Health Overview Policy and Scrutiny Committee – 4 January 2024

https://cmis.essex.gov.uk/essexcmis5/CalendarofMeetings/tabid/73/ctl/ViewMeetingPublic/mid/410/Meeting/5179/Committee/34/Default.aspx

Good morning members happy New Year um welcome to this meeting between the health of review policy and scrutiny committee held today in the council chamber we are live streaming the meeting on YouTube and a recording of the meeting will also be available afterwards we’re not expecting a fire

Drill this morning but if the alarm does sound please follow officers out of the building and gather in the cathedral grounds thank you I want to advise members um that um you may have noticed that um an item from the work program that we were also expecting to receive a report regarding

The community beds consultation from mid and South es6 ICB following a meeting with officers just before Christmas break it was agreed that this item would be removed from the formal agenda for the moment um and instead because of the topic spans both Southend and thoric also we will look to hold a joint

Scrutiny committee to handle that um and a later date with colleagues um with South End and thork we’ll be meeting with them next week to set that up so thank you go to item one which is membership apology substitutions and Declarations of interest thank you chairman apologies have been received from councelor Steven

Robinson for whom councelor Marie Goldman is substituting and from councelor Paul Gad and councelor Ian Grundy thank you thank you um in terms of Declarations of Interest I want to declare that I’m a a um count on the Council of governors of the mid and South S6 Foundation trust

For any item that that relates to thank you so agenda item two is uh minutes of the previous meeting I’ve not had anything raised in the Prem or before so I will take those as as approved agreed members thank you thank you um item three questions from the

Public I’ve not been made aware of any questions from member of the public so we’ll move straight on to item four which is the primary care update so welcome to the meeting we have a very very full cast this morning we have ly Stimson associate director of integration operations South End and

Nori North Essex East ICB I think I’ve got that sorry it’s actually Northeast Essex and suffk I think I might read it wrong I was so flabbergasted by the length of your title to be perfectly truthful um we have um pal green returning uh who is the executive lead

For Primary Care at miden South Essex ICB William Guy returning who’s director of primary care for Mid and South essic ICB anvy sha returning and she is director of primary care for harson West SX ICB and nobody gave me his title but we also have Anthony West as well so

Welcome floor’s yours thank you uh thank you if members are happy I’ll just review the the the presentation uh that we sent through to you and then open uh for questions um thank you since we last met and discussed the issue of primary care access one of the key developments

That’s happened nationally is the publication of the um primary care access recovery plan um so this plan recognizes the challenges that that patients face when trying to access general practice um and have done since the kind of pandemic um and return to kind of business as usual um that plan

Focuses on two key aspects of Access One is trying to tackle the 8: a.m. Rush um and at the last meeting I think we did uh discuss the fact that we have a system uh where we’re encouraging patient patients to all access at 8:00 in the morning regardless of the issue

Um that they’re trying to resolve um and I’m sure everybody’s been frustrated with with trying to get through on the phone at that that time um the second key key area of focus within the national access recovery plan is to try to give patients um Assurance on the

Same day that they they contact their Pat Uh their practice as to how their request will be managed whether that would be been seen in the practice a telephone consultation or seen by some other bit of the Health and Social care system um try to give them that

Assurance that that their request is being dealt with and managed on the same day they make contact UM underpinning that the the national access recovery program is a new model of modern general practice um which is detailed on on U one of the slides in the paper ERS um but this is effectively

Trying to say how do you deal with the total demand coming through to general practice um assess it triage it and manage it in a different way so that you rather than dealing with the first 30 50 100 patients that get through on the phone in the morning you try to actually

Understand relative risks relative need um and then manage that need in a different way and that does re require a whole scale change not just within general practice but across the health system critically Primary Care Remains the front end of of access to the NHS for the majority of people um accessing

Health Care in this country um as stated in the report the Kings fund analyzed that 56% of all recorded activity in the NHS happens in in general practice um but beyond um those appointments is estimated that somewhere between 70 and 90% of all patient interaction happens in general practice um so they still

Play a fundamental part of of the way the NHS delivers services in terms of that modern general practice model as I say it does require whole system change technological change digital change change in the way that we use our Workforce across primary care to try to understand what that underlying

Need is that patients are presenting with assess that need prge it and then direct it to the right place um and that’s through a process of care navigation um but been trying to use the Whole Health System to respond to to patient need rather than just general practice that we’ve traditionally done

Um and that puts onus on the ICB is to facilitate that systemwide change um to to enable access to other services such as Pharmacy Dentistry um sometimes non-health services so your third sector uh solutions that might be able to offer the best outcome for patients we put in the report three case

Studies uh one for each of the patches across um the S6 uh boundary um the first looks at total triage which is that mechanism of of understanding that total uh clinical need presented to a practice assessing that in a consistent way and then successfully navigating patients to the right solution um and

That’s been adopted in a large number of practices um across Essex but the aim is that all practices will Implement that model over the next two years um the second case study looks at cloud-based telepan um so one of the techn technological solutions required to help make the system work is effectively more

Bandwidth on your telephones to be able to deal with the volume of calls that’s coming through it is not a solution on its own um it simply allows more people to to get through to practice any one time but unless you’re doing something in in the background around changing the

The the way that we can redirect patients to other services training the staff putting in care navigation navigation Solutions all it really does is tell you where you are in a queue on a telephone system it doesn’t resolve anything but it is a critical step towards making that whole modern general practice solution

Work um and then the third case studies around empowering patients through the use of the NHS app and and the technology associated with that um as we move forward the NHS app will become um a critical part in the way patients access all NHS Services um ultimately

Will L and you can find out not just about General uh Primary Medical Services but also secondary care servic services will be plugged into the NHS app as well and become the app of choice for accessing NHS Health Care um we are um as we previously said implementing a process of care

Navigation training so critically uh we want to be able to take the patients with us on on this journey implementing a new uh model of general practice um and part of that is training our um administrative staff how do you successfully care navigate a patient so

That they are willing to engage in the convers ation about why they’re presenting to general practice that day and openness to the solutions and Pathways that might be presented the other end of that process um that care navigation um training process is is one that’s been commenced nationally but I

Think all of the systems in essics are then adopting um local uh training to reflect the local Pathways that are in place for that um I think it’s probably fair to say it’s had mixed success uh where it’s been implemented it’s it’s a model that constantly is tweaking based

On the feedback we received from patients and from the staff delivering the services um and so it will get refined over time um but increasingly is becoming quite an effective way of dealing with the demand that comes through um nationally there’s an expectation that Community Pharmacy will

Play a broader role in delivery of of patient care going forwards um and particularly being seen as a front uh line and first choice for patients who are accessing um Health Services for common ailment at the end end of this month January there’s expectation that the national Pharmacy first model will

Start to get implemented and go live um across pharmacies um all over the country um this model will allow patients to to receive um Direct Care without the need of having to go to general Practice in the first instance there’s an awful lot of work that needs

To happen around that in terms of promoting the service making sure those Pathways work getting our pharmacies on board um but but that should offer quite a lot of additional capacity two already stretched systems um I think the final slide I’ll just pick up on is around the volume of

Consultations and consultation types so the last two Hosk sessions that we’ve attended we’ve demonstrated there is increased capacity and activity happening within primary care and that whilst we’re not meeting all of the need that is presenting it’s not because we’re not trying to grow um the capacity

That’s there that trend has continued so across all three um areas of six um that there has been a growth in in consultations in within Primary Care over the last um year and we’re expecting that Trend to continue I will stop at that point Thank You members councilor

Goldman uh thank you uh chair and thank you uh William for your um if we’ll run through that presentation um I have a few questions um I I think that I’m going to ask the one that comes into my inbox most at the moment um which is the

Closure of pharmacies and in particular because you mentioned Pharmacy First and how that would add capacity to the system in chelwood in particular I get and I’m sure this happening across the country in fact um I get told about in particular boots pharmacies closing right the way across the city I’m sure

That’s happen happening elsewhere as well and of course we hear of other independent pharmacies that are closing as well um how does this affect the pharmacy first strategy and what mitigation measures are in place that’s a fair fair question I think we have seen across all of all three areas

Of Essex a large number of pharmacies Clos in the last 18 months part of that is a national Trend where people are starting to use online pharmacy provision more which is a solution for some things but obviously won’t support the pharmacy first model um part of the establishment of the pharmacy first

Model is to try to ensure sustainability and viability of community farmes going forwards to try to invest more more money into um Community Pharmacy critically I think we’ve got to work closely now with the providers with the local pharmaceutical committee um to make this sustainable otherwise we will see um unfortunately

Um challenges to the sust sustainability of community pharmacies and they do play a critical role in in terms of patient care and and we need them to continue uh to do so um but I think it is a challenge and it is a concern particularly with the big chains we”re

Seen quite a significant shift in in the way their their models operate um but we we want to work closely with um the pharmacy Community to try to make those businesses sustainable um and Pharmacy First is definitely a solution to that uh thank you I just like a followup

To that then can you just from my understanding then and I’m sure members of the public who may be watching this would also like to know how long has farmacy first been a strategy um and if so why haven’t these talks with the pharmaceutical or sorry the pharmacies

The pharmacy chains already taken place and if they have already taken place why hasn’t it led to them staying open um so the the concept of Pharmacy first um came out of the national um Prim care access recovery plan which was published in May of this year there’s

