Transcript

Hello and welcome everybody to the November session of Health in Hackney Scrutiny Commission. I've had apologies for absence from Councillor Rathbone, Councillor Adebayo, and also from Bazarit Sadiq, the Chief Exec of the HOMITUM. In terms of the general announcements, this is a hybrid meeting with some people in the chamber and some people online. For those people online, please keep your camera on when it's your items. Please keep your microphone off unless you are speaking. Please do not start conversations in the chat because they're not being looked at. We have got various members of the press, student press, welcome here, watching us in the chamber and we are being live streamed and members of the press may be watching. In terms of declarations of interest, are there any of these members? Councillor Patrick? The microphone please, Councillor Patrick. Item 7, I've got non-pecuniary interest in that I sit on the Management Committee of Hackney-Marsh Partnership Group, have a contract to deliver advice in health settings. Page 39 of item 7. Fine, we'll come to that in due course. Any others? Lovely. No, Councillor Tudeloff, sorry. That's okay, Chet, thank you. I've recently been elected as Governor for Hormeton Hospital, so I think you need to declare that, yeah? Thank you, congratulations. Thank you, very proud, thank you. So, with that then, we've got four substantive items on the agenda. The first of those is an update with respect of the City and Hackney place-based system. Of course, Bazarit is our place-based leader. We're joined today by, in the Chamber, Amy Wilkinson, who's the Director of Partnerships, and online, standing in for Bazarit, Breida McManus, who is the Chief Nurse at the Homerton. Amy, thank you for the helpful paper in the agenda pack. I think I'll hand over to you for the update. Thank you. Thank you. So, Bazarit is unable to be here tonight, and also Steph, but just by way of really quick introduction, we came and presented, I think, this time last year on the place-based partnership. And at that point, we were partway through a now integrated care board restructure, and we talked through some of the impacts of that on the place work and the wider work. We, I think, a year on are in a much more stable position. We are clear about who our team is, and there are staff structures and things like that in the pack that you can see. Bazarit has been our system leader since April, which is great. She has a really clear vision about where we're going. We also have worked with Andrew Ridley, one of the NHS ex-directors of transformation for the last three to four months, helping us think about how do we future-proof ourselves as a police partnership? What sort of shape do we need to be in to be kind of key players as part of the ICB? And what do we need to do going forward? So there are a lot of his recommendations in the pack, just for interest, and we're working through what that looks like in terms of implementation. So he acknowledges good levels of partnership, relationships, so no surprises, but a good joint vision that steered us toward choosing a few very crisp priorities. So these are details in the pack. I think probably the only thing left to say really is that we are now working as a place team to organise ourselves through the programmes, but also to articulate what each area is going to do around our three crisp priorities, which are integrated commissioning and services, moving forward with our population health work and prevention, and the next phase of what neighbourhood ways of working might look like. Thanks, Amy. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. Thanks. I think Amy has covered all of us. Thank you. Thanks. Amy, can I just open it off in terms of just understanding where we're at? I mean, this time last year there was concern in terms of, because of an NHS England instruction about a cost saving in terms of the clinical leads and a reduction to those. And I think you'd worked through a way to keep the positions in place of the same staff in place for another year. Can you give us an update on where you are for that? Yeah, so we have a relatively stable clinical leadership team in general. And we have retained all of the clinical leads that we set out with at the beginning of last year with a small top up from some very historic place funding that we had. We are in a position to do that again for 25-26, but we will be looking onward about how we structure ourselves in terms of our clinical leadership. There's not been a directive to further reduce, but we are running at slightly higher than we are funded for centrally. Just on the same vein, obviously we went through several years, particularly during the CCG period, where we sort of had somebody particularly looking after or focusing on the Hackney GP surgeries in the form of Richard Bull. I'm sort of looking at the sort of the new structure and I'm not sort of, it's not jumping out at me anyone's necessarily replacing that role. I mean, is this just a consequence of the new system that there is nobody filling that post now? Or is there somebody at a higher level who's doing it for all boroughs and in reality that doesn't mean much for Hackney? Yeah, so there you can see the primary care team just on the top of the structure there. So all of the primary care work in terms of the management and the team have been centralised to the ICB, but there is a small team dedicated to each place. So we have a band 8C by way of Helen Goodrum, who has been new in post. She's been in for about three months now, I think. So she took on a lot of the work that Richard would have done. She's quite new. There are also a few posts, a handful of posts underneath that dedicated to City and Hackney. But I think it's fair to say that that team has probably lost a bit of organisational memory. Although there is capacity building back up there. Thank you. So I've seen Councillor Adams and Councillor Luthers. Yes, Councillor Adams first. Yes. Thank you. Thank you for the presentation. On page 12, you said we have absorbed a 30% reduction during 2023-24. Is this 30% budget reduction? If so, what impact has this had on your operation? So that's the 30% reduction that Councillor Hay has just referred to. So we made that following an NHS England directive just during year 23-24. There's not a further directive to reduce, but we are supplementing some of that at place. Thank you. Impact, has that had on your operation, the way you operate and everything? Yeah. I think I might actually, if she doesn't mind, hand over to Kirsten. So Kirsten, I can see, is our clinical lead for primary care. So I think she'll be able to answer that a bit more helpfully. Hi then. Kirsten, over to you. Just being landed with that one. So I think just firstly to talk about the primary care team, then coming back to what you said, Councillor Hirst, about the new team. So we do have a new team. We've got, as Amy said, we've got Helen and we've got two other people, Teresa and Howard, working with Helen. I guess they work closely with me and I've got some, you know, I've got a long history of working within the previous team. So that helps the transition to a degree. But also I think what really helps is working with, closely with City and Hackney integrated primary care, who I know is on the agenda today. But I think that we've formed a really strong working relationship with them, meeting with them every week to try and establish a strategic plan for primary care and City and Hackney. So that was that bit. What was the other bit that I wasn't instructed to answer? The impact. The impact of the reduction in the primary care funding. Or the impact in the reduction, the 30% reduction in clinical leadership. Yeah, I think it, I mean, there's definitely an impact for sure. I think that we have to work in a different way. And we all take, we're taking on different roles within that. I think we have to structure ourselves in a different way. And we have to look for leadership elsewhere as well. So again, you know, when I'm in primary care is my area. And so I work very closely with the primary care leaders within the PCNs, the clinical directors who are funded elsewhere, from elsewhere. And also, of course, they, they sit on the board of City and Hackney integrated primary care. So I do think we have to look for different ways to get our clinical leadership. And then also we have to think about how we work with it within Nell, because obviously Nell also have clinical leads in certain areas. And we need to make sure that we, I think we have to increasingly make sure we're tapping into that as well. So it's a getting balance. Has it made a difference? Of course it does. The more clinical leadership, the better. But we do have to think about working in slightly different ways and getting our leadership in different ways. Does that help? No, thank you, Kirsten. Yes. Councillor Lucas. Thank you, Chair. And thank you for your presentation. Really useful. I just had, so page 12 again on the final point, the one around funding envelope. I just wondered if you could dig down into that essentially. It seems like there is ongoing discussions around what will and won't be devolved to place. And I wondered if you could just dig into that a bit. Give us an update. Where are the blockages within the system? And essentially kind of what are the contentious elements of that? When will we see resolution? That would be really useful to just hear a bit about that. Thank you. Yeah. So at the moment, it's an ongoing discussion. I think we've been having discussion for a couple of years. And there have definitely been different indications at different points around what that might look like. There are quite strict instructions in terms of NHS England around the ICB having one ledger. However, within that, they are starting to desegregate some of the budgets according to place. So we have nominal budgets. So I, for instance, authorised some of the contracts that are specifically linked to City and Hackney. So we are getting a much better idea about what we spend now, what went into the ICB in terms of contracting from City and Hackney. It hasn't all shaken back out yet. We also are starting to get, we've had three months worth of activity monitoring and spend, which has been really useful and just started to get a bit of reporting around the details on our BCF and other areas. So in terms of the processes and the basics for making that happen, they are happening. We don't know where it might lead in terms of an actual devolved budget, but I think it feels like we're in a good position to think about what might we want. We also need to be really careful about what we say that we want to be responsible for, given the climate. So it does feel like that conversation is moving slowly. Councillor Lynch. Hi, thank you. I just wanted to ask a question. And obviously it's really great that we've got Breida here this evening, but I can't see a nursing voice, SRO, in any of this, which is a little bit disappointing. So I'd quite like to know why that isn't there, because quite a lot of other place-based leadership teams would have the nursing voice in there. So, yeah, it was just around that really. And just in terms of your hierarchy of people at the ICB, there seems to be quite a lot of people. And it would just be really interesting to know the detail of what they're actually focused on in terms of the delivery and what that will be in terms of doing particular program manager positions and such like. Are they linked to national standards that are in place at the moment currently for performance within the NHS? Or is there scope