Agenda and minutes

The Chair welcomed everyone to the joint meeting and all present were asked to introduce themselves.

Apologies were received from Councillors Cutkelvin, Dawood and Glover.

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. 

Councillor Willmott declared an Other Disclosable Interest in Minute No 8 as he had a relative in a care home in the city.

In accordance with the Council’s Code of Conduct the interest was not considered so significant that it was likely to prejudice Councillor Willmott’s judgement of the public interest. Councillor Willmott was not, therefore, required to withdraw from the meeting during consideration and discussion on the item.

The Monitoring Officer to report that a petition has been received from Mr R Ball, on behalf of the Campaign Against NHS Privatisation requesting the Council’s Health and Wellbeing Scrutiny Commission to scrutinize the Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland.

Mr Ball has requested to present the petition to the meeting.  The petition has 243 signatures and is in the following form:-

“We the undersigned, call upon Leicester City Council’s Health and Wellbeing Scrutiny Commission to investigate and scrutinize effectively the Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland which contains plans to cut costs by closing over 400 beds (more than one fifth of all beds) despite a current bed shortage and growing need for health care.  While we welcome an expansion of community services, research suggests community services do not necessarily reduce the need for hospital beds and do not lead to a cheaper model of care.”

Scrutiny Procedure Rule 9 (a) (ii) (e) states that if a petition is presented at the same Committee meeting at which there is a report on the agenda on the same subject, a Councillor may propose that the petition be considered with the report.

Otherwise, the petition will be accepted with debate and referred to the Monitoring Officer for consideration and action as appropriate.

The Monitoring Officer reported that a petition has been received from Mr R Ball, on behalf of the Campaign Against NHS Privatisation requesting the Council’s Health and Wellbeing Scrutiny Commission to scrutinize the Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland.

Mr Ball has requested to present the petition to the meeting. The petition had 243 signatures and was in the following form:-

“We the undersigned, call upon Leicester City Council’s Health and Wellbeing Scrutiny Commission to investigate and scrutinize effectively the Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland which contains plans to cut costs by closing over 400 beds (more than one fifth of all beds) despite a current bed shortage and growing need for health care. While we welcome an expansion of community services, research suggests community services do not necessarily reduce the need for hospital beds and do not lead to a cheaper model of care.”

Mr Ball had subsequently requested that Ms Sally Ruane present the petition on his behalf.  Ms Ruane present the petition and requested that she be allowed to ask questions on the Better Care Together Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland..

Members were advised that Scrutiny Procedure Rule 9 (a) (ii) (e) stated that if a petition was presented at the same Committee meeting at which there was a report on the agenda on the same subject, a Councillor may propose that the petition be considered with the report.  Otherwise, the petition would be accepted with debate and referred to the Monitoring Officer for consideration and action as appropriate.

RESOLVED:

That the petition be received and referred to the Monitoring Officer for consideration and action as appropriate and that the petitioner be invited to submit questions when the Better Care Together Better Care Together Five Year Plan for Leicester, Leicestershire and Rutland was discussed later in the meeting.

To receive a briefing from the Care Quality Commission on their work in relation to scrutiny. 

In particular the CQC have been asked to outline the following:-

·         Their work with GP Practices.

·         The partnership working arrangements with NHS England.

·         An overview of any inspections carried out in Leicester.

·         The protocols, if any, for notifying local authority scrutiny functions of planned inspections. 

Note: The following documents have been made available since the agenda was originally published.

a)         Response to the background questions submitted to the CQC. Appendix A (Page)

b)         Copy of the presentation notes.  Appendix A1 (Page)

Michelle Hurst, Inspection Manger Central Region and Yin Niang, Interim Inspection Manager, gave a presentation on the work off the Care Quality Commission in relation to scrutiny.  A copy of the presentation had been circulated to Members prior to meeting and had been published with the agenda together with a written to response to background questions relating to the work of the CQC in relation to the following:-

•           Their work with GP Practices.

•           The partnership working arrangements with NHS England.

•           An overview of any inspections carried out in Leicester.

The protocols, if any, for notifying local authority scrutiny functions of planned inspections.