Then been negotiations with um the the national Pharmacy body in terms of the detail the pathways um uh the clinical conditions covered um Etc and remuneration R Arrangements around it over the last few months that concluded nationally um in the kind of back end of autumn um and then we’ve been on a

Process of implementation um I think in terms of that challenge I mean I can’t speak on behalf of the big Pharmacy chains I think their business model um meant that that even if Pharmacy first came online that they’re kind of strategically heading in a different direction in terms of how they

Deliver Services um I think for some of the smaller pharmacies they are Keen to see what pharmacy first looks like and and what the the kind of benefits of it will be um I think it’s unfortunately it’s just one of those timing issues where maybe it hasn’t happened as soon

As as we would have liked Nation the certainty around what the model um will bring to Community Pharmacy and therefore Pharmacy have made a decision to exit the market um but we do hope that as the the months go by that it will will make um pharmacies more

Sustainable I think just to add uh a little bit to that so there’s a couple of things when it comes to Community Pharmacy and one of the key bits is like the GP contract the Community Pharmacy contractual framework is coming to an end as well their five-year contract at

Present um and I think the the negotiations and the discussions have already started in terms of what should a new Pharmacy contractual framework look like for the future learning from some of the Clinical Services that up and down the country a number of icbs and previous ccgs used to commission

From Community pharmacies to enhance their role in the clinical pathways has been recognized now and that’s really important unlike just dispensing medicines so that whole model of the Community Pharmacy is really changing and integrating Community Pharmacy with not just the primary care itself with the GPS and dental and Optometry but

With the wider integration partners with all the with the work on terms of community Pathways with Community providers and the acutes is so critical to actually bring them into that family so that we can actually have a sustainable system the other biggest issue which uh like general practice is

Really the pharmacy Workforce itself pharmacists themselves are struggling to actually recruit and retain Community pharmacists in the Community Pharmacy shop floors and hence a lot of the pharmacies are running very much on looms and that is not always a sustainable model and does not provide the continuity of care that we all are

Seeking for as well on it part of this as well and hence it becomes a business model to actually say whether that works for us or not and hence opportunity for all of us in the respective icbs is to really think outside the box in terms of

How can we look at recruitment retention models for the pharmacist as well CU a lot of the pharmacists who are coming out from universities will now be independent prescribers so little a real opportunity as to how we can use them as part of the clinical pathway whether that’s for hypertension or other chronic

Uh conditions but more importantly how do we look at retention of these pharmacies because nobody wants to work seven days a week and not have a work life balance people are moving into general practice so that they can work as clinical pharmacist on a five day but

We are also losing people to other uh areas because they may be paying more as well so we do have just like we talk about GP recruitment retention we now are looking at Community Pharmacy recruitment retention but Pharmacy recruitment retention as a whole working with our hospitals general practice and

The Community Pharmacy so there’s a there’s a lot now for icbs who have now taken this on as as of first of April to really start looking at other Primary Care contractors and what how we Embrace that as part of our strategies which we’ve been doing for general practice a

Fair amount but how do we actually refocus on all of these others sticking with with pharmacies we’ve I think the headline is is that we’ve lost something like 300 in England alone in the last year where have those qualified people actually gone if they practices have closed do we have any

Numbers of of prees coming into the the new cycle and people retiring out do we have any indication of what that looks like yeah so at the moment we probably don’t have that level of detail that we would be seeking for because at present we are still working with health

Education England and NHS England to actually understand because they are still retaining sub responsibility when it comes to the training of the community uh training of Pharmacy as a profession and what happens in terms of pre So within east of England we’re working with the regional team to actually really start understanding the

Cohort that we are producing graduating out of all the universities that we’ve got and where where are they we retraining and then where are they we actually recruiting back into the system as well what we are doing though as each of the three icbs is ensuring that we

Are creating spaces for that training purpose so when a pharmacist does come out from University they can now do a rotational for the part of their pre-registration including a time in general practice and what we are looking at is across the three icbs is whereby practices are providing that opportunity

To actually host host a pharmacist as well as part of it but early days in terms of working that through go what we do know is we’ve been very successful in as ab’s mentioned in in person but we’ve been very successful of of getting pharmacist into general practice because of the extended scope

So part of the increased access in general Practice in your you know family GP uh Arrangements is because we’ve got M many more clinical pharmacists working in that space it’s been one of the areas that has really Shen off and they you know there’s a finite number of these

People but I think it was uh it really is important to emphasize that the bigger chains have made a business model decision it’s it’s not that they haven’t been commissioned uh boot you will know um has been put up for sale you know these are uh very strategic Decisions by

Those big infrastructure uh organizations um so it’s it’s not it’s not because they haven’t engaged in the conversations so that they think that that this model of delivery isn’t right it’s just that it doesn’t match their current business model and for us it’s very important and abne you’ve presented

Here the um Pharmaceutical needs assessment so that we we have the needs assessment uh that we work to and and match that to the demand then in general practice for uh clinical pharmacists as well as High Street um clinical pharmacists as well because the model is moving that that will be a community

Practice that works together so it is a moving feast and I think we we we mustn’t get too distracted by is is boots or or Lloyds actually indicating whether this is is the sustainable model for the future it’s a it’s um it’s a harder model of a very

Big scale to retain uh huge numbers of clinical Pharmacists and support them if you’re if you’re a smaller practice actually you can keep you can keep that um that you know closer to the the pharmacy first delivery thank you we’ll move on uh councelor stto thank you chairman um a number of

Questions which also all tieing together uh you mentioned about the app there um one of the things that concerns me is around the older part of the population uh how much of a disadvantage are they going to be because I know from experience a lot of older people don’t have the right phones

And really not sure and I could see that being a disadvantage with regards to the surgeries themselves the surgeries themselves are not getting the messages out there uh to let the um patients know how to to go ahead the first time I heard about the app was when I heard on this

Report how can you improve that um process particularly through the um patient committees that a number of surgeries have with regards to the surgeries themselves there a lot of those are private businesses how much control and how much pressure can you bring to bear on those surgeries to

Actually better a phrase get their act together and let people know what’s going on so people have a better understanding I’m happy to pick up I’m happy to pick up some of that the case study that that’s in here talks through exactly some of those issues that you mention so we’ve been

Working with u patient participation groups in practices to um raise awareness we’ve been running surgeries of how to utilize the app in surgeries we’ve been working with some of our community um groups to raise awareness and we’ve implemented a sort of train the trainer working with groups to to

Train the trainer um access to utilization um so there’s we recognize that not everybody is going to have the right phone um it’s not a um Everybody Must use the app at the moment that is a a good way and an easy access for you to utilize the map the the access services

And will relieve some of the pressure in into the general practices to allow those who can’t use the app perhaps to get through on the telephone or to walk into their practices so it’s a it’s an it’s an option at the moment um what what I would would say is

About enhancing the offer to General practices is exactly that if you utilize the app in all of its functionality in the future those who can and choose to use the app will make your life easier and will improve the access through other routes to your practice so for me

It it should be a win-win for those practices to to utilize it I accept that not all of them currently have signed up to it and we need to reach out to those to really sing the Praises and to utilize some of case study to show where

Some of these practices that have been utilizing it what the advantages are and and and getting them to tell their story and share with their peers so that they recognize the advantages of utilization chairman I do have one other question but I’ll leave that to towards the end of the item if I

May thank you uh councelor mcquiggan I’ll come to you next thank you chairman and thank you very much for that for that report just picking back up on um the pharmacies we’ve seen how difficult it is some of the closures of individual surgeries and how difficult it is to

Encourage practices to come back in their private businesses you know even when there’s premises uh available it’s been very difficult to regenerate uh those surgeries again and I’m very worried that the closure of the pharmacies will go in the same way you within my own Division I have um you

Know best practice surgeries um uh that that are growing um and are you know incorporating pharmacies within their own premises uh at the same time as I have closures of surgeries uh over the last series of closures of of local surgeries over the last few years I’ve

Recently seen uh the closure of a major service surgery um within my division serving probably twoth thirds of the popul population um within my division and and the expansion of a small private um uh Pharmacy uh that has been you know taking on additional Services I’m very concerned that the closure of those

Phaces um is going to be very difficult to come back and I wondered what steps you were taking to encourage businesses to come back perhaps in even into the premises of the previous Pharmacy uh in in my own division I’ve lost a boots um uh practice and uh which has been

Devastating to the local community and I can’t find a pathway to uh that is currently being undertaken to regenerate uh that Pharmacy and and and provide those Services again particularly the enhanced Services um that that you’ve been trailblazing here so I’m not optimistic because I can’t see where

We’re going and I can’t see the immediate reaction to those closures and I wondered how that was being planned in so if I just come in a little bit because um I think it’s a very I think it’s fair to understand that it’s a very different model when a general practice

Closes and the responsibility we have in terms of our population because theyve registered to a GP practice and what we need to do to when a Community Pharmacy closes and actually the regulations and what our role would be as an iccb um the reason I say that is for a new Community

Pharmacy to come up on any of the High Street they have to follow Market entry regulation which is National set by the the national body if they satisfy that market regulation then they would absolutely be coming on board as a new shop front coming as a Community

