Agenda and minutes

(a)  To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on 4 February 2015.

(b)  To note the outstanding actions.

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.

The following declarations of interest were made:

Councillor Carlebach is a trustee of Arthritis Research UK and an ambassador for Mencap, and the Chair of the Trust Development Authority is known to him.

Mr McVeigh is Chair of Board of Trustees, Action on Disability.

Debbie Domb is a recipient of direct payments.

This report provides a progress update on Self-Directed Support (SDS), including the Personalisation project, through which an improved operating system for Direct Payments (DPs) is being developed across the three councils.  

The Committee received a progress update on Self Directed Support, including the Personalisation project, through which an improved operating system for Direct Payments (DPs) was being developed across the three councils.

Mr McVeigh commented that the success criteria listed in 4.2 identified four benefits for the Council and one for the service user, and that there should be a more equal split of the benefits.

Mr McVeigh queried the expectation that the pre-loaded payment card for DP users would become the usual way of receiving a DP and that no new DP bank accounts would be set up during the pilot unless in exceptional circumstances.

Ms Camp responded that in exceptional circumstances, service users might require a bank account, but it was intended that the pre-loaded payment card would be a good product, which service users were happy to use. Mr McVeigh gave an example of care services being shown as ‘personal services’ and the payment being rejected as inappropriate.

Mr McVeigh highlighted the assumption in 4.8 that all social workers would understand DPs well enough to provide high quality basic advice and information to customers and the link with 4.17, which referred to the provision of on going training around the use of DPs. Mr McVeigh queried how Adult Social Care would know when social workers were able to undertake this role.

Ms Camp responded that ensuring all social workers had the required level of knowledge around DPs remained a work in progress. Expert back-up was currently provided by a team of five specialist staff and this would continue, with an emphasis on continuing to up-skill social workers, not taking away responsibility.

Mr McVeigh requested that the training module be shared to provide assurance. Councillor Carlebach emphasised the serious implications of incorrect advice. Ms Camp responded that the employment of carers was an example of where the DP team would provide expert advice, rather than expecting social workers to deal with this specialist area.

Mr McVeigh suggested that the wide range of things for which DPs could be used should be included in the training. Ms Camp responded that this was addressed in the shared DP policy, which had been in place for the past year and was due to be reviewed.

Mr McVeigh considered that service users were not aware of this new policy. Ms Camp responded that the new policy had been publicised. There was regular liaison with Action on Disability and copies of the draft had been provided at various stages. There had been discussions with the peer support group and Healthwatch across the three boroughs. There was a customer reference group attached to the pre-loaded cards project, and this group had had direct input into shaping how the cards would operate and would continue to do so over the coming year.

Mr McVeigh suggested that a letter should be sent to all service users. Ms Camp responded that it was intended to write when the pilot was about to begin. Councillor Lukey  ...  view the full minutes text for item 62.

Central London Community Healthcare will present an outline of its strategy for the next five years and an update on the progress it is making towards becoming a NHS foundation trust.

The Committee received a presentation on the strategy of the Central London Community Healthcare NHS Trust (CLCH) for the next five years. The trust was one of 19 community health care trusts, three of which were currently undergoing the foundation trust process. CLCH had a diverse portfolio of 74 different services, the majority of which were provided through block contracts with commissioners.

The presentation covered commissioners’ priorities and CLCH’s responses and how foundation trust status would support CLCH as an effective local partner. Mr Reilly emphasised CLCH’s five priorities: Quality, Transformation/Integration, Value for Money, Effective Leadership/Governance and Growth.

Ms Chesters stated that the process for foundation trust status would include an assessment by the Care Quality Commission commencing on 7 April 2015. An assessment of ‘good’ was required to proceed with the application. There would be a financial assessment by the Trust Development Authority and a final assessment by Monitor. The timeline indicated authorisation in June 2016.

