The Sub-Committee received a presentation that provided an introduction to the Integrated Care System in North East London and how Tower Hamlets Together Partnership will be involved in (i) the key challenges and pressures; and (ii) priorities for the year.  The main point may be summarised as follows:

The Sub-Committee:

• Expressed concern that the cost-of-living crisis will raise stress levels due to the looming anxiety of increased energy bills to the day-to-day struggle of trying to make ends meet.

• Commented that over time, this persistent stress would potentially trigger or worsen mental illnesses such as anxiety disorders, depression, and addiction.
• Were concerned that Barts Health are also facing rising fuel and energy bills and noted that the Trust leaders are working hard to find savings and efficiency measures to ensure that the Trusts group of hospitals can continue to provide clinical services to people in east London and beyond.

• Commented that the economic pressures will make long-standing health inequalities even worse in east London as they take their toll on people's health and wellbeing. Therefore, the Trust and its partners needs to address the wider causes of poor health and help to close the gap in healthy life expectancy between people in the deprived and affluent areas of east London.
• Noted that the cost and severity of capital budgets are now set to rise in cash terms by 2024/25. Part of the planned increase to capital investment being tied to programmes to build or upgrade hospitals, build surgical hubs and community diagnostic centres, and increase spending on digital technology and research and development.

• Acknowledged that Barts Health like any area of public sector is not immune from consideration of reductions in its budgets.
• Noted that Barts Health is making sure that its workforce is supported through the cost-of-living crisis and that the wages that they get are at a level that can support them support them which therefore is another consideration of the Integrated Care System (ICS) as it brings together the NHS organisations, councils, and wider partners in a defined geographical area to deliver more joined up approaches to improving health and care outcomes.
• Agreed that the Trust and its partners recognises that they must be able to respond to the needs of their local communities while maintaining crucial services and retaining staff across acute, ambulance, community, and mental health services.
• Noted that the responsibility for commissioning local dental services in east London rests not through the local integrated care board (ICB) but with the local area teams who hold the budget and have powers to contract for the provision of dental services according to the needs of the Borough’s residents.
• Noted, that there are plans and proposals being developed to transfer the commissioning local dental, ophthalmology, and pharmacy services to the ICB from April, 2023.
• Noted that whilst there are rising numbers of people in east London are struggling to access NHS dentistry as the pandemic had created backlogs and worsened access to these services the public Health team are working to make some of those links with individual dentists in the Borough to develop a better understanding about what the position is across all the providers.
• Commented that missing dental check-ups can mean that smaller problems in dental hygiene are not picked up and treated quickly, leading to more advanced tooth decay. Which can happen because people do not realise the importance of regular dental check-ups or that regular visits to an NHS dentist may be impossible.
• Agreed that supporting patients to be actively involved in their own care, treatment and support can improve outcomes and experience for patients, and potentially yield efficiency savings for the system through more personalised commissioning and supporting people to stay well and manage their own conditions better.
• Welcomed a commitment by the Trust and its partners to become much better at involving patients (and their carers) by: (i) giving them the power to manage their own health and make informed decisions about their care and treatment; (ii) supporting them to improve their health and give them the best opportunity to lead the life that they want; and (iii) supporting people to develop the knowledge, skills and confidence they need to more effectively manage and make informed decisions about their own health and care. This will ensure their care is coordinated and tailored to the needs of the individual, and that healthcare professionals can collaborate with patients and their families.
• Noted that urgent and emergency care staff have faced one of their busiest summers ever with record numbers of Accident and Emergency attendances. These pressures have meant that there have been too many occasions when staff have not been able to provide timely access for patients in the way they would have wanted.
• Noted that Winter pressures (i) is an NHS term that defines the spike in demand when an already stressed system experiences increased pressure impacting patient wait times, workforce capacity, well-being and health and care financial budgets.; (ii) encompasses many illnesses relating to respiratory diseases, flu, chest infections and other conditions that respond poorly to cold weather peaks in the winter.
• Noted that another problem that the NHS faces during winter is an increased risk of infection in healthcare settings where patients with weakened immune systems are at increased risk of becoming ill.
• Noted that whilst winter pressures in our health and care system is predictable, with a significant amount of planning taking place to mitigate risks and issues, there is always an element of uncertainty.
• Noted that over the past couple of years, there was more of a command-and-control approach to winter activity during the height of the pandemic; primary care networks currently have more flexibility to plan and design their own provision and, where possible, so as to be ready for the peak.
• Noted that the Trust have started thinking about what are the other plans that they might need to make should there be a recurrence of the pandemic.
• Noted that evidence indicates shows that it is better for people, and more cost effective, where clinically appropriate, to spend a short a time as possible in hospital, and to avoid going into hospital when healthcare can be delivered safely in the home environment. The discharge to assess model has been effective at reducing stays and supporting timely discharge.
• Noted that the Trust is also under considerable stress as any increase in infection rates will impact on patient care, staff absences and the resource demands of delivering ongoing vaccination and booster programmes. Which also compounds existing workforce pressures with Brexit, vaccination requirements and labour shortages in other sectors making it harder to attract and retain health and care workers.
• Noted that to avoid hospital re-admission by maximising independence support and health interventions including how existing contracts and local services can support this.
• Agreed on the importance of understanding and address the impacts of hospital discharge and prevention across the different local communities.
• Agreed that people must be at the centre in decisions that affect their lives and in designing services and solutions. People need choice and control so that support is built around their strengths networks of support that can be mobilised from the local community.
• Acknowledge that it is important to afford sufficient time to understand people’s experience of coming out of or staying out of hospital – their fears, concerns, what has worked well, and what did not and will not be just about health and care services, but about wider community support.

In conclusion, the Chair:

• Thanked the officers for their presentation and all attendees for their contributions to the discussions on this issue; and
• Indicated that he would like the Sub-Committee to receive and update next year in the items for the progress made including patient feedback.