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.

This report sets out the Terms of Reference, Quorum, Membership and Dates of meetings of the Health & Adults Scrutiny Sub-Committee for the Municipal Year 2022/23 for the information of the Health & Adults Scrutiny Sub-Committee’.  The Overview and Scrutiny Committee met on the 7th June 2022 and agreed to set up three sub-committees, including the Health & Adults Scrutiny Sub-Committee. The Overview and Scrutiny Committee also agreed the terms of reference, chairs, and membership for all three scrutiny sub-committees.

The Sub-Committee received a report that set out the Terms of Reference, Quorum, Membership and Dates of meetings of the Health & Adults Scrutiny Sub-Committee for the Municipal Year 2022/23 for the information of the Health & Adults Scrutiny Sub-Committee’.  It was noted that the Overview and Scrutiny Committee at its meeting on the 7th of June 2022 had agreed to set up three sub-committees, including the Health & Adults Scrutiny Sub-Committee. The Overview and Scrutiny Committee also agreed the terms of reference, chairs, and membership for all three scrutiny sub-committees. The main points of the discussions summarised as follows:

As a result of discussions on the report the Sub-Committee:

1. Noted the Terms of Reference, Quorum, Membership and Dates of future meetings as set out in Appendices A, B and C of the report.

To confirm as a correct record the minutes of the meeting of the Health and Adults Scrutiny Sub-Committee held on 8^th March, 2022.

RESOLVED

The Sub-Committee confirmed as a correct record of the proceedings the unrestricted minutes of the meeting held on 8^th March 2022.

The Committee are asked to elect a Vice-Chair for the 2022-2023 Municipal Year.

The Sub-Committee appointed Councillor Ahmodul Kabir as the Vice-Chair for the 2022-23 Municipal Year.

This report sets out the purpose of the Inner Northeast London Joint Health Overview and Scrutiny Committee (INEL JHOSC) and also seeks to confirm two Member reps from the Health and Adults Scrutiny Sub-Committee (HASC) to join the HASC Chair with INEL JHOSC activities.

The Sub-Committee appointed Councillor Ahmodul Kabir and Councillor Abdul Malik to the Northeast London Joint Health Overview and Scrutiny Committee (INEL JHOSC) to join the Chair as LBTH representatives on this Committee.

The Sub-Committee received and noted the following presentations from Councillor Gulam Kibria Choudhury (Cabinet Member for Health, Wellbeing and Social Care); Dr Somen Banerjee (Director of Public Health); Richard Fradgley (East London NHS Foundation Trust); Lucie Butler (Barts Health NHS Trust), Katie O'Driscoll (Director of Adult Social Care);Fiona Peskett (Barts Health NHS Trust) Denise Radley (Corporate Director, Health, Adults & Community), Jo-Ann Sheldon (NHS North East London Integrated Care System)

The Sub-Committee received a briefing on the Cabinet Member for Health, Wellbeing and Social Care areas of accountability. The briefing is summarised as follows:

A.   Development of the Health and Wellbeing Board and relationships with the NHS and private providers.

1.    Strategic leadership of social care services and safeguarding for adults.

2.    Development of an integrated health and social care economy in Tower Hamlets and neighbouring local authorities.

B.   Leadership on public health services, working with the Health and Wellbeing Board to reduce health inequalities.

C.   Championing healthy living Improve awareness and influencing resident choices through proactive behaviour change initiatives.

D.   Work with the NHS to expand GP practices to ensure people can access timely appointments including face to face.

E.   Covid-ready Public Health service with a focus on the disproportionate impact on (Black, Asian, and minority ethnic) BAME residents.

