Agenda and minutes

1.1  The O&S Officer stated that as it was the first meeting of the new municipal year it was necessary to elect a Chair and Vice Chair. He called for nominations for Chair. Cllr Adams nominated Cllr Hayhurst and Cllr Masters seconded.  There were no other nominations. Cllr Hayhyurst was unanimously elected Chair.

1.2  Cllr Hayhurst, as Chair, invited nominations for Vice Chair. He nominated Cllr Deakin and Clls Masters seconded this. There were no other nominations. Cllr Deakin was unanimously elected as Vice Chair.

RESOLVED:

That Cllr Hayhurst be elected Chair and Cllr Deakin as Vice Chair for 2022/23.

2.1  Apologies for absence were received from Common Councilman David Sales, Cllr Singh Virdee, Shane De Garis (new Group Chief Executive of Barts Health) and Rt Hon Jacqui Smith.  The Chair stated that Hardeep Virdee was attending in place of Mr DeGaris.

2.2  The Chair welcomed the new members of the Committee: Cllr Patrick from Hackney, Cllrs Khan and Kabir from Tower Hamlets and Cllrs Deakin and Akram from Waltham Forest.

2.3  The Chair congratulated Henry Black and Diane Jones on their new executive appointments in NHS NEL.

3.1  There were none and the order of business was as on the agenda.

4.1  Cllr Masters stated she was employed as Director of Transformation by HCVS (Hackney Council for Voluntary Services) in a post funded by NHS NEL.

5.1  The Chair  welcomed for this item:

  Marie Gabriel CBE (MG), Chair of NEL ICS

  Zina Etheridge (ZE), Chief Executive, NHS NEL

  Henry Black (HB), Chief Finance Officer, NHS NEL

5.2  Members gave consideration to briefing papers on: Update on North East London Health and Care Partnership, NEL Financial Strategy and Working with People and Communities Strategy.

5.3  Zina Etheridge (CE) gave a presentation on NHS NEL, the organisation that has replaced the CCGs on 1 July.  Cllr Maureen Warmby (Barking and Dagenham) and Mayor Philip Glanville (Hackney) will be the two local authority reps on the ICB.  The wider body, the ICPB, has also been set up and will set the Strategy that the ICB must have regard to. Marie Gabriel (MG) explained that with the ICPB the aim was not to duplicate arrangements but build on what they all do already and she detailed the 4 aims of the System. Most of the work would take place at the Place level and not at the board itself.  Henry Bock (HB) stated that 22/23 would be a transition year for finances and full delegation would take place in 2023/24. He described how ICS’s finances will focus on a stewardship of resources approach rather than a pure contracting and commissioning approach as in the past.

5.4  The Chair outlined for newcomers the background to the creation of the ICS.

5.5  The Chair asked how the financial flows will work from the centre to the ‘place based areas’. HB  explained that certain aspects of funding will still sit with the ‘provider collaboratives’ and they will ensure there are no conflicts of interest involved. HB explained how each ‘place’ in NEL will receive allocations for its out-of-hospital activity and will see the notional budget for the total NEL. There won’t be a contractual relationship between the ‘place’ and the provider as this wouldn’t work in the new context.  So there will be an attempt to move on from the old rules of commissioning which had been very contractual.  ZE explained that the overall aim was to move beyond the old commissioner-provider model and the conversation at place level then needs to be about what are the outcomes that we are jointly trying to achieve.

5.6  Cllr Deakin asked why it was the Group CEO and not the Chair of Barts Health-BHRUT who will sit on the ICB and about how the VCS reps are selected. MG replied that this is what emerged from the conversations that had taken place with the relevant stakeholders in the process and that the view as that they needed to have the Chief Execs there so there could be a direct focus on delivery and so they can be held to account more directly. The VCS orgs are going through their own similar processes to select their reps for ICB and ICPB, she added.

5.7  Cllr Masters asked about the scheme of delegation and in relation to a large number of small contracts. HB replied that  ...  view the full minutes text for item 5.

6.1  The Chair stated that there were two papers starting on p.39 an overall Health Update and a separate note on Whipps Cross redevelopment. He welcomed:

Zina Etheridge (ZE), Chief Executive Officer, NHS North East London,

HardevVirdee (HV), Group Chief Finance Officer, Barts Health (rep of Shane DeGaris the new Group CE of Barts Health and BHRUT)

Diane Jones (DJ), Chief Nursing Officer, NHS North East London

Ann Hepworth (AH), Director of Strategy and Partnerships

Alison Goodlad (AG), Deputy Director Primary Care, NHS North East London

William Cunningham-Davis (WCD), Director of Primary Care Transformation

Nicholas Wright (NW), NHS North East London Diagnostics Programme Director

Ralph Coulbeck (RC), newly appointed as CE of Whipps Cross

6.2  Members gave consideration to two papers:

  a) NEL Health update

  b) Note on Whipps Cross redevelopment

6.3  ZE took Members through the presentation. The NEL Update covered: Acute Provider Trusts; Covid-19; Cancer; Continuing Healthcare Policy; Highlights from the Winter Access Fund; Enhanced Access to Primary Care; Operose Health; Community Diagnostic Centres; Development of acute specialities and clinical services across NEL and Targeted Investment Fund Bids.

