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, 13^th November 2018;

(b)  To note the outstanding actions.

The minutes of the previous meeting held on 13^th November 2017, were agreed as an accurate record.

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.

None.

This report presents the findings and recommendations of the Rough Sleeping Commission.

RESOLVED

That the order of business be varied, to take Agenda Item 7 as the first substantive Item.

Fawad Bhatti presented the report, together with Councillor Sue Fennimore, which set out the work of the Rough Sleepers Commission, commissioned and sponsored by the Council, in January 2017.  Its remit was determined by what needed to happen to reduce rough sleeping in LBHF, with the key element being Prevention.  This was an expert led commission and Chaired by Jon Sparkes, Chief Executive of Crises (who unfortunately had been unable to attend due to work commitments). 

The Commission conducted wide ranging review, supported by the policy team at Crisis, gathering both written and verbal evidence from service providers, stakeholders. Peer led research was commissioned, with researchers speaking to 108 rough sleepers.  Of those interviewed, 62% were currently rough sleeping, 23% were living on the streets in the Borough; and the remainder had slept rough in the past year.  Local outreach organisations gathered the views of volunteers who worked with rough sleepers daily.  The period of April 2016 to March 2017 had seen 246 rough sleepers. 61% were new to the streets, 28% were previously seen last year, during 2015/16.  11% were recognised as returnees, and known to the outreach teams. 

Groundswell reported rough sleepers would not be on the streets, had they access to affordable housing or received help with work and to move on.  For many, homelessness was extensive.  Council and third sector staff were viewed as helpful but lacked the specialised expertise required to support rough sleepers with alcohol / drugs advice. 50% experienced difficulties with benefits and national numbers had increased over the past year.  A peer led methodology for research was selected, i.e., those who conducted interviews had themselves experienced homelessness. 46% of those interviewed self-identified as having mental health problems, with 23% experiencing domestic violence, 17% having been in local authority care, 14% formerly in the armed forces and 12% with learning disabilities.

Key findings of the report were that rough sleeping could be significantly reduced in the borough, particularly in terms of outcomes.  Welfare reform was making it hard to resolve the issue but with empowered outreach staff, specialist support could be more readily available.  There were 30 recommendations aimed at the Council and the CCG, local and central government, detailed in the report and grouped into four sections:

1.    Council implements stronger prevention framework across a range of partners and stakeholders

2.    Emergency response

3.    Housing First and housing led approaches

4.    Ensuring access and adequate supply of secure and affordable housing for rough sleepers or people at immediate risk of rough sleeping

In addition to greater collaborative working between the Council and health partners, a long-term approach was needed to ensure secure, affordable and sustainable accommodation. In Manchester for example, they were exploring options for housing first provision in new developments. There were 20 recommendations for the Council, which could not work in isolation.

Cllr Fennimore observed that it was appropriate this issue  ...  view the full minutes text for item 163.

The Committee is invited to note the statement issued on 29 November on behalf of Sir Richard Sykes, Chairman, Imperial College Healthcare NHS Trust, regarding interim chief executive arrangements (Appendix 1).

Councillor Vaughan welcomed Prof. Julian Redhead, Interim CEO, who had replaced Ian Dalton, who had left to take a new post within the NHS.  Prof Redhead explained in more detail the interim arrangements currently in place until a new CEO was appointed, and how this would impact on Trust.  The Trust had a strong succession plan that would not change its direction of travel, so it would be ‘business as usual’. Prof. Redhead had previously worked on the board.  He expected to be in post 6 months, and would continue his role as a practicing clinician.

Bryan Naylor had received information suggesting that recruitment of the departing CEO had been costly and sought further clarification as to possibility that this expense was recoverable.  Prof. Redhead responded that he was unaware of this and that they had followed accepted practice in using a recruitment agency.

Jim Grealy expressed surprise at the short tenure of the previous incumbent, who had offered an ambitious progress.  Enquiring about the status of Charing Cross, he asked if it would remain open as an acute hospital.  If the site was under pressure, he asked why not it could not be designated as an invaluable and sustainable resource in this part of London, to be retained.

Prof. Redhead responded that he would like to continue previous engagement, he explained that he had met with staff, and separately with stakeholders.  The STP plan covered five years and that nothing would be done to put patient safety at risk.

Supporting Jim Grealy’s remarks regarding the future of Charing Cross, Councillor Brown indicated that it had been made clear at public meetings that there had to be no change to the emergency provision at the site.  Prof. Redhead reiterated the comments of Dr William Oldfield and Prof. Tim Orchard, with no changes intended until 2021.  Councillor Brown stated there should be no doubt whatsoever over the future of Charing Cross because of the sheer pressure on it, and, the significantly increasing population in the Borough and West London. 

Councillor Brown commented that he saw Charing Cross as a local community facility, anticipating investment; that the Council could support though either fundraising or help with the discharge of patients, from social care perspectives; help with workforce retention and nurture a more constructive relationship in future, moving forward.  Cllr Carlebach commended staff at the Trust for their work throughout both the Westminster and Grenfell events. 

The Borough was progressing, with radical changes, regeneration, investment, and housing development in Old Oak.  Charing Cross was well placed to serve this increase.  Prof. Redhead concurred that the message was to work together to improve care for patients.

