Agenda and minutes

Apologies were received from Councillor Larry Culhane and Glendine Shepherd.

The Chair called out a roll call of Board members. There were no declarations of interest.

This meeting is being held remotely via Microsoft Teams. If you would like to ask a question about any of the items on the agenda, either via Teams or in writing, please contact: bathsheba.mall@lbhf.gov.uk

Link: Watch the meeting on YouTube

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 30 September 2020.

(b)   To note the outstanding actions.

RESOLVED

That the minutes of the previous meeting held on 30 September 2020 were agreed as an accurate record.

This verbal report from the Director of Public Health, Director of Covid-19 Response & Recovery NHS Colleagues provides an update about the following areas:

·       Test, trace and isolate – findings, next steps

·       Vaccination – prioritisation and distribution

·       Covid-19 and winter planning – NHS readiness, resident well-being

Linda Jackson and Dr Nicola Lang provided a joint verbal update on the Council’s activities in response to Covid-19.  Linda Jackson outlined the work and impact of the contact tracing programme which had gone very well.  Tracing data provided consisted of those individuals whom NHS contact tracers had been unable to contact.  By comparison, the H&F programme had successfully contacted 99% of this group, achieved by a combination of door knocking and phone calls.  Councillor Coleman observed that the rate nationally for contact tracing was 60% and that of the cohort that the Council had been asked to trace, the rate was even lower at 40%.  It was commented that the lack of impetus at a critical, earlier time would have made a significant difference and that it had been a disastrous government failure to not introduce local contract tracing and other preventative measures sooner.

Members of the Board commended Linda Jackson and her staff, regarding the results as an excellent achievement and a positive example of local expertise and knowledge being applied so successfully, under difficult and challenging circumstances. 

H&F were one of the first London councils to undertake lateral flow testing and had rolled out a targeted testing programme in care homes, with residents and staff, GPs and GP practice staff, with the possibility that this might be further extended to include sheltered housing schemes and in tandem with PCR (polymerase chain reaction) testing, in line with government guidance. The main difference between the two tests was that there was greater likelihood of a false negative with the lateral flow test. This combined approach allowed for testing in care homes.  It was reported that the vaccination programme both locally and nationally was being led by the NHS.  The local CCGs were working to help roll out vaccination programmes in a planned way and the mantra “hands, face, space” was still very much relevant in terms of prevention and awareness of the priority need for infection control.  The Liverpool mass testing programme was currently underway and although a decision had been taken to not adopt the same approach, Linda Jackson confirmed that they had an in depth understanding of local needs and were able to work with the local communities.  High risk, vulnerable groups had been identified and a planned and phased roll out would be undertaken with care homes, followed by primary care networks.  There were also plans to train staff as swabbers.  It was confirmed that the council currently had enough test kits. 

In terms of the flu vaccination, Dr Nicola Lang confirmed that the rate of uptake had not been as high as was hoped and that corrective action to address this was in progress through improved communications utilising social media and that Public Health were engaged in work with local faith communities.  Rates had been poor, but as Lisa Redfern observed, there had been a slight improved during the past two weeks evidenced by a 2% increase in uptake.  The need for closer  ...  view the full minutes text for item 5.

This item presents a verbal report from the Strategic Director of Social Care, supported by NHS colleagues, and will address the following NHS NW London and H&F activities:

·       CCG merger – state of play

·       NHS North West London – current priorities, local authority involvement, report of first ICS Chairs meeting

·       H&F ICP – Update

The Board received a verbal report from Lisa Redfern and Janet Cree regarding national NHS changes and the introduction of integration systems which included the Integrated Care Partnership.  Janet Cree updated the Board on new governance arrangements following consultation with CCG governing bodies and a conditional approval decision to move to a merged, single CCG body covering North West London in November 2020.  Acceptance of an amended constitution was recommended for consideration on 25 November by the eight CCGs and GPs would vote on whether to accept the revised constitution this week, with the results to be notified the following week.  The deadline to submit any outstanding plans was 31 December and was currently on track, subject to the vote.  GPs were expected to undertake a further vote in January on the new governance arrangements and the establishment of a new shadow governing body at the end of February, ahead of the closure of local CCGs in March and with the newly formed single CCG going live in April.

