Minutes for Health in Hackney Scrutiny Commission meeting, Dec 10 2008, 7.30PM official page

1.1  Member apologies - Councillors Maureen Middleton and Joseph Stauber.

2.1  The welcomed a new Cllr to the Membership of the Health in Hackney Scrutiny Commission.  Cllr Feryat Demirci.

2.2  The order of business was changed to take item 7 as the last discussion item before Any Other Business.

3.1  Cllr Demirci declared she was an employee of University College London Hospital.

4.1 Minutes of the meeting were approved subject to the following comments and amendments:

4.1.1  Mr McCabe referred to page 3 point 4.2.2 and requested the minutes be amended to note Cllr Kemp assured the transitional LINk members not being a co-opted member on the Commission would not prohibit them from participating in health scrutiny meetings.

4.1.2  Mr McCabe raised a second query relating to the accuracy of minutes for item 10.  The London Borough of Hackney Legal Officer present at the meeting addressed the Commission and Mr McCabe and gave the following advice.

4.1.2.1  The Legal Officer noted the minutes of the meeting were not a verbatim record of the meeting.

4.1.2.2  Comments or requests for amendments by members of the public to the minutes should not to be considered at the meeting.  The procedure would be for the individual to submit in writing their request for amendment to the minutes to the Clerk of the Commission.  The request will be considered by the Chair and the Clerk in reference to the Clerks notes of the meeting.

4.1.2.3  Constitutionally the minutes are signed-off by the Chair of the Commission and approved by the Commission Members at the meeting.

4.1.3  Mr McCabe requested it be noted he was dissatisfied with the advice given by the Legal Officer present.

RESOLVED

Minutes approved subject to the amendments stated above.

4.2  Matters Arising

4.2.1  Action from a previous meeting - Chief Executive from City and Hackney teaching Primary Care Trust (CHtPCT) to advise the Commission of the staff appraisal rate for the PCT.  The Chief Executive from CHtPCT was not present to provide a response to this action.

4.2.2  The Chair advised for action 1, 2 & 3 on page 6 the Homerton Hospital has provided details about the physiotherapy waiting times and will provide details of the Patient Experience Tracker question and fertility success rate.  These will be appended to the minutes of this meeting.

4.2.3  The Chair advised for action 1 page 13/14 - This action is being followed up and will be reported at HiH meeting in January 2009.

4.2.4  The Chair advised for action 2 page 14 - This action is being followed up and will be reported at HiH meeting in January 2009.

ACTION

City and Hackney teaching Primary Care Trust (CHtPCT) to Provide details of the trusts staff appraisal rate.

Presentation about LBH/TLT Play Strategy

5.1  Presentation by Cllr Patrick Vernon Play Champion and the Strategic Development Manager - Childcare & Play (Jackie Hopfinger) from The Learning Trust.  The main points of the presentation were:

5.1.1  The Play Champions for LBH are Cllr Patrick Vernon and Cllr Angus Mulready-Jones.

5.1.2  Hackney Play Strategy is for 2007-2012.  The Play Strategy objectives are:

·  To improve the ability of local provision to include/reach all children and young people

·  To improve the quality and accessibility of new and existing play environments

·  To raise the awareness of the importance of play

·  To support new and existing play provision.

5.1.3  They have received a 3 year funding of 3 million from the Big lottery which is funding projects like:

·  Play Away for All

·  Inclusion Transport Service

·  Extending Inclusive After School Provision

·  Play For All etc.

5.1.4  Hackney has been highlighted as a path finder to raise the importance of play.  Included in this is to improve the opportunities children have to play.

5.1.5  GLA population predictions for children anticipate an increase of 5-12% over the next 8 years.

5.1.6  It was expressed that children have the fundamental right to have opportunities to play freely without adults and experience risk. 

5.1.7  Risk in play is a developmental imperative and improve their ability to assess risk as they grow into adults.  Today’s culture is not allowing children to take risk and be challenged.

5.1.8  Evidence shows children get as much physical activity from playing outside as playing a range of sport type activities.  This is supported by recent evidence from the British Heart Foundation. 

5.1.9  Consultation for the play strategy included talking to children.  Children expressed the desire to play out side wanting more adventure playgrounds etc.  However they did express feeling unsafe and wanting adult supervision to give confidence in security.

5.1.10  Hackney has funding to renovate and build play spaces in the borough.  The aim is to make play spaces a more natural environment.  Based on the new play space guidance from the Department for Children Schools and Families (DCSF).

5.1.11   Some considered ways of improving children’s physical health means changes to the environment, highlighting the importance of play and having good quality outdoor place areas.

