Greenwich Council

Agenda and minutes.

Venue: Commiittee Room 4, Town Hall, Wellington Street, Woolwich SE18 6PW

Contact: Gurdeep Sehmi  Email: or tel. 020 8921 5134

No. Item


Apologies for Absence

To receive apologies for absence from Members of the Panel.


Apologies for absencewere received from Councillors Linda Bird, Linda Perks and Matt Hartley.


Urgent Business

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


The Chair agreed to take as an urgent item, a briefing on the current position on the Eltham Community Hospital as Item 9.


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:


Resolved –


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


Minutes pdf icon PDF 98 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 12 July 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.


Resolved -


That the minutes of the meeting of the Healthier Communities and Older People Scrutiny Panel held on 12 July 2018 be agreed and signed as a true and accurate record.


Circle MSK Service – Update report pdf icon PDF 51 KB

The Panel is asked to receive and consider the attached presentation from Circle MSK.

Additional documents:


The Director of Integrated Care Operations from Circle MSK presented this item, supported by the General Manager, Long Term Conditions from Lewisham and Greenwich (L&G) NHS Trust and the Managing Director of GCCG.   The presentation covered the scope of the service, referral numbers and key performance indicators and the work conducted within the tripartite agreement.


In response to Member questions, the Managing Director of GCCG confirmed that the three partners work very closely to deliver the tripartite agreement.  Circle MSK work very closely with the General Practitioners (GPs) and it was confirmed that commissioners are now in the position to confirm that positive outcomes are being achieved and the GCCG are happy with performance.


The General Manager, Long Term Conditions LGT said that L&G NHS Trust has worked with GCCG and Circle from onset and meet with Circle on a weekly basis.  Work is done together to reduce waiting times and track patients through the system.  He outlined that an area of concern had been the drop in activity at the site and that partners will continue to work together to make improvements.


The Chief Executive, Healthwatch informed Members that the organisation had been monitoring the implementation and delivery of the new Circle MSK contract.  Healthwatch followed Circle MSK for over a year and Officers had attended contract monitoring meetings, Circle MSK clinical steering groups meetings, had carried out a series of Enter and Views to the Circle MSK Community hub at Eltham hospital and held a series of focus groups to enable MSK patients to share their experiences.  However, it was outlined that the report is based on a small sample size of 65 people.


In response to Member questions about the small sample, the Chief Executive, Healthwatch felt that the Circle MSK administration had an adverse impact on numbers responding as Healthwatch fliers were not sent with Circle letters as planned.  


In response to Member question about choice and streamlined process and that patients with other needs found it difficult to navigate through the system and were often just given an appointment, the Director of Integrated Care Operations of Circle MSK informed Members that the service has Patient Choice Advisers and also aims to support people in other ways such as offering physio and pain management depending on what is deemed to be the most appropriate pathway.  Circle MSK works collaboratively and in partnership with Lewisham and Greenwich NHS Trust to deliver local care for local people. This means that patients who want surgery and meet the evidence based criteria for surgery will be referred to the consultant directly. Patients whose conditions demonstrates that surgery is not the best option for them will be treated by other non-surgical methods.


In response to Member questions about the Hub and Spoke model, the Director of Integrated Care Operations of MSK said that Spokes are developed in areas based on patterns of referral and confirmed that clinicians used triage guidelines to refer patients appropriately.  In line with the treatment  ...  view the full minutes text for item 5.


NHS CCG Greenwich: Transforming our Health and Social Care System pdf icon PDF 61 KB

Members are asked to receive an update from the Managing Director of NHS CCG Greenwich on the Commissioning Strategy: Transforming our health and social care system.  

Additional documents:


The Managing Director, GCCG presented this report and informed Panel Members of the process in developing the commissioning strategy that had gained formal agreement at the Governing Body meeting that took place on 5 September.  Next steps are to develop a road map for improvement to take back to the Governing body in November 2018.


The Director of Commissioning, GCCG summarised the Plan on a Page as presented on page 5 of the NHS Greenwich Commissioning Strategy and in response to Member questions said that tackling loneliness was covering in the frailty and mental health sections of the plan.


Members suggested that health workers work closely with grass roots level organisation to ensure local services for local people.


In response to Member questions, the Managing Director, GCCG said that as part of the engagement process, officers spent time with local communities, with the example given of the work with the Nepalese community to understand their needs.  The recognised that diabetes and loneliness was of real concern for this community.  Officers had learnt that working groups was crucial to bring the right level of challenge to make a noticeable shift.


The Director of Commissioning, GCCG said that the prevention section of the strategy had been co-authored with Public Health and that this section includes Making Every Opportunity Count and Live Well programmes.  It was crucial to empower people to change lifestyles. It was noted that this was a holistic challenge and it needs to be tackled jointly, which includes the third sector. 


