Greenwich Council

Agenda and minutes

Venue: Committee Room 4 - Town Hall, Wellington Street, Woolwich SE18 6PW. View directions

Contact: Gurdeep Sehmi  Email: gurdeep.sehmi@royalgreenwich.gov.uk or tel. 020 8921 5134

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Panel.

Minutes:

Apologies for absence were received from Councillor Linda Bird.

2.

Urgent Business

The Chair to announce any items of urgent business circulated separately from the main agenda.

Minutes:

There was no urgent business.

3.

Declarations of Interest pdf icon PDF 61 KB

Members to declare any personal and financial interests in items on the agenda.  Attention is drawn to the Council’s Constitution; the Council’s Code of Conduct and associated advice.

Additional documents:

Minutes:

Resolved –

 

That the list of Councillors’ memberships as Council appointed representatives on outside bodies, joint committees and school governing bodies be noted.

4.

Minutes pdf icon PDF 100 KB

Members are requested to confirm as an accurate record the Minutes of the meeting’s held on 11 January 2018 and 8 March 2018.

 

No motion or discussion may take place upon the Minutes except as to their accuracy, and any question on this point will be determined by a majority of the Members of the body attending who were present when the matter in question was decided.  Once confirmed, with or without amendment, the person presiding will sign the Minutes.

Additional documents:

Minutes:

Resolved -

 

That the minutes of the meetings of the Healthier Communities & Older People Scrutiny Panel held on 11 January 2018 and 8 March 2018 be agreed and signed as true and accurate records.

5.

2018-19 Work Programme Cover report pdf icon PDF 41 KB

To agree the work programme for 2018/19.

Additional documents:

Minutes:

The Chair outlined how extensive the work programme for the year was and pointed to an item, listed for the meeting in April 2019, 0-19 Public Health Nursing, that had been referred to the Panel by Overview and Scrutiny Committee.

 

The Chair informed Members that due to the large work programme, a scrutiny review had not been factored in for this year.  He asked Members to consider the information being presented to them over the coming months with a view to identifying an area of services that fell under the Panel’s remit they would want to conduct a review on next year.

 

Members requested, and officers agreed that, where possible, all items presented to Panel will include information on diversity and how the needs of different sections of the community are met.

 

In response to Member questions, the Chair advised that poverty issues that arose from those receiving Nil Recourse to Public Funding support would be picked up by the Housing and Anti-Poverty Scrutiny Panel.  He also advised that the Skills Academy Trust was not being presented to Panel this year and would be considered for the 2019/20 work programme.

 

Resolved –

 

The Panel agreed the schedule for the Healthier Communities and Adult Social Care Scrutiny Panel (HCASC) work programme for 2018/19.

 

 

 

6.

Health and Care Arrangements pdf icon PDF 62 KB

To note the report outlining the organisational arrangements for the health and care system in Greenwich, and to note the agreement by the Health and Wellbeing Board to the establishment of a Health and Wellbeing Executive group, and to note the description of the scope of the Directorate of Health and Adult Services Directorate.

Additional documents:

Minutes:

The Director of Health and Adult Services presented the report, reiterating the complexity of care arrangements.  He added that officers support over 3000 people a week and that the third of the Council’s budget is spent on social care.  When this was added to funding on children’s social care this equates to two thirds.  The Director of Health and Adult Services went on to explain the charts and diagrams outlined in the appendices.

 

In response to Member questions, the Director of Health and Adult Services said that if the hospital believe that patients are in receipt of Social Care they contact the directorate.  The directorate liaises with the hospital to assess those needing social care intervention when they leave hospital and supports discharges to move people to the services they need.  This could mean provision of specialist equipment or arranging care 4 times a day.

 

In response to Member questions about delayed transfers, the Director of Health and Adult Services said that there was a low level of transfers at QEH. Performance in the hospital was strong and the critical point in in the process is keeping people safe.  The responsibility of transfers was a shared one and the directorate and hospital work collaboratively.

 

The Director of Health and Adult Services felt that, in the Care Quality Commission (CQC) report, the Government’s obsession with delayed transfers was exhorted.

 

In response to Member questions about the newly established Health and Wellbeing Executive, the Director of Health and Adult Services said that this was agreed at the 20 June 2018 Health and Wellbeing Board (HWB) and that it was formalising working arrangements and would not be a decision making body.

 

Members raised concerns and asked for further clarity on the Health and Wellbeing Executive, especially as they felt this may stem increased bureaucracy.  The Director of Health and Adult Services explained that some decisions could only be made by the Health and Well-being Board and each statutory organisation has its own governing body.  There was a requirement to work together and the executive is part of the ethos and will endeavour to work together.