for them to be able to adapt and flex to what we expect to be coming down the road in terms of increased productivity? And for us as well, there's a little box that says quality and safeguarding and a little box that says medicines management, which probably for our residents is their biggest concern is about how they're treated and how they're kept well as well. So that would be great if you could answer that. Thank you. OK, can I ask you for a couple of clarifications? So when you talk about the nursing leadership, are you talking about the structure on page 20 and 21 or are you talking about the the chart on page 13? You have no, don't have a chief nurse as an SRO. You have a medical SRO and I don't know if you have any clinicians in your in your structure chart on page 13. So, so we have a really solid number of clinical leads who haven't included the clinical leadership chart in here. I can send that round to afterwards, but there's a lot of clinical leadership. Gaston can probably talk to that a little bit more. There is a chief nurse in the ICB and then the posts that you can see on page 13 are the largely the management posts. Some of them have a clinical background. Some of them don't, but they are delivering the NHS functions. So essentially the commissioning functions as prescribed by NHS England, but as ICB staff, but in city and Hackney place. The in terms of the proposal on page 20 and 21, this is about how we would like to shape ourselves going forward. And they're according to roughly three program areas that they're quite similar to what we used to have, but strengthened with SROs. We haven't had SROs for some time. So start well, as you can see, a director of children's services and a consultant paediatrician live and age well. So adults are director of adult services and the chief operating officer at Homerton and for mental health. That's the exact director for the city of London and the director for East London Foundation Trust. So there are quite a bit of clinical expertise in there. There is an ongoing conversation around potentially a community matron, something else in terms of supporting live and age well. But we're really at a point where this structure has just been agreed in the last few weeks and we're still working out what it exactly will shake down and look like as we go forward. But I don't know if Kirsten wants to come in again on the way that the clinical leads work with the team, if that's a concern. I can answer that. So, I mean, the first thing to say is the clinical leads don't or aren't all doctors. They come from a variety of backgrounds. So doctors, nurses and allied health care professionals such as physios. So we are a range now. I mean, it used to be when we were in the CCG days, it was very much the clinical leadership was very much general practitioners. Now we're from a variety of different backgrounds and we all work within our team. So, you know, as I've described, I work within the primary care team and then the other clinical leads will work within their particular team, whether that's live well or start well, et cetera. So I think that, you know, there's always we've had a really strong history in City and Hackney throughout the years of working with clinicians, with managers and with residents in that kind of triangle. And I think that we are keen to keep that going as much as possible. Just today we were talking in one of our primary care meetings about how we can engage with make sure we are engaging with our residents in a good way. So I think we will continue to work like that, clinician alongside managers, alongside residents to try and get the right balance. Councilman Lynch, do you want to come back there to go? No, I just want to say thank you very much for answering the question. Thank you. Thank you. Thank you very much for the presentation. I just wanted to check or to hear what perhaps your thoughts are on maybe what you foresee as a challenge within the strategic focus program areas that you have, giving every child the best time in life, improving mental health, and preventing mental health, ill health. And the last one, preventing and improving outcomes for people with long-term health and care needs, given that there will be potentially upcoming cuts, significant cuts to budgets. What do you foresee will be the challenges to deliver these strategic focus program areas? Thank you. Thank you. So many challenges. I'm not quite sure where to start. I think so we are working on a delivery plan that focuses on the three key deliverables. And once we're a little bit more more clear about where we're going, we can bring that back and you've got to see that more of the meat of what what we're delivering. But I think so that financial climate is difficult. We went into the ICB financially sort of break even in a good position. We've gone in with a lot of partners who are not in that position. And we've had a really strong history of good outcomes and innovative work. There is a leveling agenda. There's a lot of work around equity and equalities, rightly. But what that does mean is that there may be redistribution of growth. There may be less for some of the work that City & Hackney does because we need to support our partners. So the financial climate is really difficult. What doesn't change are the challenges that we have anyway. So challenges around health inequalities, around some of the highest rates of serious mental illness in northeast London, huge rates of childhood obesity, all sorts of things, lots of long term conditions and historic work that we've been looking at for a long time. So levels of childhood immunisations, there are some really entrenched challenges that we have. So we continue working on those and I guess kind of maintain as much as we can in terms of pace and services and quality of services as we go forward. There are, having said that, opportunities and you know that we've done neighbourhood working for a long time since about 2016. And that's quite well embedded and this has now become a really vital agenda in terms of NHS England and in terms of the London region. And we've got partners, so Newham are just starting the neighbourhood journey, Barking and Dagenham are also taking a few steps on that. But it's a huge priority for northeast London. So I think we're in a good position there to lead some of that work. And that will definitely be something that we continue to push forward and continue to use to tackle some of those inequalities and some of those challenges. Thanks, Amy. Just so I understand, if you wanted to say do some work on driving up immunisations, do you yourself at all have any residual budgets where you could decide to commission that? Or essentially do you then, do you have to go to the ICB and say we would like to do this? I'm just trying to get my hand as to whether you actually have the levers on any funds to have discretion to do what you want at the moment or not, to choose or not or not. That's an example to not avoid answering the question. So forget immunisations, that was an example only. We don't really. We don't have devolved place funding. We don't have a place budget that is ours entirely to sign off. I understand the action. Sally has been waiting patiently online. Sally. Thank you. And speaking to what you were just saying about the levelling agenda really, and just to be clear, Amy, this is not aimed at the place team. We've had conversations who have been very supportive, but I thought it would be useful for members just to understand how that budgeting affects, for instance, grant agreements with third party organisations. So obviously I'll use Healthwatch Hackney as an example, but it goes across. So I know from, and it goes through conversations with Hackney CVS and Volunteer Centre Hackney, Older People's Reference Group. These are all the third party grant agreements that come through the NHS that were originally place based back in CCG days and work really, really well. And stuff that doesn't exist in the other boroughs and now feels very threatened budgets that are shrinking. So I'll use Healthwatch as an example. You know, we work with over 50 public representatives. I believe that the system thinks it's a really, really helpful system and a way of working. But that's exactly the kind of thing which is very much under threat because of not having the devolved budgets. And we stand to lose a lot of that voluntary sector and Healthwatch type engagement work and those kind of arrangements because of the way the funding's set out and the levelling agenda. Amy, I know we've talked about this and you've always been very supportive. It's more just for the members to be aware of kind of what the impact can look like on the ground for work that we've been very proud of in City in Hackney. So just kind of putting it out there for your information, really. Thanks, Sally. I've got a follow on for that, but I'll bring Councillor Patrick in first. Thank you. I suppose it leads on from discussions that we've been having about the... I can hear myself, it's horrible. about the stresses between the play space system and the ICB. I mean, about the, yeah, how we, how the Homerton leads, Baz, actually manages, how she can advocate for City in Hackney, yet she's obviously has to report back to the ICB. And there's a conflict there. And I just wonder how, um, Baz, as, as this person for City in Hackney, we keep hearing that, um, we have to support partners elsewhere. And when we went into the ICB, had a quite, had a decent budget and significant reserves. And we now know that, um, that's all gone into the ICB and some of it's gone elsewhere. So I just wonder how we can fight for Hackney within the ICB or we can't, or are we saying that we, we can't, we just take what's given to us? Amy, do you want to, or Councillor Kennedy who sits on the ICB board, do you want to? Do you want to go first? Yes, I think it's, it's important to remember that all those, uh, leaders that the, uh, of the acute hospitals, um, in our area, and I include Baz in that, are in regular conversation with, uh, at ICB level. So we had the City and Hackney healthcare board yesterday. Um, and Baz was reporting back on conversations that she had very recently been having, um, with Zena, um, who's the chief exec at, um, uh, NHS Northeast London and Henry Black, who's the chief finance officer at NHS Northeast London. Um, so she's in those conversations with the right people all the time. And I, and I did want to make the point about, um, so I'll make a gesture. A general point based on the IMS and VACs paper that we had yesterday at City and Hackney health and care board, which is that although we can't say, look, we want to do this, here's our extra good idea. With the chunk of money that comes to us, we are allowed to shape it locally. Um, and actually one of the things we were, um, uh, commenting on yesterday was that, you know, there was, uh, there were measles outbreaks, um, around London, in other parts of London, they weren't in Hackney. And that's because based on what we'd learned about how best to get, um, IMS and VACs out to our population, we'd managed to stave off what had happened to us in other years of measles outbreaks, which is we didn't have, um, um, any big outbreaks, um, in any of our communities. So you can, you can use your local knowledge and expertise to shape a more centrally given budget. I mean, I mean, it would strike me that what we were able to do when we were in control of our own budget and destiny is be far more innovative over far more areas. And tell me if it's not fair, but that's some of that's been lost. Um, cause we don't have that flexibility