Agenda and minutes

Apologies for absence were received from Vanessa Andreae, Vice-Chair, H&F CCG; Glendine Shepherd, Assistant Director, Housing Management, LBHF; and Sue Spiller, Chief Executive officer, Sobus. Apologies for lateness were received from Janet Cree, Managing Director of H&F CCG.

There were no declarations of interest.

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on Monday, 9 September 2019.

(b)   To note the outstanding actions.

There were no matters arising.

RESOLVED

1.          That the minutes of the previous meeting held on 9 September 2020 be agreed; and

2.          That the actions be noted.

The Board to receive a joint verbal update from Lisa Redfern, Strategic Director of Social Care (LBHF) and Toby Hyde, Director of Transformation, Imperial College Healthcare NHS Trust.

Lisa Redfern and Toby Hyde provided a joint, verbal overview of a study underway looking at collaborative work between the Council and health partners in response to the Covid-19 pandemic. 

Lisa Redfern said that the study was interviewing key officers from the wider health and social care systems, highlighting successes and identifying lessons learned. The report was likely to look at the following:

1.          The development of testing capacity – Imperial had addressed resource challenges at North West London Pathology through advice and guidance on how testing could be expanded and the use of robotic technology. Residents should receive quicker and improved access to testing, which had been woefully slow nationally.

2.          Testing in care homes – The Council and health partners had put in place quicker and improved testing for residents and staff who had found it difficult to access local testing. Nine specialist teams had worked together on this.  Since early April, residents had been tested four times. Staff recognised the need to deal sensitively with those residents suffering from long-term conditions such as dementia despite working at pace. Testing was implemented that would not have been otherwise available, improving outcomes for residents and staff.

3.          Additional support for care homes – Community-based teams had been strengthened. The NHS and community voluntary organisations had played an important role in strengthening resilience within the community. 

Toby Hyde commended the work of the Council, health partners such as the CCG and local community and voluntary organisations in response to the pandemic.  The interviews were revealing three things:

·       Everyone had been clearly motivated by a collective sense of purpose to overcome the institutional barriers which had frustrated those who been trying for many years to develop integrated ways of working that would benefit residents. 

·       The importance of pre-existing, trusting local relationships, which had enabled a swift and proactive response to the pandemic without the need for a process of checks and balances at every step of the process. Frontline staff had led this work, facilitated and supported collectively by partner organisations. 

·       New ways of working were now firmly embedded. This meeting of the Board being held virtually was an example.  Key to the new working was the removal of historic financial barriers, although some of this might prove transient. There were important lessons about the extent to which financial barriers could be used as an excuse rather than an enabler of change within the local health and care system, particularly considering how finances worked across the system. We needed to adopt a taxpayer mindset rather than think about organisational finances. 

Mark Jarvis echoed earlier comments, particularly with reference to the active involvement of the CCG, many of whose staff had been redeployed and which had worked closely with the Council and care homes, taking a whole systems approach.  Cllr Coleman acknowledged the work of the CCG and mentioned that the Council had offered free car parking for NHS and social workers. 

Cllr Coleman sought clarification regarding financial barriers. Toby Hyde explained  ...  view the full minutes text for item 4.

The Board is invited to consider an update on the work of local community organisations such as H&F CAN.

Linda Jackson explained the Council’s dual approach of supporting local action and working at pace from the very start of the pandemic.  A prime example was the amazing response of the local community - residents, the local workforce and businesses.  This had provided huge support to families and communities.  Another major example was the H&F Community Aid Network (CAN) established by the Council together with two telephone hotlines for shielded and non-shielded residents respectively.  Some 9,000 shielded residents plus many hundreds of others had been supported by over 2,300 residents who had volunteered. 

A dedicated website had received over 18,000 hits, and there had been over 6,000 calls to the helplines.  Adult Social Care had included a “Conversation Matters” element to make daily contact with people who felt socially isolated.  This had supported 148 people. 

Self-organising Mutual Aid Groups (MAGs) of residents had worked to support shielding residents, telephoning people who felt lonely or isolated, and helping with daily shopping and food. The Council had reached out to them and coordinated with them.  The collective and unstinting efforts of local foodbanks, the Smile Brigade and numerous individuals and groups had achieved a huge amount for the benefit of residents. The UNITED in Hammersmith & Fulham charity had helped distribute funds, which had been fast tracked to support people in poverty or those with learning disabilities. This work would be ongoing as people continued to be supported through the expected economic downturn. 

