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 were received from Paul Fish, Royal National Orthopaedic Hospital

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.

None.

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

Deputation 1

The Committee received a deputation from NCL NHS Watch and led by Professor Sue Richards, on the sale of AT Medics to a subsidiary of Centene Corp, which was large American health insurance company. The key points of the deputation were:

• Concerns were expressed with the decision by NCL CCG to agree a change in control of the 8 APMS contracts in North Central London which had hitherto been held by the company AT Medics Ltd, allowing them to pass over the contracts to Operose, a wholly owned subsidiary of Centene Corporation, a US health insurance company which provides medical cover for Medicare, Medicaid and the Affordable Care Act (Obamacare).
• Further concerns were expressed around the fact that Centene had received a number of fines from US regulators for regulatory breaches.
• It was suggested that there were strong public objections to this change, both politically in the affected boroughs as well on the ground with residents and in the local press.
• It was felt that the CCG would not have selected a subsidiary of Centene in open competition due to its poor track record and the political fallout from doing so. Instead, it was felt that the purchasing of AT Medics Ltd along with the contracts it held was effectively a Trojan horse to afford Centene access to NHS primary care contracts. It was felt that if this was allowed to go ahead, then this would only be the beginning and Centene would look to acquire more and more health contracts in the UK. The deputation party questioned what the CCG would do if they bid for more contracts in NCL.
• Contrary to assurances given to the Primary Care Commissioning Committee (PCCC) by the directors of AT Medics that they would remain in place and working practices would not be affected, all six directors resigned their position in February and had been replaced with employees of Centene and Operose. Particular concerns were raised that the CCG were aware of this when they subsequently ratified the change of ownership in late February.
• Concerns were also put forward that during the PCCC meeting on 17 December, no mention was made of Centene being involved. Instead, this information was confined to Part 2 of the meeting which was not made available to the public and from which all non-voting members, including the community member, was excluded.
• It was contended that NCL CCG was likely put under a lot of pressure by NHSE to waive through this change of control and it was speculated this was part of  a wider political strategy by the government to agree a free trade deal with the USA.

The following arose in discussion of the deputation:

1. In response to a question around what should happen now, the deputation party suggested that the CCG needed to acknowledge that they had created a big problem and that their actions had resulted in a lack of trust. It was also suggested that the JHOSC should seek assurances from the  ...  view the full minutes text for item 5.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 29 January 2021 as a correct record.

RESOLVED

That the minutes of the meeting held on 29^th January were agreed as a correct record.

This paper provides an update in relation to health inequalities.

*Clerk’s note - due to the availability of the speakers, the JHOSC agreed to amend the order of the agenda items: to take the Health Inequalities item first, then Missing Cancer Patients, then Digital Inclusion. The minutes reflect the order I  which the items were discussed.*

The Committee received a presentation on Addressing Health Inequalities from the Ruth Donaldson, Director of Communities for North Central London Clinical Commissioning Group (NCL CCG). The presentation was set out in the supplementary agenda pack at pages 45 – 76. The following arose during the discussion of the presentation:

a.    The Committee sought assurances around the low uptake of vaccinations within vulnerable and minority groups. In response, officers acknowledged that there was trend of lower uptake levels amongst a number of communities who were at risk of inequalities. Officers advised that they working with specific groups who had low uptake rates and had held a series of open community meetings. A number of targeted community events had also taken place in different languages and adverts had also appeared on Somali language TV, for example. NCL staff had also been working with organisations such as Groundswell to reach the homeless cohort.

b.    The Committee expressed particular concern for the relatively low uptake rate amongst social care staff and queried why this might be. In response, officers advised that an Enfield Healthwatch report had set out that a historic mistrust of public services from certain communities was a key factor. It was suggested that this should be characterised as hesitancy rather than refusal to be vaccinated and that a lot of work was going on to provide information and additional assurance around this.

c.    The Committee queried what new initiatives could be undertaken around health inequalities and how could local councillors be involved in these. The Committee welcomed any opportunity for local councillors to be involved in decision making. In response, the Committee was advised that there were a number of ideas for anticipatory care models including ‘ageing well’, which were about putting more prevention into people’s care and more resources into deprived areas. Although need and budgets were compiled at a central NCL level, officers outlined a model used in Leicester were local areas bid for funds and individual schemes. It was envisaged that the development of a NCL population health committee would be one of the opportunities that could arise from moving to an Integrated Care Partnership.

d.    In response to a request for clarification, it was confirmed that the colours in the indexes of deprivation in the presentation highlighted the top 20% and that the fact that Barnet was only shown in the fuel poverty index was accurate.

e.    The Committee commented that it was not necessarily the NHS’s fault that historic mistrust in health services and vaccines existed from some people who may come from parts of the world where there were good reasons for that mistrust including corruption. It was queried the extent to which socio-economic factors played a role in  ...  view the full minutes text for item 7.

This paper provides an update on possible missing cancer patients as a result of the Covid-19 pandemic.

