Hounslow Council


Agenda and draft minutes

Venue: Committee Room 3, Civic Centre, Lampton Road, Hounslow

Contact: Ian Duke, telephone: 020 8583 2540 or e-mail:  ian.duke@hounslow.gov.uk. 

Items
No. Item

75.

Welcome and introductions

Minutes:

Cllr Bath welcomed members and officers to the meeting.  A special welcome was offered to Sue Jeffers as this would be her last meeting as Managing Director of the CCG before taking up her new role at CHHWE CCGs. The Chair and Committee thanked Sue for her help and support over the years and wished her well in her new role.

76.

Apologies for Absence, declarations of Interest and other Communication

Minutes:

Apologies were received from Cllrs Barwood, Carey, Collins and Green. Apologies were also received from Tim Spilsbury.

 

Cllrs Kaur and Smart also provided apologies due to a conflict with the Peer Challenge process.

77.

Minutes of the meeting held on 28 November 2016 pdf icon PDF 149 KB

Minutes:

The minutes of the meeting of the 28 November 2016 were agreed as an accurate record.

78.

Matters Arising

Minutes:

A copy of the STP presentation had been circulated.

 

Sue Jeffers offered to provide a written update on the future of the Greenbrook practices.

 

Action: Sue Jeffers to provide written update.

79.

Local implementation of the Sustainability & Transformation Plan pdf icon PDF 193 KB

Minutes:

The Chair reminded the Panel that at the meeting on 28 November 2016, the Panel agreed to invite Cllr Kaur and Sue Jeffers, Managing Director, Hounslow CCG to set out the Hounslow-level delivery based on the final iteration of the STP and its implications for Adult Social Care with the following:

·       An overview what these documents mean for Hounslow and the future shape delivery of health and adult care in the borough and what are the key dates and milestones moving forward;

·       Key risks and challenges to delivering this and what thinking there is currently around mitigation;

·       What does the STP mean in terms of the future funding for adult social care in the borough – has the current version met the ambitions of the Council?;

·       Planning for the closure of Ealing A&E – the panel noted the scale of increase in demand for A&E services from TW3 and TW7 and the working hypothesis of Chelsea & Westminster Foundation Trust that this might be related.

 

Cllr Bath welcomed Sue Jeffers and Alan Adams and invited them to speak to their presentation. The following summary of key points emerged from the presentation and discussion that followed:

·       Sue Jeffers distributed hard copies of a document entitled ‘Local Services Transformation within Northwest London: Our strategy for transforming Primary Care and out of hospital services’. This document had arrived at Hounslow CCG early in the day and sets out the sub-regional direction of travel.

·       The presentation provided focused on delivery in Hounslow (structured around the 5 Delivery Areas of the STP), activity around acute services and engagement.

·       Even without the STP Hounslow activity would be the same as existing strategies fitted well into the STP framework

·       Delivery Area 1 is focused on Prevention, Convenient Access and Social Prescribing and is critical to delivery of the STP. When talking through the areas the following additional points were made :

o   Patient Activation Measure – an intervention tool to improve motivation to improve the health status of those with long-term conditions

o   Wellbeing measure to improve mental wellbeing by increasing the number of positive relationships of individuals

o   Through LIFE procurement, seeking to improve provision for those with Learning Disabilities through improved help and advice and practical support.

o   It was noted that even when commissioning out service, the Council retained accountability for the quality of those services

o   Healthwatch has undertaken a survey of 2,500 on satisfaction of GP Access and this has highlighted the need for Saturday opening of GPs which is being actioned.

o   78.6% of practices have 10% or more appointments made online – this is the highest in London.

·       Delivery Area 3 sought to achieve better care for older people. The activities highlighted were:

o   Providing specialist palliative care at home to improve end of life services and experience

o   Community Recovery Service supporting rehabilitation and reablement for people leaving hospital

·       Delivery Area 4 addresses Mental Health and the core principle to address physical and mental health issues holistically. Activities  ...  view the full minutes text for item 79.

80.

