Transcript

Transcript

Welcome everyone, we're cracking on and get started the meeting, so if you can please start webcasts. Welcome to this meeting of the Outer North East London Joint Health Screening Committee. For those of you who don't know me, I'm Councillor Paul Robertson, representing the London Borough of Farkham and Dagenham, and I will be chairing this meeting today. I would like to welcome my fellow councillors present in the council chamber here at Avering, as well as NHS colleagues that have joined us here in person, and any colleagues that have joined us online. I don't think there's actually any. The committee's terms of reference will continue to apply for this hybrid meeting. I will leave microphones muted, and as with any of our meetings, please do not speak until I call you. If you wish to speak in the chamber, please indicate this by raising your hand or pressing the button on the panel in front of you. If you have a mobile phone or such device, I'd be grateful if you could please switch it off or make sure it's onto silent mode. Thank you and welcome to everyone. Firstly, just my announcements. If I could ask the health colleagues to please ensure that any presentation or introductions to items are kept as brief as possible. This will allow us to maximise the time for questions, scrutinising of any items. I may also remind members to keep questions to health colleagues on topic of their report. Next. I will be monitoring the progress as we go and move items on as required in order that we can consider all items on today's agenda. I'm sure everyone will appreciate my need as chair to ensure the meeting progresses in a timely manner. If fire alarms do sound, please make your way outside of the chamber and the town hall via the nearest fire exit and gathered by the flower holes on the main green front of the town hall. Next. Any apologies for absences or substitutes at all? Next. Any apologies for absences, please re-ııııııııııııııııııııııııııııııııııııııııııııııı kısmı We've come to disclosure of interest. Members are now invited to disclose any interest regarding today's agenda. Assuming there are no. Thank you. So we're going to move on to the minutes of the previous meeting on the 14th of January, 2025. On item four, are there any comments or points of accuracy regarding these minutes? Or can we agree these minutes as an agreed true record? Good. Thank you. We now move on to our main item on the business agenda. Item five, the health update, pages nine to 34 in the agenda pack. And could I now ask Fiona Wheeler or BHRUT to present first, following Bird Johnson from TFL, and then finally Henry back from NHS, from health as well. I would take these questions after each individual presentation. Thank you. Thank you very much. Thank you for inviting me here today to give you an update on the hospital business and some of the performance metrics. I'm going to start with our A&E department, what we call our UEC programme, urgent and emergency care. I think you've probably seen a good trajectory of improvement in the last 12 months around Queen's Hospital, A&E department and King George's. And at the moment, we are presenting a performance standard of around 77% in terms of our UEC performance. That's four hours from attending to decision or leaving. We are regularly the third out of 18 hospitals in London in terms of our performance. But it would be remiss of me to not mention the ongoing reliance on corridor care and patients waiting considerable length of time for a bed. In recent weeks, we have opened a new facility at Queen's ED, which was in the existing renal dialysis unit. And this is called a frailty same-day emergency care service. It's particularly focused on patients over 65 and over 75 who are presented to ED with less acute problems, but nonetheless would have and have been spending a lot of time in corridors outside the main department waiting for medical assessment or admission to hospital. So I'm really pleased to demonstrate that we've really thought about the care of elderly people, the environment that patients are being cared for in, and we've made the best that we can in the short term with regards to improving accommodation. As many of you will know, we've recently started a campaign to attract additional funding, capital funding of £35 million, which is for a much-needed improvement, refresh and redesign of our emergency department at Queen's. For any of you who have visited it or know people who have, it is poorly designed and full of compartmentalised services, which doesn't lend itself to modern-day delivery of care, but also a safe environment for patients because there are many different parts where we don't always have line of sight. So we are pleased to announce that it is a much-needed development, and I hope colleagues and council members will ask me any questions about that, but also support us in our aim to really improve the service for local patients. The ED department regularly sees over 750 patients a day. That's about double the amount it was designed for. And in recent months, each month across both sites, but predominantly at Queen's, we are breaking the record on how many patients attend BHRUT for emergency care. And that's a trajectory that unfortunately is seen across London, but particularly around Havering and Barking and Dagenham, the activity is going up and up. We are committed to, A, providing a safe environment, but B, making sure that services are designed properly to meet the needs of our local population, and there's lots of work going on there. We continue to receive a high number of patients with mental health presentations in both of our A and E's. In February, 367 patients attended our A and E departments. And we are working with our colleagues now, who are here today, to try and make sure there are safe alternatives to A and E for mental health patients to wait for assessment and for services, and also with the police to ensure that patients are not necessarily brought directly to A and E departments when they have a mental health presentation, and there are good, safe and better, viable options clinically for them to be assessed properly. So there is a lot of work going on in that space, but we do see, should I say, continuously high numbers of mental health presentations. I'll move on to a broad kind of update around planned care, which is elective care, which is a huge amount of work for an organisation such as ours. At any one time, we have over 55,000, we call them pathways, but essentially mostly it's patients waiting for some form of planned hospital appointment or a procedure or a surgery. And that is subject of much media attention, as you know. But we are the best performing hospital in London on waiting times for planned care, and we're very proud of that. And a lot of that talks to the dedication of the clinical staff, but also the attention to detail around making sure services are fit for purpose. We've been focusing very much on reducing the waiting list, and that was up in the 59,000s at least 12 months ago, and is now down to 55,000. And we've reduced, I've got hot off the press numbers, but our waiting list for patients who've waited more than a year is now less than 500, and that's down from nearly 2,000 about 12 months ago. So accepting that nobody wants to wait for 12 months for any kind of care, we are focusing on and delivering a much improved performance in that space, and we will continue to do that. Clearly, our target for that is zero. In cancer targets, we have at any one time about 4,500 patients waiting for investigation, diagnosis, or treatment of a cancer, of any type of cancer. And at the moment, we are delivering a good performance in receiving urgent referrals and diagnosing patients within 28 days. We're 77% against 75% target. Majority of those patients do not have cancer, and it's most important to tell people quickly when they're on a cancer pathway that they haven't got anything, any cancer diagnosis, and they can move on with either further investigations or close that chapter of their lives. So focusing very much on telling people what's wrong with them as quickly as possible. We continue to struggle with the treatment date, mainly because of elongated diagnostic processes. And what I mean by that is finding out that you've got cancer and then having to have lots more diagnostic tests before you can be treated. But we're focusing on that, and our board are particularly interested on in making sure the treatment target is delivered. And I know you've got a Cancer Alliance update later on today, so I won't speak any more about that. In terms of our money, a very hot topic for the forthcoming year, and particularly at the moment, we have a savings programme in the region of £61 million. That's against an organisation that spends nearly a billion, just over a billion pounds in revenue every year. So we've got a stretch target. It is a challenging target, but we've got lots and lots of work being undertaken to review the amount of money we spend, temporary workforce and agency staff. We are reviewing the amount of money we spend on non-pay, so non-pay procured items, such as things for operations, things on the ward, any kind of clinical non-pay activities being scrutinised and reviewed. And we're also working with our PFI partners who provide hard and soft FM services to try and get better value for money. It's most important that every penny we get from the taxpayer is spent wisely. And so our savings programme will be focused on productivity and efficiency with a clear steer to maintain and continue to provide high-quality clinical care for our local population. Thank you. Thank you. So if you do want to turn that on to Johnson and then we'll take questions after the three presenters have been. OK, hi, I'm Brie Johnson, the Chief Operating Officer in NELFD. So I'm just going to update on community health services and mental health care, but I'll start and follow on nicely from Fiona. So on the mental health, so I would agree with Fiona, we have people waiting too long in the accident and emergency department. While it's improved, it's still got a way to go. So the number of areas, so since I was here last, I was going to pick out some key things that have moved on. So we've been looking at developing, enhancing the care in the community. So one area is looking at having crisis cafes. I think I've talked to you before about doing a listening exercise in each of the places. So it would be at Embarking and Dagenham, Redbridge, Havering, More Than Forest, asking local people what they would use. So for us, we have now got a specification for each area. Embarking and Dagenham has been out to tender and going through the process now of the selection process. And then we'll be going live probably nearer June than May now. We've got a similar process in each of the other places. They're just a little bit behind on their procurement. We've opened a well house in Redbridge. So that is some community beds where people, not in need of inpatient bed on the Goodmay site, for example, but actually do need some overnight stay and some support. So that's seven bedded house and that's opened in Redbridge. And that's there to support in the community to step people up. In addition to that, we've been doing a lot of work in each of our community teams. And as an example, I'm meeting with the Redbridge team tomorrow afternoon. And one of the things we're looking at is the capacity of those teams to manage people before they end up calling an ambulance, maybe end up turning up to the accident and emergency department. One of the areas that we know locally we're short of is mental health beds. We've had a number of patients over the last year. It's ranged from early 50s up to 60s in out of area beds. We're now in our mid 30s. So we're aiming to be down under 30 for the next year. And that is to allow us some time and space to create some, a new inpatient ward, at least one on