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

Note: Order of the items have been changed subsequent to publication 

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Panel.

Minutes:

Apologies for absence were received from Councillors Olu Babatola and Matt Hartley.

 

Apologies for leaving early were received from Councillors Ann-Marie Cousins and Dominic Mbang.

2.

Urgent Business

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

Minutes:

The Chair agreed to vary the order of items to receive those having in-put from a number of partners to be received first.  The order was as follows:

 

6 became item 5 – LGT Update

11 became item 6 – Adult Social Care – Adults Discharge and Out of Hospital Care

7 – 10 as per original agenda

5 became item 11 – Cabinet Member Update

12 – Commissioning of Future Reports

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 85 KB

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

Minutes:

Resolved -

 

That the minutes of the meeting of the Healthier Communities & Older People Scrutiny Panel held on 1 November 2018 be agreed and signed as a true and accurate record and were signed by the Chair.

5.

Cabinet Member - Verbal Update pdf icon PDF 42 KB

Panel to receive a verbal update from the Cabinet Member for Adult’s Social Care, Health and Anti-Poverty.

Minutes:

The Cabinet Member for Adult Social Care, Health and Anti-Poverty provided the following update:

 

Adult Social Care was still waiting for the Green Paper. The Government did issue the NHS Long Term Plan this week, but there is no sign of a Green Paper on Social care yet, and this was already over a year late. Consequently, there was no long term answer to the local and national funding challenges for Social Care, despite a view from the LGA, every think tank and experts that the Health and Care system urgently needs the key funding questions for Social Care to be resolved.

 

Locally the Council was looking at the challenges in spending and budgets in adult Social Care through the Budget Recovery Board process and the outcome of this work will inform future strategy for the Council.

 

Adult Social Care has continued to work closely with local partners to support local people and improve services. The Health and Well Being Board had agreed a move to a more collaborative approach to working together in Mental Health, moving towards an Alliance model, which changes the purchaser provider model and draws all stakeholders into decision making. A visit to Lambeth, that already has an Alliance model had taken place to hear from stakeholders there to help develop the model.

 

The Department had been working to prepare for the systems pressures that inevitably come with Winter. These plans were developed in Partnership with NHS partners. A range of schemes, including providing greater therapeutic support in the Hospital is in place. There was extra one off funding of £1.3 million, which would be spent on a range of schemes, including stabilising the Home care market, doing more work to support the discharge of people to residential and nursing homes and boosting capacity to support discharge.

 

One of the major areas of work over recent months had been on Learning Disabilities. The Council had recently agreed to consult on developing new accommodation for older people with a Learning Disability in Lakeside View and had successfully moved the 8 residents from Ashburnham Grove to new homes as that building was no longer fit for purpose.

 

A pilot to offer different models of Day Care for Adults with Learning Disabilities had been successfully completed, with over 30 people being supported to look at different Day Care options, with over half opting for improved models of support and around a third opting to do wholly different things including securing employment. The pilot had been positively evaluated by Goldsmiths University and the approach will be rolled out across the whole service.

 

A very successful Safeguarding Conference took place on 28th November, which focused on Domestic Violence and coercive control.

 

The Department had worked really hard to clear the backlog of applications for Blue Badge permits and it is now up to date. Guidance is awaited from the Department of Transport on how the expansion of the scheme will work, as the Government has agreed to expand the scheme  ...  view the full minutes text for item 5.

6.

L&G NHS Trust - Update report pdf icon PDF 37 KB

Panel to receive and consider a PowerPoint presentation from the Chief Executive of Lewisham and Greenwich NHS Trust.

Additional documents:

Minutes:

Ben Travis, the CEO of Lewisham and Greenwich NHS Trust, accompanied by Trust officers presented an update on the Trusts activity and performance during the winter pressure over the last two months.

 

In response to Member questions, the CEO of LGT NHS Trust informed Members that the national 4 hour waiting time target for A&E departments is 95%. With the increased level of demand, to have a realistic target, an internal target of 85% had been set for Queen Elizabeth Hospital, and the current performance is 85.5%.  However, during the winter periods this dips to below 80%.  The Trust, with its partners work collaboratively and learn from other Trusts, where practical, that are performing well to continually seek ways to improve performance.  Having a full complement of acute consultants provides the right level of cover and assists in the flow of patients through the system with the biggest determinant in meeting this target being the number of beds available and the pace at which the turnaround of patients is achieved.

