Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillor Bouchier and from Mr Martyn Kingsford.

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.

Councillor Butler declared a disclosable pecuniary interest in item 8 (PFI Contract with Care UK) by virtue of the fact that his mother was resident at one of the care homes in question. He undertook to leave the room for the duration of this item.

In relation to item 7 (Tenancy Strategy) Councillor Speak and Councillor Head declared that they were representatives of the Council on the boards of local social housing providers and Mr Keith Sangster declared that he worked for Richmond Churches Housing Trust.

In relation to Adult Social Care items, Co-opted Member Margaret Dangoor declared that she was a carer.

To consider the minutes of the meeting held on 27 September 2012.

The minutes of the meeting held on 27 September 2012 were received and approved as a correct record of proceedings.

To receive a verbal update on the latest changes to local health services (to include an update on Healthwatch; an update on NHS NW London JHOSC and an update on Mental Health).

An update on changes to local health services was provided by Cathy Kerr, the Council’s Director of Adult and Community Services; Dominic Wright, Chief Officer designate of Richmond Clinical Commissioning Group (CCG); and by Dr Stavroula Lees-Karipoglou, the lead GP for Mental Health Services of the CCG. The Committee was advised that:

(i)      The CCG and Public Health Officers had now moved to the Civic Centre in Twickenham and the benefits of working in the same building as Council officers were already evident. The Council was also working with the CCG on collaborative commissioning programmes.

(ii)    The local authority would have a statutory responsibility to commission the local Healthwatch, which would come into existence in April 2013. However, this organisation would be independent from the Council. The Richmond LINk would need to be given support to become a social enterprise in order to form the basis of the new Healthwatch. Richmond was in discussions with Hounslow to consider whether there was a benefit in sharing resources.

(iii)   The CCG had been assessed in November by the national Commissioning Board and only two from 119 standards had been flagged as being of concern at this stage. This was believed to be one of the best results in London for CCGs assessed to date. This was a positive step towards full authorisation with the final calibration of results to be made by the National Commissioning Board by January 2013. The organisation was also financially strong in 12/13 and likely to make a surplus which would be carried forward into 13/14.

(iv)  The West Middlesex Hospital had recently announced that it would not be possible to become a foundation trust on its own and was seeking a strategic partner. A decision on the partner was likely to be made by the end of January 2013

(v)    The new Health and Social Care Centre in Whitton (Whitton Corner) was now open and provided new facilities for residents.

The Committee was provided with an update on the redesign of the Community Mental Health Service and on the changes that were due to come into effect in April 2013. It was explained that the new Richmond Wellbeing Service would operate in half of the GP surgeries across the borough. It was currently based in Regal House, Twickenham, but would be moving to Richmond Royal shortly. The transition between the previous service and the new one was described as well as the engagement and consultation process.

The outcome of the Adult Mental Health Rehabilitation public consultation was reported. The Committee was informed that the CCG had agreed to proceed to a new community based service. This meant that Riverside Lodge would close as current patients moved to alternative services.

In response to questions the Committee was informed that:

(i)      Once the Richmond Wellbeing Service was established fully residents would not usually need to travel more than five miles to access the service.

(ii)    Any money saved in the closure of  ...  view the full minutes text for item 27.

This report describes how the Health and Wellbeing Strategy has been developed by the Health and Wellbeing Board and summarises the principles, aims and priority areas for action in the Strategy.

Report of the Director of Public Health and Appendix A attached.

The Director of Public Health, Dr Dagmar Zeuner, presented the draft Health and Wellbeing Strategy to the Committee. It was explained that the Strategy was a statutory requirement; furthermore it allowed the Council and the CCG to ensure that the public health needs of the local population were met and that services were integrated. The Strategy had been developed in consultation with stakeholders and following discussions with patients and carers. It would be consulted on in its draft form for a six week period before being agreed in 2013. The Strategy identified four priority areas for service integration in Richmond, these being: child to adult services transition; mental and physical health services; health and social care services; and hospital and community services. The background to these priority areas was explained. It was also explained that the strategy could adapt to future changing needs.

The Committee discussed the strategy document as presented. It was noted that some technical language such as Lower Super Output Areas might make the strategy less accessible to lay readers. The Director of Public Health agreed to consider this issue.

In response to questions it was explained that:

(i)      It would be part of the Committee’s role, via the scrutiny process, to ensure that the Health and Wellbeing Board and the Strategy were delivering the desired outcomes for the community. It was also hoped that provision of services would be aided by the fact that GPs formed part of the Boards and were now both providers and commissioners.

(ii)    The Joint Strategic Needs Assessments (JSNA) was the document which held statistical information about the health and social care needs of the borough. This document had informed the development of the Strategy and would be linked to it.

The Committee welcomed the document but discussed whether some evidence from the JSNA could be more explicitly linked to or included in the Strategy in order to understand better its basis.

