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 26January 2022; 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.

Watch the meeting on YouTube

No questions were submitted.

resolved

That order of business be varied to take agenda items 7.1 and 7.2 first, followed, by agenda item 6, then item 5.

This report gives an update on changes to the way adult musculoskeletal physiotherapy hydrotherapy services are provided at Charing Cross Hospital and pilot trials undertaken to support a change in delivery.

5.1           Professor Tim Orchard, supported by Imperial Trust health colleagues Charlotte Allenby and Anna Bokobza, provided an update on changes to the way adult musculoskeletal physiotherapy hydrotherapy services were provided at Charing Cross Hospital and pilot trials undertaken to support a change in delivery.  He Commended the collaborative work with Councillor Ben Coleman, Lisa Redfern, and H&F senior social care staff to develop robust changes to the hydrotherapy service model through active engagement with residents.

5.2           The committee were provided with a timeline of key activities between October 2018 and February 2022 which saw a temporary closure of the hydrotherapy facility due to prohibitively increasing maintenance costs and service unpredictability.  An options appraisal in October 2018 had initially prompted a change in how aquatic therapy should be delivered and concerns about maintenance.  This latter issue had led to numerous unplanned cancellations and poor service provision for patients.

5.3           The outcome of the engagement led was a two-part pilot project in February 2019.  Part one included the temporary use of pool facilities at the Jack Tizard school site. The second part involved the use of the pool at the sports club on the Charing Cross hospital site for those who were transitioning towards self-directed care and recovery. The two pilots were run in tandem and evaluated but unfortunately the pandemic meant that there was a hiatus, and the projects did not properly commence until after the third wave in February 2022.  The results of the pilots were included in the report together with generally positive patient feedback, although accessibility issues were highlighted.  It was anticipated that the proposal would be to permanently close the existing therapy pool at the Charing Cross hospital site and to continue with the two pilot services across two sites.  This would improve patient experience, and address maintenance and cost issues.

5.4           Councillor Lloyd-Harris welcomed the summary and update, which had improved on the April 2019 report to the committee.  Recognising that there were limitations on the use of the Jack Tizard school site she asked if the option to further develop the Charing Cross sports club site had been explored, querying whether the limited use of the school site was sufficient to provide a robust service.  She also referenced the views of a local GP who had actively contributed to the April 2019 committee discussions by outlining his patients’ difficulties in obtaining referrals to the hydrotherapy pool and queried why this remained unchanged, given the demand.  Merril Hammer commended the Trusts response which sought a solution that recognised the value and benefits of aquatic therapy. Councillor Richardson emphasised the importance of including the “patient voice” through stakeholder engagement and commented on the disruption to the pilots and asked about the level of assurance testing undertaken.  Councillor Coleman welcomed the Trust’s encouraging approach and asked whether this could incorporate additional hours at the Jack Tizard site during school break periods or if patients could be transferred by Uber from the hospital site, given the significant  ...  view the full minutes text for item 5.

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

6.1           Professor Orchard presented the report which emphasised the importance of recruiting and supporting health staff.  NHS staff had been at the forefront of dealing with community transmission and it was not easy to now recall the level of fear and daily challenges of dealing with the pandemic from March 2020 onwards.  The swift transmission and progression of the virus in some cases meant that not much time elapsed between admission, intensive care treatment and mortality, with 70% of deaths occurring on acute wards.  Having met with staff in across the Trust, and in particular Charing Cross and St Mary’s, Professor Orchard expressed his deep admiration for the resilience of his staff and how they had responded.

6.2           The paper offered three priorities shaped around building a sustainable workforce, improving staff health and wellbeing with a counselling offer and improvements made to catering and rest area facilities.  This had been well received by staff and had made a significant difference.  Focusing on recruitment and retention it was reported that the vacancy rate was in decline. In terms of the metrics and to add context, it was reported that about 200 nurses had been recruited to deal with increased demand following Covid-19 and the recovery period to address a treatment waiting list backlog of six million people.

