Agenda and minutes

Venue: Virtual Meeting

Contact: Email: tracy.scollin@barnet.gov.uk Tel 020 8359 2315  Please note that this will be held as a virtual meeting. An audio and video live stream of the meeting can be accessed using the link below

Link: Click here for the meeting

Items
No. Item

1.

Minutes pdf icon PDF 574 KB

    Minutes:

    Matters arising from the Minutes of the meeting held on 11 May 2020:

    ·         Agenda Item 8 Pages 3 & 4 – The Chairman confirmed that the Executive Director, Adults and Health, had assured her that she had responded to the Members’ queries.

    ·        Agenda Item 11 Page 9 Bullet Point 5 – The Chairman reported that the Royal  Free London NHS Foundation Trust Quality Account 2019-20 would include the  total number of  

     cases of C.Diff  for the year, including Quarter 4 which was 30. This brought the final number to 87 cases, an increase of 33 cases on the previous year.

    ·        Agenda Item 13 Page 13 - The Health and Wellbeing Board meeting referred to by Cllr Stock would take place on 23 July 2020 at 09:00 hrs.

     .

    Corrections to the Minutes of the meeting held on 11 May 2020:

     

    ·       Agenda Item 3 Page 2 – ‘Cllr Don is the Registered Manager of Dillon Care’ rather than ‘Dillon Care Home’

     

    RESOLVED that the Committee approve the Minutes of the meeting held on 11 July 2020as an accurate record subject to the above amendment.

     

2.

Absence of Members

    Minutes:

    Apologies were received from Cllr Golnar Bokaei who would be late joining the meeting.

3.

Declaration of Members' Interests

    Minutes:

    Cllr Hutton declared a non-pecuniary interest by virtue of the fact that she is a Trustee of Barnet Carers Centre.

     

     

4.

Report of the Monitoring Officer

    Minutes:

    None.

5.

Public Question Time (If Any)

    Minutes:

    None.

6.

Members' Items (If Any) pdf icon PDF 487 KB

    ·       Member’s Item in the name of Cllr Alison Moore

    Minutes:

    Member’s in the name of Cllr Moore – Mental Health provision in Barnet during the pandemic.

     

    The Chairman invited the following to the meeting:

     

    ·       Dawn Wakeling, Executive Director, Adults and Health, London Borough of Barnet

    ·       Dr Tamara Djuretic, Director of Public Health, London Borough of Barnet

     

    Cllr Moore thanked the Executive Director, Adults and Health, for the details of mental health services that she had circulated to Members. Cllr Moore added that specifically housing issues, and dealing with housing providers, are her concern where underlying mental health issues create problems for residents and their neighbours. This had been exacerbated by the period in lockdown and she was seeking a report with suggestions for how Barnet Council and mental health services can work with Barnet Homes and Members to resolve these complex issues.

     

    The Chairman reported that she had discussed this with the Executive Director, Adults and Health, who had offered to run a Seminar about housing issues for Members in the autumn. In addition, the Chairman noted that the Director of Public Health had agreed to attend the October HOSC to provide an update on the Suicide Prevention Plan.

     

    Cllr Moore responded that she is concerned about the interface between housing and mental health but the session would be welcome.

     

    The Executive Director, Adults and Health added that she would be happy to discuss Cllr Moore’s requirements further outside the meeting and to explore how to make improvements. She suggested a report at a future meeting from the CCG, Barnet Enfield and Haringey Mental Health Trust (BEHMHT) and Primary Care, with council leads on housing to try to pick up on the issues.

     

    RESOLVED that the Committee noted the Member’s Item.

     

     

7.

Minutes of the North Central Sector London Joint Health Overview and Scrutiny Committee

    ·       None.

    Minutes:

    None.

8.

