The Joint Health Overview & Scrutiny Committee met to discuss updates from local health providers, including Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) and North East London Foundation Trust (NELFT), as well as to examine ways to improve GP access, hearing a case study from Maylands Healthcare. The committee heard that BHRUT is struggling with mental health admissions and is about to launch a new electronic patient record system, and that NELFT is working to improve community health services and mental health support. The committee also discussed the financial challenges facing the NHS in North East London.

Improving GP Access

Dr Atul Agawal, a GP partner, presented a case study on how his surgery, Maylands Healthcare, has improved patient access and experience. Dr Agawal explained that Maylands Healthcare, a surgery with 14,000 patients, has implemented two key changes:

• Exxon Health phone system: A cloud-based system designed for GP surgeries, which manages call queues, reduces waiting times, and integrates with the clinical system.
• Klinik AI-based triage tool: Patients input data about their condition via the surgery website, which is then reviewed by a senior clinician to determine the urgency and appropriate pathway for the patient's care.

Dr Agawal reported significant improvements since the implementation of these systems, including:

• Reduced phone call volume on Monday mornings from 200 to 30.
• Improved patient satisfaction with waiting times, from 28% to 68%.
• A reduction in GP workload by 20%.
• Fewer missed appointments and reduced abuse towards reception staff.

Councillor Fong asked how the model met the new contractual obligations for GP practices to offer always-on digital access with triage systems that respond within one working day from October 2025. Dr Agawal confirmed that the model already complies and that they are happy to help other practices struggling with implementation.

Councillor J asked about the feedback from staff regarding the potential for an uncapped workload with increased online access. Dr Agawal responded that while primary care is overworked, the new system helps to ensure appointments are for true medical conditions, and staff stress levels have decreased due to the improved phone system and reduced patient abuse.

Councillor Katsvang asked if people would still be able to speak to a member of staff without going through a hundred menus. Dr Agawal responded that patients will always speak to a human and will only have to press two buttons.

Councillor Weon asked how the AI system directs patients to the right place based on their input. Dr Agawal clarified that the AI only grades the cases based on symptoms, and a clinician always makes the final decision.

Ian Buckmaster from Healthwatch Havering added that Healthwatch had received positive feedback from both staff and patients at Maylands Healthcare since the implementation of the new systems.

Councillor Rizio asked what safety net is in place for patients who re-present because they feel fobbed off by non-GP clinicians. Dr Agawal clarified that the system does not automatically send patients to non-GP clinicians; the clinician makes the decision based on the information provided.

Dr Agawal stated that the North East London Integrated Care Board (NEL ICB) is using Maylands as a showcase for other practices and that two nearby practices have already visited to learn from their experience.

Health Provider Updates

BHRUT Update

Andrew Diener, Chief Medical Officer of BHRUT, provided an update on the trust's performance and challenges. He reported that BHRUT is performing well in urgent and emergency care, with close to 80% of patients being admitted, transferred, or discharged within four hours, making them the top performing trust in London and 22nd in England. However, he noted that the trust is still incredibly busy, with a high number of patients attending the emergency departments (EDs), particularly at Queen's Hospital.

A significant challenge is the number of mental health patients arriving in EDs, with an average length of stay of 20 hours. Mr Diener stated that there is a lack of capacity for mental health admissions in northeast London, sometimes requiring patients, especially adolescents, to be placed far from their homes.

The trust is also working to reduce waiting times for elective care, with over 70% of patients being seen within 18 weeks of referral. However, there were still 591 patients waiting for more than a year.

In terms of cancer care, BHRUT met the targets for the 28-day fast diagnostic standard and the 31-day standard in June, but did not meet the 62-day standard¹.

Financially, BHRUT is struggling, with a deficit greater than hoped. The trust is working to reduce its use of agency staff and bank staff to save money.

BHRUT was chosen as one of the trusts for the Baroness Amos Maternity Services inquiry, which Mr Diener said was disappointing given the significant improvements made in maternity services.

The trust is preparing for the launch of an electronic patient record (EPR) system on 8 November, which is expected to improve patient safety and data collection.

Councillor Rizvi asked what factors Mr Diener would put down to the unprecedented level of demand. Mr Diener responded that the population is growing, getting sicker and older, and there seems to be a recourse to A&E when people would have been happy to wait to see a GP or would have had other options in the past. He stated that the trust needs to work with the community to develop services outside the hospital to prevent unnecessary A&E visits, particularly for older patients.

Councillor Ponga asked what specific actions are being taken to reduce the prolonged stays for mental health patients at BHRUT and how the trust is working with NELFT and local authorities to ensure timely access to crisis care and inpatient beds. Mr Diener responded that the main issue is a lack of mental health bed capacity and that the trust is working with NELFT to make the most of the available capacity.

Councillor Jeff asked what contingency plans are in place to ensure that patients, particularly those with complex needs or language barriers, do not experience disruptions in care during the EPR rollout. Mr Diener responded that there has been a rollout of education to staff, a reduction in elective work, and an executive rotor to provide support during the transition.

Councillor Sweden asked if social care professionals would be given the same authority to make notes on the patient record as they currently have. Mr Diener said he did not know the answer to that question. Councillor Sweden also asked if the records would be shared with GPs and other trusts. Mr Diener responded that the records would be shared with Barts Health doctors, and GPs would be able to access x-ray and blood results and receive electronic patient discharge summaries.

