Agenda and minutes

The Chairman gave details of the arrangements in case of fire or other event that may require evacuation of the meeting room.

Apologies for absence were received from Councillor Dilip Patel (Councillor Philippa Crowder substituting).

Members are invited to disclose any interests in any of the items on the agenda at this point of the meeting. Members may still disclose an interest in an item at any time prior to the consideration of the matter.

There were no disclosures of interest. Ian Buckmaster of Healthwatch Havering left the meeting room during the item on implementation of Healthwatch in order to avoid a conflict of interest.

To agree as a correct record the minutes of the meetings held on 8 September 2014 (joint meetings of all overview and scrutiny committees) 9 September 2014 and 23 September 2014 (joint meeting with children & learning overview and scrutiny committee). All minutes attached.

The minutes of the meetings held on 8 September 2014 (joint meeting of all overview and scrutiny committees) 9 September 2014 and 23 September 2014 (joint meeting with children and learning overview and scrutiny committee) were agreed as a correct record and signed by the Chairman.

The Committee noted with pleasure that Havering had become only the second London borough to be awarded dementia friendly status. Congratulations were recorded to the Council, Clinical Commissioning Group (CCG) Healthwatch and local businesses who had all been involved in gaining the accreditation.

Presentation from officers of North East London NHS Foundation Trust.

North East London NHS Foundation Trust (NELFT) officers explained that a partnership had been established between NELFT and Havering CCG to deliver care at home. The productivity of community beds had been reviewed and this had led to the introduction of the community treatment team and intensive rehabilitation service (IRS).

The IRS composed of a team of physiotherapists, nurses and occupational therapists. The service, which had commenced in November 2013, operated seven days a week across Havering, Redbridge and Barking & Dagenham. A total of 535 patients had been seen since the service started. The service had received very good satisfaction survey scores and a large number of compliments about the service provided.

It was clarified that occupational therapy was no longer provided as a standalone service but was delivered within multi-disciplinary teams such as the IRS, community rehabilitation team and mental health service teams. The community treatment team was a seven day a week service treating people at home.

NELFT’s community health and social care service had been remodelled over the last six months and now consisted of six cluster-based teams comprising community nurses, therapists and mental health link workers. These teams were designed to provide longer term support at home.

The community rehabilitation team was a multi-disciplinary service for sufferers of neurological conditions such as head injuries, Parkinson’s disease, motor neurone disease and multiple sclerosis. Occupational therapists were also based in mental health services such as community recovery and early intervention teams from where casework support and specialised intervention could be offered. It was clarified that post-traumatic stress disorder would normally be treated under NELFT’s community recovery teams. It was conformed that military veterans received priority access to medical services.

Services now commissioned from the Richmond Fellowship helped people with mental health conditions access education and training and it was confirmed NELFT were engaged with these services. No other mental health services were currently being recommissioned.

The waiting time to receive treatment varied depending on acuity. Home treatment could be provided with two hours of referral while a routine response could be provided within four weeks. The period from referral to diagnosis had been reduced to 10 weeks and the national target for diagnosis of dementia was believed to be 67%. 

NELFT officers would confirm the number of Havering patients seen by the IRS to date though it was confirmed that Havering did have the highest throughput of the three boroughs. More patients were being seen by the service than under the former community beds model.

There were a total of 36 staff in the IRS. There were 1-2 vacancies that were filled with agency staff although it was agreed that recruitment to occupational therapy was a problem nationally. There were a total of 10 occupational therapists for the three boroughs covered which was a higher figure than under the community beds model.

There had been a good referral rate from GPs to both the IRS and the Community Treatment Team. Referrals could also be made by patients direct.  ...  view the full minutes text for item 16.

The lead for the Prime Minister’s Challenge Fund across Havering, Barking & Dagenham and Redbridge explained that the three local CCGs had won £5.6 million from the fund in order to improve services.

There were a total of 48 GP practices in Havering. Havering’s current population was 237,000 and this was expected to reach 250,000 by 2016. Havering also had the largest older population in London. It was felt that there was a need to improve primary care and the Primary Care Transformation Programme sought to use the monies from the Prime Minister’s Challenge Fund to do this. The funding would be used for three areas – improving GP access, supporting people requiring complex care and the introduction of shared IT systems.

