Committee Membership

Minutes of a meeting of the Health, Environmental Health and Adult Social Care Scrutiny Committee held at Kensington Town Hall at 5.30 pm on 11 May 2011

PRESENT

Members of the Committee Councillor Mary Weale (Chairman) Councillor Terence Buxton Councillor Maighread Condon-Simmonds Councillor Pat Healy Councillor Bridget Hoier Councillor Will Pascall Councillor Linda Wade Councillor Paul Warrick Others in Attendance Councillor Judith Blakeman Councillor Victoria Borwick Councillor Fiona Buxton Councillor Gerald Hargreaves Councillor Julie Mills (Cabinet Member for Adult Social Care, Public Health and Environmental Health) Mick Aulsberry (GMB) Stella Baillie (Head of Adult Social Care) Clair Bantin (Scrutiny Manager) Carole Bell (Inner N.W. London PCTs) Claire Bendall (Head of Provider Services, HHASC) Henry Bewley (Health Policy Officer) Jean Daintith (Executive Director, Housing, Health and Adult Social Care) Sonya Howard (UNISON) Sherzard Khan (Secretary, EPICS) Peter Kohn (Director for Strategy, Planning and Development, London Specialised Commissioning) Frankie Lynch (Borough Director, NHS Kensington and Chelsea) John Marsden (UNISON) Piers McCleery (Director of Strategy, Royal Brompton and Harefield NHS Foundation Trust) Steve Mellor (Group Finance Manager, HHASC) Ivan Moore (Kensington and Chelsea LINK member) Paul Morse (Director of Environmental Health) Paula Murphy (Co-ordinator, Kensington and Chelsea LINk) Jackie Nield (GMB)

Paul Rackham (Service Manager, Strategy and Commissioning and Market Development, HHASC) Dr Mark Sweeney (Chair, Kensington and Chelsea and Queen's Park and Paddington Commissioning Consortium) Christine Vigars (Chairman, Kensington and Chelsea LINk) Simon Williams (Divisional Director for N.W. London, London Specialised Commissioning) Gavin Wilson (Governance Administrator)

~ Prior to the commencement of business, the Chairman expressed sorrow at the recent death of Councillor Dr Iain Hanham (who had served as a Member of the Scrutiny Committee and its predecessor for many years, mostly recently as its Vice-Chairman) and said that she had particularly appreciated his expertise and humility in contributing to its work. This sentiment was echoed by those present. ~

A1 APOLOGIES FOR ABSENCE AND MEMBERS’ DECLARATIONS OF INTEREST An apology for absence was received from Cllr Freeman.

With reference to report A6 on the agenda, Cllr Wade said that she had a personal interest in the Alison Martin appeal, which had connections with the work undertaken by the Royal Brompton and Harefield hospital on cystic fibrosis. Cllr Weale declared a similar personal interest. A2 CALLED-IN KEY DECISION (KD03510/11/A/A): PROPOSAL TO CLOSE THE EPICS DAY CENTRE At the Chairman’s invitation, Cllr Mills commented on the reasons for her decision to approve the closure of the EPICS day centre, in her capacity as the Cabinet Member responsible for Adult Social Care, Public Health and Environmental Health, with reference to the Key Decision report before the Committee. Cllr Mills stressed that it had not been an easy decision to reach in agreeing to the closure of a Council facility which was clearly much valued in the local community it served. However, she emphasised that the decision should be seen in the context of an extended period of detailed consideration over two years, with a comprehensive review of day services for older people leading, amongst other things, to a re-evaluation of the actual demand for services against the existing level of day centre provision in the north of the borough.