In addition to the information in the presentation and the response to the background questions, the following comments were made:-

a)         There were three directorates responsible for Hospitals (NHS and private), Primary Medical Services and Adult Social Care (Care home and domiciliary care).  Each directorate had a Chief Inspector.

b)         New regulations were introduced in April which made changes to the changes the inspections and reporting mechanisms.

c)         Inspections were now carried out around five key lines of enquiries:-

            i)          Safe – people protected from abuse and avoidable harm.

ii)         Effective – good outcomes achieved for care, treatment and support, good quality of life is promoted and is based upon best available evidence.

iii)        Caring – people are treated with compassion, kindness, dignity and respect.

            iv)        Responsive – services meet people’s needs.

v)         Well led – leadership, management and governance delivers high quality care supports learning, innovation and promotes an open and fair culture.

d)         There were now four ratings for inspections – ‘inadequate’, ‘requires improvement’, ‘good’ and ‘outstanding’.  If an establishment received a rating of inadequate it was put into special measures immediately and not after six months as previously.  This meant that the NHS England and the CCG were able to put in additional assistance immediately to drive up standards.

e)         Inspections of all NHS Acute Trusts and NHS Hospital Trusts began in April 2014.  Inspections covered the 8 core services which were outlined in the presentation.  Trusts were given 2-3 months’ notice of planned inspections and requested to submit preliminary information.  Inspections usually took approximately a 1 week for acute services trusts.  Unannounced inspections also took place in both acute and community services establishments.

f)          Inspection reports were shared with the establishments for them to comment upon the accuracy of the report.  A Quality Summit was the held with the establishment and the stakeholders, Trust Development Agency, Healthwatch, CCG’s NHS England, after which the report was published on the CQC’s website.

g)         The size of the inspection team varied depending upon the type of establishment being inspected.  The Team Leader for each inspection would usually be a member of the CQC Inspection Directorate.  The Team could comprise around 30 people for a district general hospital and more for a multi-site trust or combined acute/community trust.  The composition of the various inspection teams for hospitals, primary medical services and adult  ...  view the full minutes text for item 5.

To receive an update on the current arrangements for Healthwatch in the City.

A briefing paper from Voluntary Action Leicester is attached at Appendix B. (Page )

Note: The following documents have been made available since the agenda was originally published.

A position statement from the former chair and members of the Healthwatch Leicester Board is attached at Appendix B1  (Page)

A statement from the Director Care Services and Commissioning, Adult Social Care, Leicester City Council is attached at Appendix B2 (Page)

Members received an update on the current arrangements for Healthwatch in the City.

Kevan Lyles, Chief Executive, Voluntary Action Leicester (VAL), presented a briefing paper from Voluntary Action Leicester which had previously been circulated with the agenda for the meeting.

In addition to the comments in the briefing paper, the following statements were noted:-

a)         VAL had been contracted by the City Council to deliver a successful transition from the previous LiNK to establish an independent Healthwatch for Leicester City.  VAL considered that the current Healthwatch Leicester were not as successful as the Healthwatch for Leicestershire, and the Chair of the Leicestershire Healthwatch was at the meeting if members wished to ask questions.

b)         VAL did not consider that there had been a breakdown between VAL and Healthwatch Leicester.  The recruitment process for new Board members was now underway, following the resignations of a number of Board members.

c)         Details of the current inspections being carried out by Healthwatch Leicester in conjunction with Healthwatch Leicestershire were outlined in the briefing paper previously circulated.

d)         Nationally, approximately 1/3 of Healthwatch were established on the model implemented in Leicestershire.  Approximately 1/3 of Healthwatch were organised on the independent stand-alone model requested by the City Council, but the vast majority were funded by a ‘grant process’ and not a tender process.

e)         It was envisaged to have a new Independent Healthwatch Board in place by 1 June 2015.

