Agenda and minutes

1.1  There was an apology for lateness from Cllr David.

1.2  There was an apology from Tracey Fletcher (CE of HUHFT).

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

3.1  There were none.

4.1  Members gave consideration to the background papers for this item: a letter from UNISON with the original request to consider the item; the letter from the Chair to the Chief Exec of HUHFT raising the Commission’s concerns; and her response.

4.2  The Chair welcomed for this item:

Phill Wells (PW), Director of Finance, HUHFT

Thomas Nettel (TN), Director of Workforce and Organisational Development,   HUHFT

Michael Etheridge (ME), UNISON Area Officer

Naomi Byron (NB), UNISON rep at ISS

Lola McEvoy (LM), Regional Organiser for NHS, GMB union

4.3  In opening the discussion the Chair congratulated HUHFT on receiving its recent rating of ‘Outstanding’ from the CQC.  This was echoed by all Members.  He added that while everyone was immensely proud of the Homerton, and justifiably so, this didn’t mean that there were areas where the Commission would provide some challenge and holding to account.  He asked all present to be respectful of others views in what was a contentious item.

4.4  The Chair provided an outline of the ISS contract issue.  The Trust had outsourced its soft services (catering, portering, cleaning, security) to ISS and there were about 200 posts involved.  The contract was up for renewal in Sept and HUHFT had decided to seek a new 5-year contract with ISS.  Concerns had been raised about the length of this sudden extension and a lack of adequate consideration of possible in-sourcing options, although it was understood that with a contract this extensive HUHFT could not move quickly to in-sourcing. There has been concerns about the Equality Impact Assessment and the handling of the VEAT process. VEAT stands for ‘voluntary ex-ante transparency notice’, which would allow a new contract to be awarded without the usual going out to tender and was utilised because of the current emergency situation due to the pandemic.  There had also been concerns about the lack of occupational sick pay for about half of the 200 workers who had joined ISS since 2015 (the balance having been TUPE’d from a previous contract).  Those joining since 2015 don’t receive any sick for the first 3 days of absence and on day 4 onwards only receive Statutory Sick Pay which is £92 per week. They would otherwise earn c. £80 to £100 a day, representing a substantial reduction in their take home pay.  There also had been concerns about the fact that those with Covid-19 were likely to be coming into work while ill because of the sick pay situation.  It was noted that 72% of that 200 strong work force were from ethnic minority backgrounds and so were disproportionally affected by Covid and the broader concern was that by signing this contract extension HUHFT was seen to be locking-in the existing disparities.  The Chair stated that each invitee would make opening remarks and there would then be a Q&A.

4.5  Michael Etheridge (Area Organiser, UNISON) made the following points in his opening remarks.  The extension of this contract would be devastating for these staff  ...  view the full minutes text for item 4.

5.1  Members’ gave consideration to a report from the CCG entitled City and Hackney System Operational Command: Phase Two Restoration and Recovery Plan.

5.2  The Chair welcomed for this item:

Dr Mark Rickets (MR) (Chair, City and Hackney CCG)

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

5.3  DM took Members through the report in detail and highlighted some key aspects.  He stated that the plan brings together the partnership approach across all the NHS bodies, the council and VCS in Hackney.  The borough remained in emergency level 4 position and this dictated action the CCG had to take subject to national guidance.  That morning’s ICB had discussed for example some of the practical steps to be taken to tackle n digital inclusion.  They key elements of the plan related to: out of hospital recovery; restoration of elective work and updating the Transformation Plans.  The Long Term Plan has been to the Commission in January and they were now going back to it and refreshing it in context of Covid-19 and resetting the transformation plan. There was also a refreshed look at inequalities as well as a look at governance of the ICS and the merger of the CCGs.  He added that the borough was not trailing upwards towards a second peak in Covid-19 but it needed to plan for one which could coincide with the annual flu season and the usual winter pressures.  The Communications and Engagement Group of the ICB was chaired by the head of Healthwatch and it was taking a number of initiatives including the Let’s Talk events and getting out into the neighbourhoods.  There was also a focus on producing culturally appropriate material e.g. using community languages.  On the issue of re commencing elective work there was the key issue that many diagnostic procedures are aerosol generating and so plans had to be made carefully.  The CCG continued to see HUHFT deliver expert surgical services locally but there was an ongoing discussion to reset the various specialisms across the NEL area.  City and Hackney was well placed with its Neighbourhood Model to meet patient needs in advance of admissions and to use secondary care at the neighbourhood level and City and Hackney had a progressive model for out of hospital services.  He would deal with the ICS issues under item 6.

5.4  Members asked detailed questions, and in the responses the following points were noted:

(a) Members asked about the Terms of Reference of the System Operational Command commenting that it seemed ‘officer heavy’ and lacking community engagement e.g. from Healthwatch etc.  Members also asked about the complex multi morbidity issues at NHS Nightingale and the fact that it was difficult to segregate Covid and non-Covid patients.  They asked why Covid specialisms were set up when the evidence appeared to be that this was unhelpful

DM replied that it was challenging to configure hospitals to operate in both a Covid  and non-Covid way simultaneously.  As regards the language used to describe the  ...  view the full minutes text for item 5.

