Agenda and minutes

Apologies for absence were received from Councillor Corrall.

Members are asked to declare any interests they may have in the business on the agenda.

Members were asked to declare any interests they might have in the business on the agenda.  No such declarations were made.

The Monitoring Officer to report that Councillor Myers has been appointed to the Commission in place of Councillor Cassidy.

The Monitoring Officer reported that Councillor Myers had been appointed to the Commission in place of Councillor Cassidy.

The minutes of the meeting held on 21 June 2017 have been circulated and the Commission will be asked to confirm them as a correct record.

The minutes can be found on the Council’s website at the following link:-

http://www.cabinet.leicester.gov.uk/ieListMeetings.aspx?CId=737&Year=0

AGREED:

that the minutes of the meeting held on 21 June 2017 be approved as a correct record.

The Chair referred to actions requested on previous Commission meetings and reported that:-

a)         The Chair referred to actions requested on previous Commission meetings and reported that:-

a)         The Director of Public Health had provided a written response to the questions submitted by Mr Johnson at the last meeting and the reply had been circulated to members.

b)         She had attended a regional meeting which covered an update from EMAS which had been interesting and informative. There was still a specific issue in relation to the handover times at the Leicester Royal Infirmary.  The Chair had, therefore, invited both EMAS and UHL to the Commission’s meeting in October to discuss the issues and the steps being taken to reduce the delays.

c)         The Chair expressed disappointment that the dates for the Lifestyle Services Workshops had not been provided as requested.  A further workshop on ‘healthy start’ was planned for September.   An update on the workshop outcomes had been requested for the October meeting.  The Chair felt that it was important to have widespread discussions in relation to the prevention agenda.

d)         An updated report on Lifestyle Services and information relating to letters issued for the Healthy Lifestyle Hubs has been sent out today.

e)         The Deputy City Mayor had organised a member workshop in October for the lifestyle review.  Further information relating to Infant Mortality had been received by e-mail earlier in the day and the Chair would consider whether this required further consideration at a future meeting.

f)          A response had been received to the request for information on the number of elective surgery operations being cancelled and re-scheduled. There were still some issues over waiting times for elective surgery across the 3 CCG areas primarily due to bed blocking and diversion from emergency care procedures.  The issue was linked to acute care at the LRI and this could be revisited when the STP was considered.

g)         The issue of staff sickness raised at the last meeting had been reported at OSC and a report would be considered by the Committee at its next meeting.

h)        The suggestion by the commission that FAQ’s be provided for patients being offered Shared Care Agreements (FAQ) was being considered by the three CCGs.  The CCGs proposed to issue general information to patients first and then develop further detailed information depending on medicines used by the patient.  The General Q&A would be issued shortly and the imminent and Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group would supply details of the timetables for which specific QAs relating to patients medicines would be taken forward first.

The Monitoring Officer to report on the receipt of any petitions submitted in accordance with the Council’s procedures.

The Monitoring Officer reported that no petitions had been submitted in accordance with the Council’s procedures.

The Chair reported that a workshop on Healthwatch and its future in the City had been organised by the Deputy City Mayor and a number of members had indicated they wished to attend.  A Consultation had been launched on the future provision of Healthwatch in LLR had been launched.  The Chair requested that all members of the Commission be sent details of the workshop when the date had been confirmed.

A response had also been received to the Chair’s letter to the Secretary for State for Health in relation to members concerns at NHS England’s proposal to cease commission Level 1Congenital Heart Disease Services at Glenfield Hospital.  The letter had been circulated to members of the Commission.

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

The Monitoring Officer reported that no questions, representations and statements of case had been submitted in accordance with the Council’s procedures.

The Chair indicated that she had received questions from Dr Sally Ruane, Campaign Against NHS Privatisation outside the time limits allowed by the Constitution for it to printed on the agenda but had used discretion to accept them as they raised relevant issues to the Sustainability Transformation Plan process.

The Chair had recently met CANP who had expressed their concerns and frustrations around the transparency of the STP process.  A number of these concerns related to the organisational systems for developing the STP and the Chair felt it was helpful to have these issues address in public. 

The questions and the responses received from officers are set out below:-

QUESTION 1

What are the channels and processes used by the City Council's representative(s) on the STP System Leadership Team (SLT) meetings for feeding back, updating and consulting councillors and officers, including but not confined to members of the scrutiny commission, regarding developments and proposals at SLT meetings. Are any of the records / notes arising from these feedback mechanisms available to the public?

