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East London Health and Care Partnership Updates (19.40)

Minutes:

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 post the Panorama programme and about the need to seek better assurances. WCD said they had taken a 12 month analysis of all the information available. The Chair asked how they were responding if it was clear that the activities being carried out weren’t in line with a previously agreed policy and were they accepting that there was an issue. WCD replied that they were and NHS NEL was using it as a learning experience. So far the evidence they’d seen and been supplied would suggest that there were robust systems in place and where there were failings the Provider clearly understood that they needed to improve. 

 

6.8  The Chair asked what powers/contract levers did NHS NEL have with Operose if there was no improvement within 6 months.  WCD said a breach notice would be applied to the contract and this has happened in other cases and CQC had also gone in. The Chair asked whether Operose were currently in breach. WCD replied that they were not in terms of the evidence that they had seen and  because of how the lessons learned were now being implemented. The Chair stated that they would return in a future meeting to the broader issue of how the assurance framework is being monitored.

 

ACTION:

Future item on the monitoring of the new Assurance Framework for GP Practices to be added to the work programme.

 

 

6.10   Cllr Adams asked about the Community Diagnostic Hub being mentioned for St Leonard’s and how this aligns with the Homerton’s own plans for the site.  He also asked about the robustness of the response to the monkeypox virus.  NW replied the St Leonard’s was just one of the many possible sites for future expansion as Community Diagnostic Hub 3,4 or 5 and they were working with the Homerton and local stakeholders on any decision to site the centre there.  Westfield in Stratford and St George’s sites were no further advanced as yet but they were looking at a number of possibilities.  Ann Hepworth (Director of Strategy and Partnerships at BHRUT and the SRO for Community Diagnostic Centres in NEL) described the work being done trying to identify possible sites. Population Health Need was the main driver as was the need to increase access and make more diagnostics available. 

 

6.11  DJ replied that they are applying a system wide approach to the monkeypox outbreak as they had with Covid. They’d set up clinics in 3 sexual health clinics in NEL and they were targeting those exposed and their carers.  The Chair asked whether the prevalence in NEL was the same as for the rest of London. DJ replied that NW and SE London had higher prevalence and they have bigger sites within their acute hospitals. 

 

6.12  Cllr Akram asked whether the Enhanced Access to Primary Care plan was part of the core contract or would be an opt in. AG replied that it was part of Primary Care Networks and every GP Practice had to be part of a PCN so there wouldn’t  be gaps, it would be universal.

 

6.13  Cllr Patrick asked whether all Practices within a PCN will offer it or just one.  She also asked about shortages of staff and about the risks of pulling staff from elsewhere to operate it.  AG replied that every patient will be able to access all the Enhanced Access offer equally.  There would be more routine type care offered outside of core hours e.g flu jabs or smear tests etc. WCD added that it would be a more local service rather than from a confederation.  Yes there was a shortage of staffing but the aggregation of PCNs they would be able to deliver it more efficiently and it would be for pre booked appointments for business as usual care and not urgent care. The issue was to work at scale and pool the resource and to focus on deploying the primary care staff in a more targeted way. 

 

6.14  The Chair asked what was being done to positively communicate to patients being redirected to a surgery which was not their own.  WCD replied that they had sent questionnaires to all patients in NEL and had received a 40k return rate. They were also working with PPGs in each Practice.  These were pre-booked, not urgent care appointments. The Chair suggested that greater communications activity was needed to sell this as a ‘positive’ to residents.  WCD replied that comms was vital and they were also engaging with Healthwatches also. 

 

6.15  The Chair asked whether the Community Diagnostic Hubs were nationally driven and asked what was the evidence base for them. AH replied that the evidence base was built on the Covid vaccination plan, itself built on WHO guidelines, on reducing inequalities with a focus to increasing and broadening access.  In NEL they were looking at demand against current capacity and analysing unmet demand.  The Chair asked about the monitoring of throughput to the CD Hubs.  AH replied that they would be examining both throughput and patient experience.

