Agenda and minutes

No apologies for absence were received.

There were no declarations of interest or whipping declarations.

The minutes of the meeting held on 23 January 2013 were approved as an accurate record.

There were no requests for Call-in to consider.

The Cabinet Member for Adult Social Care introduced the report which updated the Commission on the progress of his portfolio.  The Cabinet Member went through the report which summarised progress to date in terms of addressing areas of poor performance, developing commissioning plans and strategies, modernising services and setting priorities for the coming year.  Key areas highlighted were:

• Performance issues
• Safeguarding
• Referrals, assessments and reviews
• Framework-I implementation
• Quality assurance
• Commissioning and service redesign
• Older People Accommodation Strategy
• Learning Disabilities
• Mental Health services
• Future Priorities

Observations and questions were raised and discussed including:

·         Members wanted to know why a Specialist Agency had been used to undertake reviews of support plans and how much it had cost.  Members were informed that this referred to the backlog of work which had been approximately 800 cases that had been outstanding at the time of transfer from NHS Peterborough to the Council in March 2012.  The Agency called Sanctuary was brought in to clear the backlog.  The backlog had been cleared and the agency was no longer with the council.  The cost to complete the reviews had been approximately £240,000.  Sufficient savings had been identified from the reviews to make it self financing.

·         Members noted that the report stated that a major review of Learning Disabilities Day Services had commenced and wanted to ensure that the views of the service workers and carers were taken into account.    Members were informed that no one would be excluded from the consultation process.

·         Members wanted to know if the Learning Disabilities Day Services Review would be brought before the Commission before going out to consultation.  Members were informed that stakeholders were currently being engaged with to come up with proposals and the proposals could come to the Commission before going out to consultation in June.

·         The report had stated that “more than £350,000 of unused and overpaid Direct Payments have been recovered from service users as a result of implementing a more rigorous and effective process.  Members wanted to know if any hardship had been suffered as a result of recovering these payments.  Members were informed that no hardship had been suffered.  A better gate keeping process had been put in place which had identified overpayments which had not been spent but were sitting in people’s bank accounts.  This money had now been reclaimed.  Money provided for care should have been spent on care and the council had made it clearer as to what the money could or could not be spent on.  None of the money was recovered without having first reviewed the arrangements for each individual person to ensure that no hardship would be incurred.

·         Why was Adult Social Care being targeted for savings when other departments were not.  Members were informed that all service areas were being asked to make savings including Adult Social Care.

·         What was the policy with regard to the employment of agency Social Workers in Adult Social Care?  Members were advised that Adult Social Care employed all of their  ...  view the full minutes text for item 5.

The report informed the Commission of the responsibilities and implications of the transfer of certain Public Health functions from Peterborough Primary Care Trust (PPCT) to the Council under the Health & Social Care Act 2012 (“the Act”), which would take effect from 1^st April 2013.  Key areas covered were:

·         The Public Health Responsibilities of the Local Authority of which there were five mandatory services:

1.    Providing appropriate access to sexual health services;

2.    Ensuring there are plans in place to protect the health of the population, including immunisation and screening;

3.    Ensuring NHS commissioners receive public health advice on matters such as health needs assessments for particular conditions or disease groups, evaluating evidence to support the clinical prioritisation for populations and individuals and new drugs and technologies in development – this advice has become known as the “core offer” from public health to Clinical Commissioning Groups; and

4.    The NHS Health Check programme for people between 40 and 74;

5.    The National Child Measurement Programme (NCMP).

·         Transfer of contracts to the Council

·         Structure and transfer of staff

·         Implications of the transfer of responsibility

The Council would receive a public health grant which it is intended should enable it to fulfil its public health responsibilities. The grant was allocated by the Department for Health using a formula developed specifically for this purpose. For 2013/14 the sum would be £8,446,100 and this will increase to £9,290,700 for 2014/15. It was expected that the grant would be sufficient to meet the costs of the service. As some elements of the service were demand led, the service would need the same rigorous financial monitoring applied to it as for all other council services. Quarterly reporting to the Department of Health on the usage of the grant was mandated and the local authority Chief Executive would also need to return a statement confirming that the grant had been used in line with the specified conditions.

Observations and questions were raised and discussed including:

·         Members sought clarification on how the significant proportion of public health services that were commissioned through the three large provider contracts would fit in with the new Clinical Commissioning Group arrangements e.g.

o   Peterborough Primary Care Trust (PPCT) as Coordinating Commissioner and Peterborough and Stamford Hospitals NHS Foundation Trust (PSHFT) Agreement.

o   Peterborough Primary Care Trust (PPCT) as Coordinating Commissioner and Cambridgeshire Community Services NHS Trust (CCS)

o   Cambridgeshire Primary Care Trust as Coordinating Commissioner (CPCT) and Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) Agreement

Members were advised that currently Peterborough was spending money through these organisations to delivery services to residents.  This arrangement would continue but as with any contract this would be reviewed for efficiency and effectiveness to see if there were any other alternative providers or more effective ways of achieving the outcomes.

·         How did the Public Health Outcomes framework relate to the Councils Health and Wellbeing Strategy?  Members were advised that the Outcome Framework was in alignment with the Health and Wellbeing Strategy.

·         Members were pleased to see  ...  view the full minutes text for item 7.

