Agenda item


To receive an update on the following:


1.    Health & Wellbeing Board Sub Boards, namely Joint Commissioning Board (Pages 49 – 78) and Health Improvement Partnership Board (Pages 79 – 84).


2.    Better Care Fund 2016/17 Plan (Pages 85 – 158).


3.    Specific local service developments by providers:


a)    Richard Gourlay, Director of Strategic Development to provide an update on North Middlesex Hospital service developments.

b)    Barnet, Enfield & Haringey NHS Mental Health Trust to provide an update on progress following a recent CQC visit.





7.1       Updates from Sub-Boards:


RECEIVED updates from the following Health & Wellbeing Board Sub Boards:


7.1.1   Joint Commissioning Board Sub Board:


NOTED that the Board received an update from the Joint Commissioning Sub Board. 12.3.3 of report refers to a Local Authority Trading Company, which will be operating in October and will manage Adult Social Care provider services. 



7.1.2   Health Improvement Partnership Board:


NOTED that the Board received an update from the Health Improvement Partnership Sub Board.


No firm proposals had been agreed for the future stop smoking model. Any plans would need to be discussed with the CCG and agreed by council’s CMB.



7.1.3   Better Care Fund 2016/17 Plan:


It was noted that further to the HWB meeting held on 21st April, the 2016-17 plan was agreed and submitted to NHS England. Full approval was expected. The Board received and noted the contents of the plan.


Keezia Obi was thanked for her valued work on the Better Care Fund Plan to date.


7.2       Updates from Partners:


RECEIVED updates on specific local service developments by providers, as follows:


7.2.1   Future Organisational Models at North Middlesex University Hospital (NMUH) NHS Trust


The Board received a presentation from Richard Gourlay (Director of Strategic Development at NMUH NHS Trust).




·         NMUH was to be involved in the Acute Care Vanguard which was to be developed as part of the NHS five year forward view.  The aim of the vanguard was to enhance viability of local hospitals, to share formal working relationships and improve efficiency of back office administrative functions.

·         There are currently 13 successful acute care vanguards across the country.

·         The chain concept had been developed in Salford & Wigan, and Northumbria Foundation Group.  The Royal Free London could work with these foundation trusts in developing plans for their own group and the creation of a multi-provider hospital.

·         Under the models of established hospital groups, there were a range of membership scenarios. u Buddying v Shared Services and Back Office w Shared clinical support x Full membership.  The latter being the preferred choice for the Royal Free London Board who would assume full responsibility for the other hospitals.

·         The group model preferred by Royal Free would involve individual hospitals joining a group as operational units, with the group executive overseeing all units and each operational unit would be accountable to a group management structure.

·         This would provide scope to increase the resilience and efficiency of non-clinical services by increasing the pool of clinical resources available including executive leadership, finance and commercial expertise, human resources, information management and technology, procurement, communications, teaching, education and research.

·         Discussions with the Trust Board were held in March 2016 which led to an agreement to a “memorandum of understanding” to enable them to proceed to explore membership as part of RFL vanguard, envisaged from April 2017. This would also help maintain existing clinical pathways with other organisations.


IN RESPONSE the following questions/comments were received:


1.         The NMUH were clinical specialists on their own, through shared services with other providers.  It was one of the busiest hospitals in London, with in excess of 5,000 births per year, A & E and care for the elderly high in numbers. Further work was required to create a case for change and clinicians at NMUH would meet David Sloman to talk about what this could look like.


            Working together to provide the same service and sharing resources would provide a huge recruitment benefit and develop the work force for both the Royal Free and the NMUH. Resilience and stability was needed at NMUH A&E.


2.         It was highlighted that the presentation did not provide direction. Reassurance was needed for the Health & Wellbeing Board regarding the ongoing viability and sustainability of services in light of the recent CQC report and media interest.  A statement was needed on how the A&E can be secured, with increasing numbers of people attending being the major issue.


