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’.

It was noted that apologies for absence had been received from Cllr Gina Adamou and Cllr Clare Bull.

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 as noted below).

There was no urgent business to discuss.

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 Pippa Connor declared a personal interest in relation to agenda items 8, 9, 10, 11, 12 and 13 by virtue of her sister working as a GP in Tottenham.

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

None

To approve the minutes of the Adults and Health Scrutiny Panel meeting held on 5 November 2015.

AGREED: That the minutes of the meeting held on 5 November 2015 be approved as a correct record.

(Clerk’s note: It was noted that Helena Kania, although not a formal member of the Panel on the 5 November 2015, had attended and contributed to the meeting.)

This item seeks formal approval of the appointment of a non voting co-opted Member to the Panel.

The Chair informed the panel that the Local Government Act 2000 made provision for the co-option of non-elected members to Overview and Scrutiny in order to bring additional expertise/skills to scrutiny work and to increase public engagement with scrutiny.

AGREED:

(a)  That Helena Kania be appointed as a non voting co-opted Member of the Adults and Health Scrutiny Panel for the remainder of the 2015/16 Municipal Year.

(b)  That the appointment of non voting co-opted Members to the Panel be reviewed on an annual basis, at the first meeting of the Municipal Year.

To consider an update on foot care services available in Haringey.

Marco Inzani, Commissioning Lead: Better Care Fund (BCF), updated the Panel on local foot care services and the communications channels that were used to notify residents about services across the borough.

The Chair advised, that in preparing for this item, members of the Panel had received feedback from users of the Bridge Renewal Trust’s Foot Care Plus service (clinic and outreach) and had met representatives from the Hornsey Pensioners Action Group.

Mr Inzani commenced his presentation by providing a summary of the foot care services available to Haringey residents. Information was provided on:

-       Haringey Locality Teams

-       Whittington Health Podiatry and Foot Health Services

-       The Haringey Adult Foot Care Service

-       The Bridge Renewal Trust who provided affordable Foot Care+ services for older people (aged over 50 years old)

During the discussion a number of issues were considered, including:

-       The importance of using various communication channels to ensure clear sign posting and information in relation to foot care. It was noted the Council had commissioned Information Advice and Guidance services from Citizens Advice Bureaux, Age UK and the Law Centre. It was explained that these services could be accessed in the community both face-to-face or via the telephone and that moving forward it would be possible to identify how many people had accessed foot care services in Haringey.

-       An online directory for health and social care services, known as Haricare had been produced, and recently re-launched, by the council. Following feedback from members of the panel it was recognised that since the re-launch there had been a few issues with the directory but these would be addressed moving forwards.  

-       The information provided by NHS 111 in relation to foot care. 

-       Concerns were raised in relation to performance issues highlighted in the report in relation to the Podiatry and Foot Health Services provided by Whittington Health NHS Trust. In view of the costs associated with each “did not attend” it was agreed that the panel needed a better understanding of why patients did not attend and the action being taken to reduce the number of patients not attending. 

-       The panel received information concerning the regular monitoring meetings that were held with the Podiatry and Foot Health Service. It was noted that such meetings covered services provided to residents across Haringey and Islington. Concerns were raised in relation to the number of patients waiting for more than six weeks for their first appointment. In addition, it was suggested that additional monitoring was required in relation to the maintenance of the service (e.g. the time you wait for an appointment once you are in the system). 

-       The NHS Friends and Family Test was discussed in relation to foot care.

-       Further information was requested in relation to the specification for the Podiatry and Foot Health Service provided by Whittington Health NHS Trust in order to better understand the issues with performance outlined in the report.

-       Recruitment and retention issues were considered in relation  ...  view the full minutes text for item 79.

To consider an update on progress with the Non-Elective Admissions target and the results of the Care Homes Deep Dive and the Falls Deep Dive.

Marco Inzani, Commissioning Lead: Better Care Fund (BCF), provided an update on the information that had been presented to the Panel in October 2015.

Mr Inzani explained that continued progress had been made in delivering a reduction in Non-Elective Admissions (unplanned and emergency hospital admissions). The Panel noted that reduction in non-elective admissions was the main target for the BCF. 

During the discussion, reference was made to the following:

-       The fact that a large proportion of non-elective admissions in the over 65 population were due to falls and/or came from care homes.

-       The fact that higher numbers of non-elective admissions placed pressure on care home admissions.    

-       The increase in permanent residential and nursing home admissions.

-       The  effects of delayed transfer of care and work the council and partners were doing to improve this.

-       The fact that Haringey had the highest number of care home admissions and spend in relation to their comparator group.

