Agenda and minutes

The Chair welcomed those present to the meeting and noted that there was a deputation and two public questions in relation to Item 10: ‘GP Access in Tottenham Hale: Capacity Study’.

Therefore, with the Board’s agreement, as soon as representatives from NHS England were present to respond to questions, this report would be brought forward.  

To receive any apologies for absence.

There were no apologies for absence.

To consider and agree the minutes of the meeting of the Board held on 1 July 2014 as a correct record.  

RESOLVED:

That the minutes of the meeting held on 1 July 2014 be confirmed as a correct record.

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 agenda Item 13).

The Chair noted that there was one item of urgent business, ‘Implications of the New Care Act 2014’. This report was for information only and would be taken under Item 13 (the report had been circulated to members of the Board on 24 September 2014).

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

There were no declarations of interest made.

The Board considered a report, previously circulated, which provided an update on the strategic planning undertaken by the NHS and progress towards the next submission of the North Central London (NCL) Strategic Planning Group (SPG) Five Year Plan, which aligned plans across Barnet, Camden, Enfield and Islington CCGs, Public Health and NHS England. The submission was due to be submitted to NHS England in late October.

In response to points made with regard to need to ensure that Haringey was not placed at any disadvantage, given that other boroughs within the group may have different priorities and needs and different levels of resourcing; the Board was advised that individual borough’s priorities could not be altered. With regard to resourcing the Board was assured that Haringey would not be placed at any disadvantage.

RESOLVED:

1. That the content of the report, the progress made to date and the next steps outline in the report, be noted.

2. That the Board placed on record its support for the North Central London Plan.

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

As set out above the Chair noted that a deputation and two public questions had been accepted in relation to Item 10: ‘GP Access in Tottenham Hale: Capacity Study’. These had been received from:

Deputation

From Ms Vicky Ladizhinskaya

Public Questions

Michael Polledri, Chairman of Lee Valley Estates (represented by Chris Shellard)

NualaKiely, Service User Engagement Coordinator, Mental Health Support Association

Deputation

Ms Ladizhinskaya began by thanking the Board for hearing her deputation and noted that in addition to the people that had signed the original deputation request, over seventy additional people had also signed her deputation statement noting their support for this. For residents living in Bream Close, Hale Village and Ferry Lane, the difficulties attached to obtaining a GP appointment and the quality of the service provided by the local practice had become acute.

Ms Ladizhinskaya stated that new developments, including the Hale Village scheme, had seen the population of Tottenham Hale rise by 32% in the last three years and during this time there had been no increase in the provision of GP practices. In addition, the area’s largest practice, Tynemouth Road, was, by the NHS’s own admission, in the bottom ten practices in the country according to a survey undertaken in 2014. The same survey also showed that 42% of patients were unable to make an appointment when they telephoned the practice.

Ms Ladizhinskaya noted that prior to the new development at Hale Village being built there was an existing problem with the quality and provision of GP services in Tottenham Hale and that this had been compounded by a significant rise in the local population. It was noted that as part of the original planning permission granted by the Council for the Hale Village development it had been specified that a GP practice should be included within the scheme and that Lea Valley Estates had worked with the NHS to secure this. However, it had not been possible to find GPs willing to set up a practice in the area and as a consequence the space allocated for health care had been used for a kidney dialysis unit serving the wider north London area rather than addressing the primary care needs of the local community. Given the likelihood of further significant development in the area in medium to long term Ms Ladizhinskaya argued that it was essential that provision for primary care was properly considered and reflected in the plans currently being developed in order to prevent the problem worsening.

Ms Ladizhinskaya recounted her own experiences of attempting to obtain a GP appointment at the Tynemouth Road practice and a series of errors that had led to her test results being delayed by six weeks. She noted that many of her neighbours had experienced similar difficulties in obtaining a GP appointment and delays in hospital referrals. There was a general lack of communication and follow up from the Tynemouth Road practice and that was putting patients at unacceptable risk. She noted that  ...  view the full minutes text for item 107.

The appendix to this report has been circulated separately as it was too large to include within the agenda pack.  

The Board received a presentation, previously circulated within the agenda pack, from Sharon Grant, Chair of Healthwatch Haringey. Following the presentation the Board discussed the group’s findings.

