Agenda and draft minutes

Apologies had been received from Councillor Felicity Bainbridge (LB of Bromley), Councillor Lisa-Jane Moore (LB of Bexley), Councillor Clare Burke McDonald (RB Greenwich) and Councillor Christine Banton (LB of Lambeth).

RESOLVED: that the minutes of the last meeting be agreed as a true record

None.

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The Committee received a presentation from NHS England which provided a recap of the process thus far; an end of public consultation update (key findings of the public consultation taken from the independent report); a decision-making update; and next steps.

The following key points were noted:

9.1. The Consultation ran for a 12-week period, starting on 26^th September 2023 and concluding on 18^th December 2023; views were sought on the strengths and challenges of both options consulted upon, and views were also sought on how some of the challenges could be overcome.

9.2. The consultation was open to all, however specific key stakeholders included: Groups directly impacted (children and young people with cancer or who have experienced cancer (and their families and clinical and non-clinical staff from the hospitals involved); professional bodes; children, young people and their families with related experience; and communities with specific protected characteristics.

9.3. Overall, there were 2669 formal responses to the consultation which included those that had completed the survey (online and in hard copy) as well as face to face conversations and organisational responses. NHS England were happy with the number of responses.

9.4. There was an active petition that received over 10,000 signatures  and comments. It was launched by a group of people with experience or family experience of care at The Royal Marsden. The petition advocated for a different model for the future of the service, where an element of care continues at The Royal Marsden, with those at low risk of intensive care being treated there and those at higher risk of requiring intensive care being treated at St Georges. NHSE reiterated that the purpose of the consultation was to get feedback on the two options presented for the future location of the Principal Treatment Centre and that the national service specification was the driver for the change as specialist children cancer services are required to be on the same site as the children’s intensive care unit.

9.5. There was good reach to affected clinical and non-clinical staff; during the consultation NHE England heard from 155 Royal Marsden staff and 216 St George’s Hospital staff which represented a good proportion of staffing who provide the current service.

9.6. In terms of hearing from those with direct experience, around 16% of respondents were either children & young people who have been affected by cancer or family members and advocates of children and young people who have been affected by cancer. While ideally NHS England would have liked to have heard a little more from children and young people, the reported that they nonetheless had rich feedback from play specialist sessions on wards.

9.7. 16% of all respondents to the consultation were from the South East London ICB area, with a greater level of response coming from South West London. This response rate was reported to roughly align with the proportion of people who currently use the service.

9.8. Many of the SEL responses were from affected clinical and non-clinical staff and  ...  view the full minutes text for item 12.

Sarah Cottingham (SEL ICB) presented this item to the Committee. The following key points were noted:

9.1. The Committee were reminded that the ICB had undergone a detailed review process and there was a focus on minimising impact and there has been an acknowledgement that there cannot just be a sole focus on restructuring given work with wider partners.

9.2. There were 6 stages to the Management Cost Reduction process, and that the ICB was now in the implementation stage. It was reported that there had been a good response to consultation with staff.

9.3. It was reported that the ICB were managing some changes but had published the final revised structure in December and they are now undertaking a job matching process.

9.4. The overall saving was reported to be £15.2m and 25% of WTE equivalent.

9.5. The recruitment process will be completed at the end of March. 

9.6. Following a Member query it was reported that with regards to the staff consultation the vast majority of questions related to individual HR questions or understanding the HR process or to think about ways of working. Changes were made as a result of comments around job changes and job roles. Concern was expressed about meeting short term requirements in a reduced capacity- so some changes were made in a couple of areas.

9.7. It was reported that there is no guarantee that the £15.2m saving will be reinvested in South East London but it will be reinvested into patient care. Although the process was noted to be difficult for staff it was stressed that the reductions do not affect staff in front line services.

9.8. In terms of borough differentials- it was reported that there was a 30% target in overall terms which has been applied differentially which was related to work about core functions and responsibilities. It was recognised within the ICB that there are 6 borough based teams as well as SEL teams; it was reported that the SEL teams have had a bigger savings target than the borough-based teams. Some boroughs have historically had a greater level of management resource than others so that has been addressed. 

RESOLVED: That the report be noted

Sarah Cottingham (SEL ICB) presented this item to the Committee. The following key points were noted:

9.1. The national expectation with regards to performance standards specifically in terms of A&E waiting times is that there is a target to achieve by March 2024 of 76% of patients who attend A&E are to be seen and discharged within 4 hours of arrival.

9.2. There has been a huge emphasis on hospital handover with the London Ambulance Services (LAS). A handover protocol regarding a maximum wait for ambulances of 45 minutes had been implemented as a pilot and is now business as usual. This has helped improve overall turnaround times.

9.3. A lot of work had been done on overstay and discharge with investments made through the better care fund. There has also been ongoing development and expansion of community services, for example, virtual wards.

9.4. The ICS had been working on alternatives to admission within hospitals with a programme on expanding pathways for same day/emergency care units; supporting discharge rather than admittance to hospital.

9.5. There has been a lot of focus on how to support an improved Mental Health crisis offer to help reduce pressure on emergency departments. Since autumn 2023, there has been a roll out of an NHS 111 service/route for specific Mental Health concerns as well as increased bed capacity with more beds coming online for March 2024.

9.6. Despite those efforts the system remains in a challenged position. There were positive improvements in quarter 1 within UEC which was followed with more challenges and deterioration in performance which then stablished. It was reported the system is currently some way off where they want to be in terms of UEC performance. Real push in coming weeks to get as close to the 76% target at year end as possible. An improvement in January had been seen compared to December.

9.7. There had been lot of periods of industrial action- which had impacted on continuity –with priority being given to safeguarding UEC during industrial action.

9.8. In terms of discharge it was reported that a percentage of patients that are ready for discharge remain in beds while medically fit for discharge; it was explained that there are challenges which can vary day to day. On average the system are discharging 50% of people on the day they are determined to be medically fit which highlights the challenges with flow but also the opportunities for improvement.

9.9. There was a discharge summit which agreed a number of objectives including agreement on investment to support improvement in discharge processes and more funding into transfer of care hubs. There has also been additional money into capacity of intermediate care or nursing home beds. The ICS are trying to make sure use they use money wisely and have more sophisticated approaches to demand and capacity planning.

9.10. A number of discharge improvement initiatives had been agreed which were Borough related initiatives – each borough will have their own nuances. The  ...  view the full minutes text for item 14.

15.1 The Committee noted their work programme report including the items proposed previously for the Committee’s future work programme.  It was hoped that the Committee’s next meeting could be held in early Summer and be hosted in Greenwich, where possible.

RESOLVED: That the suggestions for the Committee’s work programme be noted.