Agenda and minutes

Please note that this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method. Although we ask members of the public recording, filming or reporting on the meeting not to include the public seating areas, members of the public attending the meeting should be aware that we cannot guarantee that they will not be filmed or recorded by others attending the meeting. Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on. 

By entering the meeting room and using the public seating area, you are consenting to being filmed and to the possible use of those images and sound recordings.

The chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual or may lead to the breach of a legal obligation by the Council.

The Chair referred Members present to agenda Item 1 as shown on the agenda in respect of filming at this meeting, and Members noted the information contained therein’.

No apologies for absence were received.

The Chair will consider the admission of any late items of urgent business (late items will be considered under the agenda item where they appear. New items will be dealt with at item 12 below).

There were no items of urgent business put forward.  

A Member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting of the authority at which the matter is considered:

(i) must disclose the interest at the start of the meeting or when the interest

becomes apparent, and

(ii) may not participate in any discussion or vote on the matter and must withdraw from the meeting room.

A member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Members’ Register of Interests or the subject of a pending notification must notify the Monitoring Officer of the interest within 28 days of the disclosure.

Disclosable pecuniary interests, personal interests and prejudicial interest are

defined at Paragraphs 5-7 and Appendix A of the Members’ Code of Conduct.

Cllr Connor declared a personal interest as her sister worked as a GP in Tottenham.  

There were no disclosable pecuniary interests or prejudicial interests declared by members.

To consider any requests received in accordance with Part 4, Section B, Paragraph 29 of the Council’s Constitution.

There were no deputations, petitions, presentations or questions.

To approve the minutes of the Adults and Health Scrutiny Panel meeting held on 18 March 2015.

AGREED: That the minutes of the meeting held on 18 March 2015 be approved as a correct record.

To note the terms of reference for the Adults and Health Scrutiny Panel for 2015/16.

AGREED: That the terms of reference for the Adults and Health Scrutiny Panel be noted.

This report provides an update in relation to the work of the premises task and finish group, co-commissioning and the development of new models of primary care in Haringey.

Cassie Williams, Assistant Director of Primary Care Quality and Development, Haringey Clinical Commissioning Group (CCG), provided the panel with an update on the work of the Premises Task and Finish Group (GP access); co-commissioning; and the development of new models of primary care in Haringey. 

It was noted the Premises Task and Finish Group had been working to address GP access issues, particularly in the east of the borough and to ensure adequate future provision in regeneration areas, most notably the Tottenham and Wood Green areas.

During discussion, reference was made to the strategic development plan that had been commissioned by NHS England. It was noted that a draft report had been considered by the Health and Wellbeing Board on 23 June 2015. This had confirmed there was a shortfall in provision in Tottenham Hale and Northumberland Park.

Ms Williams informed the panel that NHS England had been working to resolve these issues in a number of ways. For example, an infrastructure fund had been released for extending GP premises to increase availability of access. In Haringey, six practices had been successful in bidding for this NHS England fund with five of the bids supporting increased access in Northumberland Park and Tottenham Hale. In addition, it was noted that NHS England had been working to commission a new practice in Tottenham Hale. This would offer additional GP and nurse appointments in Hale Village until completion of a new building in 3-5 years time. This provision was intended to be in place during Autumn of 2015 and the panel was informed that longer terms solutions had started to be considered with additional capacity being included in local regeneration plans.

In terms of co-commissioning, the panel was informed that during 2014 CCGs had been invited to become more involved in commissioning primary care in collaboration with NHS England. It was noted that this was managed at a north central London (NCL) level and that there were three levels of co-commissioning that CCGs could opt for:

-       Level 1: Greater involvement – in decision making

-       Level 2: Joint commissioning – joint decision making

-       Level 3: Delegated authority – taking on delegated responsibilities

Ms Williams explained that from April 2015 NCL CCGs had entered co-commissioning at Level 1 and as a result NHS England had engaged the CCGs in discussion around decisions. It was noted that from October 2015 NCL would begin joint commissioning (Level 2).

Ms Williams concluded her presentation by providing an update on new models of Primary Care. It was explained that there was a need to increase Primary Care access and to provide more coordinated services. The panel was informed various pilots had been successfully initiated in Haringey where GPs had worked together in new ways. These included Saturday clinics, extended hours telephone consultations, a call centre and personalised care plans for over 75s with long term conditions.   