in it, you know, you know, you know, just being honest about it or not. Yeah. Just being honest about it. There's far less resource. I mean, the NHS is facing the same problems that local authorities are facing. Um, and you have to be, you have to be very careful and take those choices and get the maximum benefit out of what might be a smaller amount of money. Just on that, but just, but just also on this levelling debate, cause I think, um, Councillor Patrick made the point that under the sort of the demographic weighting when we're in the CCG structure, it didn't do too badly compared to other areas. Um, obviously we're in a new slightly different financial structure now. Oh, and I'm not, I'm not making a judgment call whether this all is right or wrong, because obviously it's like the very notion of levelling, it could be right. There's a greater need elsewhere, but are we just mapping funding that was coming into Hackney that perhaps no longer is if say contracts aren't being renewed that focused on Hackney, but that money is being spent elsewhere. Is anybody even mapping or thinking about that now or not? Or is that not, is that not being considered? Yeah, I can take sort of take that as much as, as much as we know at the moment. Um, so we, I think it's probably important to say that we, I mean, we champion City and Hackney every day. Um, and, um, but not too much, so they don't think that we, yeah, that we're annoying. But, um, the, we haven't actually cut a huge amount. The contracts that have been vulnerable are those that have, we've funded non-recurrently in the past. Um, and for lots of things we've managed to keep them going a little bit or long enough to, to find a sustainable route. So, um, there, over the next few years we will need to make, uh, more significant changes with our partners. And, and we're really committed to trying to do that together. We've, we've got some finance sessions coming up together as part of the board. Um, also to, to make sure we're aligning and we're not impacting on the same group in terms of, of what we're looking at efficiencies from. So, um, we do, we do still have a good chunk of funding. We still have the majority of the contracts that we had in City and Hackney. I think, uh, flexibility and being able to go, I would just like to do this. Here's, here's a bit of funding is not there. Um, but we, where things are really amazing, we've still managed to make a case. Like we, we recently got a parliamentary award for some of our cultural work in, in schools around mental health. Um, they've agreed to fund that even though it's been non-recurrent for a long time. So there is some wiggle room. Um, and we do continue to fight for that all the time. Um, thank you. Um, I've got one or a couple of minutes left. Is there any last question before I bring this item, um, to a close? Um, well then I will, um, thank you, um, Amy and, and Breida and Chris for that. It's very useful for us to get an update on where we are. Um, and for Kirsten as well. I think, um, it, it, it may be useful to get, again, update and again, a year's time just to understand where we are and if there's any update on those, those pressures you've talked about. Can we also just have the clinical, um, chart in there next time as well? Just so we can sort of, um, uh, understand that as well. So with that, I'll bring that item to a close and, uh, thank all those, uh, people that attended. I'm now going to move on to the, uh, next item on the agenda, which is the update on the soft facilities services contract at the Holmerton. Um, as I've already indicated, the chief executive of the Holmerton at Bazaret Centre, apologies, but we're joined by the director of the estate. So welcome Natalie, uh, Firminger. Uh, she's joining us online. Um, we've got 20 or so minutes for this item. The update is just to bring everyone up to speed. Um, but a few years ago now brought its soft services facility. So e.g. the, um, porters, cleaners, security staff in house. And we've, um, kept seats and sought to keep this as a sort of non-running, uh, question for the Holmerton as to whether they would be able to do the same thing in terms of being able to offer parity of terms, um, um, to their staff. Obviously, one of the points we've picked up on is that some of those staff employed by another agency in those roles didn't get the COVID allowance or the COVID bonus. So there are, there are sort of quite significant concerns about it. Natalie, can you give us an update on, on, on where we are and what hope there may be in the future to bring this service in house? Good evening. Um, I'm Natalie Fermiger. I'm the director of estates at Hackney, um, and at Homerton. I've been there since the end of January. Um, so I know I've met some people on the room, but not quite everybody. Um, so really nice to meet you and thank you for the opportunity to come and update you. I think, um, as outlined in the papers, the trust has undertaken, or since I've started, a review of where we are with soft FM services. Um, and when we talk about soft FM, we talk about core services. So catering, cleaning, portering, security typically. Um, and in Homerton's case, we've got some other services such as press control, window cleaning, which are slightly more specialist also included in our package. So we've been undertaking a, um, options appraisal, and we've taken a number of papers through to the board. Um, it is at this stage, correct to say, we are looking at all the options. So we are looking at total insourcing, which would mean that we would directly employ certainly the catering, cleaning, water security, as staff members and run those services ourselves. Total outsourcing. Now, when we talk about outsourcing, everyone assumes that that would be, um, ISS, which is our current provider. But when we talk about outsourcing in NHS procurement world, we are considering partnering with another NHS trust. Um, for example, but this may be an option of a provider. Um, we are looking at the potential to work with Hackney as a provider. We are looking, it's just the way of the description is just the way that the NHS procurement contracting works. It means that we have to have a service best, and we have to go out to the market, even if we end up partnering. So we put those options in, even if we are talking about outsourcing. And then one of the other options would be to do a hybrid model where we take the specialist services, which quite frankly, any other provider, they buy their specialists. So you would buy a specialist pest control company, but we would manage them. So I'll just sort of put that into the context of the descriptions that you will see in your paper. They're slightly wider than what you would typically consider. Um, we also are looking at the resources to deliver each option, including our own corporate resourcing. Um, I am the director of estates and facilities, and everyone thinks that that all lives in my world. But actually, if you look at the whole system of what you need to deliver these services, it also includes things like procurement capacity, HR capacity, and corporate function, education, all of those things as well, and finance, obviously to run these services. So it's slightly wider than just the estates and facilities that we need to consider. Program, which I'll come back to, to deliver. Um, because the reality is you don't stop on one day and do something on the other. There's always a transition period. Um, we're also considering the strategic case, and that's both for Hackney and for the NHS as well. And the phases by which we can do it. Um, I've noticed in your paper that, and in your introduction, Ben, thank you. Um, the board have recently taken a decision to extend the ISS contract. The reason for that is twofold. Um, when the last contract was extended, it was in the middle of COVID. And so ideally all this work would have started then, but because of COVID, it couldn't. And, and, I've been in place since January as a substantive member of staff. Um, but previously to that, it was a quite fragmented, minted interim run service. this and it's quite a specialist knowledge and stable workforce that you need to be able to deliver this to evaluate it so it just took a long time to recruit me in fact Baz said the other day apparently it was five times but I'm hoping that I live up to that so Natalie we've extended it for a year until September 25 that's right that's that's the current position from 2025 to 2026 to give you time to do the options appraisal now we're in post time so in other words you've got this ICS goes on for two more years pretty much from now I mean is there a strong will to try and have a different resolution come 2026 September 2026 absolutely we need to do the options appraisal and we obviously you've mentioned BARTs and I've previously worked at the Royal Free we've done this both ways there's a lot of lessons learned at the moment that need to be factored in we want to make sure that the options appraisal is covers every single item so we know fully the decision that we're making thanks Natalie I can see Breida I've got a few questions in the chamber as well shall I bring Breida in first and then I'll go to questions in the chamber so Breida thanks Councillor I think clearly I think Natalie has articulated the key to planning here we need to ensure that we plan and that we are in doing due diligence and it is a you know it's quite a process that we need to do to look at all and consider all the options so I think hence why we've extended the contract by 12 months so that that will give us the opportunity to do this right and I think as Natalie has said already clearly we now have a robust leadership team within the estates and facilities function at the Homerton and that expertise will help ensure that we do this correctly and that we get the right result at the end so I think just to reiterate what Natalie said and support why we've taken the decision to extend the contract by 12 months thanks Breida Councillor Turpinel thank you chair and thank you Natalie that was really helpful to hear um I just have I mean I have so many questions but I'm just going to ask two brief questions um it would be good to understand what sort of provision workers will have during this sort of extension time um if you could tell us that would be really fantastic also if there is anything that has been done in terms of the covet payment which they weren't entitled to receive um in my concern is that large proportion of them are global majority and black workforce and we've seen them protesting and I think we're all aware so be good to hear what what can be done about that thank you so in terms of the first point we have sought legal advice on the feasibility of extending the contract one year we can only do it by date we won't be able to just change conditions at all we will just be able to modify the existing contract will run for another year um I'm a thought really the covid payment was before my time and I honestly have not had time to do the history lesson to be able to answer that question I'm just here to talk about it Breida might be able to come on to that one Natalie yeah I think just to support so I think um in relation to the covet payments I know that our director of people um we are continuing to review what is possible I think as Natalie has said we're unable to change any of the terms and conditions but we are liating closely with ISS and the key bit here is making sure that we're communicating with ISS to work with them to see so the senior management and ISS to work with them to see what is possible in relation to terms of conditions