Apologies were received from Councillors Umar Alli, Waltham Forest (Richard Sweden substituting) Beverley Brewer, Redbridge, Donna Lumsden, Barking and Dagenham and Adegboyega Oluwole, Barking and Dagenham.

Councillor Brewer was present via videoconference.

Members are invited to disclose any interests in any of the items on the agenda at this point of the meeting. Members may still disclose an interest in an item at any point prior to the consideration of the matter.

There were no disclosures of interest.

To agree as a correct record the minutes of the meeting of the Joint Committee held on 15 June 2021 (attached) and to authorise the Chairman to sign them.

The minutes of the meeting of the Joint Committee held on 15 June 2021 were agreed as a correct record and signed by the Chairman.

Report attached.

The senior vaccination lead for North East London advised that almost 2 million vaccines had been given in North East London. More than 80% of people over 65 had been vaccinated as had in excess of 75% of people over 50. A campaign of booster injections would be starting shortly.

Work had been undertaken with the voluntary sector and faith groups to increase vaccine numbers and the outreach team had been put forward for a national award. Increasing numbers of vaccine sites were now available in community pharmacies and local primary care facilities. Vaccination centres and hospital hubs were also continuing.

A universal offer of vaccines for 12-15 year olds was being worked on and was due to start in the next week. Vaccines were already being given to 12-15 year olds who were considered vulnerable. Officers were aware of the communications sent by anti-vaccine groups to schools and this had been escalated to NHS England and the Department for Education. Guidance on this matter would be provided to schools. A third primary vaccine dose was also being considered for people with a compromised immune system.

Work was also in progress with Councils on completing the vaccination programme in care homes. The vaccination rate for care home and ancillary staff was improving and NHS clinicians were available to give additional assurance to staff.

Different approaches such as drop-in clinics were used with younger age groups. Whilst there were still some issues with younger people, the vaccination for these age groups was improving. Barking & Dagenham vaccination rates were lower, partly due to the younger and more diverse population of the borough. Work had been undertaken with faith groups and a vaccine information bus was used to visit different parts of the borough. Other approaches included webinars with a local boxing club and local businesses in order to give reassurances on the safety of vaccines. Work in Barking & Dagenham was ongoing and it was noted that 90% of Covid patients in the Barts ITU were unvaccinated.

The Joint Committee noted the update.

Report attached.

The Accountable Officer for the North East London CCG stated that the pandemic period had meant a number of necessary changes to services. Some changes had now been reversed but others would remain in the long term as they had been found to give benefits to patients. Work had been undertaken recently to reduce waiting in areas such gastric conditions and orthopaedics.

A Member felt that there were issues about the way in which both Trusts communicated changes. He felt that the Committee should see the proposals for the redesign of surgical services and that it was important to get the mechanics of communication with Members right. The Chief Executive of BHRUT confirmed that the list of wards and their usage requested by the Committee would be available shortly.

It was accepted there was a lot of pressure on primary care at present. Officers agreed that the availability of face to face GP appointments remained important. There was high demand for primary care with for example Havering GPs doing 24% more appointments than previously. Phone triage was often used but patients were then given face to face appointments if appropriate. It was noted that many younger people did prefer remote consultations.

Additional practice staff such as paramedics or pharmacists could often give effective treatment without patients needing to see a GP. Primary care systems were working flat out and fatigue of the GP workforce was a major factor. The number of Covid vaccinations given by primary care was also a factor in excessive workloads etc.

It was accepted that some complaints were received about GP reception staff but this was a very pressured environment. Many GPs were working 7 am – 9.30 pm to clear backlogs. Officers were however happy to look at specific complaints.

There was also a shortage of GPs in the area and many GPs were not willing to work in the local area. There were also significant vacancies across the whole health system. Many members of the public were also given GP appointments via NHS 111. It was felt that people may need to be reducated about the role of the NHS 111 service.

