Agenda and minutes

Apologies for absence were received from Janet Cree, Managing Director, H&F CCG; and Councillor Lucy Richardson, Chair, Health, Inclusion and Social Care Policy and Accountability Committee.

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. 

Councillor Coleman welcomed attendees and went through a roll call of members of the Board.  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 22 July 2020.

(b)   To note the outstanding actions.

A minor correction was noted under Agenda Item 10, page 13, second paragraph which should read “Recovery Curriculum Plan” rather than “Recovery Community Plan”.

Matters Arising

1.          Expansion of Covid-19 testing technology

Toby Hyde confirmed that he had raised this issue with the Director of Pathology.  The laboratory at Charing Cross hospital had capacity to test  1500 samples per day and this was currently operating at 80% capacity. It was anticipated that this would be scaled up to 3000 tests per day by mid-October.  A 17-hour turnaround from receipt in the laboratory to results being provided was sought, and 86% of samples were processed within 24 hours.  It was acknowledged that there had been some difficulties in processing and obtaining re-agents had been an issue, but this was a national problem which was being addressed.

2.          Staff eligibility for testing

Councillor Coleman sought clarification regarding the eligibility for staff with Imperial, given the anticipated increase in capacity.  Toby Hyde confirmed that 80-90% of tests were being used for patients with the remainder being used to test staff.  Approximately 10-20% of tests were potential available to staff. Toby Hyde confirmed that all symptomatic staff at the hospital were eligible for testing and that this included social workers, cleaners, porters and clinicians. Imperial also followed guidance issued by the Royal College of Physicians for clinical specialities who worked with immunocompromised patients to undertake regular testing. 

There was concern that asymptomatic social workers were not eligible.  Lisa Redfern confirmed that she had been in communication with the Programme Director of Integrated Care, responsible for hospital discharge teams.  The issue had been escalated to Julian Redhead, Medical Director at the Trust for resolution.  Toby Hyde clarified that there were two categories of testing: Firstly, any staff who exhibited symptoms would prioritised for testing, including social workers based on hospital sites and working directly with patients.  A second category covered asymptomatic staff who worked with highly vulnerable, immunocompromised patients. Toby Hyde acknowledged the need to expand the roll out of testing to all staff including those who worked in discharge teams and social care, but this was a capacity issue.  The implication was that asymptomatic staff remained active in multiple hospital sites without precautions being taken to protect vulnerable patients.

Given that testing capacity was expected to double, Cllr Coleman reasoned that an additional 10% to 20% of those tests could be potentially available to staff by mid-October.  It was noted that this issue would be further discussed outside the meeting.

3.          Testing in care homes

Dr Lang highlighted concerns following the government suspension of the Department of Health pillar 2 testing portal from mid-July to 7 September 2020.  There had been intermittent or delayed test kits, but these were being delivered again. A formal complaint was initiated by senior officers as each delay in notifying a test result occurred.  The process was being carefully monitored as such delays were unacceptable and further exposed vulnerable groups to risk. Other issues highlighted included courier transport and  ...  view the full minutes text for item 3.

This verbal report will set out the outcome of the vote on the proposed merger of the eight NW London CCGs and next steps.

Dr James Cavanagh provided a verbal update on the NWL Collaborative CCG plans to merge into a single CCG.  The members of the governing bodies had voted in two parts.  In the first part, they were asked to consider whether the CCGs should merge into a single entity.  Seven of the eight CCGs had voted in favour of the merger, West London CCG had dissented.  In the second part, the CCGs were asked if they were happy with the trajectory of the constitution.  Five CCGs (Brent, Ealing, H&F, Hounslow and West London) voted against, and the remaining three (Central, Harrow and Hillingdon) voted in favour.

A meeting was planned with West London CCG to understand the reasons for their dissension, with the intention to try and move eventually to a second vote.  The final constitution had not been agreed and following development a further iteration would go to a formal vote by the membership in December 2020.  Broader engagement with the membership was also planned to identify common areas of concern and disagreement, with the intention to explore what guidance could be provided to change the constitution. The main threats to the constitution not being agreed were outlined by Dr Cavanagh:

1.     GP members sought the appointment of the Local Medical Committee (LMC) as a non-voting member of the single CCG.  The LMC was formally constituted by the NHS and voted for by GPS and represented GPs in formal contractual negotiations. 