the Goodmay site. So at the moment, we've put a bid in for capital to give us the funding, if you like, to create the ward. I'm saying ward and wards because at the moment we've put in for two, recognising there may not be enough funding. However, we've had some questions back for further detail. So we'll be completing those in the next week or two, and then we'll have final way forward on our beds. But we will definitely be having some additional beds on the Goodmay site. And the area we're particularly challenged at the moment is our female capacity. So we will also be looking at our female pathways, but we're doing that in conjunction with our partners in East London, so in Elft. From a community health perspective, I've just picked a few key things that our local population often raise to us on musculoskeletal services. So we've had different services in different locations. So we've been working with our partners. To look at how do we standardise the service offer? And the business case has been created, looking at how we create a new offer to local people. Community children's nursing is another area that we, for example, in Redbridge, we and Elft have been delivering a community service. So we're now working with our partners in BHRUT, so Fiona and colleagues, to look at how we create a service that's actually, people work together as a team, because our team in Redbridge weren't able to manage on their own. The community inpatient beds, so people who've got physical health, perhaps frail elderly, intermediate care needs, we've got beds across sites. So for us, it's about looking at how are they working with our primary care partners, our district nursing service, and virtual wards in the community. So that's a piece of work we are collectively working on. We're also working on the frailty pathway, particularly linked into St George's. So Fiona and I were on a meeting together with teams in the last week, 10 days looking at that pathway and how we can strengthen that. And the purpose of that is to offer our local people an actual one-stop service. So when there's a need, there's swift care, if you like, a comprehensive assessment, and as far as possible, offering the maximum care as quickly as possible, as close to their home as possible, or in their own home, if possible. So they're just some examples of some of the work we've been doing, but a lot of it is in collaboration with our primary care partners, social care, and with the acute. I mean, the other bit, I won't too much because I know Henry's going to talk about finances and Fiona's already picked up. And you could mirror our discussions around the savings plan, looking at the temporary staffing, working on our productivity and efficiency in our different services, and working particularly with our social care partners to look at how we can work jointly together in the community to deliver as comprehensive a service for local people as possible. Thank you. Thank you. Excuse me. For people who don't know me, my name is Henry Black. I'm from North East London Integrated Care Board, the ICB. I'm the Chief Finance Officer, and I'm standing in for Zena Etheridge, the Chief Exec who is on annual leave today. So there's a lot of information in your pack around some of the kind of key highlights from the last committee. So there's a bit of an update on our North East London response to the government's 10-year plan for the NHS. There's an update on artificial intelligence and how that is helping support and deliver some of our priorities. There's an update on the St George's Health and Wellbeing Hub, the Primary Care Quality Outcomes Framework. So we've improved our performance against some of those metrics in recent months. So that's good news. And also a short update on our re-procurement of the NHS 111 services. So I'm not going to go through those in any detail. They're there for your information. What I'm going to do is just give the committee a bit of an overview on some of the changes that are happening at the moment within the NHS at large and how they will affect both the ICB and the providers in North East London. So on the 13th of March, the committee may be aware that the government announced that it was abolishing NHS England and the functions of NHS England were to be absorbed into the Department of Health and Social Care. So what sounds like quite a significant change, actually, it's really reversion back to what we had pre-2012 when NHS England was established. So that is quite a bold announcement that supports the, or is intended to support the government's agenda around the three channel shifts. So those are a move to have more digital instead of analogue. So move from analogue to digital. A move of resources from acute to community and a move away from treatment and towards prevention. And the tenure plan is expected to be published later this year alongside the Comprehensive Spending Review. And that is expected to describe how the NHS is going to achieve those three shifts. So as part of that, abolishing NHS England was part of streamlining that decision-making function. And that came alongside a requirement to reduce the resources that currently go into NHS England by 50% when the two bodies are merged. In addition to that, ICBs were then also asked to find 50% reductions or to reduce our management costs by 50%. And providers were also required to make a saving of a similar type, which is slightly more kind of convoluted, but it is 50% of the growth in management costs since 2019. So in other words, if in 2019, a provider spent £10 million on management costs and now spends £12 million, the growth, the difference is two. So expected to reduce that by half. So halve that growth. So for BHAT, that's about £7 million. For NELFT, in actual fact, they are already spending in 24, 25, spending less than they were in 2018-19. So there is no impact on NELFT. But for BHAT, that £7 million is already part of a very large, the £61 million savings plan that Fiona mentioned before. So that is, it's not an additional saving requirement. It's just the, you know, that forms a component part of the saving plan that BHAT are doing. And it was always intended to make best endeavours to find that from services, from costs that are not frontline services. So taking that out of management costs is always the kind of, the first place where we try to go. For the ICB, it's a big challenge. The ICB was reduced by 30% since 2022 already. So a further 50% from that baseline is massive. Overall, it works out about 65% since they were created only three years ago. So it is a huge challenge. For North East London, we currently spend about £90 million on our management costs, which sounds like quite a large number in isolation. But against our total allocation of nearly, well, over £5.5 billion, it's only about one and a half percent of the total allocation that we have is spent on management costs. But that will reduce from £90 million down to about £46 million. Excuse me. So we will also be expecting to change our functions. We are going, we are being told that we're going to become more of a strategic commissioner rather than what has happened up to now, which is that we have inherited most of the statutory duties of the old CCGs and added certain bits and pieces from other bodies. So I think it is fair to say that streamlining the duties of the ICB is a good thing. How we find a way to reduce the resources by 50% is going to be very challenging and it will be, it will be a difficult period. We're expected to do that during quarter three of this year. Quarter three runs from the 1st of October to the 31st of December. So whatever during quarter three means has not yet been clarified. NHS England are currently producing a, what they're calling a model ICB. So that is effectively a kind of pro forma of what the ICB's functions will need to be. That is expected to be published at the end of April and the ICBs will all be then required to submit a return by the end of May that sets out how we will effectively deliver all of those functions within the 50% reduced envelope. So that's the kind of an overview of our, the kind of operating environment that we're in at the moment. Breed mentioned finances. So we've just come to the end of March and closed our accounts. We are still working through what month 12 looks like and obviously we can't disclose anything formally until those accounts have been audited. However, we appear to be on track to deliver what we were asked to by NHS England. So there's no reason there to call out any concerns. And just to reiterate, after a very, very long and quite protracted process, we did manage to submit a balanced operating plan for the financial year we are now in, 25-26. That financial plan has, well, as both Breed and Fiona have mentioned, very, very tough savings targets. Over 6% CIPs in most trusts, cost improvement programmes, that's way beyond anything that we have managed to deliver before. But I think there is now a culture and a recognition of this is not going to be just about doing the same things at a slightly lower cost. There will be things that we will have to look at how we can provide the same level of service. And some of the things that we will have to be doing over the next 9-12 months will be very, very challenging. So that's the health overview. I'll stop there. Thank you. Thank you for reports. And hand over to members. Do any members have any questions? Cool. Have I got to answer Reza? Sorry, I'm terrible at pronouncing names. Yeah. Marsha, up to you if you want to go first. I'm happy to ask mine. Go ahead. Why don't you go first? I've got a bunch of mine up. Thanks for the update. And firstly, one thing I would just like to say is it's good to see the officers here in person. There's been some criticism, as you know, in the past of remotely. So thank you very much for being here in person. That's really good. I think it makes a great deal of difference. I think you can communicate better when you're here with us. Of course, this is a scrutiny committee. So I feel that it'd be appropriate of me just to explore a few of these areas that you've just been talking about. In terms of the finance, Henry, I just, the end question I will have is the impact on patient care. I've just come, I should, of course, introduce myself. I'm Councillor of Anne I'm an Essex counter-counselor and I've just got and I represent the, along with others, I represent Buckhurst Hill, Loughton South, Chigwell, and the outer, sorry, the outer areas of Essex, which, of course, use your services quite frequently. And, of course, I've just come from an Essex meeting which has talked about the ICB and its impact. So the question really would be about what's the impact of, on patient care, because I heard you, Henry, being very careful, if I may say that word, with your words about what's going to happen in the next 12 months. I think you used phrases like we're going to have to have a look at what we are going to be doing, not we are going to be having to cut patient care or whatever. So what will be the impact on patient care because for that 46 million that you're going to have to cut the ICB back, it's no joke. We know that. We know that you've been struggling for finances for some time now. So that question for you would be, Henry, please could you just tell us what the impact on patient care might be? May I just give the other one for Fiona and for Britt as well? In terms, I'd just like to also explore with you the answer here, part that you've got in here, page 24, I think it was, and the statements you were making about hitting your targets, not in your dialogue. I was really disturbed. Sorry, let's start from a humanistic point of view. Every patient who is referred for cancer starts to have her coli wobbles, don't they? They start to get really frightened and they start to wonder what's going to happen. so for you to have missed your 28-day care, 28-day, I think the words are diagnostic