Agenda and minutes

No apologies for absence were received

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

No declarations of interest were made.

The Chair noted that local media recently had covered proposals for future services at Leicester hospitals and explained that these would be considered under agenda item 11, “Introduction to the NHS Long Term Plan”.

The minutes of the meeting held on 12 March 2019 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/ieListDocuments.aspx?CId=737&MId=8653&Ver=4

AGREED:

that the minutes of the meeting of the Health and Wellbeing Scrutiny Commission held on 12 March 2019 be confirmed as a correct record.

Members are asked to note the Terms of Reference for Scrutiny Commissions.

AGREED:

That the Terms of Reference for scrutiny commissions be noted

Members are asked to note the membership of the Health and Wellbeing Scrutiny Commission:

Chair:             Councillor Kitterick

Vice Chair:    Councillor Fonseca

Councillors Aldred, Chamund, March, Sangster and Westley.

AGREED:

That the membership of the Health and Wellbeing Scrutiny Commission for 2019/20 be noted.

Members are asked to note the dates of future meetings of the Health and Wellbeing Scrutiny Commission for 2019/20.

Thursday 29 August 2019

Thursday 10 October 2019

Thursday 5 December 2019

Thursday 30 January 2020

Thursday 2 April 2020

All to commence at 5.30pm and to be held in City Hall, Room G.01.

AGREED:

That the dates of meetings of the Health and Wellbeing Scrutiny Commission for 2019/20 be noted.

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 received.

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, or statements of case had been received.

The Leicester City Clinical Commissioning Group submits a briefing paper relating to the Primary Care Hub Access at the Merlyn Vaz Heath and Social Care Centre. Members are asked to consider the briefing paper which looks at the rationale and impact of moving from a walk in appointment system to a combined pre-bookable and walk-in appointment system. In addition to the briefing paper, there may be contributions from stakeholders who have indicated their intention to speak. 

The Leicester City Clinical Commissioning Group submitted a briefing paper looking at the rationale and impact of moving from a walk-in appointment system to a combined pre-bookable and walk-in appointment system at the Merlyn Vaz Heath and Social Care Centre.

Richard Morris, Director of Corporate Affairs, Leicester City Clinical Commissioning Group, introduced the briefing paper, drawing attention to the following points:

·           The Merlyn Vaz Centre received 24,000 – 26,000 patients per year.  Approximately two-thirds of these were from the city, the remainder being from the county and Rutland;

·           When it was set up, it had been anticipated that operating a walk-in appointment system at the Centre would reduce demand on the hospital emergency department, but the number of people attending that department continued to increase;

·           Three GP hubs had been established to improve routine access to pre-booked primary care appointments by providing an additional 1,500 additional GP and nurse appointments across the city.  These were well used;

·           At the time that the walk-in centre contract was due to end in 2017, government guidance indicated a move towards providing pre-booked appointments, rather than a walk-in service;

·           Engagement with patients showed a desire to keep the service in the community, but also a desire for pre-bookable appointments in addition to a walk-in service.  The new service therefore was commissioned as a hybrid model, with approximately 20% walk-in activity.  This equated to approximately 400 bookable appointments and 100 walk-in appointments per week;

·           A decreasing number of patients had been deflected from the “front door” over the last 6 – 12 months;

·           Most patients regarded the service received in the hub as “good”, although there was some frustration that the walk-in facility had been reduced; and

·           The new hybrid system appeared to have resulted in a better dispersal of patients across the city.

At the invitation of the Chair, the Right Honourable Keith Vaz MP addressed the Commission.  For clarity, he explained that the Merlyn Vaz Centre had been named after his mother and that Professor Farooqi, Co-Chair of the Leicester City Clinical Commissioning Group, was his GP.

Mr Vaz noted that, when people were unable to see their own GPs in a timely manner, the walk-in centre provided an alternative means of accessing health care.  It was recognised that funding for services had been reduced, but as the walk-in centre was intended to provide an alternative means of accessing a GP to introduce an appointments system was against the purpose of the Centre.  Lack of walk-in facilities also meant that patients were diverted to hospital Accident and Emergency services, so moving the problem of access to services to a different part of the system. This showed that the current balance of appointments and walk-in services at the Centre was wrong.

Mr Vaz asked the Commission to consider undertaking its own survey, to identify what people were looking for from GPs and GP hubs, and offered to help run a local referendum, with the Ward Councillors, to identify if there was a desire for  ...  view the full minutes text for item 10.

Members are asked to receive a briefing paper from the Leicester City Clinical Commissioning Group which sets out the key requirements of the NHS Long Term Plan. The Long Term Plan was published in January 2019 and sets out how the NHS needs to adapt and change over the coming years to ensure it can provide sustainable health care across England.

As agenda items 11, (“Introduction to the NHS Long Term Plan”) and 12, (“The Development of Primary Care Networks”), were considered together, please see minute 12 for the discussion on this item.

The Leicester City Clinical Commissioning Group submits a report on the Development of Primary Care Networks. Members are asked to consider and comment on the report as they see fit.

As agenda items 11, (“Introduction to the NHS Long Term Plan”) and 12, (“The Development of Primary Care Networks”), were considered together, the discussion on both items is recorded in this minute.

Sarah Prema, Director of Strategy and Implementation with Leicester City Clinical Commissioning Group presented a briefing paper setting out the key requirements of the NHS Long Term Plan (LTP). 

