Agenda and draft minutes

1.1  Apologies for absence were received from Dr Sandra Husbands, Andrew Carter, Malcolm Alexander and Anne Canning.

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

3.1  There were none.

4.1  Members gave consideration to a briefing paper from the CCG “The future of health and care for the people of north east London” and the Chair welcomed for this item

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

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

Tracey Fletcher (TF), Chief Executive, Homerton University Hospital NHS Foundation Trust (HUHFT)

Laura Sharpe (LS), Chief Executive, City and Hackney GP Confederation

4.2  The Chair explained the background and context for the creation of a single CCG over the NEL footprint.  It was noted that the GP Practices who are members of City and Hackney CCG will be voting in Oct on the merger to create a single CGG covering the 8 north east London local authority areas.

4.3  DM and MR took Members through the briefing paper in detail.  He described the long history of partnership working and the long plans for devolution. Working in a collaborative way had created integrated workstreams across health and care which had been very successful. Stakeholder engagement was currently on going and they would seek members endorsement in October.  This would then allow the current Integrated Commissioning Board in City and Hackney to transform into an Integrated Care Partnership (ICP) which would also have on the key local providers on it.  Staff would be TUPE’d to the single CCG but would be posted back to continue their work in City and Hackney. Covid had delayed the process but NHSE London still requires a vote by October.  The discussions with the Primary Care Network leaders locally were very constructive they will be co-producing with them the governance documents over quarters 3 and 4.  The Neighbourhoods Programme (the PCNs) were progressing well and fit well with the required new system.  There will follow a series of Transformation Programmes which come out of the Strategic Operational Command (SOC) led by Tracey Fletcher and set up to respond to the Covid crisis and the Enabled Groups in Integrated Commissioning are making these happen.  A Neighbourhood Health and Care Board (NHCB) will be established under the ICP.  The current CCG staff will align themselves with what is needed to deliver the Neighbourhoods system and will stay within C&H.

The new local ICP and NHCB have been established under an Accountability Framework and will include both execs and non-execs from all the commissioning and provider partners locally.  Commissioning decisions, where necessary, will yield to the legislation currently in place and where there has to be conflict of interest boundaries e.g. primary care commissioning these will continue to be respected.

He added that the two Health and Wellbeing Boards (Hackney Council and City of London) will be critical in shaping the wider population healthcare management approach as they will focus on wider determinants of ill health and attitudinal issues.  The Health and Wellbeing Board will therefore be supported by new Population Health Hub which is being developed between the CCG and the Director of Public Health.  This will provide a  ...  view the full minutes text for item 4.

5.1  Members gave consideration to a presentation “Covid-19 update” in the agenda and also to an updated presentation from Public Health tabled at the meeting.

5.2  The Chair welcomed Chris Lovitt (Deputy Director of Public Health) who is new to the role and thanked him for deputising for the Director who had to give apologies. 

5.3  The Chair stated that many are requesting testing and so many can’t get them.  The key metric to watch now was hospitalisation levels.  He added that there had been some modelling the previous weekend which stated that by the next weekend the country could be at the same level of prevalence as in April. He asked Tracey Fletcher (Chief Executive, HUHFT) for an update from the acute sector perspective.

5.4  TF stated that as of that morning there was 1 patient in ICU with Covid-19 as well as 7 inpatients awaiting test results. They had not seen the same levels as BHRUT hospital.  They had seen a very small increase overall and they were in the midst of planning and reorganising to prepare for increased levels of admissions over the coming weeks.  In response to the Chair, she stated that they were in regular contact with the Public Health team and she had met with the Cabinet Member Cllr Kennedy also to discuss more frequent sharing of data from now on and he could be a conduit of information to the Commission Members also.

5.5  The Chair asked what was different this time than from the March-April period in relation to discharges of patients to care homes.  What improvements had been made. 

TF replied that they had a good record on safe discharges particularly in relation to Mary Seacole Home.  The key factor was how they worked with care home staff to minimise transfers and the risks during them.  Patients were tested through admission and before they are discharged.  She added that sometimes it would be more risky for vulnerable older patients to remain in hospital rather than go out to care homes and the key was to ensure that there were similar levels of infection control in place across both settings. 

5.6  CL took members through his presentation in detail.  The Chair thanked Public Health for providing greater triangulation of testing data by also including and comparing it with number of calls going into primary care, numbers contacting  NHS 111 and data on staff related absences.

5.7  Members asked detailed questions and in the response the following was noted:

(a) Members asked why the incidence in Shacklewell went from second highest to lowest in a couple of weeks.  They asked what was being done to ensure social distancing in shops and to enforce mask wearing on buses and what was the % success rate of test, trace and isolate in Shacklewell.

CL replied that the ward level numbers were small and availability of testing here was the key factor.  It was not possible to make conclusions about success at ward level based  ...  view the full minutes text for item 5.

