This meeting was scheduled to consider the merger of two sets of local NHS Trusts, the adoption of the North Central London Integrated Care Board's (NCL ICB) Estates and Infrastructure Strategy for 2024, and the Committee's own work programme.

Merger of North Middlesex University Hospital NHS Trust and the Royal Free London NHS Foundation Trust

The Committee was scheduled to receive a report on the proposed merger of the North Middlesex University Hospital NHS Trust and the Royal Free London NHS Foundation Trust.

The report pack states that the merger was formally proposed in January 2024 following closer collaboration between the two Trusts over a number of years. It details the process of developing a full business case, which was submitted to NHS England in July 2024 and was expected to be reviewed in Autumn 2024.

The report pack states that under the proposals, patients would continue to be referred to their usual local hospital, with minimal impact on patient travel or choice, and the hospitals would continue to provide the same services.

Patients will still be referred to their usual local hospital and our hospitals will continue to provide the same routine services for their local patients.

The report pack lists a range of benefits expected to be achieved as a result of the merger. These benefits are categorised as those that would be for patients, for local communities and for staff of the Trusts.

The report pack identifies four clinical service areas which would be prioritised for early integration following the merger:

• Cancer
• Research and development
• Colorectal surgery
• Surgical hubs

The report pack also describes how urgent and emergency care would be addressed, how corporate governance would work and how digital systems would be integrated in the merged organisation. It also sets out the expected financial impact of the merger.

The report pack claims that extensive engagement with staff, stakeholders, patients and communities has taken place since the merger was proposed.

NCL Estates and Infrastructure Strategy 2024

The Committee was scheduled to receive a report providing an update on the North Central London Integrated Care Board's (NCL ICB) Estates and Infrastructure Strategy for 2024.

The report pack claims that the NCL ICB has invested in an estates function over the last five years and has a track record of delivering new facilities. It highlights the development of a new People Strategy, and the progression of key strategic schemes like the Start Well review of maternity services. It identifies problems like a £117m maintenance backlog on provider estates and the fact that 26% of the population receive primary care from facilities not considered fit for purpose.

The report pack describes the development of a new strategy, informed by NHS England guidance, which would allocate 10% of Integrated Care Board capital investment to priority projects and 5% to local care.

It highlights a number of newly built facilities including:

• Highgate East, a new mental health inpatient unit
• A community mental health centre in Lowther Road
• A mental health crisis unit in Highgate West
• A new operating suite at the Royal National Orthopaedic Hospital
• A new day surgery unit at the North Middlesex University Hospital
• A new neuroscience building at University College London Hospitals (UCLH)

It reports that backlog maintenance fell slightly between 2021/22 and 2022/23, but identifies a system-level workforce gap, stating that [a]s the People Strategy develops, connections to the physical infrastructure (including space for training and development) will be important.

The report pack provides detail on the progress of the St Pancras Hospital Transformation project, sometimes called Project Oriel. It describes this project as hugely ambitious, and states that the aim is to redevelop the site to provide a mix of uses, including new health facilities, housing, offices and public space.

The report pack describes the ICB's Start Well initiative, which it says links service quality to infrastructure. It states that a public consultation was held to consider two options to reduce the number of maternity and neonatal units from five to four.

• Option A - retaining these services at the Whittington Hospital but closing them at the Royal Free Hospital
• Option B - retaining these services at the Royal Free Hospital but closing them at the Whittington Hospital

The report pack claims that both options would retain maternity and neonatal services at Barnet Hospital, North Middlesex Hospital and University College Hospital and would lead to significant additional investment across north central London. The report pack also details two other service change proposals that were included in the consultation:

• Closing the birthing suites at the Edgware Birth Centre but retaining antenatal and postnatal care there
• Establishing two centres of expertise at Great Ormond Street Hospital and UCLH to consolidate care for children under the age of 3 (or 5 for some specialisms) who need surgery

The report pack states that no decisions have been made about these service changes and that feedback from the consultation would be used to inform a decision-making business case which would be considered by the NCL ICB and NHS England London Region Specialised Commissioning. It states that a final decision is unlikely to be made before early 2025.

