Agenda and minutes

1.1  Apologies for absence were received from Louise Ashley (CE, Homerton Healthcare) who would be represented by Breeda McManus (Chief Nurse and Director of Governance). 

1.2  It was noted that Cllrs Deakin, Masters, Virdee and Brewer were joining remotely. The Chair welcomed Common Councilman David Sales (City of London) to his first meeting.

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 Health Transformation by Hackney Council for Voluntary Services, in a post funded by NHS NEL.

4.1  Members gave consideration to a briefing paper NEL Integrated Care Strategy development.

4.2  The Chair stated that this was discussed at the previous meeting and this would be a further update and the full document was about to be submitted to NHSE.

4.3  The Chair welcomed for the item:

  Zina Etheridge (ZE), Chief Executive Officer, NHS NEL

  Hilary Ross (HR), Director of Strategy, NHS NEL

  Breeda McManus (BM), Chief Nurse and Director of Governance, Homerton Healthcare

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

4.4  ZE and HR took Members through the paper.  It was noted that there had been systems wide workshops to develop the content and it had involved all the health and wellbeing partnerships. Recognising the backdrop of the cost of living crisis was going to be key as there will be a need to focus on the rising impact of poverty. The Strategy sets out a context and case for change, lays down priorities for system action and it puts together more measurable outcomes which will be tracked.  There are 6 themes: Health inequalities; focus on prevention and early intervention; more holistic, personalised and trauma informed care; co-production with local people and partners; working towards a high trust environment across the system and  working as a learning system.  It will provide a clear direction for the funding planning round and the local response to the 5 year National Plan. They would also be planning a ‘Big Conversation’ with residents and stakeholders to highlight it further.

4.5  The Chair asked whether there is an underlying dataset which can form the basis of future comparisons. HR replied that they had not completed work on the KPIs to be used. The work is based on a number of datasets. She added that they have a Population Health Profile across NEL which gives a good picture on prevalence and wider determinants.  They are building on use of indicators for items they already have data on so that outcomes can be carefully tracked. The Chair asked at what point will they lock down a dataset against which they can judge performance and HR explained that a mix of longer term outcomes and shorter term metrics will be built into the forward plan and there will be close clinical input to this.

4.6  Cllr Sweden asked whether there are implications for a re allocation of resources and what those might be. HR replied that the Financial Strategy will say more about how they are going to move resources to focus on prevention and health inequality. ZE added that they will first need to work out how they are to move resources into prevention and the Strategy is aiming to do this.

4.7  Common Councilman Sales asked about the 31% having Long Term Conditions and who defined these. HR explained that LTCs refer to conditions such as cardiovascular disease or COPD or diabetes which, broadly speaking, are not curable. Some are preventable so they focus on how to manage them.  LTCs refer  ...  view the full minutes text for item 4.

5.1  Members gave consideration to a joint briefing from ELFT and NELFT on What we are doing to improve access, outcomes, experience and equity for children, young people and young adults (0-25s)

5.2  The Chair welcomed:

Paul Calaminus (PC), Chief Executive, ELFT

Jacqui van Rossom (JV), Chief Executive, NELFT

who took Members through the presentation. PC explained that Services were planned and delivered in partnership with others (education, social care, VCS) and he highlighted the work on developing core therapy services, eating disorders service and the various crisis services.

5.3  The Chair stated that a public question has been received.  Malcolm Alexander (Board Member, Healthwatch Hackney) asked the following:

Will NHS NEL give a commitment in their strategy to take action to prevent patients in a mental health crisis from ever having to wait more than 4 hours from decision to admit to admission to a mental health bed.

Will they also give a commitment to the prevention of young people and children being sent outside their home borough for mental health crisis care?

5.4  In response to MA’s question on out-of-borough placements, PC stated that there were 4 units for young people from NEL and NCL and they were being treated in local CAMHS units. These were not borough specific.  There were 2 units in NEL which allowed young people to be treated closer to their families. He detailed development plans and described the huge impact the pandemic had on children and young people’s mental health causing a spike in demand. NEL was spending more proportionately than is nationally allocated for CYP but the demand graph was stark and there was further to go to meet the need in the population. He described the co-production approach to supporting the 18-25 age group and the benefits of the Advantage Mentoring Programme in NEL.

5.5  In response to MAs question on mental health delays in A&E, PC stated that they wished to return to a position where they always have an emergency bed available for everyone who was deemed to require it. There was an issue about the increased acuity of the presentations partly as a result of the pandemic and this had contributed to the recent spike but they were working hard to achieve the targets and timescales they had set for themselves here.

5.6  The Chair asked what was the waiting time for assessments.  PC replied that for routine cases it was 21-22 days.

5.7  Cllr Brewer expressed concern about these waiting times and asked about the workforce challenge of securing more psychiatrists. PC explained that for the long term they were maximising their number of training places and optimising career pathways and in the shorter term developing new types of extended nursing and therapy roles who would be able to take on some of the workload. They were also developing Peer Support roles and working more with people with lived experience of therapies which was having great results for in patient services.  Keeping and growing CAMHS staff  ...  view the full minutes text for item 5.

6.1   The Chair explained that this item allowed us to hear updates from the key local trusts.  He welcomed for the item

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

  Breeda McManuse (BM), Chief Nurse and Director of Governance for the CE of Homerton Healthcare

  Paul Calaminus (PC), Chief Executive, ELFT

  Jacqui van Rossom (JV), Chief Executive, NELFT

6.2  Members gave consideration to the report North East London Health update  and the Homerton’s additional slide which was tabled.

