Agenda and minutes

1.1  Apologies were received from Cllrs Adebayo and Samatar.

1.2  The Chair thanked Louise Ashley who had announced she will be leaving as CE of Homerton and the Place Based Leader for City and Hackney and thanked Basirat Sadiq Deputy CE at Homerton Healthcare who was present in her place.

2.1  There was none.

3.1  There were none.

4.1  The Chair stated that this item was a follow up to the discussions at the Commission on 17 July. The new system had been due to come on 30 Aug but had been delayed to 1 Nov.  They’d asked officers to come back to update us on how it was bedding in. He reminded Members that this represented a fundamental change to when Police will be deployed around welfare concerns, mental health incidents or missing persons or those who have absconded from hospital.

4.2  He welcomed for the item: Georgina Diba (GD), Director Adult Social Care and Operations.

4.3  Members gave consideration to ‘Right Care Right Person’ briefing note.

4.4  GD took Members through the report in detail. It was noted that change meant the Met Police could reconsider when police have to be deployed and there would be a change of approach to call handling. She provided reassurance that there were a number of structures in place to look at how it was being implemented and they had been given an additional two months. She stated she was pleased there had been no major concerns or escalations since it came in on 1 Nov.  Early indications were that there had been an increase in demand to NHS 111 with Mental Health calls.  A S136 Hub had been implemented.  Overall the change had gone smoothly with a lot of work in the background to ensure that structures were in place. They were waiting for feedback on costs to other parts of the system.

4.5  Members asked questions and the following was noted:

a) Chair expressed a concern about those calling 999 being referred to 111 and if there was somebody on the line that didn’t meet the threshold were they patched through to ELFT or told to phone 111.

GD replied that, unfortunately, there was a double contact and so it is not the ‘soft handover’ they would have expected so the system does create some risks.  She added that police deployments had reduced from 44% to 31% of in scope calls i.e. call relating to welfare calls if someone was missing in the community or AWOL from a health facility or in mental health crisis. There had been a 13% reduction in police deployment therefore. She clarified that even though the police were not deployed it didn’t mean a service wasn’t deployed.

b) The Chair asked if there was a beefed up ELFT triage service that could be deployed if for example LAS wasn’t needed.

GD replied that additional resources were deployed to make sure there was a response. There had also been a reduction in the number detained under MH Act and this was a positive result.

c) Members asked if the fluctuation in numbers might be as a result of people not being sure that a service is there for them

GD replied that the S.136 Hub allowed police to call in and ask for advice on cases, so what RCRP is doing is shifting how  ...  view the full minutes text for item 4.

5.1  The Chair stated that this item was to receive an update from Homerton Healthcare on the current status of discussions about the future of the ‘soft facilities services’ at the Trust including possible insourcing. The Commission had previously discussed this on 8 Feb 2023 and 9 July 2020. Soft services refer to catering, portering, cleaning, security services etc

5.2  He welcomed for the item: Basirat Sadiq (BS), Deputy Chief Executive, Homerton Healthcare and for her detailed the history of the Commission's previous items on this.

5.3  BS gave a verbal update. The contract is up for renewal in 2025.  The plan to review the service has been delayed by a year because of changes in leadership in the Trust and the estates function being moved under another director. The Trust has been recruiting to a substantive new post of Director of Estates. In the meantime they’ve appointed on 6 month secondment one of the key figures who did the insourcing work on facilities at Barts Health and he had started two weeks previously. They will need to look at the options through a Value for Money Framework and are committed to ensuring they improve working conditions of these key staff. They’ve also been discussing this with the other trusts who are part of the Acute Provider Collaborative. There is now an Estates Provider Collaborative and they are having conversations on a joint agreement around estates issues. She’s also discussed this with the Group Director of Barts Health. She’d also met with the unions to hear their concerns. As the plans progress they will look at an opportune moment to come back to the Commission with an update. 

5.4  Members asked questions and the following was noted:

a) The Chair commented that in his 11 years on the Commission this was the most promising news he’d heard on this issue and he asked about the timescale. He asked about the option to have another NHS partner such as Barts Health providing the service adding that he hoped the review won’t take too long and will prevent any need to extend the current provider just because time had run out. 

BS replied that it was helpful to bring a key contact from Barts Health to lead the review.  She was aiming to take his first draft of the review to the Trust Board and the Finance and Policy Committee in July-August. The schedule is to ensure they have enough time and she was conscious that there shouldn’t be a need to extend the current contract if that wasn’t a necessary option.

b) Members asked what form will the involvement of the unions take?

BS replied that when they met there were a number of issues that need to be addressed with ISS, the current contractor, which was separate. As they proceed through the procurement exercise they have stakeholders who will be part of that process. They meet with the unions regularly as part of the staff engagement process. They would have  ...  view the full minutes text for item 5.

6.1  The Chair stated that this item was suggested by the Clinical Director to update members on the progress being made by the City and Hackney Place Based Partnership which sits under the North East London Integrated Care Board. He reminded Members that at its meeting on 15 Nov the Commission had discussed the organisational structures of the City and Hackney Place Based System.

