Transcript

to the introductions. I think I'll slightly, I'll ask to come in first. So welcome everybody to the October Health in Hackney. In terms of Apologies for Absence, I've had Keir Omabeshi, who's the health inequalities lead at Whitbury at the Homerton, and also Councillor Patrick. In terms of the general matters of housekeeping, this is a hybrid meeting. So I've got colleagues in the chamber and a number of people online. For those online, please keep your cameras on when it's your item. Please keep your microphones off when you're not speaking. Please don't start conversations in the chat, because they are not being monitored. We are being live streamed on YouTube, we are being recorded. Members of the press are present in the chamber, and I think those are the main points. We join, welcome to colleagues from CYP. Council, before I see a hand, do you want to use your microphone? Yeah, apologies from Grace Abibayo. That's noted. Declaration of Interest, I don't think I've seen any. No, and then I've got one from Council Lynch. Is that a Declaration of Interest? Or was that just trying to, was that a Declaration of Interest? No, I just tried to manage my dog. So yes, I was just saying we're joined by colleagues from the Children and Young People's Crucifixion Commission. Welcome. They're principally here for the maternal health item, which we're coming to second. But I'm happy to take questions from any elected member as we go. We've got two substantive items on the agenda. The first is the transfer of specialist services from NHS England to NHS North East London. And I've got a number of speakers, so if I just set out how I intend to structure it for the presenters and the members, and then we can start, we've got 45 minutes of this item. I'm first going to go and ask the Director of Specialised Services, Archana Mathur, to go through her presentation, a helpful presentation, in the agenda pack, and then I'm going to open it up for a few questions, just to keep some flow to the meeting. I'm then going to go to colleagues from the Homerton, Dr Adam Croucher and Chris Buckley, because we're going to do a little bit of a deep dive into HIV services as an example of specialised commissioning, just to have their contribution and observations about the new commissioning framework. And again, I'll open it up for a couple of questions. And then I'm going to go to Mark Santos, who's joining us here in the Chamber. Welcome, Mark, from Positive East, for a third sector perspective. And then we've also got Chris Lovett, who's our Deputy Public Health Director, and Stephanie Cockburn, who's our Clinical Lead and Sitting Hackney, if they would wish to contribute as well. So members, after each speaker, I'll just take a couple of questions to keep the flow going. If I don't come to you, we'll have more time for general questions at the end. Okay. So with that, Archana, thanks for your helpful presentation. I just asked you to go through that in five or so minutes, please. Yes, of course. Thank you so much. Thank you very much for the invitation. My name is Archana, I'm the Director of Specialised Commissioning and Cancer for North East London. So as you know, from April 25, there are a significant number of specialised services that were previously commissioned by NHS, the commissioning of which is going to be transferred to London ICBs from April 25. And of course, North East London ICB is one of those. The delegation of specialised commissioning function has taken place in other England regions already as of, in fact, last April. And in London, a decision was taken to just do a little bit more due diligence, spend a little bit more time ensuring all checks and balances are in place. And therefore, that delegation is due to take place from April 25. The delegation of specialised services is a transfer of statutory function, therefore, from NHS England to the North East England, North East London ICB. It will be endorsed by the NHS England board in December of this year and then by the ICB board in January 25. The pack, I hope, is clear. Just a few points, I guess, to highlight to you. A bit about the assurance, really, because there are a few questions that were presented previously that I'll attempt to address. So plans in place to prepare for local delegation in the first place. The preparation for the transfer of the statutory function has gone through and continues to go through a very rigorous due diligence process. The exact requirements and the domains against which those assessments are being made are outlined on slide nine of your pack. It continues to be really thorough and rigorous. And so far, within North East London, we're doing really very well in passing all of our required gateways. Those gateways being with the regional team and also the regional team and by our own local governance. The next significant milestone is next week where the national moderation panel is taking place. The regional colleagues, the regional director of commissioning and the regional director, full stop, and they will then present the position for London in aggregate. The amounts of money to be delegated and how that reflects local needs and what the process is, that is described essentially on slide six and seven. The process is based on the actual, the nature of the services and the pack describes what those nature of the services are. Those are green that are going to be delegated, red which aren't going to be delegated but retained by NHS England and the blue ones or the amber ones which they're still deciding on and the clinical networks. Historically that allocation is based on the providers, so whichever activity the providers undertake is the basis for those allocations coming down to the ICBs and that is basically the starting point. What we're doing is, well not we, nationally what they are doing via this transfer is moving from that historical provider-based allocation to one that's based on population needs and that is really good news for North East London, it's really good news for ICBs because of course it means that where we are considering the needs of our population, age, sex, deprivation, etc, that weighting is therefore towards those the needs of that population so that that of course is a positive. The next planning round, the NHS goes through annual planning rounds and that will be a further opportunity to refine and define what those allocations look like. What we really want to do in the ICB is ensure that that starting allocation in April 25 is right, is reflective, that our providers are coding their activity correctly and of course that we're, you know, just making sure that we've got those checks and balances in place. Just a slight caveat is that it doesn't include any capital, all capital allocations are NHS capital in totality, there is nothing separate for SPECCOM. What else did I want to say? Yeah so patients accessing the services and the rationale for delegation is a really good thing and slide four describes the national rationale for that delegation. Really this is an opportunity for the ICBs to work more closely with their partners, with their local authorities, with primary care, whole system-wide looking at whole pathways. Specialised services are really really expensive and they're really costly and but they are needed, they are life-saving and they are evolving because of course technology and innovation is moving on at quite some pace. However the NHS is cash strapped and what we really want to do is make sure that we are managing those demands as much as we possibly can and the delegation of specialised commissioning gives us the opportunity to look at that money and that whole pathway of care and I guess when we get on to talking about HIV that will be a really good example but there are multiple ones that allow us to really demonstrate how looking upstream to prevention, early intervention with our populations is going to help manage some of those demands further down the line for specialised services. A little bit about HIV, I'm not going to talk at all in depth because I'm certainly not an expert in front of acute colleagues whose bread and butter provision of HIV services is but just to highlight that HIV the treatment and identification of HIV is one of the priorities for specialised services delegation within North East London. We've been doing a lot of really good work supported by NHS England on early identification of patients with HIV, opt-out testing in our emergency departments, working towards the national targets that are described on slide 13 of the pack. The potential of course to work with public health and again working with Chris and colleagues joining up with the sexual health strategy more broadly is a really fantastic opportunity that delegation presents us and if you think about national commissioning or regional commissioning their distance from those populations from their local authorities etc has meant that that has been challenging and that's really the main reason for delegation taking place. So that's a real whistle stop through I think some of the key questions that I was asked to advise on prior and cross referenced with the pack that you have before you. I'll stop there, thank you very much. Can you hear me? I'm happy to answer any questions. Actually can you hear me? Yes. Oh thank you, sorry I think we just had a technical issue there. Actually just going to page six of the agenda and the financial flows of your presentation, we see currently in the green column set to be delegated a total of 587 million that was otherwise spent as I understand it contract value within City and Hackney but. No that's not City and Hackney, none of these. I'm sorry, sorry, sorry the ICS, sorry forgive me, yeah the ICS 587 but the equivalent column is under the commissioning

1. Now does that mean in crude terms there is a significant shift of money out of the ICS or is it pretty much as usual if this just reflects where we currently spend our money? Yes it is, all this is, what it means is that this is just the distribution of the funding that will be transferred to each one of the ICBs because we've moved to that population based formula so all that means is there's 587 in total of green services that are provided. Those providers will deliver those services to patients that come from northeast London and broader. Within northeast London most of our flows as you'll see from there are contained within northeast London so it's relatively straightforward but if there's a patient from the east of England for example who accesses a service in BHIET then the money for that patient will go to the east of England respective ICB and flow into the provider so that's the shift. It means that for providers there is a bit of a change because they would be getting their full allocations of funding from NHS England as one whole and now they'll be getting their funding from each ICB to which the commissioning is delegated. Just so I understand that but then does this mean essentially less money, I'm still just trying to get my head around this, it doesn't mean less money is flowing into the ICS framework because otherwise if we take east of England in the current situation 96 million goes to the east of England anyway even now is that what you're saying? Yes, yes for those patients they're spending that money anyway it's the same. Fine and just before I bring Councillor Lucian, obviously we see in local authority that services get delegated to us but then they're not kept up with inflation and we get asked to do more and then we get criticised when they're not being done. I mean what sort of safety, what sort of assurances have you got that there's going to be some level pegging in terms of inflationary pressures and all the other problems that are, I mean it's a good thing the reasons you said but it can also bring a lot of problems. Do you have any assurances on that regard? Well the main assurances really are that what we know, I mean these numbers are fairly accurate, where we really need our providers to code accurately that that helps us. The other thing is is that in the next round of planning that we do as an annual cycle it gives us an opportunity to refresh. It also gives us opportunities to, for want of a better way of putting it, lobby a little bit with national. I mean the NHS is under, you know there's a lot of pressure at the moment and what we want to do is really just make sure that well the allocations are following our patients. So I think you know we're fairly assured, I mean these things are never 100% foolproof so there might be some risks but I guess based on the delegation and the learning that we've had from other ICBs there haven't been any significant risks that have been raised initially so should be okay. Thank you and Councillor Lynch, would you like to come in? Oh hi, thank you. I'm just going to ask because I know when we talk about North East London like that's basically seven boroughs and obviously whilst there is some similarities between the boroughs I sort of would imagine that Hackney is very different to Haverin and we have different needs in Hackney than we do to Tower Hamlets and to other of our neighbouring boroughs even though people might think we're all the same but we're not and we're very proud that Hackney's very distinct in that as well. So my quick question was is in terms of our financial challenges as a local authority I mean obviously Hackney isn't alone with all the other sort of probably seven boroughs that we've got in there in terms of their increasing challenges to meet the you know increasing complexity of our residents in terms of social care packages. I just wanted to know how this is going to sort of ensure that we can sort of work together in terms of the funding and obviously just make sure that we don't have a sort of significant burden on onto local authorities and again you know I wear two hats as some of you know so I just had a lot of experience in the NHS I'm not working in the NHS at the moment so I don't want to get into that sort of like you know you know you know sort of the NHS versus local authority sort of difficulties which we know we are we are trying to change I'm sure we've been now and I think we have a lot of works happening to try and reduce those potentials sort of who pays what but I just thought it'd be really interesting to sort of understand how this would impact Hackney as well and obviously you know we're very proud of our local hospital which we want to keep as well. Well it doesn't really cancel it the