Agenda and draft minutes

The Chair welcomed everyone to the meeting and members and officers introduced themselves. Fire safety, webcasting and microphone procedures were explained.

None. Apologies for lateness received from Councillor Gilgunn

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.

Councillor Finn Craig declared an interest in items on the agenda insofar as they related to  Great Ormond Street Hospital and Whittington UCL.

RESOLVED:

That the minutes of the meeting held on 23 January 2024 be confirmed as an accurate record of proceedings and the Chair be authorised to sign them.

The Chair thanked Councillors who attended the three evidence gathering sessions for the scrutiny review into access to GP services and Adult Social Care. Members had now heard from a number of residents and were very grateful to the residents who had taken the time to feedback on this topic.  Particular themes were definitely emerging,  around e-consult and digital access, staff retention and training, and access via phonelines and to familiar members of staff.

The Chair invited Councillors who had attended the sessions to report back to the Committee. 

Councillor Burgess said that the sessions were interesting. Two of the attendees had children with special educational needs and a third was a user of the Shared Lives Service, which provided foster care for adults. This latter person had cared for two or three different people  in her home, over a period of about forty years, and was content with all that the Council had provided by way of support.  Her son, who had supported her, was also going into the same service, which was a positive for continuity.  The Chair of the Family Carers’ Group and another member of that group who had a very disabled son, had raised the issue of what would happen when they were no longer able to look after their children.  This was a major worry for many people in the same circumstances.  Another worry was not being able to hire personal assistants. Recipients were happy with the direct payments from the Council, but there was a shortage of personal assistants.  The lack of suitable staff willing to do this type of caring was a major concern at the present time in Social Services generally.

Councillor Clarke had attended an Age UK meeting, which was well attended, by approximately 60 people.  The theme of the meeting was access to GP surgeries. There seemed to be a split in the Borough, with some people struggling with digital exclusion and experiencing difficulty with the e-consult forms and others able to walk in to, or telephone, their surgery, to make an appointment.  Concern had been expressed about people with mental health or learning difficulties being able to make appointments with GPs, as many of them could not access or navigate the e-consult form.  She suggested that this was an issue upon which the Committee needed to make a recommendation.  The other matter considered was the question of people not being aware of, or not knowing how to access, the seemingly plentiful Adult Social Care resources in Islington.  She anticipated that the establishment of hubs could help in this regard, advising people on getting the help they needed, given this apparent inequality of service.  Some users had mentioned that staff had been rude to them on the telephone and of their difficulties in accessing the complaints system and  in receiving responses.  Attendees had also mentioned the amount of time they had wasted on the telephone, waiting for responses from GPs or Social Services.  Some attendees had mentioned the helpfulness  ...  view the full minutes text for item 42.

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 Committee received a presentation from Simon Knight, Director of Planning and Performance, and Liz O’Hara, Director of Workforce, UCLH NHS Foundation Trust, on performance against key targets. The Committee had also requested an update on staff morale, which would also be covered in the presentation.

On the quality of care provided:

·       Infections – all hospitals were required to monitor infections carefully. Numbers of MRSA cases had been kept low for the past few years. UCLH had more cases of clostridium difficile than other hospitals and it was thought that this was principally driven by the fact that UCLH looked after a number of cancer patients.  However, these numbers remained below the target set for UCLH, which was somewhat reassuring.

·       A good indicator of nursing care was the low number of patients with pressure ulcers, with numbers remaining no higher than seven or eight each month. As a result of following best practice, UCLH was proud of the low number  of these cases.

·       Another good indicator of the quality of care was demonstrated by the comments by patients about services. UCLH compared well to other London Trusts in this respect and appeared top in a table of comparison with peers.

·       On the matter of the amount of time patients waited for care, there had been approximately 30,000 patients awaiting treatment in 2010, with the figure rising to 70,000 by 2023.  This trend was similar across the country during that timeframe.  However, numbers had increased significantly for UCLH in 2019 when a new electronic health system was taken on and which had proved a difficult time for the Hospital, attempting to keep on top of the figures and to work out what was happening in the system.  This had also coincided with the Covid pandemic.  One of the challenges now was for the Hospital to address the very long waits some patients were experiencing. UCLH was now focusing on patients waiting the longest for treatment

·       UCLH was tracked around the longest waits.  A couple of years ago, the aim was to ensure that no patient was waiting more than two years, but the focus was now on getting the numbers down to 78 weeks, or a year and a half and 65 weeks, which was 15 months. UCLH had attained the 78 week target by March of last year, although there had been particular spikes in dermatology services, affecting cancer care especially.  However, this had now improved.

