Agenda and minutes

Health Scrutiny Panel
Wednesday, 17th December, 2014 7.30 pm

Venue: Conference Room, Civic Centre, Silver Street, Enfield, EN1 3XA. View directions

Contact: Elaine Huckell 

No. Item


Welcome and Apologies


Apologies for lateness were received from Cllrs Jiagge and Neville.


Declarations of Interest

Members of the Council are invited to identify any disclosable pecuniary, other pecuniary or non-pecuniary interests relevant to items on the agenda.


No declarations of interest were made.


Chair's update


The Chair gave the following update:


Although this was the first public meeting of the Health Scrutiny Standing Workstream since the election, the Chair had been working on a number of issues relating to the health of Enfield’s residents (a summary of the meetings and visits undertaken by the Chair over this period was tabled).


Recent meetings had included items relating to North Middlesex Hospital, London Ambulance Service and hospital parking. Enfield was working closely with the Joint Health Overview & Scrutiny Committee to ensure best use of resources and to avoid duplication.


Having been made aware of the issues regarding the financial viability of the Barnet, Enfield and Haringey Mental Health Trust and the CCG funding position, the Chair had met with both parties and hoped that by instigating further dialogue, the situation around funding could be resolved.


Together with other members of the Joint Health Overview & Scrutiny Committee, the Chair had toured 3 sites (Barnet, Chase Farm and Royal Free Hospitals) and expressed her thanks to the hospital staff concerned.


The Chair expressed her thanks to Cllr Anne Marie Pearce for keeping a watching brief on stroke services. Cllr Pearce had recently viewed the excellent facilities and care at the North Middlesex Hospital’s stroke ward. In her role as patron of the local stroke association, Cllr Pearce would also be meeting with the Stroke Co-ordinator for the borough to discuss service provision in the New Year.  Monthly meetings of Stroke Action would resume from 15 January at Cumbria Lodge.


The new Ordnance Unity Centre was now open, providing GP services, dental care, a library and community space. The original GP surgery in Ordnance Road was the subject of a Councillor Call for Action from the former Ward Councillor, the late Cllr Ruth Hones. The Health Scrutiny Panel had worked actively to improve access to GP services in the area, culminating in the closure of the original surgery and the development of the new health centre and library.


Lastly, the Chair welcomed the representative from Enfield Healthwatch and thanked them for the recent audit they had undertaken of GP services.


Re-Development of Chase Farm Hospital

To receive a presentation from Andrew Panniker, Director of Capital and Estates, Royal Free Hospital Trust.


Andrew Panniker, Director of Capital and Estates, Royal Free London NHS Foundation Trust, gave a presentation on the Chase Farm Hospital redevelopment programme, the main points of which were as follows:


·         Existing buildings were dispersed over the site, in a poor state of repair and no longer suitable for modern healthcare needs.  The site therefore required comprehensive redevelopment.

·         The Trust had submitted an outline planning application on 21 November and it was anticipated this would be taken to Planning Committee on 15 February.

·         The Outline Business Case would be taken to the CCG and then to the Trust Board by the end of January.  It would then be submitted to the Department of Health.  Communication had been ongoing with the Department of Health to ensure they were kept informed of progress and it was anticipated that they would approve the OBC within 8 weeks of submission.

·         Surplus land would be sold in phased parcels from early 2015; vacant possession of residential units was being sought by end March 2015. 

·         Commencement of clearing the site in preparation for development would begin in March 2015.  During this process, clinical services would continue to be provided; the Urgent Care Centre would be moved to another location.  Necessary redecoration would also continue during the project.

·         The Full Business Case would be submitted to the Trust Board and Department of Health in the summer of 2015; this would review the OBC to ensure no material changes had occurred since its submission.

·         A number of consultation events had taken place in July, September and November with stakeholders, tenants and residents.

·         The new plan would comprise a new hospital campus over 17 acres, new residential units over 18 acres and a new three form entry primary school over 4 acres.

·         The Highlands building and car park would be retained. 

·         A new central hospital building would be built.

·         It had been decided to repurpose the Highlands building from the original plan (it had originally been intended to use the building for outpatients, with inpatients being accommodated in the new hospital building).  The new purpose of the Highlands building had not yet, however, been decided.

·         Redevelopment aimed to ‘future proof’ the site to allow for required expansion of services.

·         The new hospital building would accommodate services with heaviest footfall on lower floors and lightest footfall (ie. Inpatient wards) on the higher floors.

·         Clinical provision would include 8 theatres, an Older People’s Assessment Unit, 6 virtual booths for telemedicine, diagnostics (x-ray, ultrasound, MRI, CT scanner), a GP Out of Hours Service, 4 High Dependency Unit beds and 44 in-patient rehabilitation beds.

·         There would also be additional facilities such as a café, restaurant, teaching space and retail unit.

·         An Energy Centre would provide power to the school, hospital and some of the new residential units. 

·         There would be 483 units of housing comprising 1, 2 and 3 bedroom flats and a range of houses.  Final valuations on the land to be sold were being obtained; with a view  ...  view the full minutes text for item 303.


Enfield Clinical Commissioning Group

To receive a verbal briefing from Clinical Commissioning Group (CCG) representatives in relation to their role and current issues.


Dr Mo Abedi, Chair, and Liz Wise, Chief Officer, Enfield CCG, gave a presentation, the key points of which were as follows:


·         The CCG was a new organisation created by the Health and Social Care Act 2012.

·         The Enfield CCG had been fully licensed as at October 2013 (seven conditions had been imposed when licensed on 1 April 2013 but these had been lifted).

·         The CCG is a clinically led organisation; this is different from the previous PCTs.