 

The CEO of LGT NHS Trust reported that that there are very few places where the 95% target is met.  He said that performance at Lewisham Hospital is 92% and there are days when the 95% target is achieved.  However, there are a whole range of factors that enable this which, when taking into account the user needs, would not necessarily mean that using comparable tactics at QEH would result in improvements.

 

When asked about staffing levels at the hospital, Members were informed that these are improving and the vacancy rate has come down to 14%.  This is still a key challenge for the Trust and it has conducted a range of recruitment activity in the UK and internationally.  The impact of Brexit on the 8.1% of staff from EU countries will be mitigated as the trust will support those effected by funding their registration fees for the Government’s settlement scheme.  RBG officers are working with the Trust on ways of utilising council systems to further enhance their recruitment activity.

 

Members were advised that each ward has one trained and one unqualified nurse and it works to a ratio of 1 – 6 to ensure that patients receive the best care.  Infection control regularly monitors against standards and any concerns are escalated and actioned quickly and audited to mitigate any future risks.

 

NB: Cllr Ann-Marie Cousins left the meeting.

 

The Chair invited questions from members of the public.

 

In response to these, the CEO, LGT NHS Trust replied that where possible, accommodation needs are met for overseas staff; that there are very rarely any beds available due to demand; and that the trust in-sources private sector organisation to come in over the weekend to reduce waiting times for some patients.

 

Resolved –

 

The presentation be noted.

7.

Oxleas Trust - Report on Priorities pdf icon PDF 51 KB

Panel to receive and consider a PowerPoint presentation from the Chief Executive of Oxleas NHS Foundation Trust. (presentation to follow)

Additional documents:

Minutes:

Matthew Trainer, the CEO of Oxleas NHS Foundation Trust outlined performance and quality, finance update and feedback from the on-going CQC inspection.

 

In response to Member questions, the CEO, Oxleas NHS Foundation Trust said that number of young people wishing to access child and adolescent mental health services (CAMHS) has increased and that the newly published NHS 10-year plan has a focus on mental health provision in schools.  Young people and their parents would receive any identified support. Young people are impacted by use of social media and some take measures to emulate others.  He said that there is a need to ensure that young people’s natural growing experiences, i.e. pressures at exam times, puberty etc, are not medicalised.  The need of young people should be assessed to provide the right support at the right time.

 

There is a 24/7 crisis service for adults.  Young people requiring support at crisis would need to present themselves to A&E.  The trust is aware they need to improve the 24/7 provision for young people.

 

The trust has a number of alternative services to support people with mental health crisis support.  A patient assessment suite at Oxleas House is untiled when people present themselves at QEH.

 

There is a recognition that some people choose to make bad choices, and this is their right.  Where needed, independent advocacy services are used to assist people to make informed choices.

 

In response to a questions about finances, the CEO, said that finances are used on a service by service basis.  When looking at making efficiency services, the trust would look at bringing down back-office costs, but would ensure that this does not have an adverse impact on front line provision.

 

In response to Member questions about the spread of service provision across the three boroughs that Oxleas serves, the CEO agreed to bring detailed breakdown of services, users and spend at the meeting in March.  The update will include a breakdown of RBG service users and where they reside for Members to better understand where the greatest need arises from.

ACTION: CEO, Oxleas NHS Foundation Trust

The Chair invited questions from Members of the public present.

 

In response to these, the CEO agreed that the transition from CAMHS to Adult Services is a crucial time for this cohort.  This area had seen some improvements as services are now provided to young people up to the age of 25.

 

Resolved –

 

That the presentation be noted.

8.

GCCG - Developing Integrated Care in Greenwich pdf icon PDF 89 KB

Panel to receive and comment on the report and agree that further development of the approach should be undertaken by officers from the Council and Greenwich Clinical Commissioning Group.

Additional documents:

Minutes:

Neil Kennett-Brown, the Managing Director (MD) of Greenwich Clinical Commissioning Group (GCCG) presented this item.

 

In response to a Member question, the MD, GCCG confirmed that Section 75 referred to in paragraph 4.2.2 is the section in the Social Care Act 2000 and is the Better Care Fund that the NHS gives to CCG’s to use on services in agreement with LA’s.