·       On the number of patients waiting for over a year for treatment, current guidance was that no patient should be waiting longer than a year for treatment by the end of March 2025.  It was anticipated that this would be a very hard target for UCLH to meet, so time was being spent predicting which specialties were likely to face the most challenge, through mathematical modelling and looking at referral rates and opportunities for maximising outpatient space.

·       There had also been a significant reduction in the number of patients seen in time for diagnostic  ...  view the full minutes text for item 44.

Anna Stewart, Programme Director for Start Well, at North Central London Integrated Care Board, gave a presentation to the Committee on proposals that had been developed as part of the Start Well Programme proposals. This Programme of work had been initiated in 2021 to ensure maternity, neonatal, children and young people’s services were set up to meet population needs and improve outcomes.

Anna Stewart said that she would take notes during the discussion of this item to feed back into the formal consultation. She also encouraged all present to submit their own feedback if they had not already done so.

She noted that Start Well had been operating in north central London for approximately two years.  She described the programme as a “truly integrated piece of work”, across the whole of the ICS, involving colleagues from all of the acute trusts across NCL, as well as GOSH as a key partner and local authority colleagues. A case for change had been initiated approximately 18 months previously and then time was spent with a wide range of clinicians developing best practice care pathways, with a view to developing idealised pathways of care needed for maternity, neonatal and children and young people’s care. From there, three key areas were identified which would potentially need some organisational changes in order for them to be delivered and could not be delivered through the normal systems of working together through the integrated care system. 

The three main areas of the Programme which were the focus of public consultation were:

·       The number of neonatal and maternity units in north central London and the proposal to move from five units to four. The reason for this was changing demographic patterns, the declining birth rate in north central London, the increasing complexity both of women and pregnant people giving birth and the babies they were having who needed additional care. This meant a mismatch between the existing pattern of care available in north central London and the need. There was a lot of pressure on services looking after women with more complex needs  and complex babies, meaning pressure on the level three neonatal intensive care unit at UCLH. Conversely, there was a level one neonatal unit in NCL, which cared for the least unwell babies, which was generally half empty, because it was not able to meet the needs of the babies being born.

The proposals around maternity and neonatal services were not to save money, rather they were driven by a belief that having a smaller number of larger units would better deliver best practice care standards, improve the quality of care and improve the resilience of care in services that were historically pressured in terms of recruitment and retention.

Both options would require a considerable investment in the estate in north central London, in terms of the fabric of the buildings. Under both options, £40m capital had been earmarked to invest in those buildings. 

Two options were being consulted on:

1. To close maternity and neonatal  ...  view the full minutes text for item 45.

Manny Lewis, Assistant Director of Resident Experience, highlighted some aspects of the presentation from the Access Islington Hub initiative, which were based on the Covid response model “We are Islington”, with a specific focus on early intervention and prevention, collaboration and wrap-around support for residents.  Although the initiative had started off as a simple model of meeting residents’ basic needs, it quickly expanded into a more sophisticated model including vaccine support, support for clinically extremely vulnerable residents and a test and trace service.  All of the learning was remodelled into a face-to-face offer, meeting residents’ needs at the initial point of contact, or assisting them through the journey to achieve their needs.

There were currently two hubs open: the central hub at 222 Upper Street and the south hub at Finsbury Library, both launched in September 2023. A hub was being developed in the north of the Borough, at the Manor Gardens site, which was due to open in June 2025.  The aim of the hubs was to offer comprehensive wraparound support, including money, food, wellbeing, housing, family, community safety and work.  Unsurprisingly, the majority of people attending the hubs needed support with money, food, housing and wellbeing, all of which were linked.  Staff at the hubs had two roles. Firstly, triage advisers met with residents, talking with them to understand and identify what their needs were. This included assistance with digital technology.  Secondly came the connector sessions, which involved more in-depth support to look beyond the preventative needs and attempted to identify the underlying needs. These sessions were not time limited and staff were clear that they had as much time as they needed to get to know the person in front of them, forging a connection to identify their needs and to meet those needs.  Staff had undertaken specialised training for these roles, including trauma-informed practice, level three safeguarding and cultural competency. Training was ongoing as the needs of residents became clearer.

In terms of the priorities for the hubs, they were still in development. Continuous engagement, collaboration and partnership working was under way.  The links with Bright Lives Coaching were very important as they provided short -term support for those needing it, assisting residents to develop their own resilience and skills to develop in the future, with support from the hub.  Talks had taken place with the Single Homeless Project who were now providing sessions at the hubs.  Close links with Citizens Advice Bureau, Islington Mind and Bet No More existed, the latter of whom would be based in the hubs at certain times of the week.  The service was already working well with the Council’s Access services, adult social care, to see if it might be possible to meet needs at the first point of contact, rather than referring residents to other services, which often fed into dependency. More partnerships were in progress.