Janet Cree provided outlined the role of an ICS to lead the planning and commissioning of care for their populations providing systems leadership for a collective of NHS providers, commissioners and local authorities working together to improve local health and care provision through an integrated partnership.  The ICS would be a non-decision making, strategic group independently chaired by Penny Dash and all provider organisations would be represented including the London Ambulance Service. There was also local government leadership from Harrow Council Leader Councillor Graham Henson and City of Westminster Council Deputy Leader and Cabinet Member for Adult Social Care and Public Health Councillor Tim Mitchell.  One of the expected outcomes was to have an initial conversation about the strategic priorities for North West London.  The process was about bringing together information which would help to inform and identifying emergent priorities as part of the current NWL evolution.  In terms of next steps broad content at the ICP would need to be agreed and assurance that that there would effective engagement with stakeholders.  The anticipated vision was about improving life expectancy, health outcomes and to establish initial priorities around this such as mental health. 

Janet Cree outlined three key functions: strategic planning, delivery of care and assurance of delivery, and to look at inequality hotspots through gap analysis. The clinical strategy would be evidenced based on interventions and identify models of care suitable for NWL. This would be supported and driven by compliance with governance standards to ensure that the right leadership was in place in each of the organisations.  The intention was to provide the very best, equitable and simple local care consolidated to achieve the best outcomes and ensure that this was also reflected in terms of providing specialist care with an effective use of resources.

Having just chaired her first ICP meeting on 23 November, Lisa Redfern reported that the ICP was an alliance of NHS providers that would work together to deliver care through collaboration rather than competition  ...  view the full minutes text for item 6.

This report details the progress made towards H&F becoming a dementia-friendly borough.

The Board received what would be the first of three presentation about dementia and how the council provided support for residents and visitors to the borough diagnosed with dementia.  Jo Baty outlined that a second meeting would consider a draft strategy and action plan which would co-produced that involved input from the Dementia Action Alliance and the Alzheimer Society before final agreement at a third meeting. 

Stuart Downey outlined how his work in private practice as a solicitor supporting individuals and their families in dealing with mental health and capacity issues and his own personal experience of dementia had afforded him significant insight.  As Chair of the Dementia Action Alliance (DAA) he explained the key aim of the organisation was to encourage Hammersmith and Fulham  to be a dementia friendly society.  The scale of dementia was a huge issue affecting many people personally and professionally and H&F was unique in that it paid for home care provision for residents including those living with dementia.  There was significant statistical evidence to indicate that by 2030 the cost of health and social care within the Borough could amount to £105 million, at twice the expected rate of inflation. The number of residents currently in the borough diagnosed with dementia was 889 and this was expected to increase to 1800. 

An integrated, more holistic and innovative approach with wider community and voluntary support was advocated.  During this summer, a strategic group had been established to bring together representatives from across the borough to actively develop a network of support.  The group had looked for both quantitative and qualitative data to help identify a platform, a direction of travel and gain an understanding of existing providers within the borough, working with organisations such as Sobus.  Identifying existing strategies had not been straight forward and data had been unavailable as information had not been recorded. A different approach to dealing with dementia within the borough was needed to bring together people and services and deliver a more cohesive framework of support services.  A dementia friendly community would be a friendly community.

Kate Sergeant explained that this had been a collaborative process to date and although clinical input was required, much of the support would result from the social care community to address cross-cutting issues.  Dementia was a long-term illness spanning years, a serious diagnosis without a cure or effective medical treatment. A person with a dementia diagnosis was normally sent straight back out into the community to deal with the consequences of their diagnosis with little support. Similarly, for the primary carer of a person with dementia there were significant and challenging and an important part of the strategy would be to ensure support was provided for carers.