Pharmacy but that is linked to the health need the pharmaceutical needs assessment that that we all do and that responsibility sits with public health and Public Health in County councils so Public Health in County councils absolutely produce a a pharmaceutical needs assessment and it’s their responsibility and we work jointly with

Them in terms of actually understanding so any closures and all of those at present for my sins I chair the pharmaceutical uh regulation committee on behalf of east of England so across all the icbs on it one of my challenge to all of them as a chair is in terms of

All the other icbs is we have seen last year when we came we talked about Lloyd’s pharmacies and the closure of those we have now seeing some of our boots pharmacies and the closure of those but not just those but we are also seeing some of our small Independent

Community pharmacies as well who are just not sustainable and resilient enough and they are closing what I asked for each of the icbs to work with their Public Health colleagues is to actually refresh their pharmaceutical needs as assessment because it will have an impact on that they’ve got to be looking

At new ways of working new models as well this will take into account some of the Incorporated pharmacies as well that are in general practice or general practice where they are dispensing pharmacies as well that needs assessment is absolutely important because the market entry rules when any new Community Pharmacy wants to

Come on board will be in light of what is the needs assessment saying if the needs assessment is highlighted that in this area of Chelmsford there is a clear gap of Community Pharmacy provision and actually patients have to travel 7 8 10 miles to get a Community Pharmacy

Service then definitely that would apply and anybody who wants to come in would be um granted that permission to actually come in to Community Pharmacy hence it all Pines onto the needs assessment that is going that is currently being refreshed and being considered across everybody so I know

I’ve been talking to seex County Council on that one if I may chairman I think there’s an element of you know has the boat sailed um here and in terms of you talk about refreshing the needs assessment I’ve had quite a lot of problems trying to find the needs assessment in my particular

Area and and and to establish whether the closure of that is crippling to the community obviously my inbox is full of you know complaints from residents uh about the loss of the pharmacy and and and the fact that they’ve now got to travel to uh to to hit that or to

Transfer um to online services but the service is not the same and and and we were actually growing quite good local services from within the pharmacy uh up to the point of of closure so I’m concerned that the boat is sales I’m concerned that we’re not reacting fast

Enough we’re not putting this needs assessment forward but having got the needs assessment how that triggers a new Pharmacy or the provision of that service and I’m not clear you know how we’re going to force that um those Services into those areas uh and to fill

That that that you know the Gap in the needs assessment so I guess a little bit of a change as since taking on as ICB is the responsibility of Community Pharmacy since first of April quite new to all of us in that sense of commissioning of and

How do we generate that sort of Market or entry in terms of so that we when we are seeing things coming through and if uh there is going to be a gap Arisen how do we actually generate the market to actually encourage that and that’s what I think that’s what I’m hearing that

Where are we in this in terms of actually providing that support it is early days for us we are nine months into taking on the full responsibility of not just uh GPS which we’ve already been taken but also the dental Community Pharmacy and Optometry contracts as a whole um something that we definitely

Need to work through with public health colleagues but also as part of our own primary care strategies so we for I can only talk from from a heartfare westex perspective at this current stage one of the key things that we’ve done is refreshed our delivery plan for Primary

Care which includes all the Pod the dental optom and Pharmacy in there but whether am I looking at what sort of new community pharmacies are coming in it’s probably not as solid in that plan at present purely because we’re still understanding and learning in terms of

What do we have out there if anything else and what is the provision of service we have as well will talked about in terms of the pharmacy first model Community pharmacies when they sign up to a service does not necessarily mean that they will be delivering that service on a daily basis

A sign up of a service all that it does is actually they can then claim for it and they may have seen that one patient for that one service in the six months of it what we are working through through directors of primary care and as

A system is to actually start looking at like what we don’t want a postcode lottery so that you only get one service from this Pharmacy like we used to get from general practice before how do we actually start working with community pharmacies and encouraging them to say

That there is value in providing all of these services that are commissioned through your National contract what we need is a Level Playing Field whereby they’re all providing all of the services that they are commissioned from them and if they are unable to provide them what is the reason why they are not

Able to provide these Services is it because of lack of Staff lack of resources or what and how do if they can’t then how do they signpost the patients to the most appropriate person as well so we have a long way to go with Community pharmacies but a real

Opportunity with Pharmacy first because what it has done is patients can now approach Community pharmacist directly rather than going to the GP as getting the administrator and getting a referral as what Community Pharmacy First the Community Pharmacy consultation service did so a real change once this service gets implemented from suppose proposedly

From end of this month thank you um ay um I’d like to move us a little bit away from pharmacies for can because we we’ve kind of gone off on a tangent with them I mean I think my understanding of of pharmacies and one of the reasons that

They they’re so unviable is because they’re on a retail platform rather than rather like um Opticians um you know an optician here in chood High Street will cost you base running cost of 340,000 and that’s before you put a single item of stock a single item of furniture single bit of Kit single

Clinician into the equation so you know when you when you’re up against that you’re you’re dealing with a very different thing my own preference would be that you’d be in somewhere with a doctor’s surgery that sort of thing because that actually is where you need it rather than next de clar accessories

In a Starbucks but I think it might be useful if we have um a more developed conversation on Farm IES and what that needs assessment looks like at a later date and maybe we can add that to the work program as a recommendation later today to to take this conversation

Forward I’m going to go to counselor spenley who’s been patently waiting thank you thank you chair um so I’d like to take the conversation back a little bit to communication and looking at GP practices and new ways of working so having enjoyed myself a career in journalism and education and

Communication I understand how easy it is for people to think that communication doesn’t matter to slash communication um departments Etc so I’m really interested in this and and looking at the summary of inter interventions that you’ve got here and again um looking at how you engage with

Harder to reach groups and with the wider population more generally um so I was wondering with your own commun the icb’s own professional Communications teams how much are those teams able to work with individual practices what capacities do they have are you able to do that because I I completely

Understand the thing of going in and getting uh practices to share the best practice that that that they’re enjoying and their new ways of working but my own experience in my own District in mden is that there is the huge variations between the main practices there and in

The way that they are also able to communicate what they’re doing so I think you know the thing with the comms there and the importance of it is it’s about a it’s about the consistency of approach and also an appearance of consistency in approach between GP services so we don’t look like we’re

Getting a postcode lottery or it you know your welfare depends on what practice you’re signed up with so um yeah so really I’d like to know how much your professional communicators able to work with individual practices thank you thank you that’s a a really good point and uh I think recognizing that um

Our general practice are in dependent contractors to the NHS which I think sometimes gets uh forgot I know it’s been referenced here but it’s not broadly uh understood I think by the general public that’s probably communicate do we want to communicate that actually we we don’t we don’t want

To go there too much because actually it we need to be a family of the NHS now it isn’t possible for our professional comms team to support and certainly in MSE we’ve got 147 GP practices is not possible however um and some colleagues around the room will know uh we have alliances

For each area um so those that involve uh the alliances of Partners so ESS County councils and South End thork the volunt sector um and you know some of many elected members are part of those alliances alongside Health with the um uh local uh government as well so you

Know basilon Council molden District you know they’re all coming together now around populations and neighborhoods so actually what we tend to do is distill those messages from our professional comms team and you know my team that worked for bason and Brentwood uh will going out and they will they have a

Engagement and liais on responsibility for those practices so whilst it comes and is Guided by our professional comm’s team it’s distilled and and uh reinforced out into those practices through the people that have the strongest and most trusted relationship with the practices now have we got that

Right are we uniform every single time we’re not necessarily uniform every time because we have to adapt to the challenges of those practices but that is absolutely the flow of comm’s advice and uh engagement and how then we reinforce things like the NHS app and

How are we getting better uh take up on those sorts of things so it comes from our professional teams but it’s then um it’s then uh s relid out through the relationship managers sorry if I could just come back a little bit on that I I I see what

You’re saying there completely and that’s kind of exactly what I thought was happening however I do think there probably does need at some point to be and understand how tight money is and nobody wants to invest in comes but it’s at the heart of all of this and I really

Don’t think it’s working if I’m brutally honest for a lot of people I mean one of the problems I think you’ve got is that people who use services are engaged more easily but those who are not so engaged with using them are much harder to reach

And I think the thing with comms and the word distilling worries me slightly as somebody from a comm’s background because those messages is like Chinese Whispers actually to some extent and things don’t necessarily you know comms professionals have a particular role and I just think that maybe it’s something that needs to be

Look looked at I’m sure you are but much more intently is intensely is how is how these things are communicated thank you could quickly pick could I just add to that um I just want to add to what Pam said absolutely the strategy com strategy is set at a

More senior level but is then um implemented um by more local teams but I would like to say that there is a consistency certainly in sneeze so for example our social media um is a consistent messaging going out but linking with local communities so the the messaging is consistent but it links

Into the local communities and we do have our um engagement officers working with those um collaborative communities work accessing micr grants to really reach out because although there’s consistency in some of the messaging how we access those those groups like you say the harder to reach is not

Consistent because it has to be different because it has to be personalized to those so I think there is quite a lot of work going on um not necessarily working with individual practices but working with communities because I think the other bit is not all patients access GP surgeries so that’s

Another aspect that we have to um recognize certainly in my area that there are some patients that would not access GP practice thank you the the the micro grants sound particularly interesting so I should look into those some more thank you very much thank you chairman um if I may

