Apologies were received from Councillor Rita Palmer and Co-opted members Martyn Kingsford and Keith Sangster.

Mrs Margaret Dangoor, Co-optee, declared a personal interest in items pertaining to dementia care as her husband was a user of services provided by the LBRuT.

The Committee is asked to consider and approve the minutes of the last ordinary meeting held on 11^th November (to follow) and the extraordinary meeting held on 25 October 2010 (attached).

The Minutes of the meetings of the 25^th October and 11^th November 2010 were agreed as a correct record and the Chairman authorised to sign them. 

Representations by members of the public would be taken at the beginning of the related item on the agenda.

There were no executive decisions called in.

The Committee is asked to consider this report on the implementation of the NHS Richmond and London Borough of Richmond upon Thames Mental Health Joint Commissioning Strategy for Older People 2010-2015.

The Committee received a report of the Services Director of South West London & St Georges the purpose of which was to provide an update on the Trust’s part in implementation of the NHS Richmond and London Borough of Richmond upon Thames Mental Health Joint Commissioning Strategy for Older People 2010-2015,which were reported to the committee in February 2010.

The Committee heard representations from members of the public:

Ms Cathy Sheldon chair of the Friends of Barnes Hospital addressed the committee.

• She argued that the introduction of the memory clinic for the Borough was to be welcomed but would increase diagnosis and therefore need, at a time when services were being reduced.
• That this was a good opportunity to have organisations working together on the implementation of the strategy.  In addition, Barnes Hospital could be utilised in many new ways.
• She reminded the committee that Barnes Hospital had been purchased originally with Tax payers’ money in the 1880’s.

In response to questions Ms Sheldon added the following:

• That services for elderly people should remain separate from services for working age adults and young people

Mr Richard McIvor from LINK addressed the committee

• He responded to the paper from the Mental Health Trust.  He was concerned about the lack of consultation and engagement and the notification of events after the fact.
• He asked for a more joined up approach to be implemented and clear pathways for treatment to be available to patients, carers and other organisations.
• It was important that some inpatient services were maintained on local wards.

Sue Denby, Director of South West London St George’s Mental Health and Judy Wilson Chief Executive, joined the committee for questions.

The Chairman of the committee criticised the report for lack of clarity and asked that more explanation be provided from the officers. 

Ms Wilson explained that NHS Richmond were happier with the progress of the Mental Health Trust than when the Committee had last received an update.  In addition the Trust had now re entered the process for Foundation trust status.

She explained that consultation had begun in Mid February regarding the clinical structure but that the process had moved forward much quicker than had been anticipated.  However it was important that with a challenging year ahead financially as much work was done to cut costs immediately where it would not adversely affect patients, for example in back room services.  To further qualify this, she explained that the Mental Health Trust had not announced the stopping or cutting of admissions but the fall in demand had happened so quickly that the ward had only two patients.  The Trust was keen to provide continuity of care by transferring staff to the home treatment service where possible.

In relation to the requests for care pathways, Ms Wilson explained that the information was widely dispersed and belonged to many different organisations; combining it was a difficult task.

With regard to the future use of Barnes Hospital the Trust was keen not to discount any  ...  view the full minutes text for item 45.

The Committee is asked to consider this paper (attached) outlining Kingston Hospital's timetable and process to secure Foundation Trust status. The report seeks to gain feedback from the OSC to its proposed vision, strategic objective and service development priorities.

Also attached are the presentation slides to be used on the evening.

Jane Wilson, Director of Medicine at Kingston Hospital and Christopher Smallwood, Chair of the Trust, attended the committee and made a presentation.  A copy of the presentation is available as appendix A to these minutes.  During the presentation Ms Wilson referred in particular to the following:

• The aims of the Kingston hospital and the future savings they would be required to make.
• The next steps for the hospital – including the push for Foundation Status
• Timelines for developments
• Kingston Hospital vision
• Core emergency services
• Planned Care

• Integrated Community Services
• Proposed Strategic objectives
• Proposed Service Development Plans
• Stakeholder engagement
• Project Governance

The Committee discussed the presentation and in response to questions raised and comments made received the following additional information:

(i)      That tariff reductions were not yet known

(ii)    That some diagnostics would be moved into the community, for example ultrasound was a service which could be provided in this way.

(iii)   That the hospital must have a mature reflection on its services and on what it wants to continue to provide in the future.  Hospitals must look at what their neighbours are doing well and decide whether it is necessary to duplicate that service.

