Agenda and minutes

The minutes of the meeting held on 10 November 2014 were approved as an accurate record of the meeting and signed by the Chair.

Apologies were received  from Dr Tim Spicer and Trish Pashley.

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. 

There were no declarations of interest.

Rod Cullen, Area Manager for Hammersmith & Fulham explained that the St. Mungo’s Broadway campaign ‘A Future Now – Homeless Health Matters’ aimed to raise awareness of the impact that homelessness had on health, and the difficulties that homeless people faced in accessing healthcare.

The campaign asked HWBs to sign the ‘Charter for Homeless Health’, committing to:

·         Identify need: include single homelessness in their Joint Strategic Needs Assessment (JSNA)

·         Provide leadership to improve homeless health

·         Commission for inclusion to ensure that people who are homeless can easily access the health related services they need.

Dr McGoldrick stated that there had been a number of projects towards homeless health, including community provision. It was more difficult to access acute services, if for example homeless people had nowhere to pick up an appointment letter.

Councillor Lukey queried whether homeless people tended to go A&E. Mrs Bruce responded that there were dedicated GP practices and multi-agency teams. H&F had looked at other models across the country and aimed to do better. The discharge of people with mental health problems back on to the street was a particular problem.

Councillor Lukey offered to share with St. Mungo’s the JSNA on rough sleepers, written in February 2013.

RESOLVED THAT:

The HWB agreed to sign the St. Mungo’s charter.

Mrs Bruce introduced the report, which updated on progress in relation to the implementation of the Care Act in Hammersmith & Fulham. The report set out the phase 1 key deliverables for compliance by 31 March 2015. There were a number of work streams and these were on track to implement the deliverables. The report set out what had been involved in the work.

Mrs Bruce highlighted ‘Eligibility and the new National Minimum Threshold’ as an issue for both Hammersmith & Fulham and Kensington & Chelsea. The current national minimum eligibility criteria were based on the existing FACS criteria for ‘Critical’ and ‘Substantial’ needs. Hammersmith & Fulham currently provided a service to those with ‘Upper Moderate’ needs and Kensington & Chelsea to those with ‘Moderate Needs’. Legal advice would be sought in respect of local discretion.

A number of duties within the Care Act were likely to have financial impacts for the Council. Initial financial modelling indicated an increase in the cost of care; increased demand for needs assessments; and rising demand for deferred payments.

Mr Christie noted that the transition from children and young people services to adult services could also have implications for NHS commissioners. However, the duties in the Act to integrate with health services were not distinctly different from current practice.

Councillor Vaughan noted that transition from children and young people services to adult services was on the work programme for the Health, Adult Social Care & Social Inclusion PAC, and that it was hoped to set up a task group.

Mrs Bruce noted that, in addition to the Care Act, Better Care Fund work would be taken into account in determining how many staff were required and at what point in the Customer Journey.

The Board noted the report.

The Board received an update on progress with development of the Better Care Fund (BCF).

Councillor Vaughan asked for clarification in respect of hospital discharges and how they could impact on A&E waiting times. Mrs Bruce responded that work was in progress locally to develop a new integrated Community Independence Service (CIS), which would help people with good care at home when they might otherwise need to be in hospital. CIP would reach into hospitals to pro-actively discharge people. CIP had been developed in the BCF and was integral to the aims of Whole Systems Integrated Care (WSIC). It would be rolled out in the three boroughs.

There had been an upsurge in winter pressures over the previous six weeks, and additional money there had been additional money to support delayed discharges. Work was also in hand to standardise discharge protocols and policies across the three boroughs.

Dr McGoldrick added that it might be necessary to use interim residential care or intermediate beds to prevent delayed discharges. Funding had been allocated at the beginning of the year and CIP was also contributing. 

Ms Jones stated that NW London had invested significantly in intermediate beds. Many patients were in their late 90s and 100s and likely to have complex health and social care needs. Whilst A&E attendances were fairly stable, the length of stay had increased for non-elective patients. The CCG had been expanding transitional care facilities for these patients for sometime. Intermediate beds were provided at CLCH sites and Imperial, and also out of borough if necessary. Hammersmith beds could be offered to other boroughs, if there was spare capacity.

Mrs Bruce stated that there was a correlation between GP availability and elderly patients going to A&E. Providers were struggling with the complexity of needs and a lack of nursing bed provision. For example, there people in their 100s with dementia, who social workers had only met for the first time when admitted to hospital. Increasing demand and complexity had reduced beds and increased the need for joined up health and social care.

Dr McGoldrick noted that A&E was the place of choice for some people. H&F CCG had invested in GP practices evening and Saturday opening, out of hour’s services and the 111 service. There was good access to GPs and hospital appointments could be booked on the same day.

Dr McGoldrick suggested that the CCG and Council could work together to, for example, advertise seven day services. There tended to be an increase in A&E services between 4pm and 7pm by younger parents with children.

Ms Jones stated that A&E attendances were being analysed, but there was not one answer for the surge in attendance.

Mr Lines suggested that community pharmacies should be used as a point of access and signposting.

Mr Christie stated that there was a high churn of 25-35 year olds in the borough and information could be provided to estate agents, and also to schools and the  ...  view the full minutes text for item 47.

Mike Howard, Chair of the Safeguarding Adults Executive Board (SAEB) presented the report on a joint-working relationship between the HWB and the SAEB, including agreeing a protocol to describe this relationship and identifying any areas where joint-working might be beneficial to improve health and wellbeing outcomes for residents.

The report set out some themes that the SAEB considered required a joint response: safer recruitment; commissioning care for older people with complex care needs; and  understanding and resourcing shared responsibilities for the Deprivation of Liberty Safeguards.

The report appended a protocol setting out governance arrangements between the HWB and SAEB.

Mrs Bruce considered that the change of the SAEB to a statutory board from 1 April 2015 was welcome and overdue.  

Mr Christie suggested an annual report in respect of SAEB’s work, work programme for future years and issues.

Councillor Vaughan queried how it was intended to ensure that safeguarding was ‘everyone’s business’ and  suggested the inclusion of  examples of how safeguarding works, together with success stories.

A SAEB sub-group could focus on community engagement and making safeguarding accessible to the public, and making sure that the message was understood and spread widely. Other bodies needed to be aware of their responsibilities.

RESOLVED THAT:

The HWB endorsed the draft protocol for working with the SAEB and the three proposed areas for joint working.

The work programme was received.

23 March 2015