PRESENT: Councillors Meadowcroft (Chairman), Mrs Endacott (Vice Chairman), Baskerville, Mrs Evans, Mrs Herdson (substituting for Councillor Mrs Napier), Lenton, Majeed, Mrs Proctor and Mrs Yong.

Non-Member: Councillor Dudley

Also Present: Mrs J Burgess, Mr J Jones and Mr A Stephens (Heatherwood and Wexham Park Hospitals NHS Foundation Trust); Mrs C Finlay, Mr P Riordan and Mrs Paula Head (Berkshire East PCT)

Officers: Mr Abrahamson, Mr A Brown, Mr Herlinger, Mr Mist, Mr A Scott, Mrs Shawcross, Mrs Stamper, Mr Taylor, and Mr Thomas.

49/09 APOLOGIES FOR ABSENCE

An apology for absence was received from Councillor Mrs Napier.

50/09 DECLARATIONS OF INTEREST

Councillor Mrs Herdson declared a Personal and Prejudicial Interest in Agenda Item 14 – Adult Social Care – Service Provider Review – as her mother was in receipt of a care package.

Councillor Lenton declared a Personal Interest in Agenda Item 14 – Adult Social Care – Service Provider Review – as a Director of Windsor Housing.

51/09 MINUTES

RESOLVED: That the Part I minutes of the meetings of the Panel held on 7 September and 13 October 2009 be approved.

52/09 HEATHERWOOD AND WEXHAM PARK HOSPITALS NHS FOUNDATION TRUST – UPDATE ON FINANCIAL POSITION

Mrs Julie Burgess, Chief Executive at Heatherwood and Wexham Park Hospitals NHS Foundation Trust, made a presentation to the meeting setting out the background to the financial situation at the Trust. She explained that Monitor, the Independent Regulator of NHS Foundation Trusts, had used its intervention powers to appoint Chris Langley as the Interim Chairman of the Trust following the resignation of the previous Chairman.

Mrs Burgess explained that the Trust was working with Monitor to agree a detailed financial Turnaround Plan and that Monitor had informed the Trust that they had no reason for concerns as to the quality of the clinical care provided by the Trust to its patients.

Members were advised that, following a period of financial surpluses, the Trust had identified substantial projected deficits in 2009/10, 2010/11and 2011/12 as part of their three year planning process. Mrs Burgess outlined the reasons for the current financial position, referred to the actions being taken to address the problem and commented upon the components of the Turnaround Plan.

Mr Stephens, Interim Deputy Director of Finance, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, provided Members with a financial appraisal for the previous 6 months. He advised that the Trust had reported a deficit of £8.5m to the end of month 6 against a plan deficit of £8.7m. He stated that Berkshire East PCT had confirmed it would support the Trust in demand managing its activity to contracted levels. He also advised that activity pressures remained severe, especially in A&E attendances, and confirmed that Trust had been awarded a Financial Risk Rating of 1.

In response to a number of questions, Members were advised that the increase in A&E attendances was not unique to the Trust as A&E attendances had increased across the South Central region. Although the increase had been partially due to Swine flu, the general trend had been increasing for some time.

Mrs Burgess explained that the lack of robust systems and governance had contributed to the Trust’s poor financial situation but advised that these were being addressed. She confirmed that there were only two Trusts in the Country with a Financial Risk Rating of 1, with Heatherwood and Wexham Park Hospitals NHS Foundation Trust being the worst. However, it was stressed that there had been significant changes at Board level; with the Trust currently in the process of replacing all the non-executive Directors, and, with a new Chief Executive, Finance Director, Chief Operating Officer and Director of Nursing, there was virtually a new Management Team in place.

Members were advised that the next report from Monitor was due at the end of the Second quarter. Mrs Burgess advised that, although an improvement in the governance rating was expected, it was unlikely that there would be any improvement in the financial rating for 12 months. She also advised that capital expenditure would only be spent on high priority schemes and indicated that, although the Trust still intended to appoint a Fundraising Manager, it was not a top priority.

In response to concerns raised that, with all the focus being on turning around the financial situation the Trust may take its eye off the clinical delivery of services, Mrs Burgess advised that she had regular meetings with the Nursing Director and Medical Director and that they were reviewing services on a daily basis. She advised that if any Member had any issues or concerns with the services provided by the Trust they should write to her in the first instance.

In response to concerns raised about the length of waiting times and incorrect addresses on appointment letters, Mrs Burgess explained that the Trust were aware of the issues and were addressing them. In response to questions on the content of the Medium Term Plan, Mrs Burgess explained that the Plan was still being developed but she was happy to come back to the Panel once it had been agreed.
At the conclusion of the debate, the Chairman reiterated the need to communicate to the Panel any future changes to services that the Trust were proposing to make. It was also requested that a further update report on the Trust’s financial position, including the Medium Term Plan, be presented to the Panel at its January 2010 meeting.

