Agenda and minutes

In accordance with the Council’s Constitution, Members are asked to declare any interest they may have in any matter which is to be considered at this meeting.

There were no declarations of interest.

The minutes of the meeting held on 21 September 2022 were confirmed as correct.

The Director of Integrated Care (DIC) at North East London Integrated Care Board (NEL ICB) presented an update on the approach that the Integrated Care System (ICS) was taking to managing winter pressures in 2022/23, as well as an update on a recent winter summit that was held by the Barking and Dagenham Partnership, to consider actions that could be taken locally to keep people safe and well at home.

In response to questions from Members, the DIC stated that:

• Workforce was always a risk area; however, the ICS had received some additional funding over winter, which had been directed to providers such as Barking, Havering and Redbridge University Hospitals Trust (BHRUT), North East London NHS Foundation Trust (NEFLT) and the local authority, for these to invest in workforce capacity. Support also needed to be streamlined: in terms of Barking and Dagenham, funding needed to be streamlined to support social work in A&E and to increase capacity in emergency response services.
• Whilst the ICB did not employ frontline staff (as these were employed by the NHS providers), it was working to develop a Workforce Strategy so that each of the provider organisations would have its own Workforce Development Strategy around recruitment and retention, with some of this being related to training and skills development. There was also a constant review around caseloads and capacity. It was also considering career opportunities and new models of care, such as through looking at new roles and rotations across organisations to encourage people to work in Barking and Dagenham.
• Work was also being undertaken across the Partnership to consider care provider resilience and to undertake scenario planning to best respond to any issues, such as where care providers were no longer able to operate.
• The Barking, Havering and Redbridge (BHR) Workforce Academy was working to understand where there were gaps in recruitment and to provide recruitment opportunities.
• There were a number of services in the community that focused on proactive care; through general practice, NEL ICB had commissioned an enhanced health care home scheme, which provided multidisciplinary support to residents in care homes who had complex needs. This was a collaboration between Primary Care and community services, with links through to Rapid Response teams as necessary.
• The Barking and Dagenham Partnership had recently piloted a population health management approach to keeping people well at home, which was exploring a greater collaboration between the Health and Voluntary sectors. This had shown that a number of factors that impacted on health were sometimes best addressed by other services not provided by the NHS, meaning that greater integration between Primary Care, community care and voluntary services was essential.
• The ICB had commissioned capacity in community urgent care services. The Community Treatment team, which had had significant investment over recent years supported by system development funding, was designed to ensure that people could receive a rapid community response if their health deteriorated more rapidly, to avoid an ambulance trip into hospital. Generally, these services were for people  ...  view the full minutes text for item 56.

The Council’s Director of Public Health (DPH) introduced an update on the place-based partnership governance arrangements, outlining the structure and roles involved as part of this.

The Council’s Acting Chief Executive and Place Partnership Lead (ACEPPL), the Clinical Director for Barking and Dagenham, the Director of Integrated Care (DIC) at NEL ICB and the Integrated Care Director (ICD) at NELFT each outlined their vision for their roles as part of the Place-Based Partnership arrangements, as well as the importance of working collaboratively to address issues across the Borough.

In response to questions from Members, the ACEPPL and the DPH stated that:

• The Health Scrutiny Committee would continue to have a key role in governance and the oversight of decision-making in future. Going forward, it would be important that the Committee’s work programme align with some of the decisions that were to be taken across the ICS; as such, there was still some work to be undertaken around the governance of the Committee.
• Going forward, the Committee would no longer solely scrutinise the decisions of Health partners, but of all partners across place, which included all system leaders, such as the NHS, the Voluntary and Community sector, the Council and provider collaboratives. A challenge would be for officers to ensure that all key decisions were able to be brought to the Committee, to ensure that it would be able to deliver its statutory duties around service changes.
• It was very likely that going forward, the terms of reference for the Committee would need to be amended to account for its wider role. It was likely that the attendance for each meeting would also need to be widened, to include additional key partners.
• The Council was embracing governance changes and was working very closely with its partners.
• Partners had worked very collaboratively to address Covid-19 issues within the community and this continued close collaboration would be vital going forward to address health inequalities issues within the Borough. It would be essential to work as ‘one system’ in the future.

In response to further questions, the ACEPPL and the DIC at NEL ICB stated that:

• Ongoing and open dialogue would be essential to collaborative working.
• In terms of the decision-making process, there would be a “conflict of interest” policy; however, the majority of the work that would be undertaken through the Partnership Board would not require contractual decisions or any decisions that could have any material impact on any of the partners. The focus would be around quality improvement and improving ways of working within allocated resources, rather than considering commissioning decisions.

The Chief Operating Officer (COO) and the Divisional Director and Glaucoma Consultant (DDGC) at Moorfields Eye Hospital NHS Foundation Trust delivered a presentation on the proposal to provide additional eye care at a new site in Stratford from Spring 2023, which would bring together in one place a range of eye services for the local community including glaucoma, medical retina and cataracts, a specialist pharmacy, diagnostics, face-to-face and surgical treatments. The existing site at Barking would become a centre offering diagnostic tests for eyes, jointly operated by Moorfields, BHRUT and Barts Health. All face-to-face eye clinics provided at Barking would relocate to the new Stratford facility.

