Agenda and minutes

1.1     Nigel Bowness (HealthWatch Bromley and Lewisham) requested that his attendance at the Committee meeting on 14 October 2015 was included in the minutes.

1.2     RESOLVED: that the minutes of the meeting on 14 October 2015 be agreed subject to this amendment.

2.1     The following non-prejudicial interests were declared:

Councillor Muldoon: governor for South London and Maudsley NHS Foundation Trust.

Councillor Jacq Paschoud: family member in receipt of a package of social care.  

3.1     The Committee welcomed the response but wanted to see how the development of services and provision was progressing.

3.2     RESOLVED: The Committee noted the report and recommends that next year’s Healthier Communities Select Committee has an item on their agenda early in the municipal year that reports on the progress against the key areas of development highlighted in the report.

4.1     Susanna Masters (Corporate Director, Lewisham CCG) introduced the report. The following key points were noted:

o  The Adult Joint Strategic Commissioning Group is responsible for developing the Commissioning Intentions. It has worked closely with the Adult Integrated Care Programme Board (AICPB), Public Health, Adult Social Care and Lewisham CCG. The Adult Integrated Programme Board looks at physical and mental health, health and social care, and primary and secondary care. The commissioning happens in two parts: services for adults, and separately services for children and maternity.

o  Last year was the first year that the commissioning intentions were jointly produced. One plan was created to cover one set of priorities for the partners over the course of two years.

o  There was a period of consultation over the priorities for last year’s commissioning intentions. This included public events around prevention and early intervention, GPs, neighbourhood community teams and enhanced care schemes.

o  The priorities have been refreshed this year, but the focus has been on how to commission services to meet those priorities. One of the areas being worked on was how success should be measured in this area of work.

o  The aim for the commissioning intentions is to have a population based, outcome based approach.

4.2     Susanna Masters, Danny Ruta (Director of Public Health) and Joan Hutton (Head of Adult Assessment and Care Management) responded to questions from the Committee. The following key points were noted:

o  The move towards prevention and outcome based commissioning was welcomed. A shift in culture and ways of working was needed to ensure prevention was

o  Many contracts in health and social care are structured to pay for activities undertaken by providers. The essence is that the more an organisation does, the more it would get paid, which means the financial incentives for organisations often do not promote preventative work. For example, the general medical services contracts rewards GPs for seeing patients, but does not reward them for prevention people from becoming ill.

o  Prevention requires an opposite approach. To make prevention central for the way health and social care services are organised would require changes in the way funding flows between different organisations in the health and social care system. In Lewisham, partners are working together to change the system and create a change in the mind-set of employees and organisations involved.

o  The report mentions that around 11.9% of the population in Lewisham has 2 long-term conditions. The term long-term condition is quite wide ranging. Most people with long-term conditions go about their daily lives, but in the long run these conditions can still increase the risk of complications. Health and care services are aiming to prevent conditions from deteriorating. For example, a person with diabetes can have high blood glucose levels for years without significant direct impact. However, in the long run this can lead to amputations, blindness and kidney failure which could have been prevented. The challenge is to make people consider their future.

o  There has been  ...  view the full minutes text for item 4.

5.1     This item was discussed after item 6 Additional information savings proposals A14 and A16.

5.2     Sir Steve Bullock (Mayor of Lewisham and Chair of the Health and Wellbeing Board) introduced the report. The following key points were noted:

·      The strategy of the Health and Wellbeing Board (HWB) has been refreshed. The Joint Strategic Needs Assessment (JSNA) was carried out when the HWB was not formally set up yet but functioning in a shadow form. The JSNA has been the foundation for HWB priorities so far.

·      The HWB is still a very new creation, and the relevant legislation has left some maters unresolved. HWBs functions as a, for local government, strange hybrid between executive and scrutiny functions. This concern has been identified across London during events about HWBs, so this is not simply limited to Lewisham.