5.1.12  The importance of Planning departments to influence building design and public spaces to encourage and enable more physical activity, safer streets and safe play.

5.1.13  Play and health improvement need to work together so the play strategy can be more embedded.

5.1.14  Examples of the benefits of adventure play grounds were included in the presentation.  It was noted that LBH has 7 adventure play grounds.

5.1.15  Children have contributed towards improving the play areas.

5.1.16  LBH has received 2.5 million in funding from DCSF for the Play Pathfinder project which will fund 28 new public play spaces in parks and on housing estates. (A list of the work under the path finder project is in the presentation.  (Please contact Overview and Scrutiny Officer is you would  ...  view the full minutes text for item 5.

6.  Presentation by Mary Cannon – Chair of the Hackney Community Empowerment Network (HCEN) a voluntary sector grouping of organisations that represent voluntary sector groups on the Team Hackney Thriving Health Partnership Board.  The main points of the presentation were:

6.1  Tackling childhood obesity is concentrated on three main areas:

6.1.1.1  Healthy Eating

6.1.1.2  Physical Health

6.1.1.3  Emotional Wellbeing

6.1.2  The Chair of HCEN explained they conducted an analysis and identified there was a gap for work on childhood obesity.  An application to conduct work on this area was made and receipt of funding was agreed from the Team Hackney Partnership Board.

6.1.3  This will be a pilot project specifically focusing on the areas of healthy eating and physical exercise.

6.1.4  They anticipate going out to tender for this pilot in January 2009 and will be asking for a host organisation to project manage and design support services for children and families in the voluntary sector.

6.1.5  Data evidence showed that some communities are more overweight and obese than others.

6.1.6  The age group they will be targeting is year 6.

6.1.7  The working group formed discussed the proposals for the project and had representation from Turkish, Kurdish and Charedi Orthodox Jewish Communties.  It was decided to focus the project on these communities.

6.1.8  The project will work with children between the ages of 5-13 years old and their families targeting the communities where the culture does not recognise the issue of childhood obesity.

6.1.9  It was highlighted in Hackney there is a significant proportion of children who do not attend state schools.

6.1.10  The pilot will test out appropriate activities and develop case studies to learn from.

6.1.11  A host organisation will be asked to develop, establish and operate a programme with other voluntary sector organisations for their settings and disseminate learning from good practices i.e. Happy in Hackney.

6.1.12  At the end of the programme it is anticipated they should identify

a)  What is effective

b)  What can be mainstreamed

c)  What can be incorporated by organisation into their regular everyday activities, e.g. running healthy cooking classes for pregnant women.

6.1.13  The project is expected to operate for a year and provide information, research and evidence about what works and what does not.  To build an evidence base to be used to apply for longer term funding.

6.2  Questions and Answers

Co-opted member Mr Taylor enquired if there was evidence of obesity in non state schools.

Mr Taylor suggested for a project of one year, it might be better to try to measure effectiveness using process rather than outcome indicators - that is, since it will be hard to determine significantly attributable changes in obesity at cohort level over that short time period of time, and might be better to try to capture some data on participation - who gets involved over the year; how diverse is the participation among different ethnic groups' organisations, groups in different socio-economic categories etc.

Co-opted members Ms Wykes enquired how the  ...  view the full minutes text for item 6.

Verbal update

Members agreed to take this item as item 7.

7.1  The Chair explained The Homerton Hospital is in the process of reviewing the Patient and Visitors Policy that was implemented in May 2008.  The trust is scheduled to complete the review and report at the end of January 2009.  HiH has considered the work programme and noted the report of this review would miss the HiH agenda dispatch deadline for the meeting in January 2009.  The Chair asked Members if they would agree not to postpone the update and receive a verbal update now with the view of receiving the completed review report to the Commission as an update in March 2009.

RESOLVED

Members Agreed

7.2  Verbal update from the Director of Nursing Pauline Brown from Homerton University Hospital.  The main points of the presentation were:

7.2.1  The trust is currently consulting for the review of the policy.  They have met with the Orthodox Jewish Community, who highlighted the need for an exception in the policy related to a relative staying overnight for assistance purposes for their culture and it was noted this is being considered.

7.2.2  The views of their 6000 member of the trust are being sought and the information is being sent via the members newsletter asking for comments.

7.2.3  Contacted Hackney LINk host organisation requesting comments.

7.2.4  The Director of Nursing advised she was happy to talk to Mrs Murgraff outside the meeting about the policy.

7.2.5  Feedback is being requested for return by middle of January 2009, with the view that all response would be collected by end of January 2009 for consideration by the trust governing board.

7.2.6  It was expressed since the policy was implemented the trust had received no negative feedback but instead had received comments welcoming the restricted visiting hours.