-       The increase in the length of stay in step down facilities.

-       Ambulance callouts requested by healthcare professionals. It was noted that the main reason for callouts was the healthcare professional protocol. This accounted for 37% of callouts while falls was noted as the second main reason, accounting for 11% of call outs.

-       It was noted that non-elective rates by GP Practice were variable. It was also explained that data was missing for half of residential and nursing homes and that as a result there could be up to twice as many admissions from care homes.

-       Respiratory, Urinary Tract Infections and Musculoskeletal issues were noted as the top three reasons for non-elective admission from care home.

-       The work that was taking place in relation to reviewing Haringey’s strategy for intermediate care.  

In response to a Care Homes Deep Dive the panel was assured that the following actions/themes had been discussed with key stakeholders:

-       Develop a Primary Care Led Care Homes Service Pilot with one GP Practice linked to one are home (three in total). It was noted that this would focus on Priscilla Wakefield, Spring Lane and Osborne Grove and would prioritise falls, Urinary Tract Infections and respiratory.

-       Review the impact of winter schemes including ‘Living Care at Home’. It was noted that this was a 2 week package of support to stabilise people at home following discharge from hospital.

-       Continue to develop the role of social brokerage in developing alternative and cost effective solutions to in-borough care home placements.

-       Develop the market for alternatives to residential and nursing care. For example, extra care sheltered accommodation.

-       Determine the reasons for higher care costs in Haringey.

-       Develop a business case for an integrated discharge team.

-       Develop a business case for Step Down support to reduce the need for care home admission.

-       Develop a business case to expand the provision of reablement including provision to step-down facilities.

-       Undertake community engagement to determine issue that prevent carers from wanting a patient to  ...  view the full minutes text for item 80.

Q&A session with the Cabinet Member for Health and Wellbeing, Councillor Peter Morton, focusing on the process for co-production during the implementation of decisions, made by Cabinet in November 2015, in relation to changes to adult care services.

The panel received a verbal update on the work of the Cabinet Member for Health and Wellbeing, Councillor Peter Morton.

Councillor Morton provided an update on the following issues:

-       An update on priorities set out in Haringey’s Health and Wellbeing Strategy 2015-18. This included information on two successful bids for government funding relating to health prevention projects/pilots concerning (a) supporting people to remain in / getting back into employment and (b) creating healthy communities. 

-       The work of the Haringey Obesity Alliance. 

-       Information was provided on a new national Sugar Smart campaign. It was explained that children from Stamford Hill Primary School had launched a new innovative app that would help parents and children to see how much sugar was in everyday food and drink.

-       An update on the “No Ball Games” signs review including work that was taking place with Homes for Haringey and residents associations to raise awareness of problems associated with obesity and to encourage children to be more active.

-       The impact of fast food outlets on health and new planning ideas that had been outlined in the Council’s Local Plan Making documents. It was explained that these proposals would ban new hot food takeaways from opening within 400 meters of primary and secondary schools. 

-       GP access in Tottenham, including an update in relation to the progress of the Premises Task and Finish Group. It was noted that planned service commencement, in Tottenham Hale, was expected during late February 2016.

-       The fact that Haringey, like most other London Borough, had seen continuing increases in the demand for Adult Social Care services as a result of an ageing population and market demand leading to increased provision costs. As a result, Councillor Morton explained that the Council was consulting on a proposal to apply a 2% social care council tax precept to the 2016/17 budget. It was noted that further information on these issues could be found in the 19^th January 2016 Cabinet papers.

-       The outcome of an open tender process for the award of a contract to The Bridge Renewal Trust to be the Council’s strategic partner for the Voluntary and Community Sector.

-       An update on the facilities and plans for Protheroe House. 

During the discussion that followed reference was made to a number of issues, including:

-       The launch of Earlham Primary School’s walking bus scheme.

-       The process for care and support needs assessments in relation to changes to adult care services.

-       The finance and risk modelling that had been undertaken in relation to day opportunities transformation and changes that had occurred as a result of this work. For example, it was noted that savings of approximately £3.6 million had been moved back from years 1 to 2 in terms of the Council’s Medium Term Financial Strategy.   

-       Issues in relation to purchasing care, the costs of care packages and carers’ assessments.

-       The consultation process for the 2016/17 budget, including the proposed 2% social care  ...  view the full minutes text for item 81.

This report offers an opportunity for the Panel to consider issues arising for the Council in relation to promoting a sustainable and diverse market place in light of the Care Act and following the Commissioning for Better Outcomes Peer Review undertaken in the borough.

