Agenda and minutes

Apologies for absence had been received from Councillor Reeta Chamdal. 

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

RESOLVED:  That the minutes of the meeting held on 22 May 2024 be agreed as a correct record.

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

The Chair welcomed those present to the meeting.

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the report provided Members with an annual update on the delivery of the Carers’ Strategy and would be considered by Cabinet at its meeting in September 2024.  The report included priorities for 2024/25 and case studies which made it more real for the Committee by illustrating the issues faced by carers as well as the support provided to them.

It was noted that the Carers’ Strategy consultation had concluded and that it had received some positive feedback.  This feedback had resulted in changes to some of the wording in the Strategy to make it more accessible.  As it covered adult carers and young carers, the Strategy would need to be signed off by Councillor Jane Palmer, Cabinet Member for Health and Social Care, and Councillor Susan O’Brien, Cabinet Member for Children, Families and Education.

Mr Collier noted that there had been some deliberate repetition in this report from the last report to give Members a more rounded picture.  This would not be continued in the next report to the Committee where reference would just be made to the last report.

The report stated that Kensington and Chelsea, Westminster and Hammersmith and Fulham had a higher number of carers supported by the local authority than in Hillingdon.  However, it was noted that the SALT data did not include, for example, the carers supported by Hillingdon Carers Partnership (HCP) under the Carer Support Service contract.  These higher numbers supported meant that there were also greater numbers of carers receiving carers assessments and Mr Collier informed the meeting that the Council continued to experience large numbers of carers declining an assessment.  He stated that these local authorities would be contacted to identify whether there was any learning that could be applied in Hillingdon.

Ms Sally Chandler, Strategic Director at Carers Trust Hillingdon and Ealing (CT), advised that CT was the lead partner for HCP which provided a single point of access for carers.  The meeting was informed that CT was a carer-led organisation with 67% of its board of trustees and staff team having lived experience as carers.  HCP had been created 7-8 years ago and subcontracted a range of specialist support services such as dementia support from the Alzheimer’s Society.  Ms Chandler believed that the partnership worked really well and that the offer provided in Hillingdon was second to none, ensuring that the right services were wrapped around carers in one contact rather than multiple contacts.

It was noted that carers were required to fill in multiple assessments for a range of reasons.  As they were able to access many of the services provided by HCP without filling one in, carers would often not want to complete the Carers Assessment (CA).  This caused some tension as the Council needed to report on the number of CAs completed but the carers did not necessarily want to complete it (completion of the  ...  view the full minutes text for item 15.

Ms Jessamy Kinghorn, Head of Partnerships and Engagement at NHS England – East of England, stated that specialised commissioning had been delegated to Integrated Care Boards (ICBs) so she effectively also worked for the ICBs.  Ms Kinghorn had been attending the Committee’s meetings since 2019, with the last update being delivered at the meeting in January 2023.

Members were advised that, in 2019, clinicians had asked that Mount Vernon Cancer Centre (MVCC) be looked at, which resulted in an independent clinical review being undertaken.  The review identified a number of things that needed to be changed immediately as well as longer term objectives.  Concerns were highlighted about the need to transfer patients who deteriorated from MVCC as the facilities were not available there to support them.  MVCC needed to be run by a cancer specialist and needed to be moved to an acute hospital site.  University College London Hospital had been appointed as the specialist provider but would not take full control of MVCC until it had moved to a new site.  The current site had considerable issues with the state of the buildings.  These issues combined meant that there were a lack of opportunities and the staff at MVCC were currently unable to take part in any trials because there was no critical care support available.

Ms Kinghorn noted that a lot of patient engagement had already been undertaken as part of the review and various funding proposals had been put together.  The best option had been to build an independent cancer centre in Watford linked to the hospital site.  This would mean a slightly longer journey for come patients from Hillingdon but had still been deemed to be the best option.  To address some of the concerns raised in relation to the longer travel times, it had been agreed that a new chemotherapy service would be incorporated into the new Hillingdon Hospital build project.

Expressions of interest had been submitted for funding from the New Hospitals Programme but this bid had been unsuccessful.  This had been largely a timing issue in that it had coincided with the deterioration of RAAC in hospital buildings that needed to be dealt with urgently.  Ms Kinghorn had continued to work with the national team who had agreed that MVCC was a priority and that the alternatives did not provide a good enough option (and would cost almost as much as the new build option).  Although the source of capital funding had not yet been identified, a number of short term decisions needed to be made.

Looking forward, Ms Kinghorn had been in discussions with Hertfordshire County Council (HCC) and with the health scrutiny officers of around a dozen other affected local authorities and it had been agreed that a Joint Health Overview and Scrutiny Committee (JHOSC) be set up.  As HCC had the largest number of patients using MVCC each year, it would chair the JHOSC and Hillingdon (with the second largest number of patients) would be proposed as vice chair.  It  ...  view the full minutes text for item 16.

