Agenda and minutes

(a)  To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on Monday,12^th September 2016; and

(b)  To note the outstanding actions.

The minutes of the meeting held on 12^th September 2016 were agreed as a correct record. 

Apologies for absence were received from Councillors Hannah Barlow, Sharon Holder and Sue Macmillan and Co-optee Debbie Domb.

If a Councillor 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 Councillor with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter. The Councillor 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 Councillor with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Councillors 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.

Councillors 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 Andrew Brown declared an interest in Items 5 and 6, as Managing Director of Santevis Limited, and provided healthcare consultancy advice to Leidos Health UK.  Councillor Joe Carlebach declared an interest in Items 5 and 6, as an Ambassador for Mind, that his wife was a trustee for Mind and that his niece was employed by Mencap.

This paper presents the annual report of the Director of Public Health 2015-16 for consideration by Health, Adult Social Care and Social Inclusion Policy and Accountability Committee and was previously considered by the Health and Wellbeing Board, at it’s meeting held on 7^th September 2016

The Chair welcomed Cynthia Folarin, Deputy Director of Public Health, RBKCand Colin Brodie, Public Health Knowledge Manager, who jointly presented the Annual Public Health Report, 2015-16, from the Director of Public Health covering the three boroughs.  The report, “Sitting is the new Smoking” was a statutory requirement and focused on three key messages: physical activity is good for mental health; any physical activity was better than none; and everybody active, everyday.  The report focussed on the importance of physical activity, to those segments of the population that are physically inactive. The report particularly contributed to improving the health and well-being of the local population and highlights health inequalities.

Bryan Naylor, Co-optee, expressed concern about the repetitive nature of the report and that it only addressed one part of the overall subject.  He referred briefly to the loss of funding for a variety of activities within the borough, several of which were recommended in the report.  Colin Brodie responded that the intention had been to produce a document with a short, focussed message that would be easily accessible by the public, to highlight the dangers of physical inactivity.  Councillor Vivienne Lukey added that the Director of Public Health had selected this as the theme for the report and was in addition to other, more detailed public health reports focusing on LBHF, which she suggested be circulated to members.   It was accepted that the aim of the report was to provide a brief, clear message but Mr Naylor also asserted that the report failed to convey it’s intended message with sufficient depth. 

Councillor Natalia Perez referred to the increasingly sedentary lifestyle resulting from the amount of time spent using smart technology.  Referring to the activities highlighted in the report such as cycling, walking and swimming she enquired if any of the recommendations had been informed by the provision of subsidised services at a local level, observing that privately-run gyms were expensive.  Colin Brodie affirmed that the recommendations demonstrated a case for longer term investment in activities to save on the possible cost of future healthcare needs.  Opportunities for health benefits resulting from low cost physical activities such as gardening and housework could form part of a daily routine, as set out in the get going campaign, signposting no cost and low cost activities.  Councillor Lukey added that the Council was in the process of refreshing its sports and leisure strategy, in addition to a physical exercise strategy. 

Councillor Lukey also referred to a free event in Normand Park being organised in partnership with Queens Park Rangers Football Club.  It was acknowledged that whilst there might exist an association between the use of smart technology and less physical activity, the evidence to refute this required further analysis.   Colin Brodie continued, observing that activities requiring physical exertion were being filtered out of our daily lives, by for example, multiple car ownership or not walking to school.  It was acknowledged that it was difficult to obtain local empirical evidence to support this link, which  ...  view the full minutes text for item 94.

This report provides a post-acquisition review of the Chelsea and Westminster Hospital NHS Foundation Trust acquisition of West Middlesex University NHS Trust, one year after the formal integration of the two trusts.

Councillor Vaughan welcomed Lesley Watts, Chief Executive, and, Iain Beveridge, Consultant Physician & Gastroenterologist / Associate Medical Director from Chelsea and Westminster Foundation NHS Trust (CWFT) and West Middlesex University Trust (WMUT).  The presentation provided an update, one year after CWFT acquired WMUT, bringing together two acute hospitals, providing care for between 850,000 and 1 million people, with approximately 1000 beds, combined.  With the aim of delivering specialist care to a wider demographic, Lesley Watts explained that they were engaging closely with CCG colleagues to better understand how care could be better integrated.  Part of this involved building the right culture, embedding shared values across both sites.  Both hospitals retained distinct identities, with healthy competition driving good practice.  Staff were highly committed to the integration and commended strong performance to clear governance and leadership.  Lesley Watts reported that targets in A&E wait times, RTT (referral to treatment) and cancer and access outpatient waiting targets, had all been met, with A&E being the best performing unit in London. Another positive was lower than expected mortality rates in both hospitals, against the “required improvement” CQC assessment on both sites, prior to the merger.  There were continuing challenges, such as the patent experience and staff engagement rates which were expected to decline given the change and integration of the past year, and achieving the £3 million surplus required to release sustainability and transformation plan funding, for which they were on target.