53/09 MINOR INJURIES UNIT – ST MARK’S HOSPITAL, MAIDENHEAD

The Panel received the report that had been submitted to the Berkshire East PCT’s Board on 24 September on the review of the Minor Injuries Unit (MIU) at St Mark’s Hospital, Maidenhead. Members noted that, in the light of the significant local support for the service, the Board had agreed that it would explore a more cost effective model of care to meet the need for minor injuries for Maidenhead residents.

In response to a number of questions, Mrs Paula Head, Director of Commissioning at Berkshire East PCT, commented upon a number of alternative models that would be evaluated and explained that further information on the potential options would be detailed in the report to the PCT Board in due course. She outlined the reasons for the high cost of the current services, advising Members that significant cost savings had not been achieved as it appeared that a high proportion of people accessing the MIU would have either gone to their GP or would have self medicated, with only a small proportion of people accessing the MIU instead of A&E. Mrs Head explained other models of care were being evaluated to ensure that any future service achieve the success criteria of diverting patients away from A&E.

Notwithstanding the costs of the service, Members were of the opinion that based on current activity levels; there was demand in Maidenhead for a service that had previously been unmet. It was therefore essential that the MIU be retained. Mrs Head advised that she was not in a position to guarantee that the service would be retained but explained that the PCT’s intention was to retain a MIU but such a service had to be cost effective. A Member pointed out that, due to the problems of people accessing their GPs, more and more people were accessing MIU and A&E department.

Mrs Head also commented upon the difficulties of providing a detailed analysis of the mix of cases being dealt with at the MIU. She explained that it would require a Clinician to describe the type of clinical activity that was being carried out, which would be a time consuming task. However, Members were of the opinion that, without that detailed information it would be difficult for anybody to fully understand what was being treated at the MIU.

Mrs Head also confirmed that Councillors Napier and Majeed would be invited to sit on the Evaluation Panel.

At the conclusion of the debate, the Chairman stressed the view of the Panel that the MIU at St Mark’s Hospital was a popular and well used service, the service should be retained and that it should be provided from St Mark’s Hospital. The PCT were invited to attend the January 2010 meeting of the Panel with details of the options being considered for the MIU service at St Mark’s Hospital.

54/09 CAR PARK CHARGES AT ST MARK’S AND KING EDWARD VII HOSPITALS

Members received an update on the effect of the introduction of car park charges at St Mark’s and King Edward VII Hospitals. Members were advised that the charges, which had been implemented on a phased basis, had been introduced with little fuss and the concerns expressed about the displacement of vehicles onto the adjoining roads, particularly around St Mark’s Hospital, had not materialised. A breakdown was given of the cost of administering the scheme and income levels. Members were advised that income levels had reduced as more exceptions were being granted. Members also received details of the implementation of a new staff-parking scheme that would be implemented across the PCT sites.

Arising from the discussion, Members expressed concern that income from the car parking charges appeared to allocated to the funding of security within the buildings, commented upon to the parking problems that patients continued to have at King Edward VII hospital and questioned whether the charges at St Mark’s hospital could be removed as income levels were very low. In response, Mrs Finlay, Assistant Director Locality Commissioning (RBWM) Berkshire East PCT, reiterated that there was no cross subsidy of services through car parking charges, staff parking at King Edward VII hospital was being addresses; although it was stressed that it would be necessary for some clinical staff to park there due to the nature of their job, and reminded Members of the principle adopted by the PCT to introduce parking charges at all its community hospitals.

55/09 ROYAL BOROUGH OF WINDSOR AND MAIDENHEAD JOINT STRATEGIC NEEDS ASSESSMENT REPORT

The received a presentation from Dr Pat Riordan, Director of Public Health – Berkshire East PCT, on the Joint Strategic Needs Assessment (JSNA) for the Royal Borough, dated October 2009. Members were reminded of the Council’s and Berkshire East PCT’s statutory responsibility to produce a JSNA, which would identify the current and future health and well-being needs of the local population, informing the priorities and targets set by Local Area Agreements (LAA) and leading to agreed commissioning priorities that would improve and reduce health inequalities.

Arising from the discussion, Mrs Riordan responded to a number of questions/comments raised by Members. In particular, she explained that, although violent crime had been identified as a problem due to the levels being higher than the national average, this was principally related to the Windsor night economy. A Member referred to the initiative undertaken in Cardiff to address the problem of knife crime, which was claimed could be implemented in other areas. It was also suggested that the issue of alcohol misuse and problems with the night economy could be talked through stricter licensing of establishments. Members of the Panel were invited to address any further comments or questions on the JSNA in writing to Mrs Riordan, who would respond accordingly. Mrs Riordan indicated that a refreshed Strategic Plan was being drawn up and it was agreed that the document would be submitted to the January 2010 meeting of the Panel for consideration.