In response to members’ questions Mr Lyles stated:-

a)         The initial target of Healthwatch Leicester being established as an independent organisation from 1 April 2014 had not been achieved and VAL had assessed that the Leicestershire model was working well and should be looked at again as a model for the City.  VAL had not felt able to ‘novate’ the contract to Healthwatch Leicester as they felt that Healthwatch Leicester were not ready to become an independent body and that this was not in the best interests of the people in Leicester.  VAL took their contract responsibilities seriously and felt that patients and service users in the City required the best possible voice to represent them.

b)         VAL provided back office functions and systems to Healthwatch Leicester and when Healthwatch Leicester made arrangements to transfer its operations to Age Concern’s premises and for Age Concern to take over these functions, VAL were concerned that IT system would not be able to deliver the requirements for Healthwatch Leicester and that VAL had not been able to discuss issues fully with the lead on finance on the Board.  Consequently VAL had requested the City Council for a delay in establishing an independent Healthwatch Leicester under the terms of the contract.  This decision had been taken on the basis of best practice nationally and locally.

c)         VAL were also awarded the contract to establish an independent Healthwatch for Rutland and this had been achieved.  That contract was for one year and not three, as with the City Council, and with hindsight, it may have been better for VAL  ...  view the full minutes text for item 6.

To receive a presentation from Geoff Rowbotham, Interim Programme Director, Better Care Together, and Sue Lock, Managing Director, Leicester City Clinical Commissioning Group on the Better Care Together Programme.

Note: The following documents have been made available since the agenda was originally published.

a)         Article in the Leicester Mercury dated 21 January 2015 – Appendix C (Page)

b)         Briefing Note on Better Care Together issued by the Interim Head of Communications and Engagement, Better Care Together on 21 January 2015. Appendix C1 (Page )

c)         Copy of the presentation notes.  Appendix C2 (Page)

Geoff Rowbotham, Interim Programme Director, Better Care Together, and Sue Lock, Managing Director, Leicester City Clinical Commissioning Group gave a presentation on the Better Care Together Programme. A copy of the presentation had been circulated to Members prior to meeting and had been published with the agenda together with the following:-

a)         An article in the Leicester Mercury dated 21 January 2015

b)         A briefing note on Better Care Together issued by the Interim Head of Communications and Engagement, Better Care Together on 21 January 2015.

In addition to the statements in the presentation notes the following comments were noted:-

a)         The vision and proposals for change in the Programme had been the result of considerable discussions between 8 partner organisations as the preferred way forward to address the challenges faced by health and social care services in meeting the requirements of the programme.

b)         There was a potential financial gap of £400m if 5 years’ time if nothing was change to the way health and social care services were delivered.  This could potentially be £1.2m if the projected cumulative financial shortfalls were taken into account.

c)         The programme could only be delivered through partnership working and all 8 partner organisations delivering health and social care services in Leicester, Leicestershire and Rutland.

d)         The proposals for the clinical and social care case for change had been derived from a number of stakeholder events in January/February 2014 attended by approximately 200 stakeholders.

e)         The left shift in delivering patient care from the secondary health sector to the primary care health sector across the 8 work-streams was aimed at increasing efficiencies and increasing the overall provision of care as a result.

f)          The development of the 8 clinical pathway work-streams had been developed by a cross section of clinicians, patients and carers groups and local authority representatives to identify the intervention necessary to transform for the existing service delivery model to achieve the outcomes required in 5 years’ time.   The urgent care, frail older people and long term conditions work-streams had been tested against the Kings’ Fund Ten components of care to frame the service transformation.

g)         The programme and supporting documents were now in the public domain and had been subject to external reviews by Health and Wellbeing Boards, Clinical Senates, NHS England and the Office of Government Commerce.  Although the programme was still being reviewed it was already delivering early patient experience benefits.

h)        Examples of improved patient pathways were shown in the presentation.  One revised pathway for patients with eye problems estimated that attendances at A&E could be reduced by 2,000 visits per year by improved training and treatment by GPs and Optometrists.

i)          Service reconfiguration was progressing and De Montfort, Leicester and Loughborough universities were involved in discussions to integrate their work to support workforce development and service delivery.

j)          Patient and public involvement and communication and engagement workshops had fed views back on the proposals in December and wider public consultation would start on 16  ...  view the full minutes text for item 7.

To receive a presentation on progress against the Implementation Plan for the delivery of the Strategy.

Note: The following document has been made available since the agenda was originally published.