She considered that the officers had been assiduous in their analysis of the costs associated with EPICS, which – primarily due to the nature of the building in which it was located under the Westway – was costly to run and maintain. On the basis of the evidence presented to her, and visits she had made to EPICS and other day centres, she was satisfied that if EPICS were to close, a service of comparable quality could be offered in alternative nearby care centres for all service users eligible for Adult Social Care-funded services. Concluding her remarks, Cllr Mills said that the key words reflected in her decision to approve the closure of the centre were, ‘underused’, ‘expensive’ and ‘capacity in other services’. She emphasised that the quality of the service provided at EPICS had never been the subject of criticism, but in the current financial climate, it was important to obtain good value for money; if EPICS were to remain open, comparable financial savings would need to be found by cutting other front-line services. Cllr Mills and officers responded to a series of points made by Mr Aulsberry (GMB Union), principally relating to concerns about the availability and accuracy of data, including costs and user attendance in relation to EPICS; the absence of a full response to an alternative proposal to closure, put forward by the EPICS manager; lack of relevant information having been provided to trade unions; and Cllr Mills’ visits to care centres, and her qualifications to make judgements on acceptable standards of provision. Regarding the data presented in the Key Decision report, Ms Baillie explained that this had been provided by EPICS, with a working party (incorporating representatives of EPICS, including the EPICS manager) having verified the figures. Mr Rackham explained that a detailed response to points raised by the trade unions, the Labour Group and others was contained in appendices to the Key Decision report. Regarding her assessment of alternative provision, Cllr Mills said that her decision was based on defined inspection and performance criteria, and the professional expertise of officers. Cllr Healy raised a number of concerns about the closure of EPICS. These included the following points: whether the Council’s community engagement team would still use the building in which EPICS was based; the questionability of closing the facility on financial grounds when the Council

possessed significant financial reserves; the effect of closure on users and carers, and the risks to the Council’s reputation; inadequate alternative provision for those with moderate needs and for drop-in users; users’ perception that their responses to the consultation on closure had been inadequately heard; the failure of the equality impact assessment to properly address disability issues; an inadequate recognition of EPICS’ preventative and early intervention role; the case of an individual user and their carer, who she believed had not been consulted regarding alternative care arrangements. Responding to points raised by Cllr Healy, Cllr Mills referred to other centres which catered for older people with disability issues, such as Kensington Day Centre and the Miranda Barry Centre. Mr Rackham confirmed that there was a range of alternative centres offering suitable care and that great attention was being given to making alternative arrangements on the basis of an assessment of individual need. Regarding those with moderate or low needs, Ms Baillie confirmed that, with the exception of the Miranda Barry Day Centre, all alternative centres offered drop-in facilities. Also, consideration was being given to other options for provision, and discussions were taking place with Age Concern in this connection. Mr Rackham confirmed that the follow-up arrangements which EPICS had when a user failed to turn up, would be replicated at alternative centres. Risk assessments for malnutrition carried out through the NHS dietetic service would continue. Regarding the fact that EPICS was open on every day of the week, Mr Rackham said that the Miranda Barry Day Centre was also open at weekends. Also, discussions were taking place with the Kensington and Quest Day Centres to see whether weekend opening was possible. Responding to the assertion that a user and their carer had not been consulted, Ms Baillie confirmed categorically that every user with high needs had been assessed individually; she was aware, however, of one particular case where agreement on an arrangement for alternative provision remained outstanding. As regards the future use of the building in which EPICS was currently based, Cllr Weale said that this was a matter which fell within the remit of the Cabinet Member

for Property Services. Ms Daintith commented that, in discharging its responsibilities for funding adult social care services, it was not financially responsible for HHASC to continue the operation of an under-used day centre, or to undertake a feasibility study to assess the use of alternative adjacent Council-owned accommodation under the Westway. Cllr Hoier referred to the history of the establishment of EPICS as originally the sole day centre in North Kensington and the important and beneficial role which it had played over many years in the local community. She made an impassioned plea for the centre to remain open, and stressed the likely human cost of closure in terms of some elderly people becoming isolated and dying earlier than would otherwise be the case. She considered that users and others in the community had not been properly listened to during the consultation regarding possible closure. In her view, EPICS had been selected for closure in order to make the largest financial saving, but no detailed comparative evidence had been presented regarding other day centres’ costs and the services that they offered. She also questioned the cost of providing transport for former users of EPICS to alternative centres. Responding to points made by Cllr Hoier, Cllr Mills recognised the problem of isolation for older people, but drew attention to the fact that there was no longer one, but a number, of day centres in North Kensington. She referred again to the drop over a period of time in the number of those receiving care at EPICS, which was part of a pattern of diminishing demand for the service provided by day centres in the Royal Borough, and the result of a number of factors. Cllr Wade re-emphasised some of the critical points made earlier by Cllrs Healy and Hoier, and considered that the Key Decision report did not sufficiently demonstrate where current users would be catered for, if EPICS closed. She was particularly concerned about what would happen to those with moderate or low needs. A further source of concern was that consideration appeared not to have been given to making the model of care provided by EPICS more attractive in order to facilitate greater use and thereby keep the centre open.

