Agenda and minutes

Apologies for absence had been received from Councillor Alan Chapman.

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

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

Members agreed that, as the representative from NHS England and Improvement was now unable to attend the meeting, this item be rescheduled for 26 January 2023. 

Ms Vanessa Odlin, Managing Director for Hillingdon and Mental Health Services, Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that CNWL was responsible for mental and physical health services in Hillingdon as well as mental health inpatient services and a ward for older adults with mental health challenges. 

The Trust had faced some challenges with regard to the waiting list for children’s mental health services.  The Committee had heard from Ms Tina Swain, Service Director for CAMHS & Eating Disorders - Goodall Division at CNWL, at its last meeting about the innovations that had been introduced to reduce the waiting list and the work that had been undertaken to expand the workforce. 

Ms Odlin recognised that the pandemic had resulted in an increase in the number of children experiencing mental ill health and that further preventative work was needed.  To this end, a new model had been introduced for 0-5 year olds as a preventative measure supported by mental health teams to reach children before they went into crisis.  The model was delivered by a small team of clinicians which received referrals from GPs as these children were not yet in school.  The service looked at the whole family to identify what support was needed and what steps could be put in place.  Although this work was not yet embedded, consideration could be given to expanding it to other age groups in the future.  However, it was noted that the mental health teams in schools would cover children up to the age of 11 that were in school.  In addition, work was underway in the community for 0-19 year old physical health and consideration would need to be given to joining this up with the mental health work. 

Ms Odlin advised that Kooth (an online emotional and mental health support service for children and young people aged 11-24) had been embedded in Hillingdon and funding had recently been received to undertake preventative work on CAMHS.  Some of this funding had been given to the Council to allocate through third sector grant schemes.  Although mental health teams were not yet in all schools across the Borough, discussions were underway with North West London Integrated Care System (NWL ICS) to determine how much budget would be needed to achieve total coverage.  It was recognised that this could be more challenging if schools were not willing to engage.  

With regard to adult mental health, Ms Odlin advised that the Crisis Recovery House had opened in the summer and would be piloted over the next 12 months.  During this period, the access criteria would be reviewed.  The house was being run by Comfort Care Services (an independent sector company) in collaboration with CNWL and the local authority and had been borne out of good partnership working.  Although referrals to the Crisis Recovery House could be made at the point of crisis, the purpose of the house was to avoid crisis and for it to be included as part of  ...  view the full minutes text for item 43.

a)    Care Act Adult Social Care Funding Reforms – VERBAL UPDATE

b)    Adult Social Care Contracts – VERBAL UPDATE

c)    Public Health Procurement Update

d)    Performance Dashboard Update – VERBAL UPDATE

a)     Care Act Adult Social Care Funding Reforms

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that Ms Sandra Taylor, the Council’s Executive Director of Adult Services and Health, had previously reported on this issue to the Committee on 19 July 2022.  At that time, it had been anticipated that a care cap of £86k in funding reforms would be introduced and there would be an increase in capital thresholds from £23,250 to £100,000.  There was also to be work around the fair cost of care to address the disparity in fees paid by the Council and those paid by self-funders. 

Following the autumn statement, it was now known that the £86k care cap and the increase in capital thresholds would be effective from 1 October 2025.  The care cap was the maximum amount that an individual would be expected to pay towards the cost of their care needs in their lifetime.  Mr Collier noted that there was already a deferred payment scheme in place which meant that householders would not necessarily have to sell their homes to contribute to meeting their care costs. 

Insofar as the fair cost of care work was concerned, councils continued to wait for information from the Government about their financial allocations to be able to undertake the work.  Mr Collier advised that the cost of those additional staff that would be needed to undertake the additional assessments had been included in the Government funding but would not now be needed until 2024/2025.  Work would need to start towards the end of 2023/2024.  As this was a live issue, Mr Collier would provide Members with an update once the issue about funding had been resolved. 

b)     Adult Social Care Contracts

Mr Collier advised that information in relation to adult social care expenditure had been circulated to Members.  This information had been split between the proportion of the budget used for in-house provided services (6% - for example, care homes and supported living schemes for people with learning disabilities), Council support services (25% - for example, staffing and staff related costs) and externally provided services (69% - for example, care homes, homecare, extra care housing and supported living schemes). 