 

In response to Member questions on the health care provider market and their CQC ratings as outlined in a heat map showing areas where providers inspected by CQC require improvements, Greenwich rated very good. The Director of Health and Adult Services said that the provider market was relatively good and that there was strong collaboration to deliver this provision.

 

Resolved –

 

1.    Noted the report

2.    Noted the agreement by the Health and Wellbeing Board to the establishment of a Health and Wellbeing Executive group to support the Board in operationalising its decisions and priorities, and to develop implementation plans for Board approval.

3.      Noted the description of the scope of Directorate of Health and Adult Services of the council.

7.

Cabinet Member Report pdf icon PDF 35 KB

To receive an update by the Cabinet Member on her priorities for the year 2018/19.

Minutes:

Councillor Averil Lekau, the Cabinet Member for Adult’s Social Care, Health and Anti-Poverty provided a verbal presentation on her first 50 days as the holder of this portfolio and said she invited comments from the Scrutiny Panel to further inform her prioritises and to take back to Cabinet.

 

The Cabinet Member for Adult’s Social Care, Health and Anti-Poverty outlined the array of meetings that she has had which included, Greenwich Carers, GCCG, Air Quality Task Force and the number of events that she had attending, i.e. Dementia Awareness Day, Have your Say events, Mental Health Summit.

 

She said that the HWB agreed to review the priorities that the previous Cabinet Member regularly reported on when it met in June this year.

 

As Cabinet Member for Adult’s Social Care, Health and Anti-Poverty, she said it was important that her priorities align with the HWB, but she also has responsibilities for social inclusion.

 

She will be building on the priorities identified by the previous Cabinet Member in the previous years and these would be confirmed by Cabinet.  Her priorities would focus on the key areas for Health and Social Care and the areas of focus are likely to be:

·        Supporting healthy weight management especially in Children.

·        Improving the Mental Well-Being of people in Greenwich, particularly through Greenwich Thrive.

·        Ensuring the Health and Social care system work effectively and sustainably for people in Greenwich and that all stakeholders are working together to provide joined up high quality services for local people.

·        The Cabinet Member priority on Social Inclusion will cover more than this Panel.

 

Inevitably within these broad priorities there will be particular issues, but she said she wanted to avoid a huge priority list.  She stressed that, like colleagues on the Scrutiny Panel, she would at times focus on particular issues and that she would welcome comment from colleagues on this Panel on these broad priorities.  

 

Members welcomed the Cabinet Member having Anti-Poverty within her portfolio as this presented a great opportunity to add value to health scrutiny.  The Cabinet Member for Adult’s Social Care, Health and Anti-Poverty said she expected to be answering questions on equality and poverty in all Scrutiny Panels and that the Social Mobility Strategy that was borne out of work to implement the recommendations of the Fairness Commission would soon go out to consultation.

 

When asked about the biggest thing that surprised her during her meetings/visits/events in her first 50 days, the Cabinet Member for Adult’s Social Care, Health and Anti-Poverty said as she had chaired this particular Scrutiny Panel for 2 years previously, not many surprises came about.  However, she felt that from 2.5 years ago, the financial burdens on Health Services has dramatically changed and grown.  This was a challenge.

 

When asked about measurable and tangible outcomes, the Cabinet Member for Adult’s Social Care, Health and Anti-Poverty said that health and well-being is a process and a journey and tick boxes/number crunching may be a problem.  She explained that work being done to reduce smoking  ...  view the full minutes text for item 7.

8.

Lewisham and Greenwich NHS Trust (LGT) Presentation pdf icon PDF 49 KB

To receive and consider Lewisham and Greenwich NHS Trust’s presentation about the Trust, its priorities and what patients say.

Additional documents:

Minutes:

The Panel received a presentation from the Chief Executive of the Lewisham and Greenwich NHS Trust (CEO of L&G NHS Trust).  He introduced himself and told Members that he has been in post for three months.

 

He presented details on the populations served by the Trust, facts about the trust, key priorities, views from the regulators and what patients say about the trust.

 

The CEO of L&G NHS Trust outlined the financial challenge of having to deliver savings of £25m.  The Trust constantly looked at ways of improving patient care.  The Trust is having an impact on reducing Did Not Attends (DNAs) by the introduction of text reminders. This had reduced from 20 to 10%, reducing waiting times by increasing productivity in theatres.

 

Members requested (and the CEO of L&G NHS Trust agreed) that, where possible, more information about patient experiences and what they say would be included.

ACTION: CEO of L&G NHS Trust.  

 

In response to Members questions about how key priorities had been monitored, the CEO of L&G NHS Trust outlined the governance structure of the organisation. The Trust Board meets every month, whose role was monitoring around performance on priorities. The board had a range of thematic sub-committees that address issues under their remit.  These report back to the Board.  The executive team meet twice a month.