Change the the subject slightly was really pleased to see the the access to um secondary care information is going to be incorporated uh into the NHS NHS app it’s long overdue um and would be extremely welcome I’ve got some casework um that I’m currently engaged with at the moment where there’s a huge

Discontinuity between in the patients care between the hospital two different hospital departments and the GP where that communication has completely broken down um to the point where you where do I get my repeat prescription uh from you know this was prescribed at the hospital how do I get my repeat prescription and

Then the communication from the hospital to the surgery to get the get the doctor to actually uh prescribe that repeat prescription and the arrogance of the hospital in you know the doctor knows what to do and the doctor you know should be doing this and the doctor

Turning around and saying no I haven’t got a letter of authority I don’t know what I’m doing with this patient I don’t have the information for this patient so a complete breakdown in that particular instance now I understand that that may be uh fairly unique or you know it’s not

Symptoma IC um and then I get another uh email in my inbox from another patient with very similar um things so this would be very welcome but what I’m concerned about is that you know are we taking care of those communication gaps are we learning from those mistakes are

We trapping uh those sort of things in the future and is the feedback from the primary care system into the secondary care system working as a two-way street and I fear that it’s not at the moment um uh very good point and and one of the key requirements of the national

Access recovery plan is around the primary and secondary care interface and addressing that um anecdotally um I was speaking to one of the the GP partners of a large practice in South essics they’ve got a list size of about 20,000 they ended up having to employ a

Medical secretary to Simply deal with um interface issues and patient queries around where patients were waiting list where they missing prescriptions all of those sort of sort of issues and they end up having to get a dedicated member of staff to do that because it was so distracting for everybody else to have

To pick up one or two or three queries a day that were coming through from patients all very legitimate concerns from the patients but but but ones that in a functional system shouldn’t be happening um so one of the key key things I think all of the icbs are doing

But certainly M South eics uh we’re doing is trying to improve the clinical leadership and relationships between primary and secondary care because if we we don’t get that right um it it becomes a huge distraction for for a very stretched Workforce and we’ve got to get

Our Workforce to be as productive as it can possibly be and almost forget about the boundaries of whether you’re a primary care clinician or a secondary care clinician or indeed an administrator in either field but what’s the the kind of most efficient way of dealing with the issue uh that you’re trying to

Resolve we are a way off that um unfortunately I think since covid those relationships have gone downhill rather than uphill um but I think at least now we’re recognizing um that that needs to be addressed and there’s there’s already um some some links and relationships being fored between senior clinical representation representatives from

Primary care with um the foundation trust um and we’re we’re aing to build on that but it is to address these type of issues that that that are quite often an error with a process or a shortcoming of a process um rather than the kind of clinical management but it impacts on

The clinical management of patient and through a kind of troubleshooting Arrangement we’re addressing those issues whilst trying to forge that better relationship that will create the foundations for for for a stronger way working going forwards um I think as I said we’ve got a long way to go before

That um those relationships feel right and that the pathways are effective some of it will be underpinned by digital Solutions but an awful lot of it comes down to personal relationships between primary and secondary care um staff both clinical and non-clinical um and the ICB has got to to support that and make

Those um developments happen I think that’s probably what all of three icbs will be um focusing on over the coming months thank you um councilor Harris thank you chair thank you very much um yeah can bring it back to the Primary Care access recovery uh statements that we’ve got in front of us

Um I find it very hard to um to disagree with anything that’s said about tackling the 8 AM rush in the morning and the number of people who don’t know at the end of the day what their request is and how they’re going to be managed and you

Can see the direction of this so my question is really centered around that access recovery um for for me uh a lot of GP services are still having massive and I mean massive I’m on a local forum for my local doctor surgery a massive un people who don’t turn up for their

Appointments four or 500 a month on one surgery which is if you look at a complete doctor for the week that’s wasted um which I think is is shameful so I think they’re going to have to do something about that um I use the app

All the time on the the NHS app so I’m have AV use of that for some time and order my prescriptions on there so my question on the app is will you be able will that be is there intention to have online booking appointments through

There um and if so how would that be managed because you could see thousands of people then being converted a converters to the app and the app not being able to manage with that system because all of a sudden you know the triar in which I was just reading again

There for the third time the the documents there chairman how you going to triage that and make sure the right people get seen at the right time because all too often um and this is another question of course all too often the doctor has to be seen to refer your

The patient to the secondary care so there has to be referral process that you cannot self-refer for some issues so will that change in time it’s early days on this but I think we’re on the right road but I do think the the March 25 is

A bit ambitious because I think you know it may take longer to get to some of those achievements and aims that you’ve got than in this document but that’s NHS England setting you the direction not not us is it so so those the questions chair thank

You I’ll come on the app so the ability to book and Council appointments is an Ena already an enabled functionality of the app um in Northeast essics not all practices have got that um functionality turned on currently in Northeast essics all I can only speak for Northeast

Essics about 48% of practices have that functionality turned on um so the ambition obviously is that all practices would have that ambition on which um I agree should reduce the um number of unattended did not attend vend appointments because that functionality should be easier to cancel and I think

Will or Pam wanted to come back thank you m I think you you raised a really good point around how do you enable more functionality through the NHS app but still then um allow the total tree Arch model to work and and the critical thing is about that differentiation of demand

Between a planned care and known need versus an unplanned um episodic need um and what we got to do with um prati I is and with the the population is helped them identify the difference between the two and and where you could have um online booking for appointments for for

For those plan needs so your smears IMS and screening um annual reviews for diabetes health checks Etc where you’re being called in to to to to clinics rather than presenting yourself um an online booking system works really well because you can identify the capacity you need release the appointments uh

Notify patient that that that we’re ready ready to see you um and those patients book an appointment that’s convenient for them where we need the um the total triage to model model to work is more of that episodic and unplanned need where there’s got to be some kind

Of differentiation of your diagnosis how will are you what sort of intervention do you need do you need secondary care and that’s the bit that general practice does phenomenally well when it’s when it’s functioning um and and that’s the bit the health system uh needs general

Practice to do in order to not swamp secondary care um that being said there are some secondary care Pathways um increasingly where uh we’re identifying actually allowing patients to refer themselves straight through to secondary care is a sensible thing maternity Services is is one of those areas where

Um actually there’s a number of parts of maternity pathway where going to see your practice won’t add any value um that actually you can go straight to to maternity for for various things and so we’re we’re trying to uh develop those Pathways at the same time so that we can

Allow patients to to go straight through to secondary care where it makes sense um and and ideally then protect particularly the GPS to do that that that differential diagnosis that that they do phenomenally well managing the risk and saying which patients need further intervention be it done by the

Practice or be it done by secondary care um and we we’re trying to progress that within mid and South eics through a concept called connected Pathways um and I think you’re right that whilst the date of of March 25 is the one that we’re being given this is an ongoing

Process it’s about the way NHS is going to be accessed for years to come and we can’t just get to March 25 and think our job is done um and so through our connected Pathways program we’re trying to to build Pathways in a systematic way

To adapt to this new way of of of accessing uh NHS Services um and and just picking up the point from earlier around um the comms front so within Mitten and South essic we’ve actually invested in two dedicated comms offices one digital one one um General comms for

That connected Pathways project to keep them focused on this work um I think too often in large organizations like the NHS comm’s resources often drawn to the firefighting issue of the day we’ve recognized that if we want to do this and do this well you have to protect

That capacity to do the thing we’re trying to do over the long term um and so we’ve got a dedicated Comm two dedicated uh comm’s resources to support that program and part of that is actually about changing the mindset of people work within the ICB about what

We’re trying to do so that as we develop new Pathways we’re thinking about how does this fit in with the modern general practice model um and as say that work will go well beyond March 25 thank you CH yes on on the app I’m I’m in a doctor’s surgery that has the

App but you can only book a blood test via a conition online you cannot do it for anything else so I’m one of those 56% cuz you said said the 48% or 44% have got it so any indication about how you can in averted commas encourage mandate the doctor’s uh

Surgeries to actually go down that road and come with you on this journey because without that you’re going to be handicapped I think you just uh uh respond and see if anybody else wants to come in so I think critically with this um with this development we’ve seen practices more

Willing to engage with trying to tackle this access issue than probably anything else um that’s come before it simply because I think staff within general practice are as frustrated as their patients about how dysfunctional some elements of access have become um I’m sure probably everybody’s aware of some

Of the abuse some of the staff within general practice received um and the fact that everybody working within general practice wants to do the best for their patients and they feel that because the demand and stretch um service they’ve not been able to do that so I think we have got more willingness

To engage in this program of work than than we have done um for for previous initiatives we’ve also got um peers within primary care who want to share their learning where they have been early adopters of of of of these models and support their their colleagues to to

Make the change there is some fear I think from some parts of general practice around opening more floodgates and that that if you change your models you’re potentially going to attract demand and when they’re already struggling to deal with demand that comes through um but hopefully through

That kind of peer leadership and the support that the icbs are putting in place we will get people to move quite quickly to these new models and where they have implemented new models almost universally everybody said we wouldn’t go back to what we previously did because actually this way of working is

Much better um for the New World um maybe 30 years ago it would have been different but but for the world we’re now in um there is a real acceptance that actually this is the way forward thank you councilor Goldman thank you chair um just a couple of hopefully fairly quick questions um

