Agenda and minutes

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 minutes of the meeting held on 9 November 2016 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:8071/ieListMeetings.aspx?CId=737&Year=0

AGREED:

that the minutes of the meeting held on 9 November 2016 be approved as a correct record.

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 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 reported that all actions from previous meetings had been incorporated into the Work Programme.

A meeting of Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee had been arranged for 2pm at City Hall on Wednesday 1 February 2017 to discuss NHS England’s consultation on the Congenital Heart Disease Review affecting Glenfield Hospital.

To receive the draft General Revenue Budget 2017-18.  The Commission is asked to consider the Public Health elements of the budget.  Comments made by the Commission will be considered by the Overview Select Committee on 2^nd February 2017 prior to budget being approved by the Council on 22^nd February 2017.   

The Commission received the draft General Revenue Budget 2017-18.  The Commission was asked to consider the Public Health elements of the budget.  Comments made by the Commission would be considered by the Overview Select Committee on 2nd February 2017 prior to budget being approved by the Council on 22nd February 2017.

The Deputy City Mayor introduced the report and commented that all areas of the spending within and use of Public Health Budgets were being reviewed.  The Public Health Budgets were currently ring-fenced and grants had been reduced in recent years.  These reductions were expected to continue in future years before the ring-fence of the budget was eventually removed altogether and the public health budget became part of the Council’s overall budget framework.  The Government had required savings of £2 million since May 2015 and there were a number of spending reviews underway to identify further savings in the budget which would report to the Commission in due course.  The current budget details for public health were, therefore, lacking detail and this detail would appear through the spending review process.  The direction of travel for the future was however clear that public health services would be delivered very differently to the current situation.  The provision of public health services was far wider than those currently provided by the ring fenced public health budget.  There were health implications and benefits from a wide variety of services provided by all departments and services.

The Chair welcomed the opportunity for the Commission to comment upon the spending reviews as they progressed as this would give the Commission an opportunity to help shape future service provision based upon service outputs and value for money.

Members of the Commission made the following observations and comments:-

a)         The current report format did not provide sufficient detail on the breakdown the public health expenditure and the impact of other services on public health.  It was therefore, difficult for the Commission to make any detailed comment on this aspect of the budget.

b)         There were only 3 references to public health expenditure in the draft report and there was no reference to the impact that the Sustainability Transformation Plan (STP) would have in future service provision.

c)         It would be helpful to have an analysis of health outcomes compared to budget spend and how these compared to other comparator local authorities.

d)         All Council budgets impacted upon health and wellbeing and mental health wellbeing and there was insufficient information in the report to specific health issues to be able to make any meaningful comment.  The report also lacked any meaningful comments in relation to equality impact assessments on protected groups (protected characteristics).

e)         It would be helpful for Scrutiny Commissions to receive a short 2 page report identifying specific budget issues and implications for service delivery rather than the current general report.

In summary, the Deputy City Mayor commented on Members’ observations and answered their questions as follows:-

a)         Precise details of financial implications and the impact of  ...  view the full minutes text for item 56.

To receive a report from the Leicestershire Partnership Trust on the progress made to date in addressing the actions required after the inspection in March 2015 and the feedback received from the CQC following the re-inspection in November 2016.

The Commission received a report from the Leicestershire Partnership Trust on the progress made to date in addressing the actions required after the inspection in March 2015 and the feedback received from the CQC following the re-inspection in November 2016.

Dr Peter Miller introduced the report and commented that the original report published in July 2015 had given the Trust an overall rating of ‘Requires Improvement’ and was critical of 3 services.  The current report showed the progress that had been made since the Action Plan had been agreed with the CQC.  Currently approximately 80% of actions required had been completed with evidence and approximately a further 15% had been completed but were waiting for documented evidence.  Three Actions were currently Amber, these were:-

a)         Clinical Risk and Assessment and Care Planning

b)         Ensuring that assessment of capacity is both undertaken and recorded within patient notes.

c)         The development of a Trust-wide Mental Capacity Act assurance framework.

The CQC had re-inspected in November 2016. 86 inspectors had looked at all services again and, although the Trust had received a brief verbal feedback, they were waiting for draft report which would be issued later in the week. The final report was expected to be published in February 2017 and would be followed by ‘summit’ meeting to determine any further action plans.

