Agenda and draft minutes

1.1  Apologies for absence were received from Cllrs Adams, Akram and Deakin and from Paul Calaminus and Jacqui Van Rossum

1.2  It was noted that Cllrs Virdee and Brewer were joining remotely.

1.3  The Chair thanked Ashleigh Milson who was the link officer for this Committee at NHS NEL and wished her well in her new post at LAS.

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  The Chair stated that one of the issues which as caused some concern over the period of the development of the ICS was how the new body, NHS NEL, will work vis a vis the old CCG system and in particular the need to preserve valuable local knowledge from ‘Place’ level in the new, more centralised commissioning structure. He had invited the CE of NHS NEL therefore, to give a briefing on this.

4.2  Members gave consideration to a briefing paper - Understanding staff at place level.

4.3  The Chair welcomed Zina Etheridge (ZE), Chief Executive Officer, NHS NEL,  who took Members through the briefing which covered: Background, Place partnership principles, and staffing. 

4.4  ZE explained that the new structure would go live on 1 July and that any matter involving staffing was sensitive to the individuals involved which therefore limited the amount of detail she could give at this stage.  She reiterated that Place was fundamental to their work collectively and in partnerships.

4.5  The Chair asked whether there would be an anchor level of staffing at Place level. ZE stated that it had not been agreed yet as the current contractual arrangements of staff varied quite widely The aspiration was that staff working at Place would spend some of their time in that Place.

4.6  The Chair asked if there would be delegation of finances to the Place based structures and what attempts were being made to retain staff with local knowledge in broadly the same roles.  ZE replied that local knowledge of Primary Care would be the cornerstone of the model going forward. They already had a Primary Care Improvement Lead and a Primary Care Clinical Lead in each Place. On financial delegation she stated it was their intention that Places would have a very real role in setting the objectives for their communities.  She added that the leadership team all recognised this aspiration and acknowledged the concerns and so were, for example, updating the Terms of Reference for the Place Committees so that more delegation would be put in place from April.

4.7  Cllr Brewer asked whether NHS NEL had the balance right for resourcing staffing at Place level. ZE replied that the ICB budget was made up from a number of sources, some Programme Funded costs and some other costs.  The answer on the size of the budget depended on which elements you included. On staff numbers in the structure, she was not able to confirm any of that as yet because it had not yet been set out for staff.

4.8  Cllr Masters expressed concern that previous promises about subsidiarity appeared to be fading and asked about how best practice programmes on reducing inequalities were operating. ZE explained that the Population Health and Integration Cttee chaired by Marie Gabriel was key here and Place Committees sit within that structure. They have a series of pieces of work focusing on reducing health inequalities driven by what was set out in the recently published Integrated  ...  view the full minutes text for item 4.

5.1   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

  Louise Ashley (LA), Chief Executive of Homerton Healthcare

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

5.2  Members gave consideration to the report North East London Health updates    which comprised overview updates from Barts Health, Homerton Healthcare   and ELFT/NELFT.  SD and LA took members through the report.

5.3  The Chair asked SD how they had made insourcing financially viable. SD replied that a key focus had been bringing staff onto the ‘agenda for change’ terms and conditions and the move was important in terms of equity for lower paid staff. The increased cost could partly be offset by improvements in ways of working and having a better motivated workforce.  There was a net cost but it was the right thing to do, he added.

5.4  The Chair asked SD about sharing the learning from their insourcing journey with Homerton Healthcare. SD explained that this was happening and they also worked closely together in the Acute Provider Collaborative. LA added that she was pleased that it was happening and that they will have an opportunity to learn from it as they make similar considerations.

5.5  The Chair asked LA how the system was adapting to the new Pathology Partnership. LA explained that they had some teething problems in getting the electronic systems working and in sorting out facilities issues in the new Labs but all of these were solvable and it was bedding in. SD added that Lewisham and Greenwich NHS Trust were the third partner here so it was an in-house NHS Pathology Partnership and did not involve the independent sector.

5.6  Cllr Masters asked about keeping across developments at BHRUT and also  requested that, in future reports, more data be presented in graphical form so as to better illustrate trends. SD replied that they had similar slides on BHRUT for use at ONEL but didn’t present them here as they understood the focus was INEL, but they could present both in the future. He also undertook to provide more graphical information in future reports. JS added that more information from BHRUT is obviously focused on the ONEL committee. She recalled that she had presented on the Barts Health-BHRUT Collaborative previously and would be happy to do this at the next meeting, to provide an update on the key areas of work.

  ACTION:

'Update from NHS NEL Chair on the progress of the Provider Collaboratives' and a separate 'Update on the Barts Health-BHRUT Collaborative from their Chair in Common' to be added to the agenda for the next meeting.

5.7  Cllr Sweden asked what other medical conditions would be suitable for the virtual wards approach; about plans for further tranches of in-sourcing; about sharing best practice on IAPT; and on further integration of ELFT and NELFT. SD explained that Virtual Wards were currently used for areas like  ...  view the full minutes text for item 5.

6.1  The Chair stated that delayed discharges of care continue to be a key pressure on the local system and so he had asked NHS NEL to provide an overview of how the additional £200m (national figure) discharge fund announced in January was being spent as well as the previous £500m (national figure) ‘winter pressures’ funding which was now annual and so had an established process around its use.

