Agenda and minutes

Health & Wellbeing Board - Wednesday, 30th January, 2019 6.00 pm

Venue: Courtyard Room - Hammersmith Town Hall

Contact: Bathsheba Mall, Committee Co-ordinator 

No. Item


Minutes and Actions pdf icon PDF 143 KB

(a)  To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on 21 November 2018; and


(b)  To note the outstanding actions.


The following matters arising and actions were discussed:


  • Janet Cree to check on the progress of actions attributed to H&F CCG;
  • Lisa Redfern to check on information update regarding s.136 suites;
  • Steve Miley to lead on a joint report from the CCG and Children's Services, to provide a report to the Board on intervention work supporting refugees in the borough. 
  • Martin Calleja to discuss with Councillor Culhane the possibility of a report on Children’s Services to the Board;
  • Martin Calleja to work jointly with the CCG to provide a report on how different CCGs engage with the voluntary sector, share learning and best practice;
  • CCG to provide a report about the social prescribing pilot project undertaken recently, describing what was successful, and exploring what could be possible in future.  To also included data from participating GP practices; and
  • Martin Calleja was currently documenting service provision across the Borough as part of the ICP work, to ensure that GPs were aware, as part of plans to develop “Social Prescribing Light”, which might require fewer resources. Martin to approach the ICP programme manager about presenting this at either March or June HWB; Sue Spiller and Keith Mallinson to liaise with Martin regarding so that information about services provided by the voluntary sector could be included.


Lisa Redfern proposed an amendment to minute no. 159, paragraph 11 be replaced with “Lisa Redfern stated that CCG spend on supported housing represented a severe underinvestment compared to the level of investment in comparator boroughs.”, to clarify the point.




That the proposed amendments were accepted and the minutes agreed as an accurate record.



Apologies for Absence


Apologies for absence were received from Councillors Larry Culhane and Adam Connell; Glendine Shepherd and Dr Tim Spicer, H&F CCG.


Declarations of Interest

If a Member of the Board, or any other member present in the meeting has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.


At meetings where members of the public are allowed to be in attendance and speak, any Member with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter.  The Member must then withdraw immediately from the meeting before the matter is discussed and any vote taken.


Where members of the public are not allowed to be in attendance and speak, then the Member with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Members who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.


Members are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee. 




NHS Long Term Plan pdf icon PDF 76 KB

The NHS Long Term Plan was published on the 7th of January 2019.  This report examines the national plan, which sets out a policy and service development agenda for local NHS services.


Additional documents:


Martin Calleja provided an overview of the recently published NHS Long Term Plan (The Plan), a national document. It was envisaged that the plans would be implemented locally, to provide a world class NHS service that people want through a whole range of priorities. Strengths and weaknesses within the plan were currently being debated, but the formula for funding meant that there would be a challenging decrease in the range of available funding.


There was one reference to HWB boards as a footnote. This, with other potential factors, inferred a review of the role of local authorities in public health.  Local authorities made a significant contribution to supporting public health and that both the NHS, and HWB boards, will need to be more focused on local public health provision, and the impact on the NHS.


The Plan proposed a new mandate for ICSs but there was no assumption that funding for social care would lead to a reduction in acute beds. There was a focus on prevention and tackling inequalities, which had important implications for the Board. Local plans for ISCs would broadly align with The Plan, so it was clear where the changes would take place. The Plan encouraged full engagement with primary care networks, which were a key part of the delivery system for ICSs. It was important to ensure that these were developed effectively and in alignment with the Boroughs primary care strategy. 


It was anticipated that digital accessible services would increase, with a corresponding reduction in the number of physical outpatient appointments.  The size of GP practices would change, covering larger population groups and the number of network contracts that GPs would be expected to sign up to would increase, extending the scope of the primary care model. 


The CCG would submit a formal response to The Plan on behalf of the North-West London collaborative.  The aim was to formulate plans and to engage with the local population, to build upon existing provision.  This would be coproduced and involve the five local healthwatch organisations working across North-West London.  Cllr Coleman and Keith Mallinson queried how this would be achieved.  It was crucial to ensure that throughout the engagement process, patients were given a voice and that progress was achieved in partnership.  It was understood that plans for engagement were currently being formulated.  Resources had also been allocated to develop a four thousand strong, citizens panel for North-West London, to comment on plans.


ACTION: Janet Cree to provide further details as to how the citizens panel would be formulated


Cllr Coleman observed that the eight CCGs that formed the North-West London collaborative could be unified, and become further removed from understanding the needs of residents and local priorities. This presented a significant challenge to democratic accountability.  Learning would be shared on prevention with a London focus, but it was noted that increased investment in primary care would not reduce the need for acute services, as referenced in The Plan.  Councillor Coleman commented that the Council was not  ...  view the full minutes text for item 166.


Primary and urgent care proposals - Pre-consultation business case pdf icon PDF 61 KB

The CCG is under financial pressure and needs to ensure it is using money in the most efficient way.  This report considers the urgent care contracts that are up for renewal and the current demand for services.  The report also discusses whether savings can be made by reducing services when there is little or no usage from residents.

