Agenda item

The Chairman invited the following to the table:

·         Mr Will Huxter – Director of Strategy, Barnet, Camden, Enfield, Haringey and Islington CCGs

Mr Huxter explained local CCGs for each Borough take forward the plans incorporated within the STP and implement them in partnership with the Local Authority and Care Providers. He explained that the strategic plan was coordinated across all five boroughs, but specific arrangements such as Care Closer to Home Integrated Networks (CHINS) was led at a local level.

Mr Huxter said the arrangements across the North London Boroughs were complex, with a range of different organisations across geographical boundaries including several statutory organisations. Clinical and care leadership at Barnet is provided via a collaboration of both clinical and managerial roles, with Dr Frost as the lead from a Primary Care perspective and Ms Wakeling the lead for Adult Social Care. Secondary Care and Mental Health Trusts collaborate to provide the best service to patients. Mr Huxter said that one of the focuses of the STP was to maximise Care Closer to Home Integrated Networks and to work together to deliver progress across a wide range of areas. This work was being led at a local level, with the STP sharing good practice and providing key building blocks of what should be done at a local level.

The Committee asked what workforce challenges were currently being faced by north London Boroughs. Mr Huxter said there were challenges surrounding recruitment and retention of staff due to issues such as the expense of living in London and the attractiveness of positions offered. He said the STP was focusing on stabilising what was offered to employees and ensuring the offer was sustainable for the future.

Mr Huxter explained changes were being proposed to the way in which adult elective orthopaedic surgery is arranged. Currently Adult Elective Orthopaedic Surgery takes place at ten different sites in North Central London, with each site doing a varying volume of work. He said patients had reported different experiences and outcomes at different hospitals, suggesting inconsistent approaches across the sites. Waiting times for patients also currently varied and targets were often being missed. Mr Huxter explained that the plan was to consolidate Adult Elective Orthopaedic surgery from a number of hospitals to a smaller number of larger units with the aim of improving care. Emergency and planned care would also be separated, ensuring this did not affect emergency pressures. Additional work needed to be carried out to inform patients about what they needed to do in advance and to ensure everyone had access to innovative practices such as robotic surgery, research and clinical trials.

Mr Huxter explained that in Barnet, the majority of the planned orthopaedic operations took place at the Royal Free Hampstead or Chase Farm Hospital. The Joint Commission Committee would be making a presentation in the December meeting about engagement and recommendations about the next steps. Phase one of the work had been completed but currently the plans were a long way off being implemented.

The Committee asked how the NHS 111 service was working and whether there had been good progress on this. Mr Huxter said the service was monitored very closely, with the challenge being the wide ranging and different needs of patients phoning the service. He said the service is driven by algorithms which guide patients through a series of questions, leading them to the most appropriate person to deal with their call. A clinical review was regularly undertaken with the provider on all activity and to flag any concerns surrounding individual cases. He said they were satisfied, however they needed to keep it under review in order for people to have confidence in the system. The Committee queried how those that use the service are triaged. Mr Huxter explained that patients are asked a defined set of questions, with the relevant response provided, dependant on the patients answers to the questions. He said there was a complex set of arrangements in place but that staff were trained to take people through the questions in order to identify their needs and then recommend the appropriate medical advice or suggest where the person should go.

The Committee asked what implications the change to orthopaedic operations would have on junior doctor training. Mr Huxter said that currently there were concerns that training was not as good as it could be. The current proposal was that the same clinical team does both emergency and elective work and this would be arranged via a rota system. This would provide junior doctors with exposure of both types of operations and experience on more complex surgery.

The Committee asked if concerns about keeping people suffering with mental health conditions safe had been addressed when looking at delivering services closer to home in relation to mental health. Mr Huxter said the STP looks at prevention through to treatment and that the majority of those suffering needed the right support outside the hospital setting. He said there was a range of support services available to patients and whenever a crisis occurs the patients are smoothly and efficiently directed to the right support. The Committee asked how the partnership worked with police to provide support for those in mental health crisis. Mr Huxter said the work stream for mental health engages with the police and was currently working on identifying safe places for the police to take patients in crisis who do not need A&E treatment.

The Committee queried whether cultural and language barriers had been considered when implementing plans as the boroughs are made up of residents from diverse cultures and nationalities. Mr Huxter said the plan was holistic but the community understanding of cultural needs needed to come from a local borough level, making use of the assets within the local communities.

The Committee asked how organisations were being supported to reduce the reliance on temporary staffing. Mr Huxter said the aim was to make the north of London an attractive place for people to want to work. This would aid recruitment and retention and provide an excellent learning environment where individuals can gain experience in lots of different areas. He said objectives also included adopting new ways of working to enable working across health and care settings and maximising workforce efficiency and productivity.

Ms Wakeling said that the North London STP received funding from the London Workforce Action Board which receives money from Health Education England. This money is used to train Nursing Home Managers in leadership and overseas nurses who work in Nursing Homes to enable them to gain qualifications that are recognised in the UK. She also said that a network of ambassadors had been developed within Social Care whose role was to encourage people to move into Health and Social Care careers. A website and portal had been developed which will act as a recruitment and retention vehicle based on a model used in other parts of the country, known as ‘Proud to Care’ which would be available next year.

The Chairman asked when the locations for the elective surgery would be decided. Mr Huxter said that a lot more work needed to be done before a decision could be made about the locations. He said he was happy to provide this information when it became available.

RESOLVED that the Committee noted the report.