1. Jane Fryer, Medical Director, NHS Southwark
2. Sarah Feasey, Principal Lawyer, Southwark Council
3. Francis O’Callaghan, Director of Performance, King’s Health Partners
Minutes:
6.1 As an introduction to this item, the chair shared statistics on Southwark’s demographics and related health issues. For example; that the borough is the ninth most deprived nationally, a measurement of economic factors that significantly impact health; and that despite the borough’s comparatively young population Southwark has an increasing prevalence of dementia. He highlighted that the sub-committee has just five further meetings during the 2010/11 civic year and that members are likely to be presented with many issues regarding changes to local health services, in addition to the topic(s) that they select to review.
6.2 Susanna White, chief executive of NHS Southwark and strategic director of Southwark’s health and community services, welcomed the new members and remarked that the sub-committee has never faced such difficult circumstances as at present, or been as needed, in helping to work out how people in Southwark can be provided with the right care, yet with less money: The council’s current budget for health and community services will be reduced by 25% over a period of three years - from approximately £90 million to £65 million. She explained that this impels the need to look carefully at how a different system could still keep people safe. The new personalisation scheme will be brought into an environment of more controls but smaller budgets. She hopes that the sub-committee will be able to help identify how this can be achieved.
6.3 Regarding the budget for services provided by NHS Southwark, this will not be reduced, but there are financial pressures due to Southwark’s changing demographics and the need to provide additional procedures, etc. The chief executive stated that this similarly compels re-modelling, as budgets would be approximately £90 million adrift in five years time, unless there are changes. The proposals for re-modelled and altered services will therefore be brought to this sub-committee.
6.4 NHS Southwark will also be looking for South London and Maudsley (SLAM) to reduce the costs of their mental health services. This is already outlined in the strategic plan, but members will be informed about the emerging details for service change.
6.5 The chief executive also noted that a Health White Paper will soon be published by the new government, which is expected to outline proposals for GPs to lead commissioning. She commented that Jane Fryer, the NHS Southwark medical director, is a GP herself and will attend the sub-committee’s meetings, providing a key link to the PCT.
6.6 Members requested further information about the potential change in the White Paper regarding GPs taking up the commissioning role that is currently held by the PCT. The chief executive responded that she cannot really clarify until the White Paper is available, but that the Secretary of State’s intention is for the approximately £80 billion NHS budget (including ½ billion in Southwark) to go to GPs to commission local services via consortia, as they are most in touch with local people.
6.7 She also confirmed that some GP lead commissioning has existed in Southwark for the last four to five years and that GPs are key in leading discussions, so would be extending beyond an advisory role to having real budgets and responsibilities. The medical director commented that the PCT would need to ensure that GPs are prepared as commissioners.
6.8 Members queried how much thought at this stage the PCT had given to how it would manage consultation with the scrutiny sub-committee and public engagement, in view of the scale of expected changes.
6.9 The chief executive responded that this is something for scrutiny to discuss. She added that the PCT has not before been asked to do anything as significantly different as this; that it will need to set out an overview of its plans, but will also need to make changes more quickly than in the past,- even to manage this year’s budget.
6.10 Members commented that the council as a whole will need to think about how to include the public more in such decision-making. The medical director reasoned that it would be wise to wait for the Health White Paper, but emphasised that another key message from the Secretary of State for Health is his intention to strengthen public and patient involvement.
6.11 The chair welcomed Frances O’Callaghan, director of performance and delivery, King’s Health Partnership (KHP). The director circulated booklets about KHP and its strategic framework, and briefed members on the key points (see Appendix A). She noted, for example, that KHP is one of only 5 Academic Health Science Centres in England; that it includes 21 clinical academic groups (CAGs); and that a major agenda for the partnership within the context of the economic turndown is to support efficiency while also supporting excellence.
6.12 In response to members’ queries, the director explained that KHP is funded equally by the four partner organisations. This provides a core budget of close to £1.5 million, which covers salaries, support costs and allows some discretionary spending on research projects. At this stage there is no formal guarantee for the level of future funding: the partners have agreed to re-negotiate the budget annually.
6.13 The director added that KHP is currently working on Key Performance Indicators, and would be happy to share these in due course. She added that the partnership aspires is to ensure that research results from King’s College London are adopted in practice as early as possible and used to shape best practice; and to work out how to cross the apparent divide between physical and mental health.
6.14 Sarah Feasey, principal lawyer, Southwark council, explained her role in supporting the sub-committee by providing legal advice on constitutional points; the sub-committee’s statutory powers; and substantive issues. She introduced her colleague, Cathryn Grimshaw, who is likely to attend subsequent meetings in this capacity.
6.15 The principal lawyer explained the sub-committee’s powers in relation to local health services and the impact of the current financial climate. NHS trusts, PCTs and Foundation Trusts have a statutory duty to provide Health scrutiny committees with requested information and to consult with them on proposed service changes or developments. It is up to the sub-committee to decide whether a proposed change is a substantial variation and this impacts the requisite level of consultation. However, even when members deem a proposed change to be a substantial variation, this does not oblige the sub-committee to scrutinise the proposal.
6.16 The sub-committee also has a role in considering the quality of an NHS trust’s planned consultation. Consequently, if members are not satisfied that the proposed change is in the interests of the health service, or has concerns that the consultation was inadequate, it can ultimately refer its concerns to the Secretary of State, who can potentially challenge the trust. Members were informed that there are exceptions, however, such as when a trust believes that there is a risk to patient welfare or safety: It can then immediately terminate a service without consulting either the sub-committee, service users or local residents, etc. It should, however, inform the health scrutiny committee of its decision and actions, - and of its plans for replacement services.
6.17 Officers have recently discussed how the trusts inform the sub-committee about proposed changes. A template format is porposed to help members decide if they require further information, or want to discuss with the trust the planned changes and consultation. The template included in the agenda papers for item 7 was flagged as an example.
6.11 Tom White, Southwark Pensioners’ Action Group, spoke to the sub-committee about the proposed changes to drug and alcohol treatment services at Marina House. [The 2009/10 sub-committee had responded to formal consultation on the changes in January 2010.] Mr White was concerned that there are outstanding issues about the changes and about the adequacy of the consultation. In particular, he raised queries about the provision for self-referral. He proposed that the sub-committee hold a meeting specifically about the changes, as he believed that the concerns warranted referral to the Secretary of State. He suggested that the additional meeting be used for members to consider all the relevant information from officers and his related correspondence.
6.12 Members opted to discuss this issue further when considering the sub-committee’s work programme under item 8.
RESOLVED:
1. That members are invited to suggest improvements to the ‘trigger template’ for substantial variations on an on-going, ad-hoc basis;
2. That the ‘trigger template’ could be amended to request more information about the service user perspective of proposed changes; for example that the trust be requested to list the groups/individuals to be consulted if this is still to take place; or to outline the response to date from people needing support;
3. That regarding service variations outlined on future trigger templates that are circulated via email between meetings, members are invited to forward related questions or requests for more information to the scrutiny officer (rachael.knight@southwark.gov.uk), for these to be submitted to the relevant trust before meetings occur. This will help ensure more detailed answers are available prior to and when the sub-committee meets.
4. That should members raise several questions on a future issue, the chair and vice-chair would decide in consultation with other members whether a trust representative be requested to attend either the next scheduled meeting or a special meeting to provide a fuller briefing.