The Chair introduced the sub-committee to members of THT Partnership and the Integrated Care Board, who provided reflections and achievements from last year and outlined the priorities for 2023/24.

 

Primary Care

 

Dr Roberto Tamsanguan, GP and Tower Hamlets Place Clinical Director, emphasised  the Primary Care Network (PSN) achievements, primarily the Covid-19 Booster initiative for 2023 and the approval to deliver Spirometry (lung function) testing within the community, which detects asthma or  chronic obstructive pulmonary disease (COPD). Other notable achievements included the  implementation of digital infrastructure with all 30 GP practices, to work more collaboratively throughout the borough. Digital exclusion policies have now been established.

 

Healthspot services for young residents with GP consultation rooms are located in two youth centres within the borough to assist younger people transitioning into adulthood.

 

Dr Tamsanguan noted the  challenges within the service as the high turnover in patients, a rapid population growth, workforce and housing pressures, high waiting lists and the cost of living crisis. The sub-committee were also reminded of  ongoing issues following the pandemic and budgetary constraints.

 

PCN’s priorities involve improving resident access to primary care services and ensuring improvement plans are effective with the delivery of a PSN same day urgent care pilot programme. A promotional campaign of services to residents on ways to access primary care and the wider workforce, has been particularly effective and plans to upgrade the telephony with a cloud based service and queue functionality, to cut down call waiting times are ongoing.

 

Further to questions from the sub-committee; Dr RobertoTamsanguan, Jo-Ann Sheldon, Head of Primary Care Commissioning, NEL ICB and Zainab Arian, CEO GP Care Group;

 

·       Confirmed that Asthma, COPD and respiratory issues are increasing in the borough and it is vital patients can access spirometry testing hubs closer to home rather than visit hospitals. This will be delivered across PCN’s although location details are pending. Further details will be circulated to sub-committee members once confirmed.

 

·       Explained that vulnerable and elderly residents who do not or are unable to engage in digital technology still require access to  health care. The Digital Exclusion policy ensures they still receive GP assistance when needed, either face to face or by phone.

 

·       Confirmed that existing health centres have moved sites to accommodate patient growth in the last ten years. Details on the numbers of new GP surgeries in the borough will be brought back to the sub-committee for review.

 

·       Clarified that Spotlight Youth centre in Poplar and the Overland Children and Family Centre in Bow are the two sites with GP services. Spotlight contacted the NHS following intensive youth work engagement and the idea of GP service provision was established. It is anticipated that consulting rooms will be made available in all youth centres within the borough. Case studies are available to the sub-committee for review.

 

·       Explained that the promotional campaigns are informing residents of the various ways to access primary care, including  the aforementioned telephone and  face to face consultations, as well as utilising clinical professionals other than GP’s.

 

·       Conceded that budgetary constraints are affecting building new health centres. Discussions are ongoing with the ICB to address property interests and service charges, policy and the Integrated care system, as this is a national issue.

 

·       Clarified that GP training is an ongoing concern although recruitment and retention in Tower Hamlets is good for younger general practitioners. There are a number of workforce strategy and support services for practices and reminded sub-committee members that the service includes more than just GP’s. Pharmacists, nurses and physiotherapists also play a vital role in patient care.

 

Community Health Services

 

Dr Richard Fradgley, Director of Integrated Care and Deputy CEO of East London NHS Foundation Trust, updated the sub-committee on the positive work undertaken within community health services, who care for residents in their own home. This included the focus on improved person centred care, achieving the two hour response times to residents injured at home, who require nursing and  physiotherapy and the advance care planning work, who support residents in hospice care and fulfil the wishes of patients to stay at home with family towards the end of life.

 

Other notable achievements relate to the ongoing partnership work with the Council and The Royal London regarding discharge arrangements, reducing the waiting list which grew during the pandemic and the good work supporting older residents with mental and physical health issues. The Community Health team were also finalists at the Health Service Journal (HSJ) Awards back in March

 

The challenges with district nurse recruitment and retention and a lack of occupational therapists still exist. Although there have been improvements with the former, there is a national shortage of therapists. Service demands and financial constraints are added pressures. Priorities for this year remain establishing more district nurses, creating more apprenticeship roles and continuing to support the wellbeing of the workforce, who are still recovering from the pandemic and the cost of living crisis.

 

Mental Health Services

 

Dr Fradgley then gave a brief update on the mental health services achievements which include creating learning and development programmes, investing in improving the quality of the services in the borough, establishing  perinatal services for pregnant women and preventative mental health services for school children. The Child and Adolescent Mental Health Service (CAMHS) has been expanded and a 24hr crisis service is scheduled to open within three months.

