Agenda and minutes

Apologies for absence were received from Carleen Duffy and James Cavanagh.

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.

None.

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on Wednesday, 29June 2022.

(b)   To note the outstanding actions.

Two corrections were reported, the inclusion of Councillor Helen Rowbottom as an attendee and that under officers, Dr Ashlee Mulimba was from Healthy Dialogues Ltd and not Healthy “Diagnostics”:

RESOLVED

That the minutes of the previous meeting held on 29 June 2022 were agreed as a correct record.

Matters arising

Dr Nicola Lang confirmed that the Joint Strategic Needs Assessment (JNSA) information factsheet link had been circulated to Board members with access to a dedicated JNSA for H&F hub. Dr Lang confirmed that in respect of Agenda Item 4, Vaccines, a draft paper on immunisations had been prepared for a future meeting. The development of future item on childhood immunisation and vaccination for older children was also discussed, for inclusion in the agenda for the next meeting, if appropriate.

This report is a joint verbal update by the Director of Public Health and Borough Director, H&F Borough Based Partnership on polio, covid boosters, and monkey pox vaccinations for borough residents, and to also include information about which borough pharmacies offer vaccinations.

Covid and flu vaccination

Dr Lang and Sue Roostan gave a joint presentation beginning with an update as to the current covid rate which was 32 per 100,000.  Sue Roostan outlined details of the NHS autumn booster campaign which launched on 5 September and for which the predominant vaccine was the Moderna bivalent vaccine for adults, followed by Pfizer for the primary course in line with the Joint Council for Vaccination and Immunisation 1-9 categories.  The eligibility criteria prioritised those at clinical risk and their household members. 

The initial roll out of the campaign focused on care home residents and this would be opened to wider groups (over 75+) from 12September.  Booking would be through the national booking system, and it was confirmed that no hubs would be established with vaccine delivery largely delivered through community pharmacies as part of the primary care offer. The Northwest London roving team would be taking referrals to undertake visits to the housebound as a priority.  A lower offer was in place from the Primary Care Network (PCN) and it was reported that some GP practices were keen to co-administer covid and flu vaccines, although the latter might not be available until about October. 

Central London Community Healthcare NHS Trust (CLCH) and homelessness teams were working with PCN sites to consider setting up clinics from hostels and these would be operational shortly. The media campaign had been intentionally low coverage in part because of the current mourning period, however there was likely to be local coverage through GP practices.  Pharmacies were also offering walk in slots.

It was reported that the main vaccine for paediatric groups aged 5 to 11 years and 12 to 17 years would be Pfizer, the latter would be in accordance with the eligibility criteria, but Moderna would be the main vaccine offer.  Touching on the booking system, Sue Roostan confirmed that messaging would steer people to the national booking site and that this would also be promoted through individual GP practices with the recommendation to wait until called.

Councillor Coleman enquired if the roll out would include prisons and referenced Dr Lang’s ground breaking approached which had influenced a change in national policy.  It was recognised that mistrust issues remained, and the council continued to work closely with local community groups such as football clubs to build trust.

Councillor Alex Sanderson asked about whether the AstraZeneca vaccine would be available, and Sue Roostan confirmed that this was unlikely.

Jacqui McShannon asked if children’s care homes and vulnerable children in schools would also be prioritised as part of the roll out.  Sue Roostan explained that these would be included along with care homes, and those who were housebound if they were registered as such with their GP practice or had been referred to the Northwest roving team.  Dr Lang reported that staff at schools such as Jack Tizard, The Haven and Q House were eligible as they provided personal care. There was an anomaly within the NHS as  ...  view the full minutes text for item 4.

This report is a joint verbal update provided by the Strategic Director of Social Care and Co-Chair of the Integrated Care Partnership about how the cost-of-living crisis is expected to affect the health of borough residents and what steps the council and NHS are taking to support residents and lessen the impact.

Councillor Coleman introduced the item which addressed socioeconomic concerns following the emerging cost of living crisis and which was likely to become more severe, impacting on the health and wellbeing of vulnerable communities.  Lisa Redfern explained that this was a timely discussion given the issues around winter pressures and discharge to assess.  Councillor Harvey outlined the work being planned and the progress in providing support for residents who would be experiencing huge financial concerns.  The council hoped to work with advice and faith forums who had reported an increase in the number of people that they were seeing for a range of reasons. The intention was then to work with local businesses and to bring these different organisations together at a public conference.  A final layer of work would be to identify community-based support hubs that could offer warmth or food.

Phillipa Johnson explained that they were engaged in ongoing conversations and activities to support residents and to ensure that the NHS workforce was sighted on this work.  There was an opportunity to educate the workforce and signpost what support was available.  They were looking at population health and identifying the communities that will be greatly affected. They were also working Giles Percy and Dr Chad Hockey to support people in the north of the borough through the winter. Gathering intelligence data from Imperial and CLCH would hopefully underpin the need to protect the NHS workforce, so they were better placed to support residents. It was recognised that these were ideas that were at the development stage, for example, swapping goods, advice, or support for those experiencing hardship. 

It was important to review and ensure that there was a sensible offer in the borough and co-design this in partnership.  Discussing the use of vouchers and payment schemes for heating it was important to be aware of all the support that was available. Lisa Redfern confirmed that good communications messaging was important so that staff were well informed, for example maximising contact with residents.  Councillor Harvey confirmed that the first event would be taking place on 7October and would involve voluntary and community charitable organisations and there would be future events that were planned for November, which would also include the NHS workforce. 

