The Inner North East London Joint Health Overview & Scrutiny Committee met on Wednesday, 24 April 2024, to discuss a range of health-related matters. The meeting's agenda included updates on the financial health of NHS North East London, provider performance from key trusts, and a detailed review of mental health urgent and emergency care services. Additionally, the committee reviewed its action tracker and forward plan.

Health Update - April 2024

The committee was scheduled to receive a comprehensive health update for April 2024. This included an overview of the financial position of NHS North East London, which highlighted significant financial challenges across the Integrated Care System (ICS). The report indicated a projected deficit of £36.9 million for the year, comprising an agreed deficit of £25 million and £11.9 million in unfunded costs related to industrial action. The financial pressures were attributed to continuing healthcare costs, prescribing overspends, and pressures within mental health and learning difficulties services.

Provider updates were presented from several key NHS trusts:

• Barts Health NHS Trust: Updates included progress on the Whipps Cross Hospital redevelopment, the reopening of the Barking community birth centre, and positive results from a CQC maternity survey. The trust also reported on improvements in urgent and emergency care wait times, with over 70% of patients being seen within four hours. Progress was noted in reducing waiting lists for elective procedures, with a target to reduce patients waiting over 65 weeks by 75,000 since April.
• Homerton Healthcare NHS Trust: The report indicated strong operational performance, with ERF performance achieving 106.7% against plan for the first nine months of the year. While elective care performance showed a number of patients waiting over 52 weeks, the trust was also managing a significant number of transferred pathways from other North East London trusts. The report also detailed corporate activities, including the appointment of a new Chief Executive and efforts to reduce spend on agency staff.
• East London and North East London NHS Foundation Trusts (ELFT and NELFT): Updates highlighted a decrease in waiting lists across community health services, specialist children and young people services, and community mental health services. However, ADHD and Autism services were noted as having growing waiting lists. The report also detailed progress in urgent and emergency care, with rapid response services exceeding targets. Organisational updates included staff appointments and the Trust's partnership with the NHS England Digital Medicine Programme.

A significant portion of the discussion was dedicated to Mental Health Urgent and Emergency Care. The report detailed increasing bed-days for patients clinically ready for discharge (CRFD) across ELFT and NELFT, leading to high bed occupancy and longer lengths of stay. This situation was contributing to longer waits for admission and an increase in admissions to private sector beds. The report also highlighted that in January, 15.3% of A&E attendances for mental health reasons waited for more than 12 hours. The NEL Mental Health Crisis / UEC Improvement Network's strategy and ongoing projects were outlined, focusing on transforming community mental health services, improving access to support through 111*2, and enhancing health-based places of safety.

London Ambulance Service (LAS) Update

The committee received an update on the performance of the London Ambulance Service in North East London. The report indicated that response times for Category 1 patients remained below 8 minutes, and Category 2 response times had fallen by 30%. Efforts to reduce ambulance handover delays at hospitals were highlighted, with significant reductions noted at King George Hospital and Queen's Hospital. The report also detailed the introduction of Teams Based Working and the Future Dispatch Model, which co-locates clinicians with dispatch teams to enable joint decision-making on patient responses and referrals. The LAS also highlighted its use of specialist resources, such as mental health and community response cars, to manage demand and treat patients in their own homes.

Barking, Havering and Redbridge University Hospital NHS Trust (BHRUT) Update

The report from BHRUT detailed improvements in urgent and emergency care, with 75.08% of patients seen and treated within four hours in A&E in February 2024, the best performance in four years. The trust noted an increase in attendances but also a significant rise in the number of patients seen within four hours. Initiatives such as Same Day Emergency Care departments and virtual wards were credited with helping these improvements. The report also outlined progress in reducing waiting lists, with a reduction of over 500 patients waiting more than a year since December 2022. Information was also provided on the impact of industrial action, including rearranged appointments and surgeries, and the financial cost incurred. Cancer targets for January were also discussed, with the report noting missed targets for 31-day and 62-day treatment times, attributed to strikes, workforce issues, and diagnostic capacity.

Barts Health/BHRUT Closer Collaboration

Consideration was given to a report on the closer collaboration between Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals (BHRUT) NHS Trust, working as the North East London Acute Provider Collaborative (APC). The report discussed the benefits of collaboration, including faster and more equitable access to treatment, better value for money, and improved productivity. The focus was on developing acute services and delivering national acute targets. The decision to pause some governance changes to concentrate on work through the APC was highlighted. The report also touched upon collaboration in mental health and primary care, digital capacity, and reducing reliance on temporary staff. Discussions also covered potential collaboration with One Public Estate and the importance of learning from shared service models.

Committee Action Tracker and Forward Plan

Rosie Whillock, Scrutiny Policy Assistant, presented the Committee Action Tracker and Forward Plan. The report indicated that there were 18 outstanding actions and recommendations, which would be followed up with relevant officers. The committee reviewed the forward plan, noting upcoming items for future meetings.