Adult, Community Services and Health Overview and Scrutiny Panel
Tuesday 26 January 2010
ADULT, COMMUNITY SERVICES & HEALTH OVERVIEW & SCRUTINY PANEL
26 JANUARY 2010
PRESENT: Councillors Meadowcroft (Chairman), Baskerville, Mrs Evans, Lenton, Majeed, Mrs Napier, Penfold (substituting for Councillor Mrs Endacott), Mrs Proctor and Mrs Yong.
Non-Members: Councillors Adams, Dudley and Mrs Kemp
Also Present: Mrs C Culpin, Mr J Jones and Mrs D Thompson (Heatherwood and Wexham Park Hospitals NHS Foundation Trust); Mrs C Finlay and Mr D Williams (Berkshire East PCT); Mr T Heselton (South Central Ambulance Service NHS Trust)
Officers: Mr Abrahamson, Mr A Brown, Mr Herlinger, Mr A Scott & Mrs Shawcross.
74/09 APOLOGIES FOR ABSENCE
An apology for absence was received from Councillor Mrs Endacott.
75/09 DECLARATIONS OF INTEREST
Councillor Mrs Napier declared a Personal and Prejudicial Interest in Agenda Item 12 - Charging and Contribution Policy within Adult Social Care - as her son was in receipt of a care package.
76/09 MINUTES
77/09 VOICES INTO ACTION - ASSESSMENT OF HEALTH AND SOCIAL CARE
The item was deferred to the next meeting of the Panel.
78/09 HEATHERWOOD AND WEXHAM PARK HOSPITALS NHS FOUNDATION TRUST – UPDATE ON FINANCIAL SITUATION
Members were advised that Heatherwood and Wexham Park Hospitals NHS Foundation Trust had recently submitted their Turnaround Plan, which included a Medium Term Financial Plan, to Monitor, the independent body established to authorise and regulate NHS foundation trusts. Mr J Jones, Director of Corporate Affairs at the Trust, informed Members that the Trust would attend the next meeting to provide the Panel with a more complete picture of the Trust’s financial position. It was requested that a copy of the Turnaround Plan together with any further relevant information be circulated to Members well in advance of the meeting.
79/09 SAFEGUARDING
Members received presentations from Heatherwood and Wexham Park Hospitals NHS Foundation Trust and the South Central Ambulance Service NHS Trust on how the Trusts were implementing the requirements of the East Berkshire Safeguarding Adult procedures.
Mrs Clare Culpin, Director of Nursing – Heatherwood and Wexham Park Hospitals NHS Foundation Trust, commented upon the Government’s guidelines on multi-agency working. She explained the nature of adult abuse, outlined who may be considered an abuser, provided examples of abuse and commented upon how incidents were reported. She referred to the Trust’s Whistle Blowing Policy and the Deprivation of Liberty Safeguards, which required health or social care organisations or registered care homes to make an assessment to ascertain whether they were lawfully depriving of their liberty anyone over 18 who was unable to consent to the deprivation. In response to a number of questions, Members were advised of the procedures and protocols in place to ensure that incidents were fully investigated and any recommendations arising from case reviews were implemented. It was noted that the Trust’s Whistle Blowing Policy had not been used often as people were very open and transparent with regard to the reporting and possible incidents. It was also confirmed that the Trust did record whether incidents of abuse were reported by family members.
Mr Tony Heselton, Safeguarding Lead – South Central Ambulance Service NHS Trust, commented upon the Trust’s Safeguarding Policy and referred to the training regime that was due to commence to ensure that all staff were adequately trained and were fully aware of their role and responsibilities. He commented upon the Trust’s referral process and explained that the Trust held a large amount of information, which they shared regularly with relevant organisations. In response to a number of questions, Mr Heselton advised Members that ambulance personnel were happy to report any incidents where they had concerns. He also referred to a new recording system that had been introduced in October that highlighted their re-attendance at the same property. He commented upon the number of referrals in the Windsor and Maidenhead area and explained that the number was considered low given the current volume of activity. It was agreed that the Trust be invited back in 6 months to provide an update to the Panel.
