Agenda and minutes

Resolved: the minutes of the last meeting were agreed as a true record.

The following non-prejudicial interests were declared:

Councillor Muldoon is a governor of the South London and Maudsley NHS Foundation Trust.

Councillor Paschoud has a family member in receipt of a package of adult social care.

Councillor Paul Bell is a member of King’s College Hospital NHS Foundation Trust.

Councillor Susan Wise is a member of the King's College Hospital NHS Foundation Trust and South London and Maudsley NHS Foundation Trust.

Jane Evans (Interim Head of Governance, Lewisham and Greenwich NHS Trust) introduced the report. The following key points were noted:

·         The Quality Account covers the second full year of the merged Lewisham and Greenwich NHS Trust. The Trust has consulted widely and included the comments of local stakeholders in the report.

·         Quality is measured against three elements: patient safety, clinical effectiveness, and patient experience. There have been considerable achievements over the year, but there is still room for improvement over 2016-17.

·         As part of the “hello my name is” campaign, staff should be introducing themselves by name when they speak to patients.

Jane Evans (Interim Head of Governance, Lewisham and Greenwich NHS Trust) answered questions from the Committee. The following key points were noted:

·         One of the quality commitments is to reduce readmissions across all divisions, including within children’s ENT. 

·         Discharge lounges are now available for people who are ready to leave. This helps free-up bed spaces for people who need them. The discharge lounge is not used overnight.

·         There have been improvements in palliative care pathways – with more people being supported to move out of hospital and die in their homes.

·         An easy-read version of the Quality Account will be available in August.

The Committee made a number of comments. The following key points were noted:

·         The Committee suggested that staff should be given big yellow name badges – similar to those used at Guy’s and St Thomas’ NHS Trust – as part of the “hello my name is” campaign. Members of the Committee said this would be helpful for both patients and their relatives.

·         The Committee also commended the work of the specialist palliative care team.

Resolved: the Committee noted the report and agreed to provide a response.

Michelle Binfield (Associate Director for Public Health Commissioning, Lambeth Council), and colleagues, introduced the report. The following key points were noted:

·         Work on HIV care and support services started back in 2011, with Lambeth, Southwark and Lewisham Sexual Health Commissioners carrying out a comprehensive review of services.

·         The review suggested that the specialist service model was no longer fit for purpose and recommended mainstreaming HIV care and support services.

·         The review found that people with HIV were living longer and healthier lives and that HIV was an episodic condition, much like other long term conditions, that would be best treated by better access to mainstream health services.

·         The findings of review came to committee in 2011, as part of the initial consultation, and have been back in 2012, 2013 and 2014. Commissioners are continuing to gather further evidence through ongoing consultation.

·         This paper provides an update on the consultation on the implementation of the final stages of the HIV care and support review. This includes proposals for advice, advocacy and counselling services to be provided by local non-HIV-specialist services. It also includes proposals for assessment and signposting services to be provided by the peer support service.

·         The proposals are about moving away from specialist silos, recognising the ability of mainstream services and making HIV services more accessible and local. Some people with HIV weren’t accessing mainstream services. This doesn’t help with removing stigma or with providing a complete package of care.

·         A small number of people use the existing services. The proposals will have low impact and there has been much mitigation work, including wide consultation.

·         Mainstream providers in the proposed new pathway, including IAPT, CAB and the peer support services, are confident that they have the expertise to address the needs of people living with HIV – and have indicated they are doing so for increasing numbers of people.

·         Detailed discussions are underway with mainstream providers to ensure that they understand the needs of people living with HIV and are prepared for any additional activity the changes will bring to individual providers.

·         Mainstream services are set up to deal with more than one issue – whereas specialist services are often only able to address specific needs relating to HIV.

·         New pathways will also be quality assured over 12 months – including, for example, with mystery shoppers. The peer support service has offered to provide training where needed.