Charlotte Pomery, Assistant Director Commissioning, provided an update on issues arising for the Council in relation to promoting a sustainable and diverse market place in light of the Care Act and following the Commissioning for Better Outcomes Peer Review that had recently been undertaken.

The panel was informed that, in January 2015, Haringey had put itself forward as one of the Commissioning for Better Outcomes Peer Challenge pilots, led by the Local Government Association. The panel was asked to note that the peer challenge process was not an inspection but designed to help an authority, and its partners, to assess current achievements, areas for development and capacity to change in a constructive way.

Charlotte Pomery explained that work carried out by the peer review team in relation to the domain of the requirement to promote a sustainable and diverse market place had contributed to the development of the Council’s work in this area.

The panel was informed that the peer review team had found that the Council had a number of strengths, including: strong and responsible leadership around the budget; data and analysis being looked at systematically to drive discussions around value for money; having a developed policy on anticipating and responding to provider failure; and positive engagement from providers to engage with the Council and deliver innovative services; among others.

It was noted that the review had also identified a number of areas for consideration by the Council moving forward, including:

-       Significant additional engagement required around next steps of budget consultation, ensuring clarity of options under consideration.

-       Lack of clear approach to address inflation up-lift and Fair Fee process.

-       An underdeveloped response to the current and future needs of older people and market supply of care.

-       Lack of collation of intelligence on the diversity of the market place and of how this was being used to inform and assist micro and macro commissioning.

During the discussion, reference was made to the following:

-       The fact that the Council had established a brokerage function, on a pilot basis, to micro-commission services for individuals following assessment and support planning.

-       Issues in relation to the National Living Wage and work that was being done to address inflation up-lift and to enact a Fair Fee process.

-       The Council’s Market Position Statement.

-       Information and analysis of Haringey’s local provider market for residential and nursing care in the borough.

-       The Voluntary and Community Sector Commissioning Framework.

-       The limited capacity for nursing care home placements available locally.

-       The decision to maintain Osborne Grove Nursing home as a nursing home, delivered through an NHS provider.

-       The CarePlace initiative (a software system) that enabled participating authorities to compare rates paid for care and support services. It was noted that this information placed local authorities in a stronger negotiating position with providers.

Charlotte Pomery advised the review findings had helped to shape areas of work that the Council had been developing and the Council had acted in  ...  view the full minutes text for item 82.

This report outlines the work currently underway to develop a multi-agency approach to safeguarding and quality assurance, with particular reference to the provider market.

Charlotte Pomery, Assistant Director Commissioning, provided an update on the work that was being carried out to develop a multi-agency approach to safeguarding and quality assurance, with particular reference to the provider market,

During the discussion, reference was made to the following:

-       Sections 5 and 48 of the Care Act 2014

-       Haringey’s commissioning intentions as set out in the Council’s Corporate Plan and Market Position Statement

-       Haringey’s Provider Failure Policy

-       The roles and responsibilities of the Safeguarding Adults Board

-       The methodologies/measures the Council and partners used to assure quality of services for local residents

-       The new Pan London Safeguarding Policy and Procedures

The panel was informed that the Council would be strengthening its approach to quality assurance and contract monitoring across all provision to ensure a continued focus on quality of provision.

It was noted that the previous approach to quality assurance had been largely inward looking and whilst holding providers to account this had relied on the Council being the primary agency in the process. Ms Pomery informed the panel that the new model reflected the muliti-agency requirements of the Care Act, and where assuring the quality of services, it was explained that this would be carried out in partnership with a range of stakeholders, including providers, to enable greater understanding, a richer response and wider ownership of the process.

In order to take this work forward it was noted that a new sub-group of the Haringey Safeguarding Adults Board had been established to ensure local quality assurance and safeguarding arrangements were effective across all partners. The panel was informed that this would be supported by a revised Quality Assurance Framework and an annual work plan.

AGREED:

That the work to develop a multi-agency approach to quality assurance and safeguarding in relation to the provider market be noted.

The report attached gives details of the proposed scrutiny work programme for the remainder of the municipal year.

Christian Scade, Principal Scrutiny Officer, provided a brief update on the proposed scrutiny work programme for the remainder of the 2015/16 municipal year.

AGREED:

That the work programme, set out in Appendix A to the report, be noted.

To consider any items admitted at item 3 above.

There were no new items of urgent business.

The following dates are listed in the diary:

Ø  11 February 2016

Ø  1 March 2016

The Chair referred Members present to Item 15 as shown on the agenda in respect of future meeting dates, and Members noted the information contained therein’.