80/09 MINOR INJURIERS UNIT – ST MARKS HOSPITAL
The Panel considered the report that was due to be submitted to the Berkshire East PCT’s Board on 27 January 2010 on the future of the Minor Injuries Unit (MIU) at St Mark’s Hospital, Maidenhead. The report provided a public health needs analysis of Maidenhead, an outline of the activity and service provided by the MIU and an assessment of six potential service options for the future delivery of the service.
Members noted that the report had recommended that the PCT Board consider whether the option to integrate the current role of Out of Hours Provider with the MIU activities would provided a viable cost effective alternative to the current provision and also consider options for the future investment in the MIU on the St Mark’s site noting the PCT Operating Plan Prioritisation Tool for 2010/11.
Mr David Williams, Acting Director of Locality Commissioning – Berkshire East Primary Care Trust, referred to the pilot’s scheme’s success criteria and advised that, although the reduction in A&E attendances had only been one of a number of criteria, it was clear that there was the need to identify a more cost effective service. He advised that 80% of the people attending the MIU were registered at GP Practices in Maidenhead, 9 out of the 12 Maidenhead GP practices offered extended hours services and that people had indicated that they would go to their GP if the MIU service was not available.
Arising from the discussion, the following comments were made.
At the conclusion of the debate it was
81/09 PCT STRATEGIC PLAN
The Panel received a presentation from Mr David Williams, Acting Director of Locality Commissioning – Berkshire East Primary Care Trust on the PCT’s Strategic Plan 2010-2014, which set out the PCT’s vision, priorities and intentions until 2014.
It was noted that the Strategic Plan had recently been reviewed to reflect the change in economic activity, to take into account the joint strategic needs assessment and patient experience feedback and the outcome of the review on progress on the delivery of the original strategic plan. He provided details on the priorities that had been identified in the joint strategic needs assessment and commented upon the financial considerations that had to be taken into account that would shape spending levels in future years. He commented upon the success criteria that would be adopted by the Trust to measure performance against the Plan and outlined the key issues facing the PCT.
In response to a number of questions, Mr Williams advised that the PCT was working with Heatherwood and Wexham Park Hospitals NHS Foundation Trust to improve their systems and processes, although it was stressed that the level of patient care and the quality of the services provided by the Trust remained good. He confirmed that, as there had been a significant improvement in waiting times, waiting lists were now not considered a priority.
82/09 DEPARTMENT OF HEALTH CONSULTATION – NHS CAR PARKING
The Panel considered the consultation document issued by the Department of Health on access to and charging for car parking at hospitals. Arising from the discussion, the Panel were unanimous in it its strong support for the provision of free parking for all inpatients and their visitors and supported the view that it should be implemented within the next three years. The Panel also supported the view that concessions, such as a monthly cap on their charges or a rebate, should be provided for those out-patients that had regular appointments.
83/09 SERVICE MONITORING REPORT
The Panel received and commented upon the latest service monitoring report for activity within the Adult, Community and Health Services during the period to 31 December 2009. It was noted that the Adult Social Care budget showed a projected under-spend of £3k, which was £32k less than the £35k reported in the previous month.
84/09 BUDGET 2010/2011
Members received a report that sought to inform the Panel of progress to date in the preparation of the 2010/2011 Budget, which would be considered by Cabinet on 11 February 2010 and then Council on 23 February 2010.
The officers and the Lead Member for Adult and Community Services then responded to a number of questions/comments on specific savings proposals. Further details were provided on the compilation of the budget savings relating to the leisure centres and it was confirmed that discussions were being held with neighbouring local authorities on the production of a Housing Strategy. It was stressed that the libraries fees and charges reflected market rates and that the increase in the day rate for non advantage card holders at Windsor Leisure Centre reflected the view that the Council should not be subsidising non residents for the use of Council services and facilities.
Arising from the general discussion, the Panel made the following comments on the report.
