Agenda and minutes

Apologies were received from Emma Edhem.

There were no declarations.

To receive the Order of the Court of Common Council from 19 April 2018.

The Committee received an Order of the Court of Common Council of 19 April 2018 appointing the Committee and approving its Terms of Reference.

To elect a Chairman in accordance with Standing Order 29.

The Committee proceeded to elect a Chairman in accordance with Standing Order No.29. The Town Clerk read a list of Members eligible to stand and Christopher Boden, being the only Member who expressed a willingness to serve, was duly elected as Chairman of the Committee for the ensuing year.

To elect a Deputy Chairman in accordance with Standing Order 30.

The Committee proceeded to elect a Deputy Chairman in accordance with Standing Order No.30. The Town Clerk read a list of Members eligible to stand and Michael Hudson, being the only Member who expressed a willingness to serve, was duly elected as Deputy Chairman of the Committee for the ensuing year.

To co-opt one representative from Healthwatch City of London.

RESOLVED – That Steve Stevenson be co-opted as the representative for Healthwatch.

To appoint representative(s) to the Inner North East London Joint Health Overview and Scrutiny Committee.

It is proposed that the Chairman and Deputy Chairman are appointed.

RESOLVED – That the Chairman be appointed to the Inner North East London Joint Health Overview and Scrutiny Committee with the Deputy Chairman as their substitute.

To agree the public minutes and non-public summary of the meeting held on 13 February 2018.

The Committee noted that the external guests who had attended the last meeting had been omitted from the attendance and agreed that this should be corrected.

RESOLVED – That, pending the above correction, the public minutes of the meeting held on 13 February 2018 be agreed as a correct record.

Matters Arising

Update on Changes to Cancer Services and Breast Cancer Screening

A Member clarified that the concerns they had raised in the previous meeting about the cancer unit at St. Bartholomew’s were more specifically about the expectation that patients could receive more than one treatment in a day at the unit, and that patients were having to wait too long for mammograms. It was hoped that this could be improved.

Employment for People with a Learning Disability

The Committee was given an update on the City of London Corporation’s activities in this area. The Committee noted that the Establishment Committee was responsible for matters of employment at the Corporation itself. A major project was underway to co-ordinate work experience opportunities at the Corporation, who had various partnerships already. Led by Human Resources, this would also involve Community and Children’s Services, the Economic Development Office, the City Bridge Trust and working with a number of brokerages. This was to ensure that the new service would address the different commitments and strategies already in place or planned. It was not thought that expanding the work experience offering would impact on commitments to placements for schools, as generally students required different work experience opportunities to adults and there was a range of people that would benefit.

Members felt that the Corporation had a statutory duty to provide appropriate support where possible, but accepted that due to the wide spectrum of learning disabilities there was no ‘one size fits all’ approach. The Corporation

Report of Homerton University Hospital Foundation Trust

The Committee received a report of Homerton University Hospital Foundation Trust and welcomed Nina Griffith, Workstream Director for Unplanned Care in a cross-borough City and Hackney role, to the meeting. A new 111 service was being procured for North-East London, and the Committee was given an overview of the planned service. The intention was that one phone call would give patients access to a doctor and service if needed, with various outcomes including self-care, a GP, urgent GP or pharmacy appointment, or a referral to A&E. Call handlers would be non-clinical, but clinicians would be on hand and available if necessary. Children and elderly patients would be put straight to through to a clinician. The service was not intended to overlap with 999 which would still be the recommendation for emergencies. The Committee noted the NHE England specifications, and that the single point of entry was a strong national driver.

The Committee noted the current patient model in City and Hackney provided by the City & Hackney Urgent Healthcare Social Enterprise (CHUHSE) system was small and no longer viable. CHUHSE would provide interim cover for face-to-face GP out-of-hours services until March 2019, with the new 111 service going live on 1 August 2018, at which point the CHUHSE telephone service would cease.

A Member suggested that patients over the age of 75 may find it more difficult to express themselves over the phone and asked how the service could help these patients. It was hoped that within call handling issues like this could be picked up and inform clinicians as to how to direct the call. The Committee was informed that the Home Visiting service would also continue for City residents. A key change under the new service was that there would be more options for out-of-hours appointments and locations.

