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 was received from Cllr Rishikesh Chakraborty (Barnet), Cllr Philip Cohen (Barnet),Cllr Larraine Revah (Camden), Cllr Kemi Atolagbe (Camden), Cllr Patricia Clarke (Islington).

The number of apologies given by Members meant that the Committee was not quorate. To be quorate there are two criteria:

a)    For at least four Committee Members to be present. This condition was met.

b)    For Members from at least four of the five NCL boroughs to be present. This condition was not met.

In the circumstances, the meeting continued as a briefing for the Members present. This meant that discussions on the agenda items could continue but any formal decisions made could not be ratified.

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 12 below).

None.

The Chair declared that her sister was a doctor within the Tottenham area. Also, that she was a member of the Royal College of Nursing.

Cllr Chowdhury also declared his son was a doctor in Kent. 

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

The Principal Scrutiny Officer indicated that there had been a question from a resident of Barnet and read out the below.

“Given that the primary reason for absence from work is illness and the COVID pandemic is still ongoing – and is still causing illness and long-term health problems, do you think that reducing the spread of COVID with cleaner air in schools, and healthcare and public settings will be beneficial to the economy? ”

The Principal Scrutiny Officer indicated that there had been no answer so far from the Integrated Care Board as sufficient notice had not been given. The Chair then asked the ICB to provide a written response to the question above. ACTION.

To approve the minutes of the North Central London Joint Health Overview and Scrutiny Committee meetings on 25^th July 2024 and 9^th September 2024as a correct record.

The Committee noted the minutes to the previous meeting however they could not be formally approved as the meeting was inquorate.

To review progress against action points from previous meetings in 2024/25.

The Committee took note of an update on the Terms of Reference and the sharing of resources for the Committee between councils. The Chair strongly recommended that the members of the Committee speak to their respective CEOs or Finance Directors on this matter. ACTION

The Chair also proposed that the theme of co-production should be considered in all reports and items. ACTION

The Principal Scrutiny Officer notified the Committee that Start Well had published a report and that feedback from the Committee was needed by 29^th November 2024. ACTION

To provide an overview of the ongoing collaboration between the Whittington Health NHS Trust and the University College London Hospitals NHS Foundation Trust.

The Acting CEO of Whittington Health introduced the report to the Committee. Main points summarised below.

-       The vision of the collaboration was to use the collective strengths of the Whittington and UCLH to better serve the community and improve the sustainability of services across the two organisations. The collaboration was not driven by changes to organisational form and/or cost savings.

-       More opportunities were being considered to join multiple clinical teams together and reduce duplication in back office, non-clinical services.

-       There was a long history of collaboration between the two institutions especially within the pandemic, which had resulted in excellent patient outcomes.

-       The Acting CEO emphasised the collaboration meant that the two institutions would still be treated separately, however collaboration had meant successes – for instance when joint appointments had provided back up to services when recruitment for vital specialised areas had been difficult. This approach had worked especially well and put Whittington Health 34^th in the Patient Cancer Experience table. 

-       She explained that the Whittington Health had also set up the Virtual Ward – a service that helped patients who could be looked after at home to remain home under clinical supervision. The equivalent was found in the UCL as the ‘Hospital at Home’ scheme.

-       She stated that due to the collaboration there had been a reduction in waiting and theatre time, patients could be cared for in their own homes with the Virtual Ward and Hospital at Home scheme. The collaboration had improved services where patient care had been impacted. It had also opened research opportunities across the two organisations.

-       The team was considering more NHS partnerships – and a clinical dialogue was occurring across the two organisations.

-       The management also recognised the risks to the increase in collaboration. This included ensuring that there was adequate clinical support across the two organisations, support for charges for patients, alignment with JHOSC, adequately resourcing the merger, and assessment as to whether patients were being best served.

-       She stated that there were active communications going on across the organisations to bring out collaboration ideas.

-       Harmonising corporate functions such as finance, legal, procurement and instating joint people officers were a priority for the collaboration.

The floor was then open to questions.

Cllr White requested clarification on a statement contained within the report that pointed to “the establishment of a more aggressive Hospital at Home scheme”. He pointed out that there were risks to this as patients or their families could not be held responsible for their own care. The Acting CEO emphasised that the service would be for patients well enough to be discharged from hospital and who could be treated in their own home. The patient was monitored for a maximum of two weeks. The Acting CEO took the example of the ‘delirium pathway’ in which patients sometimes experienced confusion as a result of infection. Experiencing this in hospital made the confusion much worse. At home a full risk assessment could  ...  view the full minutes text for item 45.

To provide a finance update for the NCL including the overall strategic direction of travel, 2024/25 figures for the NCL ICB and for NHS Trusts that provide services to NCL patients.

Report to follow.

The Director of Finance Strategy and Planning introduced the report on the system financial position.  He outlined that the ICB NCL System were the system finances of nine providers and the ICB. This report covered the financial positions of all these organisations amalgamated. He outlined the outcomes of the Outturn in 23/24 . He stated that the plans had been achieved despite the high level of cross organisational efficiencies that was required to balance the books and also industrial action that had occurred twice that year. Funding to cover the industrial action had been received and he also stated that there had been a surplus. UCLH had received some late payments which had affected the budget – however this has also benefited this year’s status as Capital Allocation had been made ‘pound for pound’ plus an additional £25m in Capital Funding in 2024/5.

