Venue: Council Chamber, Town Hall, Katharine Street, Croydon CR0 1NX. View directions
Contact: Simon Trevaskis Email: simon.trevaskis@croydon.gov.uk
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Minutes of the Previous Meeting PDF 115 KB To approve the minutes of the meeting held on 28 November 2022 as an accurate record.
Minutes: The minutes of the meeting held on 28 November 2022 were agreed as an accurate record with the amendments that on page 11 in the agenda pack, ‘safelty’ is replaced with ‘safely’, and on page 5, ‘by request for further rent’ is changed to ‘increased costs’. |
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Disclosure of Interests Members are invited to declare any disclosable pecuniary interests (DPIs) and other registrable and non-registrable interests they may have in relation to any item(s) of business on today’s agenda. Minutes: There were no disclosures of interest made at the meeting. |
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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.
Minutes: There were no items of urgent business.
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Director of Public Health Annual Report 2022 PDF 667 KB The Health & Social Care Sub-Committee is asked to:- 1 To note the content of the Director of Public Health’s Independent Annual Report; and 2 To endorse the recommendations in the report.
Additional documents:
Minutes: The Sub-Committee considered a report set out on pages 13 to 26 of the agenda which provided the Annual Report of the Director of Public Health 2022. The report focused on how circumstances and experiences can impact on people’s health outcomes and spotlighted how these influences impact people unequally. The report discussed what can be done to reduce health inequalities across the life course and highlighted the work already happening around the borough to address them. The Director of Public Health introduced the item and summarised the report.
The Sub-Committee asked about the absence of women’s health and menopause services in the report and suggested that this became an item on the work programme for a future meeting. The Director of Public Health explained that they agreed that these were important issues and future Annual Reports may focus on these and related issues on sexual health, but that the focus of this report was specifically Health Inequalities. The Director of Public Health added that they took the issue very seriously and had co-founded the Menopause Support Group at Croydon Council. Members stated that they felt the lack of inclusion of menopause was an oversight and it was agreed that the Chair would engage in a scoping exercise with the Director of Public Health for a future work programme item. The Director of Public Health explained that they had been involved in the development the Women’s Health Strategy, which included menopause, and discussed the complexity of menopause support and the multiple partners responsible for providing these services and education around menopause.
Members asked why there had been less focus on the ‘Aging Well’ element, given that old age was featured as a key risk factor in many other reports, for example on COVID. The Director of Public Health explained that her Annual Report for the next year might consider this and that this report provided a reasonable overview of the whole life course and apologised if it was felt that the ‘Aging Well’ element was underrepresented. The Sub-Committee heard that the Director of Public Health report is an independent report developed on the health of the population, with a focus that the Director of Public Health chooses.
The Sub-Committee asked about the recommendations in the report, the budget for delivering these and how they would be prioritised. The Director of Public Health explained that this was not an action plan that this is an Independent report providing a compendium of health information for Croydon, and that Health Inequalities were not something that could be resolved by the local authority or NHS alone. The Director of Public Health explained that the report made a number of recommendations that reflected her view on measures that could be considered to reduce Health Inequalities that could be used by a number of organisations. Members heard that the Public Health budget was £22 million, but the content of the Annual Report was a separate statutory function to commissioning public health services with this ring-fenced funding, another ... view the full minutes text for item 4/22 |
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Responding to Urgent and Emergency Care Pressures PDF 60 KB To receive an update from Croydon Health Service NHS Trust. Additional documents: Minutes: The Sub-Committee considered a report set out on pages 27 to 38 of the agenda which an update from Croydon Health Service NHS Trust on Urgent and Emergency Care Pressures. The Chief Executive of Croydon Health Service NHS Trust and Place Based Lead for Health introduced the item and summarised the key points of the report.
The Chair asked commented on Urgent and Emergency Care Pressures being a year round issue that was more acute at winter, and asked about any imminent short term risks. Members heard that the combination of Flu, COVID and other respiratory issues had added challenge and it was not yet known if this had reached its peak or whether the challenge would further increase. The impact on staff in Urgent and Emergency care was substantial, and cumulative whilst the pressures were high. Members heard that current industrial action was affecting Croydon through the London Ambulance Service strikes, but this was being managed well; a ballot for a Junior Doctors strike was ongoing and could lead to industrial action in March 2023.
The Sub-Committee asked about patient pathways and anecdotal evidence of patients presenting at A&E instead of GPs, due to long waiting times, and pressures caused by part-time GP working. Members asked what was being done to address this, manage demand and drive residents to enrol at GPs. Members heard that capacity in hospitals, community services and primary care was greater than ever before, and that there were now double the number of GPs at the front of A&E to divert appropriate cases. The Chief Executive of Croydon Health Service NHS Trust explained that as quickly as capacity was being created, this capacity was being used due to increased demand and the slowing down of the flow of patients through services. Members heard that it was crucial to look at expanding capacity and how this capacity was used at the same time to ensure services were efficient. This was being done in conjunction with colleagues in Health and Social Care and a national pilot to integrate services was due to start in Croydon called the Frontrunner programme.
