The North Central London Joint Health Overview and Scrutiny Committee met to consider reports on a range of issues including a proposed merger of two local NHS Trusts, North Middlesex University Hospital NHS Trust and the Royal Free London NHS Foundation Trust. Also scheduled for discussion was an update to the North Central London Estates and Infrastructure Strategy 2024, and a report detailing a proposed merger of Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust.

North Middlesex University Hospital NHS Trust and the Royal Free London NHS Foundation Trust merger

The Committee was scheduled to receive a report on the proposed merger of North Middlesex University Hospital and the Royal Free London NHS Trusts.

The report explained that the full business case for merger had been completed and approved by both Trusts' boards in July 2024, and was awaiting final approval by NHS England and the Secretary of State for Health and Social Care.

The report stated that, subject to approvals, the merger was expected to take place at the end of 2024, with a planned formal merger date of 1 January 2025.

The report set out the purported benefits of a merger, which included:

• faster reduction in waiting times through combining and sharing resources to treat more patients
• more specialist care locally and more joined up community services supported through a single electronic patient record
• increased opportunities for patients regardless of location or background to participate in research and trials of new clinical treatments.

The report identified four initial areas where the Trusts would prioritise integration:

• Cancer
• Research and development
• Colorectal surgery
• Surgical hubs

The report provided further details about each service and how it was envisaged that a merger would support improvement.

North Central London Estates and Infrastructure Strategy 2024

The Committee was scheduled to receive a report updating them on the North Central London Estates and Infrastructure Strategy 2024. The report outlined the current status of the strategy and the challenges and opportunities it faced, and described the Integrated Care System's (ICS) approach to infrastructure planning.

The report provided an overview of the investments that had been made in recent years, including the opening of new health centres and the improvement of elective surgical facilities.

Primary Care Estates

The report highlighted that 26% of the North Central London population receive primary care from facilities that are not considered fit for purpose, and set out the need for investment and improvement in this area.

The report went on to describe the significant investment that had already been made in mental health facilities, citing the opening of a new inpatient unit at Highgate East, as well as a new community mental health centre in Lowther Road.

The report also described the Start Well initiative and its relationship to local infrastructure, explaining:

The Start Well programme is a long term change programme focussed on hospital-based maternity, neonatal and children’s services. These proposals have been developed with senior clinical leaders and we feel will create sustainable services that meet the needs of local people by ensuring that the right resources are available in suitable environments that meet quality standards and follow best practice.

St Pancras Hospital Transformation / Project Oriel

The report provided an update on the progress of the St Pancras Hospital Transformation / Project Oriel, describing it as:

a multi-year programme that has attracted significant national investment.

and explaining that:

The ambitious proposals will create Highgate East, a new inpatient mental health hospital on the Whittington hospital site; a significant redevelopment of the St Pancras Hospital (SPH) site; new Community Mental Health Hubs in Islington (Lowther Road) and Camden (Greenland Road); and a new Moorfields Eye Institute.

The report listed the expected completion dates of each element of the project, with the new mental health facility at St Pancras Hospital currently scheduled for completion in 2033.

Integrated Care

The report went on to describe the importance of integrated care and the role of the ICS in facilitating it. It explained that:

Across NCL, there is variation between areas in provision of larger, core estate that can support integrated hub working at scale. Without that larger estate, integrated service provision remains conceptual.

and argued that:

NCL does not make best use of the larger, core health properties it has.

It provided examples of how this could be addressed, including:

• The development of a new health centre at Brent Cross.
• The provision of space within local authority premises, such as Newington Barrow in Islington.
• The utilisation of existing void spaces, such as at Kentish Town Health Centre.
• Making existing hubs, such as Hornsey Central Health Centre, work better.

Digital Strategy

The report went on to describe the refreshed Digital Strategy, explaining that it would focus on six priority areas:

• Cyber Security
• Electronic Patient Records
• Digital Maturity
• Data
• Enabling Infrastructure
• Innovation

People Strategy

The report then turned to the People Strategy, highlighting that there was an identified gap in the local healthcare workforce, and that the ICS was taking steps to address it. The report explained:

As the People Strategy develops, connections to the physical infrastructure (including space for training and development) will be important.

The report also highlighted the link between the quality of physical premises and staff wellbeing, stating:

There is a correlation across all health sectors between the physical premises and staff wellbeing.

and providing the example of:

a 2022 BMA survey [which] found that over 38% of staff, reported their healthcare premises were poor or very poor to provide healthcare.

The report went on to describe the WorkWell Partnership Programme and the ICS's commitment to reducing its carbon footprint.

Capital Projects and Prioritisation

The report provided details of how the ICS prioritises capital projects, explaining that it had:

made a strategic decision to allocate 10% of its capital allocation to system priorities

and listing the projects that were being funded in 2024/25.

The report concluded with a section on stakeholder engagement, which highlighted the importance of community engagement, and provided an update on the NCL Start Well programme public consultation.

Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust merger

The Committee was scheduled to receive a report on the proposed merger of Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust.

The report set out the rationale for the merger, explaining that:

Our two Trusts have a history of partnership working, a joint strategy, values and behaviours, and a strong rationale for the transaction

and outlining the benefits which the Trusts believed a merger would deliver. These included:

• Providing care closer to home
• Responding to the growing and ageing population of North Central London
• Maintaining 24/7 services
• Improving performance
• Addressing workforce challenges
• Creating a stronger, single voice for mental health in North Central London

The report went on to describe how the proposed merger would align with the North Central London Health and Care Strategy, and set out the extensive programme of co-design that had been undertaken in preparation for the merger, stating that:

Over 1,000 staff, service users, carers and stakeholders [had been] engaged to develop of our Patient Benefit Case

The report went on to describe the benefits to patients of the proposals around crisis care, working age adults, and older adults with dementia, explaining:

"We will consider

inpatient services at scale in ‘One Trust’ to personalise the clinical offer across all wards, and meet the training needs of inpatient staff to better deliver care"

The report concluded with details of the financial and estates impacts of the proposed merger, and an appendix summarising the proposals.