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 Pippa Connor (Haringey).

In the absence of the Cllr Connor as the Chair, the meeting was chaired by Cllr Tricia Clarke as one of the Committee’s Vice-Chairs.

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 Clarke informed the Committee that new rules were being put in place nationally in respect of health scrutiny and reconfigurations of local health services and requested that further details on this be provided to the next meeting of the Committee. (ACTION)

None.

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

Cllr Clarke informed the Committee that two deputations had been received:

• From Brenda Allan on the issue of Operose Health – this deputation would be received under this agenda item.
• From Jan Pollock on the issue of Diabetes Services - this deputation would be received under agenda item 8.

Brenda Allan, Chair of KONP Primary Care Working Group, introduced the first deputation, explaining that there were two main elements to the group’s concerns:

• The replacement of GPs by Physician Associates (PAs), and
• The sale of 50 GP practices in London to a private equity company.

On the issue of PAs, Brenda Allan explained that there were concerns about risks to patient safety as a result of these changes, particularly following the recent death of a patient who had been misdiagnosed by a PA at a medical practice in north London.

On the issue of the sale of GP practices, Brenda Allan explained that, having acquired the practices in 2021, Operose Health had now announced plans to sell the practices to HCRG Care Group on the basis that they were not profitable, despite being paid more per patient than under the previous owners. She said that there had been little public consultation on this issue and proposed that there should be a rigorous procurement exercise and scrutiny of HCRG Care Group, and their owners T20, on their service track record, financial viability, long term commitment and suitability to provide primary care. She described deficiencies in the performance of services previously taken over by HCRG Care Group and concerns about their lack of transparency, which were set out in more detail in the written submission to the Committee. She concluded by expressing a preference for PCNs and GP Federations to run the practices instead.

Brenda Allan then responded to questions from the Committee:

• Asked by Cllr White about the role of PAs and the training that they received, Brenda Allan commented that PAs received two years of training which was fewer than GPs, nurses or paramedics and that their role were more suitable in hospital settings where they work as part of a team with more supervision. However, she said that PAs were now being employed in roles in place of GPs.
• Cllr Cohen queried the current role and powers of the ICB over this sale. Brenda Allan said that ICBs did have to approve the sale but that their decision could potentially be subject to legal challenge from the companies concerned.
• Asked by Cllr Chakraborty about the evidence that the use of PAs in GP Practices was having an adverse impact on patient care, Brenda Allan said that there was plenty of evidence from patients on delays to diagnosis and treatment as a consequence of being seen by a PA rather than a GP and that the issue was that PAs were being put in a role that they were not adequately trained to do.
• Cllr Revah expressed concern about the use of PAs and highlighted the importance of consultation and  ...  view the full minutes text for item 44.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 30^th November 2023 as a correct record.

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

RESOLVED – That the minutes of the meetings held on 30^th November 2023 be approved as an accurate record.

To provide an update on workforce issues in NCL.

The most recent previous update to the Committee on this issue was 30^th September 2022. To view the minutes from this discussion please see Item 21 at:

https://www.minutes.haringey.gov.uk/ieListDocuments.aspx?CId=697&MId=10431&Ver=4

The report for this item was introduced by Sarah Morgan, Chief People Officer at the NCL ICB, which was an update on NCL workforce issues and progress on key challenges following the previous update to the Committee in September 2022. She explained that the NCL ICS People Strategy was published in May 2023 with three main priorities of Workforce Supply, Development and Transformation.

Sarah Morgan said that retention was a particular workforce challenge and that the three main levers used to support retention were identified as Staff Health & Wellbeing, Equality, Diversity & Inclusion and Leadership & Talent. She noted the importance of helping people into careers in the context of the cost of living crisis and a decline in social mobility but that the NHS had a low percentage of staff under the age of 25 which represented a future challenge. The ICB was therefore investing in workforce as a strategic priority with a system team focused on this work.

In terms of challenges, she acknowledged issues with industrial action, low morale and low national recruitment levels for nursing places. However, in the NCL area, Middlesex University had a good record of bringing new nurses through, reliance on agency staffing had reduced and an award had been won for the NCL ICS Graduate Guarantee Programme.

She added that the ICB was also one of ten pathfinders in England to support care leavers into NHS careers in collaboration with local authorities. This was part of a national programme established in October 2022 to support care leavers into career pathways.

Sarah Morgan then responded to questions from the Committee:

• Asked by Cllr Clarke for clarification about ‘Bank’ staff compared to agency staff, Sarah Morgan explained that Bank staff were substantive staff that would take on additional shifts on flexible contracts, whereas agency staff were supplied by a third party provider. The ICB aimed to reduce reliance on agency staff through improved recruitment and better use of Bank staff.
• Asked by Cllr Atolagbe about retention and Equality, Diversity & Inclusion issues, Sarah Morgan said that there had been a lot of work in this area including with an anti-racism approach endorsed by the ICB Board in July 2023, through targeted development and opportunities and an anti-racism pledge on midwifery and nursing standards.
• Asked by Cllr Atolagbe about the progress of the Oliver McGowan Training (to provide care to autistic people with a learning disability) Sarah Morgan said that this had started in pilot form for clinical staff working face-to-face with patients and would also include online training for all ICB staff. Cllr Revah said that patients with learning disabilities in Camden had started using ‘passports’ explaining the best ways of supporting them in various circumstances and suggested that this should be used in other Boroughs.
• Asked by Cllr Atolagbe about engagement with care leavers, Sarah Morgan explained that there were a lot of relationships which provided routes into communities which helped to support care leavers, including the Prince’s Trust and Health & Social Care Academies.
• Cllr White  ...  view the full minutes text for item 46.

