Agenda and minutes

Health and Social Care Scrutiny Commission
Monday 22 June 2020 7.00 pm

Venue: Online/Virtual. Members of the public are welcome to attend the meeting. Please contact FitzroyAntonio.williams@southwark.gov.uk or Julie.timbrell@southwark.gov.uk for a link.

Contact: Julie Timbrell  020 7525 0514

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.

Impact of Covid 19 on residents and staff in Care Homes and the Home Care service

    Council and CCG staff will update the commission on PPE, testing, how residents are staying in touch family, friends and with the wider world, and lessons  learnt in protecting vulnerable people. 

     

    Unison will provide input on staff PPE and testing provision for Southwark social and  home care staff.

     

    A legal briefing on the Coronavirus Act 2020 Care Act easements is to follow.

    Minutes:

    The chair invited officers and NHS colleagues to update the commission on PPE, testing, how residents are staying in touch with family, friends and with the wider world, and lessons learnt in protecting vulnerable people. 

    An overview was provided by:

    ·  David Quirke-Thornton,  Strategic Director, Children’s & Adults Services

    ·  Genette Laws, Director of Commissioning , Southwark Council

    ·  Sam Hepplewhite, Director of Integrated Commissioning, NHS CCG

     

    PPE

    Officers explained that in the early days of the pandemic assistance to care homes had concentrated on provision of PPE, including supporting homes with the financial costs. Communication had been vital and this was provided via a newsletter– first daily, then weekly. This contained information on changes to guidelines, provision of free parking to care workers in order to avoid public transport, how to get PPE when suppliers fail, and how to use PPE. 

     

    Officers emphaised the scale of PPE requirement with 800,000 items needed locally across the sector, which included masks, googles, gloves, aprons, depending on infection.  PPE provisions ordered by homes were on occasions diverted to the NHS.  London Boroughs came together to procure PPE with Ealing taking the lead procuring 2.5 million items. Southwark led distribution for South East London. Officers explained that the council is not the routine supplier of PPE, only emergencies. Initially facemasks were in short supply; now the gloves are scarcer.

     

    Media images of PPE showed about full coverings  in hospital settings, whereas the guidelines for PPE provision in care homes was different, and that is what the council was focused on delivering to enable people to receive the care that they needed, which they did receive.

     

    Communication between care home residents and family and friends

    Communication between care home residents and friends and family had been facilitated with the use of iPads, and also on occasion by standing outside the home to see people, as well as  provision of PPE to relatives and friends so they could visit, in the case of accidents or end of life care.

     

    Testing

    Government testing stopped and then restarted. The local CCG/ NHS has been helpful in facilitating access and working closely with Public Health,  who have led on testing in care homes, which has now been done for 12 of the 15. There has been a portal to register,  targeting older people’s homes first and now moving on to working age care homes.

     

    Lesson learnt

    There are strong relationships with providers of care and shared values. The

    Ethical Home Care Charter has proved its value; our staff absence was lower than other boroughs. Officers will be prioritizing rolling out the Ethical Care Homes Charter.

     

    There was a lack  of understanding in the  Department and Health and Social Care about the  range of home care provision and remit, for example Care Homes are  not for getting people out of hospital, but rather residents homes  and there is a right for people in those homes to chose who comes in. There are 17 CQC registered providers in the borough, not only older  ...  view the full minutes text for item 5.

6.

Scrutiny review: Care Home and Extra Care Quality Assurance - draft headline report

    The draft headline report is attached.

    Supporting documents:

    Minutes:

    The chair invited comments on the draft headline report and the following points were made:

     

    ·  Officers clarified that the Older Peoples Hub is now due to go fully live on the 1 July, however services which are part of the hub have been continuing, including providing advice, which is particularly important with Covid 19 and cocooning.  The Hospital Discharge services are also continuing. Members considered the report ought to contain a specific recommendation on the Older Peoples Hub.

     

    ·  A member commented that the Commission had not spoken with the Independent Lay Advocacy service  and therefore could not be sure that they would have the capacity to deliver the recommendation which said: ‘Ensure systems are is put in place to ensure that people in homes (in and out of Southwark) who are unbefriended, have support by the Independent Lay Advocacy service, or similar’.

     

    ·  Members highlighted the importance of the complaints and benchmarking information request, which officers are due to provide more information on.

     

    ·  A member thought the recommendation on complaints could be tightened up. Officers confirmed there is a requirement for a complaints process in the commissioning contract.

     

    ·  Officers indicated support for recommendation for an Annual Care Home report, and for this to mirror the present Annual Home Care report that goes to cabinet annually, and which could also come to scrutiny annually.