The presentation detailed the case for change, the proposals and feedback from patients. In response to questions, the COO and the DDGC stated that:

• Whilst there was an eligibility criteria, the Trust did provide patient transport, which would continue under the new proposals and those eligible would be able to be transported from their homes to Stratford. Nevertheless, the Trust’s aim was to support the majority of patients who currently received their care at Barking, to remain at Barking for their care. It was looking to expand the number of patients that it could see at Barking, where patients wished to be seen there. Whilst there was a small number of patients that would have to go to Stratford for their care, the Trust would assess each patient on an individual basis to look at how it could support them.
• The Trust had a close working relationship with colleagues at BHRUT and Barts; in the future, it may be possible for patients who lived near to one of these sites, to receive their care there.
• The Stratford site would provide better and additional facilities for patients. The Trust was also hoping to offer some low visual aid appointments, so that patients did not need to travel outside of the Borough for these.
• The proposal would enable patients to receive a range of diagnostics within the community, through a separate pathway that meant that they would not need to travel to a hospital site.
• The Trust hoped to operate the Barking Ophthalmology Community Diagnostic Centre (CDC) five days a week, seeing around 21,000 patients per year. This was significantly higher than the 8,000 currently seen at Barking.
• The Stratford site would be based at the former MIND charity offices, which was a four-floor 13,000 square foot building and a four-to-five-minute walk from Stratford train and bus stations.
• Cataracts patients were currently seen at Barking for the initial part of their patient pathway and would then need to travel to St. Ann’s for their surgery, outside of the Northeast London area. The proposal would enable a “one-stop” model for cataracts patients, who would be able to receive all of their care and treatment at the Stratford site.
• Medical retina and glaucoma patients would have periods of stability where no intervention was required, with these patients being able to continue to receive care at Barking during  ...  view the full minutes text for item 58.

The Council’s Consultant in Public Health Primary Care and Transitions (CPHPCT) delivered a presentation on the Barking and Dagenham Health Inequalities Programme 2022/23, which provided context as to health inequalities in the Borough in comparison with London and nationally, how the funding was secured for the programme, programme workstreams and the benefits of the programme.

In response to questions from Members, the CPHPCT stated that:

• In terms of the debt and health pilot, the Council was identifying adults who were falling into debt, such as those who were failing to pay Council Tax, as well as those whose social care records showed that they had low level mental health problems, as it was aware that debt could exacerbate mental health issues and that mental health issues could make it more challenging to manage debt. This was a pilot that had previously been undertaken, with the Council looking to scale this up, as well as make this more effective through linking it to the NHS. Those identified would be approached and offered the opportunity to access social prescribing, with social prescribers being trained to signpost and support these residents with expert advice on debt and health.
• Currently, no referrals into Talking Therapies or IAPT would be made, as there was no medical diagnosis or clinical assessment as part of the programme. The debt workstream was focusing on reaching those residents who were falling into debt before the issue started to escalate; however, referrals could be a future iteration of the programme.
• The Council was going to look into the data that all partners held, to ensure that all across the system had the same understanding of health inequalities within the Borough. This data could then be used to better support planning delivery, through the creation of a data indicator set or dashboard that all partners could refer to. The Council was also working closely with its Data Insight Hub to support this work.

The DIC at NEL ICB stated that there was an opportunity to look at how residents could be better signposted to NHS services, and that confirmation had also recently been received that the funding for the debt workstream would become recurrent, which would help with long-term planning. Residents could also self-refer into IAPT services if they had any concerns.

The Clinical Director for Barking and Dagenham also stated that each of the Primary Care Networks (PCNs) had Inequality Clinical Leads; each PCN would likely have different prevalence rates for different conditions and the Leads would be able to identify these and concentrate resources in a tailored way to that area.

In response to further questions, the CPHPCT stated that there was a work stream which aimed to identify interventions for children and young people who were starting to develop low-level mental health issues, to provide them with support within the community to build their resilience. The ICD at NELFT stated that self-referrals could be made into the Barking and Dagenham CAMHS service; there was a phone number and  ...  view the full minutes text for item 59.

The Chair presented the proposed terms of reference for the Committee’s Scrutiny Review on the potential of the Voluntary and Community Sector 2022/23. The Committee agreed the terms of reference and noted that officers would draft a project plan, with a timeline for completion. This project plan would then be circulated to the Committee in advance of the next formal meeting for agreement.

The agenda reports pack and minutes of the last meeting of the Joint Health Overview and Scrutiny Committee can be accessed via: Browse meetings - Joint Health Overview & Scrutiny Committee | The London Borough Of Havering

It was noted that the minutes of the last meeting of the Joint Health Overview and Scrutiny Committee could be accessed via the link provided on the front sheet of the agenda pack for this meeting.

The Committee agreed the Work Programme.