Agenda and minutes

1.1  Apologies for absence were received from Cllr Patrick and Cllr Goldberg and Lloyd French (Interim Acting Chair of Healthwatch Hackney).

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

3.1  Cllr Samatar stated she was a Wellbeing Network Peer Coordinator at Mind in City Hackney and so would withdraw from item 6

4.1  Members gave consideration to two reports:

Summary report

Full report CHSAB Annual Report 2021-22

4.2  The Chair welcomed:

Dr Adi Cooper (AC), Independent Chair, CHSAB

Georgina Diba (GD), Director of Adult Social Care and Operations

Helen Woodland (HW), Group Director Adults, Health and Integration

4.3  AC described the work of the Board and took Members through the reports.

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

The Chair asked about councils safeguarding role related to impact of the cost of living crisis e.g. in relation to increased fire risks. AC described the Boards work in relation to fire risks e.g. on inappropriate use of candles and heaters as we move into winter.

Members asked about the mental health impacts of the cost of living crisis in the community.  AC described increased cases of self neglect and carers stress in the past year due to cost of living pressures. GD went on to describe the benefit of having a strong VCS sector in Hackney which contributes to the  support provided and she detailed the increased cases of self neglect and of intergenerational abuse in the past year.

The Chair asked about the Council’s Discretionary Fund not being taken up.  GD described its operation and the information campaign which has been done about the offer e.g a new booklet which covers all the help that can be provided and this is being cascaded out even to those who do not meet the statutory threshold.

Members asked about the need for such communications to be better targeted to reach the diverse and multilingual communities. GD described how the Safeguarding Team works with all the partners and it is often the community groups or neighbours who are reporting cases of possible self neglect, or hoarding or disrepair. In terms of communications they already work with those who may lack capacity or have learning difficulties so there are a range of approaches and skill sets.

The Member Champion for Mental Health asked about data quality; about how the need for mental health support might be identified earlier in the Safeguarding process; and on how ASB becomes identified as a safeguarding need.  AC replied by explaining how the approach to data reporting is nationally mandated so there is no local flexibility. On ASB that piece of work came about because of the manifestation of ASB combined with mental health distress and looking at how such situations were being addressed by the services.  GD added that data could be provided in next year’s report on primary service user types and explained that approximately 25% of their safeguarding cases have a primary mental health need. 

Cllr Kennedy (Cabinet Member) described the Income Maximisation Team’s work to ensure there is take-up of Discretionary Fund.  There will be a single webpage, phone number and application form.  Chair added that we’ve failed as a council if there is any money left in that fund at the end of the year.

Members asked why City of  ...  view the full minutes text for item 4.

5.1  The Chair stated that Healthwatch Hackney has always worked closely with the Commission but that once a year it invites its leadership in to present its annual report and reflect on the past year. This is the report which they are required to submit to Healthwatch England.  He added that Healthwatch was currently in a state of transition and would soon have a new Executive Director and Chair but he was pleased that the Deputy Director of Operations was able to attend.  He welcomed to the meeting:

  Catherine Perez Phillips (CP), Deputy Director of Operations

5.2  Members gave consideration to the Healthwatch Hackney Annual Report 2021/22.

5.6  A Member asked for Healthwatch’s view on the issue of delayed waiting times and cancelled appointments for acute care and patients seeking alternatives abroad, giving an example of a resident who had passed while still on the list. CP replied that it was an area of great concern to Healthwatch but it was a multi faceted problem. She encouraged the public to use the feedback page on the Healthwatch website so they can build an evidence base to give the NHS on inadequate service. The Chair gave some context on this issue to the Member, including previous items on it and suggested that he could provide further background to the Member outside of the meeting.

5.7  A Member asked about what progress had been made on the redevelopment of the St Leonard’s site as he was one of the ward councillors and there was concern that the site would end up as purely private residential accommodation.  CP replied that Healthwatch do plan to build on their engagement work on the future of St Leonard’s and will be doing Enter and View visits. The Chair explained how there were similar funding challenges recently from the Treasury around the redevelopment of the Whipps Cross Hospital site and that was much further along.  He added that at the next meeting they would have the new Chief Executive of Homerton Healthcare (also the Place Based Leader for City and Hackney) and that he would be raising the issue with her as the Homerton currently held the ring on this redevelopment issue.

5.8  The Chair commended the work Healthwatch had done on ensuring that GP Practices no longer demand photo ID from patients attempting to join a Practice, which is discriminatory. He explained that the Commission had also taken on this issue and written to the CCG who had given undertakings to him and to Healthwatch that the GP Practices who were outliers here would change their procedures. He asked CP if Healthwatch revisits this issue that they could keep the Commission update on progress. The Commission would also be following up on Healthwatch’s report on Dentistry at the next meeting.  Laura Sharpe (CE of GP Confederation) interjected that they had recently completed training with local GP Practices on patient registration and the law.

