Agenda item

To receive a report detailing the proposed merger of Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust.

North London Mental Health Partnership

JinjerKandola MBE- Chief Executive Officer

Natalie Fox - Deputy Chief Executive

Vincent Kirchner - Chief Medical Officer

Andrew Wright - Chief of Staff

Deputy Chief Executive, Natalie Fox, provided an update as to the status of the merger. Main points were:

·         The NHS assessment was complete, and the merger had formal sign off at Board. The merger has been pledged and will occur on the 1^st of November subject to a Secretary of State signing.

·         The two Trusts have been working closely since 2019.

·         Clinical pathways have been built and staff have developed close relationships that have benefited patients.

·         There have been talks with the Unions regarding TUPE of staff from one organisation to another.

The Chair started the discussions by looking at the finances and the potential savings the merger would make. She asked for more information regarding this namely where the savings would come from. The Deputy CEO responded the ‘Return On Investment’ would happen from the amalgamation of corporate services. Instead of two HR and payroll systems one system for one organisation would make savings. She stated that if the merger were not to occur then the organisations would move into deficit. The merger would lead to a year on year saving of 9.2% and a surplus for the organisation. The Chair wanted to know more detail on the Finances associated with the merger. ACTION

The Chair also indicated that the Estate Strategy had not been approved – she wanted to know where this left the merger and wanted more details re this. The Chief of Staff replied that they had a new Estates Strategy for the organisation and were working closely with the ICB. The strategy included the refurbishment of St Ann’s, Highgate Health Centre, and Chase Farm Mental Health Unit. He stated that the overall priority is Chase Farm, as this has been deemed as not fit for purpose. Discussion turned to the TUPE process and more details were teased out about the legalities of the merger.

Cllr Cohen then asked more about the organisational risks involved – he wanted to ensure that patients were being consulted, that the implications on waiting times were being considered but also how much local identity would be lost, and the risk to patients.

The Chief Medical Officer responded that patients would go to the same places to receive treatment. The merger would standardise the service – patients would be able to be admitted where they lived, rather than 100s of miles away if there were no facilities available. The merger would also mean that those well enough could receive Care in the Community. Cllr Cohen asked how many had been placed outside of London. The response was around ten so far. The Chief Medical Officer emphasised that although the numbers were small - this would have a big impact on treatment and life for these patients.

Discussion then turned to waiting lists. Cllr Revah asked whether the waiting list times would still be the same. The Deputy Chief Exec Ms Fox indicated that the Trusts were working on the waiting lists and that they would be published for the first time this year. The Committee wanted to know whether carers and those with disabilities were consulted about the merger. The Deputy CEO responded that they had talked to one thousand people in all. They were waiting on the results of a carers assessment which had asked how the two trusts could do things differently. This included some people with disabilities.

Cllr Revah then enquired how the Trust had felt that it learned from its mistakes and how the panel were monitoring lists. The Officer Panel responded that mistakes were fed back to the senior management team. Senior managers would then feed into professional groups and assess whether the Trust was meeting the need of the patients.

Cllr Revah also raised concern that people with disabilities were not really represented in the consultations. The Chair agreed and asked that the Officer Panel present them with evidence as to how people with disabilities are being involved with working groups and the consultations ACTION.

Cllr Milne asked how the Trust shared best practice. The Chief Medical Officer replied that at SMT (is this Senior Management Team?) level the London regional groups compare practice and evaluate services on a regular basis.

Discussion then turned to the steps that were being taken to ensure that the service was attractive to staff. The Officer Panel asserted that there was a good educational offer within the Trust, opportunities within research and development also the organisation was looking at constantly improving and the values and staff behaviours reflected that.

The Committee then raised questions about Child & Adolescent Mental Health Services (CAMHS) and how services were to be delivered in the area. The CEO responded that there is a fragmentation between how services are delivered in Barnet, Enfield, and Haringey (BEH) and how they are delivered in Camden and Islington. Ms Fox highlighted that the merger would not include CAMHS. The Chair then asked the officer panel to provide more detail, as Cllr Clarke was concerned that the merger may make mental health services more difficult to navigate for patients with different providers. ACTION.

Cllr Revah asked further about how long the waiting lists were. Ms Fox replied that they would be different in every borough. Cllr Revah asked for the Panel to provide these figures as soon as possible. ACTION

Cllr Connor questioned the panel further about the practice of Assertive Outreach and where this would sit in terms of the new approach to patient care. However, the CEO replied that this issue was in fact separate to the merger.

Cllr Connor then asked whether there was going to be a new approach to families and carers as part of the merger. She stated that there had been many instances of a breakdown in communication between the families and the key worker that had led to distress for the patient. The Chief Medical Officer replied that most keyworkers work well with families. He stated that if there are no safeguarding concerns, the keyworkers should all understand that the service and treatment must operate holistically. He admitted that the message to keyworkers should be strengthened. Cllr Clarke requested the Panel update the Committee in November. ACTION

Cllr Revah recounted an incident where a particular borough had a high amount of mental health issues some of which had resulted in suicides. She added that the borough was under investigation, and she wanted assurances from the Panel that once published, the report would be looked at by the SMT to ensure that whatever issues caused this would not happen in the five boroughs. ACTION

Cllr Connor then summed up. She highlighted in addition to the actions stated above that further information would be needed on:

·         Quality governance and what the changes in the key clinical areas were. ACTION

·         Centralisation and the risk to individual care – evidence was needed to ensure local focus was not lost. ACTION