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Agenda and minutes

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

Contact: Christopher Foxton, Democratic Services Officer  020 8496 4204 Email:

No. Item




No apologies were received.




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.


There were no declarations of interest.




To approve the minutes of the meeting held on 11 December 2018.


The minutes of the meeting held on Tuesday 11th December 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.




Terry Day of the NE London Save Our NHS made a statement regarding Barts Health, the policy concerning ID checks and the risks of charging residents for services incorrectly. It was highlighted that the homeless and migrant patients were particularly at risk in this respect. Terry Day encouraged the committee to review current policy and practice at the Trust.


Mary Burnett of the Waltham Forest London Save Our NHS raised concerns on the financial issues, additional pressures to current services and of the number of beds proposed in the Whipps Cross redevelopment plan.


The Chair thanked the public speakers for their contributions and said that there would be a written response to both of them.




Additional documents:


Consideration was given to a report from the Scrutiny Officer.

Mr Spragg introduced the item, highlighting the actions that had been raised following the meeting with Waltham Forest Child and Adolescent Mental Health Services (CAMHS) in December. The report also had responses in regards to homelessness and health and the Better Care Together programme.


He also indicated that the final meeting of 2018/19 would include the draft report of the themed review .for final approval. There would also be a follow up item on the themed reviews of 2017/18.


The Chair indicated that the Committee could expect an upcoming update from Brenda Pratt, regarding the Children’s and Maternity Portfolio of the Better Care Together programme, as indicated in the response in the report.


The Committee noted the report.




Additional documents:


Consideration was given to a report from the Redevelopment Programme Director of Barts Health Trust. Mr Finney introduced the report and outlined a number of key points that were being taken into account as part of the redevelopment programme.


He said there needed to be an agreed vision for the hospital, that this intended to be a re-provision of an acute hospital as part of a health and wellbeing hub which would help deliver integrated care to local residents. He added that there were a number of options being looked at in terms of efficiently using the estate, which would include building affordable housing.


Mr Finney noted that, although the strategic case for the redevelopment had been approved two years ago, the business case had yet to be approved by NHS Improvement. He said that the redevelopment would need to demonstrate affordability and financial viability, and that staff were developing the business case with this in mind. He also noted that it was important for there to be broad engagement with staff at all levels and the public to develop services that reflect needs.


Community Engagement - Councillor Flowers asked if there was a timeline for community engagement and if it would reflect local demographics. Mr Finney replied that the first group recruitment had been completed and they would assist in recruiting further groups to influence the work programme. The Trust was also working with the Health and Wellbeing Board and setting up a new community engagement group. Councillor Flowers noted that this group could help involve residents who may be harder to reach.


Disruption to Care - Councillor Mbachu asked if a plan was in place for the continuity of care during the redevelopment. Mr Finney said that while the project may still be three or four years from beginning, a number of options were currently being considered which may include construction of some of the proposed new buildings and decanting into them. He added that the Trust wished to learn from previous hospital redevelopments and involve clinicians in these plans to inform them of any potential risks.


Housing - Councillor Sweden asked if there were plans to offer housing provision for staff who may be unable to afford housing in the borough. Mr Finney said that there currently was an unused nurse’s home that would be redeveloped as part of the scheme. Another part of the redevelopment plans involved looking at the provision of affordable housing that would be intended for hospital staff and local key workers.


Bed Occupancy - Councillor Sweden also asked about the projections for bed occupancy, following the concerns raised by Ms Burnett earlier, and if there were any plans for alternative services. Mr Finney said that approving a business case is difficult if there are undeliverable assumptions. According to the ten year plan, the plan requires a projection of bed occupancy which will be tested for robustness and capacity looked at. Mr McDonnell added that a shared perspective of provision would be developed  ...  view the full minutes text for item 16.




Consideration was given to a report from the Associate Director of Strategic Commissioning, WFCCG and LBWF.