     

    ·  Officers highlighted that the CCQ regulate and inspect care homes, and said that it might be advisable to invite them to a meeting when reviewing the recommended Annual Care Homes report. Officers reminded the Commission that while the council commissions a number of placements at care homes, a significant amount of people are self funded, where the CQC would have a role in their complaints. Previously the council received funding to oversee care homes, but that has moved to the CQC. The CQC are therefore in a very good position to provide an overview of complaints and benchmark with other care homes, and to give their insight and intelligence.

     

     

    ·  Nancy Kuchemann, GP contributed to the discussion and said that there is a borough based piece of work on looking at the quality of GP provision to Care Homes and offed to contribute to the scrutiny review.

     

     

    ·  Officer and the Commission members supported the developments with the Lay Inspectors and ensuring theirs visits dovetail with the commissioning visits and CQC.

     

7.

Covid 19 impact on the NHS

    The item will be an initial discussion on the impact of Covid-19 on our health systems,  both directly how the health system in Southwark has been able to meet the needs of Covid-19 patients, and indirectly in regards to the wider impacts on other health conditions

    Minutes:

    Sam Hepplewhite, Director of Integrated Commissioning, CCG NHS provided an overview of the impact of Covid 19  and the following issues were covered :

     

    ·  Testing and mortality

    ·  Extensive advice provided to people shielding

    ·  On going review of cancer services

    ·  Continuity of community work

    ·  GP delivery – all practices have received a delivery of laptops to change the way people access services. Virtually all practices have remained open.

     

    The following issues were discussed:

     

     

    ·  Care homes deaths, including location.

     

    ·  The impact of the following on mortality: age, ethnicity, housing tenue, households (e.g. multi generational, over crowding), occupation

     

     

    ·  The impact on Covid 19 on the use of other urgent NHS service such as strokes and cancer, and the recent campaign to encourage people to come back safely: ‘Helping us to help you’ which encourages people to ring first for triage and an appointment time.

     

    A number of action points were agreed, which are collated and captured under item 9.

8.

Scrutiny review: mental health children and young people - Suicide briefing

    At the end of January the Commission received a report from officers that had some information on Suicide.

     

    Members at the meeting and subsequently have requested some more information:

     

    -  Recent suicide rates covering the period 2016 – 2019

    -  A race and ethnic breakdown and comparison with borough averages to see if rates are proportionate

    -  Age breakdown (particularly of under 25s given the focus of the review – if this is possible)

    -  A copy of the Suicide Strategy

     

     

    A briefing is attached.

    Supporting documents:

    Minutes:

    The briefing was noted.

9.

Covid 19 equalities impact

    This item will be an initial discussion on how Covid-19 has affected Southwark residents, and in particular the disproportionate impact of Covid-19 on some of our resident populations, such as BAME residents, older residents including those in our care homes and more deprived communities.

    Minutes:

    Commission members raised the following issues to investigate further:

     

    ·  How can our hubs reach out to people particularly impacted by Covid 19

     

    ·  Children are showing increased mental health problems, including self harm, and there is evidence of increasing Domestic Abuse.

     

    ·  The adverse impact of Covid 19 on people with underlying conditions, frontline workers, BAME, and less investigated potential vulnerabilities including sickle cell disease and Jewish heritage. 

     

    ·  Equalities impact of lockdown on people e.g. poor housing, working practices (having to go out to work), childcare responsibilities.

     

    RESOLVED

     

    Officers will provide briefings and presentations on the below for the following meeting:

     

    Current numbers of confirmed Covid 19 cases and death rate for:

     

    a)  Southwark resident population

    b)  Southwark care home residents, placed in and out of borough

     

    Below equalities data for mortality and severe morbidity (e.g. very ill)

     

    a)  Ethnicity (including Jewish)

    b)  Age

    c)  Occupation

    d)  Tenure

    e)  Size of household

    f)   Sickle cell anaemia and other underlying health conditions 

     

    Impact of lockdown on people, particularly considering equalities: e.g. people in poor housing, with childcare responsibilities, different occupations etc.

     

    Impact on health service of Covid 19 and particularly:

     

    a)  To what extent are people returning to use services e.g. stroke and cancer

    b)  How will GP services accommodate different delivery now and in future provision

     

    Impact of lock down on children’s mental health and wellbeing, including Domestic Abuse.

10.

Work Programme

    This item will discuss the next scheduled meeting on 16 July.

    Minutes:

    Commission members requested briefing papers on:

     

    ·  the merger of the South East London CCGs and  the impact  on people and service delivery;

    ·  the impact of Covid 19 on GP practices and future provision.