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.

Victoria Brignell clarified that she was Chair of the Action on Disability and Janet Cree clarified that for consistency, the spend figure quoted under the item on GP Federation and funding was £1.3 million. 

RESOLVED

That subject to the above two points of clarification, the minutes of the meeting held on Tuesday, 30 January 2018, were agreed as an accurate record.

Apologies for absence were received from, Councillors Joe Carlebach, Mercy Umeh and Sharon Holder, and from 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.

None.

This item will consider and discuss the governance arrangements currently being considered by the North-West London Collaboration of Clinical Commissioning Groups Shadow Joint Committee, and its proposed terms of reference. 

Councillor Vaughan welcomed Janet Cree, Managing Director of Hammersmith & Fulham CCG and Dr Tim Spicer, Chair of Hammersmith & Fulham CCG Governing Body.  Janet Cree briefly explained that the eight governing bodies that formed the NW London collaboration of CCGs had approved that a joint committee be set up in January 2018 in shadow form.  The development of governance and logistical arrangements required to support this new structure would be work in progress and it was confirmed that there was no delegated authority at that the time.  The terms of reference for the shadow joint committee had been drafted and published. They would be formally considered by all the governing bodies, with a power for delegated decision making most likely to be in place by the second quarter of 2018/19.

Councillor Ben Coleman expressed concern that the report had not sought two-way dialogue between the governing bodies and interested stakeholders. The shadow joint committee would be working through the issues, and feedback any insights arising from this discussion.  Janet Cree confirmed that this would then go back to each of the governing bodies for further consideration and acknowledged that there may be further amendments made to the terms of reference before being formally approved.  Councillor Coleman pointed out that there had been little clarity on this issue and that it was legitimately open to discussion and scrutiny.  Residents were concerned that local powers would be diluted and result in significant changes to services that were much needed and valued.  He asked what those changes might be and whether they would be subject to scrutiny by eight of scrutiny committees of the NW London boroughs.

Dr Spicer confirmed that there would be changes to the draft terms of reference before formal approval.  He explained that much of the CCG’s work and activities were local, elements of which took place across North West London.  In addition to supporting the on-going work of the Joint Health and Overview Scrutiny Committees (JHOSC), local scrutiny would also continue. There would be no change in terms of accountability and Dr Spicer assured Councillor Coleman that there would be consultation, recognising the importance of strong local involvement with residents.  The local health economy was complex and there was a need for a governance structure to co-ordinate the more complex health provision across Hammersmith & Fulham. This would add to acute service provision activities such as cancer.  It was explained that not all trusts do the more complex cancer treatments and care.  This was not a matter of having more ‘clout’, it was about having access to more specialist care from acute service-providing trusts.

Co-optee, Jim Grealy sought clarification regarding the CCG’s attendance at the Committee and if they represented eight CCGs, or one (Hammersmith & Fulham).  Referring to point 17, Reporting, reference was made to local representation, engagement and public reporting, which were not the same.  He asked the CCG how they would relate to the public in the Borough and address their concerns.  Dr Spicer  ...  view the full minutes text for item 183.

This report relates to the Care Quality Commission’s (CQC) inspection report on Imperial College NHS Trust, published in February 2018. The CQC report recognises improvement in some areas but the overall rating is unchanged at ‘Requires improvement’.

Professor Julian Redhead, Interim Chief Executive and Professor Janice Sigsworth, Director of Nursing, of Imperial College NHS Trust, provided a brief introduction and presentation.  The Care Quality Commission (CQC) had visited in November 2017 to look at specific services. This had been followed in February 2018 by a ‘well led’ inspection survey.  Surgery at Charing Cross remained the same as previously designated in 2014 as ‘requires improvement’. St Mary’s remained as ‘requires improvement’ and leadership also ‘requires improvement’.  While this was disappointing, Professor Redhead said that he was pleased that the CQC recognised areas of good practice, although challenges remained on referral to treatment times (RTT) around elective care.  Other areas to work on specifically included maintenance in operating theatres at Charing Cross and Prof. Redhead was disappointed about the evaluation of the emergency department at Charing Cross, identified as performing 'requires improvement’.  There was considerable pressure on staff but the Trust had plans to ensure improvement.