F.    Ensure that mental health and physical health have parity of attention

The Sub-Committee received a presentation that provided an overview of Public Health a summary of the points raised is set out below:

The Committee:

v  Noted that Tower Hamlets puts health and wellbeing at the heart of everything it does through helping people to lead healthier lives, both mentally and physically. The Council does this by (i) commissioning a range of services from providers from different sectors to create as integrated a set of services as possible; and (ii) the way it operates the planning system, policies on leisure, key partnerships with other agencies for example on children’s and young people’s services, and through developing a diverse provider market for public health improvement activities.

v  Noted that the Council wants to ensure the health needs of disadvantaged areas and vulnerable groups are addressed, as well as considering equality issues.

v  Noted that through Adult Social Care the Council aims to help people stay independent, safe, and well so they can live the lives they want to. This includes people who are frail, have disabilities or neurodiversity, mental health issues as well as the people who care for them.

v  Noted that the Council provides information and advice about care and support to all residents, offers short term help and options for longer term support if people have more complex needs.

v  Noted that through Adult and Social Care the Councilaims to promote people's independence and wellbeing, through personalised care and support that focuses upon their strengths, the outcomes they want to achieve and enables choice and control (e.g., the provision advice services designed to help people solve issues early from employment to support for people with disabilities).

v  Noted that the Council has a number of key aims to this vision, including (i) empowering people to meet their own needs, (ii) enabling people to meet their aspirations for the future, (iii) ensuring that support improves the health well-being and quality of life for those working to Co-produce services and care with people that use them, seeking to simplify the system, making it easier to understand and access, (iv) ensuring that the Council provides the right support at the right place at the right time, being flexible in the support that we offer so that it's grounded in outcomes that matter to people, (v) delivering value for money, making best use of resources and spending within the Councils means, and (vi) developing, supporting thriving communities.

v  Noted that these aims align with the Tower Hamlets together Partnership and promote a system wide approach to improving the health and well-being of people in Tower Hamlets.

v  Noted that to achieve this vision and aims, Tower Hamlets has developed 10 key work packages. These include how information, advice, and early help to adults is provided. Including the work with Tower Hamlets Connect, the Carers Centre and Linkage Plus.

v  Noted that with regard to how the Council supports people this includes (i) working to develop staff; training and supervision; (ii)  ...  view the full minutes text for item 6.2

Received a presentation on Tower Hamlets Together which is all about health and social care organisations working closer together to improve the health and wellbeing of people living in Tower Hamlets.  The Board provides a more coordinated approach to providing services, reducing duplication, and improving the overall experience and outcomes for the patients who need these services. A summary of the points raised is set out below:

The Committee:

v  Noted that the partnership includes the Council, the major NHS organisations in Tower Hamlets and the Council for voluntary service.  Through them the Board reaches out to a number of voluntary sector organizations in the Borough and is a compassionate and collaborative body that celebrates innovation in Tower Hamlets and learning from the real-life experiences of service users, carers, and stakeholders to ensure a robust focus on high quality and good values services designed around people's needs.

v  Noted that service users, carers are active and equal partners participating at the heart of all the Boards decisions and focusing on engagement, participation in coproduction (e.g., hearing directly from people on the ground about the issues and their experiences).

v  Noted that the North East London Health and Care Partnership is responsible for planning and buying health services across north east London to meet the local population’s needs, to make sure all parts of the local health system work effectively together.  The Partnership is a formal alliance of partners that sets the overall strategy that will guide the collective work, hold the wider health, and care system to account for how services are delivered in a more joined up way.

v  Noted that many factors influence the health outcomes of a population. From local environment, i.e., the conditions in which people live, to socio-economic factors like education, income and employment, and lifestyle factors such as what they eat and drink or whether they smoke, all of these affect population health. Tower Hamlets has some of the highest levels of deprivation and so a number of initiatives have been created to improve the health equity of local residents.

v  Noted that the aim of the Tower Hamlets Together children’s services programme is: “To ensure that all children and their families have access to high quality, ‘joined up’ services and opportunities in order to optimise physical, social, emotional, and cognitive development, improve life-long health and wellbeing and reduce the effects of socio-economic deprivation.”