The first question is uh William you said something interesting in your opening presentation actually I just wanted to pick up on because I don’t know if it was a throwaway kind of comment just the way you speaking or whether you had there was something behind it but you mentioned the figure

Of 70 to 90% of access to um Healthcare I think it was through the pro was through the primary route um and I found that really interesting but you taed on a few words at the end of that you said in this country and I wondered bearing I

Mind obviously I know that different countries have different Health Care Systems but how do we have any kind of comparison or benchmarking that we can look at other country systems to find out how how we’re doing or anything that we can learn from other countries good question um I I’ll be

Honest um certainly locally we haven’t we haven’t looked into comparisons elsewhere I am aware that other health care syst systems have been struggling since the pandemic in terms of of managing demand that comes through particularly in France I think that there’s a the real issue with with

Access to Primary Care very similar to our own um but certainly I think that there is a willingness to learn from from other models um that do work it’s not something we have pursued and looked at locally thank you and then my other question which is a slightly cheeky one

I suspect um you seem to be making quite a bit of progress as a huge amount of work still to be done and and it is good to see that that these things are being tackled and I’m sure residents would like always like to see the progress uh

Made more swiftly um but I appreciate it’s a very difficult um uh difficult issues that you’re tackling um what’s the one thing if we could wave a magic one what would be the one thing that you would ask for to make easier so I think for me it’s the

Appreciation that the system of General practices ch changing uh and I think we’ve coming back to comms because it very often comes back to comms we’ve sat in front of national teams that say we will do a national campaign that says actually when you see the front of a

General practice surgery now it’s got multiple Professionals in it and please don’t expect to see a GP before you want to see one of those professionals I mean as a team here we’ve got nurse Community nurse you know lots of History work in the hospital I’m a physiotherapist A’s a

Pharmacist actually as independent professionals uh we should be able to receive our clients without them going through uh a doctor um that relies on the reception not being seen as reception anymore now this national campaign has not been done and we’ve been promised it numerous times and

Going into election I don’t foresee it coming so what I think you know we need to do we’re trying to reinforce that local but as partners I think wherever there’s the opportunity to reinforce that the model of general practice is changing because there’s all those professionals there and actually that

Will help us with the demand and the experience that people have when they go into general practice that would be the rewiring that I would really really love to see because we still have high levels of disappointment that people haven’t seen a GP before they’ve seen a physio

Therapist yeah it’s we know it’s added no value and there’s lots of noise around on that and it you know actually we want to be able to um support our professionals that are in um general practice to to do something that we call is working at the top of their license

You know if I’m if I’m working in out patience or in a hospital I don’t have to have a doctor sat next to me to be able to do my job so let’s allow those professions let’s give them the respect that they’ve got in that setting just because they’re in a different setting

Let’s enable them to take take take the the role um that they that they’re trained to do thank you that was a really interesting answer and slightly surprised me and really really interesting my request to you would be to allow us to help you so come into the

District councils come into the County council do some presentations to members who can help disseminate that information through our various channels and when we’re having conversations with residents as we do regularly um help us to understand that and help us to disseminate that information for you

Yes thank you chairman if I may I’d like to pick up on something slightly slightly different out of the um what we’ve been discussing I picked up on two newspaper articles over the last two days uh in our local paper um down in the South and it refers to ghost

Patients um you may be aware Ware of this or may not you may have to come back to me on this but basically what the article is saying is that it’s cost the um Mid and South Essex uh integrated care board something in the region of

12.5 12.4 million pound in the last year for ghost patients now basing that on uh 164 pound per patient per year that’s equivalent to 76,000 patients now if you take Rochford district for example the PO total population of rord district is 83,000 so to put it into P perspective

That’s quite a vast figure when you calculate it up nationally it works out something around 5.8 million people are being paid for in the National Health System um across across the country really I’d like some comments on that uh because 12.4 million um if it weren’t

Being paid to surgeries could be used on an awful lot of other things in the NHS okay thank thank you I haven’t seen the Articles you’ve referred to um and and I will take a look at them if you can send them on to me owing to being

Out of the country until uh late last night so if they’re very recent um but but obviously the concept of ghost patients uh particularly I mean we can go into how uh general practice is funded but the the that money that comes into a practice will not not be being used on

The registered population of that practice so actually that the calculations for each general practice is um adjust Ed due to deprivation due to uh the age profile there’s a there is a national formula and it’s nominal what it means per patient really so the total allocation that comes into a practice is

Then spent on the population so it’s not that it’s not being spent or it’s being wasted obviously the way we can clean up uh patient lists is very important but it doesn’t mean I I haven’t seen a practice yet that’s said to me I’m so flushed with money uh you know well I’ll

Hand I’ll hand some back we we’re actually seeing practices that are um you know they they’re presenting to us now their accounts and and they they’re not they’re not flush at all so good uh housekeeping around the sums of money is and and the registered patients is very

Important but I can assure you that that is being spent on patient uh services and not being set you know sent anywhere else it’s part of the it’s part of the allocation of the practice to run a practice the costs are there to run a practice irrespective in

A way of what what the registrations are so yeah this article is uh commented on by the Vice chair of the Royal College of GPS uh you’re welcome to have copy of the paper I have here if you wish um but it does to frustrate me that you know

That sort of money should be better spent and uh you know I accept what your answer is but I’m not it’s not convincing me good enough we’ll get copies of that and we’ll send them to par and she can maybe have a have a dig into that um I

Think that’s pretty much it from Members unless anyone else has any questions I think um for me the papers have come a long way an awful awful long way and I can see the intention I can see all of that the frustration for me is that my

Conversation with my residents my my as a counselor haven’t changed at all they’re still frustrated that they can’t get a doctor’s appointment they’re still frustrated that they don’t know how it works I’d really like us to be at a point where I can say do this and that

Will help you get the best out of your health service but actually don’t be thinking I need a doctor because you’re not a doctor in you don’t know you need somebody to help you with the problem that you’ve got that might not be a doctor um I would take very very

Seriously councelor Goldman’s lead on this you’ve got 75 councilors elected to this Council use them so I’m very very happy I know Pam you’ve been to to scrutiny at basilon um you’ve got 42 there that you can use as well by all means if you want us to organize you

Some briefing sessions all member briefing sessions very happy to oblige um if you want to put together a one pager that we could share in the 46 community centers I have in basilon or 74 libraries we have across the county that would actually help get that message out without having this Central

Advertising campaign we very happy to help with that too so thank you very much for today um look forward to seeing you again take care okay members thank you very much for for that um just having a quick shift about on a reset and getting people in the

Right chairs now so we’re going to move to um item five on the agenda which is the mid and South fic NHS Foundation trust update sry um joining us today is uh Chris Howard who’s senior director of Estates and Facilities Jonathan dunk who is Chief commercial officer and um I

Believe online we have Laura Harding who’s the medical director and managing director of romfield so um Chris Jonathan Laura over to you yeah thank you councelor Henry morning all can I just check is Laura with us on screen she’s not entirely sure if she’s in the room or

Not I I I can hear everything I don’t know if you can hear me at all we can we can hear you okay and my camera’s on but I don’t know if you can see me we we can see you Laura so morning thank you so yeah good morning all uh so

Apologies for lack of operational or clinical presence in the room although we’ve got Laura with us uh we are in the midst of uh strike action at the moment so we’re under incred credible pressure which no doubt will come on to in the conversation over the course this

Morning so you have seen from our papers effectively we’ve got a two part update for you today first part is about our Estates uh some of our challenges some of the mitigations and the Planned Investments and the second part is a more wide ranging operational update so

If I could first ask Chris to take the Estates updates and perhaps take questions on that and then go on the operational updates thereafter thank you thanks thanks Jonathan good morning everyone um I hadn’t intended to go through the sort of line by line of the report thought I’d give you an overview

Of our approach to strategic Estates planning in the trust um but just to to to start off by explaining a bit about the uh extent of the uh estate that we’re as responsible for in mid and South essic you’ll have seen from the paper that we operate across three acute

Hospitals we also have a range of uh Community premises that we provide our services from it extends to about 400,000 square meters just under that uh it’s a complex estate consisting of um some really high tech buildings equipment plant engineering and infrastructure uh and we spend over well

Around 10% of all of the trust income on maintaining cleaning upkeeping uh the estate um our approach to strategic Estates planning is very much um about uh a forward forecast to consider on the basis of where we are now where do we want to be and how do we get there

They’re the three sort of stages and within the trust at the moment we’re in the process of refreshing our estate strategy and it’s always driven by the the needs of our population uh the clinical needs of our patients and that’s the that’s the foundation of developing our estate and supporting us

With prioritizing our capital investment to make sure that we’ve got a state that’s fit for purpose it’s functionally suitable it’s safe it’s in the right place it’s the right size um to meet the needs of the people that we’re here to serve um I suppose the three headings of

Where are we now where do we want to be and how do we get there I’ll briefly touch on those although they are referenced in the paper and um the most obvious part of the paper in terms of where we where are we now is that we

Have an estate that has a significant backlog maintenance problem um that exists across our estate both in the hospitals and in the community premises uh and the typical issues that we Face are around um deteriorating building condition uh aging engineering infrastructure um equipment and uh essential plant that

