Agenda and 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 for absence were received from Cllr Larraine Revah.

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 10 below).

None.

Cllr Pippa Connor declared an interest by virtue of her membership of the Royal College of Nursing.

Cllr Pippa Connor declared an interest by virtue of her sister working as a GP in Tottenham.

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

It was noted that questions had been submitted by Brenda Allen and Alan Morton of Haringey Keep Our NHS Public (KONP) in relation to agenda item 8 on primary care services.

The Committee determined to discuss these questions alongside the agenda item on primary care services later in the meeting.

To confirm and sign the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 30^th September 2022as a correct record.

The minutes of the previous meeting of the Committee were approved.

RESOLVED – That the minutes of the meeting held on Friday 30^th September 2022 be approved.

To receive an update on the NCL Estates Strategy including finance issues and an overview of key projects.

Nicola Theron, Director of Estates for the North Central London integrated Care Board (NCL ICB), and Adrian Byrne, Director of System Financial Strategy for the NCL ICB, introduced the report for this item highlighting the following key points:

• The recent transition from Clinical Commissioning Group (CCG) to Integrated Care System (ICS) had provided opportunities for Estates with a focus on delivering primary, community and acute investment across all five Boroughs. Recent examples included investment of up to £15m into primary care in Haringey with another £10m to follow, and investment into new Community Diagnostic Centres, including in Finchley and Wood Green, using a blend national and local capital to improve patient outcomes.
• New legislative powers for the ICB had been introduced mid-year and, with a lot of capital allocations sitting with key providers, there were tensions within the system as greater sums were being invested in primary care with a model of multi-purpose tenancies in some cases. There was therefore an ongoing process of engagement with NHS organisations across the NCL area to improve collaborative investment.

Nicola Theron, Adrian Byrne and Sarah Mansuralli, Chief Development and Population Health Officer for the NCL ICB, then responded to questions from the Committee:

• Referring to the figures on page 15 of the agenda pack, Cllr Connor requested further explanation of the funding sources for the capital and on the management of the maintenance backlog. Adrian Byrne explained that there was an annual capital resource limit of £200m but that organisations were funded on a revenue basis which included covering the costs of depreciation and the upkeep for estates. More of the funding allocations across the country were being used to manage the maintenance backlogs. NCL was in a relatively good position in relation to its maintenance backlog but did have a significant PFI (Private Finance Initiative) footprint resulting in regular costs. There were open conversations within the ICS on how to collaboratively achieve best value for capital funding, though there were some challenges posed to capital schemes by current supply chain issues. Nicola Theron added that there were around 180 primary care assets in the NCL area, mainly owned by primary care partners rather than the NHS, and that investment was taking place to assist in the delivery of more integrated models.
• In response to a question from Cllr Connor about the risks associated with £69m of acute backlog maintenance that was categorised as critical, Adrian Byrne said that this came down to assessment and prioritisation within the NCL system and that, while there were emergency funding routes available, he was not aware of any recent examples of these being used. Asked by Cllr Atolagbewhat was done to mitigate critical maintenance issues, Nicola Theron explained that, in such cases, work was required in the short term to support patient safety outcomes. For example, this could include electrical services where compliance was critical to prevent other risks. It was the responsibility of individual organisations to do this with a planned  ...  view the full minutes text for item 31.

To receive an update on NCL Primary Care Services including on previous JHOSC recommendations.

Sarah McDonnell-Davies, Executive Director of Places at NCL ICB, introduced the report for this item noting that the major themes included contracts, access, support for and retention of the workforce, and the integration agenda.

She added that NCL was a high performing primary care system and that the amount of activity in primary care had recently continued to rise, including in GP practices, as well as expanded work with community pharmacies and work with the voluntary sector on social prescribing. Approximately 60% of appointments were now being conducted face-to-face and around 51% were on-the-day appointments. There was also a greater use of data by commissioners to understand quality and performance in primary care - the Primary Care Contracts Committee (PCCC) met regularly in public and published a quality and performance report. As set out in the agenda pack, there had been an increase in NCL staffing levels overall including nurses, while the number of GPs was broadly steady.

