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 17 June 2019; and

(b)  To note the outstanding actions.

RESOLVED

The minutes of the previous meeting held on 25 June 2019 were noted as an accurate record and agreed.

Actions and Matters Arising - Clinical Commissioning Groups: Merger and the Case for Change

Janet Cree reported that the Governing Body of H&F CCG had considered a report which set out details about the potential merger and case for change. Unfortunately, H&F Save Our NHS had been omitted from the list of organisations which had provided feedback and that this would be amended.

The Governor Body of the CCG had discussed and considered a recommendation to merge in April 2021. This contrasted with prevailing views regarding an earlier merger and considered feedback and changes to the current financial situation of the North West London CCGs.  A more realistic timeline for the merger had been agreed. The CCG would remain a statutory body, be reviewed and strengthened financially.  The schemes of delegation would also be reviewed, and the CCG would continue to work with the local authority.  It was explained that this was the direction of travel, not a decision to merge but one step in the process of moving towards a merger. Further and regular reports would offer further details and assurance at future governing body meeting to ensure local accountability, focus and transparency.

Councillor Richardson said that the Council welcomed this news and the opportunity to contribute towards a process that would shape the future of the CCG of North West London.  In response to a question from Victoria Brignell regarding consultation and engagement, Janet Cree confirmed the CCG would ensure transparency throughout the engagement process. Councillor Richardson enquired about specific dates and timelines for consultation.  Lesley Watts responded that the decision to postpone the vote had considered the current financial difficulties for CCGs in North West London and that these would need to be prioritised ahead of reorganisation. A sensible timeframe would be discussed with the governing bodies and that a finalised timetable would be provided as soon as this was determined.

ACTION: CCG to provide the Council with a timetable for the proposed merger

Councillor Caleb-Landy enquired about the potential impact of the merger on residents in terms of local accountability.  Janet Cree responded that a move towards a single CCG would benefit residents through collective work to achieve economies of scale and deliver a more sustainable financial position over a greater primary care footprint.  In a follow up question, Councillor Caleb-Landy asked if any modelling work had been undertaken with a comparative sized organisation.  Lesley Watts explained that in her previous experience as a Chief Executive of a large, primary care trust (PCT), it was necessary to undertake local analysis to understand how patient pathways operated. Multiple care pathways hindered the ability to provide health care for patients and this would be balanced with the need to drive forward efficiencies. 

Jim Grealy commented that the proposed changes had been previously been presented as administrative and not patient-facing.  He felt that this was no longer  ...  view the full minutes text for item 22.

Apologies for absence were noted from Councillor Bora Kwon.

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 provides an overview of Primary Care Networks and explains how they will be organised in Hammersmith and Fulham. For Information and noting.

Janet Cree explained that this report informed members about the development and structure of Primary Care Networks (PCNs) and the aspiration to deliver direct enhanced services.  PCNs were evolving and development plans for this closely aligned to deliver the goals set out in the NHS Long Term Plan. Details about the impact of this would be provided at a future meeting.

Victoria Brignell asked what difference would be noticed by patients following the establishment of PCNs. Vanessa Andreae explained that this was currently being considered.  PCNs would be more patient facing and that it was hoped that this would lead to improved standards of care.

Councillor Coleman enquired whether any of the promised additional funding from central government would be directed to support social prescribing, to help GPs in directing patients to local services.  The success of such an approach lay with a properly resourced and supported third sector.

RESOLVED

That the report was noted.

This report provides an update from H&F CCG about their response to the NHS Long Term Plan, published on 7 January 2019.

Juliet Brown briefly outlined that the response to the NHS Long Term Plan (LTP) took a collective approach that was structured to ensure both a strong PCN and a local focus.  The LTP included how the NHS was working towards improving mental health services and access to local care for long term conditions such as diabetes.

