Agenda and draft minutes

North Central London Joint Health Overview and Scrutiny Committee
Friday, 28th January, 2022 10.00 am

Contact: Dominic O'Brien, Principal Scrutiny Officer / Fiona Rae, Acting Committees Manager  3541 Email: fiona.rae@haringey.gov.uk

Note: Briefing. Please see agenda frontsheet for links to view the meeting. 

Items
No. Item

13.

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 Members present to item 1 on the agenda in respect of filming at this meeting.  Members noted the information contained therein.

14.

APOLOGIES FOR ABSENCE

To receive any apologies for absence.

Minutes:

Apologies for absence were received from Cllrs Linda Freedman (Barnet) and Khaled Moyeed (Haringey).

15.

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:

None.

16.

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 Connor reported that she was a member of the Royal College of Nursing and that her sister worked as a GP in Tottenham.  Cllr Cornelius reported that she was a Council appointed Trustee of the Eleanor Palmer Trust.

17.

DEPUTATIONS / PETITIONS / PRESENTATIONS / QUESTIONS pdf icon PDF 496 KB

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

Minutes:

The Committee received a deputation from Brenda Allan and Alan Morton from NCL NHS Watch regarding the Estates Strategy.   Ms Allan stated that the 2018 Strategy had outlined the financial imperatives that lay behind it, which were that there was not enough funding for services.  Capital raised from asset sales had been used to address shortfalls in funding.  There had been a lack of accountability in this process and estates had been eroded.  In some cases, capital receipts had been transferred to revenue accounts. 

 

There had been political and community opposition to the plans in the strategy.  There had been no local authority on the estates decision making board.  Better decisions were taken when more stakeholders were involved.  Alternatives to asset disposals needed to be looked and decision making broadened out.  It was important that the value of estates be retained by the NHS and not just used for one-off revenue expenditure.  Details of asset disposals also needed to be put in the public domain.  She felt that the Committee should agitate for alternatives to asset disposals to be considered fully by NHS partners so that it could be ensured that the NHS had the resources it needed for the future. 

 

In answer to a question, Ms Allan stated that one option would be for the NHS to let properties for use as offices or housing so that it remained as a landowner.  This would both release funds and retain value.  She was aware that money was tight and that budgets had been capped but creativity was required in order to avoid longer term problems.   In answer to another question, she stated that the Estates Board was the key decision making body.   Membership of this needed to be broadened out and voting rights given to external participants. 

 

The Committee thanked Ms Allan and Mr Morton for their contribution.

18.

MINUTES pdf icon PDF 171 KB

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 26 November 2021 as a correct record.

Minutes:

RESOLVED:

 

That the minutes of the meeting of 26 November be approved.

19.

UPDATE ON THE ROYAL FREE AND NORTH MIDDLESEX HOSPITALS PARTNERSHIP pdf icon PDF 124 KB

To receive a verbal update on the Royal Free and North Middlesex Hospitals partnership.

Minutes:

Caroline Clark, Group Chief Executive of the Royal Free, and Dr Nnenna Osuji, Chief Executive of the North Middlesex Hospital, reported on the strategic partnership arrangement that had been developed between the two NHS trusts. 

 

Ms Clark stated that it was important that all providers in north London worked together.  In particular, there needed to be equity between services in the north and south of the area covered by north central London.  The aim of the partnership was to strengthen services and improve access.  In addition, it would allow further consolidation of more specialised services.  Chase Farm hospital had been rebuilt and was now a great facility for all in north central London.  There were also plans expand provision on the site further. 

 

She reported that it had been found that there were variations in community services in the area and the need to invest in them was greatest in the area around the North Middlesex hospital.  Such investment was likely to assist with the performance of the hospital.   The partnership arrangement could also help staff to work across the health system and area as well as bringing in more resources.

 

Dr Osuji stated that the two trusts had been working in partnership since 2017.  The relationship had now been formalised though and this has made it easier to respond quickly to challenges.   There was now a Partnership Board and a Memorandum of Understanding.  The North Middlesex hospital served the vast majority of the population of Enfield and Haringey.  There was a need to ensure that there was equity and parity in service provision and the closer arrangements would enable further consideration of inequality, including scrutiny of relevant data.  Consideration was being given to bringing the population health committees from each trust together. 

 

It was intended that the closer arrangements would increase the sum of the individual efforts of each NHS trust.  It would also provide specific opportunities for development.  The North Middlesex Hospital was a local hospital for local people and would always provide a range of core services, such as ITU, emergency care and maternity services.  There were some more specialised services that the trust was less able to provide and the new arrangements would assist in making them more accessible. 

 

She reported that during the Omicron upsurge in Covid cases, additional beds had been put in place quickly on the Chase Farm site and Cape Town ward had been established. The new arrangements had enabled this to be undertaken quickly.  There was a need to level up services in Enfield and Haringey and additional funds had been acquired to expand the community mentoring scheme.   The Emergency Department at the North Middlesex dealt with challenging numbers of presentations but less than 10% of those attending needed to be admitted and most could be dealt with better in other settings. Work had taken place with primary care to provide access at the hospital and different models were currently being looked at for longer term provision.

 

In answer to a  ...  view the full minutes text for item 19.

20.

ESTATES STRATEGY UPDATE pdf icon PDF 525 KB

To receive an update on the Estates Strategy for hospitals and the Integrated Care System (ICS).

