Agenda and draft minutes

North Central London Joint Health Overview and Scrutiny Committee
Friday, 29th January, 2021 10.00 am

Venue: Remote Meeting - MS Teams

Contact: Robert Mack, Principal Scrutiny Officer / Fiona Rae, Principal Committee Co-ordinator  3541 Email: fiona.rae@haringey.gov.uk

Note: This meeting will be webcast - use the link on the agenda frontsheet or copy and paste the following link into your internet browser: https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZDUxZjBhMDctZjIwYS00YmNlLWI0ZDEtNDBkNTI4NDZhNGI4%40thread.v2/0?context=%7b%22Tid%22%3a%226ddfa760-8cd5-44a8-8e48-d8ca487731c3%22%2c%22Oid%22%3a%22515ca3a4-dc98-4c16-9d83-85d643583e43%22%2c%22IsBroadcastMeeting%22%3atrue%7d 

Items
No. Item

1.

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

2.

APOLOGIES FOR ABSENCE

To receive any apologies for absence.

Minutes:

Apologies for absence were received from Paul Fish, Royal National Orthopaedic Hospital.

3.

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 11 below).

Minutes:

The Chair noted that a deputation had been received from NCL NHS Watch.

ORDER OF BUSINESS

The Committee agreed to receive Item 13 (Deputation on Integrated Care Systems) as the first substantive item so that local concerns could be presented to the Committee. Also, due to the availability of the presenters, this would be followed by Item 6 (Covid Update), Item 8 (Mental Health Services during the Covid-19 Pandemic), and Item 7 (Post-Covid Syndrome Pathway), before returning to the order of business as set out in the agenda.

4.

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 Cornelius noted that, in case care homes were discussed, she would like to note a non-pecuniary interest as she was a Council appointed Trustee of the Eleanor Palmer Trust. Cllr Connor also noted that she was a member of the Royal College of Nursing and that her sister worked as a GP in Tottenham.

5.

MINUTES pdf icon PDF 259 KB

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 27 November 2020as a correct record.

Minutes:

RESOLVED

 

That the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting held on 27 November 2020 be confirmed and signed as a correct record.

6.

COVID-19 UPDATE pdf icon PDF 313 KB

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

Additional documents:

Minutes:

Will Huxter, Clinical Commissioning Group (GGC) Director of Strategy, and Chloe Morales Oyarce, CCG Head of Communications and Engagement, introduced the item which provided an update on the Covid-19 pandemic in North Central London (NCL). It was noted that the pressures on health and care services were significant and that, although there had been a reduction in community cases, there were still large numbers of patients in hospital and particularly in intensive care. It was noted that a number of staff had been redeployed and partnership working was in place as much as possible. It was added that regional and national communications were highlighting that regular health and care services were operating.

 

Cllr das Neves enquired what support was in place for staff wellbeing. Will Huxter explained that a range of psychological and other support had been put in place across North Central London (NCL) and there were regular communications to staff about the support available. It was added that the Occupational Health offer was being enhanced and that specific work was underway to establish what support would be most useful for staff.

 

Cllr Smith noted that a number of NHS staff were unwell or self-isolating and asked about the levels of testing and vaccination of staff; it was also asked whether there was any reluctance to be vaccinated within the care system. Will Huxter explained that staff in hospitals and clinical staff undertook regular testing and were included as a priority group for vaccinations; it was added that there were high levels of uptake in all hospital sites across NCL. It was acknowledged that there was some vaccine hesitancy in care settings and that work was underway with all five boroughs to target support, advice, and messaging. Cllr Smith also enquired whether and how the NHS was using volunteering networks. It was confirmed that there were many good examples of partnership working with volunteers. Will Huxter noted that a written update could be provided to members on vaccine hesitancy in care settings and on volunteers within the NHS.

 

Cllr Freedman asked about the military support that was provided in intensive care. Will Huxter explained that military support was from combat technicians who assisted the experienced intensive care staff with tasks such as turning patients. It was noted that there were about 40 combat technicians currently working in NCL.

