Agenda and minutes

The Chairman will announce details of the arrangements in case of fire or other events that might require the meeting room or building’s evacuation.

The Chairman gave details of the arrangements in case of fire or other events requiring the evacuation of the meeting room.

Apologies were from Councillors Sanchia Alasia, Josephine Channer & Abdus Salam (Barking & Dagenham) Stuart Bellwood+ & High Cleaver (Redbridge) and Chris Pond Essex.

+Councillor Filly Maravala was substituting for Councillor Bellwood.

Councillors Paul McGeary (Havering) and Winston Vaughan (Newham) were also present.

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

Councillor Sweden declared a personal interest as he was managed in his employment by the North East London NHS Foundation Trust (NELFT).

Councillor Braham declared a personal interest as he worked for the NHS but not in a paid capacity.

To approve as a correct record the minutes of the meeting held on 10 January 2012 (attached) and authorise the Chairman to sign them.

The minutes of the meeting of the Committee held on 10 January 2012 were agreed as a correct record and signed by the Chairman.

It was agreed to defer the planned presentation to the Committee on hospital transport until after the Olympic and Paralympic period.

Officers would confirm if the revised slides from officers concerning Health for North East London had been circulated to the Committee.  

To receive a presentation from NHS Outer North East London officers on the planned Commissioning Support Organisation for East and North London.

NHS officers explained that, with effect from 1 April 2012, primary care services were being provided by NHS North East London and the City (NHS NELC) covering all seven North East London boroughs. The Health and Social Care Act had now received Royal Assent however and all Primary Care Trusts, including NHS NELC would therefore be abolished from April 2013. The replacement structures including Clinical Commissioning Groups (CCGs) would operate in shadow for the 2012/13 year.

There would be one CCG in each borough and all CCGs had now appointed Chairs and Clinical Directors. CCGs were planning for full authorisation from April 2013. CCG managerial support costs (a separate budget from the cost of providing medical treatment) had been set at £25 per head of population.

An organisation called Commissioning Support Services had been set up to develop support for CCGs in North East and North Central London. This would be able to provide services efficiently to local CCGs by utilising economies of scale. The Commissioning Support Services organisation was however itself under development and it was planned to submit a full business plan for the organisation to the Department of Health in August 2012. Service level agreements with CCGs and performance indicators were also being developed. Engagement with other stakeholders including Local Authorities would continue throughout the 2012/13 period.

Officers explained that there was already a great deal of collaboration or joint commissioning taking place and discussions were ongoing to ensure that the £25 per head budget was sufficient. Officers agreed to hold discussions with Councillor Braham separately from the meeting regarding issues around the introduction of community matrons into a Waltham Forest health centre.

The issue of “ghost patients” – people who had moved away from an area but remained on a local GP’s list was presently under discussion with the British Medical Association. Members noted this but were concerned that this could impact negatively on services if GP lists were not up to date.

It was accepted by officers that CCGs could collaborate on certain issues for example recent changes to psychotherapy services, but this was not a cross-subsidy.

The Committee questioned why only some GP surgeries had patient participation groups and also how the Commissioning Support Organisation would engage with the public. Officers responded that each CCG was obliged to have a named lead for patient and public involvement. Issues around non-IT access were being considered but equally many young people preferred to respond by e-mail rather than for example attend a patients’ meeting. Members felt that many GPs in, for example Waltham Forest did not take these responsibilities seriously and officers responded that these were matters that could be taken up at practice level. A further problem was difficulties seen in some areas with attempts to cleanse GP lists which had in fact been postponed in Waltham Forest.

It was clarified that the NHS NELC Chief Executive – Alwen Willams and Board now covered seven PCT areas. Inner and Outer North East London were  ...  view the full minutes text for item 18.

Discussion with North East London NHS Foundation Trust officers concerning proposed changes to psychotherapy services in Outer North East London.

NELFT officers explained that, during its most recent round of negotiations with commissioners, it had been agreed that NELFT could go ahead with changes to its psychodynamic psychotherapy services. These had previously been delivered from a dedicated building in Waltham Forest but the Trust now wanted to offer equal access to these services across its geographical area. Consultation on the proposals had been undertaken with CCGs, Local Involvement Networks and the Overview and Scrutiny Committee in Waltham Forest.

The Head of Psychological Services at NELFT added that broad support for the model had been received from NELFT staff and funding for the new service had been confirmed by the Trust Board. The Waltham Forest Health Overview and Scrutiny Committee had also broadly supported the proposals. It was emphasised that, although psychodynamic psychotherapy formed a very important part of NELFT’s services, the Trust did offer a whole range of other services with for example cognitive behavioural therapy also playing an important role.

