Agenda and draft minutes

North Central London Joint Health Overview and Scrutiny Committee
Thursday, 25th July, 2024 10.00 am

Venue: Committee Room 2 (First Floor), Camden Town Hall, Judd Street WC1H 9JE

Contact: Dominic O'Brien, Principal Scrutiny Officer  Email: dominic.obrien@haringey.gov.uk

Items
No. Item

13.

FILMING AT MEETINGS

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.

Minutes:

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’.

14.

APOLOGIES FOR ABSENCE

To receive any apologies for absence.

Minutes:

None.

 

15.

ELECTION OF CHAIR

To elect the Chair of the Committee for the 2024/25 municipal year.

Minutes:

The floor was opened for any other nominations for Chair. No nominations were received. The current Chair, Cllr Pippa Connor, was re-elected.

 

16.

ELECTION OF VICE-CHAIRS

To elect two vice-Chairs of the Committee for the 2024/25 municipal year.

 

Minutes:

The floor was opened for any other nominations for Vice Chairs.  No nominations were received. The current Vice Chairs, Cllr Larraine Revah and Cllr Tricia Clarke, were re-elected.

 

17.

URGENT BUSINESS

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).

Minutes:

None.

 

18.

DECLARATIONS OF INTEREST

A member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting of the authority at which the matter is considered:

 

(i) must disclose the interest at the start of the meeting or when the interest becomes apparent, and

(ii) may not participate in any discussion or vote on the matter and must withdraw from the meeting room.

 

A member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Register of Members’ Interests or the subject of a pending notification must notify the Monitoring Officer of the interest within 28 days of the disclosure.

 

Disclosable pecuniary interests, personal interests and prejudicial interests are defined at Paragraphs 5-7 and Appendix A of the Members’ Code of Conduct

 

Minutes:

Cllr Connor declared an interest by virtue of her membership at the Royal College of Nursing.

Cllr Connor also declared another interest by virtue of her sister working as a GP in Tottenham.

There were no other declarations of interest.

 

19.

DEPUTATIONS / PETITIONS / PRESENTATIONS / QUESTIONS

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

Minutes:

None.

 

20.

TERMS OF REFERENCE pdf icon PDF 181 KB

To note the terms of reference for the NCL JHOSC.

Minutes:

Cllr White raised questions regarding the set-up of the committee and clarification of resources and finance. It was stated that officer resources in Haringey were quite pressured. A suggestion was made that other boroughs could contribute to the resourcing of the committee. It was also noted that other important regulations were missing from the Terms of Reference. It was then suggested that the Terms of Reference should have a refresh incorporating stakeholder views.

Cllr Connor then suggested that all Committee councils should have discussions with their boroughs as to resourcing. (ACTION)

Cllr Ketan Sheth (London Borough of Brent) offered to meet with the Chair to talk through best practice in other boroughs. (ACTION)

It was then proposed that Haringey’s Scrutiny Office would put together a working group and then draft recommendations as to the new Terms of Reference for the Committee’s approval. (ACTION)

 

21.

MINUTES pdf icon PDF 327 KB

To approve the minutes of the North Central London Joint Health Overview and Scrutiny Committee meetings on 18th March 2024, 30th May 2024 & 31st May 2024.

Additional documents:

Minutes:

In response to the Committee’s request for updates on outcomes data and metrics in Mental Health, the Principal Scrutiny Officer Dominic O’Brien, explained that the updates from departments had not been forthcoming.  Discussion as to why this was followed.

Cllr Connor was then asked to follow up with CEOs of the various areas to help with timely updates from departments. (ACTION)

Minutes of the JHOSC Meetings from 18th March, 30th May and 31st May 2024 were then AGREED as a true and accurate account.

 

22.

START WELL UPDATE pdf icon PDF 1 MB

To receive an update on the ‘Start Well’ programme following the recent public consultation on proposed changes to maternity, neonatal and children’s services.

Minutes:

Anna Stewart updated the Committee as to the progress of the Start Well project. The project had moved into its consultation phase and an update was given on the interim report.  A summary of the stakeholder feedback is given here.