Sarah McDonnell-Davies then responded to questions from the Committee with input also provided from Dr Peter Christian, Clinical Lead for Haringey, and Paul Sinden, Managing Director of a local General Practice Provider Alliance:

• Asked for further details about the role of community pharmacies by Cllr Cohen, Sarah McDonnell-Davies explained that community pharmacies were nationally commissioned and that their joint working with GP practices had grown during the Covid-19 pandemic with the vaccination programme. The opportunities for further joint working were being supported locally, such as through the community pharmacy consultation scheme which was being locally funded, and there were regular discussions with the local pharmaceutical committee which represented providers in this area. There was also now an Integrated Medicines Committee as part of the ICB which included representation for community pharmacists. Dr Peter Christian added that there was untapped expertise in the community pharmacy sector which was only recently being utilised. He commented that GP practices should not be seen as the default service for everything because primary care involved a complex team of people and so signposting was increasingly important. The increased use of in-house pharmacists in GP practices was also a potential cause of workforce pressures on community pharmacists due to the finite number of qualified staff in the sector.
• Cllr Cohen commented about the pressures on the primary care system and a shortage of GP practice receptionists in some areas. Sarah McDonnell-Davies acknowledged that there were difficulties in recruitment and retention for GP practice receptionists and other administrative roles and that there was typically a high turnover. There was not the level of training and experience required when compared to a Practice Manager and so there was an ongoing conversation with the NCL Training Hub about upskilling and professional development for receptionists and administrative staff. This included issues such as handling challenging patient behaviour because of the high levels of abuse experienced by staff. Dr Peter Christian added that the position of GP practice receptionist was an important and complex role requiring good people handling skills and a  ...  view the full minutes text for item 32.

To provide responses to questions concerning the moving of mental health patients from St Pancras Hospital to facilities elsewhere in London due to construction delays to Camden & Islington Foundation Trust’s new Highgate East hospital.

Jess Lievesley, Executive Director of Strategy, Transformation and Organisational Effectiveness at Camden and Islington NHS Foundation Trust, and Jon Spencer, Chief Operating Officer at Moorfields Eye Hospital, introduced the report on this item noting that it that addressed the wider implications of the St Pancras Transformation programme, the delays affecting the programme and how these were being addressed. They then responded to questions from the Committee:

• Cllr Clarke asked why Moorfields was not waiting for the Highgate development to be completed given that patients would need to be moved to a private provider as a consequence at a cost of £150k per month. Jess Lievesleyacknowledged that this action was not part of the original consultation plan and noted that it was partly a consequence of the Covid-19 pandemic which had caused delays to the project. Mitigations were therefore being put in place to meet the needs of a small cohort of patients and there were no longer the facilities to do this at St Pancras Hospital as part of the site was about to be built upon. It was not unusual for the NHS to use outside provision when necessary and, in this case, a structured formal arrangement would be made for a period of time to give certainty of access and would maintain local links. For two or three patients, the transitional arrangements were likely to remain until September 2023 but, for most patients, the length of time would be more limited. Jon Spencer outlined the constraints imposed by the circumstances of the project, including the fact that the land at City Road had originally been sold by Moorfields at the top of the market. This meant that if the contractual arrangements were not fulfilled in the time agreed then the price would have to be renegotiated and this could put the whole project in jeopardy.
• Cllr Anolue expressed concern about the potential stress and impact on mental health for the patients. Jess Lievesley said that addressing this was at the heart of the decision making which was why the transitional arrangements had been made with a focus on keeping individuals engaged with community health teams and their families as well as keeping them based within London. Cllr Connor asked for reassurances that all families would receive written information about accessing relatives in services. Jess Lievesleysaid that for planned transitions, arrangements for individuals were made with families through discussions with care coordinators and community teams. For individuals presenting to services for the first time, this would be for local community teams to communicate this. Jess Lievesleycommitted to reiterate that guidance to staff to ensure that families knew how to access services.
• Cllr Atolagberequested further details about the reprovision of the Acute Day Unit (ADU). Jess Lievesley explained that it had been closed in 2020 as it had not been possible to safely run a service during the pandemic. The intention was to reopen the ADU in a different location but it was recognised that  ...  view the full minutes text for item 33.

To provide an outline of the 2022-23 work programme for the North Central London Joint Health Overview and Scrutiny Committee and an opportunity for Committee Members to propose additions/amendments.

Cllr Connor introduced the updated Work Programme for the Committee, noting that the next meeting in Feb 2023 would include items on the Mental Health Services Review, the Community Health Services Review and the Health Inequalities Fund. The meeting would be held in a community setting with various community groups invited to attend. Cllr Connor suggested that questions on the Mental Health Services Review and the Community Health Services Review could focus on transitions between Children’s Services and Adult Services.

To note the dates of future meetings:

19 March 2021 (special meeting)

25 June 2021

1 October 2021

26 November 2021

28 January 2022

18 March 2022

·         6^th Feb 2023 (10am)

·         20^th Mar 2023 (10am)