Agenda and draft minutes

Cllr James Hockney, Chair, welcomed all attendees.

Apologies for absence were received from Cllr Elif Erbil and Cllr Emma Supple. Cllr Supple was substituted by Cllr Michael Rye.

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

There were no declarations of interest registered in respect of any items on the agenda.

To approve the minutes of the meeting held on 28 February 2024.

The minutes of the previous meeting held on 28 February 2024 were AGREED.

For discussion at the request of the Health and Adult Social Care Scrutiny Panel.

Dr Nnenna Osuji, Chief Executive, North Middlesex University Hospital NHS Trust (North Mid) led the presentation.

She expressed apologies that the CQC rating caused some anxiety to the women the hospital served, and wanted them to know that compassionate, safe and effective care continued to be provided. Each year 3,800 babies were delivered and the vast majority had a positive experience.

One of the elements raised in the CQC report was in respect of perinatal mortality rate, but the definition in the report was inaccurate and gave a cruder rate at a single point in time. This feedback had been passed to the CQC. Women should not make the wrong decision based on that information. The trend in North Mid’s data showed an ongoing reduction in perinatal mortality rates, both neonatal and still birth rate, from 2017 to 2022. North Mid was as good or better than the national average for hospitals with a similarly sized maternity unit. Care in the ward after birth was seen as a strongly positive response, with North Mid ranking in the top five trusts according to a recent CQC patient experience survey. It was also ensured that women had the opportunity to see the same team of midwives during the entirety of antenatal and postnatal care.

Maternity services nationally had gone through great changes since 2015’s Morecambe Bay incident highlighted failings and the Ockenden report in 2022 highlighted areas of concern nationally, followed by the East Kent report. These informed the CQC framework as the predominant regulatory body and made it more challenging to get good ratings. The CQC had been particularly rigorous with maternity services, and the majority of Trusts inspected had been down-graded.

North Mid had received six CQC inspections within the last two and a half years, with the Maternity inspection taking place in May 2023. NHSE colleagues were invited in during September 2023 prior to the CQC report’s publication in December. Additionally, a Maternity Safety Support Programme was commissioned by North Mid: one of 34 trusts in the country with this programme. A Maternity Improvement Advisor commenced March 2024.

In respect of the CQC Maternity inspection, some positives were seen including:

• Clear vision and strategy with stakeholders

• Staff understood how to protect pregnant people from abuse

• Facilities and premises appropriate to keep people safe

• Infection control managed well

• Cleanliness of the unit/areas

Recommendations for areas of improvement were:

• Oversight of leadership

• Improving triage in the maternity unit

• A ‘closed culture’, speaking up discouraged

• Staff training required improvement

• Women’s feedback not always used.

Details were given of progress since the CQC inspection, including a new divisional director of midwifery role and a growing maternity team with successful recruitment of 28 new midwives in six months. There was continuing investment in recruitment and retention, and nearly 100% of student midwives chose to stay working at North Mid after qualifying. The triaging process had been overhauled to the ‘Gold Standard’ triage assessment tool.  ...  view the full minutes text for item 4.

To receive the report of the Executive Director – People, to provide an in-depth review of the Mental Health Transformation and what this means for local services and Enfield residents. This includes an outline of the approach to supporting young people in mental health crisis following Covid.

RECEIVED the report ‘North Central London (NCL) Mental Health Transformation and Childrens & Young Persons Mental Health Crisis Response Update’ and attached presentation.

Officers thanked the Panel for inviting them back after a year in respect of the transformation of mental health services across Enfield. The Community Transformation Programme was summarised in a Youtube.com animation which was linked on page 14 of the agenda pack and played to the meeting.

Questions were invited from Members.

In response to Members’ queries regarding autism and ADHD waiting times, it was advised that significant waiting times were a national problem, but work continued to reduce these and to have access to care as quickly as possible.

It was clarified that the holistic assessment function related to ‘telling once’, in response to patients’ concerns of having to repeat their story multiple times.

A transition service for 18 to 25 year olds would support those making the transition from children’s to adults’ services.

In response to queries regarding funding and access across North Central London, it was confirmed that NCL ICB had met its mental health investment standard and had given Enfield additional funding over the baseline in recognition of inequalities and service gaps, and continued investment would ensure delivery in line with the offer. There was recognition that the pathway to services could be difficult. Not everyone went to a GP for referral to CAMHS so there was support in schools and work towards coverage in all schools. It was confirmed that presentation at A&E referred to Barnet as well as North Mid. There were also walk in clinics in libraries and surgeries where a young person could go without a referral. There was currently work with Jubilee Church in respect of providing walk in clinics. Improved communication was being worked on with stakeholders about how to access those services. The engagement and governance structure ensured information was shared on a regular basis.

In response to Members’ queries regarding adults in mental health crisis, it was confirmed there were liaison services in all Enfield’s acute hospitals; a mental health crisis centre in Highgate; and a 111 call option. With transformation funding, services were being invested in such as crisis cafes.

It was advised that monitoring was done with a sophisticated management system for caseloads. Managers could monitor when a client was last seen, or should have been reallocated, etc. to supervise the service and quality.

More information was also provided in respect of performance, and that an assessment had to have the user at its centre, the care plan must be agreed with the user, and a treatment plan should be started within four weeks.

It was confirmed that following initial assessment of needs, there were four teams which specialised in different treatments, some clinical and some more emotional. At the point of entry there was a determination and allocation to the right place for needs to be best met.

Members asked about what could be done about external factors which could impact mental  ...  view the full minutes text for item 5.

To note the current Health and Adult Social Care Scrutiny Panel Work Programme for 2023/24.

NOTED

1.  The completion of the Health and Adult Social Care Scrutiny Panel Work Programme for 2023/24.

2.  The work programme item of an update on Enfield Sexual Health Community Services was deferred into 2024/25 until contract negotiations were completed.

3.  A requested agenda item for consideration for the 2024/25 work programme had been received from a member of Equalities Board that fits better under the Health and Social Care Scrutiny:

·         Reducing HIV transmission rates and ending new transmission by 2030. Local action planning and sexual health service provision.

The Chair was also asked to consider letting Tim Fellows from Enfield LGBT Alliance ask one or two questions if he attends.

To note that meeting dates for 2024/25 will be agreed at Annual Council on 15 May 2024.

NOTED that meeting dates for 2024/25 would be agreed at Annual Council on 15 May 2024.

The Chair thanked the Vice Chair, Members and substitutes for their attendance and contributions to the Panel this year. The Panel had looked at some very substantive and important items. Thanks were also expressed to the Governance and Scrutiny Team for supporting the meetings.