Greenwich Council

Agenda and minutes.

Venue: Committee Room 4 - Town Hall, Wellington Street, Woolwich SE18 6PW. View directions

Contact: Gurdeep Sehmi  Email: gurdeep.sehmi@royalgreenwich.gov.uk or tel. 020 8921 5134

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Panel.

Minutes:

Apologies for absence were received from Councillors John Fahy, Linda Perks and Miriam Lolavar.

 

Councillor Averil Lekau, Cabinet Member for Adult's Social Care, Health and Anti-Poverty also gave apologies.

 

Councillors Hartley and Mbang gave apologies for leaving the meeting early.

2.

Urgent Business

The Chair to announce any items of urgent business circulated separately from the main agenda.

Minutes:

There was no urgent business submitted for consideration. However, the Chair advised that the running order for the agenda would be changed and the Scrutiny Panel took the items in the following order;

 

Item 11   Greenwich Mind

Item 5     Maternity and Child Health Priorities

Item 8     Oxleas Mental Health Trust

Item 6     Performance Monitoring Public Health Report 2018/19

Item 7     Adult Social Care Performance

Item 9     Piloting an alliance model for mental health: co-producing better outcomes for mental health service users

Item 10   Thrive in Greenwich

Item 12   Commissioning Future Reports.

 

3.

Declarations of Interest pdf icon PDF 61 KB

Members to declare any personal and financial interests in items on the agenda.  Attention is drawn to the Council’s Constitution; the Council’s Code of Conduct and associated advice.

Additional documents:

Minutes:

Councillor Mark James declared an interest in Item10 as he was employed by TfL (Mayor of London).

 

Resolved –

 

That the list of Councillors’ memberships as Council appointed representatives on outside bodies, joint committees and school governing bodies be noted.

 

That the personal declaration made by Councillor Mark James be noted.

 

Councillor Mbang joined the meeting  at 6.35pm.

4.

Minutes pdf icon PDF 71 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 10 January 2019.

 

No motion or discussion may take place upon the Minutes except as to their accuracy, and any question on this point will be determined by a majority of the Members of the body attending who were present when the matter in question was decided.  Once confirmed, with or without amendment, the person presiding will sign the Minutes.

Minutes:

Resolved -

 

That the minutes of the meeting of the Healthier Communities & Older People Scrutiny Panel held on 10 January 2019 be agreed and signed as a true and accurate record.

5.

Maternity and Child Health Priorities pdf icon PDF 94 KB

An update on Maternity and Child Health Priorities on Perinatal Mental Health, Immunisation and Breastfeeding and introduction to solids.

 

 

 

Additional documents:

Minutes:

The Director of Public Health provided a high-level overview of the report and advised the Panel that detailed information could be provided in future reports.

 

Members queried the vaccination rates and asked if the anti-vaccination lobby and the supposed link with ASD and MMR was reducing the take-up. The Director responded that in line with the UNICEF programme officers were interacting with families and providing accurate evidence based information to them. That the long-standing issue of the link between ASD and MMR has no scientific evidence to support it. He added that the public do contact the Council regarding not vaccinating.

 

A member asked if measles, mumps and rubella could be serious, and what were the rates of infection within the borough. The Director replied all three could be serious. Measles could be fatal and rubella caused fatalities in young babies. The Council received a weekly report from National Health England that has previously highlighted outbreaks in small clusters. These were contained to stop spread. He concluded that statistically the borough needed herd immunity at 95%. The borough was currently at 80%. He did not recommend single vaccinations but this was better than no vaccination.

 

In response to questions regarding breastfeeding the Director responded; there was a systematic approach in line with UNICEF standards to encourage breastfeeding. Mothers were advised to breastfeed for as long as possible, and that the combination of bottle and breast can lead to overfeeding. He said that Greenwich’s rates were good initially but there was a need to encourage mothers to continue once they left hospital and beyond six months. He highlighted the Breastfeeding Friendly Awards that were given to businesses who welcomed breastfeeding mothers.

 

The Chair invited questions and comments from members of the public present.

 

In response to comments from a member of the public in relation to mothers unable to breastfeed due to socio-economic reasons, the reduction in antenatal care and home visits, what training was there to help mothers breastfeed. The Director agreed that the level of support was not available but it was being reviewed.

 

Resolved

 

That the Panel noted the update on Maternity and Child Health Priorities on Perinatal Mental Health, Immunisation and Breastfeeding and introduction to solids.

 

6.

Performance monitoring. Public Health Report - 2018/19 pdf icon PDF 363 KB

An update on key Public Health outcomes. The Healthier Communities and Adult Social Care Scrutiny Panel is requested to examine and consider the information and format on the selected indicators.

 

 

 

Additional documents:

Minutes:

The Director of Public Health presented the report.

 

The Panel noted the appendix and agreed that it was a far more accessible format.

 

A member questioned the disparity in life expectancy for gender, and overweight 4-5 year olds and if this related to specific areas. The Director explained that for gender life expectancy it tends to fluctuate, and ten years ago it was the other way around. The Director could provide a drill down to show health reasons, areas or by quartile of deprivation. He could also provide obesity data by ward and ethnicity. The Panel would provide a briefing of what they required.

