Agenda and draft minutes

Special Meeting - Integrated Care Systems, North Central London Joint Health Overview and Scrutiny Committee
Friday, 19th March, 2021 10.00 am

Venue: Remote Meeting - MS Teams

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

Note: Special Meeting: Integrated Care Systems. 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.


Apologies for absence 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 8 below).


There was no urgent business.



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



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.


Due to the availability of the presenters, the Committee agreed to receive Item 5 (Deputation on Integrated Care Systems), followed by Item 7 (Integrated Care Systems), and then Item 6 (Procurement of GP Services (AT Medics)).



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


The Chair noted that a deputation had been received from NCL NHS Watch on Integrated Care Systems (ICS).


Brenda Allan, NCL NHS Watch, explained that she had addressed the Committee before in relation to ICS and that a white paper, Integration and innovation: working together to improve health and social care, had now been published.


She noted that there had not been a lot of consultation but that the proposals were far reaching and would amalgamate local authority and NHS assets and services. It was acknowledged that the stated goals in the white paper were laudable but that there was a significant lack of detail in relation to the proposed positions, context, and practical arrangements.


NCL NHS Watch had concerns that the proposals would result in an unequal partnership with a lack of democratic accountability. It was stated that the letter accompanying the white paper noted that the composition of the proposed NHS Board would need to support effective decision making; it was felt that this would lead to limited representation on the main, decision making body and that not all parties would be equal partners. Although there were borough based partnerships, it was felt that these would be NHS dominated and that there would be no new funding for local authorities.


Brenda Allen, NCL NHS Watch, noted that there were concerns relating to social care, public health, and local democracy. It was stated that the current crisis in social care was not acknowledged in the white paper and it was felt that public health had not been prioritised. It was commented that the proposals would reduce the role of local government and that this would limit the ability for the full integration of health and social care. It was added that NCL NHS Watch had not been reassured by the NHS England responses to concerns raised about digital and remote consultations. It was considered that public health issues were not easily addressed by ICS and that key services addressing inequalities had been cut back by local authorities. It was stated that Joint Strategic Needs Assessments and ongoing public health work recognised the importance of addressing inequalities but that political will and funding also was required.


It was stated that there should be further consideration of how the ICS framework could be used to produce something more collaborative which genuinely involved local authorities and the public. It was suggested that further consultation was required and that the implementation of the proposals should not be rushed. In particular, NCL NHS Watch noted that further detail was required in relation to parity of representation and voting rights, how ICS would be accountable particularly where local authority services were involved, the balance of digital and in-person provision, and the role of independent providers in relation to resource allocation.


In response to a question about the importance of localised services and tackling health inequalities, Brenda Allen stated that the NHS was largely a curative organisation and that, in order to tackle inequalities, joint  ...  view the full minutes text for item 5.



To receive an update on the procurement of GP services and AT Medics.


The Chair introduced the item and explained that a deputation on the procurement of GP services (AT Medics) had been received at the Committee meeting on 12 March 2021. It was noted that there had been no time for officers to reply at the previous meeting so this item had been deferred. Frances O’Callaghan, NCL CCG Accountable Officer, Jo Sauvage, NCL CCG Chair, and Will Huxter, CCG Director of Strategy, were in attendance for this response.


Frances O’Callaghan acknowledged the concerns that had been raised. It was explained that the papers relating to the decision had been published on the CCG website. It was noted that the discussions had been split between a public meeting (part 1) and a private meeting (part 2) which dealt with any items subject to commercial confidentiality. It was highlighted that the Primary Care Committee was Chaired by a lay member and frequently had private (part 2) discussions where contracts were involved. It was explained that, in the public meeting, the decision was made subject to due diligence and checks with Companies House. It was noted that the company, Centene, was not referenced in the public part of the meeting but that this was an oversight as the company name was very clear in the private meeting documentation and was not due to any ill intent. Frances O’Callaghan apologised for anything that had been unclear.


It was explained that there had been a deputation on AT Medics in January 2021 which had been heard and responded to. The concerns raised were recognised and, in hindsight, it was acknowledged that it would have been better to proactively inform elected members. However, Frances O’Callaghan stated that she wanted to clarify what the CCG was able to do; it was explained that the CCG was committed to public sector provision but that private provision was permitted in the Health and Social Care Act 2011 and the CCG had a responsibility to act within the law otherwise it would be at risk of legal challenge and financial penalties. It was added that the CCG had now provided comprehensive responses to the deputation, councillors, and other groups and it was hoped that the position had been clarified.


In terms of next steps, Frances O’Callaghan stated that the CCG was committed to providing the best possible care. It was commented that the AT Medics contract could not be terminated but that it was rated as Good and would continue to be monitored. It was explained that, where there were workforce shortages, the NHS was sometimes reliant on external support. It was accepted that some elements of the process could have been improved but that the CCG had tried to ensure transparency and had acted in accordance with the law and other CCGs in London, including following advice from NHS England where relevant.


Jo Sauvage noted that this had been a pan-London decision, that the CCG was not able to reverse the decision, and it was unfortunate that North  ...  view the full minutes text for item 6.



To consider and discuss Integrated Care Systems (ICS).


Mike Cooke, ICS Independent Chair, Rob Hurd, Joint System Lead, and Frances O’Callaghan, CCG Accountable Officer and Joint System Lead, introduced the item which provided an opportunity to consider and discuss Integrated Care Systems (ICS). Mike Cooke noted that arrangements would need to be put in place for the 2021-22 financial year before the official legislation on ICS came into effect in 2022. It was explained that officers would be able to present the current thoughts and proposals for North Central London (NCL) and would welcome the views of the Committee but might not be able to answer all questions on the government proposals for ICS.


It was noted that the white paper proposed a national ICS framework which was intended to formalise the existing arrangements across the country. Although the white paper did not discuss the ambitions and purpose of health and social care integration, these were set out in the long term plan which was cross-referenced in the white paper. It was also noted that the white paper did not include social care as the government had decided to deal with this separately.


It was explained that the proposed approach for NCL for 2021-22 was set out on page 14 of the supplementary agenda pack. It was noted that there were five existing borough partnerships in NCL and the white paper was clear that the operation of these partnerships would be determined locally rather than detailed in legislation. In NCL, it was proposed to have a Partnership Board which would agree the overall ambitions and policies of the ICS and would include local authority Leaders. There would also be a NCL Steering Committee which would oversee operational activity and which would include local authority representatives. In addition, NCL would have a Community Partnership Forum to engage proactively and a Population Health and Inequalities Committee. It was considered that NCL was well placed to meet the ambitions set out in white paper and would be addressing some important priorities in 2021-22, including delivery of the Covid-19 vaccination programme, service recovery, and strategic reviews of community services and mental health services.


Some members of the Committee felt that the proposed structures reduced the involvement of councillors and stated that there should be some changes to the governance structure to ensure a continued scrutiny-based approach. Members enquired about the role that provider Chairs and prospective providers would play in decision making, particularly at the top level and in comparison to other parties, such as councillors and members of the public. Some concerns were also expressed about the lack of detail in the white paper regarding the relationship between health and social care.


Mike Cooke noted that he was an independent ICS Chair and explained that local authority scrutiny arrangements were not expected to change in any new arrangements. He explained that the white paper envisaged that the body making decisions about NHS spending would involve local authority representation and would be subject to the normal scrutiny arrangements. It was added that  ...  view the full minutes text for item 7.



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:


25 June 2021

24 September 2021

26 November 2021

28 January 2022

25 March 2022


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


25 June 2021

24 September 2021

26 November 2021

28 January 2022

25 March 2022