Ms Anjum introduced the report highlighting the collaborative work of the Council, WFCCG and the voluntary sector to tackle the challenges facing CAMHS. Additional funding for new digital services had been secured by young advisors. She also updated the Committee that waiting times for assessments had been improved further since the publication of the report and currently stood at:


Neurodevelopmental: 14 Months

Emotional (Psychology): 10 Months

Behavioural:  7 Months

Triage – Access and Brief Intervention: 3 Months


Mr McDonnell said that the recent ‘Time to Talk’ day on 7th February 2019 had helped inform the Young Persons Mental Health Charter and young people in the borough were making commitments around emotional health and wellbeing. Officers were making sure schools had variable options available to them including suicide prevention and mental health first aid training.


Waiting Times - Councillor Mbachu asked if there was baseline for reasonable waiting times and Ms Anjum said that it was currently 18 weeks. Councillor Saumarez asked if there was timeline to reaching reasonable waiting times. Ms Anjum said that there currently was none, but staff had been working closely the North East London NHS Foundation Trust (NELFT) and she hoped to provide a better idea of this by April/May 2019.


Councillor Mbachu asked if there was any provision for families waiting for assessment results. Ms Anjum said that threshold documents which had been commissioned by the Council had been created which provided information on specialist care and contacting those on duty. Councillor Saumarez asked about staffing levels and she said that they were currently fully staffed


Councillor Saumarez asked if there was any data linking school exclusions to acute mental crises as the Committee wish to improve the joining up of services. Mr McDonnell said that there had been efforts to link various factors with access to mental health services and noted that had been some disparity in terms of ethnicity and those who access services. Trauma informed approaches around persistent non-attenders in schools, would also help provide more data.


Funding - The Chair asked if there was any engagement work with NHS England to secure future funding. Ms Anjum said CAMHS did not currently receive any ring-fenced funding from NHS England. She added that Jane Milligan, the Accountable Officer for the NE London CCGs had briefed NHS England and was lobbying for additional funding.


The Committee agreed the following actions;


·         That services provide an update on the work undertaken to understand how different factors influence service responses to poor mental health.


·         That the committee receive an update on efforts to engage with NHS England about increased funding for CAMHS.


·         That the committee receive an update setting out the optimum performance the commissioner and providers expect to achieve given the present funding levels.





Consideration was given to the report of the Director of Public Health and Assistant Director of Adult Mental Health & Learning Disability, NELFT. Mr McDonnell introduced the report.


Ms McBrearty had been invited to share experiences of providing health services for the homeless in the London Borough of Westminster, which she noted had the largest number of homeless people in London. She explained that Central London Community Healthcare had a team of six nurses with assessment skills working in day centres to help reduce barriers to services.


She said that the average age of death for a rough sleeper was forty seven years old for a man, forty three years old for a woman and thirty eight years old if that person was a drug user. Those who were homeless were also thirty five times more likely to commit suicide than the general population.  She added that CAMHS were relevant to the issue as homelessness can be rooted in adverse childhood.


Ms McBrearty said that there were a number of misconceptions that those who were homeless had about access to healthcare. The most common of these was the requirement of identification or a permanent address to register with a GP which is not the case.


She explained that one of the barriers to healthcare access had been the increased workload at GP practices, which had created time pressure constraints, making many who were homeless felt that they would not have the time to address all of their needs.  She added that the day centres did not have appointments and functioned as a ‘drop-in’ service to help combat this perception. 


Continuity of Care - Councillor Mbachu asked Ms McBrearty how continuity of care was ensured at the drop-in centre. She replied that the centre was part of a community trust and worked closely with number of services and organisations such as St Mungo’s, but said there would be occasions where a homeless person would return to a centre and occasions where they don’t. This is sometimes due to an experience of help received by a homeless person that is felt to be ‘toxic’.  She added that one of the roles of the assessment nurses team was to try to break down misconceptions created by ‘toxic help’. In regards to providing medication for heroin misuse, nurses had access to Naloxone, which could also be provided to families in the event of an overdose.  


GPs and registration - Councillor Saumarez asked if there were any specialist GPs involved with the drop-in centre who engaged with those who are homeless. Ms McBrearty said that there was two GPs who worked in the Westminster area and ran ‘walk-in’ clinics.  Staff had been trying to create a welcoming atmosphere, but registration had still sometimes been a barrier. She added that the engagement had to come from those who are homeless, but they try to make it as easy as possible. Centres had been creating a psychologically informed environment (PIE), as behaviours can occasion be challenging and even  ...  view the full minutes text for item 18.