Agenda and minutes

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

The Chairman welcomed the new Members to the Committee.  He asked that the Committee's thanks be recorded for the work that Councillors Alan Chapman and Barry Nelson-West had undertaken on the Health and Social Care Select Committee during the previous municipal year.

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

RESOLVED:  That the minutes of the meeting held on 25 April 2023 be agreed as a correct record.

RESOLVED:  That the minutes of the meeting held on 11 May 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.  He noted that the Committee had started this review about six months ago and, during its investigations, had found the subject to be both interesting and intimidating.  As well as including the positive feedback that Members had received in its final review report, the Committee would also be looking to make a number of recommendations which would cover a number of themes, including the following three areas of improvement:

·         Signposting – there seemed to be a huge range of services available, but signposting to them did not seem to be as effective as it needed to be;

·         Reducing the waiting time – there appeared to be a lot of waiting, during which time the young person's mental health could be deteriorating; and

·         Communications – some of the communications from service providers seemed overly clinical which could come across as insensitive to some children and young people and their families.

Ms Lisa Taylor, Managing Director of Healthwatch Hillingdon advised that the three themes were largely in line with the feedback that Healthwatch had received from families.  She was aware that work had been undertaken by partners and that a concerted effort had been made to improve access to the front door.  Ms Taylor had circulated an updated version of the Thrive service map to Members.  It seemed that there was a lot of support available for children and young people's mental health but that they were finding it difficult to know how to access these services and which ones would be most appropriate to meet their needs. 

Although Ms Taylor advised that Healthwatch Hillingdon was receiving fewer reports of issues in relation to access to mental health services for children and young people, this did not necessarily mean that the issues had reduced.  The feedback from one parent had identified that if had been difficult to understand the referral pathway and that there had been a long wait to be seen.

Dr Ritu Prasad, Co-Chair of the Hillingdon GP Confederation, advised that GPs concurred that there appeared to be a lot of services but that they were difficult to find out about and access and that there didn't seem to be a way to escalate.  Whilst the service signposting was important, there also needed to be improvements in the inter-referral pathways.  Interventions such as art therapy and early support services were available but young people sometimes needed more and might need to be escalated to the Child and Adolescent Mental Health Service (CAMHS). 

Members queried whether there were issues of GPs not being aware of the most appropriate place to refer a young person with mental health issues or whether it was that there was not enough capacity in the services that were available.  Dr Prasad advised that it was a little of both: demand for services had increased but there was also a lack of awareness of what was available and what would be the most appropriate course of action.  She noted  ...  view the full minutes text for item 8.

Ms Claire Fry, The Council's Head of Service – Child and Family Development, advised that the report provided Members with an overview of the national and local context of family hubs.  The Council had developed a draft strategy for delivering a network of Family Hubs across the Borough to bring services together in a coordinated way.  The service delivery needed to be flexible.  The draft strategy was currently in the middle of a 12-week consultation which would close on 30 July 2023. 

Family hubs provided families with children aged 0-19 with a single place where they could get information, advice or guidance for a range of issues.  Support could be obtained in the early years of their child's life through the delivery of a specific Start for Life offer which incorporated access to maternity and health services, alongside support for parenting and reducing parent conflict. 

The Uxbridge Family Hub (located in the mezzanine at the Civic Centre) had opened in November 2021 and a second Family Hub was due to open in Hayes in July / August 2023 but neither had received funding support from the Department for Education (DfE).  As it was not in receipt of Government funding, the Council was able to shape the service itself and did not have to abide by the associated timescales.  A framework had been provided by DfE which had been developed to meet local needs whilst retaining the three themes that underpinned the work: access, connection and relationships.  Although the Family Hub provided a universal offer to all parents, the Council had to respond to residents' needs, which varied across the Borough. 

The Uxbridge Family Hub provided a base for the delivery of five Council services including: Uxbridge Children's Centre; the Supervised Contact Service; Multi Agency Psychology Service (MAPS); and the Youth Justice Service.  It also wrapped around services provided by health and community partners such as antenatal and postnatal community midwifery services, infant feeding support and health visiting services.

In terms of how this worked in practice, Ms Fry advised that health visitors were able to refer directly to the midwifery service if they had any concerns about a parent's preparation for the birth of their child or to Children's Centre Support Services.  Being physically co-located was thought to be really helpful (as informal connections could be made) - as was a good understanding of the needs of the population.  There should be no wrong front door and, to this end, in 90% of cases, officers were able to make the initial referral contact for the parent. 

With regard to the number of people from priority groups using the services, the following user information had been recorded in the south west data (which included Cowley and Cherry Lane Children's Centres):

·         3,889 were from low income families

·         2,344 had a child with additional needs

·         2,069 were lone parents

·         1,500 were from workless households

·         1,474 were new arrivals to the UK

It was noted that families might associate with more than one of  ...  view the full minutes text for item 9.

Detective Chief Inspector (DCI) Saj Hussein, Public Protection – Basic Command Unit (BCU) West Area at the Metropolitan Police Service (MPS), advised that he had been working with the North West London Integrated Care Board (NWL ICB) and involved in more meetings than he had previously.  The number of mental health referrals had continued to increase which had, in part, been affected by the cost-of-living crisis. 

The National Police Chiefs' Council (NPCC) had undertaken a review and identified that around one million police hours had been lost in relation to mental health detentions (which was around 10k hours per month for the MPS).  It was noted that, although approximately 20% of the calls to the MPS were mental health related, this figure was 30% in the West Area (which also had a higher level of Section 136 detentions).  Although there were still a lot of people going into A&E that were suffering and in mental health crisis, only 20% of those that attended A&E actually needed to be there. 