Among future challenges was how primary care networks (PCNs) and GPs continued to support shielded groups. There were evolving plans on learning from the MAGs and increasing community resilience, bringing businesses, residents and the voluntary sector together with the Council and health partners. 

Cllr Patricia Quigley said she had been shielding throughout the pandemic and commended Linda Jackson and her colleagues, expressing her thanks for what the Council had achieved, including its agile and speedy response to requests to provide PPE.  Cllr Quigley was critical of the government’s response, which she felt had placed disabled people at risk. 

Jacolyn Daly, a MAGs administrator, explained how the MAGs had quickly mobilised by ward, using WhatsApp to communicate.  Co-ordinators met frequently, worked well and at pace with the Council, and developed and implemented ideas quickly. The MAGs were highly local, and people appreciated getting help from a neighbour. The process had worked seamlessly especially once they had linked up with H&F CAN, for example by creating a broad network of contacts between the Council, NHS and local pharmacies. 

Jacolyn Daly suggested three aims for the MAGs now: 

·       Sustain what had been achieved so far. Conversations were needed around social prescribing and the importance of longevity in the work, getting different people involved in community activity and taking the pressure off social care teams. 

·       Support people who were about to finish shielding by helping them to venture out again and giving them the confidence and strength to interact with neighbours and go shopping or just for a walk. 

·       Support testing and  ...  view the full minutes text for item 5.

The Board to receive a joint update from Dr Nicola Lang, Acting Director of Public Health, Nicola Ashton, Strategic Commissioner and Peter Smith, Head of Policy and Strategy.

Peter Smith provided an overview of the recommendations in Public Health England’s report, Beyond the Data: Understanding the impact of COVID-19 on BAME groups. The pandemic had exposed shocking inequalities w indicated that BAME groups were disproportionately affected by Covid-19. Work had already begun on developing an action plan to deliver the recommendations in the Borough.  The Council was deeply committed to reducing health inequalities for BAME groups and to achieving concrete outcomes.

Cllr Coleman said that he and Cllr Sue Fennimore had met recently with Somali community leaders, who had talked about their community’s reluctance to engage with the NHS and clinicians. 

Caroline Durack recommended two Community Voice videos of conversations about experiences of Covid-19 on BAME workforce and communities:

·       Voices for Change:  https://youtu.be/HQkq6mZERpU  

·       Communication, Perceptions and (Mis)Information: https://youtu.be/lv6GUgVK6UY

Dr Lang noted that meetings she had had recently with Somali families had confirmed a nervousness about the NHS generally. The intention was to address this through genuine community engagement. 

Janet Cree agreed that organisations such as Community Voices were working to address fear of the NHS and said it was important to link into ongoing work with the NHS around this to ensure fears were not perpetuated. 

Cllr Coleman noted that many reports on issues affecting BAME communities had been produced but few implemented. He suggested that the Board take a “whole system” towards implementing the PHE report in full in H&F. He asked for the Board’s support for Dr Lang to lead a sub-group of the Board to achieve this, working jointly with health partners, residents and BAME groups.

RESOLVED

That in co-production with residents and stakeholders, to develop a joint Council-NHS action plan to tackle BAME health inequalities by implementing in full the recommendations of the Public Health England report, Beyond the Data: Understanding the impact of COVID-19 on BAME groups.

The Board is invited to consider a report from H&F Clinical Commissioning Group which provides an update on Primary Care.

Janet Cree introduced a primary care update. She noted that detailed slides were available.

Mark Jarvis said a “total digital triage model” had been introduced which enabled patients to contact their GPs by telephone or video so they did not need to go into the practice. Face-to-face contact continued as needed and core hours had been maintained during the restricted pandemic period. 

A dedicated escalated care clinic, sometimes referred to as a “hot hub”, had been set up at Brook Green Medical Centre for patients who potentially had Covid-19 but were able to travel safely to the clinic and be seen.  This ran from end April to end June and had now relocated to St Charles Health and Wellbeing Centre. Brook Green had previously provided a traditional weekend plus hub service  and this would eventually resume as far as possible.

The aim was to return primary care to as near a normal service as possible while recognising that continued support would be required for residents who potentially have Covid-19.  Extended access to services had been maintained in addition to weekend plus services. 

