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No. Item




Apologies for absence were received from Councillor Clare Coghill (Chair) and Sue Boon.


In the absence of Councillor Coghill, Councillor Naheed Asghar took the chair.


Councillor Asghar in the Chair




Members are required to declare any pecuniary or non-pecuniary interests they or their spouse/partner may have in any matter which is to be considered at this meeting. Interests are defined on the inside cover of this agenda.






The minutes of the meeting held on 6 December 2017 were approved as a correct record and signed by the Chair.




Consideration was given to a report of Kelvin Hankins, Associate Director, Waltham Forest CCG.

Mr Hankins introduced the report by drawing the Board’s attention to the demographic challenges facing Waltham Forest.  It is a borough of largely young people with an average age of 34.  There is a severe shortage of nursing home beds which has been aggravated by the closure of a home with the loss of 53 beds.  Even before the closure there was a deficit of 20 per cent. Such is the demand that there are only three empty beds at any one time.  Inner boroughs such as Hackney also export residents to Waltham Forest.

The CCG and the local authority in effect compete for beds.

A further element is the nature of the registered care market, which is characterised by low pay and variable quality.  The longer term solutions lie in the direction of creating an integrated system that helps people to move back home and live there as long as possible.

There are three key programmes underway:

·         Market development, involving provision of a new nursing home and joining up suppliers better.

·         Rehabilitation and reablement, especially for people with neurological conditions, some of whom are at Whipps Cross Hospital waiting for beds. 

·         Discharge Pathways: a support system that includes assessment and a team to support people to leave hospital and be looked after in the community.

The Chair thanked Mr Hankins for a useful report.

Linzi Roberts-Egan underlined the overarching need to address the overall number of beds.  She warned that it was in essence an issue of volume. There would be no immediate solution, particularly given the trend for home care hours and beds being handed back by suppliers struggling financially.  Furthermore, the redevelopment of Whipps Cross was fundamental in the drive to allow residents to stay at home as long as they could.  She told the Board that the answer lay in the room, and it was their duty to influence the decisions that needed to be made.

Brenda Pratt agreed, and said that it was up to the Council and the CCG together to address the matter systematically and fundamentally.

Lucy Shomali reminded the Board of the practicalities of identifying sustainable sites and providing buildings, and the challenge of knowing when a facility was going to close.  In this context, Alastair Finney added that the redevelopment of Whipps Cross was a long-term project and future needs needed to be factored in here and now.

Jane Mehta believed that much of the difficulty lay in the current organisation of primary care.  Too many beds in Whipps Cross were not being used for acute care and resources needed to be moved around to achieve a degree of shift.  Current organisations were inflexible, systems were rigid and furthermore there was a shortage of cash.

The Chair observed that sadly, the silence that should have been a lively discussion spoke for itself.

Ms Roberts-Egan concluded that, although this discussion had happened several times, the narrative  ...  view the full minutes text for item 4.



What is your ask of the Board and its partners in supporting the successful redevelopment of the Whipps Cross hospital site?


Consideration was given to a report by Alastair Finney, Whipps Cross Redevelopment Programme Director, Barts Health NHS Trust.

Mr Finney introduced the report and said that the arguments and vision for the redevelopment of Whipps Cross were well-rehearsed, thanks to the work of the partnership as a whole and not just Barts.  He also reminded the Board that one third of people treated there came from Redbridge and West Essex. The basic challenge remained the growth of an ageing population.

Site and vision - The site covers 18 hectares or 180,000 square metres, and provides an unrivalled opportunity to co-locate the full range of non-acute health services, along with accommodation for key workers and other residential development.  However, this all depends on approval from NHS England.

In terms of the community, Mr Finney said a Community Involvement Group was being established with the goal of genuine participation.  He also drew the Board’s attention to the joint work with the Council’s Planning and Property Teams towards the ‘One Public Estate’ concept.

Lucy Shomali added that the partnership was working together to integrate a very large and indeed underdeveloped site into a growth hub within the community, and the prospect was exciting.  A masterplan would be ready in six months.

Maintaining Momentum - Councillor Miller cautioned that the Board should be mindful that this will be a long and drawn-out process: it was important not to lose ambition or the goodwill and aspirations of residents, for example by an over-emphasis on housing.  The focus must remain on world class health care.  The Chair referred to success of the Love Whipps Cross campaign in building support, but shared the concerns about losing momentum.

