The Health in Hackney Scrutiny Commission met on Monday 11 September 2023 to discuss the increasing mental health needs in the borough, the City and Hackney Safeguarding Annual Report, and the Healthwatch Hackney Annual Report. Decisions were made regarding the approach to mental health services, the ongoing work of the Safeguarding Adult Board, and the future priorities of Healthwatch Hackney.

Increasing Mental Health Needs in Hackney

The commission received a presentation detailing the significant and increasing mental health needs within Hackney. Dr. Olivier Andlauer, Clinical Director of City and Hackney, Elft, highlighted that Hackney presents a high level of challenge in terms of mental health needs, including depression and long-term mental health problems, as well as high levels of anxiety. This is exacerbated by high levels of deprivation in the borough, with those in the most deprived areas being twice as likely to need mental health support. Substance misuse, particularly alcohol-related conditions, also contributes significantly to mental health challenges.

Jed Francique, Borough Director, added that there has been an estimated 20-25% increase in mental health needs nationally since the pandemic, a rise that has outstripped the capacity of mental health systems. He emphasised that mental health difficulties are not spread equally, disproportionately affecting certain populations based on ethnicity, age, sexuality, sex, disability, neurodiversity, and long-term health conditions.

Sharon Evans, Crisis Pathway Lead for City and Hackney, outlined the pathways for accessing crisis mental health services, which include psychiatry liaison via Homerton University Hospital's Emergency Department, a 24/7 crisis line, and the informal crisis cafe. She explained the distinction between the Home Treatment Team, which provides intensive, short-term support as an alternative to hospital admission, and Community Mental Health Teams, which offer longer-term, therapy-based support.

The discussion also addressed the pressures on Accident and Emergency departments, with increasing numbers and complexity of presentations. While Hackney's psychiatry liaison service performs well compared to other areas in North East London, there are challenges with response times due to the high volume of patients. Bed pressures and access to mental health beds were identified as a significant national issue, leading to the use of private beds and Bed and Breakfasts to supplement local capacity. The cost of private beds was noted as a considerable expense.

In response to these challenges, several improvement and transformation initiatives are underway. These include exploring the centralisation of the crisis line to support all residents across East London Foundation Trust, with the aim of increasing staff availability. A long-term plan is also in place to establish a crisis assessment hub at Homerton University Hospital. Efforts are being made to improve staff retention through training and recruitment campaigns, although national recruitment challenges persist.

Councillor Grace Adebayo raised concerns about waiting times for the crisis line, which were confirmed to be longer than desired due to the high volume of calls. The issue of abandoned calls was also highlighted. Councillor Kam Adams inquired about data collection on frequent attendees, particularly concerning the impact of social issues like the cost of living crisis, unemployment, and housing. It was explained that a High Intensity User Service Team (HIUS) specifically supports frequent attenders, gathering data on their presentations and developing individual care plans. The link between social stresses and mental health crises was acknowledged, with ongoing efforts to understand and address these wider determinants of health.

The use of Bed and Breakfasts for individuals awaiting housing or discharge was discussed, with acknowledgement that this is not a long-term solution and can be indicative of homelessness issues. The council's housing service is working closely with mental health teams to address these challenges, including for individuals with no recourse to public funds. Data is being gathered on expenditure on private beds and Bed and Breakfasts to inform future investment in alternative housing solutions.

Councillor Adams also questioned the centralisation of the crisis line across three boroughs, which was explained as a response to staff shortages and a national NHS England directive to align with the 111 service. The aim is to reduce wait times by pooling resources, while urgent assessments will remain local.

The commission also discussed the community mental health transformation agenda, a nationally driven initiative focusing on a biopsychosocial model that integrates primary and community care. This aims to improve access to psychological therapies and address wider determinants of health, with a strong focus on health inequalities. The transformation involves system-wide collaboration between local authorities, the voluntary sector, and primary care. Early steps include reconfiguring services, developing new roles such as community connectors, and strengthening links between primary care and mental health teams.

The discussion touched upon the challenges of providing adequate support for mild to moderate mental health needs, with a recognition that there are gaps in provision. The commissioning of psychological therapies was also discussed, with acknowledgement of high dropout rates and efforts to improve the fit between service offers and client needs. The council is developing a joint mental health commissioning role with health partners, with plans for a wider integrated commissioning unit.

