The Health & Adults Scrutiny Sub-Committee met to discuss progress on elective care and outpatient services at the Royal London Hospital and Barts Health NHS Trust, and to review the adult social care budget. Key decisions included a commitment to clear the 104-week elective care backlog by the end of the financial year and a focus on improving data quality and service delivery within adult social care.

Progress on Elective Care and Outpatient Services at the Royal London Hospital and Barts Health NHS Trust

The committee received an update on the progress of the Royal London Hospital and Barts Health NHS Trust in recovering elective care and outpatient services following the COVID-19 pandemic. Jackie Sullivan, Chief Executive Officer of the Royal London & Mile End Hospitals, explained that prior to the pandemic, the hospital had virtually eliminated long waiting lists and met all cancer targets. However, the pandemic led to the Royal London becoming predominantly a COVID hospital, with a significant expansion of critical care capacity.

Kathriona Davison, Chief Operating Officer for the Royal London Hospital, detailed the restoration plan, which involved separating COVID and non-COVID patient pathways to ensure safety. She highlighted the challenges faced by dental services, as well as Ear, Nose, and Throat (ENT) and ophthalmology, due to aerosol-generating procedures. Innovations such as virtual outpatient appointments, using platforms like Consultant Connect, have helped maintain a significant proportion of activity, with outpatient waiting lists only increasing by approximately 7% compared to pre-COVID levels. A project called 2Fairy has been established to create additional procedure rooms to address the paediatric dental backlog.

Stephen Edmondson, Chief of Surgery, explained the clinical prioritization framework (P1 to P4) used for surgeries, with P1 being emergencies and P4 being those who can wait longer than three months. He noted that the trust has worked to ensure virtually no avoidable deaths due to pandemic-related surgical delays. The trust is aiming to clear the 104-week elective care backlog by the end of the financial year and is also working to address the 52-week waiting list to prevent patients from experiencing longer delays. Services with significant backlogs include ENT, paediatric dentistry, urology, colorectal surgery, gynaecology, and thoracic surgery.

The committee discussed the challenges of patient choice and communication. Jackie Sullivan acknowledged that the ophthalmology service at Mile End Hospital is now run by Moorfields Eye Hospital, with relevant work moved to the Royal London and Whipps Cross University Hospital. She also addressed concerns about long waiting times in outpatient clinics, explaining that while individual appointments are expected, current clinic templates are being updated to reflect new working methods, including virtual and face-to-face appointments.

A new Family Contact Centre has been established at the Royal London Hospital to improve communication with patients and their families, offering a face-to-face service where people can talk, phone, or email. This centre will also house the Macmillan service and bereavement service. The centre will include an additional desk to handle waiting list queries, aiming to reduce the need for patients to contact their GPs for hospital-related information.

Adult Social Care Budget

Denise Radley, a member of the committee, presented an update on the adult social care budget, highlighting a forecast overspend of £2.2 million at month six of the financial year. The majority of this pressure is attributed to care packages, driven by increasing needs and complexities of clients, including the demand for additional one-to-one and 24-hour support, particularly for those leaving hospital. The council is implementing a finance improvement programme with three workstreams: data quality, practice development (including increasing the use of direct payments), and key service development areas such as the new Tower Hamlets Connect information and advice service, home care reprocurement, and technology-enabled care.

Significant risks were identified, including the ending of NHS discharge funding in March, which represents a £4 million annual risk to the council. There is also uncertainty surrounding social care reform, with upcoming white papers on social care and integration expected to have a considerable impact. The council is also facing challenges with its IT system and data quality, which are being addressed as part of the improvement programme.

The committee discussed the demographic funding cap, with a projected demography increase of £1.2 million more than the cap in the next financial year. There was also a discussion about the impact of the pandemic on the complexity of care needs, with increased mental ill health, isolation, and loneliness contributing to higher demand. The committee also raised concerns about the appeals process for direct payments and the need to ensure residents' voices are heard in financial assessments.

Better Care Fund (BCF)

Warwick Tomsett, Suki Kaur, and Phil Carr provided an overview of the Better Care Fund (BCF) in Tower Hamlets, which totals just over £55 million. They explained that this funding is not additional money but rather pooled resources from the council and the Clinical Commissioning Group (CCG) for services that support the integration of health and social care. The BCF schemes for 2021-22 include £28.8 million commissioned by the local authority and £27.1 million by the CCG.

A key development has been the introduction of a new locality programme, which aims to bring together health and care services, broader community assets, and strategies at a local level. This programme is being developed in three phases: vision setting, model testing, and transformation. New national metrics for the BCF have also been introduced, focusing on preventing chronic ambulatory care-sensitive conditions, length of hospital stay, and discharge to the normal place of residence.

The committee raised questions about navigating the system for disabled residents, particularly regarding disabled facilities grants, equipment, and occupational therapy services. The Tower Hamlets Connect service was highlighted as a key resource for providing information and advice. There is ongoing work to improve the use of disabled facilities grants and to fast-track adaptations for people with high-risk care packages. The council's equipment collection and recycling rate was noted as being good.

Discussions also touched upon the development of the Integrated Care System (ICS) and its implications for Tower Hamlets, with new arrangements set to begin from April 1st. The committee expressed a desire for greater scrutiny of the ICS budget and governance. Concerns were also raised about the long-term placement of telecare services, which currently support a range of frontline services including homelessness and domestic violence cases.