Councillor Vance asked what the trust is doing to improve maternity care, given previous concerns. Mr Diener responded that the service has improved hugely, and the trust is hoping for an upgrade in its Care Quality Commission (CQC) rating. He also noted that the number of stillbirths in the trust has significantly dropped.

NELFT Update

Carol White, Deputy Chief Operating Officer of NELFT, provided an update on the collaborative's work in mental health, learning disabilities, and autism. She noted that there has been a 200% increase in referrals across all mental health pathways since pre-COVID, and the collaborative is working to encourage people to access services before reaching crisis point.

Ms White addressed concerns raised in an open letter from the Mental Health Action group regarding the quality of talking therapy services², particularly around dropout rates. She clarified that the data cited in the letter misinterprets drop-outs and that services redirect people to other appropriate help when talking therapies are not suitable. She also stated that the services offer a full range of NICE-recommended modalities and interventions, not just Cognitive Behavioural Therapy (CBT).

Since opening the Integrated Crisis Assessment (ICA) hub in March, just shy of 800 patients have been seen, with only 20% requiring admission to a hospital bed. However, 30% of patients attending EDs with mental health issues are not known to mental health services, which is a key target area for improvement.

NELFT is also working to increase its bed base, with plans to build 30 new beds for adult mental health admissions and develop crisis houses in various boroughs.

Ms White also highlighted the work of the community healthcare collaborative, which focuses on improving community nursing, urgent response teams, and musculoskeletal (MSK) services.

Councillor Ponga asked what plans are in place to establish a local crisis house in Barking and Dagenham and expand local inpatient capacity. Ms White responded that B and D residents can use the ICA hub and the well house in Redbridge, and the collaborative is working to secure recurrent funding for a crisis house in B and D. The 30 additional beds will also be available to Barking and Dagenham residents.

Councillor Weon asked why mental health patients need a bed and what kind of mental health issues drive the need for inpatient care. Ms White responded that NELFT works with serious and enduring mental illness, such as depression, psychosis, and schizophrenia, and admits patients mainly under the Mental Health Act when they are a danger to themselves or others. The average length of stay is 42 days, which is benchmarked as the best in London.

Ms White also updated the committee on the charges faced by NELFT and a member of staff in relation to an incident in 2015. The jury found the trust guilty of a health and safety breach, but not guilty of corporate manslaughter. The member of staff was found guilty of a health and safety breach, but not guilty of gross negligence manslaughter. Sentencing is expected in early November.

ICB Health Update

Zina Etheridge, Chief Executive of the ICB, provided an update on organisational changes, strategic commissioning plans, and the implementation of the NHS 10 Year Plan. She noted that the ICB is still awaiting clarity from NHS England regarding funding for redundancies related to the organisational restructure.

Ms Etheridge outlined the ICB's strategic commissioning plans, which are focused on achieving the three shifts outlined in the 10 Year Plan: hospital to community, analogue to digital, and sickness to prevention. She highlighted various initiatives underway to support these shifts, such as integrated neighbourhood working, women's health hubs, electronic patient records, and the ShowerBox project in Barking and Dagenham³.

Councillor Rizvi asked about the number of redundancies forecasted as part of the organisational restructure. Ms Etheridge responded that the ICB's budget is being cut by about half, and it currently employs around 900 people, but the exact number of redundancies is difficult to estimate at this stage.

Councillor Rizvi also asked what strategic commissioning actually means. Ms Etheridge responded that it means ensuring that the ICB is contracting and paying for the care that delivers the most effective results for residents, using data better, and ensuring that the right providers are in place.

Councillor Sweden asked about the nature of the investment envisaged in community and end-of-life care and reducing mental health placements through out of area. Ms Etheridge responded that the ICB has set out commissioning intentions to describe the direction of travel in terms of investment and is working to address the pressures on mental health services.

Councillor Ponga asked how the mandated 50% reduction in ICB running costs will not compromise frontline services. Ms Etheridge responded that the ICB is focused on understanding any quality or equality risks arising from the reduction in size and putting mitigations in place.

Finance Overview

Samuel Thacker, Director of Finance and Partnership Services at NEL ICB, provided a finance overview. He reported that the ICS operating plan expects a system breakeven position by year-end, but the actual year-to-date position is a deficit of £59.5 million, which is an adverse variance to plan of £30.2 million. The main driver of the deficit is cost improvement plan slippage.

The ICS has submitted a financial recovery plan to NHS England, which sets a year-to-date deficit of £54.8 million. The forecast outturn for the year remains breakeven.

The total system efficiency and cost improvement plan to month 5 was £125.4 million, but only £103.6 million has been delivered, leaving a year-to-date balance against plan of £21.8 million.

Councillor Ponga asked what specific cost improvement strategies are being implemented to meet national targets. Mr Thacker responded that the ICS is monitoring the situation and working with provider organisations to address the deficit position.

Councillor Rizvi asked how the ICB can justify carrying a surplus while the major acute provider is being forced to ration its care. Mr Thacker responded that the ICB surplus was set in stone when the operating plan was signed off in April and was a commitment to deliver a surplus to offset the consolidated deficit position across the five providers.