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To approve the minutes of the meetings held on 27 March 2018 and 23 April 2018 as an accurate record.
The minutes of the meetings held on 27 March 2018 and 23 April 2018 were agreed as an accurate record.
Disclosure of Interests
In accordance with the Council’s Code of Conduct and the statutory provisions of the Localism Act, Members and co-opted Members of the Council are reminded that it is a requirement to register disclosable pecuniary interests (DPIs) and gifts and hospitality to the value of which exceeds £50 or multiple gifts and/or instances of hospitality with a cumulative value of £50 or more when received from a single donor within a rolling twelve month period. In addition, Members and co-opted Members are reminded that unless their disclosable pecuniary interest is registered on the register of interests or is the subject of a pending notification to the Monitoring Officer, they are required to disclose those disclosable pecuniary interests at the meeting. This should be done by completing the Disclosure of Interest form and handing it to the Democratic Services representative at the start of the meeting. The Chair will then invite Members to make their disclosure orally at the commencement of Agenda item 3. Completed disclosure forms will be provided to the Monitoring Officer for inclusion on the Register of Members’ Interests.
There were none.
Urgent Business (if any)
To receive notice of any business not on the agenda which in the opinion of the Chair, by reason of special circumstances, be considered as a matter of urgency.
There were no items of urgent business.
To receive an update from representatives of the South London and Maudsley NHS Foundation Trust on their recent CQC inspection.
The Director of Nursing presented the findings and recommendations as well as the improvement work to date arising from the Care Quality Commission (CQC) Core Service and Well Led inspection of July- August 2018.
The Sub-Committee learned that the inspection took place over a two week period. Five pathways as well as 20 acute wards were inspected.
There were two key areas of concern which resulted in the issue of warning notices under the Health and Social Care Act which were:
•Concern about the governance systems in a small number of wards.
•Lack of oversight of senior management on the significant issue of lack of beds on 36 occasions, 12 months prior to the inspection.
Since the inspection and feedback received there had been eight meetings of the Trust management team to address the highlighted areas of concern and had focussed upon the following:-
•The adoption of a borough by borough model of operational directorate, as well as a Clinical Director supported by a multi professional leadership team to look specifically at Croydon issues.
•Addressing issues within the clinical leadership in order to achieve parity of esteem.
•Recruitment and retention of staff and the voice of the staff across the whole organisation.
•Receipt of the draft findings from the CQC inspection and working to a strict timeline to submit to the Board as well as the CQC the improvement plan.
•Addressing challenges arising from funding challenges
In response to a Member question about what was being done to strengthen the leadership of the Croydon directorate, officers advised that many of the senior posts had been recruited and there was now a robust senior management team in place who had been devising and working on the delivery of the implementation plan. The team would be tracking and managing facilities and teams as well as focusing on patient experience.
A Member commented that the report highlighted concerns that Croydon had specific difficulties with a lack of patient discharge plans. Officers agreed that the Trust had experienced commissioning issues and which had impacted on the quality of service. The introduction of a borough based leadership and management structure would ensure that these issues were managed as a priority.
In response to a Member concern about the financial implications in terms of displacement to other services if patients were accelerated through the system too quickly, officers stated that it was important to ensure that service users were not kept as in-patients for longer than required. Indications show that the Trust was not being proactive enough in moving patients on from one system to another and the CQC had made it clear there was a need to provide care to patients in the least restrictive environment.
It was commented that it was disappointing to learn about SLAM’s rating, which had usually been good, and it was questioned whether this could be attributed to the directorate having lost line of sight. It was confirmed that lack of oversight was a key issue and one which the ... view the full minutes text for item 28/18
To receive a report from the Croydon CCG on their commissioning intentions (report to follow).
The Director of Commissioning gave a presentation which provided an update on their operating plans for 2018/19 and the draft commissioning intentions for 2019/20.
During the presentation the following points were covered:
•The strategic vision and how challenges would be managed
•Addressing the imbalance in systems relating to the Strategic Transformation Plan (STP).
•Significant improvement had been made with the out of hospital programme including the development of improved community services, life programme and other social care initiatives.
•Improvements to the accessibility of community based services were being explored with business cases for various potential improvements being prepared.
•Further challenges were identified in planned care services due to complexities
•Mental Health Services continued to be an area of challenge and remained a priority.
•Further work on action planning around discharged patients would be implemented.
•Commissioning intentions had incorporate working together to ensure service provision was in line with people’s needs.
In response to a question about what was hoped to be achieved through commissioning intentions, officers stated that they were trying to achieve a more integrated service and encourage effective partnerships through building networks with the voluntary sector, SLAM, and NHS, as well as ensuring services were being commissioned appropriately. It was important that partners worked together due to the complex needs of patients and to ensure their needs were being met, which could be achieved by working in partnership.