 

There are still significant impacts from the pandemic in a borough with the highest numbers of mental health issues in the country; and is causing severe pressure on staff, inpatient services and longer waiting lists. This is being addressed with more investment in psychiatric liaison facilities, more beds within the A&E departments and also developing service user and care priorities relating to peer support and culturally skilled services.

 

Further to questions from the sub-committee; Dr Richard Fradgley;

 

·       Clarified that the community mental health services success relates in part to GP’s and clinical leads within ELFT, working collaboratively to establish solutions to problems. Strong relationships fostered with voluntary organisations and inclusion to daily care plan meetings with mental health teams, also contribute to service accomplishments.

 

·       Explained that talking therapies are being offered to minority groups. Outreach workers are supporting members of the community, with  staff fluent in various languages and accessible both online and in person. Further work to expand the service is ongoing.

 

·       Noted that Tower Hamlets was the first borough to invest in mental health services in schools, to promote wellbeing and give emotional support, as the pandemic has increased need. This  collaborative effort is supported by children’s social care, GP’s, the community, inpatient paediatric services and other partners.

 

·       Confirmed that following the recommendations on the Rapid Review of impatient safety, Dr Deborah Dover, Director of Patient Safety, is now in post at ELFT to overview the strategy and approach to ward certification. Further details can be brought back to the sub-committee for review at a later meeting.

 

Acute Care

 

Dr Neil Ashman, CEO Royal London and Mile End Hospitals, praised the work taking place within and outside the borough in collaboration with primary care, mental health staff and the voluntary sector to maintain health. Royal London provides specialist care for North East London and South Essex.

 

The priorities are to deliver the highest quality service and continual improvement for patients, particularly with maternity care, to reduce waiting lists and the backlog of patients who have waited over 15 months for treatment following the pandemic. Other main concerns include ensuring that urgent care is swift and discharge and rehabilitation is effective, so patients can return home with continual assistance from health partners when required.

 

Dr Ashman noted challenges relate to workforce capacity pressures due to Covid and the high turnover in patients that has exacerbated the GP Care Group, who work in the urgent treatment centre. There remains a good relationship with partners and the wellbeing of all clinicians and staff are paramount, as is ensuring that culturally competent training and care is delivered.

 

Further to questions from the sub-committee; Dr Neil Ashman;

 

·       Explained that the Royal London joined the National Maternity Safety Programme to ensure the recommendations of the Ockenden report are met. Engagement with the  Maternity Voices programme is taking place and continual work with the Somali community to hear experiences of care to improve safety is ongoing.

 

[Clerk's Note - The Ockenden Review is available here: Final report of the Ockenden review - GOV.UK (www.gov.uk)

 

Integrated Care Board (ICB)

 

Charlotte Pomery, Chief Participation and Place Officer discussed the first year of the ICB and reiterated the close  working relationship between partnerships, residents and the good work across community and mental health teams during these challenging times.

 

ICB priorities include working and supporting residents living with long term conditions and employment aspirations for residents within services. Ensuring the financial and workforce strategies are implemented and embedding a co-production structure across the partnership.

 

Further to questions from the sub-committee; Charlotte Pomery:

 

·       Clarified that the 30% reduction of the NHS NEL ICB budget, noted at the INEL JHOSC meeting, relates to the running cost allowance and not the total budget. An organisational restructure is in progress and efficiency  savings for this year are £82.6 Million against an overall budget of  £4 Billion. This is approximately a 2% saving to meet the policies within the long term plan.

 

·       Noted that a draft on the health care policies was shared at ONEL JHOSC (Outer East London Joint Health Scrutiny Committee) on 27 July 2023. A working group has been established and a written brief on guidance and the next steps towards implementation will be brought back to the sub-committee for review.

 

The Chair thanked all ICB and Health Care partner representatives for the presentations and for ensuring residents continue to receive the best health care available. The sub-committee will be monitoring progress throughout the municipal year.

 

     RESOLVED that

         

1.    The presentation be noted.

 

2.    The sub-committee be briefed on the number of new GP surgeries within the borough.

 

3.    The sub-committee to be updated on the Spirometry hubs and location details once confirmed.

 

4.    The sub-committee be briefed on the ELFT Inpatient Safety Strategy.

 

5.    A written brief to the 30% reduction of NEL ICB budget and the implications for Tower Hamlets to be brought back to the sub-committee.