Agenda and minutes

Apologies for absence were received from Dr Nicola Lang.

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.

There were no declarations of interests.

To approve the minutes of the previous meeting as an accurate record and note any outstanding actions.

It was noted that Phillipa Johnson had not attended the previous meeting and should be removed from the attendance list.

RESOLVED

With the amendment noted above, the minutes of the meeting held on 28 June 2023 were approved as an accurate record.

The Joint Strategic Needs Assessment draws together data and evidence from a range of sources, including the views of parents and professionals working in the field, to describe a picture of need and service provision across Hammersmith & Fulham. The needs assessment has provided the evidence base to inform the Local Area SEND Strategy and is brought to the Health and Wellbeing Board to note.

Peter Haylock (Operational Director for Education and SEND) introduced the item and explained that the Joint Strategic Needs Assessment (JSNA) drew together data and evidence from a range of sources, including the views of parents and professionals working in the field, to describe a picture of need and service provision across Hammersmith & Fulham. The needs assessment provided the evidence base to inform the Local Area Special Educational Needs and Disabilities (SEND) Strategy. The SEND Strategy set out Hammersmith & Fulham’s local area commitment to improve the educational, health and emotional wellbeing and life outcomes for all young people in the borough aged 0-25 years who have SEND while promoting inclusion.

Alison Markwell (Head of SEND Health Partnerships/Senior Designated Clinical Officer) discussed the report and strategy. She noted that it had been developed in partnership and extensively co-produced across the local area with families and groups like Parentsactive. Following public consultation, the strategy was approved at Cabinet in June 2023.

The Chair asked what key issues had been highlighted by the JSNA. Peter Haylock said the percentage of children with complex needs was increasing significantly due to a range of factors including improvements to medical care and diagnosis. Officers noted that factors such as socio-economic status, gender, and ethnicity could have a significant impact on health. Alison Markwell added that effective early identification had also improved. She said there was a better understanding of special educational needs and disabilities now too. She noted that the numbers had been growing for several years, but lockdown had a significant impact.

Sue Spiller asked, in reference to the profile of young people with special educational needs in borough, how confident officers were that they were reaching all children, particularly traditionally excluded communities. Peter Haylock said the JSNA was based on robust data that was extrapolated out to provide an accurate representation of the community.

Sue Spiller asked if support was dependent on parents coming forward. She was concerned that some people may not know how the system worked or what support was available and would be missed in the data. Alison Markwell said a variety of methods were used to ensure families were supported, but acknowledged there was always more to be done when it came to co-production. She noted that Parentsactive were the formal co-production strategic voice of parents, but they also spoke with youth groups, families, schools, and other local groups and organisations.

Councillor Natalia Perez discussed the impact that long waiting times for diagnosis could have on children and families and asked what provision was needed to address those concerns. Alison Markwell said the social communication diagnosis pathway was the biggest issue. She said progress was being made, the Integrated Care Board had recently invested £1.6m in the service and third-party assessments had been commissioned. They were also trying to recruit an additional paediatrician, though there were challenges in the recruitment market. She added that there was a ‘waiting well’ service in place to provide support to families waiting for a diagnosis.  ...  view the full minutes text for item 4.

This item presents the Better Care Fund 2023/25 proposal for the London Borough of Hammersmith & Fulham and the H&F Integrated Care Board.

Linda Jackson (Strategic Director of Independent Living) and Julius Olu (Assistant Director, Commissioning and Partnerships) presented the paper which set out the proposal for the London Borough of Hammersmith & Fulham and the H&F Integrated Care Board (ICB) that would form part of the submission to NHS England following the meeting.

Linda Jackson noted that the Better Care Fund was the only pooled budget that the Council had locally with the NHS and that was managed at a local level. The fund helped services to be set up to get people out of hospital as quickly as possible. The fund paid for a range of contracts, including reablement, home care, and preventing people going into hospital.

Linda Jackson explained that officers were ready to submit proposals in June, but the ICS asked for further information from all eight Local Authorities which pushed submission back to the 4^th of August. Officers worked closely with Sue Roostan (NHS North West London ICB) to put a memorandum of understanding in place to ensure continuation of services.

The Chair addressed the Board and noted that the Council had been working well for years with the local NHS and the sign-off process for the Better Care Fund was usually relatively smooth. However this year, the last-minute requests from the Integrated Care System (ICS) created a huge challenge for Local Authorities.

Linda Jackson agreed it was a major challenge. The ICB requested further information on outcomes. There had been debate at NHS NW London Board level about wanting consistency of outcomes – but the Better Care Fund should be built around local communities and their needs. She felt there was a lack of understanding about what Social Care does and how localities worked together.

There was the idea that we could get efficiencies out of the fund. This led to officers having to respond to questions around outcomes. The driver was from the Finance team at North West London ICS. Officers agreed to answer the questions and do a review next year. Services could not change this year as contracts had already been agreed. We refused to respond to all of the questions as some felt unnecessary. The process seemed to be a way of removing money from system. She thanked Sue Roostan for helping to resolve the situation.

At a recent Partnership Board, Rob Herd, ICS Chief Executive, gave an apology for the way it had happened. He recognised it had damaged trust and confidence. As a result, Alex Dewsnap, Chief Executive of Harrow Council, was putting together a group to look at what Local Authorities wanted from the terms of reference for the Better Care Fund process in future. Councils and the ICS were looking at how to work better together and had produced a ‘ways of working’ agreement document.

The Chair said the situation had exposed a number of issues with the new landscape of Integrated Care Systems. Despite the serious challenges, he hoped it would lead to a better way forward.  ...  view the full minutes text for item 5.

To discuss the Board’s work programme.

Members made the following suggestions for the work programme:

·      Healthwatch survey – Nadia Taylor noted that the Healthwatch cost-of-living survey was live, and the early findings could be shared in October. The Chair asked for it to come to the next meeting.

·      ICS strategy and priorities – Councillor Rowbottom asked for a breakdown of the ICS strategy and spend, and how it aligned with the Board’s priorities and data.

·      Winter pressures - The Chair asked for an item on winter pressures at the next meeting to cover both how the NHS will deal with the usual winter pressures and the additional pressures due to the cost-of-living crisis. Linda Jackson said both the health and social care aspects of the impact of the cost-of-living crisis should be considered.

To note the following dates of future meetings:

·       13 Dec 2023

·       12 Mar 2024

The following dates of future meetings were noted:

·      13 Dec 2024

·      12 Mar 2024