The report pack highlights the proposed merger of the Barnet, Enfield & Haringey Mental Health NHS Trust and the Camden & Islington NHS Foundation Trust, stating that this would lead to improvements in inpatient facilities. It says that a previous bid for funding to improve facilities was rejected.

The report pack also highlights the importance of integrated care in the ICB's strategy for population health and highlights the importance of effective partnership working with local authorities, stating that the ICB has a designated estates lead working with each of its five boroughs.

The report pack states that a refreshed Digital Strategy would focus on six priority areas:

• Supporting integrated care systems
• Improving cyber security
• Improving population health management
• Developing a digital workforce
• Improving digital inclusion
• Delivering a better digital experience for staff

It also states that the People Strategy has a key interconnection to estates because [e]nsuring that our people have access to quality environments and the right equipment for care delivery, training, education and development is vital.

The report pack states that NCL is committed to reducing its carbon footprint, highlighting the importance of the NHS England Net Zero Building Standard which sets out guidance for reducing the environmental impact of new healthcare buildings.

The report pack sets out the ICS prioritisation process for large capital projects, confirming that 10% of its capital allocation would be allocated to system priorities, amounting to £22.5m of the £35.7m to be spent in 2024/25. It also describes a critical infrastructure risk prioritisation process.

It describes plans to invest £233m in local care infrastructure over 10 years, and sets out the sources from which this money would be drawn.

The report pack states that [l]ocal authorities are a vital strategic partner in delivering the infrastructure strategy and lists six ways in which the ICB works with local authorities:

1. Developing Population Health Strategies
2. Acting as a delivery partner for integrated neighbourhood teams
3. Close links to community groups and voluntary organisations
4. Approving housing projects and development schemes
5. Allocating S106¹ and CIL² funding
6. Acting as landlord for health services

The report pack concludes by inviting feedback from the Committee, asking:

What are your overall comments and feedback? How can we work with Local Authorities most effectively on infrastructure plans?

Work Programme

This was an update on the Committee's own work programme for 2024-25.

The report pack lists the items scheduled to be discussed in future meetings, including updates on the Start Well project, Primary Care Access and Dental Services. It also lists possible items for inclusion in future meetings, such as:

• Health inequalities fund
• Smoking cessation & vaping
• Strategic role of GP Federations
• Vaccination initiatives
• Paediatric service review
• Primary care commissioning and the monitoring of private corporations
• The efficacy of online GP consultations
• Increases in the number of people being charged for NHS services

The report pack states that the Committee should consider its own Terms of Reference when considering suitable topics for inclusion in its work programme. These Terms of Reference include:

• Engaging with relevant NHS bodies on strategic area-wide issues
• Responding to proposals for change to specialised NHS services
• Responding to formal consultations on proposals for substantial developments or variations in health services
• Promoting joint working between the five boroughs to make more effective use of health scrutiny and NHS resources

Merger of Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust

The Committee was scheduled to receive a report detailing the proposed merger of the Barnet, Enfield & Haringey Mental Health NHS Trust and Camden & Islington NHS Foundation Trust to create a new Trust which would be called North London NHS Foundation Trust.

The report pack claims that the two Trusts have a history of partnership working and a strong rationale for the merger, stating:

Our two Trusts have a history of partnership working, a joint strategy, values and behaviours, and a strong rationale for the transaction

It lists the following benefits of the merger:

• Providing care closer to home
• Responding to the growing and ageing NCL population
• Maintaining 24/7 services
• Improving performance
• Addressing workforce challenges
• Having a stronger, single voice for mental health in NCL

It describes the merger as being aligned with the vision of the NCL Integrated Care System.

The report pack claims that the Trusts have engaged with service users, staff and partners to inform their plans for the merger, stating that over 1,000 staff, service users, carers and stakeholders have been involved.

It describes the Trusts as being ambitious and highlights the following risks that they are managing:

• Internal and legal due diligence
• Quality governance review
• Risk management approach
• NHS England Review Phase

The report pack concludes by stating that:

We have a once in a lifetime opportunity to deliver exemplar mental health care in North London.