Agenda and minutes

Apologies for absence were received from Chris Boden (Chairman) and Alderman Alison Gowman.

The Deputy Chairman therefore took the Chair.

Steve Stevenson declared a standing interest by virtue of being resident in the City of London.

Vivienne Littlechild declared a standing interest by virtue of being resident in the City of London.

To approve the inquorate minutes of the meeting held on 6 November 2018.

The Town Clerk explained that, as the last meeting of this Committee had been inquorate, Members would need to consider the minutes of their previous two meetings.

a)    1 May 2018

The public minutes of the meeting held on 1 May 2018 were tabled. The minutes were considered and approved as a correct record.

b)    6 November 2018

The public minutes of the inquorate meeting held on 6 November 2018 were considered.

Mrs Mead highlighted that she had also sent apologies to the meeting and asked that these be recorded. It was also noted that it was David Maher as opposed to Dan Maher who had been one of the City and Hackney CCG representatives at the meeting. The Town Clerk undertook to make these amendments to the published minutes.

Subject to the amendments above, the minutes were approved as a correct record.

Members are asked to consider items for inclusion in the work plan.

The Committee considered suggested items for inclusion in the 2019/20 workplan.

A Member requested that an item looking at how personal budgets/carers allowances were working following recent cuts be added to the workplan.

The Deputy Chairman suggested that the workplan be reconsidered towards the end of the agenda as some of the items for consideration today may lead to the addition of further points.

Report of the Director of Community and Children’s Services.

The Committee received a report of the Director of Community and Children’s Services presenting the recently revised Terms of Reference of the Inner North East London (INEL) Joint Health and Overview Scrutiny Committee (HOSC).

The Deputy Chairman also welcomed Robert Brown, Senior Scrutiny Policy Officer at the London Borough of Newham, to talk to the report. Mr Brown highlighted that the INEL HOSC incorporated the London Borough of Newham, Tower Hamlets, the London Borough of Hackney and the City of London Corporation. The Committee had not now met since November 2017 but the plan was now to ressurect more regular meetings over the next few years.

Members were informed that a revised Terms of Reference document was attached to the report for comment and that a new protocol was also in place to help Members to have a better understanding of what types of issues could come to HOSC meetings.

Mr Brown confirmed that the City of London Corporation had one representative on the Committee and that, at present, this was the Chairman of this Committee, with the Deputy Chairman as a substitute. It was highlighted that this, however, may change given that HOSC meetings were evening meetings and that this often proved problematic for the Chairman. The Deputy Chairman state that it may be that he therefore become the City’s representative on the HOSC with a new substitute appointed. He clarified that it was not necessary for the City’s representative to be either the Chairman or Deputy Chairman of this Committee and that this would therefore be a matter for Members to decide in due course. It was noted that it would be preferable for the City to have a consistent attendee at these meetings going forward.

In response to questions, Mr Brown clarified that meetings of

A presentation from the Integration Programme Manager.

The Integration Programme Manager gave a presentation updating the Committee on Health and Social Care Integration.

The Programme Manager reminded the Committee that the City of London Corporation had entered into integrated commissioning arrangements with City and Hackney CCG in April 2017 to commission together across health, public health and social care. A governance structure was set up at the time and has proceeded. Four workstreams (delivery arms of the programme) were included – prevention, unplanned care, planned care and children, young people and maternity services.

The presentation covered the following points:

Key areas of work:

o   A neighbourhood model – integrated care at a local level built around GP practice populations of 30-50,000. It was highlighted that the Neaman Practice is part of the Shoreditch Park and City neighbourhood. The Neaman Practice are  part of the wider neighbourhood management group but tthere would be a bespoke operational model for the City. There would be  links across with the integrated care model in Tower Hamlets as many residents on the east side of the City are registered with Tower Hamlets CCGs.  The City were now meeting regularly with Tower Hamlets CCG.

o   Neighbourhood health and care services – The Committee were informed that a project was underway to look at how community health services could be realigned  to deliver the neighbourhood model and how social care services would also link in with this. Extensive engagement had been undertaken with stakeholders and engagement with residents would follow as thinking around this continued to develop.

A Member referred to recent, personal experience with the health service and highlighted that patients in the City wishing to access GP chiropody services were being instructed that they must first visit St Leonard’s. She expressed her concern and confusion around this approach. Mr Maher reported that

Report of the Director of Community and Children’s Services.

The Committee received a report of the Director of Community and Children’s Services setting out the City of London Health Profile 2018 containing summary information on the health of the people in each local authority area and factors that may influence their health.

A Member underlined that City residences were often second homes for some. He stated that, if this were the case and these individuals were accessing health care in the City, he hoped that City and Hackney were received the funds for this.

With regard to the paragraph concerning violent crime, a Member referred to a recent Evening Standard article that had produced statistics on the safest postcodes in London. He noted that EC1Y, the Golden Lane Estate, had been listed as London’s second safest postcode.

