This meeting of the North Central London Joint Health Overview and Scrutiny Committee included an update on the North Central London Estates and Infrastructure Strategy 2024 and reports on the proposed mergers of the North Middlesex University Hospital NHS Trust with the Royal Free London NHS Foundation Trust and the Barnet, Enfield & Haringey Mental Health NHS Trust with the Camden & Islington NHS Foundation Trust.

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

The report pack included an update on the proposed merger of North Middlesex University Hospital with the Royal Free London NHS Foundation Trust. The report stated that the full business case for the merger had been submitted to NHS England for approval, and if approved, the Trusts planned to merge on 01 January 2025.

The report stated that the Trusts would continue to provide the same services and patients would continue to be referred to the same hospitals, leading to a minimal impact on patient travel or choice.

As our plans do not currently involve any significant change to where the vast majority of patients would access their routine care, there will be minimal impact on patient travel or choice.

The report pack also included a summary of the benefits of the merger. These included:

• Faster reduction in waiting times
• More specialist care locally and more joined up community services
• Increased opportunities for patients to participate in research
• More co-ordinated action to improve the health of the local population
• Improved learning and career opportunities for staff
• Enhanced recruitment and retention
• New employment opportunities for local people

The report pack also detailed how four specific clinical services would be integrated following the merger:

• Cancer: The Trusts would establish a world-class cancer centre across all their sites.
• Research and development: The merger would allow the Trusts to offer patients access to all trials at either Trust.
• Colorectal surgery: The Trusts would become a centre of excellence for bowel cancer and complex surgical treatment.
• Surgical hubs: The Trusts would draw on their existing surgical hubs to create a network of centres of surgical excellence.

North Central London Estates and Infrastructure Strategy 2024

The report pack included an update on the North Central London Estates and Infrastructure Strategy 2024. The report noted that NHS England had requested all 42 Integrated Care Systems (ICSs) produce an Infrastructure Strategy for July 2024.

The report described the progress the North Central London ICS had made in developing its infrastructure, including the opening of new mental health inpatient and community facilities, a new orthopaedic surgery suite, and two new health centres each year since 2021.

The report also highlighted problems that remained with the North Central London ICS's infrastructure, including backlog maintenance, which was estimated to be £220m across the ICS, and the fact that 26% of the population received primary care from estates that were considered not fit for purpose.

26% of population receives primary care from not fit for purpose estate

The report pack detailed the key areas of focus for the ICS's infrastructure strategy. These included:

• Population Health: Developing integrated services in localities, in line with the Fuller review, that respond to local population health needs. The report specifically noted the need to support the provision of primary care at scale.
• Quality: Investing in primary care estate and delivering Project Oriel - a programme to transform mental health services and facilities provided by the Camden and Islington NHS Foundation Trust. This includes the construction of new mental health facilities at Highgate East and St Pancras Hospital.
• Efficiency: Emphasising the reduction of each Trust's carbon footprint and the implementation of a divestment strategy.

The report pack detailed how the ICS had allocated its capital budget. The ICS had allocated:

• 10% to priority projects
• 5% to local care schemes.

The report pack noted that the ICS had secured funding for several strategic schemes that are considered vital for the future of healthcare in North Central London. These included:

• St Pancras Hospital Transformation/Project Oriel: This included the construction of a new inpatient mental health hospital at the Whittington Hospital site, the redevelopment of the St Pancras Hospital site, and new community mental health hubs in Islington (Lowther Road) and Camden (Greenland Road). The redevelopment of the St Pancras Hospital site was described as a joint venture between Camden and Islington NHS Foundation Trust (C&I) and King’s Cross Central Limited Partnership.
• Start Well: A long-term change programme focused on hospital-based maternity, neonatal and children’s services, which aimed to create sustainable services that meet the needs of local people by ensuring that the right resources are available in suitable environments. The proposals included consolidating maternity and neonatal services from five sites to four.
• The North London Mental Health Partnership: A partnership between Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust to improve inpatient facilities.

The report pack also included an update on the ICS's People Strategy, which was described as key to the delivery of our ICS Population Health Improvement and Integration Strategy.