 This was a strategic response to the LTP setting out where the CCGs were currently, how they intended to work together and engage locally.  The response deadline was 15 November 2019 and it was explained that they had working on preparing a draft for some time, aiming for it to be available by the end of September. It was explained that the H&F integrated care partnership (ICP) offered the delivery of borough based local services.  It was noted that a joint meeting of council leaders, led by Sean Harris, Chief Executive of the London Borough of Harrow, was arranged for 24September 2019.

Lisa Redfern expressed concern that she had not received any formal communication about the work being undertaken by the care partnership board (which comprised of the North West London local authorities but did not include H&F and Ealing) or been consulted about the response to the LTP. The only communication received had been regarding workforce strategy.  Lisa Redfern explained that she had also not been contacted in her statutory capacity as Director of Social Care or been asked to contribute to the formulation of the draft response, which she had requested sight of several times earlier in the year.

The Council’s Better Care Fund had been drafted in the absence of any information about the LTP response.

Juliet Brown said that ‘system boards’ had been established and it was recognised that H&F did not currently form part of this.  Lisa Redfern reiterated that the lack of engagement was very disappointing.

Councillor Coleman reported that Mark Easton had previously given assurances that the Council would be fully involved and engaged. It was noted that this would be rectified at the earliest opportunity. The Council would have wished to have been included at the start of the process in producing the draft response, working jointly with NHS and local authority colleagues. In terms of governance, Councillor Coleman pointed out that Sean Harris was not a democratically elected representative or a director of social care and that he would raise the issue with members of the WLA.

Lesley Watts offered an assurance that the Council would be fully engaged going forward and confirmed that a timetable of engagement and joint working will be provided, commencing with a formal invitation to attend the meeting taking place on 24 September.

ACTION: NWL Collaboration of CCGs to provide a timetable for engagement regarding the preparation and submission of their response to the NHS LTP

Councillor Lloyd-Harris referred to page 22 of the Agenda pack and commented that H&F had a great deal of knowledge and expertise on undertaking local engagement and asked how  ...  view the full minutes text for item 26.

This report provides an update on Healthwatch activities.

Olivia Clymer provided a brief overview of the recent activities undertaken by Healthwatch.  It was noted that appendices and data was also available and would be circulated to members of the Committee.  Much of the work had highlighted new ways in which the patient experience could be better understood, for example, providing forms in local chemists as well as surgeries. 

Councillor Caleb-Landy enquired how H&F CCG had engaged with Healthwatch and how they had responded. Olivia Clymer explained that they had been commissioned by Healthwatch England to undertake national consultation, with a requirement to run consultation workshops. The consultation survey provided had not been “people friendly” so members of Healthwatch had gone out and about to help improve the number of responses.  This had been undertaken in a tight timescale in March 2019, with a report produced in May.  Healthwatch had worked with colleagues at NWL level and the H&F director of communications team to share information as widely as possible and this had been incorporated as the foundation to the CCGs own engagement work. 

Councillor Richardson asked if work on mental health, young people and learning disabilities would inform the LTP response.  Olivia Clymer hoped that this would be the case and that it would reference not just services but issues such as patient transport.  She felt encouraged that further work would be

undertaken on this.

Jim Grealy commended the report and commented that the marketing aspect had been positive.  He referred to the work of the patient reference group and the causal factors underlying the low take up of cervical smear tests by young women.  It was important to understand how North West Londoners accessed and engaged with health care.

The report also made a strong point about the loss of local voices, an increasingly important concern given the clarity of information that people required in order to make informed health care choices about the services they used. He felt that there was a recurring theme about the lack of information about services.  Olivia Clymer welcomed the positive comments and explained that the use of postcards had been undertaken locally although the materials had been provided by Healthwatch England.

Councillor Coleman referred to the CCG merger and case for change and asked about Healthwatch’s views on this. It was explained that Healthwatch interpretation of the LTP was to see a strengthened local voice, which was already very strong in H&F.  Olivia Clymer hoped that this would be further nurtured by the CCG and was concerned that this might not continue.

