The following questions were received:
John Holman: Recently I went to my GP for my audiology problem. I needed to see a consultant. My GP said he was required to send the consultant request to a private company in Brighton, who would vet it. Croydon University Hospital later sent me an appointment. Gavin Barwell MP said this was NOT government policy but a local decision?
Responses:
This is a local system implemented by the CCG 18 months ago. It helps GPs to make referrals into secondary care. The organisation is based in Brighton. It is staffed by GPs who review referrals to secondary care. This is to ensure that referrals are made in a way which reflects best clinical practice. The systems also educates and support GPs in making referrals. The service will talk through with a GP the pathway selected and the most appropriate providers.
A follow up question was made by Peter Howard: How much do referrals cost? Why not trust GPs? Referral sent to Brighton - patient has to wait - comes back to CUH. Why has Croydon chosen to do this unilaterally? Not national policy. Are we paying private companies to second guess GPs?
Response: The system was introduced to address significant variation in referrals. There were a relatively high number of instances where forms were not correctly filled in and where referrals to secondary care were not appropriate. Overall the system helps to reduce the costs of inappropriate referrals or treatments.
Anne Milstead: I asked a question last time about the levels of care available in the Borough which are noted in the minutes. They also say, "we will go back to service and ask for information requested". It seems to me that the question about whistleblowers has not been answered, nor has the question about PUBLIC involvement BEFORE the commissioning and implementation of a service.
My question this time follows from last time and is how much does Croydon Council pay for care per hour bearing in mind that the Care Home Association have costed for a minimum realistic and economic and sustainable charge to Local Authorities of £15.19 per hour, which is made up by:
£6.31 minimum wage
00.71 N/I contributions
00.81 holiday pay
15.91 with nothing for pension, which is mandatory now and I imagine that you would like the carers to have a pension?
Written response (after the meeting) from Steve Peddie (Head of Commissioning for Older People and Long Term Conditions):
In answer to the issue of whilstleblowing I do not know what the issue was but the Council clearly has a Whilstleblowing policy and in terms of commissioned services there are numerous examples of commissioners investigating allegations made by whilstelblowers of provided services.
The answer to the second issue is that the Council considers it good commissioning practice to consult with users and carers, as well as existing providers of services, before commissioning and implementation of services. The Council's Commissioning Strategy p15:
"We will understand the needs and priorities of our citizens, now and in the future and clearly specify our requirements;
We will involve customers and service users in the planning, design, monitoring and evaluation of services;"
Lastly, in terms of how much the Council pays for care per hour, this can depend on which setting we are talking about. Residential and nursing rates have previously been provided as an FOI and are in the public domain (see Appendix P&V)
Peter Howard: How many deprivation of liberty orders are made in Croydon? How many were refused? I am concerned that the only person who has to sign off is Director of Social Services? If prisoners are deprived of liberty, there is an independent review process. Why is there not an outside body overviewing these decisions by Council?
Response:
Hannah Miller: The figures are reported in annual safeguarding report. We follow the legislation on deprivation of liberty safeguarding orders to the letter. Concerns about the process would need to be made to Secretary of State. Case assessment is carried out by one of the council's care managers. It will also include a doctor's report. The recommendation will be to agree or refuse the request. My experience is that the reports are of a very high quality and if I have any doubts, will challenge.