Coronavirus Update

    ·       Group Chief Medical Director, Royal Free London NHS Foundation Trust

    ·       Director of Public Health, London Borough of Barnet

    Minutes:

    The Chairman invited the following to the meeting:

     

    • Dr Chris Streather, Group Chief Medical Director, Royal Free London NHS Foundation Trust
    • Dr Tamara Djuretic, Director of Public Health, London Borough of Barnet
    • Cllr Caroline Stock, Chairman, Health and Wellbeing Board, London Borough of Barnet

     

    Dr Djuretic spoke to her presentation which provided an update on the Local Outbreak Control Plan which Local Authorities have been asked to produce in order to prevent local outbreaks and manage any that arise. Barnet has been selected as one of the Best Practice Groups which also included Camden, Hackney and Newham. The Group is bound by guiding principles agreed at a national level and underpinned by legislation.

     

    Cllr Stock reported that the Health and Wellbeing Boards (HWBBs) have been asked by the government to work with the public to prevent and help resolve outbreaks. Two informal webinars had been held so far with community groups that are considered at higher risk of infection. The first webinar had been with Head Teachers and which 60 people had attended. The second webinar had been with the Faith Forum.  Cllr Stock added that the HWBB would like to be kept informed about any areas that they should address.

     

    Dr Djuretic added that Local Authorities have powers to impose local lockdowns and more details are awaited on this. She stated that London is fortunate in having the Public Health England London Corona Response Cell (PHE LCRC) which is providing help with contact tracing in Barnet. The PHE LCRC has also published a series of action cards for prevention and management of outbreaks in various settings.

     

    Dr Djuretic added that the work to support vulnerable people continues, including supporting them to self-isolate and providing information on testing. Barnet has been part of the national Best Practice Group Network and contributed to a guide for Care Settings, people with dementia, learning disabilities and mental ill health as well as places of worship. Barnet has implemented a Communications strategy to support its Outbreak Control Plan. This includes raising awareness on NHS Test and Trace, and focuses on houses of multiple occupancy (HMO) and landlords, as HMOs have been shown to be a risk in some areas.

     

    Dr Djuretic reported that Local Authorities, GPs and others are expected to assist with data sharing during an outbreak and adopting a proactive approach in line with the requirements set out by the Secretary of State for Health.

     

    A Member enquired what the data from NHS Test and Trace showed so far for Barnet. Dr Djuretic responded that Barnet has received notice of around 70 people testing positive for Coronavirus since Test and Trace began. In Barnet over 80% of cases and contacts had been traced, including those in Care Settings. Dr Djuretic added that she would share more data with the HOSC, when available.

     

    A Member asked whether recent reports that the Test and Trace technology did not work were true. Dr Djuretic noted that the NHS application that had been piloted on the  ...  view the full minutes text for item 8.

9.

Royal Free London NHS Foundation Trust Update pdf icon PDF 279 KB

    ·       Care Quality Commission (CQC) recommendations

    (Group Chief Medical Director, RFL NHS Foundation Trust)

    ·       Cerner Review (Group Chief Medical Director, RFL NHS Foundation Trust and Director of Performance, Planning and Primary Care, NCL CCG)

    Minutes:

     

    The Chairman invited to the meeting:

     

    ·       Dr Chris Streather, Group Chief Medical Director, Royal Free London NHS Foundation Trust

     

     

     Care Quality Commission (CQC) Recommendations Update

     

     

    Dr Streather reported that 8 out of 11 ‘Must Do Actions’ as stated in the CQC report had been completed. The remaining three (two in Maternity and one in Critical Care) had possibly now been completed but data is not yet available due to the audit being stood down during the Covid-19 outbreak. Dr Streather noted that the data should be ready by the end of August and he hoped more of the ‘Must Do’s’ would be completed by the next HOSC meeting in October.

     

    Dr Streather noted that out of 82 ‘Should Do’s’, 36 had not been confirmed as completed but full data would follow.

