Greenwich Council

Agenda and minutes

Venue: Town Hall, Wellington Street, Woolwich SE18 6PW. View directions

Contact: Denise Kevern  Email: denise.kevern@royalgreenwich.gov.uk or tel: 020 8921 5145

Items
No. Item

1.

Apologies for Absence

To receive apologies for absence from Members of the Board.

Minutes:

Apologies for absence were received for Councillors Denise Scott-McDonald and Danny Thorpe.

 

Apologies for absence were also received for Florence Kroll and Liz Butler.  (Tim Higginson sat on the Board as the representative for Liz Butler)

2.

Urgent Business

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

Minutes:

The Chair drew the Boards attention to the additional documents to Items 7 and 8 as circulated on the Supplementary Agenda.

3.

Declarations of Interest pdf icon PDF 44 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.

Minutes:

There were no declarations of interest made.

 

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 69 KB

Members are requested to confirm as an accurate record the Minutes of the meeting held on 3 October 2016.

 

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:

TheChief Officer of Greenwich CCG proposed an amendment to page 4 of the minutes, removing the word ‘over pricing’ as follows;

Developing Primary Care – The Greenwich CCG was moving towards full delegation level 3 for delegated commissioning which would provide more control over pricing locally.

 

Resolved -

 

That the amendment minutes of the meeting of the Health and Wellbeing Board held on 3 October 2016 be agreed and signed as a true and accurate record.

5.

NHS Greenwich Clinical Commissioning Group update pdf icon PDF 113 KB

To receive and note the updates from NHS Greenwich Clinical Commissioning Group provided in the appendices of this report.

 

Appendix 1           The Source

Appendix 2           Commissioning Intentions

Appendix 3           South East London Sustainability and Transformation Plan

Additional documents:

Minutes:

The Chief Officer for the Greenwich Clinical Commissioning Group (GCCG) presented the report advising that a series of workshops had been held with service providers and a further report on the analysis of the outcomes of these workshops would be presented to a future meeting of the Board.

 

She continued that the work undertaken on the commissions of a number of contracts for 2017-19 should be completed by the end of December.

 

The GAVS representative Board Member noted that the recent positive discussion, with the GCCG, on the role of the Voluntary Sector and their involvement in the bid to maintain the service of the recovery college was not reflected in appendix 2 of the report.

 

The GCCG Chief Officer confirmed that the involvement of the Voluntary sector in procurement was important and appreciated.  She had asked colleagues to look at the strategy for the Recovery College and they were talking to GP executives and other health provision partners and she was expecting that the public and the voluntary sector would be involved as the process progresses.

 

The GCCG Commissioning Intentions Officer added that discussions around positive discrimination were being undertaken with the Clinical Chair of NHS Greenwich, GPS for clinical leadership and the Voluntary sector.  It is anticipated that the outcomes from workshops to be conducted over the next six months will offer clarification on which organisations are the most appropriate to be involved and how to build the service in the future. 

 

A Royal Borough of Greenwich Councillor Board Member raised a number of specific concerns;

    Councillors were being asked by residents when the Source would re-open as they were very concerned that it appeared to be permanently closed.  The Health and Wellbeing Board would ask that efforts to get GP practices to take the Source on be doubled as there was a lack of confidence that NHS England had done much to pursued GPS to consider this.

    In respect of the Recovery College, this offered a tremendous service and it was felt there was a need for all partys to work collectively to find a way to support people in addition to the services offered by Oxleas. 

    It was felt that it would be useful to have a more collaborative approach to commissioning, building upon the existing collaborative approach developed between the Royal Borough of Greenwich and the Clinical Commissioning Group.  Examples of positive collaborative working were given. 

 

The GCCG Chief Officer acknowledged that there had been a lot of changes at the CCG with a number of new staffing appointments and there was a need to build on existing good working practices.  She continued that there was a need to build good working relationships with NHS England and develop positive joint working arrangements with partners.

 

The Director of Health and Adult Social Care confirmed that he had attended one of a regular number of joint meeting’s with the Clinical Commissioning Group (Committee in Common Meeting) that morning,  where a number of areas of  ...  view the full minutes text for item 5.

6.

Health and Wellbeing Strategy Update - post April 2018 pdf icon PDF 159 KB

To consider and agree the proposed process for updating the Greenwich Health and Wellbeing Strategy.

