Joint Health Overview & Scrutiny Committee - Thursday, 17th October, 2024 4.00 pm

October 17, 2024 View on council website  Watch video of meeting  Watch video of meeting or read trancript  Watch video of meeting or read trancript  Watch video of meeting or read trancript  Watch video of meeting or read trancript
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Summary

The Joint Health Overview and Scrutiny Committee heard reports on the performance of local hospitals and ambulance services, plans for the coming winter, a major overspend across the local NHS, and a proposed reconfiguration of maternity services.

Maternity Services

The committee heard a report on the Best Start in Life programme, which is looking at the future of maternity and neonatal care in North East London. The Case for Change report, published earlier this year, highlighted the need for changes to services in the face of a growing population, increasing numbers of complicated pregnancies, and widening health inequalities.

The programme board, chaired by Diane Jones, the Chief Nursing Officer for the North East London Integrated Care Board (ICB), will be developing potential new models of care in the coming months, which will be based on engagement with local communities. These models will take into account national guidance from reports such as Better Births and the Ockenden Report, which have highlighted the need for improvements in maternity care.

Councillors raised concerns about the lack of detail in the report about future plans. Councillor Beverley Brewer requested assurances that there would be genuine consultation with local people on any proposed changes and that recommendations would not be presented as a fait accompli.

Winter Planning 2024/25

Fiona Ashworth, from the North East London ICB, reported on the NEL Winter Planning 2024/25 process.

She highlighted the three key ambitions of the Urgent and Emergency Care (UEC) Recovery Plan for 2024/25:

  • 78% of patients being admitted, transferred, or discharged within 4 hours of attending A&E by March 2025;
  • Improved ambulance response times for Category 2 incidents, to an average of 30 minutes;
  • Reduced 12 hour waits from time of arrival in EDs.

She explained that the plan for this coming winter was based on four themes:

  1. Prevention/keeping people well: Proactive vaccination campaigns and communication strategies to signpost residents to the right services.
  2. Supporting people with an urgent need: Navigation schemes to support patients into the most appropriate urgent care setting, including the commissioning of beds from the independent sector to provide alternatives to Mental Health or hospital bedded provision.
  3. Addressing emergency needs: Schemes to support homeless patients, drug and alcohol and substance misuse pathways, and increasing the appropriateness of patients in ED by adopting a trusted assessor approach and direct access to Same Day Emergency Care (SDEC) for ambulance crews.
  4. Supporting discharges: Additional capacity in discharge operations and clinical input, and rehabilitation and reablement schemes to support older patients to return home.

Councillor Brewer raised concerns about plans to commission beds from the independent sector to provide alternatives to mental health or hospital bedded provision. She said she thought it was policy to reduce the use of independent sector beds for mental health. Paul Calaminas, Chief Executive of North East London NHS Foundation Trust (NELFT), explained that they were being forced to use more private sector beds because of the increasing demand for mental health beds, but said they had plans in place to address this, including the opening of an additional crisis house in Redbridge and a mental health crisis centre at Goodmays Hospital.

Councillor Marshall Vance questioned how the ICB intended to meet their ambitions, given the financial pressures they were facing. Ms Ashworth responded that they were focusing on a number of areas:

  • Improving hospital flow by focusing on Same Day Emergency Care, frailty, and long waits in ED.
  • Improving ambulance flow by optimising ambulance crew pathways, improving Category 2 performance and handovers, and developing a system point of access (SPoA).
  • Promoting vaccinations and ensuring a holistic approach to care.
  • Standardising integrated discharge hubs, including making funding available for equipment.

NHS North East London: Update

Zina Etheridge, Chief Executive of the North East London ICB, provided an update on the performance of the NHS in North East London. She highlighted the following key points:

  • The ICB was recently assessed by NHS England, which recognised the progress it was making, but also highlighted areas where they had more work to do.
  • Several new facilities have recently opened, improving access to services for local people. These include the Beam Park Health Centre in Rainham, the Lower Clapton Health Centre at The Portico, and the Ilford Exchange Health Centre.
  • The ICB is working to improve outcomes for people with long term conditions, including cardiovascular disease, stroke, diabetes, and respiratory disease.
  • They are reviewing the specifications used to accredit providers of surgical services, as part of a contract renewal process. However, they are not currently planning any changes to services.

Councillor Brewer expressed her disappointment that the ICB had failed to spend funds from the system development programme, which is aimed at supporting GP practices and primary care networks. She asked for assurances that the ICB would do more to support general practice this year. Ms Etheridge acknowledged her frustration and explained that project funding is not always spent within the year because sometimes projects start late.