56/09 CALL IN OF CABINET DECISION – 22 OCTOBER 2009: THE PRELIMINARY BUDGET REPORT

In accordance with Part 4 E16 of the Council’s Constitution, the Panel reviewed the decision taken by the Cabinet on the 22 October 2009 relating to the Preliminary Budget. The Panel noted its powers in relation to the review of Cabinet decisions and received a copy of the appropriate report and minutes of the Cabinet meeting.

The Members who had initiated the call in submitted detailed reasons in support of that decision. They contented that the preliminary budget report assumed large potential savings arising from reorganisation of the Directorates. Neither at Overview and Scrutiny nor at Cabinet had the detail of how that would be achieved been fully explored. Following subsequent discussions with staff, it was believed that a more open examination of those changes could take place. It was important that alterations of the significance envisaged should be properly scrutinised by the Panel tasked with doing so. It was also pointed out that there were concerns raised by Panel Members at the previous meeting that not all the information was available and therefore it was considered reasonable to call in the decision to seek clarification on a number of savings proposals.

Arising from the general discussion, the Officers and the Lead Member for Adult and Community Services then responded to a number of questions/comments on specific savings proposals, in particular:-

• Item 1 - Funding of Learning Disability Service – The officers confirmed that decisions as to the level of care/funding would be made by the Care Managers, in consultation with their Unit Manager. There would be no intervention by other officers once that decision had been made. It was also confirmed that the savings had been achieved as over the past few years the forecast spend on the service had been less than the actual spend. In addition, inflationary increases and demographic growth had been less that anticipated.
• Item 15 - Increase the number of fairs at Dedworth Manor – It was confirmed that the saving proposal had been deleted from the list.
• Item 40 – Concessionary Fares Scheme – Members were advised that, as the take up had not been as great as expected, a reduction in the budget was considered appropriate. It was confirmed that the Borough would be submitting a response to the consultation issued by the Department for Transport on the level of support to be given to Concessionary Fare Schemes.
• Item 5 – Subsidies for swimming pool and gym use for 13-19s – The subsidy was being withdrawn for 13-19 year olds during the summer months.
• Item 7 – Mobile Library Review – The savings related to the reduction in storage costs and running costs of the second vehicle, which was no longer required.
• Item 8 – Reduced Non Domestic Rates on Libraries – It was noted that the rateable values of the Libraries had been reduced following a review, resulting in the savings identified.
• Item 14 – Review of Staff Membership Costs – The officers advised that they were confident that the saving would be achieved.
• Item 26 – Review of Café opening Hours at Windsor Leisure Pool – It was confirmed that the reduction in hours equated to 2 ½ hours a week.
• Item 42 – Reduce Exhibition Budget – In response to concerns raised about the affect the savings may have on National Performance Indicator 10, the officers explained that the proposed new permanent museum in the Guildhall, Windsor would mean that there would be a reduced need for temporary exhibitions and would not have a detrimental affect the National Indicator as the permanent museum would attract more visitors.

With regard to comments on when further details on the organisational changes would be made available, Members were advised that the outcome of the consultations with the officers would be reported to Scrutiny at the conclusion of the process.

RESOLVED UNANIMOUSLY: That the Panel take no further action on the Cabinet decision relating to the Preliminary Budget Report.

57/09 SERVICE INSPECTION OF ADULT SOCIAL CARE

The Panel received the Care Quality Commission’s (CQC) Inspection Report of Adult Social Care that had been presented to Cabinet on 24 September 2009. The inspection had focused on how well the Council was safeguarding adults whose circumstances made them vulnerable and delivering increased choice and control for older people.

Members were advised that the report had concluded that, in terms of Safeguarding Adults, the Borough was performing adequately. It was noted that there had been a significant amount of investment in safeguarding services, which had now been given a higher priority across the Council. With regard to delivering increased choice and control for older people, the report had concluded that the Council was performing well.

The report had contained twelve recommendations, all of which had been accepted. An Action Plan had been drawn up to implement the recommendations and a progress report would be submitted to the Panel at a future meeting.

58/09 SERVICE MONITORING REPORT

The Panel received and noted the latest service monitoring report for activity within the Adult, Community and Health Services during the period to September 2009. It was noted that the Adult Social Care budget showed a projected under-spend of £384k, which related mainly to the impact of demographic changes and estimates of future demand for care services.

59/09 WORK PROGRAMME

Members noted the items that had been identified for submission to the next meeting. Members also discussed the possibility of holding an additional meeting in January in the light of the number of items due for consideration at the scheduled meeting.

60/09 LOCAL GOVERNMENT ACT 1972 – EXCLUSION OF THE PUBLIC

RESOLVED: That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the remainder of the meeting whilst discussion takes place on items 13 and 14 on the grounds that they involve the likely disclosure of exempt information as defined in Paragraphs 2 and 3 of part I of Schedule 12A of the Act.