Agenda and minutes

Health Scrutiny Panel
Wednesday, 22nd March, 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. He welcomed Councillor Pippa Connor a member of LB Haringey’s – Adults and Health Scrutiny Panel. He said we had worked closely with colleagues from Haringey at several meetings relating to North Middlesex Hospital. He also welcomed Noelle Skivington from Enfield Healthwatch.


In respect of item 5– Adherence to Evidence Based Medicine the Chair read out a statement from NHS Enfield CCG, as follows:


‘NHS Enfield CCG’s Governing Body have listened to the feedback that we have received so far regarding our Adherence to Evidence Based Medicine consultation and we have extended the closing date of the consultation until 30 April 2017.’

This item would be discussed, before item 4 on the agenda -Paediatric Assessment Unit (PAU). For the interests of clarity the minutes are shown in the agenda order.  


Apologies were received from Councillor Neville for lateness.  Councillor Neville was attending a meeting relating to the appointment of the new Chief Executive.



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.



Dr Cathy Cale, Medical Director and Richard Gourlay, Director of Strategic Development, will present the Trust’s Improvement Plan, developed following the CQC Inspection.


At the last meeting of the Health Scrutiny Panel, the North Middlesex University Hospital Trust (NMUH) spoke of the on-going work that had been undertaken by them to improve performance, following the Care Quality Commission’s (CQC) inspection, and their report published in December 2016. 


Dr Cathy Cale presented the Quality Improvement Plan Progress report and highlighted the following:

  • The Improvement plan combines the NMUH’s pre-existing plan with the CQC report and other CQC comments. The CQC report had identified 28 ‘must do’ and 49 ‘should do’ actions. It totals 281 actions.  Each action has an assigned lead with agreed timescales.
  • There is an assurance process for ensuring that we do what we have agreed to do. This is overseen at different levels, for example by the Executive Management Board, Risk and Quality Committee, Clinical Quality Review Group, NMUH Trust Board Meeting.
  • Some of the actions that had been achieved in accordance with the CQC recommendations were specified in the presentation. This includes the ‘End of Life Care’ strategy which has been produced and investment in additional staff to enable a 7 day palliative care service. It was noted that there has been a pause in the sending out of ‘bereavement surveys’ to relatives as we are looking to use a common survey with other North Central London authorities.
  • Other improvements that relate to Urgent and Emergency Service (ED), the CQC recommendation that ‘the trust must ensure learning from incidents is more robust and shared with all staff’ – this is now happening. There is also more efficient ambulance triage to minimise delays and the nursing establishment has been increased to provide cover for nurse led streaming service (ED). She said the streaming service ensures that the sickest people are seen first.
  • Under the Maternity service an audit had been completed regarding the stillbirth rate and a draft action plan has been agreed. The NMUH’s stillbirth rate is in line with the rest of the country but it is anticipated that this will improve.
  • One action is that children and young people up to 19should come under governance of children’s services.  A Children’s Board has been set up. The Board will look at processes for monitoring care for them throughout the organisation.


Richard Gourlay, (Director of Strategic Development) referred to one of the NMUH Trust’s aims to ensure that patient & community engagement is central to its strategic priorities and developments. He mentioned that there was a new member of the team looking at ‘Community Engagement’ - Deborah Wheeler who would be looking at how services are received by patients. He said they would be looking to put in place a suitable consultative membership model for the Trust - a ‘Governors model’.  They were also aiming to extend and develop the apprenticeship scheme with the local community.


The Quality Accounts would be published within the next two to three months and Councillors would be invited to look at them.  The Chair, Councillor Abdullahi was pleased to accept this invitation.


The  ...  view the full minutes text for item 422.



Enfield CCG will present the outcomes of the public consultation relating to the re-alignment of service provision for the PAU.

Additional documents:


Graham McDougall (Director of Commissioning CCG) presented a report which updated the meeting on the 90 day public consultation, and on the recommendation to the NHS England CCG Governing Body, that the Chase Farm PAU should be redesigned from its current form and a new model of care implemented.  


He highlighted the following:

  • The recommendation was made to the CCG Governing Body on the 15 March 2017.
  • The PAU is co-located with the Urgent Care Centre (UCC) and access is via GP referral only. Admissions have been consistently low. 
  • The consultation exercise included three public events held on 9 November 2016, 10 December 2016 and 11 January 2017.  The on-line questionnaire was completed by 101 people. (Their responses and CCG comments are summarised in the table of the report to the Governing Body).
  • There is a lot of confusion around the PAU and the UCC. Of the 101 respondents it is apparent that approximately 50% of respondents were referring to care taking place within the UCC and not the PAU.  It was noted that the UCC at Chase Farm hospital would remain open and part of new build.
  • Introduction of a 2 week urgent paediatric outpatient appointment for children and young people in Enfield, this links with expansion of paediatric services at the new build on Chase Farm.
  • The new Integrated Urgent Care service accessed via 111 allows parents to have a consultation with a health professional for issues relating to children under 5 years of age.
  • CCG looking at ways to ensure the message is promoted to people on how to use the 111 service.


The following issues/ questions were raised:


It was confirmed that three of the new Primary Care Hubs were now open


The Chair asked Graham McDougall if he is convinced that the new model will be able to cope, or are there contingency plans?

