Agenda and draft minutes

Venue: Council Chamber

Contact: Graham Walton  020 8461 7743

No. Item




Apologies for absence were received from Councillors Philip Normal, Danial Adilypour, Chris Lloyd and Robert Mcilveen (who was replaced by Cllr Mary Cooke.)



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


There were no matters for urgent debate.



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


The following interests were declared -


·  Cllr Judi Ellis declared that her daughter was an employee of Oxleas NHS Foundation Trust.

·  Cllr Richard Diment declared that he was a governor of Oxleas NHS Trust

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



To approve as a correct record the Minutes of the meeting held on 22nd July 2019.


The minutes of the meeting held on 22nd July 2019 were confirmed as a correct record.




The Chairman expressed concern that no members had received information about the Long Term Plan engagement events, as promised at the last meeting. Julie Lowe apologised and stated that she thought this had been done. She pointed out that at the time of the last meeting some of the events had already taken place. The events had been well attended, but were not intended as a full public consultation.  



Additional documents:


Julie Lowe presented an update on the South East London ICS response to the NHS Long Term Plan (LTP). The draft reply needed to be submitted to NHS London on Friday (27th September 2019) and there would be further work, including aligning with the London Vision which would be launched at City Hall the next week, until 15th November. There had already been public engagement, and additional engagement with the voluntary sector would be carried out. Discussions had taken place with Directors of Public Health and Directors of Adult Services, and local authority Chief Executives were being briefed.  The update included reports from Kaleidoscope, who had arranged the public engagement, and Healthwatch. 


Members sought clarification from Ms Lowe about the engagement programme. She was clear that there was no claim to have engaged with a statistically representative sample of the population. Healthwatch had carried out a survey with over a thousand responses and a small number of focus groups with hard to reach groups. Some work had then been carried out with Kaleidoscope, who arranged six borough-focused events (two of which had already taken place at the time of the Joint Committee’s last meeting), six topic-focussed events, a number of meetings with community groups (which had about two hundred attendees) and a survey. Members had expected following their meeting in July to be advised of the remaining dates, but did not recall receiving any information. The Chairman requested that their comments be included in the final report to NHS England.


In response to questions, Julie Lowe explained that there were legal requirements to carry out formal consultation in certain circumstances, where there were changes to services, and certain organisations and individuals had to be given the opportunity to comment. The Long Term Plan process did not involve specific changes and formal consultation was not required, so a range of engagement activity had been arranged. This was a submission to NHS England on 15th November, rather than a public-facing reconfiguration of services in South East London, and did not require submission of a letter giving JHOSC comments. She accepted that a summary table of all the engagement events would have been helpful. Healthwatch had been commissioned by NHS England to provide engagement nationally; in South East London this was not considered to be sufficient, so Kaleidoscope had been engaged, but she accepted that the engagement was not as thorough as some Members may have wanted. In addition, she confirmed that they were offering to come to Health and Wellbeing Boards before November - a meeting with health and Wellbeing Board chairmen had been held on 2nd September, but she would write out to them again. 


Councillor Diment suggested that the aims of the document were broadly supported, but requested some further comment on the system financial challenge in South East London, particularly at Kings, and the effect on residents and the services they required. Julie Lowe reminded Members that this was a five year plan, but there  ...  view the full minutes text for item 41.




Dr Angela Bhan, Managing Director, Bromley CCG, and co-senior responsible officer for workforce for OHSEL, introduced a paper on NHS workforce issues. She confirmed that they were still awaiting a full strategy from NHS England, and were working to the Interim People Plan. The workforce stream in South East London was looking at what could be best done on a collective level, adding value to the work of individual organisations. There were significant challenges in recruitment of nurses and GPs and developing a new type of workforce, with new roles such as Nursing Associates. The delivery plan responded to the challenges of the Long term Plan and the Interim People Plan under five headings -


·  Capacity;

·  Capability;

·  Contracts and governance;

·  Culture; and

·  Collaboration, engagement and enabling. 


In response to a question from Councillor Noakes, Dr Bhan explained that there were many educational providers in the area, and CCGs worked with the Local Workforce Action Board (LWAB), a multi-agency forum which looked at workforce issues, including the training of doctors and nurses, and there were a variety of local schemes involving local schools and colleges. Training slots for mainstream nursing were still all being filled, despite a reduction in applications. More could be done, especially to work more consistently across South East London. Julie Lowe added that the headline turnover rate across South East London was about 12%, much of which was normal and within the area, but this masked some very high turnover in some specialities. The pattern of turnover tended to be different between the inner and outer London acute trusts, and analysis was complicated as nurses moving to GP practice were counted as leaving the service. In terms of the impact of Brexit, the number of European nurses employed within the 46,000 workforce was relatively small, but anecdotally this number could be swelled by those affected by the status of other family members or an atmosphere where foreign staff felt that they were not welcome. 


