Members are reminded to consider the categories of interest in the Code of Conduct for Members to determine whether they have an interest in any agenda item and any action they should take. For further details, please see the attached note from the Monitoring Officer.

Members are reminded to declare the nature of the interest and the agenda item it relates to. Please note that ultimately it’s the Members’ responsibility to declare any interests and to update their register of interest form as required by the Code.

If in doubt as to the nature of your interest, you are advised to seek advice prior to the meeting by contacting the Monitoring Officer or Democratic Services

Nil items.

To be notified at the meeting.

Nil items.

RESOLVED

That the unrestricted minutes of the meeting of the Sub-Committee held on 26^th October 2021 be approved as a correct record of the proceedings subject to formal ratification at the next meeting.

The Chair:

Informed the Sub-Committee that due to unforeseen circumstances and consequent exceptionally busy demands on members, the meeting was being held online which meant that according to the current formal terms of reference the meeting is not formally quorate and as a result the status The Chair Informed the Sub-Committee:

v  that due to unexpected circumstances and consequent busy demands on members, the meeting was being held online which meant that according to the current formal terms of reference the meeting is not formally quorate and as a result the status of this meeting will be recorded as advisory. Nevertheless, it was noted that since the Sub-Committee has no decisions to take it would not affect the determination of any of the business to be

v  that she had, had a meeting with Councillor Mufeedah Bustin (Cabinet Member for Social Inclusion) regarding food nutrition in the Borough (e.g., To review use of community kitchens, benefits of putting food science back on the school’s national curriculum and accurate data to enable effective targeting of vulnerable people and families).

v  that this meeting will be recorded as advisory. Nevertheless, it was noted that since the Sub-Committee has no executive decisions to take it would not affect the determination of any of the business to be transacted at this meeting.

The Sub-Committee noted that:

v  Recommendation 4 on the Impact of covid 19 on Mental Health and mental wellbeing were outstanding, and the Chair will consult with service to agree actions and update the Sub-Committee.

v  The Chair was to visit the Cazaubon in-patient dementia assessment unit for older resident’s people living in Tower Hamlets, Newham, Hackney, and the City of London.

v  The briefing on provisions that have been put in place to support those residents who used to use Meals on Wheels had now been submitted to the Chair and would be circulated to the Sub-Committee.

v  The Chair (i) is a Member of the Local Covid Engagement Board that leads on engagement with the public regarding Covid-19 risks and prevention; and (ii) is happy to take questions from the Sub-Committee on the Board’s work.

The Sub-Committee received a report that provided an update on progress towards recovering elective care and outpatient services at the Royal London Hospital and Barts Health NHS Trust. It also covered the urgent response to dental provision in the London Borough of Tower Hamlets.  A summary of the questions and feedback provided to Members is outlined below:

The Sub-Committee:

v  Recognises that the impact of coronavirus has been unprecedented. And the Royal London Hospital and Barts Health NHS Trust now face another unique challenge with a resurgence of Covid-19 cases - just as the Trust are restoring planned care to previous levels, and as the usual seasonal pressures begin to bite. The Royal London Hospital and Barts Health NHS Trust staff have responded incredibly well to these challenges.

v  Commented that the pandemic is not just a medical phenomenon the restrictive measures undoubtedly have affected the social and mental health of individuals and the community causing disruption, anxiety, and stress.

v  Welcomed the offer by Royal London Hospital and Barts Health NHS Trust to investigate individual experiences of outpatients with particular reference to those awaiting treatment for adult and paediatric eye conditions.

v  Noted that a few months ago or pre pandemic the Royal London Hospital and Barts Health NHS Trust would expect every single patient to be offered an individual appointment. The challenge now with outpatients is that some of the clinics are now virtual and because the Trust moved to virtual very, very quickly during the pandemic and has yet to catch up with the different ways of working. It is a big piece of work to make sure that the Trust can offer patients appropriate face to face; telephone; virtual or whatever they require. However, the expectation, is that every patient ideally should have an individual appointment.

v  Observed that most long-waiting patients on the surgical waiting list will have agreed to undergo operative treatment before the coronavirus pandemic started. Many people’s circumstances may have changed because of the pandemic or other factors since then, and some patients may now have changed their minds about having surgery or wish to defer this until the pandemic is over. Similarly, some people’s condition may have changed, which they may not have wanted to inform their GP or specialist about.  Such patients are categorised under the P5 category, and its introduction will allow the Trust to view the waiting list including and excluding those patients listed as a P5.

v  Understood that as patients in the P5 category have deferred rather than declined treatment, they must not be discharged back to their GP, unless this is in their clinical interest and has been agreed by them following a conversation with their clinician.  Patients are given a review date to make sure their condition or preference has not changed. The maximum time before a review date is six months. Where a patient has been clinically prioritised for treatment in less than six months’ time, the review date and clinical prioritisation will  ...  view the full minutes text for item 6.1