The Cabinet Member for Health and Wellbeing, Councillor Morton, began by noting that this issue had been discussed by the Council’s Overview and Scrutiny Committee and that it also shared the concerns outlined above with regard to GP services in Tottenham. He noted that he strongly supported proposals to establish a Task and Finish group to look how these issues might be resolved.

There was agreement that the provision of adequate GP services was essential to the community and particularly in relation to children and families. The Cabinet Member for Children and Families, Councillor Waters, noted that the Council’s approach to supporting families focussed heavily on the importance of ensuring that all children received the best start in life and this was reflected in its focus on children aged from nought to five years of age. She noted that GPs played a crucial role in the development and wellbeing of children in this age group and added that it was essential that they had access to good quality GP services.

In response to a question, the Chair of Healthwatch Haringey confirmed that it was the organisation’s view that immediate action was required to address the lack of GP services in Tottenham Hale. Waiting for twelve to fifteen months for a feasibility study to be undertaken was not a viable option given the acute need in the area.  

It was noted that Neil Roberts of NHS England would respond to the points made under the next item.

RESOLVED:

1. That the findings outlined in the Healthwatch report relating to poor access to GP services for residents in the Tottenham Hale area, highlighted in both qualitative and quantitative evidence, be noted;

2. That the findings outlined in the report relating to the poor access to GP services for residents in the North East GP collaborative area, highlighted in both qualitative and quantitative evidence, be noted;
3. That the findings outlined in the Healthwatch report relating to the relatively poor access to GP services in Haringey compared to the national benchmark and in comparison with Camden, reflected in the number of actual GP appointments per week, be noted;

4. That Healthwatch’s call for immediate steps to be taken to supplement the GP capacity in Tottenham Hale, pending the proposals arising from the recommendation below, be endorsed;

5. That Healthwatch’s call for a working group to be set up as a matter of urgency to review the evidence and to make recommendations to the Health and Wellbeing Board, within three months, for immediate action to improve access to GP services in the short term for the residents in Tottenham Hale and surrounding Wards be endorsed (the membership should include NHS England, Haringey CCG, Public Health, patient representatives and other partners that that the Health and Wellbeing Board may wish to nominate); and

6. That Healthwatch’s call for a planning group to be established  ...  view the full minutes text for item 108.

The Board received a verbal update from Neil Roberts, Head of Primary Care at NHS England, on the provision of GP services in Haringey and particularly in Tottenham Hale. Mr Roberts also responded on points made as part of the deputation and formal questions submitted under Item 6 in relation to the lack of GP services in Tottenham Hale.

Mr Roberts began by noting that the issue of access to GP services was of concern to many people across the UK and that this was not particular to Haringey. He noted that the Healthwatch report on the capacity of GPs in Tottenham Hale was alarming and he accepted that the position appeared to be worsening based on the Healthwatch report and the experiences that had been shared by residents with the Board that evening. Mr Roberts advised that GP’s could not be compelled to establish practices and noted that the funding arrangements in place for GP practices were based on population rather than an analysis of the needs of an area. As a consequence establishing a practice in an area of significant need was likely to be less ‘profitable’ and more demanding and therefore was less attractive to GPs.

With regard to specific criticism of the Tynemouth Road Practice Mr Roberts noted that NHS England had been working with the practice to improve the quality of the services it offered and the systems in place there. Though it was disappointing that the impact of this improvement work did not appear to have taken full affect NHS England would continue to work with the practice to improve standards.

In terms of the regeneration work being undertaken in Tottenham Hale and the impact of additional population of Hale Village, Mr Roberts noted that NHS England had only been in place since April 2013 and that discussion around Hale Village and the regeneration of Tottenham Hale pre dated its existence. Therefore work was required to assess how the regeneration work and needs of a growing population would be addressed and it was proposed that this could be done in part by a Task and Finish group chaired by Mr Roberts and including representatives from the CCG, Council and Healthwatch.

In relation to the twelve to fifteen month period referred to in terms of procuring a new GP practice Mr Roberts noted that there were procurement rules that NHS England were required to follow and that this timescale was based on the need to adhere to these. Therefore ‘growing’ existing practices was an important alternative and NHS England was working closely with practices in the area to achieve more capacity and improve the quality of services. Mr Roberts also made reference to the average number of patients on a GP practice list and the importance of having sufficient nursing capacity and skills mix within a practice.

