Agenda and minutes

Members are asked to declare any interests they may have in the business on the agenda, and/or indicate that Section 106 of the Local Government Finance Act 1992 applies to them.

Councillor Bayford declared a personal interest in the general business of the meeting, in that his wife was a salaried GP, although she was not a partner in the practice.

Councillor Manjula Sood declared personal interests, in relation to the general business of the meeting, in that she was a patron of CLASP, the Chair of the Leicester Council of Faiths and an ambassador for the East Midlands for Sporting England.

Councillor Newcombe declared a personal interest in agenda item 6, “2011/12 Budget Proposals – Adult Social Care”, as his partner worked for Adults and Communities, and other family members also worked for the City Council.

Although attending the meeting as an observer, Councillor Naylor declared a personal interest in agenda item 7, “Joint Commissioning Strategy for Mental Health 2011-2013”, in that he was a Governor on the Leicester Partnership Trust, which delivered mental health services.

The minutes of the meeting held on 1 December 2010 have been circulated and the Committee is asked to confirm them as a correct record.

RESOLVED:

that the minutes of the meeting held on 1 December 2010 be approved as a correct record.

The Director of Corporate Governance to report on the receipt of any petitions submitted in accordance with the Council’s procedures.

The Director of Corporate Governance reported that no petitions had been received.

The Director of Corporate Governance to report on the receipt of any questions, representations and statements of case submitted in accordance with the Council’s procedures.

The Director of Corporate Governance reported that no questions, representations, or statements of case had been received.

The Strategic Director Adults and Communities and the Chief Finance Officer submits a report seeking the views of the Health Scrutiny Committee on the draft budget plans for the Adult Social Care Divisions.

The Strategic Director Adults and Communities presented a report seeking the views of the Committee on the draft budget plans for the Adult Social Care divisions.

In presenting the report, the Head of Finance (Health and Wellbeing) drew particular attention to the following points:-

·            The budget plan was a one-year strategy, in view of the on-going financial situation;

·            The budget plan submitted showed reductions totalling approximately £3.8 million, which had been proposed in line with the “Putting People First” agenda;

·            An important aim was to enable as many people as possible to keep living independently in their own homes.  To assist in this, the Council was proposing significant investment in enablement and re-ablement services and assistive technology;

·            In line with the personalisation approach, services would be charged at cost.  The income would be re-cycled to service users through the Resource Allocation System;

·            Commissioning was to be improved.  This could include providing some services jointly with health authorities;

·            The role of the voluntary sector was to change.  However, there would be a net investment in that sector, as people with personal budgets often chose to use voluntary sector services;

·            The cost to the Council of using taxis to transport service users was high.  The use of personal budgets would help reduce this, as some people would be able to make their own transport arrangements more economically;

·            The Council no longer had capital funds available to invest in their own care homes;

·            It was anticipated that, over the next three years, fewer people would be entering long-term residential care, but would be using alternative forms of accommodation;

·            The budget allocated for Home Care was shown as lower than the current year.  This was primarily because this money was going into personal budgets.  Service users would then decide how the money was spent and it was very likely that much of it would continue to be spent on Home Care; and

·            Service quality issues had been experienced with the Meals on Wheels service. Dis-investment in the service was being recommended.  This also reflected the increased use of personal budgets and the choice this gave to people.

The following points were made during discussion on the proposals:-

·            There was concern at the speed of the transformation of the service.  Although there was an anticipated reduction in client numbers, it appeared to be causing an increase in costs;

·            As service users would have a choice of where they spent their personal budgets, the Council needed to be careful how it set its charges.  If they were too high, they would not be used, so alternative ways of financing those services would have to be found, or ultimately they could have to close;

·            Personal budgets were allocated to people not receiving residential care according to assessed need.  Therefore, the higher someone’s needs, the higher the budget allocated;

·            The actual number of people using personal budgets (following a full assessment and application of the Resource Allocation System) was believed to be less than 25% of  ...  view the full minutes text for item 57.

A verbal update will be given on the Joint Commissioning Strategy for Mental Health 2011 – 2013.  The Committee is recommended to receive the update and comment as appropriate.

Tracie Rees, Director of Commissioning and Business Support, and Yasmin Surti, (Planning & Service Development Officer (Learning Disabilities)), introduced themselves to the meeting.