 

Cllr Cornelius noted that pharmacies had used a mutual aid strategy to share vaccination but that the five boroughs within NCL had different populations and some areas had older populations. It was enquired whether this system had been perfected and, in particular, whether there would be sufficient vaccination supplies for the second round of vaccinations for care homes. Will Huxter explained that the target populations across NCL were being examined and planning was underway. It was known that different areas had different demographics which may require additional vaccination supplies; there was regular contact with regional and national colleagues and there was confidence that there would be sufficient supplies.

 

Cllr  ...  view the full minutes text for item 6.

7.

POST-COVID SYNDROME PATHWAY pdf icon PDF 400 KB

This paper provides further information on the Post-Covid Syndrome pathway.

Minutes:

Dr Katie Coleman, Islington GP and North Central London (NCL) Clinical Lead for Primary Care Network Development, and Dr Melissa Heightman, Clinical Lead for the Covid follow up Service and NCL representative for the London Respiratory Network, introduced the item which provided an update on the Post-Covid Syndrome pathway. It was explained that the second wave of the Covid-19 pandemic had been significant and would likely be followed by increased demand for the Post-Covid Syndrome service. It was highlighted that this was a new condition and understanding of the disease was developing. It was important to have a Post-Covid Syndrome pathway and this had been developed with the recognition that it was a multi-system condition and required a multi-disciplinary approach. This had resulted in the NCL Post-Covid Syndrome Integrated Service and there was equity of access across NCL.

 

Cllr das Neves enquired whether there was confidence in the anticipated numbers of people with Post-Covid Syndrome and the extent of the role of immunology. Dr Katie Coleman stated that there was not a lot of confidence in the numbers but these were based on national figures which estimated that about 10% of the total people who contracted Covid-19 would have Post-Covid Syndrome. Work was ongoing to better understand the demand and presentation in the community and a specific Post-Covid Syndrome code would be added to the clinical system shortly. It was also noted that the numbers of Covid-19 cases had significantly increased and it was anticipated that there would be a similar increase in the numbers of Post-Covid Syndrome cases; there were concerns about capacity in the system to deal with these additional numbers. It was highlighted that sufficient funding would be key and it was important to be able to resource community teams who could assist in patient recovery. It was noted that funding conversations were ongoing with NHS England.

 

It was noted that previous cases had often started as a referral to respiratory and then another referral to the Post-Covid Syndrome service. It was explained that the Post-Covid Syndrome pathway aimed to have a single point of access which would minimise multiple referrals. Dr Melissa Heightman explained that Post-Covid Syndrome was a multi-system disease and that the best approach was often to wrap specialty teams around the patient. It was noted that immunology featured in some patients and that rheumatologists, who were included in the multi-disciplinary team, had immunology expertise. It was explained that immunologists were often based in laboratories but were sometimes contacted to provide detailed information by phone.

 

Cllr das Neves enquired whether NCL was considering the research that was being developed in Canada and other places. Dr Melissa Heightman explained that clinical services were reliant on peer reviewed publications but that there were currently no clear therapeutic options from research. It was noted that research would be continually reviewed and that some funded research programmes in the UK were due to be announced soon.  ...  view the full minutes text for item 7.

8.

MENTAL HEALTH UPDATE pdf icon PDF 491 KB

This paper provides an update in relation to Mental Health Services.

Additional documents:

Minutes:

The Chair introduced the item which provided an update on mental health services during the Covid-19 pandemic. It was noted that the Committee had received the written report and the presenters were invited to highlight any key points. The Chair also congratulated Jinjer Kandola on her recent MBE for Services to Mental Health. Jinjer Kandola, Chief Executive for Barnet, Enfield, and Haringey (BEH) Mental Health Trust, and Andrew Wright, Director of Planning and Partnerships for BEH Mental Health Trust, introduced the report.