It was questioned whether there were commissioning challenges in terms of employment of European Union (EU) staff, officers responded that workforce in general was a challenge for the borough which was not limited to the recruitment of EU staff.
A Member questioned the waiting times for GP appointments in the borough and if any noticeable trends had developed. Officers responded that generally people could get an appointment with a GP on any day, but there were more difficulties getting an appointment with a specific GP and there was variation in different areas. Demand would always outweigh supply and the key was to change culture by empowering people to self-care where appropriate as a proportion of appointments made do not require GP interface.
It was commented that inequality was mentioned through the final pages of the report and not the beginning and that there was a need for this to be more explicit in the report. Officers agreed that it was important for this to be highlighted at the forefront and more in depth work was needed in the areas mentioned.
A Member queried the optimism of the financial proposals and questioned the feasibility of the predictions made for the coming year. Officers advised that they were now out of special measures and were in a good place to fulfil the predictions made in the financial proposals.
In response to a question about how confident officers were that the new Accident and Emergency unit at Croydon University Hospital would open in 2018 and what was being done to change the culture of patients wanting to attend neighbouring hospitals for acute health ... view the full minutes text for item 29/18
To review the activity of the Adults’ Safeguarding Board April 2017 to March 2018.
The Independent Chair, who was appointed in January 2018, presented the draft annual report. The report was an amalgamation of work from the agencies involved as well as contributions from the groups and sub-groups of the Croydon Safeguarding Adult Board (CSAB).
The priorities set for 2018/19 was to build on the work of the priorities from 2017/18 which were deemed to be good strategic priorities and included the following:
•Prevention and early identification of adults as risk of abuse
•Improved commissioning of services
•Improved and effective communication with residents, boards, partnerships and agencies
•Voice of service users to be central to the work of the CSAB
•Safeguarding to be at the heart of commissioning and delivery of services.
It was also noted that more work was needed to ensure the involvement of BME groups in the work of the CSAB and that improved engagement with colleagues would enhance the quality and increase the number of referrals.
It was commented that the report highlighted that 18% more female than male experienced abuse but the report was not explicit in stating what types of abuse was experienced and as a result there was no real sense of what the main issues were.
A Member commended the work that had been done to highlight the serious illness of hoarding and praised the Council for championing this area of focus.
A Member questioned what had been done to address some of the issues identified through the feedback received from the interviews post safeguarding process, in particular where the feedback stated:
‘Worse part of the process was being anxious to attend meeting, communication poor, drawn out process and length of safeguarding processes.’
The officer responded that they were investing in communication, training and development of sub-groups. The information received was fed back to staff, through training and development in order to improve practice over time.
It was suggested that it would have been useful if the report had contained comparative figures for other local authorities on the safeguarding referrals received during 2017/18 as it was difficult to determine if the figures for enquiries that turned into substantiated referrals were average figures. The officer stated that this cross matching of data was not common practice and that it was important to note that conversion rates of referrals to investigation was more about the level of understanding of what a safeguarding referral was, additionally it was difficult to compare figures with other local authorities due to complexities and uniqueness of each borough.
A Member stated that in relation to learning and development of staff, the report suggested that there was a low uptake of e-learning. Officers replied that whilst e-learning had its benefits, it was important for staff to have more face to face training and staff were being encouraged to sign up for these sessions.
A Member enquired about the lessons learnt from the Ofsted report on Croydon Children’s Services. Officers advised that it had resulted in a refocus of the whole service and ... view the full minutes text for item 30/18
Joint Health Overview Scrutiny Committee Update
The Chair and Vice-Chair informed the Sub-Committee that they would be attending future meetings of JHOSC and were awaiting dates to be finalised.
Members encouraged the Chair and Vice Chair to write a letter to the South West London STP regarding the lack of consultation with Croydon regarding the proposals under the STP which they were legally obligated to consult on.
To note the work programme for the 2018/19 municipal year.
The Sub-Committee stated their interest on possible items to scrutinise in future meetings which included the following:
- Closure of New Addington Community Dental Service
- Croydon University Hospital A&E
- Update on London Ambulance Service following special measures status
- Croydon Drug and Alcohol Services
- NHS England’s commissioning strategy for Croydon
The Sub-Committee also discussed the possibility of an additional meeting to be held in January 2019 in order to be able to accommodate the amount of topics that required scrutiny.
The work programme was noted for the remainder of 2018/19 municipal year
Exclusion of the Press and Public
The following motion is to be moved and seconded where it is proposed to exclude the press and public from the remainder of a meeting:
“That, under Section 100A(4) of the Local Government Act, 1972, the press and public be excluded from the meeting for the following items of business on the grounds that it involves the likely disclosure of exempt information falling within those paragraphs indicated in Part 1 of Schedule 12A of the Local Government Act 1972, as amended.”
This was not required.