The North Central London Joint Health Overview and Scrutiny Committee met on Friday 31 May 2024. Due to a lack of quorum, the meeting proceeded as an informal briefing, with any formal decisions deferred to a future meeting. The primary focus of the briefing was the scrutiny of NHS Quality Accounts from three local NHS trusts: Royal Free London NHS Foundation Trust, Whittington Health NHS Trust, and North Middlesex University Hospital NHS Trust.

Scrutiny of NHS Quality Accounts

The committee received presentations and engaged in discussions regarding the draft quality accounts reports from the Royal Free London NHS Foundation Trust, Whittington Health NHS Trust, and North Middlesex University Hospital NHS Trust. These reports detail the trusts' achievements in quality over the past year and outline their priorities for the upcoming year, focusing on patient safety, clinical effectiveness, and patient experience.

Royal Free London NHS Foundation Trust

Gillian Smith, Chief Medical Officer at the Royal Free London NHS Foundation Trust, introduced the trust's draft quality accounts report. The report highlighted equality issues as a key theme for the year, with progress noted in areas such as the launch of a new Quality Strategy and Patient Safety Incident Response Framework. Challenges were acknowledged regarding increased demand for urgent and emergency care and cancer diagnosis, leading to the trust entering an enhanced support framework with NHS England. Industrial action was also noted as having impacted the ability to reduce waiting lists for elective care.

Key discussion points included:

• Maternity Services: Councillor Tricia Clarke inquired about maternity services at the Royal Free Hospital in light of recent consultations on service changes in North Central London. Gillian Smith explained that while quality of services and patient feedback were good, the declining birth rate meant that sustaining current service levels in the long term would be challenging.
• CQC Inspections: Councillor Pippa Connor, Chair of the Adults and Health Scrutiny Panel, sought further details on the Care Quality Commission (CQC) inspection of maternity services at Edgware Community Hospital. Gillian Smith clarified that only the 'safe' and 'well-led' domains were inspected, and these services were rated as 'Good'. The trust's overall CQC rating from a 2018 inspection was 'Requires Improvement'. Councillor Connor suggested that future quality accounts reports should include clearer explanations of CQC inspection statuses.
• Never Events Framework: Councillor Clarke requested an update on the Never Events framework. Gillian Smith stated that the outcomes of a consultation were not yet available but that the trust had learned from the framework's implementation.
• Equality, Diversity & Inclusion (EDI): Councillor Connor asked for more details on the 'Barnet Flow' programme. Gillian Smith explained this programme focuses on hospital admission and discharge processes to maintain patient flow, with the equalities aspect still under development.
• Patient Communications on Waiting Times: Councillor White raised concerns about residents experiencing late cancellations of appointments and difficulties rebooking. Gillian Smith acknowledged the issue, attributing cancellations partly to industrial action, and assured that cancellations were clinically overseen and that rebooking was monitored, though some patients faced longer waits.
• Cancer Patients Missed Diagnosis: Councillor Connor inquired about improvements in this area. Gillian Smith confirmed that the new Patient Safety Incident Response Framework provides national parameters for investigating incidents and identifying themes.
• Martha's Rule: Gillian Smith confirmed the Royal Free London NHS Foundation Trust is participating in the first wave of the 'Martha's Rule' pilot programme, with Barnet Hospital and Royal Free Hospital serving as pilot sites.
• Nutrition on Wards: Councillor Connor raised previous concerns about ward responsibility for assisting patients with eating. Gillian Smith stated this requires a multi-professional approach and that each hospital site has a group chaired by the Director of Nursing to oversee nutrition and hydration.
• Never Events, Learning from Deaths, and Patient Safety Incidents: Councillor Clarke sought further explanation on these linked areas. Gillian Smith described Never Events as specific, preventable incidents, 'learning from deaths' as a national framework for scrutinising deaths and improving care, and the Patient Safety Incident Response Framework as covering any incident, with those involving serious harm or death undergoing investigation.
• CAMHS Crisis Hub: Councillor Atolagbe requested details on the proposed crisis hub for CAMHS assessment. Gillian Smith explained it is a rapid assessment process designed to prevent unnecessary Emergency Department visits.
• Waiting List Statistics: Councillor Connor noted the increase in patients on the waiting list and inquired about addressing this. Gillian Smith explained that additional capacity has been added, with a clinical focus on urgent patients, and that industrial action had been a significant setback.

