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

(b)  To note the outstanding actions.

The minutes of the previous meeting were agreed as an accurate record, subject to an amendment for inclusion of the following text, under minute 165. Developing further collaborative working across NW London CCGs:

“Councillor Coleman was worried that a majority vote of members of the Joint Committee could impose decisions on CCGs who disagreed. He was particularly concerned about this with regard to acute services.  Vanessa Andreae said they preferred a consensual approach to decision making”.

Apologies for absence were received from Councillor Andrew Brown and Co-optee Debbie Domb.

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.

None.

A new co-option, to be appointed for the remainder of the municipal year 2017/18.

Councillor Vaughan welcomed Victoria Brignell to the meeting.  With an active interest in the issues affecting disabled people, Ms Brignell had been a member of the Disabled Peoples Commission and helped produce their report on co-producing local services; and was Chair of the charity, Action on Disability.

RESOLVED

That Victoria Brignell be appointed as a co-optee to the Health, Adult Social Care and Social Inclusion Policy and Accountability Committee for the remainder of the municipal year 2017/18.

The Committee is asked to consider a letter from Dr David Wingfield, Chairman of the Hammersmith & Fulham General Practice Federation (Appendix 1); and subsequent response from Clare Parker, Chief Officer, Hammersmith and Fulham Clinical Commissioning Group (Appendix 2). 

Dr David Wingfield briefly outlined concerns set out in a letter from the GP Federation to the CCG, and their subsequent response (included as Appendices 1 and 2, respectively).  The GP Federation had worked closely with the CCG.  Dr Wingfield explained that in addition to leading three practices in the Borough, he had also been a resident for 25 years.  The practices were an intricate business, with a cash limited budget funding nursing and GP services which could not be over-extended.  Local funding had historically been low and a “catch up” programme of investment was in place to address this. Dr Wingfield queried with the CCG the slow pace of delivering investment.  The GP Federation had worked with the CCG to develop the Primary Care Strategy (published September 2017) but felt that there had been lost opportunities. 

Janet Cree referenced the CCG letter of response from Clare Parker, Accountable Officer, NWL CCG, and affirmed that the CCG continued to work closely with the GP Federation.  This had been a challenging year and the first year in which the CCG had received primary care delegated funding. They had worked hard to discharge their responsibilities as efficiently as possible.  Considerable progress made and approximately £1.134 million had been spent. Collectively, she felt that good progress had been made.  £600,000 was committed to ensure sustainable primary care, as set out in the Primary Care Strategy, and continued to be a priority.  It was a challenge to ensure that accountability remained and that money was being invested for the benefit of the intended recipients.

Councillor Carlebach sought clarification about the distinction between the role of the CCG and that of GPs, with the CCG as commissioners.  Janet Cree explained that the CCG comprised of member GP practices, with a governing body having oversight of commissioning.  GPs were also providers, delivering primary care services to patients and the GP Federation covered the provider aspect, with the CCG having delegated powers to delivery primary care. 

Councillor David Morton sought clarification regarding the headroom fund 2017/18 and whether it need to be spent this financial year and what the financial risks were if it could not be carried over. Janet Cree responded that there was a plan to spend the money within the financial year. 

In response to a question from Bryan Naylor, it was explained that £1.34 million of the budget had been allocated. While he appreciated the complexities, Bryan Naylor observed that nine months into the financial year, very little of the money had been received. Janet Cree explained that the CCG were currently awaiting invoices from GP practices.  £605,000 had been allocated but the CCG awaited the receipt of invoices, before funds could be released.  To date, £190,000 had been paid, the precise detail of which she did not have but could be provided.  Janet Cree disagreed that funding had not been allocated or spent, and clarified that the areas highlighted in Dr Wingfield’s letter had been agreed as the focus of the  ...  view the full minutes text for item 173.

This report reviews the H&F response to two major incidents in and around Hammersmith & Fulham that required the authority to implement its emergency planning procedures. These were the fire at Grenfell Tower in North Kensington in

June and an explosion on a tube train in Parsons Green tube station.  The review also considered the views of local businesses and community organisations that participated in a ‘hackathon’ event convened by the council to examine the views of partners.

The Chair welcomed Peter Smith, Head of Policy, who presented a report, together with Kim Dero, Chief Executive and David McNulty, Programme Manager, HCH Finance and Resources.  The report covered the Council’s response to two recent major incidents affecting residents and visitors to this and the neighbouring borough of RBKC.  The Grenfell Tower fire had resulted in a tragic loss of life and the report acknowledged that there may be criminal charges and on-going enquiries.  The report also examined a second incident which took place at Parsons Green Tube Station.  The report looked solely at the response of the Council as an organisation and had been previously discussed at Audit Committee and Policy and Accountability Committee scrutiny meetings.  The report identified what was done well, and made recommendations for further actions. 

