The Inner North East London Joint Health Overview and Scrutiny Committee met to discuss the operational performance of Barts Health and Homerton University Hospital, the deployment of discharge funding, and progress on research and engagement initiatives. Key decisions included the ongoing efforts to clear waiting lists, the distribution of £200 million in discharge funding, and the allocation of £100,000 for research and engagement work across North East London.

Health Service Performance and Winter Pressures

Shane DeGarris, from Barts Health, provided an update on winter pressures, noting intense demand across emergency departments, though signs of easing were emerging in February. Flu rates had subsided, and COVID-19 rates remained steady. Challenges persist with discharging medically fit patients and managing out-of-borough patients. Significant progress has been made in clearing two-year waiting lists, with the 78-week cohort also on track to meet the end-of-March target. The trust has also insourced 270 porters previously employed by Serco, with further transfers planned for May. The REACH programme, designed to divert patients from emergency departments, has been extended to Barking, Havering and Redbridge University Hospitals Trust.

Louise Ashley from Homerton University Hospital highlighted the close collaboration with Barts Health and other trusts in North East London, which has been crucial during a difficult winter. The hospital is making good progress on operational recovery and waiting lists, with no patients waiting longer than 52 weeks. Cancer targets are being met, and emergency care four-hour waiting times have been challenging due to high patient numbers and increased acuity, including mental health patients. Community services are performing well, and the Integrated Care Partnership (ICP) position is positive. Homerton University Hospital has opened a new pathology laboratory as part of the East and Southeast Pathology Partnership and is opening phase one of a new critical care unit. Staff wellbeing is a priority due to pressures from the cost of living and strike action. The hospital's vacancy rate has fallen to below 10%, and staff turnover has stabilised.

Councillor Masters raised concerns about the presentation of data, suggesting that graphs would better illustrate the trajectory of progress on waiting lists. Shane DeGarris agreed to present data as run charts in future updates. Councillor Masters also inquired about updates on Barking, Havering and Redbridge University Hospitals Trust (BHRUT), and Jackie Smith, the Chair, offered to provide an update on the collaboration between Barts Health and BHRUT at a future meeting.

Councillor Sweden asked about the insourcing of staff, with Shane DeGarris confirming that Barts Health is nearing the completion of insourcing soft facilities management services, including security, portering, catering, and cleaning, by May. He also noted that the hospital's Private Finance Initiative (PFI) contract for hard facilities management at the Royal London and St Bartholomew's Hospitals is a significant outsourced contract with no plans for insourcing due to its scale and contractual terms.

Discharge Funding and Emergency Care Recovery

Clive Walsh, Interim Director of Performance, provided an update on the deployment of £200 million in national funding announced in January to support hospital discharge. Approximately £900,000 of this was spent on additional step-down capacity across inner and outer North East London, with the remainder distributed to individual localities for re-ablement and domiciliary care packages. Walsh noted that a longer lead time for future funding would allow for better planning and engagement with the third sector.

The NHS published a national Urgent and Emergency Care Recovery Plan on January 30th, aiming to improve ambulance response times for category two calls to within 30 minutes and achieve 76% of patients being seen, treated, discharged, or admitted within four hours in A&E departments by the end of the next financial year. The plan also aims to reduce overall bed occupancy to 92%. The plan includes five ambitions: increasing capacity, growing the workforce, speeding up discharge, developing new or expanded community services, and reviewing the 111 service.

A national Adult Social Care Discharge Fund of £1.6 billion is allocated for the next two years, with an estimated £20 million for North East London. The proposal is to allocate half of this directly to local authorities and the other half through the Integrated Care System (ICS) and the Better Care Fund, with joint discussions on priorities.

Councillor Masters questioned the funding formula for the £200 million, noting that boroughs with younger populations appeared to receive more funding despite the formula being based on the proportion of older people. Zina, who also contributed to the discussion, explained that the local authority allocation of the Better Care Fund uses government funding criteria that account for historic measures of deprivation, which is why City and Hackney, for example, receives more funding despite a younger population. The NHS North East London allocation of the £200 million focused more on older people and discharge needs, using a slightly different formula agreed with directors of adult social care.