6.3  SD gave Barts Health’s update focusing on: planning for winter; elective patient recovery, and on staffing and workforce.  There were still great pressures on A&E departments and a lot of work was going on with the Place Based Partnerships to speed up discharges of care, this being compounded by the cold weather and various strike actions. The latter weren’t having a direct impact in east London but there would be indirect impacts from the London Ambulance Service’s forthcoming strike. On Elective care, most of the 2 yr plus long waits had now been cleared and they were moving on to clear 78 and 52 wk waits.  On staffing they had now insourced their Soft Facility Services. Barts had also won a discharge award for work with heart patients.  Good work was also taking place at the new hub at King George’s.  The CQC had visited A&E at Barts and performance was variable but they were looking at each stage of the flow.  On the staffing front they had welcomed a new senior officer focused on Equality and Inclusion.

6.4  BM gave the Homerton Healthcare update. They’d seen a rise in ED attendance combined with wider pressures in the system and they also saw a lot of patient walk-ins.  They do have ongoing staffing challenges and they have experienced a dip in performance on the 4hr waits at A&E and so are looking at flow and pathways.  They’re also focused on discharge so they can improve flow through the hospital.  One of the challenges is admitting out of area patients which makes it more challenging to discharge them and this impacts on flow.  Lousie Ashley had now completed her second month as the new Chief Executive.  On staffing they’re trying to reduce the vacancy rates and have introduced some new financial wellbeing support for the staff and she added that 70 overseas nurses had joined since June.

6.5   The Chair asked about the financial impact of insourcing Soft Facilities Management. SD  replied it would cost more money because they would be paying comparable Agenda for Change rates as with other staff but it was the right thing to do and would generate efficiencies over time.

6.6  Cllr Brewer asked about poor A&E 4hr waits at BHRUT vs Homerton and what role ICS might have here. SD replied that they do share best practice and across NE acute trusts but the trusts vary considerably. The Homerton has fewer ambulances attendances than Queens and the nature of the care in  ...  view the full minutes text for item 6.

7.1  The Chair stated that he had invited the Chief Financial Officer of the ICS to this meeting to discuss the financial strategy, following up on issues raised at recent meetings.

7.2  He welcomed to the meeting: Henry Black (HB), Chief Finance and Performance Officer, NHS NEL.

7.3  Members gave consideration to a report NEL Financial Strategy Update.

7.4  HB took Members through the report in detail.  It covered the following themes:

Context – How we’ve used our budget in 21/22 and 22/23

Comparison of spend on different types of care, by place (22/23 budget)

The ambitions of our financial framework

We face significant challenges, both now and over the longer term

Moving to a population-based approach

Reflecting the costs of care provision to support partnership working

Creating headroom for investment

He stated how the ICS represents a profound change from that past when health and social care worked separately and the NHS worked within an internal market which incentivized competition rather than collaboration. The Financial Strategy was about devising a way of making the funding work at Place level and it was tied into the Accountability Framework.  The Place Based Partnerships (PBPs) are brand new entities which are non statutory but which sit within the statutory ICB. It will take time to mature and ensure they have the resources they need. There will be some aggregation of back office functions at NEL as would be expected and the 7 Delivery Directors at Place Level will have business partners from analytics and finance to assist them. Subsidiarity is the main principle and the Financial Framework will give PBPs responsibility over the majority of the budgeting. The Acute and Primary Care Collaboratives will manage their budgets but everything else will go to Place. There will be full visibility of the entirety of spend at Place level. There will be opportunities to make decisions about shifts of resources in the various pathways. The Financial Framework will also secure funds for investing in prevention and transformation and they are trying to ring fence 1% for transformation.

7.5  The Chair thanked HB for a very helpful presentation and stated that Members need an understanding of the new financial system from April ‘23 and to what extent will the different ‘Place Based Systems’ within NEL have the staff resource to research and make their own decisions or will all the staff be at ICS level. He also asked how the projected £42m deficit (discussed at the previous meeting) was being brought under control.  HB replied that some reporting in the press was not reflective of where they were at.  At month 8 it’s similar to the rest of the country. Everywhere was financially challenged and the NHSE position was to aim for balance.  A deficit of around £30m should be absorbed by NHSE, he added.  There was a need for a clear stabilisation of run rate in the second part of the year. The financial overhang of Covid funding in the first part of the  ...  view the full minutes text for item 7.

8.1  Cllr Sweden gave a verbal update on the work of the special JHOSC.  He stated that they had met again on 2 November and steady progress was being made. They had produced a pro forma for use when determining ‘case for change’ proposal requests. Cllr Brewer, also on the Whipps Committee, commented that it had been massively disappointing that on 6 Dec the DoH had postponed yet again some key decisions on funding.  They had stated that the “timetable would be released at some time in the new year”.  The Chair commented that he shared their frustration at this and hoped the Committee would keep a close watching brief on it.

9.1  Members gave consideration to the draft minutes for the meeting on 19 October 2022 and noted the matters arising..

RESOLVED:

That the minutes of the meeting held on 19 Oct 2022 be agreed as a correct record.

10.1  Members gave consideration to the updated work programme.

RESOLVED:

  That the update work programme be noted.

11.1  There was none.