Agenda and minutes

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

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

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

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

Resolved: the Committee noted the response.

Aileen Buckton (Executive Director of Community Services), Tim Higginson (Chief Executive, Lewisham and Greenwich NHS Trust), Tony Read (Chief Financial Officer, Lewisham CCG) introduced the report. The following key points were noted:

·         The Council started integrating staff working in the community in 2011 – including district nurses, occupational therapists and physiotherapists. Virtual Neighbourhood Community Teams of social care staff and District Nurses working with primary care have now been established. 

·         Residents had said that they found it difficult and confusing to organise their care. GPs had also said that they were sometimes unsure about where to refer people to for additional care and support.

·         GPs had said that many people they were seeing, particularly those who were lonely and isolated, could be better helped by other organisations in the community. The Community Connections programme has since been set up – matching people like this with appropriate organisations in the community.

·         The Council and the CCG brought together health and social care commissioning some time ago and are now looking at joint commissioning across the whole system.

·         A new virtual patient record, Connect Care, has been developed so that Patient records have also been integrated so that different health and care professionals can share information and work together.

·         Integration work is also focused on reducing avoidable admissions to hospital and delays with discharge. It has also led to more efficient management and better co-ordination of services.

·         The Government has now asked local authorities to have a plan in place by April 2017 for how they will fully integrate adult social care and community-based staff by 2020. Over the last year, Lewisham Health and Care Partners have reviewed the governance arrangements and established an Executive Board that will consider new models for health and adult social care integration.

·         The Board will also be looking at estates and IT and the possibility of co-locating neighbourhood teams; and how the roles and responsibilities of the workforce can encourage closer and more person-centred care.

·         A key part of this work includes closer integration with mental health services. 

Aileen Buckton (Executive Director of Community Services) and partners answered questions from the Committee. The following key points were noted:

·         A whole communications strategy about the wider transformation of services will come out alongside the SE London Sustainability and Transformation Plan (STP). It will be brought to the Committee before it goes out. The integration of health and adult social care is only a small part of this.

·         The STP draws heavily on the Our Healthier South East London (OHSEL) programme, which has had significant public engagement. The STP submission itself hasn’t been published yet because it hasn’t been finalised. But people can find a huge amount of information about it on the OHSEL website (http://www.ourhealthiersel.nhs.uk/about-us/).

·         Delays in discharging people from hospital are sometimes down to the hospital not doing its side of things, not doing all of the assessments for example. But it is increasingly down to problems finding the right placements for people with very complex  ...  view the full minutes text for item 4.

Please refer to separate report

A18 – widening the scope of charging for social care services

Joan Hutton (Head of Assessment and Care Management) introduced the report. The following key points were noted:

·         £200,000 of the proposed savings will be achieved by, among other things, removing the subsidy and increasing charges for day care meals; charging arrangement fees for those who fund their own social care; increasing charges for the Linkline/community alarm service; and changing the non-residential charging policy to reflect Government guidance.

·         A further £300,000 will be saved by improving the way payments are collected. This includes making service users aware of care charges, and sending out invoices at an earlier point in the process.

Joan Hutton (Head of Assessment and Care Management) answered questions from the Committee. The following key points were noted:

·         The exact amount that each individual charging proposal will save will be identified by analysis of each element and confirmed once the proposal has been agreed.

·         Previous IT systems have prevented the Council from being able to collect payment in better way Officers are confident that the new IT system will help improve things.

·         People are less likely to try to avoid paying care fees if it the costs are made clear to them early on in the process. 

·         The social care arrangement service will continue to be provided by the Council when charges come in for those who fund their own care.

·         Proposed charges will market tested and put out to consultation for three months.

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

·         The Committee noted that some people can well afford to pay for their social care. And that with some social care debts running into the tens of thousands of pounds, this affects the care the Council is able to provide to those who genuinely can’t afford to pay.

·         The Committee noted that some of the proposed charges seemed quite high and expressed concern that they may lead to fewer people using these services, simply creating pressures in other parts of the system – the Linkline alarm service for example.