because clearly what we need to do is is to have those negotiations we clearly are unable to commit at the moment as to what the outcome of any of those conversations will be but I think from a trust perspective we will continue to review and have those conversations because we understand in relation to the staff and the the difference in terms of reference so those conversations are continuing okay because I mean I see some I mean does seem quite arbitrary that if those for example that were brought in by BART would have got the COVID penis but those at the Homerton who were outsourced didn't I mean even even in terms of parity of people doing exactly the same job it it just seems quite um well it seems very unfair but I mean I mean I mean that that's a comment from me I mean Councilor Adams and then I see Nick Mann is one of our GPs thank you thank you for the introduction on a page 26 of you know of the um pack yeah you said the trust have now recruited a monitoring team directly mailing from ISS so I was just wondering how can the contract contract provider also be a monitor and how were you monitoring them before this and was the was that insufficient somehow so these are my questions thank you and can I just bring Nick in now as well please because we're slightly running out of time do you want to use the microphone you just explained you're still one of our GPs aren't you you're still one of our GPs in Hackney aren't the question is mainly uh around how it will affect uh particularly sick pay occupational sick pay adapt anti-social hours um because these are big sticking points in terms of uh changing contracts and also how they would be two feet across um we do have very extensive um precedent for insourcing um these sorts of facilities and given that we're supposed to be a unitary team in in Barts um and the expertise has already achieved that insourcing um I'd like to know really why why it's taking two years and also just to make a comment the um covid changes where we fought to get increased sick pay during covid um that was paid by the trust it wasn't paid by air ISS at all um and so ISS have played hardball to an extent which I think is unreasonable and they are an extremely large company um so I think do we want to if we're looking at those kinds of terms then I think we need to meet those sorts of terms uh in an equally hardball way we can insource I understand there is a an option to partially outsource or locally outsource um but insourcing really is has precedent it is cost effective it strengthens the team itself and the people who work in that team both for patients and staff um and it provides a level playing field for the services and the terms and conditions which we would want to see across the NHS not in pockets um dependent on how strong the private sector lobby their terms and conditions thank thanks Natalie do you want to take those two questions councillor Adams on um ISS also monitoring providing the monitoring role and is there a conflict and also next question thank you so if I just take a step back before that just to reassure you we have set up a trust partnership board with ISS which has previously not been into place and we've got the first meeting next week being attended by Baz so we are taking very seriously the concerns being raised and we will be addressing them in partnership with ISS um and that will be a partnership board going forward um in terms of the audit question the right there hadn't really been an um an audit function um so we've brought it in um it's pretty typical and other trusts that we worked in we haven't just taken people from ISS the jobs were advertised but as part of development some of the ice steps ISS staff applied for the job and got the job and they're great and it's really good to work together with them and their knowledge of ISS and it's creating a bridge with the team we are actively managing the ISS contract and all the terms and conditions probably in a more strenuous way than previously um and also just to note the trust are paying annual leave payments to ISS the trust that took that decision i believe about 18 months ago i think specific one was on sick paying out of hours though is there parity of those of those hats so there is in terms of the payment because the trust pay the extra payment the actual overall ISS sickness policy is not the same as the NHS so in the NHS it's not paratable that you can be off sick for six months before you go to half pay then half pay for another six months it is not paratable i'll be clear about that but we are uplifting sick pay quite significantly over the last couple of years to ensure that we get greater parity across our workforce thanks nathalie so i think i've got the final three because i'm running out of time here council lynch council of lucas as well did you have a question no so council lynch can't come along and they'll bring it to a close um so just a bit of a plug i'm sure you're aware that um that the council itself has quite a proud record of insourcing um we've been quite successful in that because we've recognized that the council very similar to homerton has been a huge provider of employment for our local residents um so it's more of a statement but my question is is one have you considered uh working and understanding how the council's been able to do that because they we've also been in you know equally difficult financial positions um but for me i think this is actually around um the fact that a lot of the staff that work at homerton um whether or not they're wearing a homerton uniform or an iss uniform they will say that they speak they work at the homerton and i think that's an absolute um something that you you really need to hold on to as well because you know we we recognize that a lot of the roles that you're talking about are those sort of roles where they are not always you know seen but they're very much well well welcomed by the by patients as well as they're being wheeled around or if they're having their dinner done or what have you so um yeah it was just a question around that because i know i had experience in my professional life and i'm sure someone on the call will as well that i remember at bart's health when they moved their substantive staff to circo and there was a lot of you know men that used to work on the docks and used to work in different roles that were really proud they had some sort of sense of you know self-worth that they worked at the london and now they felt they worked for some sort of faceless sort of company so i do think there's a real uh i think across for me and i'm not about other members in the chamber that we we are very keen to see that you know a majority of the people that work with iss at your organization are our residents and we want to see that they get the best deal out to be honest thank you um counter the level i'll take these two and then over to natalie to reply thank you chair i just yes i fully support what councillor lynch has said uh myself as a former cleaner working as well as an outsource worker i can tell you that it makes a huge difference when you're in source and you have those workers rights that we fully deserve um i just wanted to check the last time chair the last time we had the an update on the item we were told that trade unions will be more involved and i remember asking this is there any update that we can receive on how the trade unions have been involved in this decision of extension thank you actually over to you for those two please so back to the original point about working with happening that is absolutely what we would like to explore and i know certainly conversations with my new bosses the cfo have started around that it's very early days she's new as well but we're absolutely really committed to learning and sharing with happening about that and i would like just to say we are we have shared all our training except with iss and we definitely consider all of the staff one team and some of the iss staff have been there a long long long time and they are really great with sharing their stories and working with us and so it's absolutely our intention to protect that and the local workforce in every option in terms of the um liaisons with the unions in terms of your future plans we have been updating our staff side unions every month and my next meeting is on monday they're very much involved in our decision making and i liaise with them regularly as does our chief of people okay thank you i'll bring this item to a close but i mean if you are i know procurement decisions take a long period of time if you are to um enter into a new um arrangement in september 26 it would presumably the contract would have to be signed a year out so eg september 25 um so could we pencil you in for either july 25 um for what would hopefully be um an update as to where you're up to yes we're committed to keeping you updated and sort of for my own personal services that i run and these things take time so i would be pushing internally to make sure that we've got a decision by then so we've got a chance to roll it out and so i think that's perfectly reasonable i'd be more than happy to do that um thank you well well thank you coming thank you for um for filling in for baserata um and and for uh giving the updates um i think you've clearly got the sense um from all of us here this is is something that people feel um strongly about particularly bearing in mind bart has managed to uh move in the right direction on it and so um it it will be good if our um local hospital could do the same as well so but thank you thank you for your time and and with that i will uh bring this item to a close um how i now move on to the uh next item on the agenda which is item six is that the new gp provider provider organization we were due to be met um or here by andreas lambriano who is the um uh chief exec of the gp i can't see him online i'm saying kirsten are you i'm not sure if i'm if i'm landing you in it again tonight by the look on your face i might be um yes i am so um we were due to have an item um i'm not quite sure what's happened to our speaker on the uh new gp provider organization taking over from the confed um and we were expecting andreas lambriano who's the chief exec to be here i don't believe he is um it may be we cannot um spend too long on this item but are you able just to give us an overview we understand the confed has merged into this new organization with the pcns can you give us some update on what that organization is doing and how is it functioning um if you're able to without unexpectedly i can do my best um waiting to present at all um uh so where can i start so we've for for as as you'll all be aware the gp confederation has been a long-standing provider organization for g for general practice all the gps in city and hackney um in more recent years since the um since we started to have pcns um the pcns the eight pcns in city and hackney came together at um in an umbrella organization called the office of the pcns so we had essentially we had two umbrella provider organizations in city and hackney um both of which um had important roles the confederation obviously had the historical um knowledge of working with practices and supporting practices and helping practice to provide um our locally enhanced services um the office of the pcns much of the new funding for general practices is coming through pcns and the office of the pcns were providing that umbrella organization to help um to help um with those services so the um but what this did mean was we had there was it was quite a um divided um gp provider landscape in city and hackney and what we felt it was