Agenda and minutes

There were no Declarations of Interest made at this meeting.

There were no members of the public and press present.

Consideration was given to a report presented by Dr. John Radford, which provided information on how NICE Guidance on drug treatments for dementia placed restrictions on the use of Alzheimer’s drugs (acetylcholinesterase inhibitors). A recent judicial review supported these restrictions and the broader recommendations on supporting people with dementia.

The NICE Guidance represented the most cost-effective use of resources to develop services for people with dementia. Commercial pressure from drug companies had focussed attention on drug use in dementia. However, the guidance also stressed the importance of a services structure which delivered appropriate care and support for those dementia and their carers. 

The Scrutiny Panel were informed that the NICE Guidance did consider use of drug treatments, but it mainly focused on the integration of health and social care services, delivering effective support for carers and the development of memory services. It considered the impact of the ageing population on the number of people with dementia and highlighted the challenge facing health and social care agencies. Rotherham PCT and the Council were already working together to address these issues. The Adults Board commissioned a review of OPMH services which reported at the end of 2007. In addition, a new Memory Service had been commissioned which would deliver specialist assessment and support for people with dementia and their carers.

A discussion and question and answer session ensued and the following issues were raised and clarified:-

·              Equal access to prescribed drugs by patients rather than it being based on where you live.

·              Access to acetylcholinesterase inhibitors in relation to people under the age of 65 who have early onset dementia.

·              Prescribing of Alzheimers drugs not in accordance with NICE guidelines.

·              Drug treatment for Parkinsons sufferers.

·              Use of alternative drugs to reduce social isolation.

·              Investment in specialist health and social care services.

·              Need to review support and care needs to promote independence, maintain cognitive function and prevent deterioration.

·              Examples of community based services.

·              Review of specialist older people’s mental health services.

Resolved:-  (1)  That Dr. Radford be thanked for his report.

(2)  That the NICE Guidance on prescribing of acetylcholinesterase inhibitors be noted.

(3)  That a report be submitted to a future meeting on the recent review of specialist older people’s mental health services.

Consideration was given to a report presented by the Scrutiny Adviser, which detailed the Protocol developed so that the relevant local authorities could jointly scrutinise the regional and specialist health services that impacted upon residents across the Yorkshire and Humber Region. 

Examples of work done by this joint committee included scrutinising proposals for an independent sector treatment centre for South Yorkshire and jointly submitting Annual Health Check comments for the Sheffield Teaching Hospitals, Sheffield Children’s Hospital and Yorkshire Ambulance Service.

Particularly with the advent of ‘Choose and Book’, health services were now provided to patients living in an increasingly wider geographical area.  A proposed service change (for example reorganising the way that maternity services were delivered) could easily affect patients from an area that spans two or more local authorities that were not in the same sub-region.

In addition, ‘specialised services’ such as burns care and children’s cancer care were commissioned on a regional basis.  To date, there had been little or no scrutiny of these (often very expensive) services, however, any future work should be undertaken on a regional basis.

To address these issues, the Regional Health Scrutiny Network had drafted a protocol that suggested how the fifteen local authorities in the Yorkshire and Humber region could undertake scrutiny work together.  It provided a framework for any number of authorities (from two to fifteen) to meet, investigate an issue and make recommendations, taking the best elements from all the sub-regional protocols that were currently in existence.

It was proposed that, once accepted, the regional health scrutiny protocol would replace the individual sub-regional protocols, including the one for South Yorkshire.

Particular reference was made to the protocol and its contents, including:-

·              Coverage.

·              Principles for Joint Health Scrutiny.

·              Substantial Variation and Substantial Development.

·              Responding to a Statutory Consultation by an NHS Body.

·              Delegated Scrutiny.

·              Joint Health Scrutiny Committee.

·              Discretionary Joint Working.

A discussion and question and answer session ensued and the following issues were raised and clarified:-

-        Appointment of non-voting co-optees.

-        How the protocol would affect the people of Rotherham.

-        Provision of services outside the borough boundaries.

-        Set up of the regional structure and the measure of benefits to Rotherham.

-        Formal consultation process and Rotherham’s input.

Resolved:-  That the Yorkshire and Humber Joint Health Scrutiny Committee Protocol be agreed.

Consideration was given to a report presented by Dominic Blaydon, Joint Commissioning Manager, which set out a provisional work programme for the Neighbourhoods and Adults Services Directorate and the Primary Care Trust directed and monitored by the Adults Planning Board for the next three years. 

A Joint Commissioning Team was set up by the former Adult Services Programme Area (now Neighbourhoods and Adult Services) and Rotherham Primary Care Trust, to take the lead for jointly commissioning services for adults in the borough where it made sense for this to be done in partnership. The Joint Commissioning Team reporting to the Adults Board delivered against a work programme which reflected the actions within the Joint Commissioning Strategy. The action plan set out in detail the key tasks that the Adults Board had identified, incorporating lead officers and timescales. The key actions included:-

·              Joint Commissioning Arrangements.