6.3           The NHS nationally had been strategically exploring recruitment and retention and how this could be enhanced by local recruitment.  It was acknowledged that most staff who left did so within a year of joining and that those who remained, stayed long term.  Most importantly, the NHS weakness was around ethnicity, diversity, and inclusion (EDI) need to be addressed.  There was an acceptance that although 50% of staff were of Black and Asian ethnicity, this was not reflected at higher levels within the Trust.  An inclusive recruitment policy had been implemented to constitute diverse (gender and ethnicity) interview panels, and a follow up letter from the interview panel called “Dear Tim” was required, to justify all senior Band 7 and above appointments.  The scheme had achieved modest success but needed to be tested with proper feedback as to how individuals increase their chances for a successful appointment.  In addition, it had also been recognised that Black and Asian staff were less likely to apply for study leave or access training opportunities. A new programme would be launched to facilitate improvement through people management to set out clear expectations.

6.4           Co-optee Jim Grealy commended Professor Orchard for the commitment of his staff who continued to work in challenging circumstances and welcomed the report for its combination of analytical rigor, determined to tackle the difficulties inherent in recruitment and retention.  He asked if the Trust had considered an age categorisation of staff, referencing the large number of older GPs retiring from practice as an example. He also asked if the staff policies referred to would be rolled out across the wider North West London Integrated Care System (ICS).  Councillor Bora Kwon welcomed the focus of the  ...  view the full minutes text for item 6.

This report provides an update on the work being undertaken locally to provide Disabled residents access to inclusive apprenticeships. The paper also highlights the current scale of opportunities on offer through local businesses and considers how workforce remodelling of apprenticeships can support inclusivity.

7.1           Councillor Richardson welcomed H&F officers Oliur Rahman, Tom Perrigo from The Economy department, Jo Baty from Adult Social Care and Helen Green from Children’s Services.  Additional guests and contributors included Sharon Probets from Imperial, Sue Jenkins from West London College, and Clare Caccavone and Charlotte Warner, from Ambitious about autism.

7.2           Oliur Rahman provided highlights from the report which included businesses reporting a skills shortage exacerbated by the impact of Covid-19.  This was a good opportunity to engage with employers to identify and access employment opportunities for an untapped talent pool of disabled residents.  Current local data about apprenticeship take up indicated that 60 disabled residents had begun an apprenticeship.  There were approximately 8400 employed disabled residents in H&F in the borough.  The borough as an employer was one of only three London boroughs that offered an inclusive apprenticeship and there was an intention to increase the number of available opportunities.  Nationally, there were 116 inclusive apprenticeships available and as of March 2022, 11 of these were available with employers that were registered as disability confident. 

7.3           The council intended to work with 130 employers locally and tap into established networks to grow opportunities.  Adjustment was key but there were opportunities following the pandemic with significant movement in the employment market reflecting people’s choices and changes in direction. The council was also reviewing the varied support that was available through partners and how resources could be allocated to ensure that support provided through coproduction was available for disabled residents.

7.4           Sue Jenkins commented on inclusive apprenticeship and how the lack of GCSE maths and English qualifications prevented many from being eligible in accessing the apprenticeships.  The West London College had worked with four inclusive apprenticeships and about 100 people had progressed into full time employment. This had taken significant amount of effort and commitment which extended beyond making reasonable adjustments. Lobbying for an adjustment to the structure was necessary to maximise opportunities and remove barriers which would allow people to achieve vocational standards.

7.5           Clare Caccavone agreed that there were many who were autistic and did not regard themselves as disabled, but this was a long-term health condition.  Many were also unaware that they fell within the category of protected characteristics rights offered within the Equalities Act 2010.  Many young people were traumatised by the requirement to achieve the minimum standard academic qualification which was a contradictory gateway and barrier.  It was suggested that given the skills gap, sustainable work opportunities would be better delivered by changing the way in which job applications and interviews were structured, using e.g., job trial periods.  Referencing a Manchester based provider, Clare Caccavone explained that the GCSE qualification requirement had been removed with adaptations to the process to support autistic apprenticeship applicants. Depending on the development of robust evidence-based data, the aim was to replicate this approach nationally, working with councils and providers, and Ambitious about Autism welcomed the opportunity to work with H&F on this.