He explained that the ICB had inherited a historic £100 million deficit – from all the organisations that made up the ICS. However, an agreement had been made, that if balanced books were achieved in the first two financial years of the new amalgamated organisation, then the historic debt would be written off.  This had been achieved.

In response to questions as to the way the hospital finances were viewed together within the ICS Financial Systems, and the nature of incentives for individual hospitals running a high deficit to go back to a more positive balance. It was stated that there were no penalties for hospitals in deficit - all hospitals were treated the same. Work was being carried out to improve the situation of those in a worse position. It was also pointed out that any hospital in deficit would always be under greater scrutiny.

The Director of Finance Strategy and Planning also stated that funding had been successful to cover the costs of industrial action over year. The Capital Programme was then discussed. In response to queries, the Finance Director emphasised that put simply -  £180 million in Capital Funding was allocated per year however it could be rolled over into the next year, as long as allocation was carried out within that year. These projects would still be subject to change and slippage – and inflation and price rises. The Chief Strategy and Population Health Officer also clarified that in addition to updated equipment (such as MRI scanners), the Capital Fund would also fund New Builds and Business As Usual Maintenance. These projects could be carried over into the next year but would also have to be allocated in this financial year.  He emphasised that this year there had been concerns that spending plans would not cover the Capital Fund, however the organisation had received three further streams of funding, and this had helped the Trust achieve its goals. In addition, the team had put aside £14m as a contingency and audited any risk issues. 

Clarification was sought by the Chair as to whether another surplus should be sought next year in order to  ...  view the full minutes text for item 46.

To provide an overview of 2024/25 winter planning in North Central London.

Details also included about the Your Local Health Team campaign.  

The Director of Finance for Strategic Commissioning introduced the report.

-       This report was part of the annual emergency services planning. Emergency activity was up and there had been an improvement in performance averaging 76%.

-       There had been consistent challenges when it came to ambulance hand over delays. However, performance again had improved with now over 89% of ambulance hand overs being done within 45 minutes. However, he emphasised that category two hand overs were still quite problematic and needed to be worked on.

-       Hospital occupancy was still high at 98% - this, he explained, created issues.

-       The report was dynamic and contained proactive actions to help manage the influx of patients.

-       Southern hemisphere COVID and Flu population modelling had informed the assumptions.

-       The Head of Operation and Assurance added that the plan built on last year’s achievements -  and also reflected the NHS England Recovery Plan.

-       Work included:

o    Better communication across departments, so that all understood interdependencies where needed.

o   An intervention approach to promote a reduction in demand on hospitals. This would ensure that the most vulnerable patients were supported.

o   Extra capacity was also engaged  especially in children and young people’s services.

o   Flu and COVID vaccination programmes were also rolled out and extra engagement activities were being used to encourage take up of vaccinations.

o   Pharmacy First had been maximised to reduce reliance on primary care.

o   Work had been carried out with care homes to ensure that patients only attended hospital if absolutely necessary.

o   111 increased its capacity and has piloted an AI triage.

o   Targeted appointments have led to a 6% improvement.

o   Infection control policy was very robust.

o   This year has seen a robust comms plan to support this work.

The floor was open to questions.

Discussion turned to vaccinations and methods to engage all groups to encourage take up of vaccines. The Executive Director for Performance stated that issues were complex. Working with the Public Health Directors in each borough was vital for the team to understand the different needs and concerns of communities – and also where they could build stronger relationships of trust. Targeted work was being carried out to reach communities who were distrustful of vaccines. He stated that this approach had seen an increased uptake. The Executive Director for Performance pointed out that in London the  NCL had closed the gap of uptake vaccines in many communities.  He then suggested that information be circulated to the Committee about the nature of the NHS targeted work with communities, vaccine uptakes and the details of why there had been resistance from different communities. ACTION. The Chair suggested that work through nursery staff and family hubs had seen good results. The Executive Director of Performance and Transformation agreed that the ‘family effect’ had seen good results. Although there was national guidance on this targeted work – nursery staff had not been included but this was something that the trusts were discussing further.  ...  view the full minutes text for item 47.

This paper provides an outline of the 2024-25 work programme for the Committee.

The Principal Scrutiny Officer then introduced the updated Work Plan for 2025.

i-             3^rd February 2025.

• The agenda would include a workforce update including a staff representative.
• It was also requested that an update on smoking cessation and vaping be added to the agenda. Queries from the Committee included whether vaping was adequate for smoking cessation and how health bodies were managing vaping as a health concern- especially amongst young people. Discussion turned as to whether vaping  was used as a smoking cessation tool. It was affirmed that this was the case and can still be prescribed by doctors. It was commented also that National Government Guidance was not clear however there were steps being taken in central government to review the guidance. It was suggested to add this to the agenda after new guidance had been issued.
• The efficiency of online GP consultations and how accessible this was for the elderly and more.

ii-            7^th April 2025.

·         It was decided that this would be community-based meeting as per previous April meetings.

·         Items on mental health and dementia would also be discussed.

Discussion then turned to developing technology and its use in chronic long term health conditions. It was suggested whether it was possible to scrutinise the day-to-day interactions with manufacturers of technology especially in terms of confidentiality and information sharing. It was decided amongst the Committee that a written response be asked from the ICB first, and inclusion on an agenda for a later date discussed after this had been received.

·         Mon 3^rd Feb 2025 (10am)

·         Mon 7^th Apr 2025 (10am)

-       Mon 3^rd Feb

-       Mon 7^th Apr