Agenda and minutes

1.1  Apologies for absence were received from Common Councilman David Sales(City of London), Cllr McAlmont (Newham) and Cllr Deakin (Waltham Forest). The Chair added that Cllr Virdee from Newham and Cllr Akram from Waltham Forest were joining remotely and he welcomed Cllr Virdee to his first meeting of the Committee.

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

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

4.1  Members gave consideration to a briefing paper NHS NEL Health Update.

4.2  The Chair stated that there would be four elements to the item and he welcomed the following to present their sections:

a) Provider performance, collaboration update and introduction to Group CEO

Shane DeGaris (SD), Group Chief Executive of Barts Health and BHRUT

b) Winter Planning, Resilience

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

Siobhan Harper (SH), Transition Director - Primary Care, NHS NEL

c) System pressure and urgent care and enhanced access to primary care

Siobhan Harper (SH), Transition Director - Primary Care, NHS NEL

d) Vaccinations update (including Covid-19, Flu, Mpox, Polio and MMR)

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

He added that the slides also included an update on Community Diagnostic Centres, which was just for noting, as this had been dealt with in detail at the previous meeting.

4.3  Shane DeGaris (CE of Barts/BHRUT) took Members through his presentation on provider performance, collaboration update, staffing update.

4.4  The Chair asked what the issues were at Queens and King George V that had made their situation more challenging.  SD explained that there were several factors. King George V had double the number of  ambulance arrivals than the Homerton but half the number of in-patient beds. There was also considerable variation on primary care availability and a broader issue in that there was great variation across the system on delayed discharges of care.

4.5  The Chair asked if these issues were structural and if, simply, more beds were needed. SD explained that the focus was on helping patients not to have to go to A&E in the first place and looking at other things they can do at urgent care centres. He described Project Snowball about ensuring that processes are more efficient inside the hospital and the issues around sharing risk so other departments can assist with the burden.

4.6  Cllr Masters asked how practical it was to get somebody into an alternative site in the community overnight and also commented that if the Acute Trusts were offering these elements of extra support to staff didn’t this imply that they were not paying them enough. SD replied that it was more difficult to discharge at weekends and the ability to have community care packages over 7 days and a 7 day service was crucial. On pay, they were beholden to national pay reviews for substantive staff and so they are trying to help those who need additional support. He explained the operation of the REACH system which helped and operated until 10pm but admission prevention can’t take place later.

4.7  ZE took Members through the presentation on winter planning and SH took Members through the presentation element on resilience, system pressure and urgent care and on enhanced access to primary care.

4.8  The Chair commented on the need for better communications on the Enhanced Access Service and what was being done to convince patients about this new approach  ...  view the full minutes text for item 4.

5.1  Members gave consideration to a paper ‘Development of a North East London Integrated Care Strategy’ and noted that the full strategy had to be submitted to NHSE in December. This set out the plan for the ICS which came into being on 1 July.

5.2  The Chair welcomed Zina Etheridge (ZE), CE of NHS NEL who took Members through the presentation.

5.3  The Chair commented that it came across as a very top-down Strategy and there was no mention of devolution to the 8 local Places and challenge of having a broad brush Strategy across the 8 boroughs.

5.4  Cllr Khan asked about the shortages of nurses and care home staff. ZE replied that on the issue of workforce and his it is captured in the document the intention was to tease out how they want to work in NEL at a more local level and to make this happen. She added that shortage of nurses was a particular concern and one ‘Employment and Workforce’ was a key priority in the document and making sure there is a sustainable workforce in NEL and that it is populated with as many local people as possible was key. DJ also detailed the specific NEL Workforce Strategy for Nursing.

5.5  Cllr Masters asked about the recent ‘Cost of living’ Workshop referred to in the paper. ZE explained how it had been very helpful and had covered such elements as the impact on those on lower incomes who don’t get free prescriptions and on the need for greater lobbying for free public transport or a reduction in the congestion charge for those attending hospital appointments.

5.6  Cllr Brewer asked about 30% of people in NEL waiting more than 4 hrs at A&E.  ZE explained that 4hr wait specifically wasn’t within the purview of this Strategy, which is much broader, but generally the focus has to be on improving access to urgent care so people don’t need to go to A&E in the first place. She detailed the work at Queens on improving flow through the Emergency Departments and the work in Primary Care to reduce A&E attendance. 

