Agenda and minutes

The Chair introduced Members and officers to the meeting

Councillor Janet Burgess, Executive Member Health and Social Care

None

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None

RESOLVED:

That the minutes of the meeting of the Committee held on 10 October 2019 be confirmed, and the Chair be authorised to sign them

The Chair stated that she had been due to meet the CCG, however this had been cancelled due to Purdah

For members of the public to ask questions relating to any subject on the meeting agenda under Procedure Rule 70.5. Alternatively, the Chair may opt to accept questions from the public during the discussion on each agenda item.

The Chair outlined the procedures for Public questions and the fire evacuation procedures

Councillor Burgess, Executive Member for Health and Social Care was not able to be present at the meeting so no verbal update was given

Graham Norton, and Sen Brinicombe, London Ambulance Service, were present for discussion of this item, and made a presentation to the Committee, copy interleaved.

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

·         LAS operate out of over 70 sites, have 2 Emergency Operations Centres, a Motorcycle response unit, 2 HART teams, Hear and Treat, and a Cycle response unit

·         There were 772,262 111 calls in the previous year

·         The LAS attended 1.14 million incidents, handled approximately 5000 emergency calls every day, has 6000 staff, of which 65% are frontline staff. There is a growing aging population with complex health needs

·         The LAS has introduced a new five-year strategy, designed to build a world-class service for a world-class city

·         The LAS purpose is to provide outstanding care for patients, be a first class employer, provide the best value for the public, and partner with the wider NHS, and public sector, to optimise healthcare, and emergency service provision across London

·         Patients – LAS playing a larger role in 111/Integrated urgent care provision across London. Integrating 999, and 111 call answering, and clinical support, in order to provide better, and faster care. Working with patient groups, and other providers, to introduce more specialised models of care for a greater proportion of patients. Reducing unnecessary conveyances to emergency departments

·         People – LAS recruiting and retaining talent, improving engagement to make sure it is listening to staff, ensuring a healthy workplace, aspiring to excellence in leadership and management, championing inclusion and equality, and recognising and rewarding excellence

·         Public value – integrating 111 and 999 call answering will provide a more cost effective service. Pioneer services will reduce unnecessary hospital conveyances, delivering savings for system partners. Detailed internal programme of work to implement the recommendations of Lord Carter’s review into unwarranted variation within the NHS. There is also a new partnership with South Central Ambulance Service

·         Partners – work closely with a range of partners across London, the Metropolitan Police, London Fire Brigade, and increasingly with other public sector bodies in London, including the Mayor, TfL, and other Local Authorities

·         LAS is rated as good by CQC, and has exited special measures. A range of initiatives have been instituted, including reducing avoidable conveyances, upskilling the paramedic workforce to increase see and treat rates, increasing clinical effectiveness in clinical hubs, and increasing opportunities for patients to be conveyed to alternative care pathways

·         Leadership – There are CEO roadshows, and LAS has created a Leadership Development Programme, Visible and Engaging Leadership programme, and launched 2 mentoring schemes

·         Staff – in 2018/19 – recruited over 850 people across the front line – vacancy rate on 31 March 2019 was 4.6%, compared to 5.9% in previous year. 15% of workforce is from BME community. Launched second WRES action plan – senior trust leadership, workplace experience, and recruitment and development schemes. Freedom to speak up – staff survey indicator score has increased 18% between 2015-2019. Dignity at work – raising awareness and addressing bullying

·         Engagement – LAS  ...  view the full minutes text for item 123.

Jess McGregor, Service Director Strategy and Commissioning, and Ray Murphy, Joint Commissioning Manager, Older Adults, were present for discussion of this item.

Duncan Patterson, Care Quality Commission, was also present, and made a presentation to the Committee, copy interleaved.

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

·         The CQC is the independent regulator of health and social care in England. It ensures that health and social care services provide people with safe, effective, compassionate, high quality care, and encourage care services to improve

·         State of Care 2018/19 – People’s experience of care is determined by whether they can access good care when needed. There is a risk of being pushed into inappropriate care settings, and increased demand and challenges around access, and workforce risk, creating a ‘perfect storm’

·         Adult social care specific findings – 80% rated good, 4% outstanding, 15% requires improvement, 1% inadequate. There are concerns about capacity set amongst growing unmet need. Staffing is under pressure with high turnover, high vacancy rates, and a lack of people with the right skills. Continued uncertainty about long-term funding

·         State of care recommendations 2018/19- action needed from Parliament, Government, commissioners, providers and communities for more and better services in the community, innovation in technology, workforce, and models of care, system-wide action on workforce planning, and long-term sustainable funding for adult social care

·         Overview of local systems reviews – in 2017 CQC was commissioned by Government to carry out a programme of 20 local system reviews. CQC has now been asked to continue the programme - 3 new reviews, and 3 follow up reviews published Spring 2019

·         The Beyond Barriers report highlights organisations that are focused on individual drivers for success, rather than thinking as a system - system incentives are needed. For people to receive a high-quality service in a real system, there is a need for strong vision, governance, culture and leadership of organisations. There is also a need to work together to focus on the same metrics for success

·         Key themes for driving improvement – positive reaction to CQC report, leadership, cultural change, person centred care, staffing, working with partners, and building a community

·         Need for consistent, passionate workforce – great consistency of staffing makes a massive difference, there should be limited or structured use of agency staff. Staff need to be empowered to speak out, and suggest changes, and staff should be taken on an ‘improvement journey’. There should be regular supervision and training, robust recruitment and induction, and management should provide bespoke training

·         Outstanding characteristics – People are at the centre, staff who want to offer   improved life, not just a service. Good leadership extends beyond the manager, and there is a need to ensure those values are shared to inspire staff. 75% have a registered manager in post. There should be an open culture, and strong links to the local community, with a can-do attitude, dedicated staff, and be creative and innovative

·         Common success factors – Committed leaders, putting principles into action,  ...  view the full minutes text for item 124.