Resolved: the Committee agreed to refer its views on this proposal to the Public Accounts Select Committee:

The Committee expressed concern about the possibility of vulnerable people choosing not to use services like this as a result of increased charges – the Linkline alarm services in particular. The Committee recommended, should this proposal be accepted, that the Mayor and Cabinet make sure that any decrease in use by vulnerable people is closely monitored.

A19 – reduction in the staffing costs for assessment and care management

Joan Hutton (Head of Assessment and Care Management) introduced the report. The following key points were noted:

·         The proposed saving of £500,000 will primarily come from deleting 12 to 15 FTE posts from across the assessment and care management teams.

·         Savings will also come from improving staff IT, introducing mobile working, and improving access to information, advice and signposting for service users.

Joan Hutton (Head of Assessment  ...  view the full minutes text for item 5.

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

·         The Council has to save £4.7m after the Government announced further cuts to public health funding. The Council have tried to protect public health services as much as possible and believe that the impact of residents could have been greater without this. But there is still a £300,000 shortfall and officers will have to come back with further proposals in the future.

·         The current proposed savings come from preventative health services; health visiting and school nursing; and sexual health services.

Danny Ruta (Director of Public Health, Lewisham Council) and colleagues answered questions from the Committee. The following key points were noted:

Preventative health services

·         Given the level of cuts, closer integration between services and making sure every contact counts will become increasingly important in the future.

·         Officers pointed out that Stop Smoking services are a cost-effective intervention and said that the health service will have to pay sooner or later for more preventative services.

·         Lewisham’s Staying Healthy pilot, for example, is about looking at the whole environment that people live in and tackling those parts that make people fat.

·         Officers also pointed out that Lewisham has been given highest level of ‘Baby Friendly’ award and that the borough is also on the right path to increasing breastfeeding.

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

·         The Committee expressed particular concern about cuts to Stop Smoking Services. The Committee also accepted, however, that if we don’t cut these services we will have to cut services for the most vulnerable.

·         The Committee noted that it is disappointing to see cuts to public health when much of the drive towards further integration is about prevention too

Resolved: the Committee voted against making a referral to Mayor and Cabinet and noted the proposal. 

School nursing and health visiting

Warwick Tomsett (Head of Targeted Services and Joint Commissioning for Children and Young People) and colleagues introduced the report. The following key points were noted:

·         Officers received lots of positive feedback about these services during the consultation – and a mixed reaction to the proposed changes.

·         People were broadly supportive of changes to school nursing. People were also supportive of more integration between health visitors and children’s centres. But there was some concern about the possibility of families with high needs being lost by making changes to the universal health checks to include more group-based activity.

·         The Council’s equalities analysis assessment found that the proposed changes do not discriminate. But these are not finalised proposals. There will be more engagement, including with providers.

Warwick Tomsett (Head of Targeted Services and Joint Commissioning for Children and Young People) and colleagues answered questions from the Committee. The following key points were noted:

·         Representatives from the Save Lewisham Hospital Campaign expressed particular concern about the damage to children’s health. They said the cuts to CAMHS, health visiting and school nursing were very risky and concerning.  ...  view the full minutes text for item 6.

Aileen Buckton (Executive Director of Community Services) introduced the report. The following key points were noted:

·         The Council is asking for more powers in how it manages its estates and workforce. Officers are asking for the freedom to set up hubs of community-based care and to create more flexible health and social care roles (as used in the Buurtzorg model from the Netherlands).

Aileen Buckton (Executive Director of Community Services) and partners answered questions from the Committee. The following key points were noted:

·         The next steps for the pilot will be developing more detail about each area and working with the London-wide team to see what might be done without formal devolution of powers. Officers will come back to the Committee in the future with more details about workforce changes,

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

·         The Committee noted the importance of retaining the freehold of any estates.

Resolved: the Committee noted the report.

Resolved: the Committee noted the report.

John Bardens (Scrutiny Manager) introduced the report.

Resolved: the Committee agreed the work programme.

The Committee agreed to refer it’s views on savings proposals A18 (widening the scope of charging for social care services) and A19 (reduction in the staffing costs for assessment and care management) to the Public Accounts Select Committee.