·         The CCG aimed to commission services that improved the health and wellbeing of residents through the procuring of sustainable whole system care.

·         The CCG worked in partnership with the local authority and both the CCG’s and the Council’s strategies mirrored each other to help enable this.

·         Quality was monitored by ‘walking the patient pathway’; this was one of the key advantages of a clinically led organisation.

·         Although NHS England were now responsible for primary care commissioning, the CCG aimed to work with NHS England to improve primary care delivery and quality.  Key achievements in this respect included the recruitment of 4 new GPs to the Borough and delivery of a scheme to increase the identification and referral of domestic violence victims.

·         The CCG’s Governing Body is supported by sub-committees.  All are led by clinicians or field experts.

·         The Governing Body adheres to the ‘Nolan Principles’ which are set out in its Constitution.

·         Key challenges in performance were referral to treatment within 18 weeks, A&E waiting times (which was a national challenge) and improving the diagnosis rate of people with dementia.  The latter was a national target and needed to be prioritised in Enfield due to its ageing population.

·         The CCG’s Transformation Programme had six priorities.  There would be a greater focus on outcomes based commissioning, rather than counting activity.

·         The Better Care Fund would be introduced from April 2015 and aimed to improve, through a pooled budget, integration between health and social care.

·         The Enfield allocation for the BCF was £20.585m.  The spending plan for the BCF in Enfield had recently been agreed by the Health and Wellbeing Board.  Funding would be particularly targeted at services and care for older people.

·         The CCG had produced its first Annual Report and Accounts and these were available online at

·         The CCG had met its statutory financial duties for the year 2013/14, despite challenges.

·         NHS England had launched a new funding formula for NHS commissioning organisations.  Currently, Enfield was £33m below where its funding level should be; it would therefore receive under the new formula an above inflation increase in allocation.  Despite this, Enfield would still be around £20m below its target allocation.

·         The CCG aimed to increase cluster working with other CCGs and increase co-commissioning with NHS England.

·         Residents could engage with the CCG in a number of ways either via its website (see above), Healthwatch Enfield or getting involved with, for example, their GP’s patient participation group (PPG).


The following questions were then taken:


Q:        When was the decision  ...  view the full minutes text for item 304.


Enfield Council's Role in Commissioning

To receive a verbal briefing from the Director of Health, Housing and Adult Social Care.


Bindi Nagra, Assistant Director Strategy & Resources, Health, Housing and Adult Social Care, outlined Enfield Council’s role in commissioning as follows:


Strategic Leadership


Strategic leadership for health and social care commissioning was mainly provided through the Health and Wellbeing Board, which had been introduced as a requirement under the Health and Social Care Act 2012.  The Board was chaired by Cllr McGowan (Cabinet Member for Health and Adult Social Care).  Also sitting on the Board were the Leader of the Council, three corporate Directors, the Chief Executives of the North Middlesex University Hospital NHS Trust, the Royal Free London NHS Foundation Trust, the Barnet and Enfield Haringey Mental Health Trust and representatives from Enfield Healthwatch and NHS England.


The Board was an important body in the commissioning of services and set the tone for strategic commissioning in Enfield.


Key Strategies that the Health and Wellbeing Board referred to were the Joint Strategic Needs Assessment and the Health and Wellbeing Strategy.  It was noted that CCG strategies mirrored these.


The Board also had a number of sub-groups such as the Joint Commissioning Board, the Health Improvement Partnership Board and the Integration Sub-Group.


Public Health


In 2013 local authorities became responsible for public health.  Enfield Council worked to improve public health in partnership with the Enfield CCG.


The budget for public health in the current year was £12m.  The allocation for 14/15 was £40 per head of population; it was noted that the average for London was £73 per head.  The public health budget was ringfenced.


The Council’s public health budget was split between mandated and non-mandated services.  Mandated services included NHS healthchecks and sexual health services.  Non-mandated services included smoking cessation and tackling alcohol and drug misuse.  The greatest area of spend was on sexual health services.


Other services such as certain dental and HIV prevention services were also funded through the Council’s public health budget.


Joint Commissioning Arrangements


The Council had a number of joint commissioning arrangements, primarily with the CCG.  There were also a number of joint commissioning managers (for example, learning disability).


The local authority could also provide leadership and pooled funding for, for example, voluntary organisation grants, an integrated equipment service and an integrated learning disability service.


The Council also had a responsibility for commissioning Healthwatch as a consumer champion.


The following questions were then taken:


Q:        What is the formula used for calculating the cost per head (£40) you mentioned for Enfield’s allocation?  Can this be increased?

A:        This cost was not derived from a formula as such, but calculated according to historic spend. 


Q:        Was funding for learning disability services included in the £12.5m allocation for 13/14?

A:        No, this funding is not related to the public health budget.


Q:        Is the Council paying for so-called ‘bonuses’ to doctors for diagnosing certain conditions?

A:        ‘Bonuses’ is a bit of a misleading term.  We do commission some GP services using the public health budget – healthchecks and contraceptive services.  The healthchecks we commission are for  ...  view the full minutes text for item 305.


Any Other Business


No items were put forward.


Dates of future meetings

To be confirmed


The date of the next meeting was to be confirmed, but it was noted as likely to be in 2-3 months.


Exclusion of the Press and Public

To consider, if necessary, passing a resolution under Section100(A) of the Local Government Act 1972 excluding the press and public from the meeting for the item of business listed in Part 2 of the agenda on the grounds that it will involve the likely disclosure of exempt information as defined in those paragraphs of Part 1 Schedule 12A to the Act, (as amended by the Local Government (Access to Information) (Variation) Order 2006), as are listed on the agenda (Please note there is no Part 2 agenda).