Responding to Cllr Wade, Cllr Mills recognised the problems of isolation and the merits of creating a ‘Horizons’-style model of provision; however Age Concern, and other care organisations, had not been interested in offering a service from the building in which EPICS was based. Nevertheless, HHASC remained keen to consider – in conjunction with the former PCT - the possibility of finding other suitable premises. At the Chairman’s request, Mr Wilson clarified the situation in terms of next steps if the Committee confirmed the Key Decision to close EPICS, or asked the Cabinet Member responsible to reconsider it. By a majority vote of four in favour to three against, it was RESOLVED: That the Committee confirm the Key Decision taken by Cllr Mills on 27 April to close EPICS Day Centre. A3 MINUTES OF THE MEETING HELD ON 16 MARCH 2011 The minutes of the meeting held on 16 March 2011 were agreed as a correct record and signed by the Chairman. A4 KENSINGON AND CHELSEA AND QUEENS PARK AND PADDINGTON COMMISIONING CONSORTIUM Cllr Weale welcomed Dr Sweeney to the meeting. Dr Sweeney described the development of the Commissioning Consortium from its infancy as the Kensington and Chelsea Commissioning Consortium to the present, having expanded to embrace Queen's Park and Paddington at these areas’ request around six weeks previously. A successful application had originally been made to NHS London as a pathfinder early adopter Commissioning Consortium. On 17 May, the expanded Consortium was expected to become formally constituted, with a confirmed governance and organisational structure; it was also likely to be renamed, and Dr Sweeney would write to confirm details in due course. Technically, it was a sub-committee of the Inner N.W. London Sub-Cluster of PCTs, although in April 2013 the intention was that it would become an independent statutory body. Around 240,000 patients were covered by the Consortium, and that number could increase in the future. Dr Sweeney expected that the Consortium would be asked to assume additional responsibilities in the next year. It

would be critical that a cost-efficient service was provided, since the Commissioning Consortium would be required to stay within its prescribed budget. Commenting on the present pause in the Parliamentary progress of the Bill, Dr Sweeney said that he believed the proposals offered a unique opportunity for GPs to take a leading role in health provision through their new commissioning responsibilities, assisted by managerial teams. He referred to the close working between GPs in the Practice-based Commissioning Group which had been operating in Kensington and Chelsea for six years, and to a good deal having been achieved in that time. In response to questions, he was confident that GPs were strongly supportive of measures to implement the new commissioning role. He reassured the Committee that GP commissioners would continue the close collaborative working relationships established with the former PCT, now the Inner N.W. London Sub-Cluster. On behalf of the Committee, Cllr Weale thanked Dr Sweeney for addressing Members and responding to their questions. A5 PCTS CONSULT ON CHILDREN'S CONGENITAL HEART SERVICES Cllr Weale welcomed Ms Bell, Mr Kohn, Mr McCleery and Mr Williams to the meeting. Mr Kohn said that copies of the detailed consultation paper, "Safe and Sustainable - A New Vision for Children's Congenital Heart Services in England", could be made available to the Committee. He advised that local authority overview and scrutiny committees had an extended period beyond the close of the public consultation in which to comment (by 28 October). Mr Kohn highlighted key features in the consultation, which supported having two children's heart surgical centres in London, capable of providing a "world-class" service (rather than the present three, which he described as providing an "excellent" service). Cllr Warrick referred to the considerable recognition and support for the extremely good cardiac care provided by the Royal Brompton and Harefield, and asked to what extent the National Specialised Commissioning Group considered the knock-on effect on the hospital's adult cardiac (and other, e.g. for children with cystic fibrosis)

