Agenda and minutes

Apologies for absence were noted from Dr James Cavanagh, Phillipa Johnson, and Carleen Duffy.

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 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, 21 September 2022; and

(b)   To note the outstanding actions.

Dr Nicola Lang provided an update on matters arising from the Agenda Item 4 of the minutes.  It was explained that cases of diphtheria had been identified amongst migrants that were currently being housed in asylum hotels in the borough. Positive work was ongoing with the hotels to offer diphtheria vaccinations and migrants had been signed up with Brook Green General Practice.

Dr Lang reported on the recent increase in Group A streptococcal infections which was three times higher than in the last recorded peak in 2017-18.  This had been attributed to a number of different theories, for example, a lack of social distancing, low immunity and viral infections.  Dr Lang indicated that this type of infection was rare and that there was a greater prevalence of cases amongst children. Jackie McShannon confirmed that communication and messaging to schools had been effective, a meeting had been held with the borough’s primary school headteachers and a helpline established.  Guidance had been issued to allow greater flexibility to pharmaceutical prescription rules to prescribe tablets if liquid forms were not available.  Sue Roostan emphasised that there was not an issue with supplies and delivery difficulties had been addressed.

Councillor Coleman explored the issue of covid, and flu vaccine take up given that this was now becoming part of “business as usual” work.  Sue Roostan confirmed that take up rates had stabilised, with a mix of people seeking boosters or first vaccination. 

Councillor Coleman requested that the minutes reflect his concerns regarding the latest placement of migrants by the Home Office in the borough without formal notification.  The Home Office had been inefficient in its dealings and Linda Jackson had expressed the borough’s concerns to the Home Office about the level of support asylum seekers received.  A visit by Home Office officials was anticipated soon.

ACTION:

Sue Roostan to look at winter pressures communications to encourage vaccination take rates.

RESOLVED

The minutes of the previous meeting held on Wednesday, 12 September 2023 were agreed as an accurate record.

If you would like to participate by submitting a question please email bathsheba.mall@lbhf.gov.uk by 12pm, 12 December 2022.

No public questions received.

To note the delegated decision to agree the Better Care Fund agreement.

Linda Jackson provided a brief overview of the Better Care Fund (BCF) operational and strategic framework that allowed the NHS and council to establish a shared budget.  The report set out the details of the BCF financial agreement which would support a locally prioritised, integrated health and social care approach aimed at improving rates of hospital discharge and ensuring that support was provided in the community.  Key points included the retendering of the council’s home care service, proactive work with NHS colleagues to develop a more integrated approach which could reduce the reliance on community nursing, and the reprovision of existing services.

Sue Spiller asked if there were opportunities for voluntary and community services (VCS) to get involved in providing preventative support services and how this could be facilitated and delivered as part of the BCF programme.  This raised the question of how early intervention and prevention work could be funded and Linda Jackson indicated that there was scope to further explore this in the future round of funding.  Councillor Coleman highlighted a concern about home care staff being effectively asked to provide clinical support that they were not trained to deliver. It was acknowledged that this was difficult issue however, a program of training for domiciliary care workers would be implemented under the new BCF contract.

Nadia Taylor enquired if there was any indication occupational and physiotherapy staff would be taking strike action. It was confirmed that there was no information to indicate any social care strike action. Rob Hurd reported that operational plans to mitigate in response to planned action had been implemented across the North West London Integrated Care System (NWL ICS). This would ensure that contingencies were in place around service delivery, some of which would be downscaled to support essential core services to minimise the impact.

Councillor Coleman thanked NHS staff for their commitment and work in keeping residents safe. The Board felt discouraged by the government’s reluctance to engage with unions to broker a swift and effective resolution for NHS nurses and to alleviate the significant concerns of residents.

RESOLVED

That the Health and Wellbeing board approved the Better Care Fund agreement 2022/23.

To note receipt of the Discharge Grant from NHS England.

Linda Jackson reported that the Hospital Discharge Fund for 2022/23 was part government funding to support social care discharge announced in July 2022 help support timely and safe hospital discharge and avoid patient delays.  The report (page 55 of the Agenda pack) outlined details of the amount of a two part allocation of £500 million nationally, of which £16 million was allocated to the NWL ICS.  Of the national allocation, £40 million was allocated to social care and had H&F received £765k, and a further £8.6 million was allocated to the Integrated Care Board (ICB).  Plans about the  fund allocation were developed with the support NWL health colleagues.  It would be shared between domiciliary care, reablement services, step down and residential care. At a local level, there would be funding for residential care homes that required improvement and further support to help achieve improved Care Quality Commission ratings.  Detailed figures were contained in the report. 