Whittington Health NHS Trust

Sarah Wilding, Chief Nursing Director, and Anne O'Connor, Associate Director of Quality Governance at Whittington Health NHS Trust, presented their draft quality accounts report.

Key discussion points included:

• Cancer Services: Councillor Connor asked about progress on the CQUIN for Compliance with Timed Diagnostic Pathways for Cancer Services. Sarah Wilding confirmed a significant focus on diagnostics and partnership with UCLH for timely diagnosis and treatment.
• Estate Standards: Councillor Clarke raised concerns about the estate standards at parts of Whittington Hospital, citing faulty lifts. Sarah Wilding acknowledged the issues and the challenge with capital spend in North Central London (NCL). Councillor Clarke requested further details on lift maintenance.
• C.diff Infections: Councillor Clarke inquired about the rate of C.diff infections. Sarah Wilding reported 23 cases in 2023/24 against a trajectory of 13, with efforts focused on hand hygiene, antibiotic compliance, and environmental cleanliness.
• Organisational Reputation: Councillor Connor queried the use of damage to organisational reputation in the report. Sarah Wilding clarified this was not the intention of the terminology.
• CAMHS, OT, and SLT Waiting Times: Councillor Connor asked about the realism of the target to reduce waiting times for these services by 20% by March 2025. Sarah Wilding acknowledged it as a stretch target but ambitious due to CAMHS being a focus area.
• Intranet for Autism and Learning Difficulties: Councillor Connor inquired about service user input on the intranet page development. Sarah Wilding confirmed a partnership with an active learning difficulties patient group.
• Neonatal Services: Councillor Clarke welcomed progress on delayed cord clamping and the acquisition of the Concord Birth Trolley. Sarah Wilding noted delayed cord clamping had been a negative outlier, leading to a drive for improvement.
• Perinatal Mortality Review Tool (PMRT): Councillor Connor requested further details on learning from PMRT reviews. It was agreed that further details would be provided in writing.
• Start Well Consultation: Councillor Clarke asked about the progress of the Start Well consultation. Sarah Wilding stated the Integrated Care Board (ICB) would review the results, with decisions expected next year.
• Staff Survey: Councillor White highlighted the importance of staff morale and questioned the comparative approach to other trusts. Sarah Wilding explained the CQC uses comparative data and that actions from the survey included ensuring staff have the right equipment.
• Raising Concerns about Unsafe Practice: Councillor Connor asked what more was being done to increase the 70% figure of staff feeling secure to raise concerns. Sarah Wilding detailed publicity of reporting methods and noted a low proportion of anonymous reports as a positive sign of culture.
• Freedom to Speak Up Guardian: Councillor Connor noted an increase in concerns raised by administrative and clinical staff. Sarah Wilding attributed this to staff engagement and previous pressures in administrative teams.
• Staff Morale and Well-being: Councillor Atolagbe asked about actions to improve staff morale and well-being indicators. Sarah Wilding mentioned staff awards, a new Head of Well-being, and increased resources.
• Simmons House Closure: Councillor Atolagbe requested an update on the closure of Simmons House. Sarah Wilding confirmed temporary closure with staff redeployed, and ongoing work with the provider collaborative for interim arrangements, with no reopening date yet set.
• CQC Ratings: Councillor Atolagbe inquired about 'Requires Improvement' CQC ratings. Sarah Wilding noted the inspection was in 2019 and no further visits had occurred, but quality visits were ongoing.
• Data Security and Protection (DSP) Toolkit: Councillor Connor requested further details on DSP toolkit compliance. Sarah Wilding explained a drive to improve mandatory training, monitored through performance meetings.
• Urgent Response and Recovery Care Group: Councillor Connor referred to partially met targets for seeing patients within certain times. Sarah Wilding confirmed efforts to treat more patients through virtual wards, but acknowledged staffing challenges.

North Middlesex University Hospital NHS Trust

Lenny Byrne, Chief Nurse, and Vicky Jones, Medical Director, introduced the draft quality accounts report for North Middlesex University Hospital NHS Trust. They highlighted recent work on patient experience, response to the CQC review of maternity services, the patient safety incident response framework, implementation of 'Martha's Rule', procedural safety in theatres, and a paediatric diabetes audit.

