Agenda and minutes

Health Scrutiny Panel
Thursday, 5th January, 2017 7.30 pm

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

Contact: Elaine Huckell 

No. Item




The Chair welcomed everyone to the meeting. He said we were joined by two health organisations – North Middlesex Hospital and Enfield CCG and he welcomed members of LB Haringey’s – Adults and Health Scrutiny Panel.

Apologies were received from Libby McManus (Chief Executive, NMUH).



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


Councillor Pippa Connor (Haringey Council) stated that her sister was a GP in Tottenham.



To receive a presentation on the CQC Inspection and the latest performance figures.

A copy of the CQC report is attached.

Additional documents:


The Care Quality Commission (CQC) Report on the North Middlesex University Hospital NHS Trust (NMUH) was published in December 2016 and Dr Cathy Cale gave a presentation on the Trust’s response to the inspection report and spoke of future actions to be taken.


Richard Gourlay also gave a presentation on a proposal for the Trust to join the Royal Free London NHS Foundation Trust which also includes Barnet and Chase Farm Hospitals.


Dr Cale referred to the CQC inspection which took place in September 2016. The Quality report was published on the 16 December 2016. The CQC held a Quality Summit on 20 December 2016. 


Dr Cale highlighted the following:

  • The overall rating for the Trust was - ‘Requires Improvement’
  • A number of ratings were given as good. One was shown as ‘Inadequate’ – this was for the maternity and gynaecology service – i.e that it was not well-led
  • The report had been shared with staff on the day it was published. The Trust accepted the CQC report and considered it to be fair.  They stated that it focused in a balanced way on what is done well and what needed to be improved.
  • It would be used as a basis for building on improvements that have already been made.
  • An integrated improvement plan is being written. It is currently being mapped against the CQC report.  The key focus is rebuilding the confidence of both patients and staff.  Issues have been identified but in many cases these are not ‘quick fixes’.
  • Many areas are doing well – there is a need to ensure consistency throughout the service
  • The ‘inadequate’ rating given for a ‘well-led’ Maternity service, relates to subjects such as governance and learning.


The following questions/ issues were then raised:


Q) It would appear that improvements have been made in A&E (ED) but is this at the expense of other services?

A) No it has not improved at the expense of other services. There has been great motivation by staff to improve all services. We have focused on the whole hospital to improve services but we recognise that there is still a lot of work to do.


Q) How long will it take for the hospital to get to a reasonable standard?

A) Although the overall CQC assessment was ‘Requires Improvement’, many areas were considered to be good.  Some changes can be made quickly and in those cases we have made the changes needed, other situations take longer for example - the learning culture needs to be embedded and can take time.  We have time scales for everything that is to be included in the improvement plan.  


Dr Cale agreed that time was of the essence and that it was important for the hospital to get to a better standard and that everyone was working on this. She said people were already seeing improvements.


Q) From looking at the CQC report there are a number of items that should be relatively quick and easy to fix?  For example  ...  view the full minutes text for item 278.



To receive a report from Enfield Clinical Commissioning Group (CCG) in relation to the ‘Adherence to Evidenced Based Medicine Programme .

Additional documents:


Dr Mo Abedi (Chair Enfield CCG) presented a report on Adherence to Evidence Based medicine programme which considers a review of treatments based on clinical evidence, thresholds and access criteria.  He introduced Gina Shakespeare, the Project Consultant and referred to Dr Jahan Mahmoodi, Clinical Director, who has been co-ordinating the programme with the Local Authority.


Dr Abedi spoke of the main aims of the programme which are to ensure that services are commissioned where there is acceptable evidence of clinical benefit and cost –effectiveness. Also to reduce unacceptable variation across Enfield and to promote the cost-effective use of healthcare resources.  Gina Shakespeare also spoke of the consultation and engagement work undertaken.


The following was highlighted:

  • The need to adhere as closely as possible to the clinical evidence base including that published by NICE (National Institute for Health & Care Excellence). 
  • As an example Dr Abedi referred to some procedures such as in the treatment of hernias which for many can be managed without intervention. This allows for a better quality of life as operations would take place in cases of pain, or in emergency cases.
  • Referrals for treatment in Enfield are to be sent to a central repository and triaged by a local GP. This is then sent on for treatment or referred back to the GP where discussions would take place with the patient on future treatment/ management of conditions. There would remain the special funding form mechanism for cases that GP’s wish to continue to progress
  • Consultation and engagement exercises are taking place including public meetings, talking to stakeholders, information on website.  It is hoped to capture conversations at all levels.


The following questions/ issues were raised:


The Chair said communications would be very important in taking this programme forward. He asked how thresholds compared for Enfield with other areas of North London and was concerned that Enfield residents should not face potential access restrictions, which were not applied across other areas in North Central London. 


