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

·         Councillor Susan Wise is a governor of the King's College Hospital NHS Foundation Trust.

·         Councillor Colin Elliot is a Council appointee to the Lewisham Disability Coalition.

Harvey McEnroe (Lewisham and Greenwich NHS Trust) introduced the report. The following key points were noted: 

·         This year, Lewisham CCG has agreed £1.4m of resilience funding to be spent at University Hospital Lewisham. The funding is going towards a number of schemes and is expected to improve performance on the 4-hour standard by 2.4%.

·         The resilience money is being spent on, among other things, additional emergency staff, including on Saturdays and overnight; extending rapid assessment and treatment, to reduce numbers referred to more specialised services in the hospital; and continuing with “pathway navigators”, staff intended to help with quick and effective discharges.

·         Pathway navigators have successfully reduced the time it takes to complete discharge paperwork from twelve days to less than four.

·         The enhanced care and support programme, intended to avoid unnecessary hospital admissions, has been brought forward in part – the rapid response team, for example. The “Home Ward” has stalled however – the trust and CCGs will be looking again to make sure it is the best way to spend this money.

·         Further work will look at providing extra staff in the emergency department over the winter. The trust has agreed with the CCG to increase the number of nurses on shift from 16 to 18. There is also going to be extra pharmacy support to help increase the number of discharges before 1pm.

·         The number of patients discharged by 1pm 12 weeks ago was 14% - it is now 33%. The trust is still working towards to national target of 40%.

Harvey McEnroe answered questions from the Committee. The following key points were noted:

·         Improving the emergency care pathway is one of the trust’s key priorities – along with patient safety, quality and governance. Senior management are often present in the emergency department.

·         To overcome some of the recruitment difficulties it’s been facing, the trust is working closely with other acute providers in south-east London to make sure they are not driving up costs and buying each other out of the market. It has also carried out some successful overseas recruitment campaigns in the past. The impact of Brexit on recruitment is being considered.

·         The trust has broader concerns about the recruitment of junior doctors. The recent changes to junior doctors’ contracts appear to have had an impact on junior doctor recruitment. 

·         The national and regional data on the impact of flu vaccinations does not show strong correlation between increased vaccinations and reduced hospital admissions.

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

·         The Committee noted the significant increase in the proportion of patients discharged before 1pm and commended and congratulated the trust on their excellent work.

Resolved: the Committee noted the report.

Barry Quirk (Chief Executive), Dr Marc Rowland (Chair, Lewisham CCG) and Aileen Buckton (Executive Director of Community Services) introduced the report. The following key points were noted:

·         The south-east London STP has benefited from some involvement of the six local authorities in south-east London. This has been to continue to develop an integrated approach to health and social care. The local authorities are helping to make sure that local improvements to social care fit in with planned changes in health services locally (in alignment with the STP) and that cost shunting across sectors and boroughs is minimised.

·         The combined financial challenge for social care across the six local authorities in south-east London is £242m. The six authorities have identified the scale of their challenges but they have got to coordinate their six operational plans at a six-borough level so that health changes are addressed more collectively.

·         The south-east London STP was published early because NHS England was pleased with the level of cooperation within the NHS and across partners in south-east London.

·         Lewisham partners have also been pleased with the level of cooperation across the system. The STP has encouraged acute providers, and their commissioners, in south-east London to cooperate with each other and consider potential improvements to the whole south-east London system.

·         The level of cooperation within the NHS is much improved and very different to a few years ago, where institutions were working very separately and more competitively.  NHS partners are working more collaboratively and trying to look at how the whole system can change rather than just their part of it. For example, by working together to try to achieve changes in the acute sector the aim is to invest more in prevention and primary care.

·         The cooperation within the development of STP does not, however, detract from the concerns about the aggregate level of funding nationally of the NHS.

