The Adults and Health Overview and Scrutiny Sub-Committee met on 6 March 2024 to discuss the Startwell Programme, the Q3 Adult Social Care performance report, and the commissioning approach for care homes in Barnet. The committee also received updates on Task and Finish Groups and the Cabinet Forward Plan.

Children and Maternity Services - Startwell Programme

The committee received an overview of the Start Well Programme, a long-term NHS initiative aiming to reconfigure maternity services across North Central London (NCL) by reducing the number of maternity units from five to four. This change is driven by a declining birth rate and increasing complexity in maternity care. Two options are under consideration: Option A, which proposes closing maternity and neonatal services at the Royal Free Hospital and consolidating services at the University College London Hospital (UCLH), North Middlesex University Hospital (North Mid), and Whittington Hospital; and Option B, which would see services close at the Whittington Hospital instead. Option A is the preferred option due to fewer staff relocations and better capacity in receiving hospitals in North West London.

The programme also includes a consultation on the potential closure of the Edgware Birthing Suite due to low usage.

Concerns were raised by the committee regarding conflicting data on birth rate projections, with Barnet reports predicting an increase while the Start Well consultation suggests a decline. The committee also highlighted the higher birth rate within the orthodox Jewish community and questioned if overall figures masked this trend. The Start Well Programme Director assured the committee that the NHS modelling would be reviewed and that the impact on the Jewish community was being considered.

The committee expressed concerns about potential decreases in hospital beds and resources for Barnet residents, but were informed that the proposals aimed to optimise resource location rather than reduce overall provision. The committee agreed to recommend that the Integrated Care Board (ICB) be invited to a future meeting to present the public response to the consultation.

The committee also put forward several recommendations for the consultation response:

• Addressing the contradictory data on birth rates.
• Ensuring the ICB considers the impact of new housing developments on service needs.
• Exploring whether increased staffing could negate the need for service closures.
• Addressing concerns about the quality of existing maternity services at the Whittington Hospital.
• Recognising and addressing the health inequalities experienced by black and Asian communities.
• Ensuring the specific cultural understanding and sensitivity for orthodox Jewish women, currently provided at the Royal Free, is maintained.

Q3 2023/24 Adult Social Care Performance Report

The Executive Director, Communities, Adults and Health presented the Q3 2023/24 Adult Social Care performance report. The report indicated an overall improvement in performance compared to the previous year, with 63.2% of Adult Social Care Outcomes Framework (ASCOF) indicators falling within the top two quartiles nationally. Specific improvements were noted in areas such as permanent admissions to residential and nursing homes for those aged 65+, and the effectiveness of short-term services aimed at enabling residents to remain at home.

However, two indicators declined by more than 10%: the proportion of adults in contact with secondary mental health services living independently, and the proportion of older people offered reablement services following hospital discharge. The former is a health indicator outside the local authority's direct control, while the latter's decline was attributed to a significant increase in the total number of hospital discharges.

The report also highlighted the ongoing challenges of a funding crisis in social care, with demand outstripping available resources. The council is working on a refreshed resident-facing plan for adult social care, 'Our Plan for Adult Social Care 2024-2029', developed in co-production with residents and carers.

The committee noted the report, with a specific question raised about the decline in the use of direct payments, to which the Executive Director responded that the team was seeking feedback and exploring ways to simplify the process.

Commissioning Approach for Care Homes in Barnet

The committee received a report detailing Barnet's approach to commissioning care home placements. Barnet has a large and diverse care home market, with 80 care homes and 2,939 beds. The report highlighted that 85% of registered care homes in Barnet are rated 'Good' or 'Outstanding' by the Care Quality Commission (CQC), which is higher than the national average. While the provision of general residential and nursing beds is broadly sufficient, there is an under-provision of specialist care for older adults with dementia or mental health conditions.

The council calculates a 'minimum sustainable price' for care home placements to ensure the financial viability of the sector, which is determined in partnership with other NCL boroughs. The report detailed the minimum weekly costs for residential and nursing placements, excluding Funded Nursing Care (FNC). The council also block purchases 164 beds across 10 homes.

Beyond pricing, Barnet provides significant support to providers through its Care Quality function, which conducts quality assurance checks, manages quality concerns, and coordinates health and public health interventions. The report also addressed the challenges of high vacancy rates and an ageing workforce within the care sector, outlining initiatives at both NCL and local levels to support recruitment and retention.

The committee noted the report, with questions raised about the council's contribution cap on care home fees for chosen placements and the statutory timeframe for reassessments of care needs.

Task and Finish Groups Update

The committee received an update on two Task and Finish Groups:

• Primary Care (GP) Access: This group has held five meetings and gathered evidence from various stakeholders, including the NCL ICB, Barnet Healthwatch, and local GP practices. Key recommendations include improving communication about changes in primary care, learning from best practices, and advocating for closer examination of funding for Barnet given its demographic profile. The group is also seeking updates on the implementation timeline for improvements to GP telephony services.
• Discharge to Assess: This group has held initial meetings with NHS and LBB leaders and plans further discussions with Barnet Hospital and patients/carers to gather evidence on hospital discharge coordination.

The committee noted the report.

Cabinet Forward Plan

The committee reviewed the Cabinet Forward Plan, which outlines upcoming key decisions. Members were invited to identify any items they wished to request for pre-decision scrutiny. The plan included several items relevant to health and social care, such as Our Plan for Adult Social Care 2024-2029 and Adult Social Care fees and charges consultation.

The committee noted the Cabinet Forward Plan.

Adults & Health Overview and Scrutiny Sub-Committee Work Programme

The committee noted the Forward Work Programmes for the Adults & Health Overview and Scrutiny Sub-Committee and the Health and Wellbeing Board.

Other Matters

The committee also noted the minutes of the previous meeting, confirmed the absence of members, and noted declarations of interest. There were no public questions or comments, and no members' items were raised. The committee also noted the minutes of the Joint Health Overview and Scrutiny Committee.