 Elaine Oxley Head of Safeguarding Adults, and James Reilly, Independent Chair Adult Safeguarding Board, were present and outlined the report to the Committee

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

·         Key achievements – selected by the Office of the Public Guardian to pilot a scheme to raise awareness in the borough around Lasting Powers of Attorney. This is an important preventative protection against financial and other types of abuse, for people who lose the ability to make decisions about their finances, health and well-being. The Board continues to encourage partner organisations to focus on the link between homelessness, risk of abuse, and neglect

·         A safeguarding adults review was commissioned into the care of Mr.Y, and the report published in August 2019. The Islington Safeguarding Adults Board is working on an action plan to implement recommendations, and its learning from the review. 157 organisations have signed up to the Hate Crime pledge, and the service user, and carer sub group, continues to run successfully, and is positively influencing decisions of the Safeguarding Adults Board. Over the past year, a new safeguarding structure has been introduced in the Police service, which means that Islington now has dedicated safeguarding police officer posts, and this has improved communication

·         There has been a 15% increase in safeguarding adults concerns on the previous year, however safeguarding enquiries have decreased. This means that in roughly, 9 out of 10 cases of people where there were concerns, it had been decided not to proceed to a formal safeguarding enquiry

·         Referral rates for concerns remain at a comfortable level, and regular case file audits are carried out to ensure that thresholds are being applied appropriately, and proportionately, by practitioners. The three most common types of abuse in Islington last year were neglect, financial and psychological abuse

·         There were no cases to date, involving formal enquiries into any suspected cases of modern slavery, or sexual exploitation of adults with care and support needs, however work is taking place to raise awareness of these types of abuse

·         The Annual report further details progress on delivering the first year of the Islington Safeguarding Board’s 3-year strategy, and Annual Plan 2018/21. The strategy has been aligned with those of the Safeguarding Adult Boards in the North Central London cluster, and there has been collaboration, where it makes sense to do so, such as holding a joint Challenge event around Board assurance work

·         In response to a question it was stated that the Safeguarding Board is functioning well and there have been improvements in training and development across the NCL region. It was stated the serious case review into Mr.Y had highlighted  a number of issues that needed to be addressed across a number of Local Authorities and  Members requested that the summary/action plan  be forwarded to them once it is available

·         In response to a question, it was stated that there is a need for more training on the mental health/mental capacity act, and there is a  ...  view the full minutes text for item 125.

Charlotte Ashton, Deputy Director, Public Health L.B. Islington/Camden, was present for discussion of this item and outlined the report.  Georgia Brown, Chair of Islington Clients and Drug Abuse and Alcohol services, Lisa Luhman, Substance Misuse Commissioning Manager, Islington/Camden Public Health, Peter Kane, Divisional Director, Camden and Islington NHS Foundation Trust, and Liz McGrath, Clinical Director, Camden and Islington Substance Misuse service, Camden and Islington NHS Foundation Trust were also present            

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

·         Islington experiences some of the greatest levels of substance misuse related harm in London. Substance misuse has significant detrimental impacts on health services, crime and community safety, and is important contributor to adult and children’s social care needs, as well as having wider economic, employment and societal impacts

·         Better Lives, Islington’s adult drug and alcohol recovery services, has been operational since April 2018, following a major redesign and transformation programme. The vision and operating model for the new service, aligns closely with the Council’s Corporate Plan, and specifically the development of integrated, place-based working in localities focused on tackling the deeper social challenges, which prevent residents from fulfilling their potential, and improving outcomes for themselves, and their families

·         The new integrated contract and service model represents a very significant move away from previous ways of working, and service provision. As a consequence, public health commissioners acknowledged that, owing to significant mobilisation and change processes, that the provider needed to implement, in order to establish this new service, performance was likely to be impacted in the first year of the contract delivery

·         Prevalence information – new estimates of the number of crack and/or opiate users were published in 2018, and give an indication of the number of people in a Local Authority area, who are in need of specialist treatment, as well as a measure of unmet need, (based on the proportion of those estimated to be in need), who are not currently in treatment. The Home Office estimated that in 2010/11 the cost of illicit drug use in the UK was £10.7 billion per year

·         Research has shown that for every £1 invested in drug treatment, there is a £2.50 benefit to society. There were 203,808 people engaged in treatment in 2015/16, and if these people were not in treatment, they may have cost the NHS over £1billion. It is estimated that structured treatment prevented 4.9 million crimes in 2010/11

·         Health risk factors for drug misuse include - family history of addiction, socio-economic deprivation, homelessness, unemployment.  Men are more likely to use illegal drugs, and poor mental health is linked to drug misuse, and vice versa, and there are strong links between health inequalities, and drug use, however the picture is a complex one

·         Feedback from service users – mystery shopping has found that users feel that the services that are available are helpful. The service user forums have developed some positive initiatives, however there is mixed engagement across the three main service sites – Grays Inn Road,  ...  view the full minutes text for item 126.

This item was deferred until the next meeting of the Committee

RESOLVED:

That the report be noted