Agenda and minutes

• It was noted that ‘this’ (topics) should be ‘these’ (page 6).

• The Chair noted that it would be helpful to invite a representative from the public health team in Barnet to join the North Finchley Partnership Board for its next meeting on 28^th November where it would discuss the high street. The Chair would enquire about this.

Action: Chair

• Cllr Cornelius commented that agreement on the recommendations had not been included under each item in the minutes. The Governance Officer would correct this.

Action: Governance Officer

RESOLVED that the minutes of the meeting held on 6^th July 2022 be agreed as a correct record.

Apologies were received from Councillor Phillip Cohen. Cllr Anne Hutton, Vice Chair was in the Chair.

Apologies were received from Councillor Rishikesh Chakroborty who was substituted by Councillor Andreas Ioannides.

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A Member asked whether the actions on dental health promotion had been followed up since the July meeting as there was no update in the minutes. The Chair responded that she would take this back to the JHOSC.

Dr Djuretic noted that a report on dental health would be brought to the HOSC in December, including an action plan and needs assessment.

RESOLVED that the minutes of the JHOSC were noted by the Committee.

Mr Rich presented his slides about BCC engaging with carers as part of the development of the new Barnet Carers Strategy.

Mr Rich introduced, Ulla, a carer in Barnet who cares for her daughter who has schizophrenia and Ehlers-Danlos Syndrome. Ulla noted that she tries to help her daughter to maintain her independence. They share hobbies, which is also company for her as carer. She reported that she knows from other carers that many are burnt out, as they can’t leave the house or get support. 

Ulla commented that often patients need to go to A&E when in a crisis as it will take 48 hours for someone from the crisis team to attend. Many carers don’t know where to get help, and there are insufficient people in the caring profession.  She reported that some GPs are good at sharing information on where to get help, but many mental health patients are discharged from the Mental Health Trust and don’t know where to seek help when they need it.  

Ulla added that everyone in the family is affecting when a family member has a mental health problem, and people find it difficult to ask for support. Some have been disappointed when seeking support from the Mental Health Trust. From her experience many of the staff lack passion for their role. 

Cllr Stock asked how people could be encouraged to ask for help; she reported having met many residents who care for others on their own and don’t want to request help or speak about their problems. They probably need support to take breaks but are sometimes reluctant to allow anyone else to look after their loved one.

Mr Rich responded that BCC carries out work to identify carers in need of support – however there is insufficient capacity to provide enough support currently. More people are registering as carers than ever before and BCC undertakes outreach sessions for carers around the Borough. Funding has also been put aside to work with smaller community groups. Further education is carried out via the Schools Programme and the Young Carers Programme which have led to many referrals. GPs can also refer carers directly to the BCC.

Cllr Perlberg asked whether carers are sufficiently aware of direct payments provided by the council. Ulla responded that her Care Coordinator at Barnet Council had been helpful and had organised support for her daughter which has made Ulla’s life easier. Mr Rich responded that a social worker carries out a care assessment and BCC provides domiciliary care. However the BCC cannot recruit enough carers – there are an estimated 40,000 carers in Barnet carrying out a wide range of roles. Some will qualify for a care assessment but many will not. He noted that often people reach out to BCC only  ...  view the full minutes text for item 8.

To follow

The Chair invited to the table:

• Ellie Chesterman, Interim Head of Commissioning, Mental Health and Dementia, LBB
• Barry Day, Managing Director, Barnet Division/Deputy Chief Operating Officer, Barnet, Enfield and Haringey Mental Health Trust (BEH MHT).

Dr Djuretic reported that the presentation by mental health users at the last HOSC meeting had been fed back to colleagues and that Barry Day, Managing Director, BEH MHT is at the meeting to respond.

Mr Day commented that the Trust has a lot of work to do, and this had increased since the pandemic. The Trust has introduced Dialogue Plus, a different way of care planning and communicating with service users and part of a large national community mental  health transformation programme. This involved working to change language, for example to ‘how can I help you?’ rather than ‘what is wrong with you?’. 

Mr Day reported that access to services is key, particularly for patients in crisis. He reported that during September 2022, 91-97% of assessments were undertaken within the right time. The Psychiatric Liaison Service has targets to see people and assess them within an hour and achieved this at Barnet General Hospital for 97% of patients during the same time period. The Crisis Home Treatment Team has a target to assess a patient within four hours and achieved this 100% of the time in Barnet since September 2022.

Mr Day reported that additional mental health workers are being employed in primary care. The Trust is also working on its organisational culture, and feedback is important.

Ms Chesterman noted that the feedback from residents at the previous HOSC meeting was appreciated.  A Crisis Pathway Group has been set up to look at challenges patients have accessing services, with colleagues from the Mental Health Trust, Integrated Care Board, Primary Care and voluntary care. A Crisis Café provider is also involved; Mind Crisis Café is commissioned by the Trust as an alternative to secondary care, to provide on-the-day assessment of mental health needs. Also a Wellbeing Programme, package of counselling, access to group sessions, including peer-led sessions, is being developed.

Ms Chesterman added that the Trust works with service users and the Mental Health and Carer Forum to ensure that residents are involved in tenders when commissioning services, to help to shape how services are designed and delivered.

Ms Chesterman added that a Mental Health Charter for Barnet is being developed, with residents’ involvement. This is relevant not only for Trusts but also businesses and organisations across the Borough. She added that it is recognised that there are inequalities around access to service. Recently NCL ICB Inequalities Fund invested in Arts Against Knives which is helping colleagues to engage with young black men, who are over-represented in mental health inpatient services. Some creative ways, involving music for example, are being found to improve engagement with this group.