services of the proposed closure of the children's cardiac facilities to be a reasonable concern. In response, Mr Kohn referred to issues relating to paediatric intensive care and the impact on cystic fibrosis being addressed in the consultation paper. It was considered that, of the three centres in London, there would be least impact on the Royal Brompton and Harefield. However, the Commissioning Group had agreed to consider the issue of knock-on effects from the consultation proposals in more detail. Mr McCleery commented upon the relevant successful work carried out at the Royal Brompton and Harefield, and underlined that the consultation proposals' effect went far beyond destroying the hospital's paediatric cardiac care (e.g. impact on cystic fibrosis and the adult congenital programme). He said that the hospital had flagged up the significance of these anticipated knock-on effects of decommissioning at an early stage. He considered that the consultation proposal, if implemented, would be likely to remove between £30-35 million income from the hospital, thereby damaging its long-term financial viability. Mr McCleery referred to the hospital's proposal in 2009 for a national heart and lung centre, and said that he considered that bringing the hospital together with Great Ormond Street on one site would be in patients' best interests. Cllr Weale queried why the consultation proposals considered the Royal Brompton and Harefield to be less- deserving than the other two hospitals. In reply, Mr Kohn referred to a number of issues identified in the consultation paper, including the need to fulfil the criterion of treating at least 500 children a year. He also referred to the impact on a range of other services at Great Ormond Street, should that hospital's paediatric cardiac services close instead. Cllr Weale highlighted the unique service for cystic fibrosis from early years to old age offered by the Royal Brompton and Harefield, which provided a welcome continuity which was greatly valued by patients. Responding to this, Mr Williams referred to the existence of seven centres in London dealing with cystic fibrosis, and to the fact that centres other than the Royal Brompton and Harefield provided congenital heart services and cystic fibrosis care.

Great Ormond Street also provided a service through from early years to adulthood. Cllr Condon-Simmonds emphasised the need for a centre offering cystic fibrosis treatment which was within a reasonable travelling distance, otherwise there was a possibility that children might die before reaching hospital. Commenting in reply, Mr Kohn referred to an independent review which the commissioners of the consultation had agreed should be carried out to look at whether cystic fibrosis services could exist without having congenital heart services alongside. Cllr Terence Buxton referred to the existence of three centres of excellent paediatric cardiac care in London, and believed that there was a very strong case for retaining all three, rather than having just two, on the basis of not reaching a bureaucratic threshold of each treating 500 cases per year. Mr Williams said that an additional 58 cases per year would be needed to attain a suitable volume of cases in London, and this could only be achieved by a significant extension of the capital's catchment area, which would be likely to affect the viability of some regional networks. Mr Kohn added that treatment figures did not include overseas patients; this information was available from the consultation Commissioners, and could be supplied. In response to Cllr Healy's enquiry regarding the alternative proposal for working between the three centres, Mr Williams said that proposals for a single paediatric cardiac network in London and S.E. England had been put on hold when the present consultation exercise had been launched. Cllr Wade re-emphasised the importance of continuity of care for individuals affected, and the likely undermining of the Royal Brompton and Harefield's financial viability if the consultation proposals were implemented. Commenting on the 2009 proposals for a joint centre, Mr McCleery referred to the considerable amount of work which the Royal Brompton and Harefield and Great Ormond Street hospitals had put into developing this, although a problem had arisen when approval was sought from respective boards. However, he believed that Great Ormond Street might be interested in looking again at the proposals, although he stressed that these would have to be agreed on a joint ownership and operational basis.

Cllr Pascall queried whether moving to a combined two or three centre model of delivery from one site might have a destabilising effect on services at one or more of the centres. In reply, Mr McCleery said that there would be a managed transition which was jointly owned, so problems should not arise. A larger, combined operation should act as a magnet for medical talent, and should be to the benefit of all partner bodies. Mr Kohn referred to the consideration which had already been given to these proposals, and emphasised that responses to the consultation paper could, of course, endorse such an alternative. Cllr Borwick referred to the view taken by the Greater London Assembly that the need remained for three centres in London, and to the Mayor of London having written in support of this position. She also referred to the valuable outreach work which the three hospitals carried out, and to their likely long-term expansion. In some concluding remarks, Cllr Weale referred to the merits of the having a three-hospital centre of excellence, which would not necessarily have to be on one site. A response to the consultation paper would be drafted for her consideration, following which it would be circulated to all Members of the Committee, to allow the opportunity for comment.

