Discussion with NHS officers.
Minutes:
A. Takeover of Outer North East London Community Services (ONELCS)
SD explained that NELFT had a good reputation for working with local communities and that it had already moved Barking & Dagenham Community Services from the bottom to the top 20% of such organisations in the UK. There had already been some early gains seen in Barking & Dagenham Community Health Services with for example there no longer being any health visiting vacancies in the borough. Councillor Salam from Barking & Dagenham had also recently visited the Greys Court facility.
The acquisition of ONELCS was key to NELFT’s strategic gateway as it allowed NELFT entry to the acute care management sector. This allowed the opportunity to move elements of healthcare into a community setting.
SD felt that the key benefits of the ONELCS takeover were that it allowed more efficient local commissioning and gave the opportunity to work with complex care pathways. Synergy and economies of scale could be derived through e.g. integrated care pathway management and it was planned that an increase in mobile working would also deliver economies.
Now that it was combined with Barking & Dagenham Community Health Services, ONELCS would be renamed North East London Community Services (NELCS) and would form a new NELFT directorate along with those for South West Essex and mental health services. The NELFT Constitution and Council of Governors had been changed in order to increase the number of public and staff members of the Trust.
Risk areas of the takeover were seen as being the delivery of financial targets, safeguarding issues for example with health visiting in Waltham Forest and a need to increase recruitment although a full staff establishment had now been reached.
ONELCS had been registered by the Care Quality Commission with no conditions and the higher NHS Litigation Authority insurance rating had been achieved. There were high reported patient outcomes in the service and a stronger than expected performance culture. SD accepted that the financial situation was a challenge but felt that this could be managed.
A member of the public present felt that there was low public awareness of the ONELCS takeover and that there should be higher local representation among the governors. SD confirmed that the number of governors had been changed and accepted that the expanded Trust had to work more effectively with its members.
Councillor Pond asked for further details of the takeover of South West Essex Community Services and SD explained that this had been a similar process to the ONELCS takeover and the South West Essex services had been acquired in June 2011. There were three governors for each ONEL borough as well as members from South West Essex. Meetings were being arranged with the Health Overview and Scrutiny Chairmen in Essex and Thurrock and NELFT had also presented to the Thurrock committee prior to the acquisition.
SD stated that in Redbridge there was a long tradition of working across health and social care including having joint directors shared between the Council and the health sector. NELFT’s cost improvement plan gave targets over the next three years and allowed the maintaining of the current financial risk rating. A 2.5% saving was expected and there were also cost pressures within the system such as utility costs.
It was accepted that staff found mobile working difficult to adapt to. Pilots had taken place in areas such as older people’s mental health and some staff had been found to be very positive about mobile working.
SD acknowledged Councillor Sweden’s point about the varying demographics served by NELFT and felt that NELFT had tried to reflect its local communities. SD wished to standardise the quality of care delivered across the NELFT area but to also stay flexible in how services are delivered. It was also aimed to work very closely with GPs across the four ONEL boroughs.
Med Buck from Havering LINk explained that he welcomed the ONELCS takeover but asked what NELFT would do differently or better compared to the existing services. SD responded that ONELCS as an organisation had not been familiar with the concept of year on year efficiencies and it would take around 18 months before a measurable impact of the takeover could be seen. She reiterated that the long term prospects for ONELCS were good.
B. Decommissioning of Services
SD accepted that service reduction was a challenge and would occur as part of the commissioning process. This needed to be managed to minimise the impact on patients. SD wished to come to overview and scrutiny committees early about any proposed service reductions.
SB explained that, at the end of 2010/11 the Outer North East London commissioners had asked for a further 1.5% reduction in their contract with NELFT. NELFT had informed NHS ONEL that this would inevitably result in some service reduction. A list was drawn up by NELFT of schemes with the least clinical impact that could have their funding withdrawn. This included the Think Arts programme and the ecotherapy project in Barking & Dagenham.
SB accepted that these schemes did play a valuable role but emphasised that clinicians felt that withdrawing these would have the least clinical impact. NELFT had tried where possible to support the programmes continuing in some form. One-off funding had been given to Think Arts in order to tender for a third sector provider to pick up this work.
A NELFT member of staff who ran nature walks etc. had been made redundant but trained wardens in Barking & Dagenham did offer similar ecotherapy activities. Some art psychotherapy services had also been decommissioned.
SD added that only a small amount of this work had been tendered to private operators with mainly voluntary sector groups or the social enterprise option being considered.
SD agreed that NELFT should have been more open about the service decommissioning and felt that it should not have happened in the way that it did. The lack of notification had been due to the speed with which the decision had to be taken. SD confirmed that decommissioning decisions in future years would be taken to the service user reference group. MP added that the new PCT arrangements made the situation more complicated and confirmed that time and user involvement would be made available for future decisions. Councillor Light agreed that it would have been better if full answers to the decommissioning issues could have been given at the time.
The Committee noted the presentations on the ONELCS takeover and on service decommissioning.
It was agreed that SD would forward a document to the Committee seeking views on the initial priorities for the NELFT Quality Account.