Councillor Carlebach raised the issue of wards on borough boundaries, where residents might chose to be registered with a GP in a borough in which they did not live, and the need for multi-disciplinary teams to cover the same GP population. Mr Reilly responded that the payment mechanism made this difficult to achieve. Patients tended to be referred to services connected with practices, although commissioners could chose to be flexible. The allocation of money to teams on the basis of population served, not where people lived, was being piloted by early adopters.

Councillor Carlebach queried the charge of £75 by Parsons Green Walk In Centre to those patients not registered with a GP. Mr Reilly responded that the charge had been set nationally and was targeted at visitors to this country. The Centre was nurse led and was not an A&E department. The Centre could advise people how to quickly register with a GP, but people could not register at the Centre as all GPs were independent contractors. It was noted that proof of residency was required. Members noted that this could impact unfairly on disadvantaged people and asked Mr Reilly to discuss the issue with commissioners.

Councillor Lukey commented that she and Mrs Bruce had recently met with the CCG to consider how to support take up of GP registration generally and to target socially excluded people.

Councillor Lukey queried CLCH’s vacancy rates and the action taken to address these. Mr Reilly responded that average vacancy rates were in the region of 16% and were higher in respect of community staff and the north of the borough. Recruitment  initiatives included an event at Westfield, which had been particularly successful in attracting unqualified staff. Factors such as good leadership, training and opportunities to advance helped to retain staff. However, in London transport and living costs were an issue. At age 50-55, the clinical workforce had the option to consider retirement and at 55 could retire without approval. Temporary staff were employed through the NHS Employee Bank whenever possible, but it  ...  view the full minutes text for item 63.

This report updates the Committee on the Healthwatch Dignity Champions project in the London Borough of Hammersmith and Fulham.

The Committee received an update report on the Healthwatch Dignity Champions project. Ms Murphy introduced Marie Connelly, one of the dignity champions, who conducted the ‘enter and view’ visits.

Mr McVeigh queried the involvement of Healthwatch in respect of direct payments and defining outcomes and what good care could look like. Ms Murphy responded that Healthwatch had been involved in terms of home care, working with individual providers to develop contracts and was a member of the advisory board. Ms Murphy emphasised the importance of dignity in care. There was no involvement with direct payments. 

Councillor Chumnery noted that there were a number of other community champions and suggested that their good work could be shared and influence the direction of travel.

Mrs Bruce stated that there was formal contract monitoring by the Care Quality Commission (CQC) and other regulatory bodies, including the safeguarding champions and that voices in the community added value alongside the formal bodies.

Councillor Fennimore queried recruitment of Dignity Champions and whether they were representative of all groups, and particularly those who were socially excluded.  Ms Connelly responded that the Dignity Champions were representative of most ethnic groups and people with disabilities. Recruitment tended to be informal, with dignity champions recruiting each other.

Ms Murphy acknowledged that more could be done to recruit young people and informed the Committee of the supported visit by young people to an Urgent Care Centre and the young people’s report on Chelsea and Westminster Hospital paediatric wards.

Ms Murphy responded to Mr McVeigh that it was not the role of Healthwatch to submit complaints on behalf of individuals. Following an assessment of services, Dignity Champions would submit an anonymised report to the service provider. It was not their role to befriend or advocate on behalf of service users. However, they were able to direct people to advocacy and other services and provide leaflets on how to complain. There tended to be an increase in complaints following an assessment.

Councillor Vaughan commented on the value added by Dignity Champions in capturing the views of service users, families and carers and queried whether Healthwatch had compared its reports with more formal reports on home care by other organisations. Ms Murphy responded that the Dignity Champions tended to provide the soft intelligence and gave the example of a care home which the CQC had revisited after Healthwatch raised concerns. Healthwatch had been successful in informing the CQC’s inspection programme and had good informal relationships with Adult Social Care and the CQC.

Healthwatch had sufficient resources to follow up an assessment, but any unresolved concerns would be handed over to the contract managers. Healthwatch did not have the capacity to continue to follow up.

Councillor Vaughan thanked Ms Murphy and Ms Connelly for attending the meeting.