 

It was noted that there were currently more Covid-19 outbreaks in wards and among NHS staff as the new variant of the disease was more transmissible; this included up to 11% of staff unwell or self-isolating. Unlike the first wave of the disease, it was explained that there had been less of a reduction in the number of people accessing mental health services. However, it had been necessary to temporarily close some beds as a result of infection prevention control measures and there had been a need to use some out of area placements which was less desirable.

 

The Committee enquired whether there had been any decreases in service use for any services that had changed. Jinjer Kandola highlighted that all mental health staff had worked exceptionally hard to ensure that all NCL services continued throughout the pandemic. It was noted that there had been some service transformation during the Covid-19 pandemic and this included a single point of access for referrals, a new process for entry to A&E where patients were seen in a dedicated area by specialist staff, a new 24 hour telephone helpline with previous telephone numbers forwarded to the new number, and additional support for Black, Asian, and Minority Ethnic staff as well as other staff at higher risk. It was added that digital services were offered based on patient choice, specific work was undertaken to support those who were shielding, and all community case loads were assessed, risk rated, and prioritised accordingly. It was explained that there had been a focus on appropriate discharging and winter funding had been used to work with Mind and other organisations to ensure that people had the care they needed.

 

Cllr das Neves noted that future plans for health care would be managed at NCL level under the Integrated Care System (ICS) and it was enquired how it would be possible to find a balance between consistency and tackling local issues with specialised care. Jinjer Kandola explained that residents felt that they lived in a neighbourhood rather than a borough and it was important that care was delivered in this way. It was highlighted that the long term plan aimed to ensure that there was a consistent model in all five boroughs but that local specialisation would be possible. The Chair noted that it may be appropriate to discuss this issue at the Committee’s special meeting on ICS in March 2021.

 

Cllr Revah enquired what support was being provided to staff and others impacted, such  ...  view the full minutes text for item 8.

9.

DIGITAL INCLUSION pdf icon PDF 719 KB

This paper discusses digital inclusion in response to the increasing digital approach to healthcare.

Minutes:

The Chair introduced the item and explained that a number of local organisations across NCL had been invited to speak to the Committee to provide an insight into their experiences in relation to digital inclusion.

 

Rabbi Hackenbroch, Woodside Park Synagogue (Barnet), noted that, initially, there had been a lot of excitement in setting up an online presence and allowing people to see each other. Some advantages of using a digital platform were that it was possible to deliver the usual programmes, prayers, and memorials, people who were usually unable to attend for a variety of reasons had additional opportunities, and it had been possible to achieve a more personal touch with virtual breakout rooms. Some challenges were that there was an excess of digital options, including for schooling and work, and this meant that many people did not want to spend additional time looking at screens. Also, some people struggled to use digital options for a number of reasons. It was noted that, in future, the synagogue would be running virtual options alongside physical one to incorporate the whole community to maintain increased connections and engagement.

 

James Dellow, Covent Garden Dragon Hall Trust (Camden) and SoapBox Youth Centre (Islington), explained that a key principle of youth work was to engage on platforms that young people were already using; a variety of online platforms had been used during the pandemic, including a YouTube channel, and these had been very successful. It was noted that partnership collaboration and considering new options had been incredibly valuable. Although, it was acknowledged that platforms such as Teams and Zoom were not designed for young people or for natural communication and could feel quite impersonal. It was stated that it had been challenging to work in a reactive way to the national restrictions but that it would be important to think about preparedness in the short and long term future. It was highlighted that it was important to avoid saying that virtual provision was not as good as physical provision as it reduced the value of virtual which, for some people, was a better option. It was added that providing virtual hardware and internet data had helped in reducing the digital divide but that it was also crucial to provide things such as digital skills and online safety awareness.