RESPONSE

The Strategic Director for Adult Social Care represents the City Council on the System Leadership Team (SLT).  Minutes of the SLT meeting are shared with all members of the meeting, and these are available to other relevant officers in the City Council through the Strategic Director.  Verbal feedback from the Strategic Director is undertaken with the City Mayor and Deputy City Mayor on relevant matters arising from the SLT.  The Strategic Director (with the support of the Director of Public Health) discusses specific matters arising from the SLT with the Deputy City Mayor (as lead member for both Adult Social Care and Public Health) as part of ongoing management of business.  The Strategic Director and Director of Public Health advise both the Chairs of Health Scrutiny and Adult Social Care Scrutiny as to any matters arising from SLT discussions that may be of interest to Scrutiny Commissions as part of the Scrutiny agenda planning process.  The Council engages in the SLT as it is a senior officer forum for wide partnership and system development across the health and social care agenda, including but not only limited to matters relating to the Sustainability and Transformation Plan.  The SLT supports and enables strategic planning and operational partnership working between health and social care.  It supports and drives service improvement work relating to specific care pathways and needs relating to the care and health of the LLR population

QUESTION 2.

On what grounds are STP system Leadership Team meetings taking place in private? We believe these meetings are subject to the 1960 Public Bodies (Admission to Meetings) legislation and, as meetings of a joint committee of the CCGs, should be held in public.

RESPONSE - The following response from the Senior Responsible Officer for the Sustainability and Transformation Plan on behalf of the  ...  view the full minutes text for item 21.

The Director of Public Health submits a briefing report on Sexual Health Services and HIV Prevention: Service Review.

The Director of Public Health submitted a report providing an overview of the City Council’s Sexual Health services together with a summary analysis of the local need for these services.

A spending review of these services was currently underway with proposals being considered by the Executive this summer. A further report would be submitted to the Commission later in the year following public consultation on the review.

It was noted that:-

a)         Leicester had a higher than average level of under 18 year old conceptions.  The City had a larger proportion of under 18 year olds in the population than the average and there were also high levels of deprivation.

b)         There were more health needs in the west than the east of city and services needed to reflect the needs of the population.  The population in the east of the City preferred to have services provided in central clinics rather than in their own local area.

c)         Leicester had the 5th highest level of HIV outside of London and there are high rates of late diagnosis of HIV.  This resulted in poorer outcomes for patients.  If HIV is diagnosed and treated early there are good life expectancy outcomes for patients.  Ethnic minority populations are more at risk, men having sex with men and those working in the sex industry.

d)         Outreach services were available for each risk area and there was an open access to sexual health services.  Individuals could go anywhere in country for treatment to avoid stigma and the cost would be recharged to the patient’s own area.

e)         The budget for sexual health services had been reduced and the challenge was now to provide services at a suitable level to meet the needs within the available budget.  Providing services digitally or on line were being investigated.

f)          The current service contract ends on 31 December 2018 and the tender process for the new service start at the end of 2017 to enable the new service to be in place by 1 January 2019.

g)         The use of text alerts had been used for many years to advise individuals of negative test results but these did not replace the need to make an appointment where the test was positive and there was a need for a doctor to discuss the result the patient and to discuss their sexual behaviour and the effects if can have on their partners.  It was planned to increase the use of text and e-mails in the future and also increase the use of apps to make access more accessible to young people. Useof texts and e-mails were considered to be more convenient for patients and a more efficient use of staff time.

h)        It was also proposed to enable individuals to requesting testing kits for STIs and HIV on line.  The test kit would then be delivered to the individual’s home for them to take a self-assessment test and return the kit for analysis.  The provision of vending machines  ...  view the full minutes text for item 22.

To receive a verbal progress report from the Strategic Director Adult Social Care on progress with the proposed new policy.

The Commission received a verbal update from the Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group on the current situation in relation to the Settings of Care Policy.  It was intended to submit a report to the December meeting of the Commission.

The Settings of Car Policy which provides individual support care and provides guidance on the funding for care in that setting was first drafted in 2011.  A review of the policy had been led by East Leicestershire CCG and the final draft on the review had been considered by the Leicester City CCG in July.  The City CCG had decided not to adopt the revised policy at this time as it had felt that further work was required in relation to the impact assessment of the change upon the poorest and poorliest section of community receiving the care. This was because of the proposed reduction from a 25% cap to a 10% cap. 

