The Inner North East London Joint Health Overview and Scrutiny Committee (INEL JHOSC) was scheduled to discuss updates from the London Ambulance Service, the NHS North East London (NEL) system, and the Joint Forward Plan for 2024/25. The committee was also set to receive an update on the closer collaboration between Barts Health and Barking, Havering and Redbridge University Hospitals (BHRUT) NHS Trusts.

London Ambulance Service Update

The committee was scheduled to receive an update on the London Ambulance Service (LAS). The report pack indicated that LAS aims to provide outstanding emergency and urgent care whenever and wherever needed for everyone in London, 24/7, 365 days a year. The LAS strategy for 2023-2028 focuses on three missions: Our care, Our organisation, and Our London. The service has seen significant recruitment, with over 1,600 new starters in 2022/23, and has reported an increase in staff hours on the road. LAS has also set a target to reduce hospital conveyances, which it has reportedly exceeded by upskilling its workforce and introducing new services.

For the winter period, LAS planned for a surge in demand, implementing measures such as additional ambulances, response vehicles, control room staff, and clinicians. The fleet capacity was increased by 10%, and specialist resources like mental health cars were utilised. LAS also urged Londoners to use the 999 service wisely. The report pack highlighted the LAS's commitment to developing its strategy based on insight and the changing external environment, analysing population trends and horizon scanning for developments in pre-hospital care. Extensive engagement with staff, partners, and patients informed the strategy's development.

The LAS also provided a performance report for North East London, detailing face-to-face responses, average response times for different categories of calls, and the service's estate in the region. The report noted that North East London experiences the longest hospital handover delays and has a young, densely populated, and rapidly growing population with a high proportion of residents from ethnic minority backgrounds and those living in deprived areas.

NHS North East London Update

An update was scheduled regarding the NHS North East London (NEL) system, focusing on system resilience over winter. This included bringing together key stakeholders to build resilience through a new clinically led System Coordination Centre. The 'Finding the Right NHS Help' campaign was ongoing to help people access the right NHS services. Winter Wellness guides were co-produced with local authorities and residents, providing holistic information.

Vaccination figures were provided, with 169,235 seasonal Covid-19 vaccines administered and 375,000 seasonal flu vaccines given. The report also celebrated successes, noting two NEL projects that won HSJ Awards: the Tree Of Life In Schools project and a specialist pharmacy-led cardiovascular risk factor management initiative. The team at Richmond Road medical centre in Hackney also won a National General Practice Award.

The committee was to be briefed on the North Central London (NCL) 'Start Well' consultation, which concerns children, young people's, maternity, and neonatal services, and its potential impact on North East London residents. An update on AT Medics/Operose was also scheduled, detailing a potential change of control for AT Medics Ltd, which holds seven Alternative Provider Medical Services (APMS) contracts in North East London. The report outlined what this change of control would mean for patients and the responsibilities of NHS North East London as a commissioner.

The financial position of the NEL Integrated Care Board (ICB) was to be discussed, with a Month 8 year-to-date deficit of £58.2m and an adverse variance to plan of £52.5m. The report detailed financial risks to the ICS forecast outturn and the ICB's own year-to-date deficit variance. Provider updates were also included, covering BHRUT, Barts Health, Homerton Healthcare NHS FT, NELFT, and ELFT.

Joint Forward Plan 2024/25

The committee was scheduled to receive an update on the Joint Forward Plan (JFP) for 2024/25. This plan builds upon the interim Integrated Care Strategy and the first five-year plan, outlining how the ICB and its partner trusts intend to arrange and provide NHS services to meet the population's physical and mental health needs. The JFP refresh aims to reflect the coming years' delivery plans and includes new slides covering strategic system improvement portfolios, Place plans, cross-cutting themes, and enablers. The plan also highlights what is important to residents and how it impacts the plans, successes to date, and the development of a strategic outcomes framework. The approach to system planning was divided into three steps: integrated care strategy, delivery plan, and operational planning. The timeline for the JFP refresh was presented, with a final draft due by the end of February 2024 and ICB Board approval in March 2024.