· Concern was expressed that the Elderly and Physical Disability budget had reduced when the number of elderly people requiring support was increasing. The Panel were advised that, notwithstanding the increase in demand for the service, savings could be achieved through operational efficiencies.
· Concern was expressed at the effect the loss of front line staff, in particular the deletion of a Day Centre post and an Assistant Care Manager post, would have on the delivery of essential care services. The Panel received assurances that the Council would be able to meet its statutory responsibilities within the budget limits set.
· The reason why the Maidenhead Town Moor phase II was considered to be such a high priority was questioned. The Lead Member advised that Panel that he would look again at the scheme to ensure that it was prioritised correctly within the Capital Programme.
· The inclusion of the saving relating to the increase in the number of fairs at Dedworth Manor was questioned as it had been confirmed at a previous meeting that the saving proposal had been deleted.
· It was suggested that the Home adaptations scheme (Line 57 in the Capital programme) should be considered a higher priority in the Capital Programme, particularly as it was to be funded from Government grants.
85/09 CHARGING CONTRIBUTION POLICY WITHIN ADULT SOCIAL CARE
As the report had been circulated late, it was agreed that the item be deferred and that a special meeting be called to consider the report.
86/09 WORK PROGRAMME
Members noted the items that had been identified for submission to the next meeting and also identified a number of other items.
87/09 MEETING
The meeting, which began at 7.30pm, ended at 10.10pm.
26 JANUARY 2010
PRESENT: Councillors Meadowcroft (Chairman), Baskerville, Mrs Evans, Lenton, Majeed, Mrs Napier, Penfold (substituting for Councillor Mrs Endacott), Mrs Proctor and Mrs Yong.
Non-Members: Councillors Adams, Dudley and Mrs Kemp
Also Present: Mrs C Culpin, Mr J Jones and Mrs D Thompson (Heatherwood and Wexham Park Hospitals NHS Foundation Trust); Mrs C Finlay and Mr D Williams (Berkshire East PCT); Mr T Heselton (South Central Ambulance Service NHS Trust)
Officers: Mr Abrahamson, Mr A Brown, Mr Herlinger, Mr A Scott & Mrs Shawcross.
PART I
74/09 APOLOGIES FOR ABSENCE
An apology for absence was received from Councillor Mrs Endacott.
75/09 DECLARATIONS OF INTEREST
Councillor Mrs Napier declared a Personal and Prejudicial Interest in Agenda Item 12 - Charging and Contribution Policy within Adult Social Care - as her son was in receipt of a care package.
76/09 MINUTES
- RESOLVED: That the minutes of the meeting of the Panel held on 14 December 2009 be approved.
77/09 VOICES INTO ACTION - ASSESSMENT OF HEALTH AND SOCIAL CARE
The item was deferred to the next meeting of the Panel.
78/09 HEATHERWOOD AND WEXHAM PARK HOSPITALS NHS FOUNDATION TRUST – UPDATE ON FINANCIAL SITUATION
Members were advised that Heatherwood and Wexham Park Hospitals NHS Foundation Trust had recently submitted their Turnaround Plan, which included a Medium Term Financial Plan, to Monitor, the independent body established to authorise and regulate NHS foundation trusts. Mr J Jones, Director of Corporate Affairs at the Trust, informed Members that the Trust would attend the next meeting to provide the Panel with a more complete picture of the Trust’s financial position. It was requested that a copy of the Turnaround Plan together with any further relevant information be circulated to Members well in advance of the meeting.
79/09 SAFEGUARDING
Members received presentations from Heatherwood and Wexham Park Hospitals NHS Foundation Trust and the South Central Ambulance Service NHS Trust on how the Trusts were implementing the requirements of the East Berkshire Safeguarding Adult procedures.
