This meeting of the North Central London Joint Health Overview and Scrutiny Committee included a scheduled update on the ‘Start Well’ programme which consulted on changes to maternity, neonatal and children’s surgery services. There was also scheduled discussion on access to primary care services and an update on dental services in North Central London.

Start Well

The committee was scheduled to receive an update on the Start Well programme following the completion of the recent public consultation which sought feedback on three proposals for service changes:

1. Proposal one: To consolidate maternity and neonatal care across four sites rather than the current five, with two options proposed:
   • Option A: Closing services at Royal Free Hospital
   • Option B: Closing services at Whittington Health
   • Both options would retain services at Barnet Hospital, North Middlesex University Hospital and University College London Hospital, with significant investment also proposed.
2. Proposal two: To close the birthing suites at the standalone birth centre at Edgware Community Hospital whilst retaining the antenatal and postnatal services provided at the site.
3. Proposal three: To consolidate surgery for young children (under the age of 5) and low volume specialties at two ‘centres of expertise’:
   • A centre of expertise for emergency and planned inpatient care proposed to be at Great Ormond Street Hospital for Children (GOSH), which would involve creating a surgical assessment centre for improved emergency access.
   • A centre of expertise for planned day case surgery proposed to be at University College London Hospital.

The report pack included the ‘Start Well programme: consultation key findings’ report, an interim report by the independent organisation Opinion Research Services (ORS) summarising feedback gathered from the consultation. The full evaluation report will be published in due course.

The key themes from the interim ORS report were:

Maternity and neonatal services:

• Overall support for change and the challenges facing services.
• Agreement for the proposal to ensure all neonatal units in North Central London offer the same minimum level of care (level 2[^2]). [^2]: Levels of neonatal care range from 1 to 3. Level 1 provides basic care for healthy babies. Level 2 provides extra care for babies born prematurely or with health problems. Level 3 provides the highest level of intensive care for babies that are very unwell or require surgery.
• Less support for the proposal to consolidate maternity and neonatal services from five to four sites, with concerns raised about increased service pressures, longer travel times and a potential reduction in the quality of care.
• Those living near the Royal Free Hospital favoured Option B (retaining services at Royal Free Hospital) whilst those living near other hospitals favoured Option A (retaining services at Whittington Health).

Edgware Birth Centre:

• Agreement that changes were needed to respond to the challenges facing services.
• Support for the proposal to close the birthing suites, although there was higher disagreement among those living near to Sunnyside Community Center.
• Those who disagreed with the proposal highlighted concerns about a reduction in patient choice and a potential impact on the safety of low-risk births, and argued that the service provided good-quality care.

Children’s surgery:

• Agreement that changes were needed and that two ‘centres of expertise’ would be beneficial, although this was acknowledged to potentially increase travel times.
• The proposal to locate the planned inpatient and emergency surgery centre at GOSH was well-supported.
• Concerns were raised by the GOSH Executive team about the potential for unintended consequences and they suggested that further work with partners may be required to develop a more effective alternative.

Primary Care Access

The committee was scheduled to receive an update on access to primary care services in North Central London. This followed publication in May 2023 of the National Delivery Plan for Recovering Primary Care Access, which aimed to support practices to transition to a ‘modern general practice’ operating model and improve patient satisfaction, with a particular focus on tackling the ‘8am rush’ for appointments.

The report highlighted that:

• General practice delivers 95% of all NHS patient contacts in North Central London.
• The number of appointments offered by General Practice in North Central London continues to grow:
  • 680,000 appointments per month
  • 100,000 online consultations per month
  • 30,000 out-of-hours appointments per month (evenings, weekends and bank holidays)
• Patient satisfaction with General Practice has declined despite these increases, reflecting a national trend.
• North Central London now has one of the lowest GP leaver rates in the country.
• The North Central London ICB has invested £13m in primary and community estate over the last two years.

Dental Services

The committee was scheduled to receive an update on dental services in North Central London. This follows delegation of responsibility for these services from NHS England to Integrated Care Boards (ICBs) in April 2023.

Key points highlighted in the report pack included:

• The delegation of Dental Services was accompanied by a budget of £114.5m across 170+ contracts for Primary, Community and Secondary dental services.
• The North Central London ICB has initiated a wide ranging transformation programme including an additional investment of £600k recurrent funding. This programme focuses on:
  • Reducing waiting times for children and young people needing specialist care.
  • Ensuring a consistent offer across NCL for rough sleepers.
  • Providing access to specialist care for those experiencing homelessness (including asylum seekers).
  • Providing access to specialist care for those in Residential Care Homes.
  • Targeted work with schools in deprived areas to reduce the use of sugary drinks.
  • A collaborative programme of work with Local Authorities on oral health promotion.
• The number of referrals to Community Dental Services (CDS) are 40% above pre-pandemic levels, with only 8% being referred on for Acute care.
• NCL has two Secondary Dental Treatment Centres provided by University College London Hospitals (UCLH) and the Royal Free (RFL). There are also some services delivered at GOSH for complex paediatrics, which is commissioned directly by NHSE.

The report also referred to the National Dental Recovery Plan entitled Faster, simpler and fairer: our plan to recover and reform NHS dentistry, which was published on 7 February 2024. The plan included a number of commitments such as:

• Increasing access to dental care in 2024 for all those in need, starting with those who had been unable to access care over the previous two years.
• Launching ‘Smile for Life’, a new focus on prevention and good oral health for young children, delivered in nurseries and other settings.
• Expanding the dental workforce in the medium and long term.

The NCL ICB is now considering a range of developmental areas to further improve access and outcomes, including:

• Improving the oral health of patients with long term conditions, starting with those with Diabetes.
• Expanding access to specialist dental care in care settings other than Residential Care Homes.
• Improving outcomes in paediatric dental trauma.

Work Programme

The committee was scheduled to note the work programme for 2024-25, details of which are listed in Agenda frontsheet 25th-Jul-2024 10.00 Joint Overview and Scrutiny Committee on Health.

Future topics for consideration included:

• Health inequalities fund.
• Smoking cessation & vaping.
• Funding for NHS dentistry.
• Strategic role of GP Federations.
• Vaccination initiatives.
• Ambulance waiting times.
• Primary care commissioning.
• Online GP consultations.