Agenda and minutes

1.1  Apologies for absence were received from Cllrs Plouviez and Rahilly.

1.2  Cllr Snell, Dr Mark Rickets and David Maher also stated they would have to leave early for other meetings.

1.3  Apologies were received from: Dr Sue Milner, Kirit Shah, Carol Ackroyd and Richard Bull.

2.1  The Chair stated that item 9 would be taken after item 6.

3.1  Cllr Maxwell stated that she was a member of the Council of Governors of HUHFT.

3.2  Cllr Snell stated that he was Chair of the Trustees of the disability charity DABD UK.

4.1  Members gave consideration to the minutes of the meeting held on 10 July 2019.

4.2  The matters arising were noted.

5.1  Members gave consideration to a report on the draft City and Hackney response to the NHS Long Term Plan.

5.2  The Chair welcomed for this item:

  David Maher (DM), Managing Director, City and Hackney CCG

  Dr Mark Rickets (MR), Chair, City and Hackney CCG

Nina Griffiths (NG), Workstream Director – Unplanned Care, LBH-CoL-CCG

5.3  Introducing the report, DM stated that the content of the response had been through a number of forums.  The Long Term Plan was the plan for the next 10 years for the NHS and followed on from the Five Year Forward View.  One of the key challenges in north east London was the increase in population and the plan helped tackle that.  It will lead to £2.3bn more in investment in primary and community health services in NEL.  City and Hackney was in a good place and had achieved a number of successes since the last plan including reductions in obesity in the working age population.  The opportunities presented by the LTP were significant.  Going back 5 years, he said, mortality rates in mental health in NEL were the worst in the country and as of this year that mortality curve had been inverted for those living with severe mental illness. The challenge now was how to use the LTP going forward and one of the key aspects would be the Primary Care Networks which were being delivered in C&H via the Neighbourhoods Programme.  There was also now a well-established Integrated Commissioning Board and it put Marmot principles on wider determinants of ill-health at the forefront of its thinking.  Significant inroads were being made in the CYP&M Workstream, an example being the fact the recent measles outbreak had now been contained and over 1000 vaccinations had been delivered.  The ICB had been in place for 2 years and administered £50-£60m in contracts and the ambition was to go much further with this.  The presence of elected members on the ICB gave it significant levels of accountability.  Work was ongoing on having Providers join the ICB and a planning forum was being run to look at the whole architecture of the workstreams. There was also a need to include the VCS even more in the workstreams. A key focus was to reduce the pressure on acute beds and going forward on improving digital access to primary care.

5.4  Members asked about recent media coverage that London had the lowest vaccination rates in the country.  DM replied that this was still correct, for all the reasons covered at the Commission’s meeting on this, but nevertheless, solid progress was being made locally and a serious outbreak had now been successfully contained and they would be able to build on this. 

5.5  Members asked if there was a more detailed data document underlying the response paper and DM replied that there was.

5.6  Members commented that, often with these changes, Secondary Care absorbed the bulk of the money and how is it  ...  view the full minutes text for item 5.

6.1  Members gave consideration to a report from Hackney Keep Our NHS Public and the chair welcomed for this item:

  Dr Nick Mann (NM), Local GP and Member of KONP

  Nick Bailey (NB), Member of KONP

  Dr Mark Rickets (MR), Chair, CHCCG

  David Maher (DM), Managing Director, CHCCG

  Nina Griffith (NG), Workstream Director, CHCCG-CoL-LBH

Michael Vidal (MV), Public Representative on Planned Care Workstream, CHCCG-CoL-LBH

6.2  The Chair asked DM to respond to the concern about possible ‘merging’ of CCGs.  DM replied that the national expectation was that ICSs cover a population area of 2 million people.  At the other end of the spectrum Primary Care Networks, which are delivered locally as part of the Neighbourhoods Programme, work to a population of 30-50k.  The idea with the Long Term Plan was to modernise community care and to modernise the whole commissioning architecture. The expectation in the Plan was that the restructures should aim to deliver a necessary cost saving of 20% to the system.  Commissioners such as CCGs are not providers and he drew Members’ attention to the system diagram on p.29.  City and Hackney already operated as an integrated system with increased possibility for accountability.  Further transparency would be added with Providers joining the ICB and they will sit with commissioners in planning local services.  The NHS is looking to CCGs working in this integrated model by 2021 so by April 2020 a new structure needed to be worked up.  As part of this the local system will be able to set out ‘Asks’ for what it wants to commission locally.  15% of CCG activities are already commissioned already at ELHCP (i.e. STP) level.  Certain areas such as mental health bed planning or cancer pathways need to be delivered at sub regional level to be effective.  The aim was to reduce costs in the system. 

