Health Overview and Scrutiny Sub-Committee by vev19514


									            Health Overview and Scrutiny Sub-Committee

Minutes of Meeting: 1st December 2004
Councillor M Martin (MM)

Councillor M Jovcic (MJ)

L Braham (LB)                     A Siggers (AS)
S Poulsen (SP)                    E Phillips (EP)
T Bhogal (TB)
S Highfield (SH)*1

Community Representatives:
Neil Collins (NC)     Waltham Forest Voluntary Action

Health Representatives:
Sally Gorham (SG)                 Chief Executive Waltham Forest Primary Care Trust
Christa Drennan (CD)              Waltham Forest Primary Care Trust
Liz Delauney (LD)                 Waltham Forest Primary Care Trust
Simon Mills (SM)                  Project Director, Whipps Cross University Hospital Trust

Officers in Attendance:
Clive Morton (CM)       Head of Scrutiny Unit, LBWF
Carol Wilson (CW)       Director of Health and Social Care, LBWF
Bert McAlpin (BMc)      Community Services
Farhana Zia (FZ)        Scrutiny Support Officer, LBWF

Others in Attendance:

The Sub-Committee received apologies from Councillor Tim Croot and noted Councillor
Alan Siggers was acting as substitute member.

Apologies were also received from Paul Gocke, Chief Executive of North East London
Mental Health Trust and Madge Bergman.

There were no declarations of interest.

No requests to speak were received.

    Present for part of meeting
The Sub-Committee received a report on co-optee arrangements. It was noted that seven
local organisations had replied to the invitation for nominations. The committee discussed
the nominations;

SP - There are no nominations from groups representing disabled people.

CM - MENCAP and the Carers Association have put forward nominations.

LB - I have three points to make: (1) When we co-opt, I think we should have a
prerequisite that they should live in Waltham Forest or the Primary Care Trust area that
we represent. (2) I am concerned that if we co-opt seven co-optees to the committee, the
committee will be too big. 9 Councillors and 7 co-optees will make 16 members of the
Sub-Committee. (3) The organisations put forward are unknown to me but perhaps Neil
Collins can comment upon this.

NC - I know the majority of the organisations appended at A in the report save the Asian
Healthcare Project of which I have no personal experience. However I do not doubt its
worthiness. I believe most categories are covered and to the best of my knowledge
believe most of the nominees do live in Waltham Forest.

MM - I accept what you say about people living in our catchment area but what the Sub-
Committee needs to decide is if this is the most important criteria.

TB - I don't mind whether the nominee is living or working is Waltham Forest so long as
they can participate and add to the work of the Health Sub-Committee. I think it a good
thing that we have had such a good response and we should accept these people. They
have no voting rights so it doesn't make a difference to the committee other than getting
input from various organisations.

LB- What about 'out of pocket' expenses. Is the Committee to pay for this?
CM -There is no formal scheme but in the past we have dealt with claims for expenses on
a case by case basis. Community Councils have paid for things like childcare expenses
and travel and until a statutory scheme is in place, we shall continue to deal with claims in
this way.

NC- As a co-optee last year, the Council paid for training I went on.

CM - We will always try to support and encourage the personal development of co-optees.

AS - In my experience the biggest meeting held is the Tenants Council meeting with many
viewpoints and differences of opinions. I fear that you may need to increase the number of
meetings of the Health Sub-Committee if the committee decides to co-opt seven people.

MM - When I run my meetings I time limit them.

NC -The Sub-Committee does not necessarily have to co-opt all the organisations who
have put forward a nomination. It should be remembered that the committee can invite a
particular group to a meeting depending on what is on the agenda.

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EP - The Social Services Committee has co-opteed members but not all of them turn up
for every meeting. Those with an interest in 'Children's' matters do not come along when
the agenda has an item on Older people and vice versa.

CM - Tonight's agenda has two main items - Mental Health and Whipps Cross. Although
these are of interest people have a choice as to whether they want to turn up for the

The Committee agreed to accept all seven nominees for co-option.