3.         Work was currently underway with colleagues to ensure that the A&E at NMUH is somewhere where the public feel happy to attend at any time day or night.   Additional senior medical staffing from other units were arriving in ED to support the current rotas, and they will be in place during July & August.


4.         In respect of shortages in A&E consultants previously reported, it was confirmed that five new consultants & middle grade doctors would arrive on secondment and all would be in place by August 2016, one would be working at night where the greatest challenge has been. There had also been a recent appointment to the Clinical Director role in the A&E department that enhances the medical leadership.


5.         NMUH had not yet sought to involve local people or patients in the development of its tie-up with RFL, nor in its plans for the “local accountability” arrangements that would be needed. It was suggested to Richard Gourlay by Deborah Fowler (Healthwatch Enfield) that NMUH should involve patients in developing the local accountability arrangements, and that patients could also be involved in the resulting arrangements on an ongoing basis.


6.         It was questioned whether the A&E need the Vanguard sustainability? In response, the NMUH A&E has to be sustainable financially and once the work streams are in place, there will be a clearer picture of what can be delivered to this crucial resource for the local community.


7.         How would the chain work and whether a CEO will be appointed are issues currently being worked through.



NOTED the presentation and update.


7.2.2   Barnet, Enfield, Haringey Mental Health Trust Care Quality Commission (CQC) Comprehensive Inspection Outcome


The Board received an update on the BEH MHT CQC Comprehensive Inspection Outcome from Mary Sexton (Executive Director of Nursing, Quality and Governance)



·         The approach taken by the CQC Inspection measured the quality of care by how safe, effective, caring, responsive, well-led it was.

·         The CGC had inspected all core mental health services and Enfield community services.

·         The Trust had been informed of the inspection 20 weeks in advance and information received from stakeholder providers had been analysed and used to produce a data pack.

·         The CGC team comprised of 4 teams of 88 people with appropriate knowledge and expertise.

·         Final findings showed an area of challenge in the quality of the existing buildings, especially at St Ann’s Hospital, where many of the structures were 18th and 19th century.  The poor environment at St Ann’s Hospital had altered the perception of the report.

·         The CQC had found that most of the Trust’s staff were very caring, professional and worked tirelessly to support patients. Staff morale was high, with access to opportunities to further their careers.

·         Challenges and Actions identified were ustaffing v patient centred care and communication w leadership and management x premises and equipment.

·         The Trust found the CQC Inspection a helpful and positive process.

·         A Quality Improvement Plan was in place.

·         The Trust had high levels of staff engagement and the strong leadership needed to deliver the improvements required.

·         There were a number of risks and dependencies which were being addressed jointly with partners.

·         The key risk was funding for the improvements needed, which had been costed at £2 million. The Trust was in discussions with commissioners about the funding of these improvements and the CQC were aware that without investment, the action plan could not be fully delivered.


IN RESPONSE the following questions/comments were received:


1.         The Trust’s financial position was difficult at the moment. There had been a £7.5m deficit seen last year which was projected to increase this year to £12.6m. The Trust was working with NHS Improvement on a Financial Improvement Plan which aimed to reduce the financial deficit to £9.4m. With regard to St Ann’s Hospital, the Trust’s Strategic Outline Business Case was being reviewed by NHS Improvement and approval was anticipated by September 2016, which would then allow the project to proceed, which had not been possible until the business case was approved.


2.         The CQC Inspectors were not likely to return for a full inspection but a more focussed inspection around seclusion and lone working was expected before December this year.


3.         An Interim Director of Improvement had been appointed  to bring in the required expertise to lead the Trust’s Improvement Programme over the next six months.


4.         With regard to an update on patient centred care and communications with GPs, it was confirmed that more psychologists for inpatients within the wards were needed. It was acknowledged that more information on patient care needed to be communicated to GPs in a timely way


5.         Clarity as sought as to whether there were there any particular issues with Enfield Community Services? In response, it was confirmed that there were no particular issues and that the CQC report included a lot of positive comments about ECS services.

Mary Sexton was thanked for the very helpful and comprehensive review received.


Supporting documents: