Agenda and minutes

Apologies for absence had been received from Councillor Adam Bennett (Councillor Kaushik Banerjee was present as his substitute).

There were no declarations of interest in matters coming before this meeting.

RESOLVED:  That the minutes of the meeting held on 20 June 2023 be agreed as a correct record.

RESOLVED:  That all items of business be considered in public. 

The Chairman welcomed those present to the meeting. 

Central and North West London NHS Foundation Trust (CNWL)

Ms Vanessa Odlin, Managing Director – Goodall Division at CNWL, apologised that the update included in the report on the agenda had not been the current version.  The correct document had been tabled for Members and would be updated on the Council website. 

With regard to children's mental health, Ms Odlin noted that CAMHS had been meeting its response time targets in Hillingdon and no patients were going outside of the area for admission.  However, the number of patients at Hillingdon Hospital that were waiting for a bed for more than 12 hours had become a concern.  This was currently between one and nine patients each week and needed to be reduced to zero.  Access to Improving Access to Psychological Therapies (IAPT) also needed more work.

Members were advised that the community mental health hubs had been set up, combining primary and secondary adult mental health services.  This supported the "no wrong front door" approach which had also been included in training.    Ms Odlin advised that there had been an increase of over 600 in the caseload at the community hubs between April and September 2023 which demonstrated that they were being accessed.  Members asked that further information be provided in relation to the "no wrong front door" approach in relation to those in crisis and how this had been working. 

The Lighthouse had been opened at Hillingdon Hospital in August 2023 to provide people with mental health issues with a range of therapeutic interventions in an appropriate space near to Hillingdon's Emergency Department (ED), seven days a week from 8am to 8pm with third sector support.  Although CNWL had had the capital, it had not had the revenue to bolster this team to enable them to extend the service to 24/7.  However, CNWL had submitted a bid to North West London Integrated Care Board (NWL ICB) to extend the service to 24/7 with the hope that it would be up and running by Christmas 2023.

Members questioned the impact that services such as The Lighthouse and Crisis House had had with regard to improved outcomes for individuals and easing the pressure on other services.  Ms Odlin advised that The Lighthouse model would need to be reviewed to get it open 24/7 and take on more patients that were in crisis.  Since its move, the Crisis House had seen a significant increase in access - 75%-80% now with only one patient admitted to hospital.

As well as renovating the existing Health Based Place of Safety (HBPOS), an additional HBPOS had been opened at the Hillingdon Hospital site.  The Crisis Café had also been moved to a more accessible location at the back of the Crisis House. 

Ms Odlin advised that she had been liaising with Mrs Armelle Thomas who had laid down a challenge to get a wellbeing bus in place in the Heathrow Villages.  This idea had been worked up and it  ...  view the full minutes text for item 18.

Mr Chris Mayo, the Council's Assistant Director Financial Management, advised that this was the first of two opportunities for Members of the Select Committee to consider issues relating to budget planning for 2024/25 and beyond.  At its meeting on 23 January 2024, the Committee would receive a further report presenting specific budget proposals for the relevant services within its remit (which would have already been to Cabinet on 14 December 2023).  Feedback from the Committee would then be included in the final budget report that would be considered by Cabinet at its meeting on 15 February 2024. 

A marginal underspend of £23k had been reported against General Fund revenue budget normal activities as of May 2023.  Almost £2.4m of savings had been identified within the Health and Social Care portfolio in 2023/24 with none identified as being amber status.  However, inflation had added almost £60m to the budget gap and assumptions were being made about the pay awards. 

Demographic growth was at more than 2%, putting additional pressure on services, and an additional £0.7m had been identified in Public Health as service pressure.  However, this was funded within the Public Health Grant ringfence.  Budgeted capital investment in the current programme was the key driver of a £6.5m growth in debt financing and repayment costs over the medium term.  The remaining balance of Corporate Items related to movements in the TfL Concessionary Fare Levy (£4.1m) and use of capital receipts to finance transformation activity (£1,029k), alongside moving the Council Tax Older People’s Discount to being funded from base budget rather than Earmarked Reserves, with funding coming in from Hillingdon First Limited from 2023/24 and 2024/25.

Five ways of identifying savings had been mentioned in the report to achieve best value for money.  As preventative interventions were often best placed to deliver savings later on, Members asked officers to provide the Committee with more detail on how these five initiatives had saved the Council money.  Members also queried how assistive technology would help the Council to make savings. 

Concern was expressed that the inflation levels that officers were working with in forecasting might not be a true reflection and Members asked what would happen if inflation costs were even higher than anticipated.  Mr Andy Goodwin, the Council's Head of Strategic Finance, advised that inflation was being reviewed across a range of sources and that finance officers worked with procurement officers to see what negotiations were coming through.  Between now and Cabinet on 14 December 2023, action would be honed for any shocks in the market.  The approach had been to assume that inflation was running high so that the reserves were the back up. 

Insofar as earmarked reserves were concerned, Mr Goodwin advised that, at the start of the pandemic, the Council's underspend had been allocated to Covid but there had been flexibility for this to be spent on whatever the Council wanted.  The Council had used the Government Covid grants it had received first before using its own funds.  There  ...  view the full minutes text for item 19.

RESOLVED:  That the Cabinet Forward Plan be noted.

The Committee discussed the draft recommendations for its review of the CAMHS referral pathway and it was agreed that they be circulated to Members of the Committee after the meeting for comment.

It was agreed that the Cabinet Member for Health and Social Care be invited to attend the meeting on 19 March 2024 to provide the Committee with an update on issues within her portfolio.

It was agreed that further information in relation to the Drug and Alcohol Partnership Board be included as part of the health updates at the meeting on 23 January 2024.

Members discussed possible topics for a single meeting review on 21 February 2024 and were asked to contact the Democratic, Civic and Ceremonial Manager with further topics to be included in the list for consideration.  Broad information on the topics identified would be brought to the meeting on 21 November 2023 to enable Members to choose a topic and would include:

1.    How the Council provides services to communities;

2.    Care home services; and

3.    Palliative care.

RESOLVED:  That:

1.    the draft review recommendations be circulated to Members of the Committee for comment after the meeting;

2.    the Cabinet Member for Health and Social Care be invited to attend the meeting on 19 March 2024 to provide an update on her portfolio;

3.    information on the Drug and Alcohol Partnership Board be included in the health updates being provided at the meeting on 23 January 2024;

4.    Members provide the Democratic, Civic and Ceremonial Manager with possible single meeting review topics for consideration at the meeting on 21 November 2023; and

5.    the Work Programme be noted.