     

    RESOLVED that the Committee noted the verbal update. Cerner Review

     

    The Chairman invited to join the discussion:

     

    ·       Paul Sinden, Director of Performance, Planning and Primary Care, North Central London Clinical Commissioning Group (NCL CCG)

     

    Dr Streather reported that previously out of 50% of the 11,000 letters, the only harm to patients had been the delay. No ‘moderate’ or ‘severe’ harm had been found. Around 97.5% of the letters had since been reviewed, with no ‘moderate’ or ‘severe’ harm caused. Dr Streather added that all the letters are being released to patients and the Trust is ensuring that it picks up on any actions.

     

    Dr Streather commented that as a result of the review it became clear that some of the outpatient activity may not add value, given that no harm resulted in the letters not being sent. The Trust has received positive feedback on telephone and video consultations and has learnt through Covid-19 to modernise its appointments.

     

    Mr Sinden reported that the Trust has been open about this failing and its Clinical Working Group had devised a shared approach for reviewing the letters.

     

    The Chairman asked whether preventative measures were in place so that this error did not reoccur. Mr Sinden confirmed that early on the Trust and Cerner had carried out a root cause analysis for this reason, in order that this would not happen again.

     

    RESOLVED that the Committee noted the written report and verbal update.

     

10.

Alternative Provider Medical Services (APMS) and Cricklewood Walk In Centre Update pdf icon PDF 236 KB

    ·       Interim Director of Commissioning, NCL CCG

    ·       Executive Managing Director, Barnet, NCL CCG

    Minutes:

    The Chairman invited the following to the meeting:

     

    ·       Paul Sinden, Director of Performance, Planning and Primary Care, NCL CCG

    ·       Daniel Morgan, Interim Director of Commissioning, NCL CCG

    ·       Kay Matthews, Executive Managing Director, NCL CCG

    ·       Dr Charlotte Benjamin Vice Chairman, Barnet Health and Wellbeing Board and Vice Chairman, NCL CCG

     

     Alternative Provider Medical Services (APMS)

     

    Mr Sinden reported that the GP Contract had been due to end on 30 June 2020 but had been extended to March 2021 due to the disruption with Covid-19. The procurement for the new service would begin in September so that it will be in place from April 2021. Mr Sinden added that he will notify the Chairman when the contract is awarded so that he can report back to the Committee. 

     

    Cricklewood Walk in Service (WIC)

     

    Mr Morgan reported that the WIC Contract had been due to end in June 2020. Barnet and Brent CCGs had carried out a 3-month engagement exercise with stakeholders, the outcome of which determined that it would be best to close the WIC. The CCG has transferred some financial resources from the WIC into the existing GP Practice to increase appointment capacity. Mr Morgan noted that the CCG has written to all patients to encourage them to register with a local GP Practice and to make them aware of locally available services.

     

    Mr Morgan reported that the CCG had been asked whether without the WIC there would be alternatives to A&E. Mr Morgan confirmed that the CCG had set up an Integrated Care Partnership Board and one of the key work-streams was a focus on Same-Day Access for Barnet residents. A Member asked whether there would be a gap in Same-Day Access and why Same-Day Access not been made more of a priority.  Ms Matthews noted that the case had been well made to close the Cricklewood WIC and the model in its current form was outmoded. Covid-19 had resulted in transforming how Primary Care Services were delivered including remote triage and online consultations. This innovation in service delivery would be built into the model for Same Day Access.  Ms Matthews agreed to bring this back to a future HOSC for discussion.

     

    A Member enquired whether Same-Day Access will become easier for patients who wish to see a specific GP. Ms Matthews responded that GPs had rapidly implemented remote triage and digital systems such as e-consult which would take patients straight to the best practitioner for their needs.

     

    Dr Benjamin reported that since the pandemic GPs’ work had gone from around 15% to around 90% of consultations being undertaken remotely using a digital platform.  This has enabled a huge increase in Same Day Access for patients and for those patients without digital access the phone lines are much freer.

     

    A Member asked how vulnerable patients such as those who are hard of hearing, or with English as a second language, are being supported. Dr Benjamin noted that the CCG is aware of this group of patients. Language Line  ...  view the full minutes text for item 10.