allocation in statute is to the ICB so the implication in any kind of financial term as a direct consequence of delegation doesn't affect any local authority in any which way. If you were to take a whole pathway view then whether it's a specialised service or a core service it doesn't really make any difference there are the same issues so if you're talking about packages of care or discharges or those aren't necessarily any any different there are no consequences on the local authority as a result of delegation in fact what it should do is bring about much better opportunities to think about health and social care work together to address some of those things for for example the paper I presented to the January the last January ICB board I'm sure Councillor Kennedy will recall was a patient story based on a very significant risk that we have in our system at the moment which is about incentive renal dialysis capacity. Patients who require incentive dialysis it's really difficult because there is just quite simply demand that is outstripping the capacity that we have at the moment. One of the solutions or potential solutions for eligible patients is to have dialysis at home which is perfect because there are home but that requires electricity it requires water supply just to be able to manage the machines. The example that I gave in that board was the patient was a resident of Waltham Forest could just as easily be a patient of City and Hackney and what Waltham Forest Council did was help towards the electricity bill payments for that patient not all of it but a contribution to it that helped retain that patient's ability to undertake their dialysis at home. So it's an example but it's a really important one of where specialised services provides that opportunity to work much better together to you know to optimise these things. The actual transfer of that delegated function there's no impact whatsoever on local authority finances and in any way really. Thanks I was I'm just going to bring in Councillor Adams and then I'm going to go on to my colleagues. Thank you thank you for your presentation I was a bit late so probably address my question but I will ask it anyway. So the question is about the moving from the population-based resource allocation to need-based allocation methods. Will this not lead to possible divestment from the integrated care system with higher population of deprived population and how does this actually address the existing health inequality you know in North East London? Thank you. Okay yeah I think I did answer that but it may be before you joined. I mean essentially the delegation is moving from a basis where it is only based on activity that is undertaken in our providers to one is look that is looking at the needs of our population and there will be weighted formulas that our finance colleagues will know about in much more detail compared to me that are weighted towards deprivation, age, sex, etc and that is a formula that is applied North East London white so and I think it applies to other principles of financial allocations as well. So it is a helpful move in allocations as compared to what it was before which is really rather a transactional view of how you undertake allocations versus ones that are looking at well what's the what will the change in our population be. It also means that it will be variable year on year that will take account of growth hopefully well it does take account of growth in our population and turnover in our population which will then which is obvious because of course that deprivation factor is a function of growth so it should it should be enabler to to meeting and addressing health inequalities not the other way around. Thanks Arsha. Can I now bring in Dr Adam Croucher from the Homerton and Chris Buckley from your perspective if we just take a small take a side step to a focus on HIV and can I just ask for your observations on what this means for you on the ground in terms of change if anything have you got any concerns about it are you has got several opportunities for you so I don't know whether I'm whether Adam or Chris who who would want to start off from your perspective. Am I muted again? No you know we can hear you. Oh sorry Adam or Chris from the Homerton. I think maybe Adam is on mute he was going to to start. Chris you're a bit quiet is there any way I could just um yeah let me see if I can and then um maybe in fact Adam's actually frozen. Is that any better? Yeah now let's just let's just see if that's any better. Try again now Chris. Yeah sorry I was just saying Adam was actually going to start but I wonder whether he's frozen. Fine I think I think I tell you what what did you maybe if if um Adam was going to um present first shall I maybe go to um uh Mark Santos and Chris Lubbock here in the chamber and then we'll see if we can get hold of um get hold of Adam in the interim so I'll pause the Homerton and then I'll go now if I can maybe um uh Mark from a sort of third perspective um perspective again the same sort of questions to you do you sort of have any concerns excitements about the opportunities how how are you feeling about always excited thanks very much for the opportunity to chair to contribute to this conversation. I'm Mark Santos from Positive East with your local HIV charity and operate across northeast London have been doing so for three decades a role player in the HIV health and social care system. I have two observations and one is in relation to um the money um and just thinking about the challenges our ICS has um and getting the money right more not just the ICS I don't need to tell councillors in this room about the challenges that local authorities have around around finance so getting the money right feels really um important and um it does indicate in the in the roadmap that there is that shift that the councillor um talked about a population uh a population approach um but we just need to ensure that the size of the cake that we have is appropriate to our needs that would be my worry and a worry born out of um my understanding that um northeast London doesn't always do well either in in in revenue or in in capital terms in in the NHS and that will have an impact upon um our ability to continue to deliver services. The second thing um observation I have is is that this is an opportunity I I would hope that we wouldn't just lift and shift in terms of services that we would be thinking about the new challenges that we have in relation to HIV and how we can better um address those um with with the funding that that would come into more localised um into more localised control you know can we use this as an opportunity to better address the issue around disengagement from care which um or to avoid disengagement from care which is one of the one of the key issues that we need to tackle to achieve all of our fast track city um goals and could we do that by thinking about for example differently around how we deliver our clinical care could it be done in more community settings and in a way that patients and people want to access services and not necessarily um around how institutions deliver them could we also think about um is this an opportunity to to better promote the health and well-being of people living with HIV if we're thinking about doing things upstream the majority of people living with HIV are over 50 positive voices report which is a um which is a study undertaken with people living with HIV across the country um suggests that 64 percent of people living with HIV have over have one or more comorbidities and about 39 percent of of people are diagnosed with a mental health condition is this an opportunity for us to be work doing work around those as a particular sort of thinking harder about how we can um address those needs better um and um and I think those two points one around the the money which I I feel like you're you're got a big focus on and the second around that how the services will be delivered and what what will be delivered and whether they'll be meeting new challenges are where I would want to explore more and want the the ICS to to think more about. Thank you very much that was very useful and um Chris did you have any um observations to just add in before I bring in our colleagues? Yes so um thanks very much for giving me the opportunity to make some observations um we we have been preparing this for a couple of years it's not a new uh proposal to to delegate so we we have had time to prepare and what we've been doing um as you probably expect from public health is we did undertake a needs assessment around HIV not just for City and Hackney but we also did it for the whole of North East London and that's been communicated to partners such as the voluntary sector and also to the commissioners and the clinicians um I think that needs assessment does show that we we do understand some of the the um successes of the current system but also some of the challenges um late diagnosis is one of the things that we really want to focus on so if you diagnose HIV early put people onto effective treatment you essentially get the very similar um health life expectancy as somebody who's HIV negative and we have been making progress about increasing HIV testing, COVID very much got in the way of that and some of the welcome uh changes in the way that people access the NHS did bring in some some different opportunities but also difficulties around HIV testing. So on the back of the needs assessment we also developed a sexual reproductive health strategy and that has one of the areas is very much focused on living well with HIV but also getting to no new infections by 2030. There were four outcomes that we worked on um the council did adopt this as a key decision the health well-being board as well we went out to full consultation involved our partners in the voluntary sector and also residents and people living with HIV as well as broader sexual health. So the first really key outcome is reducing stigma and discrimination what kills people living with HIV now is not actually the virus it's the stigma and discrimination that people still feel when accessing services um both across the wider social care but also in NHS services and we are working to reduce stigma and discrimination but all people living with HIV receive treatment and care to achieve the best possible health and viral suppression and our needs assessment again showed that we're making really good progress but there are still some people who find it more difficult than others to continue to engage with HIV treatment services and working with our partners in the voluntary sector and primary care we think we can do better and would want to achieve more to get those outcomes and then there is a very new and significant change around prevention with the availability of PrEP so this is pre-exposure prophylaxis and pills that you can take to prevent you from getting HIV but also recognizing that for some people condoms are going to continue to be a really important prevention tool and then really importantly all people living with HIV know their status and linked to treatment and care. So for us those are the local strategic priorities we've also worked with all the other place and health well-being boards and what we hope to do I think in January is actually bring this to the ICB so that we all adopt a very similar strategic approach and then there are action plans as to how we will reduce stigma and discrimination, increase people receiving early diagnosis but then also as Mark and others have highlighted making sure people can continue to receive the excellent treatment care that we have locally. Thanks Chris but the how this dovetails in with the with the specialized services being centralized is because what there's more flexibility in that local decision making as to how they commission whereas previously they were in a one-size-fits-all straight jacket set by NHS England as to how it was done but now there's much more scope is that the is that what provides the opportunity? So I think it's always the opportunities for us to reflect on what the local need is understand what the local population is finding perhaps more difficult to access what the challenges are and then together put in place some of the the best ways of you know diagnosing people early preventing infection in the first place but then connecting people to care. So I think specialist commissioning have done they did a fantastic job for a long long time some of the innovations about bringing in new medicines new way of delivering the medicines has been revolutionary but I think that era of high-cost medicines and the need for a centralized approach has gone and what you need now is much more of integration into local systems recognizing that people living with HIV are it's a terrible phrase but an aging cohort so you know the success of HIV treatment is that a lot more people are now living for longer but that also means that we then need more of our focus around social care and you know aging well as opposed to 20-30 years ago when HIV was born to a better phrase at the life sentence. Members just before I bring in colleagues from the homerton council. Oh sorry thank you chair thank you so much for for you. Just on the challenges that you sort of mentioned I wanted to sort of find out whether you foresee this sort of new formula will either support or not or put more challenges into achieving those national targets you're hoping to achieve which from the report I note that they're not not fully where you wish them to be in terms of testing and also people accessing care. Just wanted to hear what your thoughts are on that thank you. I mean humbly I would say that the local system knows the local population better than somebody who sits in specialist commissioning is doing this for the whole of England so I think working in partnership with the voluntary sector understanding our local communities with the clinicians and the ICB I think is definitely the right approach. I mean the reality is going to be with always is we are aspiring to do more we're wanting to ensure that by 2030 there are no new infections you know and so the I think we've put in place really good strategic priorities and also a way of actually tracking our approach as well so in I think it's early next year we will be coming back to the council because the council adopted this is a key decision to give you an update on all of the progress and then similarly with the ICB if this is adopted by the ICB at a strategic level it gives us the ability