 

6.16  The Chair asked Ralph Coulbeck (CE Whipps Cross) about the recent media concerns (Health Service Journal in May and July) regarding the security of future funding for the Whipps redevelopment and a possible slow down in the funding. RC replied that they had planning consent for the second phase of the enabling work and had made good progress on beginning the clinical transformation required to support the redevelopment.  They were still awaiting a response on the second phase of the business case. They had indications that there would be a decision in the autumn.  On the reported £1m resource allocation, that was an initial allocation only and the same for all schemes. They had had assurance informally from the New Hospitals Programme that any move to the next phase would be accompanied by further funding to support that piece of the work.

 

6.17  The Chair asked whether Whipps was now in a cohort being put on a slower track. RC explained the complex funding process.  The New Hospitals Programme was divided into cohorts and Whipps Cross was in Cohort 3.  Cohort 1 was for schemes already in construction and Cohort 2 referred to smaller and much less expensive schemes.  Whipps was one of 8 in Cohort 3, previously known as ‘pathfinders’.  Cohort 4 contained the remainder of the 40 schemes which were all at a less mature stage.  He added that they were focused on Cohort 3 now moving forward.  There had been indications that Cohort 3 might be subdivided and this could yet happen but there had been a number of assessments of the scheme and the various formal and informal feedback received led them to believe that they were in the advanced end of Cohort 3 with similar schemes which have the same level of planning consent. The Chair asked about the government’s approach to phasing the schemes.  RC explained that they expected Cohort 2 to proceed much more quickly than cohort 3.  The Chair thanked RC for attending and asked for an update when further progress had been made. 

 

6.18  The Chair asked about the new Continuing Healthcare Policy and its impact on councils.  He asked whether all local authority directors of adult services in NEL were around the table on an equal footing in the discussions about the redesign of this policy.  DJ explained the context and the need for a systematic way of addressing these issues leading to calls from all quarters to sort out the huge divergence in provision. There was a wide variance across the patch with different places at different stages of development.  She stated that they had done an impact assessment which pointed to a harmonised policy having a positive impact overall and they were now working through how each local authority views the current raft of policies. The prioritisation of which policies had been done and NHS colleagues were working at place level with councils and with clinical teams to produce a single document. An engagement exercise would then commence where local authorities, stakeholders and the public can input to the new single policy.

 

6.19  The Chair asked whether the imminent consultation would clarify the differences between the old and new policies. SJ replied that it wouldn’t go into the details of each existing one, or lack of one, but would compare the previous offer to the current proposal. They would use a table to provide a high level summary of the key elements that will change and where a policy currently doesn’t exist point out that one is needed. 

 

6.20   The Chair stressed the need to go back to Directors of Adult Services to hear their views on the potential impact on councils.  He suggested that at a future meeting it might be fruitful to take one or two of the overarching themes “placements policy” or “ joint funding policy for adults’ and do a deep dive on it so Members will be in a better position to scrutinise the changes. DJ explained that the current consultation would close in late September and they would then do a sense check with the specialist group that was advising the project and would have a final version of the policy in place by the end of October to go through NHS governance procedures. A period of implementation would then follow and it was unlikely that changes would be seen until after Jan 2023 and all the stakeholders were happy with the final policy. 

 

ACTION:

That a future item on Continuing Healthcare Policy focusing on ‘placements policy’ or ‘joint funding policy for adults’ be added to the work programme and that Directors of Adult Services in the boroughs be fully involved in the redesign.

 

 

6.21  The Chair asked about a story in the Health Service Journal about the new 10% cap on agency staff spend imposed on ICSs.  HB replied that this related to the additional money given to the NHS to support inflationary pressures and one of the conditions was that each ICS had a cap on agency spend.  Across the whole ICS they will need to reduce reliance on agency staff by 10%.  This would require a switch from temp to permanent staff and from agency staff to bank staff. It would be challenging. The Chair suggested that it was unrealistic in the current climate.  HB replied that they do spend too much on agency staff and although it would be difficult, the new regulation would make it easier in the short term as the labour market would respond so that more staff would, for example, register with banks as a consequence. 

 

6.22  The Chair thanked the officers for their detailed and helpful reports and for their attendance. He suggested that there could be future items on the Acute Specialisms issue and a deep dive on aspects of the new Continuing Healthcare Policy.

 

ACTION:

Future item on the development of acute specialities and clinical services across NEL to be added to the work programme.

 

 

RESOLVED:

  That the reports and discussion be noted.

 

 

 

Supporting documents: