There were no declarations of pecuniary interests.

The Chair welcomed Members and officers to the Committee. It was noted the vacant co-optee member role was filled by Sue Kenten.

Members queried why there was a large gap between the November and March meetings. Officers explained that these were the best available dates in the Corporate Calendar. In addition to this, the Overview and Scrutiny Committee decided to reduce the number of meetings from six to five in a year, this resulted in a provisional date for early January 2020 being dropped. It was suggested that the period between November 2019 and March 2020 could be used to schedule in scrutiny review sessions, Members agreed to the suggestion.

RESOLVED:

1. To note the Committee Terms of Reference, dates of meetings and work programme tabled at the meeting.

For the Committee to appoint a Vice-Chair.

Councillor Denise Jones nominated Councillor Marc Francis as Vice-Chair of the Committee. Councillor Shad Uddin Chowdhury seconded the nomination. Members voted to appoint Councillor Francis as Vice-Chair.

RESOLVED:

1. To appoint Councillor Marc Frances as Vice-Chair of the Health & Adults Scrutiny Sub-Committee.

For the Committee to appoint one INEL JHOSC representative and one substitute INEL JHOSC representative.

The Chair sought two additional Members to represent Tower Hamlets on the Inner North East London Joint Overview and Scrutiny Committee (INEL JHOSC). Councillor Gabriela Salva Macallan was appointed as the primary representative and Councillor Shad Uddin Chowdhury was appointed as a substitute to the INEL JHOSC.

RESOLVED:

1. To appoint Councillor Gabriella Salva Macallan as the Committee’s representative to the Inner North East London Joint Overview and Scrutiny Committee. 
2. To appoint Councillor Shad Chowdhury as a substitute representative to the Inner North East London Joint Overview and Scrutiny Committee. 

The Committee received the report of Somen Banerjee (Director of Public Health) on Healthy Life Expectancy in Tower Hamlets.

Key points raised in the presentation:

• Data analysis from the Annual Report would inform the new Health and Wellbeing Strategy and Strategic Plan.
• Healthy life expectancy was defined as the period in a person’s life in which they experience good health. This period was consistently lower in Tower Hamlets compared nationally. The healthy life expectancy in Tower Hamlets was around 56 years, for example, whereas it was 71 years in Woking.
• Healthy life expectancy was lower for women in Tower Hamlets. As of 2014 the healthy life expectancy for men in Tower Hamlets increased and the trend had continued. Reasons behind this would be explored.
• There was a correlation between multiple deprivation and healthy life expectancy. Tower Hamlets still had high levels of concentrated deprivation despite the perception that the borough had risen in affluence.
• Stroke, cancer and respiratory disease were the biggest killers in the borough.  High rates of diabetes continued to affect the South Asian community. It was estimated that three thousand people remained undiagnosed. 
• The Primary Care Morbidity Survey showed Tower Hamlets had the highest levels of self-rated anxiety and depression in London but not the highest level of GP diagnosed mental health conditions.
• Tower Hamlets was an outlier in maternal health, smoking cessation and healthy diet. Wider factors such as crime, poverty, low income, insecure housing, overcrowding, poor adult literacy also impacted on wellbeing and healthy life expectancy.
• That the health and care system needed to understand who was using its services, address inequalities and consider intervention.
• Tower Hamlets had the highest level of obese 10-11 year olds. It was suggested a family approach should be taken to support healthy behaviours.
• That smoking continued to be a driver of health inequality and was prevalent in areas of deprivation. 
• The borough was experiencing significant population growth and building development. Health impact assessments had been introduced for major planning and development applications.
• The Tower Hamlets Together Board was a key partner in the strategic planning of health services.
• The cycle of deprivation and inequality could be addressed by providing support at the start of the life course during the early years.
• The framework underpinning the Health and Wellbeing Strategy addressed three key priorities, these were:  safety, a sense of purpose and a connection to other people.
• Bhutan’s ‘gross national happiness’ gauge was praised as an innovative wellbeing indicator.  Comparatively, the Thriving Cities Framework in Bristol could provide insight into taking forward such a strategy in the UK.

Summary of Member questions and officer response:

With regard to the figures on page 49 of the report, you mentioned the differential and healthy life expectancy across the Olympic boroughs in men shoot up in 2014-16, but this table shows a pattern of ebb and flow. Was this due to how the data was collected or something else?  Is the trend similar for 2017-19?

The Public Health team had also noted  ...  view the full minutes text for item 6.

The Committee received the report of Joanne Starkie (Head of Strategy and Policy for Health Adults and Community) on the Adult Social Care Impact Assessment follow up.

Summary of key points:

• Charging came in at end of 2017. The original impact assessment identified nine key areas for improvement. The assessment was conducted by a stakeholder panel that included carers. The Panel oversaw the strategy and came up with an action plan. Areas for improvement included: communications, future approach to charging and respite, clarity on charging, improving support to maximise income and avoid debt, direct payments, developing an appeals policy, approach to impact assessments and approach towards those who might end support due to charging.
• Communications was a critical issue and the council had since produced an easy read guide, produced clearer letters for correspondence, the financial assessment team offered surgeries at the carers centre to provide face to face support. REAL was consulted again to advise on making the assessment clearer. Pre-paid cards were also rolled out.
• With regard to respite care, the service was looking into alternative financial modelling to see if free respite was feasible and whether this would negatively impact other parts of the service.
• The Panel had agreed a core set of measures to measure the impact of charging.
• The situation at end of last April was similar this April; over half are being charged, 171 people have not completed an assessment form yet and so are being charged the full rate. Last April this figure was at 240.
• Last April 129 people were being charged the full amount capped at £250.00. This time it was 78 people.
• Last April 950 people were not paying for care; this had gone up to 1070. 
• 171 had not filled in a financial declaration form by this April compared to 240 people last April. These people are being charged.
• On average 54 people have requested reassessment compared to 147 requests when charging was first brought in.
• Older people and those from a white background are more likely to be charged the full amount. Those from a South Asian background and those with learning disabilities are being charged at a lower rate or not at all.
• The number of people getting an assessment per month reduced. It was difficult to establish cause and effect due to other factors so need to look into this more.
• In the original impact assessment 47 care packages stopped due to charging this went up to 88 as of this April. Some of this was due to starting and stopping a package. 
• There is a process in place to manage risk of those who want to end their package. There is a charging waver panel chaired by Divisional Director of Adult Social Care.
• Impact on wellbeing and satisfaction is ambiguous. Wellbeing gone down by 2 points but satisfaction gone up by 4 points. Last time this was reversed.
• Next steps are to continue looking at the core set of measures. It is important to note  ...  view the full minutes text for item 7.

Members queried the outcome of the migrant healthcare issue that was raised by members of the public at the last meeting. The Chair explained that this had been passed on to the Mayor and Lead Member for Health for response and that it was placed on the agenda to be discussed at the INEL JHOSC. The Chair agreed to provide feedback on the discussion at INEL JHOSC.

A member raised a concern regarding the management of local dental services. Officers advised that the dental contracts were commissioned by NHS England who could be approached for a response.