Agenda and minutes
PDF 171 KBVenue: Council Chamber, Hackney Town Hall, Mare Street, London E8 1EA. View directions
Contact: Jarlath O'Connell
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Apologies for Absence (19.00) Minutes: 1.1 There were none. |
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Urgent Items / Order of Business (19.00) Minutes: 2.1 There was an urgent item relating to delays at Homerton Healthcare and elsewhere in East London for patients presenting at A&E and diagnosed as requiring an in-patient bed. This was taken before item 4 and is reported under AOB below at item 10.
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Declarations of Interest (19.01) Minutes: 3.1 Cllr Samatar stated she was a Wellbeing Network Peer Coordinator for Mind in City and Hackney and that she was also Chair of HCVS’s LGBTQIA sub committee. |
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Integrated Delivery Plan for C&H Place Based Partnership (19.02) Additional documents: Minutes:
4.1 The Chair stated that the purpose of this item was to look now at the first Integrated Delivery Plan for the City and Hackney Place Based Partnership which replaced the CCG as the local end of NHS North East London. He welcomed:
Nina Griffith (NG), Director of Delivery, City & Hackney Place Based System Helen Woodland (HW), Group Director, Adults, Health and Integration
4.3 Members gave consideration to a background report: The Integrated Delivery Plan
4.3 NG took members through the report. The Place Based Partnership works under the guise of the City and Hackney Health and Care Board and has a range of sub committees and groups beneath it. It’s an evolution of existing integrated commissioning arrangements which of course have been in place for some time. In March the C&H HCB set strategic priorities to improve services and outcomes. That Board also works closely with the Health and Wellbeing Board and so they agreed not to set a whole new strategy but to formally adopt the same strategic focus areas. They also formally adopt the strategic priorities of NEL ICS. This shows how they aim to deliver on local priorities but also part of the wider ICS in NEL. The HCB agreed on 9 strategic focus areas - 3 on population health groups (children, mental health, long term health and care needs) and 6 cross cutting priorities on approaches relevant to all of them. These includeL social connection, healthy places, greater financial wellbeing, joining up health and care needs, tackling racism and supporting the health and care workforce.
4.4 NG explained that from these strategic focused areas they looked at how they would address the priorities and this set out in the Integrated Delivery Plan. It’s a Partnership developed plan which describes what they will be doing over the next 2 years. It doesn’t describe all the work of the constituent organisations but is about where they are specifically going to focus on in order to drive improvement. There are 3 Big Ticket Areas and 9 Big Ticket items and the Plan summarises what is being done and the outcomes they want to see. Underneath this document is a much more detailed delivery plan. The structure also includes 3 Enabler Groups on: Workforce, Digital and VCS and developing the Enabler Groups is the next key task. They will also share the plan with residents and the next step will be to pull together an Outcomes Framework which quantifies how they want to see delivery against outcomes.
4.5 Members asked detailed questions and the following was noted:
a) The Chair commented that the ability to achieve all this is built on the premise that Hackney has levers available to it in the formal Scheme of Delegation from NEL ICS. He asked would the Health and Care Board have the same volume and quantity of decision making as the local ICB which preceded it. He was also interested in a comment of Louise Ashley’s at the previous meeting concerned ... view the full minutes text for item 4. |
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Adult Social Care Reforms: Fair cost of care and sustainability (19.40) Additional documents:
Minutes: 5.1 The Chair stated that the purpose of this item is to get an overview of the many national changes to Adult Social Care and how they are likely to impact on Hackney.
5.2 He welcomed to the following:
ZainabJalil (ZJ), Head of Commissioning, Business Support and Project, Adults Health and Integration Directorate John Holden (JH), Financial Advisor, Finance and Resources Directorate Georgina Diba (GD), Director of Adult Social Care and Operations, AHI Helen Woodland (HW), Group Director, Adults, Health and Integration
5.3 Members gave consideration to 2 reports
Adult Social Care Reforms: Fair cost of care and market sustainability from Adult Services Proposed reforms to adult social care (including cap of care costs) from House of Commons Library, briefing paper. For reference.
5.4 The officers took Members through the report in detail. It was noted that the date for implementation of Fair Cost of Care had shifted as there was some uncertainty about how much finding councils will get and when and how they are required to use it. Hackney Council is continuing with planning regardless as it needs to be prepared and to support the local market. It was also noted that in late Nov following the new Chancellor’s Autumn Statement the funding plan had been changed and repurposed to form part of an overall ASC grant rather than being specific to supporting services with the ‘fair cost of care’ plans. Hackney had received £948k as start towards this exercise but funding for next year and year after was currently uncertain as to how it will come and how it will be banded. Hackney was expecting £600m next year and the year after in the fair cost of care transition but they got just £948k for now.
5.4 Members asked detailed questions and the following points were noted:
a) In response to the Chair, officers explained that this was seed funding to embed the new system. £948k was for internal use to do this exercise and communicate and work with providers and 75% of that was to be given to providers to support uplifts within this financial year and that money would be spent by 31 March.
b) The Chair asked if it was still the intention to give 75% of £948k to providers in recognition of all the cost pressures they are under and what are the conditions given to providers. HW explained that the entire exercise was in recognition of the fact that the market is charging self-funders more to balance out what the local authority was paying for its clients placed with them and this hasn’t changed. In addition, significant inflationary pressure on costs and increased demand means that the market is at risk of failure nationally. Councils need to work with providers with the funding that we’ve got in preparation for when the reforms might come in.
c) The Chair asked what is the Council’s assurance that these funds, 75% of which goes to providers, means these providers might just retain the same ... view the full minutes text for item 5. |
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Implementation of Liberty Protection Safeguarding (20.25) Additional documents:
Minutes: 6.1 The Chair stated that in the past the Commission had considered briefings on Deprivation of Liberty Safeguards (DoLS) and the system is now being replaced with Liberty Protection Safeguards (LPS) and the purpose of this item is to understand the changes being made and the impact it will have on the Council and on service users.
