Agenda and minutes

1.1  An apology for absence was received from Cllr Rahilly and for lateness from Cllr Plouviez.

1.2  Apologies for absence were also received from Anne Canning, Laura Sharpe and Kirit Shah. 

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

3.1  Cllr Maxwell stated that she was a member of the Council of Governors of HUHFT. She also added in relation to item 5 that she and the Mayor had been present for the GMB-initiated “Christmas card” protest in December at HUHFT.

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

4.1  Members gave consideration to the draft minutes of the meeting held on 4 December and noted the matters arising.  The Chair added that the PIN notice referred to in action 5.3(a) had now been circulated to the Commission members. 

4.2  Cllr Snell thanked the Chair, the O&S officer and the CE of the GP Confederation for their contributions to the lobbying letter sent to NHSE in relation to 0-5 childhood immunisations as set out on pages 15-17.  He also thanked Connect Hackney for providing the list of providers as requested and added that this group now needed to be monitored so that the great range of activity they provide can be built on as part of the Legacy Plan.

5.1  The Chair stated that he has asked Tracey Fletcher (TF), Chief Executive of the Homerton University Hospital NHS Foundation Trust (HUHFT) to attend the meeting to answer questions on two recent developments: the new Pathology Partnership and a pay dispute relating to the soft facilities contractor at the hospital.

5.2  Members gave consideration to a copy of the presentation Pathology Partnership Outline Business Case which had been agreed at the 18 December meeting of the HUHFT Board.  The plan was to create a new Pathology Partnership with Barts Health NHS Trust and Lewisham and Greenwich NHS Trust.

5.3  TF summarised the key points in the agreed Outline Business Case.  HUHFT Board had decided it would not be viable for them to update the service on their own and under the national challenge from NHSE to create pathology networks they looked to securing appropriate partners so as not to be at the whim of commercial providers in going it alone.  The next step was to develop the Full Business Case.  No contracts had yet been signed and they would continue to be a working lab on site but the Board was satisfied with this proposal.  Central to the partnership agreement was that it would be a legal agreement between three Trusts and there would a jointly appointed MD.  The three would jointly share the benefits and risks and each partner would have equal votes and a veto.  Upgrading the Homerton’s Pathology facility would require significant investments in IT.  The agreement with the other two Trusts wold give an added level of resilience to all three organisations and at Greenwich Hospital their lab was already quite new. 

5.4  Members asked detailed questions and the following as noted:

(a)  Members asked what consultation there had been with local GPs.  TF replied that there had been discussions and there was a local GP also on the Council of Governors.  Putting together the Full Business Case would now require getting down into the detail of the clinical model and this would involve further talks with GPs and these would begin the following week.

(b)  A Member questioned the quality of the service up to now with examples of tests getting lost and asked about the interim plan.  TF stated that lab services would continue on site.  She added that tests already go to Royal London as well.  Four years previously the service from Barts had not been very responsive but this had since been turned round and response rates were high.  HUHFT closely monitors turnaround times from Royal London, Newham and Whipps Cross already.  HUHFT will jointly manage the new model and so will have an opportunity to influence the other two partners and again the new partnership model will provide added resilience between the three Trusts. 

(c)  A Member asked whether there would be a full public consultation before the FBC gets agreed in March.  TF clarified that the FBC would more likely happen in April, not March.  They are now  ...  view the full minutes text for item 5.

6.1  The Chair stated that the Commission received a regular rolling programme of updates, in turn, from each of the 4 workstreams in Integrated Commissioning and Members’ gave consideration to an update report from the Unplanned Care Workstream.

6.2  The Chair welcomed Nina Griffith (NG), Workstream Director Unplanned Care to the meeting and Members gave consideration to the update report.

6.3  NG took Members through the key points of the report.

6.4  Members asked detailed questions and the following points were noted:

(a)  A Member expressed concern about the ongoing challenges with the GP Out of Hours and NHS 111 service in the new configuration.  NG replied that call answering rates were increasing.  The local GPs contacted by the CCG had also stated that the new system and that the numbers using it and the overall performance was looking much better. 

(b)  A Member asked what was being done to get more people on to the Co-ordinate My Care platform.  NG replied that this was a big area of focus as it was not just for end of life care planning but was also being used to support patients who are frail or patients with dementia.  A lot of work had to be done on rationalising the IT issues in such a shared system.  There’s a current focus on ensuring that staff at the Homerton and at St Joseph’s are using it appropriately.  Dr Victoria Holt (previous head of CHUHSE) was brought in to review the plans and now 80% of the relevant practitioners were reviewing, editing and updating CMC plans. 

(c)  A Member asked about use of co-production and in particular participation in decision making within the Neighbourhoods Programme.  NG stated that Shirley Murgraff was the public rep and held officers to account.  SM added that their job was to communicate with local communities and stated that Neighbourhoods needed to be referred to always with a capital ‘N’. 

(d)  Jon Williams (JW) added that he chaired the Communications and Engagement Group under the Integrated Commissioning Board.  It was important that public reps understood both the system and how to get involved with it.  It was quite challenging and exacting but this element has to work well if the whole integrated commissioning process is to succeed.  It’s also key to driving forward the ‘prevention’ agenda. 

