Agenda and minutes

The Chair opened the meeting and welcomed members of the public.

Apologies were received from Councillor Langhorne who was substituted by Councillor Day.

In accordance with the Members’ Code of Conduct, Members are requested to declare any interests orally at the start of the meeting and again at 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.

Elected Members are also reminded of the requirements of Section 106 of the Local Government and 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.

Councillor Bouchier declared a personal interest by virtue of her work for Age Concern.

Councillor Mathias declared a personal interest by virtue of her Professional Medical membership of Diabetes UK.

To consider and approve the minutes of the last meeting held on 29 June 2010.

The minutes of the meeting of 29^th June were agreed as a correct record of proceedings and the Chair authorised to sign them. 

In relation to the minutes the Committee asked:

o        That an update on the likely end date for the Southwark Fire enquiry be obtained and e-mailed to members of the Committee

o        That further to the Stroke Services information provided regional statistics for Richmond Borough be provided

The Committee heard representations from Mr Francis King.  He referred the Committee to the letter he had provided prior to the meeting containing four questions.  The letter is attached as appendix A to these minutes.

The Committee and Mr King agreed that the questions would be answered during the items on the agenda to which they pertained.

There were no executive decisions of the executive called in.

This report asks the Committee to confirm the appointment of the selected non-voting co-optees named there in, for a period no longer than four years.

Report of the head of Democratic Services (attached).

The Committee received a report of the Head of Democratic Services the purpose of which was to seek approval of the appointment of the following people:

o        Maureen Chatterley

o        Margaret Dangoor

o        Keith Sangster

o        Martyn Kingsford

as non-voting co-optees of the Committee.

The Co-optees introduced themselves to the Committee members and gave a brief description of their backgrounds and particular interests.

It was RESOLVED:

1.                  That the appointment of the above named people as non-voting co-opted members of the London Borough of Richmond Upon Thames, Health, Housing and Adult Services Overview & Scrutiny Committee, be agreed

2.                  That a review of these appointments be conducted after approximately two years, be agreed.

The committee welcomed the four new co-opted members and thanked them for applying for the positions.

This report updates the Committee on the further development of service for patients with Diabetes following the substantive report submitted in June, 2009, and the update provided in June 2010.

Report of the Assistant Director for PBC & Demand Management, NHS Richmond

The Committee received a report of Alex Levak, NHS Richmond, the purpose of which was to provide an update on the further development of services for patients with Diabetes since the last report to the know decommissioned Health, Housing and Social Care Committee in June 2009. 

In particular she referred to:

(i)      Prevalence had increased

(ii)    An additional £500,000 per year had been committed by NHS Richmond to diabetes care

(iii)   30 of the 32 practices in Richmond had now taken up the enhanced service scheme

(iv)  Larger practices could offer self help injection services

(v)    The backlog of Desmond courses had now been cleared after a shortage of trainers and now included refresher courses

(vi)  Unfortunately there was still a 20% ‘Do Not Attend’ rate on the self help programmes

The committee received the following responses to comments made and questions raised:

(i)      The £500,000 investment had been invested in various enhanced schemes for local general practitioners.  All the investment was for new or enhanced services which had in the past been provided by hospitals.

(ii)     That the quality and outcome measures had been changed and therefore the 09/10 figures were not comparable with those that had gone previously.

(iii)   That it would be possible to report less statistics in more detail in the future if the committee so wished.

(iv)  That new methods of reminding people to attend Desmond courses had been tried and initial results were promising

(v)    That of the 500 new ‘pick ups’ it was not known which were from GP recruitment and which were pharmacy.  Without this information it was hard to establish how successful the Health Check Pilot Scheme had been.

It was RESOLVED:

1.                    that Alex Levak be asked to return to update the meeting again in 6 months time

2.                    that the contents of the report be noted

The Committee will receive a verbal update from Dr Marilyn Plant regarding the possible implications of the expected Government White Paper, the prospective changes to healthcare commissioning and the implications for joint working in the Borough.

