Agenda item
Cabinet Member Question Time: Cllr Kennedy (19.55)
Minutes:
5.1 The Chair welcomed Cllr Chris Kennedy (CK), Cabinet Member for Health, Adult Social Care, Voluntary Sector and Culture, adding that this is an annual item where all Cabinet Members are required to attend their relevant Commission. There is no written report but three topic areas are sent to the Cabinet Member in advance so that the discussion can be focused. The three questions are:
Q1) How to protect a local voice for Hackney and to retain a meaningful element of local commissioning, fed by local knowledge, within the ICS
Q2) How to develop and expand Homecare and intermediate solutions (e.g. Housing with Care, step down flats) to reduce the growing need for Care Home places
Q3) How PCNs are working for the community and improving access to primary care
Cllr Kennedy gave a detailed verbal response on the three topic areas and in the questioning the following was noted.
5.2 In a comment on the previous item CK reminded Members that England had lost 4000 EU national GPs post Brexit
5.3 In answer to Q1 Cllr Kennedy explained the NEL and City and Hackney Place Based Structures. There were now just 42 ICSs in the country with 5 in London. The main NEL ICB meets 4 times a year and the ICPB (above it) has about 40 members on it comprising all cabinet members for health, directors of adult and children services etc from the 8 authorities as well as VCS representatives and others. He explained the local end of the ICS is the City and Hackney Health and Care Board which is our local Place Based Partnership. At the main decision making ICB level there is 1 LA rep for inner NEL and it's on a rotating three year basis and the current rep is Mayor Glanville from Hackney. He is also on the important Treasury Sub Cttee of ICB so Hackney has a strong voice. In addition Dr Mark Rickets, our former CCG Chair, is one of two Primary Care reps for all of NEL on the NEL ICB.
5.4 The 4 core priorities of C&H HCB are: Babies, children and young people; Long Term Conditions; mental health; and employment and the workforce. ICB and ICPB are public meetings and papers are available. They do want to move to in-person and they want to encourage public attendance and public questions. Our old CCG got rated outstanding many times and it is very clear, he added, that the extra funding spent then is now reflected in the better outcomes for patients. Our worry is how to protect this level of quality, adding that the argument he makes is to remind people what happens to an acute hospital’s performance when you invest in what happens outside of it in the wider community.
5.5 CK highlighted how the recent statistics on residency of patients presenting at the Emergency Department at the Homerton had shown that the percentage of City and Hackney residents had declined from 75% to 66% due to Homerton’s mutual aid to neighbouring hospitals. His argument would be that you level up and give PCNs across NEL the same level of funding and that will greatly relieve stress in acute departments.
5.6 The Chair asked about what NHS NEL staffing would remain at Place Based Level i.e. in City and Hackney. CK replied that it was still unclear. The structure they had settled on in NEL was different from that in other ICSs. He described how City and Hackney had fought to retain the Director of Integration joint role and that the Place Based Leader be a Trust CE. Others had gone for an MD type role for the whole system.
5.4 The Chair asked if we were advocating that more staff should reside at Place. CK replied that it was yet unclear but they were trying to keep the staff who know about our ‘Place’ adding that our integrated teams have proven very successful e.g. the Integrated Independence Team (on learning disability) and we were pushing to scope out more joint commissioning arrangements at the local level. The Chair explained to Members that the change from commissioning more locally and knowing the local ecosystem and the 41 GP Practices, for example, to one of commissioning from above was key. It was not enough to say that 80% of funds will still come down to Place level if you don’t have people here with the requisite local knowledge. Staff resources were fundamental to ‘Place’ being a meaningful concept, he added. CK commented that the sudden and new Dame Patricia Hewitt report on ICSs for DoH was likely to confirm what a separate IFS study also found which was the admin costs have actually gone up 12% under ICSs, and while there was an argument to be made that this would level out after the initial stage of building up the new regime, it was not a good statistic.
5.5 The Chair asked what scope there would be for local innovation if all commissioning ended up being more centralised. CK replied that it would be where you genuinely do things at Neighbourhood or PCN level such as work on prevention or anticipatory care. The Together Better project between GP surgeries and Volunteer Centre Hackney using volunteers in GP surgeries and running such things as walking clubs or cooking clubs was a great example.
5.6 Members asked about aligning local needs to the objectives of NHS NEL. CK replied that there were two parts to it, firstly being bold enough to be really specific in each neighbourhood, which is what these projects in the Health Inequalities Summit exemplified. Also building further on the Covid Community Champions work would be key. These are now serving as Health Advocates engaged in peer mentoring of parents and people with health conditions. The other aspect of this was that you should be able to afford more local projects because you have availed of economies of scale at higher levels by becoming an ICS. With this you might have to make longer journeys for acute treatments but the things that will keep you healthier longer will be available closer to home, he added.
5.7 Members asked if there was a health emergency re GPs access should be declared in the North East of the borough. CK replied that without having a lot more information in front of him he would not advocate doing this and he would need to see much more detail on the help that is available to the surgeries which are currently struggling. He said it was good that they had admitted they were challenged and that there was some comfort that there is a Resilience and Sustainability Fund in place to provide initial support. He added that he understood Members’ concerns and that the variations in performance in the NE needed closer attention.
5.8 Members asked how to improve messaging in diverse communities. CK replied that one of the best approaches was the Community Champions who are living proof that lifestyle change can lead to health improvements. People will always copy actions from those they trust and admire and therefore Peer Mentoring absolutely works.
