Agenda, decisions and minutes

Resolved: that the minutes of the meeting held on 3 September be agreed as a true record.

Resolved: that the minutes of the meeting held on 3 September be agreed as a true record.

Councillor Jacq Paschoud - non prejudicial – learning disabled family member in receipt of relevant services.

Councillor John Muldoon – non prejudicial – lead governor at South London and Maudsley NHS foundation trust.

Councillor Pat Raven – non prejudicial – family member in receipt of a package of social care.

Resolved: that the report be noted.

3.1      Martin Wilkinson (Chief Officer, Lewisham Clinical Commissioning Group) introduced the report. The following key points were noted:

• Previously, the approach to system resilience had focused on winter planning. It was now recognised that resilience plans needed to be active all year round.
• The CCG was working with partners to ensure there was a coordinated approach across Lewisham and south east London.
• An evaluation of the ‘yellow men’ campaign, which was designed to increase awareness of NHS services and prevent unnecessary visits to accident and emergency, indicated that it had been successful.

3.2      Joy Ellery (Director of Knowledge, Governance and Communications, Lewisham and Greenwich NHS trust) introduced a report on capacity solutions at the Trust. The following key points were noted:

• The report set out on-going work in the Trust to deal with limitations on capacity, with specific reference to the Queen Elizabeth Hospital (QEH) in Greenwich.
• Changes being proposed to stroke services at QEH would have a knock on effect in Lewisham, where additional capacity needed to be created to take patients being transferred from the Hyper-Acute Stroke Unit (HASU) at King’s College Hospital.

3.3      Martin Wilkinson and Jot Ellery responded to questions from the Committee. The following key points were noted:

• Work was taking place to link the yellow man campaign to NHS 111.
• Advice from NHS 111 was based on the best available data. Referrals to A&E were dependent on a number of factors about the risk to patients.
• Lewisham would follow the London wide standards for seven day working, including maintaining the presence of senior staff at hospitals at weekends.

3.4      Joy Ellery (Director of Knowledge, Governance and Communications, Lewisham and Greenwich NHS trust) provided an update on the Trust’s response Ebola. The following key points were noted:

• Inaccurate reports had been published in the media about a potential case of Ebola at Lewisham Hospital.
• A patient who represented a possible Ebola risk had been admitted at the hospital. He/she had been ‘barrier nursed’ and placed in their own room, with separate toilet facilities.
• The patient had not been locked in their room.
• The consultant on call had followed the hospital’s protocols for a possible infectious outbreak and had deemed them to represent a low risk of infection.
• Staff at the hospital had decided to contact the national press
• The hospital had updated its protocols and continued to follow government guidance.
• More potential cases of Ebola could be expected.

3.5      The Chair thanked officers for the update and recommended that the Committee be satisfied that the appropriate protocols were in place at the hospital to manage possible cases of Ebola.

Resolved: that the report be noted.

Resolved: to receive additional information about the Public Health budget in relation to the delivery of the Health and Wellbeing Board priorities and to note the report.

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

• The Health and Wellbeing Board (HWB) had agreed on nine priorities for improving health and wellbeing in Lewisham, covering the entire population.
• Delivery of priorities relating to children and young people were overseen by the Children and Young People’s partnership board.
• All other priorities were overseen by a multi-agency delivery group of officers, who provided regular updates to the HWB on progress.
• Priorities one to seven were being managed by officers in Public Health.
• Priorities eight and nine, were related to reductions in avoidable admissions and were overseen by the adult integration board.
• The board did not consider every priority at every meeting.

4.2      Sir Steve Bullock (Mayor of Lewisham) addressed the Committee; the following key points were noted:

• Lewisham had taken a proactive approach to the work of the Health and Wellbeing Board.
• However, in its current form, the Board was not necessarily sustainable in the long term.
• The Board occupied an uncomfortable position between executive and scrutiny bodies.
• The Public Health joint Strategic Needs Assessment served as the basis for the Board’s work.
• Recently the Board had considered a range of different issues.
• It was not clear why boards were given responsibility for coordinating the response to the problems identified from the review of failings at Winterbourne View.
• The Board had also taken on the coordination of health and social care integration and overseeing the delivery of the Better Care Fund.
• At its away day, the Board had agreed to focus on adding value to fewer priorities- including food, housing and social isolation.