for all of us to then celebrate what we're doing well but also be double our efforts we're doing less well. Thank you Chris. I'm going to now bring colleagues from the homerton I think Adam we lost you you froze temporarily before saying I just introduced everyone we've got Dr Adam Croucher who's the HIV clinical lead at the homerton we've got Chris Buckley who's the social care coordinator for the HIV services and we're also joined by Dr Catherine Poy who's the new clinical head for sexual health and HIV at the homerton. I understand Adam you might be sort of leaving the charge in the presentation as it were so over to you. Okay can you can you hear my voice? That we can yes. Good good okay thank you very much for inviting us this evening and thank you to the present presenters so far who who I'd like to echo everything they've said really and they're in Archambault's presentation and from Positive East and from Chris so in terms of what we have to add I think there's a reason why I invited Chris Buckley I wanted him to be here this evening is because he is an expert on the peer navigator support for our patients and he's you know written reporting that recently which shows how crucial they are to our patients and the outcomes for our patients. So I've got to try and sort of say things that haven't been said already having so I think I think the emphasis on testing is really really important. I think the emphasis on linkage to care is really really important that's both for new diagnoses and for people who have been lost to follow-up. The emergency department testing is really really important to that and actually the homerton and this London even though we could do better in terms of testing linkages to care actually pretty good and so one of the concerns I have is that as has already been mentioned we have an aging population who are living with HIV but lots of new people coming through as well who are migrants people have acquired the infection in the UK and we need to look after them throughout the whole course of their life. A late diagnosis or loss of follow-up is potentially catastrophic and people have ended up in ITU. One person staying in ITU for a few weeks with the long-term disability the inability to go back to work afterwards is incredibly expensive for everybody not least for that person and the things we can do to link people to care are not so not expensive and so actually having peer support having social care coordinators having these things that people need in our population of people who have a lot of extra needs around housing employment immigration lots of things going on as well as you know high-risk behaviors all this stuff and it all makes a difference in the end. As Danny Turton said in his presentation back in June the last mile is the hardest and the people hardest to reach the people you know are the ones who we're going to have to really look out for. Having said that we also have a population of people who are very very stable who manage their treatment very well who are young-ish and you know don't need to go and see a doctor twice a year don't need blood tests twice a year and actually can probably have relatively light touch from our services hopefully with the support of GPs and also with our experts here within the secondary care. So I think probably also trying to think the things that really really matter to us and our service is exactly has already been said stigma kills people we need to help people work through that in a localized way and it'll be very dependent on different populations across North East London. North East London has a whole huge amount of diversity. Retaining people in care through the peer support to the right sort of services for them if they're unable to come so we have CNSs our community CNSs are extremely important to keeping people alive visiting people at home doing blood tests bringing them drugs taking them to appointments all sorts of things that they do that stop people and end up back in hospital. So if you have this kind of quite it's quite hard to sort of summarize really but you have both a huge amount of complexity and quite a lot of simplicity all lumped into one with HIV needs across North East London and this is the context of sexual health services as well being crucial to finding patients to addressing prevention through PrEP and you know addressing high-risk behaviors with psychological support testing for STIs all sorts of things and the fact that those are very closely linked are actually co-cited here at the hospital is I think actually very important to good outcomes for our patients particularly in the early stages when they've been newly diagnosed with HIV. So there are some things which I think have not been included as basics within HIV care up till now and I think the the peer support and social care coordination and the community CNSs are things that really must really be part of the sort of core package and so we've got a population who were hopefully going to be funded on a needs basis but we also have work that we'll be doing which will be coded and you know traditionally we've used what we are using HAAS which I think is quite basic in terms of understanding what's going on with the population the services you offer them. So one of my concerns would be and one of the opportunities therefore is that the way that we record our work matches up well with the needs of the population and that we have adequate funds to do the work that's needed for the people who are most vulnerable and who will you know be in in trouble if they're not diagnosed or get lost to follow-up. So you know and that I think is a huge opportunity but the fact that we've got North East London joining up and the ICS and the ICBs that we can aim for the levelling up as Archder mentioned. So I hope that's a reasonable insight what I think is our priority. No that is, thank you very much Adam. I can see Councillor Lynch have you got a question? Yeah and I don't think Dr Adam will be able to answer this but I think it's just really useful and important to note that you know clinical nurse specialists especially in the field of HIV are probably some of the sort of pioneers in terms of that role in itself because having a clinical nurse specialist is such a valuable contribution to people living with HIV and with any other long-term conditions. So I just wanted to have a plea really that when I know I'm a nurse myself and I've worked within nursing workforce at a national level that sometimes those CNS roles are sometimes unfortunately seen as like a bit too costly and sometimes can be considered for you know the first sort of thing to sort of go really. I just wanted assurance that within Homerton everything that you said and I think because we we work well as a local authority as well that that those roles will still will still stay and will still be given the you know the the not the respect but the the importance that they have because I suspect a lot of those CNSs working in HIV in the community not just in Homerton but across now are probably really important at reducing admissions which we know are costly and all the other sort of associated financial burdens that could come if we remove people out of their preferred place of being at home to being in a hospital setting. Thank you. Chris do you have any other, sorry Adam do you have any observations on that before I've got another question? I just I just agree and in a way the CNSs carry a huge amount for our patients and and because it's done by area they'll often be looking after patients whose HIV care is somewhere out of borough which can make things quite complicated and we have patients who live out of borough who've been looked after by CNSs elsewhere it's excellent they exist they are currently I think we're currently understaffed in Hackney from that point of view and in some in some ways you know the isolation that people experience on account of being HIV positive the fact they're sort of specialed in some way that needs to that needs to change you know and so the role of the CNS shouldn't be to kind of take up the shortfall in care that someone receives because of the fact they're special because of their HIV. Hopefully what we'll see is we're able to manage people's HIV in a fairly straightforward way and the CNS's job will not be about that it'll be perhaps more about helping vulnerable people you know finding people who lost a follow-up and relinking them to care and and so forth which they do already but I hope that that's perhaps a subtle point but I'd like to see that role as being integrated into a wider thing where people flow through health systems not being special order excluded because of their HIV status. Thank you I see I've got council leaders but council just Stephanie Cockburn who's our clinical director wants to come in and then I'll bring you in council leaders. Stephanie? Oh Stephanie I think you're muted. Oh hopefully you can hear me now yeah so just building on some of the points that Adam was talking about about links with primary care I think much of the care that our older HIV population need around cardiovascular risk management around other parts of long-term condition management so we are working on a small test site around how we can start to think about utilizing HIV services in that light touch approach that Adam talked about but really trying to build those anchors again with GP practices for this group of the population but equally recognizing that resourcing needed for primary care in order to be able to support primary care to do that but it's an ambition in City and Hackney particularly from some practices to start to build those links much more closely around how we can care for this aging population. Thank you Stephanie. Council leaders? Yeah thank you I just want to say I think this is really really important thanks to colleagues for coming in and speaking to this really important issue. I just wanted to go back to what you said Dr Adam about the matching piece and I suppose it goes to a broader point around moving to this new system where it's a more localized community-based version of care. What work is being done at the moment to prepare for that transition? You mentioned some more sophisticated systems that might be able to be brought into you know fruition as a result of this is that is that going on now or is it sort of waiting is it a case I'm waiting to see until we're actually in the new reality before that starts to take place if that makes sense. What preparation are we seeing at the moment for that with partners? So there's been some work over the last eight months or so here done by Sarah Crichton one of the consultants here working with a few GP practices about developing shared care pathways for patients. Basically big people who perhaps find it difficult or don't want to come to our service they can perhaps instead see their GP for blood tests then we write the prescription for the medications because medications can't be provided by GPs only through specialist hospital services. We're also which will be interesting I think that's very very new but it's quite a new model of care on a national level. I think it's been done in other services but we're going to find out how well it works and what the potential pitfalls are what the benefits are more as time goes by. We're also seeing patients perhaps only once a year as opposed to twice a year it was the guidelines bare minimum but there are so many patients who are on very stable treatment who are otherwise well they can come and see us once a year and again get their prescriptions twice a year. This will hopefully reduce capacity in the service, save patients money, save the service money and allow us to focus more on people who have greater needs. I think I hope that answers your question but these are all quite new things that we will be developing well we have developed but we're implementing them now and I think we'll probably give you a better answer in about six or eight months time when we sort of the first year has elapsed. Thank you. I'm going to file two contributions and then I'm going to bring this item so close to councilor before and then Chris I would like to come back in Chris Lovett so councilor before. Yeah what I want to know is in terms of the transition has the service users had the opportunity to contribute from what they want to see differently as they're going forward. And you just want to come in there and then I'll bring in Chris. Now we may have Adam may have frozen again. Could anyone else about service user contribution? I don't know Christopher can you contribute to that? In terms of the patient's contribution. Yes yeah I mean I run a very small department with two peer navigators both living with HIV and myself and we absolutely encourage our patients to be very much involved in the model of care so we run a patient forum which people attend once a month and we will do surveys on them on the care models so yeah we involve the patients wherever we can. I just did want to add that at Homerton we're really proud to have this service of social care and peer navigators. We are actually only one of the only hospitals in the country that has full-time peer support provision and it means it makes a huge difference when it comes to stigma. As someone said before and earlier on that stigma kills with HIV more than the virus itself and it's absolutely true. 75 percent of the people that access my service identify as Black African or Black Caribbean. 