6.2  He welcomed for the item:

Dr Stephanie Coughlin (SC), Clinical Director, C&H PBP

Amy Wilkinson (AW), Director of Partnerships, Impact and Delivery, C&H PBP

6.3  Members gave consideration to the following papers:

a) Integrated Delivery Plan 22-24 for C&H Place Based System

b) C&H PBP Governance Chart

c) NEL ICB System Planning Cycle 24/25

6.4  SC and AW took Members through the reports. SC explained the situation regarding the Clinical Care and Professional Leadership (CCPL) roles. They had recruited to a refreshed model in March ‘23 after extensive engagement to establish what would work with a small reduction in resources. That was on the basis that these roles would be in place until March ‘25. Now, in the context of a more difficult financial landscape a change was made in July to put these roles in scope for cost savings. Following this they had been asked to find a 30% reduction in Place based roles in clinical leadership. This was a difficult position to be in but reflective of the challenging financial landscape of the NHS. As a Place Based Partnership, having stable CCPL roles had been key to how they maintained the high quality of their care. There had been discussion across the PBP to understand how they might mitigate these reductions, recognising that a lot of their funding is on a non-recurrent basis.

She added that they had agreed at Health and Care Board that afternoon how they would mitigate the cut by identifying some non recurrent monies that could be used for this but this would only apply for one year. The difficulty will be for 25/26 in how to reconcile differences between  what's sustainable in terms of ongoing resources and what else might be available from the ICB. They will examine how they can utilise existing resources in the PBP more effectively and how they prioritise with limited resources. She added that there were obvious risks to further reductions in CCPL roles which they are very mindful of. What had been positive however was that all the stakeholders absolutely recognise the value of CCPL and they are committed to do all they can to retain this level of resource.

6.5  Members asked questions and the following was noted:

a) The Chair asked what a 30% reduction in these posts will look like?

SC explained how they quantify this by using numbers of sessions, with one session being 4 hrs either morning or afternoon and currently they have 35 sessions per week across the PBP. This would go down to 24.5 that’s the equivalent of losing 5 days  ...  view the full minutes text for item 6.

7.1  The Chair stated that it was customary for each Cabinet Member to attend one Cabinet Member Question Time Session each year with their relevant Scrutiny Commission. The purpose was to allow Members to ask questions on areas separate from a review or other key work programme items being considered during that year.

7.2  To make these sessions more manageable they are confined to three agreed topic areas and Cllr Kennedy had been asked to answer questions on these 3 areas:

1.) How is the Neighbourhoods Programme working for Hackney, what have been its successes and what are its challenges?

2) Is the City and Hackney Place Based System working well for Hackney residents and has 'Place' been central enough in the governance of NEL ICB since its inception?

3) What could Hackney Council in particular do to help enact the 5 Missions in the recent Cancer Research UK Manifesto

Cllr Kennedy gave a verbal report and the following was noted:

NEIGHBOURHOODS PROGRAMME

7.3  Cllr K explained that the idea was about care closer to home. It started 5 years ago and City and Hackney is the envy of NEL as we have 8 Neighbourhoods and 8 PCNS that are coterminous. His Cabinet equivalent in Barking and Dagenham had remarked that they were lucky as their PCNs were not linked to their Neighbourhoods. He added that the office of PCNS in City and Hackney had agreed to a merger with GP Confederation as they were so closely aligned already. It had been agreed at the October Health and Care Board. Many others look to our system as role model and 7 are in the top ten in terms of patient satisfaction. The idea therefore is how can you get this level of cooperation into the rest of the health service. The NHS was working on getting community nursing, mental health, occupational health and community pharmacy all much closer to people and working in much closer collaboration in the Neighbourhoods. The Council was also doing this with its 4 Family Hubs which will serve 2 Neighbourhoods each and so be aligned to them. So, the NHS services will function at this level, the HCVS runs Neighbourhood Forums at that level also. Renaisi were also doing an external evaluation of the Neighbourhoods Programme.

7.4  What typified Neighbourhoods were Multi Disciplinary Meetings looking at individual cases and looking at constant attenders with reps from 4 or 5 different teams coming together to discuss one particular individual and  how best they can be supported.

  He described the Neighbourhood Leadership Groups.  He described the Women’s Health Hubs which had been created at GP practices so women can talk to different professionals in one site. He described the work on Proactive Care happening at Neighbourhood level.  They have looked at people with 3 or more conditions and proactively getting in touch with everyone over 65 and looking at their living circumstances and checking their medication. This was proactive as this was the cohort most likely to  ...  view the full minutes text for item 7.

8.1  Members gave consideration to the draft minutes of the previous meeting and the action tracker.

RESOLVED:

That the minutes of the meeting held on 20 December 2023 be agreed as a correct record.

9.1  Members noted the updated work programme

RESOLVED:

That the updated work programme be noted.

10.1   The chair reminded Members of the site visit to Oswald St Day Centre on that Friday.