6.2  He welcomed Clive Walsh (CW), Director of Performance, NHS NEL.

6.3  Members gave consideration to the report: Q4 22/23 Discharge Funding and 23/24-24/25 National Delivery Plan for Recovering urgent and Emergency Care Services.  CW took Members through the report in detail which covered: £200m discharge funding for Q4 22/23; National Delivery Plan for Recovering Urgent and Emergency Services; 5 ambitions within the Plan; and Funding

6.4  The Chair asked whether national guidance on this funding stream dictated what gets passported through to councils. CW replied that on NEL’s  share of the £600m they had identified how much they could usefully spend on step-down capacity. NHS NEL used £900k of £7.1m and remainder went to the 8 local authorities on a fair shares formula. On the new money (c.£600m) next year, c. £20m should come to NEL and 50% of that would go directly to local authorities as early as possible in the next financial year. Use of the balance will be a discussion between NHS and councils via the Better Care Fund process. He added that there were national constraints on how the BCF money can be used.

6.5  The Chair asked what discussions were going on with councils on a long term strategy to sort out delayed discharges of care, such as building more local accommodation for step-down type solutions for adult social care to reduce the need for expensive residential placements. CW replied that those conversations were taking place at both ICS and Place level. One example was that they might use some of the money to look at the division of nursing and residential beds between inner and outer NEL to examine whether more capacity could be created in Inner. Historically this was a problem due to the comparative cost of land (inner vs outer) and the nature of the properties needed for residential care. ZE added that patterns do exist in north east London and everyone finds it difficult to find places especially for patients with dementia or ‘behaviour which challenges’. They know there are gaps and in some cases where there are a relatively small number of places, the nature of the need and the local care market varies. It all needs to be looked at via a strong local lens. She added that the allocation of most of this money is via the BCF so the decision making is joint between local authorities and the NHS. There is a need to understand what overall demand and capacity is across particular footprints and unfortunately  people will end up in out of borough placements when the  ...  view the full minutes text for item 6.

7.1  The Chair stated that local research was a key part of the health system and research needed to be based on the cohorts which are as representative of the local communities as possible, if it is to have value.  He stated that NEL ICS had secured £100k to support the development of a research engagement network for NEL and he had asked the lead for this to update Members on it.

7.2  He welcomed to the meeting: Dr Victoria Tzortziou Brown (VB) OBE (Research and Innovation Lead, North East London Health and Care Partnership)

7.3  Members gave consideration to a report ‘NEL Research and Engagement Network Funding’ which outlined the context and included a short outline of the project activity and a note on outcomes and VB took Members through it in detail.

7.4  The Chair asked whether the end product would be the research itself or the new Network and how seldom heard groups could better be reached. VB replied that it was definitely the Network and that would in turn help them to reach out to underserved communities. Already certain areas were very active in engaging with research. They would focus on Newham and Barking & Dagenham as data showed under representation there and reduced participation compared to others. 

7.5  Cllr Brewer asked about the extent of research focuing on Diabetes. VB explained that a lot of work was taking place on Diabetes and they had in fact chosen diabetes and obesity as test cases for this project in order to better understand the barriers to participation in research. A lot of the research on diabetes was driven by Secondary Care and they would like to change that and ensure that the research is driven instead by patients and service users, she added.

7.6  Cllr Masters asked for clarity on the findings and assumptions re LB Newham. VB explained that it was not that the VCS sector there wasn’t active enough,  it was that the right connections hadn’t been made between those undertaking the research and those recruiting participants. The key was to use the local VCS as an important asset, she added.

7.7  Cllr Khan asked how the research will be used and what success would look like. VB replied that it would be that, in future, research was designed by service users and that more people from our diverse communities participated in it so that in the end we can be more confident that the research findings achieved apply to the totality of our local population in north east London and not just the current numbers who participate.

7.8  The Chair thanked VB for her report and suggested that at an appropriate point in a year or so it might be useful to revisit this item and hear about how the project went and whether they were able to reach into parts of the community that couldn’t do previously and what processes and methods they had used to achieve this so that there might be learning  ...  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 last met on 12 Jan ‘23 when they had discussed ‘End of Life Care’ aspects.  No clear vision of what would be proposed was yet available and officers were not yet ready to go out to any formal consultation on that aspect, he added.

8.2  The Committees work had been overtaken by events however in that they had been expecting confirmation of funding for preliminary building works at the site, a deadline on the announcement of that had been missed and then a government announcement was made that the national hospital building programme would not progress until 2025. Because of this work was now at a standstill and this was a very frustrating outcome. The Chair asked if all of the 40 projects had been stalled.  Cllr Sweden replied that it had and even though Whipps Cross was in the top list of 12, the announcement covered all and was made in the context of the current economic difficulties. 

8.3  The Chair stated that this was a very disappointing situation and he thanked Cllr Sweden and his colleagues for their efforts.

9.1  Members gave consideration to the draft minutes for the meeting on 15 December  2022 and noted the matters arising..

  RESOLVED:

 That the minutes of the meeting held on 15 Dec 2022 be agreed as a correct record and that the matters arising be noted.

10.1  Members gave consideration to the updated work programme.

  RESOLVED:

  That the updated work programme be noted.

11.1  The Chair stated that this would be his last meeting as Chair as the Chair of the  Committee rotates between the boroughs and it would now move to LB Waltham Forest for two years. ZE thanked the Chair for the constructive debates he had led and thanked the O&S officer for his work. Members thanked the Chair and the Chair wished Cllrs Sweden or Deakin well as they take on leading the committee from the next meeting in June.