(iv)  That the hospital was working to produce services in line with commissioning priorities.

(v)    That quality of care was monitored and patient experiences captured.

(vi)  That frontline staffing levels would not drop.

The Chairman closed the discussion and thanked Jane Wilson and [?] for attending.  She informed the committee that, due to the time constraints imposed by the heavy agenda any further questions should be sent to the Committee Manager who would forward them appropriately.

It was RESOLVED that the information received be noted.

The Committee is asked to consider this report (attached) which gives an overview of the government’s Public Health White Paper ‘Healthy Lives, Healthy People : our strategy for Public Health in England’, and two complementary consultation documents ‘Proposals for a Public Health Outcomes framework’ and ‘Consultation on the funding and commissioning routes for Public Health’.

The Committee received a report of the Director of Public Health the purpose of which was to provide an overview of the government’s White Paper ‘Healthy Lives, Healthy People: our strategy for Public Health in England’ and the two complementary consultation documents.

Dr Dagmar Zeuner, Director of Public Health attended to present the report and in particular she referred to the following:

• That Public Health was a priority for this Government
• That responsibility for Public Health would move from the NHS (back) to local authorities.  In support of this aim Directors of Public Health would become the principal advisors on health for local authorities.
• A new national public health service ‘Public Health England’ would be formed.
• Full implementation of the changes was scheduled by 2013
• Consultation on the white paper would close on the 8 March 2011
• Although the Borough of Richmond was a Healthy and affluent Borough there were still public health needs that should be addressed.

The Committee discussed the report and in response to questions raised and comments made received the following further information:

(i)      That the statistical information currently provided by the PCT was very good and it would continue to be used, but retrieved from other sources, in order to ascertain the Public Health needs of residents in Richmond.

(ii)    The important aspect of the upcoming changes was to ensure that they were implemented well and that the opportunity to have a genuinely local Public Health agenda was fully utilised.

(iii)   That there was not the resource available currently to provide a happiness indicator for Richmond Borough from national findings.

It was RESOLVED that the report be NOTED.

The Committee will receive a verbal update from Joan Mager, Chief Executive of Richmond NHS and Cathy Kerr, Director of Adult and Community Services on changes to local health services since the last meeting, to include information on South West London PCT’s transitional arrangements and joint working arrangements with the Borough.

The committee received a verbal update from the Chief Executive of Richmond NHS, Joan Mager and the Director of Adult and Community Services, Cathy Kerr on changes to local health services in the London Borough of Richmond upon Thames.

Ms Mager addressed the committee; in particular she referred to the following:

• Difficulties in closing financial gaps whilst maintaining services at hospitals.  It would be a good thing to move some services to the community for example many A&E patients could be treated by a GP.
• The Mental Health Trust had also reduced buildings and this combined with movement of other services in to the community placed a greater emphasis on the new Community Trusts.
• The importance of the roles of Director of Public Health, Professional Executive Committee (PEC)  Chair – Marilyn Plant , and new managing Director of the PCT.  She hoped that an appointment to the latter role would be confirmed shortly.  In other staff news Gill Robinson had been confirmed as Director of Finance at the SW London sector.
• Although the PCT remained, in order to facilitate future changes they were now involved in joint board meetings at sector level.

Ms Mager also announced to the committee that she would retire from her position on at the end of February.  The Chairman thanked her on behalf of the whole committee for her hard work and expertise over recent difficult times.

Cathy Kerr addressed the committee; she raised the following for consideration:

• She remarked on Ms Mager’s retirement and the loss of Ian Maxwell who would retire shortly after.  This would mean a different face of the PCT for the local authority to work alongside.  She reiterated Ms Mager’s remarks regarding the key roles.
• At present there was a massive development agenda to be implemented at a time of significant financial pressure for both local Government and the NHS.  However she reassured the Committee that all involved, including the local authority were, creating the best possible foundations for a successful change
• Ms Kerr also informed the Committee that the local authority had been working very closely with local GP’s as part of the process of change.

It was RESOLVED that the information received be noted.

The Committee is asked to consider a report (attached) setting out the revenue budgets for the Adult and Community Services Directorate for the financial year 2011/12.

The Committee received a report of the Director of Adult and Community Services setting out the detailed revenue budgets for the Adult and Community Services Directorate for the financial year 2011/2012.  The budget had been considered at an extraordinary meeting of the committee previously, in addition a special meeting on the 6^th January had focused on the cuts to Intensive Day Care Services.