Councillor James raised the issue of the vital agency staff and ancillary workers in cleaning and catering roles, and whether all staff received at least the London Living Wage. Dr Bhan agreed that these staff were important and included, and stated that although OHSEL did not employ staff the local trusts and their contractors were using responsible employers. Julie Lowe reported that a study had been carried out into whether all employers were paying the London Living Wage. She could not confirm the details, but conditions in London meant that it was usually difficult to recruit staff without paying the London Living Wage. 


Councillor Olisa commented that there would clearly be substantial changes to many people’s jobs, so full consultation was required. She was concerned that there were very significant changes that needed to be discussed with the Trade Unions at an early stage, and that there would be resistance if this was delayed until late in the change process. Dr Bhan agreed and stated that Trade Unions had been involved; she  ...  view the full minutes text for item 42.



Additional documents:


A message from the Save Lewisham Hospital Campaign had been circulated to all Members, and an article dated 20th September 2019 was also tabled. Members allowed Dr Tony Anderson of the Save Lewisham Hospital Campaign to address the meeting.  Dr Anderson stated that the merger proposals would remove important elements of local cooperation between the NHS and local authorities, and that there was no mention of the role of scrutiny under the new arrangements. He referred to other areas where similar proposals had been challenged and delayed. He considered that the duty to consult with local people on merger proposals had not been carried out and that terms of reference for the borough based boards and future arrangements for public and local authority involvement needed to be set out. Dr Anderson concluded by calling for the Joint Committee to ask for the process to be halted.


Martin Wilkinson, Managing Director Lewisham CCG responded to Dr Sullivan. He considered that the role of overview and scrutiny was not changed by the proposals at borough or South East London level. There were some minimum expectations from the NHS around borough based boards, but there were no terms of reference because the intention was to work with local authorities to deepen work on commissioning and discussions were on-going on these matters within all the boroughs. Issues like terms of reference and membership would be worked through in the next phase - a governance pack, including terms of reference for borough based boards, was being put together, but this would be subject to agreement by all six CCGs in the next six months. Borough based boards would still have the resources to work with local authorities on public engagement. An amendment to the paperwork submitted was that a committee was being set up to ensure that public engagement activities were strengthened. He was certain that the national guidance made clear that this was a structural change for the NHS which required engagement with stakeholders, but not formal public consultation.


Andrew Eyres reported that Lambeth CCG had discussed the proposals at a meeting that day, but members had asked for more information before coming to a decision.  He was about to take up a new Director role employed jointly by the CCG and Lambeth Council with a role on the new governing body if the merger took place. The proposals offered an opportunity for the boroughs to work more closely with the NHS.


Councillor Mark James asked whether unanimity was required amongst the six CCGs for the merger to take place. If Lambeth did not support the proposals it would not be able to take part, and then there would be concerns about how it would be able to respond to some of the strategic issues in the Long Term Plan. The Chairman asked whether the further information requested in Lambeth could be made more widely available; this would be possible, but the information was largely about Lambeth place arrangements and other boroughs might  ...  view the full minutes text for item 43.



(a) Extension of CAMHS Services up to age 25



(b) Residential Care Beds


Additional documents:


(A) Child and Adolescent Mental Health services (CAMHS) - Transition for 0-25 year olds


The Chairman referred to the six month wait for access to CAMHS in Bromley and requested further information. Martin Wilkinson stated that they were still working on the model for 0-25 services, and he was aware that there were long waits for some services.  He emphasised that the intention was not just to extend existing services that were already stretched. He was happy to provide information for South East London, but also the specifics for each borough. The Chairman responded that it was important to identify the discrepancies in services across the region, and understand what was good practice. 


(B) South London Partnership - Children and Young People’s Inpatient Care


The Chairman stated that the focus of concern was out of area placements, which put a strain on the young people concerned and their families. The Committee needed to see more information, by borough, on the number of out of area placements, how long they were and what arrangements were in place when patients left these placements - including what other bed types were available and where. 


It was agreed that further reports with more details be requested for the next meeting on both issues.



At the last meeting, the Committee indicated that it would meet in January and April 2020. The following potential days are available, and Members are requested to confirm the final dates -


·  23rd January 2020 (or 16th, 20th or 21st)


·  21st April 2020 (or 2nd, 28th or 29th)


The Committee considered its work-plan and future meeting dates.


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