It was planned to improve patient experience in primary care and to introduce more GP appointments available in the evenings and at weekends. 

The complex care workstream focussed on the 1,000 most vulnerable patients in Havering. A team had been set up including GPs, social care specialists, nurses and consultants with the aim of reducing the reliance on hospital care for this group of patients. A treatment centre was available at King George Hospital but it was explained that this would only be needed for diagnostics with most treatment taking place in a person’s home.

Care would be tailored to each patient, taking into account their goals and what they wished to accomplish. It was planned that this programme would increase primary care capacity for other patients, in addition to reducing admissions to hospital. There would be quicker decision making for the 1,000 patients under the scheme with consultants undertaking home visits. The Complex Care 1,000 team would also have access to all notes for patients using improved IT systems. This would allow better decision making for patients. Patients could choose to leave their GP to transfer to the new programme but would be free to return to their old GP if they wished.

Havering GPs were committed to the Complex Care 1000 project for two years and patient experience would be analysed by Nuffield Health. It was agreed that the patient experience analysis by Nuffield Health should be brought to a future meeting of the Committee.

GPs wished to undertake more telehealth with for example remote blood pressures teats and consultations by Skype introduced. It was accepted that the sharing of notes was an issue and that not all patients were happy for their notes to be shared within doctors. It was hoped to move to I-Pads to allow the inputting of notes directly onto all relevant systems. Following the introduction of the new IT system from February 2015, care providers and Council staff would be trained on the new procedures.

Recruitment to the new scheme had been good although and the number of GPs reaching retirement remained an issue for the health economy. GPs were aiming to encourage the training of new recruits. GPs recruited to the Complex Care 1,000 programme were very experienced and not currently  ...  view the full minutes text for item 17.

Discussion with representatives from the Havering GP Federation – Havering Health Ltd.

The Interim Chair of the local GP Federation – Havering Health explained that the Federation was a group of local GPs working together. The aim of the Federation was to ensure a well-resourced, high quality local health service. Thirty-nine o the fifty-eight GP practices in Havering had joined the Federation and this represented around 84% of patients at Havering GPs. Those practices who had not joined the Federation would also be engaged with.

The Federation was closely regulated by the Assurance Panel of the Care Quality Commission as well as by the existing GP regulations enforced by NHS England and other organisations. The Federation had also engaged with Healthwatch Havering.  

GP Federations were being encouraged by the London Health Commission in the light of declining funding for GP services. There were also increasing demands on GPs due to the ageing population and higher disease prevalence and complexity of care. GP Federations were now operating in a number of areas including Barking & Dagenham, Hackney and Tower Hamlets. The Federation wished to work with the Sub-Committee to improve the quality of care for Havering patients.

While there was a fee of £1,000 to join the Federation, it was not felt that this was the main reason why some GP Practices had declined to join the Federation. One practice had declined to join as it disagreed with the general philosophy of Federations.

The GP Federation had provided access via a hub to appointments from 6.30 – 10 pm, Monday to Friday. The level of expertise in the Federation meant it could for example help GP practices improve their rates of smoking cessation. Work would be undertaken with the Barking & Dagenham and Redbridge Federations to develop training for GPs. Recruitment would also be addressed by the Federation.

It was hoped to extend opening of the hub to include weekend GP appointments although CCG had also commissioned weekend service. This was however planned to cease operating at the end of March. The hub was a pilot scheme for two years at the end of which it was planned to procure a permanent provider.

The demand for the Federation’s out of hours services had increased recently with 28 appointments offered each evening. Weekend appointments were not available as yet. The Federation was keen to increase referrals to the service from Queen’s Hospital and the polyclinic at Harold Wood. No referrals had however been received as yet from A & E and the possibility of having the out of hours service present on site at A & E was being investigated.

The emphasis would also be placed on reducing attendances at A & E and the ‘Don’t go to A & E’ campaign was being updated with the launch of a phone app. Referrals to the out of hours hub from NHS 111 and via GPs had now commenced.

It was accepted that there was a lack of information about the out of hours service in GP surgeries that this was intentional at this stage. All Havering GP surgeries were aware  ...  view the full minutes text for item 18.

Presentation by Barbara Nicholls – Head of Adult Services on the impact on carers of Care Act assessments.