Councillor Morton referred to the CQC report from 2014 and commented that there had been relatively little improvement in the intervening period and he asked whether the Trust should be looking for causes for the lack of improvement, particularly in case of Charing Cross.  Prof. Sigsworth replied that in May 2017, outpatients had improved significantly.  A second visit from CQC in October 2017 had looked at medical services, where Charing Cross was found to have performed well on stroke services and two services marked as outstanding.  Overall, this was a positive review but Prof. Sigsworth acknowledged that St Mary’s was an issue.

Referencing the various evaluations and their respective movements as to improvement or decline, Councillor Morton observed that it was disappointing that there were basic safety actions that the Trust needed to take, such as maintaining a key to access a locked medicine cabinet.  Prof. Sigsworth acknowledged that the primary focus was patient safety.   A clinician led team which included a doctor, nurse and general manager had been formed and changes implemented since 2014, but Prof. Sigsworth recognised that there was more work to be done.  Prof. Redhead added that the CQC evaluations had been a disappointment to the staff and that the Trust would support them in helping to bring about change.  He provided an assurance that the care provided was of a very high standard. 

Co-optee Jim Grealy commented that safety was not ticked in every box and that this was a concern.  He had observed that there was a repeat occurrence of delays in treatment which was above the national average and that the reason for this needed to be clearly identified.  Prof. Redhead said that there were a range of issues such as loss of staff (ward nurses at Charing Cross) and seven operating theatres not being entirely safe.  All of this meant that there was an enormous job to be undertaken to bring about improvement.  All the Trusts safety indices were good, except for statutory management training and estates. Imperial had the biggest maintenance backlog of any  ...  view the full minutes text for item 184.

This report makes recommendations to improve the experience for

young disabled people transitioning from social care services for

children, to social care services for adults.

Councillor Vaughan welcomed Jo Baty, Mandy Lawson, Steve Miley and Lisa Redfern, who jointly presented the report.  This had been recognised as an important piece of work.  Development of the report had been undertaken some time ago and consideration of the report now presented an opportunity to understand the implementation of its key recommendations. 

Mandy Lawson explained this had been a long journey which represented a significant amount of work marking the end of shared services.  Disaggregation had presented an opportunity to create a new department and establish a sovereign service, with a commitment to co-produce at its core. To date, a disabled children’s manager and support team had been recruited, and was expected to launch on 26 March.  The Special Educational Needs (SEND) team would be brought into the integrated team, with the aim of having one practitioner per child. The approach would be piloting new ways of working, aiming to have a single pathway, replacing the previous multi-pathway method to access Adult Social Care (ASC) provision. 

Lisa Redfern said that the most exciting aspect was to unite ASC and children’s social workers, working jointly to plan care from the age of 14 through to 25 years of age. The aim was to have a fully integrated service and ensure there were no more gaps in service provision for 14-25 year olds in transition.

Steve Miley observed that at the time of the task force, many aspects appeared obvious.  Radical changes were made to reconfigure services within the new department, which reflected officer commitment to do something differently. This represented a significant change where parents and children would experience a seamless service.

Jo Baty emphasised the importance of co-production in the new service, referring to the recommendations of the Disabled People’s Commission (DPC). Tara Flood, who chaired the DPC, continued to work with officers and they had also been assisted by contributions from parents as critical friends.  This had helped officers to evaluate, address mistakes and make changes as necessary.  Hammersmith & Fulham was an exciting borough for children’s work and mainstream schools had expressed an interest in exploring work pathways.

Councillor Coleman commended Councillor Vaughan’s commitment in driving forward the work of the task group, which represented one of the Administration’s key manifesto pledges: that ASC and children’s services work together. He welcomed report which was timely in its alignment with a key recommendation from the DPC to prioritise co-production. 

Co-optee Victoria Brignell referred to page 94, section 11, opportunities for adults with learning disabilities, and asked about the possible timescales, dates, performance measures and next steps.  Mandy Lawson responded that they had just opened a new disabled children’s centre.  Employment had been offered and declined by a young person to work within the new centre, illustrating that further work would be required to improve the low numbers of employed learning disabled in the Borough.  Phase one had focused on ‘Moving On’ and establishing the new service.  Phase two would be piloting new ways of working with ASC social  ...  view the full minutes text for item 185.

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

The current work programme would be rolled forward to the next municipal, subject to confirmation at the next meeting of the Committee.

RESOLVED

That the report be noted. 

Date to be confirmed.

To be confirmed, following the London Council elections, being held on 3 May 2018.