In 2022, 60% of mental health calls had been transported to a Health Based Place of Safety (HBPOS) or A&E.  This had reduced to 45% but was still too high so DCI Hussein had been working with Ms Vanessa Odlin, Managing Director – Goodall Division at Central and North West London NHS Foundation Trust (CNWL), to identify pinch points that could be addressed.  He noted that the handover to HBPOS usually took no more than two hours which was much quicker than the handover to A&E.  Whilst waiting in A&E, police officers were not doing policing work. 

Currently, when a mental health call was received, police officers were deployed.  Officers would arrive at the scene and determine whether or not the person was in crisis and could contact the Single Point of Access / Assessment (SPA) which was provided by CNWL and staffed by mental health nurses who could provide advice on what action needed to be taken.  However, police officers and the mental health nurses tended to be a little risk-averse and training was needed in relation to the alternatives that were available to s136s.  Action was being taken to provide training for the decision-making process and to reassure them that they were making the right decisions.  If the decision was not to detain an individual under s136, the police would not be required to take any further action.  The number of s136s in Hillingdon were amongst the highest in NWL and London which could be partly because of the Heathrow airport but it was unclear what else might be causing that disparity.  Mr Richard Ellis, the Joint Lead Borough Director at NWL ICB, suggested that this information be brought back to a future meeting of the Committee once more was known about the reasons for this high level of s136s in Hillingdon. 

Ms Odlin advised that CNWL's main responsibility was to look after patients within their remit.  It was important that the  ...  view the full minutes text for item 10.

Consideration was given to the draft Older People's Plan report which was due for consideration by Cabinet on 14 September 2023 (it had previously been scheduled for the Cabinet agenda on 27 July 2023).  Mr Kevin Byrne, the Council's Head of Health and Strategic Partnerships, advised that the report might be updated between now and the Cabinet meeting in September. 

The report set out developments regarding services for older people and the Council's Older People's plan over the last year.  The report supported the Council Strategy 2022-2026 which set out the authority's seven commitments to residents and aligned with those activities taking place across the Council. 

Mr Byrne advised that some elements of the former Older People's Plan had now concluded.  These included the free burglar alarm scheme and the programme of small grants for older people's groups to hold events during the summer and at Christmas. 

One of the Councils' commitments had been to keep residents safe from harm and, to this end, Trading Standards priorities included protecting vulnerable residents from rogue traders.  Work had also been undertaken with the police and other local organisations to promote Stronger Communities and tackle community tensions and hate crime.  A promotion had been undertaken to encourage older people to join the Neighbourhood Watch and OWL schemes to receive crime reduction advice and support and CCTV had been provided across the Borough to deter crime. 

Action had also been taken to support the commitment to enable vulnerable people and older people to live healthy, active and independent lives.  This work had included support schemes in relation to dementia and the development of a falls prevention education tool and a strength balance programme. 

Members queried how the Council shaped and prioritised its offer to older residents and how feedback was obtained from health partners.  Mr Byrne noted that the Joint Health and Wellbeing Strategy was overseen by the Health and Wellbeing Board and ran in parallel to the Older People's Plan but contained more depth on the issues reported.  He advised that Members of the Committee were welcome to feed any comments on the Plan back to him.

RESOLVED:  That the report be noted. 

Consideration was given to the Cabinet Forward Plan.  It was agreed that a request be made to have sight of the Carer Support Services report (079) before it was considered at Cabinet on 14 December 2023.  It was also agreed that, if possible, the Committee have the opportunity to comment on the 2023/25 Better Care Fund Section 75 Agreement (111) before it was considered by Cabinet on 12 October 2023.  Members were advised that the Annual Report of Adult and Child Safeguarding Arrangements (SI) had been included on the Work Programme for consideration by the Committee at its meeting on 13 September 2023.

RESOLVED:  That:

1.    a request be made for the Health and Social Care Select Committee to consider the:

a.    Carer Support Services report (079) at its meeting on 21 November 2023; and

b.    2023/25 Better Care Fund Section 75 Agreement report (111) at its meeting on 10 October 2023; and

2.    the Cabinet Forward Plan be noted. 

Consideration was given to the Committee's Work Programme.  Members noted that the byelection had been set for the day of the Select Committee's next meeting (20 July 2023).  As such, it was agreed that the meeting be cancelled and that, where timings required, items be moved from that agenda to the next meeting on 13 September 2023.  Other items would be included on subsequent agendas.  The Democratic, Civic and Ceremonial Manager would liaise with Members of the Committee to pencil in an additional meeting date in December 2023 in case it was needed. 

Members agreed that a private informal in-person meeting be held at 7pm on 16 August 2023 to discuss possible recommendations for the Committee's review into the CAMHS referral pathway.  The anonymised notes from the informal witness sessions would be circulated to all Members of the Select Committee. 

It was agreed that a site visit be organised to the Uxbridge Family Hub. 

The Chairman advised Members that the next North West London Joint Health Overview and Scrutiny Committee (NWL JHOSC) would be held at the Civic Centre in Uxbridge at 10am on Tuesday 18 July 2023.  It would be broadcast on YouTube but Members (and members of the public) were welcome to attend in person.

RESOLVED:  That:

1.    the meeting on 20 July 2023 be cancelled and the agenda items moved to subsequent meeting dates;

2.    the Democratic, Civic and Ceremonial Manager pencil in an addition meeting date in the second week of December 2023;

3.    the Democratic, Civic and Ceremonial Manager circulate the anonymised notes from the informal witness sessions to Members of the Select Committee;

4.    a site visit to the Uxbridge Family Hub be organised; and

5.    the Work Programme be noted.