Agenda and minutes

There were no apologies for absence.

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

RESOLVED:  That the minutes of the meeting held on 21 November 2023 be agreed as a correct record.   

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

The Chair welcomed those present to the meeting. 

Healthwatch Hillingdon (HH)

Ms Lisa Taylor, Managing Director at Healthwatch Hillingdon (HH), advised that more than 250 residents had contacted the organisation’s information and signposting service or provided feedback during the second and third quarter of 2023/2024.  A new reporting system had been developed and implemented.  The majority of enquiries had been related to primary care, specifically access to services, which had remained consistent over the past few years.  There had also been a significant number of contacts in relation to hospital and acute care, encompassing issues like booking blood test appointments and guiding individuals to the Patient Advice and Liaison Service (PALS).

Concerns raised by residents had included long wait times, inadequate responses to complaints and challenges in keeping family and friends informed about inpatient progress.  There had been a noticeable increase in enquiries related to community mental health services and transportation issues for those with mobility difficulties. 

Social care issues had also seen an uptick, prompting the need for further examination.  Although the number of contacts received in relation to social care issues had been increasing, there had been no identifiable theme to these contacts so a more detailed investigation would be needed. 

Ms Taylor noted that there had been a decrease in dental care inquiries, which could indicate that there had been an improvement in accessing NHS appointments locally.  It was suggested that there might also have been an increase in awareness that individuals could seek dental care beyond their local areas. 

Digital outreach had been expanding through HH’s Facebook and Instagram pages.  Five new volunteers had been recruited in the last six months, which had meant that the support available for community outreach and social media communications had been expanded.  There had been ongoing efforts in relation to community engagement and research with seven community sessions being held involving around 170 people (41 people had been referred to their GP for further investigations in relation to hypertension as a result of this engagement).  Visits had also been made to Hillingdon Hospital and Harefield Hospital to gain a patient perspective on the environment and Ms Taylor had spoken with around 25 patients on mental health wards as part of an ongoing engagement initiative. 

Priorities for the next six months would include a focus on patient experience with the launch of a survey, access to GP appointments and the enhancement of community health and wellbeing sessions.  As access to primary care services had been most commonly raised by residents, it had been hoped that the survey would identify the barriers as well as what good access / practice looked like to then be able to break the feedback down for each GP practice.

With regard to the feedback loop with service providers, Ms Taylor advised that she continued to attend strategic meetings with providers.   However, as HH started to collect more robust data with its new reporting system, it would be important to explore opportunities to share this information through  ...  view the full minutes text for item 43.

The Chair thanked officers for attending the meeting.  Mr Andy Goodwin, the Council’s Head of Strategic Finance, introduced the report and noted that this was the officers’ second appearance before the Health and Social Care Select Committee during this municipal year.  It was noted that the Council's revenue monitoring for 2023/24 indicated a net underspend of £22,000 and that services within the Committee's remit were forecasted to underspend by £1 million, which had been attributed to staffing underspend due to recruitment difficulties. Adult social care placements had projected an overspend which would be funded by a one-off release from the balance sheet provisions.

The medium-term financial forecast and the budget strategy had highlighted a saving requirement of £51m for 2028/29, with identified saving programmes of £33.4m, leaving a residual gap of £17.6m. Inflation, particularly in adult social care placements, had been a significant factor, contributing £48.1m to the budget gap within the Committee's remit.

Mr Goodwin advised that service pressures were being forecast at approximately £24m, with demographic growth accounting for £4.6m and support for adult social care demand adding another £4.2m. Corporate items were adding around £14m to the saving requirement.

The consultation budget had proposed a saving programme of £33.4m, with £15.8 million required to balance the 2024/25 budget. Significant savings included £1m for mental health recovery and post-pandemic reablement.

Of the proposed £218m capital budget, £20m sat within the Committee's remit and included a £1m investment in social care equipment and £6m for the Council to set up its own care home, supporting a saving of £550,000 per annum from 2025/26.  Concern was expressed about the potential risks associated with purchasing a care home.  Mr Goodwin advised that, along with the reducing cost of energy, the cost drivers had showed a lower exposure than the open market and the Council had a low level of indebtedness.

