Agenda and minutes

1.1  Apologies for absence were received from Cllr Deniz Oguzkanli, Paul Calaminus (CE, ELFT), Osian Powell (COO, Homerton Healthcare) and the Chair welcomed Cllr Turbet-Delof - the Council’s Mental Health Champion.

1.2  The Chair congratulated Georgine Diba on her permanent appointments as Operational Director - Adult Social Care and Operations.

2.1  There was none.

3.1  Cllr Samatar stated she was a Wellbeing Network Peer Coordinator for Mind in City and Hackney and a tutor at the Recovery College.

4.1  The Chair stated that this issue had arisen from Members suggestions (e.g. "Language and cultural barriers in mental health commissioning and provision”) but also from the Annual Scrutiny Survey.  The purpose of the item was to get an overview of the work strands of ELFT, our key mental health provider, relating to tackling inequalities in the provision of local mental health services.

4.2  He welcomed:

Lorraine Sunduza (LS), Chief Nurse and Deputy CEO, ELFT

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

Malcolm Alexander (MA), Hackney Keep Our NHS Public

He added that the Commission had received questions from KONP and MA had shared Healthwatch’s joint report with the Patients Forum of London Ambulance Service, from Nov, entitled ‘Mental Health Emergency - Crisis in our A&E departments.

4.3  Members gave consideration to the report “Tackling inequalities in local mental health service’ an updated version of which was tabled.

4.4  LS and DH took members through the report in detail.  It covered

Equalities is integral to our service goals

Improving the experience of community mental health services for global majority residents

‘Let’s Talk’ report - key themes and ELFT’s response

A glimpse into the future

Mental Health Units (Use of Force) Act 2018

Core strategies for reducing restrictive practices

Use of force data for City & Hackney

Use of force impact data

Patient and Carers Race Equality Framework

PCREF - leadership and governance

PCREF - organisational competency

PCREF - patient and carers feedback mechanism

Next steps

4.5  Members asked detailed questions and the following was noted:

a) Chair asked about early intervention service users being more representative of the community than users of acute services and about trends in the ‘use of force’ data set and strategies for reducing restraining practices. LS described the challenges here in detail and explained how the mental health use of force Act operated.

b) The Chair asked about seclusions/restraining and where the disproportionality is evidenced. LS explained that unfortunately you are more likely to experience this if you are Black African or Black Caribbean but she explained how the Patient and Carers Race Equality Framework pilot was operating at each level to tackle this ongoing challenge.

d) Members asked about the training currently within the system and about how cultural diversity is being promoted within the workforce. DH gave examples of cultural awareness training in action among the teams and LS described Race and Privilege sessions and the role of the ‘freedom to speak up’ guardian, as examples. LS detailed the staff wellbeing actions and about the use of mentoring and ‘trialogue’.

e) Members asked about poor recovery outcomes for Black and Caribbean men and on diversity within BAME groups themselves. DH replied that the focus had to be on early intervention to improve outcomes, particularly for young Black men. He also detailed how discharge care plans had been improved.

f) Cllr Turbet-Delof (Council’s Mental Health Champion) asked about replacing the term ‘BAME’ with ‘global majority’; about readmission rates and  ...  view the full minutes text for item 4.

5.1  The Chair stated that the purpose of this item was to follow up on discussions the Commission had had with the Chief Executive and CFO of Homerton on 9 July 2020 about the then 5 year extension granted to ISS for Soft Facility Services at the Trust.  As the Covid pandemic intervened the Commission had not followed this up in the usual way and so it had asked for a verbal update. The Chair stated that at the recent INEL JHOSC meeting, Shane DeGaris (Group CE of Barts and BHRUT) spoke about Barts Health's positive experience of insourcing their Soft Facility Services.

5.2  He welcomed for the item

Louise Ashley (LA), CE of Homerton Healthcare  and Place Based Leader for City and Hackney, NHS NEL

Rob Clarke (RC), Chief Finance Officer, Homerton Healthcare

5.2  The Chair outlined the history of the contract with ISS for soft facilities and that when it last came up for retender there had been concerns about sick pay and staff terms and conditions. The Commission had been grateful that the Homerton had resolved those differences and they had been asked to give further consideration to the possibility of bringing the soft facilities services in house in future. The Homerton had said that this would require a lot of planning. In the interim Members had learned that Barts Health had insourced their soft facilities and while there were short term cost pressures the other advantages were seen to outweigh this. The Commission had concluded that if the Homerton was going to consider insourcing planning would need to begin soon.

5.3  LA gave a verbal presentation. She reassured Members that they were committed to including all partners who work in the trust in the staff wellbeing work they do. She added that there were Estates issues here to be considered as part of this but added that she was keen to explore how they might do things differently in future. She introduced Rob Clarke, the CFO, who was overseeing this process.

5.4  RC explained that he had come to the Homerton from Barts Health where he was Deputy Chief Finance Officer and so had first hand experience of the processes they had just gone through. They had brought Security services in first and staff were happier with the results. They were watching with great interest and would meet Barts Heath counterparts regularly. It would cost more money as the in-house packages were more generous than those in the independent sector. They would be going to tender in the first half of 2024 in order to meet the contractual deadline in advance of the contract ending in summer 2025.  He added that they had floated with Barts Health if they might be in position to bid for the contract at the Homerton. The Chair commented that this would keep it in the NHS family via Barts Health and might be a viable solution. LA explained that Value for Money was key but also cautioned that any  ...  view the full minutes text for item 5.

