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 11 September 2019.

(b)   To note the outstanding actions.

RESOLVED

The minutes of the meeting held on 11 September 2019 were approved as a correct record and signed by the Chair.

There were no apologies for absence.

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.

The Committee agreed to the appointment of Roy Margolis as a co-optee.

RESOLVED

The Committee agreed to the appointment of Roy Margolis as a co-optee.

Councillor Richardson provided a recap setting out the Committee’s consideration of the issue.  This was the third time that members had considered the in-patient unit at Pembridge House in the context of local palliative care provision which was currently suspended due to the lack of a lead palliative care consultant.

Janet Cree referred members to the CCG paper which provided update on specialist palliative care review and accompanied.  A letter dated 17 January 2020 was sent collectively from all the CCGs commissioners and providers (included in the pack).  The letter set out public engagement undertaken so far, and a summary of the work planned for the future model of care. Feedback had identified that there was an inequity of access to services across the four boroughs with 48% of residents accessing specialist in-patient palliative care services. The Committee was informed that the CCG would be planning a programme of engagement and discussion once potential solutions had been published to develop a future model of care.  The information would be collated and analysed to indicate whether a full consultation was required.  The local overview and scrutiny committees would have an opportunity to provide feedback. The Committee was informed that the CCG was aware of what the in-patient unit at Pembridge meant to residents, but it had not been advisable to recruit during a period of transition, as set out in the letter.  It was confirmed that the day patient service would remain open.

James Benson assured the Committee that providers understood importance of the in-patient unit to residents but reinforced the CCG’s view that it was not advisable to recruit during a period of transition and reiterated Janet Cree’s earlier reference to the 17^th January letter.

Co-optee Victoria Brignell asked if health colleagues acknowledged that there was a need for in-patient services at Pembridge.  Janet Cree responded that this would be identified as part of the review of in-patient services and that critical to this was to achieve the right balance of services.  Responding to a follow up point that the unit had been shut because the provider had been unable to recruit to the post, Janet Cree clarified that the recruitment process could not continue while the service was in transition. A potential candidate would have to take on a position in a service that was undergoing transition.

Councillor Lloyd-Harris queried the 48% statistic and asked why it was as low as it was.  The figure implied that people were not aware of the provision. Janet Cree acknowledged that the anomaly was part of the issue that needed to be addressed. The current service was inaccessible or unavailable and one of the outcomes that was hoped for was to ensure that uptake of the service was increased.  Councillor Lloyd-Harris commented that residents needed to be informed because it appeared that the service was intentionally being run down with many obstacles that prevented progress toward a suitable resolution. Janet Cree countered that the main priority was to achieve the right  ...  view the full minutes text for item 35.

Janet Cree clarified that the CCG had not taken a decision to close Parsons Green WiC but had requested an extension from NHS England to keep the WiC open so that the existing service would remain.  Further information was contained in a letter on the CCG’s website. At the present time there were no plans to change the WiC. 

Councillor Richardson enquired what had led to the confusion, a reprieve had been sought, then refused and then reprieved supposedly again following a Parliamentary announcement from Matt Hancock, Secretary of State for Health. Janet Cree responded that NHS guidance had set out that a change was required in December 2019 which was reported to the Committee.  The CCG had dialogue with NSH England during this time. 

Jim Grealy pointed out that the initial directive to close had come from NHS England but that the CCG statement indicated that Parsons Green would not continue.  He asked if it was necessary now to rename Parsons Green since it cannot be called a “WiC” and that it would have to put in place a bookable appointment system. There was a difference between a WiC, and urgent need and it would be helpful to understand this. Janet Cree responded that several GP surgeries offered WiC appointments and wound care and was of a similar model.  The CCG planned to utilise workforce and capacity within the existing system which was not being used optimally and replace this with a mixed model of care.  This could have GP and nurse appointment systems running simultaneously.

A member of the public sought further clarity about when the WiC intended closure around the end of March and whether any extensions were likely.  Janet Cree confirmed that was the case, but changes would not need to have happened by the end of March.  The CCG planned to undertake required engagement with stakeholders and although WiC provision may no longer be offered at Parsons Green, the unit may look different in future.  It was confirmed that 53% of patient activity was from residents of H&F.  The wider patient footprint comprised of residents from other boroughs.  Councillor Coleman observed that opposition to the closure of WiC across the country indicated widespread concern.  Reflecting on the parliamentary comments about Parsons Green remaining open, it was noted that the Secretary of State had confirmed that there would be no need for the WiC to change to appointment only.  Councillor Coleman acknowledged that this placed the CCG in an insidious position and potentially opened the floodgates to judicial review if the CCG decided to follow the Secretary of States’ policy.

