Agenda and minutes

To receive any apologies for absence.

Apologies for absence were received from Councillor Langhorne who was substituted for by Councillor Nicholson.

Apologies for absence were received from Councillor Blakemore who was substituted for by Councillor Chappell.

Apologies were also received from Keith Sangster and Councillor Bouchier.

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 the nature of the interest being declared.

There were no declarations of interest.

To consider the minutes of the meeting held on 14 January 2013 (attached).

The minutes of the meeting held on 14 January 2013 were approved as a correct record of proceedings and the Chairman authorised to sign them.

To receive a verbal presentation on partnership proposals.

An update on West Middlesex Hospital’s foundation trust application was provided by Anne Gibbs, Deputy Chief Executive and Director of Strategy at the hospital. Ms Gibbs informed the Committee that the current trust was relatively small for an acute trust and coupled with ongoing financial issues this meant that the Trust was seeking a partner in its application for Foundation Trust status.

Ms Gibbs explained that it was important to retain the existing site in Isleworth which served a wide area of North West and South West London. Issues such as clinical quality were being considered in order to determine which trust would best fit as a partner. Currently two West London hospital trusts were being considered as potential partners. A decision would be made on the preferred partner in the early Spring; however, there would then be a stakeholder consultation on the proposals including the business case.

In response to questions the Committee was further informed that:

(i)      Though Imperial College Healthcare had previously experienced its own financial difficulties this situation was improving rapidly and it was envisaged that such a partnership would be financially viable, if opted for.

(ii)    It was hoped that the services offered at West Middlesex Hospital could be further diversified in future, for example to include more elective care. There was physical capacity at West Middlesex which was currently under-utilised. Only a small amount of hospital users were currently private patients, although developing this sector would not solve all financial problems.

(iii)   Whilst cost savings had been achieved, there was a limit to the amount of savings which could be made without impacting on clinical safety.

(iv)  Both potential partner trusts owned sites within less than seven miles of West Middlesex Hospital.

(v)    Originally West Middlesex Hospital had planned to achieve foundation trust status by April 2014, but if a full merger with another trust took place then the process would be lengthened. It was important to find a resolution as soon as possible but the Trust also wanted the right ‘cultural fit’.

The Chairman thanked Ms Gibbs for updating the Committee on the current proposals.

It was RESOLVED that the update be noted.

To receive a verbal update on proposals regarding nursing staff and Health Visitors at HRCH.

An update was provided on Hounslow and Richmond Community Healthcare NHS Trust (HRCH) by Richard Tyler, Chief Executive, and Steve Swords, Chairman. This had been requested by the Committee following concerns about reported restructuring. The Committee was updated on HRCH’s financial situation. The Trust was required to make cost savings to meet a reduction in grant and inflationary cost rises. This meant saving 1.3% on contracts in most cases, but in cases where the Trust was operating services significantly above the NHS Reference Costs the Trust would look to make further reductions. The Trust had been working with experts to examine how savings could be made without impacting on quality of care. Most savings could be effected by operating differently; however, it was envisaged that some redundancies would be necessary.

The Chairman and Chief Executive explained the expected changes to staffing: twelve redundancies were expected in the worst case. Of this, the number of district nurse posts to be lost would be six. In previous years HRCH had saved £3.5m by reorganising ‘back-office’ services and this process was ongoing, but it was also necessary to carry out a review of the operation of front-line services.

In response to questions Committee Members were informed that:

(i)      Reference Costs were published by the NHS each year. Figures were established by looking at the cost of running a service compared to the output. Other trusts did meet the optimal Reference Costs and HRCH did currently have comparatively high costs. The Trust was ensuring that all activity was properly recorded. However, it was necessary to provide an efficient service to commissioners in a competitive marketplace.

(ii)    Many savings could be achieved by employing new ways of working: for example, increased used of home-working and portable technology would reduce the amount of time wasted in travelling between the office and patients.

(iii)   Out of hospital care would need to be provided in a more flexible manner, based on the requirements of commissioners. Increased collaboration between health and social care services might allow for district nurses to provide a more specialised service.

