Agenda and minutes

RESOLVED that Councillor James Hunt be appointed Chairman and Councillor Judi Ellis be appointed Vice-Chairman for the 2017/18 municipal year.

Apologies for absence were received from Councillors Ross Downing, Rebecca Lury, Clare Morris and Cherry Parker.

The Chairman led Members in thanking Councillor Rebecca Lury for her excellent work as previous Chairman of the Committee.  The Chairman also thanked Mark Easton who was standing down from his role as Programme Director of the "Our Healthier South East London" Programme.

In special circumstances, an item of business may be added to an agenda within five working days of the meeting.

Two items of business were raised for discussion comprising the financial situation of King’s College Hospital NHS Foundation Trust and proposals to reconfigure stroke services across the Kent and Medway region.

Members to declare any interests and dispensations in respect of any item of business to be considered at the meeting.

Councillor Jacqui Dyer declared that she was the NHS England Equalities Lead for Mental Health.

Councillor Judi Ellis declared that she was a Governor and her daughter was an employee of Oxleas NHS Foundation Trust.

Councillor Alan Hall declared that he was a former Governor of King’s College Hospital NHS Foundation Trust.

Councillor Robert Hill declared that his wife was the Assistant General Secretary of UNISON.

Councillor James Hunt declared that his wife was an employee of Dartford and Gravesham NHS Trust.

Councillor Bill Williams declared that he was a Governor of Guy’s and St Thomas’ NHS Foundation Trust

The Committee considered King’s College Hospital NHS Foundation Trust which had recently been put into financial ‘special measures’.  A Member underlined the need to seek reassurance for patients that clinical services would not be reduced as a result of the financial situation and informed the Committee that a request had been made to King’s for an update on the financial and operational consequences of the Trust being placed into ‘special measures’. Members requested that a full briefing be provided to the next meeting of the Joint Health Overview and Scrutiny Committee relating to the impact of the financial situation on the Sustainability and Transformation Plan and updating Members on the Trust’s future commissioning intentions, as well as identifying implications for the stability of the acute health sector across the South East London region.

The Chairman advised the Committee that Kent and Medway Sustainability and Transformation Partnership had announced proposals to reconfigure stroke services for the Kent and Medway region in which hyper-acute and acute stroke units would be consolidated onto fewer sites.  This service was accessed by approximately 70 residents of the London Boroughs of Bexley and Bromley and the Royal Borough of Greenwich on an annual basis and was likely to increase demand for services within the South East London region going forward.

The Chairman requested Members consider the forward work programme for future meetings of the Committee.

To approve as a correct record the minutes of the meeting held on 28^th November 2016.

Written questions were received from Jane Mandlik, Save Lewisham Hospital Campaign and these are attached at Appendix A.

RESOLVED that the minutes of the meeting held on 28^th November 2016 be agreed as a correct record.

The Committee considered a report providing an overview of OHSEL activity planned for 2017/18.

Sustainability and Transformation Partnerships had been launched in early 2016 to bring together different NHS and partner bodies in creating a strategic plan.  This role had since evolved, and the South East London Sustainability and Transformation Partnership now undertook a wider range of functions including setting the strategic direction for changes to health and care systems within the region and supporting NHS providers to work together.  The Partnership also worked to develop a financial strategy and enabler strategies in the areas of workforce, digital and estates, and with regulators to take an oversight of finance and performance.

The four key workstreams of the South East London Sustainability and Transformation Partnership comprised improved public engagement and transparency, a focus on national priorities and alignment of transformation with delivery, a refresh of the financial model, and the development of accountable care systems.  As part of these workstreams, detailed delivery plans had been developed for the national clinical priorities of Cancer, Primary Care, Mental Health and Urgent and Emergency Care, as well as for other key areas including Maternity Services.  Financial modelling had also been undertaken on the South East London system to identify what would be required to move back into financial surplus on a recurrent basis by 2021.  A model was now being developed to roll out accountable care across the region which would include greater integration of health and care systems, and to support this, the South East London Sustainability and Transformation Partnership had expressed an interest in participating in the second wave of accountable care delivery pilot projects which could realise additional resources and support for the South East London region.

