Agenda and minutes

1.1  An apology for lateness was received from Cllr Patrick. Apologies also received from Louise Ashley and Dr Stephanie Couglin.

2.1  There was none.

3.1  There was none.

4.1  The Chair stated that the pressures on the local mental health services have been an ongoing concern. Recent performance data from the Health and Care Board has pointed to a major spike in demand. Last month the Commission had discussed the issue of ‘Right Care Right Person’ and they’d decided to ask ELFT in to discuss the wider issues involved.

4.2  He welcomed the following invitees:

Jed Francique (JF), Borough Director for City and Hackney, ELFT

Dr Olivier Andlauer (OA), Clinical Director for City & Hackney, ELFT

Sharon Evans (SE), Crisis Pathway Lead for C&H, ELFT

4.3  Members gave consideration to a detailed report from ELFT ‘Responding to increasing mental health needs’

4.4  JD, SE and OA took Members through their presentation and the following points were noted:

a) Mental health was everybody’s business not just the Providers and they work very closely with the Council. VCS orgs, primary care and the police.

b) Presentation would look at both crisis services and community mental health services.

c) The gradient from green to red showed a high level of need and challenge in Hackney.  Mental health is very much linked with levels of deprivation. Physical health is a more a mixed picture with some positive aspects - Hackney performance was good on physically active adults but there was also a high level of substance misuse linked to mental ill health prevalence.

d) Since the pandemic there had been a 20-25% increase in mental health needs nationally and capacity and resources haven't been able to keep up.  MH difficulties are not spread equally.  There is disproportionality across a range of characteristics. You’re twice as likely to need mental health support if you’re in the least deprived areas.

e) ELFT runs psychiatry liaison, the acute unit, and crisis line so they triage for all. The crisis cafe provides more informal access at set times.  Most however are presenting at out-of-hours. In Psychiatric Liaison people get triaged, they assess need and risk and there are a number of options. They work closely with VCS.

f) ‘Home Treatment’ is for very acute patients where a person can get visits a couple of times a day. It is intensive and very short term c.2 weeks to a month, They then can be referred to Community Mental Health Teams as necessary.

g) A&E numbers have been going up and acuity getting more complex therefore the new presentations are coming to them quite unwell. They are using the Mental Health Act more. There has been an increase in stress, self harm, depression, psychosis and bi polar presentations.

h) The performance of ELFTs Psychiatric Liaison Service is one of the best in NEL with response times hitting targets at 81%. Issues coming through are complex relating to housing, substance misuse - and this takes longer to provide support.

i) Bed pressures which are recognised across the country are also an issue locally

4.7  Members asked questions and the following was noted:

a) Chair asked about  ...  view the full minutes text for item 4.

5.1  The Chair stated that each year the Commission gives consideration to the Annual Report of the City and Hackney Safeguarding Adults Board (CHSAB).

5.2  He welcomed for the item:

Dr Adi Cooper (AC), Independent Chair of CHSAB

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

Joe Okelue (JO), Senior Lawyer, Adult Social Care

5.3  Members gave consideration to the summary report and to the main Annual Report of City & Hackney Safeguarding Adults Board 22/23, which was tabled.

5.4  AC apologised for the late submission due to some design delays and took Members through the report in detail. She commented that she’d chaired the Board since 2015 and there were ongoing challenges as well as new ones. The report comprised the various achievements including the statutory duties carried out during the year including two published SARs and one commissioned SAR. The Board was obviously looking at the learning from all of these. In the past year much had been done on communication and engagement and a joint piece of work on tackling anti-social behaviour.  Another focus this year was how the Met Police works with those who have mental illness. They also worked on the impact of the cost of living crisis and its impact on safeguarding adults. The data this year was not significantly different than last year, at one point there had been a blip in reported cases of self neglect which they analysed.

5.5  Members asked questions and the following was noted:

a) Chair asked if the numbers of ‘concerns’ raised vis-a-vis the number of S.42 ‘enquiries’ carried out had risen and if this could be clearer in the report. He also asked for an update on the replacement of the Deprivation of Liberty Safeguards (DoLS) process.

AC replied that it was largely in line with the previous two years. DHSC has now deferred the implementation of the change from DoLS to Liberty Protection Safeguards (LPS) so the proposal, the consultation and the feedback process has all been put on hold. She added that there were ongoing challenges with DoLS in the context of assessing safeguarding risks so it was still a live issue for partners while a government announcement is awaited.

AC added that in relation to comparative work on concerns and enquiries, due to the impact of the cyberattack on the Council they had issues with data quality. They tried to complete the gaps with data from partners  but giving year on year comparisons for Hackney in particular has been problematic. She added however that the data can only take you so far on these issues but it of course prompts you to ask the right questions. GD added that the data is important for informing action and focus and they will be able to share more on request. She noted that higher levels of self-neglect and hoarding had been reported in Hackney than in our neighbours. As time moves on the Council will be able to provide much  ...  view the full minutes text for item 5.