It was RESOLVED:

1.      That the report be noted.

2.      That any additional comments on the Strategy from individual Committee Members be forwarded to the Director of Public Health via the Scrutiny Officer after the meeting.

To receive a report on the progress of the feasibility study which is exploring whether an Integrated Care Organisation is the appropriate model to deliver integrated adult social care and health services to older people and people with physical disabilities.

Report of the Director of Adult and Community Services and Appendices A and B attached.

The report was presented by the Director of Adult and Community Services and the Assistant Director, Community Care Services, who explained the background to the feasibility study. The Committee was advised that new legislation allowed for further integration of services but that the Council had to first examine whether this was beneficial. At this point a more detailed business plan had not been carried out: this would happen if the findings of the feasibility study were approved by Cabinet and the decision making boards of the other organisations involved (Hounslow Council, Hounslow and Richmond Clinical Commissioning Groups, and Hounslow and Richmond Community Healthcare NHS Trust).

It was explained that the proposal was that Richmond would work more closely with Richmond CCG and, alongside Hounslow borough and Hounslow CCG, would commission an integrated health and social care service for older people and adults with physical disabilities. There would still be a separate contract for each borough. In order to carry out the study the Council had examined the work of reablement and rehabilitation services where close collaboration already occurred between social services and the NHS. It was hoped that integrating services would allow the Council to work more efficiently and would deliver a better result for residents. It was acknowledged that there would be some inherent risks in the scheme: in part due to the different stages that Hounslow at Richmond care services were currently at. It was also recognised that by working more closely with Hounslow the Adults Services directorate was taking a different direction to the Children’s Services directorate which was working more closely with Kingston borough. The Council would need to ensure it was not creating new boundaries in the process of erasing old ones.

In response to questions the Committee was advised that:

(i)      A formal partner relationship would need to be established within a legal framework. The options available if any partner organisation withdrew would need to be considered, though this was considered unlikely.

(ii)    The outcome of foundation trust applications for NHS providers could also have an impact on the delivery of an integrated care service: this needed to be considered.

(iii)   Some, though not many,  ocal authorities were ahead of Richmond in integrating their services. Some of the current NHS arrangements made integration difficult to achieve and it would be useful for the National Commissioning Board to identify ways to make integration easier.

(iv)  If and when the integration project was fully consulted on further background information such as case studies and statistical information could be provided.

Some Members suggested that as part of the list of outcomes at paragraph 9 of the report the Council could consider including a pledge to offer copies of notes and care plans to service users.

It was RESOLVED:

1.      That the progress of the feasibility study and its overall direction be noted.

2.      That any additional comments on the Study from individual Committee Members be forwarded to the Director of Adult and Community Services via the  ...  view the full minutes text for item 29.

To provide Overview and Scrutiny Members with an opportunity to comment on the proposals to inform the Borough’s Tenancy Strategy, providing relevant research findings to help inform their decision making.

Report of the Assistant Director Commissioning, Corporate Policy and Partnerships, and the Assistant Director Community Service Operations and Appendix A attached.

The Assistant Director, Commissioning Corporate Policy and Strategy and the Housing Policy and Research Manager introduced the report and explained that the Localism Act 2011 required the Council to produce a Tenancy Strategy by January 2013. This Strategy was developed in consultation with local social housing providers who would have to have due regard to it in allocating tenancies. Many providers were moving towards providing fixed term tenancies rather than lifetime tenancies. The Strategy looked to set out when these fixed term tenancies would be appropriate and how long they should be for. The Tenancy Strategy also considered issues of affordable rent. At present the draft Tenancy Strategy was being consulted on before being finalised. A fuller Housing Strategy would also be produced by the Council in 2013.

In response to questions the Committee was advised that:

(i)      It was the responsibility of each housing provider to consult with existing tenants on their own tenancy policies. However, the new Tenancy Strategy would only affect new tenants.

(ii)    Reference to ‘Right to Buy’ could be included in any ‘tenure progression’ options in the strategy following suggestions from the Committee.

(iii)   The Strategy needed to provide enough different options to be workable for housing providers.

(iv)  It was felt that five years would be an appropriate minimum length of tenancy to give tenants security. This allowed tenants to invest in their homes and to build a community. Two year tenancies would only be offered in certain exceptional circumstances. Shorter tenancies increased community instability whilst requiring the same amount of administration.

(v)    A probationary period of one year was normal for most housing association tenants at present.

(vi)  Housing providers currently had an assumption that in most cases renewal of tenancies would be made after the shorter term tenancy period expired.

The Committee discussed the draft Strategy. In relation to moving people where homes were under-occupied, some Members were concerned that this might dislodge people from social and family networks. It was noted that paying heed to social support networks could be referenced in the Strategy. The Committee also discussed appropriate lengths of tenancy and the advantages and disadvantages of short-term tenancies.