56 percent of the patients in Homerton are women and 74 percent of the people accessing my service are women as well. I think a lot of people think of HIV as being a condition that affects men who have sex with men but we have a really different cohort of patients in Homerton and that's why this service has developed as it has over 14 years and my biggest concern with the transition is that that will be the funding for our service could be cut and it is a vital service that I see as a health prevention service and an early intervention service as well. Thanks Chris. Can I just bring Chris Lovett for the final observation and then I'll bring this item to a close. So I think the work that you've just heard about about the innovation of working closely with primary care, joining up with social prescribers, a lot of the work that we're doing as a local authority in terms of the cost of living crisis are all really good examples of why working with your local clinic has lots of advantages because people can choose where to receive their HIV treatment and care and there are still quite a lot of residents in Hackney who will choose to use services outside of Hackney understanding why. So it may be historical, it may be that they were diagnosed in that sexual health clinic perhaps in central London but actually I think if you are now looking at more integration with primary care, less face-to-face time needed at the clinic, that's why I think encouraging people to have trust and confidence in our local services is really important and then hopefully encouraging people to work, to come back into the local services is going to be important. So I think it is having choice is still really important for patients and some people will choose to use other services for a large number of reasons but the innovations that we're doing locally and hopefully across northeast London you know we should be looking to encourage people to continue their services, to continue receiving their care from perhaps more local services rather than traveling into central London. Thank you. I'm going to bring this to a close. Thank you all. It's very impressive to see your degree of focus and clarity of thought as to what you actually feel needs to be done and driving that forward and so I think if I understood you Chris, in January you're presenting to the ICB board in terms of future strategy and it may be then as I think Adam indicated maybe six months from year on from that will be a useful time to come back to get an update as to where we are. So that's certainly I think Councillor Kennedy who sits on the board has indicated he would be supportive of that request so excuse me as all of the place-based partnerships have adopted the strategy then the final adoption at the ICB I think would be a really great way for us to then hold all partners to account across health, social care, voluntary sector and others. Councillor Kennedy for the final word? Yeah absolutely. Just listening to the discussion in the room and online today, very clear that the ICB should be signing up to that and accepting so I'm happy to take that forward and actually probably make sure it gets agendaized if that be a word. And thank you we'll take that as a sort of an action and a result for this meeting to progress that forward. So thank you all very much and a program will be very much welcome to have you back to hear about the progress. So with that I'm going to close that item and thank everyone who attended. For those who did attend please feel free to leave the meeting if you're not involved in the next item. So the second substantive item on the agenda is in terms of mental health disparities. We are welcomed to have with us our colleagues from CYP scrutiny. We've got a number of different people, different stakeholders here so if I just jog through how I intend to share it to try and give everyone someone an idea. I was first going to go to Jarzina and who is the returning strategic lead for City in Hackney and also Justin Crowley who was the trust-wide lead for ELFT. So I understand you've put together, thank you very much for the composite presentation documents. So I'm going to ask you to speak to that and then open it up for a few questions. I was then going to go to ME8 and Muddling both from the midwifery department of a homerton from a homerton perspective and then open it up for a few questions. Thirdly I was then going to go to Sarah Summersgill from the visiting services who go out to visit patients in their homes and then open it up for a few questions. I was then going to go to Rachel who I think is on, Rachel Bournberg who's online and Debra's here as well. I'm grateful you can provide a patient voice and then we can hopefully open up for discussion. I think Diane Jones who's the chief nurse from North East London is at another meeting and hasn't yet joined us but will be. So just to start off with it can I go to Jarzina and Justine to give an introduction to the paper and maybe sort of five to seven minutes and then I'll open it up to questions. Hi there this is Justine. From what I can see Jarzina's not on the call. I am. Hi Justine. Sorry I mean I'm in person. Sorry I came in person. Hi good evening everyone. Yeah so thank you. Thank you for inviting us to attend this meeting and I think I'm too close to the mic to update on our maternal mental health disparities and challenges and how we're addressing that entity in Hackney. So what I've outlined, what we've outlined in the paper is to give a little bit of national and local context around maternal mental health and national and local asks and then we've kind of outlined our local provision in City of Hackney in terms of the pregnancy mental health pathways, maternity and neonatal voices, work that we're doing, homerton work that we're doing on the debrief clinics, the LMNS work in terms of the recent engagement around a case for change and also a brief outline of actual collaborative work that we're doing amongst maternity and prenatal mental health to understand further our inequalities where their challenges are and what we can do about it. So the paper gives sort of a brief overview of that and we've got a number of colleagues from across the system, health visiting Justine from Perinatal Mental Health, Fabio, Rachel and Deborah and our health visiting colleagues who are in the room who can speak further on those topics. So I'll hand over to Justine now, thank you. Thanks Jezina. So I'm obviously here to speak about perinatal mental health specifically and what we're doing to address health inequalities. There's just a couple of things I wanted to raise from the paper. The first one is that we have been doing quite a lot of work around this. It doesn't, I have to be honest, it doesn't work at PACE. I think this work isn't the quickest work to kind of see results from but I just wanted to highlight a couple of things that I mentioned in the paper and the first one was the Race and Health Observatory project which we are part of and this is a national project that's co-led by the Race and Health Observatory and the Institute of Health Improvement. So it's very much looking at addressing maternal disparities using an anti-racist lens and quality improvement methodology. It's a national project, there's 10 maternity systems from around England that are involved. We're the only mental health trust in that within the project. I'm actually on a Tuesday workshop now in Manchester and this is, we're focusing on increasing access for black African and black Caribbean women into our perinatal mental health services. So we're about halfway through this project so we haven't got huge amount of results at the moment but it is going forward well. Another area to highlight as well from the report is that, and I think is our issues around data, I don't think we do have a perfect set of data. I think it is an issue for us and it's one, I'm sure there'll be questions around that that might pop up later, and that's something that we're also working to address because although why we do have some data it's not perfect by any stretch of the imagination. And just a couple of things just about how the services in Hackney are linking into a wider system. We do have a perinatal improvement network that runs across the whole of northeast London and that network has been set up to address both access and inequalities within perinatal mental health. There's also a local group in Hackney which if needed Fabio can answer any questions further to that and that's a local kind of task and finish group that feeds into the perinatal improvement network. And finally the last one I wanted to highlight as well was the provider collaborative. So the perinatal provider collaborative covers north central and northeast London and just if I can try and just summarise this quickly. So the mother and baby unit which sits at Homerton is a national specialist service which previously sat under NHS specialised, NHS England sorry specialised commissioning. That commission has now been devolved to local areas so there's obviously, oh that's more place-based and more responsive to the needs of local populations. So the perinatal services also across northeast London north central London are all feeding into that provider collaborative. Again there's a real focus around addressing access issues and health inequalities. The provider collaborative has commissioned a strategic health needs assessment for the perinatal population across that whole patch and we're hoping to get that, well we will be getting that report which has been completed by the Anna Freud Centre by the end of this year. I'll stop there. Thanks, I think that's really interesting to hear about all that work. Do any members have any questions at this stage for Justine from ELFT in terms of that? Justine could you just tell us a bit more about this project you're working on and what sort of, what levers have you pulled to try, I know you haven't got the data back from it yet but to try and increase access. What are you doing differently in the project? Yeah it's very fresh of my mind as I've been talking about it all day. So it's quite a challenging one because it's thinking about where are the pinch points in the system. So we are looking, there are two main areas of focus at the moment and one is looking at our referral sources and thinking about actually how do we reach out to the people referring into our system. So that focus is going to be on GP's and what any information that we're giving to GP's because I think the feedback that we do still get is that people are not always aware of what the services are offering and that's I think some of that is because the service offer has expanded quite significantly in the past few years. So for example we're able to offer one-to-one nursery nurse support, we have occupational therapy, parent infant psychotherapy and family and couples systemic therapy which is something that they're fairly new offers and we're not sure that that message has got out yet. Another one that we're looking to increase is around self-referrals as well, we want women to be able to, if that offer is there but again it's about getting the getting that out there, that message out there. And then the other main focus at the moment is how are we communicating with community and faith groups and so that's something that we're going to be putting real effort into. We did actually, I had some interesting feedback today from an expert by Experience who was saying it's probably not our offer, it's actually de-stigmatising the services and what coming into contact with a perinatal mental health service means. So that's something that we're going to, that's our area of focus and hence that focus on going out to where the women are. Thank you Justine. Councillor Lynch. And thanks to, thanks Justine. You probably answered a little bit of this but yeah I'm just, just for me the starting point of this is that engagement with our voluntary community and faith sector partners, especially within Hackney, we know and I think Covid showed us as well that they're really key to all of this. So when you talk about going out there, there's got to be a recognition that a lot of our residents don't actually trust the NHS and the very fact that, you know, I've heard the expression 'hard to reach', I really find that not particularly helpful. So for me, I just wondered how your work that you're doing, how you're working, obviously you're here tonight working, presenting at our, well everyone's Health in Hackney Scrutiny Commission but, you know, I've worked in the NHS for a long time myself, I'm now not working in the NHS and obviously you've got the added experience of being a local counsellor but sometimes I think, you know, some of this sort of wanting to make those meaningful relationships is actually using some of the existing platforms and forums that we have already in existence within our communities and, you know, particularly for those residents, like for our Black and Global majority resident women, you know, that they, you know, we've shown, it's been shown time and time again that we can't just sort of tell people what to do, we have to actually shape what we're commissioning to do around their lived experiences and to make that the actual, you know, so that should be the sort of the real driver for any sort of improvement work that you're doing is actually what do the women want and their partners and their families but thank you. So yeah if I could just respond to that, I 100% agree, so on one of the, so obviously this isn't, our project isn't just covering Hackney, it's covering the Elft inner London boroughs, so we're covering Tower Hamlets and Newham as well, we have engaged with Sister Circle who provides, although they're primarily based in Tower Hamlets, they do cover our East London boroughs because they provide peer support for our maternal mental health service and one of the things we're working with them on is there's a group of women who don't access the services and they're actually some of the women we want to hear from, so that's one of our kind of change ideas in terms of the QI methodology is actually trying to engage with some of those women through our kind of, you know, our community organisations that we're linked in with and I just wanted, I wondered if I could, could pull Rachel Bobing in here because Rachel actually did, was involved in a piece of work with Charlotte Carthy who leads the maternal mental health service which is called Ocean and they've done a really good piece of work where they, Charlotte was going into some of the groups to talk about mental health and that's kind of what, and we were pulling on some of the learning that's already been done because I think that was quite a good model that was quite successful. I don't know if Rachel are you there? Yeah I am here, yes. Hi everyone I'm Rachel Bobing. I, just to echo what you said Councillor Anna, I totally agree and I think we started doing some of that work with, there was a lunch group in Hackney and Charlotte who was the lead psychologist was coming in literally sitting on the floor with the children and their parents, their mums and just listening, learning, understanding the community, understanding, it was all black women who live in Hackney and it was a space where they were able to congregate, validate each other's experiences but Charlotte was on hand to be able to say actually this is what we offer, this is what you can access but at the same time learning from what the people in the room actually do need and it was really