Agenda and minutes

Apologies for absence were received from Councillors Lorna Greenwood and Rebecca Filer.

Members will be asked to declare any Statutory Disclosable Pecuniary Interests, Compulsory Registerable Non-Pecuniary Interests and Voluntary Registerable Non-Pecuniary Interests in respect of items on this agenda.

There were no declarations of interest.

Broadcast of the meeting

The Chair to announce the following: ‘In addition to the rights by law that the public and press have to record this meeting, I would like to remind everyone that this meeting is being broadcast live by the Council to the Internet and can be viewed on our website for twelve months after the meeting. After that time, webcasts are archived and can be made available upon request.

If you have asked to address the meeting, you are deemed to be consenting to having your contributions recorded and broadcast, including video when switched on, and to the use of those sound recordings and images for webcasting and/or training purposes.’

Any other announcements

Broadcasting

The Chair announced that the meeting was being broadcast live by the Council to the Internet and could be viewed on the website for twelve months after the meeting. After that time, webcasts were archived and could be made available upon request. Those who were seated in the Council Chamber or participating remotely were deemed to be consenting to having their contributions recorded and broadcast and to the use of those sound recordings and images for webcasting and/or training purposes.

Order of agenda

The Chair noted that Kirsten Watters, Director of Public Health, needed to leave early. The Committee agreed to bring the Future Ambitions of Camden’s Public Health Service item forward so that it was the first substantive item of business.

Requests to speak at the Committee on a matter within its terms of reference must be made in writing to the clerk named on the front of this agenda by 5pm two working days before the meeting.

There were no deputations.

There were no items of urgent business.

To approve and sign the minutes of the meeting held on 10 July 2023.

RESOLVED –

THAT the minutes of the meeting held on 10^th July 2023 be approved and signed as a correct record.

Report of the Cabinet Member for Health, Wellbeing and Adult Social Care.

This report provides the Committee with an update relating to the portfolio of the Cabinet Member for Health, Wellbeing and Adult Social Care.

Consideration was given to the report of the Cabinet Member for Health, Wellbeing and Adult Social Care.

It was confirmed that the vaccine bus was not being used for Covid-19 vaccinations although it was available if necessary. The planning for the seasonal Covid-19 vaccination programme provided adequate coverage.

The use of the bus to deliver MMR vaccinations in areas with the lowest uptake had been innovative and UCLH was thanked for its work on the service. Learning from the exercise would be considered, including the best timing for such mobilisations. There was a need to continue campaigns to increase MMR uptake.

RESOLVED –

THAT the report be noted.

Report of the Managing Director, Camden Division, Camden and Islington (C&I) NHS Foundation Trust.

The purpose of this paper is to update Camden’s Health and Adult Social Care Scrutiny Committee on the progress of coproducing a new mental health day support service in Camden.

Consideration was given to the report of the Managing Director, Camden Division, Camden and Islington (C&I) NHS Foundation Trust.

The Chair queried how carers could link into the new mental health day support service, noting that carers may also be caring for people with mental health problems. Alice Langley, Managing Director Camden Division at Camden and Islington NHS Foundation Trust, noted that carers had been involved in the work to date and there was a need for their ongoing involvement. There was now a need to formalise the model and the offer for different groups, including carers. Camden Carers had been involved in the work.

In response to questions, the Managing Director agreed that flexibility was one of the key themes coming out of the co-design work, with concerns raised that individualised needs would not be met. There would not be any concrete time limits on support. It was also an aim that service users could benefit from the full range of services. Integral to the model was for staff from all community services to be involved in the decision-making around where someone would be best supported. Rather than taking an institutional approach, service users would also be connected with support in the community. A personalised holistic care plan would be developed with the service user and reviewed on an ongoing basis.

Consideration was being given to provision of the new service from the Greenwood Centre although there were different views on the need for additional spaces. The details on the spaces to be used are still being worked through.

In response to questions about the balance of provision for people who self-refer and those who are referred other organisations, it was noted that the service would exist as part of a network of community and crisis support provision. The service would be predominantly accessed through professional referral although it would be available to all, including those who have struggled to access support.

It was clarified that the mental health day support service would complement community mental health services who do home visits, providing alternative environment for service users. There was agreement that stigma continues to exist but that the new service would recognise challenges and support community integration.