6.3  The Chair invited Hackney Keep Our NHS Public (KONP) to respond.  Dr Nick Mann (NM) replied that it was becoming clear that City and Hackney would not survive as a small entity and with all the transfer of funding being tied into a requirement of expected behaviours this would prove troubling.  He cited the example of the Path Lab at the Homerton, stating that pathologists there did not support the changes.  In his view HUHFT would lose it all. There were a lot of issues and they wouldn’t be debated if the decision making was escalated higher.  He stated that it was his understanding that the mergers would mean that patients with schizophrenia would have to travel long distances for treatment, that mental health beds would move to Mile End Hospital and specialist care for Older People would move to King George’s and the result would be less accountability overall.  The ICS would be making all the decisions and you can’t have local decision making within a sub-regional model, he stated.  He stated that these trends were worrying and recently Virgin Health had been contracted in Waltham Forest  ...  view the full minutes text for item 6.

7.1  Members gave consideration to a report on Intermediate Care Beds which they had requested.

7.2  The Chair welcomed for this item

  Simon Galczynski (SG), Director, Adult Services

Nina Griffith (NG), Workstream Director – Unplanned Care, CCG-CoL-LBH

7.3  NG took Members through the report in detail.  It was noted that as the demand for intermediate care beds had been reduced because of the establishment of a successful Integrated Independence Team (IIT), there was now a requirement for only 2 to 4 step-up or step-down beds and this volume would not justify establishing a separate new residential unit within the borough.  They had spent the underspend on intermediate care beds on the Discharge to Assess work and they were working closely with the IIT in the lead up to that contract having to be renewed in November 2020.  They were linked in to Community Care and they continued to spot purchase beds, as required, in St Pancras or Bridges wards which are in Camden and Islington respectively.

7.4  The Chair asked for clarification on the bed numbers in 4.1 (‘GFD’ section) and the table at 4.2 which seemed to be contradictory.  NG explained the difference between “number of bed days” and “number of beds” and that the length of stay was generally quite short. 

7.5  Shirley Murgraff, a resident, stated that she did not agree with the assessment this it was a good service because in her view there was an absence of patient choice.  She stated that she had personally been a service user of the intermediate care beds at the St Pancras facility, out of borough.  She stated that City and Hackney could not say that it had unfettered access to these beds because St Pancras could refuse for three reasons:  the facility was full; priority was given to Camden and Islington residents or they did not agree with the assessment of the patient.  They could therefore veto a request for a bed.  She also stated that she did not consider these to be proper intermediate care beds but rather this was a ‘sub-acute’ ward which had patients in it who had complex conditions and so could not get out of bed.  She stated that the possibilities for a more permanent solution using the previous Median Rd site had not been properly explored before it had been closed and that that site could have had income generation possibilities. 

7.6  SG replied that the St Pancras facility was fully registered for Intermediate Care and they provided intensive multi-disciplinary care and this was different from respite.  As with every facility it had a ‘pipeline’ for admissions and there may, on occasion, be a capacity issue but no cases had been escalated to him as Director regarding patients who could not be found a bed when they needed it.  He did not agree with the assertion that there were quality issues at St Pancras.  He stated that they did have access to step-down beds there but not to ‘step-up’ beds. They currently  ...  view the full minutes text for item 7.

8.1  Members gave consideration to the 2018/19 Annual Report of the City and Hackney Safeguarding Adults Board and a covering report.  The Chair stated that the Commission considered this each year and he added that this time the Chair, Dr Adi Cooper, had had to give her apologies.  He welcomed to the meeting:

  Anne Canning (AC), Group Director CACH

  Simon Galczynski (SG), Director – Adult Services

  John Binding (JB), Head of Service – Safeguarding Adults

8.2  SG took Members through the report.  It was noted that 34% of concerns went on to become safety investigations and this had been in line with national averages.  Officers would like to hear more from people about the outcome of safeguarding investigations he added. He stated that the research had shown that most of the patient outcomes were ‘positively met’.  He stated that there had been two Safeguarding Adults Reviews (SARs) in 2018/19 relating to Ms Q and Ms F.  He explained that 14 more ‘Safeguarding Champions’ had been trained up over the year. 