Minutes:

In presenting the report the Director of Public Health and Wellbeing advised the Board that, as the Health and Wellbeing Strategy was nearing the end of year 2 of a 3 year period, it seemed an appropriate point to look at re-visiting the priorities and the proposals thinking ahead to the next strategy.  He added that the report set out the proposals and timetable and that, whilst the current strategy expires in March 2018, it was a living rolling document.

 

The Board felt that the Strategy document was an effective one and it was useful having a 3 year review target, which was putting us ahead of other authorities.  Attention was drawn to the timetable proposing that The Board agreed its Health and Wellbeing Strategy in April 2018 which may fall within the Purdah period for the May 2018 Local Elections and proposed that this needed to be brought forward to the February 2018 Board meeting.

 

The Board commented that the obesity day workshop was productive but that adult and child obesity remained a significant issue, asking if any progress had been made on the promotion of play streets, cycle lanes, etc. particularly as these were good community care activities but more could be done on improving the wider environment.

 

The Director of Public Health and Wellbeing responded that this was one of the existing key standards and more applicants for play streets were being received but not at a pace we would like.  He continued that Borough environment for activity and healthy food was very much part of an on-going action plan and that he felt that obesity should be a continuing Strategy priority as, in line with the nationally trend, this was an area in which Greenwich was not seeing improvements.

 

The Chair commented that it was understood that the Councils Regeneration Department were working hard on advertising and promoting play and living streets, cycling and walking, but there was a need to maintain pressure in these areas.

 

Resolved -

 

That the proposed process for updating the Greenwich Health and Wellbeing Strategy be agreed.

7.

Winter 2016/17 update pdf icon PDF 106 KB

To note an update on Royal Borough of Greenwich’s preparedness for Winter 2016/17.

Additional documents:

Minutes:

The Board noted the presentation, supporting this item which had been circulated on a Supplementary Agenda for the meeting.

 

The Director of Health and Adult Social Care and the Director of Commissioning for the Clinical Commissioning Group (CCG) jointly presented the report advising the Board that the CCG and the Royal Borough of Greenwich were working together with the Accident and Emergency (A&E) delivery board, the actions, in relation to this were set out in the tabled presentation.

 

The Director of Commissioning (CCG) advised that through a combination of Care Quality Commissions (CQC) imposed and self-imposed bed embargos on Care Home and Nursing Homes there had been a negative impact on hospital discharge.

 

She continued that work was on-going, with care homes with self-imposed bed embargos to resolve the situation.  Further, positive working models were being developed, between a number of partners, to support patients with acute care issues and to ensure that the elderly frail should experience one, not two or more moves, upon hospital discharge. 

 

The Director of Commissioning (CCG) Liz James advised the Board that around three weeks ago an outbreak of diarrhoea and vomiting at Eltham Community Hospital meant that the Queen Marys Hospital, Sidcup opened its acute care unit, as a matter of urgency.  Subsequently processes have been established to allow the quick opening of bed.

 

She continued that the Key National and Local Indicator is that a patient is seen within a 4 hour wait target.  The expectation of Urgent Care Centre’s is that 99% are seen, treated and discharged in 4 hours, with a 2 hour target if there is a need to transfer the patient to A&E. However, this target is not being met and investigations were being undertaken as to why this is happening and co-ordinated progress to resolve the issues. 

 

The Greenwich CCG (GCCG) Chief Officer stated that there were still a proportion of people attending A&E who could receive care in other settings, such as GP’s and pharmacists.  Further, that there was a small cohort who attended A&E frequently and there was a need to look at why and how best to assist them in using other appropriate, services.

 

She continued that the time of day that a patient accessed A&E services was a factor and greater access to GP services was being promoted through the extension of weekday opening hours and introduction of Saturday and Sunday working, which people needed to be made aware of and built on.

 

Board Members noted that the reasons people attend A&E were complex such as proximity, deprivations, not speaking English as a first language, surety of treatment and expectations. 

 

The GCCG Chief Officer advised the Board that a high level of Norovirus and embargoed beds may result in the closure of some wards.  The Chief Executive, Lewisham and Greenwich NHS Trust added that the message needed to be clearly made to the public that they should not visit hospital patients if they, themselves, felt unwell.

 

The  ...  view the full minutes text for item 7.