5. MINUTES OF THE MEETING - 14th July 2004
Minutes of 14th July 2004 were agreed, subject to the following comments.

Oral health of children in Waltham Forest and availability of NHS dental treatment
SP - Dental health of younger people should also be examined.

Item 8 -Work Programme
LB - On page 15, regarding infection control I'm pleased to say that Whipps Cross has
one of the best records on MRSA.

The minutes were noted to be true and accurate.


This report was introduced by Carol Wilson who explained the Sub-Committee had
previously considered a draft report titled "Delivering Race Equality in Mental Health" at its
meeting of 12th January 2004. This was a consultation paper issued by the Department of
Health which set out what those planning and delivering primary care and NHS Mental
Health services needed to do to improve services for users experiencing mental distress
and their carers from Black and minority ethnic communities. Members' comments and
concerns were gathered together and returned to the Department of Health through the
Local Implementation Team (LIT).

At its meeting of the 12th January 2004, the Sub-Committee had expressed concerns
regarding the level and accuracy of North East London Mental Health Trust's (NELMHT's)
data collection methods, in particular its systems for recording ethnicity of service users.

Difficulties have been experienced by the Scrutiny Unit and by Carol Wilson with regard to
obtaining an update on NELMHT's progress on data collection and information on their
Race Equality Scheme and action plan.

An e-mail from Mr Paul Gocke, the out going Chief Executive of NELMHT was received by
the committee in which he apologised for the absence of any senior managers at this
meeting. In his e-mail he explained that the report appended at number 1, of Carol's report
had been withdrawn from the Trust's Board Meeting of 23rd November as it contains
inaccurate information. He suggested that the Committee might want to invite the Interim
Chief Executive, Judy Wilson to its next meeting on 9th February 2005.

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This was followed by a question and answer session;

AS - Reports contain too many acronyms it's difficult to follow what these mean. Can a
glossary be provided?

Also, please clarify if the framework for race equality is directed towards the service user
or the staff who are employed.

CW - The purpose of the framework is to provide leadership in the development of race
equality policies towards service users.

AS- I'm still a little confused - Is the framework trying to promote race equality in staff with
the effect that this will in turn reflect in the service that is provided to the user?

CW - Yes, the aim is to promote equality in staff as well as deal with issues such as
institutional racism. In addition the framework intends to monitor the number of Black and
Minority Ethnic (BME) people who are sectioned under the Mental Health Act, on a
national basis.

SG - All NHS Trusts have to address race equality issues towards the service user as well
as its staff.

AS - Is this a significant problem in NELMHT or just a question of housekeeping?

SG - Inequality is a big issue in all Mental Health Services and a lot of work as been done
of a national basis. There may be specific issues in NELMHT.

AS -I believe there should be a sub-committee specifically looking at NELMHT.

CM - There are not adequate resources available to support a further committee.

SG -There is already the Health and Social Care Partnership Board at which mental
health issues are discussed.

CW -The committee should note that the previous structure has changed and the
Partnership Board and the Local Implementation Team (LIT) look into issues such as
mental health and learning disability.

LB - Mental health has been the poor relation in terms of focus on health and I am glad to
see something is being done. On page 34 reference is made to BPMHA. What does this
mean. Also what is meant by advocacy?

Could someone comment on the rumours that the Ferguson Day Centre is being
earmarked for closure?

CD - I apologise for the acronyms used in my report but this report was originally for
members of the PCT.

BPMHA - Black Peoples Mental Health Association.
NELA - North East London Advocacy

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There were 3 stages to the themed review:
      a) Mapping
      b) Consultation
      c) Action Plan

Users were unclear about what advocacy was. Many users referred to the point of contact
as their advocate rather than the name of service they used.

CW - We have no intention of closing the Ferguson Day Centre but Members should note
that as part of the integration of services between the PCT and Social Services a major
modernisation programme is being considered. Nick McNulty is the modernisation
manager and reviews of services are being undertaken.

Older Peoples Day Services and Community Support Services are being looked at. A
proper integrated service can be provided and there is room for modernisation. Our aim is
to enhance the service within the financial constraints and the Ferguson Centre will be
part of that review.

MM - I have several questions.