period, and you've only got a 75% target for that, that suggests to me that one in four people don't even get on to that 28 days, and you are slightly missing that 75% target, which is not too bad, but I'm really concerned that 75% of a target for cancer care, for people who are really concerned about when they first get diagnosed or their doctor sends them and says, oh, by the way, I'm going to send you for a referral for a potential investigation into cancer. It takes 28 days, it takes a month, and I know people who say, oh, I get really fretful in that month, and then for you to miss that is bad, and then on your target for treatment, 62 days for getting treatment, again, a 70, what is it, 70% target on that? I just wonder if you feel that 75% targets for diagnosis, 70% targets for treatment, slightly not being able to achieve those targets are actually really achievable targets. My real question would be, of course, thinking about those patients, why aren't they 100% knowing, of course, you can never hit 100%, nobody could ever, but unless you stretch yourself to that, you will never get anywhere near that. So, again, the cancer care is a real issue for some of the residents that I represent and I just, if I go back and say, oh, by the way, their targets are 75%, not 100%, they would obviously come back and say to me, well, why not? So, my question to you would be, couldn't you stretch those 75% to 100% and if you can't, why not? Thank you. answer first on the first part of the question. Thank you very much, councillor, and thank you for your, I know that your questions are always intended to be challenging, but you are very supportive in general about how difficult things are and how hard we are all working. You're absolutely right to call out the fact that there is, for the first time, I would say a real risk that we will have to look at the portfolio of services that we currently provide and potentially either restrict access or reduce the amount of service we can provide. That is the reality that we face. From year on year, from last year to this year, we've seen effectively a 3% real terms cut in funding and that ignores the roughly 2% population growth that we've undergone as well. So overall, a 5% effectively demand pressure, that is what is contributing towards the £360 or £370 million of savings that we're having to undertake. And as I say, in the past we've tried to do that through delivering the same services in a more efficient way or through trimming waste and duplication or finding ways through procurement and non-pay of buying stuff at a lower cost effectively. But we are going to be at a position now where that is no longer going to be possible. Just to temper that slightly, the NHS budget has increased by over 50% since 2019, so over the last six years. So what we're talking about then is a huge spike during COVID and a very, very large amount of money that was pumped into the NHS. And as the NHS often, as it grows, it finds it very easy to grow but very hard to retract. So we do have more resources going into the NHS now than we ever did before and we're offering more, a broader set of services than we ever used to before. And if COVID hadn't happened, we probably wouldn't have the amount of money we have now and the services. So there is a bit of thinking that we need to go through around, and this is what we're currently doing, around a clinically led prioritisation of services to ensure that any changes that we do make are either to restrict access where we think there will be either limited or zero patient harm, or reduced services that are not as directly patient-facing or as intensive and acute as others. We haven't made any of those decisions yet, and we have a briefing coming up, I believe, at some point soon, around what that might look like, so that we can get your support around obviously the full public consultation that we will need to do if we get to the point where we have to make any of those changes, but that is the reality, it's the harsh reality of the economic environment, and obviously we'd love to think that in the next 18 to 24 months with a new government, the government of this particular colour generally likes to invest in health, but we know that the broader global economic climate may not allow that to be the case, so we are continuing to work on the basis that we will be constrained for the foreseeable future. If I may just come back, thank you, yeah it's a shame that Whips Cross of course is not going to be rebuilt as well, you know, this government of this colour cares about healthcare, yeah, especially as we got the health minister as a local MP, it's a bit disappointing that I wasn't absolutely sure I really got the gist of my question back from you, the 46 million, I think you kept using the words management costs or potential management costs. My question was, simple, I will go back from here and patients will say to us, or residents will say to us, so will it impact on patient care? I think you alluded to some of those things, but just for my benefit, can you just give us a statement that says we will try not to impact patient care, it will impact patient care, or whatever, Henry, please. Thank you, just to clarify, the 46 million is separate from our overall savings programs, that is a top-down imposed, government imposed cut to our management costs, so we currently spend, the ICB spends about 90 million on management, and that is going to be halved effectively, so that will, that actually, on the positive side, once that is done this year, then in 26-27, that will be additional funding, which we hope will be recycled back into patient care, so that will actually be a cut to management costs, it will be very difficult to achieve, and there will be some implications to that, but that is not clinical services, that is management costs that will then potentially give more resources for patient care. In terms of a statement to guarantee that there will be no impact on patient care, I can't do that now, what we will do is we will do everything that we can in our powers to minimise any risk to patients, and that is why we are going through a clinically-led prioritisation process that ensures that any changes to clinical care will only take place in a service that has been prioritised as being the lowest possible priority, and when we do that, we then do a quality impact assessment, we do an equality impact assessment as well, and we continually evaluate and check for impact on patients, and we will do a full consultation, but to say that there will be no impact on patients is not something which we can really promise. I think the second part is Fiona for the cancer question. Thank you. So, okay, I think I may have misrepresented the figures then, because we actually met the diagnostic standard, which is that we met 76.6% of patients are told their diagnosis within 28 days, compared to the 75% target. Okay, so just wanted to clarify that, but you're absolutely right, the impact weighting has on patients, particularly when referred urgently for cancer investigations, is foremost in our minds, and it's important that we do act swiftly and that we make sure we prioritise that work. So, just to reassure you, we are meeting the target. Now, when it comes to targets, these are government targets. So, these are targets given to us as part of our constitutional standards. And so, yes, there's lots of, there are lots, we could have a philosophical debate about whether you own for 100, even though you know you're not going to do it. But I would probably be more helpful in saying that there's a huge commitment from the organisation, both in the clinical teams and the administrative teams, to receiving referrals, investigating and diagnosing and treating people as quickly as possible. The government targets are a guide about what they believe good looks like, and that recognises that, you know, in the summer holidays people are away, and not everybody, even though we instinctively feel that's right, not everybody wishes to be rushed through investigations and diagnosis, even though instinctively we feel that is exactly the right thing to do. So the targets that we are just below meeting are the 31-day, and the 31-day target is the time it's allowed for us to treat you following telling you what's wrong with you. So a window of 31 days from a confirmed diagnosis diagnosis to being treated with whichever modality of care that you get in whichever organisation. And so we are 94.5% compliant with a 96% target. So even though we haven't met the target, and I'm not ignoring the gap, it's not massively significant in terms of numbers. But all the, I mean, I spoke to our exec team this morning about the cancer targets, and we talked about what we do about patients that are breaching those targets. A 70% target for treatment within 62 days, that's the timeline that goes from your original referral to being treated. So from going to a GP to saying there's something wrong with you and commencing treatment for a cancer diagnosed problem, the target is 62 days, and we are 68.8% compliant with that as a 70% target. So I'm glad you raised it, because I think it's really important too, and I know you used the word collywobbles, and I agree with you, it's a worrying time for people. So I'm not dismissing the targets in any way, but I think we are doing a really good job considering 4,500 patients on our waiting list at any time, and also just to reassure you that we are constantly aiming to improve against those standards. So thank you. Thank you very much. I think what I'd like to say is that obviously we're trying to give you as much support as we possibly can, and it is in not criticism, it is a, as Henry said, it's a challenging question, it's a challenging outcome. Do you not, one of the things that I might think might have been a better measure, though you're using government targets, you said there was 4,500 patients probably awaiting care or on your books or in some form. I would have thought it might have been better for you to come back and say, look, we've got 4,500 patients on the cancer pathway, if you're like, and we're enabling how we can, sorry, report back possibly how you're achieving getting those people through all of those processes, because I presume what you're saying is the 60, 62 days includes the 28 days, et cetera. So I just suggest to you that maybe what it might be useful to come back to this committee and say is we've got 4,500 people on our books. This is what we're doing and this is what we're trying to achieve rather than saying, oh, the government's saying we've got 70% target. That's what we're going for, because it might be that you're hitting 90% in some of those 4,500 people, i.e. we want 4,500 people from referral to do treatment and how many of those 4,500 are actually hitting that 62-day target, if you see what I mean, rather than turning around and saying, oh, we're achieving government targets. But I applaud the work that you're doing and I just make that as a suggestion going forward. I just wanted to come back on a couple of points. So one on whips cross, just to say that while the redevelopment might have changed, the joint working we're doing together to enhance the patient care is continuing. So one of the examples there is we've been working together to look at how we who deliver the front door, if you like, with them, as part of when somebody turns up the meeting and greeting the initial screening, we have secured additional rooms, additional support from them to actually enhance that service offer. So nothing will stop us continuing to do that quality improvement and change. And I just wanted to give you some examples of where, yes, we have a delivering value program. Yes, we are looking at efficiency and productivity, but sometimes it's the right thing to do. And some of the examples that we're working on are how do we streamline our processes? People come back to us and say, well, I didn't know