helpful to have her in a space where they felt safe and they felt they could be themselves and they were around other mothers who had similar experiences to be fair. Some of those experiences were due to systemic issues that they've experienced and some of them were just things that happened and happened when you become a mother so it was a nice really relaxed environment but there was access to the service, access to the information about the service in a space where they felt safe and comfortable and it was it was priceless. Thank you Rachel for that, that's really interesting. Councillor, thank you, you hinted to this earlier about the data that might not be quite as up to scratch as we'd like, I'm just wondering what kind of improvements are being made to sort of collecting data, I would be really interested to know if there are going to be ways that we can sort of monitor this, you know hopefully see improvement year on year, I'm not entirely sure through looking through the papers whether that data is currently there and I understand there are some difficulties collecting that data and obviously we know that there are the health disparities that have been identified for black mothers and I'm just wondering if there's any way that we can also look at how, as identified in the papers, the Haredi community, if there are health disparities there as well as the Turkish and traveller communities that we have here in Hackney, I'd be really interested to know if you've got any any thoughts on that data side of things. Yes I do, so again this has been a conversation to date this race and health observatory project because we are limited to the the ethnicity recordings as set out nationally by the NHS but we're actually asked, I believe there's some work going on, so we were asked today what we wanted the race and health observatory to bring up with NHS England so that's, we have fed that back and particularly around the issues that you just mentioned as well because it's a huge issue for us. I think that there might be some work done by Humberton Maternity around being able to record that but I know that in ELFT we're not able to distinguish between that so yeah to answer your question there is some work and some thought being going into that and I guess just to say you know we can record, we're recording access and that's in NHS England a national target nationally for perinatal mental health services and that will continue so I'm not sure, I can't remember if we put it in the report but we have an access rate of 10% of the local birth rate but the local birth rate in 2016 so it's not the local birth rate as it is now in 2024 however the messaging from NHS England is that actually they want us to stick to that given we know they should there will be higher access rates as a result of some of this work that's going on around birth and loss and trauma and also kind of post-pandemic it was also deemed that we should still stick to that higher access rate. I think one other thing to mention as well which we're looking into in ELFT is putting a bit more focus as well on deprivation and putting our focus on services being able to be accessible for those people in the more deprived areas of the problems that we're serving. Thank you, Justine. I've got a slew of hands of people wanting to ask. I'm going to bring Jozina now to contribute on this. I've got a few councils ones coming but I think what I'm going to, I'll go to Jozina first and then I'm probably going to bring in Emma Yates from the Hobbiton and then I'll go to the other members questions so Jozina. Thank you. I just wanted to add a little bit on the previous question around the service user engagement and around vulnerable women. We've recently commissioned and launched a project with birth companions who are at HCVS organization who often work with vulnerable women. It's called the Izzy project and through the process of commissioning that there was a lot of service user engagement with a number of stakeholders including service users by experience and they helped shape that service in terms of support for women who are most at risk of having a baby removed at birth and those women often find that their perinatal mental health support after a baby has been removed is non-existent because they don't have their baby with them and so they fall through the gaps and so that service has recently launched and is engaging with I believe around 10 women currently in the process of supporting them antenatally whether the baby is removed or not but again in the postnatal period. And then secondly I wanted to add something to what Justine was saying around the data. Yes there are challenges around the data that we have at the moment and part of the work we're doing within our perinatal mental health task force is to look at the data that we have in city and acne across the perinatal mental health services and come together to agree on how we classify some of the ethnicity and demographic data because I think some of the challenges different people classify differently so it's hard to sort of track what everybody's doing in terms of what everyone is collecting and so we're still in the process of having those discussions in those meetings around that. And then I guess also then bridging that with perinatal mental health and maternity there are conversations in maternity around an inequalities dashboard with our population health colleagues supporting with that work and I hope that as that work progresses we might be able to integrate perinatal mental health in that dashboard and so then when we start looking at the data we hopefully will have something to bring to a future meeting. Very welcome to hear. And I have got Councillor Conway and Councillor de Lorte but before I come to you both I'm just going to bring in another speaker. I'm Emma Yates who's the midwife of the safeguarding of the Hobbiton. Emma have you got any contributions to make to this? Hi there thanks very much for having me. I just probably wanted just to speak briefly about some of the things that Jozina's mentioned around the IZZY project. It's part of a quality improvement drive for us around the care of women who are at risk of having their children potentially not in their care post birth and there's another national project, research project that we're involved in called the Hope Box Project which is launched nationally and is led by women with lived experience and that's around a service-wide drive which has involved lots of kind of input from social care, from fostering services, from contact centres in Hackney and we're very much involved in driving that programme forward and it's around providing training for all people that come into contact with vulnerable women who are in that cohort that can provide this box which is a kind of touch point around having conversations and seeing what care programmes that women may need who are very much at risk and these are the women in Embrace that we see that are the most at risk from our cohort of women. So that's a huge project that we're kind of involved in in many streams, the IZZY project being part of that and the Hope Boxes. We've also got as part of the Ocean Service we have a midwife that works within Ocean but sits within maternity as well and she's very much involved in creating trauma-informed birth plans with women and works very closely with Kaya who's our equity and inclusion midwife around ensuring that those birth plans meet the needs of particular cohorts of women and are kind of involved, that women are involved in making those plans very closely and we think about the services that we offer in a way that is inclusive and equitable to all of our women that use the services from whatever communities that they come from and Kaya's been doing lots of work with local communities going out into communities to making contact with faith leaders, going into hair shops, kind of thinking about what women need in Hackney in terms of their care in maternity services. So I think Mung Ling who's here might be able to talk a bit more about Kaya's work in terms of equity and inclusion but one of the things that Kaya's been doing is working on a day empowering maternity care study day which is going to look at kind of equity awareness and also trauma-informed birth planning to kind of help to support midwives in terms of making those care plans with women. We're also doing a lot of work with the voluntary sector in terms of making connections with organisations such as Happy Baby Community that have doulas that speak 50 different languages and provide lots of care for women who have no recourse to public funds. We've been doing lots of work around creating a pathway for those women with social care so that we can have a more seamless kind of reach in order to try to access support for those women when they're on our post-nate awards and also we have done some work which Rachel can talk to which was around creating a black and black heritage service users group so that could feed back into the wider MVP and Rachel's been a big part of that work and she could probably speak a bit more about that as we go through and also the debrief clinic which is run between the birth reframing clinic which is run between a perinatal mental health midwife and perinatal mental health nurse as well that is part of the work that we're doing with perinatal to also try to improve access to birth trauma thinking about the report that came out recently and the public inquiry around women's access to birth trauma care as well. I don't know if Mun Ling wants to come in now and add a bit more about Kaia's work from maternity service point of view or if anyone's got any questions for me at this point. There may well be, I've got a few councillors lined up so if I go to them then I'll bring in other colleagues. I first saw Councillor Conway, Councillor Conway. Thanks chair and just to start by saying how encouraging it is to hear all of this incredible work going on in this space and I'm saying this as somebody who used to be an advocate for young mothers many of whom had had their children removed from their care and to hear that we're doing work with those women who you've described slip through the net because they don't have children because their children have been removed from their care is just so encouraging to hear. But just for a bit of context the reason why this was important to us as the children and young people scrutiny commission because there's many of us from that commission here in this meeting today was because we're trying to join the dots with children's social care and because we see an over representation of black and global majority families whose children are in you know on child protection plans or taken into care and we're just I'm just curious to know I hear that you're doing the work currently with those vulnerable mothers but is there any work going on in terms of data analysis to look at the families whose children are in care and to find out whether there was anything that was missed because just from the reason why this was interesting for me was when I was working in this area I found that the parents were often diagnosed with poor mental health that was one of the main reasons why their children were removed from their care and I just thought it was an interesting exercise for us to track back and to find out where were the various different touch points that may where this parent may have been missed although it's worth me saying I feel as though I've been incredibly impressed by everything that you've mentioned today but that's just something of interest to me. Justine do you want to pick up that point from Councillor Conway about looking back? I mean I couldn't agree more I think the challenge for us is being able to access that information and that's it's a huge challenge for us being able to access information from the local authority I mean and if anyone has any hints or advice on how we might do that we would be really grateful for it. Part of that part of that work Sophie in some ways has been done by Tamsin Bicknell who was our public health consultant midwife who's currently on leave actually but she as part of her master's programme looked at the care of women who had had their children at Homerton removed from their care and looked at their experiences and went back and spoke to a number of those women about various issues including their mental health and that was part of what actually developed the Izzy project in the first place so that came out of her research work there. And Jozine do you want to tell me I mean is it back to the population health pulling that data together or is there other? No well yes no what I was going to say a little bit for Emma just said but also just to say that in the family hubs work that we're doing so you know people family hubs being set across the country we're working on a parent-infant relationship and perinatal mental health pathways for those pathways and although we're not tracking the data yet we're hopefully as this work involved perhaps it might be to the point where we're able to track perinatal mental health at the point of access referral and then maybe those families down the line in the parent-infant relationship and perhaps further support that they might receive so it's possible that we could look at that at some point but it's not something that I'm aware we're we're doing at this point. Yeah so I'm here with Carolyn who's part of public health and I think that's a really easy one for us I think we can definitely take that back to population health hub and look at some of the needs around that and track also through social care with Diane Benjamin and colleagues. Thank you I next saw a Councillor from the law. Thank you chair perhaps this question is for I mean Ayla, Justin or Emma it's been really helpful to hear my question is related to migrant women and accessing mental health whilst pregnant unfortunately we know that the inequalities are quite high but it's really sad to hear this still happening I myself experiencing when having my second child but I wanted to check in terms of the real fear that migrant women have when accessing a health care altogether but especially when pregnant about being reported to the home office and the what assurances or what sort of measures and steps do you take to make sure that this is make sure that this is a safe space for women when accessing care whilst pregnant and that they are not feeling that fear a real fear because of evidence as well of this happening