The Health in Hackney Scrutiny Commission met on Tuesday 8 October 2024 to discuss the transfer of specialised services commissioning from NHS England to NHS North East London, and to review progress on tackling maternal mental health disparities in Hackney. Key decisions included the endorsement of the transfer of specialised commissioning functions, with a focus on HIV services, and a commitment to further investigate and address inequalities in maternal mental health provision.

Transfer of Specialised Services Commissioning to NHS North East London

The commission received a briefing on the significant transfer of specialised services commissioning from NHS England to NHS North East London Integrated Care Board (ICB), due to take effect from April 2025. This move aims to improve population health management, tackle health inequalities, and ensure better value for money by bringing commissioning decisions closer to local populations.

Archana Mathur, Director of Specialised Commissioning and Cancer for North East London, explained that this delegation is a statutory function that will be endorsed by NHS England and the ICB boards. The process involves a rigorous due diligence assessment, with North East London performing well in meeting the required gateways. The financial allocation for these services, totalling £587 million for North East London, is shifting from a historical provider-based allocation to one based on population needs, which is considered a positive development as it will better reflect local demographics, deprivation, and age.

A significant portion of the discussion focused on HIV services as a case study for this devolution. Dr Adam Croucher, HIV Clinical Lead at Homerton Healthcare, and Chris Buckley, Social Care Coordinator for HIV services at Homerton, highlighted the importance of local control in addressing the complex needs of people living with HIV. Mark Santos, Chief Executive of Positive East, a local HIV charity, emphasised the need for adequate funding and innovative approaches to service delivery, particularly in addressing disengagement from care and the health and wellbeing needs of an aging HIV population. Chris Lovett, Deputy Director of Public Health for Hackney, outlined the council's work on a sexual reproductive health strategy, focusing on reducing stigma, increasing early diagnosis, and promoting prevention.

Concerns were raised about ensuring that funding allocations keep pace with inflationary pressures and that the new population-based formula adequately addresses the needs of diverse boroughs within North East London, such as Hackney. It was clarified that the delegation of this function does not directly impact local authority finances, but it presents an opportunity for better integration of health and social care pathways.

Maternal Mental Health Disparities

The commission also addressed the ongoing challenges in tackling maternal mental health disparities in Hackney, building on previous discussions. Justine Cawley, Trust-wide Lead for Perinatal Mental Health at ELFT, and Jairzina Weir, Maternity Strategic Lead for City and Hackney Place Based Partnership, presented an overview of existing provision and current work to address inequalities, particularly for Black and Global Majority women.

Key initiatives discussed include the Race and Health Observatory project, which aims to increase access for Black African and Black Caribbean women to perinatal mental health services using an anti-racist lens. Challenges with data collection and completeness were acknowledged as a significant barrier to fully understanding and addressing disparities.

Contributions from patient voice organisations, including Deborah Sayagh, Chair of the Maternity and Neonatal Voices Partnership (MNVP), and Rachael Buabeng, Co-Chair of the Black and Black-Mixed Heritage subgroup, highlighted the importance of continuity of care and culturally sensitive approaches. They stressed that the lived experiences of women, particularly concerning the disproportionately high maternal mortality rates for Black women, must be central to service design.

Emma Yates, Midwife for Safeguarding at Homerton Healthcare, detailed work on initiatives like the Izzy Project, supporting women involved with children's social care, and the Hope Box Project, aimed at providing training for staff interacting with vulnerable women. The Homerton Black & Black Mixed Heritage antenatal classes and the development of link midwives were highlighted as efforts to improve engagement and outcomes for this cohort.

Sarah Summersgill, Head of Nursing for Children at Homerton, discussed the role of enhanced health visiting services in identifying and supporting maternal mental health needs, while also noting the persistent challenges with collecting comprehensive demographic data. Councillor Jasmine Martins raised concerns about migrant women's fear of accessing healthcare due to immigration status, and the measures in place to ensure a safe and compassionate environment.

Diane Jones, Chief Nursing Officer for NHS North East London, emphasised the ask, listen, and do approach to individualised care planning, stressing that getting it right for Black women would benefit all women. She highlighted the need for reframed staff training, increased investment in charities, and tailored appointment lengths to meet individual needs. The importance of continuity of care was repeatedly stressed by multiple speakers, with data showing higher satisfaction rates for women who experience it.

The commission noted the ongoing work to improve data collection, develop culturally appropriate services, and ensure that mental health remains a key consideration in the reconfiguration of maternity services. The need for a father-friendly approach to perinatal mental health was also raised by Sally Beaven from Healthwatch Hackney.