Integration of systems - Dr Ken Aswani stressed that the future of Whipps Cross must be mirrored by a fully integrated system of health provision entailing different ways of working.  Many existing systems and pathways can be changed and reformed now and in preparation, without having to wait for a new building.  He gave the examples of new approaches to end-of-life care and the need to support people in the community, with spending patterns adjusted accordingly; and of greater emphasis on rehabilitation to keep people from going to hospital in the first place.  Too often, a frail, elderly person will go into hospital for a few days, deteriorate, and spend several weeks there.  The basic systems had to be right.

Public involvement - Althea Bart referred to a meeting of the Health and Wellbeing Forum at Chingford, where the feeling was that there were not enough answers to basic questions about the future of Whipps Cross, including the evidence base, and the engagement and involvement strategy, which she asked to be shared.  The Forum passionately wants to be involved in the design brief for an excellent hospital.  She also advocated a role for the voluntary sector in the project, and asked what the Board could do to secure a positive response from NHS England.

Holistic approach - Russell Carter  ...  view the full minutes text for item 5.



How is this JSNA approach and form different from previous ones? How are partners engaging with the process?


Consideration was given to a report by Jonathan Cox, Public Health Consultant.


Mr Cox introduced the report, and outlined the differences between the previous JSNA, which was developed as a single, static, large needs assessment at a single point in time on paper, and the new one, which is a dynamic web-based version enabling the Board to track emerging trends against the priorities for 2018-19.  It therefore has greater interactivity and search capacity, with dynamic graphs and charts to assist health and social care commissioners understand future needs.

It was noted that all services will use the JSNA, and it will help avoid duplication of work while ensuring a collective focus on the demographic challenges.

Prevention - Dr Aswani welcomed the emphasis on prevention of disease through activity, lifestyle and diet.  As people get older, they are likely to have more health conditions, and the JSNA points to strengthening the links between health and social care.  Mr Cox said that while the assessment could not encompass all the complexities of morbidity, the consistency of approach goes a long way to providing consistency in the organisation and structure of services.

Representation - The Chair noted that while internal representation on the steering group was good, but wondered whether there was greater scope for external involvement.  Mr Cox agreed that the more local and inclusive the membership the better. Waltham Forest Healthwatch was involved, and Community Waltham Forest would be invited to attend the Steering Group and to advise of how community and voluntary sector organisations can contribute to the refresh process.


The Board:

(a)  approved JSNA refresh approach outlined in this paper; and


(b)  approved priorities for JSNA chapters in 2018/19.




How should the PNA inform local commissioning?

Additional documents:


Consideration was given to a report by Jonathan Cox, Public Health Consultant.


Mr Cox introduced the report, and explained that the Pharmaceutical Needs Assessment enables NHS England to make decisions on the provision of pharmaceutical services, including dispensing and review of new medication. 


The Board’s attention was drawn to comments made by respondents referred mainly to the lack of stop smoking services, blood pressure monitoring and phlebotomy services in pharmacies.  Currently these services were provided using other models and there were no plans to commission these services through pharmacies.


The overall assessment was that there is sufficient access to services, and provision is adequate to cope with population growth.


Consistency - Althea Bart said that the Health and Wellbeing Forum had discussed provision and noticed the differences between different community pharmacies.  The Forum wished to be involved in further discussions.

Mr Cox acknowledged that not all pharmacies provide the same level of service.  The aim should be more consistent and high quality pharmacy provision.  If access becomes an issue, the PNA can be refreshed: it is not set in stone for the next three years.


Dr Tonia Myers said that the Board needs to look at the wider implications and opportunities for pharmacies, which needed to be supported to provide a wider range of services, for example chlamydia testing.  She also regretted the widely different prices for non-prescription medicines, for example Vitamin D pills, which could make a key contribution to good health.

Ms Roberts-Egan supported all measures that would assist residents to make good choices and also reduce health inequality.

Maximising potential - Dr Aswani said that the potential of pharmacists is often underused.  Of the many calls to 111, he estimated that a good proportion could be avoided by a trip to the chemist, be that for urgent care or minor illness.  He also said there should be increased effort to reduce waste: shelves of unused medicines are often discovered in people’s houses.  There were issues of patient safety caused by the interaction of several medicines from different sources.  Also a priority was the risk to the frail elderly as a result of confusion and forgetfulness.