Peggy Coles outlined how working with people with dementia inspired workshops at Hammersmith Town Hall in 2016 which provided activities and advice.  Improving a local dementia offer required a dedicated and collaborative vision. She commended the borough for building on its mission to be a  ...  view the full minutes text for item 7.

This report sets out a draft charter of inclusive standards for access to GP digital services.

Councillor Coleman welcomed Healthwatch Your Voice H&F who had been commissioned to conduct a piece of survey work which had helped to inform and help set out a draft charter of inclusive standards to provide guidance to GP practices and the wider NHS shaping access to digital services. Maisie McKenzie emphasised that draft standards were iterative, inclusive and had been co-produced with input from the Healthwatch YV H&F shadow executive committee, the local authority, CCG and HAFSON.  Nisha Devani confirmed that draft standards were derived from the response to the survey questions which also been carefully calibrated to ensure accessible and inclusive engagement.

Councillor Coleman welcomed the draft charter of standards and asked what a GP practice might commit to and adapted for use in hospitals, and what the next steps might be.  Nisha Devani explained that this was the start of the conversation and the intention was to work with GP practices to and that this would be an iterative process.  It was recognised that the NHS was currently in a state of flux with significant changes, but it was essential to engage with clinicians in order to maintain a balanced view.  Following the engagement work with residents it was now important to obtain input from GPs.  Following a question from Merril Hammer it was also clarified that although the draft charter had come out of the survey work, this information would be presented at a separate meeting of the Board. This would include the headline findings from the survey and data from the focus groups.  This would allow an opportunity to understand the core issues for patients which could vary demographically.  Councillor Richardson commented that draft charter needed to be contextualised and simplified, with greater clarity to understand who the charter was for. If aimed at patients then a “less is more” approach was suggested, written in a clear and accessible way.

RESOLVED

1.    That the draft charter of standards would be further refined with input from primary care networks and the GP Federation; and

2.    That the Board would consider a further iteration of the draft charter at a future meeting.

This report considers how the council, NHS and partners can work together to ensure that everyone in the borough has enough to eat and can eat healthily.

Jo McCormick briefly outlined the Food Action Plan (FAP) the key focus of which was on the different projects and programmes that were currently ongoing.  It was clarified that that this would also capture NHS work around the borough.  Pre-Covid there was a focus on health eating and the principle the draft aims for the borough were that no one should go hungry or be malnourished, that everyone can eat healthily and that no one should eat alone unless they chose to.  A further aim that was also being considered was eating without causing harm to the environment.  The Board was invited to endorse the FAP which brought together different strands of work and tracked the various activities.

Vanessa Andreae commented on the frailty work undertaken by consultants at Imperial and it was noted that the need for regular meal support for people was identified through patients presenting with weight loss.  The often-overlooked benefit of frozen of tinned food over fresh food was acknowledged and the Board noted the ongoing work of community groups such as the Smile Brigade which planned to deliver 600 Christmas lunches by e-bike.

Jim Grealy asked if the quality of hospital food could be reviewed at for example Imperial.  Toby Hyde commented that the issue of food was complex and that there was currently work ongoing to look at the provision of cafes on Trust sites and work with local organisations to improve the quality of food for both patients and staff.

Councillor Coleman emphasised that the aims were work in progress and would be subject to further and more nuanced refinement to reframe the aims. A suggestion to amend the wording to: “that everyone in the borough has an opportunity to eat with others” was agreed. 

ACTION: Further reports to be provided to the Board and to be included in the updated work programme.

RESOLVED

1.      That the Board endorsed the development of the Food Action Plan with Board partners and with a slightly amended third aim and that the fourth aim be considered further; and

2.      That the Board continued to steer and monitor the Food Action Plan work.

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.

RESOLVED

That the Board’s work programme be noted.

The Board is asked to note that the dates of the meetings scheduled for the municipal year 2020/21 are as follows:

Monday, 8 February 2021

Wednesday, 21 April 2021

Monday, 8 February 2020.