 

Discharge to access was outlined as a common way of discharging patients to the correct facility, using the correct pathway that meets that patient’s needs.

 

The MD, GCCG outlined what the difference was between provision as Duncan House and that at Eltham Community Hospital to demonstrate how demand is met at each site.

 

Resolved –

 

To note the report.

9.

Substance Misuse Service at QEH - Update pdf icon PDF 189 KB

Panel to receive an update on the Substance Misuse Team at Queen Elizabeth Hospital.

Minutes:

Neil Kennett-Brown, the MD of GCCG presented this information item, informing Members that this was a legacy service through the Drugs and Alcohol Team, managed by Greenwich.  GCCG made a decision to discontinue funding the current model to ensure that the funding was utilised for a better joined up model.

 

Resolved –

 

The update be noted.

10.

Adult Transformation Programme - Update pdf icon PDF 50 KB

Panel is asked to receive and consider a presentation from the Director of Health and Adult Services.

Additional documents:

Minutes:

Simon Pearce, the Director of Health and Adult Services presented this information item.

 

Members asked, that as Adult Social Care is a very important area for the Panel to scrutinise, a single agenda item meeting be scheduled as part of the 2019/20 work programme.  The item to include a summary of objectives, what has been achieved, what needs to be done as well as challenges in engaging with the service users when seeking their views on transformation.

ACTION: Corporate Governance Manager

 

Resolved –

 

To note the presentation.

11.

Adult Social Care - Adults Discharge and Out of Hospital Care pdf icon PDF 38 KB

Panel is asked to receive a presentation from partners in the discharge system and ask questions to understand the customer journey.

Minutes:

The Director of Health and Adult Services introduced colleagues from the Transfer of Care Collaborative (TOCC) and who work within the system and delivered a presentation to encourage questions from Members, with the aim of showing how the system works and some of the factors that influence it.  Three scenarios were presented and officers outlined what they would do next enabling Members to understand the complexities and ask questions about the case.

 

Case study one was outlined as follows:

Lady living in a Residential Care Home, age 88 appears unwell, and a few hours later has a fall. Care Home is unclear what has caused it so calls 999.

 

Ambulance attends, suspects fracture and therefore conveys to A and E. Tests reveal no fracture, but she remains upset and disorientated. She is admitted for further investigation.

 

Several days pass and she has a number of tests, but no new diagnosis emerges. She remains upset and tearful. Discharge planning now underway.

 

In response to Member questions about what officers should do next, the officers present said that they would seek reasons why the lady is upset and identify if she had any infections.  If all was OK, they would liaise with other TOCC professionals responsible for her care and start to prepare for discharge.  An officer from Oxleas would also be part of this team so that any mental health needs could be taken into account.

 

Officers informed members that in some cases, it could take 3-6 months to resolve any delirium that infections can cause and the quality of care in care homes are monitored regularly and officers would pick up on concerns quickly.

 

Case study two was outlined as follows:

Older man who lives alone with an existing care package, comprising one visit from Domiciliary Care each day.  He is 84 years old and has a diagnosis of mild dementia. He is losing weight; his care workers have noticed this, but he says that he is fine.

 

He does go out alone, but rarely. One day the Post Office telephones 999 as he has come to the Post Office to collect his pension, in his slippers. He has the pension paid into his account and his daughter who lives some distance away, manages his money.

 

The paramedics speak to him at length, but cannot establish why he has gone to the Post Office. They therefore transport him to A and E where he has initial assessment.

 

He remains in Hospital overnight and the following day it is established he has a Urinary Tract Infection (UTI). He is started on antibiotics. His daughter is contacted.

 

In response to Member questions, officers outlined that this patient would have been seen by the correct consultant quickly to explore best options.  They would gain advice from the dementia nurse to find a bed for him at a facility such as Duncan House and increase his care package when returned home.  His stay at Duncan House would ensure that his return to home would  ...  view the full minutes text for item 11.

12.

Commissioning of Future Reports pdf icon PDF 60 KB

Panel is asked to note the work items that are scheduled to be presented at the meeting March 2019 meeting.

Additional documents:

Minutes:

Resolved –

 

Members noted the work items that are scheduled to be presented at the 14 March 2019 meeting of the Panel.