6.4  Hardev Virdee, (Group CFO Barts), detailed the new appointments and gave a summary of the work being done on elective catch-up.  Diane Jones (Chief Nursing Officer, NEL) provided an update on vaccinations and the Continuing Healthcare proposal. Alison Goodlad (Deputy Director Primary Care, NEL) presented information on the  Primary Care Winter Access Fund, on the plan for Enhanced Access and ended on the assurance that was being provided in response to the concerns regarding Operose Health following on from the BBC Panaroma investigation which focused on a GP Practice in Tower Hamlets, part of that Group. Nicholas Wright (Diagnostics Programme Director, NEL) presented an update on the development of the Community Diagnostic Hubs and the public consultation on them and ZE concluded the presentation by giving details on the proposals to review the spread of acute specialisms across the NEL patch.

6.5  Cllr Masters stated that many people were highly disturbed by the findings of the BBC Panorama programme and asked about the timelines attached to the new proposed Assurance Framework.  WCD described the assurance framework that was being put in place regarding Operose and all the GP providers. The team had investigated the Practice concerned and were now using these Key Lines of Enquiry on all Practices in NEL. He clarified that roles such as ‘Physician Associates’ were were nationally mandated. He stated that the CQC had also been into the Practice. They had asked the BBC for other information to assist them and they had put in place additional clinical oversight.

6.6  Cllr Masters asked how NHS NEL can assure itself that the information being provided by Operose is accurate. WCD explained that they had validated the information that had been provided against what they had seen and would be  using that feedback to produce a wider framework for use across all Practices.

6.7  The Chair asked whether the evidence was dated pre or  ...  view the full minutes text for item 6.

7.1   The Chair welcomed for this item:

  Diane Jones (DJ), Chief Nursing Officer, NHS NEL

  Dr Anju Gupta (AG) GP and Clinical Lead at NHS NEL

7.2  Members gave consideration to a briefing paper ‘NHS help to try and have a baby - proposed changes for people living in North East London’’. The Chair added that Members in Hackney had requested a special local briefing on it and they were now reassured that overall it represented a levelling up of service.

7.3  Diane Jones took Members through the briefing paper. She explained that they had started from the NICE guidance and were proposing a single unified policy and they had clinical experts review existing policies and draft the new one. They were looking predominantly here at people who had a medical reason to receive assisted support with conception. They had also carried out an Equality Impact Assessment, had done a number of engagement events and had surveyed 230 stakeholders and were about to hold two more consultation events. 

7.4  The Chair stated that broadly speaking this appeared to be a widening of access and a levelling up to effectively 3 full IVF cycles and he asked about the additional costs of this policy. HB replied that cost wasn’t a driving factor here and it would be a relatively small amount of money out of the full £4bn budget.

7.5   Cllr Patrick asked about those unable to conceive without assistance having to prove they have a problem. DJ replied there were a variety ways in which people would arrive at eligibility for the service: either having tried to conceive or having previous surgery or recovering from cancer which would have had the side effect of inhibiting or preventing conception. All these would be discussed with GPs to determine the root cause. She reiterated that it was not the case that the cost of trying to prove whether there was a problem would fall on patients. It would be part of the core NHS offer and patients would be put in a pathway for tests to be done in the first instance. 

7.6  The Chair asked about contingent rules re weight and smoking which might act as a barrier to receiving the treatment and asked what support was being put in place for these cohorts. DJ replied that smoking and weight can affect chances of success in conceiving and they would inform patients about healthy options and relevant programmes of support. There might also be other health components to a case and all these would be considered before the offer of assisted conception was made. 

7.7  The Chair asked whether this evaluation was wider than just a BMI score?  DJ replied that it would be a combination of factors and the GP would make a full assessment and would refer them as appropriate to the assisted conception programme so it was a holistic approach.

7.8  The Chair thanked DJ for her report and for taking on board the comments of Members at  ...  view the full minutes text for item 7.

8.1  The Chair stated that Cllr Sweden had to give apologies so there would be no regular verbal update at this meeting.  However Members had discussed the issue under item 7 and had heard from the CE of Whipps Cross.

9.1  Members gave consideration to the draft minutes for the meetings on 16 December and on 1 March.

RESOLVED:

That the minutes of the meetings of the Committee on 16 Dec 2021 and 1 March 2022 be agreed as a correct record.

10.1  Members noted the updated work programme document. The Chair stated that NHS NEL would  want to bring items and it will be necessary to schedule items on the proposals around ‘acute specialisms’ and the next iteration of the Continuing Healthcare Plan. He asked Members to suggest items and added that the standing updates on ICS implementation would no longer be required.

11.1  There was none.