Agenda and minutes

Apologies for absence were received from Councillors Nash and Fower.  Councillors Peach and Sandford were in attendance as substitutes.

Apologies for absence were also received from Councillor Lamb, Cabinet Member for Health and Adult Social Care and Paul Zollinger-Read and Sue Mitchell from NHS Peterborough.

The following declarations of interest were made:

Item 6 – Primary Care and Urgent Care Review and Proposed Consultation

Councillor Peach declared a personal interest as he was registered as a patient at Dr Caskey’s practice.

Item 9 – Day Services Review

Councillor Sandford declared a personal interest as he was a member of the Church of Holy Spirit which was part of The Cresset.

The minutes of the meeting held on 8 November 2010 were approved as an accurate record.

There were no requests for call-in to consider.

The Commission considered the response made by NHS Peterborough to the recommendation made at the last meeting in relation to teenage pregnancy.

ACTION AGREED

To note the response to the recommendation.

The report sought the Commission’s endorsement of the approach to be taken on consultation on proposed changes to urgent care and primary care services in Peterborough.

NHS Peterborough had begun a consultation process on the future of the equitable access centre at Alma Road during summer 2010.  This consultation had been stopped in October 2010 to allow time for a review of urgent care services.  The PCT had also conducted a series of small consultations regarding the future of individual GP surgeries following which the Commission had asked for a more holistic approach by the PCT and received a briefing on the overall approach to primary care premises at its meeting in October 2010.

In view of the interconnected nature of the two service areas, the PCT now proposed consulting simultaneously on its strategy for primary care and urgent care over the next six months.  By bringing the two areas together, they aimed to set out a clear vision, which would help patients access the right care at the right time, streamlining routes into the services and improving access.

Patients currently had a number of choices for action to their health concerns:

-          Self care

-          Pharmacy

-          GP practices, out of hours GP services

-          Walk in centre and Equitable access centre

-          Accident and Emergency

These services were not currently sustainable for the following reasons:

• Multiple overlapping access points for urgent care and primary care, which meant it was difficult for patients to access the right service at the right time.  Peterborough had the highest NHS spending level per head in East of England for non-elective hospital admissions which the current systems of access contributed to.  
• Demographic changes – population forecasts indicated growth in the next 5 -10 years of 20,000 – 40,000 people which would require additional primary care.  The ageing population meant that there would also be an increase in the number of patients with long term conditions with the potential requirement for urgent care services and hospital admission.
• It was being proposed that Peterborough and Stamford Foundation Hospitals Trust would take on the management of out of hours primary care and the nurse led walk-in centre on 1 April 2011. 
• There were some significant structural pressures affecting the sustainable delivery of primary care services, including:

·         36% of Peterborough GP contractors would be over 60 in the next 5 years and eligible for retirement. 

·         Peterborough had a large number of small practices (the highest number of small practices per head in East of England).

·         Peterborough had one of the highest spend per weighted head of population in primary care in England.  There was significant variation in funding per head by practice (£62 to £155) and recently awarded APMS contracts and small practices were particularly high. 

·         There were a large number of dispersed premises, many with poor quality of accommodation, which required investment. 

·         Patients reported varied levels of satisfaction in access to their GP surgery. 

For primary care, the vision was to concentrate resources  ...  view the full minutes text for item 6.

The report provided an update on a comprehensive review of contraceptive and sexual health services for young people which was being undertaken due to the increased financial pressures faced by service providers as demand for services increased.

The review would take into account the recently completed review of Pharmacy-based Sexual Health Service and the decision to bring that pilot project to an end.  A further report on the review would be provided at a future meeting.

ACTION AGREED

To note the current review and that a further report will be provided at a future meeting.

The report detailed a number of proposed changes to the Council’s charging policy for non-residential social care services.

NHS Peterborough commissioned and provided a range of social care services for vulnerable adults on behalf of Peterborough City Council and relied on service user contributions to help fund and improve those services. The operation of the charging and collection functions for social care services was delegated by the Council to NHS Peterborough under the terms of the Partnership Agreement but responsibility for charging policy direction was retained by the Council.

