Greenwich Council

Agenda and minutes

Venue: Committee Room 5 - Town Hall, Wellington Street, Woolwich SE18 6PW. View directions

Contact: Daniel Wilkinson  Email: daniel.wilkinson@royalgreenwich.gov.uk or tel: 020 8921 5102

Items
No. Item

Appointment of Chair and Vice Chairs

Councillor Thorpe proposed and was seconded by Councillor Scott-McDonald that Councillor Hyland be Chair of the Board for the duration of the municipal year.

 

Councillor Hyland proposed and was seconded by Naomi Goldberg that Dr Ellen Wright be joint Vice Chair for the duration of the municipal year.

 

Dr Ellen Wright proposed and was seconded by Councillor Hyland that Councillor Gardner be joint Vice Chair for the duration of the municipal year.

 

Resolved –

 

1.     That Councillor Hyland be Chair of the Board for the municipal year 2017/18.

 

2.     That Dr Ellen Wright and Councillor David Gardner be appointed joint Vice Chairs of the Board for the municipal year 2017/18.

 

 

1.

Apologies for Absence

To receive apologies for absence from Members of the Board.

Minutes:

Apologies for absence were received from Dr Sabah Salman, and given for Leceia Gordon-MacKenzie.

 

The Chair noted that Jim Wintour had resigned from the Board and that he had passed on his best wishes to the Board. The Chair thanked Jim Wintour for all his work with the Board.

 

The Board noted that there was to be a change in the representative from the NHS Lewisham and Greenwich Trust, that this was to be Val Davison the new Chair of the NHS Lewisham and Greenwich Trust.

2.

Urgent Business

The Chair to announce any items of urgent business circulated separately from the main agenda.

Minutes:

There was no urgent business.

3.

Declarations of Interest pdf icon PDF 34 KB

Members to declare any personal and financial interests in items on the agenda.  Attention is drawn to the Council’s Constitution; the Council’s Code of Conduct and associated advice.

Minutes:

Resolved –

 

That the list of Councillors’ memberships as Council appointed representatives on outside bodies, joint committees and school governing bodies be noted.

4.

Minutes pdf icon PDF 54 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 6 March 2017

 

No motion or discussion may take place upon the Minutes except as to their accuracy, and any question on this point will be determined by a majority of the Members of the body attending who were present when the matter in question was decided.  Once confirmed, with or without amendment, the person presiding will sign the Minutes.

Minutes:

Resolved -

 

That the minutes of the meeting of the Health and Wellbeing Board held on 6 March 2017 be agreed and signed as a true and accurate record.

5.

Mental Health Review pdf icon PDF 39 KB

To note the review that has been undertaken by the CCG as part of both its commissioning and contracting review and its work to increase local community and patient engagement

Additional documents:

Minutes:

The report was presented by the Chief Officer of Greenwich Clinical Commissioning Group. The Chief Officer commented on mental health services and the work of the CCG in conjunction with its partners on the matter. She highlighted that mental health was one of the five priority areas identified as part of the review.  She detailed the specific targets within the priority areas. The Chief Officer drew Members’ attention to page 25 of the agenda and the key areas which were to be part of the work that the CCG would be doing over the next few months.

 

The Chief Officer of Greenwich Clinical Commissioning Group also informed the Board that the CCG was also looking at ‘Health Based Places of Safety’ to see what the implications of it would be for South East London and Greenwich, and it was expected that they would have a suggestion for its configuration by the end of October.

 

In response to a question from the Board, the Chief Officer of Greenwich Clinical Commissioning Group said there had been discussions between CCG and Oxleas with regard to potentially setting up a ‘Crisis Café’, with perhaps one being tested first in Bexley Borough. The Chief Officer said they would prefer to be doing something locally to stop people get into crisis, and a ‘Crisis Café’ would be one of the things they would look at to achieve that.

