Agenda and minutes

The Chair welcomed members from the Children and Young People’s Scrutiny Panel to the meeting to enable joint consideration of the following items:

-       Joint Mental Health and Wellbeing Framework (agenda item 6)

-       Transition from Child Mental Health Services to Adult Mental Health Services: Adults and Health Scrutiny Panel Project Report (agenda item 7) 

It was noted apologies for absence had been received from Councillor G Bull, Councillor Patterson and Helena Kania.  

The Chair will consider the admission of any late items of urgent business (late items will be considered under the agenda item where they appear. New items will be dealt with at item 13 below).

There were no items of urgent business put forward.

A Member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting of the authority at which the matter is considered:

(i) must disclose the interest at the start of the meeting or when the interest

becomes apparent, and

(ii) may not participate in any discussion or vote on the matter and must withdraw from the meeting room.

A member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Members’ Register of Interests or the subject of a pending notification must notify the Monitoring Officer of the interest within 28 days of the disclosure.

Disclosable pecuniary interests, personal interests and prejudicial interest are

defined at Paragraphs 5-7 and Appendix A of the Members’ Code of Conduct.

No declarations of interest were made in relation to items on the agenda.

To consider any requests received in accordance with Part 4, Section B, Paragraph 29 of the Council’s Constitution.

The Chair informed the panel that a request to speak in relation to NHS 111 and GP Out-of-Hours, agenda item 9, had been received from 38 Degrees and Defend Haringey Health Services. It was noted that this request would be taken as part of agenda item 9.

This report outlines the priorities and outcomes of the Joint Mental Health and Wellbeing Framework. It details the process for development of the Framework, summarises consultation feedback and highlights how the recommendations from Overview and Scrutiny reviews have been incorporated into the Framework. It also proposes a governance structure for delivering the Framework.

The Panel are asked to consider the draft Framework prior to its publication.

(To be considered jointly with the Children and Young People’s Scrutiny Panel.)

Tamara Djuretic, Assistant Director of Public Health, introduced the draft Joint Mental Health and Wellbeing Framework. The panel was informed the proposed framework had been developed with a range of stakeholders and experts across the local health and social care economy. It was noted that the framework set out a high level vision for mental health and wellbeing in Haringey.      

The panel was informed that the total spend on mental health in Haringey (including substance misuse) for 2013-14 was over £51 million. This equated to 11% of the total CCG budget and 6% of the Council’s. Tamara Djuretic noted the level of spend going to acute services versus community services was unsustainable moving forward. 

The panel discussed the aims of the framework and Tim Deeprose, Assistant Director, Mental Health Commissioning, Haringey CCG, advised that there were four priorities.    

-       Promoting mental health and wellbeing and preventing mental ill health across all ages

-       Improving the mental health outcomes of children and young people by commissioning and delivering effective, integrated interventions and treatments and by focusing on transition into adulthood

-       Improving mental health outcomes of adults and older people by focusing on three main areas: meeting the needs of those most at risk; improving care for people in mental health crisis; improving the physical health of those with mental-ill health and vice versa

-       Commissioning and delivering an integrated enablement model using individuals, families and communities’ assets as an approach to support those living with mental illness to lead fulfilling lives

Tim Deeprose commented that recommendations from previous scrutiny reviews, relating to mental health, had been incorporated into the overall framework. The priorities had been shaped in line with these scrutiny recommendations.

The panel was asked to note that consultation feedback had been generally positive although suggestions for improvement, set out in the report to the panel, had been received. 

During the discussion, reference was made to the following:

-       The national and local policy context

-       The role of Haringey’s Mental Health and Wellbeing Framework Expert Reference Group

-       The mental health needs of Haringey’s residents

-       Timescales and governance arrangements for delivery of the framework

-       Lord Bradley’s review (2009) of people with mental health problems or learning disabilities in the criminal justice system

-       The mental health needs and the effectiveness of provision for young offenders in custody and in the community.  

-       Recent mental health inquiries conducted by Select Committees appointed by the House of Commons.

-       The importance of having a whole system approach to integration and enablement including the need for effective pathways into employment and housing.

-       The impact of population growth and the sources of information that had been used to develop the framework including the local Joint Strategic Needs Assessment on mental health in children, young people, adults and older people; Mental Health HaringeyStat; Public Health England’s mental health profiles, and the CCG’s and Council’s financial information.

-       The importance of ensuring mental health services were appropriate for Haringey’s  ...  view the full minutes text for item 23.

To consider the report of the Adults and Health Scrutiny Panel.

(To be considered jointly with the Children and Young People’s Scrutiny Panel.)

The Chair introduced the project report of the Adults and Health Scrutiny Panel.