(e)  The Chair asked John Makepeace (JM) member of the Local Pharmaceutical Committee about a reference in the report on p.48 to the creation of 8 Neighbourhood Community Pharmacy Leads and asked how did this squared with the recent decision by NHSE London to cut funding for the ‘Pharmacy First’ programme in City and Hackney.  JM replied that the 8 leads would be meeting the following day to address this and they were working for example on the flu plan for next year.  The LPC was very disappointed that the funding for Pharmacy First had finally been withdrawn but was pleased that the CCG had been so supportive in their campaign against this and  ...  view the full minutes text for item 6.

7.1  The Chair stated that the East London Foundation Trust had been awarded funding from NHSE to undertake a radical redesign of community mental health services arising from the national Community Mental Health Framework for Adults and Older Adults.  Members’ gave  consideration to a briefing report.

7.2  The Chair welcomed to the meeting

Dr Priscilla Kent (PK), Consultant Psychiatrist, ELFT

Dean Henderson (DH), Borough Director City and Hackney, ELFT

Nichola Gardner (NG), Neighbourhoods Director, City and Hackney, ELFT

7.3  DH took Members through the report.  He added that for 20% of the patients whom ELFT supported the delivery happens in Primary Care with 80% in secondary care and the aim of this broad national transformation programme was to shift that around.  It represented a huge change in focus to localise and target mental health support into Primary Care.  PK added that the focus was to bring services outside of hospitals and Community Mental Health Teams and to better integrate with primary care.  She described the pilots in Hackney Marches Neighbourhood effectively extending the ‘crisis café’ concept and focused around a community centre in the Kingsmead Estate and another project in Clissold Park Neighbourhood. 

7.4  Members asked detailed questions and the following points were noted:

(a)  The Chair asked if this work involved IAPT and DH replied that no, the focus here was SMI (severe mental illness).  The Chair asked whether the 5 Mental Health Community Workers per Neighbourhood would be in GP surgeries.  PK replied they wouldn’t because many GP surgeries are small and there was a need for more space so there is a focus on sites such as community centres.

(b)  Members commented that the move from 20:80 primary to secondary care split to 80:20 was massive and asked what the driver was and what medical evidence was there that it would be an improvement.  DH replied that the drivers was better support and long term care.  Currently they supported 1500-2000 in the community with outpatient follow up. In addition there would still be 800-1000 that will need some support in secondary care and the other 2000 could be seen in a primary care or community setting, every 1-3 months.  The aim was to support them more actively and, for this cohort, the care goes out to them rather than them having to attend outpatient appointments. 

(c)  A Member asked that while this model is based around Neighbourhoods how would it cater for BME, LGBT, older people and young people.  She added that Young Black Men for example get sectioned more because the services do not meet their needs and how this new model might use co-production approaches to address this.  PK replied that their outreach is very much focused on those who don’t engage easily. They go into communities such as Kingsmead Estate and run activities which will promote mental health wellbeing such as cycling, running, boxing etc. 

(d)  Members asked what evidence ELFT had that they would get clients in via this new approach.  Which  ...  view the full minutes text for item 7.

8.1  The Chair stated that at its meeting on 4 November the Commission considered a proposal from ELFT and the CCG to consolidate all older adult in-patient beds for patients with challenging behaviour and complex psychiatric symptoms of dementia across east London into one site at Sally Sherman Ward at the East Ham Care Centre.  This would involve consolidating beds from Thames House Ward at Mile End Hospital into Sally Sherman ward.  The Commission reserved its endorsement of the proposals subject to a site visit and the Chair and the Vice Chair attended a site visit to both sites on 24 January.

8.2  The Commission gave consideration to a revised report from ELFT and the Chair welcomed to the meeting:

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

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

Dr Waleed Fawzi (WF), Consultant Psychiatrist, ELFT

8.3  The Chair stated that following the site visits attended by himself and the Vice Chair his concerns about capacity had been addressed and the Sally Sherman Ward provided far better surroundings than Thames House ward.  He was still of the view that it was not correct to say that Thames House had been an improvement from the previous location at Cedar Lodge in Hackney.

8.4  The Vice Chair stated that as the Council’s Dementia Champion she had been pleased to see the environment in Sally Sherman which was more calming and which had been decorated appropriately and had a gym and Namaste care etc on site.  The site at Mile End where 6 patients shared a bathroom was not ideal.  She took issue with the framing of this cohort as “displaying challenging behaviour” because that behaviour was often a consequence of their surrounding environment.  She had had concerns about the distance of the move but the quality of new venue somewhat made up for this.  She stated that staff had mentioned that once patients are discharged to nursing homes they do not return but she had a concern that nursing homes simply do not have the resources or skills to support this small but challenging cohort.  There was a danger that in nursing homes the medication levels would be increased to calm patients whereas they had seen the more personalised attention that distressed patients can receive in the ELFT wards. 

8.5   Members asked detailed questions and the following responses were   noted:

(a)  Dr Fawzi (WF) stated that 99% of this patient cohort come from the dementia ward pathway. Some people with dementia become aggressive and are difficult to manage and so cannot be catered for either in care homes or at home.  He added that as the care pathways improve the Trust will require fewer continuing care beds for example there used to be 60 in Hackney.  By the time most of these patients have completed their care journey at East Ham Care Centre they will just require physical care, they won’t be able to walk and there will be the physical deterioration  ...  view the full minutes text for item 8.

9.1  Members noted the updated work programme.

10.1  There was none.