Mark Jarvis said routine treatment referrals to secondary care had been paused but in moving to the recovery phase the CCG was considering how secondary care services could be safely resumed and new guidance was being formulated. 

The CCG had worked closely with the Council and colleagues to support shielded residents. It had also supported colleagues with testing and had supported volunteers where possible.  The CCG had put in place significant and enhanced support for four CCG-commissioned care homes, with GPs and a clinical lead providing additional support with guidance through remote monitoring, with a telephone helpline available 8am to 12 midnight, 7 days a week.  A multi-level disciplinary frailty team had been established, involving colleagues from a range of health specialities. Care homes had also been supported with guidance on medication reviews and assistance with prescribing.

Deborah Parkin highlighted the good practice that had occurred, which included some excellent breaking down of organisational barriers. This was attributed to the need to work at pace and the daily meetings with senior Council colleagues.  Staff were to be commended for their considerable work in setting up the hot hubs during the weekend of the lockdown (21-22 March).  This include Information Technology staff, who provided technical advice and support and enabled the “total digital triage model” platforms to be set up in each GP practice.

Janet Cree reiterated that the primary care response to the pandemic had meant that patients had not needed to wait to be seen and that face-to-face consultations had been provided where needed.  There had been an evolution in the service, which was now much more responsive. 

Cllr Coleman welcomed the Council’s strong relationship with the PCNs and GP Federation and long-standing relationship with the CCG.  He said the pandemic had demonstrated clearly that it was necessary for frontline work to be led locally. 

RESOLVED

That the report be noted.

This information report sets out the Hammersmith & Fulham local Outbreak Control plan which was developed in June and contains seven sections that outlines shared best practice with other Local Authorities.

Dr Lang said the government had required local authorities to submit an outbreak control plan by end June.  H&F’s seven-point action plan ranged from community engagement to ensuring that vulnerable people had the right support if required to self-isolate.  Separate plans focused on homeless people and schools. The Council had carried out tabletop exercises with different outbreak scenarios to ensure it could respond effectively.

A recent exercise on special schools had involved colleagues from Environmental Health and Imperial. This had been very welcome and enhanced what was normally a dry learning exercise.  H&F had chosen to expand the exercises to encompass a preventative approach. This required targeted communication and engagement work to ensure the Council was actively listening and health messages were clearly and consistently conveyed.  This would be taken forward by a sub-group of the Health and Wellbeing Board chaired by Cllr Coleman.  Cllr Coleman confirmed the preventative approach and said the first meeting would take place shortly. 

Cllr Coleman asked about the protocols for local data collection and how gaps in test and trace such as incomplete resident contact details from central government could be addressed.  Dr Lang said that this situation was fast moving and as of the previous evening the national position had changed so that the Council was now able to access patient identifiable data which contained a full residential address.  If four cases arose in the same post code area it was possible to establish whether they shared the same household or the same locality. 

Cllr Coleman welcomed the way that Public Health and Imperial had planned to work around the national data gap by developing a local plan for the Council to access complete local data.  Dr Lang said this was because of the strong level of trust between the Council and health colleagues, and the involvement of the Council’s expert Business Intelligence Team. The valuable work on data sharing with Dr Julian Redhead and Dr Axel Heitmüller would continue regardless of national developments.

Across NW London, matters would be monitored and taken forward by a weekly Covid-19 surveillance group chaired by Dr Mohini Parmar (Chair of Ealing CCG).  The group aimed to strengthen links between colleagues as it continued to monitor Covid-19 infection exceedance levels and act as an early warning system.

Cllr Coleman asked what the benefit might be if the UK had a track and trace app as in Ireland, Germany and Gibraltar.  Dr Lang noted that countries such as South Korea and Vietnam which had had great success in containing the virus had a high level of digital literacy and a functioning and effective app in place from the beginning of the pandemic. She said that an app was a helpful addition to manual testing, although not a substitute.

RESOLVED

That the report be noted.

This item is for information on only and provides slides which contains guidance about readmission from hospital of an existing resident for Hammersmith & Fulham care homes.

Dr Lang provided a brief overview of testing on discharge for those continuing to receive community support.  Anyone who was admitted to hospital would be tested, either by a GP or, if a high care package was in place, at the hospital.