 

Nick Chanda, SACRE and Multi Faith Forum member and Revival Christian Church (Enfield), explained that he had a predominantly Black congregation and the church building had not been open since March 2020. It was explained that there had been a number of advantages in providing digital options as people still felt part of the community as they could get services at home, there was no need to travel, and people could join from all over the world. It was noted that there had been some challenges; this included a lack of digital devices or accounts to access digital platforms and the need to adapt to new digital platforms where it was difficult to connect  ...  view the full minutes text for item 9.

10.

WORK PROGRAMME pdf icon PDF 355 KB

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

Additional documents:

Minutes:

The Chair noted that the work programme was set out in the report but that Digital Inclusion would need to be considered at the next meeting and that this may take the place of HealtheIntent.

 

12 March 2021

·         Digital Inclusion

·         Missing Cancer Patients

·         Health Inequalities

·         HealtheIntent

 

19 March 2021

·         Special meeting on Integrated Care Systems

 

RESOLVED

 

To note the report.

11.

NEW ITEMS OF URGENT BUSINESS

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

Minutes:

There were no new items of urgent business.

12.

DATES OF FUTURE MEETINGS

To note the dates of future meetings:

 

19 March 2021 (changed from 26 March 2021 due to the pre-election period)

25 June 2021 (provisional)

24 September 2021 (provisional)

26 November 2021 (provisional)

28 January 2022 (provisional)

25 March 2022 (provisional)

Minutes:

It was noted that the future North Central London Joint Health Overview and Scrutiny Committee meetings were scheduled for:

 

12 March 2021

19 March 2021 (special meeting to consider Integrated Care Systems)

25 June 2021

24 September 2021

26 November 2021

28 January 2022

25 March 2022

13.

DEPUTATION ON INTEGRATED CARE SYSTEMS pdf icon PDF 572 KB

To receive a deputation from North Central London NHS Watch.

Minutes:

Brenda Allen, NCL NHS Watch, explained that the deputation had been submitted in relation to the national consultation on Integrated Care Systems (ICS). It was noted that the written deputation, which had been circulated to members and published online, outlined the key issues but that NCL NHS Watch would like the Joint Health Overview and Scrutiny Committee to consider the following issues.

 

·         There were some accountability and representation concerns, including whether there would be representation and voting rights for councillors, clinicians, members of the public, patient representatives, and private sector providers.

·         Whether ICS would be responsible for present or future deficits, as some existing Trusts had a deficit, and how this would impact the ICS budget.

·         How ICS responsibilities would interact with Council responsibilities for social care and public health, including how the budgets would be pooled and managed and how much input Councils would have on priorities and spending.

·         The role of Health and Wellbeing Boards and Partnership Boards, specifically their ability to influence and determine local priorities and resource allocation and how they would be able to influence ICS level decisions.

·         Which bodies would have oversight and scrutiny powers over ICS.

·         There were concerns about the health data that would be held by ICS and held by any contractors and how data would be safeguarded.

·         It was noted that there had been previous issues with health and social care integration, including eligibility, funding, and accountability, and it was not clear in the consultation document how this would be achieved effectively by ICS.

·         There were also concerns about the mass transition to virtual access for GPs; this was understandable during the Covid-19 pandemic but it was considered that face-to-face provision was vital for continuity of care, diagnoses, and treatments. It was added that many cross-sections of the community, including GPs, preferred face-to-face interactions and this was not limited to older people or those who spoke English as an Additional Language.

 

The Committee asked about the desired role for patients and other local representatives in ICS Boards. Brenda Allen, NCL NHS Watch, explained that a number of concerns related to the erosion of local involvement. It was noted that some reduced involvement during the Covid-19 pandemic was understandable but that it would be important to ensure that this was not embedded for the future. It was stated that better health decisions were made when patient and councillor experience was included in the decision making process to design and deliver accessible healthcare. It was added that the inclusion of councillors, in particular, as voting members of the ICS Board would be essential for accountability and democracy.

 

The Chair thanked NCL NHS Watch for the deputation and noted that the voice of the community would be key to the Committee’s discussions on ICS.