Report of the Director of Community and Children’s Services

The Committee received a report of the Director of Community and Children’s Services updating Members on the progress of the integrated commissioning programme and two current key pieces of work within it – the development of a local integrated care model and the pooling of budgets for Continuing Health Care and Adult Social Care.

The Director of Community and Children’s Services informed the Committee that there were various changes including the introduction of a Sustainability and Transformation Partnership. Local authorities and the CCG had looked at introducing a single system for better delivery and outcomes. It was stressed that this would not be a merger with Hackney, but rather the pooling of some resources with the CCG which would aim to enable quicker design and delivery and drive better outcomes and efficiency. The City of London alone was a small part of the market and this model would give the City of London more of a voice and increased ability to make changes. The emergence of neighbourhood delivery would help with the City’s smaller population base. Implementation would be overseen by the Integrated Commissioning Board which included three City of London Corporation representatives. The Board would have oversight of CCG budgets. The governance structure included four workstreams, each with a Director and Senior Responsible officer. These workstreams were Unplanned Care, Planned Care, Prevention and Children, Young People and Maternity.

The changes were about collaboration and partnership and hoped to see real service delivery change, aiming for equality of service and shared understanding within and between neighbouring CCGs. Along with the 111 service, this approach would allow for more choice and opportunities in areas such as out-of-hours services.

The Committee noted the development of the neighbourhood model with regards to GP services. Members were aware of the national challenges for GP

Verbal Update

The Committee received a report of Homerton University Hospital Foundation Trust and welcomed Dr. Angshu Bhowmik, consultant in respiratory and general medicine and lead clinician for lung cancer, to the meeting. The Committee was given an overview of the process and pathways for healthcare services in diagnosing and treating cancer patients, from the point of GP referral to receiving treatment. The target timeframe for this process was 62 days and the expectation was to meet this target in 85% of cases. However, there were some legitimate reasons why this could not be met, for example in the case of patients who had recently had a heart attack.

Performance in City and Hackney against the 62-day GP standard had been inconsistent over the last 24 months. There were challenges in meeting the target, as pathways were sometimes clinically complex, and histology was often a problem. It could take up to four weeks to devise a treatment plan. Furthermore, many new drugs were available to treat cancers, but special tests were required to determine a patient’s suitability, and it could take up to six weeks to approve drug use. The pathway was stretched to the limit to enable treatments. Timescales for surgery had shortened in recent years, but timescales for chemotherapy had gotten longer. The Committee noted that the majority of treatments completed at Homerton were compliant, but patients who went for treatments at other Trusts who then breached the 62-day target still counted towards the figures for Homerton.

There were three broad categories of delays; pathway management, patient choice/behaviour and clinical complexity. The Committee was informed that areas for improvement to minimise or prevent delays had been identified such as changes to staffing and recruitment, particularly in specialist positions. The hospital was also looking at how quickly tissue samples were

Report of the Town Clerk

Members received a report of the Town Clerk regarding the Committee’s meetings and activities for the year, and the current workplan, and the following agenda items were suggested:

Histology at Royal London – To examine the procedures around histology as part of the process for cancer treatment.

Air Pollution – To look at the actions taken or being taken to improve air quality in the City of London, progress made against the Air Quality Strategy and whether the Corporation’s targets were being met.

SEND – To receive the results of the Corporation’s recent Ofsted inspection for discussion.

Healthwatch – Healthwatch representatives to attend a Committee meeting and report to the Committee on governance changes and restructuring of Healthwatch City of London and Hackney.

RESOLVED – That the proposed schedule of meetings be agreed.

To update Members on the activities of the Inner North East London Joint Health Overview and Scrutiny Committee since the last meeting.

The Committee noted that the last meeting of the Inner North-East London Joint Health Overview and Scrutiny Committee had been cancelled due to adverse weather conditions, and in lieu of a rescheduled meeting, a letter had been sent to the NHS North East London Commissioning Alliance containing questions relating to the agenda items for the cancelled meeting. The Committee noted the documents provided, including the letter sent to the NHS on behalf of the JHOSC and the letter and documents received in response.

RESOLVED – That the report and documents provided on behalf of the JHOSC be noted.

There were no questions.

There was no other business.