It was accepted that one reason for the planned changes was to make financial savings but the Trust was also committed to all areas or boroughs having equal access to its services. There was also a need to ensure the diverse population of Outer North East London received sufficient services with for example BME communities, refugees and asylum seekers all needing mental health support. Changes such as those proposed would assist NELFT to deliver more services with less money. Officers agreed that the National Institute for Clinical Excellence (NICE) did not currently give sufficient emphasis to psychodynamic psychotherapy and the UK Council of Psychotherapists had recently said therapies of this type were not sufficiently represented in NICE guidelines.

Officers agreed that there was currently not enough access to this type of therapy in areas such as Havering and insisted that services would not be equalised down to the lowest current level. These changes would allow for the first time the introduction of a specialist service in Barking & Dagenham, Havering and Redbridge. There would be teams in each borough and more resources would be allocated to reflect e.g. the high numbers of older people in Havering.

At present, some people needing psychodynamic psychotherapy services would be referred to the Tavistock Clinic in central London. Officers emphasised that the proposed model would give people access to the service in their home borough. All treatment currently carried out in Waltham Forest would also be guaranteed.

The Chairman thanked the officers for their attendance and for the considerable changes they had made to their original proposals following their appearance at the Overview and Scrutiny Committee in Waltham Forest.

The Committee noted the presentation.

To receive a presentation and update on the primary care strategy for Outer North East London.

The Medical Director of NHS NELC thanked the Committee for the invitation to attend. The primary care strategy had been consulted on between November 2011 and February 2012. All responses from stakeholders had been collated and presented to the cluster Primary Care Trust Board. The strategy had now been further developed with local stakeholders and partners via the CCGs. Ninety per cent of health care contacts were through GPs and so the strategy aimed for as high a quality of GP care as possible. There was also a need to reduce health inequalities via the strategy.

The Primary Care Strategy was based on three key principles – ensuring the best outcomes for patients, achieving value for money in primary care provision and that services are provided from fit for purpose premises. The strategy also sought to take into account the increasing number and diversity of population in North East London and the variation of health outcomes across the different boroughs.

Key recommendations of the primary care strategy included a sustained focus on improving quality and the establishment of an integrated network of primary care providers. This was already seen with a group of GPs in Chingford who had established links with health and social care and community pharmacies in order to attain a level of critical mass for treatments. The strategy also sought to ensure a suitable workforce to provide care both now and in the future and effective IT to support the health system.

The Medical Director added that a number of very useful suggestions had been made during the consultation and individual CCGs were now working with partners to develop their own local primary care strategies. CCGs would be expected to have dialogue with overview and scrutiny committees and other stakeholders concerning the strategy over the coming months. The key personnel in each borough at this stage and the main contacts would be the CCG Chair and the NHS NELC borough director.

The Medical Director recognised there was a rising prevalence of TB in certain areas. It remained a priority under the primary care strategy to seek to prevent TB in North East London. The recognition of the relevant symptoms was important and best practice would be followed in terms of advertising of TB examinations etc.

It was the case that there were very significant undiagnosed long term conditions in the local area and the Medical Director wished to ensure that patients went to their GP at an earlier stage. GPs wished to support patient engagement and would work with CCGs on how this can happen in practice. This could potentially include allowing space for self-help groups etc. to meet in surgeries, where this was practicable.

CCGs were organised to cater for specific, differing needs in each borough and to obtain the best health outcomes for the local population. There would not be a standard size of practice set as the Medical Director felt that service quality did not correlate with the size of a practice. A hub  ...  view the full minutes text for item 20.

Provisional dates and host Councils as shown below, for discussion and agreement (all 3.30 pm start):

Tuesday 10 July, Essex (Loughton)

Tuesday 9 October, Barking & Dagenham

Tuesday 8 January (2013) Havering

Tuesday 9 April, Redbridge

The Committee discussed the arrangements for future meetings including whether these should be held in the morning, afternoon or evening (or a combination of different start times). It was agreed to defer a decision on this until the matter had been discussed further at the next meeting.

To consider any other item in respect of which the Chairman is of the opinion, by means of special circumstances which shall be specified in the minutes, that the item shall be considered at the meeting as a matter of urgency.

The Committee congratulated Councillor Sweden on his appointment as the Mayor of Waltham Forest and thanked him for his hard work with the Committee. Councillor Sweden thanked the current and previous members of the Committee as well as supporting officers including the clerk to the Committee. He asked that particular thanks be recorded to Councillor Ted Eden of Havering for all his input into the Joint Committee in previous years.