Agenda and minutes

Apologies for absence were received from Councillor Sue Fennimore and Debbie Domb.

Apologies for lateness were received from Councillor Andrew Brown.

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.

Councillor Joe Carlebach declared a non-pecuniary interest as Vice Chair and Non-Executive Director of The Royal National Orthopaedic Hospital Trust.

The Chair welcomed representatives from Imperial College Healthcare Trust; Tim Orchard (Clinical Divisional Director for Medicine), Nicola Grinstead (Director of Operational Performance), and Kevin Jarrold (Chief Information Officer).

The Cerner Programme

Kevin Jarrold informed members that the Cerner system represented a move to a fully digital system, meaning that patient information would be available in real-time wherever it was needed. Implementation of the Cerner programme was currently in progress across the Trust; the digitisation of patient records and work to enable electronic prescription and administration of medications was due to be completed by March 2016. The Trust were also looking at replacing paper out-patient processes with digital systems.

Members asked if the system would be accessible for members of the public who did not have access to the internet or internet-connected devices. Kevin Jarrold responded that members of the public would still be able to choose their preferred methods of communication. The new systems would allow communications to be tailored to the individual.

Members asked if the new system allowed the Trust to track people through their hospital journey. Kevin Jarrold responded that the patient administration system did track patients through their hospital journey and, with the improved data gathered, allowed better management of recourses (i.e. fewer ‘bed blockers’).

Members asked what forms of communication the new system facilitated. Kevin Jarrold responded that the Trust’s main form of communication was currently physical letters with a follow-up text message reminder. In future they anticipated that more people would chose email as their main form of communication.

Members asked if consideration was taken of people with vision disabilities and alternate forms of communications like voicemail would be used. Kevin Jarrold responded that the new system had been implemented at Western Eye and they were developing appropriate communication systems to address specialist services. Nicola Grinstead noted that the Trust had begun engagement events for both staff and patients (the first was held at Western Eye) to better understand their needs and ideas for the system.

Members asked that all impairments were considered, as well as language and literacy problems, when considering how the Trust communicated with patients.

Members asked for more detail on how patient information would be shared with referral services and how the Trust was managing patient’s privacy considerations. Kevin Jarrold responded that the system would capture consent for how the information to be shared. The patient would have granular control over which parts of their record can be shared, so mental health information could be made private while sexual health information could be made shareable with other organisations. They anticipated a future where the record could be shared across country, but the focus for now was on local patients.

Members asked if GPs would have access to system. Kevin Jarrold responded that at the moment only the clinical document library was shared with GPs. Currently Hospitals used very different IT systems to GPs and dealt with far more complex data so it was not all relevant to their work. The  ...  view the full minutes text for item 47.

Corporate Budget Presentation

Hitesh Jolapara, Strategic Director of Financial Corporate Services, presented the corporate budget position for 2016/17.

Members asked for more information on the devolution of business rates and what it would mean for H&F. Cllr Max Schmid, Cabinet Member for Finance responded that they were waiting for the detail of the proposals from Central Government.

Members asked if the use of developer contributions was sustainable. Hitesh Jolapara responded that he was confident about the current level allocations and they would be reviewed on an annual basis.

Members asked for a schedule of developer contributions and what they would be spent on.

ACTION: Hitesh Jolapara

Members asked how many staff would lose their jobs as a consequence of the budget proposals presented. Hitesh Jolapara responded that the Cabinet and Council reports would contain that information.

Adult Social Care Budget Presentation

Rachel Wigley, Director of Finance for Adult Social Care, presented the Adult Social Care budget proposals.

Members asked if the past year’s reduction to the meals on wheels charge had affected take-up. Rachel Wigley responded that numbers had been fairly steady; 123 in the 2014 as compared with 129 in 2015.

Members noted that the structure of Careline charges meant those in private housing paid more even if they were ‘cash poor’. Officers responded that the service was being reviewed and they would feedback member comments on the fee structure.

Members, noting that contracts were a large proportion of the overall budget, asked how procurement was working with providers to ensure the best deal. Rachel Wigley responded that commissioners were working across the whole portfolio and looking at packaging contracts for the market. The service was using a new strategy that placed a greater emphasis on quality and ensured care pathways made sense. Members asked for a report on the new commissioning strategy once it was finalised.

ACTION: Rachel Wigley

Members asked about the risks of provider failure. Rachel Wigley responded that the Council did have a duty of market management under the Care Act but noted it was a very challenging environment.

Members asked for future projections for demographics and growth over the medium term. Officers responded that the service produced projections over ten years and could share this information with members.

The Chair thanked officers for their presentations and noted that the Committee welcomed their work on the budget proposals given the financial pressures faced by the local authorities. The Committee also welcomed the measures to maintain the independent living fund payments, the further reduction in meals on wheels charges, and the payment of the London living wage to carers.

RESOLVED

1.    The Committee requested a report on the new provider procurement strategy once it had been finalised.

2.    The Committee requested that officers reconsider the structure of Careline charges.

Rachel Wigley presented the budget proposals for public health.

Members noted that there was no mention of paediatric oral health in the budget. Mike Robinson, Director of Public Health, responded that this work was situated in the 0-5 service and was also being worked on by the school nurses team.

Members noted the excellent work carried out by the community health champions and asked why the associated budget was being reduced. Mike Robinson responded that the budget reduction was a saving on procurement and process, not a reduction in the champions themselves.

Members, noting a complaint about the sharp reduction in the sexual health service budget, asked how decisions were made. Mike Robinson responded that this was the first year of public health grant reductions but noted that there had been no cuts in frontline delivery.

Members asked if budget setting for adult social care and public health were considered together. Mike Robinson informed members that the current spend was based on historical analysis but the next phase was to do a zero-based review of expenditure. The vision for the services was for there to be a seamless link between public health preventative activities and adult social care services.

Some members felt that there should be more spending on cardiovascular preventative measures rather than stop smoking campaigns.

The Chair informed members that they had reached the guillotine and proposed an extension of 30 minutes. The Committee agreed the extension.

The Chair thanked officers for their presentations and noted paediatric oral health and childhood obesity as topics for the Committee to return to at a later date. The Committee welcomed that there would be no frontline cuts and hoped that the lessons from the flu vaccination programme could be replicated across the Council, with Public Health taking a coordinating role.

RESOLVED

That the Committee considered the budget proposals.

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

Members asked for an item on vaccinations to be added to the work programme.

RESOLVED

The Committee agreed the work programme for 2016/17.

Monday 14 March 2016

Monday 18 April 2016

Future meetings of the Committee were scheduled for:

·         Monday 14 March 2016

·         Monday 18 April 2016

Stella Baillie, Director of Integrated Care, presented the report which provided an update on the impact of the Care Act 2014.

Members asked for more information on the new rights to an assessment and an advocate. Stella Baillie responded that now anyone who wanted an assessment was required to have one. Advocate use was still relatively rare but the Council had extended its advocacy contract.

The Chair asked for more information on the new provision that gave carers the same rights are carers. Stella Baillie responded that officers were working closely with GPs and other partners to identify carers, particularly focusing on those who provided twenty four hour care.

Members noted that many third sector organisations in this area were not aware of the support available to carers and suggested that the Council produced a carers guide to signpost to services. Stella Baillie noted that the Council provided this information on its website but would look into producing a ‘top tips for carers’ leaflet.

Cllr Sharon Holder noted that the patient reference group were putting together a list of all local third sector organisations and could share with officers.

ACTION: Cllr Holder

RESOLVED

That the Committee noted the report.