Councillor Adams asked about monitoring arrangements to ensure discharge funding is used exclusively for re-ablement and care packages. Clive Walsh confirmed that locality-based groups involving place directors, local authority staff, and hospital staff review patient care pathways, particularly those with complex needs. He acknowledged funding constraints but stated that the premise of the money not being used for care packages is unlikely.

Councillor Sweden raised concerns about the practicality of acquiring additional step-down beds and the capacity for therapy input, particularly physiotherapy and occupational therapy, given the closure of some step-down facilities. Clive Walsh acknowledged the national shortage of therapists and the need to make jobs attractive in North East London. He also highlighted a deficit in neuro-rehabilitation and plans to expand this service, which will require significant therapy input. Zina mentioned pilot work in two boroughs on enhanced domiciliary care, training care workers to perform tasks typically done by health professionals.

Councillor Patrick questioned the ambition of the 30-minute target for category two ambulances and the 76% A&E performance target, noting that Homerton University Hospital already achieves higher rates. Clive Walsh acknowledged that some targets may not appear ambitious but stated that achieving them will require substantial plans. He confirmed that a detailed response to the national recovery plan will be developed and made public.

Councillor Kahn inquired about the allocation of the Better Care Fund, with Clive Walsh explaining that if North East London receives £20 million, £10 million will go directly to local authorities and £10 million will be managed through the Better Care Fund via joint discussions between health and local authorities at a locality level.

Regarding the 111 service review, there is a national intention to encourage patients to contact 111 first for urgent and emergency care. However, the plan is not yet fully detailed, and concerns have been raised by primary care professionals about a potential break in the patient-professional relationship. The current 111 contract with LAS has been extended for two years to provide stability during this period of uncertainty. Councillor Masters and Councillor Adams both expressed concerns about the current satisfaction levels with the 111 service, citing anecdotal evidence of poor feedback and high abandoned call rates.

Research and Engagement Funding

Dr Victoria Brown presented an update on the £100,000 awarded to North East London to support research and engagement work. The funding aims to increase the diversity of participants in research and input into study design, addressing the risk that research findings may not apply to all population groups. The programme is led by the North East London Integrated Care Board in partnership with various organisations, including the North Thames Clinical Research Network and UCL Partners.

The network has identified approximately 20 existing initiatives across North East London aimed at engaging communities in research. Workshops and outreach are being organised to understand barriers to participation and identify new ideas, with a focus on Newham and Barking, Dagenham and Havering, where data suggests underrepresentation in research. The ultimate aim is to ensure research at a system level is relevant and shaped by those it affects most.

Councillor Broom inquired about funding for diabetes prevention programmes, which Dr Brown was unable to answer directly but noted that diabetes and obesity are being used as test cases to understand engagement barriers in specific areas. Councillor Verde expressed interest in Newham's active voluntary sector and questioned how the engagement worker reached conclusions about the borough's underrepresentation. Dr Brown clarified that the issue is not a lack of activity but a need to make connections between researchers and the voluntary sector as a community asset.

Councillor Adams asked about the plan to use research findings to deliver good outcomes, with Dr Brown stating that success would be measured by research being designed by service users and increased participation from diverse communities, ensuring findings are applicable to the entire population.

Whips Cross Hospital Update

Councillor Sweden provided an update on Whips Cross Hospital, stating that progress on building works has been temporarily halted until 2025 following a public announcement. This affects all 40 of the government's new hospital projects.

Meeting Administration

The minutes of the previous meeting were agreed. The Inner North East London Joint Health Overview and Scrutiny Committee will rotate to Waltham Forest for its next meeting. The outgoing Chair, Councillor Ben Hayhurst, and Jala, who managed the committee's operations, were thanked for their contributions.