Agenda and minutes

Health and Social Care Scrutiny Commission
Thursday 27 February 2020 7.00 pm

Venue: Ground Floor Meeting Room G01A - 160 Tooley Street, London SE1 2QH. View directions

Contact: Julie Timbrell 020 7525 0514 

Link: Livestream/Video (YouTube)

Items
No. Item

1.

Apologies

2.

Notification of any items of business which the chair deems urgent

3.

Disclosure of Interests and Dispensations

4.

Minutes

5.

Community Pharmacies and Substance Misuse services

    Pharmacy providers have been on a three year contract to provide needle exchange and supervised consumption since 1 April 2017 (ending 31 March 2020). This item will discuss plans to change the commissioning arrangements.

     

    A report from the strategic director of place and wellbeing / director of public health setting out the background to the service is enclosed.

    Supporting documents:

    Minutes:

    Kevin Fenton, Strategic Director, Place and Wellbeing, and Farrah Hart, Consultant - Public Health, summarised the paper provided in advance, which outlines the proposed changes to the commissioning arrangements for Community Pharmacies to provide needle exchange and supervised consumption.

     

    The chair then invited members who are in close contact with Community Pharmacies,  to outline their concerns:

     

    ·  Delivering this service can be demanding for Community Pharmacies and they would like this service valued;

    ·  Complaints about difficulties delivering the service to go to CGL, the provider, and on occasions to the police, rather than directly to the council. There are daily complaints;

    ·  The position with St George’s Pharmacy  is unclear and this may because of complexity and miscommunication;

    ·  Concern about coverage around Elephant & Castle;

    ·  Concern about the tone of communication from the council regarding changes to commissioning arrangements, and if it was sufficiently collegiate given the important role Pharmacies play in the community.

     

    The Strategic Director responded that the CGL provider ought to communicate with the council directly on any complaints, and there has been a problem here. Going forward officers will be working on improving communication and will go back to re - engage with the pharmacies , both those willing to continue and those not.  This will particularly include engagement on the issues raised in the complaints conveyed to the provider, CGL.

     

    Officers explained the benchmarking process that had taken place with neighbouring boroughs to set new tariffs, following the end of the previous three year commissioning cycle. They emphasised the strain the Public Health budget is under and the need spend money wisely.

     

    Members asked about cold spots with poor coverage, both north and south of the borough. Officers said there is a map and they are working to ensure a good spread of geographical provision. Officers are concerned with coverage in the area St George’s Pharmacy work and they will be working with them closely.

     

    The Strategic Director offered to return in 6 months time to review delivery once the commissioning arrangements are finalised, and members indicted this would be helpful.

6.

Lay Inspectors

    Age UK Lewisham and Southwark have provided a summary of Lay Inspector work for the previous year 2019/20 and plans for 2020/21, in the enclosed letter, alongside a description of the Lay Inspectors work.

     

    Commissioners will provide an outline of current and future funding arrangements with Age UK Lewisham and Southwark.

     

    Proforma from Age UK used by Lay Inspectors when visiting care homes and two example reports used by volunteer Lay Inspectors when visiting care homes. The reports on care homes are contained in the closed agenda as they identify individuals.

    Supporting documents:

    Minutes:

    Genette Laws, Director of Commissioning, gave an overview of the future and planed commissioning arrangements between the council and Age UK Lewisham and Southwark. Historically the Lay Inspectors programme consisted of a team of 12 volunteers; the Lay Inspectors. Until recently a coordinator was employed by Age UK for 2 days per week to oversee this function. The Lay Inspector work  in groups of 2/3 and conduct 3 visits (2 day time & 1 night time) per year to each of six Care Homes in Southwark. They produce reports that are submitted to Southwark Council; however there has been no recent active engagement between Contract Monitoring and the Lay Inspectors, and that is a weakness.

     

    Ross Diamond, Chief Executive Officer Age UK Lewisham and Southwark explained that there had been a pause in the Lay Inspection work, however this will resume now the funding has been received.

     

    The Director of Commissioning said that at a recent meeting between commissioners and Age Concern the parties agreed to redevelop the scope and role of the Lay Inspectors and vitally to establish closer working relationships and joint working. Going forward the focus of Lay Inspectors would be to complement contract monitoring activities, rather than duplicate by focusing on the areas that contract monitoring officers may not get the same outcomes – e.g. speaking with residents to get their views. The Lay Inspectors will focus on seeking the views of service users, family and staff to obtain feedback, rather than formal inspections.  Visits will be coordinated in line with the overall contract monitoring schedule and regular meetings will take place to share intelligence and agree plans.

     

    The Director of Commissioning said that the scope of involvement is also to be expanded to include Care at Home. There will also be training and development in line with development of Young Inspectors roles.