The Head of Finance (Adult and Community Services) introduced the report to the Committee, in response to questions raised and comments made he informed the committee that:

(i)      That the Transport Operations budget of £3.8m covered both Adult and Children’s Services transport and there were proposed efficiencies for Special Educational Needs transport in addition to the efficiencies shown in the Transport Operations budget.    The number of drivers was necessary to provide the service needed by vulnerable residents in the Borough.

(ii)    The cost of the concessionary fares service had increased which was funded by an increase in government grant funding.

(iii)   That the budget included certain assumptions about inflation and demand for adult social care services remaining high.

(iv)  That additional NHS funding for adult social care announced by central government was not included in the Council’s budget as an agreement would need to be reached with the NHS about how this funding would be used.

(v)    That additional funding to the Council for adult social care announced by central government was harder to identify now that ring fencing had been removed from grants and was part of the general Formula Grant.  The money still appeared in the budget but may not be clearly referred to as such.

It was RESOLVED that the report be noted.

The Committee is asked to consider a report (attached) setting out the proposed amendments to discretionary charges for the Adult and Community Services Directorate. 

The Committee received a report of the Director of Adult and Community Services setting out proposed amendments to discretionary charges for the Directorate.

The committee considered the report and sought clarification regarding Care Management Review Charges and charges for care home placements for adults with Learning Disabilities.  Officers provided the following responses:

(i)      That the Care Management Review charges applied to other authorities for whom Richmond had conducted reviews.  Fees had always been charged but this year the structure and charges had been formalised

(ii)    That the charges for residential care for adults with learning disabilities related to the Council’s own residential care homes and these depended on the home in question. 

It was RESOLVED that the information be NOTED

The Committee is asked to consider two performance reports:

12a) Performance data available from Quarter 3 and

12b) Care Quality Commission findings on performance in 2009/10.

The Committee received a report of the Director of Adult and Community Services providing details of the performance of the ACS Directorate in relation to projects and indicators that monitored the council’s priorities.  The Head of Performance and Quality Assurance attended to present the report to the Committee.  She reported the following updates:

·         The Delayed Transfer of Care indicator showed considerable improvements since the last meeting.  Performance had slipped slightly over the  Christmas period but had improved since then.

·         Learning Disabilities – people in settled accommodation: This indicator had not responded so positively but the committee was reminded that this was to be expected due to the closure of a long stay hospital in the borough some years ago when patients had been moved into residential homes.

·         This indicator in its current form is not relevant for Richmond and with the demise of the CQC performance assessment the council will replace this indicator will two indicators that will monitor local priorities.

The committee requested that the indicator in its current form still be monitored for benchmarking purposes. However it is unclear whether other councils will continue to monitor the indicator and therefore whether we would still be able to benchmark.

The Committee expressed concern that delayed discharges may increase in light of the Social Work teams moving out of the acute hospitals. They were assured by officers that the situation was being monitored weekly and any problems would be identified to senior managers for resolution.

It was RESOLVED that the report be NOTED.

The Committee received a second performance report of the Director of Adult and Community Services containing the outcome of the 2010 performance ratings for Adult Social Care from the Quality Care Commission.

The Committee heard that this would be the last CQC assessment and its replacement had not yet been announced.  Richmond council had been commended on the work it had done on the implementation of Self Directed Support and in general had received very positive results.

The committee requested that in the future performance or assessment information be brought alongside case studies or examples to explain how these good practices impacted on peoples lives.

It was RESOLVED that the report be NOTED.

The Committee is asked to consider a report (attached) providing details of the first meeting of the Housing Task Group and the resulting recommendations for terms of reference.

Councillor Lisa Blakemore updated the Committee on the work of the Housing Task group.  The Committee heard that Councillor Blake more had been elected as Chairman of the Task group.  She advised the committee that at its first meeting the Group had felt that the remit set by the committee although helpful, was too broad.  It had been agreed that the groups work would be best focused on Homelessness and particularly homelessness in young people, how national policy changes may affect this problem, and how to address the complex needs of young homeless people as a local authority.

It was RESOLVED that the Task Group terms of reference included in the written report be AGREED.

The Committee is asked to consider and approve the work programme for the rest of the municipal year.

The committee received a report of the Head of Democratic Services containing the Committee Work Programme for the remainder of the municipal year.

A committee member requested that West Middlesex Hospital be invited to attend the meeting.

It was RESOLVED that the Work Programme be AGREED with responsibility delegated to the Chairman and Vice Chairman in consultation with the Health Scrutiny Officer to make any necessary changes for the next agenda.