Agenda and minutes

Please note that this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method. Although we ask members of the public recording, filming or reporting on the meeting not to include the public seating areas, members of the public attending the meeting should be aware that we cannot guarantee that they will not be filmed or recorded by others attending the meeting. Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on. 

By entering the meeting room and using the public seating area, you are consenting to being filmed and to the possible use of those images and sound recordings.

The chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual or may lead to the breach of a legal obligation by the Council.

The Chair referred Members present to agenda Item 1 as shown on the agenda in respect of filming at this meeting, and Members noted the information contained therein’.

Apologies for absence were received from Cllr Nick da Costa.

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 as noted below).

None.

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.

Cllr Pippa Connor declared an interest by virtue of her membership of the Royal College of Nursing.

Cllr Pippa Connor declared an interest by virtue of her sister working as a GP in Tottenham.

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

None.

To approve the minutes of the previous meeting.

Cllr Connor noted that there was an outstanding action point from the previous meeting regarding a briefing for Members on prevention and early intervention which would be followed up.

The accuracy of the minutes from the previous meeting was then agreed.

AGREED: That the minutes of the meeting held on 5^th September 2019 be approved as an accurate record.

To receive an update on the redevelopment of St Ann’s Hospital, including on plans to address the increasing demand for access to beds.

Andrew Wright, Director of Strategic Development at Barnet, Enfield and Haringey Mental Health NHS Trust and David Kovar, Managing Director – Haringey at Barnet, Enfield and Haringey Mental Health NHS Trust, gave a presentation to the Panel on the redevelopment of St Ann’s Hospital and mental health beds.

The presentation included the following points:

• Construction on a new mental health inpatient building commenced in January and is on time and budget with the new building due to open in summer 2020. It will re-provide the three acute adult wards and the specialist eating disorders unit.
• The second phase involves improvements to the rest of the site which will start in autumn 2020 and be completed by late 2021.
• Images displayed from the slides showed the new pedestrian entranceway from St Ann’s Road. One of the objectives of the new layout is to make the hospital clearer and easier for people to find their way around.
• Images were displayed of the interior of the building including a typical patient’s bedroom which has en-suite facilities.
• The Trust is currently facing very significant demand pressures. There are currently 28 patients across Barnet, Enfield & Haringey who are in beds outside of these boroughs, though the average is typically about 20. The national target is to eliminate all out of area placements by 2021.
• Additional investment in Crisis Teams and Community Mental Health Teams to support people in their own homes is welcome but would not be enough on its own. The Trust is creating additional 10 beds at Edgware Hospital, which will replace 5 beds currently being used in East London, resulting in a net increase of 5 beds.
• The Trust believes that there is a need for an additional mental health ward in the area, with around 18 beds, in order to meet increasing demand.
• Figures for the Trust’s current acute adult bed provision was given as follows:

o   Barnet – 41

o   Enfield – 51

o   Haringey – 50

o   Recovery House beds (one per Borough) – 30

o   Male psychiatric intensive care beds (across the whole Trust) - 14

• The solution to these challenges include partnership working across the whole system with primary care, acute hospitals and social care.

In response to questions from the Panel, Andrew Wright and David Kovar said:

• The Trust considers that the overall additional demand can be met through a combination of the net increase of 5 beds through the changes at Edgware Hospital, a new ward with 18 beds additional and further work to upstream interventions to reduce the need for beds. Dealing with delayed transfers of care could also help with this. These are cases where the patient is clinically well but where another factor, such as housing issues, prevents them from being discharged. These changes taken together would put the overall occupancy rate of the organisation as a whole at around 95%. The next stage of long-term planning would be to aim to reduce that to around 85%.
• The most important aspect of  ...  view the full minutes text for item 29.

To consider the annual report of the Haringey Safeguarding Adults Board for 2018/19.

Dr Adi Cooper, Independent Chair of the Haringey Safeguarding Adults Board, introduced the Board’s annual report for 2018/19. The Board is required to produce this report as a statutory duty. The report provides details of how the Board is delivering on its annual Strategic Plan and how it is improving safeguarding for adults in Haringey. It also includes information from partners who have varying roles and responsibilities.

