Agenda and minutes

Venue: Lewisham/Greenwich Rooms, 4th Floor, 1 Lower Marsh, London SE1 7NT

Contact: Nazyer Choudhury, Email:  nchoudhury@lambeth.gov.uk, Tel: 0207 926 0028 

Items
No. Item

1.

Apologies and Introductions

2.

Declarations of Conflict of Interest

3.

Lambeth Council's Adults Social Care (ASC) Risk Register pdf icon PDF 109 KB

    Additional documents:

    Minutes:

    Director of Integrated Commissioning (Adults), Ms Moira McGrath introduced the report.

    The meeting heard that:

     

    ·      In relation to occupational therapy, a lot of the issues related to balancing and managing the workload. Assessments were being done on how to prioritise reviews and a lot of work was being completed on social work reviews allocation, specifically examining OT. Elements had been agreed on a facilities grant assessment and OT staff were now linking with housing teams. This has been successful for managing and prioritising workload.

    ·      Many of the cases were specialist adaptations with higher-level needs and this would be linked into the neighbourhood work.

    ·      The meeting noted that the 583 awaiting adaptations was a high number and some research would be done as to why.

    ·      A good handyman/handyperson response for lower level issues was available.

     

    The risk reported regarding the potential 56% reduction on social work capacity would be reduced based on the savings and the programs that had been agreed. Work was still being done on how staff saving would be delivered. The report simply cited the worst-case scenario and the area would be revisited. Part of the assessment was how health staff were utilised, how social care staff was utilised and how the voluntary sector was engaged. More explicit proposals would be brought back and addressed at a future meeting.

    The Chair stated that in relation to risk 8, the change of political priorities, it had been outlined that the outcome of the 2018 elections would be monitored in case of a change of risk level. The Council also had a newly appointed Leader of the Council.

    The meeting noted that the new Leader of the Council was clear on the priority of the Equalities Commission and was committed to the neighbourhood working. He was also interested in the Local Care Network as a way of enabling that.

     

    RESOLVED:

    1.    That the report be noted.

    2.    That Assistant Director, Integrated Commissioning for Older Adults, Ms Liz Clegg will follow up with Ms Maria Burton for further explanation on actions in relation to improving the position on waits for OT.

     

4.

NHS Lambeth CCG Risk Register for Older Adults and Mental Health pdf icon PDF 47 KB

    Additional documents:

    Minutes:

    Director of Integrated Commissioning (Adults), Ms Moira McGrath introduced the report.

    The Chair stated that some of the overall scores had reduced and this was a positive step forward.

     

    The meeting heard that:

    ·      Some of the areas were starting to hit the point of acceptable risk.

    ·      Risk 27 (in relation to DTOC) would be reviewed and may be de-escalated as the target from NHS England had been reduced.

    ·      Attempts were being made to contain the risk regarding district community nursing. Significant assurances had been received that the teams were making inroads into the vacancy rate. The new models of community nursing seem to be supporting this. The level of vacancy rate was below 20% on average with one area in particular achieving very low vacancy rates. However, despite this, Guys and St Thomas’s did not wish to de-escalate the risk but it was anticipated that the new neighbourhood nursing model would have a positive impact on the figure.

     

     

    RESOLVED:

    That the report be noted.

     

5.

Living Well Network Alliance - Living Well Centre proposal pdf icon PDF 779 KB

    Minutes:

    Director of Integrated Commissioning (Adults), Ms Moira McGrath introduced the report. The report was very well received by members of the Committee.

    The meeting heard that: 

    ·      There was one proposed entry point via the borough based triage and which would incorporate the Living Well hub.

    ·      Ms Sue Gallagher felt it would be helpful to see a description of people taken through the system to gain a more clear understanding. This could be compiled of a case study of an individual who was severely depressed, an individual who suffered from acute anxiety, an individual who had recurrent psychosis and a long term enduring mental health person.

    ·      There are number of issues with primary care. For example, there were issues regarding the Clapham family service (as the contract was due to finish on 31March and it was being determined whether or not the contract should be extended). There were issues about staffing that the service was currently hosting and clarification was needed on about the acquisition of employment rights for those staff members.