Councillor Caleb-Landy asked if it was possible to establish what the financial impact would be on the budget to reconfigure the WiC.  Janet Cree responded this could be checked and would depend on the specification which might comprise of both WiC and appointments.  In a response to a question from Victoria Brignell Janet Cree noted that Parsons Greens was regarded as a centre of excellence  ...  view the full minutes text for item 36.

The Committee received a joint presentation from Janet Cree and Vanessa Andreae. This had been prompted by a “requires improvement” CQC rating given to a local GP practice.  It was noted that the practice has an action plan and that the role of the CCG was to provide support and guidance as the responsibility for improvement lay with the practice itself.

Councillor Mercy Umeh asked what the impact on residents had been.  It was confirmed that most residents would be unaffected.

Jim Grealy welcomed the update and reassurance offered and the fact that 19 practices had performed well with 8 achieving a “good” rating.  However, 50% of those that were not deemed good were in deprived parts of the borough. He expressed concern about the equalities impact on residents and urged the CCG to review this as a priority.  It was noted that practices were private businesses and that if a practice was rated as inadequate, he asked what monitoring procedures were in place, and, what was the monitoring process was to review matters before this stage. Vanessa Andreae acknowledged that there was an impact on patients but observed that patients were also very loyal to their practices.  CQC inspection regimes had evolved over the years and had become more policy and procedure based, monitored by the GP Federation.  If a practice had not reviewed its policies then it was likely to be challenged.  Janet Cree added that the newly established Primary Care Networks (PCNs) were perceived as part of the solution and that changes implemented across a PCN enhanced provision.  Vanessa Andreae highlighted as an example of the this the low take up of immunisations which could result in a “requires improvement” rating.  This had been an issue in H&F and there had been an immunisation working group but that this had been disbanded.  In another example, a local GP practice had received a national award on their work to improve the number of women undergoing cervical screening.  It was noted that there was a need for more proactive collaborative work and the Committee indicated that it would welcome innovative opportunities for the Council to assist the CCG in for example, advertising health information and guidance for residents regarding flu prevention on the Council website.

ACTION: Council to assist the CCG in for example, advertising health information and guidance for residents regarding flu prevention on the Council website

Referencing an earlier point about inequalities it was noted that the PCN was part of the solution around supporting both the network and offering peer support, particularly where there was workforce retention.

It was confirmed that there was regular monitoring of individual practices.  A practice would receive a two week notice in advance of a CQC visit and the GP Federation was allocated resilience funding to support prior to a practice inspection.

RESOLVED

That the Committee considered and noted the report.

Mark Easton provided a brief update on numerous changes to the CCG operating model. Engagement had commenced about the move towards a single CCG.  The CCGs had begun to explore what would happen within the transitional year and to develop an understanding of what happened at both CCG and borough levels.  This had led to some engagement work prior to December 2019 and there were proposals in train to cluster management teams.  It was clarified that this was not about having four clusters that would exist as autonomous structures.  The intention was to have 8 CCGs with 8 managing directors and to maintain some shared functions with 20% of staff working between boroughs and 80% working locally. 

Councillor Coleman commented that the move towards clusters presupposed a merger which was yet to be agreed and that the criteria and conditions for the merger had not been made known.  Councillor Coleman requested that the NWL Collaborative CCGs provided information about what conditions would have to be met for a merger to proceed.  He also requested that the Committee be provided with the details of the work plans identified in paragraph 1.3 of the report.  He continued that he had been surprised by a letter consulting CCG staff about prospective cluster arrangements without having discussed these arrangements with the Council.  It had been reported that H&F would be clustered with Ealing and Hounslow, but this was not the case.  H&F CCG was to be potentially clustered with Central and West London CCGs, an unwanted arrangement that reflected a historic local government arrangement between the three boroughs and which no longer existed. Councillor Coleman also sought clarification about the financial and administrative needs of GP at Hand and how this would be met by the NWL Collaborative.

