Agenda and minutes

1.1  Apologies have been received for Cllr Deniz Oguzkanli, Cllr Emma Plouviez, Jarlath O’Connell, Tracey Fletcher, Kirit Shah, Dean Henderson, David Maher, Ilona Sarulakis and Jenny Cooke.

2.1  There were none.

3.1  Cllr Maxwell said that she is a Member of Council of Governors of Homerton University Hospital NHS Foundation Trust.

3.2  Cllr Snell said that he is Chair of Trustees at DABD UK.

3.3  Dr Mark Rickets said that he is Chair of the City and Hackney Clinical Commissioning Group.

4.1  Dr Mark Rickets corrected the figure in the second paragraph of page 9 (6.6) of the minutes from 4,000 to 30,000.

4.2  Members gave consideration to the minutes on Monday 7 January and agreed, following minor amends, that they are a correct record.

5.1  Cllr Hayhurst said that he had spoken to members about this item and that due to the seriousness of the issue the item could not wait until the March meeting before being addressed. The Commission recognised, however, the limited time the Council had had to develop a full response. As a result, Cllr Hayhurst explained that the Commission had invited Anne Canning to offer the Council’s immediate response to the report and would expect a full action plan to be presented at the next meeting in March 2019.

5.2  Anne Canning thanked the Commission for the opportunity to respond publicly to the report. She referred to both the Care Quality Commission report and the response provided by the Council on the Adult Social Care webpage for service users and their families, which were noted. She said that this response will be updated as the Service develops its plans.  She said that Housing with Care operates at fourteen locations across the borough and provides care services to 230 people. The Council provides the care services and the housing is provided through a different contract with the registered landlord. The Service was last inspected in 2016 and received a ‘Good’ rating from the CQC. It was inspected just before Christmas 2018 and found to be ‘Inadequate’.  The Inspection has a number of different domains and the Service was found to ‘Require Improvement’ in two of these - (1) the service is caring (2) the service is responsive. The Service was found to be ‘Inadequate’ in all other domains.

5.3  She explained that certain actions set out by the CQC need to be completed by 8 March 2019 and other actions will take place over a longer period. In the 6-18 months period following January 2019 the CQC will re-inspect the Service.  She said that the Council treats with the utmost seriousness the findings of the report, regrets the impact that inadequate services have had on service users and would like to apologise publicly for this failure.  She said that there is a tight action plan to respond to the report and that a group of staff from Adult Services meet weekly to oversee this work. The Service has placed itself on a number of regimes as part of its response. For example, the Service is putting itself through the Provider Concern process used by Adult Commissioning, has brought in external scrutiny and is working closely with the CQC to test what the Service is doing. Senior staff from Adult Services are meeting with Service Users and their friends and families to provide reassurance and inform how the Service responds.  There is an event planned for Thursday 7 February with Hackney Healthwatch to have an open discussion with service users and their families about how they would like the Service to respond. She said that working with Hackney Healthwatch provides another layer of Scrutiny that the Service is adequately responding to the report.

5.4  She explained that one area of criticism in  ...  view the full minutes text for item 5.

6.1  Members gave consideration to a briefing on the Obesity Strategic Partnership.

6.2  Tim Shields, introduced the paper, stating that the Obesity Strategic Partnership takes a whole systems approach to try and achieve impact on this issue. He explained that he has been Chair of the Obesity Strategic Partnership since it was established three years previously. He said that the most recent results from the Child Measurement Programme found Hackney above both the London and National average for childhood obesity. He explained that children who are overweight or obese tend to remain overweight or obese in adulthood which can lead to cardiovascular disease, certain types of cancer, and mental health problems. He also referred to substantial social inequalities in relation to obesity with people from more deprived backgrounds more likely to be obese. He said that the causes of obesity are many and complex. For example, the physical environment, the social environment, physiology and individual behaviour. He said that a whole system approach tries to address these factors and how they interact.  He said that the Partnership was started in 2016 and brings together a number of partners from across the health and care, housing, businesses, VCS organisations and young people. He said that a workshop is planned for Thursday 7 March for the Partnership to develop a ten year strategy. This process replicates what other local authorities have done and cities in Europe.

He said that one of the challenges of taking a whole systems approach is about how you measure impact. He referred to Figure 7 as the system map for obesity, the need to concentrate on what would have the most impact, and being open to failure. He said that Appendix 1 provides an overview of the work of the Partnership and how it has taken action at different levels of influence - for example at a policy level, an organisational level and an individual level. He referred to certain successes - for example, the reduction in high sugar food and drinks in vending machines in leisure centres, community cooking courses and the daily mile for Primary School children.

6.3  He handed over to Jayne Taylor to provide more detail on the activity of the Partnership. She referred to a Scrutiny Review carried out by the Children and Young People’s Scrutiny Commission in 2013 and said that all of the recommendations from that report have been taken forward.  She said that she would welcome Members’ influencing the Partnership as it sets out its new strategy and how the Partnership can engage residents.