Additional documents:


Janet Cree provided details about primary care and urgent care proposals, pre-consultation business case.  It was confirmed that the term “underutilisation” would be replaced with something more helpful. This was the pre-consultation business case to ensure that the right decisions were being made and to ensure that it was informed.  The next step was to present the business case to the NHS Clinical Senate.


Cllr Coleman asked about the options for change in UCC (urgent care centre) services. Janet Cree responded that there was a case for closing the Hammersmith UCC, between 12pm and 8am, due to low attendance.  Cllr Coleman queried the reduction in GP out of hours appointments, also being considered in the proposals at the same time.  Janet Cree explained that the proposal was to move from the local specification to the national one.  Moving to the national framework would ensure lower levels of underuse and bring the Borough into line with what other CCGs offered.  The national framework was also less costly and could potentially produce savings.  Vanessa Andreae added that that the adjustment was proportional to the list size of each practice, so the larger practices could offer more extended hours.


ACTION: CCG to consider if the potential saving does equate to the 20% reduction in cost


Keith Mallinson reported that Healthwatch had met with the CCG and communications officers to ensure that details of the proposed changes were clearly communicated in plain English.  Healthwatch was keen to work with the CCG to ensure proper public consultation.


Development of the consultation and the shape of the engagement, required some final refinement and would be ready in mid-February.  It would target patients and members of the public and it was acknowledged that not all patients would be residents of LBHF.  The consultation would contact registered patients, and, over night service users from Ealing (low in number), so Ealing councillors will also be consulted.  Patients registered with GP At Hand would also be contacted and since the consultation was available online, this would reduce the costs. 


The Board queried how questions in the consultation would be worded, and how accessible it would be.  There was an awareness that engagement in the consultation was a process of self-selection but placing the information at accessible, public points, such as libraries, would be helpful.  A member of the public commented that this was the first time that they had heard about the hubs and suggested that focused, targeted interventions were needed. Other points of access such as children’s centres and schools, messages in newsletters, council media channels, were also suggested as ways of raising awareness.  Although it was recognised that there was a potential ‘workload’ in most options.


Each of the proposals would have a different, cumulative impact and Councillor Coleman expressed concern about this. The combined effect of changes in all three could not be understated and it was difficult to present the full range of arguments for the changes at the same time.  He asked about the questions  ...  view the full minutes text for item 167.


Isolation and Loneliness pdf icon PDF 492 KB

This report sets out a draft action plan which offers an overall approach

and an initial series of actions aimed at reducing isolation and loneliness

in Hammersmith & Fulham.


Anita Parkin reported on the draft Social Isolation and Loneliness (SIL) Action Plan, which provided an overall approach to addressing SIL, within the framework of the both the Boards and the Councils SIL priorities. Anyone could experience SIL but some groups were more vulnerable, confirming links to deprivation, poverty and homelessness.  Loneliness itself was harder to define or quantify. Any approach should be cost effective and make good use of existing resources. Many service providers and communities were actively trying to address this, bringing communities together. 


In 2018, the Board undertook an exercise that indicated little evidence of the impact. However, this work clearly identified groups such as older men, and new mothers, supporting the view that the experience of SIL was not limited to older people. Most, recent interventions were offered to these two specific groups.  The question to ask was how to identify connections between individuals and groups.  There were real opportunities to involve commercial organisations and businesses.  They had recently met with representatives from the Queens Park Rangers Trust and had discussed potential areas of good work. 


The report covered three key areas: prevent, respond and restore. Section 8.2 of the report set out possible actions and the outcomes that were anticipated. A core steering group would be necessary to maintain impetus, and to help determine and shape delivery of the planned actions and outcomes.  This should be a community led group. It was also important look within our own organisations at for example, staff training.  Within the Council, there were frontline staff who had regular contact with residents.  Both regular and incidental encounters with residents were essential contact opportunities to utilise for the benefit of those experiencing SIL.


Councillor Coleman pointed out that if there was to be improved engagement with residents, then the starting point was from within Boards partner organisations. The Council, for example, needed to ensure its own staff were not SIL.  A third of Council staff lived within the Borough, therefore two thirds travelled long distances to get to work.  There was a need to train and equip staff.  Councillor Coleman encouraged the CCG to engage in dialogue with hospital trusts and GP practices to highlight the approach. It was important to understand how each organisation supported its own staff.


Giles Piercy, from White City Enterprise welcomed the draft action plan.  He expressed an interest in undertaking and supporting small projects, and local initiatives, which could be combined and supported by larger projects, such as White City Enterprise. 


In terms of next steps, a combined, community based approach was necessary to move forward.  There was a recognition that advocating new projects was not the solution, but to build upon previous work, enhancing what was currently working well and developing this further. Social prescribing was not a new method of working, but could address SIL but it was important to develop a template for guidance. 


A collective, partnership approach was required to allow engagement and to initiate projects.  Considering the involvement of local  ...  view the full minutes text for item 168.


Work Programme

The Board’s proposed work programme for the municipal year is set out as Appendix 1 to this report.


The Board is requested to consider the items within the proposed work programme and suggest any amendments or additional topics to be included in the future.




Any Other Business




Dates of Next Meeting

The Board is asked to note that the date of the next meeting scheduled for the municipal year 2018/2019 is Wednesday, 20 March 2019.


The date of the next meeting was noted as 20 March 2019.