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

(b)  To note the outstanding actions.

Meeting was inquorate therefore no formal business transacted.

Meeting inquorate therefore no formal business transacted.

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.

Meeting inquorate, therefore no formal business transacted.

Healthwatch Central West London is an independent charity and membership organisation, supporting people who live, work or use health and social care services in Hammersmith & Fulham, Kensington & Chelsea and Westminster. The report provides a summary of its existing work, its progress and findings.

Councillor Vaughan welcomed Helen Mann, Programme Manager, Healthwatch to the meeting.  As with neighbouring boroughs, the intention was that this would be a standing item for future meetings, to ensure that the organisation was able to provide regular input into health issues affecting Hammersmith and Fulham residents.  It was understood that the organisation had gone through a lengthy period of transition and restructuring and that following this, a new Chief Executive had recently started.  A new volunteer co-ordinator had also been appointed and had spent three months getting to know volunteers.  Healthwatch aim to raise awareness of health issues such as the STP, was a primary goal.  It was noted that 94% of people had not attended any public health event and the intention was to actively work jointly with the CCG to address this.  The following key points of the discussion were noted:

• A recent signing posting event had encouraged attendance from across the three boroughs.  It was noted that residents found it difficult to find information on social care provision and navigate the administrative process in order to access that care.  This indicated the level of work still required to improve health advocacy;
• There was no indication as how long Healthwatch would continue to operate under Hestia Housing Support, its parent charity, and they were currently awaiting the outcome of the due diligence submission provided on 12^th April;
• 66 responses had been received in response to a simple survey that Healthwatch had undertaken, with a decision taken to not ask respondents about their views on the STP.  Healthwatch indicated that they would be happy to share this; and
• That better engagement could be facilitated through the removal of language barriers.

This report summarises the work and findings of the JSNA on End of Life Care, including recommendations for key partners.  The report also summarises the local direction of travel for End of Life Care in Hammersmith and Fulham, and continuing progress made against the JSNA recommendations since publication of the report. 

Councillor Vaughan welcomed a number of officers, both commissioners and providers: Colin Brodie, Public Health Knowledge Manager, Public Health, LBHF, Toby Hyde, Head of Strategy, H&F CGG, Matthew Mead, Integrated Care Programme Manager, H&F CCG, Holly Ashforth, Deputy Chief Nurse and Director of Patient Experience, CLCH, Darren Jones, Associate Director of Quality, CLCH, Anthony Clarke, Senior Social Work Practitioner, H&F CCG, Megan Veronesi, Head of Service Development and Communications, Trinity Hospice, Viv Whittingham, Head of Service Care and Assessment, Adult Social and Vanessa Andreae, H&F CCG.

This was a detailed, technical document which summarised the joint work undertaken by the local authority and the CCG on the JSNA on End of Life Care.  It was signed off by the LBHF Health and Wellbeing Board in March 2016 and provided an overview of the provision of end of life care across the three boroughs.  The following key points of the discussion were noted:

• End of life care was not simply care during the last few days or weeks, but could cover a period of months or years, usually following a serious long term condition.  It should cover physical, emotional and social needs, cross cutting across a number of different sectors;
• Paragraph 3.8 of the report set out five key recommendations.  This was primarily about a culture shift of moving on from the provision of palliative care to an open discussion, addressing issues such as individual choice, control and exploring broader options;
• There was a shift in terminology from “end of life” to “last phase of life”, noting that there was now greater likelihood of functional or gradual, decline spanning a number of years;
• A primary recommendation was that each individual received an easily accessible and agreed care plan, that had been consulted upon with friends, family and clinicians;
• CLCH – it was important to support staff to enable them to have difficult conversations about last phase of life care;
• Events were planned throughout “Dying Matters” week, planned for 8-14^th May.  The 2016 event had been well received, however, it was also acknowledged that there needed to be improved communication and information provided about workshops and events;
• There was significant variation across the three boroughs in terms of raising awareness of the issue;
• A key issue was about empowering staff based in for example, sheltered housing accommodation and not just about offering palliative care. It was about how to facilitate a humanitarian and compassionate approach alongside professional care.  This ought to be a shared and informed decision making process, making people feel comfortable and avoiding a fear of retribution culture; 
• Recognising that cognitive decline often pre-empted last phase of life, it was acknowledged that not everyone was able to engage and that there was a need for earlier intervention, with preparation or planning being a prerequisite in much the same way as a funeral plan.  This was not the same as simply having a conversation with your GP;
• The provision of  ...  view the full minutes text for item 130.

This report is provided by Imperial College Healthcare NHS Trust and covers the performance and activity of the Accident & Emergency service during the winter period November 2016 to March 2017.

Councillor Vaughan welcomed Dr William Oldfield, Deputy Medical Director

Claire Braithwaite, Divisional Director of Operations, Medicine and Integrated Care, Mick Fisher, Head of Public Affairs, from Imperial College Healthcare NHS Trust.  The Trust managed a number of A& E services that included emergency departments (ED), urgent care centres (UCC) and specialist emergency centres, located at St Marys and Charing Cross hospitals.  This had been a challenging winter period nationally but a month on month improvement had occurred through the period December 2016 to March 2017, with a new acute service commencing at Charing Cross.  It was noted that a new UCC had become operational at St Marys in April 2016, operated by Vocare.  Dr Oldfield explained that they were remodelling critical care facilities and that they were signs of improved quality of services.  The following key points of the discussion were noted:

• This had been a challenging winter, with target of seeing 95% of patients being seen within fours not being met.  On average, 87% of patients were seen within four-hour, however, there was demonstrable trajectory of improvement from December onwards;
• With reference to figure 5, in paragraph 4.2 of the report, it was noted that during 2017, the position showed much improvement, when compared with Feb-March of the previous year;
• In terms of key challenges, it was recognised that contrary to media reports, most patients presenting at A&E sites need to be there.  There were increasing numbers arriving by ambulance, which also presented significant operational challenges;
• Remodelling of care at St Marys UCC had experienced short terms operational difficulties, with the result that that the streaming services (to either UCC or ED) experienced difficulty with managing extended wait times, delivering consistent streamlining services and maintaining adequate staff levels, particularly overnight;
• There had been significant changes to improve UCC with an extending programme of work to improve resilience targeting not only A&E, but the range of service provision from when a patient first presents to discharge.  Regular weekly meetings now monitored projects and required actions, with scrutiny and support from senior officers;
• The Trust acknowledged that they had not met the required standard but there was improvement;
• Dr Oldfield referred to a funnel affect, with large numbers of patients accessing service through single point.  Remodelling to maximise available space, calculating demand and resources, particularly staff, accordingly would see this become more streamlined.  Emergency medicine was hard, with staff requiring significant experience – taking up to 15 years to train an emergency consultant - in what was a highly pressurised, challenging environment;
• Difficulty in accessing other services could indicate a causal link to increased A&E attendance, particularly with some waiting periods of up to 18 weeks recorded for Referral to Treatment.  Members of the Committee highlighted the point that vulnerable and elderly residents struggle to access GPs and how easy was it for people to access primary care in the community.   Although it was noted that this was outside of the Trusts remit, it  ...  view the full minutes text for item 131.

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

Meeting was inquorate therefore no formal business transacted.

The date of the next meeting will be Tuesday, 13th June 2017.

The dates of meetings for the remainder of the new municipal year are as listed:

Tuesday, 4th July 2017

Tuesday, 12th September 2017

Tuesday, 14th November 2017

Tuesday, 12th December 2017

Tuesday, 30th January 2018

Tuesday, 13th March 2018

Tuesday, 24th April 2018

Tuesday, 13^th June 2017