The Committee received a verbal update from Dr Marilyn Plant on the possible implications of the Government White paper and the prospective changes to healthcare commissioning.  Dr Plant described her role within the PCT and reported that she was also a voting member on the joint body of PCTs.  In addition she was a member of the London Clinical Senate.  She had also been a GP in Barnes for 20 years and before that a GP in Hammersmith.

She explained to the Committee that she had not provided papers in advance of the meeting as the situation had been changing daily and therefore she would provide a verbal update of the situation as of now.

In particular she referred to the following:

·         PCT’s would remain a statutory body until April 2013 when they would be dissolved.  This would be formally resolved once the primary legislation had been passed but was expected to be the case, it was likely that this legislation would be taken through the next parliamentary session.

·         As a result of this expected legislation would be that GP’s would be responsible for commissioning of services as opposed to the PCT’s; this she explained would be a similar exercise to the fundholder GP initiative some years ago but without the voluntary element.  This time also, not only would planned care be commissioned by GP’s but also acute care.

These things were expected but there were she reported things that were less clear

• There was no clear guidance on which of the many functions of the PCT would be transferred to GP’s, it would not be possible to transfer the functions wholesale.
  
  
• Those functions not taken on by GP’s would go elsewhere, some may transfer to local authorities.
  
  

The committee heard that two practice based commissioning groups had been established and were meeting regularly in order to develop and craft services for the future. 

The size of GP Commissioning consortia was not designated in the original advice but a letter recently received from D Nicholson recommended that would serve a population of 500,000.  Under this size it was not expected that a practice could achieve a financial balance.  Dr Plant reminded the committee that all of this ongoing work was pre-emptive in order to complete a smooth change over in 2013.

In response to comments made and questions raised the committee heard the following:

(i)      That it was not clear as yet whether the Mayor / GLA would have a overarching role after 2013

(ii)    That the move to GP commissioning should certainly increase GP awareness of financial costs

(iii)   That the PCT was putting in place the necessary tools to ensure a safe and effective transition to GP Commissioning

(iv)  That joint working continued successfully between the PCT and the Local Authority.

(v)    That it was hoped that by April next year a ‘shadow’ format for the changeover would have been produced.

It was RESOLVED:

1.                    that the current position be noted

2.                    that Dr Marilyn Plant return  ...  view the full minutes text for item 17.

The Committee will receive a presentation from Richard Tyler, Managing Director of

Hounslow & Richmond Community Healthcare regarding the progress towards and arrangements made for the final end state of HRHC.

The Committee received a presentation from Richard Tyler of Hounslow & Richmond Community Healthcare the purpose of which was to update the committee on the future of HRCH and the current position.

The presentation is attached as appendix B to these minutes.

During discussion of the presentation the committee heard that:

(i)      The formal submission of a bid, including PCT Board support was required by the end of September

(ii)    The formal DH assessment panel was scheduled for 29^th October

(iii)   Should the bid be unsuccessful the partner selection process would need to be restarted and the committee expressed a view that in this case a Richmond, Hounslow and Kingston partnership would be preferred.

It was RESOLVED that the information and actions in the report be noted and endorsed.

This report contains a Summary Annual Report of achievements during 2009-2010, and identifies the priorities for 2010-2011.  These priorities build on achievements and developments since implementation of the 2008 Improvement Plan arising from the Inspection by the Care Quality Commission (CQC).

Report of the Assistant Director of Commissioning Care Services, Adult and Community Services.

The Committee received a report of the Assistant Director for Commissioning Care Services, introduced by the Director Adult and Community Services.  The purpose of the report was to introduce the Summary Annual Report of achievement during 2009-10 and identify priorities for 2010-11.  It also contained information on good practice approaches and useful information sources.

In particular she referred to the following:

(i)      That through successful awareness raising there had been an increase of nearly 20% in reporting of safeguarding issues.  Of those issues reported about 40% would go through to formal investigation.