Action: Healthier Communities Scrutiny Panel / Director of Public Health

 

A member asked what were the underlying links to infant respiratory infection emergency admissions. The Director said there were a range of factors including air quality, parents smoking in the home, the management and support for children with asthma.

 

A member questioned why the diabetes and dementia figures were estimated. The Director explained that they were based on a demographic and deprivation profile and based on self-reporting.

 

The Chair invited questions from members of the public.

 

A member of the public drew attention to Type 2 diabetes and food and exercise used as a basis for treatment. She asked if there were education programmes in the borough. The Director referred to the Live Well Service which could be accessed by the public directly via a phone number or the website or other services via GPs. A member suggested setting up a group where people could help each other.

 

Another member of the public queried if low lying prams and buggies could be a cause for concern in relation to air pollution. Also that there were fast food outlets within 100m of schools adding to child obesity issues.

 

Resolved

 

That the Panel noted and considered the information and format of the selected indicators on key Public Health outcomes.

 

Councillors Hartley and Mbang left the meeting 8.22pm.

7.

Adult Social Care Performance pdf icon PDF 98 KB

This report sets out key issues in Adult Social Care and offers an approach to performance management and oversight.

 

 

 

Additional documents:

Minutes:

The Director of Health and Adult Social Care presented the report. He asked the Panel to consider the information provided and to use this to explore which areas they would like to scrutinise for the future work programme. The work was split in to six key headings: Integration, Budget and Costs, Safeguarding, Market and Quality, Benchmarking and Workforce.

 

Under Integration, he said that there was value, but no evidence of cost reduction, it was more the quality of patient care improved. In respect of Budget and Costs, he advised that there were significant cost pressures for social care. Budget information would be incorporated in to Transformation reporting.

Action: Director of Health and Adult Social Care

 

For Safeguarding, he said that there were six cases currently under review. The reviews looked at failure of care, which were the result of a range of issues. This did not include suicide and deaths in hospital. Procedures allowed where concerns were raised - ongoing monitoring, embargo and stopping of placements, or termination of contract.

 

He continued that Workforce was a critical issue, given the effect of Brexit on care worker numbers.

 

A member of the public drew attention to the reasons for the difficulties of recruitment, including conditions and wages. He  highlighted the need for a skilled and stable work force.

 

Resolved

 

That the Panel noted the report on Adult Social Care Performance.

8.

Oxleas Mental Health Trust pdf icon PDF 605 KB

An update from the CEO, Oxleas Trust will be provided.

 

 

 

Minutes:

The Chief Executive Officer, Oxleas Trust gave a presentation to the Panel.

 

He highlighted the merging of the Primary Care Plus teams would provide a single integrated team. Further to the s136 suite at the QE2 Hospital in Woolwich, another suite was being built and would be open in June 2019. The s136 suites were a legal requirement under the Mental Health Act, that provided detention outside of a Police station.

 

He continued, the Crisis Service was now a seven day per week, 24 hour service. Access was via a Single Point of Contact telephone number (if a client were experiencing a crisis). He added there has been a significant increase in children’s mental health crisis, and there were plans to extend the service offering. Children tended to call in either the morning or early evening.

 

He said that the new adolescent DBT (Dialectical Therapy) service has provided a saving by reducing the number of private sector beds needed. Unplaced emergency admissions were also being reviewed, to reduce the number of private beds used.

 

He explained that the data showing the use of s136 by ethnicity had disproportionate figures under black or black British and other ethnic groups and this was being analysed and further information be provided to the Panel once this had been reviewed.

 

A Panel member commented that there was less contact between community services and young black men. She advised that further work was required around this cohort. Another member asked if amendment and re-classification of the data retrospectively was a possibility. The Chief Executive Officer advised it would be more prudent to re-start the analysis and review after six months.

 

The Chair asked if it were possible theoretically to run a budget deficit. The Chief Executive Officer responded yes, but the service tried not to, as costs could spiral out of control. There were plans for capital investment but these were financed through other property sales.

 

A Panel Member asked how the DBT service was delivered. The Chief Executive Officer said this was mostly through talking therapy, via a GP referral. DBT was triaged by Time to Talk, A&E and GPs. The aim was to provide more mental health liaison in schools.

 

In response to a question regarding the £9.5 million savings and how they would be achieved, the Chief Executive Officer said clinical productivity and back office costs. Front line services would not be targeted. The savings were needed due to increased demand and NHS staff pay.

 

Resolved

 

That the Panel noted the update for Oxleas Mental Health Trust.

9.

Piloting an alliance model for mental health: co-producing better outcomes for mental health service users pdf icon PDF 85 KB

To receive and comment on the report on a “test and learn” approach to achieving better outcomes for citizens and better value for money through a joined up approach to commissioning and service delivery.

 

 

 

Minutes:

The Assistant Director, Health and Adult Services presented the report.

