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Agenda and minutes

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No. Item



Apologies have been received from Councillor Saumarez. Councillor Fitzgerald will be attending as a substitute on behalf of Councillor Saumarez.


Apologies were received from Councillor Catherine Saumarez. Councillor Marion Fitzgerald attended as a substitute for Councillor Saumarez.




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 was managed, but not employed by the North East London NHS Foundation Trust (NELFT).


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




To approve the minutes of the meeting held on 10th October 2018.


The minutes of the meeting held on 10 October 2018 were approved by the Committee as a correct record 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 for public participation.


The Chair asked the Committee if the agenda order could be varied to allow the witnesses from Barts Health to leave earlier if they wished and it was RESOLVED that item 10 – Health Services for the Homeless would be taken after item 6 – Hospital Discharges and how system partners work together.




Additional documents:


Consideration was given to a report from the Scrutiny Officer.


Andy Spragg introduced the report noting that the report contained responses from the CCG following the last Committee meeting.


There would also be a follow up meeting with the Chair, Vice-Chair and CCG regarding the recommendations for the Child and Adolescent Mental Health Services (CAMHS). This meeting would be minuted and notes circulated to the Committee for information.


The Committee noted the report.





Consideration was given to a report from the Associate Director of the Waltham Forest CCG.


Kelvin Hankins introduced the item, outlining the range of priorities from section 6 of the report. He said that in 2018 a partnership review was commissioned to highlight key areas that needed to be improved.  He added that the priorities aimed to help improve discharge figures and work more collaboratively with system partners.


Patient Discharge - Councillor Geoffrey Walker asked how many members of staff were in Whipps Cross Hospital to assist with assessing and arranging the discharge of patients. Mr Davies said that there twelve full time social care staff assigned to the wards. Ms Madden said there were nine expert nurses and flow co-ordinators to assist.


Non-Complex Patients - Councillor Richard Sweden asked Mr Hankins to clarify the rehabilitation pathways for patients who received neurological care, particularly for those with without complex conditions.


Mr Hankins replied that the CCG had wished to develop better pathways, particular for patients that while they may not need specialised care, but require bed-based rehabilitation. The challenge that the CCG had, was the volume of patients meant that current pathways were not cost-effective, though the CCG was looking for partners across North East London.


He explained that the CCG had been looking at the potential to expand the Ainsley unit. The Committee was informed that, while it had not reached full capacity, there was still a gap in provision, as the places assigned to women were full. The unit had been reviewing options in opening up provision. The Chair asked if there would be a need for resources if there was a plan for expansion. Mr Hankins replied that if it was decided that it was needed the provider would make a business case for resources.


Discharged patients - Councillor Sweden asked if the discharge rates were affected by patients who are readmitted soon after being discharged from hospital. Mr Hankins replied that post-surgery assessments are completed within the community meet national standards.


He said that there was current work to see if any screening needs to happen in the hospital. He noted that currently some discharged patients go straight home, whilst others may go to a nursing home, this would be agreed with their families first.


If a resident, to enable their discharge, has a hospital assessed healthcare need. This will be met in either a nursing home or a home setting.  The CCG will fund this through Continuing Health Care (CHC) funding for a month pending a full CHC assessment. This assessment will determine if the longer term funding comes from ASC or the CCG.


Timescales - The Chair asked if there were any timescales for the actions identified in the report. Mr Davies said that there had been individual timeframes set against each action and these have been put in place. He said that the long-term actions had been, planned for the end of March 2019 but he planned to meet with Ms Madden to  ...  view the full minutes text for item 6.



Additional documents:


Consideration was given to a report from the Public Affairs Manager of Barts Health NHS Trust and the Senior Commissioning Manager of Urgent Care and CCG Performance.


The item was introduced by Mr Hankins, who said the core of the report looked at High Intensity Users (HIU). He said that the service helped identify frequent users who may have complex needs, coordinated support systems and created an action plan to put in place around them. The service had been running for nearly two years and while it is not dedicated to the homeless, it tended to identify where homeless people were regularly accessing Urgent Care.


