Agenda and minutes

Roch Maher and Randhir Suriyae gave apologies for absence.

In accordance with the Members’ Code of Conduct, Members are requested to declare any interests orally at the start of the meeting and again immediately before consideration of the matter. Members are reminded to specify the agenda item number to which it refers and whether the interest is of a personal or prejudicial nature.

Members are also reminded of the requirements of Section 106 of the Local Government Finance Act 1992 that they should declare and not vote on specified matters if they are two months or more in arrears with their Council Tax payments.

There were no declarations of interest.

To consider and approve the minutes of the last meeting on 28 January 2009 (attached).

The minutes of the meeting held on 28 January 2009 be received and approved and the Chair be authorised to sign them.

·         Mr Francis King

·         Mr Paul Lampugh

There were no executive decisions called-in.

As part of the annual health check, the Healthcare Commission measures performance by reference to the standards identified by the Government in National Standards, Local Action (Department of Health 2004).  These cover seven key areas, or domains;

·               Safety

·               Clinical and cost effectiveness

·               Governance

·               Patient focus

·               Accessible and responsive care

·               Care environment and amenities

·               Public health 

There are 24 core standards that set out a minimum level of service, which patients have the right to expect and the PCT is required to report on how it has performed against these.

Report of the Director of Primary Care, Nursing & Integrated Governance, Richmond & Twickenham PCT attached.

Sinead O’Connor, Director of Primary Care for the Primary Care Trust (PCT) was present for this item.

Following questions from the Committee, the meeting was advised that:

·        There was general compliancy with the core standards.

·        Records and assessments were available for members of the Committee to inspect.  This could be done by giving members log-in details to a website that hosted the information.

·        There was a process for picking up on side effects caused by drugs, which involved GPs recording any observations that they had made, although it was recognised that some of these were lost in general practice.

·        It was important to have measures in place to detect errors.

·        The PCT was not ‘passive’ in its approach in looking for issues that patients encounter.

·        There was some uncertainty about future arrangements once the Care Quality Commission comes into operation in April 2009.

·        The PCT tries to make itself as accessible as possible.

RESOLVED that the report be noted.

Hounslow Provider Services (HPS) and Richmond & Twickenham Community Health Services (RTCHS) have been discussing closer working relationships for the last 18 months.  The publication of World Class Commissioning accelerated the process culminating in both PCT Boards signing off the full business case (fbc) for a management alliance with effect from April 2009.

The alliance was always intended to be a transitional arrangement with the specific objective of determining the final external form of the respective provider services.  As the fbc made clear, the level of due diligence undertaken made it likely that the alliance would recommend a full merger in due course whilst acknowledging that the alliance structure was flexible enough to be dismantled if necessary.  However, the absence of definitive guidance from the Department of Health on timescales and organisational form made it difficult to assess the likely life-span of the alliance and any subsequent changes.

The publication of Transforming Community Services in January 2009 provides the necessary guidance and the aim of this paper is to assess its impact on the life-span of the alliance and provide a high level timeline of prospective changes over the next 12-18 months.

Report of the Chief Operating Officer, Community Health Services & Estates, Richmond & Twickenham PCT attached.

Richard Tyler, Chief Operating Officer, Community Health Services & Estates for Richmond and Twickenham PCT was present for this item.

Following questions from the Committee, the meeting was advised that:

·        Whichever PCT was the lead in this scheme, the relevant Chief Executive would have overall responsibility although the scrutinising of the new body could fall to Committees at both the London Borough of Richmond upon Thames and the London Borough of Hounslow.

·        Areas of expertise varied in both Hounslow and Richmond & Twickenham PCTs and these could be shared more effectively.

·        Richard Tyler stated that the preferred model of operation was the Community Foundation Trust model, although he did not wish to pre-empt any future decision.

·        The commissioners needed to be fully aware of the needs of both local populations.

·        The drive nationally was for evidence based commissioning.

·        Although it was hoped that the new arrangements would be in place by the end of the year, this would be dependent on factors such as consultation .

·        Generally staff retention was not an issue, although the changes had begun to affect staffing in some areas.

·        The consultation period may need to be extended because it was scheduled to take place over the summer.

Councillor Carr, Cabinet Member for Adult Services, Health and Housing, added that the Committee’s views were welcomed on the consultation.  Councillor Carr was concerned about the joint arrangements and that it was important the commissioners keep this in mind.  She also added that anything which affects Teddington Memorial Hospital was of great interest to the local community and any plans that involved it needed to be communicated very clearly.