The report detailed the main changes from the previous JFP, including new slides on strategic system improvement portfolios, Place plans, six cross-cutting themes, and enablers. It also outlined what is important to residents, successes to date, and the development of a strategic outcomes framework. The plan describes the challenges and assets within the North East London partnership.

The JFP is structured around several key areas:

• Our unique population: Highlighting the diversity, rapid growth, and significant health inequalities within North East London, with a focus on poverty, deprivation, and ethnicity.
• Our assets: Emphasising the people, research and innovation, leadership, financial resources, and primary care as key strengths.
• Our challenges and opportunities: Detailing urgent and emergency care pressures, planned care backlogs, the need to expand and improve primary care, and the development of community care resources. The report also addresses the unaffordability of the current care provision blend and workforce challenges.
• How we are transforming the way we work: Outlining transformation programmes across urgent and emergency care, community health services, primary care, planned care, cancer services, maternity, babies, children and young people, long-term conditions, mental health, and employment and workforce.
• Our supporting infrastructure: Covering specialist commissioning, digital infrastructure, finance, and physical infrastructure.
• Place-based Partnerships: Detailing plans for Barking & Dagenham, Havering, Redbridge, Tower Hamlets, Newham, Waltham Forest, and City & Hackney.
• Our Cross Cutting Themes: Focusing on health inequalities, prevention, personalised care, learning system, co-production, high trust environment, and the role of anchor institutions.

The report also discussed lessons learned from the development of the first NEL Joint Forward Plan, including what went well and areas for improvement. The NEL Outcomes Framework was presented as a way to measure the effectiveness of the ICS strategy by focusing on achieved outcomes. Next steps for transformation programmes were outlined, emphasising the need for prioritisation in light of financial constraints and workforce reductions.

Barts Health/BHRUT Closer Collaboration

The committee was scheduled to receive an update on the closer collaboration between Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals (BHRUT) NHS Trust. This collaboration is part of the North East London Acute Provider Collaborative (APC), which aims to provide strategic leadership for the transformation of acute clinical services. The report highlighted that the APC supports the population health goals of the NEL Integrated Care System and focuses on planned care, cancer, and critical care.

The closer collaboration between Barts Health and BHRUT, established in October 2021, focuses on enablers for effective local delivery of APC strategy, including leadership, workforce, informatics, and corporate services. The report outlined progress made to date and future developments. The rationale for collaboration was presented, citing NHS England's expectations for trusts to be part of provider collaboratives to reduce unwarranted variation, improve resilience, and ensure specialisation where it provides better outcomes and value.

The report detailed the significant asset base of both trusts and the rationale for their closer collaboration, including facing similar performance challenges, attracting and retaining talent, drawing on joint assets and experience, and learning from each other. Specific areas of focus for the collaboration include:

• Clinical: Creating conditions for clinicians to collaborate more easily and effectively, aiming for fair access to the best possible care through strong local hospitals linked to specialist facilities.
• Digital: Developing a digital infrastructure to improve clinical decision-making, engage patients, and make work easier for staff. This includes securing funding for an electronic patient record (EPR) at BHRUT and implementing a shared maternity digital solution.
• Workforce: Redesigning the workforce and improving staff working lives, leading to greater opportunity for flexible staffing models and harmonising medical and bank rates.
• Corporate Services: Achieving greater effectiveness and efficiency through operating corporate services and purchasing at scale, including streamlining services and implementing shared systems. The report noted the shared non-emergency patient transport service.

The committee was also to receive an overview of the Acute Provider Collaboration (APC), which shapes clinical strategy and has established a Clinical Strategy group. Benefits achieved to date by the APC include planned care backlog reduction through mutual aid and the extension of the critical care retrieval service.

Committee Action Tracker and Forward Plan

The committee was scheduled to review the Committee Action Tracker and Forward Plan. The Action Tracker details actions arising from previous meetings, including requests for information and recommendations. The Forward Plan outlines potential agenda items for future meetings, such as updates on the NEL Estates Strategy, the Acute Provider Collaborative, and specific health topics like testicular cancer and the 111 service. Items to be scheduled included follow-ups on the Assurance Framework for GP Practices and the disputes resolution procedure.