 

During discussion on detentions under s163 of the Mental Health Act 1983, the Borough Commander stressed that there was a critical capacity and demand issue. The Director of Health and Adult Services added of the approximately 23 s163 suites across London only 2 of them met the gold standard for staffing, and the feedback from users was that these places tended to be unpleasant. Only about 4 of the suites were in South East London, and some of the suites were in inappropriate places. Work was being done to start to improve them and there was some government grant for this. The Chair of Oxleas Trust said he did not think the situation with regard to the s163 suites could continue much longer. Oxleas’ beds were frequently full; they were working with the South London and Maudsley as they had a couple more beds. However, he suggested that more beds might not necessarily be the answer: for example, ‘Crisis cafés’ were a success, if they could have earlier intervention, if they could confidence with their home treatment service, and also some people were admitted who perhaps should not have been.

 

During discussion on the Child and Adolescent Mental Health Services (CAMHS) the Chief Officer of Greenwich Clinical Commissioning Group explained that in terms of responsibility it was a joint effort between the CCG and Children’s Services and it was important that it be so.  The Director of Children’s Services commented that it was too early yet to see the impact of the newly commissioned model of integrated therapies with a CAMHS in-reach service. The Director of  ...  view the full minutes text for item 5.

6.

Discussion on Accountable Care Organisations for Greenwich pdf icon PDF 105 KB

To support work to explore the potential implications in developing an Accountable Care System for Greenwich.

Minutes:

The report was presented by the Chief Officer of Greenwich Clinical Commissioning Group. She noted that there were questions about what Accountable Care System (ACS) are and what they were not. The Chief Officer said they were proposing to start a process of looking at what might be sensible for Greenwich. Greenwich was not an isolated system, it sat within organisations that covered three boroughs. They had to consider who the partners might be, and she suggested that might include primary care, the local authority, voluntary sector, mental health, and acute trust; and they had to consider what that meant in terms of organisational form and governance and the roles of those partners. The Chief Officer informed the Board that all other Boroughs were starting to think about this. There had been some guidance issued by NHS England. The Chief Officer noted that some people were uncomfortable with what an ACS might mean, and commented that Accountable Care Organisations might be more difficult to achieve than an ACS.

 

There was a discussion of the matter. Councillors expressed concern as to whether it was more fragmentation of the health service, and that the term ACS was meaningless. It was questioned what an ACS would actually do to improve services. It was highlighted that the Council could not be responsible for delivery of emergency care service if the Council did not have control or influence over them. It was felt that there was a case for looking at a partnership with Lewisham in particular as Greenwich shared an acute trust with them. It was suggested an ACS might mean another level of bureaucracy. As the HWB brought partners together it was not clear why another body was needed if the HWB fulfilled the proposed role. If was not felt that they should explicitly move towards an ACS at this stage as they needed more detail as to what it meant.

 

Dr Ellen Wright commented that who the partners were was not the difficult part, the difficulty would be the governance, finance and the risk, and how it would work in practice.

 

The Chief Officer of Greenwich Clinical Commissioning Group said the ACS was meant to integrate, to pull things back together after the fragmentation after the Health and Social Care Act. It was noted all partners had anxiety as to what it meant. The Chief Officer clarified that at this stage they were only to set up a workshop to explore the proposal.

 

Resolved –

 

1.       That the report be noted.

 

2.       That the Board supports the work to explore the potential implications (benefits, risks, challenges and opportunities) in developing an Accountable Care System (ACS) for Greenwich.

7.

Realignment of 17/18 BCF Greenwich CCG's Utilisation of the Better Care Fund 2017/18 in Partnership with the Royal Borough of Greenwich Local Authority pdf icon PDF 64 KB

To agree the proposal to realign the BCF funding

Additional documents:

Minutes:

The report was presented by the Director of Health and Adult Services. He clarified the proposal and he drew the Board's attention to the Appendix. He made a correction to page 96 of the agenda.

 

The Chair requested a corrected version of page 96 be circulated to Members.

Action: Director of Health and Adult Services

 

In response to a question from the Board the Chief Officer of Greenwich Clinical Commissioning Group explained that the additional beds mentioned on page 97 of the agenda had been commissioned at Foxbury to help with the discharge of patients. They had stopped using Foxbury at the beginning of August in preparation of re-opening Eltham.

 

Resolved –

 

That the proposal to realign the BCF funding as set out in Appendix A of the report be agreed

8.

