Agenda and minutes

To note any changes to the membership.

1.1       No apologies received.

To receive declarations by Members and Officers of the existence and nature of any pecuniary interests or any other significant interest in matters on this agenda.

2.1       Councillor Bott declared that in relation to item 6, he is a practising dentist working in a private practice.

To approve the minutes of the meeting held on 8 November 2021.

3.1       RESOLVED: That the Committee approve the minutes of the meeting of 8 November 2021.

Update to the Committee on current and forthcoming issues in this portfolio.

4.1       The Committee received a written report from Councillor Tim Mitchell (Cabinet Member for Adult Social Care and Public Health) who provided a short verbal update on current and forthcoming priorities in his portfolio.

4.2       The Committee discussed the following topics in detail:

•           the new building strategy for St Mary’s Hospital;

•           planning for the wind-down of vaccination centres;

•           provision for outpatients and acute care;

•           statistics on vaccinated and unvaccinated people in the City;

•           the White paper: People at the Heart of Care, bidding for funding and where the money should be allocated;

•           compulsory vaccinations for care home staff and workforce planning;

•           plans for the Carlton Dean redevelopment; and

•           updates on the Beachcroft contract.

4.3       Concerning the listed outpatients building at St Mary’s Hospital, the Committee sought clarification on the strategy to upgrade the building.  The Cabinet Member advised the Committee that unfortunately the issue had not been resolved and it was a matter for Planning.  However, that the Cabinet Member felt that the building should be fit for purpose and was not convinced of its suitability.

4.4       The Committee discussed the falling rates of Omicron and COVID-19 generally and queried the Council’s plans for reducing the vaccination infrastructure, including centres and pop-up centres; and if there was an assumption that this would now be reduced and wound-down.  The Cabinet Member advised the Committee that it was an NHS matter, and the Council was very much in the hands of the NHS.  The Cabinet Member informed the Committee that in his view the Council would move to a model where COVID-19 vaccinations would be delivered as a part of business as normal and would involve GP surgeries, pharmacies, and support from Primary Care.

4.5       Concerning out of borough outpatient care, the Committee discussed transportation for frail patients, and the costs to patients.  The Committee sought clarification on how the Cabinet Member was informed when such provisions were moved out of Westminster.  The Cabinet Member confirmed that patients would be asked to travel further whilst the acute sector caught up and that NHS England had invested money in the private sector in order to bring down NHS waiting times. 

4.6       The Committee queried the partnership change for outpatient testing.  The Cabinet Member stated that he was not aware of any changes to the partnership and would have been informed of any such changes but would confirm and report back to the Committee.

4.7       The Committee requested that a map be provided of the locations where Westminster residents are being sent for outpatient care.

4.8       Members of the Committee discussed the number of unvaccinated residents (44%).  The Committee noted that the council was working with health partners to improve vaccination number and queried if the council should know who these individuals are, as the numbers did not seem to be improving.  The Cabinet member confirmed that 61% of residents had been vaccinated, he confirmed that the council did not know who had been vaccinated, however  ...  view the full minutes text for item 4.

The report provides a written update on the Gordon Hospital inpatient wards and CNWL’s mental health provision for Westminster.

5.1       The Committee received a written report from Ela Pathak-Sen (Director of Mental Health Services in CNWL), Graham Behr (CNWL, Consultant Psychiatrist) and Anne Sheridan, (CNWL, Consultant) who provided a short verbal update on the temporary continuing closure of the in-patient wards at the Gordon Hospital.

5.2       The Committee discussed the following topics in detail:

•           the pressure facing Mental Health services;

•           outcomes from the Voice Exchange Project;

•           the impact of the hospital’s continuing closure on Westminster;

•           the number of consultants recruited;

•           the numbers of patients being treated outside of Westminster; the rise in unwell people across Central North-West London and the number of compulsory admissions to in-patient units; and

•           the increase in admissions under the Mental Health Act.