7.3  Questions and Answers

The Chair asked the Director of Nursing/Corporate Development to explain to the new co-opted members the amendments to the visitors policy.

The Director of Nursing/Corporate Development explained the visiting hours were restricted and amended; they have maintained their patient rest period and restricted the number of visitors.  It was emphasized they would negotiate exceptions for specific circumstances.

Mrs Murgraff commented that as a LINk members she had not been advised about the consultation request from the Homerton Hospital.  Mrs Murgraff expressed concern about the time frame in which to respond to the consultation taking into consideration the Christmas holiday period and staffing arrangements.  Mrs Murgraff commented that she had been advised there is up to 6 visitors at a bed and nothing had been done to implement the policy.  Expressing concern about the trust monitoring of the policy highlighting that although the policy was good if it was not strictly implemented it was not working.

The Director of Nursing/Corporate Development explained if a patient witnessed the policy not being implemented they could report this to the duty managers if they felt the staff were not ensuring the policy was being followed.  The Director of Nursing/Corporate  ...  view the full minutes text for item 7.

Members agreed to take this item as item 8.

8  Presentation by Director of Public Health for London Borough of Hackney / City and Hackney teaching Primary Care Trust (CHtPCT) of their quarterly service update.  The main points of the presentation were:

8.1  The PCT remain in a strong financial position and are forecasted to break even for the end of the financial year 2008/09.

8.1.1  CHtPCT has received an assessment rating from the Healthcare Commission for 2007/08 and they were rated as GOOD for use of resources and FAIR for quality of services.  Comparing the rating to other PCTs in London this is good.

8.1.2  The PCT has a Commissioning Strategy Plan which is a five year plan of their proposed investments for health services in City and Hackney.  The Commissioning Strategy Plan is refreshed annually and the new refresh was submitted to NHS London on 28^th November 2008.

8.1.3  The key priorities in the plan this year are:

8.1.3.1  Primary Care

8.1.3.2  Urgent Care,

8.1.3.3  Cardiovascular (Heart disease and Stroke)

8.1.3.4  Healthy weight (this has been given a higher priority in the plan this year)

8.1.3.5  Cancer (including smoking)

8.1.3.6  Mental health

8.1.3.7  Communicable diseases (including TB)

8.1.3.8  Children’s Health, (including Maternity Services)

8.1.3.9  Patient experience.

8.1.4  PCTs are expected to separate their commissioning and provider services.  Autonomous Provider Organisation (APO) gives more freedom but remain under the same board.  Work on the separation agenda continues and on the longer term options for all three PCT divisions.

8.1.5  The PCT is undergoing an assessment process called world class commissioning. 

8.1.6  The PCT has been required to submit a number of comments to the Strategic Health Authority and panel members for assessment.

8.1.7  This assessment looks at their current skills and how good they are at understanding the needs of the local people.  Also how good the organisation is at contracting services and will set out how the organisation will develop and improve.

8.1.8  CHtPCT is collaborating more closely with Tower Hamlets and Newham PCT to improve their abilities as commissioners.

8.1.9  TB update noted the PCT and LBH had signed a service level agreement for a new service to provide housing for homeless people with TB during treatment. 

8.1.10 The audit of the Directly Observed Therapy has been completed and a draft report is available.

8.1.11 The first stage of the TB audit was reviewing a sample of patient records from the Homerton Hospital and the second stage is reviewing the patient experience, it was noted a report will be available upon completion in the new year.

8.1.12  The PCT has been shortlisted for the Health Services Journal Award in category of best overall PCT in the country.  CHtPCT did not win this award but came second highly commended.  The reducing Infant Mortality Work Programme submitted by the Homerton Hospital won an award at the HSJ in the category of health inequalities.

8.2  Questions and Answers

Mr Vidal commended the PCT on the  ...  view the full minutes text for item 8.

Members agreed to take this item as item 9.

9  The Director of Public Health for London Borough of Hackney / City and Hackney teaching Primary Care Trust (CHtPCT) presented the draft Joint Strategic Needs Assessment Document for City and Hackney.  The main points of the presentation were:

9.1  The purpose of the JSNA is to describe the current and future wellbeing needs of the local residents in City and Hackney.

9.1.1  Information to contribute towards producing the JSAN was collated from residential survey and stakeholder event.

9.1.2  The is statutory requirement on Local authorities and PCTs to produce a JSNA by April 2009.

9.1.3  Locally this work has been completed by a working group consisting of representatives from PCT, LBH, The Learning Trust, City of London Corporation and Voluntary Sector groups.