Another key element was engagement sessions and working groups. Islington’s success was due to the development of good links with  ...  view the full minutes text for item 46.

Councillor Nurullah Turan, Executive Member for Health and Social Care, referred to a recent email to councillors about the measles outbreak and MMR. 

He was pleased to report that the Council had received about £4m funding for a new GP clinic on Andover Estate.  The existing GP clinic on the Estate was due to close as it had been taken over by a private developer, unfortunately sold by its previous owner.  The new developers were due to contribute to the new health centre and the Council was working with them. The new clinic would be on the Newington Barrow Way site and would be a state of the art establishment.  All the proposals had been approved in the previous week.

He was also pleased to report that the GP closure he had mentioned at a previous Committee, based in New North Road, would no longer close, as the GP had managed to find a partner, which was apparently unusual. This would mean 1800 patients would not have to move to another GP service or find another pharmacy service as there was one on site.

He also drew the Committee’s attention to recent news about the development of  two new Alzheimers drugs.  These treatments significantly slowed symptom progression of Alzheimers disease and were most effective when given as early as possible. A decision was expected from drug regulators this year as to whether they could be approved for use in the UK. The treatment could mean the end of Alzheimers disease, offering hope that one day it might be considered a long-term condition, with people managing their symptoms and living full lives. However, only a relatively small number of people were likely to be able to access them as the majority of people were diagnosed quite late.  However, because services were so well connected in Islington, the Borough was one of the leading places for dementia diagnosis.  The Alzheimers Society had unofficially described Islington as a “Dementia Friendly” Borough.

One of the issues discussed at Healthwatch Islington was private care access, where Islington councillors raised the issue of the challenges faced by ethnic minority groups and the changes required. Healthwatch Islington had requested Healthwatch England to reserve a space on the Healthwatch London agenda to ask how others  had used the Healthwatch England report to influence delivery and see how good practice might be implemented in Islington.  Healthwatch Islington were also developing a strategy to get more men involved in their research.

A meeting had been held with the London Medical Council in the previous week, where he had been informed that fewer older patients were coming through for consultation. He had asked for figures and would take it up with next week’s ICB meeting.

He had visited a surgery, the Miller Practice, and one of the issues raised was the estate. A visit had taken place to Pharmacy First in Newington Green, where things were working, although when discussed with LMC, concerns had been raised about the likely overprescription of  ...  view the full minutes text for item 47.

Jonathan O’Sullivan, Director of Public Health, invited questions on his written report on Public Health performance for quarter 2 in 2023/24.

Questions/responses were as follows:

Could the Committee have a picture of measles in the capital at the moment?  The response given was that there had definitely been an increase in measles cases month on month, across London as a whole.  There was also a similar pattern in the west Midlands. There was concern about the level of measles, mumps and rubella vaccination uptake, both for the first and second doses.  Together with the NHS, the Council was working on a range of activities to improve measles, mumps and rubella vaccination uptake. As was apparent in the report, there was currently no data available through the local health system, so authorities had worked carefully on a triangulation of the other vaccinations given at the same time and the Director of Public Health had said that he was very confident that it was just a data coding issue which was not being picked up in the local system.  He noted that in national data, an increase in MMR 2 vaccination was evident, again supporting the sense of a local coding issue.  Key messages had been shared with councillors about the importance of the MMR vaccine, including sharing some of the information in community languages. NHS colleagues were doing more in terms of promotion and roll-out to the community to encourage more people to attend for their vaccinations.

The Chair reported that he had met the Bangladeshi Association last year  and had met with Islington Public Health staff and offered to attend the mosques with information on vaccinations.  He had suggested to the imam that it would be helpful if he could attend a Friday prayers session to talk about the issue.  The Director of Public Health said that it would be helpful for councillors, who were trusted in the community, to do anything they could to spread the message about vaccinations.

On substance misuse, it was noted that services were delivered by the organisations “Inroads” and by “Via”, the latter including outreach work for various people. Confirmation was requested on whether the carrying of Naloxone was carried by the outreach workers only?  There was reference in the report to “services collaborate closely with criminal justice partners to ensure effective pathways into treatment from prison, probation and police, which includes co-locating of services and in reach support” and how exactly this was working in Islington?  There was also a reference to “strong service focus for the coming quarter to help increase people with opiate addiction coming into treatment services.” and whether there were problems with nitazenes and higher risks of overdose?  The Director of Public Health replied that naloxone was carried by outreach workers to promote supplies for people using opiates as it was considered important.  Harm reduction was most important. The kits previously were injectables but were now nasally administered.  There was an initiative with community pharmacies who were in  ...  view the full minutes text for item 48.

The Chair suggested that it would be helpful to receive a presentation from the Access Service at a future meeting, particularly to hear about how outcomes were monitored.