The Committee received a presentation which set out the impact of COVID-19 on Cancer treatment in NCL. The presentation was introduced by: Professor Derralynn Hughes, Haematologist at Royal Free and Dr Clare Stephens, GP and NCL CCG governing body member. Nasser Turabi, Managing Director for the NCL Cancer Alliance was also present for this agenda item. The presentation was as set out in the supplementary agenda pack at pages 35-44. The following arose from the discussion of the presentation:

a.    The JHOSC noted that cancer referrals were down 30% in January 2021 from January 2020, however this position had improved from a drop of 70% in April 2020. Cancer referrals were now back to pre-Covid levels, however it was cautioned that this was not the whole picture as it related to referrals from GP practices and that there were longer term considerations in other areas.

b.    The JHOSC raised concerns about the impact on staff from increased waiting times and backlogs and queried the extent to which staff may be close to being burnt-out. In response, NCL officers acknowledged these concerns and advised that there were not many opportunities to expand the staffing base as the field of cancer treatment was very specialised. This was also compounded by existing staffing shortages. The Committee were advised that Trusts were allowing staff to carry over leave and were also providing opportunities for them to take this leave. The JHOSC were advised that overall, cancer services were not of particular concern, as the prioritisation and funding for cancer treatment was there. Other NHS services were likely to be more affected due to the high volume of usage such as ENT or orthopaedics.  

c.    In relation to a follow-up question around why there was a shortage of anaesthetists, the JHOSC was advised that critical care doctors and anaesthetists received the same training and so when critical care was ramped up in the wake of Covid, anaesthetists were the first to be drafted into critical care.

d.    NCL officers assured the Committee that although there was a backlog and that this was more acute in community care settings, that everyone who need urgent cancer care would have access to it. Other, non-urgent, cases may need to be mitigated in order to prioritise the urgent cases.

e.    In response to a query about whether, in order to support those with longer term manageable issues, other services needed to be bought in from other providers, NCL reiterated that, overall, cancer was prioritised and urgent cancer services had been protected but that some people whose condition could be managed would see delays. It was suggested that having to bring in support from other areas and other providers was more applicable to other areas of NHS care.

f.     The JHOSC queried whether there were areas within NCL that could benefit from improved communications around the services that were offered and, conversely, those not available?. In response, it was noted that they had NCL were not aware of  ...  view the full minutes text for item 8.

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

The JHOSC received a presentation on digital inclusion, which was introduced by Will Huxter, Director of Strategy– NCL CCG and Chloe Morales Oyarce, Head of Communication and Engagement - CCG. The presentation was set out in the supplementary agenda pack at pages 5-34. The following arose from the discussion of this agenda item:

1. The JHOSC raised concerns about the risk of non face-to-face GP appointments, brought in because of Covid, being introduced permanently and emphasised the importance of being able to see a GP in person. In response, NHSE advised that face-to-face appointments would continue but that they also wanted to give people a choice about accessing services. NCL CCG set out that services were starting to go back to normal but that a range of digital services would be available for those that wanted them.
2. The JHOSC sought assurances that the IT systems were in place to support this and that these systems were up to the job.  In response, the CCG acknowledged these concerns and advised that these were long-term commitments about how services were offered and that as part of the roll-out of the projects within this digital approach there would be opportunities to improve the IT systems and IT processes in partnership.
3. The Committee emphasised the importance of user research and engagement when changing services. NCL CCG acknowledged that there was more that could be done about improving the experience of patients. However, there was an online representative board in place, which had local representation, however this did not include political representation. It was noted that the political oversight was done through the overarching programme board.
4. The JHOSC also emphasised the centrality of equalities legislation and the fact that the NHS would have to set out specifically how each of the protected groups would not be unduly affected by NCL’s digital approach. This point was acknowledged by NCL CCG and the committee was advised that they were looking to develop an action plan around this.
5. In response to a question, the JHOSC was advised that the responses to E-Consult even in Enfield were relatively low, so it was difficult to say why the scheme had performed better there than elsewhere. It was suggested that this was likely due to it being better communicated to residents in key locations, such as local GP surgeries.
6. Will Huxter agreed to circulate an updated annotated version of the slides which included a glossary of terms. (Action: Will Huxter).
7. The JHOSC sought further assurance about the absolute right of patients to see their GP in person. NCL CCG reassured the JHOSC that this was absolutely the case and that the term ‘right to digital’ was just about giving people a choice.
8. The JHOSC raised concerns about the possibility of patients who accessed services digitally being given first choice of appointments, for example. In response, Members were advised that GPs would respond appropriately and that there was no desire to just funnel people down digital means of access.
9. The CCG agreed to  ...  view the full minutes text for item 9.

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

The JHOSC considered the draft work programme.

In relation to additional items for inclusion on the work plan, the following items were put forward:

• Follow-up/feedback on the Royal Free discussion from a previous meeting. (September).
• Item on Integrated Care Systems and the local authorities role within this. (TBC)
• Funding inequalities/finance element of health inequalities. To include Public Health review funding allocations. (September).
• GP Services, to include the GP federation. (June)
• Digital exclusion (June)
• Services for young adults transitioning to adult hood. (TBC)

It was agreed that the Scrutiny Officers would circulate a draft work programme via email for further comments.  (Action: Rob Mack).

RESOLVED

The North Central London Joint Health Overview & Scrutiny Committee:

1. Noted the work plan for 2020-21;
2. considered proposals for agenda items for meetings in 2021/22;
3. agreed provisional items for the first meeting of the Committee of 2021/22, which would be on 25 June 2021.

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

N/A

To note the dates of future meetings:

19 March 2021 (special meeting on Integrated Care Systems)

25 June 2021

24 September 2021

26 November 2021

28 January 2022

25 March 2022

19^th March 2021.