The Chair thanked Mr Roberts for attending and responding to the points made earlier. She opened discussion by noting that the average number of patients on a GP’s  ...  view the full minutes text for item 109.

The Board considered a report, previously circulated, which set out proposals with regard to the establishment of a Health Care Integration Programme in order to enable the Council and the Clinical Commissioning Group (CCG) to jointly achieve better outcomes for local residents, improve the user experience and to deliver efficiencies and value for money.

There were five appendices included within the report, as set out below and these were considered in turn:

Appendix 1 – Healthcare Integration Programme (presentation)

Appendix 2 – Value Based Commissioning for Older People with Frailty

Appendix 3 – Mental Health Framework

Appendix 4 – Better Care Fund Re-Submission

Appendix 5 – Scrutiny Review and Response Report

Healthcare Integration Programme (presentation)

The Board received a presentation setting out the vision and scope of the Integrated Care Programme and the Board then discussed this. In response to a question the Board was advised that one of the principles that underpinned the work around the programme had been to focus on building and developing existing structures and relationships rather than using time and resources to create a new set of structures.

There was agreement that the proposals formed a good example of multi-agency working and that in order to support the work and ensure that it was properly embedded training across the various organisations would be needed. 

Value Based Commissioning for Older People with Frailty

The Board considered a report that provided an update on progress in developing an outline business case for Value Based Commissioning (VBC). The Board was advised that VBC was an important part of delivering integrated care and that Haringey was leading in the development of work in this area.

RESOLVED:

That the proposals set out in the report be noted.

Mental Health Framework

The Board was advised that the Mental Health and Wellbeing Framework (MHWF) was being devised in order to bring together all of the existing strategies and to set out a clear vision for improving the mental health and wellbeing of Haringey’s residents from early years throughout adulthood and into older age.

RESOLVED:

That the Mental Health and Wellbeing Framework scoping document be noted and that approval be given to the process for developing the MHWF outlined in the report.

Better Care Fund Re-Submission

The Board considered a report seeking endorsement of the revised Better Care Fund (BCF) Plan, which was submitted on 19 September, as the agreed vision for improving the health, wellbeing and the independence of Haringey’s residents, through the delivery of integrated health and social care services. It was also noted that the Lead of the Council would formally note the revised BCF Plan on 3 November.

RESOLVED:

1. That the revised BCF Plan, submitted on 19 September 2014, be endorsed as the agreed vision to improve health, wellbeing and the independence of Haringey’s residents, through the delivery of integrated health and social care services.

2. That it be noted that revisions made to the Plan, as required by NHS England, were set out in Appendix 3 of the report.  ...  view the full minutes text for item 110.

The Board considered a report, previously circulated, which presented the Annual Public Health Report and planned local anti-stigma and Mental Health and Wellbeing campaign for October 2014.

The Board was advised that the 2014 report focused on the Health and Wellbeing Strategy outcome ‘Improving Mental Health and Wellbeing’ and that it explored what was meant by ‘wellbeing’ and how this was linked to both physical and mental health. The Annual Public Health Report focussed on communicating messages that would engage all residents in Haringey regardless of their mental health and wellbeing state. It was envisaged that the report would initiate and open discussions about people’s own mental health and wellbeing, promote early recognition of signs and symptoms and encourage people who required help to access the appropriate services.

RESOLVED:

That the Annual Public Health Report and planned local anti-stigma and mental health and wellbeing campaign for October 2014 be noted.

The Board considered a report, previously circulated, which set out the progress made to date with respect to the development of a new Pharmaceutical Needs Assessment (PNA) and the timetable for this.

RESOLVED:

1. That progress made to date with respect to developing the PNA be noted;

2. That development of the PNA be delegated to the Director of Public Health;

3. That approval be given to PNA Steering Group’s Terms of Reference and membership; and

4. That the timetable, as outlined in paragraph 5.9 of the report for consulting on, approving and publishing the PNA be noted and agreed.

To consider any new items of urgent business admitted at item 3 above.

As set out under CNCL104 above an information report entitled ‘Implications of the New Care Act 2014’ was considered as a new item of urgent business.

RESOLVED:

That the report be noted.

Members of the Board are invited to suggest future agenda items.

The dates of future meetings are as follows:

Ø  13 January 2015

Ø  21 April 2015

It was noted that the date of the next meeting was 13 January 2015 and that the meeting currently scheduled for 21 April 2015 may need to be rescheduled.