2.     Representation and localism.  It was important to listen to members and take this into consideration when constitution was redrafted.

3.     West London CCG they felt that they had managed their funding well and were in a strong financial position.  They were concerned that the significant advances they had made in supporting vulnerable groups would be undermined, and that they would be deprived of local influence.

Dr Cavanagh highlighted some of the benefits that could be achieved through the merger. The ability to commission more services collectively would help to address health inequalities across the north west London area.  Councillor Coleman responded that there had been little assurance that a levelling up to reduce inequalities would not result in poorer services.

Additional issues around governance and not having proper representation at local authority level were also worrying concerns.  Local authorities had sought an increase of up to four representatives on the single CCG.  Dr Cavanagh confirmed that no final decision had been made but concurred that one representative was not enough. However, a balanced approach was required to establish fair and proportionate representation. 

There was consensus that a genuine partnership would require collaboration between health and local authorities, on a level similar to that established in response to Covid but not having fair and democratic representation was a significant concern.

RESOLVED

That the verbal update be noted.

This report sets out details of the council’s action plan, in co-production with residents and other stakeholders, to ensure a collaborative, compassionate and resilient community in H&F, building on the close working between the council, residents, health services and community and voluntary organisations during the Covid-19 pandemic.  

Linda Jackson presented a report to the Board which set out the activity undertaken across health, social care and the community.  There had been dialogue with GPs, Imperial College Healthcare NHS Trust and community providers.  The pandemic had prompted a more strategic approach and recognised that the demand for support was now different reflecting a shift in need.  The aim was to also understand what community engagement meant and what infrastructure would be needed to help build resilient, sustainable communities.

Councillor Coleman commented that this had been an opportunity to identify resident led groups, to understand and capacity build greater resilience within communities.  Giles Piercy commented that volunteers from a range of community groups (H&F CAN, MAGs and the NHS) had worked collectively to provide local support during the pandemic.  The response to Covid had stimulated an incredible opportunity to connect locally. It was confirmed that the planned roll out outlined in the report would be borough wide.  The CCG and HAFSON welcomed the report and offered the support of in progressing the outlined approach and to help channel communications to groups that the council might not be able to reach.

RESOLVED

1.       That an update on the work detailed in the action plan to develop and sustain Compassionate Communities is provided to the 8 February 2021 meeting of Board. Further updates to be determined at each meeting; and                                                    

2.       That the CCG liaise with the Director of Covid-19 Response and Recovery to help progress work on refining and implementing the action plan for Compassionate Communities.

This report sets out the councils work 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", in co-production with residents and stakeholders.

Dr Lang’s report outlined an approach to implement all of the BAME Public Health recommendations in full, making them action orientated rather than focusing on the data.  Within this framework, the aim was to work with what was known such as the links between housing and health, to break down barriers, with a joint council and NHS plan to tackle BAME health inequalities.  Dr Lang thanked colleagues in Housing Services and the NHS for their contribution and support in understanding the full impact of Covid-19 on BAME groups. Dr Lang explained that the working group had begun to work together and that new members had been added from Healthwatch, H&F CCG, CWEE Collaboration of CCGs, Imperial and H&F. The initial approach was to focus on the following recommendations:

Recommendation 2:

To work with the community, GPs and NHS. Dr Mandek Hussain was conducting a large piece of work on Somali perceptions of immunisation with the GP Federation.

Recommendation 5:

Where English was not a first language. This was a major workstream being progressed with the support of adult learning to help improve access to health systems.

Recommendation 6:

Culturally competent communication.  The intention was to work and talk  with communities in ways that make sense to them utilising for example social media such as Instagram, WhatsApp and YouTube.  Work being was also being done on producing videos in Arabic and Somali.

Recommendation 7:

Wider determinants of health (income, the quality of the housing, education and work). Dr Lang reported that they had met with colleagues in Children’s Services and The Economy Department to explore this.  Glendine Shepherd confirmed that housing colleagues were keen to be involved and look at the Housing Allocation Scheme to explore how the allocation process could be more inclusive. The Scheme was not static and evolved continuously with small, refined changes. Although recommendations from the working group could be included, any large or significant changes would be subject to a governance process. 

