Council and democracy

To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 17 February 2015.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee, held on 17 February 2015, were approved as a correct record.

To receive additional items that the Chair is of the opinion should be considered as a matter of urgency, in accordance with Section 100B (4) (b) of the Local Government Act 1972.

An urgent item of business was raised for the Members attention by the Chief Operating Officer of HealthWatch Thurrock on Coach House, a residential care home. The providers, Family Mosaic, have served notice to the CCG.

The Officer confirmed that Family Mosaic was no longer in the market to run this service and keeping this home open was not an option. There are currently nine Thurrock residents in the home. The Officer confirmed that the options for replacement were not huge and that each patient would need to be dealt with individually and in a sensitive manner.

The Chair asked for clarification on how long it would take to find replacement homes for the residents. The Officer confirmed that clinical assessments will be carried out individually for each patient so therefore no timescale can be given at this time.

The Committee agreed that the Coach House item be referred back to the Committee in October 2015 for review.

RESOLVED:

1.         That an update on Coach House be included on the work programme for October 2015 under Items Raised by HealthWatch.

Councillor Cherry declared a non-pecuniary interest in respect of Agenda 9 ‘Adult Social Care – Budget Review and Service Reduction’ as his wife works for SERCO in the Thurrock Therapeutic Service.

Councillor Gupta declared a non-pecuniary interest in respect of Agenda 9 ‘Adult Social Care – Budget Review and Service Reduction’ as he was a carer.

The Health Overview and Scrutiny Committee Terms of Reference were noted.

The Officer presented the report which highlighted a summary of the findings and feedback from both the pre-consultation and public consultation process which informed the Thurrock CCG’s decision to close the walk in service from April 2016 and reinvest the funds in four GP hubs across Thurrock.

The Officer referred Members to Appendix A – Evidence of completion of the Public Consultation Plan.

The Officer confirmed that the Corringham and Tilbury hubs were up and running. Open for three hours, 9.00-12.00am, on a Saturday and Sunday. The Grays hub was due to open by the end of July 2015 and the South Ockendon hub were due to be opened in September 2015.

The Committee agreed that more information on the locations and the opening times of the hubs was required so this could be more available to residents.

Councillor Gupta asked the Officer if the data received from the consultation was sufficient to make the decision to close the Walk in service which would have an impact on residents. The Officer confirmed that the report data was from the public meetings and consultation feedback. HealthWatch Thurrock also publicised and shared the consultation and consultation document at a further 700 meetings. The Officer confirmed that all the evidence received was sufficient.

Councillor Gupta asked what happened to the petition on the Walk in Service. The Officer confirmed that they had heard of such a petition but never saw any evidence and it was not presented to the CCG.

The Chair asked for clarification on why the South Ockendon hub is now located in Purfleet. The Officer confirmed that over the past six months they had visited four different premises and the Purfleet site was the only one that the CCG had agreement  to run the  weekend GP hubs. The Officer also confirmed that if you lived in South Ockendon or Aveley you would have the option to go to the Grays hub if you wished.

The Grays hub will be situated at the Thurrock Hospital. If a more central location became available the Officer confirmed that they could shift the hub.

Councillor Gupta stated that the hubs were not proper GP appointments but more for an emergency appointment. He stated that a patient is in more need of an appointment with a GP rather than an emergency appointment.

Councillor Halden asked the Officers where the funding had been found to open the hubs as the Walk In service had not yet closed. He understood that the walk in service had to be closed first so that invested funds could then be used to open the hubs. The Officer stated that the GP hubs were being funded by a pot of money awarded by NHS England. The money saved from the walk in service would be used to invest further in the hubs to develop them further.

A discussion took place on the challenges of GPs in the borough and how these were being addressed.

The Chair stated that he was  ...  view the full minutes text for item 5.

The Director of Commissioning Operations, NHS Midlands and East presented the report that provided a summary of the key issues for NHS England with regards to primary care strategy.

It was agreed by Members that Alastair McIntyre from NHS England be invited to future Health Overview and Scrutiny Committee meetings.

Councillor Halden commented that he found the report helpful but was expecting a bigger picture. Particularly on those areas that were under-doctored and what was being done to recruit GPs.

The Officer apologised that the report wasn’t more specific to what Councillor Halden expected. His report focused on the recent challenges in the Tilbury area. The Officer continued to state that Thurrock had the lowest ratio of GPs to patients and that the area must be targeted to develop primary care and make it more attractive, with better infrastructure and GP schemes.