9.1.4  The decision was taken to produce the document early (by November 2008) so that it could be used to influence the commissioning decisions made for 2009/10 by LBH and CHtPCT.

9.1.5  The key priorities identified are:

9.1.5.1  Getting people into the workforce

9.1.5.2  Health promotion – healthy schools positive out of schools activities

9.1.5.3  Healthy weight

9.1.5.4  Smoking – prevention

9.1.5.5  Immunisation

9.1.5.6  Mental health promotion and services

9.1.5.7  Sexual health

9.1.5.8  Maternity services

9.1.5.9  Life expectancy

9.1.5.10  Needs of specific care groups – e.g. learning disabilities.

9.1.6  A stakeholder event was held at the end of July 2008 which approximately attracted 60 stakeholder to the event.  This provided valuable information for the document.

9.1.7  The finding were presented for discussion with a range of people such as Team Hackney Thriving Healthy Communities Partnership, Hackney Management Team (HMT) PCT Directors, Board and Clinical Commissioning Executives, Health in Hackney Scrutiny Commission, City Health Overview Scrutiny committee and children and Young People Partnership.  The early findings were also presented to the Transitional LINk group.

9.1.8  The findings of the JSNA has been well received and additional comments received have been addressed.

9.1.9  This is now the final document and has been signed-off by LBH Executive and City of London Corporation and is expected to be published at the end of this calendar year.

9.1.10  Presentation of the document to the Commission is for comments on

9.1.10.1  Inaccurate data

9.1.10.2  How can be improved and areas expanded

9.1.10.3  Ways to make the document more user friendly.

9.2  Questions and Answers

The Chair enquired what is the impact to the trust producing a document for two organisations that have completely different needs and referenced the difference in death rates on page 63 of the agenda.

The Director of Public Health acknowledged there was a distinct difference between the two organisations but highlighted CHtPCT had a statutory duty towards both organisations.  The City expressed the desire to see their needs more clearly in the document and this format met with satisfaction for both.

Co-opted member Mr Taylor referred to page 84 and remarked that the section titled What works could be described as generic and queried if the PCT  ...  view the full minutes text for item 9.

Discussion on LB Waltham Forestproposals to restrict fast food takeaways near schools or youth facilities.

Members agreed to take as item 10 last because it was a discussion item being led by the Chair.

10  The Chair led the discussions and highlighted the following main points:

10.1  Residents of LB Waltham Foresthad consulted and it is has been reported in the media that 93% support the proposals.

10.1.1  Queries had been raised by Members of HiH about the evidence to support implementation of these proposals would improve health well being for children and LB Waltham Forest had not conducted any further research but referred to the DOH document the Healthy Weight, Healthy Lives: A Cross Government Strategy for England.

10.1.2  Mr Vidal highlighted this proposals would only related to new fast food outlets but would not apply to existing premises and would limit competition.

10.1.3  Co-opted member Mr Taylor commented these proposals failed to address the status quo, and advised there was evidence to link BMI to density of fast food outlets and the availability of vegatables.  Mr Taylor commented what was not clearly identified was the impact of this action in the future and highlighted if the premises closes what would replace it.

10.1.4  The Chair pointed out the commission was advised previously about Manchester who had decided to take a softer approach to encourage sanction if the premise offered health food options on the menu.

10.1.5  Cllr Price highlighted although the proposals did not solve all the issued it was important to recognise token gestures.

10.1.6  Mrs Murgraff referred to page 42 italic paragraph at the bottom of the page and expressed delight that the police had recognised they had a duty to implement these proposals and welcomed this.

10.1.7  Cllr Sharon Patrick commended the proposals by LB Waltham Forestreiterating there is a good deal of public concern about fast food outlets and their appeal to children.  Cllr Patrick referred to LBH Shoreditch SPA and noted when this policy was introduced it did not affect existing licensed premises, but meant any new premises would need to comply with the restrictions of the policy and if a premises wanted to change their license they would need to meet the restrictions of the SPA.  Cllr Patrick highlighted when this policy was introduced there were doubts that it would be successful because it did not affect exiting premises, but it has proved to be a huge success.

10.1.8  Co-opted member Mr Taylor reminded the Commission there was a variety of ways to make it difficult for premises.

10.1.9  Cllr Demirci highlighted introducing a new policy like the Shoreditch Special Policy Area required a lot of research and urged this not to be forgotten.  Cllr Demirci also suggested another option could be to look at food consumption.

10.2  Questions and Answers

The Chair advised the Commission LB Waltham Forest is scheduled to have a consultation report ready for January 2009 and anticipate a decision about the policy will be made by their Cabinet in February 2009.  The Overview and Scrutiny Officer has been speaking  ...  view the full minutes text for item 10.

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