In response Mark Easton referred to agreement reached between the 8 CCGs to merge in principle. In a caveat to this, there remained several issues that members of the governing bodies requested further information about.  Broadly speaking these were encapsulated by five bullet points contained at page 13 of the Agenda.  A more detailed paper had been submitted to the Joint Committee (of the NWL Collaborative) and covered the areas which the governing bodies said that they wanted to be satisfied about before they recommended that their members should vote in favour of a merger. Currently, the Collaborative was developing the answers to the questions posed by the governing bodies.  It was confirmed that this would be shared with the Committee when it was finalised. The document was essentially a derivative of the document produced in December 2019 and was currently in development. It was anticipated that this would be ready over the course of the next week.  It was hoped that a further consultation document would be published for staff but that the priority would be to work out arrangements for the interim year before worked commenced on the longer-term changes.  In response to a question about when this might be made available  ...  view the full minutes text for item 38.

Councillor Richardson welcomed from Healthwatch Olivia Clymer and Eva Psychrani who presented their recently published report “Healthcare in the Digital Era an Exploration of young people’s health needs and aspirations in Hammersmith & Fulham”.  The report explored the impact of digitisation on young people nationally a link to which was included in the pack together with a consultation link inviting comments from the public and stakeholders. Key findings in the report which had engaged with young people in H&F included the use of technology was not necessarily linked to health, concerns about finding the right information online and that young people were more comfortable with accessing the NHS online using log in credentials.  There was also an emphasis that maintaining a digital approach did not infer that traditional face to face access should be ‘lost’. The report had received a positive response and would ensure that NWL CCGs engagement plans around digital was communicated clear to residents to help alleviate patient difficulties in accessing services.  Reference was made to the previous point about with 48% of people using specialist palliative care services implying an issue around signposting which might be replicated in technology. This was an opportunity to develop an approach early on.

Councillor Richardson identified that the Council’s approach to addressing mental health focused on prevention.  Jo Baty confirmed that this was an issue that was being covered at Health and Wellbeing Board.  Prevention was a big area of work and endorsed the findings of the report.

Co-optee Roy Margolis welcomed the report and its interesting recommendations and asked if more detail was available about the recommendations and specifically if any work had been undertaken on the cost of implementing them.  Olivia Clymer responded that the role of Healthwatch was to identify issues, provide challenge and affect change so that the patient voice was heard and acknowledged.  There were further details in the main report and could be included in an appendix to the report. Keith Mallinson, as Chair of the Healthwatch Central West London Committee reported that he had recently attended a CAB forum presentation and was shocked at how many people were being signposted to services which were no longer accessible.

Jim Grealy asked how many young people consulted a GP in person and if there was a sense of whether having a digital approach was preferred in place of attending an appointment at a GP surgery.  Eva Psychrani explained that there was a sense that follow up and prevention work could be digitised but that everyone needed the confidence and reassurance that arose from a face to face appointment.

It was noted that this was a valuable report in given the number of people who were being turned away from CAMHs (Children and Adolescent Mental Health Services).  Councillor Lloyd-Harris observed that it was helpful to have a definition of mental health which normalised the issue.  The perception for example that drugs, and alcohol issues were ‘normal’ and therefore not perceived to be a problem by the  ...  view the full minutes text for item 39.

Lisa Redfern led a presentation that informed the Committee of planned departmental financial spending for the forthcoming year and the intention to deliver again a balanced budget.  Key achievements included free home care, subsidised meals on wheels, the commencement of a podiatry service and ensuring that all contractors paid staff the minimum living wage. Two in-house services had been rated as outstanding and improvements to other services had received positive feedback from residents. A safeguarding peer review by the Association of Directors of Social Services had achieved an outstanding result. Delayed transfer of care figures had now placed the borough as the third lowest in London and a quality assurance framework had just been launched.  These were all achieved under challenging circumstances with increased demand, greater acuity of need, and complexity of care within an ever-reducing budget.

Councillor Lloyd-Harris enquired about the current level of the Council’s reserves.  Hitesh Jolapara responded that the reserve figure needed to be considered in the context of ten years of austerity.  H&F was average in London in terms of the level of reserves which was currently retained at £90 million.  The Corporate budget would contribute a further £7.2 million to reserves which included income received through business rates.  The Council’s intention was to continue to be ruthlessly financially efficient.

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

RESOLVED

That the Committee notes the report.

24 March 2020

Tuesday, 24 March 2020.