To receive apologies (if any).

Apologies were received from Councillors Ray Best and Darren Wise (present via videoconference). Apologies were also received from co-opted Members Jack How, Julie Lamb and Ian Rusha.

Members are invited to disclose 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 time prior to the consideration of the matter.

There were no disclosures of interest.

To approve as a correct record the Minutes of the meetings of the Committee held on 20 July 2022 and to authorise the Chairman to sign them.

The minutes of the meeting held on 20 July 2022 were agreed as a correct record and signed by the Chairman.

Report attached.

Officers representing the BHRUT Acute Trust advised that the post-pandemic period has seen a large rise in requests for healthcare. BHRUT was only meeting its constitutional standards to treat people within 18 weeks of referral on around 60% of occasions. On cancer performance, the Trust was exceeding national targets with around 87% of patients receiving treatment within 62 days of referral.

Work was ongoing to reduce waiting lists and to lower waits for MRI and CT scans. The Trust was investing £15m in a new diagnostic centre in Barking to address this. This would not be live for at least a year and further updates could be provided. Details of engagement with the public on these proposals could also be provided. Super clinics had also been run to improve patient volume in certain specialities. Measures to address workforce pressures included improved training for staff including cost of living support such as vouchers for staff and access to school uniforms.

The Trust Executive team was seeking to keep a focus on areas identified by the Care Quality Commission. There had been a rise in urgent cancer referrals although it was still hoped to meet cancer targets over the next six months. It was agreed that an update on progress with meeting cancer targets should be given to the Sub-Committee in approximately six months.

It was not felt that the current level of vacancies would impact on the Trust’s ability to deliver the 18 week treatment target. It was hoped this target could be met by early 2024 although cancer targets would be met sooner.

Recruitment and retention issues were not just limited to A & E with many clinicians choosing to live outside London. The Trust was keen to offer its staff career progression across the whole economy. It would be checked if there were currently opportunities for Trust staff to work with the Council.  

Regarding the recently publicised computer error at the Trust, a lot of referrals due to be seen during the pandemic had been held off until after that period. A scripting error had however taken patients off the waiting list after 6 months. The affected patients were now being seen as a priority.

The waiting times issues were not unique to London but officers accepted there was a backlog of long waiting patients at BHRUT and Barts Health. There was a commitment to address this issue across the NHS.

The super clinics were mainly carried out at weekends and it was planned to manage care differently based on the learning from these events. These would not continue indefinitely and there was a need to decide about NHS weekend treatment nationally. An update could be given on the numbers of staff involved in super clinics.

More private sector support was used by the NHS during the pandemic. Other NHS providers were now more commonly used with e.g. Moorfields giving support to the ophthalmology department. At King George Hospital, a Care UK unit continued to provide support for day surgery.  ...  view the full minutes text for item 4.

Report attached.

The new health facility at the St George’s site would support Queen’s in areas such as early diagnostics and minor surgery. The impact of events such as the war in Ukraine meant the cost of the project had risen from £27m to £37m. The capital funding for the project had however been covered by the Integrated Care System for North East London.

A decision from the Department of Health on the project business case was expected on 14 November. Work had already started on the site with a completion date of March 2024.

The new facility would allow staff to work at the site for different providers which would be attractive to staff, allowing them to learn different skills. Issues with access to parking at the site had now been resolved.

The Sub-Committee noted the update.

Report attached.

The Deputy Director of Planned Care at the North East London Integrated Care Board explained that the delivery of phlebotomy had been changed by the Covid-19 pandemic. Work on a new model of phlebotomy had recommenced following the pandemic.

A pilot to test the provision of phlebotomy at weekends had taken place 22 sites across the three local boroughs. The pilot had produced very high levels (in excess of 95%) of patient satisfaction. 98.3% of over 65s had reported it was easy to get an appointment.

The service would be provided by NELFT and the business case for the permanent model had now passed the first stage. An offer had been made to primary care to deliver blood tests. A number of local GP surgeries had taken this up. Children’s phlebotomy was carried out via BHRUT. Guidance on the process for this was available. The children’s pathway was dependent on the confidence of the phlebotomist to carry out the procedure. There were separate phlebotomy streams at BHRUT for children under 7 and aged 7-12.

The Sub-Committee noted the position.

Report attached.

The Long Covid clinic at BHRUT had received coverage in the national and international news. Access to the Long Covid service was best in Havering although there were lower levels of referrals to therapeutics. A team and learning approach was adopted in the Trust’s approach to treating Long Covid.

On the issue of enhanced access to primary care, an increase would be implemented from October 2022 to 60 minutes worth of appointments being available per 1,000 patients. One GP surgery in each primary care network would be required to offer appointments 6.30 – 8.30 pm on weekday evenings as well as 9 am – 5pm on Saturdays. This would be in addition to the existing GP hubs.

The new service was based on 28,000 patients responding to a survey. On line booking of GP appointments was not available yet – this was a national issue. It was noted that enhanced access in the Crest Primary Care Network would commence at the Rush Green Medical Centre but that this may move to Raphael House. Bookings would be able to be made either on the day or up to two weeks in advance. Patients would be seen by a multi-disciplinary team.

The existing GP access hubs would continue until March 2023 at which point the service would be reviewed. A Member raised the older demographic of residents in the east of Havering but officers explained that a hub had been established in the south of the borough to be a facility for the under-served areas in South Hornchurch and Rainham. It was necessary to take a realistic view with such facilities and this could be addressed over time.

It was accepted that there was understaffing in Havering for GPs, GP nurses and Health Care Assistants. A scheme to attract GPs who wished to further their areas of interest had proved successful and it was aimed to increase the number of GPs and GP nurses in Havering by 2025. Better staff training and development was also being introduced to improve retention of staff.

Local work was looking at upskilling existing staff to e.g. assist with the vaccination programme and offer more opportunities for work experience across the borough. The enhanced access to primary care model could be assisted by bank doctors if there were staffing issues. Bank nursing could also be used to provide out of hours primary care cover.

The Council’s Director of Public Health advised that health inequalities referred to unfair, avoidable or systematic differences in health outcomes. This was also impacted by wider determinants of health such as smoking rates, income levels, housing and access to and the quality of health & care services. Other factors included ethnicity, gender and the location in which people lived.

Inequalities assessments were carried out but it was felt that Members could scrutinise this area as they had a collective responsibility to ensure decisions were robust. The inclusion of health & sustainability comments in reports of Council Executive Decisions was currently being considered.

Life expectancy  ...  view the full minutes text for item 7.