Agenda and minutes

If a Councillor has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Councillor with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter. The Councillor must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where Members of the public are not allowed to be in attendance and speak, then the Councillor with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Councillors who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Councillors are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee.

Mr Steve McManus and Dr William Oldfield gave a presentation of Accident & Emergency (A&E) performance at Imperial College Healthcare NHS Trust (ICHT).

Whilst there had been no increase in the total number of attendances at ICHT,  there had been an increase in St. Mary’s Hospital (SMH) T1 (a consultant-led 24-hour service with full resuscitation facilities). This had been in line with the planned increase following the closure of the Hammersmith Hospital (HH) emergency unit closure.

The Charing Cross Hospital (CXH) T1 attendances had been broadly static, although there had been some variations. The figures did not reflect the patterns of attendances. There were surges in activity, particularly at SMH, where there could be a difference of 100 in attendances from one day to another. In addition, T1 activity included a greater level of category A/London Ambulance Service activity. This had become the normal level of activity.

The presentation set out:  the key initiatives in place in respect of winter resilience planning; and the additional actions being taken in respect of the A&E improvement plan; and referred to the NHS review of A&E services in NW London.

In conclusion, Mr McManus stated that ICHT was not where it wanted to be, but was focusing on improvements and deploying resources to bring about these improvements.

Mr Naylor outlined his recent experience at CXH, when he had attended A&E on a Monday afternoon. The area had been full and staff overworked. Mr Naylor had been admitted to an Assessment Ward where he had overheard staff discussing how to move patients to other areas of the hospital. Mr Naylor queried what ICHT was doing to implement its promises.

Mr McManus responded that it was recognised that teams were working very hard to deliver appropriate care, and they were being supported through additional capacity in terms of beds and staff, at both SMH and CXH. It was likely that Mr Naylor had attended CXH during the outbreak of infection, when 22 beds had been closed. This infection had been contained and the beds re-opened.

Mr Naylor commented that it did not make sense to close A&E departments and close beds. Mr McManus stated that ICHT was not looking to close the CXH Emergency Department, but was waiting for national guidance on Emergency Departments. In the foreseeable future, there would be no changes or services withdrawal. Dr Oldfield added that it was not just an issue of capacity, but also staff who were able to make decisions. The six emergency consultants in place from mid-December were joint appointments between SMH and CXH.

Councillor Carlebach queried the number of patients who had received the flu vaccination. Dr Oldfield responded that patients who were thought to have flu related illnesses were asked about the vaccination, but this data was not captured.

Councillor Carlebach queried whether there was any evidence of patients with fairly serious illnesses contacting their GPs  ...  view the full minutes text for item 43.

The Chair asked Mr Stuart Lines, Ms Lynda Gibbon and Dr Tim Spicer to explain the responsibilities of Public Heath, NHS England (NHSE) and GPs in respect of the Under Fives Flu Vaccination Programme.

Mr Lines stated that Public Health had local responsibility for ensuring that the system was working properly and that as many children as possible received the vaccination. NHSE commissioned services with primary care.

Ms Gibbon stated that NHSE  commissioned GP providers to offer free flu immunisation to all eligible children. NHSE funded and monitored services and worked with CCGs to identify any sub-optimal performance.

Dr Spicer emphasised that the services were commissioned with individual providers. The role of the CCG was to improve the quality of primary care and to support practices in difficulties. In addition, it was responsible for some operational issues and working with 31 practices to gain consensus.

Ms Gibbon added that Public Health England was responsible for the national procurement of the vaccine. The vaccine was supplied free of charge to NHS commissioned providers.  NHSE monitored the uptake as GP providers were contracted to provide activity data on a weekly basis via the public health surveillance system. Public Health England was responsible for publicity and had produced a range of resources for parents.

Ms Gibbon responded to a number of queries raised by Councillor Vaughan. The current uptake figures for Hammersmith & Fulham were:

Ms Gibbon explained that the cohort of children with long term medical conditions sat within the cohort of all children/adults at clinical risk. Contractually, there were no uptake targets. The World Health Organisation target of 75% had been adopted as best practice. The contract for children with long term medical conditions which ran from 1 September to 31 March, would be reviewed mid-point and extended beyond March if necessary.

Similarly, there was no specific target for uptake amongst healthy children. The aim was to exceed the previous year’s uptake.

Ms Gibbon stated that an example of sub optimal performance would be a practice not reporting activity data. The national IT issues in September, which had now been resolved, had impacted on initial data reporting.