In response to Members’ questions the Chief Executive Leicestershire Partnership Trust stated that:-

a)         It would be disappointing if the report did not recognise that improvements had been made in many areas; although the CQC might be concerned that the mental health pathway still required improvement and that there were too many people being placed out of county, which the Trust did not wish to see either.  The Trust was not an outlier in this respect as many other Trusts were also in this position.

b)         It was hoped that the STP would make the Trust more sustainable, although the process was not about increasing capacity but about supporting more people in their own homes.  Currently, 60% of patients were admitted against their will under the Mental Health Act. The Trust was in the middle 50^th percentile of beds per population.  However, people were in hospital longer with more delayed transfers of care within the system.  The delayed transfers could be attributed to a number of reasons, such as waiting for physical adaptions to patients’ homes or that no available and suitable support services were in place for them. 

c)         The re-inspection had looked at 15 separate service lines and each one would receive a rating.   The final report would be submitted to the Commission when it was published.

d)         The 3 Amber ratings were because the Trust was required to demonstrate that the ‘actions’ had been achieved on a consistent basis and, whilst significant progress had been made, it was expected that the CQC would still expect further work to be done.

e)         The Trust had increased expenditure on services and had the evidence to support this, but  ...  view the full minutes text for item 57.

To receive the draft Leicester, Leicestershire and Rutland Sustainability and Transformation Plan which was published on 21^st November 2016.  The Commission is asked to comment upon the proposals during the current engagement period.  These comments will then be considered to determine whether any elements of the draft Plan need amendment prior to the formal consultation on those elements of the Plan which require it in early 2017.   

At the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee on 14 December 2016 it was agreed that this Commission would take the lead on the scrutiny the new model of care for the primary care sector and the services reconfigurations for UHL acute hospital sites and Mental Health aspects.

Members are asked to focus on the new model for primary care at this meeting, as the other two aspects will be considered at separate meetings.   

The Commission received the draft Leicester, Leicestershire and Rutland Sustainability and Transformation Plan which was published on 21st November 2016.  The Commission was asked to comment upon the proposals during the current engagement period.  These comments would then be considered to determine whether any elements of the draft Plan needed amendment prior to the formal consultation on those elements of the Plan which required it in early 2017.   

At the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee on 14 December 2016, it was agreed that this Commission would take the lead on the scrutiny of the new model of care for the primary care sector and the service reconfigurations for UHL acute hospital sites and Mental Health aspects.

Members were asked to focus on the new model for primary care at this meeting, as the other two aspects would be considered at separate meetings. 

Prof Azhar Farooqi, Co-Chair Leicester City Clinical Commissioning Group (CCG) and Tim Sacks Chief Operating Officer East Leicestershire and Rutland Clinical Commissioning Group.

Prof Farooqi introduced the report and stated that he would be happy to submit further progress reports in the future.  Although expenditure on health care services was expected to increase in future years, the continuing rise in population, coupled with an increase demand from the ageing population on health services and fast developing technology, clearly indicated that the increased funding would not keep pace with the projected costs.  If nothing was done there was a projected deficit of £350m by 2020.  This represented finding savings of approximately £80m per year (approximately 4% of the budget per year).  It was important, however, that changes were clinically and not financially driven.  It was accepted that were some areas where improvements were needed.

Primary Care services had been subjected to 10 years of static funding; a number of practices had closed, and existing practices faced pressures from, the inadequate infrastructure of many existing buildings (which were unsuitable to deliver high quality care), increased care in the community, increased emphasis on secondary prevention to stop people with conditions developing more complications and changes in prescribing.

Most GPs were currently employed on a national contract, although this may change in the future to allow commissioners to make the changes that may be needed to provide future health services in the primary care sector.  There were, however, a number of areas where the CCG could work with GPs to deliver workforce recruitment and development. For example, many GPs had received training to deliver advanced levels of diabetes treatment over recent years.  There was still a need for more GPs, advanced practitioners and pharmacists.

New models for GP working, such as federations, were being developed to deliver enhanced patient services and to meet the challenges being faced by primary care.  This may mean that if patients required a specific service or specialism that was not available in their own particular practice, they may need to go to another practice within the federation that was able to deliver that service  ...  view the full minutes text for item 58.

The Scrutiny Policy Officer submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2016/17.  The Commission is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Scrutiny Support Officer submitted a document that outlined the Health and Wellbeing Scrutiny Commission’s Work Programme for 2016/17.

AGREED:

That the Work Programme be noted and the review of maternity services be brought forward.

The Chair declared the meeting closed at 7.50 pm.