The report provided the Commission with an update on the progress made with developing an Adult Social Care Dementia Strategy and on the commissioning of a Dementia Resource Centre.  The Commission were presented with a YouTube video which illustrated how dementia day care had been developed elsewhere in the country.  This highlighted some of the things that could be achieved through the commissioning of the Dementia Resource Centre in Peterborough.  The range of services to be provided at the Dementia Resource Centre would be:

• Advice and information
• Day Opportunities
• Interventions
• Carers support

The specification for the Dementia Resource Centre was currently being developed and the tender and associated services would be completed by June.  The Dementia Strategy was presented in draft and Members were informed of the key areas which were:

• gaps in service provision and priority setting,
• the Vision for dementia services – commissioning intentions
• action plan

Observations and questions were raised and discussed including:

·         Members wanted to know if there were drugs available to control dementia.  Members were informed that there was a range of medication to support people with dementia.

·         Members sought clarification on what the Capital Investment of £600k would cover.   Members were advised that the £600K was made up of two elements:

o   £500K would be allocated to the Dementia Resource Centre.  This would be spent ensuring the Dementia Resource Centre was an appropriate environment to deliver dementia services from.

o   £100K would be allocated to develop wider community based resources.

·         What would be the capacity of the Dementia Resource Centre?   Members were advised that it would depend on which service was being provided.  In terms of information and advice it would meet the needs of the wider population.  In terms of a day centre the capacity would be for approximately thirty places for people with dementia.

·         Would the Dementia Resource Centre be built to allow for expansion?  Members were advised that the physical site may not allow for expansion but flexibility of the delivery of the services would be provided for as the demand grew.

·         Members sought assurance that accessibility would be a key consideration when the site for the Dementia Resource Centre was being considered.  Members were assured that accessibility was a key element regarding the site of the centre.

·         Members sought assurance that Adult Social Care was working closely with the Clinical Commissioning Group and in particular with regard to the Firm which was a multi disciplinary approach unit.  Members were advised that the Clinical Commission Group and Adult Social Care were working together.  In terms of the Firm there were key services that Adult Social Care would be looking to work together on which were Intermediate Care and Reablement.

·         Members commented on the fact that the Dementia Resource Centre would not be a custom made building but an existing building that would be adapted and were concerned that with the growth of dementia patients the building would not be able to cope with demand in ten years time.  Members were informed  ...  view the full minutes text for item 8.

The report updated the Commission on the Clinical Commissioning Groups (CCG) progress in developing its Commissioning Plan for 2013/2014.   Members were advised of the distinction between the Primary Care Trust (PCT) that the CCG.  The CCG commissioned acute care i.e. hospital care, community care and mental health care for the 864,000 people that were registered in GP practices across the CCG.  It did not commission primary care e.g. GP contracts, dental services or pharmacy services.  These services were commissioned by the National Commissioning Board.

 A presentation was given covering the following key areas:

An update which included the following points:

•          One clinical commissioning group (CCG) for Cambridgeshire & Peterborough, including three practices in Herts and two in Northants

•          Federation of eight local commissioning groups (LCGs)

•          Delegated budgets for local decision making with central accountability and robust governance

•          National Commissioning Board approved authorisation on 23 Jan 2013

•          CCG to take on full responsibilities from April 2013.

The work of the CCG so far:

•          Operating in Shadow Form since April 2012.

•          Governing Body met in public for the first time on 5 Feb 2013

•          Clinical Accountable Officer plus eight GPs, secondary care doctor, three lay members and executive directors

•          Building relationships with partners and communities

•          Developing the vision and values

•          Developing medium-long term plans.

The context in which the CCG worked:

•          2013/14 allocations: £854 m

•          Population: 831,000 (based on ONS figs, not registered)

•          Challenged provider landscape

•          A growing and ageing population with health inequalities

•          An efficiency plan in 2013/14 of £30m.

Priorities for 2013/2014:

• Care of the Frail elderly
• End of life care
• Health inequalities, particularly in relation to coronary heart disease

Observations and questions were raised and discussed including:

·         People on long term medication require monthly prescriptions.  Was this the most cost effective way of prescribing long term medication.  Would it be better to prescribe on a three monthly basis or even longer?  Members were informed that there had been a drive in Peterborough to move to monthly prescriptions.  The reason behind this was that prescribing on a three monthly basis can often produce a lot of waste where medication is not used.  Prescribing monthly also meant that the GP could monitor patients in a better way.  Some medicines also had a use by date which would also dictate how often they were prescribed.

·         Members sought assurance that a system that was operated by GP’s would be patient focused and not on the interests of the GP.  Members were advised that this was one of the main reasons there had been a split in responsibility and that   the Primary Care Trust would commission primary care. The GP contracts sat with the PCT and in the future it would sit with the National Commissioning Board not the Clinical Commissioning Group.

·         How will the Clinical Commissioning Group plan for the growth in Peterborough and how were you going to get the doctors to plan and facilitate that growth.  ...  view the full minutes text for item 9.

The Commission received the latest version of the Council’s Notice of Intention to Take Key Decisions, containing key decisions that the Leader of the Council anticipated the Cabinet or individual Cabinet Members would make during the course of the following four months.  Members were invited to comment on the Notice of Intention to Take Key Decisions and, where appropriate, identify any relevant areas for inclusion in the Commissions work programme.

ACTION AGREED

The Commission noted the Notice of Intention to Take Key Decisions.

The meeting began at 7.00pm and finished at 10.15pm