Agenda and minutes

The Chair stated that he had agreed to the inclusion of ‘Under Fives Flu Vaccination Programme in Hammersmith & Fulham’ to the agenda, on the grounds of urgency,  due to the fact that the flu vaccination season was now here and therefore the issue could not wait until the January meeting.

The minutes of the meeting held on 17 November 2014 were approved as an accurate record and signed by the Chair, subject to the addition of the following:

24. Call for Evidence on Engaging Home Care Service Users, Carers and Families

Page 6, third paragraph, add ‘Councillor Chumnery stated that a change of mindset was needed and Mrs Bruce agreed that this was urgent.’

Apologies for lateness were received from Ms Domb.

There were no declarations of interest.

Ms Karikari, stated that the Casserole Club was a community food sharing scheme, which connected people in a local area who were passionate about food and cooking and the community with older people who could not cook for themselves, to share meals on a regular basis. The benefits included: reduced social isolation and loneliness; improved food provision among older people; helping people to stay independent for longer; strengthened connections between generations within communities; and providing a flexible approach for people to volunteer their time and skills locally.

Ms Karikari stated that volunteers were required to complete a criminal records check and food hygiene test. Local recruiters such as Age UK helped to find diners and sign them up. The Casserole team helped to match cooks and diners.

The report which had been tabled, set out the development of the Casserole Club and its achievements. The Casserole Club was not currently live in the three boroughs.

Catherine Pymar stated that Open Age, which had started 21 years ago in Kensington & Chelsea, championed an active life for older people. It worked across the three boroughs to enable anyone aged 50 or older to sustain their physical and mental fitness, maintain an active lifestyle, develop new interests and make new friends.

Open Age had over 4,500 members and provided some 400 weekly activities. There had recently been a grant from Hammersmith & Fulham Council.

Lunch groups were held in Westminster and Kensington & Chelsea, both in restaurants and sheltered housing schemes, with a local delicatessen delivering to groups. A two course meal was provided for £4.50. Open Age was able to subsidise meals up to a value of £8.50, through grants.

Open Age tried to help particularly those people who were isolated and lonely and had issues with public transport. Home visits were made to encourage people to participate in activities and help with public transport was provided. The focus was to get people out of their homes and to build on the community and networks in the local area, thereby reducing isolation. Open Age aimed to  support physical and mental wellbeing, to engage with the local community and to use local businesses.

Pat Bunche, Interim Director of White City Enterprise, a not-for-profit social enterprise, soon to become a registered charity stated that the Enterprise helped the community to take on the delivery of local services for White City and Wormholt.

There was a good opportunity for jointed up work in getting residents into the community. Projects included a support network for local parents called ‘Neighbourhood Mums and Dads’, aimed at young isolated families. The Enterprise was working with Big Local and Hammersmith United Charities to deliver a number of other befriending projects, aimed at vulnerable local people, generally older people. All projects relied on volunteers. An IT mentoring project helped people to get online and there were plans to develop community gardens.

The Community Champions, who supported their neighbours by passing on advice and building awareness, would host the Healthy Winter  ...  view the full minutes text for item 33.

A briefing on flu immunisation for children by Dr Andrew Burnett, Interim Consultant in Public Health Medicine and a report by Lynda Gibbon, Interim Immunisation Manager for London, NHS England (NHSE) had been received.

The Chair had agreed to the addition of this item on the grounds of urgency, because of concerns in respect of the lack of uptake of the vaccination by children under five, the target cohort for 2014/2015 winter season.

The report from NHSE set out the uptake for  children in Hammersmith & Fulham in the cohorts two years, three years and four years to the end of November 2014. Whilst the uptake was slightly higher for children with long term medical conditions than for healthy children, it was still significantly lower than the target to offer the vaccine to 100% of the eligible cohort.

Mr Lines emphasised the importance of this public health prevention initiative. The public health function was split between Public Health England and NHSE, which had commissioned GP providers to offer free flu immunisation to all eligible children and to provide activity data on a weekly basis. Whilst performance was not good, there was also an issue with poor data, partly attributable to the way in which GPs reported and the churn of patients.

It was the responsibility of the commissioned provider (GP practice) to invite parents to attend with their children for vaccination and to continue to invite them if they did not attend. Public Health England had produced a range of information for parents to support their decision making.

Councillor Carlebach stated that he had asked for the item to be included on the agenda as parents had reported to him a lack of clarity over the availability and delivery of the flu vaccination for children under 5 years. He considered the uptake unacceptable and that it put lives at risk, particularly those with long tem medical conditions, who were more vulnerable. He considered that councillors should take ownership of the problem and give a voice to those who were unable to speak for themselves.

Councillor Carlebach stated that he had been told that many GPs had not informed families that the vaccine was available. Nurseries and children’s centres appeared to have little or no information, and similarly school nurses and health visitors. Councillor Carlebach considered that there should be a plan for contacting these groups.

Mrs Bruce stated that NHSE and Public Health England were responsible for commissioning these services. Councillor Brown noted that NHSE had a relatively small number of staff. He considered that the role of NHSE was commissioning, and that in year monitoring was the responsibility of the local authority and that the Public Health budget could be used to get the message into the community, for example whilst school children would be mostly over five, they would often have siblings. The Council website and Twitter feed could also be used to inform people.  Councillor Brown added that preventable health conditions incurred pressure on the  ...  view the full minutes text for item 34.