really important as the leaders of general as in the leaders within primary care was that we had a strong voice um of um general practice within city and hackney and we had a strong provider organization which would could work as part of um the city and hackney place-based partnership um and so we've been working over i mean over the last two years but it's really very intensively for the last year um to bring those two organizations together and to merge into one organization and that happened on the first of august um this year so this um this new organization and it is a new organization um um is now called city and hackney integrated primary care um it carries on the with the um functions that confederation did before and also that the office of the pcn did before but it provides us it um with a stronger it puts us in a stronger position within primary care to continue to deliver those services and it gives us a stronger position in which to act as a partner within the place-based partnership um the the coming together has been hard work but actually the transition was really smooth we've retained all the staff from across both organizations so we've got that organizational memory and that really um so so the the people because of course it's the people that help provide the services that make the organization what it is and we've retained that from across both organizations which has been amazing um so now it's consolidating that and making it an even stronger organization going forward um i think it's important to point out that we are the first um area in the whole of the country that has done this that has brought their pcns into within the g within a federation um so all our pcn clinical directors sit on the board of the organization and provide clinical leadership for that organization and that's really important because as new services come up um they are being driven commissionally from the assistance from central this from nhs england they're being driven through pcns so we've got now a structure where we can um hopefully do that in a really in a strong way um across city and hackney um in terms of the kind of the organization setup i'm not part of the organization other than being a member from a member practice so i can't really talk to the organizational structure i hope that was helpful that yeah that was very helpful thank you um and i know and do you and i appreciate you might not be able to answer these questions but previously the um confed had quite a healthy pot of money i think at one stage even up to a million pounds a year in terms of various contracts it was giving out to different gp practices is that still at the same level or is that have we seen a decrease there in terms of um uh what what is that well how much has been passed forward it's a new organization or is there a decrease now do you know so as it stands at the moment the budgets have not changed so that all the money going into the confederation and all the money going into the um into the office of pcns has stayed the same so there has not been any change there's not been any increase in funding and there's no not been any decrease in funding so it's literally been a merging of budgets of course i think probably what you're alluding to is what's going to happen going forward with the the pockets of money for the enhanced services that we don't know and we have done a lot of work me myself and um steph cocklin's or steph cocklin the clinical director have been doing lots of work with along with others of course um to try and secure that funding um going forward that funding has to come through now so that's the question um i think that we had we had a meet at the um health and care board um this week yesterday we had we had a long discussion around this and really strong support from our partners um to the from you know baz and others saying look we need to make sure that people understand that these contracts help to provide the stability within our system and without these contracts gps cannot help to support the system in the way they have done before and therefore partners like the homerton will not be able to continue to be in the stable condition that they are so there's really strong feeling within the whole of sitting hackney that we need these contracts to continue we are lobbying within nell um i think a good position at the moment is that would be that them to roll over these contracts for another year so it gives us a so that it gives this um nell an opportunity to to then think about what things are going forward now have promised that well they've the stance from now it's always going to be about leveling up not leveling down you know i don't know um is the answer to that so at this point i think a good outcome would be we would roll the contracts over for another year um i think that's what you know that would be a good outcome at this stage that's really helpful councillor kennedy wants to come in uh thank you kirsten's covered most of it but i did just want to uh point out two things so firstly there's a regular monthly practitioners forum um which is where uh gps um all come together do catch-ups have very very focused kind of like almost petra kucha type five minute updates uh from different parts of the system um about um various issues uh new working practices etc etc for the first time we had one in person i think for the first time since covid i'm going to say um at uh st joseph's hospice last week um and uh agnes um i don't think andreas was there agnes from ipc was there caroline miller who's the chair of um ipc was there um and actually it was really good to hear um their pride in having gone through that hard piece of work um and actually being able to sit in front of a room full of um gps and go um look we've done it we're here this is this is how we're now interacting with the current system and the the second thing was just to back up what kirsten said about um how much we looked yesterday at the locally enhanced services what they add to the system um and actually having ipc um and a single gp representative body gives us a much better chance of arguing um to the to the wider system that we should keep those services um one of the the things we we're going to dig out because we think we can find it and it's there is is showing how much having those services relieves the pressure on the homerton and enables it to provide the mutual aid to the rest of the system and so you basically the message to nell is if you lose the um les's and all those extra stuff that they do especially stuff like the duty doctor um then the homerton doesn't have that ability to um almost be like a shock absorber for the rest of now that that that's good to hear that that's um coordinated um work is going on um members i see councillor lucas there uh thank you chair and thank you kirsten for that impromptu presentation um it's it's really helpful to hear and you might not be able to answer this question but i suppose from the picture that you painted there are the sort of mid to longer term challenges around funding but operationally it seems to have been a success and that things are working well and you know being the first to have made this transition i assume there are kind of you know stakeholders across the country whose eyes are on the region and sort of looking for best practice are there any areas that you're aware of where there have been some teething problems from an operational perspective and is that are there any learnings at this early stage that have kind of been fed back to um senior positions and you know that can help others who are making this kind of similar transition to um to be as smooth and as effective as possible i think one of the challenges i mean there are those challenges in bringing together two two different organizations always that's of course there is always because you're gonna you've got to build a whole new team together um and i don't think historically there has been difficult in the relationships if i'm honest between the two organizations so that's there's been a there's a lot of work being done on relationship building and i think um that's one challenge i think the other challenge which is i think it's going to be even more of a challenge going forward is thinking about what what do we do on a pcn level to deal with population health health and what do we do on a city and hackney level because pcns which has been driven centrally this is an nhs england initiative pcns is all about population health and and what and really getting that those small pockets you know we've got eight pcns in city and hackney and delivering the for that that population really specifically for that population and that you know that i absolutely understand the principle behind that however then you get to a situation where you're going to have some things in one pcn which is not in another pcn and then you've got to think are we going to start creating inequalities across city and hackney so that's i think a real challenge for us um in the organization what do we deliver on a city and hackney footprint and what do we deliver on a pcn footprint and my challenge for ipc because remember i'm not representing ipc i i don't work for them i and in fact i i'm there to challenge them in many ways my challenge to them is if things are different in different pcns you need to explain to me and the residents why they're different and sometimes that will be really justified and there'll be a reason for example immunization funding going into and being done in a different way in the north of the borough because of our population that i am you know that's fine explain it but i think that's where we need to be really careful about making sure we don't create inequalities and also thinking about you know as a city in hackney gp body we've always been a really strong united body of gps and we want to make sure that that continues and we don't start to get divisions between different pcns in an unhelpful way so for me and i think that would be a challenge wherever you do this what happens on a pcn level and what happens on a place-based level and i think we have to keep asking ourselves that that's great thank you kirsten i'm just trying to see whether i mean i've got i can ask can i just i'll bring council term i mean one of my concerns um previously was that i don't think it's now but the chair of sort of the pcn group rotated around sort of amongst amongst the eight i presume that and i my observation at that stage was that how can you have consistent leadership if it's constantly rotating around is that now is that now ended with this with all the pcn leads sit on the the governing body and there's one chief exec who provides sort of oversight and structure and direction is that is that the sort of the essence of the structure yes so you have you've got the you've got the chief executive you've got caroline miller as the chair um in position so she was the previous chair of the gp confederation she's the lay chair she continues as the chair of the of the city and hackney ipc um and you've got the eight pcn clinical directors sitting on the board they're also they've also um there's also a medical director position which at the moment is um actually i'm not sure if i'm allowed to say that but anyway they've got an interim position at the moment um which is providing some continuity from from before so there um there is a structure now where with with a strong leadership put in place and now it's about consolidating that and making sure that the board is as strong as it can be and they're doing lots of development around board development around that thank you