The CCG had asked for further impact studies to be undertaken over the next 3 months.  The impact upon new patients would be reviewed as if new policy was in place to see the impact it would have.  These reviews would end in November and the CCG would consider the issue again by January 2018.  The existing 2011 policy would remain in force for the City and West Leicestershire CCGs until the issue was considered again following the current review.  Although the East Leicestershire CCG had approved the policy they had not yet decided when it would be implemented.  The City CCG had taken this action because it affected patients with a severe disability such as a brain injury.  Patients could live for a long time and require significant support for their care either at home or in a setting of their choice.   There was a risk with the proposed changes that some vulnerable patients could be moved out of a home setting and put in an institutional setting, which could impact significantly upon both the patient and their family.

The Deputy City Mayor welcomed the CCG’s decision not to proceed at this time.  He had concerns that there was risk of post code lottery in relation to Care Policy within the 3 CCGs for LLR.  He felt this was part of an issue around the sustainability of the working arrangements for the 3 CCGs and the need for coherence within the system. 

Members commented that:-

a)         This showed the fragmentation within the current system and it was questioned how the STP could be applied across the LLR footprint if there was going to be differential implementation of the policy within the geographical area of the STP.

b)         The continuance of 3 separate CCGs was questioned as the current situation could lead to differential standards of patient care within the STP.

c)         It was also considered that health inequalities would be amplified by the 3 CCGs working differently in affluent areas to those with high levels of deprivation

The Chair commented that  ...  view the full minutes text for item 23.

The Leicester City Clinical Commissioning Group (CCG) to submit a report providing an update on the development and delivery of the CCG’s Primary Care Strategy and how it links with the General Practice Forward View delivery across the Sustainability and Transformation Planning footprint of Leicester, Leicestershire and Rutland.

Leicester City Clinical Commissioning Group submitted a report providing an update on the development and delivery of the Leicester City CCG Primary Care Strategy and how it linked with the General Practice Forward View (GPFV) delivery across the Sustainability and Transformation Planning (STP) footprint of Leicester, Leicestershire and Rutland (LLR). The paper focused on reporting against delivery of key milestones for Q1 and Q2, and described some of the links between national and local approaches to supporting and sustaining primary care in Leicester City.

The Chair stated that Members had already received to briefing to better understand the process and reasons for the Five Year General Practice Forward View and the Primary Care Strategy in the context of the STP.  It was likely that this issue would be re-visited as part of subsequent discussions on the STP.

The Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group stated that:-

a)         The Five Year General Practice Forward View was a national directive to address the primary care challenge across the country.  The review covered issues of access to GP services, workforce of GPs and other practice staff and funding of primary care.  The CCGs were required to prepare a plan across the LLR footprint on the delivery of services in the next 5 years.

b)         The initiative included practical and funding actions against five key areas, investment, workforce, workload, infrastructure and care re-design.  A key element was the ‘Releasing Time for Patients programme which included support to accelerate change either within individual practices and federations of practices.  There were 10 high impact areas to support this initiative but it was not expected that all practices and federations would implement all 10 areas but it was expected that practices would develop at least 2 or 3 of them. There would be some limited funding per patient to support practices.

c)         Access to GP services in Leicester had traditionally been amongst the worst performing nationally in the last 10–15 years.  Leicester had regularly been in the bottom 5% percentile.  The CCG had attempted to improve access by investing in hubs to give as much opportunity as possible to access GP services.  The 3 hubs provided 1,300 additional appointments per week.  The hubs had full access to all patients’ records and were therefore able to take into account the patient’s history and current medication during the consultation and treat the patient as though they were consulting their own GP.  The hubs had been successful and were utilisation rate of 95%.  They were busy during the day and on Saturday’s but demand dropped significantly after 1.30pm on Sunday’s.  The CCG was in the process of procuring the hubs on a permanent basis.

d)         The CCG had operated a Golden Hello scheme to attract GPs to work in the City.  This had been successful in recruiting 11 GPs in the first 2 phases, with a third phase open to all practice staff currently ongoing.  The CCG was also now involved in an  ...  view the full minutes text for item 24.

The Chair submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2017/18.  The Commission is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Chair submitted a document that outlined the Health and Wellbeing Scrutiny Commission’s Work Programme for 2017/18.

Members requested that an update on the proposal to stop prescribing paracetamol and gluten free items be added to the work programme.  The Chair stated this could be added to the item on repeat prescriptions which was being submitted to the November meeting. 

The  Chair declared the meeting closed at 8.30 pm.