The Health in Hackney Scrutiny Commission met to discuss the impact of NHS England's 10-year plan on local healthcare, the future of soft facilities management at Homerton Healthcare, integrated neighbourhood teams, and patient data sharing via the NHS Federated Data Platform. The commission heard updates from NHS North East London (NEL), Homerton Healthcare, and the Good Law Project, and discussed concerns about data security, ethical considerations, and the integration of services.

NHS Federated Data Platform

The commission discussed the NHS's new Federated Data Platform (FDP) and its implications for patient data sharing, hearing from Niall Canavan, Chief Information Officer for NHS North East London Health and Care Partnership and IT Director at Homerton Healthcare, Tom Nettel, Deputy Chief Executive, Homerton Healthcare, and Duncan McCann, an expert on data and technology law from the Good Law Project.

The FDP aims to create a unified data infrastructure across the NHS to improve data consistency and enable better analytics. NHS England has contracted with Palantir for the platform and IQVIA for privacy-enhancing technology¹. Niall Canavan explained the goal is to solve the problem of inconsistent data reporting across different NHS trusts by establishing a common data infrastructure and standardised definitions.

Tom Nettel noted that while the implementation of the FDP is not currently mandated, trusts are being asked to provide plans on how they will maximise its benefits. He also clarified that Homerton Healthcare is already participating in an FDP system by providing data to the London Ambulance Service's 'My Clinical Feedback' App.

Duncan McCann from the Good Law Project raised concerns about Palantir's ethical record, its involvement in surveillance and immigration enforcement, and the potential for patient data to be misused. He also highlighted the lack of transparency surrounding the project and the risk of vendor lock-in.

Key concerns raised during the discussion included:

• Ethical Considerations: Palantir's history and values were questioned, with concerns raised about the company's involvement in controversial projects.
• Data Security: The security of patient data was questioned, particularly around the pseudonymization process and the potential for re-identification.
• Civil Liberties: Concerns were raised about the potential for data sharing with the Home Office and the impact on vulnerable groups, such as asylum seekers.
• Vendor Lock-In: The risk of the NHS becoming dependent on a single monopoly supplier was highlighted, with concerns about the long-term implications for data management and innovation.
• Opt-Out Rights: The limitations of the opt-out process were discussed, with concerns raised about the lack of control over how data is used for primary care purposes.

Councillor Claudia Turbet-Delof raised concerns about how the platform aligned with Hackney's goal of becoming a Borough of Sanctuary, particularly for undocumented migrants and other vulnerable residents who may fear accessing healthcare due to immigration status. Councillor Christopher Kennedy, Cabinet Member for Health, Adult Social Care, Voluntary Sector and Culture, said that he would raise the issue with the relevant Cabinet Member.

The commission requested a future update from Homerton Healthcare once a decision has been made about the way forward.

Changes to NEL ICB and the NHS 10 Year Plan

Charlotte Pomery, Chief Participation and Place Officer, NHS NEL, provided an update on changes arising from the NHS 10 Year Plan and their potential impact on the City and Hackney Place Based System.

Pomery explained that progress had been slower than anticipated due to national delays in securing funding for redundancies. She outlined the strategic shifts from treatment to prevention, hospital to community, and analogue to digital, which the operating model will support. She also emphasized the importance of maintaining connectivity between neighbourhoods and ensuring oversight at the place level.

Key discussion points included:

• Restructuring and Staffing: Concerns were raised about the impact of the 50% reduction in ICB headcount on staff morale and the ability to plan for the long term.
• Place-Based Model: The importance of maintaining Hackney's successful place-based model was emphasized, with concerns raised about the potential for services to be delegated to neighbourhoods and the loss of oversight at the place level.
• Budget Management: Questions were raised about the ICB's flexibility in budget management under the new structure and the status of the 80/20 budget allocation split between the centre and place.

Councillor Kennedy said that there was room to be optimistic about what can be done locally, and that Hackney could use this as an opportunity to shape things better themselves.

The commission requested a future update when the ICB is in a position to share the new structure.

Integrated Neighbourhood Teams

Dr Kirsten Brown, Clinical Director City and Hackney Place Based System, NHS NEL, Dr Tehseen Khan, GP Spring Hill Practice, and Dr Stephanie Coughlin, Chief Partnership and Place Officer, Homerton Healthcare, presented an update on Integrated Neighbourhood Teams (INTs) in City and Hackney.

The presentation outlined the strategy for using population health insights at a hyperlocal level to address health inequalities and promote good health and wellbeing. The goal is to strengthen community and professional relationships and deliver more tailored and effective care.

Key discussion points included:

• Integration of Services: The importance of integrating NHS and council IT systems was highlighted, with concerns raised about the historical challenge of these systems not communicating effectively.
• Community Engagement: The need to promote resilience and work with partners, particularly the voluntary sector, was emphasized.
• Estates Challenges: The potential for estates challenges to hinder progress was acknowledged, and the need for funding to address these challenges was highlighted.
• Engagement with Young People: The challenge of engaging young people in neighbourhood forums and practice groups was discussed, with suggestions for exploring alternative channels for engagement.

Dr Khan said that the key focus would be on using key partners that are embedded within the community to help with engagement, and that the principle would be to continue to work with diverse communities to ensure that everyone has a chance to contribute to the agenda.

The commission requested a future update on the progress of the INTs and the development of the model.

Soft Facilities Management Services at Homerton Healthcare

Lei Wei, Chief Finance Officer, Homerton Healthcare, provided an update on the future of Soft Facilities Management Services at Homerton Healthcare.

Wei explained that the Trust's Board had decided not to insource these services and would proceed with open procurement using the NHS's 'Soft FM framework'. The procurement process will consider alignment with NHS job terms and conditions.

Key discussion points included:

• Financial Alignment: Concerns were raised about the potential for contractual terms and conditions to be less favourable than those offered to NHS staff.
• Union Engagement: The importance of ongoing engagement with trade unions was emphasized.
• Covid Payments: A member asked for clarification on the issue of the previous Covid payment for outsourced staff. Tom Nettel clarified that that Covid payment referred to only applied to directly employed NHS staff and not to temporary or outsourced staff and this was a national decision for which the Homerton was not funded.

The commission emphasized the need for transparency on contractual parity with NHS staff and requested a future update on the procurement terms once they are settled.