Agenda and minutes

1.1      RESOLVED: that the minutes of the meeting held on 25 June 2015 be agreed as an accurate record.

2.1      The following non-prejudicial interests were declared:

Councillor Muldoon - Lead Governor of South London and Maudsley NHS Foundation Trust.

Councillor Jacq Paschoud - Chair of the Parent Carers Forum; and a family member in receipt of a package of social care.

Councillor Pat Raven – trustee of Lewisham Disability Coalition and a family member in receipt of a package of social care.

3.            Care Quality Commission Update

3.1      Ian Brandon (Interim Inspection Manager Hospitals Directorate, CQC) gave a presentation to the Committee. The following key points were noted:

·           The CQC’s purpose is to make sure that health and social care services provide people with safe, effective, compassionate, high-quality care and to encourage care services to improve.

·           A CQC inspection will produce a rating on the following scale: outstanding, good, requires improvement and inadequate.

·           The CQC can intervene in the work of providers in a number of ways ranging from regulatory action through to putting conditions on services and even starting criminal prosecutions.

·           After the Keogh review in 2013, the CQC changed its approach to inspections. The new inspections regime means that hospital inspection teams always include specialist inspectors, clinical inspectors and experts by experience.

·           After an inspection of a hospital, a quality summit is held with the provider and stakeholders to launch the quality improvement process.

·           Lewisham and Greenwich NHS Hospital Trust was last inspected by the CQC 18 months ago. As a result, an action plan was created to improve the care provided. The action plan contains 140 metrics. These metrics are continuously monitored by the CQC as the action plan is being implemented. 

3.2      Ian Brandon responded to questions from the Committee and the following key points were noted:

·           The CQC performs both announced and unannounced inspections. It can inspect providers 24 hours a day, and will often focus attention on the change-over between shifts. 

·           The CQC has recently acquired new powers to look at the sustainability and financial position of providers, but there is an ongoing conversation about the division of these responsibitilies between the CQC and the NHS Improvement Agency.

·           To assess the responsiveness of providers, the CQC looks at patient flow through the hospital from admittance through to discharge. It specifically looks at discharge planning, planning for the needs of the local population (e.g. winter planning and capacity planning), and shift patterns of staff.

·           In schools, a rating of indadequate can lead to difficulties in recruitment. The CQC is reviewing the impact of its new rating system for this potential issue, although it hasn’t been a problem so far. When a trust is rated as inadequate, often special measures are imposed and external support is put in place.

·           When issues of particular urgency are identified during an inspection, the CQC will raise them as soon as possible with responsible staff and this often leads to immediate changes.

·           When issues require improvement, the CQC can issue warning notices containing a deadline for change or send letters of action which highlight major concerns and ask for immediate action.

·           The CQC is an independent arms-length body that inspects both NHS providers and private providers. It has been inspecting private providers since April 2015. It’s too early to tell how private providers compare to NHS providers in inspection results. Both types of providers are required to meet the same regulatory standards. Often private providers will use different performance metrics to NHS  ...  view the full minutes text for item 3.

4.            Lewisham Future Programme: 2016/17 DRAFT Revenue Budget Savings Proposals for Scrutiny

4.1      David Austin (Head of Corporate Resources) introduced the main savings report; the following key points were noted:

·           This report should be seen in the context of the Medium Term Financial Strategy that was presented at Mayor and Cabinet meeting in July, which presents the Council’s financial strategy up 2019/20. The Council is working towards the savings targets set for the Lewisham Future Programme, as public austerity is expected to continue.

·           The Comprehensive Spending Review will be announced on 25 November, with the Local Government Financial Settlement (LGFS) expected to be announced in early December. It isn’t until the LGFS that Council will know what budget it can set in February.

·           It was agreed by Councillors last year that £45m of savings needed to be identified in setting the budget for 2016/17. The proposals presented amount to savings of between £25m and £26m, which leaves a gap of about £20m to fill. Further savings are still being developed, and will be presented to the Committee when they’re available.

·           The specific proposals for this committee to examine in detail amount to roughly £8m, of which roughly £3m are proposals for the 2015/16 budget and £5m are proposals for the 2017/18 budget.

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

·           The proposals look ahead for two financial years, and for those proposals due to be implemented in 2017/18, detailed plans will only be brought forward at a later date.

·           The proposals A11 to A15 fit within the overall framework of Adult Social Care Integration.

·           The Public Health savings proposals have been developed to meet the targets from the Lewisham Future Programme, but don’t contain any plans to deal with the in-year savings to Public Health Grant proposed by central government.

4.3      Aileen Buckton and Joan Hutton (Head of Assessment and Care Management) responded to questions from the Committee on savings proposals A11: Managing and improving transitions plans. The following key points were noted:

·           The Council is developing supported living schemes for young people with complex needs in the borough, to avoid the cost of expensive out of borough placements. Work has started to develop these proposals with a target to implement them as part of the 2017/18 budget. A detailed proposal for the creation of these places is expected to be presented to a Mayor and Cabinet meeting in the autumn.

·           Choices between different types of provision will be available to young adults, but these choices will be constrained by the budget available to the Council, the resources of young people themselves and their relatives as well as the availability of other services.