Page 18 - Nos 3.2. You refer to comments made by members. Have members seen these

Page 19 - 1st Paragraph - "Members asked that progress made in meeting Trust's Race
Equality targets be reported back.." What is the timescale for reporting back to this

Did anyone attend the London wide event on Equality and Race at the Kings Fund?

Page 19 Point 4.1 Were the self-assessments and action plans done? What proof do we

Page 19 Point 5.1.1- What proof has this committee that NELMHT carried out a self -

Page 20 Point 5.2.1 & 5.3.1 - What proof have we that the activities outlined in these
paragraphs were completed?

CW - In answer to your questions, I can say the following:

Members commented on the consultation paper via this Committee and some members
wrote to the LIT. The comments were gathered and referred to the Department of Health.
If you would like to see the comments made I can arrange for this.

The capture of management information is something that we all need to improve. On
behalf of my NELMHT colleagues I would say that they have acknowledged that they have
some way to go with regard to BME monitoring. This is also true for the PCT whose work
in this area is on going.

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MM - We need to see something more tangible. To say that the work is incomplete is not
acceptable. Also what about the timescale?

CW - Figures need to feed into the national systems and strategies. Work is being done
on the SEPA system for recording information. We are not compliant. In other words we
have not yet succeeded.

With regard to Race Equality targets, again further work needs to done. It's clear from
Paul Gocke's e-mail that the NELMHT board will be considering this further on the 25th
January 2005, so perhaps the committee can ask for an update after that.

With regard to the PCT's themed review this was carried out within the timescales.

BMc - Nuzhat Anjum and myself attended the London Wide seminar. We have completed
the self-assessment and have done an action plan. We have a meeting this Friday, 3rd
December to take forward the action plan.

CM - The committee could take a report on this when it meets on the 9th February. The
situation at NELMHT is very fluid and whilst the out going Chief Executive has said that
the Board will consider the issue of race equality at its board meeting of 25th January, this
Committee should bear in mind that with the best of intentions this may not happen.

MM - The impression I get is that monitoring is not being done when it should be. There
are timescales that are not being followed. Both carers and users of mental health
services are getting a raw deal - There is no action just reports.

MJ - Why aren't timescales being complied with?

CM - Chair, I think we have had a fairly clear outline from the Chief Executive of the
circumstances surrounding this report. I think it would only be fair to hear from the Interim
Chief Executive and the new management team at NELMHT once it has been

CW - On a more positive note, it should be said that we had a good assessment for our
performance in the Autumn review that was carried out by the Strategic Health Authority.
We received no reds.

The Strategic Health Authority monitors performance against a traffic light system. The
Red, Amber and Green lights indicate the direction of our performance is heading. Red =
poor performance, Amber = heading the right direction and Green = good/excellent

We do have a lot of work to do. I am pleased to say that our Home Treatment Team offers
a 24-hour access to those in acute need.

SG - Given the change in management at NELMHT, this is a signal that the concerns are
being taken seriously. Our PCT commissions services from NELMHT but we do not
performance manage them. The Strategic Health Authority does and they have intervened
because of the concern they have.

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The non-executive board member of the Trust is there to performance manage the Chief
Executive and perhaps it would be appropriate for this Committee to write a letter to the
non-executive so that this issue is on his/her agenda.

MM - I understand that NELMHT is 11.2m in the red.

SG - This is across the 4 PCTs it provides services to. There is a financial issue but
modernisation is also a problem. Write a letter to the non-executive member of the board.
The Chief Executive is accountable to them.

NC - The BME population is over represented in the mental health service. The work that
the PCT has done - i.e. the themed review has caused a stir and there is a marked sea
change and it is important to acknowledge this.

Some of the difficulties are technical rather than the quality of service provided to users. I
believe the problem is with the way assessments are carried out. The majority of staff
employed are BME staff, there is no shortage in this sector.

We do not get quality assessments. We record religion, race etc and this is systematically
done but no help or training is provided to staff. I have asked for figures regarding gender
breakdowns but this has never been provided.

In addition to this, I would say that we as organisations are all at fault. The voluntary and
community sector are not good at recording data on equalities either.

