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, 2 July 2018.

(b)  To note the outstanding actions.

The minutes were agreed as an accurate record, subject to a spelling correction, under minute 191, Declarations of Interest, which should be “Lygon” Almshouse. It was also noted that Councillor Lloyd-Harris’ question about social housing and wheelchair adaptations had received a detailed response and had not been recorded in detail.

Apologies for absence were received from 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 Mercy Umeh declared an interest in respect of Agenda Item 4.

It was noted that Healthwatch’s Annual General Meeting unfortunately coincided with the date of the PAC meeting, an update will be provided at the next meeting in December.

This report was commissioned in response to HISPAC discussions regarding national and local concerns about NHS workforce recruitment and retention.  It sets out Imperials approach, metrics and policies across all key sites and offers some insight into how they support and engage with staff.

AND (combined)

This report to the Health, Inclusion and Social Care Policy and Accountability Committee from Chelsea & Westminster Hospital NHS Foundation Trust (the Trust) provides a position update. The report includes current Trust and London benchmarking performance reporting and an indication of action and interventions planned for further support.

A presentation was given by Professor Tim Orchard and Professor Janice Sigsworth.  Professor Orchard acknowledged that recruitment and retention of staff had been a primary focus for a significant period. Imperial was a large organisation with over 7500 staff working across several sites, responsible for delivering high quality care.  Imperial was ranked in the top three Trusts nationally with one of the lowest mortality rates in the UK, and had worked hard at staff engagement across a large workforce.  Staff engagement was a challenge and the organisation had struggled with some key issues, particularly how senior staff were seen.  Measures to address this included rotating meetings and increased frequency of ward visits.  Professor Orchard acknowledged that they also needed to use tools such as social media more effectively to develop a presence with staff.

Staff turnover was a national challenge and in terms of metrics vacancy rates for London were 2.9%, with voluntary turnover rates at 9%, although they were aiming for 10%.  Additional challenges also included how the organisation dealt with poor behaviour and performance.  A premium for recruitment had been introduced, for example, for care of the elderly wards and acute, and the Trust recruited internationally where necessary. Recruiting well was key to achieving deliverables and to move forward from the Requires Improvement rating for CQC (Care Quality Commission).  Focusing on people and culture, the Trust had three years previously engaged with 4000 staff, to better understand the values and manage expectations.

Professor Orchard stated for the record his deep regret regarding Staff Nurse Amin Abdullah who had ended his life, following a formal disciplinary hearing which had resulted in his dismissal.  Professor Orchard acknowledged that Mr Abdullah should not have been dismissed and hoped that the experience would help the Trust to change its procedures for the benefit and protection of staff. He expressed concern that the use of less informal processes to address poor performance had declined and that there was a reactive response to deal with matters more formally.  Professor Orchard introduced Kevin Croft, who had recently been employed by the Trust as an interim measure.  A new protocol had been introduced so that a senior manager from another site would review cases prior to a decision being reached, to ensure consistency, objectivity and impartiality.  To date, 31 cases had been reviewed, eight had been returned for either more information to be obtained or for informal action to be taken.

Professor Orchard assured Councillor Richardson that Mr Abdullah’s case should not have been the subject of a formal disciplinary hearing.  Mr Croft’s investigation and performance framework protocols had been implemented and there were now the tools in place for dealing with all forms of poor performance.  There was a need to train staff in how to deal with some performance issues informally and for the performance evaluation processes to align for both doctors and other medical professionals.  Finally, it was important to take full account of equality and diversity issues, and it was acknowledged that  ...  view the full minutes text for item 204.

This report is intended to give an update on the major improvements within the adult in-patient mental health service since the full CQC inspection of the Trust which took place in November 2016.

The Chair welcomed Sarah Rushton, Operational Director for WLMHT. It was explained that the there was an on-going CQC inspection of the trust and that it would be helpful to report on the outcomes of the reviews at a future meeting. In terms of beds, WLMHT was always running to full capacity.  There was a lack of seclusion facilities in the psychiatric care unit, with one for older people, with 20 beds per ward which therefore exceeded guidance for ward mental health patients. Since an earlier CQC inspection, sustained improvement had been noted and the Trust was currently running at 85% capacity (as noted in paged 55 of the Agenda pack).  The Trust planned improvements included the relocation of a number of wards to the ground floor, and alterations that offered better physical and mental health care facilities.  In terms of suspended beds, there were plans to permanently move to 20 bedded wards, and have suitable facilities to support disabled patients.

Parminder Sahota reported that the Safeguarding Adults Executive Board (SAEB) would shortly be meeting for the first time but during the interim, the LBHF continued to be members of the triborough SAEB. Many changes were planned and the Trust would work with the local authority to ensure communication was fluid.

Councillor Richardson asked about younger patients and isolation. It was explained that the trust provided support across the three boroughs, but the trust did not have individual care plans for each patient that came through the Trust and would not mix people in a way that would cause an issue. However, the trust did not have the facility to accommodate younger people.

Jim Grealy asked how many beds the Trust believed it needed and what was the time delay between referral and getting a bed, and, what was the level of returns following a discharge. Sarah Rushton responded that they were developing a model of the total patient flow. The Trust was also considering an initiative involving community treatment at home, to use less beds, which was about to commence. It was confirmed that readmission rates had been within targets and there was not currently no time gap between referral and admittance. Work around improving patient flow had ensured that beds were now available according to need.  The Trust could also accommodate sectioned patients and Helen Mangan confirmed that patients could be detained under the statutory mental health regulations, which could be done immediately, comparted to previously years.

Councillor Kwon enquired about the recent publicity indicating that the police lacked capacity for out of hours provision. Ms Rushton took the view that there was a professional duty of care towards people with mental health and was disturbed by news the police would be reluctant to assist. Part of the role of the police was to undertake safeguarding work collaboratively with colleagues across social care and health services.  There was increased joined up working and the police were in regular contact with mental health professionals.

Councillor Lloyd-Harris referred to page  ...  view the full minutes text for item 205.

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

Several items were noted for inclusion for work programme which included a report from the Older Peoples Commission and the SAEB annual report.  The inclusion of an additional date would also be explored.  

Tuesday, 4 December 2018

Monday, 11 February 2019

Tuesday, 26 March 2019

An additional meeting date will be confirmed for January 2019.