Agenda and minutes

1.1  Apologies for absence were received from Cllr Clark and David Maher.

1.2  Apologies for absence were also received from the following members of CYP Scrutiny Commission invited for item 5 – Cllr Conway, Cllr Woodley and Cllr Patrick.

2.1  The Chair welcomed the following Members of Children and Young People Scrutiny Commission who were present for the joint item on the CYP&M Workstream: Cllr Gordon, Cllr Etti, Jo Macleod, Ernell Watson and Shuja Shaikh.

2.2  The Chair welcomed Dr Sandra Husbands the new Director of Public Health for Hackney and the City to her first meeting of the Commission.

2.3  There were no urgent items and the order of business was as on the agenda.

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

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

4.1  Members gave consideration to the minutes of the meeting held on 12 September.

4.2  Members gave consideration to the matters arising

5.1  The Chair welcomed members of Children and Young People Scrutiny Commission for this item.

5.2  Members gave consideration to an annual update from the Children and Young People and Maternity (CYP&M) Workstream of Integrated Commissioning and he welcomed to the meeting:

Amy Wilkinson (AW) (Workstream Director)

Anne Canning (AC) (Group Director, CACH and Senior Responsible Officer for the CYP&M Workstream).

5.3  AW took Members through the briefing and Members asked detailed questions on it.  The following points were noted.

(a)  Members asked about the challenges around the complexity of provision of mental health support in schools and how the Wellbeing and Mental Health in Schools (WAHMS) project will take this forward.  AW detailed the range of interventions being taken and commented that they struggled with the overarching commissioning landscape because schools can commission whatever they wish.  Even after the Council publishes its plan this will continue to be the case.  Members asked therefore how can we properly assesses the effectiveness of what is being done differently.  AW replied that the council does have levers here such as the Providers Alliance and CAMHS is a key part of HUHFT and ELFTs service provision and the CCG also plays a crucial role.  The point of the CAMHS Alliance is to try and bring all these elements together.  AC added that schools are the biggest commissioners outside of the system and if they are better informed then they will make better decisions therefore she was much more hopeful that progress can be made. 

(b)  Members asked about progress in engaging with BME communities in young people’s mental health.  AW replied that solid progress was being made with more referrals now coming from the Charedi community e.g. in perinatal mental health. The Council and CCG were also developing a strategy on Adverse Childhood Experiences as they acknowledged the crucial role that intergenerational trauma played in young people’s outcomes.

(c)  Members asked how WAHMS would be evaluated and whether the recent £70m national transformation funding for mental health, of which ELFT benefited, would be used for CAMHS transition work.  AW replied that Public Health was leading on it, a range of indicators had been agreed and she would share the evaluation report.  She added that the recent new ELFT funding would partly go towards CAMHS.  Funding would rise from £5m to £10m and VCS work nationally would also receive additional funding and support was being targeted also at Black and Afro Caribbean young people up to age 25.

(d)  Members asked what additional prevention measures, other than those outlined in the paper, were being attempted on tackling school exclusions and asked whether a more transformational solution might now be required?  AW replied that phase 4 of the CAMHS strategy was ambitious and they were just about to publish an Integrated Emotional Health and Wellbeing Strategy (2019-2024) which would address some of these issues.  This would come  ...  view the full minutes text for item 5.

6.1  The Chair stated that the Commission had received a request from East London Foundation Trust and the CCG to consider a change proposal to consolidate all older adult in-patients beds for patients with behavioural and complex psychiatric symptoms of dementia, across East London, into once site at Sally Sherman Ward at the East Ham Care Centre.  This particular plan envisaged that patients currently in Thames Ward at Mile End hospital be consolidated within Sally Sherman Ward in East Ham.  He noted that the Commission had considered similar proposals relating to dementia or ‘functional older adults’ in 2018, 2015 and 2012 involving moves from Cedar Lodge in Homerton into Mile End Hospital

6.2  The Chair welcomed for this item:

Eugene Jones (EJ), Director of Strategic Service Transformation at ELFT

Dan Burningham (DB), Programme Director – Mental Health at CCG

Dr Waleed Fawzi (WF), Consultant Psychiatrist, ELFT

And Members gave consideration to the report “Consolidating dementia and challenging behaviour in-patient wards”.

6.3  EJ took Members through the report noting that this cohort were dementia patients and not ‘functional older adults’ which had been the subject of a previous case for change.  The aim was to consolidate the two wards as both had been under-utilised for some time.  WF stated this cohort would be on an acute ward for anything from 6 weeks to 3 months and were not suitable for discharge to a care home as they had high physical and mental health needs.  He stated that ELFT noted the concerns about travel times but that the change for Hackney patients in terms of travel time by car would be, in his view, negligible.  There would also be a hardship fund to cover taxis for those family members or carers affected to ensure that the new site was as accessible to them. 

6.4  DB stated that from the commissioner’s perspective they had initially been sceptical about this proposal but having visited the new site they were satisfied that the built environment in Sally Sherman ward was much better.  It had more light and more space and would provide a range of activities and services there to improve the quality of life of these patients e.g. barbers and hairdressers.  The décor was specifically chosen to aid dementia patients. 