Needs replacing because it’s at the end of its useful life um we also have site congestion so uh for those of you that visit any of the sites you’ll know it’s often a problem to park we don’t have sufficient parking capacity we don’t at some of our sites have very much land to

Enable further site development either and that’s particularly an issue for us at at South End less so at Broomfield uh and BAS um where do we want to be well we obviously want to provide safe compliant functionally suitable estate in the right place but we also want it to um be

Efficient and sustainable uh and in the NHS we have a a target of achieving Net Zero carbon for our estate by 2040 so that’s also something that’s on our radar in terms of our investment priorities how do we get there well the the main weapon for us to develop and

Improve our estate is through capital investment um typically in any Year we will spend something around a 100 million on Capital but that’s not just in the the premises that that’s also on our Digital Services infrastructure um but a good a good percentage of that is

On um our estate it’s both spent on um backlog maintenance and targeting those critical risk elements of our backlog maintenance but also making sure that we’ve got um sufficient capacity within our estate to provide the essential services that we’re here to provide um we have um from a strategic planning

Perspective with our estate this I suppose it’s an issue with a lot of the public sector is that our planning cycle is quite short because of the nature of the funding cycle and so whilst we try and strategically plan for 5 10 years in advance um we have to do that in the

Context of not understanding what the capital allocations are going to be that far in advance um so our Capital uh investment that we have access to really comes from two different sources we we have a a capital investment pot that is derived through the ICB and shared

Amongst the providers within the ICB but we also bid for initiative funding that’s held centrally by the Department of Health um we’ve had some success in the last year or so in bidding to invest in community diagnostic Centers uh our elective surgical facilities um and also we’ve following trust merger in

201920 we’ve been successful in drawing down some Capital to enable acute services reconfiguration and that that’s referenced in the the paper I I think the the fin aspect of providing an estate under that Banner of how do we get there is making sure from an efficient point of you um

We’ve got the right amount of estate it’s a very very expensive overhead um and consequently Estates rationalization is Al always something that we will look at if we’ve got buildings that are not significantly uh or sufficiently used or they’re in a condition where we may it

May be more efficient for us to rovide that estate elsewhere that’s particularly the case for our least uh leas in estate because we can sometimes generate Revenue savings by rationalizing services and consolidating but we have to do that in the context of providing services in the right location

For the people that we’re here to serve and on that point I think I’ll I’ll stop and um open up to questions so members we’re going to do this um in two half we’ll do the the states aspect now so councilor spencley youve indicated so it won’t surprise you to

Know that I’ve got some questions as I’m from Warden district and I’m going to ask about St Peters and I I I’ve read this and it you know we’ve had consultations as members um at morn District Council recently with with um D doti and others um but it’s very depressing

Because the the backstory there as I’m sure you aware are aware is that we’ve been pretty much promised a new health hub for decades so to read that this building is in the state that it’s in and I have to say this this really only just covers it

We’ve got lifts that apparently the lift compan is refusing to repair anymore because they’re so outdated we’ve got a first floor where it’s dangerous to take heavy patients apparently um we’ve got rain coming in when it rains and we are in a district where the access the services needed is is I’m

Afraid it’s been neglected for a long time so this this this wasn’t something that that couldn’t have been seen coming everybody I think has been aware of the state of St Peters for a very very long time and one thing that I I I did have

To stop um somebody who was giving us um some feedback from the NHS from the ICB on um to to members had to stop him because he was he carried on and on and on about the building which I get but you’re talking about a strategic Way Forward what is the Strategic Way

Forward for mden because another consultation I mean do we have any idea of the number of public consultations that have gone on around the provision of services at the new health Hub there over the years so I’m gonna I’m going to leave it there because I do feel

Passionately about this and obviously I feel passionately about this on behalf of my residents thank you um thank you before I um hand that back to you I mean I would say that whatever’s come before has come under another entity it is a very recent merging of this so we’re now dealing

With a new entity that will obviously have to take their own their own aspect but um s petus is certainly something I’m nowhere near as as Jonathan as you know s petus is something that’s even come up in in my area as as an issue of concern of a

Team yeah I’ll tell that one so yeah thank you for the questions uh so I I guess there’s a few points making back on that so clearly as Chris has said the building is in a state of disappear and isn’t fit for purpose I think partly

That’s because uh passes your time but I think actually that building probably isn’t fit for purpos in terms of design to deliver Modern Health Care Services regardless of how much money we spent on it so actually when we’re thinking about how we utilize our scarce resource we’ve

Got to think about how we can deliver the maximum benefit for our patient population so I take I take absolutely what you’re saying but I think that is clearly part of our considerations um whilst we’re not talking about the consultation here today clearly there are conversations on going around future provisions of

Services in the modern geography I think one of the key tenants of whatever we do detered to bring forward we’re about reprovision of services locally as far as possible and I think that’s a key commitment to which will be made in any future consultations and also making sure that the commitments to substantive

High quality facilities in that geography will remain so whilst I can’t talk today around some of the detail because clear that’s got to come thereafter I think we hear what you’re saying and there is a commitment to make sure the people of M do have access locally to as many high quality services

As is possible I only want to come back briefly because this can’t all be about Moren um but as you you will be aware there’s this huge issue with the South M relief Road and access to the plan new health Hub on the state on the site that

It was going to be and we’ve had some feedback now that other sites are being looked at um I just I’d just like to reiterate that point that we need clarity about what’s happening going forward um it cannot carry on like this and and I think the problem with another

Public consultation is that there have been so many historically whether it’s involved the people before us here or not that people are tired of it and they want some they want some action now thank you thank you your points have been noted Richard I’ve now got uh counselor

Stepto thank you chair um you touched on the parking issues in particular South End have you looked and considered offsite parking I.E uh Park and Ride um I pick on south end because that’s one I know best um I know of two very large sites that would be quite suitable for

Park and ride without too much of a planning issue and that potentially I think they could be self-funding i’ like to know your comments on uh thank you Council setto um the the parking issues at South End each of the sites have got their own sort of characteristics when it comes to

Congestion uh and with South End um one of the things that we’ve looked at recently because there is a a degree of Redevelopment going on on the site which results in losing some spaces is looking at offsite uh opportunities for exactly what you’ve described and we have engaged with some Partners locally to

Look at that um we haven’t implemented it at the moment because the um the the extent to which parking spaces have been lost through the development we’ve been able to absorb by reorganizing space availability within our multi story car park on the site so actually we haven’t

Had a sort of an overspill problem that said we do still have on some days particularly busy out patient days some instances where we have um patients curing to get into the car parks on on prle well but by and large that’s that’s not a common problem apart from one or

Two hotspots but we keep we’re keeping it under review and it’s certainly something that um we wouldn’t rule out in terms of the the other two sites um I I’ll comment on Broomfield first of all because there was a park and ride so service in place for Broomfield prepandemic and the service was

Suspended um we are in um discussions with Ence County Council colleagues at the moment about reinstatement of that Park and Ride service and we hope to be able to make an announcement about that early in the new year with regards to the South End uh

The two sides that I’ve got in mind are both in my division and my District board if I can be of any assistance behind the scenes please contact me and I’m only too willing to try and assist you in that thank you uh we’ll move to councelor Goldman now thank you chair um

As a city and county councelor in chelsford I’m concerned to see that brunfield hospital is on this list as having um a backlog of maintenance issues I was wondering if you can tell me how that backlog arose and uh give us an examp some examples of the things

That are on that list and what’s being done about them thank you yeah thank thank you um brenfield hospital is an interesting piece of estate in so far as it’s a it’s a it’s a game of two halves I suppose is one way of putting it in that we’ve got a big

Proportion of the site which um was a new build um through PFI investment uh and that part of the estate doesn’t have back log problem um the retained estate um has a more significant backlog maintenance problem um and there are two sort of key aspects to the backlog maintenance which we’re currently

Addressing um the first one is the engineering infrastructure and um over the course of the next uh three months we’ll be bringing online a new combined heat and power system which enables us to turn off all of the steam systems on site and those steam systems were a significant component of the backlog

Maintenance so there’s a big element that will be dealt with through that but also we have on the site in one of our buildings uh some uh rack planks these reinforc uh arated concrete planks um which also form a component of the backlog maintenance number and we’re um

We’ve removed the first planks um over the last couple of months and we’ve got a program to completely replace all of the roof where those planks are located over the course of the next um 12 to 18 months and that also removes a significant component of the backlog on the

Site thank you um councelor Harris thank you chairman thank you very much um a very honest report here I see um 218 million pound in this this list here I’m looking at page 28 there um but that’s very concerning is that accumulated is that happened over a particularly long period of time because

It doesn’t say that where are we now in that section whether we that built up over a period of time was this these figures the same last year the year before and the year before or have they grown exponentially which I suspect um so that’s the first question and then it

Talks about dispos of assets that do not meet the criteria of mon standards for clinical Service delivery um How would um be assessed against the needs of the NHS and and the you know the particular sites these areas serve thank you thank you thank you so so the first

Question about the the historical accumulation of of backlog um there there are a range of different reports um in the public domain that clearly set out the progression in the value of backlog maintenance nationally and the the current level of backlog maintenance sits at around 10.2 billion pound so

This is a problem across the NHS and this has been growing uh a significant rate year on year for the past 15 years or more um within our own trust um the data that we present in this report was based on a comprehensive condition survey of our state from