Sue Spiller commented that small voluntary sector groups would struggle to meet the cost of heat, utilities and that this might have a direct impact on clients.  The same applied to smaller or independent businesses.

Councillor Perez enquired about actions to support those who were digitally excluded and what the timing was in terms of collaboration to provide support, recognising that the autumn/winter period would be coming up soon. Councillor Harvey responded that work was in progress, the council maintained a household discretionary fund and a fuel bank was also accessible through the welfare rights team.  Councillor Perez suggested that information was shared with GP practices to better signpost referral pathways more effectively.  Lisa Redfern confirmed that it was crucial to share information about what the council  ...  view the full minutes text for item 5.

This report explains the impact of NHS England cutting funding for the Discharge to Assess programme, which was brought in during Covid to free up hospital beds by funding local authorities to assess patients immediately after their discharge from hospital rather than before.

Councillor Coleman summarised the report which responded to a change in national policy and for government funding for large care packages without assessment.  This meant a return to the previous model of funding care where needs were assessed by social care services.  Councillor Coleman reported that the eight London Boroughs intended to not provide discharge to assess services.

Councillor Rowbottom set out her understanding of both the NHS multidisciplinary teams and social care departments perspectives and described the potential tensions that existed between the need to discharge when it was clinically safe for the patient to be at home, supported by an appropriate care package, and the difficulties of sustaining a patient in clinical hospital care, with risk of increased cost, delays and slow recovery risk to the patient.

A further concern was that carers were being asked to provide clinical support at home that they were not trained to give.  

Lisa Redfern confirmed that the department had reverted their procedures to assessing patients in hospital before discharge and that this arrangement was now in place across North West London.  Sue Roostan responded that there was evidence to indicate that the discharge to assess model had previously worked successfully with assessments carried out in a person’s home.  This had reduced package of care and risk. The key was to ensure that the person got home, and that the assessment was undertaken within the right timescale.  Acute care, where the person required care for more complex conditions and severe needs was a concern.  Sue Spiller sought further data to identify any potential trend patterns to evidence any difference in the discharge to assess model which Lisa Redfern confirmed would be looked for.

ACTION:

Strategic Director of Social Care to contact the Business Intelligence Team, to identify data evidencing any different trend patterns in the discharge to assess model of care; and the Director of Public Health to contact a colleague at Imperial College Healthcare NHS Trust and seek out any academic studies that may focus on this issue

RESOLVED

That the Board will monitor the impact of the assessment in hospital model of care in terms of social care provision and how this affects both residents and social care staff.

This report commissioned by the Director of Public Health was previously circulated to the Board and is provided for formal agreement. It sets out an evaluation of local pharmaceutical services and how this aligns with local population need.

Nicola Ashton outlined the work undertaken and the various stages of the process leading up to the formal agreement of the borough’s pharmaceutical needs assessment.  Some feedback had been received from pharmacies about opening hours and dementia pathway referrals and these were addressed in the final report, with the recommendations presented on page 4 of the report were noted.

In the discussion which followed it was agreed that a future agenda item for the Board would be to discuss the role of community pharmacies in the context of immunisations and vaccinations, dementia and how it might be possible to shape the development of pharmacy work roles.  Sue Roostan reported that the commissioning of community pharmacies, optometry and dentistry services would be returning to borough level control.  In response to a query from Councillor Alex Sanderson, Dr Lang explained that £85k of funding was being made available specifically for children’s dentistry services.  Dr Lang reported that she would shortly be meeting with dentists and CLCH to ensure that dentistry treatment pathways were clearly signposted.  Data had indicated some improvement and Dr Lang was keen to see this continue.

Councillor Harvey enquired if there was a central directory listing NHS dentists who treated children.  Sue Roostan confirmed that there was, and this had been shared with Afghan refugees and was also available on the NHS website.

ACTIONS:

1.       To make accessible details of the children’s dentists on the council website;

2.       For the Director of Public Health to email details of the work with CLCH to Sue Spiller;

3.       To bring children’s dentistry back to a future meeting of the board; and

4.       For Phillipa Johnson to include this area of work within the ICB and Pharmacy Action Plan.

This report from the Head of ACE and School Admissions is presented for information.

The Board is requested to consider the items to be included in the agenda for future meetings.

The Board members noted future items that had been agreed through their discussions of the previous items.

Councillor Coleman reported a governance and constitutional issue with the ICB regarding the poor representation of local authorities on the ICB.  There had previously been an assurance to increase the number of representatives and Councillor Coleman highlighted disparities between the North West London ICB and other ICBs, with only one other ICB in Devon with a similar constitution.  A request had been made to align the NWL ICB constitution with others. The challenge of an ICS was to gain a stronger understanding of how local authorities operate differently to NHS organisations and vice versa.  There was a need to work collaboratively and the absence of a constitution that was representative could not facilitate equitable decision-making or generate a culture of respect between the NHS and local authorities.  Councillor Coleman stated that H&F would not be participating in the ICB until this was amended.

The Board is asked to note that the dates of the meetings scheduled for the municipal year 2022/2023 are as follows:

Tuesday, 13 December 2022

Tuesday, 14 March 2023

Tuesday, 13 December 2022.