It was RESOLVED:

1.      That the report be noted.

2.      That any additional comments on the Tenancy Strategy from individual Committee Members be forwarded to Assistant Director, Commissioning Corporate Policy via the Scrutiny Officer after the meeting (but before the draft Strategy be considered at Cabinet in December).

This report provides Members with an update on negotiations to vary aspects of the Council’s Private Finance Initiative (PFI) contract with Care UK for residential and nursing care across three care homes within the Borough.

Report of the Assistant Director, Adult & Community Services attached.

Having declared a pecuniary interest Councillor Butler left the room for the duration of this item.

The Assistant Director, Community Care Services, presented the report. The background to the report was explained. The Committee was informed that the Care UK contract had been established in 2001 but that since this time the Council’s requirements had evolved due to changing local demographics. The report explained the current services provided at the care homes in question, the different types of beds and services that the Council commissioned (e.g. residential or nursing categories), and the existing requirements of clients. There was currently an over supply of standard residential care beds which the Council had to pay for regardless of whether used. It was proposed that this system was realigned to better fit current needs and to allow for more flexibility in bed use.

In response to questions the Committee was advised that:

(i)      The Council could not impose changes and had to work within the prevailing contract mechanisms. To effect the changes required it was necessary to negotiate with Care UK so a suitable arrangement was put in place that was beneficial to both parties. The changed arrangements would be reflected in approved and acceptable contract variations.

(ii)    Arrangements to manage issues arising from private residents who could no longer afford to pay for their own care would form part of the revised agreement so as to protect the financial impact to the Council.

(iii)Respite care remained a key service and would be provided from with the contracted beds available or alternatively sourced if none were available.

The Committee discussed financing for residential and nursing beds and the mismatch between self-funders and those who were funded by the local authority.

The Committee welcomed the report and recognised the need for flexibility, but also the constraints of the contract given it had been drawn up for a long period of time.

It was RESOLVED:

That the report be noted.

This report is being presented to enable scrutiny of the Adult Social Care and Housing revenue and capital budgets.

Report of the Director of Adult and Community Services and Appendices A to D attached.

The report was presented by the Head of Finance who provided a summary of the information contained therein. It was explained that the forecast under-spend of £333,000 only represented a 0.5% variation from the overall projected budget. The Head of Finance outlined which services had forecast under-spends and which had forecast overspends. In relation to adult social care a planned under-spend was to be used for other services in line with Cabinet Member agreement. This would be reflected in future reports to the Committee so that it would no longer be registered as an under-spend. The report also outlined the current forecast overspending on homelessness; however, the new ability to discharge housing functions via private sector housing should in part address this and reduce the numbers of people in temporary accommodation in the future. The Head of Finance additionally provided information on the Adult and Community Services Capital Programme.

In response to questions the Committee was informed that no one had yet been offered private sector accommodation: the Council needed to wait for suitable properties to be available at the same time as suitable clients presented themselves. This system was not easy to manage as there was currently a high demand for private rented property in the borough and available properties could not be reserved indefinitely. In relation to payments to assist people remaining in their current properties, it was explained that discretionary housing benefit payments could be made in some cases, but that the available funds were limited and the Council had spent 71% of its allocation in the first half of this financial year.

The Committee discussed funding that had been allocated to useful projects such as Winter Warmth and Safe at Home projects and funding for carers’ breaks. Members also discussed responsibility for funding care provision when clients moved from one borough to another. It was heard that it was sometimes necessary to employ a legal procedure to determine which authority was responsible for care in certain more complex cases.

It was explained that in relation to transport services, some changes in funding had occurred with the start of the new school year, but that savings of £200,000 were anticipated overall.

It was RESOLVED:

That the report be noted.

This report provides an update on performance in relation to projects and indicators for Adult Social Care and Housing for the period July to September 2012. 

Report of the Director of Adult and Community Services attached.

Margaret Dangoor was not present for this item.

The Director of Adult and Community Services introduced the report and explained that there were no areas in which the Directorate had been underperforming in order to be reported. However, the report provided additional information about homelessness and procurement.

It was RESOLVED:

1.      That the positive progress in relation to delivery of key priorities for Adult Social Care and Housing be noted.

2.      That the local impact of national housing changes be noted

3.      That the progress on procurement in Adult Social Care be noted

To receive a report giving details of the proposed work programme for the Health, Housing and Adult Services O&S Committee.

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

Margaret Dangoor was not present for this item.

The Committee considered its work programme for the remainder of the municipal year.

It was RESOLVED:

That the Work Programme attached at the Appendix be noted, subject to the following additions and alterations:

·        Update on West Middlesex Hospital foundation trust application (possible presentation) to be considered in early 2013

·        Amalgamate all JHOSC updates into one item in January 2013

·        Budget and Fees and Charges items to be considered towards the beginning of the agenda in January

·        Housing Services item could be considered in March 2013 rather than February