TB - I think we should write a letter to the non-executive member to inform them of our

AS - I make the assumption that NELMHT provide a lot of older peoples services. There
must be an overlap. With a population that is growing older are there issues of race
equality? Is there sharing of information and a cohesive drive to a shared problem?

CW - I am not an expert but in terms of the review we are taking forward it is clear the
structure needs changing. There is an imbalance in the type of day care services provided
to older people.

People with dementia are the main users of mental health services but we need to look at
other services. For example, older people who suffer from depression or anxiety. The way
services are at the moment, we do not provide a fair share of the cake to the latter.

Work is going forward and we are bringing up to standard things that matter. For example
under the leadership of Sally Gorham we have looked at hospital discharge and have
equalised the situation for intermediary care. Our long-term plans are to balance out
services for dementia patients and those who suffer from functional illnesses such as


          The Sub-Committee agreed the Chair of the Health Overview and Scrutiny
          Committee should write a letter to the non-executive board member of

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          NELMHT. The letter should express the concerns of the Sub-Committee with
          specific reference to the race equality scheme and data management system
          for recording information.

          Should invite the Interim Chief Executive to the next meeting of the Health
          Overview and Scrutiny Committee on 9th February 2005 to explain the situation
          at NELMHT.

Simon Mills, the Project Director responsible for the redevelopment at Whipps Cross
informed the Sub-Committee about the latest position with respect to the redevelopment.

Simon explained that the bidding process is underway. Usually 4 bidders are reduced to 2
and then 1. However there has been 2 expressions of interest for the Private Finance
Initiative (PFI) scheme.

Simon hopes to present the name of the preferred bidder to the Trust's Board in
September 2005. This will be a 30-year PFI agreement so a lot work is required.

The Trust has decided to keep the "soft" services in house - for example catering staff,
laundry and portering staff who have traditionally in the NHS been provided by external
contractors. The legal team is negotiating the Access Road and work is underway to
decant the site.

There have been changes to the number of car parking spaces that will be available but
Simon is talking to Kevin Herring, the Planning Officer to resolve this. The Trust has learnt
there are some areas on the site, which are marked as non-developmental. A factor that
may impact on the issue of car parking spaces is the new Patient Choice Charter - which
allows the patient to decide which hospital they would like treatment in.

Notwithstanding this, the Green Travel Scheme comes into force in January 2005.
£1,000,000 as been provided by the Trust to sponsor new bus routes into the hospital.
The buses will be energy efficient and there will be a hydrogen refuelling station on the

The regeneration aspect of the redevelopment falls into three categories:
      a) Environmental
      b) Social & Economic
      c) Partnership in Health.

With regard to the Partnership in health, the Trust has already established with the Job
Centre Plus, a scheme called Jobs Junction. 23 people have been employed through this
scheme and from the 1st April 2005, the PCT and NELMHT will also benefit from the
scheme. Simon explained that the Trust also has links with Waltham Forest College who
offer NVQ qualifications and skills to potential workers.

The report presented by Simon stated that greater engagement was needed from Officers
from the Local Authority, which has been hit and miss. Only one officer attends meetings
regularly - Erica Drew from Agenda 21.

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Simon explained this was a major issue especially as the Borough and the Trust are
loosing out on money ring fenced for this purpose.

This was followed by a question and answer session:

LB - Does the redevelopment include the "Walk in" centre?

SM - No, it does not. The Walk In Centre is a service provided by the PCT, which is on our

LB - Originally there was to be a multi-storey car park. What happened to this and how
can members become involved other than the planning committee?

From our training in the Summer, I understood the Health Committee, needs to be
informed of any changes that you are making. Why were we not informed?

SM - Changes to the plan have been discussed with the Planning Committee. I am not
aware that this also needs to be discussed with the Health Committee.

CM - We can take advice on this but my understanding is the Health Committee needs
only be consulted where there will be a "substantial variation" in the services provided by
the hospital. In this instance, the new hospital replaces the old - like for like and services
are continued to be provided.

SG - One of the complimentary things about this Health Committee has been that it has
focussed on health issues in contrast to other borough's. Car parking spaces is for the
Planning Committee to resolve. There is only one place to talk about health issues and
that is at this committee so let not loose sight of this.