The Chair observed that some pharmacies helped people manage their medicines, while others did not provide the service, and the Board agreed with Ms Bart that this was a potential source of health inequality.

Brenda Pratt felt that the role of good pharmacy provision was so key to health that pharmacists needed to be integrated into local leadership and involved in designing services.  This should be reflected in the Joint Strategic Needs Assessment (JSNA).

Members believed that the discussion had given rise to some interesting points that deserved further exploration, and agreed with Dr Khan’s suggestion that a representative of the North East London Local Pharmaceutical Committee should be invited to a future meeting.



The Board:


(a)  agreed publish the Pharmaceutical Needs Assessment in line with its statutory duty;

(b)  agreed that the PNA be refreshed annually in line with  ...  view the full minutes text for item 7.




Consideration was given to a report by Jane Custance, Director of Strategic Planning and Development LBWF and Carl Edmonds Deputy Director Strategic Commissioning WFCCG.

Jane Custance introduced the report and updated the Board on progress with healthcare delivery and GP provision in Waltham Forest. The report focused on the key priority areas where the needs are greatest due to the estimated population growth.


The Council has been working in partnership with WFCCG to improve healthcare provision across the borough, both to deal with identified issues about the quality of the estate and also to provide increased capacity.  The CCG produced an Estates Strategy in 2016, reviewing GP and other health provision across the Borough and proposed the creation of Hubs and Networks as a way of addressing population and healthcare transformation challenges in the borough.

Eight Network Areas are proposed grouped around purpose-built facilities.  Work is also underway to provide integrated health care at the redeveloped Town Hal Campus and to reprovide the obsolete St James surgery using Council-owned units.


Ms Custance said that the current machinery could deal with the historic pattern of population growth, but not the new, major housing growth where health provision lags behind.

Ms Roberts-Egan referred to the challenge posed by GP surgeries that are essentially small private businesses, and not geared to provide the full range of high-quality, large scale services that residents deserve.  It is frustrating when health provision is apparently secured through planning gain, only to see it founder on the Heads of Terms: this is not in the spirit of partnership and exposes the capacity of the current model of GP provision.  Councillor Miller added that the Council wants to see a surgery to serve the new housing around Lea Bridge Station, but no-one has come forward.

Dr Anwar Khan, as Chair of the Joint Commissioning Committee, said they had considered the state of GP provision across North East London.  He agreed that new surgery premises should not be built on the present model.  The need to reflect integrated care teams and the latest that IT has to offer.

Ms Roberts-Egan said that despite the high principles around the table, the list continues to grow and the principles must translate into firm commitments.  For all the effort that went into provision at Sutherland Road, residents are still not receiving high-quality services.  Ms Shomali agreed, and said that despite rational long-term planning, integrated facilities were not appearing in Waltham Forest as they should.


The Board noted the report.   




Consideration was given to a report of the Public Health Team, which was briefly introduced by Joe McDonnell.




The Board noted the Health and Wellbeing Scorecard and agreed to use it as a basis for reviewing performance across the three domains of the HWB Strategy.



(a) Children’s Healthy Weight

(b) End of Life Care

(c) Drug & Alcohol and

(d) Mental Health


RAG-rating and narrative on progress (challenges, barriers and next steps)


(e) Priority Refresh

Additional documents:


Consideration was given to a report by Neil Young (Strategic Board Coordinator.


Mr Young briefly introduced the report, which brought to the Board’s attention the updated action and work programmes being developed in multi-agency partnership task and finish/ steering groups across four thematic areas for 2017-19.




The Board noted the progress of its  four task and finish/steering groups working on cross-cutting and Health and Wellbeing Board specific priorities as follows:


  • Children's healthy weight
  • End of life care
  • Alcohol and drugs
  • Mental wellbeing



SECTION 106 REQUESTS pdf icon PDF 253 KB

Additional documents:


The report of the Public Health Team related to the use of Section 106 monies for the Breastfeeding Welcome Scheme and the installation of a gym at Chingford Children and Family Centre, 5 Oaks Grove, Chingford E4 6EY.




The Board approved the use of Section 106 monies as recommended.




Ms Robert-Egan said that given the gravity of the issues discussed at the meeting, the lack of contribution from a number of those present had been noticeable.  Dr Aswani agreed and said that the will for change and the realities on the ground called for an end to procrastination.