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Scrutiny Health & Social Care Sub-Committee
Tuesday, 17th January, 2017

Health and Social Care Scrutiny Sub-Committee Minutes

Date:
Tuesday 17th January 2017
Time:
6:30pm
Place:
Council Chamber, Town Hall, Katharine Street, Croydon, CR0 1NX
 

Attendance Details

Present:

Councillor K Bee, Councillor C Bonner, Councillor S Fitzsimons, Councillor A Flemming, Councillor M Mansell, Councillor M Mead, Councillor A Pelling, Councillor A Stranack, Councillor L Woodley

Also present:
Barbara Peacock, Executive Director, People,
Rachel Flowers, Director of Public Health, Stephen Warren, Director of Commissioning, Clinical Commissioning Group, Janice Still, Clinical Commissioning Group, Martin Ellis CCG, Caroline Baxter, Dr John Chan, GP, Clinical Commissioning Group and Rachel Soni, Adult Health and Integration, Croydon Council.

Item Item/Resolution
MINUTES - PART A
A1/17 HEALTHWATCH CO-OPTION

A vacancy occurred due to Mr Darren Morgan, HealthWatch Croydon having stood down from his position as a Co-optee representing HealthWatch Croydon. Mr Jai Jayaraman, HealthWatch Interim CEO had advised that he would contact the Committee once a replacement had been appointed.

 

The Committee RESOLVED to note this information.
 

A2/17 MINUTES OF THE MEETING HELD ON 8 NOVEMBER 2016

The minutes of the meeting held on 8 November 2016 were agreed and signed as an accurate record of the meeting.

A3/17 DISCLOSURE OF INTEREST

At 6.35pm, Councillor Andy Stranack disclosed that he was a member of the Specialist User Group reviewing Outcome Based Commissioning for Over 65s.

A4/17 URGENT BUSINESS (IF ANY)

None.

A5/17 EXEMPT ITEMS

None

A6/17 CABINET MEMBER QUESTION TIME:
COUNCILLOR LOUISA WOODLEY, CABINET MEMBER FOR FAMILIES, HEALTH AND SOCIAL CARE

Councillor Louisa Woodley supported by her senior management team, Barbara Peacock, Executive Director and Rachel Flowers, Director of Public Health and Martin Ellis were in attendance to provide Members with a whistle stop tour of the families, health and social care portfolio.

 

Healthier food choices were discussed in relation to BME groups on lower incomes and how they are being encouraged to make healthier food choices. The promotion of healthier schools with 30% of Croydon schools committed to the programme.

 

The "Go On" - digital age has started to build relationships between the younger and older generation with the elders learning from the younger users. The department are using a digital health programme which is the first of its kind. Public Health England stated "all providers should follow Croydon's lead".

 

The Committee were concerned that the department continues to be consistently overspent and queried why as the overall budget is known. It was reported that the authority is consistently underfunded per head of population, currently there is a recognised gap of £800k. Central government are aware and are in agreement that the social care budget is underfunded.


Members enquired how the department assess its services against other authorities. Officers reported that there are peer review meeting across authorities in a safe environment officers can share experiences and give examples. It was reported that financial pressures are evident across the country in the area of adult social care.


Other boroughs had been able to use reserves to balance their books, Croydon doesn't have this. Officers are yet to visit other boroughs to make comparisons but had spoken to peers and concluded that Croydon are working better than some other areas.


Mental health is the most challenging and the one area that Croydon would like to make a difference.


Staffing continues to be a key area of concern, the department needs to recruit and retain permanent staff on either a long and short term contract. Structure will be reviewed with the restructure of 0-65 services. The authority would like to train more of our own staff currently agency and interim staff are covering the service. Over the last 12 months 33 new social workers had been recruited and retained.


Councillor Woodley was proud to announce that the Gateway service had attracted two visits from the Select Committee. The service will be expanding, using Fieldway as a successful pilot, opening a new centre in New Addington which would also connect the two communities.


Members discussed what action were being taken to improve how people can work independently by increasing the number of people who are receiving personal budgets. Personal budget champions that are service users are championing personal budgets.


The Committee discussed how staff are being retained against the wage gap that Croydon experiences against other inner London authorities. Officers reported that a defined training path was in place to attract and retain staff and a broad package is offered at all levels.


Additional information on person budgets could it include comparisons with other budgets.


The Committee concluded that they would like to keep a watching brief on personal budgets. It was agreed that the committee wanted to see what had changed for those older carers with children with learning disabilities.

 

It would also be useful to have a greater understanding of the programme of the review of care packages and across the department, the Committee would like to review what is not working well.
 

A7/17 TRANSFORMING SERVICES FOR PEOPLE WITH LEARNING DISABILITIES

CCG officers were in attendance to present this items and to respond to the Committees questions were Stephen Warren, Director of Commissioning supported by Caroline Baxter, Croydon Council.


The Committee heard the case for change in the delivery of services for people with learning disabilities, this had been necessary as demand had increased with older and younger people requiring assistance.


Officers recognised case management was important to ensure clients regular review of need and have increased capacity to deal with the additional workload. Considerations included the review and refresh of staffing skill mix and appropriate care and support for those older clients with ageing parents.
Members discussed the Cherry Orchard Road Day service and asked had had been the timescales and the outcome of the consultation process. Officers were in a position to report that the facility is currently being refurbed and service users will have the opportunity to decide if they want to be relocated back to Cherry Orchard Road, initial feedback is that the clients are happy with the alternative facility. Member would be kept informed. Members wanted to be clear that the users and carers understand that this is likely to be a permanent move? Officers confirmed that no decision has been made regarding the Cherry Orchard site and the future provision could accommodate half the site being dedicated for returning clients.


