Agenda and draft minutes

There were no declarations of interest made at the meeting.

There were no members of the public or press at the meeting.

Councillor Hoddinott reported that the Secretary of State’s Judicial Review into the proposed closure of the Children’s Cardiac Surgical Hospital in Leeds had found that the consultation process was unfair and legally flawed.

Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 1^st February, 2013.

It was noted that the Childhood Obesity Review Group had not met as yet.

Resolved:-  That the minutes of the previous meeting be agreed as a correct record.

-        Verbal update from meeting held on 27^th February, 2013

It was noted that the minutes of this meeting would be submitted to the next meeting.

Councillor Hoddinott asked why Community Alcohol Partnerships had been commenced in Deprived Communities when most of the evidence suggested that it was those in employment that had issues with alcohol.  Had the Board taken the evidence into account?

Dr. John Radford reported that 1 of the aims of the Partnerships was to reduce the supply of alcohol particularly to children under the age of 18 and hopefully see less violent behaviour in that cohort, less street drinking and also reduce street drinking in the older age groups where it was clear that abuse was taking place.  He agreed that the evidence base suggested that there was a significant hidden problem that Partnerships would not address.

-        Presentation by Chris Edwards, NHS Rotherham

Chris Edwards, Chief Officer, NHS Rotherham/Rotherham Clinical Commissioning Group, gave the following powerpoint presentation:-

What do the changes mean for Rotherham?

-          Rotherham Primary Care Trust/NHS Rotherham would be abolished in March, 2013

-          There would be (at least) 6 new bodies in its place:-

·           Rotherham Clinical Commissioning Group – Expected to be authorised to formally start in April, 2013

·           RMBC – Public Health responsibilities transfer from NHS to RMBC in April, 2013

·           National Commissioning Board (NHSCB) – would cover all of South Yorkshire and Bassetlaw based at Oak House, Bramley.  Includes GPs/Dentists/Pharmacists/Opticians contracts and specialist commissioning

·           HeathWatch – would be formed to promote the views of patients and Service users

·           NHS Property Services – all estates owned by NHS Rotherham e.g. health centres

·           Public Health England – Health Protection Agency would also lead on commissioning support to the Commissioning Board – specialist commissioning covering vaccination and immunisation

Funding

-          NHS Rotherham £460M

·           RMBC Public Health = £14M

·           Rotherham Clinicial Commissioning Group - £330M

·           NHS Commissioning Board GPs/Dentists/Pharmacists = £116M

Who is CCG represented by?

-          David Tooth, Chair, Long Term Conditions/Urgent Care

-          Chris Edwards, Chief Officer

-          Richard Cullen, Vice-Chair, Finance

-          Ian Turner, Primary Care

-          Phil Birks, Rotherham Foundation Trust

-          Julie Kitlowski, Clinical Referrals and Pathways

-          David Pokinghorn, Children and Young People

-          Jason Page, Prescribing

-          Russell Brynes, Mental Health, End of Life Care and Equality and Diversity

-          David Plews, Medical Director, NHS Rotherham Metropolitan Borough Council

What Services will the CCG commission?

-          Unplanned (unscheduled care)

-          Planned (scheduled care)

-          GP prescribed medication

-          Mental Health and Learning Disability

-          Children and Young People

Policy decided that most of Children’s Services would be commissioned by the CCG but School Nursing would remain the responsibility of the Council and Public Health.  Health Visitors would come under the NHSCB for 2 years and then transfer.  This was a risk area

-          End of Life Care

-          Transport services for patients

-          Any qualified provider services

-          Services jointly commissioned with RMBC

-          Services the CCG commissions from GPs (small)

Financial Challenges

-          Nationally the NHS had to save £20B

-          Rotherham would have to save approximately £80M by 2014/15

Challenges for the CCG

-          Overall the NHS spent approximately £2,000 per person

-          Approximately ¾ of the £2,000 per head was the responsibility of the CCG

-          Some areas which were very important for patients such as GP services and very specialised services were the responsibility of others (NHSCB or Public Health)

-          Costs and demands for services were increasing faster than NHS spending

-          Much of the balance of the spend was hard to change e.g. most of the money was spent on urgent hospital care

-          There was a chicken and egg problem in that the CCG could not spend more on prevention until it decreased the cost of acute services

CCG Urgent Care Review

-          A new Urgent Care Centre for  ...  view the full minutes text for item 63.

-        Presentation by Chair and Acting Chief Executive

The Chairman introduced Peter Lee, Chairman of Rotherham Foundation Trust Board, and Michael Morgan, Interim Chief Executive of Rotherham Foundation Trust.

Peter gave a brief resume of recent events at the Trust.  As a result of the Nicholson challenge, the NHS had been required to save £20Bn across the country of which Rotherham’s proportion was £50M over 3-4 years.  It was fair to say that the Board had not acted quickly enough in terms of recognising it had to make the savings.

As a result, the Trust had come to the attention of Monitor, the independent regulator of NHS Foundation Trusts, who assess the quality of service provided, financial stability and sustainability of a Trust.  When examining the Trust’s finances, the Trust had been downgraded to a 2 from a 3 as it had not achieved the required savings.  They then examined the plans for the organisation and the way the organisation was moving forward and decided that they had concerns about the financial stability of the organisation.  Monitor had declared the Trust to be “in significant breach” but decided not to exercise Intervention Powers as they were satisfied with the quality of care but not the financial recovery.  A recovery plan had to reach them by 18^th March together with monthly meetings and reports. 

Work on the plan was underway and would be submitted in accordance with the deadline. 

