Agenda item

5.1  Councillor Dora Dixon-Fyle introduced herself as the cabinet member for health & adult social care.  She had been enjoying her first six months in post and was looking forward to this evening.  Susanna White, chief executive of NHS Southwark, also introduced herself and referred to the significant changes imminent in the health and social care world.

  Dulwich Hospital (Question 1)

5.2  Members asked what role the council had in ensuring continuing medical services at Dulwich Hospital.  Councillor Dixon-Fyle stated that the council could influence but not control what happened at the hospital which was managed by the PCT and in the future would be managed by its successor body.  Susanna White stressed that this was a long-standing and difficult issue.  Some services run by Kings College Hospital had moved off the site.  Emerging leaders of the new Southwark consortia of GPs had asked for a further option appraisal in respect of the hospital.

5.3  Members stressed that plans had gone from closing a third of the site for a polyclinic to the possibility that after over a hundred years of providing medical services the site could almost become vacant.  Susanna White pointed out that the renal dialysis service was still located at Dulwich but did not take up the full footprint.  The current strategic plan included a health centre of a modest size but this depended on funding.  In response to questions she stated that she was unable to provide an implementation timetable.  Councillor Dixon-Fyle commented that it would be important to first be clear what was happening with the GP consortia.

5.4  The chair reminded members that Councillor Noakes, the vice-chair, had offered to set up a site visit to Dulwich Hospital.

  Health & Wellbeing Board and future of scrutiny (Questions 2, 3 & 4)

5.5  Members asked the cabinet member how she envisaged the composition and role of the Health & Wellbeing Board.  Councillor Dixon-Fyle stated that she understood the board would include a range of people, including GPs, local councillors and representatives from the LINKs.  She was keen that it was properly scrutinised.  Members were unclear how the scrutiny function could be subsumed into the board and services continue to be properly held to account.  Councillor Dixon-Fyle could not confirm the government’s view but would support scrutiny remaining a separate function.  The chair hoped that the sub-committee would be invited to comment on any proposals from government.

  Social care (Questions 5, 6, 8, 12, 13, 15 & 16)

5.6  In respect of question 6, members highlighted the government’s plan to remove disability living allowance from anyone living in a residential setting and asked whether there was any indication of the number of people this would affect in Southwark, the amount of allowance and any impact on the council’s budget.  Councillor Dixon-Fyle responded that it was the council’s priority to keep people in their own homes for longer.  Susanna White commented that there were no specific figures available.  She was happy to take this away and circulate figures.  There was a  clear impact on the individual’s budget but no assumption could be made about this being made up by any council funding.

5.7  Members asked whether there was any certainty about the figure of an extra £2 billion for social care referred to at question 8.  Councillor Dixon-Fyle stated that these were headline figures of which it was thought that £1 billion would be going to the NHS and the other £1 billion to social care.  Nothing had been received to confirm this.  Susanna White was confident that at least £1 million would be set aside but did not know how this would be directed into Southwark.  She was not sure if it would come to the PCT, whether it would be clearly labelled or ring-fenced and where accountability would be held.

5.8  In response to questions about the work of the re-ablement team (question 6), Councillor Dixon-Fyle explained that people were being assessed all the time.  Members emphasised the importance of monitoring the services delivered by nursing homes in the borough and asked what action the cabinet member would advocate where homes were not performing to standard.  Councillor Dixon-Fyle stated that the priority was to get the best homes for Southwark’s residents and to commission high quality of service.  If necessary the council would suspend referrals into a home.  Susanna White commented that the council had been commended on its work in supporting at risk individuals in individual care homes.

5.9  Members queried the status of the cabinet’s pledge to halve the price of meals on wheels (question 12) and asked for details of the timetable and whether consultation had begun.  Councillor Dixon-Fyle indicated that work coincided with the budget process.  Options had to be considered against the back-drop of the reduction in money from central government.  There was no intention to reduce the quality of meals.  In response to questions from the chair, Councillor Dixon-Fyle confirmed that when the price of meals had been increased there had been a drop in take-up and that an increase in take-up could have an impact on the health of residents.

5.10  In respect of question 15, members asked whether the cabinet member would continue to campaign against the flawed adult and children’s social care funding formula.  Councillor Dixon-Fyle stated that she would be seeking to ensure that Southwark received all the funding it was entitled to.