Action: Mr Bewley

On behalf of the Committee, Cllr Weale thanked Ms Bell, Mr Kohn, Mr McCleery for addressing Members and responding to their questions. A6 TRI-BOROUGH RISKS FOR ADULT SOCIAL CARE Introducing the report, Ms Daintith advised that it was also being presented for consideration at the equivalent scrutiny committees at Hammersmith and Fulham and Westminster. She drew to Members' attention a number of the key risks and measures of mitigation set out in the report. In response to an enquiry from Cllr Wade, Ms Daintith explained how she envisaged that services would be delivered in practice, and risks managed, at a local level, under Tri-borough working. Responding to points raised by Cllr Pascall regarding the possibility that the three councils might not always share

the same objectives, or pathways to achieve these objectives, and the difficulty of benchmarking costs, Ms Daintith referred to the three councils' shared vision and to the opportunities to achieve service improvements through working together as a larger commissioning partnership, with delivery through the Central London Community Healthcare NHS Trust. In reply to a point raised by Cllr Terence Buxton about the possibility of 'cultural risk' to the Royal Borough through Tri-borough working, Ms Daintith acknowledged that a significant cultural shift was possible. However, she referred to the sovereignty guarantee that formed part of the Tri-borough proposals. It was proposed that children's services would be hosted by the Royal Borough, whilst Hammersmith and Fulham would host adult social care. Cllr Weale asked that a report tracking relevant Tri- borough developments be presented to each meeting of the Committee for the time being, and indicated that she would speak to HHASC about the format of this report.

Action: Cllr Weale/Ms Daintith Cllr Weale asked all Members of the Committee to take a particular interest in relevant reports relating to the Scrutiny Committee in the context of Tri-borough, which were presented to Cabinet.

Action: Committee Members to note Cllr Weale asked that the chief executive of Hammersmith and Fulham be invited to address the next meeting of the Committee on 6 July, given his authority's lead role in relation to adult social care under the Tri-borough proposals.

Action: Ms Daintith

A8 CABINET MEMBER'S REPORT ON CURRENT ISSUES Ms Daintith advised that a report on the updated Joint Strategic Needs Assessment would be presented to the next meeting of the Committee.

A9 KENSINGTON AND CHELSEA'S LOCAL INVOLVEMENT NETWORK (LINk)

Ms Vigars drew the Committee's attention to progress in a number of areas of the LINk's activities. In particular, she highlighted the work being carried out (in partnership with the 'host' team and the Council) to develop an application for pathfinder status for a Local HealthWatch. This application would focus on joint working with Hammersmith and Fulham and the involvement of patients in the commissioning cycle. She recognised that the proposal for greater joint working between Kensington and Chelsea and Hammersmith and Fulham LINks, including sharing office accommodation, might present some challenges, and it would be critical for the respective LINks to maintain a very local level of involvement.

A10 MISCELLANEOUS MATTERS Cllr Weale thanked Cllr Wade for having carried out a Rota visit to Ellesmere House, and reminded other Members of the Committee that the intention was for them to carry out their visits by August.

Action: Committee Members to note Cllr Weale drew Members' attention to an invitation from L.B. Hammersmith and Fulham to contribute to an investigation into children's oral health by a scrutiny task group which that authority had set up. Individual Members of the Committee were welcome to contribute comments to the scrutiny review, which was being administered by Mr Michael Carr ([email protected] ).

Action: Committee Members to note In response to an enquiry from Cllr Healy about filling the present two vacancies for monitoring Trust board business, Cllr Weale said that it would be appropriate to consider appointments once pending by-elections had taken place. Ms Daintith reported that Chelsea Care, a provider of homecare, had gone into liquidation a few days earlier. She said that arrangements were being made for suitable alternative care for all users affected. A report would be presented to the next meeting of the Committee providing further information. The meeting ended at 8.21 p.m.

Chairman