thank you yeah councillor to the love i saw hannah thank you the new this is about digital primary care the new secretary of state is pushing for more digital primary care how will this impact the front line of hackney gps in an 18 in the next 18 months and if he is for under your remit to answer to the next question i'm quite curious to know what role position um associates play in this new merge and how it's being delivered across gps in hackney thank you so sorry i need clarification question the question is about digital digital the sort of the government drive for digital access and digital appointments for patients and in terms of um what's being done at how's that operating at a a local level and the second question was in terms of um associates in gp practices i i suspect you won't be able to answer them necessarily from an organization perspective but from your own perspective as a gp are you able to assist okay yeah so and i don't think that it's um the i don't think the city and hackney ipc would necessarily have a position on that at the moment i can talk to as a gp and as certainly as a primary care clinical lead so in terms of digital services i think so online access has been around for a while now um and i think city and hackney is quite forward thinking in that so all the practices have got online access um in terms of booking appointments um many practices are operate a triage model i think we have worked really hard in city and hackney to make sure that we haven't we're not creating a digital divide so for example in my practice and you know again you know we obviously have 37 seven different gp practices so everyone they all work slightly differently but i you know in terms of my practice you know we often we make sure that people who phone people who walk in who people who who access our services online get the same offer and i think many practices in city and hackney do that um in terms so that's online access in terms of physicians associates we do have physicians associates working in city and hackney they have been um they have been really really strongly supported in the in city and hackney there's been a model from the beginning where there's been a lot of training going in to um the supervision of these physicians physicians associates now there is a massive political um picture emerging around physicians associates and you know many people are coming out in favor or against and this is this is a huge it's a minefield i would say on a very localized level our physicians associates are really very very well supervised because across city hackney there is a gp who's worked with all of them and with all gp supervisors to make sure that these our physicians associates are um are operating safely so for example again in my practice we have one physician's associate um everything that every patient that she sees have been has been triaged by one of our gps so we're very careful of what she sees and she has a named gp supervisor for every clinical session who who who um goes to every single patient with her she doesn't prescribe she doesn't make she doesn't um you know order investigations without the gp's input so you know that i think that i you know obviously it's a minefield i'm not going to answer that um you know the national debate on this i know and see i i do i can answer that in city and hackney i feel that those um physicians associates have been very well supervised um and those things have been in place from the beginning um thanks kirsten i'm going to draw um this item so close we need to move on um thank you very much for stepping in um and it's very good news to hear um the work that has been done um to merge the pcns with the conflict i remember laura sharp i think was trying to do it um before she left i was trying to advocate for something of that so i'm sure she'd be very happy to hear it's happened it's also good news in our history of innovation um to be the first place in the country to understand to have done it and to be um experimenting with what seems to be a very sensible approach so in fact thank you very much for that and hopefully um we will be able to speak to andreas at some point um soon um and get his input so um kirsten thank you very much for stepping into the um stepping in there and i'll bring this to a close can i now move on to the last substantive item um on the agenda which is the medium term public health financial plan we're joined by um our director of public health dr sandra husbands um thank you uh sandra for um the helpful um uh schedule and table in the agenda pack um with respect to the savings um the backdrop is that um because of the cost pressures that all local authorities are under uh you were asked to make three million pounds worth of savings as i understand it over a three-year period and uh this is um the proposals that you brought forward in that regard and you're going to um just talk us through um some of them as you'll be aware there's been some considerable focus on the reduction of the the falls or the closure of the the non-continuation of the funding for the full service and so if you could particularly address that aspect um but with that over to you thank you chancellor hayhurst i just want to add a couple of additional points of the background um and one of those is that um we work as a joint service across city of london and hackney and although each of local authority is um allocated a separate public health grant the work that we do is very much linked and tied together and um we do all of the commissioning or the vast majority of the commissioning of um public health services and interventions from hackney on behalf of the city of london as well um and then the other one which just to make sure that everyone is um aware of it is that the public health grant is actually a ring fenced grant so it has some conditions attached to it so um we are making um or planning to try and make the three million pounds of savings um it's not savings in the traditional sense where we will be reallocating the money elsewhere across hackney council we're only making savings from the hackney grant we're not making any savings from the city grant um and we'll be reallocating the money elsewhere across hackney council in ways that support um activity that is delivering public health outcomes in accordance with the grant conditions but at the same time it's supporting the general fund and therefore um hackney's financial position overall and so i just wanted to make sure i clarified those two things first and then just want to draw attention to um the um criteria that we used we went through the process of reviewing the um our contracts you may remember we were here about a year ago and talking about the fact that we had um agreed that we would need that we would find three million pounds but we didn't at that stage know exactly where it was going to come from and we've gone through a process of reviewing the grants um across all of our spend but to look for opportunities to reduce our spending our directly controlled spending um based on the criteria that i have at paragraph 2.5 in the paper but also determined by the um timing with which we would be able to release those funds so um that did mean that things were um contracts that were due to come to an end within that three-year period were much more likely to be targeted as an opportunity for achieving savings although it would wouldn't be only on that basis it had it had to be on the basis that um there were that we were meeting these um uh criteria not necessarily all of them at the same time but definitely that the um the spend that we were um um looking to reduce um or shift or where we might shift it to would still be in line with our public health grant conditions um so the other thing of note of um is that there's a shortfall about three quarters of a million shortfall so far in what we've been able to identify and so we will be having to um take a second look and um perhaps be asking some tougher questions to see if we can um plug that gap over the um 26 27 financial year excuse me we'd already delivered um some savings um and you'll remember that we'd um decommissioned the chips plus um sexual um youth sexual health service in the the last financial year which made a major contribution towards our 24 25 um uh savings and then 25 26 is where the bulk of it comes in but we still have that shortfall of um about three quarters of the million that we're going to be looking for and so then the table at um at uh section three shows you where we've already delivered some and then um others um where they where they say they're in progress it means that we've identified the opportunity and that the work to consider how and by when and um with what process this money could be um liberated um is ongoing um so then um specifically in relation to the fall service so you can see in the table it doesn't say anything about falls but it does talk about physical activity and that's um encompassed um the falls for the specific falls prevention services comes within the physical activity line um the the rationale for reducing um or for discontinuing that um was really that it's it's it's not necessarily it's not necessarily in keeping with our strategic objectives around prioritizing prevention and and um and population level approaches and um and that it really although the mrs for the falls prevention service community prevention service um is called prevention it's actually a secondary prevention services for people who've already fallen and um it is more suitably would more suitably be funded by the nhs as part of a whole system force prevention pathway and as um amy mentioned earlier we do have a number of services in city and hackney that have never been commissioned on a recurrent basis and unfortunately apart from this element of the falls prevention service none of it has and um so we we are working with nhs colleagues to um do a review of the whole whole system pathway of falls prevention and where the public health contribution in that it best plays in which is not necessarily in in paying for a treatment service so i stop there and um open for questions or was there anything else you wanted me to to pick up first no thank you just just just as my understanding just so everyone's got the um understanding on the falls prevention service it's commissioned um the group is provided by a group called mrs and essentially what that 85 000 pounds as i understand it per year does is there's the half a year for six months the year it has provided nine sessions a week only for half the year and it's been available for over 55 as i understand it um there are other full services commissioned by the nhs for the over 70s and other and other cohorts um so that's that's my understanding of the overall um the overall picture on that um on that issue um so i see except this except it's only 65 000 not age ah so the physical activity line is everything that we're cutting around around physical activity fine okay so the falls per se is 65 000 okay thank you for clarifying that right um okay i see some hands go up so um councillor turbidolov thank you very much thank you dr husband's for the very helpful explanation especially around the criteria regarding reallocation or shifting or reduction of services you you mentioned already the the falls prevention unit which is create has created quite a lot of upset amongst residents at the prospect of it closing and i'm also seeing the mental health well-being network which has been an amazing service for residents my question is will this although i i appreciate this identify savings and we still got three