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Agenda and minutes

Venue: Committee Room 2 - Waltham Forest Town Hall. View directions

Contact: Chris AC Baker, Democratic Services Officer  020 8496 4204 Email:

No. Item




Apologies were received from Councillor Richard Sweden. Councillor Steve Terry substituted for him.




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 Anna Mbachu declared a non-pecuniary interest as she and her partner both worked for Barnet, Enfield and Haringey Mental Health Trust. This does cross-London working with NELFT.




To approve the minutes of the meeting held on 10 July 2018.


The minutes of the meeting held on10 July were agreed by the Committee and signed by the Chair.




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.




There were no requests from the public to speak.


The Chair reminded everyone that today was World Mental Health Day.




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Aysha Patel said the report included how the homeless can access health services.


The Chair asked why access to GPs by the homeless was not routinely monitored by the CCG. Aysha Patel confirmed that GPs often did not record whether patients were homeless. The Committee was informed that the CCG estimated approximately 10 - 54 homeless people accessed services per month. It was highlighted that individuals could complain about a GP if they were refused access on account of being homeless, though councillors commented that this may not be a process familiar to vulnerable homeless people.


The Committee was informed that there had been little uptake for the hubs on Sundays. Councillors were supportive of Sunday opening hours for the hubs, and it was commented that there should be more done by GPs to promote weekend opening hours.


Councillor Terry noted that the graph on page 34 showed that Waltham Forest GP practices were below the national average, and queried whether there was a timetable for improvement. Aysha Patel explained that the CCG produced an action plan where GP services were identified as requiring improvement by the CQC (Care Quality Commission), and she would bring a case showing where the CCG had supported a GP following a CQC inspection. It was highlighted that a Quality Improvement lead was responsible for supporting GPs in this respect.


Councillor Flowers asked whether the CCG had evaluated the impact of Brexit on the GP workforce. Aysha Patel replied that the CCG had not undertaken specific work, though NHS England was currently undertaking an evaluation at a national level. Councillor Saumarez expressed concern about how the Single Point of Access pilot would impact on patients with complex needs, particularly in ensuring they were seen by a GP with an understanding of their medical history. Aysha Patel commented that the Single Point of Access pilot was intended to create additional capacity for GPs to see patients with complex needs, and to ensure that people were appropriately triaged. It was also highlighted that the hub model would reduce the demand for routine or emergency appointments, enabling GPs to spend more time with patients with complex needs. The Committee stressed the importance of ensuring patients were given a range of suitable options in terms of accessing their GP. 




a)    That the CCG actively promote the complaints procedure to homelessness health charities to ensure people unable to access services know how to raise their concerns.

b)    That the CCG undertake additional communications to promote GP services on Sunday in order to maximise uptake.

c)    That the CCG undertakes modelling to assess the possible impact of Brexit on its GP workforce.

d)    That the GP Single Point of Access pilot ensures that it is consulting vulnerable groups, such as older people and the homeless, to ensure that the new model meets their needs.

e)    That the CCG demonstrate its compliance with the commitments required by the London Homelessness Health Programme (for the final themed review).




a)    The  ...  view the full minutes text for item 5.




Joe McDonnell introduced the report, and informed the Committee that at the end of March 2018 there were 2896 adults and 4291 children who were homeless and who were the responsibility of Waltham Forest. It was noted that information on their access to health services was not routinely recorded, particularly for those placed outside the borough where health services were the responsibility of the hosting authority. It was highlighted that residents placed outside the borough were provided with an information and advice pack on how to access health services, though this had not been reviewed by Public Health.

Shumon Ali-Rahman queried the ethnic composition of the homeless population in Waltham Forest, and asked how it compared to other London boroughs. It was commented by officers that ethnic minorities were often at higher risk of being made homeless, and that the trends were broadly similar across London boroughs, though no specific comparisons had been done.

The Chair commented that she had met with the voluntary organisation Feet on the Street earlier in the day and a number of areas for improvement had been identified including access to dental services.

A number of Committee members asked about continuity of records for those housed in other boroughs - for when they were placed outside and for when they returned. Joe McDonnell commented that this depended on individuals registering with a new GP.

In response to a point from Councillor Flowers, Joe McDonnell said that those without recourse to public funds may include asylum seekers; they were entitled to emergency and primary care.

The Committee discussed vaccinations. Witnesses were not aware of specific efforts to target the homeless and rough sleeping population. Members commented that this should be considered a priority, due to the high vulnerability and risk of infection amongst this group.

Councillor Pye commented that voluntary sector partners and Council officers needed training to spot the signs of sepsis, based on an experience she shared with the Committee regarding a resident. She also requested that the Children and Families Scrutiny Committee which she chairs be copied in to any relevant reports, given the high number of children that are considered homeless.



a)    That Public Health provides additional analysis on the ethnic breakdown of the homeless figures and how this compares to the borough’s statistical neighbours.

b)    That Public Health review the information packs provided to those placed outside the borough in respect to accessing local health services.

c)    That the Committee engages with dental care providers as part of its Themed Review.

d)    That the CCG and Public Health work together to assess the number of homeless accessing health services, and this forms a component of future Joint Strategic Needs Assessments.

e)    That the CCG and Housing provide a response on how continuity of care is provided for those moving back into the borough.

f)     That the CCG and Public Health review the extent to which best practice guidance has been adopted.