Minutes:

Nicola Theron, NCL Director of Estates, outlined progress with the Estates Strategy.  The previous update to the Committee had been before the Covid pandemic.  New governance structures had since been put in place.  There was now an Estates Board which included Council representation, although it was not a decision making body.  There were also local estates forums which included a range of representatives from individual boroughs, including Councils.  These looked at how partners worked together, shared agendas and the securing of external funding.   Representation from the Committee on these would be welcome. 

 

More than 50% of primary care accommodation had been assessed as unfit for purpose.  There was a driving need for investment and the realisation of assets.  The process was also about reinvestment of capital.  The aim was to ensure that all of primary care estates were fit for purpose but there was insufficient capital available currently.  However, there had been some successful external bids for capital. 

 

It was noted that it was important that there was system wide prioritisation covering the next three to ten years.  There was not enough funding at the moment although some had been obtained though Section 106 agreements and the Community Infrastructure Levy (CiL).  NCL were looking to work with partners on a local and national basis. 

 

Ms Theron reported that there was a need to blend spending on estates and digital provision in a better way.   There were some emerging examples of where this was taking place.  There was also a need for increased capacity at borough level with consistency and improved access.  Health inequalities also needed to be addressed as well as better coordination of governance arrangements. 

 

The three year indication of capital allowances was useful as it facilitated planning.  There was a £20 million reduction in capital though and consideration was being given to clinical led prioritisation.  It was expected that the capital shortfall would reduce.  There was a need for ambition to be maintained and external funding to be obtained. 

 

It was noted that Estates Strategy was likely to be updated later in the year.  It would need to ensure that Primary Care and Primary Network (PCN) priorities reflected local needs and optimises work with local authorities.  There had been few recent estates disposals because of the pandemic.

 

In answer to a question regarding local estates forums, Ms Theron stated that they were similar in each borough.  The Camden forum had met recently and the meeting had involved around 20 partners, including a number from the Council.  They typically met quarterly but there were also informal monthly meetings.  There were terms of reference for the forums.  Representation from Councillors would be welcome, either on an ad hoc basis or more regularly.

 

The Committee requested further information regarding terms of reference, how local concerns were fed into the forums, their relationship with the NCL Estates Board.  Details of membership and access to minutes were also requested.

 

In answer to another question, Ms Theron stated that she was happy to provide  ...  view the full minutes text for item 20.

21.

DENTAL SERVICES UPDATE pdf icon PDF 170 KB

To receive an update on dental services.

Minutes:

Kelly Nizzer, Andrew Biggadike and Rakhee Patel from NHS England reported on NHS dental services in north central London. 

 

Ms Nizzer reported that dental practices had been asked to close at the start of the Covid pandemic due to safety concerns for patients and staff.  They had remained closed for 12 weeks, which had caused a large backlog.  During this period, only patients in urgent need had been seen.  Urgent care hubs had been established and these had been treating between 1500 and 1750 patients per day.  These were still operating, although the numbers of them had been reduced.  Primary care dental services were being gradually re-established, with full capacity being reached in the current quarter.  The backlog in each borough varied and was dependent on the size of the NHS contract. 

 

£50 million of short term funding had been allocated by the government to address backlog.  The funding was only for eight weeks and could not be carried over.  It did not provide for the full range of treatments and was only intended to stabilise patients.  There was a London wide access issue for dental care and this had been the case before the pandemic.  Services were doing that they could to deal with it.  There were still 35 urgent care hubs and these were operational from 8:00 a.m. till 1:00 a.m. and were treating 600 patients per day.  This was not happening anywhere else in the country.  However, they could only see people who were in pain.  The eight weeks of additional funding was welcome but would not fully address the backlog. 

 

Mr Biggadike reported on waiting times for secondary and acute care.    There were no patients waiting for more than 104 weeks at the Royal Free but there a small number waiting for between 52 and 89 weeks.  At UCL, there was only one patient that had been waiting over 104 weeks and the majority were under 52 weeks.  The backlog was affected by clinical priority as those waiting for dental procedures were often not considered high enough.  Some additional funding had been obtained to provide additional general anaesthetic procedure rooms at Barts though.  North east London and Barts had the longest waiting list.   Community Dental Services were recovering well but still under pressure.  In respect of looked after children, there was a pilot project in place for high street dentists to treat them.  Oral health promotion was reliant on being commissioned by local authorities and some were better than others in doing this.

 

Ms Patel reported that there was variation in the levels of dental health amongst children in north central London.  27% of five year olds had been found to be suffering from some sort of decay.  Levels in Haringey and Enfield were well above the average.  Mr Biggadike stated that London wide fluoridation would address this but it was very unlikely to happen.  Some schools had supervised brushing as part of oral health promotion.  Some oral health promotion work was also done with special  ...  view the full minutes text for item 21.

22.

WORK PROGRAMME pdf icon PDF 220 KB

This paper provides an outline of the 2022 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

Additional documents:

Minutes:

It was agreed that the next meeting of the Committee would consider the following items:

·         Mental Health and Community Services Review; and

·         ICS Finance.

 

In respect of the proposed LUTs item, Ms Mansuralli reported that that the service was now operating according to clinical guidelines and there was no further reviews planned.  Only adults were being treated by the service whilst children were being treated by Great Ormond Street  and other NHS tertiary providers.  It was agreed that she would provide a short update in writing to confirm this.

 

In respect of the Mental Health and Community Services review item, it was agreed that the two issues would be separated out.  Although there were common areas between them, there were also key differences.

 

It was agreed that the Fertility Review and Digital/Health Inequalities be added to the list of items for future meetings.  In addition, the proposed item of workforce should be expanded to include details of initiatives at between the Royal Free and the North Middlesex Hospital.