Agenda item

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 had been found that people, particularly health visitors, believed that working through an agency gave them greater freedom.

Councillor Holder queried where the work outlined in the presentation related specifically to the CLCH. Mr Reilly responded that CLCH worked in partnership, and had demonstrated effective partnerships with local authorities. Community care was different in that services were predominantly delivered in people’s homes. Whilst specialist services were provided in hospital, the CLCH’s work happened in clinics, to provide an early diagnosis and to support people in rehabilitation. Nurses managed conditions through follow up services in the community and reduced risk.

Ms Chesters added that CLCH was able to focus on the provision of high quality community services, and had made good progress in delivering services innovatively and in line with best practice.

Mrs Bruce queried whether the foundation trust model was out of date in view of the changing models of care and finance. Ms Chesters responded that foundation trust status was national policy. If an organisation did not achieve foundation trust status, it would be subsumed into a trust which had achieved foundation trust status. Mr Reilly added that the assessment process was demanding. Monitor had already adapted the system, for example in respect of financial risk in the current climate, with the focus on risk aware, rather than risk adverse. There was a move towards a more collaborative approach in respect of assessing governance.

Mr Reilly was requested to provide a local briefing for Hammersmith & Fulham.

In response to a query from Councillor Chumnery, Mr Reilly clarified some of the terms used in the presentation. ‘In reach’ related to the work of community nurses in visiting patients in hospital and working alongside hospital staff to plan discharge as soon as it was safe.

In the Autumn, preparations were made to support primary care and A&E, by providing additional resources for pinch points. A ward at Charing Cross Hospital had been opened to provide ‘Winter beds’ for rehabilitation, for those patients who were fit enough to leave an acute ward but not fit enough to go home. Social Care would make arrangements for re-ablement.

Councillor Fennimore queried the role of the CLCH in the uptake of the flu vaccination. Mr Reilly responded that Urgent Care Centres had been tasked with the distribution of the vaccination. Staff had been encouraged to have the vaccination, as they could be a route of transmission. There had been variable results across London, with an average of only 30% of staff taking up the vaccination, despite an enormous effort in campaigns. There was not sufficient belief in the efficiency of the vaccination.

Councillor Vaughan queried the timeline, should CLCH not achieve foundation trust status in June 2016. Mr Reilly responded that it would be dependent on the improvements required. It had been three/four months or one year in other organisations.

Councillor Vaughan thanked the CLCH for their attendance and summarised the actions and recommendations.

Action:

1. Updates on workforce development and foundation trust status to be provided.

2. A local briefing for Hammersmith and Fulham to be provided.

Action: CLCH

RESOLVED THAT:

1. The Committee recommended that:

(i)            the CLCH discuss with commissioners the issue of multi-disciplinary teams covering the same areas as GP populations.

(ii)           information on GP registration be provided at Urgent Care Centres.

2. The forthcoming CLCH CQC report be added to the work programme.