about my appointment, the letter never arrived. Why aren't you using email? So that's one key project we're looking at. Digital dictation and using digital across our teams, looking at more efficient patient scheduling. Fiona mentioned facilities management. And that's a piece of work we're doing as well. We're looking at the use of our assets. Are we using our buildings as effectively as effectively as possible or have we been not using them as effectively and renting rooms elsewhere that we could stop doing now? I mean, I could go on all day, but there's a lot of work that needs to be done to enhance and make sure we're spending the money we've got wisely. Of course, there are some difficult decisions as well and we will all be part of the piece of work that Henry referred to. Yeah, councillor. Yeah, thank you very much. And can I go on record to also extend my thanks to all of the officers for being present here in the chamber? It really does make a massive impact. I'm councillor Kaz Rizvi. I am from Epping Forest District Council, also the Cabinet Portfolio Holder for Community Health and Wellbeing. I'll try to keep my questions as brief as possible in the interest of time, but I think probably they're mainly relevant for Henry. Just moving on, obviously, from the point that you talked about regards to NHS England, I think it is definitely very worrying and quite concerning times, not just for ICB staff, but also residents of North East London as well, in terms of what the 50% reduction or cost saving which is expected is going to, you know, affect local services. I mean, I suppose the reduction from £90 million down to £46 million is going to result in, you know, a big change and a big shake-up and I can't imagine, you know, as you said, clinical services are going to be withdrawn. It clearly won't because I think that would cause a lot of uproar. But surely the streamlining is going to mean job losses for local people and possibly some really senior ICB staff. So I wonder what messages are being communicated to some of those really worried local senior members of staff within the ICB. And then the second point that you touched on was about, obviously, you know, the level of investment which has been pumped into the national health and residents here and, you know, members of the public here that, you know, this government is putting in record amounts of money. But surely it's a bit of a paradox if record levels of investment are being putting in, but significant cuts are being expected of the ICB. So I wonder what your view on that as the chief finance officer was. And the final question, which was actually something that wasn't covered in the update, which I was quite surprised about, was members of this committee received an email, I think, on the 21st of January, soon after our last J-Hosk, about the repercurement of services which have been given up by Elft. And I think that was specifically for three sites at Victorian, Five Elms and Dagenham, Rainham Health Centre in Havering and Artminster Medical Centre in Havering as well. And I wonder, sort of in light of what has been expected of the ICB, what will happen to those three sites that need repercurement and whether there was any update on that. And then the third question was about something that you covered verbally, about the potential repercurement of the 111 services in North East London, which at the moment I understand are covered by the London Ambulance Service and what we might be looking at sort of in terms of a new model of 111 services in NEL, as well as sort of what any potential timeline for that will be looking like. Thank you. OK, thank you. So firstly, thank you for your your kind words. And it is it is a very, very difficult time for staff. One of the things that we pride ourselves on and we aim to do as an anchor institution is to recruit as much of our staff from our local population as we possibly can to provide employment opportunities for local people. What that means, the converse to that means that when we find ourselves in this kind of position where we are having to reduce our workforce significantly, then that does. You're right. It has a knock on impact and we are very, very, very aware of that. There's very little that we can do around influencing, you know, the kind of decision that was made by central government. There is a working group that is chaired by the the current chair of NHS England and the chief exec of NHS England, so Penny Penny Dash and Jim Mackey, which is working on this, the what they're calling the design of a model ICB. And we're fortunate enough to that Zina Etheridge, our chief exec, has been invited to join that group. So there we will have some influence and some say on what the kind of new organisation looks like. In terms of messaging and support to staff, there's there's again, there's a limit to what we can do because this is a top down mandate and it is going to happen that the 90 million will become 46 million. There's nothing we can do about that specific fact. However, what we can do and what we've committed to doing is a couple of things. Firstly, we we provide real time information as soon as Zina knows anything. She sends either an all staff message and then convenes a briefing the following day. So as soon as we know anything, we are we're conveying that to staff as soon as we possibly can. Secondly, we have a commitment that we are working with staff to to to work through what other areas that could be least impactful. I mean, it's difficult to say that anything is going to be less impactful than anything else, but where we could potentially make those savings and then also engage staff in the redesign of the new entity. It's going to be really, really difficult to do that because it's going to be done at such pace. We've effectively got a month to redesign the organization, which is when we did the previous restructure did take too long, but it but we did that over 18 months. This is this is being done in in one month. And the third thing is that we have commissioned a broad range of staff welfare programs. Some of those will be about helping people who unfortunately will will be losing their jobs to kind of go out into the job market and have the best best possibility of of securing a job there are there is a fairly generous redundancy package. I know it's not a nice way of describing it, but, you know, it is better than than than than in some some areas where redundancies are is just the statutory only. So the NHS provides more than the statutory redundancy. So so there will be support to staff in that regard. You asked about the paradox of the of this the increase in funding, and yet we still have to make savings. And I absolutely agree. It does feel slightly odd. The reality is that the during the pandemic, a vast amount of money was pumped into the health service and we were very successful in increasing resources that were necessary. So just as an example, we went from having about one hundred and twenty, I think, intensive care beds across northeast London to four hundred and fifty. And at one stage, four hundred and twenty of those were were were being used for COVID patients. So we had a handful of beds available for non-COVID, where normally we would have one hundred and twenty beds that were available for, you know, where people have road traffic accidents, where people need intensive care otherwise. So so we were able very, very short notice to to grow our capacity very quickly. And what tends to happen is once you've opened a ward, once you've staffed a ward, once you've got new staff and new new teams in, it is much harder to to take those staff away than it is to to increase them. So we have got ourselves to a position where the resources are have outstripped even that increase in in funding. And it is fair to say that the acuity of patients and the just the general demand, there are a number of kind of obviously respiratory is, you know, issues that are kind of legacy from COVID, but also mental health problems that then, you know, we we have always had long waiters who are experiencing a kind of a crisis, mental health crisis in ED. That's always been an issue. It's never been as many as we have now. And that that that takes up a huge amount of cost. And and and it it reflects a massive increase in the burden and acuity of of the health care needs of our population. So so we we have got more money than we had six, seven, eight years ago. But the amount of demand and the amount of, you know, health need that is consuming all of that resource is even greater than that. So that's that's why we're now in a position where we are having to reduce that, reduce that further. You mentioned two specific bits which I'm not going to be able to give you any any detail on that is the re-procurement of the three primary care practices. There is a there is work ongoing for those that there will be no disruption to those services, but the precise process and timelines of of of how we re-procure those. I don't have that detail immediately to hand on the one one one there is a there is a bit of a again, I don't have the details to the tip of my tip of my tongue, but there is an update in on the in the pack around one one one re-procurement. I can provide more information and send a note after the after the committee if that's that's help. Yeah. Yeah. Thank you, Chair, for letting me call that. I think on the two specific points, it might be worthwhile. I appreciate in Zena's absence, it's a difficult ask, but maybe a written response would be most helpful because I think the residents of those three areas would be extremely keen to find out what is going to happen in terms of their access to GP surgeries. And then, you know, on the similar point, obviously, what what will happen in one one one services. Are there any other members or questions? Just a couple for myself. Obviously, I know it is a difficult time for the ICB staff. But my worry is it kind of feels like it's a number just plucked out of the air. And it is very much going down the line of management bashing as the NHS always seems to be having. The NHS couldn't function without many of its senior leaders. And the concern is essentially we will end up losing essentially not board level level, but kind of your finance managers, HR, VP, who are vital to be able to actually run a workforce. I know from my experience, I can't do anything about my finance manager. And it's that kind of there's that concern that even from trust's perspective as well, losing that staff will have ultimately a big impact on patient care. And we won't be able to develop where you put you won't be able to develop services going forward in the future. And I was just touching on the the FDS data as well. Obviously, that I understand that's a trust position. Obviously, there must be services like dermatology where they demand is so much higher. And it's it is a national issue. Cancer service, lung cancer services as well, that their data is much more lower because obviously that the diagnostic pathways are so much more longer is it might be useful for us to be able to break it down in terms of which cancer areas are the most kind of touching and they are all struggling essentially as well. And in that case, we'll move on to the next item. Or does the committee wish to make any recommendations on this report? Yeah. Cancel. Yeah, just a recommendation for a written update on the repercurement for 111 end of the primary care practices. Yeah. So many thanks. More than welcome to say that you are free to go as well. We should like to. We now come to item six, which is an ICB deep dive into cancer, which is on page pages 35 to 68. As we can. As can be seen from the gender papers item six, we have a deep dive from the ICB with regards to cancer, which will be presented by Femi Odaway, Managing Director of NEL Cancer Alliance and Angela Wong, Chief Medical Director, Chief Medical Officer for NEL Cancer Alliance. Again, I'll take any questions once the presentations have been presented. Hand over to yourselves at the end. Thank you. And apologies for being late. The PAC provides, as you mentioned, a deep dive into the work that we're doing as a cancer alliance, which is a joint work with partners across North East London. So just going to just provide an overview of the areas that we cover. We do cover eight boroughs in North East London and throughout the year, our work is based on preventing cancers, spotting cancers sooner and providing treatment at the right time and supporting families affected with cancer as well. Just to give you a profile of the cancers across North East London, we diagnose around 73,000 patients, sorry, 73,000 patients are diagnosed with cancer across North East, oh, sorry, oh, sorry, 7,735 patients exactly are diagnosed when we take a look at our last year's data with cancer. We have 73,000 referrals across NEL, so it's a huge amount of referrals across North East London, and we're happy to say that the majority of these patients do not, are not diagnosed with cancer. So it's only a small proportion that are diagnosed with cancer. 