Merril Hammer, Save Our Hospitals (SOH), asked what the criteria and evidence was for downgrading Charing Cross, for it to cease being viable; and commented that it would help the community to have a clearer understanding of the opposing arguments.  Prof.  Redhead confirmed that he would be delighted to continue to meet with SOH but responded that the  ...  view the full minutes text for item 164.

The Committee is invited to review the report on ‘Developing further collaborative working across NW London CCGs’ presented to the Hammersmith and Fulham CCG Governing Body on 26 September and to consider its implications for local democratic accountability.  The report is attached as Appendix 1.

Councillor Vaughan welcomed Vanessa Andreae and Janet Cree to the meeting.  The paper provided an overview of collaboration and governance arrangements, about democratic accountability and how commissioning arrangements will operate across the eight North West London CCGs. 

Janet Cree outlined on the collaborative working.  The paper produced for the Committee was based on a paper submitted to the September meeting of the CCG Governing Body.  The intention was to work better with the other CCGs, to ensure the best healthcare for residents in Hammersmith & Fulham, and remain accountable to the local community.  It was important to note that the Borough boundaries and CCG boundary did not align and that approximately 50,000 H&F residents were registered outside the borough.

The CCG explained that easier and quicker decision making would benefit residents and help improve patient flows and commissioning.  Working on out of hospital services, with GP practices and collaborative with other CCGs would facilitate this.  Decisions being determined by clinicians in the borough across 8 CCGs was difficult so the aim was to create greater efficiencies and avoid duplication. This was an in initial paper to formulate what shape and form the joint committee would take and how decisions would be made.  This would be further developed, to be considered at a governing body meeting in January 2018.   The joint committee will meet in public, rotate in terms of its location in different boroughs; and may also be streamed. 

Councillor Brown sought assurance that different channels of communications and use of technology were seamless across different NHS bodies.  Vanessa Andreae confirmed that they were some way from this.  Consent was needed to allow a patient records to be uploaded but this was increasing. Care plans were prepared but not always communicated or accessible, either as paper copies or digitally.   All practices used SystemOne so that all patients, under community cardiology and respiratory care, had benefitted from improved patient record access during treatment.

Councillor Carlebach commented that the collaborative working arrangement was excellent and encouraging.  He referred to a paper by Dr Ingrid Wolf highlighting significant gaps in the paediatric training of GPs.   In response, Janet Cree reiterated that the paper’s focus was the organisation of CCGs so that level of detail was not provided. One of the aims was to reduce unwarranted variation, and differential offers and provision across North West London.  One of the key drivers was to have common standards and outcomes that could be expected for patients, for example, locally working to ensure training for specialist paediatric GPs, with cascaded training.

Co-optee Patrick McVeigh concurred that the combined CCGs would be better placed to collectively commission more efficiently but sought clarification regarding Accountable Care Partnerships (ACPs) and Accountable Care Organisations (ACOs), in relation to the Health and Social Care Act 2012 funding restrictions.  Janet Cree clarified that ACOs were different organisations which merged to form one entity.  In Hammersmith & Fulham, there was an Accountable Care Partnership, where partners worked together collaboratively.

Councillor Vaughan referred to joint commissioning  ...  view the full minutes text for item 165.

The purpose of this report is to update the council on changes to the community podiatry services Hammersmith & Fulham CCG commission from Central London Community Healthcare Trust (CLCH).

Vanessa Andreae briefly explained that several people had said the service was well structured but acknowledged that there had been dissatisfaction about how the service was running, and issues around eligibility.  It was noted that the service had not provided quality or value for money.  There had been complaints about patients not being seen in a timely fashion and that people with low risk were no longer eligible for the service. 

A member of the public commented that they had not been given information, and struggled to get appointments, without an evaluation as to their risk level and eligibility.  The service had been changed to free up appointments but this had created a two-tier system.

It was explained that the review had been undertaken in October and that there was still a cohort of patients to work through. The CCG expressed disappointment at the decommissioning and were awaiting reports from CLCH.  The CCG confirmed that they further review the podiatry service to see how the changes had progressed and concurred that it was not helpful to be told that the service would improve and it hadn’t.  Councillor David Morton commented that the central line booking system was problematic and that it was better to telephone St Charles direct. 

Bryan Naylor commented that older people had been very disappointed with the podiatry service for a long time.  The service was not working well and required further review.  Vanessa Andreae apologised for the negative experiences resulting from poor service and agreed that there would be further feedback provided to the Committee.

In response to comments from Councillor Coleman regarding the quality and cost of podiatry services and feedback from residents at local engagement events, Vanessa Andreae explained that the CCG had signposted paid for services, pointing out that they could not specifically recommend these.  It was acknowledged that the cost was relative to each individual and was an equalities issue, given the variation in fees.

Councillor Vaughan, in concluding the discussion, commented that there needed to be further engagement on podiatry services and welcomed the CCG’s agreement to return to the Committee with more detailed information, following further discussions with the provider, CLCH.

RESOLVED

That the report be noted.

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

RESOLVED

That the Work Programme be noted.

Tuesday, 30^th January 2018

Tuesday, 13^th March 2018

Tuesday, 24^th April 2018