that women that do not have an immigration confirmed status will be able to continue to have the full care in a very compassionate and supportive way thank you. Emma are you able to answer that? Yeah I can probably talk a bit to that I think it's it's about us actually going to the women rather than the women coming to us so us actually being able to go out to where the women are and to see them and to provide the care in a space that feels suitable and acceptable to them and also to there's another prong to that involving third sector organisations that can provide lots and lots of support and wrap around and you know get access to food banks get access to things items for baby and provide and also then also thinking about those women's mental health and what their needs are in terms of their mental health but providing that in a way that is acceptable to them and and and meaningful and not you know using terms that we we use in in mental health care that might be meaningless to those women it might actually be approaching it in a different way that feels like an acceptable way for them in order to access care and that's an ongoing that's ongoing work. Thanks Emma I've got I can see that a few more Councillors wishing to come in before we do I also want to bring in another speaker Sarah Summersgill who's from the health visiting service commissioned by the Homerton. Sarah can I bring you in? Yes you can hi hello I'm Sarah Summersgill I'm the head of nursing for children at the Homerton so health visiting comes under my remit. One of the things I think was really evident when we were looking at this to pull the paper together was the the data issue which I think people have been mentioning throughout and also the demographic data that we are able to sort of uncover and I think some of that is related to the the issue that I think it was Justin was mentioning around the data set that is the ethnicity data that is mandated by the NHS so what we and you can see from the paper that actually that we have about 50 percent where we have other and we it's unknown so from our from our data it's very difficult for us to pull that information about what the useful information around this topic particularly so I just and then we are doing a lot of work on that at the moment we've got a quite a lot of data issues that we have been working on since our primarily since the new contract started last year but how we record our data how we can pull our data the assessment forms that we have that enable us to sort of identify and pull out the information that we need we have improved on that a lot but we still are struggling so in terms of being able to present that to you that's that's why there's a sort of bit of a gap there in the in the paper that we've done I think from a health visiting point of view we are health visitors are very much a they're in a unique opportunity because they go into they see babies as soon as they're they see mothers antonately and then they see babies as they are born and throughout up until the age of five if necessary if there's a safeguarding need or if there's a there's a vulnerability there one of the in the recent contract we now have a we have five levels of care so we have an intensive service I think somebody was talking about the the under 18 so any any mother that gives birth under the age of 18 will automatically be on an intensive service which will on that service there will be a huge increase in the number of visits that that mother will have and those visits will continue until that mother or family etc can move off that service because they've been given the support that they require the I'm just thinking sorry I have my notes here one of the other things that we have in the new service is we've got high impact health visitors and we've got them to cover a wide variety of areas which are able to provide additional support training to health visitors but also additional support to families who are suffering from suffering under more of the vulnerabilities that we see with them our cohort in Hackney the we work very closely with other agencies so health is does although they don't themselves provide psychiatric input or psychology input they signpost to a huge number of places dependent on what that family that mother father's needs are and we work really closely with GPs we work with the family hubs we work with talk changes is an area particularly where we've developed a really quite a good pathway in terms of getting parents and families being seen within a fortnight within two weeks of being referred to them to offer them that support and somebody else mentioned about the the asylum seekers the health is did an awful lot of work with the hotels with the the residents in the hotels around sourcing food around helping so again signposting families to sort of useful support networks for them and that was a really that was really positive input from health visiting there I think it's important to recognize as well from a health visiting point of view that that any of these mental health it can be recognized anywhere anywhere along that pathway so they perinatal and on into the later period up until up until they leave the service and then transition to school nursing etc there are in we have an infant feeding support group that is working very hard to to manage this issue around the ethnicity data so what we get is pulled through into health visiting and then it relies upon the health system to pick up the rest of the information that is not there so we're working hard with all the teams to get that data in there so that we can we can we can pull that information but infant feeding team are really important they work really closely with particularly with the family hubs and they one of the things that they're doing at the moment is starting to go to the there's black and black niche heritage antenatal classes which the infant feeding team we've got an infant feeding nurse specialist midwife who is going into going to be into those ones to do breastfeeding sessions because one of the things health visitors do particularly is they look at the mother-baby interaction so it's about picking mums picking up cues from their babies and being able to support that that side of things as well which is obviously really important in terms of maternal mental health and bonding with their bonding with their babies etc I'm in terms of specifically around health inequalities again it's difficult to pull any information from our data and it's something that we are going to be working on and we are starting to work on as I said with the alongside health visitors alongside infant feeding alongside family hubs GPs etc yeah so I think thanks Sarah I was going to bring in the first thing to hear about all those different angles can I bring in Councillor Martins if I can because I know you've been waiting patiently for a question thanks there I just wanted to ask the question I mean it's great to hear there's so much support for women I wanted to ask a question in relation to the statistic that black women in particular are four times more likely to die in childbirth has there been any work in terms of that correlation between that and also the mental health aspects I think it was quite alarming to see that and I think it was around 40% of women die because of mental health related issues has there been any correlation between those two statistics and also on the back of that in terms of the support that is on offer and you mentioned doulas and a lot of the support offer like there's different languages spoken etc but I wanted to ask in terms of the cultural aspects have there been any considerations in terms of that and how different cultures are taken into consideration and how that wraparound support is provided in that context as well yeah Emma I can see your hand up can I just take you for the first part of that Emma yeah I my hand was up because I was just because Sarah had mentioned the targeted antenatal classes so really I wanted to expand on that a bit because that's a big piece of work that that Kaya is actually leading which is around providing targeted antenatal classes for black and black mixed heritage women which is specifically to provide a space for those women and their partners to be in and receive antenatal information and care planning and information around black breastfeeding networks and other sort of sources within the community and to try to kind of foster relationships within the group so that women can actually support each other as well around their mental health around having their having their children and providing you know and and networks and all of those things so those classes have been really really important as part of the kind of equity strategy for Homerton Maternity I'm not Kaya as you can tell and I'm afraid that I can't it's really hard for me to speak to a lot of the work that she's doing around equity and inclusion I kind of wish she was here but I don't know if Mun Ling is here and able to speak a bit more about because we have you know we have a huge agenda in terms of the work that Homerton Maternity is doing around various programs within Capital Midwife and NMC about improving kind of equity and inclusion and access for women in terms of their maternity care and I think Jasmine a lot of the questions that you're asking are probably going to be better answered by them because that's kind of my area of expertise is around the safeguarding and the care of vulnerable women obviously I touch on a lot of the work with Kaya and she inputs into our we have an enhanced maternal mental health study day which part of that is around inclusion and equity and access to mental health care for women and that's about kind of educating our midwives a bit more about what the needs of of the women in our care might may be and how we can better help support them I'm just trying to think about sorry the other bit of your question if I'm I've answered. Do you know about maternal deaths and whether there is a this from a Homerton perspective whether there's a disparity there on the data? In terms of I'm not going to be able to speak to kind of Homerton's record in terms of maternal deaths and disparities I you know maternal deaths in themselves are quite rare and I know at the Homerton it's it's a very very rare occurrence we'd have to go back and look at look at data over years in order to get a kind of anything meaningful in terms of those numbers I should think in terms of we do know in terms of babies and and that that we know that black babies are much more likely to be born you know that they're much more likely to have bad outcomes in terms of stillbirth etc and and there's there's a lot of work going on around around that in terms of NICU care and supporting women in terms of information around what the risks of stillbirth are and things like you know diabetes and preeclampsia etc but I again I wish there was somebody else from maternity services here that will be able to speak to that in a bit more detail because I know there is a lot of data that we do have that is available for that but that needs to come from Monday and and Kaya. No no no thank you Emma so Jasmine I think we'll take those questions back and maybe yeah see if we can get some response offline for you from Kaya who's the head of the qualities and midwifery that obviously is not with us today. Councillor Lynch I saw you next. Hi thank you chair gosh I've got quite a few observations and I have got a question as well chair so don't worry so it's just it's just it's just to make an observation and I just wanted to ask a question around your workforce because we know that black and global majority women will probably respond better to somebody that looks and sounds like Rachel and Councillor Martins and I just wondered what your cloud visiting workforce looks like and I just wanted to ask a question around where the health visitors are based and whether or not there is any value in actually doing that joined up working obviously given Rachel's role and some of our BCFS's there is that there is that tendency for the NHS to get a little bit worried about quite rightly around sort of you know patient confidentiality and what have you because for me what I'm hearing here is that we need to start shaping our sort of workforce and our professions that we have at the home attending within the wider community and I think there's some work that's actually been done within the local authority about having to do that is around we actually have to shape what our women need in Hackney and particularly our women who are pregnant and you know in terms of sort of saying that you know don't really you know just report this proportionality of safeguarding that are raised I suspect it is you know because of the very nature that some of our black and global majority women are probably living in quite difficult challenging social situations in terms of housing potentially more like to have an abusive partner etc etc they probably are actually very very much on the radar of the safeguarding processes so just on that note as well we do have a corporate parenting board at Hackney council and it would be really interesting to sort of to see what work is being done with those I wouldn't like to make assumptions but I suspect given the fact that people that we know that a care experience can sometimes have difficult situations in terms of relationships and probably more likely as well to sort of fall to become young mums as well and again all of this just you know just goes back to what we need to look at which is the you know the systemic and structural reasons for why women of black and global majority experience and basically racism within our within our NHS providers I'm not saying that's happening in the homerton but particularly but also in terms of you know a lot of this mental health is is brought about because of the fact that we we have a you know we have we are in a borough that has significant inequalities and you know that that's very much influenced by where people live who they're in a relationship where their families are and what worries me is that you know we we know that we've got significant pressures within Hackney and other boroughs around temporary accommodation you know where is the role of health visitors in terms of that that being you know a priority as well is that you know we we we aren't at that stage but we know in neighbouring boroughs there's been an attempt to move some of our sort of people in temporary accommodation sort