6.2 He welcomed to the following
Dr Godfred Boahen (GB), Principal Social Worker, Adult Services, AHI Georgina Diba (GD), Director of Adult Social Care and Operations, AHI Helen Woodland (HW), Group Director, Adults, Health and Integration
6.3 Members gave consideration to 2 briefing notes:
LPS implementation - cover sheet Liberty Protection Safeguards - Briefing to HiH
6.4 HW introduced the report explaining that this was another piece of legislation brought in and with implementation postponed repeatedly. The report gives the timeline and the work being done to prepare Hackney for it.
6.5 GB explained that this went to the heart of how society looks after people who need care or support and protection but do not have the mental capacity to consent and so safeguards are required. DoLS changed the legal framework around depriving people of their liberty. Then an important Supreme Court Judgement in 2014 clarified what constitutes a DoL which then made the sector realise that the thresholds were lower than previously thought and this led to expansion of referrals and the system was then seen as overly bureaucratic and in need of simplification. The Law Commission made proposals which became the LPS. It increases the settings where safeguards apply, it expands the function to other Responsible Bodies and it includes 16-17 yr olds for the first time. A final Code of Practice is still subject to consultation so they are awaiting that before the date for implementation is known. So the Council has had to plan amidst this uncertainty and all this within the context of workforce shortages. There is a need to consider the needs of all the relevant partners involved locally so that a seamless transition can be enacted. They have done a number of consultations with staff to develop the model and they have also worked with trusts, the ICB and Children and Families Service. The LPS needs to be underpinned by principles and values and the recognition that the demography of Hackney requires an LPS model that must respond to the cultural needs of residents. The local model also is being co produced and they are taking a whole systems approach. Between Jan and Mar ‘23 they will work with providers and advocates to finalise the local model. They also need to train the work force and to scale them up to deliver the care and support. They are already working with partners to develop clear care pathways to enable a seamless transition.
6.6 Members asked detailed questions and the following points were noted:
a) The Chair asked that with the expansion of the Responsible Bodies to be involved, what risk was there when ... view the full minutes text for item 6. |
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Refresh of Mayor of London's Six Tests for health service configuration FOR NOTING (20.55) Additional documents: Minutes: 7.1 Members gave consideration to a letter from Dr Tom Coffey (Senior Health Advisor to the Mayor of London) updating London Scrutiny Committees on the refresh of the Mayor’s Six Tests.
RESOLVED: That the letter be noted.
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Minutes of the Previous Meeting (20.56) Additional documents: Minutes: 8.1 Members gave consideration to the draft minutes of the meetings held 16 November and the Matters Arising.
RESOLVED: That the minutes of the meetings held on 16 November be agreed as a correct record and that the matters arising be noted.
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Health in Hackney Scrutiny Commission Work Programme (20.57) Additional documents:
Minutes: 9.1 Members gave consideration to the draft work programme for 2022/23.
9.2 The Chair added that for the 12 January there would be an item with Dr Kirsten Brown (Primary Care Lead for C&H, NHS NEL) on the current challenges on registration and access as well as the annual Cabinet Member’s Question Time Session.
RESOLVED: That the Commission’s rolling work programme for 2022/23 be noted.
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Any Other Business (20.58) Minutes: 10.1 The Chair stated that the Commission had been asked by Cllr Selman and by Healthwatch Hackney to investigate a worrying rise in the waiting times being experienced by mental health patients in Homerton A&E in being admitted to a mental health bed after they had been diagnosed as requiring one and that long waits at A&E were particularly inappropriate for this cohort. The Chair had asked Nina Griffith (NG), Director of Delivery, City & Hackney Place Based System to provide a verbal report.
10.2 NG gave a verbal report. It was common for people in mental health crises to be taken to an ED because these are deemed to be safe places where people can seek an assessment and access other services they need. Police can bring them there also. A key performance measure here is the time people wait between a decision to be admitted being made and actual admission and the target points are 4 hrs and 12 hrs and nobody should wait 12 hrs. In the past very few had breached this standard. In the past 8 months however there were a number of breaches and this problem as a pan London one pointing to the increased demand on mental health crisis services and on mental health beds. It was not an acceptable situation as all partners were focused on this at C&H, NEL and London wide levels. Locally there has been an increase in demand both on mental health beds but also seeing an increase in length of stay in in-patient wards so both creating the pinch point and blockage. As regards solutions, they have put in place extra capacity creating a Section 136 suite as well as additional capacity away from A&E in the Reybould Centre which ELFT operates on another part of the Homerton site. That creates a calmer environment for those in crisis. Capital works are also ongoing to create extra capacity for those needing mental health beds and this will open in January.
Secondly ELFT is procuring an additional 40 independent sector inpatient mental health beds to also help ease the pressure. The plan will be that those extra beds will be for Out of Area patients and will release the main ELFT beds for local area patients. She added that in an ideal world you would never put people in Out of Area beds as they require the wraparound care from community services from their own local area. They are trying to ensure the most optimal pathways to keep local patients within in-area beds and this should free up significant capacity within the system to enable that.
The third area they are addressing is length of stay and the flow. Additional discharge monies have been announced through ASC Discharge Fund and part of that locally will go on mental health discharge. In addition and separate to that they’ve commissioned additional step down capacity in b&bs for those who can’t be easily discharged into their own homes ... view the full minutes text for item 10. |