v  Noted that neither demand nor supply factors alone explain the extent of the pressures facing the NHS. The explanation is more complicated and has to do with the flow of patients through the health care system, and the ability of the system to ensure supply meets demand when it is under pressure and care is disrupted (e.g., the pressure on social care and general practice has led to more demand for hospital services).

v  Noted that the priorities that the Board are working on this year, include children's mental health, the living well program, access to health  ...  view the full minutes text for item 6.3

Received a presentation on primary care services in Tower Hamlets that provide the first point of contact in the healthcare system, acting as the ‘front door’ of the NHS. Primary care includes general practice, community pharmacy, dental, and optometry (eye health) services. A summary of the points raised is set out below:

The Committee:

v  Noted that primary health care providers deliver a wide range of services to patients including improving prevention, tackling health inequalities, and supporting better patient outcomes in the community through productive primary care, improving patient access.

v  Noted that a significant element of the new investment for the NHS to be directed at primary and community services, and a large proportion of this will be channelled through the relevant networks. 

v  Understood that the contract is between the commissioner and individual practices and is contingent on being part of the network.

v  Noted that as part of improving patient outcomes seven networks have been in development over the past year to move them more towards improving population health (e.g., children's asthma and work around access for digitally excluded and young people's access as well.

v  Agreed that the covid-19 pandemic has exacerbated access problems in general practice and patients have reported finding it difficult to book appointments and access treatment.

v  Noted that Healthwatch have indicated that GPs must prioritise telling patients that they are open for face-to-face appointments wherever possible.

v  Understood that Healthwatch have found that while remote appointments were more convenient for some patients, they did not meet everyone’s needs, with some patients left “worried that their health problems will not be accurately diagnosed,.”

v  Agreed that wherever possible that GPs should offer patients a choice of the type of appointment they would prefer whether it be video, face-to-face, or a home visit.

v  Noted that the report also found that some patients had been struggled to get appointments for regular health check-ups, treatments, and drug reviews, meaning that some were unable to manage their condition.

v  Understood that throughout the pandemic GP practices have been open, seeing patients face-to-face whenever it was clinically necessary to do so.

v  Commented that digital innovation is discriminating against those for whom accessing GP’s is already difficult, but GP’s will also be losing the fundamental role as witness to patients’ lives, a role that constitutes one of the foundations of the NHS. The relationship engendered by a patient booking to see their doctor in person is essential for them and for their GP’s.

The Sub-Committee received a presentation on the provision of Acute Care a summary of the points raised is set out below:

The Sub-Committee:

v  Noted that Barts Health NHS Trust (i) provides acute medical services for patients who require short-term care for urgent or emergency conditions; (ii) a consultant-led service that provides rapid assessment and treatment for patients with urgent and emergency conditions.

v  Noted that some patients will go home after their visit whilst others will stay in hospital where they will receive the care that they need on a specialist medical ward. An acute medicine consultant quickly assesses each patient – and may also see a specialist doctor, such as a cardiologist, within 24 hours.  Following an assessment, the patient may receive immediate treatment or be admitted for further care on one of our specialist medical wards. Many patients are able to go home with 12 hours and are provided with access to support services if they need them.

v  Noted that Barts Health NHS Trust (a) offer dedicated short stay units, for patients with urgent and emergency conditions, who need to stay in the hospital. If further hospital care is required, then the patient will be admitted to one of the Trusts specialist medical wards; and (b) provide a network acute medical care from the Royal London services that which reach out beyond Tower Hamlets (e.g., Newham and Whipps Cross University Hospitals).

v  Noted that the Trusts objectives mirror those of Tower Hamlets together in that it wants to be an inclusive organization, improve the health and care services of the local population.

v  Noted that the Trusts intends to build effective partnerships and hence engagement with the Sub-Committee and Tower Hamlets together.

