You are here:

Agenda and minutes

Venue: Committee Room 3 - Waltham Forest Town Hall. View directions

Contact: Holly Brogden-Knight, Democratic Services Officer  020 8496 4211 | Email:

No. Item




An apology for absence was received from Shumon Ali-Rahman, Co-opted member.



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


Councillor Sweden declared a non-pecuniary interest as he is managed, but not employed, by NELFT.



To approve the minutes of the meeting held on 27 March 2018.


The minutes of 27 March 2018 were signed and approved as a correct record.


Matters Arising:

Page 10

Members had requested that the cause of the drop in self-harm hospital admission data discussed at the January meeting be revisited, and asked whether this was due to a reduced service or different pathways, and was it an appropriate drop or a risk. Joe McDonnell, Director of Public Health, stated that there had been follow ups with Whipps Cross Hospital and the CQC (Care Quality Commission) and was confident the drop is due to new pathways to admission – where previously patients were admitted before treatment, now, generally treatment is administered before being admitted.


Action Tracker

The Chair had written to Waltham Forest CCG and Waltham Forest CAMHS (Child and Adolescent Mental Health Services) regarding referrals and found the response unsatisfactory. It was recommended that Andrew Spragg, Scrutiny Officer, shared the information and follow up with the new Committee following the Councils Annual General Meeting.




Members of the public are welcome to participate in scrutiny meetings.  You may speak for three minutes on a topic related to the Committee’s work, and fifteen minutes in total is allowed for public speaking, at the discretion of the Chair.  If you would like to speak, please contact Democratic Services (details above) by 12 noon on the day before the meeting.








Jonathan Cox, Public Health Consultant, introduced the report, which set out updates on progress to recommendations made regarding End of Life Care commissioning and provision.
Mr Cox explained that there were two working groups transform End of Life care:

·         Waltham Forest End of Life Care Transformation Board made up of clinicians and managers.

·         A non-clinical task and finish group working on coordinating information and communication.

Mr Cox added that there had been a restructure of the End of Life task and finish group to work on the following specific areas:

·         Comprehensive needs assessment.

·         A piece of work around renewing contracts, for example with care homes.

·         A work stream for training on needs development within healthcare staff.

·         A piece of work surrounding rapid access to social care services to ensure death happens in preferred location.

Councillor Rackham asked for information regarding out of hours support and clarification on what kind of service was available. Mr Cox answered that the Transformation Board were aiming to redesign the support available to ensure there is specialist palliative care accessible 24 hours a day.

Councillor Walker asked what information was available regarding carers and surviving family members, specifically regarding death at home. Mr Cox answered that the need for support for those groups had been identified and the Transformation Board were engaged with people using bereavement services, including relatives, to ensure we get the information required to shape that support.

Councillor Mitchell asked for clarification regarding CMC (Coordinate My Care) and how it was working in terms of uptake and response, as ability to share plans was critical, and asked what activities were taking place within the general population to highlight it. Mr Cox explained that, with regards to highlighting, there was a ‘Dying Matters’ awareness week in May, but there was a need to be clear with how we can engage people in the Borough. In terms of CMC he explained that there was a pilot of its usage in Chingford and that the next challenge was to roll it out across the entire Borough, but there was some IT work to do and some information governance issues to overcome.

Councillor Sweden expressed concern regarding whether patients approaching the End of Life that did not have cancer were getting inferior care than those with cancer and asked whether the Clinical Transformation Board were working with hospices and other providers, such as Marie Curie Cancer Care and Macmillan Nurses. Mr Cox stated that only 50% of those on the GP Palliative care register had cancer so there was work around all areas and explained that the Clinical Transformation Board were looking at all areas of End of Life, not just oncology. Linda Finch, Associate Director Strategic Commissioning - Waltham Forest CCG, explained that Macmillan Nurses are involved at Whipps Cross Hospital and are proactive in coordinating care plans.

Councillor Sweden also expressed concerns about bereavement services for children and the lack of use of volunteers in End of Life care and referenced paragraphs 16 and  ...  view the full minutes text for item 5.


GP ACCESS pdf icon PDF 123 KB

Additional documents:


Aysha Patel, Head of Primary Care – Waltham Forest CCG, introduced the report, which included the following topics:

·         How different types of contracts work.

·         How the CCG plans to improve GP access, including extended access.

·         Issues facing GP practices, for example increased demand.

·         Patient satisfaction rates.

Ms Patel concluded that there was a clear need for change, and that funding from GP Forward View may enable that going forward.

Councillor Rackham asked why clinical notes are not available 24 hours a day, and suggested that they could be if an automated system was used. Ms Patel stated that 24 hours access had been commissioned and explained that currently GP Access Hubs have access to records from 6.30am to 9.30pm and that all OOH (Out of Hours) and UCC (Urgent Care Centres) have access to records 24 hours a day.

Councillor Rackham asked if other services can access records from GP services and whether patients would, through record sharing, be able to use GP facilities in other Boroughs. Ms Patel explained that a system to allow record sharing was being developed but there were information governance issues. Currently when a patient goes to any point of care they need to give consent for their records to be seen. With regards to using facilities in other Boroughs, there is work looking into a North London footprint but it was a complex issue with funding, for example.

The Chair asked if a patient could be registered at two practices. Ms Patel answered that it was not possible due to funding streams – practices are paid a fee per patient a year. Currently funding to practices is based entirely on list size, but the Carr Hill formula could be used to weight them.

Councillor Sweden asked if there were practices that don’t meet reasonable needs of patients. Ms Patel clarified that contractual reports were vague on what meeting needs looks like, but there were sanctions that could be put in place for practices that were not meeting their contracts, for example shutting on a Thursday afternoon.

Members of the Committee raised concerns regarding ease of contacting GPs, both by telephone and electronically, suggesting that there are a limited number of appointments available to be booked online, for example, and that GPs rarely have or use email. The Chair suggested telephone triage could be useful for limiting numbers of patients actually visiting practices potentially unnecessarily, and therefore making more actual appointments available.

Ms Patel explained that the CCG had invested in commissioning a platform for GPs to use online services, which may take some time for GPs to start using. Ms Patel explained that, with regards to telephone triage, it was different at each practice – some use it and also have telephone consultations, and some choose not to. At this stage practices can’t be forced to conduct them but once protocol regarding telephone consultations is changed nationally it will trickle down to the local area. She emphasised the need for the community to feedback  ...  view the full minutes text for item 6.



Additional documents:


The Chair spoke briefly on the themed review and thanked all involved for a really good report comprising of 17 recommendations. He stated that the report should now go to Cabinet for approval and work should start as soon as possible.


Councillor Sweden suggested that it also be reviewed by the Health and Wellbeing Board once all new positions are known.



The Committee unanimously agreed on the report and thanked Andrew Spragg, Scrutiny Officer, for his work and thanked all contributors.




·         That the report is presented to the relevant Cabinet member and goes to the Health and Wellbeing board as soon as possible post-election.




Additional documents:


The Chair highlighted the mental health discussions from the September 2017 meeting and suggested that mental health training should occur with all new councillors.
Mr McDonnell referenced ‘Time to Change’ hubs and explained that Waltham Forest had the only funded hub in London. The Chair requested that the Committee have an update in six months’ time.


Regarding recommendation 7, on page 67 of the agenda pack, which suggested a  focus on school leavers resilience and  risk training around substance misuse, Mr McDonnell explained that this had not been identified as a need but was happy to take back to the Public Health team if that was what the Committee wanted.




·         That in six months’ time the Committee are provided with an email update on the ‘Time to Change’ hub.


The Chair thanked the Committee and officers for their hard work.