Agenda item

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 public engagement around the commissioning intentions. People tend to indicate they would like care to be provided in the community. The challenge is to now make people aware of the care provided in the community.

o  Foundations are in place in the Neighbourhood Care Teams to provide people with a single point of contact for their care, although in some cases it may be two points of contact instead of one. GPs can refer patients they are concerned about to a Neighbourhood Care Team, which also includes district nurses and social care workers. There are coordinators and care support workers across each neighbourhood. The teams aim to provide wraparound care and to proactively identify people’s care needs. This will require a change in the way health and care professionals work and relationships being built between different employees.

o  Work is being developed in the community to prevent malnutrition of Lewisham’s residents. The Committee will receive more information about this work.

o  The commissioning of care provided focuses on the entire population in Lewisham – not just the segment of the population registered with a Lewisham GP.

o  There are likely to be discrepancies between the population of the borough and the population registered with a Lewisham GP as people in London are often registered with a GP across a borough boundary. Some people remain registered after they moved outside the borough or sometimes even once deceased. There are also people registered with GPs who don’t show up in the Census. All this makes it difficult to do a like to like comparison on populations.

o  Access to social workers is being increased on the weekends and discharge from the hospital partly happens over the weekend. It can often be easier for family members to meet with a social worker over the weekend to discuss care arrangements due to work commitments during the week.

4.3     The Committee made the following comments:

o  The move towards prevention and outcome based commissioning was welcomed by the Committee.

o  There is a move to provide more care in the community, and to ensure people require less in-patient and emergency services. But the difficulty might be the transition from current services and expectations to these new models. People are not yet aware that, for instance, Neighbourhood Care Networks exist and that they are a service people can use. This change in awareness is needed for people to start using new services.

o  It can be difficult for people to navigate the different services they might need for their health and social care across primary, secondary, health and social care. Providing people with a single point of contact in the form of a clinical coordinator can help people navigate the system.

o  The funding for the CCG is based on the population in Lewisham registered with a GP, but not every resident is registered with a GP. Sometimes it can be some of the most vulnerable residents and people with complex care needs who are not registered but will still require care. This must be particularly apt in London with its transient population. It leads to a mismatch in funding for the population and the needs of the population.

o  It is concerning that one third of older people who present to hospital suffer from malnutrition.

4.4     RESOLVED: that the Committee would be provided with information on the work done to prevent malnutrition and information on the mismatch between GP registered population and actual population of Lewisham.