11.

North Central London Clinical Commissioning Group (NCL CCG) pdf icon PDF 318 KB

    ·       Executive Managing Director, Barnet, NCL CCG

    Minutes:

    The Chairman invited the following to the meeting:

     

    • Kay Matthews, Executive Managing Director, NCL CCG
    • Dawn Wakeling, Executive Director Adults and Health, LBB
    • Dr Charlotte Benjamin, Vice Chairman, Barnet Health and Wellbeing Board and Vice Chairman, NCL CCG
    • Colette Wood, Director of Primary Care, NCL CCG
    • Ian Porter, Executive Director of Corporate Services, NCL CCG

     

     Merger of CCGs

     

    Mr Porter presented his slides on the merger of the five CCGs which is part of the NHS Long Term Plan. The merger went live on 1st April 2020.

     

    Mr Porter reported that the purpose of merging the CCGs is to optimise the balance between NCL-level and Borough-level services. NCL CCG has a single Governing Body with two elected representatives from each Borough. Barnet’s representatives are Dr Charlotte Benjamin and Dr Clare Stephens. Cllr Caroline Stock attends regular meetings with CCG representatives – with a lead health and social care member from the five NCL local authorities attending meetings of the CCG Governing Body.

     

    Mr Porter noted that the Covid-19 pandemic had meant integrated care working between key partners had accelerated. Many partners had fed back that although this had been a challenging time, they did not want to lose some of the positive changes that had resulted. Engagement with the public remains key – with ten community representatives currently being recruited to support the CCG’s committee working.

     

    The CCG would be tackling health inequalities and also its budget deficit which stood at £59million prior to the pandemic. The budgets for 2020/21 had been set by the legacy CCGs. Prior to the merger, budgets had been agreed with funding for services commissioned on a Borough basis. Mr Porter noted that the CCG would not disinvest from that but any new investment will be applied differently across the NCL CCG. Emergency legislation remains in place with NHS England (NHSE) currently taking control of significant elements of the CCG budget during the Covid-19 response. Further guidance is expected at the end of July.

     

    Mr Porter noted that four voting members sit on the new Governing Body who previously sat on the Barnet CCG Governing Body:  Ian Bretman, who was previously a lay member on Barnet CCG, and would be the designated lay member for patient engagement and involvement and Claire Johnstone, Registered Nurse, who was previously on the Governing Body for Barnet and Enfield CCG. The two newly elected GP Members for Barnet also previously sat on the Barnet CCG Governing Body i.e. Dr Charlotte Benjamin and Dr Clare Stephens.

     

    The Chairman asked whether the different governance system in Barnet (Committee System as opposed to Cabinet) could cause any problems for the new CCG. Mr Porter responded that a key aim of the Local Authority representation is to help ensure strong partnership working between health and social care – and the provision of local authority perspectives on key issues. They are non-voting members who provide insight for the decision-making process so the different governance structures would not be an issue.

     

    The Chairman asked  ...  view the full minutes text for item 11.

12.

North London Hospice Draft Quality Account 2019/20 pdf icon PDF 2 MB

    ·       Director of Clinical Services, North London Hospice

    Additional documents:

    Minutes:

    The Chairman invited the following to the meeting:

     

    • Fran Deane, Director of Clinical Services, North London Hospice
    • Assistant Director of Quality, North London Hospice

     

    Ms Deane thanked the Committee for their patience in allowing the NLH to bring the Quality Account 2019-20 later in the year to the Committee due to the Covid-19 pandemic.

     

    She added that the Carers Strategy, the new clinical database and the work on non-medical prescribing had been carried forward to next year due to the pandemic. Also, the upgrading of the Inpatient Unit bathroom had had to be placed on hold but instead the NLH is proposing to review the delivery of some of its health and wellbeing services. A

    6-month post had been created to review the NLH’s virtual response to health and wellbeing and to work on setting up groups to support patients in the community.