v  Noted that it is the Trusts ambition to get benefits in terms of continuity, safety, and quality of care for patients as well as being providing well-being and an improved environment for staff and as referenced previously the Trust has built up some really good partnership working through the pandemic.

v  Noted that the Trust is very keen to build upon this good work with partners to promote careers at the Royal London and Mile End, be that clinical or nonclinical as well.

v  Noted that the Trust is very keen to be part of the future plans in respect of how services will be sustained given the population growth.

v  Noted that at Mile End the Trust plans to create a diagnostic centre of excellence that will provide easier access for residents to attend and have a diagnostic tests that will then hopefully expedite any pathways that they might require.

v  Agreed that to have effective health care patients need to have trust in the health system and health care professionals

v  Indicated that with unemployment remaining a persistent issue in the Borough, apprenticeships within the NHS are becoming an increasingly valuable career path.  The apprentices will gain skills and knowledge to provide support to ensure the delivery of person centred,  ...  view the full minutes text for item 6.5

The Sub-Committee received a presentation that provided an overview of the of the Mental Health Service in Tower Hamlets and a summary of the points raised is set out below:

The Sub-Committee

v  Noted that Tower Hamlets has a high level of prevalence of both common mental illness and severe mental illness

v  Noted Tower Hamlets has a disproportionately young population and high levels of mental health problems indicating future increase in need.

v  Noted that the COVID-19 pandemic has caused significant loss of life and disruption. The lockdown restrictions that were introduced whilst necessary to control the virus, have had widespread and negative economic consequences, uprooted everyday life, enforced social isolation, and exacerbated health inequalities.

v  Understood that the wider determinants of mental health have also been negatively impacted by the pandemic – employment, social contact. Likely exacerbated in LBTH due to overcrowding levels and lack of outside space.

v  Noted the Borough has well established voluntary sector services for people with mental health problems and critically in Tower Hamlets that in regard to mental health everybody has a role to play in supporting people with mental health conditions to make a difference.

v  Noted that Tower Hamlets was one of the first areas in the country to pilot mental health in school’s teams and now have two mental health in school’s teams and these are services that bring mental health professionals into schools to understand mental health conditions when they are emerging and to put the right preventative support in place at the right time.

v  Noted that there are plans to establish a third mental health and school team in 2023 and there has been a huge growth in capacity and ability to provide talking therapies for people with anxiety and depression and people can access the service through their GP.

v  Noted that over the last couple of years work has been undertaken to transform community mental health services for adults with more serious mental health conditions such as schizophrenia or bipolar disorder, and this has been really to organize local mental health services into much more integrated teams around the Boroughs neighbourhoods.

v  Noted the community connectors employed by voluntary sector organizations that provide pathway into psychology such as the (i) Women’s Inclusive Team (WIT) is an organisation which supports disadvantaged women in Tower Hamlets and neighbouring boroughs; and (ii) Crisis Café was set up during the first wave, due to COVID and provides an alternative space for people in crisis, with access to clinicians, therapists and support staff at evenings and weekends.

v  Noted the Reinforce Appropriate, Implode Disruptive (RAID) Mental Health Liaison service is a team of health professionals who assess, treat, and manage people with mental health problems who come to the emergency department of Royal London Hospital or who are a patient on the wards (Mile End & Royal London & St Bartholomew’s Hospitals) who have a physical health problem and who may need additional support due to a mental health difficulty. The  ...  view the full minutes text for item 6.6

Members of the Sub-Committee were asked to submit their suggestions to the Work Programme before the Scrutiny Away Day on the 16^{th of} July 2022.

The Chair:

v  Placed on record his thanks to all the Members and Cllr Gulam Kibria Choudhury; Dr Somen Banerjee; Richard Fradgley; Lucie Butler;  Katie O'Driscoll; Fiona Peskett; Denise Radley; and Jo-Ann Sheldon for their contributions to this evenings Sub-Committee meeting; and

v  With no other business to discuss called the meeting to a close.