Ms Prema reminded the Commission that the LTP contained a vision for how the NHS would develop over the next 5 – 10 years and what it would deliver.  Previously, a commissioner and provider model had been used, creating contractual relationships, but the new model moved towards a partnership relationship.  The key to this would be to consider services from a Neighbourhood, Place and Systems perspective.  For example, Place would help in the consideration of services that could not be delivered economically at a Neighbourhood level and Systems would relate to sets of outcomes based on the health needs of the population under consideration.

MS Prema then drew attention to the following points:

·           As part of the LTP, it was anticipated that Integrated Care Systems would be designed and in place nationally by 2021.  These would be developed from Sustainability and Transformation Partnerships;

·           The first thing that needed to be done under the LTP was to establish Primary Care Networks;

·           The draft People Plan had already been published, giving some direction for national initiatives on how recruitment was to be undertaken; and

·           In creased use of technology, (digitally enabled care), would be embraced in all aspects of care.  For example, it was anticipated that patient follow-up appointments could be reduced by one-third through the use of technology.  This would release resources for use in other areas.

Richard Morris, Director of Corporate Affairs, Leicester City Clinical Commissioning Group, then discussed the development of Primary Care Networks (PCNs), showing the presentation attached at the end of these minutes and making the following points:

o    PCNs were an element of the Neighbourhood part of the LTP;

o    PCNs required groups of GPs to work together, so were not a new idea;

o    GPs had been asked to come together in groups of registered populations of between 30,000 and 50,000.  The former was a minimum number that would be acceptable, but there was a small degree of flexibility regarding the upper number;

o    PCNs were formal arrangements, which they had not been previously, having contracts from Clinical Commissioning Groups to provide primary care;

o    All PCNs were required to appoint a Clinical Director and would receive funding for this and other specified roles.  It was understood that the Clinical Directors all would be current GPs;

o    A number of service specifications would be issued at a national level in April 2020; and

o    Ten PCNs had been created across the city.  All GP practices were participating.

Members expressed concern that GPs already were unable to cope with the demands being made on them and queried how these changes would improve that situation.  In  ...  view the full minutes text for item 12.

The meeting adjourned at 7.47 pm and reconvened at 7.59 pm

The Assistant City Mayor for Health and the Director of Public Health will deliver a presentation that provides an overview of Leicester City Council’s Public Health and its priorities for 2019/20. Members will be asked to consider and comment on the presentation as they see fit.

Councillor Dempster, Assistant City Mayor for Health, reminded Members that currently there was a move towards community-based provision of public health services.  As part of this, a holistic approach was being adopted, moving away from a narrow focus on health, which hopefully also would lead to greater parity between physical and mental health services.  The presentation circulated with the agenda papers explained how work on this was beginning and observations from this Commission on this work were invited.

The Director of Public Health introduced the presentation that had been circulated with the agenda for this meeting.  He noted that the ring fenced grant received from the NHS had been reducing and it was not know when these reductions would stop.  At present, 0.9% of this grant was allocated for Public Mental Health in 2019/20 and Councillor Dempster expressed concern at this low level of expenditure.  Members noted that 17.8% of this grant was allocated for “Other council services” in 2019/20.  These were services such as sports, walking and cycling which added public health value but mostly fell within the remit of other scrutiny commissions.

The Director drew Members’ attention to the work done by Mori, on the Council’s behalf, to identify how Leicester residents rated their health.  This had identified that 75% had rated their health as good in 2018.  This was an improvement, but some significant challenges remained to be addressed.  There were various determinants of health, some of which were lifestyle factors.  However, it needed to be recognised that these factors were not always choices, as people could be driven in to situations.  Consideration therefore needed to be given to how this could be addressed.

Members suggested that this provided an opportunity to work alongside primary care networks and asked how this could be achieved.  The Director explained that it was hoped that the driver for future strategy would be through the Joint Integrated Commissioning Board.  Although much still was unknown about the new structures proposed for primary health care delivery, the new joint health and wellbeing strategy provided an excellent opportunity to work with providers.

The Commission stressed the need for Public Health to work with services such as housing and social care services.  The Director explained that this already was underway.  For example, Public Health officers were in active conversation with Planning officers regarding standards for internal and external space in relation to housing.  This was an example of how the delivery of some public health initiatives would be through other services.

AGREED:

1)    That the Director of Public Health be asked to ensure that this Commission continues to monitor how the development of public health initiatives in relation to the development of primary care networks; and

2)    That this Commission asks the Assistant City Mayor for Health and the Director of Public Health to consider giving early attention to developing a strategy for how Public Health could impact on housing space standards through the developing Local Plan, it being recognised that this will require evidence  ...  view the full minutes text for item 14.

The Scrutiny Policy Officer submits a document that outlines the Health and Wellbeing Scrutiny Commission’s Work Programme for 2019/20.  The Commission is asked to consider the Programme and make comments and/or amendments as it considers necessary.

The Commission received and considered its outline work programme for 2019/20, noting that this would be developed as the year progressed.

AGREED:

1)    That the Chair of this Commission be asked to liaise with the Chair of the Children, Young People and Schools Scrutiny Commission to consider how issues such as education Health Care Plans for children, childhood obesity and children’s mental health services can be scrutinised;

2)    That scrutiny of Maternity Services be included in this Commission’s work programme; and

3)    That all Commission members be invited to advise the Chair, Vice-Chair or Scrutiny Policy Officer of any suggested items for inclusion in the Commission’s work programme.

The meeting closed at 8.34 pm