Staff Morale - Councillor Sweden asked about the extent to which the service has improved staff morale, recognising that the circumstances of those who regularly attend Urgent Care can impact on staff. Ms Madden noted that all support is welcomed. They had seen increased stability in the recruitment of nurses, which is usually an indicator of good staff morale. Whipps Cross was now looking into ways to provide the stable recruitment of middle-grade doctors. Ms Madden added that the service provided the right processes for dealing with disruptive patients.


Funding - The Chair asked if there was continued funding for this service. Mr Hankins replied that there was mainstream funding provided by the CCG. He also noted that the impact of the service had saved some money that was being reinvested into other services. Mr Davies added that there was a housing officer that was also being funded by this and that there would be further reviews to monitor the impact.


A+E Pressures -The Chair asked if this had reduced the amount of phone calls to paramedics. Mr Hankins replied that the aim of the service was about admission avoidance and stopping unnecessary calls to either of the 999/111 service. Ms Madden said that there was on-going work with the ambulance service to offer more pathways to patients.


Councillor Anna Mbachu asked Ms Madden about what the biggest challenges were in meeting targets for A+E. She replied that patient demand had been one challenge as the A+E unit at Whipps Cross has a limited capacity. Other challenges included recruitment of staff and also looking after patients with complex needs.


The Committee agreed the following action:


·         That the CCG provide data on how Waltham Forest compares to other North East London boroughs in relation to high intensity users.





Consideration was given to a report from the Associate Director of the Waltham Forest CCG.


Mr Davies introduced the report and noted that the lead of each the three key systems would go into further detail.


Communities – Mr Davies said the Integrated Care System (ICS) had a range of work which interlinked with the other two programmes and was outlined in section 7.1 of the report. Care and Wellbeing pathways were important to the programme and there had been collaborative work between NEFLT and the council. There was also work around improving patient discharge outcomes.


Urgent Care – Ms Madden said the ICS was a large transformation project that had not been seen before in the UK and there was a lot of work that was still ongoing. The programme aimed to provide the best patient outcomes with A+E departments working closely with NELFT.


End of Life Care ­– Mr Finney noted that some authorities had tried to implement ICS before with little success. Mr Finney said that he felt that this was a better model as providers and commissioners had come together with a shared vision and were approaching it for the right reasons. He added that patient-centred approach was more likely to succeed where a top down approach has previously failed.


He said that the ICS was a forerunner to the redevelopment scheme at Whipps Cross hospital and developing what the hospital will look like in the future.


Savings – Councillor Walker asked about the savings from the ICS development. Mr Hankins replied that anything that had been saved had been reinvested into other services. He added that the development was in early stages and that there would be clear targets in the future. Ms Pratt said that any savings that were reported back had been looked at a segregated level, in individual services, and not the full picture, but it would be part of the future process.


The Chair asked for an update on this in twelve months’ time.


Data Sharing – Councillor Sweden asked how the barriers of data sharing across services had been overcome.


Ms Pratt acknowledged that it had been a difficult process but there had been collaboratively working to merge patient and resident information for medical practitioners can access. She said that there had been an ambition in the borough to pilot community-based records. Practitioners would have access to information from a range of services including ASC, NELFT and the CCG to see any relevant data needed. Mr Davies added that the integration would allow for more clinical input.


GDPR – Councillor Walker asked about the GDPR implications of the sharing of patient data across services. Ms Pratt said that the development had been supported by the Government’s Information Governance Steering Group. They had set up the London Health and Care Information Exchange, which moved away from needed explicit consent from each person for each service to an assumption that information would be shared across them. The adoption was being tested  ...  view the full minutes text for item 8.




Consideration was given to a report from the Associate Director of Health & Social Care Integration and Better Care Together Programme Lead.


Ms Pratt introduced the item noting that the Better Care Together programme was a transformation programme that helped create the ICS development.


Ms Pratt said that one of the challenges is the measurement of success. Data is not collected across the programme, although some organisations and services may collect individual data. She said that system requirements would be put in place, which was the same as current internal requirements to help create an inside picture to help see if services are meeting targets.