The NCL ICS People Strategy is key to the delivery of our ICS Population Health Improvement and Integration Strategy.

The report highlighted the fact that North Central London had a workforce gap at system level and that the ICS was taking steps to address this.

NCL ICS has identified a gap in its workforce at the system level and is taking steps to address that.

The report noted that there was a correlation across all health sectors between physical premises and staff wellbeing and that the provision of high-quality physical infrastructure was important to staff recruitment and retention.

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

The report concluded by emphasising the importance of effective working relationships with local authorities.

Local Authorities are a vital strategic partner in delivering the infrastructure strategy.

The report listed a number of reasons why local authorities were vital to the successful delivery of the strategy, including their role in:

• Developing Population Health Strategies
• Approving housing projects and development schemes that may drive the need for additional local health services
• Allocating Section 106 and Community Infrastructure Levy funding.

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

The report pack included a report on the proposed merger of the Barnet, Enfield & Haringey Mental Health NHS Trust with the Camden & Islington NHS Foundation Trust. The report detailed the rationale for the merger and the benefits that the Trusts expected to be realised as a result of it.

The report noted that the two Trusts had a history of partnership working, a joint strategy, values and behaviours, and a strong rationale for the transaction.

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

The report stated that the merger would allow the Trusts to:

• Provide care as close to home as possible
• Respond to the growing and ageing population
• Maintain 24/7 services
• Improve performance
• Address workforce challenges
• Be a stronger, single voice for mental health in North Central London.

The report outlined the Trusts' plans to co-design the new Trust with service users, staff and partners. It noted that the Trusts had already engaged with over 1,000 stakeholders, including:

• Service users
• Carers
• Staff
• Voluntary sector organisations
• ICS colleagues.

The report detailed the benefits that the Trusts expected to realise from the merger in three key service areas:

• Crisis: The merger would allow the Trusts to create a single point of access for all North Central London Crisis Services, prevent unplanned care, and introduce a standardised model of care for crisis services.
• Working Age Adults: The merger would allow the Trusts to operate as a single bed base, develop a consistent inpatient rehabilitation offer and introduce a standardised model of inpatient care.
• Older Adults and Dementia: The merger would allow the Trusts to implement a needs-based approach to the provision of older adult services, fully implement home treatment teams and introduce a standardised model for dementia care.

The report also outlined the financial and estates impacts of the merger. It stated that the merger would generate anticipated savings of 9.2% by Year 3 (2027/28) and that it would allow the Trusts to:

• Improve the efficiency of their estates
• Improve estate utilisation
• Provide quality facilities for staff and service users.

The report concluded by setting out the Trusts' ambition to create a once in a lifetime opportunity to deliver exemplar mental healthcare in North London.

A once in a lifetime opportunity to deliver exemplar mental healthcare in North London, which we cannot do if we stay as we are

Work Programme

The report pack included an update on the work programme for the North Central London Joint Health Overview and Scrutiny Committee.

The committee's terms of reference included:

• Engaging with relevant NHS bodies on strategic area wide issues in respect of the co-ordination, commissioning and provision of NHS health services across the whole of the area of Barnet, Camden, Enfield, Haringey and Islington.
• Responding, where appropriate, to any proposals for change to specialised NHS services that are commissioned on a cross borough basis and where there are comparatively small numbers of patients in each of the participating boroughs.
• Responding to any formal consultations on proposals for substantial developments or variations in health services across affecting the areas of Barnet, Camden, Enfield, Haringey and Islington and to decide whether to use the power of referral to the Secretary of State for Health on behalf of Councils who have formally agreed to delegate this power to it when responding to formal consultations involving all the five boroughs participating in the JHOSC.

In addition to the items already on the work programme, the committee had previously indicated it wished to receive further updates on:

• The health inequalities fund
• Smoking cessation & vaping
• The strategic role of GP Federations
• Vaccination initiatives
• Paediatric services
• Primary care commissioning and the monitoring of private corporations operating in primary care
• The efficacy of online GP consultations
• The increasing number of people being charged for services that were previously free through the NHS.