Agenda and minutes

(a)   To note the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on 10 November 2021; and

(b)   To note the outstanding actions.

Councillor Lucy Richardson, Chair, noted that the actions raised at the previous meeting under Agenda Item 6, Mental Health Update had been responded to by the trust and would be followed up and that the minutes of the previous meeting held on 10 November 2021 were noted, with one minor typo.

Apologies for lateness were noted from Councillor Mercy Umeh.

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 meeting is being held remotely. If you would like to ask a question about any of the items on the agenda, either remotely or in writing, please contact: bathsheba.mall@lbhf.gov.uk.

You can watch the meeting live on YouTube: Watch the meeting live on YouTube

The Chair noted that public questions had been submitted by Merril Hammer (Hammersmith and Fulham Save our National Health Service) in respect of Agenda Item 6, Mental Health Integrated Network Team).

For the Committee to receive a verbal update from the Director of Public Health on Covid-19 and Director  COVID-19 & Lead for Afghanistan refugees.

5.1           Councillor Richardson welcomed back Dr Nicola Lang and Linda Jackson who provided an update on the council’s ongoing Covid-19 response.  The rate of infection for borough was currently 875 for every 100,000 and was in a slow decline, similar to the rest of London.  At the end of December 2021, the rate was 2600 per 100,000.  Most of the borough’s schools had reported cases, predominantly higher in primary school, amongst children aged 5-10 years, replicating the peak of cases arising in secondary schools over autumn.

5.2           Co-optee Keith Mallinson commended the work and commitment of Dr Lang and her colleagues, which he felt was undermined by the comparatively poor response of Transport for London (TfL).  Councillor Amanda Lloyd-Harris endorsed comments in respect of Dr Lang and also TfL.  Enquiring about the rates of infection primary schools, she sought a comparison with overall London figures.  Dr Lang confirmed that there were approximately 1800 new cases being reported weekly which was slowly decreasing. The current rate ranked the borough as the 12^th highest (mid placed overall). One of the underlying factors attributed to higher local figures was the volume of testing which was predominantly one of the highest in London. 

5.3           Residents were well motivated about getting regularly tested and the council continued to work closely with primary, secondary and special needs schools, offering support and guidance on preventative measures. Dr Lang observed that younger children found it harder to maintain social distancing and also attributed the higher rates prevalent amongst primary aged children to being unvaccinated, as they were the last of the population groups to be vaccinated.  Dr Lang commended the excellent work of local headteachers who had worked hard to boost morale and encourage greater resilience amongst their pupils during a very difficult period, dealing with wave after wave of Covid-19.  In response to a follow up question from Councillor Lloyd-Harris, Dr Lang confirmed that she was not aware of parents holding “Covid-19” parties so that children could become infected.

5.4           Lisa Redfern thanked and commended Dr Lang’s clinical foresight in 2020 to appoint an infection control nurse. It was likely that H&F was the only local authority amongst the eight north west London (NWL) boroughs to have taken this approach which strengthened the council’s outbreak management control. Expertise applied to support care homes and for those in receipt of direct payment, was also applied to support schools. Health colleagues had acknowledged the huge benefit of this kind of well balanced, and dynamic intervention, which had helped facilitate a controlled reopening of care homes. Cllr Richardson commended the response of council officer teams, led by Dr Lang and Lisa Redfern.

5.5           Co-optee Victoria Brignell sought an update on the hospitalisation numbers, whether this had plateaued or was declining.  She also sought an update on vaccination rates.  Dr Lang reported that the vaccination rate for H&F, was 63% of registered patients (not by the number of residents).  Numbers had gradually increased, partly attributed to concerns about  ...  view the full minutes text for item 5.

The Committee to receive a report from the West London Trust providing operational information about the Mental Health Integrated Network Teams, and including details of the recently redesigned services.

6.1           Councillor Richardson welcomed Dr Chris Hilton and Helen Mangan from West London Trust. This was a follow up report to one that was provided at the previous meeting of the committee and provided members with insight into the MINT service provision for H&F residents.  Although a brief was agreed, it was explained that unfortunately health colleagues were only able to meet this in part, due to severe Covid-19 related service pressures.  It did not cover transitional mental health care for children and young people, to adult services, which was subject to ongoing transformation work and Dr Hilton assured the committee that he would explore this further with members at a future meeting. In addition, some demographic information had only been superficially covered, focusing on the ethnic coding of individuals accessing the MINT service.  Dr Hilton commented that MINT represented a new community mental health service reconfiguration.  Referencing page 19 of the report, he accepted that the detail of this had lacked clarity for service users. The MINT service offered a different, geographical configuration replacing the previous service pattern.  What was primary care mental health, accessible as part of the SPA set of services, included treatment and recovery teams, had been augmented.  They now geographically aligned with the north and south centres of the borough to integrate more closely with the local primary care networks.

