Apologies were received from Councillor Muhammad Ansar Mustaquim and Councilman Christopher Bolden.

The Chair declared a non-specific interest in that she was employed by UNISON union.

Councillor Ben Hayhurst declared he is a Governor at Homerton University Hospital.

Councillor Sweden declared that he is manged by North East London Foundation Trust but he is not employed by them.

Correction on page 10 of the pack, change Terry Bay to Terry Day.

Correction on page 10 – Chairs of JHOSC are not members of the STP board. Statement to be removed.

Clarification on page 13 of the pack, paragraph 4 – Ian Tompkins, Director of Communications East London Health and Care Partnership, added the East London Health Partnership was launched in July 2017 as an internal meeting but there were reps present. The meeting is targeted at health partners and other government transformation groups. The work on the payment programme has been extended to September 2017. There will be further engagement with interested parties in the New Year.

Councillor Anne Munn added that her interpretation of the discussion was that Councillor Maxwell was asking for an update on the east London health payment system consultation and requested to receive a report on this at the February meeting of this group.

In order to have more time to discuss the topic, the Chair decided that an update on the East London Health and Care Partnership Consultation should be added to the February agenda of this meeting.

It was decided a standing item for updates from the new Single Accountable Officer (Jane Milligan) should be added to future agendas. 

Very briefly Mr Tomkins confirmed Jane Milligan has been appointed Accountable Officer from 1^st December 2017. Shadow arrangements will be in place until April 2018. One of her first tasks will be to look at governance arrangements and the scheme of delegation. He advised this topic should be revisited at the next meeting.

Councillor Hayhurst expressed concern that Hackney’s population may be too small to form a Sustainability and Transformation Partnership (STP). It was confirmed that there is no minimum population figure to form an STP, the half a million figure was guidance and not a requirement. 

Having noted the above amendments, the minutes were agreed as an accurate record of the meeting.

ACTIONS

1. An update on the East London Health and Care Partnership Payment System Consultation to be added to the February agenda of this meeting.

2. Chair to provide list of working groups.

Michael Vidal

'Will the commission consider referring the decisions of the CCG Boards to the Secretary of State?'  My reasons for making this request are:

1. The question of how you can legally remove the existing Accountable Officers and replacing them has not been given a satisfactory answer. I would refer the Commission to paragraph 4.1 of my August submission to the last meeting of the Commission.
2. It is clear from the comments made by some of the members of the City and Hackney CCG Board in approving the proposal they only did so because of a threat from NHS England to use its intervention powers if they did not agree to the proposals.
3. The power to make these arrangements under s.14Z3 of the NHS Act 2006 (as amended) is a discretionary power as can be seen by the use of the word may and not must in the section. Accordingly, in making the threat NHS England caused the NHS City and Hackney CCG Board to unlawfully fetter its discretion.
4. NHS England in saying that matters have to be done at the NEL level are subjecting the statutory function of the CCGs which only relate to people in its area to the need to comply with a non-statutory requirement.
5. The proposal seeks to circumvent the abolishing of Strategic Health Authorities  by s.33 of the Health and Social Care Act 2012 by creating bodies with a strategic role but no legal basis.

Mr Vidal’s questions were noted.

Jackie Applebee

Our question is: When the NHS is on the point of collapse due to unprecedented underfunding by the current Government, do the councils agree with us that this money would be much better spent on front line patient care?

We also urge the councils to note the most recent  Kings Fund report which expresses concerns about STPs and their ability to deliver within the financial constraints: 

https://www.kingsfund.org.uk/sites/default/files/2017-09/STPs-London-Kings-Fund-September-2017_1.pdf

and to join with us in insisting that these plans are not deliverable without swingeing cuts to NHS services.”

Ms Applebee’s questions were noted.

Kate Brintworth, Head of Maternity - East London Health and Care Partnership, introduced the item.  As part of the Five Year Forward View the Maternity Transformation Board was set up by NHS England to ensure recommendations from the Better Births Review were delivered. Key areas of action included, reducing still birth, learning, ensuring women have a better experience of care, continuity of care and the option to give birth in a midwifery setting. 

It was recognised that collective action would be required to meet the new standards so Local Maternity Systems were introduced to take leadership and action. The East London Local Maternity System (ELMS) provided a report on their activities over 2016/17.

