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:

i)              Tuesday, 4 December 2018

ii)             Tuesday, 15 January 2019

(b)  To note the outstanding actions.

Councillor Amanda Lloyd-Harris raised a number of concerns regarding the contents of the minutes which she hoped would be addressed outside of the meeting.

RESOLVED

That the minutes of the previous meeting were agreed.

None.

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 Lloyd-Harris declared an interest due to her involvement and interest in H&F Mind.

This report provides the Committee with an update as to the H&F CCG plans for financial recovery.  This also includes an update from Healthwatch.

Councillor Richardson welcomed the CCG to the meeting.  This item would contribute to the currently on-going discussion regarding the CCG financial position and help facilitate further dialogue.  Councillor Richardson assured NHS colleagues that it was not the Committees intention to revisit points but to ensure that members clearly understood the CCGs rationale for resolving their current situation.  A letter from the CCG in response to the chair’s letter dated 15 January 2019 had been received but further clarity was sought around some of the issues raised. 

The pre-consultation business case had a specific action on patient transfer but any changes could only be implemented following consultation, as part of the implementation plan.   An assurance meeting with NSH England, Clinical Senate had reviewed the business case and was awaiting final sign off. A date for the consultation was expected and the CCG would return to the Committee as part of the Consultation.  An engagement event had been held at the Irish Centre, facilitated by the CCG on 29 January 2019.  There was a challenging target for savings to achieve, with £9 million identified to date.  The intention was to continue with engagement and the financial recovery plan would need to be ratified by the governing body.

Anne Drinkell (Save Our Hospitals) asked a question about the proportions of people who died in hospital and in hospices. H&F did relatively well at enabling people to die at home and this was not reflected in the terms of reference.  At the same time, statistics from the CCG indicated that there was a significant gap between how many people would like to die in a hospice and how many people do so.  The inference was that there would be a reduction in the provision of palliative care.

Sue Roostan explained that a full strategic review of palliative care would be undertaken. They were still in the process of gathering evidence, and it was not yet envisaged what the shape of the provision would be for residents. She concurred that many residents wanted to die at home.  The 2016 JSNA (Joint Strategic Needs Assessment) for H&F recognised that percentage of people dying at home was high, which indicated that the Borough was doing better compared to the national average (5.9% of H&F residents died in a hospice).  Comments for the palliative care review were required by 13 February, and would be sought from members of the public, those directly affected, hospice staff and other stakeholders. 

With reference to the planned savings figure of £17 million, Bryan Naylor pointed out that £9 million of this figure had been identified, with the remainder being rolled into the following financial year.  He raised very strong concerns about organisational under performance.  He had observed that increasingly, the concept of a local provider had become diluted with a corresponding increase in management. The retention of senior management throughout this situation was questionable and open to challenge, given the need to identify savings. Further evidence was needed to  ...  view the full minutes text for item 229.

Councillor Richardson welcomed Stephanie Bridger, Jane McGrath and Sarah Rushton from the West London Mental Health Trust.   A full inspection of the Trust had been undertaken between August and November 2018 and the report had been compiled in two parts.  The report had been published in December 2018 and the Trust had been moved from good to outstanding, for caring across all services.  The Care Quality Commission (CQC) had commented on improvements but there remained some requirement notices in places and work was underway to ensure that these were resolved. The CQC had been particularly impressed with the Trusts work on co-production and partnership working.  Considering the patient perspective was a radical approach, looking to build treatment plans that placed the patient at the centre.

Commenting on staff recruitment and retention, it was recognised that this was a London-wide pressure with specific challenges, it was noted that in other areas such as Harrow, a consultant psychiatrist was a member of the clinical team. By contrast, Hammersmith and Fulham did not have a similar, consultant led model and that this was a CCG funding issue. 

Stephanie Bridger outlined the Trusts initiatives, which offered a varied range of staff training opportunities. Different educational pathways such as apprenticeships (including for occupational therapists), peer support; and encouraging retired nurses back into practice, would help to retain staff.  The Trust was focused on service team specific recruitment events, rather than Trust wide events.  The difficulty was not the lack of expertise, but around the mix of skillsets needed, for example a band 5 rather than a band 6 nurse based in the community.  The pressures on recruitment were well recognised, particularly since the nursing bursary had been abolished. The Trust was investing in training their own staff, as part of its unique selling point.

Jen Nightingale asked if the funding training would be ringfenced and it was explained that the extra cost of investment was more financially efficient than resorting to agency staff and allowed the Trust to retain staff.

Councillor Caleb-Landy asked about what steps the Trust was taking to address patient seclusion.  Stephanie Bridger explained that they had developed a matrix around seclusion but that there was a lack of seclusion facilities in Hammersmith & Fulham, which compromised the Trust’s facility to safeguard an individual’s privacy and dignity.  This was being managed and the Trust’s board had oversight of these concerns, particularly in sites such as Broadmoor, which the Trust also had responsibility for. 

Councillor Richardson asked if work around developing community based services included support for suitable housing for those with specialised needs.  It was confirmed that this provision was within the remit of the Council, not the Trust. Lisa Redfern explained that she chaired a weekly meeting board with a sensory housing officer to consider appropriate and supported housing, particularly around discharge to ensure that the correct provision was in place.

Councillor Richardson commended the work undertaken by the Trust to significantly improve ratings.  The Trusts intent around recruitment and retention was  ...  view the full minutes text for item 230.