RESOLVED:

That the report be noted.

6.1  The Chair stated that the issue of the effectiveness of the local network for lower level mental health support was one which the Commission had covered many times and this new iteration of the mental health network was the third he had considered. He was pleased however that a new more integrated model had now been designed and was going out to tender.

6.2  Members gave consideration to a report City and Hackney Integrated Mental Health Network.

6.2  The Chair welcomed for the item two officers from Public Health who are re-commissioning the service as well as two representatives from Mind who were the previous leads for the Network.

Jennifer Millmore (JM), Senior Public Health Specialist

Dr Sandra Husbands (SH), Director of Public Health

Vanessa Morris (VM), Chief Executive of Mind City, Hackney and Waltham Forest

DevoraWolfson (DW), Board Member of Mind City, Hackney and Waltham Forest

6.3  JM and SH took members through the presentation.

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

The Chair asked why if the focus has shifted to those with much more complex needs how will the re-designed service continue to support the lower level need across the very culturally diverse groups in Hackney.  JM explained that the new service would still provide support to those groups.  It was a “low level IAPT” intervention as it contained pathways for mild to moderate.  In the new iteration they would be focusing on people with complex needs because that’s where the demand is and where there aren't any alternatives for this cohort locally. She added that IAPT services locally can provide the necessary culturally competent offer already and have a number of providers embedded within local communities. She added that the local VCS also provide great community based interventions also and are better placed to provide those in many instances.

For the benefit of new Members the Chair detailed the history of the previous network. He asked if the commissioners were envisaging contracting the existing range of community organisations such as Derman to provide some services as part of the new IMHN. JM replied they were all able to bid. SH added that as commissioners they were addressing a need that had revealed itself over the past few years. They would also be expanding the offer to include more preventive work as there is a need to try and address all the gaps in provision. Once the network is in place they will continue to work with the new network and the partner providers to understand what the next iteration will need to be as it will be an ongoing process of improvement.

The Member Champion for Mental Health welcomed the report and added that as a new councillor she had not been aware of its existence. She asked at what point are patients referred from IAPT, expressing a concern at the long waiting lists for the latter.  She also asked how do people who are not existing  ...  view the full minutes text for item 6.

7.1  The Chair stated that in February and March the Commission had held in depth discussions on the future of Primary Care in Hackney.  Hackney had benefited from a successful GP Confederation whose task was to drive up quality, and as its longstanding Chief Executive was about to retire, the Commission had invited her to come to the meeting to give a verbal presentation on her reflections as she departs and in particular on how primary care in Hackney can best optimise the new ICS structures to its own benefit.

7.3  He welcomed to the meeting Laura Sharpe (LS), Chief Executive, City & Hackney GP Confederation.

7.4  LS thanked Members for the invitation and gave a verbal presentation. She reflected that we do not know how the ICS will settle in or what will happen at NEL level and what will happen locally as a consequence. A key issue is the 80:20 split which NHS NEL has promised would be retained i.e. 80% of funding would come down to locality level with 20% being commissioned at sub regional level.

7.5  She explained that it was a very difficult time for General Practice with a perfect storm of massive and serious clinical need, combined with a workforce crisis.  She described how normally they received many more applications than there are places for the local GP Salaried Scheme but this year they only received 1. Typically they would receive 12. New trainees were opting to take a year out as they were worried about the levels of pressure and stress.  There is a vital need to take care of the primary care staff and keep the ones we have so they don’t burn out, she added.

7.6  Another issue was how GPs can support patients through the cost of living crisis as the numbers of consultations are rising as a consquence.

7.7  She had a general concern with ‘Access’ being seen as the ‘be all and end all” and worried that it was all the government talked about.  She added that it was only one part of the mix that comprises Quality of Care and this is getting lost in the conversation. There is a need to protect more time for those patients who need it more and if ‘Access’ becomes just about those who shout loudest then we all lose. The focus has to be about quality and continuity of care for those who need it most. 

7.8  She expressed concern about the current 7 yr contracts with the GP Confederation which run out in 2025.  These help manage such things as Long Term Conditions and Hackney does it really well and they need to be protected as it has taken 10 years or more to move to a more preventive approach to primary care in Hackney.

7.9  She added that City and Hackney is now a balanced ecosystem because it has high performing GPs, mental health services, community services and all this means that our key acute hospital (the Homerton  ...  view the full minutes text for item 7.

8.1  Members noted a document on new government guidance on how ICBs, ICPs and local health scrutiny committees should work together.

ACTION:

That the report be noted.

9.1  Members gave consideration to the draft minutes of the meeting held on 29 June 2022 and the Matters Arising. As the meeting was not quorate at this point, formally agreeing these minutes was deferred to the next meeting.

10.1  Members gave consideration to the draft work programme for 2022/23.

RESOLVED:

That the Commission’s rolling work programme for 2022/23 be noted.

11.1  There was none.