2021 and so what what we do each year is um do a mini reassessment uh and we apply an indexation to the value of that backlog based on the industry inflation that we see in building costs so each year we’re seeing an inflationary Factor against that backlog number and with the

Capital that we’re able to invest in backlog it’s fair to say both within mid and south6 and on a national basis there isn’t sufficient investment going in to to have a real impact on bringing that number down uh and we need to put much more investment both in MSE and

Nationally to have an impact on um the backlog figure that’s the reality I think um the with um sorry can you just repeat your second question yes certainly a disposal of assets question about um the needs of the the population and the fact that you may need to dispose of some of

So the process that we go through if we’re considering disposable an asset is um something that is clearly defined within the NHS and it’s always assessed on a needs basis so we will’ll only dispose of an asset if we can demonstrate we’ve got suitable provision

Um to replace that asset and um the the only example that we have that’s been subject to consultation within our our um geography in the recent past is we have made a commitment to dispose of oret hospital um that’s in abeyance at the moment because we’re unable to um

Deliver all of the reprovision plans that we would need to to enable that site to close so it’s not currently being closed uh until we can set find satisfactory solutions for those Services we don’t have any other confirmed closure plans at the moment thank you chair and I just fin a

Question on the m& is that mechanical engineering or mechanical and electrical thank you very much yeah and and a final comment which I think you will agree with chair the the CDs the the diagnostic Centers have been its success story I think um across the whole of essics where you’ve done that there’ve

Been a very very welcome change to the organization so well done for that thank you thank you um councelor Moore yeah just just a quick question uh you mentioned rack at uh at um I can’t think when at the building now brunfield is there a problem at

Bason simple answer to that is no um we bason was one of the sites that was suspected as potential r and um we we carried out detailed surveys um when the rack problem first became a a a national priority um we’ve recently reinspected bason with uh support from NHS England and a national

Team of R experts and they’ve reconfirmed that there is no rre at bason members any further questions no okay um okay we’ll hand over in just a second I think um I think for me I I’ve been to all of your recute hospitals and I see a

Very very different I see chelsford as being a fantastic looking location certainly the bit that I’ve seen the Opthalmology and and and that front end and you have a trail of ancient buildings out the back and other little suets that that don’t seem to be up to

Up to mustard but I think looking at the new most of your hospitals basilon um that’s a horror story in certain areas that front entrance that new approach the way that that and patient flow seems to be incredibly incredibly improved but when I go into that back office where we

Have our own people our staff neurology for example crammed into this room with a big window that should be a window but it’s got a big lump of plant Machinery outside it now so it’s no longer a window it’s a sort of a silhouette of of

A of a tank or something that’s outside you know and I think then about is it any Wonder we can’t R retrain recruit because you know we went to neurology we went down the hall we saw another young chap with a student doctor in there and

You think why would this lad want to come and spend 10 15 years of his career in this building that that great building does great service does amazing thing wonderful people working there but actually it’s it’s not a great environment for our for our teams our staff to work in South and similar

Equation mods in different bits of buildings and yet actually functions very well considering it’s exactly twice the age of basle so I think you’ve got you have a lot of work to do you’ve your work cut out for you to to consolidate the the um portfolio and make sure that

We get the best concentrate more on the service rather than the the location or the building I think the service for local um is far more important than concentrating and preserving a building we know that as as as borrow counselors um trying to maintain a portfolio of community centers and God knows what

Else if you try to do everything you’ll do nothing if you try to so right you know we’ll work on this let’s do that and I think that’s that’s maybe the way forward we’re going to go now to the next part of your update so Jonathan I’m

Going to hand over to you I think and yeah thank thank you coun Henry uh so again as request I’ll take the paper as read I guess a lot of what’s in that paper but you can see it’s framed in the context of industrial action which has

Been ongoing since last April and we’re currently in the midst of a six day six day strike after a similar strike just before Christmas and I think it’s probably fair to say and Laur no doubt elaborates in questioning that we are under incredible pressure at the moment

The volumes of patients pitching up at the hospital uh certainly since Christmas until now has gone up significantly that coupled with the Striking uh means that we are under huge pressure and we’re having to run run the hospitals effectively in incident mode at the moment certainly through to the

End of this current strike we are getting really good support from our system Partners both across the Health Service and Beyond uh but nonetheless we’re in a period of incredible pressure and that is having implications for the sites in terms of delivery of some of our

Standards uh in the paper we draw out some of the impacts of that on us over the last year in terms of activities we’ve had to cancel so 31,000 outpatient appointments 4 and a half th000 surgical procedures these are massive material volumes which are impacting on our ability to deliver Upon Our required

Performance obviously that’s playing out now in terms of our waiting times uh and Beyond there are some good news stories in there so in terms of our ability to maintain performance despite those challenges I think there are some uh quite significant success stories there despite that

Pressure uh in terms of where we are experienc some the pressure more broadly you can see in the paper ambulance arrivals at the hospital November to November year year 22 to 23 46.8% increase across our site that’s unprecedented in terms the level of pressure but you can see there actually

Despite that we’re reducing the uh time for ambulance handovers materially so a year ago it was taking over an hour to hand over ambulances we’ve now got that down to less than half an hour and we are committed to getting uh all of our Ames as best we can under that half hour

Standard so some significant improvements there I guess cancer and RT are the measures by which most people measure the performance of the hospital andic targets and you can see in the paper obviously industrial action has impacted there but we remained committed particular on the cancer one to our existing trajectories getting back to

Where we expected to by end of March this year in terms of elective RT performance there’s a there was a commitment to get to 65 weeks uh elimination by March 24 and 52 weeks by March 25 clearly industrial actions continuing to have an impact on that and

We are making huge strides in that but I think that is going to present some challenges especially once we understand the consequences of the current six day strike action and anything which may follow over the rest of the year but nonetheless our weight in lists have

Come down hugely over the period of the last 12 months as I walked into the chamber I heard some comments around uh making sure we’re using our money effectively and reducing waste and you can see in the paper some of the steps were taken around that around how we’re

Looking to reduce the number of do not attends outp appointments uh how we’re looking to move better towards using testing before we move straight to our patients to more effectively triar I’m moving towards patient in initiated follow-ups in terms of outpa as well so we don’t have unnecessary

Outpatient intendis and putting the hair back in the hands of the patients wherever possible we talked about Diagnostics already and the benefits of cdc’s there it’s absolutely essential the demand for Diagnostics is going up exponentially without that capacity we simply won’t be able to cope uh but we’re making significant strides there

And the final part of the paper talks about some of the additional recognition and achievements of the hospital so National staff recognition it’s really important that we see our staff delivering on that national scale and we’re seeing that consistently some of the innovative ways we’re using some of our CH charitable contributions to

Change the way we deliver some of the care for our patients and also some of the inovative treatments so using some of our supports and volunteers across the side so there’s a lot of content there I won’t go into the detail I’m happy to take questions and say Laura is

With us as well from a clinical and site leadership perspective at brunfield thank you thank you Jonathan um Laura did you want to come in with with anything uh no I mean the the the paper as Jonathan says we take it as red and it gives a lot of the sort of details

And figures um just in terms of industrial action I think uh yeah it’s it is very pressured um and the the timing of the industrial action particularly this week coinciding with what is already a very pressured time of year just adds to that so um we can talk

A little bit more about that if if anyone’s got questions about it but we plan extremely effectively for the industrial action it’s almost become something that we um have got used to doing over the last year so our planning is is quite slick now um and and we have

Lots of mitigations in place to keep our patients safe and to keep our staff safe because uh you know the staff that are working during this time are doing a lot of extra work um and are under a lot of pressure themselves to to sort of keep

Going and keep going so we do a lot of of work leading up to the strikes not just about patient safety but also about keeping our staff safe and the well-being of our staff thank you um members any questions councelor Harris councelor Cole yes thank you chair um really it’s just a

Question about the cancer uh delays um as professionals I’m guessing and I’m I’m assuming I’m right that Cancer’s develop at different pace and rate in different people of course but I’m assuming that when you manage that list you make sure that the top priority ones

Are at the top of that list and the Lesser ones are managed down the list a bit not that you want to do that but you’ve got to do that um I’m assuming that’s correct yes yes um so so whenever we’re looking at at you know cancelling appointments or operations um it it

There’s a prioritization system that we go through the clinicians um and by clinicians I mean not just doctors but but specialist nurses and and other professionals involved in the patients care will assess each sort of individual case and work out if it’s something that can wait even even even though we’ve got

Industrial action this week we do have operating list going on we do have Clinic appointments going on um with with the staff that we can sort of release to do that and those patients that are being seen are those ones that fall in those priority areas where any

Delay even just by a week or two might make a difference um so we we sort of prioritize those first um and anyone else that’s had their operations or their appointments canceled have already been rebooked and given new dates as soon as POS possible after it’s over so

There is a sort of stratification if you like of of risk um and then that we also have a a sort of harm review process whereby patients that have had treatment delayed are reviewed subsequently to see whether it did cause any harm or not so so we’re constantly reviewing and re and

Revising thank you for confirming that thank you thank you chairman councelor Goldin thank you um Jonathan you mentioned or you highlighted the um very large increase in ambulance arrivals um from November 2022 to November 2023 which um according to the paper was 46.8% I mean that’s that seems