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

Hitesh Jolapara provided a corporate perspective on future public expenditure.  National expenditure had continued to decline up to 2018-19, where there had been a slight uplift.  General grant funding had reduced by £3.3 million, representing a 60% reduction in real terms.  Each year, one-off funding allocation was provided to Children’s Services and Adult Social Care and there had been a growth in business rates, as part of a pilot to divert funds direct to councils. 

Comparatively, urban and city authorities had traditionally lost out to provincial needs, and this might be impacted by the governments fair funding review. H&F was expected to achieve £34 million in savings, to maintain a balanced budget.  Growth for 2019-20 included a council tax increase of 2%, accepting the social care precept; and the Council’s share of business rates would be 48%, generating approximately £78 million but likely to be lower as the rates process was subject to appeal.

Lisa Redfern provided the Adult Social Care (ASC) financial overview. ASC prioritised enabling people to live independently at home, providing support for them and their carers.  Underpinned by an approach that advocated co- production, ASC aimed to deliver integrated care.  In terms of highlights, the Council had, for the fifth consecutive year, agreed not to impose homecare charges, and it was significant that it was the only authority able to do so. Similarly, the costs of meals on wheels (£2 per meal), and of providing the Careline (medical alert) facility would also remain static. 

Despite these positive achievements, there remained significant challenges.  Demand for ASC continued to increase. People were living longer and enjoyed a better quality of life but longevity varied from area to area. Local authority funding had decreased and the cost of care had continued to rise. The care market was volatile but the Council was committed to ensuring that all staff received the London Living Wage (LLW).  Supporting 3100 residents, the discharge of patients had an impact on the ASC budget, with people leaving hospital with greater acuity of need. 

ASC would deliver a balanced budget and achieve significant savings.  Excellent feedback had been received from CQC, and the Community Independence Service, which now offered a blue print for providing community based services, had been highly commended.  ASC continued to work hard to streamline and improve back office provision, looking for ways to be innovative and cost efficient. Consequently, the deployment of agency staff had been reduced by 50%. 

The Transitions Into Adulthood service was an example of developing innovative services, designed to fit around need.  Working jointly with Children’s Services, the aim was to work with young people from the age of fourteen.  Earlier intervention allowed a more bespoke, tailored support offer.  Growth funding for this year was non-recurrent and there was no guarantee that the winter pressures grant funding would continue in future years.  The Better Care Fund programme was also under review. Salary costs constituted the single, biggest budgetary pressure, exacerbated by the Councils commitment to LLW.  ...  view the full minutes text for item 231.

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

Anita Parkin and Nicola Ashton provided an overview of Public Health and outlined the various ways in much Public Health allocated funds across the Council departments to ensure that health outcomes were supported.  These included targets such as increasing life expectancy, smoking cessation or supporting rough sleepers; and acknowledged that people in different parts of the Borough often had different experiences.  In addressing the wider determinants of health, Public Health worked with other departments across the Council. They worked particularly closely with ASC, supporting vulnerable adults and children, and facilitated prevention work, for example:  health protection, working and responding to major incidents, healthcare and preventing mortality. 

Understanding the financial picture, Public Health received £22 million to support locally, sensitive health priorities for Hammersmith & Fulham residents.  Over 200 public health outcomes were provided within the Public Health Outcomes Framework 2017 and the issue was how to understand how this could be locally interpreted.  Emily Hill set out the figures as to where the Public Health grant was spent and reported that there was a reduction of 2.6%.  The key point to consider was the positive impact of Public Health investment across the Council, contributing to meeting public health outcomes.  The current funding trend indicated a downwards trajectory although a financial reserve had accumulated, counterbalancing that decrease and could ensure service continuity, if necessary.  It was recognised that in terms of risk, future funding will eventually cease, excluding provision for essential services which would continue.  There had been an increased and a review of the funding allocation would be undertaken. 

Jim Grealy, in the context of the reduced Public Health grant, asked if Public Health worked to support children.  Lisa Redfern explained that strategically, Steve Miley, Anita Parkin and herself, were members of the Health and Wellbeing Board, and worked closely to deliver on a range of early years.  They also attended monthly meetings with the CCG to consider core and strategic, operational issues.  Anita Parkin briefly outlined the healthy schools provision, and added that it was necessary to look at improved ways of working with schools to help young people build emotional resilience, and prepare them adequately for later life.

Councillor Coleman commented that Public Health operated right across the Council. He had requested to meet with all those who worked directly with young people to find ways in which the current range of outcomes could be improved upon.  It was important to see the impact of preventative policies.  He planned to meet with schools, parks and leisure services to address this and to ensure that Public Health funding was well spent.

In response to a query from Councillor Kwon, it was explained that the pie chart indicated the different portions of spend. The Council determined how to deliver on public health outcomes by investing in different departments. Much of this was apportioned to ASC and Children’s Services and very little allocated elsewhere. Councillor Coleman added that Public Health was well placed to work alongside other departments.  For Public health  ...  view the full minutes text for item 232.

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

It was noted that the CCG would be returning to the March meeting of the Committee, as part of the formal consultation.  It was noted that because of timetabling difficulties, it was noted that Imperials Draft Quality Accounts 2019/19 could be considered at an extra meeting to be scheduled for the end of April.

Tuesday, 26 March 2019

The next meeting of the Committee was noted as 26 March 2019.