53,000 patients across North East London currently live with cancer. So that was data from the last, again, from the last data that we've got for across North East London. So I provided a profile of just what cancer and the volumes of cancer looks like across North East London and what our referral looks like as well. And I know we touched on performance a little bit earlier, predominantly in one of our provider areas. But if we take a look at performance overall, over time, we've had some dips in performance throughout the year, but we have seen some strong performance over time. And again, in terms of the FDS standards, I don't know if Fiona mentioned earlier, Ron, that there has been improvements there. There has been massive improvements with the FDS data across North East London in general. So we are on target to delivering against the standards that have been set by NHS England, especially the FDS, the 62 days and 31 days as well. So I just wanted to touch on those three points in regards to cancer, but also the points around the volumes of referrals that we have before we start moving into some of the earlier diagnosis work that we do, the diagnostics and treatment work and our personalised care work, which I'm just going to take us through. Thank you. Thank you very much. And thank you for inviting us to come back to describe our programmes of work which span the whole cancer pathway and are very much aligned to our vision to improve cancer outcomes in North East London, reduce variation and provide that holistic care and to deliver this through being at the forefront of testing, innovation and transformation so that we lead to sustainable change. So when we talk about early diagnosis, this covers three main streams, screening, awareness and prevention. When we look at screening, this is the undertaking of diagnostic tests for patients at risk, usually by age. So cervical screenings, women 25 to 64, breast screening is 50 to 70, bowel cancer screening is 50 to 74. And we also have a new cancer screening programme that was called the Targeted Lung Health Check, but is now called the Lung Cancer Screening Programme. Now, these patients are asymptomatic and the yield of cancer varies with these programmes, but by nature of being asymptomatic, about 0.8% of all patients who are screened for breast cancer will have breast cancer and that risk increases with age. It's about 0.1 to 0.2% for cervical screening and it's about 0.3 to 0.6% of all patients who attend for bowel cancer screening. Now, in our first slide and in our job, you know, our aim is to increase the screening uptake because this is free to all patients or the population according to age and in the case of lung cancer screening, not only age but age but smoking. And as you'll see in the table on our first page on the early diagnosis of cancer screening, this has improved in every single borough in 24, 25 compared to the preceding year. It's a mixed bag for breast screening. For here, the average overall is better for 24, 25 compared to the preceding year. And in bowel cancer screening, this has dipped a little bit. And I think that, you know, we need to do a little work to understand that because that traditionally has been quite a, had the highest uptake overall. And I think that may underlie the fact that we also have a faecal immunochemical test that's been introduced to the suspected cancer screening probe, suspected symptomatic patient pathway. And perhaps that's what's led to a dip in the bowel cancer screening, but we will look at it. But what I think this shows when we consider awareness, the Cancer Alliance have worked together pan-London to improve cervical screening. So that's something that we think has demonstrated a benefit. One of the initiatives that we've also developed in North East London, together with North Central London, is HPV self-sampling. So a way of actually undertaking cervical screening more privately because you have a, you can self-sample. And so we think that this is demonstrating some benefit. And there's a deep dive to do to understand and perhaps to focus on bowel cancer screening in this year. But by and large, these are national programs in which we have demonstrated improved screening uptake over the last year. Now, the lung cancer screening program is a new screening program which focuses on age, so 54 to 74, but as well as smoking history. And the yield of cancer from this program is about 1 to 3%, so it's higher. And for this program, this has been administered solely through the Cancer Alliances. And within this program, again, we're really pleased in North East London to have achieved 77% of Stage 1 and Stage 2, so early diagnosis in the lung cancer screening program that has been delivered by us as a Cancer Alliance. And this is in comparison to lung cancer staging overall of about 36%. So it's a really, really important initiative to achieve that 77%. The target, if you like, from a national perspective is for 75% of all cancers to be diagnosed at Stage 1 and Stage 2. So it's been exceeded in the lung cancer screening program that has been delivered by the Lung Cancer Alliance. And I think, you know, we take the learning that we've delivered from this program to try to improve the awareness across the board for the other screening programs. So then we talk about awareness. And so this is about increasing, you know, as the name suggests, increasing awareness through, and we've got a bit more of a deep dive into some of the communication strategies that we have. And part of it has been through non-traditional means, so TikTok, Facebook, you know, LinkedIn, all measures to try to increase the awareness of cancer symptoms and signs so that patients will, or people will come forward to seek medical attention sooner. Because what we know, a bit like the screening program, if you're asymptomatic, if you come when you have early symptoms, your outcome is likely to be better. And from a financial perspective, it's also cheaper. So it's really, really good for the sort of health economy overall. We've got some slides just highlighting some of the awareness programs that we've delivered and continue to deliver. And some of them, for example, breast screening for women with a serious incident of mental illness shows how we target trying to target inequality to try to raise awareness in certain groups, because we know that patients with mental illness tend to have a later diagnosis. So it's very much a strategic, data-driven model for raising awareness, again, across the board and trying to reduce inequality. So I think we've listed some of the projects that we've done. And I think, again, what we've tried to do is develop materials that are sustainable. So it's not a game, which is shown in football stadiums, you know, targeting the 50% of men. That will cover, you know, we'll cycle that to cover a range of increasing awareness of cancers, starting with the most common to begin with. Again, you'll see that we've targeted gypsy and the Roma travellers, where, again, there might be poorer outcomes because of reduced access. So this very much is in keeping with our vision to, you know, improve access for all, reduce inequality and improve cancer outcomes. I think you touched upon earlier about thinking about AI and technology. Again, we've given some examples. So we bid to the Department of Health for AI for chest x-rays. And this was because 70% of the reporting backlog was the chest x-ray problem. And what this, what introducing this has done overnight is there aren't any backlogs. You know, the machine, the AI is reporting every single x-ray within three minutes. And we, we've developed prioritization. So the clinical prioritization that those that we call a P1A are those that need to be reported within 24 hours. So that will include TB or, you know, a pneumothorax, you know, lung puncture. And those within 72 hours, 72 hours will include cancer. So, so that will allow us to, again, to have early diagnosis and deliver the faster diagnosis standard, because what we're trying to do is, you know, the machine will tell us that this one, this, this patient looks like they'll have cancer. They will, it will be reported by human because of herma regulation or any patient that's been exposed to ionizing radiation has a right to have that reported. And what this will do is it will just pull people through in the queue so that they will be reported in a timely fashion. We've given other examples. So we've mentioned clinical animations again, you know, I think we've been short this for quite a few prizes, you know. And again, what this has done is to, there's a suite of 19 videos that are made to clinical animations that can, are in a multitude of languages so that it will really explain and can be watched. And again, and again, you know, what does the clinical trial mean? What does chemotherapy mean? What does immunotherapy mean? What does it mean to have surgery? So again, a suite of information that can support patients and patient experience and information regarding their pathway. We've got other examples of teledermatology. So again, remote taking a picture, using artificial intelligence to support risk stratification of that patient, and then perhaps reducing or allowing those patients that are referred from primary care into secondary care that, you know, those are the patients who are going to have a high yield of something being wrong. We've also looked at the multidisciplinary team. So all patients on a cancer pathway, if they look suspicious of cancer, are diagnosed and discussed in a multidisciplinary meeting. This was at first introduced about 15 to 20 years ago. But the number of patients being discussed is going up and up and up. And the quality of the discussion will go down just simply because you've got two minutes per patient. So what we're developing across North East London that will allow standardization of care across all our providers is that standard of care so that if somebody has this on their CT scan, therefore, you know, this will be the likely treatment. And so it will help us protocol standard pathways to allow richer discussion for patients that are more complex. And so we will have protocoling MDTs, treatment MDTs, MDTs for patients who might have metastases or recurrence. So, again, these are just a sample of the work that we're doing. We've got the breast nostalgia pathway. So, again, reducing patients coming through an urgent suspected cancer pathway because we know if you have breast pain, it's much less likely that you're going to have breast cancer. And there's a new pathway that's come in, which is the unscheduled bleeding on HRT. And, again, we're linking in across all of our pathways to ensure and our CDC capacity to reduce that proportion of patients who might have come in on an urgent suspected