Members asked that the numbers and information be broken down further, if possible, to provide the following:

·         How much was spent on contracts providing preventative action?

·         Spend split by provider type - social, voluntary and private provider.

·         Which providers had the largest number of contracts?

·         The number of local providers.

·         How much of the services were subcontracted?

·         Top 6 companies regarding the amount of funding that they received from the Council.

Mr Collier advised that the spend distribution for adult social care in Hillingdon would be broadly similar to that of other local authorities.  He would draft a proposal that reflected the meeting’s discussion to provide the Committee with more information about the breakdown of the Council’s spend on external providers and email it to the Chairman and Councillor Nelson to ensure that  ...  view the full minutes text for item 44.

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the 2022/23 Better Care Fund Section 75 (s75) Agreement report was due to be considered by Cabinet at its meeting on 15 December 2022.  The Better Care Fund (BCF) initiative had been in place since 2014/15 to bridge the difference in the legal systems between health and social care.  The BCF worked to a national timetable with planning requirements that had been sent out to local authorities late, hence why the 2022/23 plan legal agreement was only just being taken to Cabinet in December 2022. 

The Council and NHS partners had devised a BCF plan that met national requirements on how local authorities and the NHS should work together to deliver local and national priorities.  This plan had been agreed by Hillingdon’s Health and Wellbeing Board in accordance with national requirements.  The s75 agreement was very detailed, and included such things as setting out the delegation of functions, financial arrangements, meeting jointly agreed objectives and also risk sharing arrangements. 

Mr Collier advised the Committee that the care market was struggling nationally and that Hillingdon was not immune to these pressures.  The Committee was informed that the Council had care market management and development responsibilities under the 2014 Care Act and that these were reflected in the BCF plan and the s75 agreement.  This included channelling Government provided funding to providers as well as support from the Care Home Support Team, which was a collaboration between primary care and the Central and North West London NHS Foundation Trust (CNWL).  This service entailed care homes having allocated care home matrons who contacted them on a regular basis to provide advice and assistance on clinical matters to help prevent crises that could lead to hospital attendances and admissions that were avoidable.

The Committee was further informed that the Council’s Quality Assurance Team was in regular contact with care home and home care companies working in Hillingdon to provide information, advice and support, e.g., explaining Government guidance and requirements.

Mr Collier noted that care home and domiciliary care (also known as homecare) provision were two of the largest areas of spend in the adult social care budget. 

Mr Collier explained that a personal health budget was an amount of money to support a person’s assessed health and wellbeing needs, which was planned and agreed between the person with assessed health needs and the local NHS team.  The Committee was informed that this was similar to personal budgets to meet assessed adult social care needs. 

The Committee was informed that there were different types of personal health budget and, similarly with social care personal budgets, one of these was direct payments where money would go directly to the individual.  Mr Collier advised the Committee that the Council had been managing personal health budgets paid as direct payments on behalf of the NHS for many years as the process was very similar to direct payments meeting social care needs.  The operation of this  ...  view the full minutes text for item 45.

It was agreed that the Mount Vernon Cancer Centre Strategic Review Update due to be considered at this meeting be rescheduled for 26 January 2023.

Information about a review of orthopaedic inpatient surgery in North West London had been circulated to Members of the Committee on 21 October 2022 and it had been noted that the consultation period would close in January.  It was agreed that an update be requested for the meeting on 26 January 2023.

An update on the implementation of recommendations from the scrutiny review about making the Council more autism friendly had been scheduled for 26 January 2023.  It was agreed that this be moved to the meeting on 26 April 2023 to combine it with the consultation on the draft autism strategy. 

RESOLVED:  That:

1.    the Mount Vernon Cancer Centre Strategic Review Update be rescheduled for 26 January 2023;

2.    an update on the NWL orthopaedic inpatient surgery review be scheduled for 26 January 2023;

3.    the update on the implementation of the recommendations from the review about making the Council more autism-friendly be rescheduled for 26 April 2023 and combined with the draft autism strategy; and

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