Individual contracts had been put in place with independent GPs and community pharmacies across London. In addition, NHSE had developed a service level agreement for GP Practices to enable them to offer flu vaccinations to unregistered individuals who might present opportunistically or out of hours and to provide weekend sessions.

Councillor Carlebach stated that the figures quoted by Ms Gibbon were different from those given to him by the CCG. There were a number of key players but a lack of co-ordination. He had seen no plan or letter going out to children in the borough. There had been no letter given to children at his son’s nursery. There was no ownership of the programme. Hammersmith & Fulham was the worst  ...  view the full minutes text for item 44.

This report has been circulated late to enable the latest budget information, including from the provisional local government finance settlement, to be incorporated within the papers.

Mr Hitesh Jolapara highlighted the key points on the corporate overview of the revenue budget and Medium Term Finance Strategy (MTFS), namely the MTFS position, the budget assumptions, the Government grant, fees and charges (main expceptions to the standard increase), budget risks/balances/earmarked reserves, 2016/17 and beyond, the Autumn statement and expenditure and resources forecast 2014/15 to 2021/22.

The proposed savings overall was £23.8million for 2015/16 and £40.9million for  2016/17 (cumultative savings). The Council Tax would be reduced by 1% in 2015/16. There were further reductions to be made and by 2019/20 there would have been a reduction in total of around 57%.

Mrs Rachel Wigley highlighted the key points in respect of Adult Social Care, namely the service vision, the major changes for 2015/2016, the budget headlines, LBHF/ASC Efficiencies, Fees and Charges, the Gross Spend Plan 2015/2016, Risks and Plans for the Future. The presentation set out the Better Customer Experience by Increasing Efficiency and Partnership Working totaling £6.5 million.

It was proposed to abolish charging for home care services; reduce the cost of meals on wheels to £3; and freeze charges for Careline.

The report set out the Public Health budgets and issues. Savings of £366k general fund were proposesd to make Public Health a fully grant funded service.

Councillor Carlebach queried the savings in respect of the reconfiguration of services with the Learning Disabilities client group. Mrs Wigley responded that there were three measures: a review of customers placed in out of borough supported accommodation; maximising in house day care provision; and a review of residential care home facilities.

Councillor Lukey stated that the proposals were in line with feedback that: out of borough placements were unpopular because of high transport costs; there should be a range of housing options; and the proposal to close the in-house learning disabilities service was rejected.

Mr McVeigh noted that some specialist care was provided out of borough and this might be difficult to replicate.

Councillor Lukey stated that whilst this was a finance driven strategy, there were other important isssues and specifically safeguarding, and finance would not determine where people were placed. 

In respect of the Independent Living Fund (ILF), all social care support would be provided by the Council and ILF funding would be transferred to the Council via a grant. Confirmation of funding levels was awaited. However, the Council had agreed that current ILF users would continue to receive ILF funding until 30 June 2016, if they were still eligible.  Mr McVeigh stated that officers should be breifed to give this assurance. Councillor Lukey responded that she had written to 55 individuals, and she had thought that this was eveyone in receipt of the ILF. There had also been a number of meetings.

Councillor Brown stated that the overall budget was disappointing, and specifially the Adult Social Care savings of £6.5 million, especially when money was being received from the NHS throught the Better Care Fund. Councillor Brown queried whether the dependency on better integration of care with the  ...  view the full minutes text for item 45.

This item had been discussed with the previous item.

Councillor Lukey paid tribute to Debbie Domb and HAFCAC, who had lobbied for the abolition of charging for home care services.

RESOLVED THAT:

The PAC recommended to the Cabinet:

1.    To abolish charging for home care services provided to customers in the borough on 31 March 2015.

2.    For services delivered up to 31 March 2015, for which charges will still apply, to pursue these charges for a period of three months, ending 30 June 2015.

3.    To write-off total estimated home care debt of £133,000 as at 1 July 2015, and delegate authority to write-off the debts to the Executive Director of Finance and Corporate Governance and Deputy Executive Director and Director of Finance and Resources, Adult Social Care and Health.

4.    To request additional provision for bad debts of £91,000 from the Corporate Finance from the bad debt provision account.

This item was deferred.

The Committee is asked to consider its work programme for the remainder of the municipal year.

This item was deferred.

Wednesday 3 December 2014

Tuesday 6 January 2015

Wednesday 4 February 2015

Monday 13 April 2015

4 February 2015

9 March 2015

13 April 2015