8.

Home First Service update pdf icon PDF 106 KB

To note the update on the Home First Service development.

Additional documents:

Minutes:

The Board noted the presentation, supporting this item, had been circulated on a Supplementary Agenda for the meeting.

 

The Senior Assistant Director Partnerships and Operations took the Board through progress of the development of the Home First Service presentation as the appendix to the report.

 

She confirmed to Members that they were correct that Bexley had previously had the greater number of long stay patients, unnecessarily in hospital, waiting for discharge to appropriate housing and support.  However, since Bexley had addressed issues with Care Home Agencies and implemented a discharges to access pilot the position had changed and there were now more Greenwich residents ‘bed blocking’.  She added that Greenwich was initiating similar discharge practices as Bexley, which should address this situation.

 

The Chief Executive, Lewisham and Greenwich NHS Trust added that there were fewer patients who were Bexley residents than Greenwich residents in the Queen Elizabeth Hospital.

 

The Senior Assistant Director Partnerships and Operations responded to members that Greenwich had a number of challenging cases, also Greenwich tries to place patients in local facilities where as Lewisham spreads its net wider and their home care provision is larger.  She felt that borough demographics’ also played a part.

 

The Director of Health and Adult Social care advised the Board that a number of care homes, in Lewisham, were closed last year, creating a capacity issue for them.  This year Greenwich is facing a capacity issue as there is not enough provision to meet demand.  Further, as the care home market faces more embargoes there are capacity issues which need to be addressed.

 

The Senior Assistant Director Partnerships and Operations confirmed that the home is best model.  Proposals should enable people to remain in their own home longer. However, provisions had to exist to address the situation where this was no longer a practical situation for the person concerned.

 

The Chief Executive, Lewisham and Greenwich NHS Trust  advised the Board that when the system was at near capacity the impact was often out of proportion and there was always the concern that a care home could be closed due to a Norovirus outbreak, which, due to the known effect, would cause the entire discharge system to stop.

 

The Senior Assistant Director Partnerships and Operations added that how care homes are supported on awareness, deterring and dealing with infection control was a vitally important role that all parties had a part to play in.

  

Resolved –

 

That the presentation on the progress of the development of the Home First Service be noted.

 

9.

Better Care Fund update pdf icon PDF 31 KB

To receive a verbal update on the progress of the Better Care Fund 2016/17.

Minutes:

The Director of Health and Adult Social Care gave an oral report advising that he had attended a joint meeting with the Clinical Commissioning Group (CCG), earlier in the day, and both the CCG and the Royal Borough of Greenwich were clear on the financial and performance issues required to be met in line with the Performance Indicators.  That the Better Care Fund guidelines 2017/18 are due to be released shortly at which time further discussions will be undertaken with the CCG as to the identified shared achievement goals.

 

The Board felt that it would be beneficial if a substantive report on the achievement’s and collaborative working patterns was presented to a future meeting of the Health and Wellbeing Board.  Further, that such a report shows how the removal of £6million from the budget does not damage our ability to meet admissions and service demands.

 

The GCCG Chief Officer advised that they were waiting on guidance.

The Director added that it is challenging but looks positive.  Further, that both parties are aware it is a fragile system and both share the aim of providing services at Best Value.

 

Resolved –

 

That the oral update, given by the Director of Health and Adult Social Care, on the Better Care Fund 2016-17 be noted.

10.

Lewisham and Greenwich NHS Trust Quality Accounts 2015-16 (Information Item) pdf icon PDF 107 KB

To note the ‘easy read’ version of the Lewisham and Greenwich NHS Trust Quality Accounts 2015-16.

Additional documents:

Minutes:

The Chief Executive, Lewisham and Greenwich NHS Trust confirmed that this was intended to be an easy to read, simplified document, to ensure that it was accessible to the widest number of people.  He confirmed that there had been little feedback, at this time.

 

Members commented that similar ‘easy read’ reports would be helpful as a support to the full technical reports.

 

The Chair welcomed the ‘easy read’ version of the Lewisham and Greenwich NHS Trust Quality Accounts and felt that the Council could learn from this document commending it as a clear and accessible way of passing on information clearly.

 

Resolved -

 

That the ‘easy read’ version of the Lewisham and Greenwich NHS Trust Quality Accounts 2015-16 be received and noted.