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 3 November 2021 were confirmed as correct.

The minutes of the meeting held on 19 January 2022 were confirmed as correct.

The minutes of the meeting held on 23 February 2022 were confirmed as correct.

The Integrated Care Director (ICD) at the North East London NHS Foundation Trust (NELFT) and the Assistant Director for Children’s Services (ADCS) at NELFT delivered a presentation on Children’s Community Health Services. This provided context as to:

• The range of services delivered by NELFT in the community for children and young people (CYP);
• The impact of future population growth on services;
• Referral and caseload rates, across all services collectively, and for speech and language therapy, occupational therapy and physiotherapy;
• CAMHS waiting times and referral rates;
• The Mental Health Support team (MHST), which was being established to provide tier 2 support for four schools in Barking and Dagenham (BD);
• Referral and caseload rates within both the universal school nursing (5-19) teams, and within the specialist school nursing service, which supported Trinity and Riverside Bridge schools;
• The ongoing review of the paediatric integrated nursing service, with NELFT working with the Clinical Commissioning Group (CCG) and Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), to look at consolidating and redesigning services to better meet the specific needs and conditions of CYP in BD;
• Funding, and 2020/21 CAMHS spend, with parity of funding for CYP and CAMHS provisions remaining an issue across the NEL system;
• Two diagnostic reports around mental health, and learning disability and autism (ASD), which had been commissioned by the North East London Integrated Care System (NEL ICS), to inform commissioning bodies as to actions to be undertaken around ‘levelling up’ and parity of investment. NELFT would continue to be an active partner in discussions, with a view to ensuring a greater level of investment in service provision for BD residents.

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

·  The data presented related only to Barking and Dagenham. The reason for many of the referral and caseload spikes, depending on the graph viewed, was due to Covid-19 and recovery work. Some of the referral spikes also pertained to school term times, with more referrals arising during school terms and less during school holidays. As many face-to-face services had not been offered by NELFT during the pandemic, it had put in lots of resources to address any backlogs, which had also accounted for caseload data spiking.

·  Before the pandemic, mechanisms were introduced for CYP, parents and carers to self-refer. Access levels into CAMHS had grown over the last few years, with work undertaken with schools and with social care, and the introduction of hot clinics, playing a large part in this. NELFT was now close to meeting its access target, which was set at 35% of the target population.

·  NELFT had created a brief intervention pathway, to support better engagement in terms of early help and utilising the wider network of early support across the local authority. This meant that NELFT had been able to move to a much more rapid assessment position than in previous years. It also ensured that those CYP who needed very specialist interventions, which often had longer waiting times, could  ...  view the full minutes text for item 41.

The Integrated Care Director (ICD) at the North East London NHS Foundation Trust (NELFT) and Associate Director of Nursing & Quality (ADNQ) for Barking & Dagenham at NELFT delivered a progress update on the CQC Improvement Plan that it had developed to address the “Must Do” and “Should Do” findings, as a result of its CQC inspection in June 2019. The update also followed on from NELFT’s previous presentation to the Committee (minute 10, 21 October 2020 refers). The presentation highlighted actions undertaken so far to address the inspection findings, with only one “Must Do” and five “Should Do” actions remaining open, which related mainly to Essex and Kent services, and not to those in Barking and Dagenham.

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

• From a Barking and Dagenham service perspective, NELFT was working to embed all actions as core business as usual activity. NELFT had undertaken a thorough self-assessment in terms of where it felt that it stood against each of the five domains inspected and felt that there was now good evidence that it was able to demonstrate compliance against these, based against the work that it had undertaken to address any concerns; however, it was still awaiting the CQC’s determination on this as part of its next inspection.
• There were still some challenges, such as waiting times, which had been exacerbated by the pandemic in some areas. NELFT had seen particular surges in referrals in some areas and had redeployed a significant number of staff from some services at the height of the pandemic, which had led to decreased function in these particular services. One “Must Do” action was around addressing waiting lists in the Kent ASD pathway, with specific reasons pertaining to Kent as to this; however, NELFT was inspected by the CQC as a whole trust, with Barking and Dagenham only one part of this.
• Nationally, funding had been made available to address elective waiting lists, with acute hospitals and community trusts across the country having submitted plans and trajectories around reducing these, to get to a compliance standard of 18 weeks. This would require additional workforce for NELFT, who had submitted workforce plans as to this.
• Whilst some services had few vacancies, others such as district nursing, had higher vacancy levels. NELFT had partnered with a new recruitment supportive agency, Just R, to launch a new recruitment campaign across NELFT, and had spent a lot of time investing in staff networks. NELFT had also been recognised as a Working Families Top Ten Employer 2021, as well as nationally in terms of the work that it had undertaken in terms of workforce race equality and disability equality standards. As Barking and Dagenham had its challenges, such as increased complexity of needs and higher deprivation levels, NELFT acknowledged that it took special individuals to work within the area and that it needed to provide extensive training and development opportunities, to attract high quality employees.
• The NHS and NELFT both worked with the  ...  view the full minutes text for item 42.

The Council’s Director of Public Health (DPH) delivered an update on the Integrated Care System and Borough Partnership proposals and governance. This detailed the current proposals and recommendations, with a decision paper on these shadow governance arrangements to be taken to the 14 June 2022 Health and Wellbeing Board. He recommended that these arrangements be presented to the first Health Scrutiny Committee of the new municipal year, for comments and scrutiny. The target date for having the confirmed joint arrangements in place would be April 2023, with all involved then engaged in a programme of finetuning and building on these.

In parallel to this, North East London was also establishing an acute provider collaborative, composed of Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barts and the Homerton. The DPH recommended that the Committee invited BHRUT to present these emerging arrangements in more detail, in the new municipal year.

A further collaborative to be established was the community collaborative, composed of North East London NHS Foundation Trust (NELFT), East London NHS Foundation Trust (ELFT), the Homerton University Hospital Foundation Trust and Barts Health NHS Trust, with an important question being around how local authority services interfaced with this provider collaborative, as it was centred on the wider determinants of health, and social care. A further collaborative was also to be developed around the Primary Care Networks (PCNs). The DPH recommended that the Committee scrutinise these arrangements in the new municipal year, inviting Councillor Worby and the other relevant leads from these provider collaboratives to present in the next eight months.

The Integrated Care Director at NELFT echoed the DPH, in that there was lots of change in progress, with all trying to better understand the functionality, form, relationships and interdependencies between collaboratives and place-based partnerships. Both highlighted the importance of ensuring that solid foundations were built, to ensure that the arrangements were fit-for-purpose and best served the local community. In scrutinising the arrangements, the DPH stated that it was important for Councillors to consider that these presented an opportunity for themselves and partners to have more control and influence over services across the integrated spectrum of social care, Health and Community Solutions. As such, Councillors needed to ensure that the resident was at the centre of thinking as to how services were provided, that these were accessible and met complex needs, and that these worked to narrow health inequalities within Barking and Dagenham.

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 web-link on the front sheet of the agenda.