5.7  The Chair asked about a recent Health Services Journal news story about the £42m budget variance in NHS NEL’s budget after just 5 months. He asked whether it could be brought into line and what were the consequences.  ZE replied that while this was a significant number it represented 1% of total budget in NEL. It was a variance from plan rather than simply pure overspend and they were working very hard to bring the numbers back in alignment. The Chair asked how ICSs were supposed to handle overspend at the end of the year and whether it would be picked up by Treasury and what were the technical levers here for the ICS. ZE replied that the clear guidance from NHSE was that they must make every effort to get it back in line by the end of the financial year  ...  view the full minutes text for item 5.

6.1   The Chair explained that as part of the new ICS an Acute Provider Collaborative had been created involving Barts Health, BHRUT and Homerton Healthcare whereby the three acute health trusts in the patch would work to agree a single approach to service development proposals.  The APC first met in July and plans for engagement and consultation would emerge over the following months. 

6.2  He welcomed for this item:

  Rt Hon Jacqui Smith (JS), Chair in Common, Barts Health/BHRUT

  Zina Etheridge (ZE), CEO, NHS North East London

6.3  JS gave a verbal presentation on the plans. In summary there would be 5 Collaboratives covering : Mental Health, Learning Disability and Autism; Community Services; Primary Care; VCS; and Acute Care.  The focus is on improving outcomes for patients and on ensuring value for money. The APC is now focusing on its work plans which are wide ranging and a key element is having an Acute Clinical Strategy.  They are also looking at taking on more responsibilities for Specialist Services and at developing the work on Clinical Trials. They’ve also added strands such as ‘Babies children and young people’; ‘workforce;’ and ‘information and informatics’. Each programme has been assigned lead from one of the Trust  and they have an Executive Group and a Shadow Board which is chaired by Sir John Gieve. They are bringing together some of the work done previously at Trust level e.g. on HVLC centres.  Support had been canvassed for creating a network of centres of clinical excellence in surgery but this had been delayed by the pandemic. They are now back at the task and reflecting on the learning from the pandemic, which had accelerated some of the work and stopped others. JS cautioned that it was early days and the APC plan hadn’t yet been seen by the boards of the individual Trusts nor the APC Board itself but it will come back and of course feed into the Forward Plan for NHS NEL in time for next March. 

6.4  The Chair asked to what extent this was an Estates issue. JS replied that an element of it was and neither was it all about High Volume Low Complexity care but how to ensure resilience of Critical Care.  The challenge was how to get more services out of hospital, what will deliver the best outcomes, what do the Clinicians say and what do we need to move around to accommodate those changes. She added that in the APC they do not have a Masterplan and they are genuinely having to go back and to work done before the pandemic to review it in light of what we learned since. 

6.5  Cllr Brewer asked how will the APC practically assist with improving outcomes for patients e.g. on eliminating 4 hr waits in A&E or the huge 62 day cancer wait backlogs. SD replied that during the pandemic every hospital had cancelled routine surgery leading to a huge backlog.  NEL had been hit harder earlier with Covid  ...  view the full minutes text for item 6.

7.1  Cllr Sweden gave a verbal update on the work of the special JHOSC. He stated that the fiscal constraints on the project were challenging. He added that since the elections in May the committee now comprised largely new members. He explained that they had agreed with NHS officers a protocol and a pro-forma for substantial variations which this committee might wish to use. 

7.2  Cllr Brewer, also a Member of the Whipps Cross JHOSC, stated that they were anxiously awaiting the outcome of NHSE’s Major Project Review Group meeting on 6 December, where crucial decisions on the future of the project would be made. 

7.3  Shane DeGaris added that the enabling works (e.g. on the car park) had been agreed. The Chair asked if the funding agreed thus far was only for  enabling works.  SD replied that the Secretary of State had announced £30m covering three schemes for enabling works, including Whipps, but that final confirmation of the bulk of the funding was still awaited.

8.1  Members gave consideration to the draft minutes for the meeting on 25 July 2022 and noted the matters arising..

RESOLVED:

That the minutes of the meeting held on 25 July 2022 be agreed as a correct record.

9.1  Members gave consideration to the updated work programme.

10.1  There was none.