Ms Jan Major, the Council’s Assistant Director Direct Care and Business Delivery (Provider Services and Commissioning), advised that local authorities were encouraged to produce an Adult Social Care Market Position Statement (MPS) under statutory guidance issued under the Care Act 2014.  The MPS set out the current demand for care and support services, projections for future demand and opportunities to develop / provide the support that would be required from 2024 to 2027.  Consultation was currently underway and it was anticipated that document would be read by existing providers, potential providers, voluntary and community organisations and service users.

The report stated that different approaches were being used to ensure a diverse market of quality services.  Ms Major advised that residents had a range of choices and could purchase services through Direct Payments.  The views of residents were also sought through groups such as the Disability Assembly and the Older People’s Assembly.  It was agreed that Ms Major provide the Democratic, Civic and Ceremonial Manager with examples and further detail of what this meant to residents in reality for circulation to the Committee. 

Members asked about the benefits of integrated commissioning for Hillingdon.  Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that there were circumstances where there were low volume / high costs specialist services needed which meant it was difficult to give a personalised approach in Hillingdon.  However, working with colleagues in North West London meant that economies of scale could be achieved when using the same specialist service providers.  There might be times where Hillingdon would act as the lead commissioner. 

With regard to personalised care and personal health budgets, Ms Major advised that some individuals would use this budget to employ a personal assistant.  For example, a blind resident had been using their personal budget to employ a personal assistant who had been teaching them to cook.  As such, as well as domiciliary care agencies, the Council now also signposted individuals to personal assistant recruitment providers.

It was noted that Hillingdon had a higher number of care homes than other local authorities (44) but it was queried whether these were of a high enough standard and fit for purpose.  Ms Major recognised that the report had not provided that level of detail but advised that the Council had been working with the care homes to ensure that they met a minimum standard and would put measures in place where necessary to help them achieve this standard.  Standards in Hillingdon were comparable with those in the rest of North West London. 

Work had been undertaken with partners to ensure that residents were kept at home for as long as possible before moving into a care home.  Interventions such as extra care provision and telecare (assisted living technology) had been developed to help achieve this objective. Ms Major advised that there were three extra care services in Hillingdon that the Council was responsible for and a fourth where the local authority had 100% nomination rights.  This  ...  view the full minutes text for item 17.

The Chair provided an update on the CQC inspection of Hillingdon’s Adult Social Care services.  He noted that the inspection was due to be completed by the end of this week and that the process had included conversations with a range of stakeholders including himself and Councillor Punja.  The Chair would circulate information that he had received in relation to the inspection to Members of the Committee on Thursday 25 July 2024.

It was anticipated that the CQCs final report would be available in approximately three months.  This report would provide the Committee with a valuable resource in terms of its role of scrutinising social care. 

Councillor Corthorne suggested that the CQC assessment framework could be used to form the basis of future reporting to Committee on adult services so that Members were sighted on issues in advance which might help them discharge the Committee’s statutory scrutiny function.  The Chair stated that using the CQC assessment framework to structure the Committee's scrutiny of Adult Social Care might be useful but that more would be known once the CQC's report had been published.  During the CQC process, the Chair and Labour lead had been briefed on the inspection and the Council's engagement with it.

RESOLVED:  That:

1. the Chair circulate supporting information to Members of the Committee; and
2. the discussion 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 hospice service provision in the Borough be included on the agenda for the Committee’s next meeting on 11 September 2024 and that the health updates item that had been scheduled for that meeting be moved to 9 October 2024.  It was suggested that contact be made with some service users that would be affected by the proposed changes to establish their thoughts.  The witness sessions for the major review would be moved back in the Work Programme to start on 12 November 2024.  The Cabinet Member for Health and Social Care and the Corporate Director for Adult Social Care and Health would be invited to attend this meeting to provide Members with an update on what had been going well and what improvements were being introduced. 

With regard to the major review topic, it was agreed that the Committee review early intervention and prevention and that the Chair and Democratic, Civic and Ceremonial Manager draft and share the terms of reference for the review with the Committee Members for their comments over the summer.  It was suggested that there be a focus on the changing demographics in the Borough and enabling residents to access services without prompting significant cost burdens (the impact of language barriers and the digitisation of services).  Members were reminded that a scrutiny review of digitisation had been undertaken by another Select Committee in the last few years.

It was agreed that the following be the subject of single meeting reviews: 

-       pharmacies and the delivery of front-line services.  As the services provided by pharmacies had an impact on GPs, it was agreed that this single meeting review be undertaken first; and

-       GP coverage across the Borough.

RESOLVED:  That:

1. hospice provision be the subject of a single meeting review on 11 September 2024;
2. the Chair and Democratic, Civic and Ceremonial Manager draft and circulate the terms of reference to the Committee for a major review of early intervention and prevention with the first witness session taking place on 12 November 2024;
3. the health updates item previously scheduled for 11 September 2024 be moved to 9 October 2024;
4. the Cabinet Member for Health and Social Care and the Corporate Director for Adult Social Care and Health be invited to attend the meeting on 12 November 2024 to provide the Committee with an update;
5. single meeting reviews be undertaken in relation to pharmacies and GP coverage; and
6. the Work Programme, as amended, be agreed.