During discussion, reference was made to the following:

-       Standards of practice for confidentiality and patient consent to information /  ...  view the full minutes text for item 40.

This paper informs Members of the principles and methodology that will support the consultation and co-production processes.

Cllr Peter Morton, Cabinet Member for Health and Wellbeing, informed the panel that throughout the consultation for the Medium Term Financial Strategy (2015-2018), he had given a commitment to come back to service users and carers to consult on any detailed proposals for adult care services. 

Cllr Morton commented that the current model for adult social care in Haringey did not do enough to prevent care and support needs escalating, and was unsustainable in the long-term. It was noted that in 2014/15, for every £3 the council spent, £1 went on adult social care. The panel was informed that while demand for services continued to rise, the money available to fund them had reduced. Cllr Morton advised that on 16 June 2015 Cabinet had agreed to carry out specific consultation and further engagement with residents and partners on issues including:

-       Increasing the Council’s capacity to deliver re-ablement and intermediate care service;

-       Increasing the Council’s capacity to provide Supported Living Accommodation and Shared Lives schemes;

-       Increasing the availability and flexibility of specialist services within the borough meeting the individual needs of residents.      

Beverley Tarka, Interim Director of Adult Social Services, explained that the consultation process would commence on 29 June 2015 and close after 90 days, reporting back to Cabinet in November 2015. The panel was informed that this process would be an opportunity to: (a) explain in detail specific proposals and the likely impact of the service offer and (b) seek views and understand concerns about how to shape and implement services for the future.

During the discussion, reference was made to the following:

-       Lessons that had been learnt from the Medium Term Financial Strategy and Corporate Plan (2015-2018) consultation period.

-       Ensuring information provided to service users and carers was accessible and provided in accessible formats.

-       The Council’s statutory responsibilities to provide services to meet the assessed needs of adults.

-       The Council’s commitment to safeguard adults at risk and commitment to work with service users and their families and carers in the design of services.

-       Equality Impact Assessments that had been undertaken as part of the proposals for the Medium Term Financial Strategy (2015-2018). It was noted that these would be reviewed, updated and monitored.

-       Risks, and concerns, associated with the transfer of social care services to social enterprises and ensuring any risks were managed.

-       The importance of gathering information / insight on how social enterprises had been used to deliver health and social care in other parts of the country to ensure Haringey could benefit from any lessons learned.

-       The implications of the Public Services (Social Value) Act (2012).

-       The importance of contract monitoring and quality assurance when  commissioning services.   

In response to questions, Charlotte Pomery, Assistant Director Commissioning, informed the panel that the Council had set aside £20,000 for independent advocacy to help support individuals and carers to understand the proposals and ensure they could fully take part in the consultation process. The panel  ...  view the full minutes text for item 41.

This paper provides an update to Scrutiny on the Council’s approach to quality assurance and its relationship with the CQC; options for keeping Scrutiny informed of CQC inspections; the work that is underway with Sevacare and the CQC in light of the recent inspection; and the progress that has been made in delivering the improvement plan for KLOE 5 – “Is the service well led?” in relation to the CQC Inspection of Haringey’s Community Reablement Service.

The panel considered the report of the Interim Director of Adult Services, and Assistant Director for Commissioning, setting out the Council’s approach to quality assurance and its relationship with the Care Quality Commission (CQC).

During the discussion, reference was made to the following:

-       Sections 5 and 48 of the Care Act 2014.

-       The roles and responsibilities of the Safeguarding Adult Board.

-       Ensuring links between quality assurance and safeguarding were made,  understood and followed through when delivering value for money commissioned services.

-       The Council’s plans, set out in the Corporate Plan and Market Position Statement, for transforming adult social care that placed greater emphasis on supporting people to manage their own care through personalisation, early intervention and prevention.

-       The need for effective quality assurance to be informed by good feedback and engagement, notably from users and cares, but also from wider stakeholders including the CQC, providers and staff, Healthwatch, the CCG and other agencies.

-       Options for keeping scrutiny informed of CQC inspections. It was noted that nationally the CQC had indicated a keenness to work with the scrutiny function of local authorities in a more proactive and joined up way. It was proposed that the CQC should be invited to attend scrutiny on an annual basis to: set out their inspection programme; talk through any emerging themes; and to ensure awareness of the standards and approach being adopted.   