·              Older People’s Mental Health (OMPH)

·              Occupational Therapy Services

·              Intermediate Care

·              Long Term Conditions

·              Mental Health (adults of working age)

·              Learning Disability

A discussion and a question and answer session ensued and the following issues were raised and clarified:-

-                 Commitment for long term conditions.

-                 Involvement and consultation with those individuals with long term needs.

-                 Impact on inspection ratings and customer satisfaction.

-                 Changes to the Occupational Health Services following the review.

-                 Size of budgets and whether any proposed cost savings were envisaged from the joint commissioning of services.

-                 The Home Care Enabling Service and what this entailed.

-                 Differences between individualised budgets and direct payments.

Resolved:-  (1)  That the report be received and the contents noted.

(2)  That an updated work programme and progress report be submitted to this Scrutiny Panel in six months’ time.

Consideration was given to a report presented by John Mansergh, Service Performance Manager, which described the progress on the Healthier Communities and Older People (HCOP) block of the Local Area Agreement (LAA) between March and October, 2007.

Of the four stretch targets agreed in the LAA, two were rated ‘on target’ (direct payments and breathing space) and two were rated ‘off target’ (older people helped to live at home’ and ‘reviews’).

Remedial action was in place to improve performance on the indicators that were off target.

The Scrutiny Panel were informed that during this past year there have been significant national changes as Central Government had developed a new performance framework with seven key outcomes and approximately two hundred indicators.  It was now expected nationally that Community Strategies would be refreshed to reflect the new framework.  New LAAs would be developed by every authority which would become the main action plan for the Community Strategy.  The Chief Executive’s office was co-ordinating work to refresh the Community Strategy and identify priorities for both the Community Strategy and the new LAA.

The Council would negotiate thirty five targets/indicators for the new LAA with Government Office Yorkshire and Humber by 8th May, 2008, for final agreement in June, 2008.

The Directorate and PCT were liaising with the Chief Executive’s office to ensure that the local priorities for health and social care were appropriately reflected in the new Rotherham LAA and geared to reflect the national outcomes for social care.

A discussion and a question and answer session ensued and the following issues were raised and clarified:-

-                 Challenge, decision and achievement for the stretch targets.

-                 Timelines for actions and overlap of the old and new targets.

-                 Non-achievement of the stretch targets and the impact on rewards.

-                 Direct payments to be based on individual need and service driven.

Resolved:-  (1)  That the progress reported and the recovery actions underway be noted.

(2)  That the development of the next generation of LAAs be noted.

The meeting considered a Forward Plan of Key Decisions as prepared by Adult Services with regard to Neighbourhoods and Adult Services – between 1^st April 2007-31^st March 2008.

Resolved:-  That the Forward Plan of Key Decisions, as submitted, be agreed.

Resolved:-  That the minutes of the meeting held on 10^th January, 2008 be approved as a correct record for signature by the Chairman.

With regard to Minute No. 107 (Budget 2008/09) no further potential savings were identified to close the anticipated funding gap.

Resolved:-  That the minutes of the meeting of the above Committee held on 19^th December, 2007 be received and the content noted.

The Chairman introduced Councillor Robin Stonebridge, Non-Executive Director of the PCT, and Ben Chico, Practice Based Commissioning Manager, to the meeting to give a presentation on Practice Based Commissioning.

Councillor Stonebridge gave a brief history of how practice based commissioning evolved, partnership arrangements, health care needs of patients, review of existing services and how they could be better delivered.

The presentation drew attention to:-

·              Practice Based Commissioning Overview.

·              Practice Based Commissioning Successes.

·              Ophthalmic Triage.

·              Community Geriatrician.

·              Anti-Coagulation Service.

The Scrutiny Panel were informed that the presentation provided only a brief overview of the service and further information would be provided once the services currently being delivered on the one year pilot had been evaluated.

A discussion and a question and answer session ensued and the following issues were raised and clarified:-

-                 Choice of Opticians in the Town Centre.

-                 Optician Availability and Service Provided.

-                 Number of Referrals to these Services by G.P.s.

-                 Flexibility of Services.

-                 Simplicity of Blood Testing.

-                 G.P. Practice Involvement in Practice Based Commissioning.

-                 Accessibility of Services for Patients not in the areas signed up to the pilot services.

-                 Location and Coverage of the Consortia of Practices.

-                 Sharing of Best Practice across the Country.

-                 Selection of Pilot Services and the Spread of Participatory Practices.

Resolved:-  That Councillor Stonebridge and Ben Chico be thanked for their very informative and interesting presentation.