Agenda and minutes

North Central London Joint Health Overview and Scrutiny Committee
Friday, 27th November, 2020 10.00 am

Venue: Remote Meeting - MS Teams

Contact: Robert Mack, Principal Scrutiny Officer / Fiona Rae, Principal Committee Co-ordinator  3541 Email:

Note: This meeting will be webcast - use the link on the agenda frontsheet or copy and paste the following link into your internet browser: 

No. Item



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 to the notice of filming at meetings and this information was noted.



To receive any apologies for absence.


There were no apologies for absence.



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).


There were no items of urgent business. The Chair noted that, due to officer availability, item 8 (Post-Covid Syndrome Service) would be taken after item 6 (Primary Care during the Covid-19 Pandemic).



Members of the Committee are invited to identify any disclosable pecuniary or prejudicial interests relevant to items on the agenda. A member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting at which a 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 their borough’s Register of Members’ Interests or the subject of a pending disclosure must notify their Monitoring Officer of the interest within 28 days of the disclosure.


There were no declarations of interest.


MINUTES pdf icon PDF 269 KB

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 25 September 2020 as a correct record.


Cllr Cornelius drew attention to item 6 of the minutes, Declarations by Members, and noted that she was a ‘Council appointed Trustee’ rather than a ‘Council appointed member’ of the Eleanor Palmer Trust.




That, subject to the above amendment, the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting held on 25 September 2020 were confirmed and signed as a correct record.


In terms of matters arising from the minutes, the Committee asked for clarification of whether the 85 community health beds, meant for testing care home residents to prevent Covid-19 outbreaks when they returned to care homes, were included within the 200 surge beds or whether they were a separate provision. It was also enquired whether people with disabilities in supported living accommodation were being provided with the same access to testing as care home residents. The Chair noted that these questions would be provided with written answers.


Post meeting note:The table below showed all units capable of taking Covid ‘bridging’ patients (patients due to be discharged to a care home but awaiting a negative test). These were referred to nationally as ‘designated’ sites. The column marked ‘beds’ showed the capacity of the units pre-surge. The column marked ‘max surge’ showed the maximum capacity if all surge beds were used. Part of the surge capacity at Chase Farm had currently been implemented. All 240 beds were capable of being ‘bridging beds’ if required. These beds were mainly used as step-down from hospital, but not exclusively. There would be occasions when a patient was admitted directly from the community or other pathways.


Provider (NHS)



Max Surge


Finchley Memorial Hospital



Edgware Community Hospital




St Pancras




Chase Farm







(This table did not show all NCL P2 block capacity. Units located in care homes or extra care sheltered units, such as Mildmay, St Anne’s, and Priscilla Wakefield, were not intended as bridging beds.)


In relation to testing access for those with disabilities in supported living accommodation, it was noted that the national testing regime had provided regular testing for care home staff (weekly) and residents (monthly) in recent months. It had been announced that the national offer would provide increased testing for extra care and supported living settings shortly. In North Central London (NCL), local testing capacity had been provided to address the gaps in supported housing (and other social care settings). This had been provided by the local NHS and its use had been directed between public health and adult social care departments.


The Chair noted that the action tracker had been circulated as a late paper. It was explained that a number of the actions had been completed but that the key outstanding items were a written update on the Lower Urinary Tract Service (LUTS) Clinic and a seminar on health and social care integration hosted by Mike Cooke. The Chair added that the remaining items on the  ...  view the full minutes text for item 5.



This paper provides an update on primary care in the North Central London area during the Covid-19 pandemic.


Will Huxter, Clinical Commissioning Group (CCG) Director of Strategy, introduced the item and explained that he had oversight of ongoing programmes. He noted that Dr Katie Coleman, Islington GP and North Central London (NCL) Clinical Lead for Primary Care Network Development, and Keziah Insaidoo, Health and Care Close to Home Programme Manager, would present the item and answer questions.


Dr Katie Coleman noted that primary care had worked extremely hard during the Covid-19 pandemic to meet the needs of the local population. It was explained that there were some challenges for staff and patients and that some significant changes had been required to ensure safety. It was noted that the detail was provided in the report but that a major concern had been access to healthcare during the pandemic. Dr Katie Coleman explained that, initially, GP surgeries were not open and people were unsure how to access their GPs. There was now a digital approach to gain access to GPs and it was acknowledged that the digital approach had caused some problems for a small but significant portion of the population. It was added that it had been challenging to return to a ‘business as usual’ position, particularly for those with Long Term Conditions (LTCs), child immunisations, and cancer identification. It was commented that the responses of primary care were listed in the report and included creating a dedicated service to support the needs of people with Covid-19 and post-Covid syndrome. It was added that things were developing quickly which involved ongoing learning and responses to challenges.


It was noted that the Committee had been interested in assessing how services had changed for patients and their pathways, particularly in the case of diabetes as there had been some concerns that residents had not been able to access blood tests. Dr Katie Coleman noted that, at the early stage of the Covid-19 pandemic, those with LTCs were not able to access GPs. It was explained that there had been a great deal of fear for patients and staff; however, this had improved as more was learnt about the virus and about how to protect staff and patients.