An answer was given that an ill child would go to NMUH or Barnet hospitals for emergency situations.  He said we would continue urgent care outpatient appointments and continue working with paediatricians.


Q: I understand that there is a potential under new ‘two week appointment’ proposals to see more children more quickly than under the existing arrangements?

A: Yes this would probably be so, this is linked with the expansion of paediatric services as part of the new build at Chase Farm.


Councillor Pearce said whilst she hated the thought of us losing a service, however if the new model is better for the people of Enfield then she would not disagree with changes.


Councillor Hamilton referred to the changes at Chase Farm hospital and said it should be remembered that the NMUH and Barnet hospitals are already overloaded. She was concerned whether the proposals might put additional people at risk.  Graham McDougall said a considerable number of children use NMUH but only a tiny number are transferred there from Chase Farm hospital, this is because they would be dealt with under the Urgent Care Centre.


It was confirmed that anyone  ...  view the full minutes text for item 423.



Enfield CCG will provide an update on the consultation process.

Additional documents:


Graham McDougall (Director of Commissioning CCG) and Mark Eaton (Interim Director of Recovery Enfield CCG) presented the report which updated the meeting on progress of the Adherence to Evidence Based Medicine (AEBM) Programme. It also included a copy of the consultation document.  A report on this subject had been presented to the last meeting of this Scrutiny Workstream in January 2017 and to the Health and Wellbeing Board in December 2016.


It was noted that the NHS Enfield CCG’s Governing Body had listened to the feedback that they had received regarding the ‘Adherence to Evidence Based Medicine’ consultation and had decided to extend the closing date of the consultation until 30 April 2017.


The following points were highlighted:

  • That a consultation event would take place on 24 April 2017.
  • That NHS England had asked Enfield CCG to undertake a review of all the services purchased and provided to ensure that they offer the best quality care and health outcomes for patients.
  • That the service currently has a deficit of £40m.  It is necessary therefore, to look to see if the CCG is investing wisely and ensure any procedures provide benefits to patients and that these outweigh risks.
  • The CCG originally looked at 192 procedures which had been ‘whittled down’ to 13.
  • The consultation had been advertised on the website and advertised in ‘Our Enfield’, they had also written to stakeholders.
  • Discussions were taking place with North Central London colleagues. Enfield are leading on this.


The following questions/ issues were raised:


Q: Have we advertised in GP surgeries?

A: We have written to GP’s with a press release but we are unable to demand that notices are put up in surgeries


Councillor Neville agreed that it is important that the consultation gets the widest audience.  He said that there is probably a large proportion of people who do not visit their doctor often, however some people visit a lot and they are the ones that probably have more of an insight as to what the consultation means.  These people therefore need to be given an opportunity to provide an input.  He did not think doctors would be unhappy to advertise the proposals.


Councillor Hamilton thanked the CCG for extending the consultation period. She referred to the CCG being placed under special measures and said there had been concerns that there were an insufficient number of GP practices in the borough. It was stated that historically we had been underfunded.  As part of Sustainability Transformation Plan £3 m is being invested into primary care and have focused on key cohorts such as for older people.


Councillor Cazimoglu (Cabinet Member for Health and Social Care) referred to the £40m NHS England deficit which has not been resolved. She said this is a massive underfunding issue. She is pleased that the consultation exercise is to be extended as serious concerns had been raised by residents especially in relation to hip and knee procedures.  We have a lot of elderly people in the borough and  ...  view the full minutes text for item 424.



The North Central London STP is being developed and Enfield CCG will update Members on the progress in relation to Enfield.

Additional documents:


Graham McDougall introduced this report which updated the meeting on the North Central London STP which is being developed, he highlighted the following:

  • The first draft was submitted to NHS England on 21 October 2016.  The STP supports the Five Year Forward View to 2020/21 in three key areas – Health and Wellbeing, Care and Quality and Finance and Efficiency.
  • The presentation that accompanied the report summarised the work being undertaken in the key workstreams to inform the development of the North Central London STP which includes : Urgent & Emergency care, Planned care, Mental Health and Health and Care closer to home.
  • The necessity for sustainability plans to be developed as there would be a substantial gap in treasury funding for NHS across the country (approximately £30 billion) in five years’ time.  The aim is to reshape the focus of care – developing new models of care that can support people to stay well for longer through early identification.


The following issues were raised:

  • It is essential that we have good primary care in the borough
  • It was queried whether  it was necessary to have a STP for North Central London, as it was understood that in some parts of the country this was not happening and authorities were preparing  their own sustainability plans. Graham said there were some different arrangements elsewhere such as in Mansfield however, we had not opted for that.
  • We need to have a clear understanding of what STP’s are trying to achieve. 
  • It is crucial for the voluntary sector to be involved such as Age UK. if additional support is required.
  • Bindi Nagra (AD Strategy & Resources HH&ASC), said his team had identified priority areas but more detail was needed.  



Members noted the report and the associated steps to inform the Sustainability Transformation Plan submission.




To note the conclusion of the work programme for 2016/17


The Work Programme for 2016/17 wasNOTED.




To receive the minutes of the meeting held on 5 January 2017


The Minutes of the 5 January 2017 were AGREED.