Agenda and draft minutes

In accordance with the Council’s Constitution and the ICB Sub-Committee’s Terms of Reference, Members of the Committees in Common are asked to declare any interest they may have in any matter which is to be considered at this meeting.

The minutes of the Health and Wellbeing Board and ICB Sub-Committee meeting held on 16 January 2023 were confirmed as correct.

Welcome to Jamie Postendorfen, Chair of the Just Say Parents’ Group

The Chair welcomed Jamie Postendorfen from the Just Say Forum to the meeting.

Jamie was the first resident invited to address the Committees in Common and was asked to outline her story and experiences as a local resident who used services from all those represented at the meeting.

Jamie outlined her background as a fostered / adopted child and her experiences as a carer, initially supporting her mother and father from a very young age and now caring for her 19-year-old son who had severe learning disabilities and a partner who was awaiting a diagnosis for autism.  She explained the difficulties she had experienced in securing the support that her son needed and deserved and referred to the particular hurdles she was currently facing as her son transitioned into adulthood.

Jamie volunteered in the capacity of Chair to the Just Say Forum, an information group made up of carers from Barking & Dagenham which worked closely with the local authority and formed part of a national network of carers and parents. The Forum received a small amount of funding from the Department of Education which they use to provide parents and carers with appropriate training, hold open meetings to share information, problems and life experiences, which in turn they feed back to the local authority to get help and assistance. That said even with that support, life can be very difficult and challenging for individual carers/parents, as well she knew from her own experiences.  She had a lot of knowledge about 0-16 but when it came to managing the transition into adulthood, she was unprepared for, as she described, the ‘bombshell’ that it is. Although she had done a considerable amount of research she was shocked as to how much a carer/parent needs to know because in her experience the local authority who have a duty to help quite often don’t know themselves.

The Chair encouraged all those in attendance who had not already meet with the Forum to do so, given their knowledge and experiences. She referenced a recent joint session where they looked at why the services collectively were getting the issue of transition so wrong, especially as in most cases this was not about children who were not known to authorities. It certainly should not be left to carers/parents to have to do their own research. One of the challenges, and why the Committees in Common had decided to invite the likes of Jamie to address the meeting was so that everybody could think about whether they offered the right services and what each provides to support residents, highlighting as an example the case outlined by Jamie regarding her non-verbal son, who has rights himself.

Opening up to discussion, the Cabinet Member for Educational Attainment and School Improvement asked Jamie of her experience regarding her son’s education, whether there was enough preparation and support for him, what the challenges were and, going forward, what could be improved. Jamie responded that she was not made aware that transition  ...  view the full minutes text for item 42.

Patrick Brooks from the London Ambulance Service made a presentation about the pressures the service had been under this winter, the proactive work the LAS has been doing with stakeholders and partners, and against that backdrop, information around response times and performance particular in relation to Borough GP practices.

LAS was the only Pan London NHS Trust which operates across the whole of London covering all the London Boroughs and the City. He outlined the number of calls taken over a typical day including over 5,000 and 6,000 to 999 and 111 respectively. There are three levels of service namely ‘hear and treat’ where people are dealt with over the phone by callers and clinicians with a range of pathways and advice suggested, then others dealt with at the scene through what is known as ‘see and treat’ and finally ‘see and convey’ where people are taken to A&E.

Currently there are 3,200 paramedics supported by 1,400 emergency medical technicians, with a broad range of skills together with 380 nursing and medical staff in control rooms and 1,300 call handlers. In NE London there are 853 paramedics and technicians who collectively carried out over 33,000 face to face responses between 1 January and 26 February 2024.

Mr Brooks outlined the various categories of calls and response times. Over the last winter period there was a call increase of 7,000 in core demand, in response to which he outlined the strategy for managing this demand.  Hospital handovers played a crucial part and the Service continued to work with its NHS partners in NE London to reduce delays and safely release ambulance crews from hospitals which has made a big difference for medics and patients, freeing up clinicians to attend to those who need the most urgent care. The main thing is to ensure patients are directed to the right pathways and minimising the number conveyed to hospital emergency departments. As things stand less than 50% of patients attended are ending up at hospital.

In response to the presentation a number of questions/observations arose. These included whether the LAS felt there are enough services in the community available to avoid escalation to hospital. The primary pathway available are the GP’s. In NEL there are a lot of community service pathways available, however the challenge comes when they reach capacity.

From a customer care perspective, issues were raised regarding how the level of harm caused by ambulance delays was evaluated and, from an acute perspective, how many individuals were driving relatives or others direct to hospital when they should be in an ambulance receiving treatment before they arrive at hospital.  Although the current response time to category 1 (life threatening) met the 7-minute national target and category 2 (emergency / potentially serious) at 29 minutes had, over the past few months, dramatically improved, it was recognised that the service did not know with any certainty on a case-by-case basis where the greatest risks sat, resulting in many unwell patients requiring treatment self-presenting  ...  view the full minutes text for item 43.

Fiona Russell, LBBD Director of Care, Community and Health Integration together with input from Kelvin Hankins, NEL ICB and Matthew Cole, LBBD Director of Public Health provided a summary of the recent discussions at the Committees in Common Development Session which focussed on how the CIC had operated over the past year.