The Officer stated that the Estate Strategy for Tilbury would be ready by December 2015.

The Officer confirmed that the buildings/GP premises were a significant part of the process. The CCG is working with the Director of Adults and is currently in the interview process for recruiting a new primary care lead.

Councillor Gupta asked for regular updates on the progress of recruiting GPs from the NHS which will be discussed at future committees.

The HealthWatch Thurrock Representative commented that it is their role to represent the Thurrock residents and that communities need to be involved in the decision process.

The Officer confirmed that patients were being written to, informing them of all GP changes and issues.

The Chair asked the Portfolio Holder, Councillor Rice, if items would be referred to Cabinet so that they could be made available to the press.

A discussion took place on how to improve GP surgeries and highlighted the following:

- New GPs do not want to have their own practice

- New GPs do not want premises responsibility

- Ratio between GPs and Patients needs to be right – higher patient to GP ratio than average      

- Packages to attract new GPs

- Other options and incentives – but not just focusing on the money

- Training to ensure current GPs are supported

- Be aware that practices nurses and other primary care roles were also in crisis and needed to be addressed

Councillor Halden left the meeting at 8.22pm.

The Director of Adults requested Director of Commissioning Operations to streamline the system on how the buildings can be used. He confirmed that he was already working on this.

The Chair agreed with the report but agreed that residents need to be consulted on changes.

The Committee agreed that the Primary Care item be referred back to the Committee in December 2015 for review.

RESOLVED

1.         That the update report on Primary Care in Thurrock be noted.

2.         That the item Primary Care be added to the work programme for December 2015.

3.         That Officer Alastair McIntyre, NHS England, be added to the Health Overview and Scrutiny distribution list.

The Officer presented the report which stated that the Essex Health and Care Economy had been selected for the first wave of the newly announced Success Regime. The two other areas selected were Devon and Cumbria.

The Officer stated that this was a national directive to address long standing and deep rooted issues that were affecting the quality and sustainability of services for patients and the public.

The Officer explained that the success regime would not solve all of Essex problems as it is a large and complex area with a population of more than 2 million. The key issues for Essex were recruitment and the high turnover of staff.

The Officer explained that arrangements were still to be put in place, the most important being the recruitment of the Programme Director who would oversee the work. Further updates will be reported back to Members in the December 2015 committee.

The Chair commented that it sounded like an exercise of taking facilities from one area and putting them into another and why Essex could not be split into two (North and South).

The Officer confirmed that no assumptions had yet been made on facilities and confirmed that as Essex is such a large authority this may have to be the case.

The Chair and Members agreed that it was actually only a name at this time and nothing else seems to be in place.

Councillor Gupta stated that there should be more services rather than structures.

The Director of Adults stated that there is some nervousness as to where this success regime is taking us but at this time it should not stop anything else happening and permission will be given to do something new if required.

Councillor Cherry asked the Officers how Thurrock will cope with more people moving into the area. The Officer confirmed that funding is in relation to population, so regeneration of the borough generates more opportunities and more budgets. Hence more people would mean an increased budget for more staff and services. The Officer confirmed that the population growth in the borough should not be seen as a negative.

Councillor Rice stated that forward thinking of services should be more around the demand of today and not what they were like years ago.

The Committee agreed that the Success Regime item be referred back to the Committee in December 2015 for review.

RESOLVED

1.         That the contents of the report to introduce the regime and any implications that emerge for Thurrock were noted.

2.         That the item Success Regime be added to the work programme for December 2015.

Officers Andrew Pike, Alastair McIntyre, Yomi McEwen and Dr Anand Deshpande left the meeting at 8.52pm.

The Director of Adults, Health and Commissioning introduced the report which highlighted a series of Council budget savings which were no longer deliverable and required all directorates to make additional in-year savings. The report looked at how these savings will be realised and what areas will require consultation.

The Officer stated that the directorate’s contribution to the Council’s in-year savings target is £500,000 – to be delivered this year.

The Officer talked Members through the list of proposals to deliver the £500,000 savings. Four savings proposals will be subject to consultation which will commence on 1 August and will run for 8 weeks working with the Thurrock Coalition. Other savings will be implemented immediately by management action to ensure the figure is delivered this year.

The Thurrock Coalition representative agreed that the appendices will have a major impact and cause emotional distress to residents.

Councillor Gupta asked the Officer if any analysis on the management structure had been undertaken. The Officer confirmed that there is evidence that the management structure is not top heavy, that there is a right balance for the service delivery and that the structure is continually looked at.  In fact manager workload had increased significantly including new duties and responsibilities.