In considering the update, a Member requested that more detailed financial information be provided on planned OHSEL activity.  The Member also asked for clarification on how this would affect the number and use of hospital beds, and the Lead Officer, South East London Sustainability and Transformation Partnership confirmed that there were no plans to reduce the number of hospital beds across the region.  A Member noted that patients often accessed support from multiple sources including social care, acute, mental health and primary care services and that  accountable care would need to provide ‘wraparound care’ to patients which simplified the system of receiving health care and support, such as through multi-skilling the health care workforce.  The Chief Executive, Oxleas NHS Foundation Trust reported that Oxleas NHS Foundation Trust had placed increasing emphasis on community care for patients accessing mental health services in recent years, and was working in partnership with South London and Maudsley NHS Foundation Trust and St George’s Hospital to consider how key services such as Child and Adolescent Mental Health Services could be delivered more effectively, as well as with other key partners to develop early intervention services across the region.

RESOLVED that the update be noted.

The Committee considered a report providing an update on mental health provision.

Mental health remained a core part of the Sustainability and Transformation Plan and was prominent in the clinical transformation pillar.  The key priorities for mental health across the South East London region included improving the provision of health-based places of safety, achieving parity of esteem and integration of physical and mental health and developing an approach to address workforce difficulties across the South East London region.  Other key priorities included building on progress in reducing out-of-area placements for acute inpatients and developing new models of care for accountable care systems.

The financial position of the South East London Sustainability and Transformation Partnership remained exceptionally difficult, placing an increased focus on the need for new ways of working to deliver service improvement.  All Clinical Commissioning Groups within the South East London region had met the Mental Health Investment Standard for 2017/18, and system providers continued to assure themselves on the make-up of the allocation across all key partners to ensure it genuinely met the standard.  It was the intention of Clinical Commissioning Groups within the region to meet the investment standard for 2018/19 as set out in their two year Operating Plans; however it had been recognised that this would be particularly challenging in the context of both workforce constraints and the increased pressure and demand on the system.  To mitigate this risk, providers and Clinical Commissioning Groups within the South East London region were developing joint strategies and plans to maximise resources which would include pooling budgets across health and social care.

The Chief Executive, Oxleas NHS Foundation Trust reported that work had been undertaken to deliver parity of roles across mental health services within the South East London region.  Mental Health clinical staff would also be given opportunities to advance by achieving approved clinical status which was expected to increase the retention of skilled staff in clinical roles. 

In considering the update, a Member underlined the impact of the affordable housing shortage on recruiting and retaining a skilled mental health care workforce and on patients receiving inpatient care.  The Chief Executive, Oxleas NHS Foundation Trust confirmed that a new housing scheme at Queen Mary’s Village, Sidcup had been developed to offer homes for shared ownership or for rental at intermediate market rent to Oxleas nurses and staff, NHS staff and other key workers who lived or worked in the London Borough of Bexley.  Should this scheme be successful there was potential to roll it out to other areas of South East London in partnership with Housing Associations and developers.  A care plan was developed for all patients admitted for inpatient mental health care including how their discharge would be managed and where possible, patients were supported to sustain existing tenancies.

Following a request by a Member, the Chief Executive, Oxleas NHS Foundation Trust confirmed that information relating to a reduction in out-of-Borough placements would be provided to the Committee following the meeting.  The Member also requested that  ...  view the full minutes text for item 8.

The Committee considered an update on the Orthopaedic Clinical Network which was being developed with the aim of providing elective orthopaedic services on fewer sites across the South East London Region to support the implementation of the Getting it Right First Time recommendations.

Following an extensive assessment and consultation process, it had become clear that it would not be possible for a consensus to be reached on the best model to adopt within the South East London Region, and it was therefore proposed to move forward with creating an Orthopaedic Clinical Network across the existing three providers.  Terms of Reference had now been formulated for the Orthopaedic Clinical Leadership Group and it had been recommended to the South East London Sustainability and Transformation Partnership that the Network be established and that a Clinical Lead be appointed.  From 2018/19, orthopaedic services would be commissioned against the standards and performance metrics set out in the Getting it Right First Time report, and the Network’s progress in delivering quality and efficiency benefits would be independently assured by the London Clinical Senate.  Commissioners would review the findings of the Clinical Senate on embedding the Getting it Right First Time recommendations over the three sites after 12 to 18 months, at which time a decision would be made on whether quality and efficiency benefits had been met and could be sustained across three sites.