6.4  Cllr Demirci (Cabinet Member) said that she was confident that a whole systems approach was the right approach to addressing obesity in Hackney. She said that work is ongoing to ensure that health and wellbeing is part of the built environment and enables an activity lifestyle. For example, she said that Public Health are working closely with the Regeneration Service and Transport Service to make progress in this area.  She acknowledged that it  ...  view the full minutes text for item 6.

7.1  Cllr Hayhurst introduced the item and said that he would invite presentations from guests before taking questions.

7.2  Jane Lindo (JL) said that the East London Health and Care Partnership is developing a Primary Care app that covers the seven boroughs within the STP. She said that digital is both an enabler and transformative technology for the overall STP strategy. She noted that the review of Primary Care across  East London is still ongoing, the publication of the NHS long-term plan and the new GP contract and that all of these pieces of work have a strong digital element.  She said that there is a focus on learning from best practice in digital technology and acknowledged that Tower Hamlets is leading on this way of working through e-consult services and targeting of the younger population. She noted that Tower Hamlets have learnt that their young population are generally healthy but that when they are ill they often go to A&E and may not be registered with a GP. This shows that a different offer is required for this group. She said that she will be working closely with Tower Hamlets to learn from their work in this area and the effectiveness of digital services.  She said that NHS England and the London programme have made available up to £500,000 for each STP to be a Digital Accelerator. She said that she is working with a CCG to use this money for digital primary care services.  She also referred to the development of a NHS app to integrate with digital primary care services. She said she wanted to stress how the seven boroughs are working together on this agenda rather than going into detail about the content of the plans.

7.3  Cllr Hayhurst welcomed Dr Fiona Sanders and Dr Jackie Applebee from City & Hackney and Tower Hamlets Local Medical Committees to the meeting and invited them to give evidence.

7.4  Dr Fiona Sanders (FS) said that Doctors were generally positive about Artificial Intelligence and digital services. However, she said that digital service needs to be universal and fully integrated and cannot be a bolt-on to the existing system. She said that bolt-on services like GP-at-hand can be very destablising.  She said that digital services need to be instead of other types of services and not as well as. She said that the number of GPs has decreased despite the commitment to an increase of 5000 and workload pressures need to be reduced by digital services.  She said that she thought more thought needed to be given about how the public understand different services and how they would like to use digital services. She referred to a recent survey from Which? reporting that 95% of people do not want digital services and that the introduction of digital services needs to have patient support.  She noted the loss of funding for Pharmacy First which she thought was a bad decision and ran against the digital agenda set by NHS  ...  view the full minutes text for item 7.

8.1  Cllr Hayhurst invited Nina Griffith (NG) (Workstream Director, Unplanned Care) to update the Commission on the Unplanned Care Workstream of Integrated Commissioning and Members gave consideration to the report. He asked her specifically to update the Commission on the delivery of the NHS 111 telephone service in the borough.  

8.2  NG explained that her update sets out the workstream structure, vision and strategic principles and the three main areas of work. These three main areas are (i) the neighbourhoods programme (ii) integrated urgent care programme and (iii) discharge programme.  She said that there is system wide support and buy-in for the neighbourhoods programme. She said that an approved Neighbourhoods Strategic Framework has been agreed by commissioners and providers. In the medium-term the workstream hopes to influence a new End-of-Life service and dementia service in the borough in 2019.

8.3  She said that the NHS 111 service has been live since August 2018. She said there were teething problems at the beginning and that this meant the service did not meet its specifications. For example, some people did not receive a clinician consultation. She said that this had now improved and that more people are receiving a clinician consultation. However, she said that the service is not currently meeting the access standards within the contract that include; the time to answer the call, call abandonment rate and the time for a call back from a clinician. She said that there has been improvement but the standards are not being met. She said that this issue was escalated in September 2018 with fortnightly meetings with the Chief Executive of London Ambulance Service (the provider). Since these meetings LAS have put in place key clinical and operational senior support for the service. There is also better clinical Governance to look into incidents and complaints. These arrangements have been in place since January 2019. LAS are also looking at the operational functions of Clinical Assessment Service (CAS) to provide better support and meet surges of demand. She said that there has not yet been a significant change in the numbers but that these changes were only introduced in January 2019. She said there has been no discernable increase in A&E attendance at Homerton Hospital due to these issues and in fact they reduced after August 2018 although this would not be because of the service.

8.4  Cllr Hayhurst asked how that matched with the report that A&E attendance has increased at Homerton Hospital.

8.5  NG said that these figures pre-date August 2018 and that she has figures showing a decline since August 2018. She said this could not be attributed to the 111 service.

8.6  Cllr Snell asked how satisfaction with 111 is measured and assessed.

8.7  Michael Vidal asked how the neighbourhoods programme interacts with existing GP networks.

8.8  Christopher Sills asked if the closure of Median Road had contributed to the lack of beds for Intermediate Care.

8.9  NG said that there is a NEL 111  ...  view the full minutes text for item 8.

9.1  Members gave consideration to the updated Work Programme.

10.1  Cllr Hayhurst stated that he had not received any items for AOB.