She highlighted the main findings which included that the CIC had reduced duplication, facilitated consistent and strong engagement, that relationships were growing and deepening, that there was healthy challenge and a preparedness to have the difficult conversations, an appreciation for a space for good discussions and the ability for deep diving. Issues for improvement focussed on matters of governance and specifically thinking about ideas for joint agenda planning, following up actions, as well as the tensions and conflicts around having space for both discussion and to business, such as making decisions around commissioning, finance etc, especially seeing there are only have two hours available every two months. 

Finally, a questionnaire and survey had been issued to all participants who were encouraged to complete and return it, the review and evaluation of which would be used to form a report to be presented to the next meeting of the Council’s Health Scrutiny Committee.

Kelvin Hankins then summarised the discussions on the proposed priorities for this Forum as a system which led to a lively debate and helpful feedback. Whilst there was broad agreement, there was work to be done about achieving an all-age approach, the challenge as to where assisted technology sat, how outcomes would be measured, not just the historical ones, and their relevance to residents, and how this linked to the big conversation and residents’ views, and how this would be articulated into the overall plan. All this would be pulled together and reported back to the next meeting of the CIC for more discussion.

Finally, Matthew Cole, LBBD Director of Public Health reported on the LGA Public Health Review feedback where eight recommendations were made, most of which related to how partners work together in this Forum and in Place arrangements. A series of meetings were planned to work through the next steps which would be presented for consideration to the Place Executive on its journey to the Committees in Common. 

Philip Williams, Head of Localities Commissioning made a presentation on a new strategic approach to healthy weight in Barking and Dagenham. He outlined the scale of the problem with the Borough having one of the highest rates of overweight and obese adults and children in London leading to increased risk of morbidity and mortality from conditions such as type 2 diabetes, hypertension, cardiovascular diseases, liver disease and some cancers. National child weight measurements had recently been issued which were not good, but also masked some considerable differences across the Borough with some schools having up to 70% of the children that were considered overweight or obese compared to an overall average of around 40%.

The primary means for tackling the issue has been through the delivery of individualised weight management programmes, with the focus of many of these programmes focussing on supporting individuals who were at higher risk of disease due to their unhealthy weight. Given there were of the order of 100,000 adults classified as overweight/obese it would take more than 150 years to offer everybody a programme, which was simply not practical. Also, evidence showed that generally this approach did not lead to sustained changes in healthy behaviours beyond the life of the programme. Therefore, this has necessitated a different way of doing things at a population level. There were many different interconnecting factors involved with the issue from environment, social, economic, cultural, biological, to where people live etc. Consequently, this needed to be addressed in the round rather than focussing on simply being overweight. There were hard choices to make and certainly no quick fixes, but it was vital to start somewhere.

The approach needed to be a whole Borough Partnership. It was not feasible for one body such as the Council to solve the problem. It would require a partnership approach around food, activity, the environment collectively supporting work around healthy weight. The proposal involved designing a new model of support that recognises all these factors, providing upstream interventions connecting heath, the Council, the VCS and local community groups.

To achieve the aims of this new approach this Forum needs to facilitate the change working with a provider who will act as an enabler in the process, using their expertise in engaging with communities, networks and partners, and their experience of developing innovative healthy weight initiatives.  Once a partner was in place it was proposed to engage them to do the design work in Phase 1 between July 2024 and March 2025 and implement a Health Weight Plan under Phase 2 from April 2025.

Mr Williams outlined what the Plan would look like, which would involve amongst other things, supporting ongoing partnership work around food, activity, and the environment, facilitating the delivery of co-produced community weight and nutrition activities, and working with the likes of the VCFS and partners, to build a volunteer/ network of healthy weight champions and peer support groups.

There were of course inherent risks. It would be a lot harder to achieve,  ...  view the full minutes text for item 45.

Claire Brutton, Head of Disabilities’ Commissioning, presented a report explaining that due to delays in the current procurement exercise for a new contract, for the reasons set out in the report, it was necessary to seek approval for a variation of the contract for the provision of Adult Substance Misuse Service with CGL to extend it for five months from 1 April to 31 August 2024, in accordance with the Council’s Contract Rules.

The Health and Wellbeing Board resolved to:

(i)  Approve the variation of the contract for the provision of Adult Substance Misuse Service with CGL for a period of five months from 1 April to 31 August 2024 in accordance with the strategy set out in the report; and

(ii)  Delegate authority to the Strategic Director, Children and Adults, in consultation with the Cabinet Member for Adult Social Care and Health Integration, to extend the contract and all other necessary or ancillary agreements.

Claire Brutton, Head of Disabilities’ Commissioning, presented a report explaining that due to delays in the current procurement exercise for a new contract, for the reasons set out in the report, it was necessary to seek approval for a variation of the contract for the provision of Young People Substance Misuse Service with V-I-A (formally known as WDP) to extend it for five months from 1 April to 31 August 2024, in accordance with the Council’s Contract Rules.

The Health and Wellbeing Board resolved to:

(i)  Approve the variation of the contract for the provision of Young People Substance Misuse Service with V-I-A for a period of five months from 1 April to 31 August 2024 in accordance with the strategy set out in the report; and

(ii)  Delegate authority to the Strategic Director, Children and Adults, in consultation with the Cabinet Member for Adult Social Care and Health Integration, to extend the contract and all other necessary or ancillary agreements.

There were no questions from the public.