It was recognised transition within mental health services at the age of 18 years could be problematic for many reasons. During discussion concerns were raised about the “cliff-edge of lost support”. From a point where young people received regular, focused support for their mental health needs it was noted that by turning 18, young people could find themselves on their own, unprepared for the shift from a child-centred developmental approach to an adult care model.

It was explained that evidence had been gathered from a variety of stakeholders including; Barnet, Enfield and Haringey NHS Mental Health Trust, Haringey CCG, Mind in Haringey, Open Door, Young Minds, First Step, Camden and Islington Mental Health Services and importantly Haringey’s front line staff in Children’s and Adult Mental Health Services.

The Chair highlighted a number of issues, set out in the panel project report, including:

-       The need for young people to be supported right through from age 0-25

-       The proposed “Heads-Up for Haringey” model

-       The need for information sharing across agencies

-       Concerns about levels of funding for Child and Adolescent Mental Health Services. 

The panel agreed the new Joint and Mental Health Wellbeing Framework (discussed under item 6 on the agenda) was an opportunity to improve mental health services and to improve the mental health and wellbeing outcomes for Haringey residents. The Chair commented that taking the panel’s recommendations forward, as part of the framework, would help ensure there was no “cliff-edge”.

RESOLVED:

That the recommendations, set out in the Transition from Child Mental Health Services to Adult Mental Health Services: Adult and Health Scrutiny Panel Project Report, be agreed and that the final report be considered for approval by the Overview and Scrutiny Committee on 26 March 2015.       

To approve the minutes of the meeting held on 22 January 2015.

RESOLVED: That the minutes of the meeting held on 22 January 2015 be approved as a correct record.

To receive a presentation from Jill Shattock, Director of Commissioning, Haringey Clinical Commissioning Group, and Dr Sam Shah, Clinical Lead – NHS 111 Governance, concerning plans to commission an integrated 111 and Out-of-Hours service to start in April 2016.

The Chair informed the panel that a request to speak had been received concerning plans to commission an integrated 111 and GP Out-of-Hours service.

Dr Natasha Posner, on behalf of the Defend Haringey Services Coalition and 38 Degrees, addressed the panel and raised a number of points, including:

-       Concerns that Clinical Commissioning Groups in Camden, Islington, Haringey, Barnet and Enfield were about to embark on a tendering exercise for a combined 111 and GP Out-of-Hours service across the five boroughs.

-       The need to have local services with local GPs 

-       Concerns that the new service could be provided by a private company.

-       The need for a pilot study to ensure the amalgamation of 111 with Out-of-Hours across five boroughs improved services.    

-       The need for better consultation and engagement with the public.

-       Concerns about the proposed length of the contract 

The panel then received a presentation from Jill Shattock, Director of Commissioning, Haringey Clinical Commissioning Group (CCG), and Dr Sam Shah, Clinical Lead – NHS 111 Governance. 

The panel was informed that Haringey CCG had been working with other CCGs in North Central London to integrate the NHS 111 service and the GP Out-of-Hours service to enable both services to work better together.

It was noted that 111 was a free telephone number that helped people with urgent, but not life-threatening, conditions to access the most appropriate service or to receive self-care advice. Ms Shattock advised the panel that between April 2013 and March 2014 an estimated 33,000 calls had been made to 111 from people living in Haringey.

The panel was informed that GP Out-of-Hours services ensured people could access primary care, for urgent problems, when their GP surgery was closed. It was noted that Barndoc provided the service in Barnet, Enfield and Haringey and that GP Out-of Hours services were accessed via NHS 111.

The following points were discussed:

-       GP co-operatives

-       Telephone triage services

-       The patient journey before 111

-       The 111 patient journey   

Dr Shah informed the panel that 111 had been introduced, as a pilot, in 2013 and had replaced NHS Direct. The panel was assured that a number of lessons had been learned, including:

-       Combining 111 and GP Out-of-Hours services under a single contact had helped patients to get the right services quicker, with less time spent being passed from one call handler to another.

-       Early input from a nurse, GP or pharmacist helped patients get the right advice/treatment more quickly.

-       111 could make better use of local community services

-       The need for 111 to develop better online/app interfaces 

-       The majority of users of the 111 service were between 18 and 64 years old. 

In terms of the proposal to commission an integrated 111 and GP Out-of-Hours service, Dr Shah advised that there would be an increased clinical mix in 111. This would include:

-       The introduction of GP early intervention in 111 calls and rapid clinical reassessment of green ambulance dispositions.  ...  view the full minutes text for item 26.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. In October 2014, CQC introduced a new approach to regulating, inspecting and rating adult social care services.