8.2  JB took Members through the ‘areas for development’ section of the report and explained how they were working on how to get more feedback from those who had used the service and to this end they were developing a Service Users’ Engagement Network. He also explained the campaigning they were doing on tackling modern slavery with a campaign being launched on 18 October and the work they were doing on chronic rough sleeping.  He explained that at last year’s Annual Report item they had been encouraged to have greater service user involvement in the training of the Safeguarding Champions and this was now taking place.

8.3  AC stated that the CHSAB had made a significant contribution too to the work of the Integrated Commissioning Board particularly in its work with the CHSCB (safeguarding childrens’ board) on transitional safeguarding which was aimed at ensuring that vulnerable adolescents are properly supported and do not lose out during the transition to adult services. 

8.4  Members asked why there wasn’t an SAR relating to the case of the homeless man who had recently died in Stoke Newington, which had received much media coverage.  JB replied that it was after the cut off point for the report and a decision on whether there would be an SAR couldn’t be taken until after consideration of the Coroner’s Report, which  was still awaited.  SG added that he would expect there to be an SAR in that case as there were definite lessons to be learned around managing mental capacity issues affecting those who are street homeless.  Members commented that many members of the public were upset and angry about that case that there was generally a public lack of awareness about safeguarding issues. 

8.5  A Healthwatch representative asked why the case of the 32 year old who had died of scabies infection wasn’t included.  JB replied that it happened after the 2018/19 cut off and would be included in next year’s report. 

8.6  Christopher Sills,  ...  view the full minutes text for item 8.

9.1  Members gave consideration to the draft report of its review on ‘Digital first primary care and the implications for GP Practices’.  The Chair stated that this was being presented for comment before it would be presented for formal agreement at the next meeting.

9.2  Dr Mark Rickets (MR), Chair of City and Hackney CCG, stated that they had already fed back on the draft recommendations.  It was important to note that the CCG did not employ GPs and so could not direct them, which he felt was the inference in Recommendations 1 and 2.  The Chair responded that this merely illustrated the point that nobody appeared to be holding the ring on this issue in the STP area. 

9.3  MR stated that if you drove up access there would be resource implications.  He added that NHSE was also currently consulting on the patient registration funding and contracting rules. 

9.4  A Member took issue with why this was being discussed.  It was up to the Commission to make its own recommendations and the NHS would then would have an opportunity to respond afterwards he said.

9.5  Laura Sharpe, Chief Executive, City and Hackney GP Confederation, stated that she had pointed out that directing Recs 1 and 2 to them was inappropriate as they were just the provider.  If someone wanted to commission them to expand this work they would do their best to do so but the Confederation only had 4 staff.  The system in NEL did not dictate to GP Practices on digital transformation.  She acknowledged that there needed to be a serious response to GP at Hand but Practices can respond how they see fit.  MR added that part of the reason why they had not been responding sufficiently on this drive for digital first was that they were so busy doing the day job. 

9.6  Members commented that perhaps the findings of the review would assist the CCG and the Confederation in making the case for a system response on digital first primary care.  Private operators were moving into digital primary care and the situation must be responded to, they added.  MR asked what response they should make. Members replied that there was no single solution but there was a need to ensure that the local system responds adequately in a way which ensures that GP Practices survive and thrive. 

9.7  Dr Nick Mann (NM) commented that there was, in his view, extreme pressure coming from NHSE on digital and larger forces were at work here, giving the example of the push for a London wide electronic patient record. 

9.8  The Chair stated that Members would consider whether any amendment to the wording of the two Recommendations was required and to bring it back for agreement.

10.1  Members gave consideration to the updated work programme.

11.1  Christopher Sills, a resident, raised the issue of a young woman who had been terminally ill but had recovered and who whose subsequent treatment by the health service had been lacking, in his view.  The Chair cautioned that this was case work and the Commission could not get involved with individual cases.  He asked Mr Sills that if there were systemic issues which merited the Commission’s attention they would give them consideration and requested that he email him with these.

11.2  Shirley Murgraff, a resident, asked about the status of the feasibility study on the future of the former Median Road Resource Centre.  The Chair agreed to request a note on this from the Deputy Mayor/Cabinet Member.

11.3  Shirley Murgraff, a resident, stated that she had written to the Commission asking for its assistance regarding the issue of the poor take-up of pension credits in Hackney.  Recent reports from Independent Age and Age UK had highlighted that there was c. £26m in unclaimed pension credit in the borough and she asked what the Council was doing to ensure that every single pensioner and pension age couple in the borough knows about their entitlement and are encouraged to apply for it.  The Chair replied that he would ask the Cabinet Member for Finance and Housing Needs to respond.