Agenda and minutes

The Chair introduced Members of the Committee and welcomed witnesses to the meeting.

The Chair also welcomed two new Members of the Committee, Councillors Ismail and O’Halloran, who had been appointed as new Members of the Committee to replace Councilllors Gantly and Hamitouche.

Councillor Andrews

None

If you have a Disclosable Pecuniary Interest* in an item of business:

§  if it is not yet on the council’s register, you must declare both the existence and details of it at the start of the meeting or when it becomes apparent;

§  you may choose to declare a Disclosable Pecuniary Interest that is already in the register in the interests of openness and transparency. 

In both the above cases, you must leave the room without participating in discussion of the item.

If you have a personal interest in an item of business and you intend to speak or vote on the item you must declare both the existence and details of it at the start of the meeting or when it becomes apparent but you may participate in the discussion and vote on the item.

*(a)Employment, etc - Any employment, office, trade, profession or vocation carried on for profit or gain.

 (b)Sponsorship - Any payment or other financial benefit in respect of your expenses in carrying out

  duties as a member, or of your election; including from a trade union.

 (c)Contracts - Any current contract for goods, services or works, between you or your partner (or a body

 in which one of you has a beneficial interest) and the council.

 (d)Land - Any beneficial interest in land which is within the council’s area.

 (e)Licences- Any licence to occupy land in the council’s area for a month or longer.

 (f)Corporate tenancies - Any tenancy between the council and a body in which you or your partner have

  a beneficial interest.

 (g)Securities - Any beneficial interest in securities of a body which has a place of business or land in the council’s area, if the total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body or of any one class of its issued share capital. 

This applies to all members present at the meeting.

None

The Chair stated that the order of business would be as per the agenda

RESOLVED:

That the minutes of the meeting of the Committee held on 14 September 2015 be confirmed and the Chair be authorised to sign them

The Chair will update the Committee on recent events.

The Chair referred to the dispute between the Government and junior doctors over the renegotiation of their contracts and that there is a lot of anger amongst junior doctor over the proposals.

The Chair added that he attended a meeting on 25 September of the North Central London Joint Overview and Health Scrutiny Committee and discussions took place on possible changes as a result of a report from Carnell Farrar and that the JOHSC had requested more details to be presented to a future meeting of the Committee.

The Chair reported that there is projected to be a £400m defecit in the NHS trusts  by 2020 and that 22% of the population accounted for the use of 64% of resources and too many people attended A&E when it is not necessary. All the 5 PCT’s in North Central London were making efforts to reduce these attendances.

The Chair added that the JOHSC also discussed the out of hours/111 service contract and that they had requested that the service should be profiled to fit individual boroughs needs, as each borough is different and that there appeared to be more positive engagement on this.

The Chair also referred to the GP appointments scrutiny recommendations and that he would be meeting with the Executive Member Health and Wellbeing on the implementation of these, given the concerns expressed at the last meeting, and would report back to the next meeting.

The Chair outlined the procedures for Public questions and the filming and recording of meetings.

A member of the Public asked a question in relation to the proposed closure of the Margaret Pyke centre and it was stated that she was concerned at this and that Central and North West London NHS Trust should prioritise women’s services, especially the important area of contraception, and keep the Margaret Pyke Centre open. She added that the centre is valued by clients and if the centre were closed the valuable work on research and training would also be lost.

Discussion took place as to the tariffs system for the payment of GUM and contraception services and the fact that there had been a lack of consultation and engagement with staff or patients.

The Director of Public Health stated that she recognised the inconsistencies in funding in the GUM and contraceptive services and that consideration is being given to an integrated tariff across London and that no firm options were yet available for consideration on proposals for the future of the Margaret Pyke Centre. In addition consideration needs to be given to whether there needs to be a different delivery model for these services. The Director of Public Health added that she was continuing to have discussions with L.B.Camden and would be visiting the Margaret Pyke Centre the following day.

The view was expressed that Margaret Pyke is an internationally renowned centre and the building had been refurbished at extensive cost recently. Contraceptive services were a basic right for women and if the services were broken up they could not be delivered in the same way.

The Chair indicated that the Committee had heard a convincing argument that the Centre should be retained and that it did not appear that the only option available is to reallocate services elsewhere. It was added that any proposals would represent a significant service provision change and therefore any service change proposals should be referred back to Committee for consideration.