Yasmin Surti then gave a presentation on the Joint Commissioning Strategy for Mental Health, during which particular attention was drawn to the following points.  (A copy of the presentation is attached at the end of these minutes for information.) :-

·            The audit of mental health services on which the Strategy was based had been done during 2009/10;

·            A lot of consultation had been undertaken, enabling key priorities to be based on what people had said they wanted;

·            Although 42% of those consulted had expressed a preference for hospital based services, local services also were very important to them, with 49% preferring community-based services.  However, there were not enough providers to give people the kind of support in their own homes that they wanted; and

·            Proposals for how the service could move forward were included in the Strategy, along with commissioning priorities and actions.

At the invitation of the Committee, Councillor Naylor, Lead Member for Health and Community Safety, addressed the meeting, reminding Members of the interest he declared in this item, in that he was a Governor on the Leicester Partnership Trust, which delivered mental health services.

The following points were raised during discussion on the draft Strategy:-

·            In response to a question about what joint initiatives were being undertaken for prisoners and offenders, it was noted that the Bradley Report in 2010 had set out specific outcomes that should be sought when people returned to the community from prison.  The court process could be used to help offenders as well.  Work also was underway to identify how offenders could be removed from previous associates, the results from which were expected in September 2011;

·            Autism in children needed to be identified as early as possible, so that they could be helped to overcome the barriers they faced and possibly also reduce their levels of need in later life;

·            Although autism was dealt with through the Mental Health Strategy and overseen by the Mental Health Implementation Board, there was a separate Autism Strategy for Leicester, Leicestershire and Rutland;

·            Training needed to be provided for families and carers of people diagnosed with dementia, particularly those caring for sufferers at home;

·            A provider / commissioner service split had been established for mental health services.  The lead commissioner was the health authority, although some City Council officers worked on this, (for example, looking specifically at supported housing);

·            The City Council worked with other providers to ensure that the data used to monitor and evaluate the Strategy was sound.  There previously had been some problems with the quality of data, but the gaps were being identified and closed;

In response to questions from the Committee, Yasmin Surti undertook to consider how to make it clearer in the Strategy how it was linked with the local Carers Strategy.

Aileen Holyland, NHS Leicester City, will provide an update on progress with the commissioning of dental services in the City.  The Committee is recommended to receive the update and comment as appropriate.

Aileen Holyland, NHS Leicester City, gave a verbal update on progress with the commissioning of dental services in the City, explaining that:-

·            There currently were 215 dentists working in 58 NHS dental practices in the City.  Of these, 46 were general practices and 12 were specialist, (mainly orthodontic).  These practices also were able to offer private treatment;

·            31 practices across the City currently were accepting patients.  A plan showing their location in the City was tabled and is attached at the end of these minutes for information;

·            One large orthodontic practice in the City had a waiting list of approximately 12 – 18 months;

·            Contracts for dental services were activity based and were monitored through annual reviews;

·            A patient pathway had been commissioned with City practices for minor oral surgery;

·            The current budget for dentistry was £14.5 million.  Of this, approximately £12 million was ring-fenced for general dentistry;

·            Additional investment had been received during 2010/11 to set up new practices.  As a result, 2 new sites had been created in the City and five new contracts established with existing practices, enabling an additional 22,000 patients to be treated;

·            There was a target to treat 202,000 patients by 2013.  As at January 2011, just over 188,300 patients were being treated.  Information on the numbers of patients treated was tabled and is attached at the end of these minutes for information;

·            Monthly checks were made with each practice, by telephone, to determine if they were treating new patients.  This also was monitored through each practice’s annual review;

·            NHS Leicester City had the highest number of children in the East Midlands with decayed, decaying, or missing teeth.  This situation was being addressed, for example through the issue of tooth brushes and specific training for hygienists;

·            Some practices called patients every 6 months, even though National Institute for Health and Clinical Excellence guidelines stated that recalls could be every two years.  Leaving longer gaps between recalls would help release capacity for other patients to be seen;

·            Work was ongoing to try to make contact with hard to reach groups in the City;

·            Practices were being encouraged to market themselves;

·            There was a national proposal to introduce contracts with providers of dentistry services based on capitation, registration and quality.  Some local practices had applied to be included in the 60 pilot studies that would be carried out nationally;

·            Procurement was underway for a salaried dental centre and domiciliary provision was being reviewed;

The following points were then made during discussion on this item:-

·            The oral health team visited schools to educate children and young people in oral care and hygiene;

·            It was recognised that some people were scared of visiting the dentist and that work needed to be done to encourage them to attend;

·            Communication was important, particularly in settings such as care homes.  Further training could be useful, for example in how to communicate with people with dementia;

·            Dentists were required to give three months’ notice of leaving a practice, so that  ...  view the full minutes text for item 59.