(iv)  Other posts which were being reduced or re-graded included podiatrists, physiotherapists and administrative posts. Whilst some funding of health visiting was being reduced, this service would continue to operate about Reference Costs in line with national policy.

(v)    HRCH currently employed 650 clinical staff including 106 (FTE) district nurses.

The Chairman thanked Mr Swords and Mr Tyler for updating the Committee.

It was RESOLVED that the update be noted.

A representation was heard from Mr Peter Marks, a member of Richmond LINk steering committee and mental health group, and a member of the Maddison Carers Group.

[This representation and the following discussion occurred after the Mental Health update items A and B.]

Mr Marks addressed the Committee on the redesign of community mental healthcare services: he was concerned that since the time when he had previously addressed the Committee (November 2012) there had been a shortage of information provided to carers about the extent of the proposed changes. He asked for carers to be consulted fully on any proposals before they were implemented and to be given details of the associated financial costings. He was particularly concerned about the movement of mental health patients to primary care services and whether patients’ needs could still be met. He was also concerned that future funding changes would have a negative impact on the service. However, he did acknowledge that since the service provider had changed the mental health services in the borough had greatly improved.

In response to Mr Marks’ representation Dominic Wright (Chief Officer Designate of Richmond Clinical Commissioning Group) stated that the CCG and the Council had been working with carers and were being as transparent as possible in their proposals. Evaluation of changes was ongoing and it was not yet possible to have a complete picture. However, he could provide a further briefing for the Committee Members on the proposals with input from the CCG clinicians and the service provider. It was important for Members to focus on the outcome of the proposals and whether the changes offered a better service for residents.

In response to a query from a Committee Member, David Bradley, Chief Executive of South West London and St George’s Mental Health Trust, stated that he would examine whether it was possible to re-establish the equivalent of a Patient Advice and Liaison Service for mental health services.

It was RESOLVED that a further written briefing on community mental healthcare redesign be provided by the CCG including input from clinicians and the service providers (South West London and East London Mental Health Teams).

To provide an update on mental health commissioning led by Richmond Clinical Commissioning Group (CCG). This report sets out current commissioning developments and future commissioning intentions.

Report of the Head of the Joint Commissioning Collaborative attached.

The report was presented by Dominic Wright, Chief Officer designate of the Richmond Clinical Commissioning Group (CCG), and Cathy Kerr, the Council’s Director of Adult and Community Services.  The key changes to services and new commissioning initiatives were highlighted as outlined in the report. It was also noted that budgeting for Mental Health Services in Richmond was above national average and that figures for 2011/2012 spending were likely to be relatively good. In future services would become more community-based with a greater emphasis on primary healthcare. The Council and the CCG would need to commission in a flexible manner and to look at a holistic approach to care.

In relation to dementia care it was noted that the Council has also been in contact with smaller voluntary sector providers to look at innovative ways to meet residents’ needs, for example via the ‘healthy walks’ scheme.

In response to questions the Committee was advised that:

(i)      The CCG and the Council were looking at a method of service provision based on different categories of need. It was difficult to assess the outcomes of mental health spending and this represented a challenge to commissioners. 

(ii)    It was hoped that by redesigning services at this point it would avoid short-notice ward closures as had happened in other locations in the past.

(iii)   Community Mental Health Teams already employed social workers and it would be important to look at how resources were directed between social workers and public health workers.

(iv)  Since July 2012 when the mental health contract had been awarded to a new provider the service had greatly improved. Contracts were negotiated on an annual basis as with all NHS services.

In response to discussions on dementia care services, some Members suggested that day care services should be provided in more locations across the borough. The Director responded that the Council was not planning to commission new day care facilities, but that in the last two weeks had supported a voluntary sector capital bid which could enhance existing provision for people with dementia.

It was RESOLVED that the current position in relation to mental health commissioning within Richmond be noted.

To receive a verbal update on South West London and St George’s Mental Health Trust and the application for foundation trust status.

An update on South West London and St George’s Mental Health Trust was provided by David Bradley, Chief Executive and Mireia Pujol, Associate Medical Director (Richmond).

In relation to primary mental healthcare services the Committee was advised that:

(i)      23 clusters had been developed which represented different levels of mental health need. The CCG, South West London and St George’s and East London Mental Health Trust were working together to identify how many patients would be allocated to each cluster in the borough. This did not include patients with very serious mental illnesses.