Dr Lang noted there was complex and different guidance on readmission and returning to a care home, a completely new admission and admission to e.g. sheltered housing. Lisa Redfern clarified that testing from hospital to care homes in H&F had now been in place for some time.  However, guidance for testing people with complex needs who were being supported in their own home had only recently been implemented, and there was anecdotal evidence to indicate that some people were still not being tested. 

Toby Hyde said the key point was that the Covid-19 status of any patient should be established and that the patient should be managed appropriately. Cllr Coleman said he was aware of at least one such case where the Covid-19 status of a patient with support needs had been unknown. He agreed to forward details to health colleagues. 

Cllr Lucy Richardson enquired about staff who were not part of an individual’s household unit but employed by frail or disabled people through direct payments. Would they have access to testing when these people were discharged from hospital?  Lisa Redfern said that for many weeks from 17 March the Council had held daily telephone calls with providers. Letters were sent to people in receipt of direct payments saying who to contact and how to arrange for testing, and how to get regular deliveries of PPE. 

From the start of the pandemic, the importance of maintaining communication links with approximately 500 people in receipt of direct payments had been clearly understood and information and guidance regularly shared.   To date, the Council had procured approximately 5 million items of PPE at a cost of over £2 million.

RESOLVED

That the report to be noted.

The following items are suggested for the Board’s workplan:

·       COVID impact on young people’s mental health

·       Digital Inclusion - GPs online 

1.        Covid-19’s impact on young people’s mental health

Dr Lang said she had contacted Children’s mental health commissioner Anjana Chakraborty and had also had preliminary discussions with Jan Parnell (LBHF, Assistant Director of Education), Sam Lord (Transitions Consultant) and Carol Cook (Early Years Advisor).  Ongoing work included a borough mapping exercise undertaken by Jan Parnell’s team.  A meeting was also planned for mid-August with the CCG, who currently commissioned “Kooth” (online counselling and support for young people), with a view to taking a more fruitful, collective approach. 

Dr Lang said the intention was to compare what the Council was buying with what the CCG was commissioning. Jacqui McShannon added that they wanted to include the voice of young people. She mentioned the excellent consultation work undertaken with the Youth Council, together with the Compassionate Community recovery plan.  This had included a video which addressed children’s concerns about returning to school together with a huge piece of work on a “compassionate curriculum” as part of the recovery plan.  This could be presented at the next meeting of the Board.

Cllr Coleman mentioned a recent conversation with a young person who co-ordinated a local MAG and who was questioning their value of their schooling, given the virus’s impact on further education and employment.  Jacqui McShannon said their work would focus on young people up to the age of 18 years but that they were also interested in joint commissioning for mental health.  The intention was to work with the CCG and bring to the Board a separate piece of work on joint commissioning for those transitioning into adult services. 

Talking about the specific needs of young people whose mental health may have been affected by Covid-19, Cllr Coleman asked what the Council and health partners could do as large, anchor institutions to promote opportunities such as internships.  Jacqui McShannon was unsure if this could be included within this specific piece of work but agreed that it should be included within joint service planning with partners and possibly as part of the Council’s Industrial Strategy.

Cllr Richardson said the Health, Inclusion and Social Care Policy and Accountability Committee (HISPAC) was currently developing a piece of work on supported employment for young people.  Support from both Dr Lang and Jacqui McShannon would be welcome in bringing this to the September meeting of HISPAC in a way that co-ordinated with the Board’s work.  Cllr Coleman suggested that the employment work be included as part of the report being brought to the Board on the mental health of young people. Jacqui McShannon said The Economy department was leading work on the Industrial Strategy to which Children’s Service was contributing, looking at post 16 opportunities and apprenticeships. The supported employment work was sizable and warranted being a separate piece.

Jacqui McShannon asked how health partners would contribute to the work on understanding the health impact of Covid-19.  Janet Cree said a meeting was planned with Ms McShannon for the following week. Work on the recovery  ...  view the full minutes text for item 10.

Cllr Coleman said the council was working towards becoming a dementia friendly council and had established a dementia action alliance group led local businesses and residents, with a view to developing a dementia strategy. Dementia data sharing was suggested as a future agenda item and Linda Jackson agreed to develop this further with the CCG. 

RESOLVED

That a future agenda item for the Board on dementia data sharing to be developed with the CCG.

The Board is asked to note the date of the next meeting on Wednesday, 30 September 2020.

Wednesday, 30 September 2020.