To me to be a very very large increase in arrivals um do you have any idea what’s causing that large increase in arrivals so in terms of uh a strong evidence based no there’s lots of uh hypotheses around what might be driving that whether that’s access to primary

Care potentially in terms of uh increased accurity of health conditions in the community postco uh and variety of those kind of them but in terms of an explicit answer to your question no I don’t know whether Laura might want to add to that at

All no I mean we we we have done we’re constantly sort of analyzing um not just the the numbers but um in terms of after patients have arrived at the hospital those that have subsequently then uh required admission or whether they’ve been turned around and charg straight

Away so you know whether whether they should have come in the first place type of thing so we’re constantly reviewing that um and and the thing that that seems to strike is that the accurity of of patients arriving certainly over the last 12 months has been much higher

We’ve obviously got a a continually Rising elderly population and certainly when you look at the ages of those that aring by ambulance it’s tending towards the the sort of more extreme elderly uh end of the population um and there’s no doubt that the population is growing as

Well I think in in all of our um patch not just around chelsford but all three hospitals we we’re seeing increase uh population so that inevitably will have a knock on as well but the the number of conveyances is certainly going up and the conveyance rate or percentage if you

Like um of of those that that come um is fairly constant so we’re not seeing an increasing percentage of 999 calls arriving it is it is a volume issue you know they they are seeing an increased volume of calls and so we’re seeing an increased volume of arrivals um there’s

A lot been put in place to try and reduce the volume of P of patients that arrive by ambulance so obviously um the East Ambulance Service themselves um try and do a you know hear and treat see see and treat and try not to convey say paramedics can deal with the problem at

The scene we have one11 obviously to intervene um to try and reduce the conveyances but um we we in spite of all of that we are seeing increasing numbers of patients conveyed to the hospitals I have a a question um you have a vast amount of people

Rocking up to to casual every day how many of those people don’t need to be there that’s a good question it’s it’s a trick question but I mean yes I think what I’m trying to arrive at is is the wider system of health health supporting um the acute hospitals where

They need the support are there frustrations because people can’t get to see a GP as in our previous conversation and they’re turning up on your doorstep because you can’t turn them away um there’s an element of that I think some of it is is a public perception that they believe that

They’re not going to be able to see a GP and certainly sometimes you every now and then we’ll do a bit of a a sort of spot check um for a day and sort of ask people did you try to contact your GP um and you know a fair proportion will say

Well no there’s no point so they haven’t tried because the perception is that there there’s no point um so there’s there’s you know obviously a bit of work there that we could maybe do with with sort of publicizing um I know for a fact that our GP colleagues are seeing more patients than

Than previously um and that they’re snowed under um I think P I think the public concept of of um primary care has changed I think during covid they they started to have a very immediate access to primary care because a lot of it went virtual so if they phoned they got a

Call back the same day which was something that you know prior to covid because they weren’t using the technology you phoned and you waited for an appointment sort of thing um and I think there’s there’s a bit of um as with everything socially now there’s a bit of expectation of

Instant access to everything so if you if you do phone and try to get an appointment with a GP and you can’t get it today even if it can wait you know that you can come to A&E and you will be seeing today um so I think there’s also

A little bit of of a shift in in what the public expect and want as well um whereas preco I think they would be happy to wait for 24 48 hours for for a nonurgent appointment I think people are less less willing to wait now because they’ve got used to that very

Instantaneous access to everything um that was stepped up so I think there’s a shift in public perception I think we do get good support from from our colleagues in Primary Care um there’s always you know we’re always looking for for more more support and more that we

Can do um I think the use of alternatives to medically qualified staff is a step in the right direction um the use of Pharmacists the use of non non- doctors nurse practitioners Advanced practitioners um both both in in our Hospital settings and in Primary Care is is helpful because um I think

You know not not every problem needs to see a doctor um and I think also another another sort of issue coming out of covid particularly with children is that um a lot of new parents during covid didn’t have that sort of social network and family pickup that that people used

To um and problems that in the past you would sort of go to a family member and say oh you know it doesn’t look so well today what would you do and you would get advice from from the family um a lot of that went the support from nurseries

And things like that so I think I think we’ve seen again sort of a bit of a shift in the confidence of the public to sit things out and self treat and and wait thank you um I think final question now from counselor mrig no I’ve got a

Hand up um sorry councelor Johnson’s just popped up on my screen with a with a yellow hand yes thank you Mr chairman uh I’m just listening to what Laura was saying about uh since covid um people uh if they don’t get it straight away they’re

Not happy to wait 24 48 hours but I don’t know whether she meant that generally because you don’t wait 28 or 48 hours for a non-urgent appointment at my surgery you wait two weeks uh and even for an urgent one you sometimes wait a week so I I don’t know whether

That was you weren’t talking about what I thought you were talking about or I’ve misunderstood thanks um it was it was partly generally I think you know life is a bit more instantaneous isn’t it for particularly young people um you know you get your phone out order something and it arrives

Within within the hour um so I think I think there is a shift in that in that sort of wanting everything instantly um I agree you know a lot of surgeries can’t offer appointments that quickly um but an awful lot of them um can offer at

Least a a telephone call back or an appointment with a non non-medical professional within that time frame thank you um councelor Johnson did you want to come back no I’m happy with that thank you thank you councilor mcgrier thanks very much chairman I think I was very surprised like councilor Gman

On how much the ambulance service usage had had gone up since the last report we had to this committee by the ambulance service themselves and how they were struggling to provide that service particularly in respect of the turnaround times that they were encountering at the hospital I know

We’re driving those down we’re not nearly at the Target levels yet uh unless we’ve had and but we’ve had this significant increase in capacity and and usage particularly at a time where we’re trying to encourage other services to take that load away from the ambulance service so we’ve had a massive growth

Um we don’t understand the reasons for that growth from what you’re saying um and I think that you know that’s something that we should understand going forward so we’ve had this huge increase uh in in capacity it seems to be increasing um and we don’t understand

What it is so I just wondered if that’s something we could look at as a committee in the future um on on on where that capacity uh is going to limit out and and what the reasons for that increase capacity before I think it’s important that that’s understood um and

That’s planned for in in the future but fantastic that the the service has been able to cope with that additional capacity given the reports that we were given just under 12 months ago uh in this committee thank you um any any comments well yeah firstly thanks for the positive uh feedback

Around the performance I think in terms of that question I think it is exactly the right exam question so I think as a health system we need to take that one away to come back with some information and some uh evidence basis behind what’s happened and what is likely to happen

Going forward so I think if we take that as an Ask as a health system thank you well I I see no further hands up and um I understand you guys have quite a lot going on at the moment um I I do have one final question from

Me um a year ago pretty much probably a year ago almost to the day you had a CQC inspection and it took us to July to get the report and by that point you’d already done sign made significant improvements um can you tell me if um maybe where you are with those

Improvements on that Journey because obviously that’s still always on the horizon in terms of specifics perhaps if we can come back to unless Laura wants to come in on uh exacts but it’s something we track uh on an ongoing basis of the CQ action plan the interventions the measures we committed

To uh delivering our things which we track routinely on a monthly basis as I trust in terms of our tracker for that perhaps if we could commit to bring that to the next meeting where we’ll bring in a specific update around progress and measurables thank you that would be

Great and I think um we can request Council gri we can request an update from the east of England Ambulance Service as well on some of their figures relating to Essex so um we’ll leave it there Laura uh Jonathan Chris thank you very much for your time today um best of

Luck with your industrial action and your winter pressures all combined Take Care thank you thank you okay members we’re now going to move on to item six which is um Chairman’s report and I don’t really have a great deal to to add um being as we’ve just come out of December

I will add that um the Hosk visit to the east of England Ambulance operations center um has still not been arranged and I don’t see any further movement on that until probably at least March when we’re out of the winter pressures and this this um aive influx of ambulance

Business um so we’ll move on from there item seven members updates councelor stepto I understand you have a couple of items you want to talk about yes just to let members know we have our first working party meeting of the 106 um s106 money uh next week on the

10th and then again on the 11th um we had a a pre meeting where we went through various terms of reference and what have you um which I think all the members have had a copy of I think is that gone out with all the members or just the working party

I think so yeah okay but if anyone member wants to know a bit more detail about what we’ll be covering please let me know after the meeting I’ll go through it with them thank you Jer just a verly update you and the committee chair um that there’s been no further Communications

From the josk about any meetings to do with the north S6 and and S the suffk uh Hosk areas thank you formally noted that’s that’s great okay so item eight is the work program um we’ve already discussed we were going to add an update from the east of England Ambulance Service C McAn

Can I just add to that chairman there’s obviously a deficiency in the kpis that were being reported there and you know the reasons for visits and not being recorded and monitored as so could we add that on to what apis are there uh and are they fit for

Purpose in other words they’re not identifying the reasons for the increased um usage of the system um and you know that there doesn’t seem to be a mechanism for reacting to that em okay thank you um we will come back to members with that joint working aspect with thoric

And south end in relation to the community beds um are there any further comments on the work program okay members agreed with the work program okay that’s lovely thank you um date of the next meeting will be Thursday the 1 of February at 10:30 in committee room one

And that I’ve not been notified of any urgent business or any urgent exempt business so thank you very much Happy New Year that concludes the meeting members thank you