The Joint Health Overview and Scrutiny Committee met on Thursday 17 October 2024 to discuss a comprehensive health update across North East London. Key topics included performance updates from Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), the delegation of specialised commissioning, winter planning, financial performance, and updates from the London Ambulance Service and North East London Foundation Trust (NELFT).

BHRUT Performance and Financial Update

Fiona Wheeler, Deputy Chief Executive and Chief Operating Officer at BHRUT, presented an overview of the trust's performance. She highlighted that despite July and August being among the busiest months ever for A&E departments, BHRUT maintained a 78.9% four-hour target for all A&E attendances. However, she acknowledged that too many patients still experienced long waits, particularly due to capacity issues at Queen's Hospital, which was built for 120 patients a day but regularly sees over 300. A £35 million reconfiguration project is planned for Queen's Hospital to address this.

Wheeler also noted a parliamentary award for improvements in reducing ambulance handover times at King George's Hospital. She mentioned that 331 patients with mental health issues were referred to A&E in August and that BHRUT is working with NELFT to improve mental health care pathways and create dedicated physical space for patients with mental health presentations.

Regarding planned care, BHRUT has a waiting list of 66,434 patients, with 89% awaiting outpatient appointments. Efforts are underway to increase capacity through Saturday clinics and high-volume operating lists. Financially, BHRUT reported a deficit of £18.2 million at the end of August, which was £9.1 million adverse to plan. Cancer targets are being met, with 74.8% of patients diagnosed within 62 days, and the opening of two community diagnostic centres is expected to increase scan capacity.

Delegation of Specialised Commissioning

Archna Mathur, Director of Specialised Services and Cancer for North East London, provided an update on the delegation of specialised commissioning from NHS England to Integrated Care Boards (ICBs). This move aims to allow ICBs to take a holistic view of clinical pathways and finances. Key priorities for specialised services in North East London include HIV, liver and hep C, cardiology, renal, sickle cell, neurosciences, and complex urogynaecology.

Winter Planning

Fiona Ashworth presented the winter plan for 2024/25, building on the comprehensive work undertaken in the previous year. The plan focuses on keeping the population well through vaccination campaigns, optimising care for patients with long-term conditions, preventing unnecessary hospital attendance by promoting access to GPs and 111, and ensuring timely hospital discharges. A system coordination centre is in place to provide visibility of pressure and capacity across North East London.

Financial Overview

Henry Black, Chief Finance Officer for North East London ICB, reported a year-to-date deficit of £87.2 million at month five (August), which was £53 million adverse to plan. He noted a slowing down of this variance, indicating a stabilisation of the financial position due to hard work across organisations. Key drivers for overspends included ongoing run rate pressures, efficiency and cost improvement plan slippages, industrial action costs, and the impact of a cyber-attack.

London Ambulance Service Performance

Alex Ewings, Associate Director of Ambulance Operations for the London Ambulance Service in North East London, reported improvements in response times for Category 1 and Category 2 patients leading up to August. Category 2 response times in North East London were below the London average. However, he acknowledged challenges in inner London boroughs, with a performance gap between outer and inner boroughs. Ewings also highlighted the positive impact of team-based working for staff and the service's shortlisting for several national awards.

NELFT Updates

Paul Calaminas, Chief Executive of North East London Foundation Trust (NELFT), provided updates on mental health, learning disability, and autism services, as well as community health services. He reported significant pressure on mental health crisis services, with 51 individuals currently in additional beds. Calaminas noted that 70% of patients presenting in crisis were new to mental health services, often experiencing social crises. Plans are in place to create a mental health emergency department space at Goodmayes Hospital. He also mentioned the new crisis line via NHS 111 and improvements in talking therapies and physical health checks for those with severe mental illness.

Maternity and Neonatal Services

Diane Jones, Chief Nursing Officer for the ICB, presented engagement findings on maternity services. The Case for Change report highlighted a growing population, more complex pregnancies, and health inequalities necessitating changes to maternity and neonatal services. Feedback from the public indicated a desire for greater continuity of care, particularly in the postnatal period, and improved breastfeeding support. The ICB is now working on developing potential future care models based on this feedback.

Other Discussions

During the question and answer session, councillors raised concerns about:

• The use of System Development Programme funding and its impact on supporting GP practices and Primary Care Networks.
• The increase in 12-hour breaches in A&E departments and the need for assurances on eliminating long waits.
• Ambulance response times, particularly for Category 2 patients in inner London boroughs, and potential links to 20mph speed restrictions.
• The financial deficit and its potential impact on patient care.
• The timeliness of receiving diagnostic reports for cancer patients.
• The provision of services for learning disabilities and autism.
• The timetable for next steps in maternity service reconfiguration and the assurance of genuine consultation.
• The continuation of the Ilford Exchange health centre and the availability of data on its impact.
• The specific plans for achieving the winter planning ambitions, including reducing 12-hour waits and ensuring 78% of patients are admitted, transferred, or discharged within four hours.
• The use of independent sector beds for mental health provision and the policy to reduce their use.
• The national target for Category 1 ambulance response times and its dependency on hospital handover times.
• The continuation of pop-up clinics in Barking and Dagenham and the potential for future in-person questions at committee meetings.

The committee noted the presentations and the information provided. No formal recommendations were made at this meeting.