Agenda item

The themes for the annual interview with Councillor Catherine McDonald, cabinet member for health and adult social care, are attached.

6.1  The chair welcomed the cabinet member for health and adult social care, Councillor Catherine McDonald, to her annual interview. She was then invited to comment on the first theme: Access to Health Services in Southwark, which is the subject of one of the committee’s reviews. The chair started by remarking that the committee has heard evidence that one of the main drivers for rising demand at A & E is an increase in older people attending who are acutely unwell. She asked the cabinet member to explain what the council is doing to address this trend.  The cabinet member responded that she understands that A & E is a barometer for the hospital and the health system as a whole. She explained that the council is helping to people to live at home longer with-out a hospital admission. GPs have been invited to look at this cohort of older people and to do an assessment to prevent later demand - for example grab rails to prevent falls. The council is also looking at housing policy - for example the administration re-introduced wardens and will be expanding the provision of extra -care, which provides nursing on site. She ended by noting that Southwark is one of the top performers in enabling people to be discharged and providing re-enablement to support recovery.

6.2  A member commented that the LMC report said that education on using A & E appropriately is needed; how can the council help with this. The cabinet member referred to the poster campaign out that advises people to go to the doctors or pharmacy for more minor complaints. She commented that the Health & Well – Being Board is well placed to look at system problems.

6.3  A member commented that there are massive changes in the NHS arrangements and real term cuts, and asked how the cabinet member thought this was affecting the health system. The cabinet member agreed with the members comments on the scale of the change and commented that lots of organizations are bedding down.  She added that ‘integration’ is a very important , and referenced the Southwark and Lambeth Integrated Care Programme which is making the best use of resources in times of constraint  and frozen budgets,  by bringing partners together to create a more integrated patient journey.

6.4  The chair then asked the cabinet member to comment on the second review theme: Prevalence of Psychosis and access to mental health services for the BME Community in Southwark’. The cabinet member responded that she is keen to promote resilience and that a Mental Health Strategy is being developed, and that this recognizes the diversity of different communities. There has been consultation work to inform the development of the strategy. A member commented that it would be useful to see the results of this and that the committee had heard some excellent evidence from church leaders on the effectiveness of a recent capacity building programme.

6.5  The committee then moved on to third them on ‘Older Persons Day Care, including voluntary older people’s day centers’. A member commented that he had been in touch with a number of old people day centers and he reported that  while some are still functioning many are very much struggling - for example a significant number no longer offer transport. He said that many people were not assessed as eligible for care, and so were not in a position to use personal budgets to fund their use of day centers. He commented that some day centers are very low in numbers while others have a bigger attendance, and he is worried about their ability to survive. The cabinet member commented that there is a movement is towards individualized care rather than block contracts, and this was the direction of travel for both the last government and the present one. She said that many people are moving toward individual funding - and choosing different options.

6.6  The cabinet member continued by explaining the council gave support and transitional funding - something like half a million pounds for providers to move to a new business model and the council  also started up an innovation fund,  so there is extra services for older people to choose. The member responded that he had been contacted by a day centre who said that they were contacted out of the blue to apply for some additional funding. The cabinet member inquired who this was and the member said that he did not feel comfortable naming the organization as he wanted to protect their position; he was more interested in the general approach.

6.7  The committee then moved on to discuss Personalization; the seventh theme. The cabinet member was asked how the council was doing and she explained that around 94% of eligible service users of have personal budgets. There are four groups of clients with different rates: older people have 97% take-up; learning difficulties 80%; mental health 98%; and physical disabilities 99%. She explained that the council is doing development work with individuals and is in the top quartile of councils. Sarah McClinton, Director of Adult Social care, said that there will be a 100 % take up by the end of the year.

6.8  A member commented that there was cross party agreement on the principle of Personalization; however he was concerned about patchy practice and had heard cases where people had to wait two years to complete the assessment process. The cabinet member agreed that two years did sound ridiculous and encouraged the member to contact her with concerns. She went on to remark that there is a balance to be struck on the pace of take-up, as the council does not want to rush people through. The council is also doing what it  can to stimulate the market , so there are services available for people to exercise choice and control,  but some people may struggle with this as Personalization means more decisions need to be made .The expectation that individuals do more for themselves can be scary , which is why support is important . She added that young people are more familiar with Personalization. Sarah McClinton explained that some personal budgets are still managed by council or by an independent provider. She added that a quick process is not necessarily most optimal or imaginative; a longer process can achieve a better result.

6.9  A member asked if there is an opportunity for people to change their minds about the plan and Personalization. The cabinet member explained that plans are regularly reviewed, and this underlines the importance of a good process which is designed to find ways to meets people's needs - within available funds. She assured members that the council does not let go; there is ongoing support.

6.10   The chair invited questions on the forth theme of ‘Intermediate care’ and a member asked how many intermediate beds are available; on behalf of  Councillor Capstick , who was unable to attend the meeting. The cabinet member explained that the council do not have intermediate beds; however there is re-enablement and said that she would be happy to correspond with Councillor Capstick on this.

6.11  A member then referred to the fifth theme on Public Health asked the cabinet member about the council pensions fund’s investment in tobacco and how compatible this was with the Public Health priority to cut smoking. The cabinet member commented that she agreed the council is doing everything possible to reduce smoking and this would impact on reducing health inequalities. She referred to the council assembly question on this issue and the advice given to the pension’s advisory board that pension funds had a duty to put the financial interests of itsbeneficiaries first. She noted that that there is equal representation from Labour, Liberal Democrat and Conservatives members on the panel, so it is odd to defend a policy when Labour is in a minority. She reported that there will be a review into the adoption of ethical investment principles and a staff poll will be conducted. She added that she is certainly not of the view that responsible investment reduces returns; but there is a balance to be found between the two poles.

6.12  A member reported that he understands that two major sexual health contracts are up for renewal and he is concerned that this could lead to cuts - particularly given high levels of STDs, HIV and drug use amongst the Southwark population. The cabinet member commented Public Health is one of the opportunities that came to the council with the change to NHS arrangements. The funding that is coming over is about 22million and this has been ring-fenced to achieve the outcomes. She said contracts should not just be rolled forward, the council needs to scrutinize every arrangement. She referred to evidence generated by the Joint Strategic Needs Assessment and the importance of the Health and Well-being strategy, and the focus on the priority of reducing health inequalities. She agreed thathigh levels of STDs, HIV and drug use are a huge area of concern and assured members that they will continue to see large investment.

6.13  The chair referred to the sixth theme,  ‘Meals on Wheels’, and the cabinet member said the council  reduced the meal charge to £2.52 , and are committed to a further reduction to £1.71 ; a 50% reduction since 2010 . She reported that this is significantly lower than most London Boroughs. Older people are one of the most deprived groups and a hot meal is a basic minimum. The Meals on Wheels service is also an important moment of social contact.

6.14  A member refereed to the theme on Substance Misuse and asked the cabinet member, on behalf of Councillor Capstick, how closely the council is working with offenders to address health issues. The cabinet member reported that the 12 week Radar programme works to reduce and deter offending. This provides intense support and the programme will be adding a nurse as the council knows that offenders are at risk of drug and health problems. A member commented that 12 weeks does not sound long enough and asked if this was related to funding constraints. The cabinet member commented that Radar is a nationally recognized programme.

6.15  Lastly the chair invited questions on the Adult Safeguarding theme and the cabinet member commented that there is a new Independent chair of the Safeguarding panel.  She was asked about the priorities and the cabinet member responded that one significant priority is to reduce the number of safeguarding alerts at Care Homes through the Care Home Strategy. The chair ended the interview by thanking the cabinet member.