 

In response to a Member query about discrepancy on patient views and regulator rating, the CEO of L&G NHS Trust said this reflected the different perspective of those giving feedback.  Patients care about good services and regulators look at things that patients take for granted, i.e., how end of life pathway was working, vacancy rates.  He said that both perspectives are valid.

 

In response to Member questions about the patient feedback statistics, the CEO of L&G NHS Trust said that he would provide the figures broken down by hospital.

ACTION: The CEO of L&G NHS Trust.  

When asked if these are looked at alongside complaints, the CEO of L&G NHS Trust said that complaints had not increased hugely, but the Trust responds to them in a timely way. The CEO of L&G NHS Trust assigned those that require investigation and signs the responses that are drawn up.

 

He said that it was about the learning from investigations and making sure staff feel safe to raise concerns as well.

Measuring the moral of staff is very important and he recognises that more listening sessions needs to take place that allow people to talk to him. He wants to get people talking about their experiences, as a significant number did not have the same experience, so that they can learn from each other and contribute to changing the culture.

 

The Trust had recently had an unannounced inspection of medical wards and surgery and that they were expecting a full inspection in September.  The CEO of L&G NHS Trust said that he would be optimistic to get a rating of good, but  ...  view the full minutes text for item 8.

9.

Performance Monitor Report 17/18 Q4 pdf icon PDF 580 KB

To examine and consider the information on the selected indicators and   to use the information to continue the panel’s ongoing assessment of how effectively the Council and its partners are meeting the health and wellbeing needs of the local population.

Minutes:

The Director of Health and Adult Services presented the report and explained that there were a whole number of Key Performance Indicators (KPIs) that the relate to health services.  The current basket of indicators that were reported on where agreed by the Panel in 2013.  These would be reviewed.

 

The Chair suggested and Panel agreed that a briefing session be arranged for Members to fully understand the range and number of indicators that information needs to be gathered for.

Action:  Directorate of Health and Adult Services.  

 

Resolved –

 

The Panel examined and considered the information on the selected indicators which are based on the public health, NHS and adult social care outcome framework.

10.

Eltham Hospital Report pdf icon PDF 34 KB

To receive an update on Eltham Community Hospital.

Minutes:

The Chair reminded Members that a written briefing note was circulated to them a day earlier.

 

Neil Kennett-Brown, the Managing Director of the Greenwich Clinical Commissioning Group outlined the history to set the scene in respect of the development of the state of the art Eltham Community Hospital. 

 

There was a combination of chair and bed geriatric assessments to determine the level of support required allowing those that do not require prolonged hospital care are supported at home.

 

The Hospital had 2 GP practices, a diagnostics unit and a theatre on the ground floor. There were 2 wards on the first floor.  Muscular Skeletal (MSK) services are also delivered on site.

 

The unit opened in August 2017 and in started 7 day operation in October.  GPs, Care Homes and Local Authorities can refer to it.  A geriatrician is linked to the rapid response team to work out if the hospital is the best place for the patient to be.  This prevented hospital admissions.

 

Since the hospital opened, the referrals to services had been low, averaging out to five a day.  The services remained underutilised with only 3 beds being used. Winter 2018 saw QEH full to capacity and even at the busiest points, 60% of the beds in Eltham Community Hospital were empty.

 

In response to Member questions on reasons for low level of referrals, the Managing Director of the Greenwich Clinical Commissioning Group said that there was hope that the referral numbers would increase as GPs are able to get advice via telephone in advance of making referrals.

 

Eltham Community Hospital provided 40 beds.  It is proposed that this was reduced to 20 and the clinical assessment unit and ambulatory Care Unit conduct chair based assessments at QEH.  The unit would not be closed, as the intermediate care capacity would increase to 30 beds.  GCCG is working with Oxleas Trust to negotiate a good rate for them to run the ward at ECH.  In the long term, there was a need to be less bed dependent and to deliver care in the community.

 

In response to Member concerns about underutilisation, the Managing Director of GCCG said that over the last two winters, there was a state of the art facility in Eltham that was not being used, whilst the bed occupancy at QEH was sometimes above 100%.  This change would see all beds used.  The new development at QEH will allow for a decant ward to support the elderly and frail.

 

Members expressed that as concerns have been raised by the community GCCG must be clear on how they communicate this change.

 

In response to Member questions about the cost of services at Duncan House, the Managing Director of GCCG said that this was cost effective.  To further support and develop the community offer, GCCG fund therapists to delivery services at Duncan House.

 

The Managing Director of GCCG in his concluding remarks outlined the recent CQC rating that GCCG had received.  The rating had gone up from inadequate to  ...  view the full minutes text for item 10.