Key discussion points included:

• CQC Inspection: Councillor Connor requested further details on the recent CQC inspection, which rated the trust overall as Requires Improvement and maternity services as Inadequate . Lenny Byrne detailed key issues identified, including grievance case management, responsiveness to complaints, closing serious incidents, leadership development, and concerns about the potential merger with the Royal Free.
• Maternity Services CQC Review: Lenny Byrne explained the 26 compulsory actions identified by the CQC, including safety issues and triage management. He noted the implementation of the 'BSOTS' system for triage and the automatic placement onto a national support programme, including a midwifery expert. Recruitment of 27 new midwives was underway, and a national skill mix review was pending. A programme of listening events and culture improvement measures had been put in place.
• Staff Feedback: Councillor Atolagbe observed a lack of staff feedback in the report. Lenny Byrne responded that significant contact had been made with maternity teams, including listening events and executive visits, and that further information on staff feedback could be included in the final report. Councillor Connor suggested that evidence and data demonstrating positive change would be beneficial. Vicky Jones added that the NHS staff survey had been reviewed, and action plans were being developed, particularly regarding communication.
• Never Events and Deaths: Councillor Clarke welcomed zero Never Events but noted that 25 deaths were judged to have been likely caused by problems in care. Vicky Jones explained the low threshold for scrutinising deaths and that the trust had a higher proportion of in-hospital deaths. She emphasised the importance of preventing stillbirths and that the trust was in line with peers on adjusted ratios, with a focus on an improvement plan.
• Patient Safety Incidents: Councillor Connor queried the significant increase in patient safety incidents resulting in severe harm or death between September 2019 and May 2024. It was agreed that these figures would be checked and an explanation provided in writing.
• Maternity Support: Councillor Connor requested further details on improvements to support in maternity care. Vicky Jones cited improved triage follow-up processes and interpretation services.
• Delayed Cord Clamping: Councillor Clarke inquired if the hospital trusts were working together on delayed cord clamping, referencing the discussion with Whittington Health. Vicky Jones confirmed NMUH had a previously low rate but now considered 100% of babies for delayed cord clamping, with over 70% receiving it.
• Patient Nutrition and Hydration: Councillor Connor asked about ensuring patient nutrition and hydration on wards. Lenny Byrne detailed protected mealtimes, a 'red tray' system for identifying patients needing support, and a hot meal service in the Emergency Department. He acknowledged that further detail on actions taken could be provided in the final report.
• Conditional Discharge Patients: Councillor Connor asked about support for conditional discharge patients to reduce readmissions. Lenny Byrne reported on information packs for discharged patients and a review of clinical nurse specialists to ensure clear discharge planning.
• 'North Mid Loves Our Patients' Initiative: Councillor Atolagbe suggested further data should be made available on this initiative.
• CT Scanning: Councillor Connor noted a decline in CT head and spine scanning due to patient volume and Emergency Department space. Vicky Jones explained that older patients now receive concurrent CT head and spine scans due to higher injury risk, and an external provider assists with night-time reporting.
• CQUIN Funding: Councillor Connor inquired about CQUIN funding. Vicky Jones confirmed the national funding programme had ended, and NMUH would focus on CQUINs relevant to their safety priorities.
• Report Clarity: Councillor Connor observed that reassurances given during the meeting were not always clear in the draft report. Lenny Byrne acknowledged this as helpful feedback for the final report and noted the challenge of including all accumulated data.
• Service Improvement Priority: When asked to highlight one issue that could improve services, Vicky Jones prioritised addressing pockets of poor culture to ensure patients feel confident they will be treated with kindness and respect. Lenny Byrne identified improving maternity services and establishing a Patient Partnership Council as priorities.

The meeting concluded with Councillor Connor thanking the representatives from each trust for their attendance and noting the agreed follow-up actions.

The meeting was attended by Councillor Pippa Connor (Chair of the Adults and Health Scrutiny Panel), Councillor Tricia Clarke (Vice-Chair), Councillor Matt White (Chair of Overview and Scrutiny Committee), Councillor Kemi Atolagbe, Councillor Rishikesh Chakraborty, Councillor Jilani Chowdhury, and Councillor Andy Milne, who attended online. Dominic O'Brien, Principal Scrutiny Officer, was also present. Apologies were received from Councillor Philip Cohen, Councillor Chris James, and Councillor Larraine Revah.