Vaccination and immunisation rates against infectious diseases pdf icon PDF 238 KB

Presentation from London Borough of Hounslow, Councillor Corinna Smart and Dr Imran Choudhury

Additional documents:

Minutes:

The Chair reminded the Panel of the background to this item. The borough is facing a number of public health challenges in particularly under Health Protection where outcomes of Childhood Vaccination, Flu Vaccination and Incidences of TB have been comparatively worse than other boroughs. In the last meeting on 28 November it was agreed to include this item on the agenda for this meeting in order to understand the following:

1.     The profile of persons affected by infectious diseases in LBH in terms of age, gender, ethnicity, religious or cultural background and disability and the particular needs and challenges presented;

2.     The health systems and local service response to the specific areas of low achievement, in particular where LBH achievements fall within the lower threshold of the Public Health Outcomes Framework (PHOF);

3.     The health promotion & behaviour change activities in terms of achievements and monitoring impact through health outcomes;

4.     The existing allocation of resources and quality of services delivered under health protection and health promotion & behaviour change.

 


The Chair welcomed Imran Choudhury and Clare McKenzie and asked them to run through the presentation that had been provided with the papers. The following summary of key points emerged from the presentation and discussion that followed:

·       The system of accountability for immunisations is complex and fragmented with 4 different bodies responsible. Local authorities have responsibility for independent scrutiny and challenge for the arrangements put in place by NHS England, Public Health England and the CCG and their providers. Local authorities do directly commission school nursing services which undertake immunisations.

·       Immunisation rates have increased in Hounslow, and are on a par with comparator boroughs, but like the rest of London the borough is struggling to reach the 95% benchmark to reach ‘herd immunisation’. The factors affecting this are the high birth rate, population mobility in London, and demand pressures on GPs. There is also the issue of misinformation around immunisation that is affecting more affluent households.

·       The last outbreak of infectious disease was the measles epidemic in 2013. The system responded well to this but it highlighted that the data available is not very good.

·       Data collection is particularly problematic. Latest NHS England data was corrupted and whilst efforts are underway to address this, it is affecting ability to target households and hold GPs to account.

·       A key problem is that practices are not calling and recalling patients back quickly enough, but this is a key area for improvement in 2016/7. Coordinators are being put in place to address this and this should impact of performance during 2017/8. This would be a real game changer.

·       BCG offer is provided to all babies born in Hounslow or resident in Hounslow when they are born, and this is a priority action for 2016/7. There had been a shortage of the vaccine in previous years but this has been rectified. Health Visitors will promote vaccination with every contact, and this will be reinforced by a national campaign through NHS England.

·       Adult flu vaccination is lower  ...  view the full minutes text for item 80.

81.

GP Access Review findings

Relationship between satisfaction with GP practices and A&E usage.

 

Minutes:

Ian Duke provided an overview of progress since the last meeting. Three new areas had been targeted because of a flaw in the original data analysis. These were based in the west of the borough and represented the areas where avoidable A&E was at its highest. Satisfaction data for the local GP practices had been considered and suggested that satisfaction with those practices did not seem to be a factor. However a mapping of registered GP practices used by residents in these areas showed a wider distribution across the borough, beyond use of the local practices. This would need to be considered further – for instance could distance be a contributory factor.

Further work had shown that avoidable A&E usage in these areas had increased but was being undertaken by fewer people. This suggested a behavioural driver and the next stage would be to look at this more closely. In order to do this profiling would need to take place to see whether there were common characteristics at play. This would also allow for discussions to take place with those demonstrating those characteristics should that be deemed appropriate.

 

The Panel expressed some surprise that GP satisfaction might not be a driver, given their own experience. Ian Duke explained that it might still be a driver but it was not showing in the data obtained so far. The Panel agreed that the profiling go ahead and that this be reported back to the next meeting.

82.

Work Programme pdf icon PDF 21 KB

Minutes:

The Panel agreed that the substantive items at the next meeting would be Social Isolation and Mental Health & Dementia.

83.

Any other matters that the Chair considers urgent

Minutes:

No items raised.

84.

Date of Next Meeting - Tuesday, 25 April 2017 - 7.00 p.m.

Minutes:

The next meeting was scheduled for 25 April at 7pm.