Councillor Joe Carlebach welcomed the report but commented that with regards to the Parsons Green incident, he was aware of children travelling through the area and little assistance being made available to those children.  One child was particularly traumatised.  Councillor Carlebach suggested that where there were reports of people traumatised from serious experiences, the Council should consider what support could be immediately implemented in the aftermath.

Councillor Carlebach also reported that The Real Community Grenfell charity, which worked with survivors living in the Borough, had experienced great difficulties in finding accommodation within the Borough.  He asked if officers could offer any assistance in exploring options for a more permanent location for the group. 

Kim Dero explained that she had worked with Nick Austin, Bi-Borough Director for Environmental Health, and David McNulty, in the preparation of the report.  Referencing earlier comments about which committees had considered the report, it was confirmed that at the Children and Education Policy Accountability Committee, three local head teachers had attended and recounted the incident and resulting trauma.  This was new for all those involved but agreement was reached to work with schools, in future. Council officers and social workers had liaised well with affected schools, particularly Lady Margaret School, located closest to the Station.

Responding to Councillor Carlebach’s second point, Kim Dero reported that 27 families were resident in hotels, located in LBHF, awaiting accommodation offers from RBKC.  She continued, that the Council had wanted to make space available but had been unable to successfully manage a more permanent base for The Real Community charity.

Councillor Mercy Umeh highlighted the work of people based on the Edward Woods estate and the allocation of charitable goods and money raised for survivors.  Kim Dero acknowledged that Hammersmith Town Hall had been inundated from day one, when 10-11,000 items were received.  The Council had never managed donations before and people had spontaneously brought and donated items.  A hackathon was organised, bringing together community organisations, involving 140 people, to discuss community strength and resilience. To illustrate, a lot of fresh food had been donated, much of which was wasted because many were fasting at the time of the incident.  Given the size and nature of the response,  ...  view the full minutes text for item 174.

This update will also include a Briefing On ‘The Future of Charing Cross’’ Healthwatch CWL Report. 

Councillor Vaughan welcomed Olivia Clymer, Chief Executive, and Eva Pyschrani, Engagement Lead, from Healthwatch.  Olivia Clymer explained that the report set out the research undertaken to evaluate patient and community views about the future of Charing Cross Hospital, because of the lack of clarity about what the future held for a valued and cherished organisation.  The methodology of the survey framed questions submitted to NWL CCGs and was then asked of local people.  Two pieces of outreach work were undertaken to understand the experience of people using Charing Cross.

The report considered patient involvement, experience, treatment, communication, travel time and patient perceptions of what a local hospital was.  The methodology meant that the questions went to the CCG, then out in the field, and to the hospital, to capture responses of the public.

There was overwhelmingly positive appreciation of the hospital.  Patients said that they wanted to be involved in shaping the future of the hospital. In its conclusion, the report emphasised that the Charing Cross was an important part of the community for local people. 

Councillor Morton said that he felt reassured by the report and that services would be safe until 2021.  However, given that borough was estimated to increase by 15,000 people, he sought stronger assurances to address future provision.  Olivia Clymer concurred but explained that it was not within the gift of Healthwatch to do so. They could help scrutinise how decisions about health services were being made and hold NHS decision makers to account.  They were currently awaiting a response from the NWL collaborative.

Janet Cree said that this was an excellent report and suggested that it be included on the Imperial College Healthcare NHS Trust (Imperial) board meeting agenda.  It was important to hear residents’ concerns and how much they value the hospital, and the CCG offered to assist with facilitating this. 

Bryan Naylor commended the report but queried the small sample size of the survey, expressing concern that it would be too easy to dismiss because of the small number of respondents.  He suggested that it would benefit from further work, which would lend it more weight.  Victoria Brignell added that given how the NHS was stretched, why even contemplate closing Charing Cross, forcing people to travel further for treatment? 

Olivia Clymer welcomed the positive comments provided.  This was a robust piece of work, with a simple, clear message. She indicated that she would like to see how recommendations could be taken forward. 

Jim Grealy thanked Healthwatch for a thorough piece of work, which represented what long-term patients and residents already recognised and highlighted concerns about losing Charing Cross, which would not diminish.  He said that the hospital was not replaceable and it would be helpful to see an accurate report on the demographic developments in this part of London, referencing the needs of an ageing population, which must be considered.  He said there had been no new thinking since Shaping a Healthier Future (SaHF) and the STP.  ...  view the full minutes text for item 175.