Adult social care in England was being transformed through the implementation of personal budgets, which allowed service users to have greater choice and control in how they met their support needs. A personal budget could be taken as a cash payment paid directly to the service user so they could arrange and pay for their own support or it could be held and used by NHS Peterborough on behalf of the individual to purchase support services.  Increasing numbers of personal budgets for social care were now being offered and taken up in Peterborough and therefore, the Council’s charging policy for non-residential social services needed to be reviewed so that it could properly accommodate this change and to ensure that it complied with new charging guidance.  The new charging guidance was built on the original Fairer Charging guidance which had been issued in 2003 and on which Peterborough’s current policy was based but in its current form did not support the implementation of personal budgets.  Service users who were the least able to pay would be protected and should not be required to pay more than they could reasonably afford, taking into account the income available to them, and allowing for their reasonable expenses.  Many councils, including Peterborough, had chosen to subsidise the charges for some care services by setting the chargeable amount for each service below its true cost however this approach had resulted in the application of subsidy in an inconsistent and inequitable way over time and councils had now been advised to consider this aspect of their charging policies when reviewing them to take account of the new guidance.

A number of proposals were being considered:

i)          Compliance with new Department of Health Fairer Contributions Guidance

The new guidance stated that when deciding what contribution an individual would make towards their personal budget, councils needed to agree on the maximum possible contribution a person could be asked to make, subject to the levels of their income and savings. Under the current charging policy, up to 100% of the cost of the service was collected and it was proposed that the same principle would be applied in that up to 100% of the personal budget amount could be collected as a charge, depending on the result of the financial assessment, and how much the service user could reasonably afford to pay. This meant that people who had savings/capital with a higher value than the upper capital limit (currently  ...  view the full minutes text for item 8.

The report advised the Commission on a proposed review of day services for older people.

Peterborough had four day centres for older people which were managed by Peterborough Community Services (PCS), the PCT’s provider arm and these centres provided services to people who met the eligibility criteria for adult social care.  The voluntary sector also provided other day care services in the city, some of which were open access.  The in-house day services were as follows:

• Copelands
• Greenwood House
• The Cresset
• Welland House

Figures showed that vacancy levels within the day centres were low and as a consequence the unit cost of those services was high.  Within the City Council’s budget proposals, a review of day centres was suggested which would be based on:

·         The need to modernise day centre provision and ensure it could meet the needs of future generations.

·         The need to ensure a greater choice and flexibility of services so that people could buy the services they wished with their personal budgets.

·         The need to ensure sufficient services for people with dementia in the future.

·         The need to ensure that all services were cost effective and that savings were made where this was not the case.

·         The view in the government’s new vision for adult social care which indicated that councils/PCTs should not, unless in exceptional circumstances, directly provide services such as day care themselves.

The proposals for day services would be developed within the principles set out in the national vision for adult social care and the local personalisation programme “Living my Life”.  This set out that everyone should be able to:

·         Live as independently as possible.

·         Make their own choices to achieve their personal goals and aspirations.

·         Take appropriate risks.

·         Live their lives free from abuse and neglect.

·         Maximise their health and well-being.

The following principles had been used to generate the overall budget and service plans for adult social care and the day services review would be set within this framework:

Early intervention and prevention – in order to reduce cost pressures, all should be done to prevent people needing the services in the first place.  Investing in services to enable people to continue living independently in their own homes would continue.

Re-ablement – these were very intensive services which lasted for around six weeks and helped people get ‘back on their feet’ after a fall or illness.  This area was being invested in as part of the overall budget proposals.

Personalised services – if people did need ongoing social care services, ensuring that funding was allocated in a fair and clear way by allocating personal budgets so that individuals would have choice and control over the services they received.

In carrying out the review officers would:

·         Use the above principles to guide the work particularly in relation to effective prevention and personalised services.