Ivan Browne, Public Health Consultant with Leicester City NHS, will give a verbal update at the meeting on levels of flu in the City and how they are being dealt with.

Ivan Browne, Public Health Consultant with Leicester City NHS, gave a verbal update on levels of flu in the City and how they were being dealt with:-

·            During 2010/11, one of the largest increases for a long time in the incidence of flu was experienced.  There were a lot of viruses around, which led to a very sharp increase in reported respiratory illness;

·            A graph comparing flu levels in Leicester City in 2009/10 and 2010/11 was tabled at the meeting.  This is attached at the end of these minutes for information;

·            Leicester tended to experience flu before other areas of the country.  Its levels of flu this year were not considerably higher than national levels, but were experienced earlier than in many other parts of the country;

·            Very high numbers of people had accessed emergency care departments, resulting in 509 confirmed or suspected influenza admissions in December 2010.  Of these, 17 needed critical care, as a result of which a number of elective procedures needed to be rescheduled;

·            A lot had been learnt from the Swine Flu outbreak in 2009/10, so the authorities were quick to react this year;

·            This year, anti-viral medication had been distributed through community pharmacists, but they had not been advised in advance that this would be done.  They therefore had not had an opportunity to acquire stocks of the medication.  However, when it appeared that there would be a shortage, some stocks were obtained from the national stockpile.  As a result, the area did not run out of anti-viral medication;

·            A vaccination programme also was undertaken this year.  When the vaccine became in short supply, arrangements were made to share it between surgeries, so supplies did not run out; and

·            Flu levels were now returning to expected levels.

The following points were then made in discussion on this item:-

·            The flu season had occurred a few weeks earlier this year than last;

·            Some people had refused the flu vaccine this year, as that given in 2009 had made some people feel ill and some people did not want it if it contained a swine flu vaccine.  This initially had led to low take-up of the vaccine, but as flu levels increased, so had take-up levels;

·            It was not known why Leicester had such high levels of flu.  Investigations had been made in to likely factors as far back as the early twentieth century, but no conclusive evidence had been found.  The suggestion that the physical  location of the City, in a dip, could be a factor would be considered;

·            Although the severity of flu in children became a major issue, the Department of Health decided that it was not appropriate to vaccinate children under five.  Health representatives from across Leicester raised their concerns about this with the government, but the reply had been that vaccinations should continue to be targeted to the previously identified “at risk” groups; and

·            From the start of the vaccination programme, expectant mothers were a high priority, as they experienced the  ...  view the full minutes text for item 60.

The Deputy Director of Public Health and Health Improvement submits a report on the findings of the Leicester Health and Lifestyle Survey 2010.  The Committee is recommended to note the recommendations arising from this Survey and to comment as appropriate.

The Deputy Director of Public Health and Health Improvement submitted a report on the findings of the Leicester Health and Lifestyle Survey 2010, explaining that it provided an overview of self-reported health.  He further advised the Committee that it would form part of the Director of Health’s Annual Report 2009/10 and would be used as the basis for future improvement.

The Deputy Director of Public Health and Health Improvement drew particular attention to the following points:-

·            A sample size of just under 2,400 people aged 16+ (male and female) had been used for this survey.  This equated to approximately 100 people per Ward;

·            47% of the population of the City did not drink alcohol and a high proportion had never drunk it.  This was largely due to the high Black and Minority Ethnic population.  However, high drinking levels were concentrated in the remaining population, leading to high levels of resulting harm;

·            Levels of drug taking in the City were low;

·            With regard to diet, very few people did not eat any fruit and vegetables;

·            This survey recognised physical activities often not included in other surveys, so obtained different results to those surveys;

·            Responses to questions on sexual health showed quite high rates of condom use, but actual levels varied between different age groups;

·            Risk factors could be relevant to several issues, giving clustering of multiple risk factors.  For example, the survey showed that people who smoked more were less likely to eat well; and

·            It had been hoped that the report would be annual, but in view of current financial restraints, it now was likely to be undertaken every two years.

The Committee was concerned to note that only a quarter of respondents recognised the importance of not smoking.  One reason for this could be that, if smoking was taken for granted, people could be not noticing health warnings, or it could be that more publicity was needed for the message about the health implications of smoking.  This also applied to alcohol consumption.