A Member referred to the paragraph on new STI diagnoses. She recalled that this Committee had previously been informed that people would no longer be permitted to use their office postcode to access sexual health services so that funds could be adequately reclaimed. Officers undertook to look into this matter further and report back to Members. It was, however, highlighted that the recently published statistics were taken up to July 2018 and it could, therefore, be that there was a lag in the data around this as a new clinic had now been established.

RESOLVED – That Members note the City of London Health Profile 2018 and consider how they might use it to shape their forward-planning process.

Report of the Director of Community and Children’s Services.

The Committee received a report of the Director of Community and Children’s Services presenting the 2017/18 Clinical Commissioning Group assessments for mental health, dementia, learning disabilities and diabetes.

Members were pleased to note that City and Hackney CCG had received an ‘Outstanding’ assessment rating in terms of Dementia. A Member went on to refer to the fact that there were very few care/nursing homes in the City and Hackney area with none at all in the City itself and just 3-4 based in Hackney. Another Member recalled that there had previously been a respite care centre based in the City of London Maternity Hospital but that this no longer existed.

The Deputy Chairman referred to the City and Hackney’s ‘Requires Improvement’ assessment score in terms of Learning Disabilities. He said that he failed to understand how this score had been arrived at from reviewing the information provided within the report. He asked for greater clarity around this going forward. Mr Maher highlighted that there was currently a difference between how data on learning disabilities was considered nationally and how it was uploaded and recorded locally. The Deputy Chairman reiterated that he would still like to see more clarity in future around what exactly required improvement in this area, where and why. Mr Maher stated that Officers had sent back similar feedback on this data.

The Assistant Director of Commissioning and Partnerships confirmed that the City currently had 14 clients registered as having learning disabilities and confirmed that the City was meeting their needs satisfactorily. Members suggested that a note to this effect would be helpful in future reports.

RESOLVED – That, Members note the report.

Report of the Director of Community and Children’s Services

The Committee received a report of the Director of Community and Children’s Services alerting Members to the publication of a new NHS Long term plan and setting out key messages from the Local Government Association and a response from the Accountable Officer of NHS North East London Commissioning Alliance.

A Member commented that the cuts to funding were extremely concerning.

The Integration Programme Manager reported that the City of London Corporation, like others, did receive winter pressures funding and that and that some of these funds had been used to trial the engagement of an additional member of Occupational Health staff to see what value this might add to the services provided in supporting hospital discharge.

Mr Maher reminded Members that 2019 was the final year of the current 5 year NHS plan and that it was proposed that a 10 year plan (called the Long Term Plan) be introduced thereafter. He acknowledged Member concerns around funding cuts and stated that this was particularly concerning around social care. He added, however, that he felt that mental health had made significant gains particularly around the introduction of more specific, measurable goals.

It was highlighted that there was a greater focus on digital care within the Long Term plan with the intention being that all service users would have the right to request an online consultation with their GP by 2022. There was a strong indication that this would be preferable for City workers and also younger people. A Member stressed the fact that City and Hackney CCG were not responsible for the health care of City workers if they were not also resident in the area. The Assistant Director of Commissioning and Partnerships clarified that online consultations would be linked to the users own GP practice and would be dependent on

A report and presentation of the Interim Director of Consumer Protection and Market Operations.

The Committee received a report of the Interim Director of Consumer Protection and Markets Operations relative to the City Corporation’s Draft Air Quality Strategy.

The Air Quality Manager presented the report and supplemented this with a presentation to Members, slides for which were tabled at the meeting.

The Air Quality Manager highlighted that Air Pollution was very much a public health issue. The Presentation touched on the background and context of the strategy with the Air Quality Manager underlining that this was a statutory function for the organisation. She was pleased to report that there had been improvements in the City’s air quality which was now regularly monitored in many locations throughout the Square Mile. Members were informed that the City had been an Air Quality Management Area since 2001 and that an action plan around this had been in place since 2002, against which Officers regularly reported on progress.

The Air Quality Manager went on to report that Nitrogen dioxide and small particles were the pollutants of concern, the former being heavily associated with respiratory issues. The City, situated at the heart of London was affected in terms of air quality, by what happened in the surrounding boroughs. The City’s narrow streets and tall buildings also enabled pollutants to be ‘trapped’. Buses were a particular problem, as depicted by the Fleet Street area. However, Members were informed that positive steps were being taken here with the introduction of hybrid vehicles and electric single decker buses on City routes.

A Member questioned the increase in pollutants around the Barts Hospital site. The Air Quality Manager confirmed that this was a result of the movement of the sites power/energy plant which was very large in size. She confirmed that Officers were keen to explore this matter further with the hospital site’s

There were no questions.

Committee Work Plan 2019/20

The Assistant Director of Commissioning and Partnerships undertook to review the Committee Work Plan in light of comments made at today’s meeting and to put forward a revised version of this for consideration and prioritisation at the next meeting of this Committee.