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Apologies and Introductions
Apologies had been received by Dr Harpal Harrar, Ms Sabera Ebrahim and Ms Liz Clegg.
Declarations of Conflict of Interest
None were declared.
RESOLVED: That the minutes of the meetings held on 27 February 2019 be approved as an accurate record of the proceedings.
Ms Moira McGrath, Director of Integrated Commissioning (Adults), presented the report.
The meeting noted concern regarding the length of time some had been on the waiting list.
In response to questions from Members, the Committee heard:
· Follow ups on patients were done to make sure people were still in need of the support they were receiving.
· Some signposting would be provided for referrers and information on the website had improved. People would be encouraged to look at the information.
· Di Aitken was going to work on a letter to send to GPs advising of long waitsThe report related to people who either owned their own home or privately rented. The process for those renting from the Council was different
· Examples of how people have been reviewed and prioritised can be shared with the Committee. There was an opportunity for Health, Social Services and Housing to work together and efforts would be made to ensure that this would occur.
· The Housing Strategy had a vulnerable people’s component and had been in place for three years. Some work would be done with the Housing team to refresh this. A draft of this work would be brought back to a future meeting as this would partly outline how support was being provided; such as how people with mental health issues were in the bidding process and how the Health In All Polices approach as part of the Health & Wellbeing Strategy was being developed.
The Chair felt that reporting could be done on housing informing about housing association and council tenants. The Council historically had a bad reputation in relation to housing but things appeared to be improving. Approximately £500 million had been spent on refurbishing homes including new kitchens, bathrooms and heating systems. The repairs service had improved and further improvements could be made. He also noted that he received fewer volumes of casework regarding repairs or other services. More assistance would be given to those who have had difficulties but the situation in general was comparable to most landlords. Many Housing Associations were also falling under scrutiny.
Ms Sue Gallagher expressed concern about the level of financial wastage in the Council’s history such as unattended repairs and scaffolding, issues with roofing, poor workmanship and attention to detail.
The meeting noted that a report on Housing and Health would be useful to the Committee alongside a similar report from Healthwatch.
The letter to GPs would be sent in due course and information would be gathered regarding how many clients were on the green, amber and red list for long term care.
1. That the work being undertaken by the OT service to manage waiting lists be noted.
2. That a few examples of people supported by the service be shared.
3. That work with the Council Housing Strategy and vulnerable people’s pathway be spread at a future meeting when re-drafted.
Ms Moira McGrath, Director of Integrated Commissioning (Adults), presented the report.
The Chair noted that the changes in the DoLs regulations would result in a decrease in risk and these would be recorded in the numbers within due course.
In response to questions from the Committee, the meeting heard:
· There were no immediate changes regarding the situation of employment of staff as part of the LCN work. Some of the work related to access to information and advice and reducing the amount of people needing to use the service in the first instance.
· Further work may lead to further interventions regarding social care and how universal services in the NHS would be used.
· Collaborative work would be done with Guys and St Thomas’ on reframing work that may be being unnecessarily duplicated or handed off.
· The work would be presented to the Committee in due course.
1. That the report be noted.
Ms Christine Caton, Chief Financial Officer, presented the report.
The meeting noted that a patient had been identified who had a Lambeth based GP and had used Lambeth services for several years, but was in fact a Croydon resident and had his services paid for by Croydon, despite him being a Lambeth responsibility.
Some discussion was held regarding the clarity of the numbers outlined in the report. The meeting heard that the approximate 7% overspend was calculated to a total of approximately 2% because the CCG had a risk reserve to manage issues (such as inpatient bed days) and this budget responsibility was aligned with the CCG.
In response to questions from the Committee (particularly relating to reducing the overspend), the meeting heard that:
· The main areas from an NHS perspective in driving the reduction was the position on acute bed days.
· There was also some overspend on placements affecting the Council more than the NHS.
· From the NHS perspective, the position on bed days focused around patients who were ‘super stranded’ (those staying in excess of 200 days).
· There was some difficulty dealing with the 12 people driving the length of stay and bed utilisation.
· Private overspill needed to be funded as beds were not available to new patients.
· A series of measures had been agreed following on from the MADE event which had taken place several weeks prior to this meeting.
· One of the immediate actions that had been agreed was to conduct a test for five of the ‘super stranded’ individuals involving a combination of high-end supported housing, focused input from the rehabilitation team and PA support. The Alliance Management Team was working on this offer.
· There was some non-recurrent resource to test over the 2019/20 period. This would not be only one facility as the needs of the service users were quite different.
· There were some issues regarding PIKU. It was difficult to manage without overspill for PIKU. Beds were generally available for men but this availability was not the same for women.
· Cases for the ‘Super stranded’ individuals had been examined and it was concluded that ‘bespoke’ offers were needed for them. Long term solutions would need to be created.
· There had been a reduction in overspend, partly with PICU. Additional PICU may need to be commissioned and this was predominantly an issue relating to women.
· There had been an increase in workload generally. The Hub was in a state of flux; there were changes in Assessment Liaison, CMHT and the reported numbers needed to be considered with a critical eye.
· The Hub was facing high levels of pressure and concerns had already been expressed regarding staffing levels. Therefore, there was some focus work to reduce case loads. Some of the issues related to benefits, housing related queries etc. Work needed to be completed to ensure that service users were getting the support they needed. Some of the work would involve Mental Health professionals working with housing agencies to help resolve ... view the full minutes text for item 6.
Links Between Committees in Common & Lambeth Together Governance - verbal update
Ms Moira McGrath, Director of Integrated Commissioning (Adults),presented the report and informed that there were new proposals regarding the restructure of meetings. In the new proposals, the Lambeth Together Governance meeting would commence immediately after the conclusion of the Committee in future meetings. It was suggested that from the next meeting onwards, the meeting of this Committee would last hour and a half before being immediately followed by the next meeting (Lambeth Together / Alliance).
A recommendation needed to be made on the revised membership of Lambeth Together. It was proposed that changes to the membership would be made later in the year. Any recommendations to the changes of membership was subject to the approval of Cabinet and the CCG Governing Body.
The care coordination work would move forward as part of the recommendations. The proposals regarding Local Care Networks would be submitted in due course. The proposals needed to be tested to see how well they would work.
The Health and Wellbeing Board would be aligned with Lambeth Together.
The newly arranged meetings would be tested in the upcoming informal April 2019 meeting dates. If the proposals were acceptable, then they would be submitted to the CCG Governing Body and Cabinet
1. That the update be noted.