of outside of outside of the boroughs I'm hoping we will never get to that in Hackney but you know all of this is just it's just all linked together and stringed in strategically to be honest so I think we need to be really mindful that we might work in this organisation and we might have this particular role in that organisation but we should all be and I'm sure there is this passion and this commitment to do the best for our black mothers but you know the most sort of welcoming piece of information I've heard today and it's not to not to discredit any of you as presenters is the work that Rachel's doing which is actually like let's actually just go out and and you know it's it's not it's not difficult we don't need lots of lots of data it's quite obvious that we have a high proportion of black and global majority women in Hackney. Thank you chair. Thank you Catherine and I think Jozina was going to come in there. Thank you my response was not really for about health visiting but I just wanted to add to something that Emma said earlier around and what that's going on in maternity so Kaya has been involved in a piece of work around health inequalities and we've recently recently worked with the population health hub to commission the two pieces of work one is around doulas so providing doula support for women from global black and global majority ethnicities in City of Hackney through the birth process to provide them with that sort of additional support where they might require needed during their antenatal care and then secondly there's a piece of work around translating key maternity documents into six key languages that are spoken in City of Hackney for those women who have language barriers limiting them in terms of how their understanding of the maternity antenatal care that they're receiving. Another bit of work that maternity are doing is around providing link midwives they've talked about you know in the service making sure that the women who are providing care to the midwives who are providing care to pregnant women look like them and and and sound like them so there's been discussions around providing link midwives in specific ethnicities and I think that's a bit of work that maybe Mung Ling and Emma might be able to expand on a little bit but that piece of work is going on and then thirdly Rachel and Deborah are on the call from our MNVP and I think you're going to come to them in a minute but yeah. Thank you I was going to come to Rachel and Deborah I'm sorry can I just quickly come to you to sort of in response to Councilman Lynch's question before I come to Deborah and Rachel in terms of the workforce reflecting the community it serves and cultural sensitivities what work are you doing in that regard? Well our workforce I think does reflect we have a lot of of our health has come from Hackney the majority of our health visitors are black and global majority health is just the vast majority what we don't have is any Orthodox or any Jewish unfortunately we don't have any Jewish people and it's it's really interesting that because that would be we have a very large cohort there and that would be something that would be really helpful it's just it's it's just not not something that we're managing to do at the moment although that would be that would be fantastic and I would love that so from that perspective we we and as I say a lot of them do come from Hackney as well so we have we do have quite a reflective workforce of the of the people who live in the borough I think yeah so sorry what was the other question? No that that was largely in terms of the Councilman Lynch's question about the workforce reflecting. Can I now take the opportunity to bring in more of the patient voice so Deborah who's the chair of maternity and neonatal voice partnership and also we've heard from Rachel as well but Deborah can I just bring you in there for your contribution thank you sorry I'm down as Harry Lee she was the she was the outgoing chair just before I forgive me no no worries just before I come on to give a bit of an update I wanted to go to Councillor Lynch's point on demographics and a few of us have spoken about demographics Kaya actually sent me the demographics earlier this year and our black black mixed heritage community is 17% our Jewish orthodox community is 13% and our white British white other excluding Jewish orthodox is 45% Asian and Asian mixed heritage 14% so slightly out of date numbers but I think I was I was personally surprised by those numbers I thought I thought our black and black mixed heritage would be larger I thought our Jewish orthodox might be larger and it's also interesting to see proportionally how many of those women are having children because we know in the Jewish orthodox community even though they account for 13% they're having a lot more babies than other communities in the area so the work that I do with Rachel and our committee is that we are volunteers within Hackney most of us mums who've had our babies at Hackney in in recent years and we go out into the community and collect feedback from from other women who've had their babies I joined in January of this year and we have a team of around eight of us two from the Jewish orthodox community Rachel who covers the black and black mixed heritage and other all the team is you know very diverse demographic we've increased feedback by over 200 since we've since we've started in January most of this feedback is via our online survey but we do do some face-to-face sessions where we get feedback with the homerton midwives we've done this twice with birth companions one was actually earlier today and we've done this also with bump buddies so really trying to to capture feedback from those who are more vulnerable consistently the main thing that comes up again and again and again is that when a woman has continuity of care anti-natally so that's one midwife the irrespective on the outcomes of their birth labor post-natal period they end up with an emergency section a third or fourth degree irrespective of that they score higher satisfaction on their overall labor pregnancy when they've had continuity of care so all the data is showing us that so I speak with Sarah Latham our head of midwifery quite a lot on that to say how can we make sure we we you know we create a model that can guarantee some more continuity of care so that's that's probably the main thing that comes through with the data the other consistent challenge that we have is around the post-natal ward we know some we're not the only trust to have that issue but very very low satisfaction from women on the post-natal ward the physical environment you know and lots of other things you know the things that come up again and again is the feel of real lack of care we had one quote saying we know the NHS is stretched and it's a challenging environment but you know you really start to feel irrelevant when you're on that post-natal ward on the perinatal side I guess for for myself and you know I personally come into feedback around this only actually today and in more recent times and keen to work more closely to understand because the feedback we get on the nbu has not has not been the best and also a lot around how are they better informed about you know do they have to be on the nbu are they you know some some of the women have said can you just explain that acronym sorry maternity baby unit it's for women with mental health issues and they have a unit that they can be on pre-giving birth or post-giving birth and it's on it's within homerton and it's women who are at higher risk of having a bad mental episode post having their baby but yeah I guess more to understand around that and and I think some of the midwives that were at the session today was saying how do we make sure homerton maternity and that unit are more closely connected and I'd like to bring you in again because um to talk more about um your experience and I'll bring counselor counselor thank you so much um and um as as I've already been introduced introduced I'm Rachel and I am the black and black mixed heritage MVP chair and to be honest there was a little gap in my my work because I decided that things were going so great I went to have another baby in homerton um and so there was a little break but I'm back and we are due to have our next meet up with um mothers who have used the service um on on the 24th of October which is quite significant because obviously it's black history month and recently there was the black maternal mental health awareness week and I think it's really important that um counselor martins brought up the statistics a lot of the black women that are entering and the black mixed heritage women that are entering homerton are entering with the knowledge that they are part of these statistics they're entering the services knowing that they are at risk and so if that's not already going to impact somebody's mental health we already have if we don't acknowledge that in the initial interactions with these people then we're already missing the opportunity and I think what kaya and the and the team have been doing is that in the antenatal classes the conversations around specifically around being a black woman a black woman who's having a baby a black woman who's having a baby in a system that can unfortunately cause you some harm um not necessarily physical sometimes it can affect your mental health being able to address those in the antenatal classes has really helped um well for me has helped um just understand and to navigate all of that and in those spaces because they become peer support spaces what kaya has done is that the the mothers that attend the antenatal classes then can congregate afterwards as well at our at our mm at our maternity voice partnership um coffee mornings so when we host a coffee morning we simultaneously invite those mothers who had attended the antenatal classes as well and hopefully they they've met each other in the waiting areas they've seen each other around and when we sat in the last um coffee morning I did before I had my baby I vividly like it was so interesting to see that we asked about mental health and actually the the one of the staff from the mental health service ocean came to that as well and we asked about mental health and some people said well I haven't thought about it but there was somebody in the room who had accessed the service and she was able to validate and help others to think right I need to tap into this service because it actually exists I didn't know nothing about it but somebody here has has had access to it and they're fine they're still here they didn't take their children away the stigmas that can be pushed to the side for a second let me just listen a little bit to what's what this mental health stuff is all about so I think what I say all of that to say that the cross working across the MMVP us creating spaces where we can sit together for coffee or for tea it might not hit the data and the statistics that everybody wants to hit but actually it's having such an impact in the community um and the MMVP listen the maternity voice partnership I need to stop doing acronyms being able to keep going out like Deborah was saying going out and and listening to people where they are doing our surveys working with the teams in in the hospitals and not shying away from this these statistics they are real they are people they are me I could be one of those people so the moment that we're all acknowledging them and addressing them we're finding that actually going head on and saying how do you because I know when I had my maternity care I was asked okay is there anything worrying you I know you've heard these statistics is there anything worrying you and this was at the homerton every single mother needs to be able to have those conversations and the people that are affected by these statistics greatly need to be able to have those conversations as well and so we're working on it we're doing a lot of different things trying different things sometimes the risk like um Justine said earlier sometimes the results are not as quick um as we might want them to be but the moment we get out there and and let at least one person be able to understand that the service is not going to take their babies away it's to help them and they can be free in their thoughts and say what they feel the the greater move towards making a better service and so that's what we're doing and hopefully the next coffee morning will be a success I'll be dragging my baby along too and we'll be listening and learning again and it's always an open conversation to improve the service Thank you Rachel that's brilliant um brilliant observations thank you um I've got Councillor um Gordon uh Councillor Lucas I've got a whole slew over here and uh Sally Devon I'm going to take that as a group because we've only got sort of 10 minutes less and then I want to bring Diane Jones in at the end so Councillor Gordon has been waiting. Is that any better? Yes got you. Hello? Yeah we've got you Margaret. Hello? Oh we can hear you. Okay sorry about that Yes I'm Councillor Margaret Gordon I'm the Vice Chair of the Children and Young People's Scrutiny Commission um thank you very much for all the presentations it's really really encouraging to hear about all this work in this space and particularly for me because I used to be a long time ago um on the maternity services liaison committee with the Homerton Hospital it does sound like there's been a lot of really a lot of work to be done in you know in terms of um you know inclusion for for all mothers and you know increasing equalities um just a couple of sort of no questions slash observations um Deborah I was very struck by what you said really in terms of continuity of care um which and I know there's really really compelling evidence there has been compelling evidence for a long long time that that's one of the sort of really most important um things in terms of maternal outcomes that women get a trusted relationship with their you know and consistent relationship with their care provider um and I really really hope that something could be done about this I mean I know it is it's challenging with sort of workforce challenges and various different models um have been um have been tried but I mean that has to be one it really has to be one of the sort of priorities for any sort of um any system of maternity um I suppose the second um question I really wanted to sort of focus on um was I mean there's a lot of really brilliant targeted work um being done here um