Possible themed review recommendations for the final report  ...  view the full minutes text for item 6.



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The Chair welcomed the impressive work of the Young Mental Health Ambassadors (YMHA), and the quality of the report.


Abdur-Raheem informed the Committee that the project wanted to raise awareness of young people’s mental health, and to highlight how young people experience the services that were intended to support them. It was pointed out that young people wanted a safe social space to attend. The Committee was informed about the project’s various successes, including the number of young people who were considering becoming YMHAs.

The Chair commended the report’s six recommendations, and asked the Committee to endorse them. It was noted that the Chair would write to the relevant partners asking that they respond to each of the recommendations.

Jane Brueseke highlighted the value of peer to peer work, saying that young people often found it easier to discuss issues with other young people who had similar experiences. It was highlighted that professionals were also available if people needed additional support, or were concerned about a disclosure. The Committee was informed that the YMHAs were feeding into the specification for an on-line service.

Nuzhat Anjum said she was proud of the YMHA programme which WF CCG supported, and that the young people’s feedback had been useful in planning and delivering services.


The Committee endorses the recommendations of the report.  It will write to the relevant services and Directors to ask them to provide a response to the Young Mental Health Ambassadors, and to this Committee.




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The Chair reminded the Committee that the services were intended to support vulnerable young people, including those at risk of self-harm or suicide. It was noted that a supplement report had been published for the Committee a few hours before the meeting, highlighting actions intended to reduce the delays being experienced by young people referred to the service. The Chair highlighted that Waltham Forest ranked 28 of the 30 areas listed in the report.  She commented that the average level offunding per person in London was £104, while in Waltham Forest it was £59.


Nuzhat Anjum commented that she had written the supplement report in response to specific concerns raised by the Committee Chair. She informed the Committee that the Waltham Forest Council Deputy Chief Executive and Leader had both expressed concern regarding the current waiting times. It was highlighted that a business case was in the process of being drafted. The Committee was informed that the CCG were under considerable budgetary pressure, and the funding levels reflected savings needed in order to balance its budget. It was highlighted that when the capacity issues came to light, NELFT had put in place a mitigation plan. The Committee was informed that the Trust continued to contact families every 6 to 12 weeks, with scope to prioritise high risk cases. The business case, if successfully signed off by the senior leadership of the CCG, would see additional staff recruited to manage capacity.


Councillor Pye asked what the Task and Finish Group had achieved. It was commented by witnesses that the Task and Finish Group had initially assessed impact, auditing the waiting list and caseloads to ensure children were not placed at risk by the mitigation measures. Councillor Pye highlighted that the risk and mitigations did not include consideration of what would happen if the business case was unsuccessful, or if funding continued to prove inadequate for needs. She also commented that she would want to see the CCG benchmark its referral times to ensure it was setting a goal for its improvements.


Joe McDonnell said that the Task and Finish Group had looked specifically at operational and clinical issues, and longer term issues were now being considered by the CAMHS Board.

Councillor Pye requested an update showing how the commissioners and providers managed the three top risks, and a clear trajectory for short-term improvements. In addition she asked for an assurance that increased funding would deliver improvements, querying why funding was less than other CCGs in London.


Councillor Walker said that the figures were unacceptable, for example delays of 19 months. He wanted an assurance that any additional funding provided for CAMHS would be protected. Nuzhat Anjum explained that the government had not ring-fenced transformational funding for CAMHS, and the figures had been built into the CCG’s base budget.


Councillor Naheed Asghar asked a query about what work had been undertaken to ensure that the provider was providing value for money. Joe Lindo commented that NELFT provided the best possible service,  ...  view the full minutes text for item 8.




Joe Lindo left the meeting.


Joe McDonnell said there were three main component services under the Young People’s Specialist Early Response Service (YPSERS). The model the Council had commissioned was intended to improve integrated working. The Committee was informed that NELFT had been awarded the contract from April 2018, though over the next six months it had become apparent that it was unable to deliver the new model, such as the fast track element for Looked After Children. Joe McDonnell expressed the view that the service had not adapted to respond to the specialist needs for which it was commissioned. The Committee was informed that the officer-recommended option to Cabinet was the third one in the report, which was to terminate the current contract and seek to retender through an alternative provider or providers. This would be considered by Cabinet in November 2018. The Chair requested that the link to the Cabinet papers and decision be circulated to the Committee.




That the Committee receives the Cabinet report and a update on the future of the Young People’s Specialist Early Response Service.




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The Committee noted that there were a number of items for the next agenda. At the suggestion of the Scrutiny Officer, the Chair agreed to ask Budget and Performance Scrutiny Committee to review the impact of the reduction in the Public Health grant at a future meeting.