·           The provision of additional places at House on the Hill would happen in a phased way, with a total capacity of 40 places but initially only 10 places becoming available. Aside from the places at House  ...  view the full minutes text for item 4.

5.            Lewisham Annual Public Health Report

5.1      Danny Ruta introduced the report. The following key points were noted:

·           This report is produced by Public Health to provide an independent assessment of the health of the population of Lewisham.

·           The main focus of this year’s report is on children’s health from pre-natal through to the age of 18.

·           This report has been produced in close collaboration with the Children and Young People’s directorate. The draft Children and Young People Plan (2015-18) has already taken account of many of the recommendations contained in the Public Health Annual Report.

5.2      Danny Ruta responded to questions from the committee. The following key points were noted:

·           Lewisham’s high birth rate compared to the average for London and England, has implications for the demand for maternity and childrens’ services, as well as possibly creating cases of toxic stress due to the poverty of the population.

·           Premature mortality from cancer in Lewisham is higher compared to London and England. The Committee expressed concern about the prevalence of breast cancer, cervical cancer and cancer in the under 75s. Officers are developing a cancer prevention action plan.

·           Funding is being sought for a pilot of a Maternity Early Sustained Childhood Home-visiting Programme (MESCH), as this approach has had good outcomes in Australia. 

5.3      RESOLVED: to note the report.

6.            Public Health Grant Reallocation 2015/16

6.1      Janet Senior (Executive Director for Resources and Regeneration) introduced the report. The following key points were noted:

·           As part of the 2015/16 budget, potential disinvestments from Public Health funded services were identified of £3.1m.

·           The Council must use its Public Health Grant for activitities that have a positive impact on public health outcomes. The Executive Director for Resources and Regeneration and the Director of Public Health have identified a list of Council activities with a positive impact on public health outcomes that could be supported by the re-investment of the £3.1m, and prioritised them according to the greatest public health outcome. 

·           The savings in the budget directly managed by the Director of Public Health have been absorbed by a reshaping of the Public Health services, not by cutting services completely. 

·           By comparison, the in-year cut to the Public Health being proposed by central government would result in a real reduction of services to the Council.

6.2      RESOLVED: to note the report.

7.            Scoping Paper – GP Missed Appointments

7.1      The Chair introduced the item:

·           In March 2015, the Chair received a letter from the Chair of the Patient Participation Group at the Grove Medical Centre in Deptford. The letter explained that missed appointments wasted the time of GP’s and receptionists as well as inconveniencing other patients and therefore suggested that Committee might want to look at the issue.

·           The Chair recommended that the Commtitee - when deciding whether to undertake the review - consider whether it would add value, how easy it would be to gather the relevant data and whether any recommendations would be acted on. 

7.2      Diana Braithwaite (Director of Commissioning & Primary Care,Lewisham CCG) addressed the Committee. The following key points were noted:

·           Data on Do Not Attends (DNAs) is not routinely collected nationally. Individual GP practices may very well not collect this data.

·           The CCG commissioned the Primary Care Foundation to support GP practices with the more generic issues of access, which encompassed DNAs. However, it is important to note the DNAs are a small element of improving access to GP services. Of the 40 practices in Lewisham, 36 took part in this work. All appointments were recorded including appointments with nurses and phone calls across these 36 practices for one week. This resulted in a large volume of data.

·           Only 6 practices had DNA rates of over 7.5%. Of this only 3 had rates above 10% and the highest rate was 11.6%.

·           On review of the findings the Primary Care Foundation indicated that there were so few numbers of appointmnets involved, that it would not be worth  diverting practice resources to reduce the occurance of DNAs.

·           The CCG is reviewing NHS England’s Transforming Primary Care in London: a Strategic Commissioning Framework in terms of access to GP services; and offered to return to the Committee later in the year with more information about GP access, and suggestions for how the Committee could contribute.

7.3      Simon Parton (Chair of Lewisham Local Medical Committee) addressed the Committee. The following key points were noted:

·           The main concern for the LMC is patient access. Missed appointments mean that another patient has not been able to access their GP practice.

·           It is important to look at this issue in the wider context of access to GP services. Demand for GP services is increasing and GP’s tend to serve as a gatekeeper for access to other NHS services. However, there is no gatekeeper for access to GP services themselves.

7.4      RESOLVED: That a review into GP mIssed appointments not be carried out, but that the committee receives information from the CCG about the wider issue of access to GP services as part of the 2016/17 work programme and considers a review into the wider issue of access to GP services.

8.            Select Committee work programme

8.1      Simone van Elk (Scrutiny Manager) introduced the report. The Committee discussed its programme of work and agreed to add an additional meeting to the work programme in early December to replace a meeting that had been cancelled earlier in the year.

8.2      RESOLVED: that the work programme be noted, and an additional meeting be held in early December.

9.            Referrals to Mayor and Cabinet

9.1      RESOLVED: to refer the Committee’s views on savings proposal A14 and savings proposal B2 to the Public Accounts Select Committee.

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The meeting ended at 10.15 pm

Chair:

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