LB - Why was the Tobacco and Health Scrutiny Panel Report not referred to this

CM - The Commission approved the request for the Panel investigation and therefore the
Panel reported back to the Commission. It does not have to go back to the committee who
suggested it.

MJ - I am concerned about the car parking situation at Whipps Cross and transportation
links. There is no bus service from Chingford to Whipps Cross but we do have one from
Hackney to Whipps Cross. This is outrageous.

EP - I have three points to make.

   a) You say that you are receiving expressions of interest from bidders. Is it in their
      contracts that they must employ local people?

   b) Car parking is an issue. A lot of the car park spaces have been lost by the work that
      is on going but why is there no pavement outside the Plane Tree Centre. This is
      very dangerous. Also charging is high and many people especially the elderly
      cannot afford this. People are parking on adjoining streets.

                                                                                         Page 9
   c) I am alarmed by what you have said regarding officer input. When I was a member
      of the Scrutiny Panel which looked at the redevelopment this was something that
      we were very keen for. I think this committee should make a strong
      recommendation to Cabinet about what the Council's input as been.

SM - I can answer as follows:

   a) It is a legal requirement that the contractors must employ local people.

   b) 6 out of 9 car parks are at an acceptable standard. The car parks are named and
      numbered and have been signposted. There are 2 external buggies, which pick up
      patients and we intend to provide internal buggies in the hospital complex.

      I agree the Plane Tree Centre did not have a pavement but this has been resolved.
      We have help points throughout the hospital and patients get to speak to a live
      person. For the proposed hospital the main entrance will be in the middle of the site
      and will be easily accessible.

      I am aware there is not a good bus service that links the hospital to Chingford but
      this is not in our hands. We have provided the local authority with one million
      pounds but the emphasis is to link the Leytonstone regeneration with Walthamstow

      Charging is an issue but the reality is that it's here to stay. It is a source of income
      generation and also government policy. Our front line staff do experience abuse
      and we do want to be a good neighbour by encouraging visitors not to use
      adjoining streets but it's a no win situation because the residents may not want a
      Controlled Parking Zone. We hope to get the parking to a 50/50 ratio between staff
      and visitors to the hospital.

AS - I am concerned about what alternative health provision there will be. What
assurances can you give this Committee. It is likely that by the time this project is
completed the hospital may already be obsolete in terms of the number of people it can

SM - No, services will not be prejudiced because we have built on models like the Thames
Gateway and the Stratford Redevelopment. We have designed the new hospital in such a
way that if bed capacity needs to be increased then this will not be a problem.

NC - Is the Construction Academy still going ahead? There will be more people moving
into the area so increased pressure will be placed on GP and A&E services.

SM - The Construction Academy has been launched and is still on the agenda. As for an
enhanced GP Centre the PCT is responsible for this and they have a LIFT company for
this area.


A formal reference be sent to Cabinet asking them about the lack of involvement from
officers with regards to regeneration opportunities which are being missed.

                                                                                       Page 10

The Sickle Cell Anaemia and Thalassaemia working group met on the 30th November
2004 and heard evidence from Haringey Primary Care Trust as well as City & Hackney
Primary Care Trust. The working group heard about their specialist Sickle Cell and
Thalassaemia Centres and asked about the benefits of have specialised care for

The working group will be meeting on the 14th January 2005 in order to interview the
Service Manager of the Waltham Forest PCT and will be hearing evidence from officers
within education and housing.

The Working Group hopes to report back to the Sub-Committee in February 2005.

Members were asked to note the work programme for the next meeting.

LB - Why does the work programme not include the item about the lack of dental
treatment available in Waltham Forest. We had this at Social Services and Corporate

CM - Members may want to consider the value of the same report going to three

LB - Why are we looking at Podiatry Services. The Committee dealt with this in February

EP - There have been a lot of changes with regard to this service. I think it would be useful
to have an update on this subject.

MM - Do we need them to come back to us or will a briefing do?

EP - I think we need them to come back to the committee. We need more than a
circulation. It affects a lot of people especially the elderly.

The meeting closed at 10.20 p.m.



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