At the invitation of the Committee, Councillor Naylor, Lead Member for Health and Community Safety, addressed the meeting.  He expressed disappointment that it would only be possible to undertake this valuable survey every two years and questioned whether it would be feasible to undertake it in conjunction with partners, such as the local universities.  In reply, the Deputy Director of Public Health and Health Improvement advised that a number of regular surveys had been curtailed by a number of bodies, due to financial restrictions.  The City Council currently was considering if it could do a survey of some kind, in conjunction with its partners, to cover the resulting gaps.

Councillor Naylor also drew attention to how some areas had improved.  It was noted that it was not known at present if these improvements had occurred as a result of health programmes, or whether factors such as ward boundary changes had produced these results.  Some “super-output areas” had been identified a few years ago, but more detailed analysis  ...  view the full minutes text for item 61.

Sarah Cooke, NHS Leicester City, submits a report that provides an overview of the NHS Performance Framework and local processes that are in place to ensure that NHS Leicester City provides an effective and efficient health service to its local population.  The Committee is recommended to receive this report and comment as appropriate.

Sarah Cooke, NHS Leicester City, submitted a report that provided an overview of the NHS Performance Framework and local processes that were in place to ensure that NHS Leicester City provided an effective and efficient health service to its local population.

Sarah Cooke introduced the report, explaining that NHS Leicester City had had a strong performance framework in place since 2007/08.  The framework was set nationally, but it was decided at a local level how it would be achieved.  As a result, the local performance framework for Leicester City was a joint one with the County.  This facilitated consistency of targets, which were set through the strategic operating plan.

Targets were regularly challenged, to ensure they were being delivered, as the NHS was required to achieve a certain threshold.  These were the “vital signs” set out in the report.

The following points also were noted:-

·            Improvement had been achieved in a number of areas.  These were set out in Appendix A to the report;

·            As a good practice measure, there had been a change in the definition of Thrombolysis.  Making it more appropriate had enabled a better picture of service delivery to be obtained;

·            Chlamydia screening and dental services had improved;

·            Recorded childhood obesity had increased;

·            NHS Leicester City had some concerns about mortality rates, but these were improving, through work undertaken through the Health Inequalities Plan;

·            There were two measures for stroke care.  The first of these was that people referred to hospital should go on to the right unit and the second was that people suspected of having had a TIA should receive a scan within 24 hours;

·            New data collection methods had been established in 2009. These had not been validated, so some of the results appeared to be low.  The statistics were now improving;

·            It was not known why some people with suspected heart attacks were being taken to the Leicester Royal Infirmary, rather than Glenfield Hospital and, in some cases, had to wait several hours to be transferred to Glenfield Hospital.  It was possible that this was due to how the service had been commissioned by either the University Hospitals Leicester or the East Midlands Ambulance Service.  This would be investigated and Members advised; and

·            The Committee welcomed the increased rates of immunisation.

RESOLVED:

that the Director of Corporate Governance be requested to circulate a link to the website containing national indicators / comparators for the information contained in this report to all members of the Committee.

The Director of Public Health and Health Improvement submits a report to inform the Committee of the publication of a Public Health White Paper and two consultation documents and to seek views on the proposals.  The Committee is recommended to note the publication of the documents and the consultation arrangements developed so far, and to advise on further steps to support the consideration of the White Paper and consultation documents within the City Council.

The Director of Public Health and Health Improvement submitted a report informing the Committee of the publication of a Public Health White Paper and two consultation documents.  The Committee’s views on the proposals also were requested.  It was noted that it was intended that the proposals would be implemented during the next 12 – 24 months.

At the invitation of the Committee, Councillor Naylor, Lead Member for Health and Community Safety, addressed the meeting, advising Members that a meeting for all Councillors to look at these documents was being arranged.  The date for this had not been agreed yet, but would be before the new consultation end date of 31 March 2011.  In the meantime, all Councillors were encouraged to respond individually, or collectively, via the Department of Health website.

Councillor Naylor further reported that he had attended a consultation event on 9 February 2011 in Nottingham.  Key comments made at this event included:-

·            The proposed framework was sound and should work;

·            Fewer performance indicators were requested; and

·            Local flexibility to change indicators was requested.

The Members’ Support Officer submits a document that outlines the Health Scrutiny Committee Work Programme for the municipal year 2010/11.  The Committee is asked to consider the programme and make comments and/or amendments as it considers necessary.

RESOLVED:

1)         that the Health Scrutiny Committee Work Programme for the 2010/11 municipal year be noted; and

2)         that any comments on, or suggestions for, the Work Programme be passed to the Members Support Officer.

The meeting closed at 8.44 pm