quarter million more to look into for savings will this not create future expenditure for the council uh and nhs because actually is cutting services where it will create need and it will come back to us eventually thank you uh if we did nothing at all and simply cut the services um i i think you're right it would it would create um likely create further need um partic and demand particularly on it on the nhs um uh specifically with respect to the falls prevention service that we do have a whole range of other physical activity opportunities that are actually much more suitable for um primary prevention and will have um a greater reach um and we're not planning to cut those at all but as i said we're we're working with our nhs colleagues on trying to develop a pathway so at the moment we've got um a rather fragmented um and um not recurrently funded falls prevention pathway um and what we and what we need is a more integrated and um integrated pathway that's funded on a recurrent sustainable basis but we all but we also need to do a lot more work before people have their first fall which is where um public health has much more of a role um and then with respect to the well-being network again we've been um in conversation with nhs colleagues for quite a long actually a few years um and this it always sounds like it's an excuse when we say kovid intervened but kovid did intervene and actually there's been an issue with us trying to get the falls prevention work developed over many years and also some work with around mental health over many years so in a way having to make these financial reductions is a really good opportunity to give us that impetus to do the work as a whole system the mental well-being network um elements of it provide talking therapies but more of it is providing community-based um more it has therapeutic benefits but you wouldn't call it therapy work it's not delivered by psychologists it's more social it's more about connections and um and we're not considering cutting the whole network we're considering reducing the amount that we spend on it while also working with nhs colleagues about community mental health provision and making sure that the provision that they have is um i guess is needs in a more culturally appropriate way which was that that was that gap in service provision was the reason that the mental well-being network grew up in the first place but with um um that um mel icb and elft um signing up to anti-racist statements then we can be holding them to account to say so now deliver your services in a more anti-racist way and we'll work with you to help you understand what that means and what it looks like but also to make sure that we have a whole system suite of services and offers for people both in terms of the population level um main uh developing connections and and maintaining your own personal resilience to guard against mental health as well as um more appropriate and um nhs delivered community-based mental health offers and and um and whatever else we end up needing as a more more of a mental health service for people serious mental illness in terms of it being more culturally appropriate and i'm sorry that i'm kind of um fumbling over my words this evening i've just got a migraine which is why i kept turning my light and my camera off and it just makes it a bit difficult to find the right words no well thank you for um thank you for being here in those circumstances um sandra um i saw um uh nick first then i'll come to council leaders and council lynch thank you um i'm a gp i've also um just been newly elected in the council of governors and so i've been aware of quite a number of uh people with concerns about the falls prevention service being cut um and i'm aware that that kind of runs through a gamut of cuts uh across public health um but i'm here particularly with concerns about the cuts of the falls prevention service it isn't just um just an outline it's not just nine sessions uh a year i think you said it's it's actually nine different classes that are provided it's 52 weeks it's a a one session a week for 52 weeks and it fills a gap from the homerton physio based service which provides the first eight weeks and then the mrs continues from eight weeks to 52 weeks um so what that's doing is building stability ensuring safety and providing the idea is that it allows people who have experienced injury and weakness and disability and vulnerability to improve their situation and these are mrs are more highly specialist physios uh than the physios who provide the first eight weeks so there's a very specific service um and since 2019 um it's really the stats are really awkward because although there's been a big fall in hackney since 2019 the pandemic intervened and there was a big fall everywhere um i imagine that was partly to do with death and partly to do with people not going outdoors so perhaps that's an interesting caveat of when you look at the statistics you need to think about what's behind them because no one wants to see uh older people not going outdoors even if it makes the figures look good there's nothing i've heard from dr husbands that gives me an impression that that specialist service will be uh compensated for in any other way um and it therefore i could it doesn't reply it's not replaced by what i think she's referring to as primary sort of prevention ie which is essentially group exercises the new age stuff um which are great but they don't serve the same function at all um it will inevitably as i've spoken to the two lead geriatricians of the homerton who are also very concerned and have raised concerns about the falls prevention service cuts um and they are of the opinion that um this service will have to be re-provided otherwise you're going to cause um unnecessary deaths injury but more than that it's a any admissions inpatient stays gp consultations um social care disability all of those things are real and will operate in lieu of those cuts um i'm going to bring um dr husbands in to um reply if i can um because i've got other counties who want to um come in as well dr husbands yeah thank you um and thanks for the question i wasn't trying to imply that the um group exercises new age games etc that you referred to was a direct replacement for this so i was making the point that that's the space in which public health should be operating and that a specialized service like this it it should really be being commissioned by the nhs um i'm going to bring in uh council lynch um thank you dr husbands and thank you uh dr man and i just i have to say in all my career as a uh a nurse i've been a nurse for over 20 years i've worked predominantly in this patch i've never known a public health um fund falls prevention i've just got a couple of questions um one is i i understand that this this falls prevention service it seems very intense it seems um very specialized i just wanted to want to know dr husband's do we have any data on actually the sort of diversity of these people that attend these classes given um you know hackney's quite diverse because the sort of the i've had many emails they they seem to come from a sort of one predominant uh population within within hackney and i'm wondering whether or not this is a sort of word of mouth prevention service that has sort of grown the popularity because of the the experiences people have had and also i just wanted you to just clarify the safeguards we have in place already to stop the sort of potential concerns that um the gp has mentioned around deaths or what have you because i suspect my own my own professional experience would would would tender that those people that are uh sort of um at high risk of falling would already have some sort of um statutory sort of things in place already as opposed to a sort of the situation where this is sort of you're feeling a little bit doddery you can sort of do a bit of tai chi and well street common and and hopefully that will prevent you from falling so um and again i wondered if there was any actual formal data that sort of had a correlation between attendance at this service and uh reduction of um uh you know emergency admissions to um homerton ed or to our primary care colleagues in terms of sort of slips and trips and falls and and that that sort of um that sort of evidence-based really that i'm sure has still has influenced your your need to and your sort of decision making around putting this forward as a potential um area that would would would it would have uh less risk than some of the other universal things that you've spoken about which will probably have a bit more of an impact on the diversity of our borough yeah well thanks for the question um unfortunately we it has been a bit of a challenge to get comprehensive data um what we do know is that mrs has seen on average about not quite 200 patients a year when about we estimate that around 8 000 or a minimum of 8 000 people in our population locally are at risk of falls um so i can't tell you anything about the the demographic breakdown of those patients except that the majority of them actually are over um i was gonna say over 65 i think it's actually over 75 yes the majority of them are over 75 um about um 70 percent of them are over 75 even though the service in principle is open to people who are 85 55 and over um and the other thing is that it's not going to close imminently we were planning that when the contract comes to an end at the end of march that that would have been the time when we we were no longer going to commission it um but between now and then we would be doing work with um nhs and other partners to develop alternatives so it's so it's not going off a cliff there is the possibility if if we can't do the work and um obtain the suitable funding or alternative pathways in the nhs that we could because i think we still got the possibility within the contract to to add one more extension for a year um but that then that undermines our savings plans and that also has an impact on people who have social care needs in the council so um so that so that so we're that's where we are with that um it's not going to fall off a cliff it's not imminent it's several months away we're doing the work behind the scenes to look at alternatives and actually did also have a plan a communications and engagement plan um so we weren't going to cut residents and service users out if they just somehow got leaked and they um and so you know that communication sort of jumped the gun a bit and um hasn't been done in the most um effective or proactive way as a consequence um what i can tell you as well about the impact is that um as dr man said we have seen um a decline in falls it's it's um mirrored than the national trend but we have been consistently above the national trend in terms of um people falling and therefore it's difficult to suggest any real impact from the service you may have slightly um frozen on us um sandra um if oh i think i've got you back there um i was saying it was a bit different yeah i was saying it's a bit difficult to to um correlate the the impact of the service with any impact on the numbers of people falling or attending early i see sally there council lucas do you have a question before i bring i'm selling slightly off topic chair so i'm happy to let the thank you very much and um i just want to say this obviously reflects the very challenging financial situation that the council faces so i want to commend colleagues for taking the sort of looking at these very difficult decisions and being in a position where these are unfortunately having to be taken um so i just wanted to make that point at the start um just a technical