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Agenda and minutes

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No. Item




Apologies of lateness were received from Councillor Mbachu.




Members are required to declare any pecuniary or non-pecuniary interest they or their spouse/partner may have in any matter that is to be considered at this meeting.  Interests are defined in the front cover of this agenda.


There were no declarations of interest.




To approve the minutes of the meeting held on 24th April 2019


The minutes of the meeting held on the 24th April were agreed by the Committee and signed by the Chair.




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Additional documents:


Consideration was given to a report from the Corporate Director of Integrated Commissioning. Mr Lobban presented the report and explained the work that had been completed since his previous report to the Committee in the last municipal year. He addressed the report and that the appendices set out the responsibilities of his role in the context of the relationships between the clinical commissioning groups and directors of primary care, and the work that had happened within the priority areas.


CAMHS - The Committee asked how the commissioning service would envisage working with the Council, schools, mental health workers regarding Children and Adolescent Mental Health Services (CAMHS), and if there had been any successes.


Mr Lobban said that historically the NHS’s intensive support team had noted that previous funding had been going to the wrong tier of support, there had been increased funding for the specialised help tier (Tier 3), but he felt that there needed to be increased funding for the early help and targeted services tier (Tier 2).


Mr Lobban said that he was unsure of past successes in schools, but many of them had implemented the THRIVE model, which had helped identify the demand for the service in schools, but not in being able to support and treat those who had been identified as requiring CAMHS support. He added that the CCG had intended to attend a workshop with practitioners in the education sector to help gain insight into best practice nationally.


Mr Lobban said that some schools had Tier 2 support, but this was not directly provided by the school and wished to engage with the North East London NHS Foundation Trust (NELFT) to ensure that this tier had input from clinicians.

He said that the aim was to join up services in partnership to use and resources in the correct way, as well as meeting the required NHS targets.


The Committee asked how much further investment was being provided for CAMHS. Mr Lobban said that £900,000 was going to be provided, subject to the review on the outcomes and targets. The Committee said that any further investment into CAMHS should happen after the current review had identified the gaps were funding would be needed.


Patient engagement The Committee asked how patient voices are taken into consideration. Mr Lobban said that the CCG had been receiving feedback back from Healthwatch and the Patient Service Group and were looking at ways co-producing documents for future feedback. The Committee said that new commissions would be required to capture patient voice, otherwise it would be unclear on how services are being delivered.


Patient outcomes – The Committee asked how patient outcomes were measured. Mr Lobban said that in the case of domiciliary care, outcomes were measured by ‘Time and Task’, but for other service, the choices for patients had been limited and that the CCG needed to work with providers to ensure better outcomes.

He added that there was a need to look at how patients accessed services in  ...  view the full minutes text for item 5.



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Consideration was given to a report from the Senior Transformation Delivery Programme Manager from NEL CSU. Mr Henry introduced the report and highlighted the background to the paper. He noted that there was currently a public consultation on the proposed changes to CCG funded for procedures, which would align the CCG with national policy, and the proposals had been brought to clinical and patient engagement events and had tried to make the consultation as accessible as possible for each audience.


The consultation ended in July 2019, which had seen 230 responses, and would be opened to the clinicians in August 2019. Mr Henry said that he welcomed further feedback from the Committee.


Ending treatment funding - The Committee shared concerns of stopping certain treatments for patients. Mr Henry said that the proposals would ensure that patients would be following the correct pathways for treatment, as surgery may not be the best option for them. The Committee asked why the proposals sought to stop routine funding for acupuncture and lumbar disc replacement. Ms Glyn said that there had not been strong enough evidence base that those treatments helped patients as effectively as other pathways. She said that some homeopathic treatments were only helpful as part of other integrated pathways and wished to provide guidance to help support patients holistically. She added that patients should be informed of community options that may yield better outcomes for them.


Decisions for surgical intervention - The Committee asked if the decisions for surgical procedure were made by GPs. Mr Henry said that GP’s could decide this if the patient met all the criteria for this. If the surgeon felt that the patient required the surgery and GP disagreed, then the surgeon can go before the independent funding review panel and make their case on why the patient required the surgery rather than other pathways. Dr Aswani added that the need for surgery in some cases was clearer at the GP-level, as GPs can explain to the patient why surgery may or may not be required, instead of sending the patient around the hospital circuit needlessly.


The Committee asked if it was appropriate for the criteria for surgical intervention in the cases of trigger finger and hernias should include the ability to return to work, as patients who suffer from these cannot return to work unless they receive surgery. Mr Henry said that this could be considered, but cases would need to be made before a decision for surgical intervention.


The Committee, noting the proposal to change the criteria for grommets for glue ear in children, suggested to have a dispensation to ensure that there will be funding for the procedure for children with down syndrome.


The Committee noted that waiting times felt absent from the criteria. Dr Aswani said that rather than waiting times, the criteria was about the order of treatment offered, ensuring that the least invasive and lowest risk treatments are offered. Ms Glyn added that had been in place to ensure that  ...  view the full minutes text for item 6.



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Consideration was given to a report from the Scrutiny Officer. Mr Spragg introduced the report and drew the Committee’s attention to the completed actions from the previous municipal year. He said that the Committee could expect further items from Mr Lobban, further reports around the work on CAMHS and the ongoing redevelopment of Whipps Cross hospital. He added that at the next meeting he intended to hold a longer pre-meeting to offer an opportunity for newer Committee Members to learn more about the health sector.


The Chair said that he wished to meet with each Committee member to discuss the key priorities that they wanted to address as part of the health scrutiny committee.


The Committee agreed that they needed to have oversight of the Whipps Cross redevelopment. Mr Spragg said that while the growth scrutiny committee were looking at some aspects of the redevelopment, the duty of oversight still belonged to the health scrutiny committee. The Committee also suggested to hold a stakeholders meeting with health and social care providers.


The Chair said he was looking into topics for joint-scrutiny with other scrutiny committees.