Members noted that responses to the engagement activities suggested that e-service users of the Acute Day Unit (ADU) at the St Pancras Hospital site had valued it and wanted some elements from that service to be incorporated into the new offer. Officers commented that research in 2021 into ADUs nationally had concluded that ADUs required further research. It found that there were positive outcomes and satisfaction for service users indicating that some elements should be retained. However, previous experience of ADUs was that they could be siloed and lack dynamism and reach. Locally there were good complementary day support services but there was some duplication and they did not link well together.

The Chair thanked officers for attending the meeting.

RESOLVED –

THAT the report be  ...  view the full minutes text for item 8.

Report of the Director of Integration (Camden Borough) North Central London Integrated Care Board.

This report:

·       sets out the changing national and regional context for primary care;

·       summarises the ICB’s work with providers to deliver better primary care in Camden over the last 12 months; and

·       identifies key challenges, priorities and plans for the coming year.

It provides detail around important facets of the service offered by Camden general practice, as well as our focus areas for collaboration including patient involvement, access, estates, workforce development, digital development, and improving quality.

Consideration was given to the report of the Director of Integration (Camden borough), North Central London Integrated Care Board.

In response to questions about consistency of GP services, Simon Wheatley, Director of Integration, commented that GPs were independent contractors in a publicly funded system and each practice had its own identity. They had different operating models to meet the different needs of their registered users. However NHS policy was for people to have consultations in the manner they preferred, including with translations or face to face. There were complaints processes, including the potential to escalate to the Integrated Care Board (ICB), if the service felt short of expectations.

With regard to concerns about the availability of prescribed medicines, Dr Dee Hora, Camden Borough Clinical Director, commented that when there was advance notice of medication shortages, prescription changes could be planned. However, often patients only discovered that medicines were unavailable when they reached the pharmacy. Pharmacy colleagues sat in the ICB and tried to alert GPs of shortages. There was also work underway on streamlining communications with community pharmacies.

Kamran Bhatti, Assistant Director Primary Care, reported on the work with Primary Care Networks and GP practices to communicate the Enhanced Access service to all patients. Information should be on the website and appointments accessible via the GP team. There was still work to do but feedback that many residents were unaware of the Enhanced Access service would be taken back.

In response to questions about what levers the ICB had to foster change in primary care, the Director of Integration commented that, while 10 years previously the commissioners would have used hard levers such as competition and commissioning, they now used soft levers such as collaboration, influence and encouragement. The ICB worked closely with the Clinical Directors of the Primary Care Networks and with the GP Federations to set directions of travel.

Chaima Hale, a physician associate ambassador for NCL training hub, explained that during introductions, a physician associate would explain their role but this was not always absorbed. Raising awareness of the role and developing guidance around their scope of practice was part of the purpose of the ambassador. Patients were given the option to see a GP or nurse rather than a physician associate if that was their preference. Gold-plated supervision was also very important for physician associates and the ambassador was working with the ICB and the NCL training hub to ensure this was in place.  

Returning to the issue of medicine shortages, it was clarified that community pharmacies were independent and there was no way for GPS to check availability of medicines without ringing around. There had been an increase in the use of electronic prescribing that assisted with patients looking for available stocks.

In response to questions about walk-in centres, NHS England had moved away from the provision of walk-in centres as there was huge variation in what this meant in different areas. In Camden there were challenges due to the heavy through-flow of non-Camden  ...  view the full minutes text for item 9.

Report of the Executive Director, Adults and Health.

This paper gives an overview of the work taking place across Camden Adult Social Care, with a particular focus on Neighbourhoods, Adult Early Help, Co-production (Participation and Engagement), Transforming Care and Support at Home, as well as the Accommodation Strategy.

Consideration was given to the report of the Executive Director Adults and Health.

Jess McGregor, Executive Director Adults and Health, elaborated on the Integrated Neighbourhood Teams (INT), explaining that work was underway to identify buildings for co-location, starting with the East Neighbourhood. The Neighbourhood Coordinator role for the East was out for recruitment. The INTs built on years of collaborative working. To date, integrated work had relied on multi-disciplinary meetings but in future services would co-locate and work together more routinely.

In response to questions about financial support to the voluntary and community sector (VCS) who were providing services to hard to reach groups, including on referral through social prescribing, it was confirmed there was no additional money but current budgets within the wider system could be spent more effectively together. An intentional design-led approach, rooted in resident participation, would be taken to find better ways to spend the resource.