5.11  Councillor Dixon-Fyle updated the sub-committee on the situation with regard to the premises of the Southwark Pensioners Centre (question 16).  The centre had signed a twelve month lease at its present premises and hopefully would move to Walworth Road Town Hall in due course.

  Childhood obesity rates (Question 7)

5.12  In response to further questions about the impact of free school meals on health, Councillor Dixon-Fyle made clear the benefits of helping children to stop eating fast food and reducing their salt intake.  This would enable children to perform better at school and the council would be able to review this when considering the outcome of the pilots.  Councillor Dixon-Fyle indicated that she would liaise with Councillor Catherine McDonald, cabinet member for children’s services, in reviewing the impact of healthy free school meals.

5.13  Some members were not convinced of the impact on childhood obesity and asked whether any evidence could be circulated to demonstrate the positive outcome, particularly as this was an expensive policy at a time of cuts in funding.

  Changes in provision of health care (Questions 9, 11 & 14)

5.14  Councillor Dixon-Fyle stated that the cabinet report of 23 February looked at the transfer of responsibilities between NHS Southwark and the council.  The Public Health White Paper was due imminently.  Some members asked why the cabinet was supporting proposals for Southwark to become a GP Consortia Pathfinder.  In Councillor Dixon-Fyle’s view it was important to begin working with the consortia in order to ensure that services continued in the borough.  Southwark had offered to become a pathfinder in response to the government’s agenda.

5.15  Susanna White commented that the government agenda was developing rapidly and that Southwark’s GPs had already formed a consortium.  She explained that it was possible for funding to accessed more quickly if a consortia was a pathfinder.  From the GPs’ perspective it was important to do the best possible within the changes.  Most places would try to be pathfinders because of the money allocated and because working closely with councils would assist GPs.  NHS London expected to set aside £50 million to support GP development.  Susanna White added that being a pathfinder did not mean having to do every aspect of commissioning straight away.  Practice based commissioning had already been in existence for a couple of years and a the leads had formed a single consorita.

5.16  Councillor Dixon-Fyle emphasised that the council did not want a reduction in the quality of services.  Susanna White stated that huge changes were not expected immediately and that GPs were taking more interest in how services were designed.  Members raised the issue of disadvantaged groups who in some instances have felt that GPs are not best able to meet their health needs and asked what additional support might be provided to GPs to meet such demands.  Susanna White responded that NHS Southwark was keen to support GPs locally to help them understand more about the needs of different patient populations.

5.17  A member cited the examples of mental health and alcohol related issues and was concerned that individual GP practices would be able to meet the associated needs, for instance to make available the same level of care to people who had in the past been referred to Marina House.  Susanna White commented that the first point of call for patients was primary care and that many of the GP practices had received specialist training.  Jane Fryer responded to a particular point of view quoted in Southwark News.  The majority of GP practices in Southwark would provide a service for drug and alcohol abusers with a quick route to specialist services if necessary.  Practices worked closely with street agencies and the voluntary sector.  Members were interested in the number of GPs who had undergone training and in the turnover of GPs in Southwark.

5.18  In respect of question 14, members asked for an indication as to the number of voluntary organisations providing preventative services who were part-funded by the council or NHS Southwark, the total amount of funding and where it came from in the budget.  Councillor Dixon-Fyle replied that the figures could be provided at a later date.  She explained that cabinet members had been contacting voluntary groups and community councils and explaining the budget principles.  The chair commented on the council’s requirement that groups conform to the current equality obligations and that the committee was looking at the equality impact.  He questioned whether the council and NHS Southwark were ensuring they were consulting those groups most affected.  Councillor Dixon-Fyle confirmed the council’s intention to work with the groups over the next few months and beyond.  Jane Fryer reported that a number of voluntary groups were already beginning to engage with the emerging GP consortia.

  Section 106 Money  and Larcom Street (Questions 3 & 4 to Susanna White)

5.19  Members asked why so little section 106 money had been spent by the PCT.  Susanna White referred to the written answer and stressed that the PCT had every intention of spending the money but that it had to be spent in the right way.  There was not always an appropriate scheme in the relevant area.  In response to further questions Susanna White offered to confirm that there were no allocations in respect of Dulwich.  She also clarified the situation in respect of Larcom Street where the partner was currently unable to make a full capital commitment.

  Future interviews

5.20  The sub-committee agreed to recommend the 2011/12 Health Scrutiny Sub-Committee to invite back the cabinet member and chief executive to a meeting early in the new municipal year.