In relation to those with LTCs, GPs were able to search their patient lists and actively identify those whose conditions were most poorly controlled and who were at the greatest risk of complications; this enabled GPs to stratify their populations. Therefore, someone with diabetes would be identified by a GP and would be contacted over the phone for an assessment. It was noted that this could be undertaken by a Healthcare Assistant or Pharmacist and that training for virtual support had been provided to staff. It was highlighted that a number of diabetes cases involved behavioural and lifestyle considerations, such as diet and exercise, which could be addressed virtually. After this initial assessment and identification of care needs, a patient would be offered an appointment for their annual blood tests; the GP or Pharmacist would generate and send a pre-filled form  ...  view the full minutes text for item 6.



This paper provides an update on secondary care in the North Central London area during the Covid-19 pandemic.


NaserTurabi, Programme Director for NCL Cancer Alliance, Derralynn Hughes, Professor of Haematology at the Royal Free London and Co-Clinical Director for NCL Cancer Alliance, and Clare Stephens, Barnet GP and NCL Board and Co-Clinical Director for NCL Cancer Alliance, introduced the item.


NaserTurabi noted that this item would focus on the cancer patient pathway and experience during the Covid-19 pandemic. He explained that, at the start of the pandemic, there were concerns about the spread of the virus and the vulnerability of cancer patients and some services had paused. It was noted that protective measures had been put in place and services were now around pre-pandemic levels. In terms of patients, NCL was ensuring that the pathways were Covid safe and had returned to pre-pandemic levels of diagnosis and treatment fairly rapidly. A key concern was the drop in presentation of new cancer cases. It was explained that cancers were normally diagnosed through multiple routes, such as via GPs, routine hospital appointments, screening, and emergency presentations. Based on a comparison of previous year cancer diagnoses, it was estimated that there were 600-650 missing cancer cases. It was noted that there was a national communications campaign encouraging people to present.


Clare Stephens explained that a cancer awareness measure assessment survey was undertaken in Camden and Islington in late summer; of the 1,300 respondents, 65% admitted to delaying getting help or advice for potential cancer issues, 55% said that they did not want to overwhelm the NHS and felt that they could wait, and others had stated that they were concerned about catching the virus.


Cllr Smith noted that there were a significant number of missing cancer cases and asked whether people knew about the Covid prevention measures and whether this had helped to reduce fears. Naser Turabi noted that there was a communications campaign called ‘Help Us to Help You’ which encouraged people to present when they had seemingly minor symptoms which could be cancer symptoms, such as changes in bowel movements and skin changes. It was noted that this was a national campaign and, furthermore, NCL hospitals had been featured on Channel 4 News and in the Evening Standard. It was also noted that significant effort was being expended by healthcare professionals and endoscopy numbers were actually higher than pre-pandemic levels.


Cllr Cornelius enquired whether there was still an issue with breast screening and endoscopy waiting times. In relation to endoscopy, it was noted that there were capacity issues as the air in the room had to be cleared between procedures. However, more appointments had been made available, including at weekends, and the service was due to be back on track by the end of next quarter. It was added that there had been significant progress and those with cancer concerns had been prioritised. Derralynn Hughes highlighted that no cancer patients were waiting for an endoscopy beyond the normal length on a 62 day pathway. In relation to breast screening, it was explained that the primary concern  ...  view the full minutes text for item 7.



This paper provides a summary of the Post-Covid Syndrome Clinic at University College London Hospital (UCLH).


Dr Melissa Heightman, Clinical Lead for the Covid follow up Service and NCL representative for the London Respiratory Network, introduced the item. She explained that that a clinic was started to meet patient need in May 2020 when it transpired that patients going home from the Accident & Emergency department (A&E) were having difficulties related to Covid-19; this was followed by similar reports about the long term effects of Covid-19 from the community through GPs. It was noted that University College London Hospital (UCLH) was named as the key provider for the post-Covid assessment service. It was stated that there had been over 1,000 appointments in the assessment clinic for around 800 people and that half of these people had been referred from outside NCL as there was a national shortage in this area. It was explained that the clinic had a multi-specialty team and tried to offer a ‘one stop shop’ for patients, covering respiratory, cardiology, neurology, and therapies assessments. It was added that clinicians tried to follow a clinical line of questioning but that there was a huge amount of information missing in this area and treatments were not guaranteed to be effective. It was highlighted that the team was working to develop an integrated care pathway for patients but that evaluation was required in relation to how to assess someone in primary care, when to make a referral, how to investigate, and the correct forms of rehabilitation.


The Chair noted that some patients had expressed concerns that they had been referred to other specialists but had not been given access to the post-Covid syndrome service. It was enquired whether people should specifically ask for a referral. Dr Melissa Heightman noted that people should talk with their GP about their symptoms. There was increasing awareness of the service amongst GPs and there was a process to follow with screening questionnaires and initial tests. It was explained that GPs would then decide the best course of action for the patient; this could involve the post-Covid syndrome service or another course of action.