cancer pathway. And, finally, our last programme is Personalised Care, which covers patient experience. Again, very much focused not only on targets for operational performance, but actually for patient experience to be the best it can be. So we monitor that and have put in place strategies to support that improvement. And, you know, the information and communication across all of our providers as to how we're doing in that and across the whole pathway as the first few questions span how many times a patient would have seen their GP before being referred in. Some of the other strategies support workforce, such as the Personalised Stratified Follow-Up. And this is something that has now become a standard across all pathways, PIFU, so a patient-initiated follow-up. So that will increase the outpatient capacity for new patients. And this is supported by a remote monitoring system so that patients can access their records and also have timely access back into the hospital as they need. One of the other key developments that we've brought in in the last couple of years has been prehabilitation. And this has been really, really important because it used to be that you would look at patients in North East London who might have been at an early stage and it would have looked like, you know, why did we not treat that patient? But at the time, due to many factors, they potentially weren't fit enough. So they might have had the same cancer stage as somebody who was fitter, but then they couldn't have surgery. So a really important initiative that we've introduced is prehabilitation. So patients will go to the gym to improve their fitness, to allow them to have radical treatment. And this has been not only really successfully taken up with great patient experience, it has also improved, it has also been, if you like, sustainably commissioned, if you like, within most of our providers. And so through those efficiencies, so that's been really helpful. The personalised care programme also is focusing on workforce, so we know that we don't have enough workforce and part of the work that we're doing is, in terms of innovating, is to look at, you know, can we do things differently? Can we bring in cancer champions? Can we bring advanced nurse practitioners in? Can we look at how we might use, how we might support the workforce in non-traditional roles? So, for example, the number of different immunotherapies that are coming out or NICE approved is sort of 40% every year. We don't have enough oncologists to deal with that. But if we work with our pharmacists and our nursing team working together as a multidisciplinary team, it may be that the consultant, you know, starts cycle number one. And then you have both nursing and pharmacy, if you like, reviewing the patients in the second or third cycle, and then perhaps towards the end or middle, you know, the medical team will all be working together. So these are all different initiatives that we're looking at. I think some of the things that we're doing as well is actually reducing the duplications. So one of the pieces of work that we've done is that we've ensured in the workforce that, you know, every MRI should have, if you like, half a whole time equivalent of an MRA physicist. And what that does is really ensures that we improve the quality of the scans that we do. So there was this statistic previously that perhaps a third of patients who attended, you know, in the independent sector, having an MRI would have to have them repeated because it's a very long scan. But some of the work that we've done through using AI and also through training of the radiographers when we take to take a scan, so patients don't leave if the quality isn't good enough, if they've not managed to breath hold, has allowed us to be both more productive and reduce that duplication. And then I'll hand back now to Femi regarding our communication program. Thank you. One of the last two slides that we had in the pack was around our work with, on communication and engagement. This is a key area for us, actually, because it allows us to really engage with our communities. Last year, when I say last year, from April 2024 to March 2025, we attended over 80, just over 80 community events and engaged with over 4,000 residents. That's crucial for us in terms of, you know, understanding the needs of our communities, also finding the best ways to provide some of the education around symptoms and promote earlier diagnosis of cancer. We also have a patient and carer's community of practice group that we set up last year. That's grown in membership to over 70 members in that group. And what that team does is that they work very closely with the hospitals and the pathways to try and provide their lived experiences to enable hospitals to improve pathways. So that's something that we've done. And also they bridge the gap between the hospital providers and patients as well. So that's been something that's been really helpful. We've had a few events throughout the year, last year, to really drive our focus on earlier diagnosis, but also how we support each other whilst managing for those patients that are going through a cancer diagnosis and going through treatment as well. Again, there are a number of leaflets that we've produced over the years. We've also, and we share those leaflets, not only within North East London, but we share it wider as well. We share it with other cancer alliances and other partners that are providing support for cancer patients and carers. We've also, we also have a tool that we've recently expanded, which is a re-site tool on our website, which also allows us to engage better with patients of all backgrounds and all different languages. So it has over 100 languages on there as well. So it allows us to communicate and provide relevant information to patients of all backgrounds as well. We also have a podcast. So if you haven't checked out our podcast, it's something that we launched last September. Please do check it out. It provides key information to patients and it also provides a lot more detail through speaking to our clinicians around pathways, symptoms and what to do and what not to do. So it's really, it's been, it's been something that we've been developing over the last, since September and it's, it's grown. We have, we've had 10,000 listens, over 1,500 downloads and we've had quite a lot of streaming time. And so when you get a chance, please subscribe, it's on our, on our website. In terms of our priority, there's also been some awards. I think Angela mentioned it earlier on in, in some of the sections that she, she was talking about. So we've also been shortlisted for national awards for some of the work that we've been doing across North East London. And that's predominantly our campaigns. And we have won awards for some of the other campaigns that we've also led across North East London. And so I guess some of our work across North East London has been recognized with our partners as well. So the work hasn't stopped as a cancer alliance. We still have funding for another year. So some of the work that we're doing in 25, 26 is we're going to be driving the earlier diagnosis agenda, and also promoting access to patients, access to cancer care for patients across, across our system again. So you'll see different, different campaigns throughout the year and a lot more work and engagement with our partners across North East London. So, thank you, thank you, thank you, thank you, do any members have any questions at all? Yeah, excellent. Hello, and apologies for my late appearance. My main question really is about the, it was alluded to obliquely by Henry's report, which I got the end, the tail end of. And I just wondered what were the pinch points in the slide, page 46 for members, 60-day referral to treatment standard. I just wondered what were the pinch points, I mean, whilst the performances, I wouldn't criticise the performance levels particularly, I just wondered what, how this could possibly be improved, you know, where were the hold-ups in it? And we know that for years on this group, we've been hearing about how we compare poorly with our European comparator states in terms of terms of early diagnosis and effect in terms of treatment. So I just wondered, it's really a question as, you're doing all right, but how can we do a bit better? The other basic question is, I was impressed to hear about being in the particular demographic. I was particularly pleased to hear about the lung cancer screening programme. I just wondered how you got on it. Maybe I should declare an interest, Chair. And I was very interested in the increasing awareness programme, and I noticed that the Gypsy and Roma Traveller Initiative and the awareness in the Haredi Jewish community. And I suppose my question was, is there an attempt to recruit advocates for these programmes from the groups that we're attempting to reach? And teledermatology is very good. I think that just appears to be at Homerton, but are there any plans to make that more widely available throughout the footprint? Thanks. I guess in reverse order, one of the things to highlight in terms of the 62-day pathway, you know, the first thing you have is FDS, which is largely a standard that's available to reassure patients who don't have cancer. And there's a 31-day standard, which is the standard of 96% of patients once you've been diagnosed with cancer to get it in treatment. And one of the things that we probably potentially haven't highlighted enough is that we exceed that standard. Sometimes we're the only region in the country that's still living on that. So in terms of your question regarding the pathway, pinch point, it is the diagnostic. So we know that once you've got cancer, patients are being treated quickly and probably the best in the country. Or, you know, there are only one or two alliances that are delivering on that. And we know that that is the diagnostic part of the pathway. And one of the challenges is that, as you will have seen in our data, the sort of positive predictive value is set at 3%. So 3% of all referrals are anticipated to have cancer. It's deliberately made with some vagus symptoms, again, to achieve early diagnosis. And 97% of patients on the cancer pathway do not, in our case, it's 96.5% do not have cancer. And so sometimes, you know, we do have a little bit of a challenge for patients who are referred in and perhaps who don't feel that ill, not wanting to attend. And that's why that tolerance has been set at less than 100% or, you know, at 77% currently. But it definitely is the diagnostic part of the pathway and where it's more invasive. So having a colonoscopy, having a hysteroscopy, that's where we have the sort of challenge of sometimes patients needing to have one or two, you know, diagnostic test book because they haven't had adequate bowel prep. And again, that's something that we look at or perhaps they need it under a general anaesthetic. So, again, that's something that we're looking at that capacity, although we don't want to encourage general anaesthetics because it's not good for you. But finding that right balance and, again, looking at benchmarks of, you know, our general anaesthetic rates compared to elsewhere, because, you know, we don't want to do more than elsewhere. But we also need to make sure we've got enough general anaesthetic diagnostic capacity. But it really is the pathway pinch point is really in that diagnostic space. And, you know, patients can have CTs and MRIs and there's a standard to measure, you know, how, what percentage of patients have that within a six week period. But what we don't really measure is that once you've had a cancer scan, that should be reported within three days. And so, again, as a Cancer Alliance, that's something we're really trying to focus. It's not mandated by the Royal College of Radiologists, but, you know, it is there as an ideal standard. So it's something that we're trying to promote the uptake of and measure