ACTION: Update on action plan to implement PHE recommendations to be provided to the 8 February 2021 meeting of the Board.  Further updates to be determined at each meeting.

 ACTION: Assistant Director of Housing Management to share a briefing being prepared for the Cabinet Member for Housing, which addresses the housing needs of BAME groups, with the Cabinet Member for Health and Social Care.

RESOLVED

That the report and actions be noted.

This report reviews the impact of  lockdown on young people’s wellbeing and the support available, looking at young people’s experiences and at council services and plans going forward.

Mandy Lawson provided the Board with details of the work undertaken to support H&F children and schools throughout the pandemic and currently.  Work was progressing on the production of a Joint Strategic Needs Assessment (JSNA), with further data to follow. CAMHs (Children and Adolescent Mental Health services) provision had continued throughout the pandemic predominantly based at Glenthorne Road with the exception of some face to face services. CAMHs was a Tier 3 service providing services for children and young people with more severe, complex and persistent disorders delivered across the community. 

The full impact on children’s mental health was yet to materialise and all services would be delivered in response to local need, with some adjustment.  A key priority was to continue with suitable provision that offered comprehensive support teachers and pupils according to local need, reviewed and refined as needed.  Officers would continue to develop a wider response to Covid-19 and to understand and identify any possible gaps working with the CCG. 

Councillor Quigley highlighted the possible impact and exposure to mainstream news and social media about Covid-19 on children and young people.  Mandy Lawson explained that CAMHs Tier 3 continued and that support was in place to ensure that pathways were open and accessible.  Officers were also working with colleagues in The Economy Department to improve their perception and understanding of the impact of Covid-19 on the local economy to ensure that opportunities for young people transitioning to adulthood remained viable. Officers were also exploring options for extending CAMHs provision to the age of 25 to allow for a more planned transition. 

ACTION: An update report to be provided to the Board meeting planned for 21 April 2021.

ACTION: That the Board receives a draft of the Joint Strategic Needs Assessment on the mental health and emotional health and wellbeing of children and young people in H&F (21 April).

ACTION: That Children's Services explore and develop a thematic meeting (April) on mental health, children and young people, with the aim of including contributions from young people (H&F Youth Council).

RESOLVED

That the report and actions be noted.

This report sets out the project being led by Healthwatch – working with residents, GPs and the CCG – to ensure that online consultations do not exclude any residents from accessing a GP, the project to include the development of practice standards and guidance.  

Councillor Coleman welcomed Maisie McKenzie to the meeting.  The report provided an update on Healthwatch Your Voice H&F work about understanding the patient experience of using digital channels to access GP services and the impact of Covid-19. The work had been conducted using Survey Monkey and the community app Next Door developed in partnership with HAFSON, and with members of the Healthwatch Your Voice H&F Executive Committee to ensure that questions were appropriately framed and reflected areas of interest locally. The survey opened on 21 September 2020 and was available until 12 October 2020. Follow up work would include a series of virtual focus groups.

Following a discussion around the ways in which multiple communication (easy read, and in braille, large print) and media channels could be utilised, such as texts and emailed links, Board members offered support to promote the survey within their respective organisations. Healthwatch confirmed that they were working with the CCG to look at communications, for example, text messages and how these were worded.

Toby Hyde said that this was an excellent piece of work and welcomed the opportunity to review the findings of the survey and link this to the work Imperial had undertaken. There were currently multiple platforms being used for video consultations, with differences between primary and secondary care systems.  It would be helpful to understand resident experiences of using different platforms and the possible challenges that this entailed.

ACTION: Board members to support Healthwatch H&F work on the survey by cascading information through their respective organisations, and, utilise their existing databases to maximise engagement and response to the survey where this has been offered and appropriate (CCG, Housing department  and HAFSON).

RESOLVED

That the actions and the report be noted.

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.

The following agenda items were discussed and agreed for inclusion in the Board’s work programme:

• Update on Compassionate Communities at every meeting;
• Dementia and older people, and as part of this discussion, digital access to services and the effect of this on older people;
• Recovery programme work currently being undertaken by H&F CCG and Imperial (joint report); and
• To include the Covid-19 update as a standing item.

The Board is asked to note that the next meeting of the Board will be on Wednesday, 2 December 2020.

Wednesday, 2 December 2020.