    ·      Work needed to be done on the information received by GPs and their practical experiences.  Harpal Harrar was convening a group of GPs to test this further.

    ·      There were currently different entry points for different service users and the new service would replace the current hub and bring together separate mental-health teams.

    ·      There would also be work done to further develop some of the best aspects of what had worked in working between primary care and secondary care, such as virtual clinics.  There would be a consultant in each of the three areas. There was a particular skill in liaison that was difficult to find in consultant staff but this needed to be replicated into the teams.

    ·      The outreach function would be developed over a longer timescale. There were some short term solutions by re-purposing current activity in network providers and there would be further re-commissioning over time.

    ·      In relation to the network providers, there were a wide range of offers from peer support to the Mosaic Club House. There were a number of providers providing employment support, floating support and supported housing offers.

    ·      Work would be undertaken to develop longer term framework agreements for supported housing.  In relation to meeting the criteria for a psychologically informed borough, there had been work done in hostels and psychological teams were looking at the role of trauma and having a generally more holistic approach for these individuals. For example, there had been emerging evidence regarding adverse childhood events and how this affected people but more research was needed on how to best deal with these issues.

    ·      More focus would be placed on advice and guidance in relation to maintaining a psychologically informed borough.

    ·      It was noted that people with mental illness had more challenges with their physical needs so  it was important to integrate of both physical and mental health services. This would be done through the LWNA and in developing links with the work on LCNs

    ·      The report appeared  ...  view the full minutes text for item 5.

6.

Lambeth Advance Care Planning Consortium Big Lottery Bid - verbal

7.

Project Smith - report on activities Year 2017/18 pdf icon PDF 1 MB

8.

2018/19 Financial Position as at Month 8, November 2018 pdf icon PDF 944 KB

    Minutes:

    Chief Financial Officer, Ms Christine Caton and Head of Finance, Mr Peter Hesketh introduced the report.

     

    The meeting heard that:

    ·      There had been a further increase in occupied bed days (for mental-health patients). This had been covered by funds set aside but it was not clear if the increase was seasonal. Progress was being made with the acute recovery plan as well as the work of the trust. Step forward beds were also being introduced.

    ·      Recently, multi-agency discharge events had been held which had some success in discharging patients between 50-100 days length of stay. There were around 17 patients who were categorized as ‘super stranded’. This meant that they had a stay in excess of 200 days. An event would be held on 14 February 2019 to examine these patients in detail.  Consideration would be given to examine how these patients issues would be best addressed but a detailed qualitative examination needed to be performed on these individuals. The new community offer should reduce people coming into hospital beds in the first place. The general aim was to return patients to the average length of stay, which was 30 days. This would allow for the appropriate use of beds.

    ·      During the Alliance Leadership Team meeting, Neil Robertson had informed that the offer in relation to women specifically needed more work as there were specific issues regarding the experiences of women in acute mental health beds. There appeared to be a cohort of women who were frequent attendees of the services. The meeting noted that there was a woman only crisis service in Islington and there was a feeling that there was a need to pay specific attention to the differences between women and men because their experiences appeared to be different.

    ·      The detailed information as result of work being done to actually solve the problems appeared to be making progress.

    ·      The East London beds were mainly for the Croydon area and were not generally for the use of Lambeth patients but they had helped reduce overspill for SLaM overall. Lambeth had five people in private overspill but Lambeth did not have overspill in beds located in other boroughs. Generally, the assessment on the number of beds required was correct on the basis that Lambeth could reduce the length of stay.

    ·      The team had performed a number of visits in the country to look at different aspects of experience in other hospitals and had examined different themes (such as the crisis theme). It was found that around 80% of people admitted in Lambeth appeared to already be known to the service and were known to mental health teams. Other places in the country would not have percentage rate this high. The best average numbers were between 30% to 40%.

    ·      Some of the issues of late referral were partly caused by some teams not having the right skill set. It was generally difficult to recruit to the community mental health teams and at times certain referrals that needed to be  ...  view the full minutes text for item 8.