Finance Overview

Henry Black, Chief Finance Officer for the North East London ICB, reported that the NHS in North East London was facing a year-to-date deficit of £87.2m, a variance to plan of £53.2m.

He explained that the key drivers for overspends at a provider level were as follows:

  • Run rate pressures: Increased demand for services, including the need for additional independent sector beds for mental health patients, and increased acuity of patients on wards.
  • Efficiency and cost improvement plans: Providers reported efficiency slippage of £14.9m at month 5.
  • Industrial action: Cost the system £7.6m.
  • Cyber-attack: Cost the system £0.7m.

He said the ICB was working with NHS providers to implement a number of financial controls in order to bring spending under control. These included reducing the use of agency staff and trying to reduce demand for services. However, Councillor Vance expressed concern about the size of the deficit, saying it made him wonder “how well we are going to be able to perform and provide for our patients given that you don’t have the money.” Mr Black acknowledged that the financial position was extremely challenging but reassured the committee that patient safety would always come first. He said that the efficiency savings being made were about providing the same services at a lower cost, not reducing the scope of services available.

London Ambulance Service Performance Report

Alex Ewings, Associate Director of Ambulance Operations for the London Ambulance Service (LAS) in North East London, reported on the performance of the LAS.

He highlighted the following key points:

  • Response times to Category 1 and Category 2 patients in North East London had improved in recent months.
  • In August, the response time for Category 1 patients in North East London remained below 8 minutes, and the response time for Category 2 patients remained under the 30-minute target.
  • There was a performance gap of about 15 minutes between the outer North East London boroughs, which were performing better, and the inner boroughs, which were performing worse.
  • The LAS was continuing to work with NHS partners to reduce delays in handing over patient care at hospital emergency departments.

Councillor Chaudhry asked about the national target for Category 1 calls and whether delays at hospitals were impacting on the ability of the LAS to meet this target. Mr Ewings explained that the national target for Category 1 calls is 7 minutes and that the LAS was just over this target. He said that they were doing well nationally, and that there were no regular patient harm incidents as a result of the delays. However, he did acknowledge that delays at hospitals were a challenge for the LAS and could lead to delays in responding to other calls.

Councillor Brewer welcomed the efforts being made by the LAS to improve its performance, but expressed concern about the 30-minute target for Category 2 calls, saying that she would want to see the LAS more aligned with the national target of 18 minutes.

NELFT Updates

Paul Calaminas, Chief Executive of NELFT, provided an update on the performance of mental health and community health services. He highlighted the following key points:

  • Mental health services were facing significant pressures, with increasing numbers of people presenting in crisis for the very first time.
  • NELFT was needing to use additional beds on a daily basis to provide care for all of the outer North East London residents who need admission to hospital.
  • They were working to address these pressures, including the opening of an additional crisis house in Redbridge and a mental health crisis centre at Goodmays Hospital.
  • The proportion of the population in outer North East London able to access talking therapies had significantly increased and they were now able to offer a very prompt response to referrals.
  • Physical health checks for people with serious mental illness had also significantly improved, and outer North East London was now among the highest performing areas in the country.

Councillor Brewer expressed her concern about the long waits for mental health patients in A&E departments, which currently stand at an average of 22 hours at BHRUT. She asked for reassurance about what was being done to reduce these waits. Mr Calaminas acknowledged the long waits and said they were working hard to reduce them, but explained that this was a complex issue and there was no quick fix. He said that many of the patients presenting in A&E were new to mental health services and had complex needs, and that they often had to wait a long time for a thorough assessment. He also said that the long waits were compounded by a lack of bed capacity, but that they were working to address this by opening new crisis beds.

Observations by Committee Members

Councillor Brewer and Councillor Chaudhry both expressed a preference for future meetings to be held in person, rather than online, so that they could better interact with officers. Councillor Brewer also expressed disappointment that several officers had had to leave the meeting early because of other commitments. She said that she understood that their time was precious, but asked that they try to allocate their time to allow them to attend the meeting in full. Councillor Chaudhry echoed this concern, saying that “time is precious for all of us”. Councillor Mazur, who was standing in for the committee chair at the last minute, said that he would pass these concerns on to the relevant officers.

Attendees

  • Bert Jones
  • Beverley Brewer
  • Catherine Deakin
  • Donna Lumsden
  • Emma Friddin
  • Ian Buckmaster
  • Kaz Rizvi
  • Manisha Modhvadia
  • Marshall Vance
  • Richard Sweden
  • Sunny Brar

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