To receive a presentation about out of hospital care for adults with diabetes in North Central London.

Prior to the presentation of the report on this issue, Jan Pollock introduced a deputation on the issue of Diabetes Services. She informed the Committee that she was a long-term user of insulin as a Type-1 diabetic. She described experiencing a severe hypoglycaemic attack while under the care of the Royal Free hospital in the 1990s for an operation because blood sugar tests were not carried out. She asked for further details about the current treatment of diabetic people when using NHS services. She also expressed concerns about the current shortage of certain drugs used by diabetic people as they were now being used by non-diabetic people for the purposes of weight loss.

Amy Bowen, Director of System Improvement at NCL ICB, introduced the report of diabetes services informing the Committee that, as a system, a commitment had been made to focus on prevention, early intervention and proactive care. This was challenging in a system with high levels of demand and real pressure on services but the aim was to intervene before a crisis occurred while improving equity of access to services. This required both a focus on the medical elements of the service but also addressing the wider determinants of health.

Referring to the slides, Amy Bowen highlighted progress on outcomes and recovery after the Covid-19 pandemic but acknowledged that there was further work required, including proactive preventative work with young people. She also noted that the comments from the deputation had demonstrated the importance of the individual’s role in managing their health and close collaboration with them as people with diabetes tended to be expert patients.

Amy Bowen then responded to questions from the Committee:

• Referring to page 57 of the agenda pack, Cllr White noted that 8 care processes were referred to but only 7 were listed. Amy Bowen agreed to clarify this in writing. (ACTION) Cllr White also queried why the proportion of diagnosed patients receiving all 8 care processes was relatively low. Amy Bowen acknowledged that the figures were low but explained that there was a new primary care model for long-term conditions based on outcomes and this included the proportion of diabetes patients receiving all 8 care processes and the 3 Treatment Targets referred to on page 59. Four of the five NCL Boroughs had chosen to focus on the 8 care processes as their key outcome for 2024/25.
• Cllr White noted that some diabetes patients were managed by their GPs rather than a diabetes specialist. Amy Bowen said that more specialised support for often needed for Type-1 diabetes patients due to the underlying mechanisms of the condition and complexity of management, so support tended to be provided by secondary care. However, most aspects of Type-2 diabetes could usually be effectively managed by primary care services.
• Asked by Cllr White about the long-term conditions referred to on page 62 and links with psychological services referred to on page 61, Amy Bowen said that these were metabolic diseases including cardiovascular disease, coronary heart disease, chronic  ...  view the full minutes text for item 47.

To receive an update on the engagement findings report for the NCL Surgical Transformation Programme: Ophthalmology Surgical Hub.

The report for this item was introduced by Richard Dale, Executive Director of Performance and Transformation for the NCL ICB, Jon Lear, Senior Operations Manager at Royal Free London NHS Foundation Trust, Rachel Anticoni, Director of Operations at Royal Free London NHS Foundation Trust, and Dilani Siriwardena, Deputy Medical Director at Moorfields Eye Hospital and NHS London Clinical Director for Ophthalmology.

Richard Dale told the Committee that the report provided an update on the progress and engagement work that had taken place in relation to the Ophthalmology Surgical Hub proposal since the previous report to the Committee in June 2023. There were over 260,000 patients waiting for elective care in NCL, of which 30,000 were waiting for surgery. It was anticipated that the new surgical hub would enable an additional 3,000 operations per year.

Richard Dale added that the key feedback from the engagement exercises included that residents wanted well trained and supportive staff, a choice of appointment times, advice and support for vulnerable patients, the opportunity to discuss choices for surgery with a GP, support for travel where necessary and for spare capacity to be used to help reduce waiting lists in other areas.

DilaniSiriwardena explained that, while the clinical benefits were clear, some patients could be impacted by the change in location as set out on page 71 of the agenda pack. Patients who live close to Chase Farm Hospital or Whittington Hospital would have a longer journey to Edgware Community Hospital instead. However, patients would still have the option to transfer to a provider that may have a closer site.

Jon Lear explained that the benefits of the new surgical hub would also include a more efficient use of theatre capacity and a reduced number of cancellations. The number of procedures at Edgware Hospital were still at an early stage but 159 had been carried out in October 2023 and 323 carried out in November 2023. Staff and patient feedback had been largely positive. A small number of patients had chosen to have their procedure carried out elsewhere and this had been facilitated.

Richard Dale, Dilani Siriwardena, Jon Lear and Rachel Anticoni then responded to questions from the Committee:

• Asked by Cllr Revah whether patients were made aware of their option of choosing an alternative site for their procedure at an early stage, Dilani Siriwardena confirmed that this should be happening now as part of the process with their GP or optician when arranging the procedure. Richard Dale added that patients would also receive information at this stage about waiting times at each site.
• Cllr Clarke and Cllr White expressed concern about the more difficult and longer transport requirements that some residents would experience. Richard Dale responded that, under existing arrangements, patients who meet the eligibility criteria can access patient transport to and from sites. GPs could provide information to patients about their transport choices at the same time as explaining the options for their procedure site. He also noted that the majority  ...  view the full minutes text for item 48.

This paper provides an outline of the 2023-24 work programme for the NCL JHOSC.

It was noted that the next meeting on 18^th March would be on the topic of the mental health and community health core offers in NCL. Community and voluntary organisations from across NCL would be welcome to attend and so Members of the Committee were reminded to suggest organisations that could be invited.

Meeting dates for 2024/25 will be published shortly.

·         18^th March 2024 (10am)