Discussions around the open public office confirmed that commissioning patterns had not altered considerably and that officers continue to have conversations with users, carers and their families to ascertain the level of their expectations. The end of January beginning of February officers hoped to have more information.


The Committee were concerned that many elderly clients would require more support and asked if any work was being done with this group of people to ensure that they are receiving the right level of support. Officers reported that most of the well-established, older cohort are no longer with us and that they are working to ensure the best possible support for those that remain. Offers of counselling to parents with children with learning disabilities is available as one main concern is that life expectancy can be shorter.


The Committee when considering the service asked what evaluation of the model of care would look like. The team confirmed that changes should result in customer satisfaction and some evidence that the service was making a difference. Happier and healthier and that the client group is happy to live in the particular setting.


The Committee concluded that the issue was a work in progress and would like to consider developments over the next 12 months to have a better understanding of how the Council is meeting the needs of this client group.
 

A8/17 OUTCOME BASED COMMISSIONING FOR OVER 65S - THE CROYDON ALLIANCE

Representatives of the Croydon Alliance were in attendance to report to the Committee, this included Stephen Warren, Director of Commissioning CCG, Martin Ellis, CCG, Rachel Soni, Head of Adults, Health and Integration, Croydon Council, Barbara Peacock, Executive Director for People, Kate Pierpoint, Age Uk Croydon, Dr John Chan, Clinical Lead, Croydon GP Collaboration and Janice Still, CCG Janice Still, John Goulston CHS had sent his apologies.


The Alliance reported that the Outcome Based Commissioning for Over 65s had been presented at December meeting of the Cabinet. This is the first year of a 10 year running contract, where the financial risk of £223m per annum had been split between CCG, £180m, £44m Adult Social Care and £30m is third party spend, however the bigger risk sits with the Council as the responsible organisation delivering social care. All parties have the belief that this is the right approach to deliver future adult social care.


Members raised concern that the Alliance agreement term of 10 years could have sustainability risks. Officers agreed that there is a risk which is why the contract is split 1 year followed by 9 years. The Committee considered that the two areas nationally that has explored an alliance model had both failed. Officers confirmed that they went "too fast" and that the guidance had been changed following these false starts. Croydon is in a "good place" with the models of care and the multidisciplinary team working, it is a good new story for Croydon.


The Alliance is committed to a long-term contract to ensure that the services transformation can take place. Across the authority, officers are signed up to long term contract.


The Committee asked the Alliance how the Health Scrutiny Sub Committee should scrutinise outcomes, as the contract is complex and recognised that as a committee there is a need for an exercise in how to scrutinise OBC in the future. Some of the areas of performance which could be reviewed are the measurement of progress, evidence of budget management etc.

 

The Alliance discussed timescales and that overall the OBC has slipped about a year, 23 Dec was a new deadline for the heads of terms to be signed off. A lot of work has been done to complete on the Alliance, with a start date of 1 April 2017.

 

Officers confirmed that the OBC should achieve 5% savings year on year for the 10 year term. This will be achieved by moving care to a different format, focusing on out of hospital locations, keeping people fit and well, strengthening community services as hospital provision is very expensive, transformation is the key.

 

The Committee were concerned that if savings are not realised who will happened to the budget. Officers reported that the transformations that are required are very important, as a major plan for all Alliance partners. Realistically it is going to take a few years to deliver.

 

The Committee concluded that they are more assured by the presentation and that as the Alliance are conducting the reviews that as things develop if these could be brought back to scrutiny.
 

A9/17 CCG PROGRESS REPORT ON THE PRIMARY CARE VARIATION REDUCTION STRATEGY

Officers in attendance to present this item from the CCG were Stephen Warren, Director of Commissioning, supported by Janice Still, CCG
Members agreed to receive this report and to forward any questions and issues to officers directly.

 

It was also agreed to bring this item back to a future meeting for further scrutiny.
 

A10/17 ANNUAL REPORT OF THE DIRECTOR OF PUBLIC HEALTH 2016

Presenting officer Rachel Flowers, Director of Public Health was pleased to present this annual report to the Committee. Rachel discussed the approach she used which had resulted in a piece work that demonstrates the positives around live changes. The report had been positively received by the Cabinet, giving a timely insight into the Croydon prospective of social isolation which had been the subject of media attention.


The report would be used as a baseline measurement of where we are at currently and how to measure trends going forward. This was meant to be a useful tool to measure against outcomes in other areas, a helpful benchmark.

 

The Committee asked what thinking there may around the annual report for next year. The Director was keen to retain the opportunity to select the topic herself which she did not want to divulge at this time but could report that the final document would be accessible and readable.
 

A11/17 SOUTH WEST LONDON JOINT HEALTH AND OVERVIEW SCRUTINY COMMITTEE

The JHOSC are due to meet tomorrow 18 January 2017 in Merton to review the draft South West London STP. The Chair would update the Committee at the next meeting.

A12/17 SOUTH EAST LONDON JOINT HEALTH AND OVERVIEW SCRUTINY COMMITTEE

The JHOSC had not met since the last meeting of the Sub Committee.


The single place of safety had was due to open once all boroughs were in agreement regarding centralised costs.
 

A13/17 WORK PROGRAMME

The Chair and Vice Chairman agreed to follow up the issue regarding financial special measures with the CCG and CHS and if appropriate receive a report at the next meeting.

A14/17 [THE FOLLOWING MOTION IS TO BE MOVED AND SECONDED AS THE "CAMERA RESOLUTION" WHERE IT IS PROPOSED TO MOVE INTO PART B OF A MEETING]
MINUTES - PART B
  None
The meeting ended at 9:38 p.m.