Agenda and minutes

Apologies were received from Dr Christopher Hilton (Dr Julia Renton attended in his place) and Janet Cree.

Councillor Lucy Richardson, Dr Nicola Lang (Director of Public Health), and Michelle Dixon (Imperial College Healthcare NHS Trust) attended the meeting remotely.

If a Member of the Board, or any other member present in the meeting has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Member with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter.  The Member must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where members of the public are not allowed to be in attendance and speak, then the Member with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Members who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Members are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Standards Committee.

There were no declarations of interest.

To approve the minutes of the previous meeting as an accurate record and note any outstanding actions.

The Board agreed the minutes of the meeting held on 28 March 2023 as an accurate record.

The Board agreed to change the order of the agenda as follows – 6, 5, 4, 7, 8.

This item presents the Integrated Care System (ICS) Health and Care Strategy for North West London for challenge and comment.

Toby Lambert (Northwest London ICB) introduced the item which presented the Integrated Care System (ICS) Health and Care Strategy for Northwest London for challenge and comment.He noted that the strategy built off the existing work of the JSNA and Health & Wellbeing Strategies. They were gathering feedback from all Health & Wellbeing Boards and would incorporate them into the final strategy.

Toby Lambert noted that the engagement period would run to the end of July. There was a form on their website for residents to provide feedback. Councils could provide feedback through Health & Wellbeing Board meetings and could also provide longer written responses. The Chair noted H&F may share the minutes of the meeting or provide a written submission at the right time.

ACTION: Linda Jackson / David Abbott

Councillor Natalia Perez asked if there were groups that the ICS wanted more engagement from. Toby Lambert said each section of the strategy had its own engagement process, but engagement had taken place with partners, the residents forum, and colleagues in communications had been working to build links with each group and community.

Merril Hammer commented that the strategy presented was not specific enough. She said the strategy should clearly articulate the current position, have baseline figures to measure progress against, and outline the plan to get to the desired end point. She highlighted the maternity and children and young people sections as a good example. But she felt it was wrong to put palliative care as something that was being done well, noting they were 10 months late to report. She also felt the mental health section was seriously lacking, with little or no detail about baseline provision, need, demand, measures of inequality, productivity, or staffing.

Toby Lambert said he agreed some sections were more detailed than others, explaining that it was partly an artefact of how the document was produced. He noted there was supporting data available in the needs assessment on their website, but it was not as comprehensive as he would like.

Jim Grealy discussed the need for a clear articulation of what success and failure in each area. He also said there needed to be a realistic look at what could be staffed with the expected resources. Toby Lambert said the strategy would feed into a joint forward plan, which would have more detail about finances and workforce. He noted that while there were shortages in some key professions, overall, they had more staff than ever before. The challenge was how best to deploy that workforce.

The Chair asked if the joint forward plan would contain detailed targets and outcomes. Toby Lambert said it would.

Jacqui McShannon highlighted transitions from Children’s Services into Adult Social Care, mental health, and autism as areas that needed more focus. She warned there was a growing cohort of people whose needs were not being met. The Chair also said the strategy did not include enough on autism. Toby Lambert said there had been similar feedback from others and he would  ...  view the full minutes text for item 4.

This item presents a briefing paper from Imperial College Healthcare NHS Trust about the delayed refurbishment and rebuilding of Charing Cross, Hammersmith and St Mary's Hospitals.

Michelle Dixon (Director of Engagement and Experience at Imperial College Healthcare NHS Trust) presented the item about the delayed refurbishment and rebuilding of Charing Cross, Hammersmith, and St Mary's Hospitals.

The Chair asked for clarification that the planned rebuild of St Mary’s Hospital in Paddington, and extensive refurbishment and some new build at both Charing Cross Hospital and Hammersmith Hospital had been pushed back beyond the original commitment of 2030. Michelle Dixon said the hospitals were still in the programme and would receive funding for a business case and enabling works (e.g., upgrading a building’s power supply), but the bulk of capital funding would not be committed until after 2030.

The Chair asked if the Trust had received any response to their bid for enabling works made in August 2022. Michelle Dixon said they had not received a response yet.