This report outlines the key aspects of the new inspection regime and the findings of the Reablement inspection, which was carried out in July 2014 as part of the CQC’s pilot inspections and reported in December 2014. The report also notes how Council registered adult social care services have been preparing for future inspection by CQC.

Beverley Tarka, Interim Director of Adult Social Services, introduced the report and outlined key aspects to the new inspection regime and the findings of the Reablement inspection carried out in July 2014 and reported in December 2014. 

During the discussion, reference was made to the following:

-       The new approach that had been taken by the Care Quality Commission (CQC) to regulating, inspecting and rating adult social care services.

-       CQC’s new approach included the use of Intelligent Monitoring to decide when, where and what to inspect.

-       Under the new framework, inspectors would assess all health and social care services against five key questions: is a service: safe; effective; caring; responsive to people’s need; and well-led?

-       The Key Lines of Enquiry (KLOE).

-       The work that had been facilitated by Gerald Pilkington Associates to help inform high levels proposals in relation to reablement.

The panel was informed that overall the Haringey Community Reablement Service had been rated as a good service. However, it was recognised areas for improvement had been highlighted in relation to KLOE 5 – “Is the service well led?” It was noted an improvement plan had been put in place to address identified areas and the panel discussed the progress that had been made in delivering the action plan. A variety of issues were discussed including staff supervisions, quality assurance tasks and processes.   

It was noted, to date, that 979 adult social care services had been rated by CQC nationally under the new framework, with 1.2% being rated outstanding, 63.6% rated as good, 27.6% requiring improvement and 7.6% rated inadequate. The panel was informed that services rated as outstanding were normally re-inspected within 2 years; good services within 18 months; services requiring improvement within a year; and inadequate services within 6 months.

RESOLVED: That the report be noted and an update report (progress made in delivering the improvement plan) be prepared for consideration by the Adults and Health Scrutiny Panel during the 2015/16 Municipal Year.

An opportunity to question the Cabinet Member for Health and Wellbeing, Councillor Peter Morton, on his portfolio.

The panel received a verbal update on the work of the Cabinet Member for Health and Wellbeing, Councillor Peter Morton.

The following issues were discussed: : 

-       Haringey’s approach to implementing Part 1 of the Care Act 2014. The panel was informed that proposals, agreed by Cabinet in March 2015, paid particular attention to new eligibility criteria and deferred payment arrangements.  

-       The work of the Health and Wellbeing Board in relation to improving Primary Care in Haringey. An update was provided on work being led by Haringey CCG and NHS England in relation to addressing access to primary care across the borough.

-       The work that had taken place with a range of stakeholders and experts across the local health and social care economy to set a high level vision for mental health and wellbeing in Haringey.

-       The importance of ensuring mental health services were appropriate for Haringey’s diverse communities and ensuring appropriate monitoring arrangements were in place for the Joint Mental Health and Wellbeing Framework. 

-       The challenge of having a reduced budget and the need to find new and different ways to build more resilient communities supported by services that made evidenced and sustained improvement.

-       The work that would need to take place over the coming months, including public consultation, to ensure priorities and outcomes outlined in the Council’s Corporate Plan were delivered to “empower all adults to live healthy, long and fulfilling lives”.

-       Feedback on a recent Cabinet Member site visit to “Bringing Unity Back into the Community” (BUBIC). The panel was informed that BUBIC was an award winning community based organisation that provided peer support for drug users, ex-drug users, their family and friends. It was suggested scrutiny members should be invited to take part in similar site visits moving forward.

-       The work that had been taking place to address childhood obesity and teenage pregnancies. It was noted data from the Office for National Statistics showed that between 2012 and 2013, the most up-to-date figures available, teenage pregnancies in Haringey had dropped by 37% falling faster than both the London and national averages. The panel agreed that the Council’s approach to dealing with teenage pregnancy should be shared to enable improvements to be made across other service areas. 

In addition, Cllr Morton provided an update concerning the Protect Our Women (POW) project that helped raise awareness of the dangers of gender-based violence. It was explained that this had been developed by the charity Solace Women’s Aid in partnership with Haringey Council. It was noted that a group of young people had recently been recognised for completing this educational project.

RESOLVED: That the update from the Cabinet Member for Health and Wellbeing be noted and used to develop the work plan for the Adults and Health Scrutiny Panel for 2015/16.

To note the outstanding items from the panel’s work plan for 2014/15.  

RESOLVED: That the outstanding items from the panel’s work plan for 2014/15 be noted.

There were no new items of urgent business.

The schedule of meetings for 2015/16 will be agreed by Full Council on 23 March 2015.

It was noted that the schedule of meetings for 2015/16 would be agreed by Full Council on 23 March 2015. 

18:35 hrs to 21:15 hrs