Barry Quirk and colleagues answered questions from the Committee. The following key points were noted:

·         It is important that local authorities bring critical challenge and point out any service and financial gaps in the STP.  It is not for local authorities to agree the plan – set at the sub-regional level, it is principally an NHS plan devised with involvement from Councils who secure social care services locally. In Greater Manchester the creation of a combined authority (for social care and other functions) city regional devolution includes health and social care.  Other places, including "sub-regions" within London are less developed.  But, at the same time, all social care authorities do need to make changes as a result of their own service challenges and financial pressures. It is important that they work with health services in doing this.

·         The STP is not principally about financial cuts, although it does involve cost reduction, efficiencies and productivity improvements. However the scale of the aggregate financial challenge for the entire NHS system in SE London is very high (£1 billion). Partners across south-east London are working together to bring some of  ...  view the full minutes text for item 5.

Susanna Masters (Lewisham CCG) and Dee Carlin (Lewisham Council) introduced the report. The following key points were noted:

·         The purpose of the partnership commissioning intentions is to provide the public and providers with an opportunity to see and comment on a summary of the CCG’s broad plans and priorities. They also set out what the partners expect from providers – this includes population-based approaches; strengthening primary and community-based services; promoting healthy living; and developing new services using co-production with a whole system approach.

·         This is the third year of joint commissioning intentions. They cover not just CCG commissioning, but adult social care and public health as well. The only way local partners can address the significant challenges they face is by working together.

·         The focus of this year’s commissioning intentions is on prevention and early action, planned care, and urgent and emergency care. The strategic aim is to focus much more on prevention and early action to reduce the demand for urgent and emergency care.

Susanna Masters answered questions from the Committee. The following key points were noted:

·         The Single Point of Access for referrals for health and social care is well used by the public. Partners are now looking at providing people with more information, and access to other services, rather than just processing a standard referral.

·         The number of transgender people in Lewisham is very small, but partners will include this group in the commissioning intentions.

·         The Community Falls Service’s proactive outreach work will include housing providers.

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

·         The Committee expressed concern that many of the priorities in the commissioning intentions are very similar to those services that have been cut under the public health budget.

·         The committee also noted that the greater use of technology, including electronic health profiles, has the potential to reduce costs and help people better manage their health and care.

Resolved: the Committee noted the report.

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

·         Devolution in London is not just about health and social care – there are various other pilots going on across London on various other powers that could be given to local authorities.

·         Lewisham’s devolution pilot is now focused on estates and workforce. The pilot is exploring ways to change the way buildings are used so that staff can be co?located, and create new combined health and social care roles so that providers can work in a more flexible way. The latest business case also includes a request for transformation funding from the One Public Estate programme (jointly run by the Cabinet Office and the Local Government Association).

·         The first multi-disciplinary team should be collocated in the Waldron early in the new year. The proposed hub for central Lewisham is likely to be in the Ladywell area.

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

·         The Committee noted that with any new devolution arrangements, that there must be appropriate governance, transparency and accountability to avoid the risk of democratic deficit.

Resolved: the Committee noted the report.

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

·         Professor Michael Preston-Shoot has been appointed as the new Chair of the Adult Safeguarding Board.

·         Some of the key achievements in adult safeguarding over 2015/16 include improved multi-agency working; devising a communications strategy; establishing an information sharing agreement; and creating a dedicated team to process Deprivation of Liberty Safeguards (DOLS) assessment – which has reduced the waiting list to zero.

·         There has also been a peer review of safeguarding in Lewisham, which included scrutiny of the board and our work. There are occasionally quality assurance issues from providers that can become safeguarding concerns. The results of the peer review so far been very complimentary on our work to prevent quality assurance issues becoming a safeguarding concern; on our management and standards of practice regarding DOLS; and our safeguarding partnership work.

Resolved: the Committee noted the report.

Resolved: the Committee noted the report.

John Bardens (Scrutiny Manager) introduced the report.

·         The Scrutiny Manager informed one member of the committee, who had queried what changes are happening to tuberculosis services, that he would share the briefing that he had received from an officer to help clarify what is happening in Lewisham. 

Resolved: the Committee agreed the work programme

The Committee didn’t make any referrals.