Linda Jackson highlighted a concern that the programme did not sufficiently address the provision of “step up” preventive work in H&F which contributed significantly towards ensuring that residents did not need to go to hospital.  Sue Roostan elaborated on the operational aspects of the fund reporting that Linda Jackson would be co-ordinating a fortnightly meeting to monitor the delivery and expenditure of the programme.  Rob Hurd commented that there were two key objectives to address immediate needs, but the monitoring and assurance process could develop an evidence base to inform future provision.  Releasing the funds was imperative given that it covered a short period of winter provisioning, and both health and social care partners had signed off on the agreement. Councillor Coleman concurred that it was important to analyse the impact of this work to understand the delivery of future provisioning and that this could be considered further by the Board.

Merril Hammer commented that the issue of funding extended beyond the scope of ensuring sufficient pay for health and social care staff.  It was about retaining and sustaining expertise and knowledge within the staff workforce.  Care staff were able to find more lucrative opportunities in areas such as retail. Lisa Redfern acknowledged that there were significant national difficulties in achieving a fair cost of funding for social care and that this had been widely recognised without resolution. Overall, funding was insufficient to meet increased costs, accentuated by greater acuity of care and complexity of need, with more people leaving hospital that required support at home. This would not be adequately resolved without societal acceptance of the need to fund social care. In addition to the introduction of a Living London Wage (LLW) in H&F, career progressing development initiatives were available to all care staff.

The Board explored the need for a financial resolution that fundamentally addressed the core issues facing councils about how they managed and delivered social care support, both prevention and intervention, to help reduce the need for hospital based treatment. Linda Jackson reiterated that it was important to  ...  view the full minutes text for item 6.

The Board will explore the current governance structures and how the Integrated Care Board works with local borough-based partnerships to achieve excellent health and social care across North West London.

• Introductions by the Chair, Councillor Ben Coleman and Rob Hurd, Chief Executive Officer, Integrated Care System
• Local Delivery and Health Campaigns
• Resident Involvement In Health & Care Partnership, H&F

ICS Overview

Rob Hurd presented an overview of the North West London Integrated Care Board (NWL ICB), which delivered a range of services to a population of 2.1 million across 8 boroughs, within a budget of £4.5 billion.  The ICB recognised that there were significant variations in demography across the area and that this required a whole systems integrated information centre to develop an analytical understanding of population health.

The pandemic had exposed the need for significant work in order to build trusted relationships between health care providers and residents, and to address the inequalities experienced by some population groups in accessing health services.  The ICB budget also held a strategic commissioning role for health care services for the area.  The ICB was required to work in partnership with the eight local authorities in order to develop strategic priorities tailored to evidenced based population health needs. 

Each locality was supported by a borough based partnership, which in Hammersmith and Fulham was the H&F Health and Care Partnership H&F HCP.  The Integrated Care Partnership (ICP) consisted of a membership drawn from the eight local authorities and chaired by Penny Dash.  The ICB co-ordinated and convening of work of health partners to address operational issues by delivering an assurance framework as required by NHS England, which potentially did not align with locally driven perspectives.  Details of the ICB structures and systems links were explored in more detail (page 60 of the Agenda pack).

Merril Hammer sought further information about the proposed relationship between the Integrated Care Partnership and residents and what this would look like, given her concerns about the lack of engagement with residents and how they may not be able to input into service development and delivery.  Rob Hurd explained that engagement was expected to take place through the borough based partnerships to facilitate resident involvement and to value the input of local authorities, strategically facilitated by the ICB. Rob Hurd emphasised that this was the start of a process at a local level and would require a long term approach, and he acknowledged that this could occasionally be influenced by central government initiatives.

Detective Inspector Luxan Thurairatnasingam asked about the ICB perspective on A&E departments and whether these incorporated the whole NHS framework as one structured and accountable system, given changes to the administrative framework of the NHS, particularly in relation to mental health care, and the importance of data sharing and integrated systems.   Rob Hurd explained that a core aspect informing the ICB structure was to achieve a refined, scaled up collective approach, streamlining models of care.  The intention was to address the variations in services across NWL and ensure that provision reflected local population need.

 Acute provision in NWL was collectively delivered by four trusts and the ICB regarded this as one service, comparing and contrasting its constituent parts to identify improvements to the service. A collective approach embedded greater strength and stability in commissioning. The NWL ICS was unique in having clear regulations  ...  view the full minutes text for item 7.

To discuss board’s work programme for 2022/23.

Noted.

Tuesday, 14 March 2023

14 March 2023*</AI9>

*The date of this meeting was subsequently changed to 28 March 2023.

14 March 2023*</AI9>

*The date of this meeting was subsequently changed to 28 March 2023.