RESOLVED that:

1. The report be noted.
2. The Chair communicate with the Chair of the equivalent Committee for Hounslow over the issue of scrutinising the new body.

Prior to the launch of the LINk on 30 October 2008 and the establishment of a Host team to support the development of the LINk, the London Borough of Richmond upon Thames through an officer of authority had responsibility for publicising the forthcoming establishment of Local Involvement Networks, which were to be set up within every borough which held responsibility for social care services.  The officer, Tony Earle, then Performance and Quality Assurance and Corporate Complaints Manager for Adult and Community Services organised a number of events/meetings to attract interest from the community and begin the developmental work prior to the launch of the Link.  All the individuals who responded to these and maintained their active commitment to the LINk were invited to form the first LINk Steering Committee with the responsibility of establishing the LINk on a firm footing during its first year until the date of the first Annual General Meeting.

Report of Margaret Dangoor, Chair of Richmond upon Thames Local Involvement Network attached.

Margaret Dangoor presented the item to the Committee:

·        The relationship with the host was at an early stage of development.  They were new posts and still required a degree of ‘bedding down’.

·        There were some very well informed members of the LINK committee and this was proving useful.

·        The LINK committee had set up its own rules of governance.

·        The Hosts would be publicising these groups in the near future in order get a greater attendance.

·        In publicising these groups, they would be targeting harder to reach people within the community.

·        There was now a need to have partner organisations involved and feeding into the system.

Following questions from the Committee, the meeting was advised:

·        Of the statutory responsibilities placed upon LINK.

·        That these groups were independent, although there were means by which to govern them.

·        That the group was involved in children’s health services, but not children’s social services.

·        About the level of involvement from children’s services providers.

·        Who the ‘hard to reach’ groups were.

The Committee congratulated and thanked Margaret Dangoor and the LINK for all of their hard work.

RESOLVED that the report be noted.

The LBRuT Community Meals contract comes to an end on the 30 April 2009.  The Health, Housing and Social Care Overview and Scrutiny Committee established a cross Party Scrutiny Task Group (STG) that was tasked with reviewing the Borough’s Community Meals service, examining the options available to the Council and making a recommendation based thereon.  Cabinet considered the findings and recommendations of the Scrutiny Task Group on 12 May 2008 and all recommendations were accepted. The main recommendations in relation to re tender of the meals services in relation to meals provided in service users own homes and meals provided at the Council run Intensive Day Care Centres (IDCC’s) were pursued with Cabinet on 23 February 2009 agreeing the award of these contracts to Apetito Ltd. This report brings the Committee up to date on progress with implementing the task group recommendations and implementation planning for the transfer to the new meals contract by May 2009.

Report of Director of Adult and Community Services attached.

Jim Rogan, Assistant Director, presented this item.

Following questions from the Committee, the meeting was advised that:

·        The granting of a contract could not take place sooner because there was a period for those companies that had placed bids to appeal against the decisions.  None of the companies had done this.

·        Providing hot meals was being considered as an extra service at additional cost to the service user.

·        The additional cost to the service user for receiving a hot meal in Hounslow was £3.80 per day on a contract basis.  It was not known what the cost of doing this on an ad-hoc basis would cost.

·        There was publicity about the alternative arrangements available to people.

·        The Committee would receive a report after 6 months of operation.

·        Transport to luncheon clubs was still an issue that was being looked at.

·        Reviews on the new service was being carried out by care managers face-to-face with the service users.

·        There would be means testing in place to ensure access to this service.

·        There had been a decline in the number of people taking up community meals services in recent years.

·        Service users would get advice on what options were best for them.

Councillor Carr stated that one of the main drivers for the task group carrying out the review was because the quality of food provided was very low.  She felt that this concern had now been addressed.  Councillor Carr added that Cabinet had asked for a 6 month review of the service, where it was hoped that the benefits of the new system would be seen.

RESOLVED that:

1. The Committee receive a report on the Community Meals Service after 6 months’ of operating the new system.
2. The report be noted.

The Scrutiny Task Group initially set out to review Child & Adolescent Mental Health Services (CAMHS) in the borough.  However in response to the review of services that was taking place by the statutory agencies the task group decided to focus on the emerging commissioning strategy to develop the services for the emotional wellbeing and mental health of young people.

Report of CAMHS Scrutiny Task Group attached.

It was hoped that the Children’s Services Overview and Scrutiny Committee would take up some of the issues that the report raised.  It was felt that it was very difficult to find the right questions to ask because it was a transient situation throughout the preparation of the report.

