Agenda and minutes

1.1  Apologies for absence were received from Cllr Oguzkanli and Anne Canning.

1.2  It was noted that John Makepeace was present for Kirit Shah from the Local Pharmaceutical Committee.

2.1  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 draft minutes of the meeting held on 29 January 2020 and noted the matters arising.

 5.1  Members gave consideration to the Hackney Local Account of Adult Care Services 2018/19.  The Chair stated that the Commission considered this each year.

5.2  The Chair welcomed for this item:

Simon Galczynski (SG), Director Adult Services, CACH

Charlotte Taylor (CT), Strategic Programmes Manager, CACH

Sophie Jobson (SJ), Programme Manager, CACH

5.3  Officers took Members’ through the report. They highlighted: that co-production is now central to their work; the work done on the campaign to tackle financial abuse; the work on direct payments; the work done on developing pages on autism for the website; the success in recruiting permanent work force and the development work being done in embedding best practice.

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

(a)  Members asked where new cost savings could be made, considering the volume of savings already made.  Ian Williams (Group Director, Finance and Corporate Resources) replied that savings were required from all quarters as they develop the next Medium Term Financial Strategy and news on the latest government funding settlement was awaited.  Nationally the funding for both adult and children’s social care and to tackle homelessness was a serious issue and after 10 years of austerity there was a need to look at budgets very closely. There was a strong commitment however within the Council to protect services for the most vulnerable.

(b)  Further to 3.2 on p.18, Members asked officers to explain what “3 Conversations” was. CT explained that it was about putting the individual at the centre of a number of conversations and about providing support at the right time.  The aim was to look at the positives in people’s lives and how services can fit within this.  The first conversation is focused on the individual’s overall situation to assess the issues in their lives and to respond as necessary with adaptations or telecare or support via the voluntary sector or personal support.  The second conversation relates to those in crisis and focuses on how to respond differently if a person hits a crisis point.  The third conversation relates to provision of long term support. 

(c)  Further to p.54, Members asked how the new Carers support service was working out.  SG replied that the need to improve the quality of life of carers drove the development of the new model and after much work, the organisation ‘Carers First’ had been commissioned and the response to the new model had been very positive thus far.  “Carers assessments” as they used to be termed were now completed by social workers under the new system. 

(d)  The Chair stated that at the January meeting the Unplanned Care Workstream, the Workstream Director in her report had stated that they had been dealing with a 27% increase in Delayed Transfers of Care which contradicted what was in this report. He asked whether the discrepancy was due to both looking at different timelines.  He added that the Overall Financial Position report, which went to Scrutiny Panel, had referred to a near  ...  view the full minutes text for item 5.

6.1  The Chair stated that he had asked for this item because the issue was now developing and that Jane Milligan the Chief Accountable Officer for ELHCP had provided some insights on this the previous nigth at INEL JHOSC.  Members gave consideration to three briefing reports from the CCG.

6.2  The Chair welcomed to the meeting: 

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

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

Sunil Thakker (ST), Finance Director, City & Hackney CCG

Ian Williams (IW), Group Director Finance and Corporate Resources, LBH

Laura Sharpe (LS), CE of GP Confederation

Dr Nick Mann (NM), LMC representative

6.3  DM introduced the reports by running through the history of development of the STP and now the proposal for an Integrated Care System.  The Long Term Plan had evolved from the devolution pilot of 2016 which was focused on getting better value from the local health resources. This had led to the creation of the ICB whose Workstreams were now well established.  A further development from this was the new Neighbourhoods Framework, so City and Hackney had a well-articulated story of progress to report.  The Long Term Plan acknowledged that everything City and Hackney had been doing up to now was what was needed. There was a need to reduce administration cost with 20% being a target figure.  City and Hackney however had always underspent its budget.  As thinking on the ICS developed the idea of having 3 subsystems had been accepted.  These would comprise: BHR, WEL and C&H.  One of the key areas of contention now is how to evolve from three systems already in operation to a single overarching system with 3 sub-systems beneath it.  Work was being done to define a ‘Set of Asks’ to the system on what C&H would want NEL to do.  The obvious areas of specialised commissioning, maternity beds and mental health beds were best delivered across a bigger footprint.  This set of Asks would also ask for more control and autonomy. 

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

(a)  The Chair asked what the timeline was for the effective handing over of power to a single CCG in April ’21.  Didn’t all the CCGs have to agree to the proposal in their Governing Bodies during this summer? DM replied that it was about the distribution of power within the system not a ‘handing over’ and it was incorrect to view this as some kind of spectre.  It was instead, he added, about having the power to shape a new system to benefit everyone in NEL. They were not using the term ‘shadow’ board either for the period from April ‘20 to April ’21, instead there would be a steady planned transition from the 7 formal CCGs, which already operate in 3 systems in any case, to a single ICS which would provide strategic oversight as well as economies of scale.  He reminded Members that the Joint Commissioning Committee  ...  view the full minutes text for item 6.

7.1  The Chair stated that Shirley Murgraff of Hackney KONP had raised this issue with the Commission.  This related to NHSE’s formal consultation on the service specification for the implementation of Primary Care Networks (PCNs) known in Hackney as the Neighbourhoods Model.  Both KONP and HAPIA had had serious concerns about the lack of time which had been provided for the consultation which had run over the Christmas holiday period.  Members gave consideration to Mrs Murgraff’s request and to a letter which HAPIA had sent to Sir Simon Stevens expressing serious concerns about the engagement process.

7.2  The Chair stated that he did not want to get into a discussion of the consultation timings as the date had now passed but he asked Members to note both the original request to the Commission and the letter which Malcolm Alexander, the Chair of HAPIA, and also a Hackney resident, had sent to NHSE.  He welcomed for this item:

Laura Sharpe (LS), Chief Executive, C&H GP Confederation

Dr Mark Rickets (MR), Chair, C&H CCG

Malcolm Alexander (MA), Chair, Healthwatch and Public Involvement Association (HAPIA)

Jon Williams (JW), Chair, Healthwatch Hackney

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

7.3  LS stated that she was very pleased that NHSE appeared to have listened to the concerns here and this was very good news.  There had been a furore from various GP bodies and the GP Committee of the BMA had thrown out the proposals.  In summary the new service specifications would have meant lot of extra work for GP Practices with very few new staff.  She stated that the previous Friday the new GP Contract had just been signed between DoH and the BMA and this had contained significant improvements.  There would be an increase in the range of staff PCNs could recruit with an average of 20-24 staff per PCN.  Locally they would have 21 new staff across a range of roles.  This represented a significant increase in GP support staffing.  The previous proposal required local CCGs to provide 30% of the new staffing costs but they had backed down and now 100% would be funded nationally.  The second major worry about the GP contract had been the very complicated and detailed proposed service specs which were supposed to start in April.  These had been pulled and the revised specs were 2 pages instead of 20.  There was also a lot in the new contract about GP mentoring and on support to long term locums etc and overall this package was very good news.  Now PCNs had been put on a much better footing from the new financial year.  As regards the role of the GP Confed locally on this, she stated that she would be meeting with 4 of the 8 neighbourhood directors the following day to begin the work.

7.4  MR stated that he too was very surprised by how things had turned out and was pleased that 100% of the new funding would be reimbursed nationally  ...  view the full minutes text for item 7.

9.1  Members gave consideration to the updated work programme for the year.

9.1  There was none.