The Officer also stated that credit was due to his team for implementing the Care Act and that Service Users will see these impacts over some time.

Thurrock HealthWatch Representative asked the Officer to consider changing the consultation period of 8 weeks to 12 weeks as it currently states in the Compact.

The Officer confirmed that he is happy for this to be changed but stated that savings may not be fully delivered this year if this time is extended and that further saving opportunities would have to be identified in addition to those detailed in the paper. The Officer will finalise the document and share the consultation paper in mid to late August.

The Chair suspended standing orders at 9.15pm. All members agreed to continue.

Mandy Ansell, (Acting) Interim Accountable Officer of Thurrock CCG stated that the cuts would most definitely put further pressure on NHS services, with more people going to A&E. She appealed that the cuts be made elsewhere that did not directly impact on the most vulnerable people.

Councillor Rice stated to the committee that there was no easy option. A 25% reduction in adult social care already had staff working over and above and it is now time to listen to the consultations and look at undertaking services differently.

Councillor Cherry asked for some examples of the items of equipment up to the value of £50. The Officer stated that they were preventative measures such as raised toilet seats or towel rails. These items will be part of the consultation. The Officer also confirmed that residents who have difficulties installing such items could use the services handy man or work with the local community to do tasks. Councillor Cherry supported this.

The Committee agreed that the Meals on Wheels Paper  ...  view the full minutes text for item 8.

The Officer introduced the report which provided the committee with an update on the Health and Social Care Transformation Programme.

The Officer stated that since the report was been issued the Department of Health had confirmed that Part 2 of the Care Act would be delayed until 2020. The Officer stated that further clarification was still required.

The Members were advised that Part 1 of the Care Act became operational as of April 2015 and that although the Council had met the requirements of Part 1 of the Act there were still a number of risk areas and that it will take time for some of the changes to be embedded. The Officer stated that through the Care Act Implementation Group activity will be undertaken to measure how well embedded certain elements of the Act were.

The Officer also updated the Committee on progress made to implement the Better Care Fund Plan (BCF).  An Integrated Commissioning Executive has been established to oversee the delivery of the BCF and its accompanying project plan.

The Committee agreed that the Health and Social Care Transformation Update item be referred back to the Committee in December 2015 for review.

RESOLVED

1.         That the contents of the Health and Social Care Transformation Update Report be noted.

2.         That the Item Health and Social Care Transformation Update will be added to the work programme for December 2015.

The Officer introduced the report which detailed that following the Chancellor’s pre-budget statement the Public Health Grant was to be cut nationally by £200 million.

The Officer confirmed that if this figure is applied pro-rota to all local authorities it will amount to a cut of £614,000 to Thurrock’s allocation. The Officer stated that further clarification was still required to understand how this will be delivered.

The Chair stated that the reason why it had gone so quiet is that local authorities had already signed their public health contracts. The Officer agreed that this might be the case.

The Officer referred the Members to the proposed reductions on page 143 of the Report.

All members agreed that these cuts should be publicised as a means of communicating and educating residents on what services are available and how to utilise them better.

The Chair agreed and that the introduction of the community hubs may also help get this message across.

RESOLVED

1.         That the contents of the report to consider and comment on the proposed reductions to the Public Health Grant for 2015/16 are noted.

The Chair and Members agreed that the following items be added to the work programme:

·                That an update on Meals-on-Wheels be included on the work programme for October 2015.

·                That an update on Coach House be included on the work programme for October 2015.

·                That an item on HealthWatch be included on the work programme for all meetings.

·                That an update on Primary Care be included on the work programme for December 2015.

·                That an update on Success Regime be included on the work programme for December 2015.

·                That an update on Transforming Adult Social Care be included on the work programme for December 2015.

·                That an update on Savings will be included on the work programme for December 2015 under Item Budget Update.

Members were in agreement with the proposed changes to the work programme, following which the Chair requested that an updated work programme be circulated to the Committee and officers following the meeting.

The Chair advised the committee that the October 2015 committee would be cancelled due to insufficient business. The Chair requested that Members, officers and co-optees will be notified of this following the meeting.

RESOLVED

1.         That the work programme be noted subject to the amendments detailed above.

2.         Pursuant to Chapter 5, Part 2, Committee Procedure Rules, Paragraph 2.2 and after consultation with the Chair the September meeting is duly cancelled for insufficient business to transact.