City and Hackney Safeguarding Annual Report

Dr. Adi Cooper, Independent Chair of the Safeguarding Adult Board, presented the annual report, highlighting ongoing challenges and new issues in safeguarding adults in Hackney. The report details the board's achievements, including the publication of two safeguarding adult reviews and the commissioning of one, with an ongoing improvement agenda arising from these reviews. Work has also focused on communication, engagement, and training, as well as joint work on anti-social behaviour and transitional safeguarding.

The report outlines the board's priorities for the current year, which include addressing issues such as the Metropolitan Police's approach to individuals with mental illness and the impact of the cost of living crisis on safeguarding adults. Dr. Cooper noted that while data on concerns and inquiries is largely in line with previous years, comparative data for Hackney has been problematic due to issues following a cyber attack.

Councillor Kam Adams inquired about the status of the Liberty Protection Safeguards, which are replacing the Deprivation of Liberty Safeguards (DoLS). It was confirmed that the Department of Health and Social Care has put these proposals on hold, although the assessment of mental capacity in the context of safeguarding risks remains a focus.

Councillor Adams also asked about the outcome of a self-assessment using the Safeguarding Adult Partnership Assessment Tool. Dr. Cooper explained that the assessment informed the strategic priorities for the year and that the detailed analysis, while not included in the annual report, could be shared with the committee.

The discussion delved into mental capacity assessments, which are undertaken under the Mental Capacity Act and are decision-specific. It was explained that these assessments are crucial for safeguarding as an individual's ability to make decisions about risk can be affected by various factors, including mental illness, learning disabilities, coercion, and physical health conditions. The ongoing drive to improve practice and understanding in this area was emphasised, particularly concerning the nuances of executive mental capacity and the right of individuals to make choices that may involve risk.

The criteria for attending safeguarding courses were clarified, with training available at various levels for anyone involved in safeguarding in Hackney, including staff and volunteers.

Healthwatch Hackney Annual Report

Sally Beaven, Executive Director, and Deborah Cohen, Chair, presented the Healthwatch Hackney Annual Report. They highlighted the organisation's achievements, including winning the Impact Award for their work on GP practices. The report details the extensive feedback gathered from residents on their experiences with health services, which informs Healthwatch's investigative work and outreach.

Key findings from the past year include an 18% increase in overall satisfaction with GP services and a 2% increase in satisfaction with Homerton University Hospital. Healthwatch Hackney holds core functions such as signposting and entering views, alongside NHS contracts that enable collaborative work with local services.

Projects undertaken include work with neighbourhood forums to ensure resident voices are heard and to embed co-production. The community voice contract focuses on capturing local experiences through outreach and forums, with recent work including surveys on spirometry services and virtual wards, and an in-depth report on living with long COVID. The engagement and co-production contract supports co-production across health and care services, working with a diverse group of public representatives.

Specific reports highlighted include work with Chinese and Vietnamese communities to address language barriers in accessing care, a project on patient experience in maternity care, and a significant report on access to emergency hormonal contraception through Hackney pharmacies, which revealed issues with provision. An accessibility audit of community pharmacies was also conducted.

The commission discussed Healthwatch's collaboration with the Integrated Care Board Partnership Board and other Healthwatches across boroughs, noting that this partnership is working well and allows for joint responses to issues affecting multiple areas. Future priorities for Healthwatch Hackney include a greater focus on social care and continued work on health inequalities, with specific initiatives planned around women's experiences of menopause, starting with Black women and then extending to the LGBTQ+ community.

Councillor Claudia Turbet-Delof inquired about how Healthwatch decides which topics to investigate. It was explained that decisions are informed by feedback received, with entry views often focusing on areas where concerning feedback has been consistently heard, such as mental health services and specific GP practices. The people's feedback panel, which meets fortnightly, is open to council members and provides valuable insights into residents' experiences.

The balance between Healthwatch's role as a watchdog and its commissioned work with the NHS was discussed. It was emphasised that Healthwatch sees its role as a critical friend, working collaboratively with the system to identify issues and be part of the solution, rather than simply calling out problems. The organisation is committed to involving local people in co-production and participation.

The future work plan includes a greater focus on social care, with discussions around conducting social audits of green spaces and exploring how public representatives can contribute to this. The commission also noted the ongoing pressure on adult social care and the potential for Healthwatch to play a valuable role in understanding the resident's perspective on transformation agendas.

The meeting concluded with the agreement of minutes and a discussion of the work programme, which aims to incorporate suggestions from councillors on various topics, including Chagas disease, charging regulations for migrants, hoarding, learning disabilities, suicide, the cost of living crisis, and parasite infections.