The Committee thanked Richard Poxton, his team and Bernadette Lee for their assistance in preparing the report.

RESOLVED that:

1. The heading on page 87 be amended to read “3. Conclusions”.
2. The report be agreed subject to the above amendment.
3. Responsibility for the for monitoring the implementation of the commissioning strategy’s action plan be transferred to the Children’s Services Overview & Scrutiny Committee.

The draft work programme has been drawn up, in consultation with the Chair and Vice-Chair, from items in the forward plan and from action arising from previous meetings of the Committee.  

The Committee is requested to consider the items within the proposed work programme, set out at Appendix 1 to this report, and suggest any amendments or additional topics to be included in the future.

Information items are included in a Briefing information/General Information Pack, which has been sent to Members of the Committee separately to this agenda. A list of reports included in the Pack is attached as Appendix 2 to this report. The pack can be accessed via the following link: http://www.richmond.gov.uk/reports_for_information.htm

Items included in the pack will not be discussed at the meeting. If you wish to discuss any issue arising from the reports included in the pack please contact the Committee Manager, whose details are given on the front sheet of the agenda. Your enquiry will be forwarded to the Chair of the Committee, the Cabinet Member or appropriate officer.

Report of the Principal Democratic Services Manager attached.

RESOLVED that a report be received after 6 months of operation of revised community meals service.

To receive a short verbal report from the PCT on issues in, and proposed changes to, local health services (if any).

·               Paul Mitchell, Director of Strategy & Commissioning, Richmond & Twickenham PCT, will provide a verbal update on the future provision of older people mental health continuing care service.

Professor Joe Collier declared a personal interest by virtue of knowing one of the doctors involved in a recent investigation.

Sue Denby, Service Director and Dr Crystal Romilly, Associate Medical Director Forensic Services – South West London and St George’s Mental Trust attended for this item.

The Committee was informed that:

·        Two patients had absconded and two had escaped from Springfield Hospital.

·        An escapee was someone who had escaped the from the hospital and an absconder was someone who had been allowed out for a period of time and had not returned.

·        Richmond and Twickenham’s escape rates was comparable to other sites around the country.

·        Measures were being put in place to make hospitals more secure and further exceed the national minimum requirements.

·        Rigorous internal investigations took place whenever a patient escaped or absconded.

·        A lot of time was spent evaluating whether a patient was going to be safe within the community.

·        People with special needs were more likely to be a victim than an offender.

·        Part of the Trust’s work was to raise awareness of the needs of people with mental health problems.

RESOLVED that the presentation be noted.

Paul Mitchell, Director of Strategy & Commissioning for Richmond and Twickenham PCT was present for this item.

The Committee was informed that:

·        Caring Homes announced that there would be a delay to the programme of around 6 months.

·        There had been a meeting with some members of the Committee where a list of actions were drawn up.

·        The March PCT board meeting would receive an update on the situation and that this Committee had representation on the board.

·        There was a need to find alternative suitable locations for the residents of the St John’s facility, although it was emphasised that the long term goals of the plan had not been forgotten.

·        Close attention was being paid to the fact that it was not desirable to move residents twice.

·        It was not possible to maintain care arrangements for patients at St John’s for the entirety of the 6 month delay because there were so few patients reliant on the care there.

·        There had been a review of estates held by various partner organisations where three sites had been identified as being underutilised.  These were St John’s, Barnes Hospital and Richmond Royal.

Following questions from the Committee, the meeting was advised that:

·        It was still the intention to proceed with Caring Homes, for future service users.

·        The aim was to build in choice for the patient.

The Committee heard the following representations:

·        Mr Francis King drew attention to a letter that he had written and invited questions from members of the Committee.  Mr King also said that the Twickenham and Richmond PCT was a very good organisation.  There had been correspondence between Mr King and Dr Vincent Cable, MP, over the issue of St John’s and Dr Cable had suggested an open session where all interested parties could share ideas.

·        Mr Paul Lamplugh said that the number of patients at St John’s was so low because they had been deliberately run down.  Mr Lamplugh added that people were assured that this centre of excellence would be replaced by another facility that was just a good, but now the aim was to place people wherever beds could be found. He finished by saying that the initial point of the whole exercise around St John’s had been lost and things should return to where they had started.

The Committee expressed its sympathy for the residents of St John’s and their carers.

RESOLVED that the report be noted.

This item gives Members of the Committee the opportunity to report on any meetings on local issues they have attended on its behalf.

There was no feedback.