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 1 February 2023 were confirmed as correct.

The Associate Director of Nursing and Quality (ADNQ) at the North East London NHS Foundation Trust (NELFT) and the Integrated Care Director (ICD) for Barking & Dagenham at NELFT presented an update on the NELFT Care Quality Commission (CQC) Inspection as of March 2023. This provided context as to:

·  The CQC Well-Led inspection of NELFT between April to June 2022, with NELFT subsequently being issued with a new rating of “Good”;

·  Overall Well-Led feedback that NELFT had received from the inspection;

·  Positive feedback that had been received as to safeguarding at NELFT;

·  The Well-Led Improvement Plan, including the nine “Should Do” recommendations that had the CQC had made following the Well-Led review, and the monitoring and progressing of the Improvement Plan; and

·  The Quality Support Visit programme at NELFT.

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

·  During the Covid-19 pandemic, complaint response times had decreased, as well as investigations around the most serious incidents; as such, there had been some delays and some increased 90-day responses for complaints and increases around the 45-day response for serious incidents being completed.

·  Since the pandemic, this response backlog had improved. NELFT had a very robust process in terms of incidents being reviewed on a daily basis through Datex, which was an electronic system used by NELFT for incident reporting and complaints monitoring. NELFT’s acknowledgement rate of complaints within three days was now at 90%, with the close-down of complaints in terms of the 28-day framework being dependent as to the complexity of the complaints themselves.

·  Some of the Inspectorate team that had inspected NELFT in 2022, had also inspected NELFT in 2019. The Lead Inspector had praised NELFT for its cultural and behavioural changes, with many of the challenges previously identified in the 2019 inspection, such as around senior leadership, having been addressed, such as through different Chief Executive arrangements and embedding a more just and compassionate culture.

·  NELFT aspired to become an “Outstanding” Trust; the Trust would use its CQC action plan and the number of quality improvement workstreams within this, to meet the requirements in order to achieve this “Outstanding” rating.

·  NELFT faced a number of challenges, such as operating in an area of significant population growth and the continued impact of the Covid-19 pandemic. The new place-based arrangements would present a different opportunity around how NELFT planned and organised health provision to help address some of these challenges.

·  NELFT had a number of staff recruitment and retention programmes, with the recruitment process having an induction and speed-dating for new recruits. NELFT also had one of the best staff survey results in London. It had a number of accolades in terms of its work around recruiting staff from Black Asian Minority Ethnic (BAME) backgrounds; in Barking and Dagenham, 60% of its workforce came from a BAME background.

·  NELFT’s staff had voiced that they came to work for NELFT due to its inclusivity, agile working and flexibility, having won awards around family friendly practices, workforce race equality standards and disability  ...  view the full minutes text for item 74.

The Consultant Obstetrician and Gynaecologist (COG) at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) delivered a presentation on the Early Pregnancy Assessment Unit (EPAU), which provided context as to:

·  The service itself and how it could be accessed;

·  Care and support for people who miscarry;

·  How the Trust worked to decrease the risk of repeat miscarriages; and

·  How patient feedback was addressed by the Trust.

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

·  It was recognised as best practice for an Early Pregnancy Unit to have a quiet room, where patients and their families could receive bad news and where staff could break this bad news. Prior to the pandemic, the Emergency Gynaecology Unit and the Early Pregnancy Unit were located on a different hospital ward; however, during Covid, the use of the wards was changed, with Gynaecology moving to a different ward and the new physical environment not being as bespoke for the service. As such, BHRUT was working to re-establish the quiet room which was present on the previous ward. 

·  In the new ward, women and families that received bad news would be taken to a quiet area in a side room; however, this was not currently bespoke.

·  In regards to the decreased miscarriage rate in 2022/23 in comparison to during the pandemic, the birth rate had also recently dropped, with a direct link between a lower miscarriage rate and lower birth rate.

·  There were some staff who were trained in mental health first aid, to support both staff members and patients. The staff that worked within the Early Pregnancy Unit were expected to have communication skills training, including around breaking bad news and in recognising patients who were in mental health distress.

·  BHRUT had links with SANDS (a bereavement charity) and its Bereavement midwives did provide close support in terms of links with the Adults and Perinatal mental health services. The vast majority of this staff also had experience of working within the maternity service; as there were close links with the perinatal mental health service, it was very easy to make a direct referral into these clinics. BHRUT also had the facility for inpatient referral to the Adult mental health services, for mental health crises as a result of an early pregnancy problem.