(ii)    It was recognised that it was difficult to categorise all mental health problems and for this reason many different factors (such as daily living skills) were used to determine the scope of each cluster. Packages of care could then be developed for each cluster which met the level of need.

(iii)   Due to the varied and ongoing nature of many mental health problems it was not always appropriate to develop a ‘payment by outcome’ system for the service.

(iv)  Some mental health issues could be linked to the current economic situation but levels of serious mental illness were not rising.

In relation to South West London and St George’s application to become a foundation trust, Committee Members were informed that:

(i)      The Trust was currently undergoing external scrutiny from representatives of the Department for Health. The next stage of the business plan to be examined would explain how the Trust intended to improve quality of services and work more closely with partners.

(ii)    As well as looking at out of hospital care the Trust needed to develop its estates management. Following a stakeholder event, options being considered included the possibility of using the Barnes Hospital site for inpatient services for young people with Mental Health problems.

(iii)   It was hoped that foundation trust status would be achieved in April 2014.

The Committee Members discussed the implications of the redevelopment of the Springfield Hospital site. It was noted that further details of the Trust’s business case, including site options, should be available by April 2013.

The Chairman thanked David Bradley and Mireia Pujol for their updates.

It was RESOLVED that the updates be noted.

This report provides an update on the procurement progress within Adult Community Services in relation to:

·         Adult Service Commissioning: Transition from Voluntary Sector Grants.

·         Adult Care Provision: Priority Programme

Report of the Director of Adult and Community Services attached.

The report was presented by Grahame Freeland-Bright, Head of Service Development and Cathy Kerr, Director of Adult and Community Services at the Council. Officers highlighted the key commissioning programmes within the Adult and Community Services Directorate and provided an update on timescales.

In response to questions from Members it was explained that a letter would be sent to voluntary sector providers the following day in relation to proposed procurement arrangements for commissioning support services. The specifications for contracts were not yet defined. Much of the reason for the delay in this was due to engaging further with the voluntary sector on the commissioning process. The Council expected that in moving to a commissioning approach the types of local services currently provided would continue but would be delivered differently: services would be delivered in partnership, building upon existing good work and networks. Sufficient capacity would be developed to deliver a core range of services across a local area, recognising local experience, and allowing flexibility for discrete services to be provided by smaller providers for more local populations. However, some services would need to be more evenly distributed across the borough.

In relation to commissioning of community transport, it was explained that this would not affect local neighbourhood initiatives such as the Voluntary Mileage Scheme. In relation to rent subsidies for the voluntary sector, it was noted that work was still being carried out to examine the full details, but that this could be met by the overall available funding. Members suggested that the letter being sent to the voluntary sector providers could include information about this.

It was reported that grants would continue until new services were operational. In addition, transitional funding would be available to support organisations through changes. 

Members were concerned that the delay in the implementation of voluntary sector commissioning was causing anxiety for organisations. Officers recognised this, but explained that it had been necessary to work with the sector in developing proposals and that more detailed information would soon be available. Members were encouraged to refer any organisations with specific concerns to the Adult and Community Services Directorate.

It was RESOLVED:

1.      That the update be noted.

2.      That a briefing note would be provided to all Councillors to inform them of the changes to voluntary sector funding.

To receive an update on the Committee’s proposed work programme.

Report of the Head of Democratic Services and Appendix A attached.

The Committee discussed its work programme for March and June 2013 and the appointments to the Quality Accounts Sub-Committee.

The Director of Adult and Community Services advised the Committee of a consultation on St George’s Healthcare’s foundation trust application. There was not space in the work programme for this to be considered at the next Committee meeting but Committee Members were invited to respond to the consultation directly if desired.

It was RESOLVED:

1.      That the work programme for the remainder of the 2012/13 municipal year and for June 2013 be noted.

2.      That Councillor Head be nominated as a new member to sit on the Quality Accounts Sub-Committee (in addition to Councillor Jones and Margaret Dangoor).

3.      That Maureen Chatterley be nominated as a substitute to sit on the Quality Accounts Sub-Committee when necessary.