Agenda and draft 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 Chakraborty and Cllr Atolagbe.

Apologies for lateness were received from Cllr Clarke and Cllr Revah.

Apologies for absence were received from Richard Dale, Executive Director of Performance and Transformation (NCL ICB).

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).

None.

Cllr Connor gave information that she used to work at the North Middlesex University Hospital (NMUH). She is also a member of the Royal College of Nursing, and her sister works as a GP in Tottenham. Cllr White gave information that he was an outpatient of NMUH Diabetes Department.

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

The Scrutiny Officer stated that none had been received within the statutory period.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 25^th July 2024as a correct record.

The Committee was still waiting for responses to some actions from the last meeting. The Chair ran through follow up questions for the Scrutiny Officer stemming from the NCL Mental Health Community Core Offer Implementation Update report.

• Item 3 and how quickly contracts were being given in the Voluntary and Community Sector. ACTION
• More details were requested on Item 5 regarding the lack of appropriate community support for those who were clinically ready for discharge but remain in a hospital bed. Information was also requested on how the Mental Health Trust was working with councils and other organisations to resolve this. ACTION
• Cllr Connor then requested further information as to which schools were part of the Mental Health Trust’s Trailblazers programme. ACTION

Cllr Cohen told the Committee that the Barnet Primary Care Access Consultation had concluded. The full report on the results will go to Barnet’s Cabinet in September. Cllr Cohen will let the Committee know once approved. ACTION

The Chair updated the Committee as to the Terms and Conditions work conducted. She then suggested that the action tracker should be part of the meeting pack – and time allocated to run through it after the ‘Minutes’ agenda item. ACTION

It must be noted that 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 before 10:45am could not be ratified. Minutes were NOTED BUT NOT APPROVED by the Committee. Minutes to be approved at next meeting – ACTION.

To receive a report detailing the proposed merger of the North Middlesex University Hospital NHS Trust and the Royal Free London NHS Foundation Trust.

North Middlesex University Hospital (NMUH) and Royal Free London Group (RFLG):

Dr Nnenna Osuji - Chief Executive of NMUH.

Peter Landstrom - Chief Executive of RFGL.

The CEO of the Royal Free Trust Mr Landstrom introduced the topic. This was an update further to a Committee briefing in February. He stated that a decision was made to further explore the merger. The full business case was finalised. He explained that the business case was now with NHS England where appropriate testing and scrutinization will occur. After this, a recommendation for approval/refusal will be made to the Secretary of State. He emphasised that the merger was not for financial benefit but for the removal of barriers that prevented service delivery going further and faster for staff and patients. He stated that the Royal Free London Group (RFLG) covers several services and locations, however local leadership and identity remains strong. He wanted to reassure the Committee that the merger was designed to keep services local for residents.

Dr Osuji explained that the merger would provide benefits to both organisations, in terms of surgery, elective hubs, clearing the backlog from COVID as well as presenting advantages in terms of Research and Development. She used the example of Colo-rectal surgery. A larger number of Colo-rectal surgeries brought complex cases together. The merger meant that clinical practice could be standardised with training and innovative practices could also be used such as robotic surgery.

She emphasised that there were still internal conversations with staff and stakeholder engagement that was still ongoing. Work was continuing on the dedicated Terms and Conditions. Dr Osuji then invited feedback and questions from the committee.

Cllr Connor expressed apprehension that the NMUH would no longer be a ‘sovereign’ hospital but a ‘fourth health unit’ in the RFLG as per the terminology in the report. She speculated that this may influence staff morale and how patients saw the hospital. She felt that the terminology should reflect integration. She also wanted to know with what confidence it could be said that in a few years' time there would not still be a problem with getting the right treatment to a particular cohort of patients. She wanted assurance that the NMUH would still be a local hospital for local people.

Dr Osuji assured the Committee that the hospital would remain uniquely NMUH. She emphasised that the outcome of the merger would be the same – to have access to excellent care no matter where residents live and for the Group to have strong community links where they operate. Furthermore, she explained that they had looked at ‘warranted and unwarranted variation’ in statistics related to population and care. In response they had looked at representation in the corporate structure. The CEOs of all local health units would be represented at Board. They are considering expanding further local representation at Board, however non- execs and local units are still represented in sub committees and working groups. The role of ‘critical friends’ to her were  ...  view the full minutes text for item 33.

To receive an update on the Estates and Infrastructure Strategy for North Central London.

NCL ICB- Estates and Infrastructure

Bimal Patel - Chief Finance Officer of NCL ICB

Owen Sloman - NCL Strategic Estates

The Chief Finance Officer of NCL ICB introduced the topic. Main points included were:

·         The Estates Plan now includes the infrastructure plan. Infrastructure also covers IT and workforce, as well as physical assets. There are 42 ICS infrastructure plans, and each region will be adding to this.

·         A lot of the plan has already been delivered.

·         There was a ‘critical infrastructure risk,’ however, the team were successful in getting more capital. There was a £177 million base allocation, and the team were successful in securing another £48 million.