5.3       Concerning the increase in admissions under the Mental Health Act, the Committee was informed that the Community Mental Health teams were under immense pressure and patients were being released before they were well.  The Committee queried if the money from the closure should be invested in Mental Health Services as there were not enough resources.  Responding to the question, Graham Behr advised the Committee that investing in community resources was the right direction and that there had been a change in the model, where access had been widened by incorporating primary health care serves in to the “one stop shop” model.  He stated that this allowed higher interface and interaction with GPs to support managing people as soon as interventions had been completed.

5.4       The Committee sought further clarification on the Voice Exchange project and whether it was entirely staff orientated.  The Committee also wanted further information on the treatment and care.  Responding to the query raised, Ela Pathak-Sen advised the Committee that whilst the report was not yet published, those who participated in the project had very much appreciated the work that staff had done for them, however for them to be able to receive better and more compassionate care, staff members needed to be cared for better.  She added that service users also wanted to be more involved in decision making.

5.5       The Committee noted the letter which had been received in relation to staff experiences which was shared with partners.  The Committee sought clarification on why people were re-admitted to mental health services.  Mr Graham Behr advised that when looking at data across all the boroughs the biggest cause for readmission was drug use.  He informed the Committee that investments in Westminster had been directed to supporting young men in particular, however it was not an issue that they had the answers to immediately.  The Committee noted earlier comments with regard to funding from the closure of the Gordon Hospital going into mental health care, however, but doubted that the finances were organised in that way. 

5.6       The Committee noted that, during its round table discussions with Clare Murdoch, she remarked that the CQC report had found the Gordon Hospital to be unsatisfactory and stated that it must be invested in.  The  ...  view the full minutes text for item 5.

The Committee are to receive reports on oral health in Westminster.

The papers from Westminster Public Health are to follow.

6.1       The Committee received a report from NHS England Dental Service on Oral Health in Westminster (represented by Dr Huda Yusuf and Jeremy Wallman) and Westminster’s Public Health team.  The Committee also welcomed as external expert witnesses Martin Skipper (Head of Policy, London Dental Committees Confederation) and Emilie Szasz (a practising NHS dentist and owner of a dental practice in Westminster Chair of the Kensington, Chelsea and Westminster Local Dental Committee)

6.2       The Committee discussed the following topics in detail:

•           the treatment charge system, the cost of materials and the balance between acute and emergency treatment;

•           the decay statistics for children under 5 and supporting parents for improved outcomes;

•           oral health inequalities and the procedures for oral health care in care homes;

•           oral heath provision for the homeless and rough sleepers, in particular the impact of substance misuse on oral health;

•           the use of social media for promoting oral health, the costs of oral health treatments and the fear of visiting the dentist; and

•           the ability to register with NHS dentists and the fluoridation of the London water supply.

6.3       The Committee discussed the pricing and charge structure outlined in the report.  The Committee queried whether COVID-19 delays had resulted in more extensive and more costly dental work, and whether this had caused issues.  Responding to the Committee’s query, Martin Skipper advised the Committee that, from a commissioning point, this was an issue as routine issues had become urgent, and practices were seeing more complex and long-drawn-out treatments.  Emilie Szasz advised the Committee that costs had increased, including the cost for materials.  She added that patients were coming in large numbers and because the UDA system does not measure access it is very difficult for the commissioners to know exactly what is happening

6.4       The Committee noted the 3 measures required to tackle the problem of decay amongst for children did not appear to be complex.  It noted that one third of children were suffering from tooth decay and the position had worsen over the last 5 years.  The Committee wondered if there should be more work to educate parents.  The Committee suggest that social media should be used as another tool to promote oral health as nearly all parents will have a smart phone.

6.5       Dr Huda Yusuf (Senior Clinical Consultant, Public Health England) observed that “victim blaming” parents was not constructive and that the focus should be on issues that impact on child oral health, such as child poverty, deprivation, and access to education and opportunities.  It was also felt that the ‘Commission Better Oral Health’ guidance providing an evidence-based intervention was a key tool. It was noted that Westminster had implemented a number of these interventions such as training of the wider workforce, health education and social care, empowering parents to take control over their lives. 