RESOLVED:

That any proposals for reconfiguration of services for sexual health and contraception in relation to the above be referred back to the Health and Care Scrutiny Committee for consideration

There was no update submitted to this meeting

Peter Rhodes, Assistant Director of Operations, London Ambulance Service, was in attendance and made a presentation to the Committee, a copy of which is interleaved.

During consideration of the presentation the following main points were made –

·         Approximately 25% of Londoners are not registered with a GP and there are significant health inequalities and variations in life expectancy

·         The LAS is the only pan London provider working with 32 Trusts, 32 Clinical Commissioning Groups, operating in seven clusters, seven System Resilience Groups, five Urgent and Emergency Care networks

·         Demand for services is increasing year on year and in 2014/15 there were over 1.7 million requests. Operating budget is £316m and has 5,000 staff, 71% of which are frontline

·         There is a changing workforce with more graduates, women and a higher turnover of staff and expectations. Transformation is taking place with a management restructure of frontline staff and recruitment drives

·         The LAS main contract is to provide emergency service and urgent care ambulance (999) contract and is commissioned by NHS Brent CCG on behalf of all the 32 CCG’s across London

·         It is an annual contract which runs between 1 April 2015 and 31 March 2016 and operates 24 hours a day, for 365 days per year and the contract value is £267m per annum

·         The 3 main challenges are staffing where morale needed to be improved as well as increasing staff numbers. There is also an ever increasing demand on services and the LAS will need to continue to find new and innovative ways of managing demand. The culture and management style of the organisation also needs to change as evidenced by staff feedback and external surveys

·         In terms of recruitment LAS are running a national and international recruitment campaign for frontline staff, targeting Australian paramedics and increasing the number of places available at UK universities. Approximately 820 staff will be recruited this financial year, which includes 150 new posts

·         In terms of performance LAS reached 75% of Category A calls in just over 10 minutes in 2014/15 and are now reaching 75% of Category A calls in just over 9 minutes so far in 2015/16. LAS work closely with the CCG and all the Acute Trusts in North Central London to develop pathways and reduce patient wait times

·         Most patients are conveyed to the Whittington (31%) followed by UCLH (22%)

·         In response to a question it was stated that it is mainly young people that did not register with a GP and that they tended to go straight to A&E

·         LAS stated that staff in the staff survey in 2014 had indicated that they were concerned about the culture of management and a lot of work has taken place on improving local management who were visible to staff. There is also a new Chief Executive who is well respected by staff

·         It was noted that the 2015 staff survey is now currently taking place

·         A Member enquired whether there had been any improvement in recruitment of BME staff  ...  view the full minutes text for item 148.

Eshwyn Prabhu, Islington Planning Department, Alan Keane and Jonathan Weaver, NHS England and Fiona Ernes and        ,  Islington CCG were present for discussion of this item and made a presentation to the Committee, copy interleaved.

During consideration of this item the following main points were made –

·         There are cost pressures in London however there are a number of initiatives to improve capacity and access to primary care

·         There is an Islington I HUB pilot which has secured funding from PM Challenge Fund which will extend core GP hours in Islington, provide three physical hubs across the borough, with a single point of entry via a smart phone telephone interface, including clinical triage and be supported by digital information channels

·         Islington has the lowest proportion of single handed contracts compared to other NCL boroughs. Since October 2014, 3 single hander GP practices have closed with a combined list of 4711. Capacity audits of neighbourhood GP practices during the consultation indicated that patients could re-register

·         Islington is above the national average for FTE GPs per 1000 patients

·         The average GP and Nurse FTE per 1000 patients combined across London is 0.75 and Islington is the highest in North Central London. This indicates that Islington provides sufficient clinical capacity for GP and Nurse FTE per 1000 patients

·         The GLA estimates a projected increase of 41,500 (20%) over 15 years

·         Growth varies by ward from 11% in Canonbury to 34% Bunhill however there is uncertainty as the actual number of homes or bedroom sizes are not known until planning permission is finalised

·         Islington GP consultations are high at the start of life and from middle age increase sharply. Islington population aged 65-74 is expected to grow by 35% and aged 75+ by 39% from 2011-16

·         Research has shown that someone living in the most deprived areas consults a GP as often as someone 20 years their senior in the least deprived areas

·         There are a number of issues associated with Primary Care premises –

Complex arrangements of tenure, where premises are improved and have rent increases this is picked up by the CCG to ensure alignment with strategy, Better Care for London recognised that across the capital up to 30% of primary care premises are not compliant with the Equality Act 2010, strong focus from national bodies on how estates can be an enabler to service transformation

·         From 1 October 2015 Islington CCG became a co-commissioner with NHS England which means that they both worked together to commission primary care

·         Estate is a priority across North Central London CCG’s who are working together to develop plans and Islington and Haringey are working on a joint strategy due in December 2015

·         The strategic direction is to develop more local provision in the community so it is likely that there will be more co-location of primary care

·         The recent Bunhill example showed how local planning could work and the project team included NHS England, L.B.Islington Public Health and Planning, NHS Property services, Islington CCG and  ...  view the full minutes text for item 149.