Michael stated that it was important to note that Rotherham was in a situation that was not unique to other Trusts within the UK.  Included in the report to Monitor would be the first year very robust budget process together with years 2 and 3.   Monitor had also requested a 3 year strategic plan to be submitted in September, 2013, looking at all the services throughout the Trust. 

Michael had started in Rotherham on 1^st December, 2012, to work on transformation issues but it had soon become clear that it was a turnaround company that was required.  An interviewing process had commenced and Bolt Partners appointed.  Michael had commenced in his new role at the beginning of February, 2013.

A question and answer session ensued with the following points raised/clarified:-

Financial Situation

-          How had the Trust gotten into such deep financial troubles?  Financial performance was flagged up as an issue in February, 2011.  What has been done since then?  Would the Trust be able to achieve the required savings?  Could the Trust go “bust”?

The Trust had always spent its income on its services which did not have a reserve fund.  The impact of the required savings and the Trust not acting quickly enough in certain areas resulted in it finding itself in a position where it was spending the money it was not receiving as well as not making the efficiencies at a sufficient pace.  The Trust had been in breach in 2010/11 because it had not achieved savings required then by Monitor.  In the past funding had always appeared and the problems solved.  In the  ...  view the full minutes text for item 64.

Deborah Fellowes, Scrutiny Manager, submitted the findings and recommendations of the Scrutiny Review of Autistic Spectrum Disorder in Rotherham.

The overall aim of the review was to achieve a better understanding of patterns of Autistic Spectrum Disorder (ASD) in Rotherham leading to the development of appropriate support and assistance to families affected by it.  It had taken place in a climate of budget reductions and, therefore, also wanted to look at the potential for more effective use of existing resources.

The review had been structured around 4 objectives:-

-          The reasons for the higher diagnosis rates

-          Services required at diagnosis stage and after

-          16+ support and transition

-          Budget implications.

The Key messages from the Review were as follows:-

·           Early intervention and prevention work was key for children with ASD

·           Mental Health needs of children and adults with ASD could arise because of the lack of support

·           Lack of clarity about where the lead of support laid – Education, Health etc.

·           It was difficult for many parents to make sense of all of the different agencies that were involved in the area of work

·           There had been significant progress made with the area of work and this needed to continue with clear leadership and direction

·           To ensure the best outcomes for children and young people with ASD, parental voice and influence was absolutely crucial

·           All of the recommendations formed as part of the review were about more effective use of existing resources, achieving better value for money and becoming better organised in delivery of support.  It was the view of the review group that there should not be a need for additional resources to implement the recommendations

Resolved:-  (1)  That the findings and recommendations set out in the report be endorsed.

(2)  That the report be forwarded to the Overview and Scrutiny Management Board and Cabinet.

(3)  That the Cabinet response to the Scrutiny Review recommendations be fed back to this Select Commission.

This item was deferred due to the absence of the Cabinet Member for Health and Wellbeing.

Resolved:-  That, under Section 100A(4) of the Local Government Act 1972, the press and public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in Paragraph 3 of Part 1 of Schedule 12A to the Local Government Act, 1972 (as amended March, 2006) (information relating to the financial or business affairs of any particular individual (including the Council)). 

Resolved: -  That, under Section 100A(4) of the Local Government Act 1972, the press and public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in Paragraph 3 of Part I of Schedule 12A to the Local Government Act 1972 (as amended 2006 – information relates to finance and business affairs).

The Service Manager, Adult Community Services, submitted for information the final proposals for Transport and Catering arrangements for the Learning Disability Day Care Service based on the recent consultation with customers and carers.

Transport Provision

Extensive work had been undertaken with a number of officers who were aware of customers and carers’ needs to review the change to current transport provision.

Catering Provision

At present the current in-house Day Service catering arrangements, delivered on site, were underutilised by customers and therefore not cost effective.  Recent consultation had shown that customers were accepting of the choice of taking their own packed lunch or purchasing a meal from the café.

Discussion ensued on the proposals with the following points highlighted:-

-          Approximately 30% of the clients were in receipt of the higher level Mobility Allowance

-          Concerns raised at the consultations with regard to those who had learning difficulties and not able to feed themselves or have the ability to choose what they wanted to eat.  There were a significant number with complex needs that needed support with feeding and that would not stop

-          Some would need a bus buddy – consideration was to be given to this in the consultation

-          Running alongside these proposals was a tendering exercise across Adult and Children Services with private providers.  Work had been undertaken with Procurement who were conducting the tendering process and having discussions with private providers so they were well aware of the proposals

-          £39.10 quoted in question 10 of the consultation questionnaire was the unit cost.  It was a flat rate charge which was less than the lowest DLA rate.  Clients were not financially assessed.  If it was raised with the Service it would be looked at but not assessed as part of their care package cost

-          Routes were being taken into consideration to ensure the length of time a client could possibly be on the transport was kept to a minimum

-          There would still be cafes on site available for customers who wished to purchase snack items – it was the old dining rooms that were being closed – or there was the option of making their own meal

-          People had the choice whether to attend a Day Centre.  Some were taking the choice of taking their Direct Payment instead.  Younger people found that Day Centres did not meet their needs.  If there was a reduction in the number of people using day centres it would be seen by a rise in the number of Direct Payments.  Then there would be a need to change the way in services were provided

Resolved:-  That the report be noted.

-       Thursday, 18^th April, 2013

Resolved:-  That a further meeting be held on Thursday, 18^th April, 2013, commencing at 9.30 a.m.