6.1  Members gave consideration to a report Update on the Planned Care Workstream of the Integated Commissioning Board .

6.2  The Chair welcomed for this item:

  Siobhan Harper (SH), Workstream Director – Planned Care

SH stated that Andrew Carter, the SRO for the Workstream, had to give his apologies as he had been having technical difficulties connecting to the meeting.

6.3  SH took members through the highlights of the report.  The focus of the Workstream had been on recovery and restoration of services post the peak months of the Covid-19 pandemic and ensuring people were accessing the care they needed. She explained how they had established Acute Provider Alliances across the NEL patch where the key providers had formally come together to deliver elective care and to ensure that they all met the stringent infection control guidance under Covid so that operating theatres, for example, can be kept Covid free.  There were plans for developing surgical hubs for low acuity and high volume conditions and there will be designing sites for specific surgeries to help deliver the restoration of elective care, as per the rigorous targets set for them by NHSE as part of the national recovery.  She also drew Members’ attention to the fact that cancer surgery did actually continue during pandemic and many did get treatment e.g. from private providers via Barts Health.  There were however serious delays in more diagnostic parts of the care pathways e.g. endoscopy, because there were restrictions on how many patients could be seen in one day.  She added that cancer screening services had been reinstated and women were being encouraged to ensure they have their checks.  Another issue for the Workstream was the fact that many were experiencing symptoms of “long Covid” and were finding recovery quite difficult.  Together with partners in primary care and mental health they were developing Covid specific pathways for patients whose conditions are complex, multi-faceted and which present in many ways.

6.4  Members asked detailed questions and in the responses the following was noted:

(a) The Chair suggested that there was scope for a communications campaign by Public Health in relation to ‘Long Covid’ and the long lasting health ramifications for many people of the virus. 

(b) The Chair asked whether ‘virtual by default’ in primary care was exacerbating the digital divide and what action plans were in place to support those who are on the wrong side of this divide and feel they are being locked out of the system.

SH replied that the ICB’s IT Enabler Group, led by the Digital Team at Hackney Council, were working on a number of fronts on this for example there was a piece of work on maximising opportunities to learn about digital world, there was a specific project on helping those with learning disabilities to access additional hardware and work was being done in Mental Health services involving supporting clients to use their personal budgets to purchase the equipment they need.  She added that the  ...  view the full minutes text for item 6.

7.1  The Chair stated that each year the Commission considered the Annual Report of the local Healthwatch and the Chair welcomed for this item:

  Jon Williams (JW), Executive Director, Healthwatch Hackney

7.2  Members’ gave consideration to the Annual Report 2019/20 of Healthwatch Hackney and the associated presentation.

7.3  JW took members through the highlights of the report.  He also gave apologies for the interim Chair, Malcolm Alexander, who had been unable to attend.  He added that a permanent Chair would be recruited in due course.  He suggested that there should be closer work with the local VCS on the digital divide issues as, in his view, this problem would only get worse.  More generally, over the year they were detecting a lot of frustration from residents about a top-down approach in the NHS e.g. the surgical hubs or the move of the dementia beds to East Ham.  There had been a small drop in satisfaction levels but this had also been the trend.  The need for better support for long term mental health patients was also a concern, much of the focus was on the lower level clients seeking IAPT.  He stated that Healthwatch had been very proud of its large volunteer base.  He stated that many residents were concerned about the government’s hostile environment policies and that charging poor and vulnerable people was a deterrent to them seeking vital health care and represented very bad policy making.  He explained that the co-chaired the Communications Enabler Group of ICB  and more work needed to be done to understand how greater public involvement can be taken forward.  He also highlighted the existence of the Involvement Alliance which aided existing organisations to work better together.  In terms of funding, they continued to be well funded by the Council despite the pressure it was under and they had also received much funding support from the CCG.  They had discontinued their involvement in City Healthwatch.

7.4  Members asked questions and in the replies the following points were noted:

(a) The Chair commended Healthwatch for striking such a good balance between being funded by both the Council and the CCG and at the same time holding both to account so well.

(b) Members commended the quality and accessibility of the report again this year.

(c) A Member commented that there was a low level of awareness about how the local GP Confederation sets minimum standards for GP Practices and that this was an excellent way to achieve consistent approaches across them all but residents were not aware of this function.  He asked if a piece of work could be done to look at the awareness of the public on the existence of these common standards and whether Healthwatch had done any surveys on this.

JW replied that this was an excellent point and that they had not done any specific surveys on this but it was something they could pick up with the Confederation focusing on patients’ rights and service user rights akin to  ...  view the full minutes text for item 7.

8.1  Members gave consideration to the draft minutes of the meeting held on 30 July and noted the matters arising.

9.1  Members’ gave consideration to the updated work programme for the Commission.  The Chair stated that he wanted to continue to keep some spaces open in order to respond to fast changing situations such as Covid and that they would request a further verbal update on Test and Trace for next month.

10.1  There was none.