6.1  The Chair stated that the purpose of this item was to receive an update on NHS NEL’s wider plans for Community Diagnostic Centres and the Hackney impact.  It was noted that this had been discussed at INEL JHOSC but on a pan NEL basis.

6.2  He welcomed for the item

Louise Ashley (LA), CE of Homerton Healthcare  and Place Based Leader for City and Hackney, NHS NEL

Rob Clarke (RC), Chief Finance Officer, Homerton Healthcare

6.3  Members gave consideration to two tabled notes:

  (a) NEL Community Diagnostic Centre update

  (b) Report on (future use of) St Leonard’s

6.4  The Chair outlined the history of CDC plan and explained that it appeared that Lower Clapton Surgery was currently in a final short list. He asked when would the decision be known and would there be a new building.

6.5  RC took members through the briefing note.  It was noted that a decision was due by the end of February. The available funding to make the changes needed in Lower Claton wasn’t yet in place but they were trying to recycle underspends from elsewhere to fund this proposition.  The alternative option, the Spoke Model, might end up the preferred option however, as it would be covered within the existing budget envelope. He added that there was an absolute need for these services and so they were pushing hard.  One of the requirements for CDCs was that they cannot be located within an Acute site. 

6.6  The Chair asked if the other alternative, the Spoke Model would put it outside of Hackney.  RC replied that it would but if Hackney got it the Homerton would be contracted to run it and this would really complement their current staffing models as they could run joint rotas etc because of the proximity of Lower Clapton site. LA added that Homerton Healthcare had an excellent reputation in diagnostics and with a need for a site in this part of NEL there was no reason why it shouldn’t get it.  The Chair asked to be kept informed.

ACTION:

CE of Homerton Healthcare to inform the Chair as soon as a decision was made on the siting of the proposed Community Diagnostic Centre.

6.7  The Chair asked for an update on the St Leonards site. He explained that the Homerton had been looking at the possibility of an Asset Transfer but 8 days previously the government had intervened generally stopping the process of asset transfers to Trusts completely so that the previous plan was now ‘dead in the water’ and we were returning to a degree of uncertainty.

6.8  RC took Members through his briefing note. He explained that relations with NHS Property Services had been complex, both sides having different approaches and priorities. In the past two months there had been a change of leadership and they had started to engage much more with NEL ICS about the use of this site. They had invested £3m this year for example in replacement windows. They were now  ...  view the full minutes text for item 6.

7.1  The Chair stated that the purpose of the time was to receive an update from the Group Director AHI on the current status of the latest hospital discharge  funding schemes and how they might impact Hackney. This was an evolving situation and hence it was a verbal report. He added that on 9 Jan 2023 the SoS for Health had allocated an additional £200m discharge fund to Integrated Care Systems nationally. This was publicised as the NHS purchasing additional social care beds. This is on top of a November announcement of what is normally called ‘winter pressures’ funding.

7.2  He welcomed for the item:

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

Malcolm Alexander (MA), KONP (who had submitted a question)

7.3  Members gave consideration to a tabled note Questions about Discharge Funding.

7.4  HW gave a verbal presentation and also referred to the additional tabled note.  She stated that the £500m in Nov was part of the now normal ‘winter pressures’ annual funding. There was an established process for this. Hackney was consistently one of the best performers in terms of length of stay and they have well established processes for managing such funding. She explained that they have a small allocation of flats in a Housing with Care scheme which are appropriate for Step-down care and they used this funding to increase that number. They also used it to put in place a team of social workers and OTs and therapy assistants to ensure that people don’t get stuck in ‘step-down’. They work with NHS partners closely on how they manage the flow and what the money is spent on.  The further announcement of £220m nationally was specifically around how to increase the number of residential and nursing beds and this was not necessarily one of the issues faced in Hackney as we rarely have people waiting for that purpose. They had increased the number of beds slightly but haven’t taken a large chunk of that funding as they would not want to put people in restrictive or care home beds who would not need it.

7.5  Members asked detailed questions and the following was noted:

a) Chair asked why Hackney doesn’t have as much of a problem as others re nursing beds. HW replied it was complex but, culturally, our social workers are more comfortable in supporting people back into the community than perhaps elsewhere. We don’t have the option of residential placements as readily available as others so social workers work very hard to develop alternatives.

b) Members asked whether care home staff were equipped to manage the higher acuity of these patients and what happens if patients refuse to move into a care home.  HW replied that they were not using this money for any care home staffing but rather for the Move On team of social workers. Legally they look at the least restrictive option and care homes were last resort.  More often they have the opposite problem in that families are  ...  view the full minutes text for item 7.

8.1  Members gave consideration to the draft minutes of the meeting held 12 January 2023 and the Matters Arising.

RESOLVED:

That the minutes of the meetings held on 12 January 2023 be agreed as a correct record and that the matters arising be noted.

9.1  Members noted the updated work programme.

RESOLVED:

That the updated work programme be noted.

10.1  There was none.