4.3      Aileen Buckton (Executive Director for Community Services); Sir Steve Bullock (Mayor of Lewisham) and Martin Wilkinson (Chief Officer, Lewisham CCG) responded to questions from the Committee. The following key points were noted:

• In previous guidance for the Better Care Fund, partners had been directed to adopt a national target for reducing A&E admissions. This overall target had been dropped, but partners were still required to work in a planned way to prevent avoidable admissions.
• There could be no ‘double running’ of plans so work was required with partners to manage and reduce the potential risks of moving from one pattern of working to another.
• Officers had sought advice from legal about the scrutiny of the budget for Public Health. The responsibility for looking at the budget sat with the Healthier Communities select committee.
• The clinical commissioning group recognised the importance of improving access to primary care. Work was taking place to enhance capacity and improve access to services.
• The proposals in the budget had been mapped against the borough’s health and wellbeing priorities – and it was considered that there would be no substantial impact on the delivery of these plans.
• It was recognised that there was a link between physical and mental health. The South London and Maudsley NHS foundation trust (SLAM) had recently become a ‘smoke free’ trust, as part of its efforts to  ...  view the full minutes text for item 4.

Resolved: to agree the plan for consulting on charging for adult social care services; to share the committee’s views with the Public Accounts Select Committee.

5.1      David Austin (Head of Corporate Resources) introduced the report. He set out the difficult financial situation facing the Council and provided an overview of the process for scrutiny of the savings proposals.

5.2      David Austin responded to questions from the Committee, the following key points were noted:

• Information about numbers of, and expenditure on, agency staff was included in the Council’s annual employment profile, which was scrutinised by Safer Stronger Communities Select Committee.
• The use of agency staff was not a specific area for review as part of the Lewisham Future Programme.
• The requirement for staffing was considered across all of the savings proposals.
• The use of agency staff was dependent on service requirements and user need.

5.3      Aileen Buckton (Executive Director for Community Services) introduced the adult social care proposals. The following key points were noted:

• The purpose of social care was to keep people safe and well cared for.
• The Lewisham Future Programme proposals were split across four areas:
  • Care (which was the area of highest cost)
  • Assessments and management
  • Prevention
  • Means testing
• The proposals for adult social care would require ‘whole systems change’ working with the five other South East London boroughs to deliver integrated changes to health and social care.

5.4      Joan Hutton (Head of Assessment and Care Management) introduced savings proposals A1: cost effective care packages. The following key points were noted:

• The savings proposal reiterated the focus on working with the service users and carers to support individuals to be as independent as possible.
• The most cost effective options for delivering care and support would be considered within the review and assessment process.
• Officers would ensure that each person assessed would be involved in determining how their care and support needs could be met. This would involve looking at how they might contribute to meeting their care and support needs.
• It was recognised that there were different ways of meeting people’s care needs.
• Support could be reduced in an appropriate way.
• The laundry service had been running for 20 years; it had started at a time when people did not always have access to washing facilities at home, and when support for incontinence was not as effective, which was no longer the case.
• Individual users of the service would be re-assessed on a case by case basis to determine support needs in relation to laundry.
• A number of people were receiving meals on wheels at day centres. There were other, more cost effective ways of providing meals within these settings.
• There was a move towards personal budgets (where people were given information about the funding available to them) and direct payments (where people were given the money to fund and arrange their care).
• It was proposed that service users would be assisted to carry out online shopping, with carer support, using their direct payments.
• Links could be created with local providers such as cafes and restaurants to provide delivery services.
• Some people might pool their budgets and attend a restaurant or lunch club  ...  view the full minutes text for item 5.

The report was noted for information.

Resolved: to note the report.

7.1      Jeff Endean (Housing Strategy and Programmes Manager) introduced the report. The following key points were noted:

• A report about older people’s housing in the borough had previously been considered by the Committee.
• This report set out the initial findings from a consultation about the future of the Kenton Court and Somerville Extra Care schemes.
• Residents had been supported in the consultation by an independent advocate.
• Findings of the consultation and recommendations would be presented to Mayor and Cabinet on 12 November.

7.2      Jeff Endean (Housing Strategy and Programmes Manager) responded to questions from the Committee, the following key points were noted:

• It was hoped that the completion of the consultation and a decision by Mayor and Cabinet on 12 November would end the period of uncertainty for residents of Kenton Court and Somerville.
• A third of the residents in these schemes had already moved to other accommodation.
• The Kenton Court and Somerville buildings were not suitable for Extra Care housing and the options for rebuilding or remodelling them were not considered to be feasible.

Resolved: to note the report.

Resolved: that decisions about the work programme for the following meeting would be delegated to the Chair of the Committee.

Resolved: that decisions about the work programme for the following meeting would be delegated to the Chair of the Committee.

Resolved: to refer the Committee’s views about the Lewisham Future programme to Public Accounts Select Committee.

Resolved: to refer the Committee’s views about the Lewisham Future programme to Public Accounts Select Committee.