Agenda and minutes

Before moving to the formal business of the meeting the Chair with great sadness asked the Committee to note the death of her Majesty Queen Elizabeth II. Throughout her reign of more than 70 years, the Queen had been an inspiration to people not only from this Country but across the world, through her tireless commitment to her public duties and to her people. She would be sorely missed. May she rest in peace.

The Chair then asked everybody to stand in quiet reflection for a minute’s silence.

In accordance with the Council’s Constitution, Members are asked to declare any interest they may have in any matter which is to be considered at this meeting.

There were no declarations of interest.

The minutes of the meeting held on 23 March 2022 were confirmed as correct.

The Director of Strategy and Partnerships (DSP) and the Diagnostics Programme Director (DPD) at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) delivered a presentation on the proposed diagnostic centre at Barking Community Hospital (BCH), which was part of a national NHS England-funded programme of diagnostic centre building, that would help to improve access to diagnostics to support the early diagnosis of disease. The presentation detailed that:

• The Community Diagnostic Centre (CDC) preparations were already underway, with a Computed Tomography (CT) scanner and Magnetic Resonance Imaging (MRI) scanner currently being built there.
• The construction of the larger building containing the majority of the diagnostic capacity had been subject to two recent public consultations, which had both reported very positive findings. The CDC was proposed to cost £15 million to build and would contain the full suite of diagnostic services (such as CTs, MRIs, X-rays, ultrasounds, physiological measurements and blood tests);
• The aim of the CDC was to enable residents to go to a ‘one stop shop’ for diagnostics before they were fully referred into secondary care, so that any issues could be determined.
• Over the next couple of years, it was planned to build one CDC in Barking, one in Mile End and a third in another location.
• The Barking CDC was proposed to open between October-December 2023.

The Cabinet Member (CM) for Adult Social Care and Health Integration stated that, whilst herself and other Council colleagues had lobbied hard for this very positive development, she wished to put on record her thanks that the system had listened to all concerns and taken action to address these.

In response to questions from Members, the DSP and DPD stated that:

• BHRUT had submitted a provisional business case to NHS England (NHSE). Whilst this did not specify every exact detail, it would provide BHRUT with the

£14.9 million for the construction of the building. NHSE had confirmed that it was satisfied with the provisional business case and had given BHRUT a formal letter of agreement to confirm that BHRUT could access this funding.

• NHSE had also committed to three years of revenue funding to pay for the staff to run the scans within the centre. Whilst this was the maximum length of funding that NHSE would currently provide, this was not to say that there would not be funding after this three-year period.
• The funding was entirely new money that was being given to the system from the NHSE pot of programme funding, that would not need to be repaid.
• Whilst BHRUT could not guarantee exact waiting times as part of this new CDC as it did not know how much demand would change and grow, the CDC would help to reduce the current backlog. The majority of access to the CDC would be through direct GP referrals, rather than through lengthier referral processes through GPs and then hospital consultants as previously.
• As the CDC would not be based in a hospital, the diagnostic services would be more sustainable and could  ...  view the full minutes text for item 48.

The Director of Primary Care Transformation (DPCT) and the Clinical and Care Director (CCD) Barking and Dagenham at NHS North East London (NEL) delivered an update on enhanced access. The presentation detailed that:

• All Primary Care Networks (PCNs) in England would be required to offer patients a new ‘enhanced access’ model of care from 1 October 2022, which would see GP practices open between 6.30pm-8pm from Mondays to Fridays, and between 9am and 5pm on Saturdays. ­­This would replace the current Extended Hours and Extended Access services, marking a shift in the way out-of-hours non-urgent services were provided across North East London.
• The PCNs had subcontracted and were working alongside the GP Federation to provide these services. As part of the NHS England (NHSE) specification, the PCNs were also working alongside new roles funded by the NHSE, such as clinical pharmacists, physiotherapists and occupational therapists.
• To support PCNs with engaging their patients, NHS NEL had run a North East London-wide survey on provided services, of which there were just under 5,000 responses from Barking and Dagenham residents.
• The model would evolve as ongoing resident feedback was received, as well as to cater to the needs of patients.
• A mixture of GP, nurse and therapist services would be offered, as well as face-to-face, telephone and remote appointments.
• The new model would run from three sites locally.
• Additional funding had also been secured to keep the current GP Access Hub service running until 31 March 2023.