·      HWB has had to identify priorities, and it easy to say everything is a priority. The question for the HWB now is how to take matters forward. In the strategy refresh decision has been made to focus on three areas: (a) the integration of health and adult social care; (b) preventing ill-health and promoting independence; (c) supporting our communities to become healthier and more resilient. Given the financial pressures for the Councils and its partners in the health sector, these areas have to be prioritised, especially the integration of health and adult social care.

·      The remaining question is how the HWB can add value, as he HWB does not control any resources directly. But relies on the resources and work of its constituent parts to deliver against the HWB’s priorities.

5.2     Danny Ruta commented on the report. The following key points were noted:

·      The focus of action in the next couple of years would be on how to achieve long-term outcomes. The aim is to act on the levels of the population, community and individuals. In addition it was important to make each contact count with a health care professional or other public sector worker in Lewisham.

5.3     Sir Steve Bullock and Danny Ruta answered questions from the Committee. The following key points were noted:

·      The HWB is a hybrid of executive and scrutiny functions. The Board has a duty to scrutinise the workings of its constituent bodies, as well as having executive powers. The Healthier Communities Select Committee can add value by looking at whether the priorities for action have been delivered against by the constituent bodies of the HWB. It may be less useful to look at the work and output of the HWB directly.

·      The universal free vitamin D scheme mentioned under Priority 1 Achieving a healthy weight in the report, was intended to contribute to healthy nutrition and consumption of healthy food overall. Officers are unaware of a direct positive link between consumption of vitamin D and a healthy weight.

·      BSG immunisation is currently provided to babies a couple of weeks after birth by health visitors. There are currently discussions undergoing as to whether midwives should be trained to administer  ...  view the full minutes text for item 5.

6.1     This agenda item was moved forward on the agenda to be discussed directly after agenda item 4.  

6.2     Joan Hutton introduced the information on savings proposal A14 Managing the demand for formal social care and achieving best value in care packages. The following key points were noted:

o  This savings proposal is a continuation of the savings agreed in 2015-16. Commissioners are now required to consider what people can still do for themselves, and work with families to establish this. Care needs of individuals are reviewed more often to ensure the packages of care provided are timely, cost effective and proportionate to need.

o  The case studies included in the report provide a flavour for the kind of changes to care packages that are being implemented.

o  There is a process in place to ensure people can raise issues with officers if there are problems with the care package. This change is difficult for many people, as some residents have been provided with a certain level of care for a very long period and the adjustment if care is reduced can be hard. If levels of care are reduced this is done gradually. The process is being managed carefully and at the time of the meeting there had not been any complaints to the Local Government Ombudsman.

6.3     Joan Hutton responded to questions from the Committee. The following key points were noted:

o  The website is being developed to be more accessible to people.

o  Several options are considered when discussing and deciding on care arrangements with residents. Although 7 hours of care a week for a very elderly resident may seem like a limited amount of contact, some people don’t want much interaction with social services.

6.4     The Committee made the following comments:

o  The Committee thanked officers for the detailed case studies, which were very useful for the Committee to be able to assess what the savings proposal would entail.

o  It may be difficult to make these new ways of providing care, including via the website, accessible to people who are not already engaged. Sometimes making website more accessible can lead to them becoming more accessible to people already using them – not to the sites being used by people who weren’t using them before.

6.5     RESOLVED: the Committee noted the report.

6.6     Danny Ruta introduced the information on savings A16 Public Health. The following key points were noted:

o  The Council currently spends £200k a year on providing free swimming from its Public Health grant. This funding is spent on providing free swimming for under 16 year olds, as the leisure centre contracts provide concession for over 60 year olds.

o  Just under 14.000 residents in Lewisham used free swimming over the last financial year. This is a sizeable chunk of Lewisham’s population. 23% of the residents younger than 16 used the free swimming provided at least, while 8.7% of the 0-16 population swim at least once a month. Only 20 children or  ...  view the full minutes text for item 6.

6.1     Simone van Elk (Scrutiny Manager) introduced the report. The Committee discussed its next Committee meeting, and mentioned that, depending on the circumstances at the time, it may be good to receive information on how the proposed junior doctor strike would impact on the trusts attending the next Committee meeting.

6.2     RESOLVED: that the work programme be noted.