Agenda and minutes

1.1  Apologies were received from Cllrs Plouviez and Oguzkanli.

1.2  Apologies were also received from Cllr Demirci and Dr Sue Milner.

2.1  There were no urgent items and the order of business was as on the agenda.

3.1  Cllr Maxwell stated that she was a member of the Council of Governors of Homerton University Hospital NHS Foundation Trust.

3.2  Cllr Snell stated that he was chair of the Board of Trustees of the disability charity DABD UK.

4.1  Consideration was given to the minutes and matters arising from the meeting held on 12 March.

  CLOSURE OF SORSBY MEDICAL PRACTICE

4.2  The Chair stated that further to the AOB item on the closure of Sorsby GP Practice at the previous meeting he had submitted a number of follow up questions to the CCG as Members had some ongoing concerns about the issue.

4.3  Members gave consideration to the following email responses received from the CCG:

----------------------------------------------------------------------

1) Which neighbouring Practices are taking up the Sorsby patients and can you demonstrate that they have the capacity to cope?  He would like to see a map to indicate the distance patients will have to travel.

Since 11^th April 484 out of 4200 patients have already registered with a new practice. 37% have gone to Lower Clapton Surgery; 26% to Wick Surgery; 13% to Lea Surgery. The nearest practices confirmed that between them they have capacity to take on over 10,000 extra patients (Sorsby has 4,200). The CCG is providing financial support to surrounding practices to help them cope with the spike in new registrations. At point the CCG’s assessment is that practices can cope. Based on the current trend only two practices appear to have more patients registering than they said they could cope with – Nightingale is forecast to receive 52 patients (an increase on its current list size of <0.5%) and Athena is forecast to receive 364 patients and has capacity to take on 300 patients. Based on current numbers about 3% of patients may have to register with their second choice of practice. The CCG is monitoring the numbers on a weekly basis. If patients register at the current rate then the list should be fully dispersed before the end of June. About 15% of the Sorsby list live outside of Hackney or live outside of the Clapton Park Estate.

2) What happens to those requiring home visits?.  Members are well aware that this Practice is in the most deprived corner of the borough and the patient cohort is particularly vulnerable with a lot of older people and people with complex needs.  Transport provision is not good in this area and transport for those who are elderly or with limited mobility to the other Practices IS a problem.  There is one bus.  Are there plans therefore to increase the number of home visits to accommodate these patients and if not why not?

There are 52 patients on the current Sorsby home visiting list. Receiving practices will be required to carry out home visits where clinically indicated as part of their contractual duties.

3) Members also have concerns that the consultation was inadequate in that the meetings were held during the day and for a proper engagement some should have been held in the evening so those working full time  ...  view the full minutes text for item 4.

5.1  The Chair stated that this was the third in a series of updates on the review of the Integrated Learning Disabilities Service which the Commission had requested, the last one being in September 2018.

5.2  Members gave consideration to the update report and the Chair welcomed for the item

Anne Canning (AC), Group Director CACH

Ann McGale (AM), Head of Integrated Learning Disabilities Service

Tessa Cole (TC), Head of Strategic Programmes and Governance

Penny Heron (PH), Joint Strategic Commissioner – Learning Disabilities

5.3  In introducing the report TC stated that this was the third update and the new model was in place and the service now had a 2-provider model with ELFT and LBH.  One of the big challenges was to recruit permanent staff and much progress had been made with 6 new social workers and a new permanent Head of Service in place.

5.4  AM added that there had been extensive consultation on a redesign of the service and they now had a much more joined-up offer. The focus was much more on achieving independent outcomes. She described the 4 new pathways which were being rolled out: Preparing for Adulthood; Referral and Review; Intensive Support; Ongoing Support.  The Intensive Support model would focus on dual diagnosis patients (mental health and learning disability) for example.  Multi disciplinary teams were working to prevent crisis and with an increased focus on preventions.  The Referral Pathway would focus for example on those who were new in the area or whose needs had changed and on reviews against the set Performance Indicators.  The Ongoing Support pathway had a focus on social care for health.  Officers had been asked to report back specifically on out of borough cases and she explained that this was a complex area.  Many were historic and had been out of borough for 20 or 30 years. These were given a chance to return and ensure if they did they are properly linked into local services and in receipt of the advocacy they needed.