across North East London to support that being more timely, because that will in itself really support that diagnostic turnaround. In terms of patients and people being part of our work programmes, absolutely. You know, we do have focus groups. So potentially, if you do know colleagues outside who might want to be involved, then please let us know. And I think, do you want to come in on any of the other questions? Yeah, it's the same with the lung screening programme as well. Yeah, the lung cancer screening programme. So the way that we were sort of initially commissioned, if you like, from NHS England was a sort of 40% rollout. So we focused, if you like, in Barking and Dagenham to begin with, because that had the highest smoking rates. And we've sort of followed the prevalence of smoking in terms of our strategy for rollout. We did have initially, well, you know, the aim is to sort of have a 40% population coverage within four years. And we were given that sort of the green light to go ahead faster. But the money has been cut back a little bit this year. So we're sort of reviewing what impact that might have in terms of our accelerating the rollout across, you know, across northeast London. Because, as I say, we've gone by prevalence. We've not yet gone to City and Hackney, Waltham Forest. So, you know, we've got work to do in terms of that rollout and how we manage with the reduced financial envelope that we have. Do you want to come back on it? Oh, sorry. If in my work as a counsellor and feathering my own nest, if I thought that I might benefit from the lung cancer screening, how would one go about getting it through the GP or? The programme is, so there will be an invitation that is sort of managed by the GP, but it's actually the company that we're using to identify. But we started in Bartholomew and Dagenham, then we went to Tower Hamlets, then we went to Newham, and then we've gone into Havering. So it's sort of which area. But perhaps we can look at that outside of this and it's helpful. Waltham Forest. OK, so Waltham Forest. And that's why we had the green light to go ahead faster. And Waltham Forest was probably going to be our next borough that we're going into. We definitely will be going into Waltham Forest. So it definitely will be coming soon. It is a phased approach. So in terms of the programme, in terms of getting to 100% of the coverage of now, which is something that we're doing this year from April onwards. Just your point around the 62-day being the pinch point, it is a pinch point nationally. And it's been a challenge. And although we've seen some improvements across North East London, you are right, there's been some challenges associated with that. Which is why, I guess, as the providers across North East London, they've been focusing on improving the diagnostic pathways as well. So there's been a lot of work that's been done on the diagnostic pathway to improve earlier detection of cancer and to also fast track some of the tests that we have across our cancer pathways as well. Also, there is some of the things that I think Angela mentioned earlier, Ron, in regards to us exploring how we use technology on our pathways to ensure that we can ensure that our patients can flow through those pathways a lot earlier. So that will enable us to improve the 62-day pathway as well. But a lot of our challenges has been around the diagnostic weights and staffing associated with that as well. Thank you, Angela and colleague. Just a couple of points, if I may. As I said earlier, or alluded to earlier, I represent some of the southwest Essex towns, such as Buckhurstil, Louton, Chigwell, and all of that. Absolutely. I wondered if it was possible in your table here where you identify, you say, which borough and what percentage of people are screening. Is there any possibility you could collate that data for that particular area? And the reason I keep alluding to it is because every GP within those areas focus on the London hospitals. Some of them get sent to Harlow, of course, but a lot of them get sent to the London hospitals. So I just wondered if it's possible to maybe put southwest Essex or something as part of your table to say, I don't know if that could be done. It'd be good if you could. So we can see in southwest Essex just some of the same sort of numbers that you're getting in the London boroughs. Coming to the point of AI, and as you just alluded to, how it might help a 62-day diagnostics period, et cetera, because you heard me talking to Fiona earlier about it. Which parts of what part can AI play in terms of which diagnostics it can do of which cancers? I'll try to put that in another way. As I understand it, it's very good maybe with breast cancer. But at this moment in time, it's not very good with other cancers. Now, I don't know if that's right, wrong, or whatever. And I just thought, and my third question would be, given that you're trying to identify a patient comes in, you do the diagnostics, et cetera, where the communications process is. Because coming back again to southwest Essex and maybe some of the other boroughs, how the communication gets back to, say, GPs and back to patients. Because, again, I use an example that I've got a particular resident who's got cancer. And the question was, I was waiting for the letter to come from the hospital. And here I am six weeks later still waiting for a hospital. And then you go to the GP, and the lady went to the GP, and she said, I don't know either. You'll just have to wait until that comes back. So I was just wondering if you're saying that AI can improve some of those things. I just wondered if some of the communications processes could be improved as well. Thank you. In fact, one of the programs that we didn't actually speak about is conversational AI. So, you know, we look at retail and banking, you can access that 24-7. You know, what about if you're a patient on a colorectal pathway, and you've got to have a colonoscopy, and you're taking your bowel prep, and you vomit? You know, what next? And so we are developing with British Telecom, so, you know, another institution, a bit like the NHS, and Soprano, who are the largest texting service in the country, a conversation, a chatbot, effectively. So that if this happens, you can say, actually, I've had this, and it'll be like, don't worry about it, you can still go in. And what we're hoping in phase two of this project is that it will also, you know, if somebody really can't go in, you know, I'm feeling terrible, I absolutely can't go in, that it can go in and cancel that appointment, and give them another appointment that's not too far away, so they don't get lost in the system, no phone calls needed, you know, just auto happens. And then perhaps create a pool of patients who might be, you know, if we get a short notice cancellation, it won't be a colonoscopy, because you need to take bowel prep, but if it's a sigmoidoscopy, or just starving for six hours, you know, would you be interested? And then that will also help us, you know, improve our utilisation and capacity, so we don't waste slots, basically. So that's one of the artificial intelligence, you know, yeah, you can say it, you know. One of the artificial intelligence that we're looking at. So we're looking at clinical support, but we're also looking in the. Yeah, I mean, just to touch on some of the points that Angela mentioned as well. So we are using AI for communication. We're also trying to utilise it in the background as well with general administrative support. They're all linked in terms of, actually, how do we focus on areas where we've got the greatest challenges? So that's a, it's a project that we are expanding on this year. So there is going to be a lot more communication generally, and not just, not only the conversational AI. Just on your points around, I've written it down as what areas could we utilise AI to get the greatest gains? So Angela mentioned chest, we're utilising machine learning on our chest x-rays. So that's to identify any abnormality a lot earlier on in the pathway. We mentioned dermatology as well briefly. Again, there are areas where our clinicians haven't been satisfied with how the results have been, have been achieved. So there's some more work in some of those areas to, to explore it further and see other kind of best practices in other areas. So there are, there are many areas that we use in AI across the country and globally. But I guess what we're doing is taking areas where there is evidence and there is confidence, clinical confidence in the use of AI technology. So it's, although we've got core areas so far, which are two areas so far, we are going to be expanding over time as technology has become more advanced. I think one of the challenges with AI is, you know, who's accountable? So one of the reasons it works very well with chest x-ray is because, you know, this, this actually needs to be reported by humans. So it's a quick safe and then a safety net and then actually has to be reported. Some of the skin AI might be that, you know, the machine does it and then you don't get a referral in. We wouldn't feel comfortable with that at this stage because what if it misses something? So that's why at the moment we would always insist on a sort of second human read and then to feed that learning into, if you like, the learning or information there is nationally and internationally in that regard. And the chest x-ray in itself has also been, you know, learning because we also want to make sure that it doesn't overcall so that, you know, people get more CT scans that they, you know, than is necessary. So we're monitoring all the, if you like, the metrics to make sure that it is giving value. And I think one of the things that the AI is doing is because it's pre-reading what we're hoping in and where an x-ray, for example, is normal. That's where we hope that because, you know, the machine said it's normal. So the person that's doing the second read has, you know, has got a sort of a bit of an advantage. So we're hoping that that will give us a sort of 40% productivity gain to this challenging time of, you know, less money. Thank you. Yes. Yeah. If I may share a follow-up. Yes. The other part of the communication bit I was talking about is I seem to remember you saying, oh, we get an x-ray and AI goes zoom. And within three seconds, we've got some sort of direction of where we're going. Oh, it looks good. It looks bad. It's a referral. The point I was making about coming back to the GP is it always seems to be that the patient has to go back to the GP for the results that come from the diagnostics or whatever has been done by the patient. And I'm just wondering how we, that communication can be improved. It may not be AI coming back to what Richard said earlier. And some of the, I think, some of them, I think Richard, we were on a previous meeting where we were talking about the records were being digitized as opposed to manual records that they've got at the moment. I don't know if that's still the case and whether that digitization will help to improve the communication. I'm just really thinking about if you're telling me, oh, we've got AI and someone comes in for a breast cancer and they get an x-ray. And within three seconds, we know which direction we're taking. And then six weeks later, a patient goes to the GP and says, I've not had any letter. I've not had any update. That's really not making a great deal of a forward movement. It's not really improving, is it, really? And as I say, I just wonder how we can get that communication back to the GP. So I think one of the unusual things, so just to be able to implement this for two years and then from that learning to form the business case for it to be continued. One of the things that we did was to sort of look at that whole pathway and look at the communication at which point and by forming the prioritization buckets, because so if it's really serious and it's got to be reported within 