RESOLVED

That the report was noted.

James Benson provided a brief overview which set out the background details. The service had been suspended temporarily and was now permanently closed and that a decision to cease recruitment had been taken.  They had continued to support staff and residents and were proud to report that no staff had been lost although some had retired. Paragraph 3.7 of the report outlined planned next steps.

Janet Cree added that the CCG independent review had been published in June 2019. Engagement had been undertaken with patients and the palliative care working group.  The aim was for the engagement to progress, to be followed by an agreed service specification which was currently being outlined.  Formal consultation would commence once the service specification was completed. It was confirmed that information and papers would be circulated to the Council and to all stakeholders as part of the engagement process.

Councillor Richardson invited Dr Paul Thomas to provide the Committee with his personal experience of palliative care services, balanced with his professional expertise and understanding as a clinician.  Dr Thomas extensive background of over thirty years included the development of what was now regarded as Primary Care Networks for collaborative working in Liverpool (1989 and 1995) and again in Ealing (2010, where he was the Clinical Director for Ealing PCT).  He was presently a full-time carer for his wife who was being looked after by the Pembridge Unit. 

Dr Thomas explained that his work in Liverpool’s PCT was similar to what was being currently replicated with the LTP, with interlinked and multiple services delivered from surgeries.  It was vital that palliative care remained on the LTP agenda, it was not possible to disentangle this from integrated care as one led to the other.  Dr Thomas referred to “community orientated integrated care” and how it was important to understand how multiple systems connected and fitted together. Dr Thomas supported the view that palliative care services be continued at Pembridge and opposed any bed closures at the unit. 

In thinking about what constituted a “healthy” death it was helpful to also consider what was disease.  A successful system must integrate primary care and personal care which should work in tandem.  The question to ask was how this work could and what were the different approaches to health care, and, how could primary care teams work to improve patient care hand overs.  Dr Thomas was of the view that a healthy death was as important as a healthy death.  A support network of friends and family was essential, as were the components of achieving a healthy life.  Dr Thomas offered three points for the Committee and CCG colleagues to consider:

1.   There will be a need for more palliative care beds in future.  There will be an increased number of isolated elderly people and fewer cancer patients and part of the integrated care system approach is to keep people out of hospital.  The role of the Pembridge unit was not just to offer beds, but it could have  ...  view the full minutes text for item 28.

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

Janet Cree and Vanessa Andreae jointly informed the Committee that the CCG had taken a decision to close the Parsons Green walk in centre.  It was reported that the CCG had sought special dispensation from NHS England to keep the walk-in centre open until the end of March 2020 and were awaiting the outcome of that request.  Formal notice of the closure would be made by the end of September.  Janet Cree explained that core standards for an urgent treatment centre included being open throughout the day, access to a doctor, access to urine testing facilities and routine appointments and these could not be met at Parsons Green. Janet Cree added that the CCG had initially thought that with slight changes the Centre could continue. The CCG had carried out a review in December 2018 which concluded that the Centre offered high quality services and value for money.  NHS England determined that it was not acceptable to continue to offer services from the walk-in centre and that there would be no other walk-in centres nationally.  It was noted that this was also the case in other parts of London such as Barnet.

Janet Cree continued that the CCG had looked at ways to fit the walk-in centre to the new standards or find an exemption that was sufficiently robust. The majority of the activities undertaken at the walk-in centre included ear irrigation and wound care, with most patients living in the vicinity of Parsons Green.  These were also services that could be provided by other GP surgeries and the CCG regarded this as an opportunity to work with the Primary Care Network.

ACTION: That the CCG will provide more detailed information about this to the Committee

RESOLVED

That the Work Programme was noted.

11 November 2019 at 6pm

27 January 2020 at 7pm

24 March 2020 at 6pm

The date of the next meeting was noted as Monday, 11 November 2019.