·  There were referral criteria into the Perinatal mental health unit, with all midwives having a certain level of training in looking after patients who did have mental health concerns. There were two levels of the perinatal mental health service, with one being midwife-led and one being for women with more severe mental health illnesses, with these women being eligible to be seen within the joint consultant and perinatal psychiatric service. There was no waiting list to be seen in the joint clinic, with the service also being recognised as being a best practice model.

The Integrated Care Director (ICD) for Barking & Dagenham at NELFT stated that NELFT was the provider of the perinatal infant mental health services (PIMS), which  ...  view the full minutes text for item 75.

The Council’s Director of Public Health (DPH) delivered an update on the developing place-based partnership arrangements, which the Council had to agree with the North East London Integrated Care System (NEL ICS) and partners such as BHRUT and NELFT and which would come into place from 1 April 2023. The DPH stated that:

·  All had been in discussions and wished to streamline processes; often there were too many meetings, with the same agenda items. As such, it was agreed that a joint Committee of the Health and Wellbeing Board meeting at the same time as the Integrated Care Board Sub-Committee would be a useful approach. This would assist in speeding up the decision-making process and help all partners to address health inequalities issues at a much quicker rate.

·  Between now and July 2023, all partners would need to consider how this approach would operate, in terms of aspects such as administration. It may also consider whether membership of the Health and Wellbeing Board (HWB) would need to be refined; for example, Primary Care Networks (PCNs) and the GP Federation were not currently on the HWB or the ICB Sub-Committee.

·  A report would be presented to the 13 June 2023 HWB and the June 2023 NEL ICS Board, asking all to agree to these arrangements in shadow-form for the next 12 months.

·  Public Health would return to the Committee’s 24 May 2023 meeting, to enable the Committee to ask any further questions that it had around the arrangements.

·  It was hoped that the arrangements would bring issues closer to local politicians and residents, so that they could have a bigger say in decision-making around resources and how issues were addressed, so that services were more accountable to local people and were more tailored to their needs.

The DPH delivered a presentation on the Joint Local Health and Wellbeing Strategy 2023-28 refresh framework for delivery and consultation. This detailed:

• The statutory duty of the Council to produce a Health and Wellbeing Strategy, which sat with the Council’s Health and Wellbeing Board. It set out the health and wellbeing needs of residents and mapped out what was needed to be undertaken over the next three to five years to improve health outcomes;
• The context, intended vision and key principles behind the Strategy;
• How the Joint Health and Wellbeing Strategy interlinked with other strategies and delivery plans;
• The consultation dates for the Strategy, which was open for comment between 30 March and 30 April 2023; and
• How it was intended for the Strategy to be monitored in terms of progress.

The Committee requested an informal consultation session between itself, the Cabinet Member for Adult Social Care and Health Integration and Public Health, for Members to provide wider Committee feedback on the Strategy.

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

• The consultation was available online, for residents and interested partners to provide comment. The consultation was also being complimented with various focus groups, working with specific partners that the Council had networks with. The Council was also engaging with professionals, partners and the wider community through social media, digital media through the website and the Council’s newsletter.
• Consultation had also recently being undertaken around the Council’s Best Chance in Life Strategy for prenatal conception care through to age 25; the outcomes of which were also being factored into the Health and Wellbeing Strategy.
• The Council was engaging with typically “harder-to-reach” patient groups, such as the homeless, asylum seekers and emerging communities, such as the growing Romanian community, through its existing networks, partners and Healthwatch.
• One of the most difficult aspects of delivering medical and mental health care was communication. There were various barriers to being able to communicate with people, such as where an individual had a learning disability or a language issue, or due to technical medical language. When new communities came to the Borough, there was also often a need to explain how they could access primary care, registering with a GP and what an individual was entitled to through the health system.
• The Council was investing more in interpretation services, as it had found that leaflets were often ineffective in assisting those who were not fluent in English.

The Integrated Care Director at NELFT stated that NELFT had a contract with the Language Shop, which provided interpretation services across a range of London boroughs and health providers, for both sign and spoken languages, in telephone and in-person formats. Whilst it recognised that many families would translate for other family members, it did not rely on this as a source of translation, as it acknowledged that family members could mistranslate information, as well as due to challenges in the Borough around issues such as domestic violence and coercion. If an individual had an access need,  ...  view the full minutes text for item 77.

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.

It was noted that the minutes of the last meeting of the Barking and Dagenham Partnership Board were included from pages 69-80 of the agenda pack.

The Work Programme was agreed.