  • 67% of stakeholders agreed that change was needed to address current challenges facing services.
  • Overall agreement that all neo-natal clinics should offer the same amount of care (at least at Quality Level 2).
  • However, there was less support from stakeholders for consolidating maternity and neo natal services from 5 to 4 sites.

 

The Committee’s formal response to the interim report was requested by August 16th. (ACTION)

The floor was opened to the Committee for questions.

Cllr White questioned the framing of the results of the stakeholder feedback. Although the beginning of the feedback phase seemed open ended, there was a clear policy direction proposed through the case for change with the closure of one of the units. It was explained by Sarah Mansuralli that although stakeholder feedback was sought, the process was about developing the case for change, and defining the baseline of services that should be delivered. None wanted to see the units close, but stakeholders understood Level 2 Quality of Care was needed. However, this quality of care was not possible with 5 units open. Wynne Leith then added that with a smaller number of births, the numbers of deliveries would be diluted around the whole of north London. This in turn would deskill many consultants and the level of care would be at risk. Cllr White then responded that it could be made more explicit in the report that the proposals are being led by experts rather than stakeholders.

Discussion then turned to the quality of stakeholder feedback. Cllr Chakraborty required clarification as to the degree of engagement and representation and questioned whether ‘reach’ had been included as a ‘response’ in the consultation. The Committee was assured that this had not been the case. ‘Reach’ had been separated out from overall response statistics.

Cllr Connor then outlined that this was an interim report. The Committee was then advised to give feedback appropriate for a draft and not final report.

Cllr Cohen asked why the consultation had not been about closing a facility rather than the open approach that had been favoured by ICB. It was reiterated that the aim of the consultation was to look fairly at all the viable options and make sure the proposals were well informed and designed, using staff expertise and patient experience as its basis.

Cllr Clarke was pleased that 67% of stakeholders had accepted the need for change. She suggested that responses may have been skewed as feedback from the Royal Free was included. (Royal Free Maternity and Neo Natal Services closure was deemed by all as the most likely). However, Ms Stewart denied that responses were skewed or particularly negative from the staff at the Royal Free. She outlined that there were other units that were under  ...  view the full minutes text for item 22.

23.

PRIMARY CARE ACCESS pdf icon PDF 1 MB

To receive an update on access to primary care services in NCL.

Minutes:

The report was introduced by Katie Coleman which is summarised below:

·         Primary care or GP Services made up more than 90% of all NHS activity in North Central London, and 95% of all activity in the NHS.

·         GP services in North Central London carried out more than 800,000 appointments and of those 740,000 were ‘in- hours’ appointments. 50% of targets were dealt with on the day.

·         In North Central London, GPs were responding to an increase in demand, however it was noted that GP services were attaining pre- pandemic levels of service.

·         Patient satisfaction with GPs services were declining across the country.

·         It was noted that adequate recruitment and retention of GPs, as well as consistent funding of the service must be focused on, if not, GPs would not be able to keep up with demand.

The Committee was then asked for comments and questions on the report.

Cllr Connor stated that the report was extensive and needed some focus. It would be useful to include a summary of points for the Committee to consider.

Cllr Clarke also pointed out that there was no mention of the GP Federation in the paper. Katie Coleman responded that GP Federations were vital for GPs to have a consistent approach to healthcare. The GP Federations have a strong voice in North Central London in working collaborations. This is being developed further by the ICB.

Residents in Cllr Revah’s ward had difficulty seeing their GPs - sometimes waiting 3-4 weeks for an appointment. Cllr Revah also stated that there are issues with patient confidence in the ability of GPs to diagnose illness over the phone. Face-to-face appointments are preferred. Katie Coleman responded that over 69% of GP appointments are face to face. And although there are still some issues with seeing patients within a suitable period, levels are returning to pre- pandemic levels.