·         Develop proposals that took account of the fact that everyone eligible for social care services would, in future, have their own personal budget (currently around a third of  ...  view the full minutes text for item 9.

The report provided an update on progress made in implementing the recommendations of the national “Six Lives” Report, detailing the service improvements that had been developed in the last year and outlining on-going work around annual health checks and other developments for people with learning disabilities.  The report also described the process for transferring these services to the City Council.

‘Six Lives’ related to a report by Mencap entitled ‘Death by Indifference’ which was published in 2007 and which outlined case studies of six people with learning disabilities whom Mencap asserted unnecessarily died as a result of receiving worse healthcare than people without that condition. Following referral of the six cases to the Ombudsman an independent inquiry into access to healthcare for people with a learning disability chaired by Sir Jonathan Michael was held resulting in the publication of the ‘Healthcare for All’ report.  That report identified significant failings in the provision of general healthcare services for people with learning disabilities and a key recommendation was that commissioners, such as NHS Peterborough, should be satisfied that similar situations could not happen within their commissioned services.  The Ombudsman also recommended that all statutory commissioning bodies of learning disability services should ensure that they had effective systems in place to:

·         address inequalities of care that could arise for patients with a learning disability condition; and

·         make sure that patients with a learning disability were safe in the services provided.  

In March 2010, the Care Quality Commission (CQC) published a set of six indicators for all NHS organisations to ensure equality of access to healthcare and all NHS organisations were required to review their performance against those key indicators.  In October 2010, the Department of Health published a ‘Six Lives Progress Report’ which identified that all local authorities and health organisations had put in place plans to address the two recommendations within the Healthcare for All report.   The progress report highlighted the factors that contributed to making a positive difference to improving health and social care services for people with learning disabilities as being:

·         leadership

·         effective engagement with people with leaning disabilities and their families in reviewing and planning services

·         annual health checks by GPs

·         liaison nurses and health facilitators in acute services

·         reasonable adjustments to services such as easy read literature, and longer appointment times with health professionals

The progress report also identified two main areas where there remained concerns:

·         the capacity of, and consent by, people with learning disabilities in relation to the decisions made about their healthcare; and

·         the understanding of the particular needs of people with a learning disability by health staff who provided generic health services to people with a learning disability

Over the last year there had been considerable effort put into improving the healthcare services available to people with learning disabilities in Peterborough and NHS Peterborough had successfully addressed the issues of leadership and effective engagement with people with learning disabilities and their families in reviewing and planning services.  Considerable progress had also been made on  ...  view the full minutes text for item 10.

The report presented the Care Quality Commission’s performance assessment summary for 2009/10 which was required to be submitted to an open meeting of the Council.

A key aspect of the Care Quality Commission's assessment entailed a review meeting which took place on 22 July 2010 and which had considered aspects of the statutory social services functions which related to adult social care.  The annual performance assessment judgement and summary was published in November 2010.

Overall social care services for adults were deemed to be "performing well" at delivering outcomes which was an improvement on the previous year's rating.  On six of the seven outcome areas (improved health and well-being, improved quality of life, making a positive contribution, increased choice and control, freedom from discrimination and harassment, and economic well-being) services received a rating of performing "well".  One outcome area (maintaining personal dignity and respect) was rated "adequate".

Improved performance had been recognised in two areas as we had moved from "performing adequately" to "performing well" for the choice and control outcome and we had achieved a rating of "performing adequately" for the dignity and respect outcome, which was largely focused on our safeguarding work.  These were the two areas on which we had been focusing over the last 18 months.

ACTION AGREED

To note the Care Quality Commission's Performance Assessment Summary.

The latest version of the Forward Plan, showing details of the key decisions that the Leader of the Council believed the Cabinet or individual Cabinet Members would be making over the next four months, was received.

ACTION AGREED

To note the latest version of the Forward Plan.

We considered the Work Programme for 2010/11.

ACTION AGREED

To confirm the work programme for 2010/11.

Monday 14 March 2011 at 7pm

Monday 14 March 2011 at 7pm