The Chair, Councillor Clare Harrisson welcomed everyone to the Inner North East London Joint Health Overview and Scrutiny Committee (INEL JHOSC) meeting and asked everyone to introduce themselves.

Cllr Harrisson also welcomed the ‘Tower Hamlets Keep our NHS Public’ delegation who posed the following questions to the Committee in relation to the North East London Sustainability and Transformation Plan (NEL STP).

Carol Saunders addressed the Committee stating the following:

Firstly, Simon Stevens told the House of Commons Public Accounts Committee this month: “We are going to formally appoint leads to the 44 STPs. We are going to give them a range of governance rights over the organisations that are within their geographical areas, including the ability to marshal the forces of the CCGs and the local NHS England staff.”

In this context, can the Tower Hamlets Scrutiny Committee tell us who will in future be accountable for the planning and commissioning of health services within Tower Hamlets and the NEL footprint, given that – as we understand it – the statutory duty for this rests with the local CCGs or, in the case of public health, with the local authorities?

Secondly, if current arrangements are being rewritten, what role will remain for local authority health scrutiny committees? Does the committee share our concern that local authorities may lose their powers to scrutinise and influence local health service provision and, if so, does it intend to express this view to NHS England?

Cllr Clare Harrisson thanked Carol Saunders for her questions and stated that NHS representatives would address the questions raised as part of Item 4 on Governance.

Apologies for absence were received from Cllr Clare Potter, INEL JHOSC representative for Hackney Council.

No member of the Committee declared a pecuniary interest.

To agree the minutes of the meeting held on 13^th December 2016.

The Chair referred members of the Committee to the minutes of the previous meeting held on the 13^th December 2016. The Committee agreed and approved the minutes as an accurate record of the meeting subject to the following amendment

Page 8 – Stephanie Clark is a member of ‘Tower Hamlets Keep our NHS Public’ campaign group and not a member of Healthwatch.

Jane Milligan, Executive Lead for the North East London Sustainability and Transformation Plan (NEL STP) introduced this item.

She said the STP process signalled a move towards working in a larger geographical area and that the governance arrangements to support the strategy and system level change was essential to ensure the development and implementation of the STP. Twenty organisations in East London have been working together to develop the East London Health and Care Partnership (ELHCP which previously known as NEL) STP.

The ELHCP STP plans to hold roadshows in the summer and is consulting Overview and Scrutiny Committees and other stakeholders, in developing its governance structure. The diagram on Page 27 gives an overview of the structure that the STP is looking to achieve. Task groups will continue to develop the document, as it’s a live document and groups such as the Mayors and Leaders Advisory Group, Community Group and Assurance Group will feed into the structure.

The ELHCP have developed a draft Partnership Agreement for the governance arrangements, which is not legally binding but is intended to ensure a common understanding and commitment between partner organisations.

Jane Milligan informed the Committee that the STP were aiming to shape and refine the structure going forward.

Dr Sam Everington, CCG Chair, Tower Hamlets CCG and NEL STP Clinical Lead then gave the Committee Members examples of how working together can achieve better results for the patient.

Example 1

A project on Palliative Care has seen multi-disciplinary teams managing terminal care enabling patients the choice to die at home with their loved ones present.

Example 2

Maternity Care has been improved with Midwifery-Led Clinics co-existing with Maternity Units and offering more choice and support to new mothers.

Example 3

Outpatient services have been improved with GPs able to refer patients for blood tests with improved systems to view test results via an email response.

Example 4

The STP will allow for Mental Health Care to be on an equal footing with physical disease, as the organisations within the partnership will be working to integrate their specialisms, to provide a more holistic approach to health and care.

Jane Milligan referred to the question raised by the ‘Keep our NHS Public’ group and said discussion was necessary as to how oversight and transparency would be achieved. She said that as the Lead Officer she was a conveyor to the ELHCP STP and each organisation was working collaboratively to achieve the right direction of travel. The ELHCP STP was aiming to bridge the gap between Commissioner and Provider organisations. 

The five-year forward view would provide the partnership with an accountable care system and there were no plans to take away the role of Overview and Scrutiny Committees.

This was followed by questions and comments from Members of the Committee and responses from NHS Representatives.

·         Cllr M Mustaquim – Top of Page 24 states the shadow arrangement came to an end in March 2017. What is operating in its place?

·         Diagram on Page 27,  ...  view the full minutes text for item 5.

Henry Black Chief Finance Officer, Tower Hamlet CCG and NEL STP Finance lead presented his paper outlining the financial case for change and the reasons for the creation of the STP. 

