Greenwich Council

Agenda and minutes

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Contact: Jean Riddler  Email: jean.riddler@royalgreenwich.gov.uk or tel. 020 8921 5857

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Panel.

Minutes:

Apologies for absence were received for Councillor Hartley.

 

Councillor Singh apologised for having to leave the meeting early.

2.

Urgent Business

The Chair to announce any items of urgent business circulated separately from the main agenda.

Minutes:

There were no items of urgent business for consideration.

3.

Declarations of Interest pdf icon PDF 34 KB

Members to declare any personal and financial interests in items on the agenda.  Attention is drawn to the Council’s Constitution; the Council’s Code of Conduct and associated advice.

Additional documents:

Minutes:

Councillor M. James advised that he was no longer a Governing Body member of Middle Park Primary School.

 

Resolved –

 

That the list of Councillors’ memberships as Council appointed representatives on outside bodies, joint committees and school governing bodies be noted.

4.

Minutes pdf icon PDF 65 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 10 July 2017.

 

No motion or discussion may take place upon the Minutes except as to their accuracy, and any question on this point will be determined by a majority of the Members of the body attending who were present when the matter in question was decided.  Once confirmed, with or without amendment, the person presiding will sign the Minutes.

Minutes:

Resolved -

 

That the minutes of the meeting of the Healthier Communities & Older People Scrutiny Panel held on 10 July 2017 be agreed and signed as a true and accurate record.

5.

Update on Musculoskeletal Services in Greenwich pdf icon PDF 55 KB

To consider the presentation providing an update on the Musculoskeletal (MSK) Service and to consider and agree to monitor the Key Performance Indicators (KPI’s).

Additional documents:

Minutes:

The Director of Commissioning for Green Clinical Commissioning Group (GCCG), the Director of MSK Operations (Circle) and the Clinical Chair of NHS Greenwich Clinical Commissioning Group (GCCG) took the Scrutiny Panel through the PowerPoint presentation on the current positon of the Musculoskeletal Services (MSK) and Key Performance Indicators.

 

It was commented by the Panel that it was surprising that the Lewisham & Greenwich Trust did not appear to have been invited to contribute to the presentation.

 

Director of MSK Operations apologised to the Scrutiny Panel and the Chief Executive of the Lewisham & Greenwich Trust.  She added that it had been shared with members of the operational team but not the senior team at Lewisham & Greenwich Trust, which was an oversight and any future presentations would be shared.

 

Members noted a discrepancy between the number of people recorded as referrals for April to July and those recorded on the 18 week RTT Update.  What was the correct figure; had the number of people accessing hospital care reduced and had patient needs improved or were they waiting longer for hospital care.

 

The Director of Commissioning (GCCG) explained that these figures covered two different roles. The first figure related to the number of referrals made by GP surgeries, which was expected to be 2000 per calendar month but an, unexpected, additional 600 referrals were received, though not all those people referred went onto the orthopaedic waiting list, some were being seen directly by a rheumatologist.  That the second figure related to the number of people on the waiting list for orthopedic surgery.  She assured the Scrutiny Panel that the number of people on the waiting list was reducing.

 

The Director of Commissioning (GCCG) responded to the Panel Members that it was not possible to provide comparison figures for the past six months and the six months previous to that due to changes in systems management of waiting lists.  However, it was possible to track a number of patient activities, since April and provide the details to the Panel Members.            

Action: Director of Commissioning (GCCG)

 

The Director of MSK Operations responded to the Panel Members that there were four options available to patients referred to Circle MSK services but they did not have to progress through them all and would be directed straight to the most appropriate option for their situation, which may be physiotherapy or surgery referral.

 

The Panel was concerned that this was not the situation in reality and an example was given by a Member of the public of a patient advised they required knee surgery being told to lose weight instead.  That there was a need to ensure that the patient flow and pathways were correct and being applied correctly.

 

The Director of MSK Operations gave assurance that there were surgical guidelines being followed to ensure surgical procedures had the best chance of success.

 

The Director of Commissioning (GCCG) added that the Lewisham & Greenwich Trust were still treating people that had come to them before the central referral process came  ...  view the full minutes text for item 5.

6.

Healthwatch Greenwich GP Access Report pdf icon PDF 36 KB

To consider the presentation and report on GP access prepared by Healthwatch Greenwich.  

 

Additional documents:

Minutes:

The Chief Executive for Healthwatch Greenwich & the Volunteer Development and Outreach Officer for Healthwatch Greenwich gave a PowerPoint presentation highlighting the background to Healthwatch Greenwich their role.

 

The Chair continued that the report before the Scrutiny Panel looked at GP practices and receptions; particularly with attention on the advice being given to people with Nil Recourse to public funds.  She asked if the closure of the Walk-in-Centres had increased the use of the A&E department and if there was an increase in the use by the transient population.

 

The Chief Executive for Healthwatch Greenwich informed the Panel that the main block to accessing services was people being asked to provide ID and proof of address, which they were often unable to do. He confirmed that Healthwatch Greenwich was aware that the CCG had been taking action to improve the practices awareness that this was not a requirement and should not result in patients being unable to register, but there were still ongoing concerns. Further, Healthwatch Greenwich had a patient champion working with patients to get them registered with GP’s and often faced issues were practices refused to offer an appointment until the patients’ medical records had been received. 

