Greenwich Council

Agenda and minutes.

Venue: Committee Rooms 5 & 6 - Town Hall, Wellington Street, Woolwich. SE18 6PW. View directions

Contact: Jean Riddler  Email: jean.riddler@royalgreenwich.gov.uk or tel. 020 8921 5857

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Panel.

Minutes:

Apologies for absence were received for Councillor Paul Morrissey and Harpinder Singh

 

Apologies for lateness were received from Councillor Matt Hartley.

 

Apologies for leaving the meeting early were received from Councillor John Fahy.

2.

Urgent Business

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

Minutes:

There were no urgent of business submitted for consideration.  However, the Chair advised that the running order for the agenda would be changed and the Scrutiny Panel took the items in the following order;

 

Item 5 - Lewisham and Greenwich Trust (LGT) update

Item 8 – Greenwich Clinical Commissioning Group – QIPP Savings

Item 9 - Greenwich Clinical Commissioning Group – South East London Sustainability and Transformation Plan

Item 6 – Cabinet Member’s Progress Report on Council priorities

Item 7 - Monitoring report on selected health and social care performance indicators.

 

3.

Declarations of Interest pdf icon PDF 34 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:

Councillor Clare Morris declared a personal interest in all the items on the agenda as she held an honorary contract with the Lewisham and Greenwich NHS Trust.

 

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 121 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 26 September 2017 and 1 November 2017.

 

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 26 September 2017 and 1 November 2017 be agreed and signed as a true and accurate record’s.

5.

Lewisham and Greenwich Trust (LGT) update pdf icon PDF 48 KB

The Panel is asked to consider the Trust’s update, appended to the report. 

Additional documents:

Minutes:

The Chief Executive of the Lewisham and Greenwich Trust (LGT), gave an illustrated presentation, highlighting that the Queen Elizabeth Hospital had one of the better rates for ambulance to hospital patient handover times in London.

 

In respect of the current financial position he commented that whilst they were one of the better Trust financially, it was felt they could do better.   Savings created through improved efficiencies were re-invested into staffing provision and it was anticipated that the Trust would end the financial year with a deficit of, no more than, £65million.  Collaborative schemes with other Trusts had not delivered the financial savings anticipated. 

 

The Chief Executive LGT stated that staff vacancy levels were higher at Lewisham Hospital than at the Queen Elizabeth Hospital.  Further, whilst levels of sickness could indicate poor staff morale, and the A&E Department had been under pressure for the past 5 weeks, the position on sickness was positive.  Having said that where hospital staff were falling ill they appeared to be sicker for longer and, for the first time, there were high respiratory infection rates among young consultants. 

 

He advised that the overall performance of the Trust was above the expected 86%, and fewer patients were waiting for beds but there was still a daily pressure on staff to ensure the discharge process was efficiently undertaken to release beds quickly.   That planning permission had be granted for a 3-storey extension to the north-western corner of the main hospital building which would provide additional space including alternative clinical space during the planned infrastructure improvement works. 

 

The Chief Executive LGT responded to Members questions advising that the bed occupancy rates, at this time of year, was always above 95% and, in rare situations exceeded 100%, but areas for safe patient care had always been created in these situations. 

 

In respect of patient re-infection, he stated that this was always a risk

and, in the longer term, the new building would allow wards to be reduced from 6 to 4 patients.  He noted that infection control was one of the Trusts areas of strengths and each month, via public Health England, he had to sign off on 6 infective disease notifications and there was very little infection in the hospital.

 

The Chief Executive LGT responded that he had received no reports of patients being treated in ambulances but there would be occasions for   Emergency Department staff to assess a patient, whilst still in the ambulance and this would be recorded; no incidents of this had happened this winter.  Further, there were no cases of people arriving by ambulance and being discharged before admissions.

 

With regards to staff accessing housing and the impact on recruitment, the Chief Executive LGT felt that this was not an area the Trust could resolve in isolation and there was a desire to work with the Council, who have greater experience with housing provision, on ways forward.

 

Members expressed their desire to support the development of a key workers campus / housing and to  ...  view the full minutes text for item 5.

6.

Cabinet Member's Progress Report on Council priorities pdf icon PDF 151 KB

The Panel is asked to consider the progress report on the implementation of programmes of work to implement the Cabinet priorities adopted for Health and Social Care, including public health.

 

Minutes:

Councillor David Gardner – Cabinet Member for Health and Social Care, including Public Health, addressed the Panel advising that joint working with the NHS, through the Joint Emergency Team, was going extremely well.  He noted that there were still issued around the delay in transferring patients ready for discharge from hospital to Care Homes but a lot of the embargoes, imposed by the Care Quality Commission (CQC) had been lifted, which should start to ease this position.  He assured Members that whilst this area was going better it was one that could still do better and this was being monitored. 

 

The Cabinet Member for Health and Social Care continued that there were a significant numbers of patients ready for discharge from hospital that could be returned to their homes with additional support however, whilst support was available during daytime it was lacking at night which needed to be addressed.  It was anticipated that patient access to their care funds would encourage supported independent living and allow individual greater choice.  He accepted that there had been poor performance in respect of dealing with Mobility Blue Badge applications but new staff had been engaged and the backlog had been cleared.

 

In respect of Nil Recourse to Public Funds there was pressure to retain continuity whilst maintaining fiscal obligations to residents.  A new interrogation system had been instigated which had enabled spend to be reduced to £29million and whilst this was still a high monetary outlay it was not the highest level in the country.

 

The Cabinet Member for Health and Social Care confirmed that the Health and Adult Service transformation programme was continuing but the speed of delivery did not reflect the ambition for the scheme.  It had been accepted that for some users the pace of adoption had had to be reduced to one they were comfortable with. 

 

In respect of delayed adult hospital discharge to social care the Director of Health and Adult Services accepted that there were continued delays in respect of the discharge of people with mental health issues, which needed to be addressed. 

 

The Cabinet Member for Health and Social Care advised that individuals’ access to personalised budgets was progressing but there were issues with the technology and ensuring accurate budget details were issued as well as protecting the system and individuals from fraud.  He noted that the take up of personal budgets had slowed somewhat and it had to be accepted that it was not a suitable arrangement for all clients.

 

With regards to the Borough wide implementation of the London Living Wage across the Borough the Cabinet Member for Health and Social Care confirmed that good progress was being made in many areas but there were issues with some areas, such as residential care, were companies did not hold contracts with the Council.

 

The Cabinet Member for Health and Social Care advised that the Greenwich Live Well Scheme was proving successful and the seven Live Well Coaches were accessible via telephone and Greenwich Live  ...  view the full minutes text for item 6.

7.

Monitoring report on selected health and social care performance indicators. pdf icon PDF 801 KB

The Panel is 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.

 

Minutes:

The report was considered without debate.

 

Resolved –

 

That it be agreed to note the information on the selected indicators which are based on the public health, NHS and adult social care outcome frameworks.

 

That it be agreed to 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.

 

 

 

8.

Greenwich Clinical Commissioning Group - QIPP Savings pdf icon PDF 43 KB

The Panel is asked to consider a report/presentation from Greenwich Clinical Commissioning Group (GCCG) on QIPP Savings.

(Please note the presentation will be issued separately)

Additional documents:

Minutes:

The Chief Executive of Greenwich Clinical Commissioning Group (GCCG) gave an illustrated presentation on the planning for the 2018-19 Quality Innovation, Prevention and Productivity (QIPP) advising the CCG would be receiving an increase of £10.1m allocation. However, it was forecast that the base cost’s would increase to £24.4m, and after identifying areas of savings and funding it was predicated there would be a financial gap of £2.6m.

 

He continued that they faced ‘non demographic price changes’, a longer lived population, higher levels of demand and increasing expectations.  QIPP did deliver on improving patient outcomes and GCCS was in a similar position to other CCG’s in London.

 

The Managing Director GCCG stated that they shared information and learning with other CCG’s around the country identifying potential  collaborative opportunities.

 

The Associate Director - Urgent Care at the GCCG, added that frequent attenders would seek to access services from multiple providers and a Frequent Attendees Scheme had been piloted in one area in October 2016 and running for 1 year and produced good results.  The GCCG was confident that this scheme could be expanded, taking into accounts lessons learned, to reach and support patients in their communities.  This was a bespoke scheme for Greenwich and involved the use of health case coaches and champions, 1-2-1 support, sign posting, support at home and in hospital.

 

The Panel expressed concerns at the 2018-19 predicate a financial gap of £2.6m and sought clarification as to what the difficulties and impact on the providers would be.  Further members requested a written updated on how the GCCG were performing against their 2017/18 delivery intentions and how they intended to close the funding gap .  Members requested that this be included in the 2018/19 Scrutiny Panel work programme to come to a future meeting.

Action: SCDO / Managing Director GCCG

 

The Managing Director GCCG responded that if the funding gap was rolled over it would simply increase and a plan had been developed to reduce the gap.  Further, the GCCG worked collaboratively with other CCG’s, which also involve an element of financial risk sharing and support, but working as a total system was best practice.

 

The Scrutiny Panel asked what, if any, had been the impact of the closure of the Walk In Centres on the Queen Elizabeth Hospital A&E department and if there was an increase in attendance of people not registered with a GP.

 

The Managing Director GCCG confirmed that access hubs had been established in Eltham and Thamesmead, opening – 4pm to 8pm Mon- Friday and 8am to 8pm Saturday and Sunday and there was a good level of public awareness of this provision.  He stated that attendance on weekdays and Saturday was good but lower on Sunday and awareness of the service continued to be promoted through GP’s and Healthwatch

 

He continued that people attending A&E for dressing changes were being redirected to their GPs and support was being given to those not registered with a GP to register.  There was  ...  view the full minutes text for item 8.

9.

Greenwich Clinical Commissioning Group - South East London Sustainability and Transformation Plan pdf icon PDF 42 KB

The Panel is asked to consider an update report/presentation from Greenwich Clinical Commissioning Group (GCCG) on South East London Sustainability and Transformation Plan.

(Please note this will be issued separately)

Additional documents:

Minutes:

The Chief Executive of Greenwich Clinical Commissioning Group (GCCG) and the Director of Communications and Engagement Our Healthier South East London (OHSEL) gave an illustrative presentation on the OHSEL activity plans for 2017-2018 & 2018-2019.

 

Members sought details of specific services which directly affected or benefited the residents of the Greenwich Borough and what could be further developed.

 

The Chief Executive GCCG responded that London was unique with a number of services crossing Boroughs which allows partners and providers access to a wider model of support and learning.  There were no large structural changes planned from the current areas partners were delivering on.

 

Members comments that there was a widely held conspiracy theory, by many member of the public and stakeholders, that there was a move to sell off NHS services to create a US style health service and asked what action the GCCG and OHSEL were taking to combat this and clarify the true position.

 

The Director of Communications and Engagement OHSEL responded that nothing had been published that supported this and engagement with the Scrutiny Committee and Stakeholders had been undertaken to achieve a borough wide understanding of the processes.  If the public were worried about the privatisation of the NHS it indicated that the message being given was not clear and this could be a national failing by NHS England

 

In response to Members questions the Chief Executive GCCG confirmed that the Next Steps on the Five Year Forward View document was published in April and everyone, including partners, had a duty to meet the national clinical priorities and financially remain with budget.

 

The Director of Communications and Engagement OHSEL confirmed that the formal submission would contain greater detail and case study details.  He responded to Members that whilst there was nothing in the case studies that they felt they wouldn’t want the Scrutiny Panel to see, they had not been authorised to share this information, as yet. 

 

Members requested a copy of the submission and/or case studies that informed the submission made to NHS England.

Action: Director of Communications and Engagement OHSEL/ Director of GCCG

 

Members encouraged that the Next Steps on the Five Year Forward View document be publicly shared as much and as quickly as possible, particularly with stakeholders, to help combat the perpetuation of privatisation conspiracy theories.

 

The Director of Communications and Engagement OHSEL advised that development of an Orthopaedic Clinical Network for SE London had been discussed at the Joint Our Health South East London (JOHSEL) meeting in December.  A lot of information on usage had been gained and this could be shared with Members

Action: Director of Communications and Engagement OHSEL

 

The Scrutiny Panel accepted addresses from a member of the public who questioned the actual desire of the GCCG to public consultation as the information on the QIPP had been given to stakeholder with less than a week to respond on it.  Also, information was often circulated at short notice or after events had taken place.  

 

The Chief Executive GCCG  ...  view the full minutes text for item 9.