The Chair asked how much money the Trust was having to spend each year on backlog maintenance. Michelle Dixon said they spent between £7-8m every year on each of the main sites.

The Chair asked for confirmation that if residents saw building works it was maintenance. Michelle Dixon said they could receive money for some enabling works before 2030, but not expansion or refurbishment.

The Chair asked if other hospitals in the core group of forty were slower to complete their business plans, was there scope for the Trust to jump the queue? Michelle Dixon said she anticipated that to be the case. She noted that Charing Cross and Hammersmith could do phased works rather than a complete rebuild. The Trust was hoping to be able to use its land as leverage to get upfront funding before 2030. The Chair asked if there was support from the Government for that. Michelle Dixon said they were speaking to the New Hospitals Programme about it.

Jim Grealy said that residents expected new hospitals to be completed by 2030, but now we learn there is no money guaranteed until 2030 and rebuilds take a long time. He asked when the hospitals would be finished. Michelle Dixon said they were hopeful that the land strategy would enable works to be done before 2030 but if that did not work it would be the late 2030s. She was concerned that the buildings at St Mary’s would not last that long though.

Merril Hammer asked if the Trust were planning to use money from land sales to help pay for the rebuild, would the Trust be refunded for that. And if not, what might that money have been used for if not spent on the rebuild. Michelle Dixon said the money would always be used to offset building costs.

Nadia Taylor asked what the impact on patient services would be during the planned rebuild. Michelle Dixon said the state of the buildings impacted on patients every day. She highlighted the ingenuity of the estates teams in keeping services running.

Councillor Natalia Perez asked about contingencies in case of extreme scenarios like flooding. She also asked  ...  view the full minutes text for item 5.

Toby Lambert (NHS Northwest London ICB) introduced the item.

The Chair raised concerns about the most recent Better Care Fund (BCF). He explained that the BCF was normally agreed locally with the Council and the NHS, with the aim of getting people out of hospital as quickly and safely as possible. However, this year the Finance Department of the ICP was not acting in an appropriate way and was refusing to approve the budget. This had led to people being stuck in hospital for weeks and weeks.

Toby Lambert said the ICP was not happy about the current situation and conceded there were better ways to manage it. He noted that while the amounts had not been fully signed off as of the date of the meeting, the overall quantum remained. Any money committed would be paid.

He understood the unhappiness around how it was communicated and the transparency, but the ICP had to follow the national guidance and ensure the money was being used effectively as they were accountable for it. He said he would feed the Board’s comments back to the ICP.

Linda Jackson commented that the BCF had been worked on jointly since 2015. It funded a lot of contractual services. She suggested the ICP should sign off the funding stream for 2023-24 with a condition saying there would be a joint review of next year’s spend.

Linda Jackson added that in terms of outcomes Northwest London had reported consistently reliable performance on discharge and had been leading in London for months. She said holding back discharge money put the area’s performance on discharges at risk and had done damage to a lot of challenging work by colleagues at the ICS. The situation had challenged local partnerships and damaged trust and relationships with the ICP. She urged the ICB to sign off the funds for 2023-24 and agree to work together on 2024-25.

Sue Roostan (NHS Northwest London ICB) said she understood the comments from the Council, but they were looking for a level of consistency around the minimum level of contribution. She noted that it was not a cost saving exercise, it was about consistency across the boroughs.

The Chair said this approach had done more damage than anything since the start of the ICS arrangements. They had not engaged early and showed no understanding of how local authorities worked. He said it needed to stop this year. The Council committed to do everything it could to work with and inform their finance team about how we work and the differences between the local authorities in the area. He asked the representatives from the ICB to take the Board’s comments back and work with colleagues to rebuild the trust that has been lost.

Toby Lambert said took the points made on board and would take them back.

The Chair thanked Toby Lambert for attending.

To discuss the Board’s work programme.

The Chair asked members to send any work programme suggestions to the clerk.

To note the following dates of future meetings:

·       20 Sep 2023

·       13 Dec 2023

·       12 Mar 2024

The following dates of future meetings were noted:

• 20 Sept 2023
• 13 Dec 2024
• 12 Mar 2024