Agenda item

5.1    The chair outlined the sequence of actions related to this issue taken since the 30 June meeting: that he had written on behalf of the sub-committee to Donna Kinnair, Director of Nursing and Commissioning, NHS Southwark to raise members’ queries from 30 June; that an ad hoc meeting was held on July 29 to discuss the PCT response; that further queries were raised with the PCT following this meeting; and that the PCT’s subsequent answers left two key concerns regarding the following:

- the additional (rather than routine) training provided to GPs as a result of service changes or where in Southwark GPs have received additional support; and

- how the restructure has met equality legalisation obligations (specifically those under the DDA).

5.2  The director of commissioning explained that the PCT was not providing specialist training for every GP: Under the move to the poly-system structures some GP practices were being aggregated; and currently 23 GPs covering 49 practices have been trained. Further training will follow the establishment of more poly-system hubs. The PCT cannot insist that every GP is trained, but is doing what it can to increase the take-up of training.

5.3  Regarding the consultation process, the director commented that it had not been initiated in a proper manner, but had since been carried out correctly. She added that the PCT had complied with the consultation conditions stipulated by the previous sub-committee and with the relevant health legislation.

5.4  The chair asked whether the PCT had complied with the relevant equalities legislation. The director responded that an Equalities Impact Assessment (EIA) had not been carried out initially, but that the PCT had ensured specialist provision for service users with disabilities.

5.5  Tom White, Southwark Pensioners’ Action Group, commented that the early consultation had made no mention of the offender management services; that a consultation event he had attended had only three service users present; and that the PCT had not reported why the changes should go ahead despite the dissent about the reduction of self-referral.

5.6  Tony Lawlor, Senior Commissioning Manager, Mental Health and Substance Misuse Commissioning, NHS Southwark explained that the PCT had consulted on the primary care strategy in 2008/09. The outcome was the move to primary care as the focus of patient care and as the gateway to secondary treatment. Consequently, self-referral at Marina House was planned to cease. This was put on hold however, during the subsequent consultation on Marina House services.

5.7  In response to member queries, the director confirmed that the GP training provided was level 1. Members then pointed to the volume of problems in Southwark related to drug and alcohol misuse and raised concerns about the adequacy of GP capacity to deal with patients needing related treatment. The director of commissioning responded that the PCT had developed a strategy to increase capacity, which was still being implemented. She confirmed that in line with the reduction of specialist services, additional training was being provided for health professionals in the GP and voluntary sectors.

5.8  Members sought further clarification about GP training and the arrangements for service users consulting GPs who have not been trained. The director of commissioning explained there are currently 25 GPs with the specialist training, but that every practice can access specialist advice by telephone when needed. The medical director added that some GPs have been providing specialist drug and alcohol services for the last 20 years; that the PCT is aware of where there are some small gaps in terms of coverage and is trying to get practices to work together. It was also reiterated that the training is not obligatory, and is therefore not measured against a fixed target.

5.9  Members commented that the establishment of satellite clinics seems delayed and requested an update. The director of commissioning responded that alterations to Marina House were still necessary in order to establish the offender services there; that the transferred services at Blackfriars were due to become operative in February; and that SLaM was undertaking a review which would identify suitable venues for more community drug services: currently a handful of satellite clinic venues had been identified.

5.10  Members raised queries regarding self-referral and whether this would now be an option for all service users.  The director of commissioning confirmed that this had been agreed. Self-referral patients would be assessed to determine whether it would be appropriate for them to be passported to other services.

5.11  Members also highlighted two issues regarding the related consultation: i) that its duration was less than 12 weeks; and ii) that it did not appear to fulfil the EIA obligations. The director of commissioning stated that the 2009/10 scrutiny sub-committee had explicitly agreed to the consultation lasting 8 weeks; and that the Equalities duty had not been addressed initially, but provision for patients with disabilities had since been made. Susanna White, NHS Southwark Chief Executive and Strategic Director of Southwark Health and Community Services, commented that the consultation process had not been perfect and that she had apologised to the previous sub-committee. She added that there was no requirement for all consultations to last 12 weeks, and that going forward it may be necessary for consultations to happen relatively swiftly and to be proportionate to the volume and scale of other changes.

5.12  The chair referred to a 2007 court case involving Harrow Council, in which part of the case was lost due to the decision-makers having not received full EIA information. He commented that it would be disturbing if the PCT were not having due regard to Equality law, and that reference had only been made to physical impairment disabilities. He queried what work had been done regarding people with mental health problems. The director of commissioning replied that the PCT had engaged with the most vulnerable service users, not within the formal consultation but as part of the pre-discussion. She offered to provide a timeline of how the consultation engaged with people and complied with DDA (Disability Discrimination Act) obligations.

5.13  Jennifer Quinton-Chelly, a local resident, outlined some of her previous involvement with local SLaM services and noted that she had hoped to become a member of SLaM, but had received no response to her request over two years. She asked how interested individuals and local groups could be better informed about consultations and related meetings.

5.14   Tom White was of the view that wonderful services for drug and alcohol misuse had existed at Marina House a year ago and that some patients were still being referred by GPs to access services there on a daily basis.

5.15  In response to comments from members of the public, members clarified that no services were being lost, rather that particular services were being relocated from two sites to one. It was also noted that this issue had been considered for over 18 months and that in view of the number of anticipated future issues, there will be more proposed changes than the sub-committee will be able to review and that in this case a way forward would be to monitor that the satellite clinics are established and that the specialist training continues.

RESOLVED:

1.  That the PCT forwards a copy of the Equality Impact Assessment (EIA) produced for the re-design of services at Marina House and outlines the trust’s compliance with relevant DDA guidance.

2.  That the PCT keeps the sub-committee informed about the arrangements for the relocation of services from Marina House to Blackfriars that are scheduled to become operative in February 2011, in particular:

-  the number and location of the satellite clinics and when these will be available;

-  the number of part-time and full-time GPs who have completed specialist training in the management of substance misuse.

3.  That the PCT and scrutiny project manager take steps to help ensure that interested individuals and local groups are more informed of service re-design consultations and their respective related meetings; and

4.  That the PCT discusses with SLaM the claim from local individuals that they had asked to be involved with the related consultation, but were not included.