Cllr Smith enquired about the numbers of post-Covid syndrome for Black, Asian, and Minority Ethnic communities who had been disproportionally impacted by Covid-19. Dr Melissa Heightman noted that there was an excess of white, British people in the patients referred and it was not certain whether this reflected the nature of post-Covid syndrome or whether this related to health inequality. It was explained that, on average, 34% of post-Covid syndrome patients were from Black, Asian, and Minority Ethnic backgrounds. However, in one cohort of patients that had been proactively contacted after leaving A&E, 47% of people were from Black, Asian, and Minority Ethnic backgrounds.


Cllr Das Neves enquired whether the post-Covid service had sufficient capacity for demand and whether GPs were sufficiently aware that they could make referrals. Dr Melissa Heightman noted that some communications work was required but that the London pathway needed to be confirmed beforehand  ...  view the full minutes text for item 8.



This paper provides a written response to the deputation made at the North Central London Joint Health Overview and Scrutiny Committee meeting on 25 September 2020 on temporary service changes made in response to Covid-19.


The Chair stated that this item detailed the written response to the deputation made at the meeting on 25 September 2020 on temporary service changes made in response to Covid-19. It was noted that a question had been received from a member of the public about how a pan-London Joint Health Overview and Scrutiny Committee (JHOSC) would be set up. It was explained that the health scrutiny regulations required a JHOSC of all of the local authorities affected be set up to respond to proposals by NHS bodies for permanent and substantial changes to services. If and when such proposals were brought forward, action would be taken to set up an appropriate health scrutiny body to respond. Whether this was a pan-London JHOSC would depend on the nature and scope of the proposals.


It was noted that the written deputation response, which added to the verbal response provided at the meeting, was published online but would also be circulated to the people who had brought the deputation. It was added that the Committee would ensure that any proposals were scrutinised effectively.


Cllr Freedman enquired whether it was clear to local people that the changes were temporary. She noted that there had been a petition in Barnet about the temporary move of Children’s Services from the Royal Free to Barnet Hospital and it was clear that the petitioners thought that the changes were permanent. Will Huxter noted that the communications on this issue explained that the changes were temporary. He added that the temporary nature of the changes to paediatrics had also been stressed at a recent scrutiny meeting in Camden. He acknowledged that these sorts of messages did not always get through to local people but noted that any substantial permanent changes would require consultation.




To note the report.



This paper provides an outline of the 2020-21 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

Additional documents:


The Chair noted that the items on General Practice and Digital GP could be removed from the work programme as there had been detailed discussion about GPs during this meeting and there would be further discussion relation to digital inclusion at future meetings. It was noted that there was a wider item on tackling inequalities through prevention and early intervention but that it might be useful to consider this specifically in relation to the disproportionate impact of Covid-19 on ethnic minorities. The Chair also stated that the Committee had requested reports on the post-Covid syndrome pathway, the Healthy Intent initiative, digital inclusion, and missing cancer patients. 


Rob Mack, Principal Scrutiny Officer, explained that a seminar delivered by Mike Cooke on the integration of health and care had been organised but had to be cancelled due to the national lockdown. It was suggested that this could be reorganised to be delivered as an online seminar.


Cllr Das Neves suggested that mental health should be added to the work programme as this extremely important at present. The Chair added that Dr Katie Coleman had referred to an increased suicide risk and she believed that a piece of work was being developed to support mental health. Cllr Revah added that the mental health of carers had been significantly impacted during the Covid-19 pandemic and asked for carers to be included in any paper on mental health.


Cllr Smith suggested that health inequality and the disproportionate impact of Covid-19 on Black, Asian, and Ethnic Minority communities would require further consideration. The Chair stated that this was a very wide-reaching topic and that it might be useful to consider health inequality as part of the digital inclusion paper, particularly if digital services were not being accessed by particular communities; it was noted that it would be helpful for this paper to include what was being put in place to mitigate health inequality. The Committee commented that it would be useful to invite some organisations working with Black, Asian, and Ethnic Minority communities and faith communities as they had direct experiences and would bring a different perspective. It was added that this report would need to be underpinned by specific data.


Cllr Cornelius noted that a seminar was being delivered to Barnet councillors relating to Covid-19, housing, and mental health; it was suggested that this seminar or the research undertaken might be useful to other Councils.


Rob Mack, Principal Scrutiny Officer, noted that Camden Council had undertaken a report on the disproportionate effect of Covid on Black, Asian, and Minority Ethnic communities which could be circulated to the Committee. The Chair added that Hackney Council had hosted a meeting with a number of high profile speakers and that it might be useful to see if they had produced a follow up report.


29 January 2021

·         Post-Covid syndrome pathway, including communications, the financing for the therapies teams, and a section about which communities were presenting with post-Covid syndrome given concerns about the disproportionate amount  ...  view the full minutes text for item 10.



To consider any items of urgent business as identified at item 3.


There were no new items of urgent business.



To note the dates of future meetings:


29 January 2021

26 March 2021


It was noted that the dates of future meetings were:


29 January 2021

26 March 2021