Mrs Clare Culpin, Director of Nursing – Heatherwood and Wexham Park Hospitals NHS Foundation Trust, commented upon the Government’s guidelines on multi-agency working. She explained the nature of adult abuse, outlined who may be considered an abuser, provided examples of abuse and commented upon how incidents were reported. She referred to the Trust’s Whistle Blowing Policy and the Deprivation of Liberty Safeguards, which required health or social care organisations or registered care homes to make an assessment to ascertain whether they were lawfully depriving of their liberty anyone over 18 who was unable to consent to the deprivation. In response to a number of questions, Members were advised of the procedures and protocols in place to ensure that incidents were fully investigated and any recommendations arising from case reviews were implemented. It was noted that the Trust’s Whistle Blowing Policy had not been used often as people were very open and transparent with regard to the reporting and possible incidents. It was also confirmed that the Trust did record whether incidents of abuse were reported by family members.
Mr Tony Heselton, Safeguarding Lead – South Central Ambulance Service NHS Trust, commented upon the Trust’s Safeguarding Policy and referred to the training regime that was due to commence to ensure that all staff were adequately trained and were fully aware of their role and responsibilities. He commented upon the Trust’s referral process and explained that the Trust held a large amount of information, which they shared regularly with relevant organisations. In response to a number of questions, Mr Heselton advised Members that ambulance personnel were happy to report any incidents where they had concerns. He also referred to a new recording system that had been introduced in October that highlighted their re-attendance at the same property. He commented upon the number of referrals in the Windsor and Maidenhead area and explained that the number was considered low given the current volume of activity. It was agreed that the Trust be invited back in 6 months to provide an update to the Panel.
80/09 MINOR INJURIERS UNIT – ST MARKS HOSPITAL
The Panel considered the report that was due to be submitted to the Berkshire East PCT’s Board on 27 January 2010 on the future of the Minor Injuries Unit (MIU) at St Mark’s Hospital, Maidenhead. The report provided a public health needs analysis of Maidenhead, an outline of the activity and service provided by the MIU and an assessment of six potential service options for the future delivery of the service.
Members noted that the report had recommended that the PCT Board consider whether the option to integrate the current role of Out of Hours Provider with the MIU activities would provided a viable cost effective alternative to the current provision and also consider options for the future investment in the MIU on the St Mark’s site noting the PCT Operating Plan Prioritisation Tool for 2010/11.
Mr David Williams, Acting Director of Locality Commissioning – Berkshire East Primary Care Trust, referred to the pilot’s scheme’s success criteria and advised that, although the reduction in A&E attendances had only been one of a number of criteria, it was clear that there was the need to identify a more cost effective service. He advised that 80% of the people attending the MIU were registered at GP Practices in Maidenhead, 9 out of the 12 Maidenhead GP practices offered extended hours services and that people had indicated that they would go to their GP if the MIU service was not available.
Arising from the discussion, the following comments were made.
- Residents had not been aware at the commencement of the pilot that the MIU had been established based on the need to reduce activity levels at A&E.
The success criteria should have been clearly set before the establishment of the MIU pilot.
It should have come as no surprise that, based on experience elsewhere, the MIU had generated additional demand and had not reduced attendance figures at A&E.
It was contended that a lot of the treatments provided by the MIU could not be provided at a GP extended hours booked service.
The Panel was not convinced that the PCT’s Prioritisation Tool fully satisfied all the issues the PCT Board should be considering when looking at the future of the MIU.
At the conclusion of the debate it was
- RESOLVED UNANIMOUSLY: that the PCT Board be advised that the Panel were of the opinion that it would be considered unacceptable if the MIU was to close as it had been a success and had provided enhanced healthcare to residents of Maidenhead. The Panel were firmly of the view that the MIU should remain and that the Royal Borough would take all action open to it if the PCT Board agreed to decommission and close the service.
81/09 PCT STRATEGIC PLAN
The Panel received a presentation from Mr David Williams, Acting Director of Locality Commissioning – Berkshire East Primary Care Trust on the PCT’s Strategic Plan 2010-2014, which set out the PCT’s vision, priorities and intentions until 2014.