A member of Healthwatch Redbridge asked for details of the patient engagement process around service changes. Officers responded that this depended on which provider ran the service. It was accepted that the NHS should be better at communicating such changes. The BHRUT Chief Executive added that the NHS should accept that it needed to get better at explaining the clinical rationale for changes to service. It was accepted that people wanted BHRUT to explain changes and involve patients. The Chief Executive was happy to have discussions with Members and Healthwatch re  service changes.

Service changes were shown in the agenda papers and on Trust websites. Newsletters were produced for stakeholders and the public but it was accepted that communication could be more effective. Regular meetings were held with Healthwatch in order to discuss service improvements.

A representative of Healthwatch Barking & Dagenham stated  ...  view the full minutes text for item 13.

Report attached.

The Director of Strategy and Partnerships at BHRUT that change was needed to services due to demographic change in Outer North East London and the need to eliminate health inequalities. An appropriate workforce and hospital estate was required to achieve this and the collaboration work with Barts Health would assist with this aim.

The clinical strategy would consider the wider determinants of health and where services are located. There would be a collaborative approach to the strategy with the justification for proposals being shown. Whilst discussions were at an early stage, interviews and surveys were being held with residents, patients and stakeholders. A clear plan would be developed for the oversight and accountability of the clinical strategy. 

The Trust Medical Director agreed that BHRUT must engage with the community in the development of its services. There remained Covid-related constraints on services however which meant it was challenging to deliver the clinical strategy in the current period.

Members felt that the Trust should be flexible about processes and outcomes but it was important short term changes did not conflict with long term plans. Concern was raised however about the very low response rate to the residents’ survey. It was suggested that, if available, the draft Clinical Strategy should be brought to the next meeting of the Trust.

Officers responded that there had now been in excess of 1,000 responses to the survey but they were happy to share the Trust’s communication and engagement strategy. Work would take place with Healthwatch respond to concerns and challenges raised engagement on short term system changes. Officers were happy to hold further discussions with Healthwatch outside of the meeting.

It was agreed that, if the Clinical Strategy was available by the time of the Committee’s December 2021 meeting, it should be brought to that meeting for scrutiny.

Report attachded.

The Committee was advised that the collaboration between BHRUT and Barts Health was in line with recent legislation covering areas such as the role of Integrated Care Systems. This encouraged providers to work more in collaboration than competition. The primary motivation for the closer collaboration was to achieve better outcomes for residents. Officers added that Trusts often collaborated and this partnership presented an opportunity to see what could be done better together.

Closer working would help BHRUT to deal better with the challenges of population growth in the sector. Local hospitals were being made more resilient by for example the opening of a new ED at King George Hospital in November. Collaborative work was also undertaken with the London Ambulance Service and for example the Royal London Hospital on emergency care pathways at Queens Hospital.

A Member suggested the new Chair of the two Trusts be invited to the next meeting of the Joint Committee. Concerns were raised however over whether BHRUT would remain independent and whether the Trust Chief Executive would remain as the accountable officer for the Trust. The Trust Chief Executive confirmed there was no plan for a merger and that he would remain as the accountable officer. It would be for the Chair to decide on the make-up of the Trust boards. The joint arrangements were only scheduled to April 2022 at present. Joint appointments could not be ruled out if they were felt to deliver better outcomes for all residents in North East London.

Members raised concerns that many services were being centralised to Inner North East London and officers responded that they wished to use their assets better give better accessibility of services to all residents. Consideration was being given to what additional services could be introduced at Barking Commmunity Hospital. It was hoped to reduce variation in services across the whole of North East London.

The Joint Committee noted the position.

The Joint Committee is invited to suggest items for inclusion on its future work programme.

As discussed, the Committee agreed to scrutinise the BHRUT clinical strategy at its December meeting, should this be available. It was also agreed to invite the new Chair in Common of BHRUT and Barts Health to the next meeting of the Joint Committee.

Meetings of the Joint Committee will be held at 5 pm on the following dates, venues to be confirmed.

Tuesday 14 December 2021

Tuesday 8 March 2022

The next meeting of the Joint Committee was scheduled for Tuesday 14 December, venue to be confirmed.