question before going to substantive one so at table one past um point 2.8 um you've obviously identified you know over a million pounds worth of savings in 25 26 and then 24 25 and 26 27 it's slightly less so is that because of the nature of the contracts coming up during next year why is that not more spread out if that makes sense i assume that's because the contracts come up next year right and then just just a second quick question if i may around the mental health well being network i know we've spoken a lot about falls but also you know this is quite a substantial amount of savings being um made by the looks of this um this chart that you've presented today and i just wanted to ask a question within the risk mitigation section and a bit further down the piece which is around this service sort of the savings made affecting certain um parts of the community disproportionately i wonder if you could just say a bit more about that and and what's being done to mitigate that because obviously you know mental health is a really crucial issue it's on the rise it's something that is really um you know prevalent in lots of our residents lives and it would be um useful to know kind of again the mitigations how you're working with other partners in the nhs to really um solve that and tackle it head on so slightly off tack hopefully that's okay sondra yes thank you that's that's absolutely fine thank you so in terms of the um the phasing of the savings that was in part so the 20 23 24 sorry looking yeah 24 25 was because we had less time during the previous financial year to identify savings that could be realized within year um and then and the bulk of it 25 26 is because we've done the work this year but also it's about the timing of when um contracts were coming to an end or we had a break clause that enabled us to renegotiate them um and um and 26 27 again that's about the timing of um contract expiry dates or break clauses but um we'd already reached most of the savings in the in the previous two years um and that's why we've still got that challenge to go back and find that further three quarters of a million in terms of the mental well-being the risk in the mental well-being network around um the impact on certain communities um i referred to it a bit earlier but maybe i wasn't very specific the the mental well-being network provides a range of services including um talking therapies either as individuals or groups to um in to people from our communities in specific um where the offer both of the therapy as as well as the sort of group activities are offered in um offered by community organizations who work with particular groups within our community often ethnic groups or um groups of who identify from a national origin like turkish or um parodi jewish or black caribbean or whatever and the reason that the well-being network is an attractive proposition or who use it is that they don't feel that the mainstream nhs services really meet their needs in in the way that they want them to be met um so they are in principle all entitled to have access to nhs talking therapies but they just don't feel it really works for them and um and of course there's also the issue with the wrap around services that go with the talking therapies within the well-being network not being part of the nhs service and so we're still in early discussions actually with well-being network part providers but also with nhs colleagues about how we can bridge that gap so that the people who take who avail themselves of the talking therapies through the well-being network can get their entitlement to those therapies through the nhs but in a way that where they feel supported and also that it's culturally appropriate and that may be about how we get the network to work with the nhs as opposed to providing an entirely separate set of services that we haven't got to the bottom of that at the moment and and sandra on that point is is is the 500 000 pounds worth of savings there the entirety of that provision because i think i'm familiar it's the book of killim it's the german it's that it's those partner organizations that that's that's right and the the full budget is about 1.3 million and we're taking it it's a car not a not a not an end of that of that no that's right yes actually most of them are not um for most of the savings we're not cut we're not terminating the services we're reducing the budget and then either um reformulating the service or renegotiating etc okay so i mean i think i think those long memories will remember i think there was a similar thing about eight years ago with with the the this sort of service with german book and i think we had a lot of feedback from the gps in terms of um missing that missing that service and then and and then there was then there was some pushback on that but i understand if we're not if if it's just a parcel of that um some service is still being provided um sally thank you and yeah it very very difficult when there just just isn't isn't the money and those cuts do you have to come from somewhere we appreciate that i don't know if it's helpful just just to share the health watch perspective particularly around the falls prevention um dr husbands and colleagues have had some communications with us and just to put it put it to to members that health watch supports and understands that thinking that public health should be there with the more up upstream preventative work because that feels to us that that's that's where that should sit with public health i agree there's other things that should be coming through the nhs and we've just heard earlier from amy about funding from there so we we we we appreciate that from a health watch acting point of view and to to say that we're very grateful for invitation to kind of be able to be involved to support residents to be involved and work to shape kind of future pathways around falls prevention and make sure that we're able to allow different community groups groups and residents to be involved in that work looking to the the future so thank you to public health for that invitation i just felt might be helpful to to share the health watch thoughts on that on the subject thank you thanks sally um sandra do you have any observations there or um yeah just to say thank you sally and that is and it is very helpful to um to have the support of health watch and and other um colleagues to to work with um patients and communities to make sure that we're collectively coming to the right solutions to to meet the the needs locally i did want to say one other thing because i just forgot to say earlier which is that um there are some cost pressures so to to counterbalance all of this and some of some of which you'll be quite aware of so the um um national insurance um employers um increasing national insurance for employers um contributions the um increase in the um living wage um potentially future agenda for change increases um actually there's the 24 25 one that we haven't taken account of for nhs staff um medical um you know doctors and dentists increases in pay as well all of these have implications for the service before make it more difficult for us to be able to um make the reductions while being able to maintain the levels of service that we currently expect we will and then particularly with respect to um sexual health services i think the big risk there is that um we're not able to either control the the tariff um because uh we're not able to get a set of kind of london-wide negotiations that enable us to do that and and then we're all not able to control out of area activity which means that some providers who shall be nameless who um attract a lot of business from people who don't live in their area um will um possibly put a big dent in our um savings that we're trying to achieve from sexual health so that's that's just something to do um bear in mind that we still need to look for that three quarters of a million in addition to what we've already identified but there are other pressures that are going in the opposite direction but i mean sandra just on that um i didn't i don't fully understand the the what what is meant by the tariff element i understand how we if somebody goes to a provider out of out of borough and they use their service sexual health prevention service we get re-billed for it and thus we don't have control so i understand the second point what was the first point on the on the tariff yeah sorry so um basically it's how much they get paid so it's an it's a payment by activity type of um service or type of arrangement i should say so um at the moment we have a contract with homerton who is our local provider and um we have had a pan london agreement that um if we um each of us each local authority um has a commission contract with a local provider that they can then specify a marginal rate which will apply to the out of area providers it doesn't apply outside of london anyway although our main issue is with other providers within london um but it it's become the system has become more and more fragmented over the years and it's been it's becoming more and more difficult to achieve that pan london agreement that says that this is we all pay this and um so for some areas it may be less of an issue and for some it's a big issue so we have really relatively high um rates of sexually transmitted infections in city and hackney um and also fairly high traffic to certain providers outside of city and hackney so that not being able to harmonize the amount we pay i.e the tariff poses more of an issue for us than it might for other people thank you and i mean that strikes me as an area that is ripe for representations to um national government as to reformulating that in a more fair way with a sort of a consistent tariff and um trying to deal with what could be some of the other issues you i mean are our submissions of representations being made um on that area as to thought in terms of reformulating how it works um not specifically like not that it's it's funnily enough it's one of the things that doesn't necessarily exercise my colleagues in the association of drugs of public health but maybe because they're mostly not as badly affected as we are okay well thanks thank you for that i'm sorry i remember that that has been that has been raised i think um on a few occasions before as well as you say we're impacted by it um unless there's any other um questions there i'm going to um draw this item to a close thank you um uh sandra for uh bringing this i mean as you say the council's under enormous um financial pressure um there's an in year a significant in-year deficit as well so these are not like we fully appreciate these are not positions um you would otherwise be um wanting to make but they are being fought upon us um in order to um keep the council running on in a balanced sense so uh thank you for um uh taking the lead in in having to make these difficult decisions but in the most um sensitive way possible um and thank you for the for the updating relationship um and and when you are when you are aware in terms of the remaining um three quarters of a million that we see um at 2.8 that's still there if you could if you could again just brief us on um on what those areas are but thank you for transparency um and uh and sharing this with us it's appreciated um members with that um i'm going to start wrapping up the meeting so i draw that item to a close can i take item eight the minutes of the previous uh meetings agreed please um the work program is at the end of the agenda i haven't been notified of any other notified of any other business and with that i close immediately thank you you