     

     

    The chair invited questions from members and the following points were raised:

     

    ·  Six homes visited are those most used by older people in the borough and include the commissioned Anchor care homes and the nursing homes with most Southwark residents.

     

    ·  The Lay Inspectors would undertake at least one visit per year (3 in one) but would repeat if there were concerns.

     

    ·  The Care at Homes scheme will be particularly focused on those people without regular family contact and the un- befriended, aiming for a 1000 contacts. It would be a planned telephone call.  If concerns are uncovered the response provided is still being scoped out - it is expected that Age UK volunteers  would relay these to the council and close links with officers will be essential.

     

    ·  The Director of Commissioning said the Care at Home would be an expanded project with a different cost envelope. Age UK Lewisham and Southwark COE said they would be delighted to take on this extra work and employ more people and more volunteers.

     

    ·  Both the Director of Commissioning and the Age UK CEO agreed the new Lay Inspection programme can be quite speedily resumed using existing volunteers,  ...  view the full minutes text for item 6.

7.

Review: Care Homes quality assurance - follow up briefings

    This item will cover:

     

    A summary of current and future commissioning arrangements for care homes in Southwark for older people.

     

    Proforma used by monitoring officers when visiting Care Homes and the last 6 months care home monitoring reports from officers.  The reports on care homes are contained in the closed agenda as they identify individuals.

    Supporting documents:

    Minutes:

    Two discussions were held on Care Homes, firstly on progress towards commissioning two new nursing care homes, and secondly on quality assurance in present homes used by Southwark.

     

    Commissioning new Care Homes

     

    The Director of Commissioning provided a presentation that outlined the Council Plan commitment to open two new nursing homes and current commissioning progress on delivering this. Cabinet has given permission to award contracts for local provision.  The intention is to tender with three bidders to award contracts for high quality care. The Engagement Group is the core group coordinating the programme. This consists of council and CCG staff, Healthwatch and Age UK. Wider engagement has taken place with the community sector, residents, older people in care homes and families. A Co-design group has been established of volunteers and this has conducted interviews with providers. Theses are now being evaluated.

     

    The chair invited questions and the following points were made:

     

    ·  The decision on the providers will be decided utilising the process the Director of Commissioning outlined. Presently the specification and price is being decided, with a decision pending May.

     

    ·  Two providers are definitely offering to build new homes. Other provision might come from utilising existing buildings.

     

    ·  The majority of residents who are presently housed out of the borough want to move back to Southwark; however a minority may want to stay where they are. A survey showed that 80% would want to move closer to home.

     

    Contract monitoring of existing Care Homes and Lay Inspector visits

     

    Two proformas were enclosed in the agenda. One used by monitoring officers when visiting care homes and one used by Lay Inspectors when visiting care homes (provided under item 6). In addition members were provided with the last 6 months care home monitoring reports from officers and two example reports produced by volunteer Lay Inspectors when visiting care homes.  The reports on care homes were contained in the closed agenda as they identify individuals; however the discussion is summarised here.

     

    The following points were made regarding visits and inspections:

     

    ·  Officers explained that Anchor homes are consistently rated Good by the CQC, which means the CQC will only return every two years. It was noted that the quality of care in a home can deteriorate quite quickly if a good manager leaves.  If Lay Inspectors visit and make a poor report that would not trigger a CQC visit as there is no direct link, however it would influence the  contract management relationship. Individuals can raise concerns with the CQC, as can the council. Officers do share intelligence with the CQC; however this doesn’t always trigger a visit, though on occasions it does. The council would always visit if there were concerns raised.

     

    ·  Members commented that Ofsted do not always seem to acknowledge local feedback. Offices said that the CQC ought to acknowledge responsive feedback and they also have a financial list of providers at risk.

     

     

    ·  Officers advised that the Older People’s Hub could give more information to prospective older people and friends and family  ...  view the full minutes text for item 7.

8.

Review: Mental Health of children and young people

    The London Assembly Health Committee  has produced a report on the impact of Adverse Childhood Experiences, a theme of the scrutiny  review. 

     

    The report is enclosed:

     

    Connecting up the care: Supporting London’s children exposed to domestic abuse, parental mental ill-health and parental substance abuse.

    Supporting documents:

    Minutes:

    The London Assembly Health Committee report on the impact of Adverse Childhood Experiences, ‘Connecting up the care: Supporting London’s children exposed to domestic abuse, parental mental ill-health and parental substance abuse’. This is a theme of the scrutiny review. The report was noted.

9.

Work Programme

10.

Lay Inspector Reports

11.

Status Visits and Monitoring Reports of Care Homes