6.1  The Chair stated that each year the Commission considers the Annual Report of the local Healthwatch which is submitted to Healthwatch England.  We use the report as an opportunity to discuss the performance of the organisation during the past year and to discuss its priorities and future plans. He welcomed the new Chair

6.2  He welcomed for the Item:

Deborah Cohen (DC), Chair of Healthwatch Hackney

Sally Beaven (SB), Executive Director of Healthwatch Hackney

And he congratulated them on the Healthwatch England Awards they had received for their work on ID demands for access to GPs, work that allowed real change to happen in the local area.

6.3  Members gave consideration to the Annual Report of Healthwatch Hackney 2022/23 and to a summary slide presentation.

6.4  DC took Members through the presentation and thanked the officers and many volunteers for their hard work. She explained that her background was as a health journalist with the BBC. She was very pleased about the HWE award as it was their main award. SB added that as well as their core statutory healthwatch function, the organisation also holds contracts through the NHS which enable them to perform a watchdog function allowing them to engage in a lot of collaborative work. They work closely with HCVS on the Forums for the Neighbourhoods and there is a focus on embedding co production. Their local insight reports draws in feedback from each of the Neighbourhoods. She described their Community Voice contract which recently included reports on: Spirometry, virtual wards, living with Covid and on patient transport. They have a significant engagement and coproduction contract with NHS but their E&C Manager acts for the whole system. She explained the System Influencers which allows young people to get involved in the system. She described the investigatory reports and their Enter & View work which have exposed poor behaviour such as patient experience in maternity care during the pandemic, or overlooked areas such as on the impact of language barriers on the Chinese and Vietnamese community. She described the mystery shopper approach they used on the report on access to emergency hormonal contraception, which had used young people to carry it out and which revealed that they were being charged when they shouldn’t have been. She described the Peoples’ Feedback Panel where we go through comments and their Information Exchange Meetings which are still held online.

6.5  Members asked questions and the following was noted.

a) Chair asked how Healthwatch Hackney was working with the other 7 Healthwatches in north east London on the ICB Partnership Board.

SB replied that all 8 meet fortnightly online and Hackney has reps attending ICB regularly. Maternity issues was a good example of where the 8 united on a coordinated approach to NHS NEL based on what was done initially in each borough.

b) Chair asked what were the priorities for the next year.

SB explained that she had met with the Director of Adult Social Care and Operations as they  ...  view the full minutes text for item 6.

7.1  Members gave consideration to the draft minutes of the previous meeting.

RESOLVED:

That the minutes of the meetings held on 17 July 2023 be agreed as a correct record.

8.1  Members noted the updated work programme and again noted the list of suggestions which had emerged from the engagement exercise with residents and stakeholders.  The Chair stated that he had now populated the draft programme and had attempted to encapsulate all the suggestions from Members.

8.2  The Chair went through some of the outstanding suggestions.

a) On the suggestion re Chagas disease, he suggested this be referred to INEL JHOSC as it would be more fruitful to look at this across an NEL footprint because of the numbers involved.

b) On the issues of poorer health outcomes for Black Women and Black Men this would be incorporated into a possible item in January.

c) On the issue of NHS charges for migrants he stated that this had been covered extensively in the past by the Commission and at INEL and there had been letters to and from Ministers and the O&S Officer could update the Member on that.

ACTION:

O&S Officer to share papers and outputs from the various items on migrant charging with Cllr Turbet-Delof.

d) On the issue of hoarding this would be added to the work programme.

e) On the issue of increased levels of suicide relating to cost of living this had been touched on at this meeting and also Scrutiny Panel will be revisiting that. Cllr Turbet-Delof asked for the papers on the levels of debt leading to self harm and suicide and what data there might be on presenting issues for those who are self harming. Chair replied it had been covered to some extent in the ELFT report earlier and it appeared this was very much on their radar.

f) On the issue of how the Neighbourhoods system is interacting with the PCNs and the GP Confed this will be revisited.  The Chair added that they would also look at the staffing structure in the Place Based System vis-a-vis what prevailed under the CCG.

g) Cllr Turbet Delof suggested that the issue of being exposed to diseases from parasites arising from exposure to dog faeces in streets and parks should be explored. The Chair suggested that a number of these suggestions, in the first instance, would benefit from a briefing from Public Health to determine the extent of the problem and subsequently a decision could be made on making it an agenda item. These could take the form of a Members Enquiry.

h) SB added that their reps had discussed the idea of social audit of green spaces and this issue could link in with that. The Chair cautioned that this would stray into the remit of Living in Hackney SC and suggested they check with them in the first instance.

ACTION:

Director of Public Health to respond to Member Enquiry from Cllr Turbet-Delof on the following: Chagas Disease; Suicide and self harm; and the serious health impacts of dog fouling in streets and parks.

RESOLVED:

That the updated work programme be noted.

9.1  There was none.