It was stated that the CCG would continue to carry out work with partners in North Central London, and ensure that there is a standardised system across the North Central London area . The objective is to ensure all patients get ‘what works’ and to achieve performance standards with the same differentials/ consistency.  Thresholds and how we are keeping to them have been discussed with the Health & Wellbeing Board.


Q) If all goes well when will the programme be implemented?

A) The CCG plans, are subject to the outcome of its engagement and consultation, and decision making by North Central London partners. Implementation date is 1 April 2017.


Q) Under the referrals system will the triage person be second guessing the GP?

A) The function of the triage is not gate-keeping, it is to ensure the clinician is including adequate and relevant material and that the person has been investigated at the correct level. 


Q) Two of the procedures mentioned -for hips and knees will cause concerns as people in pain resulting  ...  view the full minutes text for item 279.



To receive a presentation from Enfield CCG on progress of the urgent care review.


Graham McDougall (Director of Commissioning CCG) gave a presentation on the North Central London Integrated Urgent Care Service and highlighted the following:

  • The service combines the 111 and GP ‘out-of-hours’ services.  This integration system is being done nationally. We are ahead of many other authorities as ours commenced at the beginning of October 2016.
  • This ‘clinical hub’ brings together GP’s nurses and pharmacists and will deal with approximately 22,000 calls a month.
  • There is a future proposal for this to also include mental health issues
  • Priority is given to patients who are elderly, in care homes and the under 5’s
  • Of calls received 33.4% received a clinical assessment. 
  • 18% of calls were closed by being given advice, 12% callers received face to face appointments with out of hours GP and 8-9% were referred to A&E.
  • If someone wishes to see a GP then they are booked into one of the ‘hubs’
  • Calls from care homes to 111will come up as an alert and would enable direct transfer to a clinician. One aim of this is to avoid people ringing 999 


The following questions/ issues were then raised:


Councillor Abdullahi spoke of the information provided that accounted for 73% of calls received and wondered how the remaining numbers were allocated. Graham McDougall would revisit the data. It was agreed that whilst 94% of callers had found the IUC service to be very or quite helpful, it may be useful to find out from the remaining 6% what they thought of the service as a way to ‘drive up’ results.


Q) Where will the hubs be based for those people wishing to make a direct booking?

A) They are at – Evergreen, Freezywater, Carlton House(Town) and Green Lanes (Winchmore Hill)


Q) Does the ‘Chat’ service still exist for Care Homes?

A) It does still exist and has been highlighted as providing an excellent service


Q) Why would people be advised to use the 8 to 8 hub rather than using their own GP?

A) The idea is that there is a central point for the locality to help with availability.  Appointments are mainly for those people who cannot use the GP surgery in core hours.


It was stated that this had been a good example of patient involvement in the consultation process.



That Enfield CCG would provide further updates on the Urgent Care Review to the Health Scrutiny Panel.



To receive a presentation, from Enfield CCG, on the consultation process relating to the service re-design of the Paediatric Assessment Unit.


Graham MacDougall, (Director of Commissioning CCG) gave an update on the public consultation for the proposals for service re-alignment for the PAU. 

The following was highlighted:

  • That the consultation on proposals would be completed on 15 January 2017. There is an on-line survey and consultation events are continuing to take place.
  • A report on findings will be considered by the CCG’s Clinical Reference Group on 8 February 2017 and a final decision will be made by the Governing Body on the 22 March 2017.


As the next meeting of the Health Scrutiny Workstream is to take place on the evening of the 22 March 2017, it was agreed that a representative of the CCG would come along to update the meeting on the decision taken on the PAU.


The following question was raised:


Q) Where is the CCG in respect of its assessment?  Is there to be a further assessment and how does Enfield CCG compare to others in the country?

A) We are under special measures because we are in deficit to NHS England and are subject to monthly scrutiny.

We are on target for the year and are fully compliant with special measures, therefore we are in a good place to move forward.

In terms of other authorities, we are one of three who are in special measures in London, however I do not know how many there are in the country.



That a representative of the CCG would come along to update the next meeting of the Health Scrutiny Workstream on the 22 March 2017 on the decision taken by the Governing Body on the PAU.



To note and agree the Work Programme for 2016/17.


The Work Programme was NOTED and would be updated to include update items on the North Middlesex Hospital and the CCG –Also regarding the decision on the Paediatric Assessment Unit .  It was also thought useful to discuss the number of Urgent Care Hubs at an informal session as it was questioned whether four would be sufficient for the Borough.







To receive the minutes of the meeting held on the 5 October 2016.


The Minutes of the 5 October 2016 were AGREED.



Wednesday 22 March 2017


The next meeting would be held on Wednesday 22 March 2017 at 7.30pm.