Councillor Vaughan welcomed Hitesh Jolapara, Strategic Finance Director and Emily Hill, Head of Corporate Finance.  In addition to providing a corporate perspective, the presentation provided an overview of the MTFS for Adult Social Care (ASC).  The national real terms department budget changes indicated significant growth. For example, ASC increased by 10% starting in 2010, with everything else in decline.  Funding in real terms from the Department for Communities and Local Government (DCLG), had decreased significantly over 2010-16.  Local Government expenditure GDP (Gross Domestic Product) was 6.5% in 2010, decreasing to 4.5% in 2016, with a downwards trend continuing to 2022 and beyond. 

Pension budgets nationally increased by 34% in cash terms, but cash for ASC nationally had flatlined and reduced slightly. Since 2010/11, a reduction in government grant of £70 million reflected a 54% reduction in real terms. Plans to localise national non-domestic rates (NNDR) had been shelved, however London was one of several areas within a pilot scheme, which was on-going and NNDR for London had just been agreed (a potential benefit of £2.6 million).  Review of fair funding for local authorities analysed all key parts of the funding formula and was briefly explained.  Loss of funding for London, was often a gain to the shires.

Budget papers were subject to formal agreement at the February Budget Council meeting.  The approach was to freeze Council Tax again, and not to apply the ASC precept.  Nationally there were assumptions around this, Government modelling for the 2018/19 LGFS assumed 3% Council tax increase, which was likely to be the case with most other local authorities.

The Westfield Expansion would bring in £2.2 million; and statutory fees and charges for parking, children, adults, and housing would be frozen, unless a statutory increase was levied.  Developer contributions from S.106 funding amounted to £1.7 million and would fund more police officers in the borough.

Referring to the H&F resources forecast, a 2% increase had been budgeted for with assumed expenditure such as pay inflation.  For financial planning, a headroom of £6 million per annum was assumed from 2019/20 onwards, to allow for increased costs of care packages and in costs imposed by providers. 

Hitesh Jolapara explained that budget setting was not just about income or efficiencies, but allowed for growth, highlighting the £1.3 million Better Care Funding (BCF) input. Focusing on a high-level summary of income for next year, it was explained that there was £2.9 million in growth across all departments.  The Finance and Development Policy and Accountability Committee had considered a full set of budget papers. This was a balanced budget, but cumulatively there was a huge challenge of meeting a £40 million funding gap.

Lisa Redfern, Director for Adult Social Care presented the MTFS for ASC, providing an overview of challenges and achievements. ASC’s key purpose was to promote independent care for residents and to keep people at home for as long as possible. Funding for ASC had decreased since 2010 but demand for services had increased.  More people lived  ...  view the full minutes text for item 176.

This report sets out the budget proposals for the services covered by this Policy and Accountability Committee (PAC). An update is also provided on any changes in fees and charges.  

Councillor Vaughan welcomed Richard Simpson, Public Health Finance Manager, and Gaynor Driscoll, Head of Public Health Commissioning Adults, to present the MTFS for Public Health.  Richard Simpson reported that challenges remained to achieve more for less, with numerous competing demands.  The aim was to provide support in the most impactful way for residents, to maximise outcomes, with a decreasing amount of funding, with better value. 

It was explained that Public Health grant funding for 2018/19 had been reduced by £600,000, requiring further savings.  One outcome was to use the budget in fresh ways, particularly given the establishment of the Public Services Reform directorate.  This meant working more closely with community groups, residents, and other key stakeholders in health. 

They had achieved a significant amount of savings within the MTFS, with closer contract management, monitoring and service redesign.  To illustrate, the smoking cessation programme had achieved the second highest results in London, and the third highest nationally.  The Community Champion programme engaged with 500 people in the Borough.  This was an uplifting programme about how communities could drive change. A total of £6 million in funding had been released to support projects across the Borough in addition to these commissioned services.

Richard Simpson explained in more detail the savings required to balance the loss of grant funding and how these had been negotiated. £22.8 million was the planned expenditure for 2018/19, with a substantial sum of £6m as above sitting in the transformation budget, allowing Public Health to capitalise on opportunities across the whole council as a result.

Richard Simpson said grant certainty in the short-term mitigated some of the risks. Despite unpredictable risks and opportunities, a balanced budget for 2018/19 was assured.

Janet Cree nquired about family and children’s funding, specifically, obesity contracts.  Referencing p161 of the report, Richard Simpson replied that obesity had been identified as a public health priority, although specific contracts would expire and the work would be undertaken jointly in other services.

Councillor Vaughan thanked officers for a detailed and informative presentation, and acknowledged that significant outcomes continued to be delivered through the way in which Public Health had re-engineered provision across the borough. 

RESOLVED

That the report be noted.

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

RESOLVED

That the Work Programme be noted.

Wednesday 3 December 2014

Tuesday 6 January 2015

Wednesday 4 February 2015

Monday 13 April 2015

The date of the next meeting was noted as Tuesday, 13^th March 2018.