With reference to page 55 of the reports pack, Councillor Ann Munn asked to learn more about the new models of cross boundary working. The Chair of the East London LMS used the Neighbourhood Midwives social enterprise as an example where there is continuity of care throughout pregnancy to six weeks after birth. 

Councillor Ben Hayhurst asked how continuity of processes is maintained when they have five hospital sites across the patch and the trust is a separate entity.

Ms Brintworth explained that communication between the sites is good because there is an existing network in place that regularly meets. There are five delivery packs used across the sites which have been standardised to save £80,000.

Councillor Susan Masters queried how the ELMS programme will be funded over the next five years. Tracey Fletcher, Chief Executive of Homerton Hospital, explained an NHS England bid for £7.5 million has been submitted and feedback on the bid will be given in the New Year.

There was a discussion on the flow of patients across London. Ms Fletcher informed the group that a piece of research has been conducted on demand levels but it was very difficult to specify what birth numbers would be due to changing demographics. She said the birth rate is expected to go up but this is unlikely to be by a huge amount. This year there were 2000 less births than the 5000 predicted. There has been a recent trend in more women, particularly from Hackney, choosing to go to north east London hospitals such as the new University College London Hospital (UCLH).

Representatives from Homerton Hospital acknowledged Hackney’s changing demographics. They said they needed to challenge the local perception that new hospitals like UCLH had better maternity care because on the whole UCLH and Homerton provide a comparable service.

The discussion moved on to maternal mortality rates. Councillor Hayhurst suggested the death rate being higher in east London may be driving patients away. Ms Brintworth explained that the mortality rate is relatively low considering the number of high risk cases that are presented. East London hospitals are seeing an increase in the number of older women, diabetic women, obese women and women diagnosed with cancer choosing to give birth. These factors can influence the maternal mortality rate.

Councillor Hayhurst asked what measures were  ...  view the full minutes text for item 5.

James Cain, Head of Workforce Transformation, Health Education England, presented the report on Workforce. He said that when the 44 STPs were formed Health Education England was tasked with creating 44 multi-agency action boards.

Population growth has resulted in pressure on health services.

There are pockets in east London which are under doctored. In addition to this the nursing workforce is migrating away due to affordable housing issues.

Workforce retention is included in a work stream. Providing people with careers as opposed to jobs is a key theme in the work. The apprentice levy has increased to enable more local people to enter the workforce as local people are more likely to stay on longer term.

The national target for increasing the number of GPs is 500. North East London has a target of employing 19 additional GPs. Given the population demand, new roles are to be introduced into primary care including physician associate and care navigator. In secondary care a nursing associate role will be introduced.

Dr Sam Everington said that investment is a key factor in retention. Commissioners have invested in training science graduates to learn some GP skills over a 2 year training course. He argued that the diversification of roles is an essential benefit to a changing workforce and used the example of utilising pharmacists, who are over represented in the borough, to support GPs with paperwork and prescriptions. He also advocated for e-contact consultations.

The Chair asked primary care colleagues what they thought about virtual consultations, also referred to as the Babylon Project.  On the whole the GP’s agreed that it was a major risk and encouraged ‘cherry picking’. They thought the funding formula was rather crude, for example a young person with significant needs would generate the same charge as a low risk patient.

Steve Gilvin, Chief Officer, Newham Clinical Commissioning Group, acknowledged that cherry picking is an issue but said there will be a menu of options on what can be provided which is a good thing.

Wendy Matthews, Deputy Chief Nurse /Director of Midwifery, Barking, Havering and Redbridge University Hospital NHS Trust, asked what impact Brexit would have on European nurses.

Mr Cain replied that on average European junior nurses leave after two years but experienced nurses tend to stay on. Health Education England is focussing efforts on training newly qualified nurses. There is a Capital Nurse Programme to ensure London nurses are given the best training. With regard to Brexit, there has not been a significant shift towards nurses leaving the country but the reduction of the pound has resulted in difficulty in attracting European nurses on salary.

Councillor Hayhurst asked a question about housing options available to nurses and whether the health service and local authority worked in a joined up way to ensure key workers are provided with suitable housing.

It was noted that there has been little joined up working with the health service and local authorities on key worker housing. Members suggested offering workers a suite  ...  view the full minutes text for item 6.

There was no other business.