The Head of Adult services explained that the Care Act had received Royal Assent in May 2014 and that the legislation would be enacted from April 2015. The associated funding reforms would take effect from April 2016. The Act put carers on the footing as those they cared for and placed upon the Council a new duty to support carers. Personal budgets, a form of direct payments were also now on a legislative footing.

The funding system for care and support was being reformed by the Act with a cap introduced on care costs and a much higher threshold for care payments. These changes would have a lot of implications for Havering. The universal deferred payment scheme was also being extended which allowed Councils to reclaim care costs from a person’s property after they had died.

Also being introduced was a continuous duty of care if people moved between boroughs as well as new duties to ensure care was still provided if a provider failed. Transition arrangements between children’s and adult care were also strengthened by the Care Act. Safeguarding adults would also now be placed on a statutory footing. The Council already had a Safeguarding Adults Board which met bi-monthly and the Council was required to ensure that the Board had a proper workplan. The Council and partners were also required to cooperate when conducting investigations and partners could not demand any payment for doing this. A process was being for the Board to conduct safeguarding reviews and advocacy for safeguarding was also required to be supported.

Regulations covering the duties and responsibilities of the Council had been published in October 2014. A lot of current adult social care legislation, some of which was contradictory, was being replaced by the Care Act.

The current position was that people with savings in excess of £23,250 would have to pa\y the full cost of their care but under the Care Act, this would be raised to £118,000. The maximum contribution paid towards care would also be capped at £72,000. This did not include up to £12,000 per year on ‘hotel costs’ such as food and accommodation, which still have to be paid, even if the maximum cap had been reached.

The average cost of a Havering care placement was £550-600 per week and people reaching the age of 18 with care and support needs would have a zero cap and hence would not be expected to make any payment. The situation for people who were already in the system or who entered care just before the funding reforms commenced was unclear and further guidance from central Government was awaited.

It was expected that more assessments of care needs would be required under the Care Act but it was not possible to be certain of numbers at this stage. Draft guidance on the funding reforms was expected in December (2014) but it was noted that there were 41 older people’s care homes in Havering with a total of 1,550 beds.  ...  view the full minutes text for item 19.

To consider any item of which the Chairman is of the opinion, by means of special circumstances which shall be specified in the minutes, that the item should be considered as a matter of urgency.

It was AGREED that an update on the work the CCG was undertaking in Children’s Health should be brought to a future meeting of the Committee.

It was also AGREED that the CCG’s workstream on common illnesses and improving patient knowledge should be scrutinised at the Committee’s March meeting.   

Under the Council Continuous Improvement Model, to receive an update from officers on the implementation of Healthwatch in Havering.

This item was an update on the implementation of a Cabinet Decision that had been due under the Council Continuous Improvement Model.

The Quality Manager explained that the Health and Social Care Act 2012 had required the Council to commission a Local Healthwatch organisation by April 2013. Healthwatch Havering had evolved from the former Havering LINk organisation and worked in conjunction with Healthwatch England – an independent national consumer champion for health and social care.

Local Healthwatch (Healthwatch Havering) had a number of functions including signposting, promoting choice and recommending areas of investigation to Healthwatch England and the Care Quality Commission. It was the statutory responsibility of the Council to ensure that Healthwatch Havering was delivering an effective service.

Funding for Healthwatch Havering totalled £117,000 derived from a formula grant from central Government and additional local funding. Final allocations of funding for the next financial year were expected to be known by January/February 2015.

The Council had been required to establish an independent and credible Local Healthwatch in Havering that also offered value for money. Healthwatch Havering had established good relationships with the Council, CCG and Care Quality Commission.

Healthwatch Havering sought to act on complaints and concerns regarding quality. Healthwatch representatives visited care homes and other facilities and spoke to service users, relatives and staff. Healthwatch had made a lot of reasonable and realistic requests for improvements to providers and many of these had been implemented by Trusts, care homes etc. Officers therefore felt that Healthwatch Havering was providing an effective service and offering value for money.

Members noted with pleasure that Healthwatch Havering had received considerable recognition outside of Havering itself. The representative from NELFT added that the Trust had received enter and view visits from Healthwatch and supported its work fully.

The Chairman added that he was full of praise for Healthwatch Havering and its work. A Healthwatch director played an important role at meetings of the Committee and the Chairman felt that Healthwatch gave important and welcome support to the work of the Committee.

The Committee NOTED the update.