The Sub-Committee received a presentation which highlighted (i) the overall budget for adult social care; (ii) the position at month 6 of the 2021/22 financial year; (iii) delivery of savings; and (iv) pressures/risks going forward and the approach to managing these.  A summary of the questions raised by the Sub-Committee and feedback given is summarised below:

The Sub-Committee

v  Agreed that the quality, reliability, and effectiveness of our adult social care system depends on a workforce that feels valued, supported, and encouraged to be the best. 

v  Commented that this support will need to be focused on levelling up the knowledge, skills, and experience of care colleagues across the sector through the establishment of a new knowledge and skills framework, promoting varied careers pathways, and making the most of any investment in learning and development.

v  Noted that patients can defer their operation whilst remaining on the waiting list for treatment, although until now there has been no systematic way of capturing that a patient has chosen to defer treatment (e.g. concerns about COVID-19).

v  Noted that the Department of Health and Social Care will be publishing a White Paper to improve health and social care for all and that the Council and its partners will continue to work with the Department of Health and Social Care and NHS England as they produce further guidance and support to facilitate the changes envisaged by this bill. Accordingly, Members indicated that they wanted to receive details of any risks envisaged to the delivery of  services to residents from the health and care Bill.

v  Requested a clear outline of process of appeals and fair process for panels and appeals e.g. the scope for a residents’ voice within the debt recovery panels and if individuals might be able to attend their panel meetings.

v  Noted the impacts of Covid on people's physical and mental well-being which can manifest through an impact on their needs for care and support.

v  Acknowledged that carers have also been adversely impacted during the pandemic in several ways and therefore the support that they may have been offered may not been available during significant periods of time through the period of the pandemic and therefore for several reasons people’s needs have become more complex because of that.  In addition, the Borough must work out a whole range of financial implications that are going to start to have an impact and that work has only just started as the Government is due to make further announcements that will provide more details.

v  Noted that from October 2023 the (i) Government will introduce a new £86,000 cap on the amount anyone in England will need to spend on their personal care over their lifetime, (ii) upper capital limit (UCL), the point at which people become eligible to receive some financial support from their local authority, will rise to £100,000 from the current £23,250, and (iii) lower capital limit (LCL), the threshold below which people will not have to pay  ...  view the full minutes text for item 6.2

The Sub-Committee received a presentation on the Better Care Fund (BCF) to provide (i) a timely update of recent actions relating to the BCF which will include an overview of the considerations and outcome of the Borough’s internal BCF review, updating on proposed and future changes to the BCF (including areas for future integration); and (ii) an update on changes made to our recently submitted 2021-22 Better Care Fund plan and associated Section 75. A summary of the questions and feedback provided is outlined below:

v  Noted that in terms of how people navigate the disabled facilities grant system, I think one of the ways in which we are trying to do that is through the Tower Hamlets connect which serves as an access point to Adult Social Care services in the Borough that help residents to live an independent, healthy, and fulfilling life.  It provides free, independent, quality-assured information, advice and advocacy across health, social care, and social welfare to resolve issues and to prevent or delay any needs or problems from getting worse.  However, the Council have recognised in the review that was undertaken earlier in the year that there is work to be undertaken around the Disabled Facilities Grant and how that is used and how better use could be made of the Grant such as the prioritisation of high risk care packages and fast tracking of adaptations for people and having a real focus on getting that money spent e.g. putting in a handrail on the stairs; building a ramp up to afront door or bigger works like stair-lifts or showers.

v  Noted that the council is committed to making disabled facilities grant available to all eligible owner-occupiers, tenants, and property owners, so that disabled residents can remain safe and independent in their own homes.

v  Noted that when people have finished with equipment they can be collected and the recycling rate of equipment is good and the Council does well in terms of people being able to give back equipment that they no longer need, and that being used again where it is appropriate for other people.

v  Noted that all Clinical commissioning groups (CCGs) will be merged across their integrated care system (ICS) boundaries by April 2022, as part of proposed changes to legislation designed to hand ICSs the direct commissioning power.  It will also create a ‘single pot’ of funding, bringing together CCG commissioning and primary care budgets along with other funding allocated to systems.

v  Noted that a briefing paper could be prepared for the Sub-Committee on the proposals about what it means for Tower Hamlets.

v  Noted that the Health and Well-Being Board will be asked to approve the Better Care Fund Plan for 2021-22 as part the NHS England Assurance process and due to the late issuing of guidance and scheduling of Health and Wellbeing Boards this year this will be a retrospective approval (due to the plan having been submitted from assurance on the 16th of November 2021). However,  ...  view the full minutes text for item 6.3

With no other formal business to discuss the Chair called this meeting to a close; thanked all those attending for their contributions and informed the Committee that the next meeting would be on 8^th March 2022.