The Managing Director, GCCG informed Members that funding of £100,000 per annum had been set aside to develop a small grants programme for the third sector to apply to, so that activity can be delivered locally.


The Director of Public Health outlined the priorities that are being addressed by the Health and Well-Being Board.  These include obesity, which is being presented on at the next Scrutiny meeting. Obesity is a growing risk to ill health and is taking over smoking prevalence. The Director of Public Health offered to provide information on the whole Health and Well-being Strategy to show how partners will work together to deliver this.


In response to Member questions, the Managing Director, GCCG said that Mental Health was a national priority and that it was a statutory duty to meet the Mental Health investment standard.  He outlined that if funding sees a 3% growth, funding for mental health provision has to be increased by 3% and payment can only be grown down based on results. Crisis and intervention provision are areas where challenge is faced by providers as this provision will reduce the number of people presenting themselves at A&E.


In response to Members questions about transition points, Officers agreed that this was a very critical phase in the lives of service users and to achieve better outcomes, people should not have a cut-off point due to age. 


In response to Member questions about QIPP proposals not a different phrase for cuts, the Managing Director,  ...  view the full minutes text for item 6.


Monitoring report on selected health and social care performance indicators. pdf icon PDF 1 MB

Members are asked to examine and consider the information on the selected indicators which are based on the public health, NHS and adult social care outcome frameworks 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.


The Chair outlined informed Members of the Panel that as agreed at the last meeting, a briefing had been arranged to take place so that Members could get a better understanding of the range of statistics that health services report back on. 


The Director of Health and Adult Services said that the range of indicators include, NHS Social Care indicator sets, public health sets as well as many others.  He asked that Members to think about what will help them understand performance in Greenwich so that the briefing can be focused.


Resolved –


The report be noted.


Commissioning Future Reports pdf icon PDF 43 KB


Panel is asked to note the work items that are scheduled to be presented to the meeting of the Healthier Communities and Adult Social Care Scrutiny Panel taking place on 1 November 2018.




Additional documents:


The Chair told Members that he was making arrangements for a separate meeting to take place in January 2019 to think about the work programme for 2019/20.  Details of this would be communicated in due course.

ACTION: Corporate Governance Manager


Resolved –


Members noted the work items that are scheduled to be presented at the 1 November 2018 meeting of the Panel.






Update on Eltham Community Hospital


The Chair agreed to take as an urgent item, a briefing on the current position on the Eltham Community Hospital had been circulated to Members and he asked the Managing Director, GCCG to say a few words. 


The following was outlined by the Managing Director, GCCG:


There are two units currently in operation at Eltham Community Hospital;

·        The Community Assessment Unit (CAU) – 10 beds

·        The Greenwich Intermediate Care Unit (GICU) – 20 beds.


Both units offer step-up and step-down pathways for patients requiring a period of care and rehabilitation to prevent admission or before their return home following discharge.


In July, it was agreed that the location of chair-based comprehensive geriatric assessment service would change from Eltham Community Hospital to Queen Elizabeth Hospital (QEH). This move ensures that all demand goes through one place (the ambulatory care centre at QEH) and consolidates the geriatrician resource required to complete these assessments at QEH. Chair-based comprehensive geriatric assessment moved to QEH on July 30th.


In August, a proposal to merge the GICU and CAU into a 30-bedded integrated unit was approved by Greenwich Clinical Commissioning Group’s (CCG) Financial Recovery Board. As a result of this approval, Oxleas NHS Foundation Trust began a consultation with their staff across both units to enable them to work towards the consolidation of the workforce onto one unit.


The formal consultation with staff was launched on 17 August 2018 for a period of 30 days, closing on 16 September 2018. Posts are affected in three ways; due to a proposed change to working practice or shift patterns, or because the post is at risk due to a higher number of posts being in place at a particular grade than will be required to run the new unit.


10.6 WTE posts are affected in that there are more staff in post than posts available. These staff will need to undergo a competitive interview selection process. Oxleas are committed to avoiding redundancies by actively seeking suitable alternative employment for staff affected. If this is not possible using the posts currently available within Oxleas’ structure, then both Oxleas and the CCG are fully committed to facilitating discussions with partners, including Lewisham and Greenwich Trust, to find alternative employment for affected staff.


Plan for Winter 18/19 - From October 1 2018, there will be one 30-bedded unit at Eltham Community Hospital which can provide step-up and step-down support for adults (mostly frail elders). The beds will be referred to as Eltham Community Beds at Eltham Community Hospital.


The unit will continue to offer step-up and step-down pathways for patients requiring intermediate care to avoid patients going into the acute hospital unnecessarily and to support the transition of patients from hospital to home.


Eltham Community Beds will have single admission criteria, with a focus on preventing admission, readmission and reducing acute lengths of stay. Patients requiring the following support will be accepted;


Sub-acute care– for patients who are clinically stable but require short term on-going inpatient medial, therapy or  ...  view the full minutes text for item 9.