Councillor Brown acknowledged that his perception of the merger had changed, and reflected that he was now convinced that this had been the right course of action, with a rare and successful evolution of the two hospitals, setting a highly positive example to other NHS organisations.  In response to a question as to what could be identified as a failing and what the Council could do to assist, Lesley Watts explained finances remained her biggest concern, together with trying to persuade the organisation that maintaining a surplus was a good strategy to encourage greater investment.  She continued that staffing recruitment and the turnover of staff was another issue.  WMUT was very much a local hospital, staffed and served well by its local community, with the average age of staff at WMUT being approximately 47, by contrast, there was a very young workforce at CWFT, where the average age was 27.  Iain Beveridge confirmed that there was a real crisis in maintaining a medical workforce currently and that because of the changes in the previous year, they were behind the curve on recruitment and retention.

Patrick McVeigh sought assurance that following the EU referendum and the UK’s decision to leave the EU, the views of the Trust would be communicated to NHS England.  Lesley Watts responded that they had been asked to articulate information about current staff skill levels.  As an aside, she reported that CWFT and WMUT had dealt robustly with both staff and patients, who had expressed negative or vitriolic comments about overseas NHS  ...  view the full minutes text for item 95.

This report seeks to integrate the work and findings of the Hammersmith and Fulham CAMHS Taskforce with the Hammersmith and Fulham Future in Mind Transformation Plans which have been submitted to NHS England. 

Councillor Vaughan welcomed Angela Caulder, Joint Commissioning Manager, and, Fiona Murray, Transformation Manager, North West London CCGs, who jointly presented the Children and Young People’s Mental Health (CAMHS) ‘Transformation Plan’ Update.  The report brought together the findings of Councillor Alan D’eath’s Child and Adolescent Mental Health Taskforce Report 2016 and the development of the CAMHS transformation plan.  In 2015, the CCGs in collaboration with local authorities, agreed proposals to improve mental health services for young people, which included establishing a community eating disorder service for under 18s, and, to ‘transform’ local mental health services for young people in line with the recommendations made in ‘Future In Mind’.  Angela Caulder highlighted the following three achievements:

·         The H&F schools pilot, a successful bid to become one of fifteen national sites.  This linked ten schools together with CAMHS provision from the West London Mental Health Trust, with two hours per week in school (with a specially trained mental health lead in each school) and several young people seen in school, with a further four schools added to the programme, now extended to March 2017;

·         The eating disorders service, established on 1^st April 2016, in collaboration with Ealing and Hounslow CCGs, as a hub (Ealing) and spoke (LBHF) model.  This was as self-referral service, with cases being seen within four weeks, and, a one week wait for urgent cases and linked to the CAMHS national specifications for eating disorders; and

·         Out of hours’ service, working with 8 CCGs across North West London, involving both Central and North West London Foundation Trust (CNWLFT) and the West London Mental Health Trust (WLMHT), which had received positive feedback, with the pilot being continued.

In terms of next steps, there were several actions required, including the further integration of CAMHS within existing mental health provision, and, for local authority supported, early intervention help in schools and within the wider local community.  Fiona Murray explained that they were working towards developing seamless transition, alignment, and provision with other boroughs, highlighting the mental health referral route and ensuring that the provision is sustainable.   In terms of co-production, it was explained that flexible approach was required and that they were working with Rethink, to develop a strategy for LBHF, WCC and RBKC.  A children and young people conference was planned, to better understand what worked well and what could be improved, highlighting the use of apps and whether these were helpful.

Councillor Perez welcomed the report and commended the encouraging approach undertaken which was notably child-centred.  She sought confirmation about how inpatient beds translated at local level.  Angela Caulder explained that within H&F, children did not spend long in A&E.  Those that did were offered a CAMHS professional and could be discharged without seeing a doctor.  They were looking to increase the number of beds available in 2017/18 and it was noted that whilst there were sufficient beds in London, there was significant take up of them  ...  view the full minutes text for item 96.

The Committee is asked to consider its work programme for the remainder of the municipal year.

Councillor Joe Carlebach requested that the Committee consider the Sheltered Housing Review report, recently considered by the Economic Regeneration Housing and the Arts Policy & Accountability Committee, at their meeting on 6^th September 2016.  It was agreed that a copy of the report be circulated to members for consideration, with a view to taking a decision at the next meeting of the Committee as to whether to include the item on the Agenda for the Committee. 

Referring to Councillor Lukey’s comment about planned work on the sports and leisure strategy, in addition to physical activity, Councillor Vaughan asked that that this be included in the Work Programme.

Councillor Brown requested that an item on increased number of cases of tuberculosis be added to the work programme, considering also a public health strategy for addressing this.  An item on the Disability Commission was also agreed for inclusion. 

RESOLVED

That the Work Programme be noted.

Wednesday, 2^nd November 2016

Monday, 12^th December 2016

Tuesday, 31^st January 2017

Wednesday, 8^th March 2017

Monday, 10^th April 2017

The Committee noted that the date of the next meeting will be Wednesday, 2^nd November 2016.