·         There won’t be any change to the enhanced specialist HIV social care support for families affected by HIV.

Michelle Binfield (Associate Director for Public Health Commissioning, Lambeth Council), and colleagues, answered questions from the Committee. The following key points were noted:

·         The early diagnosis of HIV has improved. Through working closely with GPs, testing for HIV has become normalised and is routinely offered.

·         The National AIDS Trust (NAT) provided their views during the original review of HIV care and support services. While they had concerns about how the recommendations might be implemented, they accepted that the duplication with mainstream services was inefficient.  ...  view the full minutes text for item 4.

Danny Ruta (Director of Public Health, Lewisham Council), and colleagues, introduced the report. The following key points were noted:

·         The government has made cuts to the public health budget in successive years. £2m of savings were agreed by Mayor and Cabinet in September 2015. But since then, Lewisham has been asked to find a further £2.7m of savings. In total, Lewisham now needs to save £4.7m by April 2017

·         There has been a huge amount of work done to inform the proposals in the paper. Looking at how we might deliver services in a different way to make the most of the money spent – including looking at where savings can be made in both mandatory and non-mandatory services. There have also been a number of consultations – particularly around substance misuse.

·         The paper outlines proposals and consultation activity in four key areas: preventative health services; health visiting and school nursing; sexual health services; and substance misuse services.

·         Preventative health services cover a wide range of activity – as set out in the paper – with a total value of £2.1m. The Council is proposing to consult on savings of £800,000. These will be achieved through a combination of re-commissioning, redesign and potential termination of some services.

·         There has already been some consultation activity around health visiting and school nursing, and there will be further consultation with more parents and young people over the summer.

·         The consultation work so far has found that there is a strong demand from parents and users for more information and advice online and through social media. There are also lots of examples of good work between health visitors and children’s centres, but it’s inconsistent and there is significant overlap. There’s the possibility of more group-based, rather than one-on-one, activity.

·         When services have gone out for tendering recently, it has generally been existing providers bidding for services. There has been no private sector involvement so far.

·         In terms of sexual health services in Lewisham, there are currently: four sexual health clinics; a specialist (Genitourinary Medicine) GUM service; GPs providing contraception and STI testing; and pharmacies providing emergency contraception and STI screening

·         Lewisham is a young borough and there has been a significant increase in demand for all services. There has been a 22% rise in GUM, for example. This is putting unsustainable pressure on services.

·         Commissioners are looking to work more collaboratively across London and find better ways of managing services. This includes, for example, proposing a new Integrated Sexual Health Tariff for local authorities.

·         Commissioners are also looking to provide more services online. This is generally quicker and cheaper – and allows more people to be helped.

·         There has been lots of consultation already, looking at how to move services away from clinics. This includes, for example, looking at what services could be provided online and how pharmacies could be used for testing and contraception. 

·         Young people should be seen for the first time in a sexual health clinic or by their GP.

·         The  ...  view the full minutes text for item 5.

John Bardens (Scrutiny Manager) introduced the report. The following key points were noted:

·         The Chair mentioned that the he’d received a letter from the Save Lewisham Hospital campaign about the sustainability and transformation plan – an information item on the agenda – and that the Scrutiny Manager would arrange a response from officers.

·         The Committee also asked about the progress on a possible item on the re-organisation of TB labs in London. The Scrutiny Manager explained that he’d spoken to Public Health England and the Newham CCG and was now waiting for a response from the Lewisham CCG.

·         The Committee agreed to combine the items on the work programme about place-based care and neighbourhood networks, as these would cover similar information.

·         The Committee also agreed to move the item on adult safeguarding, currently on the September agenda, to October so that the committee would have more time in September to scrutinise the Lewisham Future Programme proposals.

·         The Committee also agreed to move the item on elective Orthopaedics, also on the agenda for September, if there was any delay to the current timeframe.

Resolved: the Committee agreed changes to the work programme

The Committee didn’t make any referrals