Back to top arrow icon Back to top
  1. Home
  2. Agenda item
 Menu

Agenda item

Discussion with new Leader of NEL ICS City and Hackney Place Based Partnership (19.02)

Minutes:

4.1  The Chair welcomed:

Louise Ashley (LA), Chief Executive, Homerton Healthcare and new Place Based Leader for City and Hackney Place Based Partnership.

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

Nina Griffith (NG), Director of Delivery, City & Hackney Place Based System

 

He welcomed Louise and Breeda to their first meeting of HiH and stated that the purpose of this item was to question the recently appointed CE of our largest acute trust Homerton Healthcare and the Place Based Leader for the City and Hackney Place Base Partnership, which is part of NEL ICS.

 

4.2  Members gave consideration to a background report: North East London Integrated Care System & City and Hackney Place Based Partnership

 

4.3  LA thanked Members for the welcome and gave a verbal update the key points of which were noted:

 

Background as general nurse, paediatric nurse, health visitor, then chief nurse in many places, spending the past 4 years as CE of Dartford and Gravesend Trust. Worked in Homerton previously and set up their Starlight Paediatric Services Unit.

The ground work that’s gone into integrating health and care in City and Hackney has put in it a very good place and is way ahead of comparators.

Having the Mayor on the ICB and Cllr Kennedy as Chair of the City and Hackney Health and Care Partnership Board, both providing a strong voice for the borough, shows a commitment to joint working which is not present in other places.

Conscious that there continues to be a nervousness locally about Barts and fears that the Homerton could not survive on its own but there are excellent working relationships between the two trusts already in place and the good work in integrating care is down to this.

Understand the concerns about finance flows pre vs post ICS and noted that the ICS is working on a financial strategy but this work moves slowly.

She and her Chair, Sir John Gieve, continuously point out that others can learn from C&H and so removing the resource from us to level up elsewhere, where there weren't similar levels of investment say in primary care in the past,is not the way to go. She has excellent working relationships with both Marie Gabriel and Zina Etheridge.

It looks like there will be some sort of return to Payment by Results after two years of block contracts (due to pandemic).  There will be money to place based commissioning for development work and there will be transformation monies also..

Currently no appetite to devolve all commissioning and monies down to Place level and while that might sound like an attractive option it would only distract us from some of the development  work we need to do in the Neighbourhoods for example.  They do not want lots of additional work thrown down from the ICB without the resources to deal with it. 

On the elective backlog at the Homerton itself, most elective work had to be stopped during the pandemic and so they have about 25k on waiting lists now.  Prior to Covid it was about 19k.  Some of that increase is down to various coding changes. 

Their 18wk wait rate is still 4500 and this hangs heavily· However nobody at Homerton is on the 104 wks or 78 wk wait unlike in other parts of NEL. Homerton does have 72 patients who have waited a year and this is not good enough. They are steadily working through them and remain one of the best performing in London..

 

4.4  Members asked detailed questions and in the responses the following was noted:

The Chair asked, notwithstanding the Acutes beng directly commissioned from the ICS for certain activity, would the bulk of the money which used to be spent by the CCGs remain at Place or be kept at the ICS level. LA replied that some would still come down to place; there has been a top slice of that across NEL for transformation i.e. developments that will then be allocated out to areas. It is still unclear, she added but there won’t be a reduction in what City and Hackney receives but some of the development funding might be directed to other areas which may be further behind.

The Chair stressed that there was a need to protect Hackney’s interests and there need to be absolute transparency and if money flows were essentially being diverted to other areas then this can’t just be done at ICS level without proper, accountability, scrutiny or knowledge adding that he appreciated that Outer NEL has older population and that there are counterbalancing arguments but there needs to be transparency about these money flows.

 

ACTION:

CE of Homerton Healthcare to provide high level breakdown by category of funding which City and Hackney CCG received and spent in its final year.  This is to assist discussions at both HiH and INEL on comparing financial flows.

 

 

A Member asked about the relationship between Barts and the Homerton, the latter not having a seat on ICB board.  LA replied that Homerton Healthcare protects itself by being high performing and that Hackney is miles ahead on the way we do integrated health and social care and on the development of the Neighbourhoods.  She added she has a very close working relationship with Shane DeGaris the CE of Barts Health and he has no interest in consuming the Homerton. The focus needs to be on patients and the population and we need to get the best deal for residents and the Homertron has excellent relationships with the specialist services at Barts and indeed it could not provide what they provide and they do it really well. 

The Chair asked about the impact of the advent of the Acute Provider Collaborative on the Homerton. LA replied she was the Deputy Chair of the APC and that feeds into the Population Health and Care Cttee which feeds into the ICB.  The APC has worksteams on children maternity etc and all feed into APC board and work on things across the system such as elective and emergency care.  A lot of the focus has been on other trusts currently because of ambulance waiting times and A&E performance in the wider system.  She added that while the Homerton does not have a seat on the IBC the Mayor does and that Shane DeGaris represents Acute Providers on it, not just Barts.  Sir John Gieve (Homerton Healthcare Chair) also chairs the APC Board.

A member asked of the 25k on elective waiting list what percentage are classified as urgent or life saving treatments. LA explained how in urgent care patients are classified into 4 categories (P1 to P4). P1 refers to life threatening cases and they get top priority obviously.

 

ACTION:

CE of Homerton Helathcare to provide breakdown of the elective care waiting list by category.

 

 

A Member asked if the 8 Neighbourhoods have the resources required to meet their priorities and for an update on the St Leonards redevelopment plan. LA replied that the 8 Neighbourhoods aligned to PCNs have some development funding but there is never enough to do what they want to do. They are exploring closer working relationships including with academia to support their work and of course each Neighbourhood has different needs and this also needs to be factored in. On St Leonards she stated that they had been offered the opportunity to take over the site which is currently owned by NHS PropCo and there is a way for this transfer to be arranged but before that can happen very many assessments that need to be done to ensure they can do it.  She added that if they just took over St Leonard’s currently there is no money to support it being re-developed and that is not acceptable.  So there have been assessments of land values et t and looking at similar hospital developments where parts of the land need to be sold to pay for the hospital redevelopment. She added that it was a bid they’d like to develop but they have to get it right and it will take time to complete all these assessments.  She commented that If she had the capital funding to do this tomorrow she would.  She undertook to keep Members updated.

 

ACTION:

CE of Homerton Healthcare to provide an update on the progress of the plan to redevelop St Leonards Hospital site. Item to be scheduled once there is sufficient progress to report.

 

 

4.5   The Chair thanked LA and colleagues for their attendance and asked if LA could return at the appropriate time with an update on the St Leonard’s development and if the officers could assist  with providing a comparison of the budget flows for City and Hackney pre and post the ICS.

 

RESOLVED:

That the report and discussion be noted.

 

 

Supporting documents: