Greenwich Council

Agenda and minutes.

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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 absence were received from Councillors Olu Babatola and Dominic Mbang.


Apologies for leaving early were received from Councillor Matt Hartley.


Urgent Business

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


The Chair agreed that as this is an on-going contractual issue to take as an urgent item, a brief statement, without debate, on the Substance Misuse Service at Queen Elizabeth Hospital (QEH) as Item 11.


Minutes pdf icon PDF 80 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 13 September 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.


Councillor Mariam Lolavar requested that one change be made to the minutes.


Resolved -



That the minutes of the meeting of the Healthier Communities & Older People Scrutiny Panel held on 13 September 2018, with one amendment as below be agreed and signed as a true and accurate record.


Item 5, bottom of page 3 – Paragraph to read as follows: Circle MSK informed Members that the model used was based on a particularly the complex worst case scenario and was only used for illustrative purposes.


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.


Health and Social Care Winter Preparedness pdf icon PDF 37 KB

Panel to receive a report on the preparedness of services for winter 2018.

Additional documents:


The Managing Director, Greenwich Clinical Commissioning Group, (GCCG), Chief Executive of Lewisham and Greenwich (L&G) NHS Trust, Assistant Director Health and Adult Services and the Director of Projects at Oxleas outlined their respective organisations plans for winter and stressed that the plans allow for a whole system approach with greater integrated activity to achieve best outcomes.


In response to Members questions about the take up of flu vaccines by staff, the Chief Executive LGT NHS Trust said that it had been difficult historically to get staff to receive this vaccination and it would be good to reach the 75% target.  Activity and campaigning over the last 2 months had taken place to increase take-up.  The Trust had been learning from others that have succeeded, i.e. peer vaccinations were being offered as well as a flu bus going to the hospitals within the Trust to encourage take-up.  The trust is doing everything that they could, but as take-up is voluntary, some members of staff do not want to have this vaccine. 


The Director of Projects at Oxleas outlined how the Trust had been incentivising take up by ensuring staff were aware that some of them may be carriers of the virus and would not necessarily have symptoms and how trained colleagues were delivering this vaccine to other colleagues.  The Trust was exploring how they compare with other trusts.  He concurred with LGT and RBG in that the challenge was that some staff choose not to have this.  He was confident that they will have a higher take-up this year, but reaching 75% would be a challenge. People with pre-existing conditions were advised that they needed to consult their GP’s before having this vaccine. 


The Director of Public Health said that LGT NHS Trust reported that the Trust had a 45% take up last year and Oxleas was below 45%.  He reported that Public Health England collects information on take-up but this was not yet available. This data would show direction of travel for trusts.   Members asked to see data once available.

ACTION: Director of Public Health


In response to Members questions about flu vaccination take-up at GP surgeries, the Managing Director of GCCG said that GP’s were incentivised to deliver vaccines to vulnerable adults and children.  The feedback that had been gained from GP’s is that the Quadrivalent vaccine (QIV) being administered improves the immune system for those over 75 years old. 


In response to Members questions about admission avoidance, the Director of Commissioning, GCCG explained how the roll out of the telehealth service was dependent on IT infrastructure being good and was allowing direct access to staff and enabled a 6.5% reduction in the London Ambulance Service need to take patients to hospitals.  The aim was to put in place as much wrap-around support at all care homes.  He explained that the next step would be to make improvements at the ambulatory service.


In response to Member questions about the report being based on things not being right in  ...  view the full minutes text for item 5.


Lewisham and Greenwich Trust - Pathology Services pdf icon PDF 36 KB

Panel to receive a report on the future of Lewisham and Greenwich NHS Trust’s pathology services.

Additional documents:


The Director of Strategy, LGT presented the report highlighting the national change and the LGT position. She said that procurement processes started in August 2018 with expressions of interest needed to be submitted by end September.  GSTT and KCH want arrangements in place before the end of their current contract (September 2020).  A hub and spoke model currently exists within LGT with each hospital having a rapid response laboratory to service the needs of the A&E departments.  This ensures that test results are turned around in 1-2 hours.  Technology allows a quick exchange of information.


The Managing Director GCCG said the GCCG is part of the SEL STP and are required to work together as a regional network.  The LGT decision is respected, but felt that this had come too early given the particulars of who the new providers are not known, as the procurement has just started.  However, LGT advised that the timeline for their decision had been dictated by the SEL procurement process, where a decision was required from the Trust by the end of September whether to stay within the procurement or to look for an alternative NHS network.  It would be key to have high quality, value for money services in place and the national directive is that NHS organisation was required to be in a pathology network.


In response to Member questions, the Director of Strategy LGT NHS Trust said that this provided an opportunity for efficiency gains and the trust have a hub and spoke model already.  The Trust had to be in a network to provide these services and the decision on which network they join was being considered.


In response to Member questions about judging quality of the service the Director of Strategy, LGT said that a range of criteria was used to measure bids against each other.  There are comparators that can be looked at before a decision was made.  She pointed to the NHSi webpages that outlines all the measures for Pathology Services.


Members endorsed the Trust’s decision to join a different pathology network provided by the NHS, and requested a report back on the effect on staffing, perhaps as part of the 2019/20 work programme.

ACTION: Director of Strategy, LGT NHS Trust


In response to Member questions about volume of direct access to pathology services provided to GP’s if the Trust goes into contract with wither South West London or Barts Network, the Director of Strategy said that 48% of overall LGT activity supports GPs and they would like to retain the GP work.  However, this is not their decision as this rests with CCGs.


The Chair asked if Members of the public present had any comments or questions.


In response to questions from members of the public, the Director of Strategy said that there will be no change to the oncology services.


Resolved –


That the report be noted.


Update on Healthy Weight in Greenwich pdf icon PDF 407 KB

Panel to review the most recent obesity data (October 2017) and consider the local response, including the focus of the new RBG Member-level Healthy Weight Taskforce.


The Director of Public Health presented this report.


In response to Members questions, he stated that most RBG schools use GSPlus, who holds a gold standard in nutritional foods for schools.  However, there were an increasing number of schools that had chosen a different provider and this is something that the task force being led by the Cabinet Member for Adult Social Care, Health and Anti-Poverty may wish to look at.


Officers are currently analysing data on ethnicity, wards and determinants which can be brought to a future meeting. Members felt that as risk posed by Obesity now surpasses the risk of smoking, and has many determinants, a single agenda item meeting be considered in the future.  This would enable scrutiny of providers of school meals, providers of leisure services etc.  The Chair said that a scope for this item should be developed in time for the Panel’s meeting to discuss the 2019/20 work programme.



In response to a point raised by a member of the public, access to good quality home cooked food for those living in bed and breakfast accommodation, the Director of Public Health said that work on food poverty had been done, which included support to this cohort.


Resolved –


The report and presentation be noted.


Greenwich Clinical Commissioning Group - QIPP Update - Focus on Diabetes pdf icon PDF 52 KB

Panel to receive an update on GCCG’s Quality, Innovation, Productivity and Prevention – focus on Obesity.

Additional documents:


The Director of Commissioning GCCG presented this item.


In response to Member questions, the Director of Commissioning GCCG said that a breakdown of risk factors and statistics on type 1 and 2 diabetes would be circulated.

ACTION: Director of Commissioning, GCCG


He outlined how incentive schemes like diabetic clinics being offered at primary care level to take people out of Type 2 diabetes work.  He also outlined the learning gained from other models, such as West Hampshire where diabetes nurses hold group sessions for 10-12 people so that patients can learn from each other.  He said that there were still challenges in bringing in ideas that people are resistant to.


In response to questions and comments by members of the public, the Director of Commissioning GCCG said that a work programme with the Nepalese Community is still being delivered.  He also explained that online education services are available to assist patients.


Resolved –


The presentation be noted.


Greenwich Clinical Commissioning Group - Update on Treatment Access Policy pdf icon PDF 55 KB

Panel to receive an update on GCCG’s Treatment Access Policy.

Additional documents:


The Director of Commissioning GCCG presented this item.


In response to Member questions, the Director of Commissioning GCCG said that Cancer was part of the exclusions and was exempt from this process.


This policy was enabling clinicians to consider the impact and outcome of treatments being offered and where it was judged that a particular procedure would not have a positive outcome, a different one would be considered.  Patients would get the best outcome in the safest way.


In response to Member questions about consultation, the Director of Commissioning said that where a change or cessation of a procedure was being considered, a full consultation and equality impact assessment would be conducted.


In response to a Member question about IVF treatment, the Director of Commissioning GCCG said that the current TAP continues to fund these.  Policies are based on clinical practice and all treatments that meet thresholds would be accessible.  He also clarified that regardless of whatever procedure was followed, an application could be made for funding. 


In response to comments and questions by members of the public about the way forward, the Director of Commissioning GCCG said that points made will be taken on board when they go out to future consultation.


Members asked that when reviewing other treatment areas, reports be brought to this Panel for comment.

ACTION: Director of Commissioning, GCCG.


Resolved –


The presentation be noted.






Commissioning of Future Reports pdf icon PDF 44 KB

Panel is asked to note the work items that are scheduled to be presented at the Healthier Communities and Adult Social Care Scrutiny Panel taking place on 10 January 2019.

Additional documents:


The Chair advised Members that the Substance Misuse item will be included on the agenda for the January meeting.


Resolved –


Members noted the work items that are scheduled to be presented at the 10 January 2019 meeting of the Panel.


Briefing on Substance Misuse Service at QEH



The Director of Commissioning, Greenwich Clinical Commissioning Group made the following statement.


The impact of drug and alcohol use across England is wide spread with additional concentration of drug dependence higher in deprived areas and certain populations. Across England over 10.4 million adults drink in excess of the recommended levels of alcohol of which 595,000 need treatment for alcohol dependence. 2.7 million people took an illicit drug during the last year with over 301,000 people addicted to opiates and / or crack cocaine. This has a significant impact on prevalence for drug and alcohol harm for families with around 20% of children “in need” affected by drug misuse and 18% by alcohol misuse. Over a quarter of cases on the child protection register involve parents with drug and or alcohol misuse. It’s estimated that there have been over 1.1m admissions into hospitals across England for alcohol related illness which has seen year on year growth now sitting at 2,185 admissions per 100,000 population. 45% of mental health suicides across England have history of alcohol misuse. There are also significant impact upon crime with around 45% of acquisitive offences committed by crack / heroin addicts, and 48% of convicted domestic abuse perpetrators having alcohol misuse history of 73% had taken alcohol at the time of committing the domestic abuse.

Across our borough of Greenwich we currently experience higher than England average for both drug and alcohol related admissions (112 and 2,211 per 100,000 population respectively), with admissions for alcohol related illness doubling over the last eight years and we are currently 6th highest in London. For drug misuse we have the highest level of admissions in London. We have the fourth highest prevalence rates for HIV within London at 6.29 which is nearly three times that of England. 53 percent of opiate users in our population are not registered onto a programme. Our highest admissions remain a combination of Alcohol and multiple drug use of psychoactive substances. Substance Misuse has an impact on risk taking behaviour, especially within our younger population where we currently have 1,502 diagnosis of STI per 100,000 population (compared to England of 794).


Over the years our system in Greenwich has provided support to these patients, however we have not seen improvements in outcomes for our population. Our current system remains silo working, with patients having fragmented care, and with limited or no evidenced improvements in their outcomes. We have teams within our system that don’t have effective communication and ability to share and interact in a secure way between databases and systems. When patients need acute care whilst they are on programmes with either CGL or Beresford teams they have to be admitted via A&E rather than booking a planned care intervention (expect of emergency cases). High numbers of patients discharged from hospital are not followed up at 28 days. We also experience a smaller group of patients who have complex needs as a result of prolonged substance misuse that are remaining in hospital rather  ...  view the full minutes text for item 11.