The Joint Health Overview and Scrutiny Committee met on Thursday 23 October 2025 to discuss significant updates on primary care access, hospital trust performance, and the strategic direction of North East London's health services. Key decisions included a detailed review of innovative GP access models, an update on Barking, Havering and Redbridge University Hospitals NHS Trust's performance and financial challenges, and a comprehensive overview of the North East London Integrated Care Board's (ICB) strategic commissioning plans and financial position.

Improving GP Access

Dr. Atul Aggarwal, a GP partner at Maylands Healthcare, presented a case study on how his practice has transformed primary care access. Maylands Healthcare implemented two key solutions: the X-on Health cloud-based telephone system and the Klinik AI-based triage tool. The X-on Health system has improved call management, reduced waiting times, and eliminated engaged tones, leading to a significant reduction in missed calls and a smoother workflow for reception staff. Klinik, an AI tool accessed via the practice website, allows patients to input their symptoms, which are then triaged by a clinician. This system has led to faster, fairer access to care, with 68% of patients satisfied with appointment waiting times. Dr. Aggarwal highlighted that the practice has seen a 20% workload reduction and freed up three to five GP sessions per week by redirecting 40-60% of contacts to non-GP staff, such as pharmacists and healthcare assistants. This approach has also boosted staff morale and reduced abuse at the reception desk. The practice's success has led to discussions about sharing this model with other practices across North East London.

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

Professor Andrew Deaner, Chief Medical Officer at BHRUT, provided an update on the trust's performance. He reported that BHRUT's A&E departments had their second busiest month on record in May, with a 79.9% performance against the four-hour target in July, placing them 22nd out of 121 trusts nationally. However, the trust is experiencing significant pressure, with Tuesday of that week being the busiest day ever recorded at Queen's Hospital. A major concern is the number of patients with mental health conditions attending A&E, with an average stay of 20.2 hours for these patients.

In terms of waiting lists, 71.2% of patients received their first treatment within 18 weeks of referral, with 591 patients waiting for over a year. The trust met its cancer diagnostic targets for the 28-day and 31-day standards in June but not the 62-day standard. Financially, BHRUT is facing a deficit greater than anticipated, partly due to costs incurred during the junior doctors' strike. The trust has significantly reduced its spending on agency staff.

A significant development is the upcoming launch of an electronic patient record (EPR) system on 8 November, which is expected to improve patient safety and data sharing across BHRUT and Barts Health sites. The trust has also seen improvements in its NHS league table ranking, moving to mid-table. The maternity services at BHRUT are part of a national investigation led by Baroness Amos, although the trust has recently received positive feedback from a Care Quality Commission inspection, describing significant improvements.

North East London Collaborative Update

Carol White, Deputy Chief Operating Officer for North East London Foundation Trust (NELFT), presented an update on the North East London Collaborative, focusing on mental health, learning disability, and autism services, as well as community healthcare.

Mental Health, Learning Disability and Autism (MHLDA) Collaborative: The collaborative aims to improve outcomes, quality, value, and equity for individuals with mental health issues, learning disabilities, and autism across North East London. Despite increased investment in areas like home treatment teams and a new mental health A&E (Integrated Crisis Assessment Hub), the rise in mental health crises continues, with a 200% increase in referrals since pre-COVID. The Integrated Crisis Hub has seen nearly 800 patients since its opening in March, with only 20% requiring hospital admission. However, a significant challenge remains the insufficient bed capacity, with plans to build 30 new beds for adult mental health admissions. The collaborative is also addressing concerns raised by the Mental Health Action group regarding the quality of talking therapy services, particularly dropout rates and the range of therapies offered.

Community Healthcare Collaborative: This collaborative aims to improve community health services by working across NHS trusts, local authorities, and other providers. Key updates include standardising community nursing services, achieving above-national-target performance for urgent community response teams, and strengthening pathways for children and young people. There is also a focus on reducing waiting lists for musculoskeletal (MSK) services and improving stroke and rehabilitation pathways. Joint working between BHRUT and NELFT is streamlining processes in A&E, improving falls prevention, and reviewing diabetes pathways. A one-stop shop for dementia diagnosis at St George's Hospital is also in development.

North East London Integrated Care Board (ICB) Health Update

Zina Etheridge, Chief Executive of the North East London ICB, provided an update on organisational change and strategic commissioning. The ICB is undergoing a significant restructure to reduce running costs by 50% and move towards a strategic commissioning model, as mandated by NHS England. This involves a new operating model focused on strategic commissioning, with a senior leadership team comprising a Chief Clinical and Quality Commissioning Officer, Chief Finance Officer, Chief Strategic Commissioning Officer, and Chief Strategy Officer. Ralph Coulbeck has been appointed as interim Chief Executive.

The ICB is developing a long-term system strategy, with a focus on population health outcomes, equitable care, and addressing health inequalities. This includes refreshing the system strategy, developing medium-term financial strategies, and setting commissioning intentions for various health areas. Providers are expected to produce five-year integrated delivery plans in response. The strategy embeds the Good Care Framework, focusing on accessible, person-centred, competent, and trustworthy care, and an Outcomes and Equity Framework to tackle health inequalities. The plan also outlines three key shifts: hospital to community, analogue to digital, and sickness to prevention.

Finance Overview

Samuel Thacker, Director of Finance and Partnership Services at NEL ICB, presented the financial position as of August. The ICB's operating plan aimed for a break-even position by the end of the financial year. However, at month five, the system reported a deficit of £59.5 million, an adverse variance of £30.2 million against the planned deficit of £29.4 million. This is largely due to slippage in cost improvement plans, particularly at BHRUT and Barts Health. A financial recovery plan has been submitted to NHS England, projecting a year-to-date deficit of £54.8 million, but the forecast outturn for the year remains break-even.

Regarding efficiencies, the total system efficiency plan for month five was £125.4 million, with £103.6 million delivered, resulting in a year-to-date gap of £21.8 million. BHRUT is reporting significant efficiency slippage. The ICB itself reported a £1.5 million positive variance against its planned deficit. Councillor Kaz Rizvi raised concerns about the ICB holding a surplus while BHRUT faces significant deficits, to which Mr. Thacker explained the ICB surplus was committed in April to offset provider deficits.