24 hours, that report will be there. It will be issued at beyond the system, CERNA, Millennium, that the GP can access and that the patient should be contacted within 24 hours. So we've done it, if you like, according to what is on the x-ray. And if, for example, somebody has a cancer, they will be recalled within 72 hours. That will be reported and be informed. So one of the things that we've done is we've spoken about it in all our subgroup and program groups, which has probably this is across the whole of northeast London, primary care are aware. And all the hospitals are following the same pathway. There is also a wider program that we're looking at as an entire system, which is the utilisation of the NHS app. So the NHS app currently you'll be able to access, I think it's still limited, but it's still on the development. You'll be able to access all of your health records. You will be able to access letters and results in the future. The challenge around results is that some of these need to be interpreted first. But I know there's a wider program around that. And we're going to link in as a cancer alliance to ensure that some of the projects that we're working on also has that. We're talking to each other whilst we're doing that. So I think although we haven't solved or we haven't solved that problem today, I think there's a wider piece of work around that. I know there's a wider piece of work around that for the future. You also mentioned a point around having the data specifically by borough. We have presented here before where we've presented that data by borough. We can send that information back. We can provide that information back here as well. Yeah, we can do that, of course. We're going to be part of the team. Yeah. So if Chair is fine, we can set a breakdown back to this group as an action for us. Just because of the interest of time, I'm going to move on to the next item. But thank you for coming to that and presenting. Obviously, quite an important topic. I think one of the key recommendations, obviously, yeah, if we're having the breakdown of including the West Essays, I assume it probably fits under another accounts for alliance as well, though. So, yeah, many thanks for coming. Obviously, more than welcome to stay, but you are free to leave as well. So we now come to item seven, a discussion on the Superleap bus route, as shown in the supplementary agenda. Ian Buckmaster, representing Healthwatch Havering, requested us to discuss the proposed Superleap bus route. So, Ian, please now ask you to present to start the discussion. Thank you, Chairman. Thank you for that. And thank you for allowing me to bring this up as an urgent item. And I apologise to the committee that I haven't been able to prepare a written report, simply because this issue only arose less than two weeks ago. And obviously, all the deadlines are long since missed. By way of introduction, this is light relief to what the heavy clinical stuff we've had before. But I think in its own way, it's just as important. And although what I am going to talk about is specifically within Havering, it will affect residents, certainly of Redbridge and Barkin and Dagnum and possibly Waltham Forest. I apologise, it doesn't affect South West S6 as far as I know. But there may be people that might find it helpful when we get... Just by way of background, Transport for London are introducing a network of buses called Superloop, which in many ways resemble what most of us will recall as Green Line buses back in the day. They are express buses that don't stop at many stops, but which will cover eventually the whole of London. And it's all part of the mayor's way of putting right some of the wrongs that were caused by the ULES when it was introduced a couple of years ago. I'm not going to go down that particular rabbit hole. I'm just going to concentrate on this. And what you have on the screen there is the TFL proposed route, which is essentially starts in Gants Hill, goes along Eastern Avenue, past King George Hospital, which is a crucial point, till it gets to the junction with North Street Romford. Then it goes down North Street through Central Romford into Queen's Hospital, where there's already bus stands that probably many of you are aware of. And it then leaves Queen's and it then goes to Roneo Corner, which is a local landmark. It then heads more or less south through Elm Park to join a road called South End Road, which runs between, broadly speaking, between Hornchurch and Rainham, goes down to Rainham. It takes a slightly different route to most buses and it serves an area which is called the Beam Park development, which is a massive redevelopment on what used to be Ford's grounds, basically, which extends through to Dagenham and then into Barking. Massive development. And then it goes on to serve Ferry Lane industrial estate right at the south of Rainham, right on the edge of the Thames, which has never had a bus route before now. Principle of SL12, which is what the Superloop bus is, is brilliant. I don't think there's any argument that it's well worth it. Where we have taken issue with it is on its route between Roneo Corner and South End Road. Tyra, could I have the next slide, please? Now, this is a slide which illustrates the routes in green, which TfL are proposing. As you can see, it serves Elm Park Station. It sort of wanders down the western side of Havering. What we are proposing, and what I hope the committee will feel able to support us with, is an alternative route from Roneo Corner along Hornchurch Road to Hornchurch Town Centre, during which point it passes the Harrow Lodge Leisure Centre. And several people have mentioned in the talks we had about the benefits of exercise and fitness for health and well-being. And the Harrow Lodge Leisure Centre costs Havering Council a great deal of money, and it delivers health and well-being. That is roughly, can you see along the red line, about halfway along the red line, there's some squiggles, to be honest with you. I'm not quite sure. I think that says A124, which is the road number. But that's roughly where the Leisure Centre is. OK, so it goes into Hornchurch Town Centre, and then it goes down Station Lane. You can see, thank you, Taiwo. Yeah, there's Hornchurch. You go down Station Lane, there's Hornchurch Underground Station, which is not quite as well used as Elm Park Station, but is more central to a lot more people, I would say. Oh, that's not. Oh, right, thank you. Now, crucially, and this is echoed by what several presencers have said, the Blue Cross there represents the St. George's Health and Well-Being Centre, to which people are being referred from Queen's and from King George, and indeed, probably from further west, certainly from the Gatsill area. Residents of Redbridge will be referred there. Residents of Barkin and Dagnan will be referred there. There is currently no bus service directly between King George and the St. George's, and the one direct bus service from Romford to St. George's is the 252, which goes all around the houses. To get from Hornchurch to Romford, it goes south. It goes all along that red line to where the green line joins it near the bottom of the slide, and then it goes all the way back up again, and it takes twice as long as any other way of getting there. And then we propose that the route continues down, which is the route of the 252, and then joins the existing proposed route, where the green and the red join together. I'm sorry that the projection system means that you can't see this as clearly as I would like you to, but it can't be helped. Thank you for pointing it out, Tyra. So, members, what I'm asking for, I don't want you to commit to campaigning or anything like that, but I would like, if possible, the committee to express support for the proposal. We will be putting it to Transport for London. The consultation on the Route SL12 is open until the end of May. I think it's the 26th or 25th or 26th, 23rd of May, thank you. So, that's what, six weeks left. If the committee feels able to support this, it would be helpful for us to be able to say that in the submission that we will be making. Thank you. Can you say it's going past the new St. George's Hub? Will it go into the hub? Because the bus stops there are so far for people to walk to. Well, I don't think it could go in. There isn't the space. But one of the things we are including in the submission is a request for a bus stop outside St. George's. The nearest bus stop from it is 110 metres away. I get a lot of complaints. And one route, the 193, which goes near but doesn't go near the site, it moves away. And that's 220 metres away, which is a long way if you've got a mobility problem or are elderly. So, we will be asking for the bus stop as well. One of the things about St. George's was that when the planning permission was granted, there was a severe restriction on the number of parking spaces, on the grounds that there would be public transport available. And there ain't. One of the things about St. George's was that when the planning permission was granted, there was a lot of parking spaces. One of the things about St. George's was that when the planning permission was granted, there was a lot of parking spaces. Do any other cats there? Well, formally to endorse what Ian has proposed, just asking that if the colleagues are in agreement that Ian sends round the door, the final draft of the response so that we can just cast our eyes over it and make any minor changes that we might think appropriate. Yeah. But I would just remind you, Ian, when we first embarked on the great task of the Einel Josk, we were trying to get a very minor change in a bus route, I remember, for an urgent care centre in Ilford, with a singular lack of success, but let's have a go. Do any other members have any comments? Thank you, Gia. It's a really good proposal. I'm really, I'm the councillor of BIM World, and you know that you mentioned already lots of construction going. Your plan, is it touching that, is it crossing to Barking Hospital as well? Thank you. That's, that's my question. Well, certainly, the panel is open. There is no bus route from Rainham stroke Bean Park that goes anywhere near St George's at the moment. You'd have to change at least once. If we can get the SL12 to go to St George's, that will serve Bean Park. Not the areas further west, but certainly the areas between Dover's Corner and where Seamy is, and around that sort of space. I think that would be, they would get well served by the SL12 if we can pull this off, and I hope for more success than we had previously, Richard. I hope we can, this would be beneficial. I think it will benefit far more people. The, the area through Elm Park is already heavily congested, and I think sending the SL12 that way will just add to the congestion. Do you have a comment as well? If everyone, if members of the committee are happy, then certainly we would support that. I mean, it does make logical sense to myself, but yeah, we will happily support any submission. Thank you. So yeah, thank you that item. And yeah, so, and just for information on the final bit, following on from an earlier email from Xena Efferidge, NHS Chief Executive from the ICB, you have all been sent a diary invite for an online briefing session where, where they will walk us through the financial situation, current challenges, and our, and our, their high level plans to address those across North East London. Um, an agenda will be sent out in advance to this meeting. Um, thank you. So that concludes the meeting. Um, as such, the date for the next meeting is the 8th of July, 2025. And the venue is yet to be confirmed, be confirmed at a latest date. Um, yeah, a safe journey home. And please stop broadcasting. And hopefully the rain has just stopped. Yeah. Just one thing. It's the 8th of July. The council have had their 8th of July. No, no, no. No. Ok. So, it's the 8th of July. 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