He said that over the course of 2016, the health and care organisations across 7 boroughs in North East London (NEL) had worked together to develop a draft STP plan. The STP set out how the NHS Five Year Forward View would be delivered across the NEL footprint and how local health and care services would need to transform in order to ensure their financial sustainability and improve their clinical effectiveness.

He referred members of the Committee to pages 33- 36 of the agenda and explained in detail the various scenarios, projections and modelling undertaken by the STP and why it was important achieve financial sustainability.

Members of the Committee asked the following questions to which Mr Black responded:

Councilman Mead – Page 41 refers to making better use of infrastructure. Are you seeking to co-locate services and free up assets?

Yes, that is the aspiration. NHS needs to make better use of its assets and with the improvement in digital technology there may be less need for ‘bricks and mortar’ – buildings.

Councilman Mead – What will happen with the funding raised?

The capital receipts would be reinvested but we need to ensure we are utilising our asset stock correctly.  The Naylor review stated organisations would retain capital receipts. We need a clear strategy on how we manage space and the number of departments we need. There is opportunity to lobby Parliament on how we access funding.

Cllr C Harrisson – What impact has the Bart’s Trusts deficit had on the STP and will you not be shifting the cost onto Local Authorities, who do not have funding, rather than make an actual saving?

We are mindful of this and hope to improve access to care at an earlier stage. The STP is trying to create an accountable care system and this is our direction of travel. Transformation of resources and a whole systems approach is required, which includes local authorities.

Barts Health Trust has the biggest deficit in the Country – but not in percentage terms. The government has acknowledged this and we are working to bring this down. This year the deficit was £82m but we are moving in the right direction to reduce this.

Denise Radley, Corporate Director for Health, Adults and Communities at Tower Hamlets added that the figures presented in the report were purely NHS finances and whilst Social Care was moving towards a more integrated model, there were gaps in finance which needed to be factored in.

ACTION: The STP to provide financial figures showing a more integrated financial model.

Cllr M Mustaquim – Page 33 states the population is set to grow by 18% in the next fifteen years. How are you going to bridge the gap in our borough?

The Clinical Strategy sets this out in more  ...  view the full minutes text for item 6.

Luke Readman Chief Information Officer, WELC CCG and NEL STP Lead Officer presented his paper on the Digital Enablement.

He stated the NEL STP was looking to make better use of Information Technology to help support health, social and community care providers, in order to meet the needs of local people.

Digital technology would enable the development of new, sustainable models of care to achieve better outcomes for patients, with a focus on prevention and out of hospital care.

The Presentation attached to the agenda gave a detailed account of how the Local Digital Roadmap’s (LDR) become the footprint for the STP and what steps had been taken to bring together the three LDR into one LDR.

Three key themes had emerged

(a)  To have a single systems approach

(b)  Connectivity – Hospital’s being able to see GP records and vice versa

(c)  How to drive improvements once data is available.

Four work streams have been developed

·         Addressing server problems at Barts Health Trust

·         How data is shared across the pathways

·         How data is pooled together, with real time data

·         How patients can access their own information.

Dr Osman Bhatti, GP in Tower Hamlets, Phil Koczan of Waltham Forest CCG, Dr Charles Gutteridge of Bart’s Health Trust, Dr Bhupinder Kohli Newham Hospital proceeded to give examples of how technology had enabled them to provide better, safer care to patients and how this had led to improved outcomes for their patients.

Members of the Committee raised the following questions to which the NHS representatives responded.

Cllr S Akhtar – How easy is it for patients to access their own records?

Mobile phone and desktop access is available and patients can register ‘online’ with their GP practice. Information available is limited at the moment however with the STP initiative, over time we hope to scale up the data available.

Cllr C Harrisson – One GP registration would be welcomed. It is fragmented at present.

We seek consent of the patient every time they move GP surgery however we are looking to create a ‘single citizen’ ID, which would apply nationally. Roll out is expected in September/October time.

Councilman W Mead – Are there plans to include hospitals in Central London and not just the providers in the NEL STP footprint?

Our plans are to create a single system across our footprint, before taking steps to network with others. Much depends on hospitals in Central London as to if they want to share information in this way.

Cllr S Masters – It’s great to hear the good news stories. What would be the one thing you’d like to resolve as part of the digital offer?

To increase the number of patients accessing their own records. Presently 10% do however it would be good to achieve 90%. We acknowledge a publicity and engagement campaign is required to change human behaviour and get them to use the digital platform. The ELHCP STP is aiming to help organisations within the partnership achieve this.

Cllr S Masters  ...  view the full minutes text for item 7.

The Chair informed Members of the Committee that the next meeting of the INEL JHOSC would be held on the 26^th June 2017.