Mr Day reported that Barnet has twice as much voluntary sector engagement around mental health services than the other NCL Boroughs. Work is ongoing to create a  ...  view the full minutes text for item 9.

Annual update – to follow.

Dr Julie George, Deputy Director, Public Health, LBB spoke to her report.

Dr George noted that the report is the first annual update on the Suicide Prevention Strategy. The Strategy had so far achieved good results, with no suspected suicides in Barnet during the three months that the prevention campaign was running. Experts by Experience’ had informed the programme, and suicide prevention training had been provided for a number of people. An evaluation report would be shared when available and a further update would follow for the HOSC in a year’s time.

The Chair commented that the media had recently reported that the highest suicide rates had been found to be amongst men employed on construction sites. Dr George responded that CommUnity Barnet has been commissioned to undertake some work around this.

Cllr Cornelius requested an update on the online Mental Health Awareness Training (page 22) for school staff and parents. Dr George responded that her colleague Jane Abbott had commissioned this training, which anyone could access, with more in-depth support available to school staff.

Cllr Cornelius asked about public health representatives being invited to groups which was noted as ‘in progress’ (Page 27) due to the departure of the Clinical Lead. Dr George responded that the partnership has a new Clinical Lead which who will take this forward.

The Chair thanked Dr George and wished her well for her retirement.

RESOLVED that the committee note the key achievements in suicide prevention during 2021/22, recognises the trends in data related to suicide and self-harm in the last year, and that the committee continues to receive an annual update on suicide prevention.

The Chair invited Colette Wood, Director of Integration, NCL ICB to the table.

Ms Wood reported that the North Central London Integrated Care Board (NCL ICB) has taken on the responsibilities of the Clinical Commissioning Group (CCG) and so far held two Board meetings. The Barnet CEO, John Hooton is Chief Executive Officer for Barnet and NCL on the ICB.

Ms Wood noted that the Integrated Partnership Board will meet later in 2022, with leaders from all five councils invited. Work has been ongoing for 2.5 years to ensure that the ICS has good governance and is in a strong position. Art Against Knives, Healthy Hearts and work around frailty are part of the planned work so far. An update would be prepared for the HOSC in 2023. 

The Chair thanked Ms Wood and said she looked forward to hearing its progress at the HOSC on 27^th February 2023.

RESOLVED that the Committee noted the verbal update.

Including preparation for 'flu season and Covid-19

The Chair invited to the table:

• Dr Nick Dattani, Interim Borough Clinical Lead, NCL ICB
• Beverley Wilding, Acting Deputy Director (Barnet) Primary Care and Community Commissioning, NCL ICB

Dr Dattani reported that the ICB had led on the Autumn-Winter vaccination programme and residents over the age of 50 or with long term conditions, carers and frontline health staff had all been invited to have Covid-19  booster vaccines. So far 3.3-3.4 million vaccines had been delivered in total across NCL, with 2.5 million of those being delivered in primary care and community pharmacies. This had been coordinated with the ‘flu jab and included using the opportunity to invite people for other jabs as needed.

Possibly 18-30 year-olds would soon be invited for booster vaccines, and a lot of work had been carried out in Barnet to ensure deprived areas were reached as these had a lower uptake. 

Cllr Cornelius asked how much GPs are paid per Covid-10 vaccine. Dr Dattani responded that there is an item of service fee £10.06 across England, for ‘flu and covid. The payment was higher during the first wave of the pandemic as there was a larger cost of delivering this. He added that GPs generally break even on the costs. The vaccines are available at designated sites, not all GP Practices.

Dr Djuretic reported that the Covid vaccines given in schools in Barnet last year was the highest across NCL at around 40-50% of pupils.

Cllr Zubairi asked whether there is any potential harm in receiving ‘flu and Covid vaccines at the same time. Dr Dattani responded that it is encouraged to have both together to reduce the amount of time experiencing any side effects, which would be spread over two separate periods of time if undertaken separately.  

Ms Wilding reported that winter planning is ongoing in NCL throughout the year, and the five Boroughs are working jointly on this. Bids had been submitted for additional funding from NHS England (NHS). The ICS is looking into how it can improve  discharging patients from hospitals to ensure more beds are available. In addition from the end of November additional beds in community services should be available, which should be open to Barnet Hospital and Chase Farm Hospital. The key issue is workforce, with the northern area of the Borough facing more pressure.

To deal with winter pressures there is likely to be control and command centres in each of the ICB areas. Further updates on this would follow.

Ms Wilding reported that the ICS is also investing into services to help take more complex patients home through increased nursing, and purchasing interim beds to get patients back into care homes. It has also been recognised that more end-of-life resource is needed.

Ms Wood noted that the ICB would ensure Investment goes into primary care and community services, though workforce is a constraint. In Barnet the A&E Delivery Board coordinates a winter plan, which partners had been working on for some time. 

Ms wilding  ...  view the full minutes text for item 12.

The Chair noted the following:

• 27 February 2023 – Integrated Care Board update on Transformation Plan
• 17 May 2023 – winter pressures vaccination – lessons learnt
• 8 December 2023 – NHS Estates and Sustainability in the NHS
• 8 December 2023 – Long Covid – Users Group
• Mental Health Trust – to follow 

resolved that the committee noted the Forward Plan and agreed the above changes.

None.