     

    Ms Deane reported that Covid-19 had accelerated some of the NLH’s learning and development opportunities with nearly 2000 learners having attended online courses.

     

    There was a delay in presenting full data due to the introduction of the new clinical database, Egton Medical Information Systems (EMIS) going live in January. Full data would be available in 2021.

     

    Ms Deane noted that a Director of People has been recruited and this post has been beneficial with the introduction of a People Strategy and clear direction to develop the workforce. 

     

    The Committee scrutinised the draft North London Hospice Quality Account 2019-20 and wished to put on record the following comments:

     

    • The Quality Account was well presented and easy to navigate with an interesting mixture of information and including a ‘Patient Story’ demonstrated the ethos of the Hospice.
    • The Committee was delighted to see that three of last year’s ‘Priorities for Improvements’ will continue again this year, as Members felt that they were of great importance: the Carer’s Strategy, training on Non-Medical Prescribing and ongoing development of Egton Medical Information Systems (EMIS). EMIS was considered of vital importance providing the Hospice with access to patients’ records and information sharing as 96% of GP Practices in Barnet, Enfield and Haringey are on the same system. (P.6-9)
    • The Committee praised the progress made on the’ Productive Ward in the Impatient Unit’ to improve and initiate new ways of working thereby enabling nurses to spend more time with patients. (P.10)
    • The Committee noted that a Priority for 2021 ‘IPU Bathroom Spa Experience’ aimed to improve the current facility by adding new blinds, a privacy curtain as well as creating a small changing area and expressed disappointment that the facility was currently closed due to Coronavirus social distancing recommendations. (P.13)
    • The Committee was glad that the Audit of the Dementia-Friendly Environment had been rated ‘Good’ and looks forward to hearing how work progresses on the few potential improvements which were identified. (P.16)
    • The Committee was pleased that there were positive results in the Audit of Five Priorities of Care following the introduction of electronic documentation in January 2020 as part of the EMIS project.  ...  view the full minutes text for item 12.

13.

Adult Elective Orthopaedic Surgery Review pdf icon PDF 784 KB

    ·       Regional Director of Specialised Commissioning, NHS England

    Minutes:

    The Chairman invited to the meeting:

     

    ·       Will Huxter, Executive Director of Strategy, NCL CCG

     

    Mr Huxter presented his slides. He reported that there would be two partnerships (north and south). The most relevant one for Barnet is that between the Royal Free London NHS Foundation Trust and the North Middlesex Hospital, with the Inpatient Unit at Chase Farm Hospital. The Royal National Orthopaedic Hospital is also in Barnet.

     

    Mr Huxter reported that some changes had been made to the public consultation due to Covid-19, with some of the discussions being held virtually. Several meetings had been held, seeking views of Barnet residents and professionals. The results of the consultation will be published in early August, including a Health Inequalities Impact Assessment. A JHOSC meeting will be held across the five North Central London Boroughs in September (held on 4September), as well as a meeting of the Governing Body. The service would begin to be implemented following this, subject to the decision of the CCG Governing Body.

     

    Mr Huxter reported that he would probably be able to report back to HOSC in October with further details on the implementation plan from the Trusts.

     

    RESOLVED that the Committee noted the written and verbal update.

     

     

14.

Health Overview and Scrutiny Forward Work Programme pdf icon PDF 175 KB

    Minutes:

    The Chairman reported that the following would be added to the Forward Plan:

     

    October 5 2020:

     

    ·       Adult Orthopaedic Surgery Review Update

    ·       Services in Finchley Memorial Hospital

    ·       Cllr Moore’s Member’s Item

    ·       Suicide Prevention Plan Update

    ·       Winter pressures 2020

    ·       Services currently available in GP Practices, Hubs and Walk in Centres

    ·       Flu Vaccinations

     

    Update on APMS – December or February 2021.

     

    RESOLVED that the Committee noted the Forward Plan.

     

15.

Any Other Items that the Chairman Decides are Urgent