6.2           Co-optee Keith Mallinson commented that the report lacked clarity about the SPA issue and did not address the previous concerns identified by the committee.  In his experience, individuals who suffered a mental health episode and need to be seen urgently, or a relative who needed urgent support and information, required clear guidance and direction towards the SPA.  The reality was that this was not the experience of many service users who felt “pushed” towards Accident and Emergency (A&E).  He felt that streamlined, SPA services focusing on service users was required to help navigate mental health pathways.

6.3           Dr Hilton acknowledged that navigating the SPA could be confusing and referenced page 24 of the report, which set out service details.  He explained the Trust’s SPA provision, which was intended to run 24 hours a day, seven days a week, offering an advice and support line for patients and carers. The SPA did not itself deliver services but helped to identify the appropriate care service, including crises care. This was a freephone service, open to all H&F residents, and in particular, for those individuals requiring immediate assistance. Dr Hilton apologised for the confused messaging and frustration for service users that this had caused. A review was currently underway to avoid individuals from being passed between multiple teams and a SPA would help improve capacity.  The SPA, however, was primarily for planned referrals as well as an advice and support line and distinct from MINT, which offered planned care. 

6.4           Councillor Richardson observed that the issue of the SPA raised questions about the consistency of care provided and the advice offered by staff. Dr  ...  view the full minutes text for item 6.

This report sets out the budget proposals for the services covered by the Committee.  An update is also provided on any proposed changes in fees and charges in the budget.  Cabinet will present their revenue budget and council tax proposals to Budget Council on 24 February 2022.  A balanced budget will be set in accordance with the Local Government Finance Act 1992.

In recognition of the significant increases in the cost to living for residents due to inflation and Government tax increases, the administration proposes to freeze council tax and not to apply the government modelled 1% Adult Social Care precept increase.

7.1           Councillor Richardson reported that there was a minor amendment to the papers to replace appendix 2 of the report.  Emily Hill provided a corporate overview to the Medium-Term Financial Strategy 2022/23 (MTFS) within the context of government policy.  The borough had seen a funding reduction in real terms since 2010, with about 20% less lower funding overall, although social care demand had increased exponentially.  The 2021 autumn spending review implemented changes to local government public spending anticipated within the next three to four years.  Greater efficiency savings were required, identifying and eliminating waste to protect service provision.  The amount that could be saved without impacting on services was rapidly shrinking as efficiencies became increasingly difficult to identify.

7.2           A one-off government grant allocation of £6 million was an additional investment to compensate for the increase in national insurance.  An added concern was the increase in inflation, most recently at 5% which added further cost pressures, particularly impacted by Covid-19. Overarching corporate concerns included Covid recovery and how this was likely to develop, regardless of covid restrictions, demand or potential variants. In addition to inflationary increases, Brexit remained a concern together with wider economic developments, future local government financial and levelling up reforms which were likely to be detrimental to London.

Lisa Redfern highlighted key Adult Social Care (ASC) achievements and despite another difficult year, frontline services would continue to be delivered, and within a balanced budget.  The volume of demand was significant, and the department continued to maintain its vision to compassionately support residents. Home care services and the direct payment scheme supported over 2000 residents, including older and disabled people.  The Meals and A Chat (previously Meals on Wheels) service model had been refreshed to help address social isolation and loneliness.  ASC also worked preventively with residents, with the support of CAN (Community Aid Network) volunteers. Other compassionate, financial decisions included no increase to Careline charges and paying contractors and sub-contractors a London living wage.  A decision to close care and residential homes had actively helped to protect vulnerable residents.  The council had also been an early adopter of lateral flow testing and had ensured that isolating care staff had received financial support.  Workforce development had considered how demand could be better managed working closely with care home providers, helping to prevent delayed discharges. Whole systems working between social and primary care colleagues had shaped and improved reablement practices, working with providers to actively support residents.

7.3           The department consistently sought innovative ways in which residents could be supported and services protected, such as using Amazon to order community equipment to be sent to residents quickly.  Better value and efficient service delivery were key hallmarks of innovative provision that included strong leadership and workforce sustainability practices to effectively manage services.  The River Court short break service dealing with high needs cases had achieved a third, “outstanding” Care Quality Commission (CQC) rating, which was a significant achievement, as had the reablement service, which had also been categorised as “outstanding”.  ...  view the full minutes text for item 7.

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

Councillor Richardson reported that the committee’s response to the NWL consultation on palliative care would have to be co-ordinated outside of the meeting as this was due on 23 February 2022 (date subject to confirmation by the CCG).  Merrill Hammer reported that a wide range of consultation and engagement activities had been arranged and subsequently cancelled, which may require an adjustment of the consultation timetable.

Wednesday, 23 March 2022

Wednesday, 20 July 2022.