(ii)    A new performance framework had been put in place to ensure consistent good practice through shared learning.

(iii)   A new recording system had been put in place to ensure consistent good practice and analysis of cases for learning

(iv)  Information was provided on the types of abuse being reported and of the gender and ethnicity of the victims.  These two factors were in line with national profiles.

(v)    With regard to the Safeguarding Adults Partnership Board and criticisms that it was Council heavy on the membership, Cathy report that membership reflected the range of responsibilities that sat within the Board and further Voluntary sector organisations had now been encouraged to join.

(vi)  That approximately 50% of reports of abuse go unsubstantiated

(vii)That lessons were always being learned from other authorities and national cases; for example after the deaths of Fiona Pilkington and her daughter in Leicestershire, Richmond reviewed its interagency working practices and communication

In response to question 3 of the earlier representation made by Mr King (see appendix A) the Director of Adult and Community Services clarified the position on vacancy rates..  A deliberate decision had been taken not to recruit to permanent posts as they became vacant in light of the whole system redesign..  Owing to the massive changes that were likely to come as a result of the redesign staffing had been put on hold in order to help reduce redundancy costs in the future.  Agency staff were being used to cover vacant posts and the Director reported that we had a number of very experienced agency staff.

Now that the new structure had been agreed to, permanent posts had been agreed with the vacancy panel and would be advertised shortly.  Although it was not the reason for unfilled posts at present retention and recruitment had been an issue in the Borough in the past and therefore new posts would have enhanced benefits in order to reduce staff losses in the future.

It was RESOLVED:

1.                  That the achievements of the Safeguarding Adults Partnership Board be noted

2.                  That the priorities for 2010/11 be approved.

3.                  That the Director would provide a written briefing in Spring 2011, to inform the Committee of the position regarding social work vacancies.

The Committee will receive information on an NHS Consultation regarding Children’s Heart Surgery and also consider the Consultation information as a standard agenda item for the Committee.

Report of the Head of Democratic Services and Health Scrutiny Advisor (attached).

The committee received a report of the Head of Democratic Services and the Health Scrutiny Advisor the purpose of which was to receive information on upcoming and current Consultations that the Committee may want to contribute to.

The report contained at specific information on consultation from the NHS regarding Children’s Heart Surgery.

In relation to the public representation question 2. it was reported that London-wide or regional scrutiny arrangements were not being considered for other consultations.

It was RESOLVED

1.                  That arrangements for Consultation on Children’s Heart Surgery be noted

That ‘Consultation Information’ become a standard agenda item of the committee, be agreed.

The Committee will receive a brief verbal update on any changes to local health services since the last meeting

The Committee received a verbal update in respect of changes in Health Services since the last meeting of the Committee from Ian Maxwell, NHS Richmond.

In particular he referred to the following:

(i)      That the HRCH and GP / Borough based commissioning items on the agenda had covered most of the recent changes. 

(ii)    That the PCT was currently managing huge changes effectively and hoped that it was resilient to more change in the future.

It was RESOLVED that the information received be noted.

This item was not included in the original publication of the agenda but is now available and will be considered as a late item.

The report gives details of the proposed work programme for the remainder of the municipal year 2010/11 and outlines ways in which the committee can add value to regular reports on performance of services in their area.

.

The Committee received a report of the Head of Democratic Services the purpose of which was to give details of the proposed work programme for the remainder of the municipal year 2010/11.

It was RESOLVED:

1.                  That an item on Housing and the responsibilities of the Local Authority to the Homeless be brought to the next meeting

2.                  That a scoping meeting take place to assess the possibility of creating a Housing Task Group, to include Mr Martyn Kingsford, Councillor Blakemore and Councillor Coombs plus two more committee members to be confirmed.

3.                  That the item on RHP / Paragon services be removed

4.                  That information on EDF as suggested by the Environment Overview and Scrutiny Committee be sought.