5.5  Members asked about staffing.  AM replied that the staffing establishment remained the same and the service worked in multidisciplinary teams to avoid duplication.  There were 48 FT and PT and 6 new permanent social workers would help reduce the dependence on agency staff.  This issue was a national one. 

5.6  Members commended the co-production approach and the user forums and commented that forums might not always be representative and asked how people got appointed on to them.  They also asked what was being done to ensure outreach to groups such as the elderly, BME and LGBT groups.

5.7  AM replied that many had been on the forums for a long time but much work was going on to attract new members.  The new Supported Living organisations in the system were also represented and the health staff were also bringing in new people via the programmes such as those on healthy living, movement, dance, dieting etc.  They were also reaching out to young people still  ...  view the full minutes text for item 5.

6.1  The Chair stated that this was the latest in the rolling programme of updates from each of the Workstreams in Integrated Commissioning.  This time it was the Planned Care Workstream and Members gave consideration to the detailed report.

6.2  The Chair welcomed:

Siobhan Harper (SH), Workstream Director – Planned Care, CCG-CoL-CCG

Andrew Carter (AC), Senior Responsible Officer for Planned Care Workstream and Director of Community and Children’s Services, City of London Corporation.

David Maher (DM), Managing Director, City and Hackney CCG

6.3  SH took Members through the report in detail.  She stated that Andrew Carter from City of London was the new SRO for the Workstream having taken over from Simon Cribbens.  On outpatient transformation she stated that they were looking at ways in which care was delivered and described examples such as the ‘virtual fracture clinic’ and the dermatology service where the use of digital photo submissions was transforming the approach and avoiding patients having to come in for minor consultations face to face.  On the issue of the over performance in elective care at the Homerton she started that the CCG had been able to mitigate it and there had been an external audit of the data to better understand the pathways and what the drivers were.  A full audit was expected at the end of Q1 and then appropriate financial adjustment were expected.  She added that in relation to the over spend in ILDS it would not be possible to commission ones way out of the financial pressures.  By using joint funding arrangements they were trying to establish the level of health need and match it to the level of care need that was not being served. They was also some non-recurrent funding which was being used to alleviate the financial challenge.  She stated that they had been successful in their bid to the Prioritisation and Investment Committee of the CCG to secure funding for the ‘Housing First’ programme and this was now out to procurement.  This was a health integration model which would provide benefit to the whole system.  On the issue of Continuing Health Care things were looking much better.  Great progress had been made in ensuring the clients were assessed within 28 days and more was being done on arranging for assessments to take place out of hospital and in either the home or in the care home.  On Cancer performance the data remained hugely disappointing.  The system was capturing more people at Stage 1 and Stage 2 which was good but screening remained a problem and so people were not being diagnosed early enough.  Work was going on to drive up screening and detection rates.  Bowel cancer which was very treatable still had rates which were too high and there was targeted work going on about that. 

6.4  Members asked about the over spend in elective care.  What were the drivers and whether this would result in a backlog and longer waiting times.  Members also asked if this problem  ...  view the full minutes text for item 6.

7.1  The Chair stated that this was the final evidence session at committee for the Commission’s review on ‘Digital first primary care and the implications for GP Practices’.  He welcomed to the Commission:

David Hodnett (DH), Programme Delivery Lead – The NHS App, NHS Digital

Tristan Stanton (TS), NHS England

Dr Phil Koczan (PK), NHS England

7.2  The Chair added that Members had been sent the links to the background information about The App from the NHSE website and had been encouraged to download it in advance of this discussion.

