid-19 pandemic and redrafted in the context of the implementation of Integrated Care Boards, aligning with the cancer system aims and objectives, the Population Health and Integrated Care Strategy and the Core20PLUS5 framework on health inequalities. The focus on prevention, awareness and screening included supporting and encouraging people to present to primary care early and to take up their screening invites, a targeted lung health checks programme which was still at an early stage, and identifying people with a high risk of developing cancer through genetic testing. Prevention was part of the strategy but this was a shared priority across the health system. There was an action plan associated with the strategy and this was only a two-year plan as the future availability of resources beyond this was not known.

Ali Malik and Fanta Bojang then responded to questions from the Committee:

• Referring to the case study on page 62 of the agenda pack, Cllr White commented that this example did not necessarily reflect some of the higher risk factors such as deprivation.
• Cllr White commented that prevention was preferable to treatment, both in terms of health outcomes and cost to the NHS, and suggested that support networks to help people reduce their tobacco and alcohol consumption and better manage their weight could help. Fanta Bojang said that the prevention budget sat elsewhere, but that there were active programmes in areas such as smoking cessation across the system and that the Royal Free were piloting a Healthy Living hub initiative. Ali Malik agreed with the focus on prevention and added that managing cancer as a long-term condition through support networks could also be beneficial.
• Cllr Clarke asked about methods of early detection such as through bowel cancer testing kits or dentists advising patients about mouth cancer for example. Fanta Bojang responded that the action plan highlighted the issue of drawing upon healthcare professionals across the whole system. Ali Malik added that a Primary Care Cancer Strategy had also been developed which addressed education and awareness across primary care staff, picking up on possible signs of cancer.
• Cllr James expressed concerns about low rates of cervical cancer screening. Fanta Bojang agreed that there was a long-standing challenge with a national decline in screening rates, though there were sometimes upticks in rates when there were national campaigns or publicity  ...  view the full minutes text for item 11.

For the Committee to consider the detail of and rationale for changes in this area, the equality impact assessment, the approach to engagement and the travel analysis.

The presentation on the NCL Surgical Transformation Programme: Ophthalmology Surgical Hub Proposal was provided by Dilani Siriwardena, Deputy Medical Director at Moorfields Eye Hospital and NHS London Clinical Director for Ophthalmology, Jon Lear, Senior Operations Manager at Royal Free London NHS Foundation Trust, Marco Inzani, Deputy Director of Strategic Programmes for NCL ICB and lead for the Surgical Transformation Programme and Richard Dale, Executive Director of Performance and Transformation NCL ICB.

Marco Inzani explained that there were current more than a quarter of a million patients waiting for elective care in NCL. Ophthalmology was one of the higher volume specialities and the waiting lists had grown by 48% over the past seven years. There were also risks associated with waiting including health deterioration and increased complexity of care so this really affected people’s quality of life. It was not possible to keep up with demand in NCL despite initiatives including evening/weekend working, using capacity in the independent sector and Trusts offering mutual aid to each other.

Elective Orthopaedic Centres had previously been developed in NCL, at Chase Farm and at UCLH, and these had doubled the number of surgeries for hip and knees. The aim was therefore to replicate this in other specialities, beginning with ophthalmology. In developing the engagement work, the focus had been on what mattered to patients and a key finding was that patients were willing to travel further if this meant that they would be seen quicker and that the service was better.

Marco Inzani continued by explaining that the main proposals were to consolidate surgery from Whittington Health and Chase Farm Hospital to the Edgware Community Hospital and Royal Free Hospital. Outpatient appointments and tests would remain at all local hospitals so it was just the surgery that would move location, which would typically be only one or two appointments. Patients would still have a choice of three Trusts in NCL and it was expected that this would drive efficiency and productivity. There was expected to be an additional 3,000 procedures per year which could potentially help patients to be treated 10 weeks earlier. He explained that the downside was that some patients would have to travel further, estimated to be an additional 19 minutes by public transport on average. The maximum additional journey time (i.e. for someone who lived close to Chase Farm Hospital who needed to travel to the Edgware Community Hospital) would be 90 minutes but this would be for a very small proportion of patients. They would also continue to have the option of travelling to Potters Bar, which is closer but outside of the NCL border. 

Dilani Siriwardena added that ophthalmology would ideally involve two theatres running in parallel with senior supervision for all patients and a reduced likelihood of late cancellations. This was already the type of service provided by Moorfields and St Anns, but for Royal Free staff they may have to travel between sites during the day which reduced the number of patients that they could treat.  ...  view the full minutes text for item 12.

To provide an outline of the Committee’s 2023-24 work programme.

The Committee then discussed the Work Programme for 2023/24. The September 2023 meeting had provisionally been scheduled to include items on Finance, Start Well and Diabetic Services. However, it was now necessary to include an update on the Ophthalmology Surgical Hub Proposal in the September 2023 agenda. It was agreed that the Diabetic Services item could instead by taken at the November 2023 meeting.

The November meeting now included the Diabetic Services item as well as items on the Estates Strategy, Workforce update and Winter Resilience. It was agreed that the Workforce item could instead by taken at the January 2024 meeting.

It was also agreed that a written update should be requested on the Camden Acute Day Unit issue, which had previously been discussed by the Committee, to be received ahead of the September 2023 meeting.

To note the dates of future meetings:

·         11^th September 2023 (10am) – Islington Town Hall

·         13^th November 2023 (10am)

·         29^th January 2024 (10am)

·         18^th March 2024 (10am)

·         30^th October 2023 (10am)

·         29^th January 2024 (10am)

·         18^th March 2024 (10am)