Dr Cooper explained that the Board meets four times a year but that much of the work is carried out through a series of sub-groups. The Safeguarding Adults Reviews sub-group covers one of the largest areas of work and looks at referrals of cases that meet the statutory criteria and to oversee all Safeguarding Adults Reviews (SARs). This year there had been a referral from the Police which didn’t meet the threshold for a SAR did require the sub-group to look at issues of homelessness and rough sleeping which became a work programme for the Board. There was also a referral which led to a new priority being identified for 2019/20 to review the transitional safeguarding in conjunction with Children’s Services. 

In terms of SARs, workshops had been held and progress monitored on the Robert SAR which took place a couple of years ago. The report on the Ms Taylor SAR was published in February 2019 which is the second SAR published in Haringey since the Care Act 2014 was implemented. That report is summarised in the annual report. A successful workshop had recently been held on disseminating and understanding the learning from this SAR.

The Quality Assurance sub-group provides a monitoring function for the Board looking at performance information, care services and policies and procedures. It also provides a function to hold partners to account. The sub-group also looks at the data on safeguarding adults and can escalate any issues that the Board needs to consider.

The Prevention and Learning sub-group’s role is to promote awareness across the Borough through actions such as events, information stalls and leaflets on issues such as modern slavery, self-neglect, fire risks and domestic abuse. There is ongoing work on training and development with a focus last year on the charity and voluntary sector to build community awareness of safeguarding.

The report also includes a summary of the Safeguarding Improvement Plan, an NCL Challenge Event bringing partners across the area together to share learning, activity data, the priorities for 2019/20 and the Strategic Plan for 2018-21.

Overall the Board is pushing to move forward each year and improve in different areas and there is a really high level of commitment from partners. There are challenges with the churn of front line staff, changes in organisational structure and pressures of demand and lack of resources on services. 

In response to questions from the Panel, Dr Cooper, Beverley Tarka, Director of Adults & Health and Charlotte Pomery, AD for Commissioning said:

• That the transition issue with young people was an area that the Board looked at for a number  ...  view the full minutes text for item 30.

To receive a general overview of CQC inspections recently carried out in the Borough.

Sujesh Sundarraj, Commissioning and Safeguarding Officer, introduced the report which covered the quality assurance functions in the Council and the CCG and the joint work with the CQC. The Council has a risk register in place for providers and inspections are carried out with different variables used to risk assess including CQC reports, whistleblowing, complaints and feedback from professionals and families.

There are four providers high on the risk register currently as set out in paragraph 2.2 of the report. These all require intervention and the outcomes are recorded on the right hand side of the table which include measures such as improvement plans and increased monitoring visits.

The report also covers the 33-bedded Ernest Dene residential care home which had closed for a two-year period for refurbishment work. This impacted on five service users, wo were then reviewed appropriately and supported to move to alternative accommodation.

A total of 13 CQC inspections had been carried out in the previous quarter (Jul-Nov 2019), 12 of which were rated ‘good’ and 1 rated ‘requires improvement’. Out of the overall 22 locations in Haringey rated ‘inadequate’, ‘requires improvement’ or uninspected, there are existing placements in 6 locations. Of the 16 others, there is one rated as ‘inadequate’ by the CQC but the service provided has now decided to close the business. As a percentage of commissioned services located in Haringey, 91% are rated good with 9% requiring improvement.

With regards to out of borough placements around 80% are in the NCL area. A lot of dialogue and information sharing takes place in the NCL quality sub-group which meets on a monthly basis.

In response to questions from the Panel, Sujesh Sundarraj, Beverley Tarka and Charlotte Pomery, said:

• That there are two residents at Osborne Grove and there is always ongoing work to improve the offer of care there regardless of whether it may close in the future. The ‘requires improvement’ rating has been in place for a long time since the last CQC inspection and staff have been working to improve the care provided.
• Regarding homecare services provided by another borough which do not have sufficiently high rating, these are monitored through the quality assurance process and social workers are also asked to carry out reviews.
• There are a total of 85 registered locations in Haringey which include homecare, nursing, residential supported living, etc. The placements in locations rated ‘requires improvement’ were pre-existing before that rating was imposed by the CQC. After this the care of the service users were reviewed.
• Asked why Peregrine House care home did not appear on the list of locations that ‘requires improvement’ this was because a new CQC rating of ‘good’ was in place following an inspection that took place earlier in the week. 
• Arrangements for staffing and resources for quality assurance was constantly being reviewed and there is additional capacity through the joint work with the CCG. An additional staff role had recently been added to support quality assurance.

To receive an update about the planned changes to Haringey’s domestic violence perpetrator programme as part of the Violence Against Women and Girls (VAWG) strategy.