 

She explained that the model would provide better outcomes, accountability across all areas, financial transparency and shared governance. She said that Greenwich has a high demand for in-patient services needing supported accommodation.

 

A member asked what success was likely to look like and how the model would engage with young people. The Assistant Director replied that those with severe mental health issues were in and out of in-patient units leading to a loss of skills for independent living. The model would build on their confidence and interests. Providing employment support and training, increasing motivation and resilience and access to job markets. In co-ordination with CAMHS and the Oxleas Early Intervention Service work would be undertaken with young people.

 

The Chair asked if there were links between mental health problems and drug use. The Assistant Director said there were a high proportion of clients with associated substance use problems requiring psychological intervention.

 

Resolved

 

That the Panel noted the report on the alliance model for mental health.

10.

Thrive in Greenwich pdf icon PDF 79 KB

An update on implementing Thrive Greenwich. Thrive Greenwich is based on Thrive London which is a London wide approach to improve Mental Health and Wellbeing. This work forms one of the priorities of the Greenwich Health and Wellbeing Board.

 

 

 

Additional documents:

Minutes:

The Assistant Director of Public Health presented the report.

 

He highlighted the six priorities of Thrive Greenwich as follows:

·               A city where individuals and communities take the lead

·               A city free from mental health stigma and discrimination

·               A city that maximises the potential of children and young people

·               A zero suicide city

·               A city with services that are there when and where needed

·               A city with a happy, healthy and productive workforce.

 

He added that there were 4 groups co-ordinating the various elements of the project, the Mental Health and Wellbeing Partnership Board, the Greenwich Mental Health Strategic Leadership Group, Children and Young Peoples Mental Health Transformation Group and Suicide Prevention Strategy Steering Group.

 

A member asked if accessing a client’s story was integral to shaping the programme. He responded yes, personal experience was being drawn on, including for example, engagement with parents whose children had attempted suicide and service users on mental health reference groups.

 

Resolved

 

That the Panel noted the update for Thrive Greenwich.

11.

Greenwich Mind pdf icon PDF 45 KB

To receive and consider a presentation from the Chief Executive Officer (CEO) of Bromley, Lewisham & Greenwich Mind.

 

 

 

Additional documents:

Minutes:

The Chief Executive Officer of Bromley, Lewisham and Greenwich Mind gave a presentation.

 

He gave an overview of the timeline for the merger with Bromley and Lewisham and a summary of how BLG Mind would operate going forward. He highlighted that counselling provision was for up to 24 sessions per person. There were two part-time clinical leads and two coordinators. Delivery of the majority of sessions was provided by a team of 20 voluntary counsellors. Sessions were available in up to 14 languages.

 

The Service Manager, Commissioning explained the agreed revised KPIs. He added that meetings were held with the Clinical Commissioning Group to review them.

 

In response to questions from the Panel he said that the service was accessed via Mindline or the website which was the first point of contact. He would ensure the Panel were provided with the telephone number.

Action: Chief Executive Officer

 

He continued, Greenwich had a smaller volume of clients than the other two boroughs with a staff of fifteen. Service user numbers were in the region of 500 per year, plus more than 2000 contacts through Mindline per year. No services had been lost, as a result, of the transition but some had reduced in scope, particularly advocacy and social activities. The advocacy service was now more focussed on statutory advocacy. The service worked with the Greenwich Law Centre regarding benefits advice. Securing of more funding would provide the opportunity to build and develop the service.

 

In relation to realised efficiencies, he said that Greenwich Mind did not have funding to support its costs. Central functions were now across the three boroughs.

 

He said the three major benefits of the merger were, reduced expenditure because of the centralisation of functions, the model of service delivery and national funding which means coverage has improved, there were more services reaching out to different people. Greenwich Mind had no outstanding debts, as the Council had supported the merger and put the services on a sustainable footing.

 

The Chair queried the disparity of staff numbers with the other boroughs. The Chief Executive Officer agreed as Greenwich staff were not all full-time. This was based on the range of funding, the majority of income was from commissioning contracts. Bromley and Lewisham had been commissioned to deliver more substantial services.

 

The Chair also asked who funded which services. The Chief Executive Officer said that Mindline was the Clinical Commissioning Group (CCG), Employment Support was NHS England and would be the CCG, counselling services and any others were Council. He added that the Council was the most significant funder in Greenwich.

 

A member asked if funding was equal for all three boroughs. The Chief Executive replied, funding for the transition was an exceptional one-off by Greenwich. Ongoing, Bromley was the largest, then Lewisham and Greenwich the lowest.

 

The Chair invited members of the public to comment.

 

In response, the Chief Executive advised that demographic information was available and reported to the commissioners. Peer support monitoring was undertaken, and volunteers supervised  ...  view the full minutes text for item 11.

12.

Commissioning Future Reports pdf icon PDF 50 KB

To note the work items that are scheduled to be presented to the meeting of the Healthier Communities and Adult Social Care Scrutiny Panel on 25 April 2019.

 

 

 

Additional documents:

Minutes:

Resolved

 

Members noted the work items scheduled for presentation at the meeting of 25 April 2019.