6.6       Anna Raleigh (Director of Public Health) confirmed that using social media to promote improved oral health was certainly something that the Council would  ...  view the full minutes text for item 6.

The report introduces the Adults Autism Strategy, Changing Lives: Shaping our Autism journey together 2021-2024.

7.1       The Committee received a report on the WCC Autism Strategy Bernie Flaherty (Bi Borough Executive Director of Adults) presented the Autism Strategy and report

7.2       The Committee discussed the following topics in detail:

•           The need for concrete commitments, levels of funding and the accuracy of the statistics presented in the strategy

•           The action plan for how the council would achieve the statements and description detailed in the strategy

•           How the Council will ensure social value is embedded in the strategy

•           Ensuring the continuing work with that service users

7.3       Emma Colverd (Founder and manager of Safe Haven Basketball) was invited to comment and ask questions.  Ms Colverd welcomed the strategy, she felt that it was very thorough and cover the main factors.  She wanted to make two points, the first was that the delivery of the strategy should be as good as the strategy itself and she queried how and what measures would be put in place to set expectations, targets and monitor performance and outcomes.  Ms Colverd also suggested the use of secret shoppers, to establish user experiences for people with autism.  Ms Colverd advised the Committee that she was concerned that the Autism strategy may become less important, and possibility shelved after the elections in May.

7.4       The Committee welcomed the repot and thought that it was very interesting and appreciated the case studies presented.  The Committee found the presentation of the report difficult to read.  The Committee felt that the report was very good at describing the problems, however in terms of actions and commitments, there was very little concrete commitment.  The Committee also felt that there was no real commitment to funding, just a mention of £50,000 for solving the issues with IEPT at the very end of the report.  The Committee noted that the graphs (P.42) suggested that the numbers would increase and then decrease, the Committee felt that there was no evidence to support this and queried the accuracy of the data.

7.5       Responding to the queries, Bernie Flaherty advised the Committee that regarding performance, the council needed to take a deeper look, as it was not clear.  She also added that there were wider issues to consider, i.e., diagnoses rate, which was many times lower than what it should be and businesses doing more to support outcomes.  Ms Flaherty advised the Committee that the data nationally was very poor, and the council was working with health colleagues to try and establish baseline data.  The Committee noted that other issues like poor access to mental health and support were key and required specific actions to tackle these issues.

7.6       Gareth Wall advised the Committee that this was a strategy with high level aims and ambitions set out by residents and service users.  He advised that detailing the action is the that would happen next.  He added that each of the seven pillars had a group assigned to it, working on four areas, ‘what’s going well’, ‘were to focus, ‘how  ...  view the full minutes text for item 7.

The report asks the committee members to consideritems for the Committee’s 2021/2022 work programme. 

8.1       The Committee received a report on its work programme and discussed the work programme for the remainder of the municipal year. Artemis Kassi reminded the Committee that there was one final meeting before the local elections in May.  Ms Kassi advised the Committee that the following items were suggested for the next meeting:

•           an update on Gordon Hospital;

•           a report from Healthwatch;

•           Joint Strategic Needs Assessments; and

•           an update on the work programme.

8.2       Artemis Kassi advised that there were still unallocated items, and that the scrutiny team would be approaching the directorates with regards to planning the work programme for the upcoming year. The Committee asked why the statutory Public Health Annual Report had not been published. Anna Raleigh confirmed to the Committee that the Director of Public Health’s annual report was a statutory report and the 2021 report had been through governance and would be uploaded to the website very shortly.  She added that the Annual Health report would be published in the spring or early summer 2022.  It was agreed that the Annual Public Health report would be brought to the Committee prior to publication in either June or September and that Anna Raleigh would liaise with Artemis Kassi to confirm the dates.

8.3       The Committee observed that it would like more information on where Westminster residents were going for tests and noted that the information may be provided as part of the NWL integrated care system.  The Committee also suggested more items on Care Homes and Public Health services being delivered by the voluntary sector, such as “Step down beds”. The Committee also sought information about the progress of the Obesity/Metabolic Diseases task group.