Will Maimaris, Director of Public Health, provided an update on Haringey’s domestic violence perpetrator scheme. He described domestic violence as endemic with three out of ten women suffering domestic violence in their lifetime. Haringey has one of the highest levels of domestic violence in London. Haringey Council has a Violence Against Women and Girls (VAWG) Strategy for 2016-2026 which has 4 key strategic priorities. The report focuses on prevention and intervention strategies which target domestic violence perpetrators. This is a new area with emerging evidence.

Haringey’s programme in this area since 2016 is the Domestic Violence Intervention Project (DVIP) commissioned through the Richmond Fellowship which works closely with Children’s Social Care. The programme has three core elements which are an expert risk assessment, a violence prevention programme for perpetrators and a women’s support service. The programme is currently oversubscribed with 64 referrals received in 2018/19 and 28 places commissioned. One limitation is that it is an English language programme but 60% of the men referred speak English as a second language so steps are being taken to identify community groups to train individuals as interpreters and mentors to perpetrators. The main concern with the programme is that the interventions could be taking place at an earlier stage to reduce harm. The programme also has links to other services such as the substance misuse service.

In response to questions from the Panel, Will Maimaris said:

• On whether the budget of £70,000 was too small, this was only a part of the overall VAWG strategy which has a budget of £700k overall. There is also a multi-agency MARAC where cases are discussed. However, it is important to recognise that this is an area where more investment is needed. Cllr Berryman asked for further information about how the domestic violence budget has changed over the last ten years and Will Maimaris said that he would send these details in writing. (ACTION)
• The service is stretched in terms of resources and there is a case for expansion but it is also embedded in Children’s Social Care so there is other capacity there in support.
• Evidence is emerging but a literature review has been carried out which could be shared with the Panel. (ACTION) More approaches could be developed and tested in the local delivery is more funding was available.
• On whether the length of time for the interventions were sufficient to change quite entrenched behaviour, the evidence is not clear on this but there is also a question of ensuring appropriate follow up work from social care.
• On how abused men are supported, the services directly commissioned are for women and girls as the vast majority of victims are women and girls but there are some nationally provided programmes for men.

The Panel requested that a further update on this topic is provided in around 9 months time. (ACTION)

To receive information about the progress against performance indicators for Priority 2 (People) for Q1 of 2019/20.

Charlotte Pomery presented the performance indicators for the People priority for Q1 of 2019/20. This includes three outcome measures on children & young people although parts of these cover some of the transition issues. In terms of Adults & Health the two areas of focus are outcome 7 on healthy and fulfilling lives and outcome 8 on strong communities. Will Maimaris said that one of the indicators, healthy life expectancy, is the years lived in good health and there is a significant gap of 15 years between the west and east of the borough which underpins all of the efforts that the Council is making on public health.

Charlotte Pomery said that the Green-Amber indicator on non-elective admissions to hospital and the Green indicator on delayed transfers of care reflects the partnership work carried out through the Better Care Fund. The indicator on the proportion of adult safeguarding cases with risks removed or reduced is also on track. The proportion of residents with a high happiness score had not recently been surveyed which is why it is grey in the report. Similarly data is not always regularly available for some of the Strong Communities indicators so some of these are grey as well. Overall, the relevant parts of the performance wheel are green, amber or grey.

Asked how happiness is measured, Charlotte Pomery said that this is typically done through a survey using the Royal Edinburgh score. Asked about enabling more people to walk and cycle, Will Maimaris said that a briefing note on active travelling had been provided for a previous scrutiny panel meeting which could be recirculated. (ACTION) There is also a Physical Activity Strategy for the Borough. Cllr Connor commented that though the physical activity indicator was green, Haringey was still well behind some other boroughs such as Islington. Charlotte Pomery said that quite ambitious targets had been set and that green indicators mean that the target is on track and not necessarily that everything is as good as it could be.

Asked about the healthy life expectancy figures which were showing as red, Will Maimaris said that there is a long time lag with the data which presents problems in tracking progress. The Haringey life expectancy has improved and overtaken the London average, though there are significant inequalities within the borough. Asked why the indicators life expectancy at birth is showing as red for men and green for women, Will Maimaris said that he would provide further details on this in writing. (ACTION)

-       6^th January 2020 (6:30pm)

-       25^th February 2020 (6:30pm)

-       6^th January 2020 (6:30pm)

-       25^th February 2020 (6:30pm)