but we're we're obviously you know part of a sort of wider system and there is a lot of stress and pressure on mental health services um there are a lot more children children and young people um who are growing up with mental health challenges who you know will be becoming um mothers and their partners themselves um so you know there's a lot of sort of history and stress there and obviously as sort of my colleague Councillor Lynch has touched upon as well there is you know a lot of people living in very sort of you know challenging social circumstances in relation to sort of challenging challenges with housing um you know and the cost of living crisis um and as well as you know inequalities and racisms all of these things I mean parent mothers and families don't exist in isolation so I just um so though there's a lot of sort of brilliant work here I just really want to um I am still nervous that the sort of you know there isn't enough really in the entire system out there with all the you know sort of different demands on mental health um and other sort of workforce services um you know I still think um you know there's going to be some brilliant work but I think we really need to work together both as a sort of local authority and you know and as health services to make sure that every bit of the system sort of works together as well um you know in terms of you know um health managing to make sure that um you know that families get the you know the maximum access to support across the system I mean it's it has a lot of pressures on sort of young families you know in relation to housing you know Councillor Lynch touched on housing um housing insecurity across all tenures you know is a really really difficult thing to deal with particularly when you've got the challenges of having a baby so I think we really need to look at how the whole system supports um mothers um you know mothers and their families. Thank you Councillor Gordon um I'm going to go to Sally now and then wrap up for um uh observations in in the council chamber and then I'm going to bring Diane Jones in so Sally thank you thank you thank you I'll be I'll be super quick because I can see we're nearly out of time it was a couple of quick comments Deborah I was very very interested to hear what you said about the mother and baby unit we are just about to publish our entry and view report health watch has got gone on to that that ward and chatted to my mother chatted to staff and done and can be and we were we're actually quite quite surprised by how positive the feedback that we received so I'm very very interested to look at some of your your data and match it up because we've looked at all of those mental health rules and it's really really some really good stuff coming coming away from the mother's talking there so I just wanted to throw that in and again I was kind of half hesitant to to say this but I think it feels appropriate we're um we're involved in it in a big piece of work to make Hackney a father-friendly borough which is particularly focusing on perinatal mental health in dads and it's really struck me in the whole of this conversation which which rightly we're talking about kind of maternal perinatal mental health but I feel like we're working towards changing the landscape and the culture so that when we think of mums and babies and families actually there is a space to think about are we thinking about dads how are we supporting that that that's that space and I just kind of wanted to put it put it out there and say watch this space we're going to be developing that and trying to change the culture around around how we think of dads when we think particularly about perinatal mental health so just throwing that out there thank you. Thank you Sally and now in the chain the first have a recap of who was it Councillor Adams, Councillor Ross. Thank you thank you for the presentation my question is one of your objectives of the NHS long-term plan for community perinatal and mental health teams is to increase the availability of specialist EMH community care for women who need ongoing support for 12 months after that to 24 months. I was just wondering what has been done in that area to ensure that this kind of service kind of get implemented in the long run. I'll go to Diane to pick up that when she talks in a minute Councillor Ross. Thanks chair I'll just have two quick questions the first one was about the baby and you group which was piloted earlier this year which on the face of it looked really great and I just wondered what um your plans were with that group whether you're planning to continue that and if so if you are going to engage young members themselves in um structuring what that will look like and then going to a point that one of the contributors mentioned earlier which was on education um particularly you know around staff training um I wondered what if what that will look like if it hasn't been implemented already or if it has you know what that covers so that we can understand a bit better what um or how that is actually going to address the underlying root causes behind the disparities um any inequalities that we see um for black and global majority women just before I bring um um Diane in at the end Jozina are you able to sort of pick up any of those that those Councillor Ross's last points there um I was actually going to ask about the did you say the mother and baby group baby I think maybe Rachel may be able to expand on that a little bit more actually okay Rachel did you pick up that question uh Rachel did you pick up that question from Councillor Ross about the um is it is it is it the BM the baby and you group is the young women's perinatal support group um with that group I'm not involved in that group the group that we um so I've been involved in is the black and black mixed heritage MMVP I'm not sure MEH is here yeah I was just about to say Emma can speak to that uh well I can try to it's the first year a new group and it's run through first steps psychology or it's run through first steps psychology well we've got things I think I think it may be something we can we can advocate offline in terms of um it continuing to take it back um before we bring this meeting to a closing can I just bring in um Diane Jones Diane you're you are the um chief nurse across the NEL um uh patch yes yes Diane was going to I was going to ask the the question from Councillor Adams um just a moment ago but also can I just throw in just to finish off you obviously you've just finished your consultation um and I think we're awaiting sort of the um results of that I mean one thing we did know was that mental health didn't really feature at all it out in there in the consultation documents so what assurances can you give us that that is going to be a key consideration in any reconfiguration of services that they flow thank you um just if my name is Diane Jones and I'm the chief nursing officer for the integrated care board and the partnership um thank you for inviting me today so very quickly for any key consideration for women going through pregnancy and women and families um it's around ask listen and do we've got to get into that space of asking women about what are their needs what are their preferences what do they want in terms of what looks good for them over and above you want a healthy baby because we should expect that for everybody we need to then listen to them and the uh the care plan and the action plan for that woman needs to be individualized for them therefore where they have mental health needs that will be picked up in that individualized care plan so I'm advocating that how we move forward is we ask we listen and we do and those are the three things and that's coming from where we work with people with autism and autistic people that is the same approach we need to take with our communities the other thing is around if we get it right for black women we will get it right for all women so again it goes back to that point that Rachel mentioned about when we have that first contact whether it's a health visitor or anybody else we need to ask about them and their worries I'm a black woman my daughter is of childbearing age my first worry is oh my god you are three more times likely to die in childbirth that is my first worry for her being pregnant not congratulations yeah you're going to have a baby my first worry is what is going to go wrong for you therefore that's what we need to do with somebody that's about the training we need to reframe the training for our staff around former informed and what are the worries of our BME and global majority women because if you get that bit right you will get it right for everybody that will pick up any mental health issues that that we have with amongst our communities and be able to address them so we are working with our mental health providers we very much need to work with our charities in our communities in in in Hackney more than we do the NHS are very very poor at working with charities they are the ones that can really lead the way in this space so we're going to have to do a sea change of investing more in charities than we do at the moment because charities cannot survive because we keep taking cuts to charities and we need to do more for those charities if we want to see any difference the final bit I'll say is that we need to make sure that those appointments that women have are focused on their needs if everybody has half an hour that is a sort of one size fits all and it doesn't fit all where women have less needs their appointment should be 10 15 minutes and we add those additional minutes onto women that have additional needs so one of the things that we're looking at within the LMNS the local maternity neonatal system is that we want to reframe the appointments we do not have additional time but we want to reframe the time that each woman gets so that it's tailored to what their needs are and I think the final thing I wanted to pick up was that we are absolutely hearing the same thing over and over that continuity of care and continuity of care is really really important that's the part we've got to also respond to and I think one of the speakers said that as much as the woman may have a poorer outcome if she's had continuity all the way through she feels informed as part of her decision making it's more likely that she is comfortable should I say I don't know what she's with what that outcome is but she feels she understands and she was part of that so two key parts of training going forward is around how do we really ensure that women and pregnant people are informed on the decisions that they're going to be making and how do we get it right based on the needs of those individuals as opposed to a one-size-fits-all and those are the things that we want to take forward so it then encompasses the needs of women who have mental health issues the consultation that we just did was around the case for change we were looking at is there a need to change maternity services overwhelmingly everybody has said yes we need to make changes what we're now taking that feedback into is what should those models of care look like and that's the next phase of the of the maternity and reconfiguration that we're looking at and Diane the fact that the consultation did mention mental health that still will be a key part of the new configuration it definitely will be it's mental health and the other thing that came out really clearly was learning disabilities and women's access where they may be deaf or have other disabilities we need to start to tailor it towards the needs of individuals so mental health will be a part of that and the very last word to counselor Adam can you just repeat your question for Diane please all right please can so it says that one of the objectives of the NHS long-term plan for community perinatal mental health teams is to increase the availability of specialists PMH community care for women who need ongoing support from 12 months after about 24 months so I was just wondering what's been done in this area or if anything's been you know if anything's going on at the moment to make sure that this service has been put in place thank you thank you for that so it's an ambitious ambition aimed within the long-term plan we've got to be able to factor that in within the cost envelope that we have because we don't have a huge resource of people what we're looking at is new roles that can support women in their mental health so it won't necessarily be specialists in mental health but we are looking at having support workers who are trained in mental health that can support that pathway for women. Thanks Diane I'm going to wrap it up there and thank you to all our I've got I've got one more oh Fabio hey sorry sorry I just want yeah sorry my name is Fabio I'm the one of the operational lead for the perinatal team in Acne I just want to add something about the ambition of the NHS England to increase the perinatal intervention from 12 to 24 months as a perinatal team in Acne we have been accepting referrals since three years now over 12 months and what we have done we have been able also to keep our clients longer in care while before we had a cut day that it was 12 months now we are able to keep our clients longer for you know to to offer more intervention and in a longer period of time but yes we have definitely opened up to this to this ambition and yes since three years since the the NHS ambition was set up we have starting started to accept referral over 12 months so I just wanted to add this because you know we are quite proud of something that we have been done in terms of what NHS England has asked us to implement so you should be well done thank you thank you thank you for that thank you thumbs up from Councillor Adams I'm going to draw this out because a very big thank you to all our contributors for a fascinating and well-informed discussion as to where we're at I think it's clearly something that once Diane has maybe published the results of the consultation and maybe at a point when we maybe have more data if the hub could help with that it might be a good item to to return and I think there's been some very useful suggestions made by colleagues as well so thank you very much everyone for attending I'll draw that item to a close just for the remaining items on the agenda members can I have last meetings minutes agreed please work plan is at the back of the agenda for noting I haven't been notified of any other business and with that I close the meeting thank you very much everyone