John Bardens (Scrutiny Manager) introduced the report. The following key points were noted:
· The Scrutiny Manager explained that the draft report is based on the findings from the three evidence sessions and the written evidence submitted. The report is divided into sections based on themes arising from these findings. The Chair has also circulated draft recommendations for members to consider.
· Cathy Ashley (Lewisham Pensioners’ Forum) asked to address the committee. She stressed the importance of emphasising the financial difficulties being faced by the health and care system - £900m shortfall for NHS health and care services in south-east London, and a further £242 million gap for local governments and social care.
· Cathy Ashley also said that evidence from the review showed that people are facing difficulties accessing the support they need and that many are being asked to rely on family and neighbours. Those without these support networks, however, are falling through the net.
· Nigel Bowness (Healthwatch) emphasised how helpful it was for Healthwatch to be involved in the engagement work of this review and would like to continue to be involved in this and other work. They said that there is a lot more they can do to help the committee engage with the local community.
· Healthwatch pointed out that they are a key part of the SAIL programme in Southwark and suggested that they could work in the same way as part of SAIL in Lewisham.
· Healthwatch also offered to support the council with its regular adult social care survey – they said that they can help to reach those people who may usually struggle to have their voice heard.
· Healthwatch noted that many of the people with learning disabilities that they spoke to as part of the review stressed that they wanted to be able to access mainstream activities and services, not just day centres and specialist provision.
The Committee discussed the report and draft recommendations. The following was agreed:
· The Committee agreed to amend draft recommendation 2 to say that Lewisham Health and Care Partners should ensure that they keep in regular contact with other boroughs when discharging people outside of Lewisham.
· The Committee agreed to amend draft recommendation 3 to say that Lewisham Health and Care Partners should ensure that the neighbourhood care model being developed reflects the diverse social and demographic nature of the different communities in Lewisham.
· The Committee agreed to amend draft recommendation 9 to say the Lewisham Health and Care Partners should engage with local stakeholders (such as Healthwatch) when telling local people about the changes to health and social care.
· The Committee agreed to amend draft recommendation 11 to say the Committee appreciates that the Council and its partners will do all they can to make sure that the integration of services works for local people, but that the Committee notes that there is a risk to social care as a result of government-imposed cuts.
Resolved: the Committee agreed the draft report considered as the final report of its review and agreed the recommendations as tabled by the Chair, subject to the amendments noted in the minutes. The Committee also agreed that the report and recommendations be presented to M&C for response.
The full list of agreed recommendations is set out below:
Work to speed up hospital discharges and avoid admissions
1. Lewisham Health and Care Partners (LHCP) should return to the Committee with an update on the progress of the “ward at home” scheme within six months of the conclusion of this review.
2. LHCP should monitor the figures for discharge delays caused by having to make arrangements for non-Lewisham residents to be discharged outside of the borough. They should also maintain regular contact with partners in other boroughs to tackle these delays as effectively as possible. LHCP should provide the Committee with an update within six months of the conclusion of this review.
Developing new neighbourhood-based models of care
3. LHCP should return to the Committee within six months of the conclusion of this review with more detail about the model of community-based care being developed (influenced by the Buurtzorg model) in order to address the following questions:
· With one key worker responsible for the majority of someone’s care, in teams that are self-managed, how would quality be monitored and assured?
· How would the model, which in the Netherlands has teams of a maximum of twelve nurses, scale up in Lewisham, where the proposed neighbourhood networks would cover larger areas?
· How would the model, which appears from the evidence to be quite expensive to operate, work in Lewisham in the context of ongoing public sector budget pressures?
· How would the model work in Lewisham given the diverse social and demographic nature of the different communities in Lewisham?
4. With the closer integration of community-based services, LHCP should consider an integrated complaints process, which is accessible to all who may need to use it.
Supporting the effective integration of health and social care
5. The neighbourhood-based care models currently being developed by LHCP should be carefully tailored to meet the needs profile of the areas they’ll serve. The Committee should be provided with information about how LHCP plan to do this within six months of the conclusion of this review.
6. Given that it is a key aim of integration, LHCP should set clear targets for reductions in unplanned hospital admissions and monitor performance against these. This would allow stakeholders to monitor progress.
7. LHCP should do all they can locally to make sure that the regulatory processes involved in health and care do not act as a disincentive to more integrated ways of working.
8. LHCP should continue to explore ways of embedding integrated health and social care teams in each of the four neighbourhoods in order to achieve lasting cultural change.
Communicating and engaging with people about the changes
9. LHCP should review how the changes to health and social care are being communicated and how people, residents and staff are being engaged in the process. They should engage with relevant local stakeholders to help with this. Other areas have made use of case studies to help with explaining complex changes like this
10. There should be more co-production in the changes to health and social care and the development of the new models of care.
11. While it may not be necessary to communicate to the wider public the organisational changes taking place behind the scenes, LHCP should effectively communicate these changes to relevant staff and health professionals in the borough, and in the voluntary and community sector.
12. The Committee appreciates that the Council and its partners will do all they can to make sure that the integration of services works for local people, but the Committee also notes that there is a risk to social care as a result of government-imposed cuts.
The views of people using health and care services in Lewisham
13. LHCP should ensure that all staff are able to provide a personalised and responsive service to people in their homes at all times.
14. LHCP should review how the current complaints process for community-based services is working and how and when people are notified of it.
Making the most of voluntary and community sector services
15. LHCP should draw up a plan on how they can work together to build capacity and avoid duplication in the area of activities for young adults with learning disabilities. People with learning disabilities represent a significant proportion of adult social care service users and developing more community-led services for this group could have a significant positive impact.