7.6           Councillor Richardson asked  ...  view the full minutes text for item 7.

This report provides an update on workforce sustainability in the organisation with a focus on the specific following areas:

• Safe staffing and vacancy rates
• Recruitment and retention
• Staff health and wellbeing initiatives
• Equality, Diversity and Inclusion

8.1           Dr Nicola Lang provided a brief update on the council’s response to Covid-19, supporting Professor Orchard’s thought-provoking remarks about the resilience of NHS staff and how this was mirrored by a similar impact on social care staff.  It was reported that case rates were increasing in the borough with about 1 in every 400 cases confirmed as Covid positive and that a similar trend was being replicated across London and nationally, but this increase was slowing down.  Hospital admission rates linked to Covid-19 were being carefully monitored. The highest rates had been identified in the 25-29 age bracket and a new variant of the ba2 Omicron variant had begun to appear, which was 30 times more infectious than the original Omicron variant.  This coupled with a relaxation in social distancing rules, increased socialising, waning levels of immunity through vaccination had combined to provide an increased rate.  Vulnerable older groups could continue to protect themselves through the Spring Booster programme. Loosening restrictions was difficult to manage as some people found it psychologically harder to adjust to a more open regime.

8.2           Councillor Lloyd-Harris asked if it was time to reintroduce publicity to remind people that Covid-19 was still present, and that the vaccination programme was still open to those who had not been vaccinated.  Dr Lang welcomed the question and reported that the council’s communication team continued to disseminate NHS guidance.  Spring boosters and third doses were currently open to the over 75s and people aged over 12 with immunosuppression or other conditions.  It was difficult to judge the public appetite for further Covid-19 publicity as there were other important health communication campaigns that needed attention e.g., measles, mumps, and rubella (MMR).  This was difficult as some parents had not managed to get young children immunised during the pandemic. 

RESOLVED

That the verbal update was noted.

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

9.1           Councillor Richardson provided brief background details about the North West London Collaborative of Clinical Commissioning Groups end of life engagement work and the work the committee in scrutinising the temporary closure of in-patient palliative care services at the Pembridge Hospice. A formal decision about this was delayed because of the pandemic and remained under discussion, whilst further engagement work was undertaken. Jim Grealy added that the movement from the initial local engagement covering RBKC, H&F and Brent, had now evolved to a North West London focus, covering significantly greater numbers. Also worth noting was that this review covered adult palliative care and not children and young people. Although the Integrated Care Partnership had been helpful, it was suggested that an integrated, more inclusive review would have been helpful.  Patient choice was another emerging theme, with a need for more structured pathways that more appropriately accommodated a person’s needs and final wishes, with timely transition from home to hospice care. It was confirmed that re-engagement on this issue would commence following the local elections on 5 May. HaFSON had prepared a report which was available to members.

9.2           Councillor Richardson reported that a former member of the PAC, Brian Naylor had suggested that the PAC review the provision of ophthalmic services and the Western Eye hospital. Locally, the NHS was the main provider of services to about 6000 H&F residents with visual impairment, a figure estimated to increase by 27% within 10 years. It was agreed that this would be develop as a future scrutiny item for July or a future meeting.  Suggested items for July included:

·       West London Trust (MINT, CAMHs transition and single point of access update)

·       Ophthalmic services and Western Eye

·       Supporting local GPS (long list)

Wednesday, 20 July 2022

Councillor Richardson noted that this was the last meeting of the 2021/22 municipal year and took the opportunity to thank all officers, guests and contributors, and committee members for their hard work and support.  Councillor Richardson also thanked the committee co-ordinator for her organisation and support of the committee’s work.  Councillor Lloyd-Harris echoed the comments and thanked Councillor Richardson for her leadership of the committee. The date of the next meeting was noted as 20 July 2022.