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 Chris James (Enfield), Cllr Andy Milne (Enfield) and Cllr Rishikesh Chakraborty (Barnet).

Cllr Tom O’Halloran (Enfield) joined the meeting in place of Cllr Andy Milne (Enfield).

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 10 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 confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 11^th September 2023as a correct record.

The minutes from the previous meeting were approved by the Committee.

RESOLVED – That the minutes of the meeting held on 11^th September 2023 be approved as an accurate record.

To receive an update on Start Well - a long-term change programme focusing on children & young people’s and maternity & neonatal services in a hospital context.

Report to follow.

Cllr Connor noted that, although the report covered the consultation approach, the papers did not include the consultation itself as this was not due to be launched until 11^th December.

Sarah Mansuralli, Chief Strategy & Population Health Officer at North Central London Integrated Care Board (NCL ICB), introduced the report, explaining that this built on previous briefings and provided the Committee with the opportunity to comment on the approach to consultation. As an Integrated Care System, there was an overall focus on inequalities, value for money and social/economic development. The Integrated Care Strategy identified Start Well as a priority with a focus on service improvement and pregnant women’s experience of care and the role of the workforce as being critical for population health.

Sarah Mansuralli explained that the Case for Change had been published in June 2022 with a strong evidence base for improving care at an early age having an impact on population health outcomes. The Start Well programme had commenced in November 2021 and had benefitted from extensive clinical and service user input with the development of best practice care models and understanding the case the changing the way that services were organised. In NCL the birth rate was declining but the complexities of births was increasing. There were high vacancy rates in birthing centres which could compromise the choice of services while there was imbalance of demand across services leading to an over/underutilisation of particular units. The number of deliveries at the Edgware Birth Centre was declining each year with just 34 deliveries in the previous financial year. In addition, the fabric of estates in NCL was not up to the standards required by best practice models.

The new models of care were designed to address these issues, making each unit clinically viable, maintaining choice and improving the patient experience. The documents provided to the Committee demonstrated that doing nothing was not an option as the existing model was no longer sustainable. The following changes were therefore proposed:

• To move to a model with four units providing maternity and neonatal care instead of five units.
• This would mean having three Level 2 units and one specialist Level 3 neonatal intensive care unit at University College London Hospital (UCLH).
• There would no longer be a Level 1 unit or a stand-alone birthing centre.
• Pathways for paediatric surgical care would be streamlined.

Anna Stewart, Programme Director for Start Well, set out details of the options being included in the public consultation:

• Option A involved the UCLH as the specialist Level 3 neonatal unit, with Barnet Hospital, North Mid Hospital and the Whittington Hospital as the three Level 2 units. Maternity and neonatal services at the Royal Free Hospital would be closed.
• Option B also involved the UCLH as the specialist Level 3 neonatal unit, with Barnet Hospital, North Mid Hospital and the Royal Free Hospital as the three Level 2 units. Maternity and neonatal services at the Whittington Hospital would be closed.
• Option A had been identified as  ...  view the full minutes text for item 35.

To receive an update on the NCL Estates Strategy.

Nicola Theron, Director of Estates for the NCL ICB, introduced this item noting that a number of specific questions asked by the Committee were addressed in the report. She highlighted the recent progress of the Estates Strategy including investment in the Primary and Community estate, with a number of new build and refurbishment projects set out in the report. An update was provided on the St Pancras Transformation Programme and asset disposals were also described in the report with an uptick in 2027/28. The graphs on page 18 of the agenda pack illustrated the critical backlog maintenance of around £121m with the effective maintenance of estates essential to deliver good quality patient care.

Nicola Theron explained that there were corporate expenditure limits on the overall capital and leasing spend for NCL which was £178m this year. It was necessary to work carefully and creatively to use not just national capital but also other sources of funding. NCL was one of the few ICS areas to set aside 5% of the capital budget for primary/community services. The Community Investment Fund/Section 106 (CIL/S106) funding was a significant source of funding as illustrated in the report.

With regards to Local Estates Forums (LEFs), the list of local authority representatives was provided in the report and this included a good range of senior officers and policy leads but more limited representation from Councillors.

Nicola Theron then responded to questions from the Committee:

• With regard to the St Pancras Transformation Programme, Cllr Connor asked about risk and financial stability for the second site. Nicola Theron said that the Moorfields site was being delivered separately from the second site where there were a series of other transactions, including a partnership with the private sector that was adding skills and expertise to the project. The programme was operating in difficult market conditions in terms of disposals and construction. The objective was to align the whole long-term programme and various sources of funding with the objectives of optimising health outcomes and ensuring minimal disruption. Sarah Mansuralli added that the programme involved a sequence of planned transactions so there was always a risk concerning the transactions being completed within the planned timescales. There was therefore a lot of focus on risks and mitigations throughout the programme. Cllr Connor requested that progress with the project and the associated risks be included in the next update report to the Committee in 12 months’ time. (ACTION)
• Asked by Cllr Connor about the 28% of NCL patients who access primary care from inadequate ‘tail’ estate, as illustrated on page 18 of the agenda pack, Nicola Theron said that the principle worked to was that health outcomes were better achieved in larger, better quality estates and the national policy was that commissioners should promote the delivery of services from ‘tail’ estate to ‘core’ assets.
• Asked by Cllr Cohen whether the Edgware disposal was linked to the overall major planning changes for Edgware town, Nicola Theron confirmed that this was dealt with as a separate  ...  view the full minutes text for item 36.

To receive an update on the implementation of the NCL fertility policy review.

Penny Mitchell, Director of Population Health Commissioning for NCL ICB, introduced this item, reporting that the implementation of new NCL Fertility Policy, which had begun almost 18 months previously, had gone well with strong communications activities and a number of benefits demonstrated. There was now greater collaborative working with primary care and specialist providers and the policy was embedded as standard commissioning activity. She emphasised the gratitude of the ICB to the residents who had been involved in the development of the policy and also thanked the Committee for their previous input.

Cllr Connor concurred regarding the effective communication and engagement process, added that this had supported by financial backing for the services and expressed her hope that good communications with clinical colleagues and GP practices would continue following the implementation of the policy.

Sarah Mansuralli added that the policy had been part of the broader approach of the ICB in addressing inequity of provision and variation in outcomes for residents which was also a theme of other programmes including Start Well and the Community Health/Mental Health review.

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

The updated Work Programme was noted by the Committee and Members were reminded to provide any suggestions for future agenda items to the Chair and the scrutiny officer.

To note the dates of future meetings:

29^th January 2024

18^th March 2024

·         29^th January 2024

·         18^th March 2024