Members asked about bed blocking and were informed that there was a system in place to check the status of patients in the hospital on a daily basis to identify expected discharge dates. These dates could be extended for a variety of reasons, and these factors all contributed to the figures of those who did not require medical care, but were still in hospital. The Sub-Committee heard that because this was multifaceted, the issue was complex to solve, but work streams were looking at all factors in collaboration with Health and Social Care. Members discussed anecdotal cases of patients who had been in hospital for a significant length of time due to mental health factors, and suggested that additional psychological help for these patients could increase rates of discharge. The Chief Executive of Croydon Health Service NHS Trust agreed that this was an important issue that ... view the full minutes text for item 5/22 |
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Adult Social Care & Health Directorate - Budget & Performance PDF 140 KB The Sub-Committee is recommended to 1. Note the updates on: • 2022/23 Period 7 (October 2022) budget and savings position. • 2023/24 indicative savings (as of 10 January 2023). • The Council’s position in relation to the benchmarked key performance indicators. 2. To consider any comments it may wish to make on the 2023-24 indicative savings proposals, which will be fed into the wider budget scrutiny process led by the Scrutiny & Overview Committee.
Additional documents: Minutes: The Sub-Committee considered a report set out on pages 39 to 70 of the agenda which provided the 2022/23 Period 7 (October 2022) budget and savings position, 2023/24 indicative savings and benchmarked key performance indicators for the Adult Social Care & Health Directorate. The Corporate Director for Adult Social Care and Health introduced the item and summarised the report.
The Chair thanked officers for the detailed report and key performance data, and asked about the Period 7 Financial Monitoring figures. It was noted that an underspend was predicted for 2022/23, and it was asked why savings had not been achieved in some areas. The Director of Adult Social Care Operations highlighted the area of Disability Transitions; it was noted that significant savings had been made but that there had been difficulties in meeting the targets that had been set. The department was looking to address this through increased recruitment of staff to conduct reviews, as it was acknowledged that reviewing capacity was not sufficient; whilst there had been constant recruitment there had still been a shortfall in staffing. There had been better management of costs in the market since the start of the Director of Adult Social Care Policy & Improvement, by looking at ways to ensure the market remained resilient and was developed to provide better and more cost effective solutions.
The Sub-Committee heard that demand from 18-65 year olds was being well managed, and was the 19th largest of London boroughs; Croydon was the third best performing borough for reducing demand from over 65s from the previous year. The Director of Adult Social Care Operations explained that the direction of travel on many indicators was good and that all cases were scrutinised heavily to ensure the best value was achieved with safe and legal outcomes.
On Table 4, page 41, the Chair asked about the savings that had not been delivered and to what extent workforce issues had contributed to this. The Corporate Director for Adult Social Care and Health explained that all of these numbers were being tracked, and that reviews were ongoing alongside work to ensure that the flow from hospital discharges remained consistent. There was not sufficient qualified social worker capacity in the market, and so it had been important to look at skill mixes in officers to see where non-social worker roles could provide support. The Corporate Director for Adult Social Care and Health highlighted that the quality of work had not dropped and that culture change in the department was ongoing.
The Director of Adult Social Care Policy & Improvement explained that there had been issues with recruiting to Commissioning inside of Adult Social Care, and that good strategic commissioning was vital to delivering savings targets through a partnership approach with Operations. Commissioning capacity was now in place, it was thought that the department was in a much better place moving into 2023/24 to deliver a greater pace around reviews which it was hoped would make savings targets achievable. The importance of supporting staff who ... view the full minutes text for item 6/22 |
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Healthwatch Croydon Update PDF 61 KB This item is an opportunity for the Manager of Healthwatch Croydon, a co-optee on the Sub-Committee, to provide an update on their latest activity. Additional documents:
Minutes: The Sub-Committee received an update from the manager of Healthwatch Croydon, and co-opted member of the Sub-Committee, Gordon Kay, on the latest activity of his organisation on pages 71 to 204 of the agenda and in the attached slides.
The Chair related an experience of using NHS111 in an emergency, and stated that this had resulted in them being put on the correct pathway; the study was commended and it was asked when it was likely the recommissioning of NHS111 would be seen in Croydon. Gordon Kay responded that there was a wider piece of work around increased capacity in the South of the borough but was encouraged that additional GP capacity could now be booked through NHS111.
Members asked about the difference between GPs and GP Hubs, and confidence in the new A&E service. The Sub-Committee heard that GP Hubs were meant to be an intermediary step between a GP and a hospital, but provided limited services. Members heard there was confidence that those who went to A&E would be seen, and that there were high satisfaction rates for those who got to A&E early in their pathway.
The Chair asked if there were any topics from the report that should be included on the work programme and heard that the system should be monitored on a whole and viewed from the patient perspective. The Chair commended the report and thanked Healthwatch for providing it to the Sub-Committee. |
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Scrutiny Work Programme 2022-23 PDF 104 KB The Health & Social Care Sub-Committee is recommended to: -
1. Note the most recent version of its Work Programme, as presented in the report.
2. Consider whether there are any other items that should be provisionally added to the work programme as a result of the discussions held during the meeting. Additional documents: Minutes: The Sub-Committee considered a report on pages 205 to 208 of the agenda, which presented the work programme for review.
The Chair noted that Menopause would be added to the work programme, following a scoping exercise with the Director of Public and Councillor Benson. It was noted that scoping exercises would also be conducted on the two items scheduled for the April 2023 Sub-Committee. The Sub-Committee stated that it was keen to conduct some in person meetings in preparation for these items. |