Annual Health Protection Report 2016-17 pdf icon PDF 197 KB

To receive the Annual Health Protection Report 2016-17

Minutes:

The report was presented by the Director of Public Health. He drew the Board's attention to the issues of cancer screening and TB and the actions taken with regard to them.

 

In response to a question about Age 5 immunisation from the Board the Director of Public Health replied that the Royal Borough of Greenwich was marginally below the London average for that child immunisation, he clarified it was not school nursery delivered but done through GP practices. He said that the promotion of immunisation was systematically built it to the commissioning of children’s centres; all children’s centres were signed up to the Healthy Early Years Framework.

 

The Director of Children’s Services added that perhaps more could be done to promote it in the nursery setting. Dr Ellen Wright said that all GPs sent out reminders for pre-school boosters.  Dr Krishna Subbarayan suggested the school admission questionnaire might be a good way to catch missed ones.

 

The Director of Children’s Services would confirm if the schools admission questionnaire asked whether child had had the Age 5 immunisation.

Action: Director of Children’s Services

 

In response to other questions from the Board the Director of Public Health agreed there was room for doing better with cancer screening, and that they needed to look at guidance and the good practice of other authorities. It was noted there might be an issue with the unpleasantness of the bowel cancer test. He clarified that of the 7 key areas listed at 5.1.5. of the report some were not amenable to local action but they were covering they areas they could do locally. The C.difficile trajectory was based on historical figures; Greenwich had not been doing well until recently, but was now improving.

 

The Chief Officer of Greenwich Clinical Commissioning Group added that though the current bowel test was tricky, across the country 50% were able to do it. They were now going to be moving to just one test which should be a lot easier for people, pilot tests have shown a 10% increase in returns.  The Chief Officer emphasised that GPs made a huge difference with regard to cancer screening, the evidence was that it was GPs who persuaded people to take the tests.

 

The Chief Executive for Greenwich Action for Voluntary Service commented there needed to be more general information about cancer, as there was a fear about it, because early diagnosis could be life saving.

 

Resolved –

 

That the Annual Health Protection Report 2016-17 be noted.

9.

Thrive London pdf icon PDF 39 KB

To receive an update on the launch and next steps on the Mayor’s Mental Health Strategy: Thrive London

Additional documents:

Minutes:

The report was presented by the Director of Health and Adult Services. He drew Members’ attention to the six aspirations and actions for London as set out on page 130-131 of the agenda, and informed the Board that Greenwich was to host a Thrive event.

 

The Chair noted it was an excellent initiative.

 

Resolved –

 

That the update the Board on the launch and next steps on the Mayor’s Mental Health Strategy: Thrive London be noted.

*

The Director of Public Health advised members that the next meeting of the HWB was to be an informal workshop to refresh the Health and Wellbeing Strategy.

 

 

 

 

 

 

 

 

 

***

The Chair agreed to the members of the public addressing the Board.

 

Three members of the public addressed the Board and raised comments about

   funding for the Bridge forensic mental health hostel.

   the concern that the ACS was a change to the NHS, that it was a US-style insurance system.

   whether resources allocated for mental health were actually being used for mental health

 

The Chair of Oxleas Trust advised that the Bridge charity did superb work at the Tilt project hostel providing a comprehensive package. Financially, Oxleas were constantly stretched, and this had been their most challenging year.

 

The Chief Officer of Greenwich Clinical Commissioning Group advised that the guidance for contracts for ACS had been published on 8 August. The Health Service Journal had a number of points in terms of the implications for GPs. Some of the proposed changes would need primary legislation but there would be a lot of discussion before they got to that point; it was the understanding of the Chief Officer that there was commitment to a service free at the point of delivery and to a tax funded system. ACS were called health maintenance organisations in US, some were based on insurance, and they had had very good outcomes.

 

The Chief Officer of Greenwich Clinical Commissioning Group explained that a key way they were held to account on mental health spending was on a standard called the parity of esteem. The CCG had to report on how much new money they were spending on mental health. Mental health was now 1 of 5 national priorities of NHS. The Director of Health and Adult Services added that there was an anxiety across London re capacity about bed number. There were strong relationships between partners but there were some big challenges.