6.1  The Chair welcomed Dr Mark Rickets (MR) Chair and David Maher (DM) Managing Director from City and Hackney CCG for this item which was taken jointly with item 5 above.

6.2  The Chair stated that if it was not for the pandemic the CCG would be coming to this meeting with an update on where it was with consulting the CCG Members on the move to the single CCG for NEL and asked whether this work had been paused.

DM replied that it had been paused but the overall timescale not changed however active work had had to stop.  He reflected that the various Gold Command type meetings which he attended at an NEL level and his leadership on End of Life Care and Mental Health for example had demonstrated how so much was now coordinated at an NEL level and the response to Covid-19 had represented an ICS in action.  All the providers had come together to do the planning and there had also been a greater sense of ownership from local boroughs in terms of their relationships with the health service across NEL.  What this practically meant for the CCG was that they had started to engage again with the local CCG Members.  City and Hackney stood out by having its CCG, its acute provider and its mental health provider now all having been rated as Outstanding as well as highly regarded services from the local authority. They were very mindful of the successful building blocks they already have in place and this structure will be a critical part of next four months work as the ICS is put in place.

6.3  The Chair asked when C&HCCG will go to its membership to vote on the dissolution. DM replied that this would be no later than mid Nov according to the timetable from NHSEL.  They would be having preliminary conversations up till Sept and will seek get a vote in Oct on a Constitution all can support

6.4  The Chair asked about money flows.  Would 10% or 15% still go up to ELHCP (the NEL STP) for services better commissioned at that level.  He also asked whether changes to the demographic weighting of the money flows would adversely impact Hackney. 

DM replied that this would all have to be part of what he CCG members will need to agree.  He added that there was also talk London being given its allocations at an ICS level and no longer at a CCG level.  Their expectation was that a ratio of 80:20 (20% flowing up) was what they believed was necessary, but it was not possible to say anything more concrete at this point. The Chair commented that if the settlement was worse, then this would cause great alarm at the local level about an overall loss of funding arising from the merger.  MR added that in terms of constructing the new constitution to make all this meaningful, this document would be a large, complex and legally binding  ...  view the full minutes text for item 6.

7.1  The Chair stated that following the updates in March and June he had invited the Dr Sandra Husbands (SH) Director of Public Health back for a verbal update as this was a rapidly evolving situation.

7.2  SH stated that there had been a slight increase of 7 in the previous week and this had included a cluster of cases relating to a particular setting.  They were benefiting from the experience of Leicester which had had to go back into a local lockdown and it was causing all to reflect more on whether local authorities are getting all the data they need to fully understand the local context.  She stated they were not explicitly asking for person id’s but receiving just totals wasn’t much use to them.  Outside London, Pillar 1 and Pillar 2 data had been collated separately, but London was now receiving both and also data of better quality was expected to come in the following week.

Since the previous meeting a lot of work had been done locally including the publication of the full Local Outbreak Plan at the end of June.  This was a dynamic plan which would be updated and amended as new information came to light.  She had just been on a London-wide exercise with the police and other partners examining scenarios for local outbreaks in London and establishing what specific powers might be needed.  They were also producing a number of Standard Operating Procedures for such settings as schools, care homes, places of worship, work places so that those who run them know what they need to keep it safe and to manage the people involved and what to do if they become aware of a case who might have infected others. 

Work was also ongoing on the Data Dashboard, which the Chair had requested, to provide local reassurance.  A key issue was collating the data and presenting it in a way that was useful to policy makers. A test version was ready and over the next two weeks the aim was to test it with various stakeholders.  The need to make sure the public facing bit and the professional facing bit are both fit for purpose. 

On testing she stated that since the discussion at the previous meeting they had explored with Barts Health whether they could provide lab support to local testing.  They were working with ELHCP partners on this and was a seamless system.  There was some capacity to do local testing either home kits or in centres.  She cautioned that a limiting factor here was that there was an international shortage of the reagent for antigen testing.  Supply of reagent was controlled nationally with limited provision for each lab meaning Barts Health wouldn’t have enough to scale up to the level they would need for a significant local programme.  She added that Queen Mary University of London was carrying out a trial of using a different approach to processing the tests and wanted to enrol all the care homes  ...  view the full minutes text for item 7.

8.1  The Chair stated that there was a vacancy for Vice Chair following the resignation of Cllr Maxwell after her appointment as a Cabinet Adviser.

8.2  The Chair called for nominations.  Cllr Spence proposed Cllr Snell and Cllr Plouviez seconded.  There were no other nominations.

8.3  The Commission unanimously voted Cllr Snell as Vice Chair.

9.1  Members gave consideration to the draft minutes of the meeting held on 9 June and the matters arising.

10.1  Members gave consideration to the updated work programme for the Commission.  The Chair added that he wanted to maintain an element of flexibility in the programming because of the fast moving situation regarding the impact of Covid-19.  He stated he would communicate with Members on developing the programme.

11.1  There was none.