Cllr Chowdhury reiterated that the residents in his ward also had issues with getting appointments. His own experience was that patients would give up waiting in the telephone queue for an appointment. He stated that also the online consultation forms are not easy to access or use. Not all people have access to digital channels and therefore access to emergency appointments for all, was questioned. He also raised that his feeling was that some GP surgeries are taking more patients than their capacity allows. Ms Coleman responded that it is a requirement that GP practices respond to patients on the day with information, signposting to other services or an appointment. She also stated that GPs are not allowed to deny locals access to their services, so were unable to limit patient numbers.  She, however, admitted that the system was not perfect. The ICB was working with GP practices to decrease variances in how patients experienced the service across the locality. It was pointed out that funding was at the lowest level, but the service was experiencing an increase in demand.  Regarding online consultations, she acknowledged the challenges patients experienced, and suggested  ...  view the full minutes text for item 23.

24.

DENTAL SERVICES pdf icon PDF 899 KB

To receive an update on dental services in NCL.

Minutes:

The Committee then received an update on NCL access to dental care, introduced by Mark Eaton and Jeremy Wallman. Previous committee meetings had expressed concerns about funding, NHS contracts, and access for children’s dental health services.

The report is summarised as below.

·                     The Dental, Optometry and Community Pharmacy Services were brought under ICB management in 2023 and had undergone a transformation programme.

·                     An extra £600k has been allocated to dental services that offer support to more vulnerable residents such as asylum seekers, rough sleepers, and those in residential care. It also went toward reducing waiting times for children and young people who need more specialist care.

·                     Patients in acute pain can access urgent appointments through NHS 111. A commitment has been given by the ICB to support Looked After Children and the development of Child Friendly Practices in dentistry.

·                     Additional investment has been made in preventative work and in supporting children with SEND.

·                     Community Dental Services have been used to reduce the number of patients needing to be treated in more specialist centres. Only 8% of patients referred for specialist care resulted in treatment in a hospital setting.

·                     The main focus for the ICB since delegation has been on expanding access to Primary Dental Services including helping practices to develop new skills, increasing workforce capacity, and reducing the number of practices handing back their contracts.

·                     Future work includes improving oral health for those with diabetes (who are particularly vulnerable to loss of teeth), and piloting work to identify illnesses such as cardiovascular disease in patients with oral health issues. Also, a new cross-agency pediatrics pathway will lead to improved outcomes for children and young people.

Mr. Eaton explained that the ICB could not change the contract it held with Primary Care Dentists. It was not a statutory requirement for dentists to take on NHS patients, or to deliver any NHS activity against their contracts, with some practices actively blocking NHS patients. Substantially more could be earned by dentists taking on private patients than those on the NHS. However, it was noted that better access to NHS services exist within London than in rural areas.

Cllr White asked whether there could be some incentives for dentists to take on NHS patients. Mr. Eaton responded that for an NHS patient a dentist would earn around £28 for each unit of dental activity, but for the same work the dentist could earn anywhere between £30 and £300+ privately. This acted as a disincentive for many to see NHS patients.  Mr. Wallman also reiterated that dentists were not obliged to see patients under the NHS, indeed registration was very informal in some practices. However, this was a national policy issue and cannot be addressed locally by ICBs.

Cllr Clarke commented that although dentists were not getting paid more for seeing NHS patients, £28 was still expensive for most residents. For those on the breadline there were still questions as to whether they were receiving any dentistry at all. This was acknowledged  ...  view the full minutes text for item 24.

25.

WORK PROGRAMME pdf icon PDF 206 KB

This paper provides an outline of the 2024-25 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

Additional documents:

Minutes:

Cllr Connor pointed out the present time constraints at the meeting. It was then agreed that the committee would reconvene at a later date, to discuss the work plan and terms of reference in more detail. (ACTION)

 

26.

DATES OF FUTURE MEETINGS

To note the dates of future meetings:

 

·         9th September 2024 (10am)

·         11th November 2024 (10am)

·         3rd February 2025 (10am)

·         7th April 2025 (10am)

Minutes:

              9th September 2024 (10:00 am)

              11th November 2024 (10:00 am)

              3rd February 2025 (10:00 am)