The Inner North East London Joint Health and Overview Scrutiny Committee met on 24 April 2024 to discuss a range of health-related issues affecting the region. Key topics included a proposed merger of joint health and overview scrutiny committees, a comprehensive health update covering finance, provider performance, and mental health services, and an update on the Committee's action tracker and forward plan. The committee also heard from a member of the public regarding the lack of Functional Neurological Disorder (FND) services in East London.

Proposed Merger of Joint Health and Overview Scrutiny Committees

The Committee discussed a proposal to merge the Inner North East London Joint Health and Overview Scrutiny Committee (INEL JHOSC) with the Outer North East London Joint Health and Overview Scrutiny Committee (ONEL JHOSC) to form a single committee covering the entirety of North East London. Zina Etheridge, Chief Executive of NHS North East London, explained that this merger would align with changes in the local healthcare landscape and the collaborative work already spanning the region, noting that no other area in the country had two separate scrutiny committees.

However, the Committee expressed significant concerns regarding the potential for an erosion of accountability and the impact on decision-making processes. Members felt that a single, larger committee might not have sufficient time to thoroughly discuss all critical topics, potentially affecting residents. There was also disappointment regarding the consultation process for the proposed merger, which some members felt undermined trust between local authorities and the NHS. Councillor Beverley Brewer of Redbridge Council echoed these concerns, stating that no members of the ONEL JHOSC agreed with the merger and that stakeholders from Essex County Council and Epping Forest District Council should be included in discussions. The Committee agreed that this was an important issue requiring careful consideration, with discussions also touching upon place-based leadership and decision-making powers. They also considered how the two existing committees could work together more effectively if a merger did not proceed, focusing on aligning agendas and forward plans to prevent duplication.

Health Update - April 2024

The Committee received a comprehensive update on the health landscape in North East London, covering financial performance, updates from key healthcare providers, and the state of mental health urgent and emergency care.

Finance Overview: Henry Black, Chief Finance Officer for NHS North East London, presented a challenging financial picture, with the Integrated Care System (ICS) facing a forecast deficit of £36.9 million. This deficit is attributed to pressures in Continuing Healthcare, a significant overspend in prescribing (£31 million), and pressures within mental health services, including high-cost adult placements. Provider trusts are also reporting substantial deficits, driven by the impact of industrial action, slippage in efficiency plans, inflation, and payroll costs, including agency staffing. Despite these challenges, the ICB is working on a financial recovery plan, with a mandate to break even by March 2025, though this is acknowledged as a significant challenge nationally.

Provider Updates:

• Barts Health NHS Trust: Rebecca Carlton, Chief Operating Officer, highlighted improvements in staff survey results and progress on the Whipps Cross Hospital redevelopment. While operational performance was impacted by industrial action, emergency wait times had improved, and more elective activity had been undertaken. The Trust also reported positive outcomes from a CQC maternity survey and the opening of a new dental clinic. Concerns were raised about the Trust's position in finance and productivity charts, with workforce issues and temporary staffing identified as areas for improvement.
• Homerton Healthcare NHS Trust: Bas Sadiq, Chief Executive, reported strong operational performance in elective care and emergency services, although cancer treatment performance was below target. The Homerton Healthcare Fertility Unit's license had been suspended by the Human Fertilisation and Embryology Authority (HFEA) due to concerns about three incidents, with the unit unable to accept new patients. The Trust is working with the HFEA and NHS England to address these issues and manage capacity across North East London.
• East London and North East London NHS Foundation Trusts (ELFT & NELFT): Lorraine Sunduza, Chief Executive of ELFT, presented updates on community health services, noting that a high percentage of adults and children were starting treatment within 18 weeks of referral. Waiting lists for ADHD and Autism services continue to grow. The Trusts are also collaborating on a NEL-wide Rapid Response Improvement Network to prevent acute hospital admissions.

Mental Health Urgent and Emergency Care: Lorraine Sunduza also provided an update on mental health urgent and emergency care, highlighting a significant increase in patients presenting at A&E with mental health issues. This has led to high bed occupancy rates (routinely over 95%) and an increased reliance on private sector beds, which are considerably more expensive. ELFT declared an internal critical incident in March due to sustained high bed occupancy and system-wide pressures. Collaborative work is underway with local authority and place-based partners to improve discharge arrangements for patients who are clinically ready for discharge, which is identified as the biggest flow challenge. The Committee expressed concern about the critical incident status and the demand for acute mental health beds, particularly for male patients. They also inquired about the quality data for the Right Care, Right Person initiative and the impact of the 111 press 2 service.

Public Participation - Functional Neurological Disorder (FND) Services: Mr George Bleakley, a resident of Tower Hamlets, spoke to the Committee about the absence of Functional Neurological Disorder (FND) services in East London, highlighting that this region was the only one in England without such provision. He shared his personal experience of having to travel to Camden for services and stressed that with appropriate help, outcomes for FND patients could be significantly improved. Zina Etheridge stated she did not have the immediate information to address the issue but would add it for future discussion. The Committee requested that this issue be incorporated into the forward plan and that a formal response be provided at the next meeting.

Committee Action Tracker and Forward Plan

Rosie Whillock, Scrutiny Policy Assistant, presented the Committee's action tracker and forward plan. It was noted that eleven actions had been completed since the last meeting, with five in progress and eleven outstanding. The Committee reiterated their request for a formal response regarding the Functional Neurological Disorder (FND) services issue raised during public participation. They also agreed to add a discussion on how the forward plans of the INEL and ONEL committees could be aligned to avoid duplication of reports.

Decisions Made

The Committee noted the reports presented and recommended the following actions:

• Officers to provide a response regarding Operose transferring their services in December without NHS permission.
• Officers to check if the NEL Mental Health Crisis Network had Local Authority representation.
• The Committee noted the report on the Committee Action Tracker and Forward Plan and added the following to the action tracker/forward plan:
  • Members to hear a formal response to the public speaker regarding Functional Neurological Disorder (FND) services in North East London.
  • The Committee to consider ways the forward plan could be aligned between INEL and ONEL to avoid duplication of reports.