In response to a question from the Chairman, the Programme Director, "Our Healthier South East London" Programme confirmed that patients within the South East London region would not be compelled to use services within the Orthopaedic Clinical Network and could continue to use other orthopaedic services, such as those offered by Dartford and Gravesham NHS Trust.

Members discussed the recent announcement that Guy's and St Thomas' NHS Foundation Trust and Johnson & Johnson Managed Services would be working together to deliver an Orthopaedics Centre of Excellence at Guy’s Hospital.  This would include the construction of three new operating theatres which would increase the total number of operating theatres to eight. The Consultant Orthopaedic Surgeon and Clinical Director of Surgery, Guy's and St Thomas' NHS Foundation Trust advised Members that it had been projected that demand for Orthopaedic services would continue to increase as a result of the ageing population, and that the Centre of Excellence would deliver sufficient additional capacity to meet this increasing demand as well as supporting innovation and research in the area of orthopaedic surgery.  The partnership did not represent a privatisation of the service as Guy’s Hospital already used Johnson & Johnson Managed Services within its existing supply chain, and one of the key aims within the proposed new arrangement was to streamline processes to procure devices, surgical instruments and implants required for orthopaedic surgery to reduce costs.  To support this, work had been undertaken with individual surgeons over the past two years to identify best practice in orthopaedic surgery, supporting surgeons to work more efficiently.  In response to a question regarding the total project value, the Director, Commercial  ...  view the full minutes text for item 9.

The Committee considered an update on Community Care – Strategy and Governance.

Within the South East London Region, Community Care was delivered via Local Care Networks which had been designed collaboratively by the six Clinical Leadership Groups.  All local areas within the region had adopted the target model which would embed an integrated pathway of care to be supported by delivery milestones encompassing the London Primary Care Standards.  The new model of Local Care Networks would realise a number of benefits including longer opening hours for primary care, increased use of digital technology to improve patient experience and social prescribing in which patients would be supported to manage their own health.  The new way of working also aimed to improve access to diagnostics, including for the management of long term conditions, and increased joint working with specialist providers to improve reablement and end-of-life care. An updated governance structure had now been agreed and would be used to support the leadership and oversight of the Community Care strategy.

The Clinical Chairman, Bromley Clinical Commissioning Group outlined a new model of care that had been introduced to the London Borough of Bromley in the form of three Integrated Care Networks launched in October 2016 which took a Multi-Disciplinary Team approach to making appropriate care and support available to Bromley residents with complex care needs.  Over 550 referrals had been made to the Integrated Care Networks during the first nine months of operation up to the end of June 2017 with an average service user age of 82 years.  All key partners had now signed an Integrated Care Network Alliance Agreement which set out the objectives, expected deliverables and operational framework for partner working, and consideration was being given to how this model could be used to support other vulnerable groups such as people with heart failure.

In discussion, a Member suggested that new models of care would benefit from linking in with the Mayor of London’s strategies.  Another Member emphasised the value of involving the voluntary sector and carers in delivering new models of care, which might require a change in culture and language.  In response to a query from a Member on how parity of esteem could be built into new models of care for patients with mental health needs, the Programme Director, "Our Healthier South East London" Programme confirmed that this issue was being reviewed and would be supported by a planned realignment of Oxleas NHS Foundation Trust management teams to Borough-level.  The Member suggested that this work be aligned with Thrive LDN which was a London-wide movement to improve mental health and wellbeing and was supported by the Mayor of London.

A Member noted the need to promote new initiatives effectively, such as longer opening hours for primary care.  The Member also underlined the benefits of non-medical interventions such as social prescribing and highlighted the importance of encouraging diversity of provision within new models of care, such as inclusivity of community groups.  The Programme Director,  ...  view the full minutes text for item 10.

The Committee received the King’s Fund Report which provided the results of an analysis of the five London Sustainability and Transformation Plans published in October 2016.

RESOLVED that the report be noted.

There was no Part B (Closed) Business.