Agenda and minutes

To receive any apologies from members of the Committee unable to attend.

Apologies were received from Councillor Jones (Richmond Upon Thames) Councillor Elizabeth Howlett (Wandsworth) and Councillor Peter McCabe (Merton) who was substituted by Councillor Sam Thomas (Merton.)

To receive declarations of interest from Elected Members pertaining to items on the agenda. Members are reminded to state the agenda item to which the interest relates and the type of interest being declared.

Councillor Burstow declared a personal interest with regard to the matters to be discussed as part of the agenda. The nature of the interest being that her husband held the role as Minister of State for Care Services.

To consider and approve the minutes of the last meeting held on 21 June 2012.

The minutes of the meeting held on 21 June 2012 were signed by the Chairman as an accurate record subject to the following amendments:

• Councillors Taylor (Surrey County Council) and Councillor Thompson (Kingston Upon Thames) be added to the attendance list.
• Reference to clarification sought regarding financial scoring criteria by Councillor Honour be included within the relevant minute.

To receive questions from members of the public for officers in attendance from the Better Services, Better Value Team of NHS South West London.

The Chairman has indicated that this session will last no longer than 30 minutes.

{Written questions can be submitted for a written answer.)

*Please also find attached, for information only  the responses to questions raised at the public question and answer session on 10 May 2012.

There were no questions from members of the public in attendance.

The Joint Committee to comment upon and approve the proposed updates to the Rules of Procedure.

Members received a brief outline of the updates to the Rules of Procedure for the Committee following the increased membership and changes to public representations.

Resolved: That the revised Rules of Procedure be approved.

The Committee to consider information from Better Services Better Value regarding capital estimates for each of the reconfiguration options.

Russell Cake, 2020 Finance, NHS SW London, provided Members with an overview of the capital costs and methodology for the Better Services, Better Value review. In outlined the capital estimates for each option, he clarified that there were two different capital estimates for Option C as the site buildings estate could be reconfigured in two different ways. Option A (status quo) was noted as an unsustainable option due to the need to bring about clinical improvements as part of the review.  The Pre Consultation Business Case (PCBC) would include full costings (including revenue implications) and financial rationale for the proposals.

The Committee considered progress towards the out of hospital goals and questioned the difference in totals for each of the Boroughs. It was clarified that the starting position differed across South West London. Clarification was sought regarding the individual schemes, costings and timescales included in the figures.  Mr Cake made reference to the incremental capital for Better Services Better Value when compared to the North West London’s preferred option.

Members were provided with detailed information regarding the methodology for estimating capital associated with reconfiguration costs and modelling the requirements for out hospital care. A question was raised regarding the estimation of population growth within the cluster area and regard to local authority’s future housing development plans. Mr Cake was unable to comment on how the housing development plans had been utilised to estimate population growth.

A number of questions were asked regarding how capital would be secured for the reconfiguration and more widely with regard . Mr Cake confirmed that Better Services Better Value considered itself in a strong position to secure monies, based on the initial calculations on affordability based on the turn on capital employed and initial modelling work of net present value.

A discussion took place regarding previous agreement that the Committee would be able to scrutinise the Pre-Consultation Business Case (PCBC) as its meeting in September. Rachel Tyndall, Better Services Better Value Senior Responsible Officer outlined the NHS sign-off process for the PCBC prior to the launch of the public consultation. It was clarified that the document, until final sign-off would be constantly evolving. Members of the Committee re-iterated the previous agreement that the PCBC would be provided to the Committee for consideration at the September 2012 meeting, in compliance with the Access to Information Regulations.

The Committee requested that a revised timeline (including consultation start date) be made available as soon as possible.

The Committee resolved that:

1. Detail will be be provided regarding the individual schemes, costings and timescales included as part of the capital costs of out of hospital goals within the Pre-Consultation Business Case.
2. Revenue streams and operating costs for each of the reconfiguration options would be open to initial comment by Members as part of the Pre-Consultation Business Case.
3. A draft version of the Pre-Consultation Business Case would be considered by the Committee in private session at the meeting due to take place on 3 September 2012 in full accordance with the  ...  view the full minutes text for item 37.

Members to receive information regarding proposals for the Better Services Better Value public consultation.

The Committee considered a draft version of the Consultation Plan for the Better Services, Better Value Review.

Charlotte Gawne, Director of Communications, NHS South West London outlined the key elements of the consultation plan. She noted the desire of the Trust to consult as widely as possible using different methods of communication to ensure those most affected are able to share their views. She sought the views of the Committee in using the local Community and Voluntary Services (CVS) to make closer links with community organisations and using local authority consultation leads.

BSBV were noted to be working with the Consultation Institute as a critical friend in developing the consultation plan. To ensure the consultation plan could be adapted based on responses received, it was noted that review stages would be built into the consultation plan to enable further work to be undertaken with underrepresented groups.

Health Guides would be nominated from each of the Borough’s to assist with targeted community engagement.

Ms Gawne noted that the final consultation document would be reviewed by a readers panel and the Plain English Crystal Mark accreditation would be sought. The analysis would be undertaken independently by Ipsos Mori  and work would similarly be undertaken to ensure the questions included as part of the consultation were clear and neutral.

In response to questioning from Members, the Committee was informed that:

• Officers from BSBV (including clinicians) had been working closely with some senior staff in the Trusts and this engagement work would be rolled out further as part of the formal consultation process.
• Detailed plans to support workforce development across the cluster would be put in place as part of managing the review in the future
• It was likely (although not confirmed) that the consultation would be based on one final preferred option.
• Work would be taken (with support from the Surrey County Council appointees to the JHOSC) with patients on the fringes of the South West London area.
• Better Services Better Value had already undertaken some consultation work with potentially affected groups which had resulted in good levels of feedback (eg Tweet chats with new Mums.)

A detailed discussion took place regarding the clarity required as part of the consultation document to outline why no change was not an option for the Better Services Better Value review.  In response to questioning about consulting with people who may be fearful or angry about the proposed changes, it was noted that two stage events, allowing for reflection time would create higher quality results.

As a minimum, two public consultation events would be held in each Borough and residents panels would also be utilised as a representative sample of the local population.

Ms Gawne, in responding to questioning from Members noted that the clinicians leading the review were committed to listening to residents and that responses to the review would not be weighted in any way.

Additional bodies / option for consultation suggested by Members included:

• Feeding Councillor views (if required) through  ...  view the full minutes text for item 38.

The Committee to consider a report regarding NHS South West London’s plans for out of hospital care.

Marilyn Plant, Richmond General Practitioner, representing the Better Services Better Value review provided an overview of the plans being developed for out of hospital care. She noted the vision for out of hospital care and stressed the need for a fully integrated system of high quality patient care. Particular focus was given to integrating health and social care, physical and mental care and the need for effective case management of those with long term conditions.

The Committee considered the demands and challenges facing out of hospital care in the coming years and it was emphasised that all residents should have equal access to quality of care across the whole cluster area. Clinical Commissioning Groups would in future be corporately responsible for delivering the required standards of performance.

Ongoing out of hospital initiatives were highlighted to the Committee across all boroughs and it was noted that workforce development would play a key part in delivered effective high quality out of hospital care as staff would be required to work more flexibly across a range of settings and care pathways.

In responding to questions from Members, Dr Plant noted that acute care could be provided most effectively when provision had been consolidated on one or two key sites. Long term conditions care should be provided in the community as close as possible to the patient’s homes.

The Committee noted concern about the poor quality of care delivered by a very small number of General Practitioners. The revalidation process was highlighted to Members with a view to encouraging those who performed less well to focus on appraisals and constant performance review. Practices would also be incentivised to use buildings more flexibly and provide services in a less traditional manner.

The overarching nature of the proposals were noted by the Committee and evidence sought regarding the feasibility of proposals and the connection between this and work on the ground. The role of the Health and Wellbeing Boards were noted to be central to delivering fully integrated services and as a key mechanism for facilitating discussion amongst the key parties.

The Committee resolved:

1. To note the report.

The Committee to consider a report seeking feedback regarding witnesses to be contacted as part of the work of the Joint Committee and proposed timescales for the work.

The Committee resolved that:

1. This item be deferred to the next meeting of the Committee on 3 September 2012.
2. Dates be sought from Members of the Committee for witness sessions, the invitees and format of which would be discussed by the Committee on 3 September 2012.