5.9 Members asked what was the formula to allocate resources to Place Based Systems. CK replied that the full details on exactly what funding is available and how it will be distributed but that for example the first funding from the government’s Hospital Discharge Fund (previously called ‘winter pressures’) was out and City and Hackney had received £2m. Half of that is distributed on an age based formula and the full breakdown of that is in the papers which went to the 9 Jan Health and Care Board. The Chair added that the recent INEL JHOSC papers detailed that outer NEL boroughs with older populations were receiving extra top up support over more demographically deprived but younger-aged boroughs.
5.10 Members asked what more could we have done to retain the doctors lost due to Brexit. CK replied that leaving the EU was the reason for this exodus and a total lack of confidence about their security and freedom of movement to move back and forth and visit families was the main cause for the doctors’ departure. A significant number felt they had been left with no choice but to go back to their home countries and this was a great loss to our health system.
5.11 CK responded in detail to Q2 ‘How to develop and expand Homecare and intermediate care solutions to reduce need for care home places’. He stated that this question mirrored the Manifesto Pledge 193. The point here is that it is not a binary home vs care home decision. Currently 1250 people receive Homecare with 210 in Housing with Care schemes and then 550 residents are placed in Residential Care Homes and two thirds of these have to be placed out of the borough. Most people do not want to end up in residential care, he added, and it was vital therefore to reduce the numbers and provide better and earlier alternatives. For this reason the Council was recommissioning Homecare services later this year. He added that although Housing with Care had been insourced, the Council does not own the 14 buildings involved which are split between four RSLs. The Council therefore is looking at better and more innovative solutions and working closely with RSLs.
5.12 CK added that there was a need to ask some difficult questions here and to interrogate, for example, our house building programme and the pledges we have made as a council to build 1000 new social homes. We need to ask where is the Supported Living in this mix? He stated that this was an area where officers were probably ahead of members on the need for an innovative approach and suggested the Scrutiny could perhaps do some further work on this. He cautioned that none of this would happen quickly however but we can improve the data we collect and do the appropriate modelling and future projections of need to help us win the argument. He added that there was greater scope for better use of assistive technology in homes to save work or the number of care visits. There was a need to look at the potential of new technology, used appropriately, and to embrace it. There was also a need to look more at cooperative models of working. He illustrated how some people are able to recover some of their mobility and hence some of their independence and we need to look closely at those in Housing with Care for example and continually reassess and support.
5.12 CK responded on Q3 ‘How PCNs are working for the community and improving access to primary care’. The key to this he stated was the Additional Roles Reimbursement Scheme (ARRS) in GP Practices. This encompasses such roles as pharmacists, social prescribers etc. as well as helping the Neighbourhoods to develop further. The use of multi-disciplinary teams meeting on individual cases and work on anticipatory care is key. It is important too to constantly challenge health inequalities. He shared with Members the C&H ‘Health Inequalities Summit - Case Studies Brochure’ from 11 Jan 2022. That detailed an incredibly impressive range of local joint working and most of these came out of PCNs. He described some of them such as: ‘Uncontrolled Blood Pressure in Black People’ the ‘Together Better’ programme (referred to earlier) expanding to 16 GP surgeries; ‘Nutrition management in Sickle Cell disease in Shoreditch Park and the City’; ‘Improving Immunisation at Springfield PCN’. They all produced better outcomes for a relatively small spend and were contributing to the successes illustrated by the data in the previous item on GP Access.
5.13 Cllr Adams sought reassurance that the concerns he had raised would be acted upon. CK replied that he understood the frustration but that he was confident that Dr Brown and RB would act on the points raised. He also described the commitment to support Healthwatch’s ‘Patient Voice’ work and welcomed SBs comments that the data on patient satisfaction levels on GP phone systems and GP access was on an upward trajectory, overall. He concluded that we will always want performance to get better and will continually look at those at the bottom of performance tables as well as those on top.
5.14 Members asked about plans to deal with increased dementia in the population. CK replied that a robust Dementia Strategy for the borough was in place which needed to be built upon. Looking to the future there was a need to rethink housing provision models and not just accept that all HRA funded building should go to straightforward residential homes. The Chair asked if there were examples in the UK of future proofing some housing with care options in new builds as part of any new HRA stock. CK replied there was and there was the potential to build much more variety into stock but there was a need to be bolder about this.
5.15 The Chair thanked Cllr Kennedy for his attendance and his insightful and helpful responses. He stated that he would explore inviting the Group Directors for Finance and Corporate Resources and for Adults Health and Integration to a future item to explore this housing aspect further because there must be an ‘invest to save’ element here as it would generate significant savings on residential care placements in the future. He added that the Commission would take forward the following:
Future proofing the house building/home regeneration programmes by building in a greater variety of housing stock in order to accommodate growing demand for adult social care/housing with care type support
GP Access challenges specifically in the NE of the borough
How will the future roles of the GP Confederation and PCNs align
5.16 The Chair stated that Cllr Binnie-Lubbock was unable to attend but had submitted a Question to Cllr Kennedy on whether there is a target based plan to reduce or cease commissioning health and social care from any providers still using zero hours contracts? CK responded that this would require a more detailed response than could be given at the meeting and undertook to provide a written answer.
ACTION:
Additions to the work programme:
Future proofing the house building/home regeneration programmes by building in a greater variety of housing stock in order to accommodate growing demand for adult social care/housing with care type support
GP Access challenges specifically in the NE of the borough
How will the future roles of the GP Confederation and PCNs align
RESOLVED:
That the discussion be noted.
Supporting documents:
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