The following items are suggested for the Board’s workplan:
· COVID impact on young people’s mental health
· Digital Inclusion - GPs online
Minutes:
1. Covid-19’s impact on young people’s mental health
Dr Lang said she had contacted Children’s mental health commissioner Anjana Chakraborty and had also had preliminary discussions with Jan Parnell (LBHF, Assistant Director of Education), Sam Lord (Transitions Consultant) and Carol Cook (Early Years Advisor). Ongoing work included a borough mapping exercise undertaken by Jan Parnell’s team. A meeting was also planned for mid-August with the CCG, who currently commissioned “Kooth” (online counselling and support for young people), with a view to taking a more fruitful, collective approach.
Dr Lang said the intention was to compare what the Council was buying with what the CCG was commissioning. Jacqui McShannon added that they wanted to include the voice of young people. She mentioned the excellent consultation work undertaken with the Youth Council, together with the Compassionate Community recovery plan. This had included a video which addressed children’s concerns about returning to school together with a huge piece of work on a “compassionate curriculum” as part of the recovery plan. This could be presented at the next meeting of the Board.
Cllr Coleman mentioned a recent conversation with a young person who co-ordinated a local MAG and who was questioning their value of their schooling, given the virus’s impact on further education and employment. Jacqui McShannon said their work would focus on young people up to the age of 18 years but that they were also interested in joint commissioning for mental health. The intention was to work with the CCG and bring to the Board a separate piece of work on joint commissioning for those transitioning into adult services.
Talking about the specific needs of young people whose mental health may have been affected by Covid-19, Cllr Coleman asked what the Council and health partners could do as large, anchor institutions to promote opportunities such as internships. Jacqui McShannon was unsure if this could be included within this specific piece of work but agreed that it should be included within joint service planning with partners and possibly as part of the Council’s Industrial Strategy.
Cllr Richardson said the Health, Inclusion and Social Care Policy and Accountability Committee (HISPAC) was currently developing a piece of work on supported employment for young people. Support from both Dr Lang and Jacqui McShannon would be welcome in bringing this to the September meeting of HISPAC in a way that co-ordinated with the Board’s work. Cllr Coleman suggested that the employment work be included as part of the report being brought to the Board on the mental health of young people. Jacqui McShannon said The Economy department was leading work on the Industrial Strategy to which Children’s Service was contributing, looking at post 16 opportunities and apprenticeships. The supported employment work was sizable and warranted being a separate piece.
Jacqui McShannon asked how health partners would contribute to the work on understanding the health impact of Covid-19. Janet Cree said a meeting was planned with Ms McShannon for the following week. Work on the recovery programme was being undertaken collectively across NWL. This would also focus on mental health and would link in with the work across the health sector.
Cllr Coleman said it was important that the Board identified any opportunities for joint working to help achieve greater health outcomes for H&F residents.
RESOLVED
That a Children's Services report to the Board be provided on (i) work undertaken with schools on local community resilience and recovery plans, and (ii) work currently being developed with the CCG on the joint commissioning of mental health services for young people transitioning to adult services.
2. Digital inclusion - GPs online
Cllr Coleman noted that the new opportunities for patients to present and be triaged online was a positive experience for many but might not be right for everyone. There was a question about how to maintain access for all to GPs.
Janet Cree said a piece of work was underway to bring together GPs, PCNs, health partners and community groups to explore access to digital consultation services and to ensure that online triage conversations did not disadvantage those with limited digital access. Mark Jarvis said that digital poverty and digital exclusion were concerns that would be included as work developed and had already been picked up through the CCG’s work with the Patient Reference Group. Work had also commenced with SOBUS to understand patient access to services, working with the Borough’s community and engagement team.
Mark Jarvis said the CCG shared Cllr Coleman’s views on mapping out the current provision and was keen to work collectively towards a piece of work to address this. Deborah Parkin agreed and said virtual services were an adjunct for those patients for whom face-to-face consultations were unsuitable.
Jaime Walsh said this was an important matter that warranted the involvement of Healthwatch, which played a pivotal role as a point of contact for patients. A project plan had been developed which was currently being explored collectively with health colleagues.
Janet Cree said part of the approach across NWL was to standardise the model and make more effective use of resources and to enhance existing provision. She acknowledged that there might be a preference for virtual services but that resources would need to be in place to support those who found this unsuitable.
Toby Hyde said Imperial was currently in the process of submitting a research grant application to fund research on this and had co-designed a project with Open Age. A workshop was due to be held which would look at the delivery of primary and secondary care services for older people and at how virtual consultations would affect different population groups.
Caroline Durack said that there was evidence to suggest that many people ignored text messages and that how information was communicated and managed was an important part of the digital conversation.
Cllr Coleman suggested that it would be helpful to develop collectively in a co-produced way a codified set of standards for online consultation to reassure patients about expectations. This might be provided to practices as a best practice model.
Deborah Parkin said all GP surgeries now had a digital platform which allowed GPs to offer a broad spectrum of primary care services and which had been effectively used during the pandemic. The model might not remain in its current form (which was developed to prevent patients coming into surgeries) but was expected to evolve. A nationally funded, long-term work programme for digital services had been implemented, for which national standards had been agreed. It was clear that this was not intended to replace face-to-face provision but to support it. She agreed it would be useful to have ongoing discussions with patient participation groups but clarified that this work had been in development over many years. This had culminated in the swift implementation of an online model during the pandemic within 48 hours.
Toby Hyde said there had been a huge increase in digital consultations both in primary and secondary care, which he acknowledged raised issues around digital inclusion. Moving to digital consultations was a huge culture change for many patients and created a great opportunity to reduce the NHS carbon footprint and as regarded accessing advice. He referenced the excellent work of Open Age, which had started coaching sessions that had taught people how to use Zoom and conference call technologies and addressed concerns about digital inclusion. This was a learning process and the model of care had moved from being predominantly face-to-face to a virtual model within 48 hours. This had significant implications for the way in which services were currently provided but it was acknowledged that there would remain a subset of residents who would struggle to engage with virtual consultations and digital services.
Cllr Coleman acknowledged Janet Cree’s point that it was not for the HWB to develop a set of legal standards but proposed that the Board led on reviewing standards, given that the development of a model set of standards was an iterative process that would require further refinement. The Board agreed that Healthwatch would lead on bringing together the collective work being undertaken on this issue.
RESOLVED
That Healthwatch coordinate a project with the Council, the NHS and residents to ensure that online consultations do not exclude any residents from accessing a GP. This work to include consideration of best practice standards and guidance for online GP consultation.