 

The Panel asked how many people were supported under Nil Recourse to public funds and if they were entitled to register with a GP what evidence was there that practices were turning down their applications to register.

 

The Director of Health and Adult Services advised that 300 families were supported by the Nil recourse team and no issues had been raised that they were facing challenges registering with GP’s.

 

The Volunteer Development and Outreach Officer for Healthwatch Greenwich responded that the Healthwatch advocate advice service was contacted, at least once a month, by people with Nil recourse who were having problems registering with a GP.  However, this number had begun to increase to 2 to 3 cases per month.  He continued that Healthwatch Greenwich had been involved in some strongly worded discussion with GP’s about registration issues where they were concerned about possible fraudulent action, with many practices stating that they felt that there was a need to know who the patients were.  He noted that fraud could be dealt with by referral to other bodies.

 

The Chief Executive for Healthwatch Greenwich added that access to primary care was a right that should not be restricted.  Further, in addition to Nil Recourse there was a large element of the population who found it difficult to provide residential information including homeless people and people having were having to reside at properties short term i.e. ‘sofa surfing’.

 

He continued that with the closure of the Walk-in-Centres the Urgent Care Centre at the Queen Elizabeth Hospital, provided by Greenbrook Healthcare saw an increase of 5% people who were not registered with a GP.  He acknowledged that there would always be a number of people, mainly from the transient population, who would not register with a GP. 

 

The Chief Executive for Healthwatch Greenwich responded to  ...  view the full minutes text for item 6.

7.

Housing strategy for people with a learning disability in Greenwich. pdf icon PDF 39 KB

To comment on the draft Housing strategy for people with a learning disability in Greenwich and use the pre-decision scrutiny process to develop comments, including those from a Roundtable meeting and joint Healthier Communities and Housing Scrutiny Panel meeting, which will be forwarded to the Cabinet Member for consideration.

Additional documents:

Minutes:

The Panel Members noted that as part of pre-decision scrutiny, they had seen the detailed proposal and the Panel Members had identified the process to be followed to ensure any recommendations made would be taken on board.

 

The Assistant Director Commissioning and Business Support advised that three separate documents would be produced; one would present the full strategy, one would be a summary of the strategy and one would be an accessible version of the strategy summary.   That, having taken on board the Panel Members suggestions, the accessible version of the strategy summary would be the public facing document with the target audience being people with Learning Difficulties. 

 

The Assistant Director Commissioning and Business Support confirmed that the proposal fell within the current contract costing and there was potential for savings.

 

The Assistant Director Commissioning and Business Support responded to the Panel that, going forward, Golden Lane Housing would be involved in lease arrangements with private landlords.

 

The Panel felt that some elements of the summary were overly descriptive and needed to be in plain English as people needed to understand what was being said.

 

The Director of Health and Adults People Services confirmed that officers would look at the wording to ensure it was accessible. 

 

In response the Panel Members comment that young disabled people should be given a higher priority; the Director of Health and Adults People Services agreed that this may be appropriate and would be considered.  He continued that a lot of work had been undertaken in modelling the cost of provisions and trying to identify hidden costs which, whilst difficult, was proving to be a good discipline and officers were getting better at this.  He advised that implementation would present all departments with challenges. 

 

The Panel noted that there was a concern that there was a need for leadership and maintained co-operative working to make this a success. 

 

The Director of Health and Adults People Services indicated he was mindful of this and the challenge of sustaining the strategy for, at least, 5 years.  He stated that it was necessary to find a way to establish and sustain multi-department ownership and oversight for at least 5 years.

 

The Director of Health and Adults People Services replied to the Panel members that it should be possible to issues a letter of support for the strategy from the Chief Executive.   Further, an investment plan would be implemented as part of the commitment to the strategy and help to ensure a financial focus be maintained on delivering on the priorities.

 

The Assistant Director Commissioning and Business Support added the delivery plan and investment document would be renewed each year and made available as a public document.

 

The Managing Director of the Clinical Care Commissioning Group (CCG) felt that this was a good report with the right strategy approach.  Further, if it was implemented correctly, by all parties, there should be a continuation of care and provision without disruption to clients.

 

The Scrutiny Panel felt that references to the  ...  view the full minutes text for item 7.

8.

Monitoring report on selected health and social care performance indicators. pdf icon PDF 787 KB

 

 

To examine and consider the information on the selected indicators which are based on the public health, NHS and adult social care outcome frameworks and to use the information to continue the panel’s ongoing assessment of how effectively the Council and its partners are meeting the health and wellbeing needs of the local population.

Minutes:

A Member asked if, in relation to paragraph 5.4 of the report, the comparison of indicators used signified what Greenwich was not getting right and if there were any other areas of concern.

 

The Director of Health and Adult Services responded that different Boroughs did better in different areas which was accommodated for as the differences were often small variants. 

 

Resolved –

 

1.     Considered and noted the information on the selected indicators which were based on the public health, NHS and adult social care outcome frameworks.

 

2.     Agreed to use the information to continue the panel’s ongoing assessment of how effectively the Council and its partners are meeting the health and wellbeing needs of the local population.