Agenda and minutes

To approve the minutes of the meeting held on 21 October 2020 as an accurate record.

RESOLVED that the minutes of the meeting held on 21 October 2020 were agreed as an accurate record

In accordance with the Council’s Code of Conduct and the statutory provisions of the Localism Act, Members and co-opted Members of the Council are reminded that it is a requirement to register disclosable pecuniary interests (DPIs) and gifts and hospitality to the value of which exceeds £50 or multiple gifts and/or instances of hospitality with a cumulative value of £50 or more when received from a single donor within a rolling twelve month period. In addition, Members and co-opted Members are reminded that unless their disclosable pecuniary interest is registered on the register of interests or is the subject of a pending notification to the Monitoring Officer, they are required to disclose those disclosable pecuniary interests at the meeting. This should be done by completing the Disclosure of Interest form and handing it to the Democratic Services representative at the start of the meeting. The Chair will then invite Members to make their disclosure orally at the commencement of Agenda item 3. Completed disclosure forms will be provided to the Monitoring Officer for inclusion on the Register of Members’ Interests.

There were no disclosures at this meeting.

To receive notice of any business not on the agenda which in the opinion of the Chair, by reason of special circumstances, be considered as a matter of urgency.

There was none.

TBA

There were none.

(Verbal update)

The Director of Public Health updated the Board on the Covid-19 situation in the borough. She stated that the infection rate in the community was slowly falling due to lockdown. Currently, Croydon was the 6^th highest rated borough and the 20^th local authority in the country. She told the Board that the latest variant of Covid-19 was disproportionately affecting the south Asian community.

Dr. Agnelo Fernandez, NHS CCG and Vice Chair, addressed the Board and stated the following:

• At least 15,000 people had been vaccinated in Croydon.
• There were six new GP community sites that had gone live based in Old Coulsdon, Purley, Valley Park, New Addington, Thornton Heath and Fairfield Halls.
• The vaccinations were focused on the over 80’s and those in care homes, including staff, and next age would move onto the vulnerable/shielding group.
• A limiting factor was transporting the Pfizer vaccines. This made it difficult to deliver into care homes, which was why they had to administer that vaccine in a centre.
• The AstraZeneca vaccine was easier to transport which enabled it to be administered in care homes.
• GP Surgeries that were offering vaccinations had been given permission to reduce some of their other services due to a shortage of staff.
• In February 2021, sites would open in central Croydon and Crystal Palace, which would speed up the vaccination programme by providing a good coverage of the borough.
• There were issues in vaccine supplies, with some sites stating that they were not receiving the supplies to meet demand.
• The army were also providing assistance and were posted to support different sites.
• There were issues in relation to staff absences due to shielding or because they contracted Covid-19.
• An issue with the vaccination programme was hesitancy. The vast majority of residents who were over 80 years of age gladly received the vaccine, however, there had been reluctance amongst some groups particularly in the black and Asian community which included care home and practice staff. There needed to be more information circulated to enable people to make informed decisions in regards to taking the vaccine.

The Executive Director for Health, Wellbeing and Adults informed the Board that the information being circulated locally was likely to be the most accurate data because there had been an error in national data recording. Whilst attending the Health and Resilience meeting, noting care homes submitting data, a technical issue in how that data was processed was discussed.

In response to a question regarding vaccine shortages, the Vice Chair stated that patients were able decide whether they go locally or to attend the mass vaccination sites.

The Director of Public Health informed the board that the priority in terms of vaccination had been decided nationally based on clinical risk and stressed that social distancing measures had to remain in place despite the vaccine roll out in order to minimise risk of spreading the virus.

In response to a question from a councillor, the Vice Chair informed the Board that, despite the lack  ...  view the full minutes text for item 5/21

(Verbal update)

The Executive Director for Health, Wellbeing and Adults informed the Board that the consultations were a national exercise and every local authority across the country was in a different position, Croydon’s being good. He stated that the proposals in the consultation were endorsing some of the practices that Croydon already had in place for a while. He informed the Board that they wanted to respond as the One Croydon Alliance because they were in agreement that the ICS would continue to enhance the work that the council were already doing.

The Vice Chair informed the Board that the reorganisation proposed by the ICS consultation was a huge project. As a result, there had been a lot of concerns about these changes being conducted during the pandemic because many people were busy, such as clinicians. Whilst these changes had been planned for some time, there had been a lack of consideration in regards to the lessons that had been learnt during the pandemic of integrated working. The fact that it was an engagement rather than a consultation had not given the opportunity for clinicians to provide feedback because they had been preoccupied.