-       The progress that has been made in delivering an improvement plan (set out in Appendix A to the report) in relation to the CQC Inspection of Haringey’s Community Reablement Service.

-       Work that was underway with Sevacare in light of a recent CQC inspection that had found people using the service were at significant risk of receiving inappropriate or unsafe care.

Charlotte Pomery, Assistant Director for Commissioning, informed the panel that Sevacare, a large home care agency, had a block contract with the Council until 31 March 2011. It was noted that this contract had expired and the Council no longer had a contract with Sevacare. However, it was explained Sevacare had remained a high volume provider in the borough, albeit with diminishing volumes of work.

Beverley Tarka, Interim Director of Adult Services, advised that the most recent CQC inspection of Sevacare had taken place in December 2014. The CQC had found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. It was noted the CQC would take enforcement action against the registered persons and would report further on this once completed.  

The following points were noted:  

-       Following the announcement of the inspection results, the Council’s Establishment Concern Procedure had been instigated and as a result an immediate suspension of new care packages with Sevacare had been put in place.

-       Referrals to Sevacare would remain formally suspended for the foreseeable future.

-       New referrals would be made to alternative providers.

-       The roles and responsibilities of the Safeguarding Adults Team in relation to activity in  ...  view the full minutes text for item 42.

The aim of this report is to assist the Adults and Health Scrutiny Panel in prioritising topics for inclusion in the scrutiny work programme for 2015/16.

The Chair informed the panel that throughout May and June a number of activities had been employed to support the development of the scrutiny work programme. This included a public survey, a Scrutiny Cafe event, and informal meetings with Cabinet Members and Senior Officers.  In addition, Haringey’s Obesity Conference, held on the 25 June 2015, had provided a useful networking opportunity to discuss a number of issues raised in section 8 of the report.   

Jeanelle de Gruchy, Director of Public Health, informed the panel that over 200 delegates had attended the conference. In addition a new Haringey Obesity Alliance had been formed by a wide range of partners including the Council, the local NHS, Homes for Haringey, the Tottenham Hotspur Foundation, and local schools. It was noted that the aim of this alliance was to help reduce obesity in Haringey by supporting more people to eat well and be physically active.     

During the discussion on obesity, reference was made to the following:

-       Looking at how scrutiny could engage and involve local communities in helping the Council to better understand the challenges and barriers to creating an environment where the healthiest choice was the easiest

-       Looking at how scrutiny could support local community groups to help change behaviour, fostering interconnections between settings

-       The role of schools and Children’s Centres

-       The influence of race, ethnicity, and culture on childhood obesity

-       Asset based approaches within healthcare

-       The work the council was doing to review all “No Ball Games” signs

-       Enfield’s use of Health Trainers to help people wanting to improve their general health and to make healthy choices 

-       Information from scrutiny work elsewhere, including Tackling Childhood Obesity in Birmingham (2014)

-       The importance of any scrutiny work in Haringey being carefully scoped to ensure it was manageable and established clear questions to be investigated

The following issues were discussed in relation to themes that had emerged from the Scrutiny Cafe, outlined in section 8 of the report: 

-       The importance of prioritising and selecting issues for scrutiny involvement that complimented Corporate Priority 2 – “Enable all adults to live healthy, long and fulfilling lives”

-       Access to GPs and looking at how scrutiny could engage and involve local GPs and other local healthcare providers in their work

-       The importance of scrutiny monitoring the impact of proposed changes to adult care services

-       Adult Safeguarding

-       Haringey’s Reablement Service

-       Paediatric A&E attendances and admissions

-       Suggestions in relation to loneliness and isolation. This included a suggestion that the panel should look at Neighbourhood Connects towards the end of 2015/16 to ensure it was delivering agreed objectives and tackling issues associated with loneliness and isolation across the borough.    

In addition, it was agreed that the following items, discussed under items 8, 9 and 10 on the agenda, should be prioritised for inclusion in the panel’s future work programme:

-       An update on the Premises Task and Finish Group (Access to GPs) – with input  ...  view the full minutes text for item 43.

There were no new items of urgent business.

The following dates are listed in the diary:

-       Thursday 17 September 2015;

-       Tuesday 1 March 2016;

-       Plus one to schedule. 

The Chair referred Members present to agenda Item 13 as shown on the agenda in respect of future meeting dates, and Members noted the information contained therein’.

18:31 hrs – 20:52 hrs