Ms Paula Murphy, Director Healthwatch, Central West London (CWL) and Sam Wallace, Borough Manager for Hammersmith & Fulham presented the report, which provided an update on the implementation of Healthwatch (CWL); outlined key projects; and invited PAC members to consider the potential for joint working.

Councillor Barlow queried progress in respect of the outstanding concerns in respect of Shaping a Healthier Future (submitted in October 2014). Ms Murphy responded that Healthwatch CWL met monthly with Dr Tracey Batten to inform the patient engagement programme and clinical strategy. In addition, there were monthly meetings with the Chair and Managing Director of the CCG. Healthwatch CWL aimed to ensure that what local residents were saying influenced changes.

Mr Wallace responded to a query regarding mental health and young people in Hammersmith & Fulham that there were concerns in respect of availability and sign posting, and sometimes a lack of understanding of the role of the various organisations. Information was not joined up.  Healthwatch had spoken to young people and visited local CAMHs services and hoped to be involved in the Hammersmith & Fulham multi-agency task group. The project had identified a gap in respect of parental mental health. The report had been presented to the Children’s and Education PAC.

Children had been placed out of the borough as a consequence of a reduction in the  number of in-patient beds. It was hoped to undertake more work, in conjunction with Healthwatch in other areas.

Mr Naylor referred to the importance of the concept of co-production, and Age UK’s experience of meetings but no significant co-production with the CCG. Ms Murphy responded that, in terms of the NHS, there was definitely room for improvement. There was a need to widen communication. Healthwatch would welcome a patient engagement strategy, which included a vision and milestones.

Mrs Bruce responded in respect of placements of young people, that there was a clear policy of not placing young people out of the borough. The figures would be provided to the Committee as part of the report on transition from Children’s to Adult Social Care. Councillor Carlebach commented that it might be parental preference that the best place for a young person was out of borough. It was not possible to provide all facilities within borough.

Members queried the role of Healthwatch in making recommendations on national proposals and how evidence was fed into the recommendations. Ms Murphy responded that there was a statutory requirement for organisations to provide a response to Healthwatch within 20 working days, in a formal manner. The response in respect of Hammersmith Hospital was due by the end of the week.

Healthwatch could submit evidence and make recommendations to the Safeguarding Board, Scrutiny Committees and Health & Wellbeing Boards. Dignity Champions were able to enter and view publicly funded health and care services, and make recommendations about how those services could or should be improved. The report was confidential for 20 days and then made public and shared with the commissioners of the  ...  view the full minutes text for item 35.

Mr Cuthbert presented the proposal to reform Adult Social Care. The report set out the five reasons for such a change.

In spring 2014, the three councils had commissioned an independent review of Operations beginning with focus groups from each borough. The groups were asked to explain their experiences and the reviewers picked four things that mattered most: control, quality coordination and clarity.

The report summarised the issues in respect of the changes in the borough’s population and the Council’s extended legal duties, brought about by the Care Act and the Children and Families Act.

The national policy of care in the community had meant that more complex care currently happened in or near people’s own homes. New initiatives like the Better Care Fund meant that this trend would continue. The Council’s medium-term financial plan showed that the budget for Adult Social Care, currently £64million would be £56million in 2016/2017. There would be a 10% reduction in Operations staff.

The report set out the proposals to reform Operations, with a simple service structure with only two teams, with a clearer role:

(i)      A short-term, integrated Community Independence Service to help people when a problem with their health or a crisis in their life put them at risk of losing their independence,

(ii)    A local service for people whose long-terms needs were mostly stable which helped them manage their support and lead an independent life.

Mr Cuthbert stated that whilst the proposals could be funded through the Better Care Fund in 2015/2016, the funding for the service was uncertain from the second year.

Mrs Bruce stated that the proposed new service enabled savings of £0.5million in 2015/2016 and plans for additional savings of £1.3m for 2016/2017.

Councillor Barlow queried the accountability of the different organisations. Mrs Bruce responded that Adult Social Care Operations would remain a  statutory service of the Council, integrated with health services. The Director of Health & Adult Social Care was the Accountable Officer for discharge of the Council’s statutory duties, unless it was agreed to delegate part of the duties going forward. This model did not delegate. The responsible GP would be held to account by Adult Social Care. The service specification would set out the hours, both in hours and out of hours operation.

Councillor Brown queried whether a unit on the Charing Cross site was still under consideration. Mrs Bruce responded that this model was primarily out of hospital care, whilst the Shaping a Healthier Future proposals were in respect of reconfiguration of acute hospitals. Mrs Bruce had not been briefed in respect of an intermediate facility on the Charing Cross site.

Councillor Lukey stated that a meeting with the CCG had been cancelled and would be re-scheduled, The Council needed to understand the better offer for that site. Councillor Lukey was not aware of the site proposals.

Councillor Holder commented that the proposals looked similar to the Whole System described by the CCG. Councillor Carlebach added that the proposals needed to be locality based,  ...  view the full minutes text for item 37.

The Chair proposed and it was  agreed by the committee, that the guillotine be extended by 5 minutes to 10.05pm.

RESOLVED THAT:

1. Consideration would be given as to how to add an item on the integration of healthcare, social care and public health to the work programme.

2. The Public Health item be brought forward to an earlier meeting.

3. An additional meeting would be required, in view of the number of items on the work programme.

20 January 2015

4 February 2015

13 April 2015