RESOLVED THAT:

The Committee noted the report and thanked the dignity champions for their work  and the excellent benefits, particularly for service users.

This report updates on the ‘go live’ implications to prepare for the requirements of the Care Act 2014.

The Committee received a report on the ‘go live’ implications to prepare for the requirements of the Care Act 2014. The majority of the provisions would come into force in April 2015. The changes required would need to be fully embedded as part of an ongoing change management approach.

Ms Domb queried the standard operating procedures developed over the previous few months. Mrs Bruce responded that it was necessary for these procedures to be put in place to demonstrate compliance with the Care Act. It was intended to develop a more flexible tool across the three boroughs, as the current Resource Allocation System or RAS did not allocate the true market cost of care for people with complex needs.

The appointment of a Lead Practitioner had been mentioned earlier, and customers would be invited to be part of this work, which would focus on outcomes and greater transparency. The processes should be less prescriptive and more high level and enabling.

Mrs Bruce responded to Councillor Vaughan’s query in respect of what the Care Act would deliver, that it would bring about huge changes, with all legal frameworks being either changed or abolished. There would be policy and funding reforms, including deferred payments and a cap on care costs of £72,000. Adult Safeguarding duties would be on a statutory footing and there would be well-being responsibilities and a duty to integrate services with partners.

RESOLVED THAT:

1.    The report be noted.

2.    A further update on the Care Act be added to the work programme.

This report describes both the mandatory and non-mandatory public health responsibilities, functions and services delivered in the London Borough of Hammersmith & Fulham.

The Committee received a report on public health responsibilities, functions and services delivered in the London Borough of Hammersmith & Fulham.

Councillor Carlebach queried:  the relationship with the Joint Strategic Needs Assessment (JSNA); the absence of paediatrics or oral health as a key work area; the choice of a key indicator for tooth decay in children age 5, when there was significant tooth decay in children under this age, many of whom had teeth removed under general anaesthetic; and the conflicting advice from Public Health and the CCG in respect of school absences, whereby schools required a note from GPs and the CCG advised parents not to take their children to a GP.

Mr Lines responded that the requirement to produce a JSNA had been placed on  the NHS and local authorities some seven years previously. The JSNA was led by Public Health, which also undertook the main analysis and presentation. Post the transfer of funding to local authorities, there remained a leadership post in the Public Health team for the JSNA. The JSNA informs commissioning.

The Public Health Children & Families team led on a range of work, including child oral health. The indicators were national ones, and not from the Public Health Outcomes Framework.

Mr Lines noted that decayed, missing or filled teeth (DMFT) in children might be indicators of other diseases and poor diet.

In respect of the conflicting advice from Public Health and the CCG, it was noted that the issue had been raised with Andrew Christie and that he would be able to provide an update in respect to the messages being given to parents by schools.

The Chair proposed and it was agreed by the Committee that the guillotine be extended to 10.10pm.

Mr Lines was unable to respond to specific queries on key work areas such as NHS Health Checks and children and families issues, and offered to bring more detailed reports about the Public Health programmes to future meetings.

Councillor Vaughan referred to the issues in respect of administration and promotion of the flu vaccination, and whether there were any other issues about which the PAC needed to be aware. Mr Lines responded that preventative health was reflected in the forthcoming public health strategy. Screening, particularly cancer screening uptake was another issue, and this was partially covered in the strategy. There was shared responsibility between Public Health England and NHS England, and a need to work across the system to ensure good uptake.

Councillor Carlebach noted the absence in the strategy of muscular skeletal conditions and the need to focus on prevention and the wider determinants of health. Mr Lines responded that Public Health would support the preventative aspects of the Care Act, which were likely to be most relevant, and could bring a report to a future meeting.

RESOLVED THAT:

The committee recommended that:

1.    Tooth decay in all children, not just age five, should be a key indicator.

2.    Public health advice in respect of children off  ...  view the full minutes text for item 66.

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

The work programme was noted.

April 2015: Date to be confirmed.

The date of the next meeting is to be confirmed.