6.5  Members asked detailed questions and the following responses were   noted.

(a)  The Chair took issue with the various bed projection numbers stating that the new total for the 3 boroughs would be 37 (but flexed to 41) and Sally Sherman would have 19 (flexed to 23) which would represent a reduction of 18 beds in the system overall?  EJ clarified that the issue of usage was complicated in that beds were also being used by other patients from outside of the 3 boroughs.  This cohort ideally should not be present and they are identifying other solutions for them.  WF clarified that as this ward was under-utilised they had allowed it to be used for other patients outside this particular clinical cohort and he  ...  view the full minutes text for item 6.

7.1  The Chair stated that he had asked Adult Social Care and Healthwatch Hackney to return with an update on the improvement plan on the Housing with Care Service.  Members gave consideration to the update report from Adult Services on the progress made, to the CQC’s re-inspection report from Sept 2019 and to Healthwatch Hackney’s own report on the service from Aug 2019.

7.2  The Chair welcomed for this item:

  Ilona Sarulakis (IS), Principal Head of Adult Social Care

  Anne Canning (AC), Group Director CACH

  Jon Williams (JW), Director of Healthwatch Hackney

7.3  In introducing the report IS stated that there had been progress on the move to more permanent staffing for the service with more half-time staff having moved to full-time.  JW added that the re-inspection report from CQC and the service’s own update was showing great improvement but there were still clear challenges and he continued to have some concerns about clients being, in many ways, ‘warehoused’ by the system. The care plans were better but they did not feel that these were properly understood by clients and their families.  The quality of food had improved.  One of the challenges was social isolation. Another was busy staff feeling they cannot support clients as well as they would wish to because of the pressures of time.  The Chair thanked Healthwatch for their important input to the work in response to the CQC inspection. 

7.4  Members asked questions and the following points were noted.

(a)  Members asked about the sustainability of the quality improvements going forward.  AC replied that they were committed to Quality Assurance here in the light of the learning from the failed inspection.  The service will be inspected again in a year.  She added that Adult Services Commissioning had a Provider Concerns Process which it regularly used in monitoring external providers but it had not used this on the internal service and they had learned from this.

(b)  Members asked about care workers picking up on housing related issues of clients but being frustrated in making any progress with them.  IS replied that housing issues had come up on a number of occasions.  There was a forum with the Registered Providers (i.e. housing associations) where social workers could progress issues and there was a need to enhance this partnership working.  AC added that the social workers do not have the power to instruct a housing provider and of course the housing element of care was not part of the CQC’s inspection remit.  Most of these issues related to Registered Providers and not Hackney Council as the housing provider.

(c)  Members asked about the model in use here and whether care workers were used to best advantage considering how for example the pressures are different at night and how this could breed a sense of insecurity among service users.  IS stated there was no single model and staffing had to be flexed to meet the times of greatest need and this was always the challenge.

7.5  The Chair  ...  view the full minutes text for item 7.

8.1  The Chair stated that this issue had been raised with the Commission by the Local Medical Committee (LMC) and he had invited Public Health (the commissioner), City and Hackney GP Confederation (the provider co-ordinator) and the LMC (representing local GPs delivering services on the ground) to discuss the concerns raised about the effectiveness of this contract and the complaints about its burden on GPs.  Members gave consideration to a report from Public Health on “Sexual Reproductive Health Services in GP practices”.

8.2  The Chair welcomed the following for this item:

Dr Sandra Husbands (SH), Director of Public Health, C&H

Dr Andy Liggins (AL), Consultant in Public Health, Corporation of London and lead commissioner for these sexual and reproductive health services for City and Hackney

Dr Deborah Colvin (DC), Chair of the City & Hackney GP Confederation

Laura Sharpe (LS), Chief Executive, GP Confederation

Dr Fiona Sanders (FS), Chair of Local Medical Committee

Dr Nick Mann (NM), Member of Local Medical Committee

And he welcomed Dr Husbands and Dr Liggins to their first meeting of the Commission.  He also apologised for the limited time available to discuss this item because of previous items having taken longer than anticipated.

8.3  AL took Members through the report noting the commissioning history of these services and that the GP Confederation had just taken on this contract in April and that it was potentially a 5 year contract and it was therefore early days yet in terms of its performance.  He concluded that if parties to the contract were unhappy then it was in everybody’s interests that they talked to each other.  He added that he was new to City and Hackney.

8.4  The Chair asked FS to outline the local GPs concerns.  She stated that this contract was over complicated, under-funded and undeliverable.  She listed some examples of the difficulties it had caused. For example where they could in the past just issue condoms they now had to get the patient to register in a bureaucratic process and do an interview.  She added that the KPIs were not achievable.  She added that the funding in the contract was capped so what would happen when the money might run out part way through the year.  This needed to be a simple process and instead GPs, who were already under great pressure, have had this added burden. 

8.5  DC on behalf of the GP Confederation added that she agreed with Dr Sanders in many respects.  GPs were being asked to do more by everyone and were in a difficult position.  Contracts need time to bed-in.  They had spent two years trying to perfect this contract and parts of it are underfunded.  Another challenge related to the new online app for ‘contact tracing’ of sexual partners in relation to STDs. 

8.6  NM stated that his objection was that it fragmented and compartmentalised what they used to do.  Under the new system he was now ineligible to fit LARCs because he does not also fit implants as  ...  view the full minutes text for item 8.

9.1  The Chair stated that at the September meeting he had postponed the formal agreement of the report of the Commission’s review to allow some additional time for any further comments from the stakeholders.  There had been no other changes from when this was discussed at that meeting and he therefore asked the Commission to agree the report.

10.1  Members gave consideration to the updated work programme for the Commission.

11.1  There was none.