Katie White, Andover TRA, Janet  Manderson, Girdlestone TRA and Ken Kanu, Help on Your Doorstep were present for discussion of this item and gave evidence to the Committee.

Julie Billett, Director of Public Health was also present together with Damian Dempsey, Housing and Adult Social Services.

During consideration of the evidence the following main points were made –

·         The Girdlestone Estate had been built in 1975/76 and 95% of the properties suffered from some sort of dampness problem

·         The problems of dampness on the estate has led to instances of depression, respiratory problems, allergies, coughs and colds, and the issue affected flats on all levels not just the ground floors

·         There had been constant issues with the Council in resolving these problems and tenants often gave up however major works were planned in the future and it was hoped that these would remedy the problems

·         There seemed to be a number of causes of the dampness problems on the estate including leaks from central heating pipes, roofing, lack of DPC, balconies etc.

·         There were also problems with leaks from the flat above the Community Centre, which was a leasehold flat and there had been ongoing problems with the Council and the leaseholder in resolving this issue which meant the Community Centre often cannot be used. Councillor Nicholls stated that he would investigate this issue with the TRA and the Housing Department

·         The Committee were informed that a programme of works is being drawn up on the Girdlestone Estate and a pilot scheme would shortly be started with  a rolling programme of major works commencing in 2017/18 for the rest of the estate, however there may still be the difficulty of accessing leasehold flats where there were central heating pipe problems

·         The Andover TRA stated that there were not only problems in the new Andover blocks but the old blocks as well and may flats suffered from dampness problems

·         There was poor communication by the Council when faults were reported and often tenants requested a report or feedback following a surveyors visit and this never happened and tenants often gave up and continued to live in damp conditions

·         The Andover TRA stated that there were similar medical complaints of tenants to those at Girdlestone Estate, respiratory problems, coughs/colds, asthma, especially in children, and tenants suffered depression, both caused by the problems and the difficulties in getting it rectified. Housing officers did not respond to e mails or enquiries and tenants never got feedback on visits and often problems remain unresolved or the dampness was just painted over

·         It was stated that the pilot scheme on the Andover Estate is in relation to the new blocks

·         The Andover Estate TRA also made reference to the problems that some tenants had experienced in relation to the installation of new kitchens and bathrooms and that this had caused condensation due to cupboards being placed in front of the air bricks

·         In some flats the dampness was so bad children had to sleep  ...  view the full minutes text for item 150.

Marian Harrington, Chair of the Adult Safeguarding Board and Elaine Oxley,Housing and Adult Social Services were present for discussion of this item.

During consideration of the report the following main points were made –

·         Under the Care Act 2014 the Council now has a statutory responsibility, through the Health and Care Scrutiny Committee to lead the Borough in safeguarding adults

·         It was noted that physical abuse, financial abuse and neglect have remained the top three categories for several years and that the percentage of cases which were substantiated or partially substantiated has risen by 20% in the last year

·         Islington has had its first serious case review for a number of years and an action plan is being worked on in order to address issues of concern. The case involved a discharge from hospital and measures had now been put in place to address these issues with care homes and Whittington and UCLH Trusts and relevant GP’s

·         In response to a question as to the interface between the Adults Safeguarding and Childrens Safeguarding Board, it was stated that there is an interface and there were teams in place to deal with the transition to adult services and there was a reciprocal arrangement for a member to be on the Boards. There is also shared learning and whole family training is being looked at

·         The Chair stated that in view of the time limit for closing the meeting any questions to the Chair of the Adult Safeguarding Board would need to be submitted in writing for response

       RESOLVED:

(a)  That any questions be submitted in writing to the Chair of the Adults Safeguarding Board

(b)  That the contents of the report be noted and to commend adult social services staff for their commitment to preventing abuse, where possible, and responding to concerns of abuse or neglect of vulnerable Islington residents

RESOLVED:

That, subject to the addition of the Healthwatch Work programme being added to the November meeting, the report be noted