With regard to concerns expressed about care and support services at home, the Executive Director Adults and Health agreed that the environment was challenging. Despite a commitment, there was no nationally funded social care service. The Covid-19 pandemic and workforce challenges contributed to the problems but Camden was in a stronger position than some places. No home visits of five minutes were taking place, with the expectation being that visits would not be shorter than 30 minutes. Camden Council had been an early adopted of the London Living Wage, resulting in significantly less turnover in the care workforce. The commissioning approach to build and support local organisations such as Hopscotch to provide care services mean that there was strong local resilience and Camden was not reliant on a single national provider. Where providers were experiencing workforce challenges, they were supported.

In response to questions about how co-location would make on the individual level, the Executive Director Adults and Health informed the Committee that a group from the Integrated Care Executive (the strategic leadership group for the Health and Care Partnership) had visited Manchester in August to look at the INTs. Co-location enabled teams to routinely work together, with professionals looking across what each other was doing to enable a more holistic approach with fewer repeat visits to service users from different services. The Cabinet Member for Health, Wellbeing and Adult Social Care noted that morale was high in the Manchester INTs, with staff feeling they were able to work together to solve problems.

Comments were made about the suitability of treating long-term complex needs within a crowded urban environment, with impacts on both the individuals and neighbours. The Executive Director Adults and Health commented that the Accommodation Plan was moving away from previous approaches that would review the way accommodation-based services were working. With the ambition for residents to live in their own homes, there was a need to think of housing in the round and not just the supported accommodation being commissioned. This included how Adult Social Care was working with Landlord Services. There was work underway  ...  view the full minutes text for item 10.

Report of the Director of Public Health.

This paper provides an update on the transformation of Camden’s Public Health service following changes in its organisational structure, which led to the de-merger of the shared Camden and Islington service and the establishment of a distinct Public Health service for Camden. The report details the current Public Health Workforce and Teams and outlines the department’s priorities.

Consideration was given to the report of the Director of Public Health.

In response to a request for an update on Covid-19 and immunisations, Kirsten Watters, Director of Public Health, noted that there was a new variant under investigation but it was not yet a variant of concern. There was a lack of clarity over its transmissibility and level of vaccine escape. A decision had been made to bring forward the seasonal influenza and Covid-19 vaccination programme. While there had been some increase in hospitalisations, it was not clear if this was because of the variant or if it was due to fading immunity. It was confirmed that those who worked or lived with vulnerable people could self-declare and receive the vaccination.

It was noted that developments planned in Camden would increase the number of residential units and it was queried how Public Health influenced thinking on the health needs arising. The Director of Public Health confirmed that there was close working with the NHS on planning for health services on the basis of population projections and needs assessments. Data and modelling for health service needs was provided for large developments.

In terms of gambling harms, substance misuse services were commissioned and gambling harms would be looked at as part of this. Work was being undertaken with the London School of Hygiene and Tropical Medicine which was looking at the provision of gambling establishments, gambling-related harms and an assessment of the types of services that could be provided.

In response to questions about data, it was explained that the shared Camden and Islington Public Health service had always carried out borough-based analysis and no disentanglement had been necessary. There was still one intelligence post shared with Islington for efficiency but all analysis was borough-based.

There was a query whether ADHD had been treated as a Public Health issue. The Director of Public Health explained that a needs assessment was being taken for neurodiversity in children and there was an intention to ensure planning was needs-based rather than diagnostic-based. All completed needs assessments were published on the website.

The Director of Public Health confirmed that there was a commitment to continue funding the Community Champions Programme following an evidence review that had shown its benefits. There would be an assessment of how to expand or develop it. Information on funding for the Community Kitchen would be circulated to the Committee.

ACTION: Director of Public Health

The Winter Wellness Programme was provided in partnership with a VCS (voluntary and community sector) organisation and the outreach support service. VCS organisations could also refer to the Programme and the support offered was holistic.

It was explained that social value referred to the return to society from the spending of public money through additionality such as employment opportunities and apprenticeships arising from contracts.

The Cabinet Member for Health, Wellbeing and Adult Social Care expressed her pleasure at the new arrangements for Camden’s Public Health service and the potential to integrate health and wellbeing into all  ...  view the full minutes text for item 11.

Report of the Executive Director, Adults and Health.

This paper sets out the Committee’s work programme for 2023-24 and tracks actions from previous meetings.

Consideration was given to the report of the Executive Director of Adults and Health.

The Chair suggested that the Committee scrutinise the budget deficits at the Royal Free Hospital at a future meeting.

ACTION: Senior Policy and Projects Officer

RESOLVED –

(i)             THAT the work programme for 2023-24 (Appendix A) be noted; and

(ii)            THAT the Committee’s Action Tracker (Appendix B) be noted.

There was no urgent business.