It was noted that the Strategic Plan had recently been reviewed to reflect the change in economic activity, to take into account the joint strategic needs assessment and patient experience feedback and the outcome of the review on progress on the delivery of the original strategic plan. He provided details on the priorities that had been identified in the joint strategic needs assessment and commented upon the financial considerations that had to be taken into account that would shape spending levels in future years. He commented upon the success criteria that would be adopted by the Trust to measure performance against the Plan and outlined the key issues facing the PCT.
In response to a number of questions, Mr Williams advised that the PCT was working with Heatherwood and Wexham Park Hospitals NHS Foundation Trust to improve their systems and processes, although it was stressed that the level of patient care and the quality of the services provided by the Trust remained good. He confirmed that, as there had been a significant improvement in waiting times, waiting lists were now not considered a priority.
82/09 DEPARTMENT OF HEALTH CONSULTATION – NHS CAR PARKING
The Panel considered the consultation document issued by the Department of Health on access to and charging for car parking at hospitals. Arising from the discussion, the Panel were unanimous in it its strong support for the provision of free parking for all inpatients and their visitors and supported the view that it should be implemented within the next three years. The Panel also supported the view that concessions, such as a monthly cap on their charges or a rebate, should be provided for those out-patients that had regular appointments.
- RESOLVED UNANIMOUSLY: That the Panel’s comments on the consultation paper on NHS Car Parking as outlined above be forwarded to the Department of Health.
83/09 SERVICE MONITORING REPORT
The Panel received and commented upon the latest service monitoring report for activity within the Adult, Community and Health Services during the period to 31 December 2009. It was noted that the Adult Social Care budget showed a projected under-spend of £3k, which was £32k less than the £35k reported in the previous month.
84/09 BUDGET 2010/2011
Members received a report that sought to inform the Panel of progress to date in the preparation of the 2010/2011 Budget, which would be considered by Cabinet on 11 February 2010 and then Council on 23 February 2010.
The officers and the Lead Member for Adult and Community Services then responded to a number of questions/comments on specific savings proposals. Further details were provided on the compilation of the budget savings relating to the leisure centres and it was confirmed that discussions were being held with neighbouring local authorities on the production of a Housing Strategy. It was stressed that the libraries fees and charges reflected market rates and that the increase in the day rate for non advantage card holders at Windsor Leisure Centre reflected the view that the Council should not be subsidising non residents for the use of Council services and facilities.
Arising from the general discussion, the Panel made the following comments on the report.
· Concern was expressed that the Elderly and Physical Disability budget had reduced when the number of elderly people requiring support was increasing. The Panel were advised that, notwithstanding the increase in demand for the service, savings could be achieved through operational efficiencies.
· Concern was expressed at the effect the loss of front line staff, in particular the deletion of a Day Centre post and an Assistant Care Manager post, would have on the delivery of essential care services. The Panel received assurances that the Council would be able to meet its statutory responsibilities within the budget limits set.
· The reason why the Maidenhead Town Moor phase II was considered to be such a high priority was questioned. The Lead Member advised that Panel that he would look again at the scheme to ensure that it was prioritised correctly within the Capital Programme.
· The inclusion of the saving relating to the increase in the number of fairs at Dedworth Manor was questioned as it had been confirmed at a previous meeting that the saving proposal had been deleted.
· It was suggested that the Home adaptations scheme (Line 57 in the Capital programme) should be considered a higher priority in the Capital Programme, particularly as it was to be funded from Government grants.
RESOLVED UNANIMOUSLY: That the Panel’s comments on the Budget Report 2010/2011, as outlined above, be forwarded to Cabinet for consideration.
85/09 CHARGING CONTRIBUTION POLICY WITHIN ADULT SOCIAL CARE
As the report had been circulated late, it was agreed that the item be deferred and that a special meeting be called to consider the report.
86/09 WORK PROGRAMME
Members noted the items that had been identified for submission to the next meeting and also identified a number of other items.
87/09 MEETING
The meeting, which began at 7.30pm, ended at 10.10pm.