Agenda and minutes

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

Fiona Russell (Local Government Association) gave evidence to the committee. The following key points were noted:

·         Three key documents were referred to for information on the key enablers, barriers and measures of success in relation to the integration of health and adult social care:

The journey to integration: Learning from the seven leading localities – which analyses at the experiences of seven different areas across the country.

Stepping up to the place: The key to successful health and care integration – which looks at the ten essential characteristics for a fully integrated health and care system.

Stepping up to the place: Integration self-assessment tool – which is intended to help local areas assess how ready they are, and understand what some of their local challenges might be.  

·         The second report focuses on three areas: shared commitments, shared leadership, and shared systems. Its key points include that integration has to be personalised, preventative and person-centred; it has to focus on the skills and capabilities of communities; and the measures of success need to be driven by the outcomes important to local people.

·         In terms of leadership and accountability, the report said it’s crucial that leaders of the system are able to step outside of their own organisation and make decisions based on a shared vision – and that you have the governance arrangements to allow decisions to be made this way.

·         In terms of shared systems, the report also stressed the importance of having in place the right payment systems, workforce strategy, information sharing arrangements as well as a shared risk stratification model.

·         The LGA have been very clear, however, that no single model or approach will work for all – integration has to be based on the needs of the local area.

·         Successful integration is also very much about a cultural change. Areas shouldn’t impose an organisational form on the local system – it’s more about working in different ways with local partners and working more around individuals.

Clive Grimshaw (London Councils) also gave evidence to the committee. The following key points were noted:

·         The Committee were told about the reflections from some the London-based devolution pilots, particularly those relating to integration (Lewisham, Hackney and north-east London).

·         One of the key enablers has been getting the culture right – building strong and open local partnerships that allow people to sit around the table and have open, frank conversations about what they want to do across health and social care.

·         Without the right culture and partnerships, it becomes much more difficult to make progress with some of the more practical enablers around things like IT, workforce, and estates.

·         One of the key barriers are the assurance and regulatory mechanisms, which don’t recognise the integrated systems that local areas are trying to set up and end up working against local visions of integration. Sustainability and Transformation Plans (STPs) were mentioned as an example.

·         In terms of what success may look like in the long run, it’s about bringing health decisions closer to  ...  view the full minutes text for item 3.

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

·         The Committee noted that recruitment of staff seems to be a general problem and that so long as there is uncertainty around Lewisham Hospital, and the impact of the STP, these problems are going to remain.

·         The Committee also applauded the success of the Navigators, which provide administrative support to wards, and the positive impact they have quickly made by taking some of the paperwork tasks away from medical professionals.

Resolved: the Committee noted the report.

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

·         This year the annual report focuses on obesity. The sugar-smart campaign is being launched soon (Lewisham being the first borough in London). Lewisham is also a national pilot for a whole-system approach to tackling obesity.

·         As well as action on sugar, there’s going to be action on physical activity and losing weight. But the main message is to stop blaming individuals – recognising that in the UK today it’s almost impossible not to put on extra weight and that it’s the environment we’ve got to change.

·         The Great Weight Debate is also going on across London. This is also about shifting the debate from blaming people to looking at the environment we live in.

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

·         Lewisham and Greenwich NHS Trust has signed up to the sugar-smart campaign and pledged to take action this year to improve food for patients and staff.

·         A key part of the whole-system approach is increasing school meal uptake. Officers are currently working with two schools in the borough with high school meal uptake. One has a digital fingerprint system, which reduces queueing and allows parents to track what their children are eating.

·         Lewisham has 1 chicken shop per 1000 people – the 13th highest rate in the country. Officers will be working with takeaways to get them to sell healthier food. There are lots of examples of takeaways doing this without losing sales – the Charlton Kebab House, for example.

·         Officers will monitor sexual health data following the redesign of sexual health services in the borough. Lewisham needs more sexual relationship education in schools, but there isn’t the resources. Lewisham has also pioneered primary care based HIV testing.

·         To generate publicity for the sugar smart campaign, Lewisham is working in partnership with the News Shopper. Officers will also be proactively approaching organisations – focusing on schools first, then takeaways near schools, and then GP practices. Officers will also look at approaching the supporting living sector.

·         Officers would like Lewisham Councillors to do their bit and get schools in their wards to sign up to sugar-smart and the Daily Mile initiative. University analysis of the Daily Mile initiative has found, in some areas, that obesity rates have halved.

·         According to the national obesity expert, there is not enough evidence yet on the link between aspartame in diet drinks and cancer. Sugar-free drinks should still be considered as a better alternative to those with sugar. But officers will look at ways of identifying and promoting alternative, natural sweeteners as part of the sugar-smart campaign.

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

·         The Committee noted that we need to move away from using words like obese, as they label people and make them feel guilty.

·         The Committee pointed out that some school playgrounds in Lewisham are not  ...  view the full minutes text for item 5.

John Bardens (Scrutiny Manager) introduced the report.

·         The Committee decided to look into having an item on the impact on services in Lewisham of the Greenwich CCG’s decision to award the musculoskeletal services contract to private healthcare company, Circle Health.

Resolved: the Committee agreed the work programme

The Committee didn’t make any referrals.