Funding - Councillor Sweden asked if the programme fund had been losing money due to Delayed Tranfer of Care (DToC) performance. Ms Pratt replied that the fund was assured for 2018/19. There was a requirement to evidence how the additional funding from the Better Care funding was contributing towards reducing the volume of DToC. The funding was at risk if this could not be demonstrated. Ms Pratt added that services were waiting on guidance for how Better Care funding would be allocated and assessed in the future.


End of Life Care – Councillor Sweden asked about the development of the End of Life Care service, noting that the service was already in place. Mr Hankins said that it was linked with the ICS. Councillor Sweden asked if the End of Life Care charter could be shared with the Committee.


Childrens Services – Councillor Walker asked if there had been any progress with respect to developing children’s services through Better Care funding. Mr Hankins said that it had been more challenging work and that had been an ambition of the programme for a while. The partnership had been working with Heather Flinders to identify areas that could benefit from Better Care funding investment, such as SEND, Safeguarding and Urgent Care.


Councillor Walker asked if there had been any reliance on funding for Child and Adolescence Mental Health Services (CAMHS). Mr Hankins said that CAMHS was important, though Better Care funding was focussed on other work streams. It was highlighted that the model for End of Life Care for children was in need of development. The Chair asked for an update once the new model had been established.


Governance – Councillor Flowers asked if there was any joint-governance across the programme. Ms Pratt said that there was recognition for appropriate, but not identical governance structures. Ms Lindsey Hyde said that there are reports that go to the Health and Wellbeing Board.


The Committee agreed the following actions:


·         That the Committee receive a copy of the End of Life Care Charter 

·         That the Committee receives an update on how children’s health and care are being integrated through the Better Care Fund and Integrated Commissioning Function.




Consideration was given to the report of the Assistant Director of Transformation and Integration of Adult Social Care, and the Programme Leader of Adult Social Care.


The report was introduced by Mr Newman who said that the function was part of a national drive, but needed to meet the needs of the borough. Since the initial report publication, Mr Newman said that the three new director posts had been recruited for and there were three new portfolios with prevention at the heart of these. He said that it was intended that leadership tier would be staffed by the 1st April 2019 and a full complement of staff by Summer 2019.


Employment Opportunities - The Chair asked how the success of finding employment opportunities for adults with learning disabilities would be ensured. Mr Hankins said that an integrated approach helped identify and reduce any barriers to opportunities, ensuring that the whole pathway for each person was considered holistically. He said that ways of monitoring would be explored. Mr Davies added that it was important that commissioning services work together to provide opportunities.


Financial Scale - Councillor Walker asked about the scale of the function and if the individual budgets would be included in the ICS. Mr Newman said that the function would have an integrated staffing model, and the Section 75 agreement was being developed for Cabinet to consider. This would propose a merge of both the Council and the CCG budgets for community services, and was estimated as a total of the budget to £170 million. He said that the Strategic Commissioning Joint-Committee would have responsibility for the governance of this budget.


Councillor Sweden asked for further clarification on the risks related to the section 75 agreement, as noted in the report.  He commented that the NHS and local authority had different financial cultures. Ms Hyde said that the agreement would cover this, though the report that went to Cabinet would not go into the same level of detail. Mr Hankins added that the Section 75 agreement would articulate how these risks would be managed.


Market Strategy - Councillor Flowers asked what the market strategy looked like. Mr Newman replied that there had previously been a statement of market provision. Since then, provider forums had been joined up and the integrated function had sought to drive innovation and diversification. It also helped provide a more organised approach, strengthening current practice and helping to manage risk. The strategy aimed at key areas such as nursing home capacity in the borough.


Mr Hankins added that the integration demonstrated the need to take action. Previously, separate systems have not helped the market and the integrated commission would stop unnecessary competition.


The Committee agreed the following action:


·         That the committee receive a report on the section 75 agreement decision prior to its consideration by Cabinet.


The Chair thanked the officers and authors for their reports and closed the meeting.