7.3  DH stated that beginning in 2016 NHSE had centralised the planning for an App for primary care functions.  It was now in a national roll-out phase.  A new system for ‘Log In’ was in place requiring the applicant to submit a photo from their phone and a photo of their passport to assist with confirmation of ID. This was for those who don’t already have an online account with their own GP.  15.3 million people now had an online account.  The App would allow patients using a smartphone or tablet to: check symptoms, find out what to do when they need help urgently; book and manage appointments with their GP; order repeat prescriptions; securely view their GP medical report; register to be an organ donor and choose how the NHS uses their data.  He added that the test programme had 3000 users on it and the majority never had an online account.  There was a large procurement exercise around the App and 4 platforms had been selected to progress the work: EMIS, TPP, Vision and Microtest.  They were on track for the 1 July date for full roll out. 

7.4  The Chair asked how the App would integrate with all the various local systems for online triage that they had been looking at as part of the review.

7.5  DH explained that on the first version of the App had no online triage at the front end.  They were working on this functionality now and had started with one of the providers E-consult and would proceed to the next three, they would not be locking any provider out but had to start somewhere.  They had 32 applications, whittled it down to 7 and were now working with EMIS, TPP, Vision and Microtest. What they were currently saying to patients was that if appointment booking was not currently on the App for their GP they could always proceed outside of the app and book online in the normal way using the various platforms which GPs are using such as Patient Access or Evergreen Life etc.  This was like a modular system whereby various pieces would be added on as they become ready.  They were also working on electronic referral systems and enhancements such as electronic prescriptions but for now the focus was very much on primary care.

7.6  PK and TS explained that another key part of the mix was the NHS Log-in which would make accessing all of this  ...  view the full minutes text for item 7.

8.1  The Chair gave a verbal update on the meeting of INEL JHOSC held on 3 April.  He stated that there were two substantive items the NEL Estates Strategy and the 10 year NHS Long Term Plan.  He added that while the funding bids from ELHCP (the NEL STP) had failed the bid to Cabinet Office for some seed funding to work up proposals for the options for redeveloping the St Leonard’s site, as part of the ‘One Public Estate’ pilot, had been successful.  One of the issues to be considered was when the time would be right to run an engagement event in the community. 

8.2  A resident (Mr Sills) added that as a borough Hackney needed to decide what it wanted to do with the site and there was some urgency here. 

8.3  The Chair stated that his preference was to organise a Scrutiny Engagement event on the future of St Leonard’s which could involve a public meeting with a panel from CCG, HUHFT, ELFT, LBH.  A member stated that he was confused what had happened to the London Devolution Pilot and whether this had been superseded by the ELHCP.  The Chair added that there was a need to hear from the local NHS about: St Leonard’s, the possible transfer of mental health beds from HUHFT to Mile End (Barts Health) and plans for GP re-configuration.  He added that there was a view that there was a trade-off being made between increased elective capacity and mental health beds. 

8.4  David Maher (MD of C&HCCG) replied that the Neighbourhood Model was key here.  The development of St Leonards as part of One Public Estate provided key opportunities for the borough.  The issue in relation to the move of mental health beds was not about an exchange.  He was the mental health lead for ELHCP and what was envisaged was similar to what been achieved successfully for stroke and cancer services i.e a vision for a mental health centre of excellence which would drive up outcomes for the local population.  The Chair replied that there would be a degree of political unhappiness if different aspects appeared to be traded off against each other and this would require careful handling and appropriate engagement and consultation. 

8.5  Michael Vidal stated that he as a public rep on the Planned Care Workstream and was involved in initial work on the St Leonard’s issue and he undertook to liaise with the O&S Officer on the more appropriate timing for holding a possible engagement event.  The Chair thanked him for this.

8.6  The Chair reported that the items for the next two INEL JHOSC meetings would be as follows:

19 June 2019:

· Waltham Forest formally welcomed into the INEL JHOSC family

· NELCA /ELHCP Accountable Officer update

· Early Diagnostic Centre for Cancer at Mile End

· INEL System Transformation Board

18 September 2019  ...  view the full minutes text for item 8.

9.1  Members gave consideration to the work programme for the Commission.

9.2  The Chair stated that the final part of the evidence gathering for the ‘Digital first primary care’ review would comprise focus groups with were being run by Hackney Matters and which would feed into the review.

10.1  There was none.