·         The ICB wanted to work closer with Local Authorities to find out what the best way was of disposing assets - and reinvesting in Health and Social Care.

Cllr Connor then asked why the Infrastructure Strategy had been now merged with the Estates strategy. She enquired whether this was something that NHS England had wanted to get to grips with what was going on across all 42 ICB sites, or whether it was helpful for the ICB to assess estates and infrastructure together. The Head of NCL Strategic Estates affirmed that it was the NHS England who wanted to see these two workstreams together, however he also stated that it was helpful to evaluate both workforces and digital, as well as physical assets as much of them are integrated together. Also, because the Trust has some very ambitious green plans to deliver – so in his opinion it made sense.

Discussion then turned to finances. The Chair then asked whether the £48 million was in addition to the £177million allocation – and whether this would be allocated for Primary Care. The Chief Financial Officer responded that some of the additional money would go to 2 or 3 strategic Primary Care sites, as it would stop patients coming into Emergency Departments.

Cllr Cohen then asked about the Estates Forum in each borough. It was agreed that personnel in each team would be circulated to the Committee. ACTION

Cllr Cohen then stated that he had been asked by constituents, whether there were still plans to include keyworker housing at Finchley Memorial Hospital. The Head of Strategic Services indicated that he did not have the details but could update the Committee- ACTION

Cllr James indicated that Enfield Council was going through every piece of land they owned – she advised the officer panel to act quickly if they would like to acquire some of the divested land. Cllr James said she would liaise with Property Services at Enfield Council to make sure the NCL ICB was kept informed. ACTION

Cllr Connor then asked the Committee to go back to the respective boroughs to make sure that the Estate team had sight of any divestments. ACTION. Cllr Connor added that it would also be good to know how the NCL Estate teams operated. How Council- led schemes and Section 106s operated was then talked about. It  ...  view the full minutes text for item 34.

To receive a report detailing the proposed merger of Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust.

North London Mental Health Partnership

JinjerKandola MBE- Chief Executive Officer

Natalie Fox - Deputy Chief Executive

Vincent Kirchner - Chief Medical Officer

Andrew Wright - Chief of Staff

Deputy Chief Executive, Natalie Fox, provided an update as to the status of the merger. Main points were:

·         The NHS assessment was complete, and the merger had formal sign off at Board. The merger has been pledged and will occur on the 1^st of November subject to a Secretary of State signing.

·         The two Trusts have been working closely since 2019.

·         Clinical pathways have been built and staff have developed close relationships that have benefited patients.

·         There have been talks with the Unions regarding TUPE of staff from one organisation to another.

The Chair started the discussions by looking at the finances and the potential savings the merger would make. She asked for more information regarding this namely where the savings would come from. The Deputy CEO responded the ‘Return On Investment’ would happen from the amalgamation of corporate services. Instead of two HR and payroll systems one system for one organisation would make savings. She stated that if the merger were not to occur then the organisations would move into deficit. The merger would lead to a year on year saving of 9.2% and a surplus for the organisation. The Chair wanted to know more detail on the Finances associated with the merger. ACTION

The Chair also indicated that the Estate Strategy had not been approved – she wanted to know where this left the merger and wanted more details re this. The Chief of Staff replied that they had a new Estates Strategy for the organisation and were working closely with the ICB. The strategy included the refurbishment of St Ann’s, Highgate Health Centre, and Chase Farm Mental Health Unit. He stated that the overall priority is Chase Farm, as this has been deemed as not fit for purpose. Discussion turned to the TUPE process and more details were teased out about the legalities of the merger.

Cllr Cohen then asked more about the organisational risks involved – he wanted to ensure that patients were being consulted, that the implications on waiting times were being considered but also how much local identity would be lost, and the risk to patients.

The Chief Medical Officer responded that patients would go to the same places to receive treatment. The merger would standardise the service – patients would be able to be admitted where they lived, rather than 100s of miles away if there were no facilities available. The merger would also mean that those well enough could receive Care in the Community. Cllr Cohen asked how many had been placed outside of London. The response was around ten so far. The Chief Medical Officer emphasised that although the numbers were small - this would have a big impact on treatment and life for these patients.

Discussion then turned to waiting lists. Cllr Revah asked whether the waiting list times would  ...  view the full minutes text for item 35.

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

The Chair asked the Committee what items should be on the Workplan for the next two years. The topic of ‘Winter Planning’ came up as a major issue to be scrutinised. Discussion then turned to whether the meetings were too long or too short for the time allocated to them.

An idea was raised that extra meetings may be the answer however extra resources would be needed if this was the case.

After discussion it was proposedthat, due to the workload of the Committee, the number of regular JHOSC meetings per year should be increased from five to six per year and the meetings themselves be extended to three hours long. The Scrutiny Officer noted that this would need to be discussed with the ICB and also with NCL Democratic Services teams. ACTION

To note the dates of future meetings:

·         11^th November 2024

·         3^rd February 2025

·         7^th April 2025

·         Mon 11^th Nov 2024 (10am)

·         Mon 3^rd Feb 2025 (10am)

·         Mon 7^th Apr 2025 (10am)