In response to questions from Members, the DPCT and the CCD stated that:

• The model would be flexed to accommodate the various preference types for appointments and the PCNs would continue to work with patient groups, to suit their needs. NHSE had also specified that PCNs needed to provide a range of appointment types.
• When patients booked an appointment, they would be asked which type of appointment they wanted; if a patient wished to have a face-to-face appointment, it would be offered to them.
• They would return to the Committee early in 2023 once the service had been running for a few months, to bring back data and feedback from residents as to the new services offered.
• Whilst there was already an existing weekend and evening service for urgent appointments, the ‘enhanced access’ model would be for routine appointments and would increase GP opening hours for these.
• It was estimated that around 72,000 additional appointments could be undertaken each year through the six PCNs in Barking and Dagenham working together, as part of the “enhanced access” model. NHS NEL would ensure that the current in-hours offer would not reduce due to this, and could bring back data on the number of appointments provided in the first quarter, upon their return to the Committee in January 2023.
• It was hoped that the model would increase the uptake of screening programmes, for those who were only able to book after-work appointments.
• NHS NEL was in discussion with Council colleagues about the Borough’s Family and Children’s Hubs, and services  ...  view the full minutes text for item 49.

The Director of Primary Care Transformation (DPCT) and the Clinical and Care Director (CCD) Barking and Dagenham at NHS North East London (NEL) delivered an update on the Tulasi Medical Centre and the Faircross Health Centre, following their inadequate Care Quality Commission (CQC) ratings, to assure the Committee of the action that was being taken to improve these. The presentation detailed that:

• Tulasi Medical Centre had been rated inadequate against all key questions asked by the CQC (about whether services were safe, effective, caring, responsive to people’s needs, and well-led). It had also had its registration with the CQC suspended; it could still hold its GP contracts under the regulations, but whilst it was rated inadequate and addressing CQC issues, it had had to subcontract its services to the GP Federation.
• There would be a six-month period in which Tulasi Medical Centre would have an action plan in place, approved by the CQC and NHS NEL, to address the issues found by the CQC. An NHS NEL team would monitor progress with the Centre on a weekly basis, as well as to support around aspects such as medicine management, safeguarding and infection and disease control.
• As a commissioner, NHS NEL had also issued a breach notice to Tulasi Medical Centre, which the Centre had six months to address. The Centre would be monitored by the regulator, CQC, and NHS NEL as it provided its services under the GP contract. NHS NEL would also work with NHSE to look at the competencies of the clinicians working at the site.
• Faircross Medical Centre had been rated inadequate by the CQC, but could still hold their registration with the CQC. Whilst NHS NEL was working with Faircross on its action plan, it had been inspected earlier in the year, and so was further ahead in addressing its remedial actions.

In response to questions from Members, the DPCT and the CCD stated that:

• At the end of the six-month remedial period, a CQC reinspection would take place. These often took between four-five days, with the CQC bringing in a new team to thoroughly check actions across all key domains, to ensure that auditing was being undertaken correctly and that policies were in place.
• GP practices did change over time. The Tulasi Medical Centre lead held a lot of responsibility on their own; one of their actions was to look into recruiting partners to share the workload. The lead had held various roles in the system and had since stepped back from these, to concentrate on their GP practice.
• The CQC worked independently from NHS NEL, but other practices were undergoing inspections as part of the CQC’s inspection cycle. Through the Borough Partnership, NHS NEL was looking at holding a quality roundtable to look into general practice, focusing on workforce, funding and workload issues, as well as what the system could do to best support practices and help them to prepare for CQC inspections. It was also holding educational training events looking at inspections, data  ...  view the full minutes text for item 50.

The Chair presented a report asking the Committee to appoint three Members to the Outer North East London Joint Health Overview and Scrutiny Committee (ONEL JHOSC) for the 2022/23 municipal year. The Committee agreed to appoint Councillors Robinson, Lumsden and Chowdhury to the ONEL JHOSC.

The agenda reports pack of the last meeting of the Joint Health Overview and Scrutiny Committee can be accessed via: Browse meetings - Joint Health Overview & Scrutiny Committee | The London Borough Of Havering

It was noted that the minutes of the last meeting of the Joint Health Overview and Scrutiny Committee were included as part of pages 47-51 of the agenda.

The Chair presented the draft work programme for 2022/23, following previous discussions with the Director of Public Health, the Operational Director for Adults Social Care and the Cabinet Member for Social Care and Health Integration, as to what the priorities should be for the year.

Members agreed the draft Work Programme, as well as to undertake a scrutiny review relating to the Voluntary and Community Sector (VCS) during this municipal year; of which the terms of reference would be scoped and brought back for agreement at the Committee’s next meeting on 14 November 2022.