Health and Social Care was continuously looking to innovate and develop new ways of working and service provision to help manage pressures. This was evident in the savings within this area that were linked to investment in digital solutions - Members queried whether this would look and feel different in the future.  Mr Jon Smith, the Council’s Head of Finance - Adult Social Care, advised that the Medium Term Financial Forecast regarding the reablement programme looked to prevent costs of people coming into the service.  To prevent service users from seeing a diminished service, there would be a move to using more services such as Telecare and a focus on getting reablement services to residents as soon as possible.  A model was being developed to track the effectiveness of this support. 

Members queried how the demand for adult social care was increasing yet there had been a reduction in the associated budget.  Mr Goodwin advised that officers reported on demand led growth in the service separately to the savings.  Demand led growth had increased by £3m to account for demography and then the savings had been taken out to mitigate for  ...  view the full minutes text for item 44.

The Chair thanked Ms Lisa Taylor (Managing Director at Healthwatch Hillingdon) and Ms Vanessa Odlin (Managing Director – Goodall Division at Central and North West London NHS Foundation Trust) and her team for their contribution to the review of the Child and Adolescent Mental Health Service (CAMHS) referral pathway.  They, and the other witnesses involved in the review, had provided valuable insight into the subject matter. 

It was noted that the Committee had agreed the recommendations for the review at the previous meeting and were now considering the final report.  Members agreed that the report provided honest, action driven recommendations with a focus on improving communications.  It would be important to ensure that the Committee tracked the progress of the implementation of the recommendations with regular updates on tangible outcomes.  Ms Odlin assured Members of her commitment to taking the report back to her teams for implementation and emphasised the need to think beyond the services CNWL delivered, considering external organisations and collaborative efforts within the Hillingdon system.  She would report back to the Committee with updates during her regular attendance at meetings. 

Ms Taylor noted that this issue had been considered previously but that this time there seemed to be an increased investment in making positive changes and improvements to services.  She advised that she would be working on the Thrive mapping exercise over the next year and would be taking it forward with health professionals and voluntary sector services. 

If permission was given, it was agreed that the Thrive map be attached tp the final report. 

RESOLVED:  That:

1.    if permission was given, the Thrive map be attached to the final report; and

2.    the report be agreed. 

The Chair noted that the paper had effectively set out the purpose of the Committee's work.  He stated that the second and last paragraphs provided excellent summaries which should be incorporated into the annual scrutiny report to articulate the Committee's mission.

It was noted that the removal of the ability to refer matters to the Secretary of State would not practically alter the Committee's way of working as this had not previously been a power that could be effectively utilised.  Members suggested that the Committee's primary powers lay in compelling individuals to provide information and referring matters to regulators if necessary.  These powers were thought to be more practical and useful in the Committee's operations.

RESOLVED:  That the report be noted. 

Consideration was given to the Cabinet Forward Plan. 

RESOLVED:  That the Cabinet Forward Plan be noted. 

Consideration was given to the Committee’s Work Programme.  It was agreed that the Democratic, Civic and Ceremonial Manager liaise with Mr Keith Spencer to arrange a visit to the Hub.  

At the meeting on 21 February 2024, it was agreed that, instead of just looking at GPs, Members discuss the provision of all primary care and health services (including GPs) in the rural areas of the Borough, specifically Heathrow Villages and Harefield. 

It was agreed that the meeting scheduled for 23 April 2024 be cancelled and rescheduled in May 2024 after the Annual Council meeting.  Members were asked to contact the Democratic, Civic and Ceremonial Manager with their availability. 

RESOLVED:  That:

1.    the Democratic, Civic and Ceremonial Manager liaise with Mr Spencer to arrange a visit to the Hub;

2.    the meeting on 21 February 2024 be extended to include the provision of all health services in Heathrow Villages and Harefield;

3.    the meeting on 23 April 2024 be cancelled and rescheduled in May 2024; and

4.    the Work Programme, as amended, be agreed.