Concerns had been raised by clinicians, such as GP’s, of the removal of Clinical Commissioning Groups (CCG) and the resulting loss of influence and involvement of GP’s and hospital clinicians to the system. The plans discuss clinical leadership, however in practice that would be on the periphery and not centred to decision making.

The British Medical Association (BMA) and the Local Medical Committee (LMC) raised serious concerns about the future of general practice in these plans, and that Primary Care Networks (PCN) were not representative organisations or statutory bodies. This would lead to the voice of General Practice being reduced even further. While this could be mitigated in Croydon through several different means, the face of General Practice would still change and there were associated risks. Without the involvement of clinicians in the decision making process, there may be a rise in the costs of healthcare, as well as the inefficiencies and the quality of care also decreasing.

There were real concerns  fed back by the LMC’s and by the BMA, however it was uncertain whether they would be taken into account due to the engagement in place of a consultation. He stated that from a Croydon perspective, they could mitigate some of the issues because integrated care already harboured strong relationships within the borough that could be built upon further.

The Chair of Croydon Health Services NHS Trust informed the Board that one of the strengths in Croydon was that clinicians have taken the lead in the planning of services and that they worked across the divide between acute physicians and those who work in primary care and general practice. He stated that despite whichever system would be implemented nationally, they would mitigate that within Croydon and provide reassurance to the public that acute physicians and those that work in primary care would continue to work together to  ...  view the full minutes text for item 6/21

(Verbal update)

The Executive Director for Health, Wellbeing and Adults stated that Croydon  was now operating in a Section 114 notice, however there were other local authorities in similar situations. He stated that the council continued to meet their statutory need in relation to social care. The council were currently waiting for the capitalisation directive that was submitted in December 2020 and conversations with the Ministry of Housing, Communities and Local Government (MHCLG) were ongoing.

The Executive Director for Health, Wellbeing and Adults informed the Board that there was a plan in place to form an independent panel which would be the conduit between the Secretary of State and the council. The Health & Wellbeing Board would continue separately from that process. He assured the Board that by the end of the financial year the council would be informed whether they had been granted the capitalisation directive. This would allow them to decide the budget and work on the medium term financial strategy 2020-24, which would reduce costs in social care.

In response to the Vice Chair, the Executive Director for Health, Wellbeing and Adults stated that the Council's reduction in spend was not just about social care but wider well-being and ensuring provisions could remain in place even if they had to be delivered slightly differently. The members of the independent board had not yet been appointed, however once the board was implemented, the Health & Wellbeing board would not simply receive information about future changes being made but they would also have some influence in the changes that were implemented.

The Chair of Croydon Health Services NHS Trust stated that the NHS would continue to support the council, particularly the social care services.

Planning had been conducted with the Local Government Association (LGA) and their specialist around health and social care. They had been helpful in informing the council that making changes to provisions and spending too quickly would not result in good outcomes for people and that it was recommended to reduce the funding over a longer period of three or four years.

(Report attached)

The Healthwatch Croydon CEO introduced the report. She stated that this was the first year that the local leadership board was in operation and they had produced 11 reports pre-Covid-19. She informed the Board that Healthwatch was dedicated to listening to the concerns of local residents and patients and finding solutions.

Healthwatch engaged and surveyed local people and collated that gathered information. These were then presented as reports to those who held power and responsibility in the sector to make a difference and implement the necessary changes where possible.

Healthwatch had developed a ‘Prioritisation Matrix’ which enabled them to determine whether they could make a difference by carrying out work in a particular area and whether they were the right people to carry out that work. Following that exercise, they would then review whether other work was happening elsewhere, and if it was, they would not continue work and saturate that area or would liaise with other service providers.

The Healthwatch Croydon CEO informed the Board that the pandemic prevented them from carrying out their 2020-21 planned work. Their focus during the pandemic was to help their partner organisations in their work.

The Healthwatch Croydon CEO informed the Board that they were going to produce a report on dentistry. In the coming months, the Healthwatch Croydon would study dentistry websites to see what information was available to patients. They would then devise a survey which would allow patients to detail their experiences of NHS dentistry.

RESOLVED – That the Health & Wellbeing Board agreed to note the report.

The following motion is to be moved and seconded where it is proposed to exclude the press and public from the remainder of a meeting:

“That, under Section 100A(4) of the Local Government Act, 1972, the press and public be excluded from the meeting for the following items of business on the grounds that it involves the likely disclosure of exempt information falling within those paragraphs indicated in Part 1 of Schedule 12A of the Local Government Act 1972, as amended.”

This item was not required.