Copy of the presentation notes.  Appendix D (Page)

Bev White, Lead Commissioner (Dementia) Care Services and Commissioning and Mark Wheatley, Public Health Specialist, Mental Health and Vulnerable Groups gave a presentation on the progress made against the Implementation Plan for the delivery of the Strategy. A copy of the presentation had been circulated to Members prior to meeting and had been published with the agenda

In addition to the information shown in the presentation the following comments and statements were noted:-

a)         The national costs for dementia services of £26.3m were more that the costs for strokes and cancer services combined.

b)         The achievements to date were listed in full in the presentation.

c)         Much work had been undertaken to design leaflets for dementia sufferers and carers.

d)         The City Council’s Dementia Care Advisors are a point of contact for people living with dementia from diagnosis onwards.

e)         In 2014 there was a focus during National Dementia Week on BME communities in response to previous comments made by members to raise awareness and support.

f)          Work was progressing under the Frail Older People priority work-stream of the Better Care Together Programme.  Data was being gathered on services in all sectors.  A bid to the CCG to fund a project to explore the reasons for under representation of BME communities in dementia services had been submitted and the outcome was awaited.

g)         The dementia diagnosis rate in Leicester was 67% which was one of the best in the country compared to the national average of 48%.  A stretch target of 72% had been set for the end of the year.

h)        The diagnosis rates of dementia by ward and by ethnicity were contained in the presentation notes previously circulated.  The ward analysis identified those ward where the rates of diagnosis were significantly higher or lower rate for Leicester as a whole.  There was an under representation in the diagnosis of 16.8% of the Asian/Asian British ethnic category compared with their proportion of the total population of 25.7%.

In response to members’ questions, the following responses were noted:-

a)         Officers were working with the CCG to understand the disparities on the rates of diagnosis by wards and ethnicity.

b)         Although Rushey Mead Ward had a number of elderly persons’ homes, the rates for diagnosis of dementia in the ward were close to the average for the city as a whole.  It may be that a number of people in residential care may not be formally diagnosed with dementia.  They may be engaged with primary care services and may have entered residential care for other reasons and developed dementia as they grew older.

c)         Good practice for new build care homes is to have separate accommodation aimed at residents with similar levels of need. Advice was given to potential investors in the city on the requirements for new build care homes.  This separation was not always possible in existing care homes but staff are required to have training to be able to deliver care to people with differing levels of dementia  ...  view the full minutes text for item 8.

To receive a presentation that provides an overview of the key implications of the Care Act 2014 and progress so far in planning for the implementation of the changes. A briefing note for Councillors is attached at Appendix E as background information.

Note: The following document has been made available since the agenda was originally published.

Copy of the presentation notes.  Appendix E1 (Page)

Gwen Dowsell, Programme Manager, (Business Change) Care Services and Commissioning gave a presentation that provided an overview of the key implications of the Care Act 2014 and progress so far in planning for the implementation of the changes. A briefing note for Councillors and a copy of the presentation had been circulated to Members prior to meeting and had been published with the agenda

In addition to the information contained in the presentation the following comments were noted:-

a)         The provisions of the Care Act would come into force on 1 April 2015 excluding the funding reforms provisions which would come into force on 1 April 2016.

b)         The main emphasis of the provisions of the Act was to shift the focus on preventing, reducing and delaying care and support needs.

c)         The Act placed an obligation on local authorities to assess needs against a national eligibility threshold, and, at this stage, it was not envisaged that this would create a significant impact upon current demands.

d)         There were some additional duties in respect of prisoners’ rights to social care.

e)         Further guidance on the funding reforms was expected but currently it was proposed to operate a cap on lifetime costs of care of £72,000 for people 65 years and over.  The means test threshold would increase to £118,000.

f)          Details of the proposed national and local public information campaigns were detailed in the report.  11 wards had been selected to receive door drop leaflets by the agency undertaking the work for the Department of Health.  These wards had been selected by postcode areas to give the demographic profile of the target group for the leaflets.  The postcodes selected were LE4–6, LE4-7, LE5-2 and LE5-5.

g)         The current IT system was being updated to accommodate the requirements of the new legislation as part of the software update contract.

h)        There could be an influx of people coming forward after the information campaigns, particularly carers, and arrangements were being made to be able to respond to them.

i)          The suggestion by Members of using ward community meetings to publicise the changes would be incorporated into the local information campaign.

RESOLVED:-

                        That the officer be thanked for their presentation.

The Chair declared the meeting closed at 9.25 pm.