Overview and Scrutiny Emergency Services Review Overview and Scrutiny Committee October 2013 Membership of the Overview and Scrutiny Committee in 2013/14: Councillor Alan Hall (Chair) Councillor Helen Gibson Councillor Kevin Bonavia (Vice-Chair) Councillor Sven Griesenbeck Councillor Olufunke Abidoye Councillor Carl Handley Councillor Jackie Addison Councillor Michael Harris Councillor Obajimi Adefiranye Councillor Ami Ibitson Councillor Anne Affiku Councillor Mark Ingleby Councillor Christine Allison Councillor Stella Jeffrey Councillor Abdeslam Amrani Councillor Darren Johnson Councillor Pauline Beck Councillor Madeliene Long Councillor Paul Bell Councillor Chris Maines Councillor John Bowen Councillor Jim Mallory Councillor David Britton Councillor Pauline Morrison Councillor Duwayne Brooks Councillor John Muldoon Councillor Suzannah Clarke Councillor Marion Nisbet Councillor Jenni Clutten Councillor Sam Owolabi-Oluyole Councillor Liam Curran Councillor Stephen Padmore Councillor Vincent Davis Councillor Jacq Paschoud Councillor Amanda De Ryk Councillor John Paschoud Councillor Alexander Feakes Councillor Philip Peake Councillor Peggy Fitzsimmons Councillor Eva Stamirowski Councillor Julia Fletcher Councillor Alan Till Councillor Patsy Foreman Councillor Dan Whittle Councillor Vicky Foxcroft Contents 1. Chair’s introduction .............................................................................. 2 2. Executive summary ............................................................................. 3 3. Recommendations .............................................................................. 7 4. Purpose and structure of review ........................................................ 10 5. Findings ............................................................................................. 14 6. Finance .............................................................................................. 15 7. Assets ................................................................................................ 21 8. Perception ......................................................................................... 29 9. Response .......................................................................................... 38 10. Prevention ......................................................................................... 66 11. Access ............................................................................................... 79 12. Partnerships ...................................................................................... 87 13. Future ................................................................................................ 92 14. Monitoring and ongoing scrutiny ....................................................... 98 15. Glossary of terms .............................................................................. 99 16. Sources ........................................................................................... 103 1 1. Chair’s introduction The Emergency Services Review is the culmination of many months hard work by Overview & Scrutiny at Lewisham Council. I would like to thank the small scrutiny team for all their guidance and dedication. Councillors of all parties have examined the Ambulance, Fire and Police services in detail including Lewisham Hospital’s Accident and Emergency department. The common themes emerging from the review are that there are significant funding reductions leading to major service changes. Furthermore, services that aim to reduce demand like prevention and probation are under severe strain too. The Emergency Services Review shows that 2010 was a high water mark for Lewisham’s 999 services. This review would not have been possible without the co-operation and participation of the Ambulance, Fire and Police borough leaders and I would like to thank them for all their efforts. Since the Emergency Services Review was agreed the Court of Appeal has ruled that the Secretary of State for Health, Jeremy Hunt did not have the power to make decisions on Lewisham Hospital following the appointment of a Trust Special Administrator for another NHS Trust. All this shows that our final recommendation: “The Mayor and Council must continue to be vigilant to ensure that Lewisham has the best possible Emergency Services” is prescient. Councillor Alan Hall Chair of the Overview and Scrutiny Committee 2. Executive summary Lewisham is a diverse, vibrant and well-connected south east London borough. Its population is fluid and dynamic, accessing London’s variety of employment, leisure and cultural facilities. The population has in recent years been impacted most significantly by austerity, with incomes down, significant benefit reductions and growing levels of homelessness. All local public service agencies have been facing rising demand and significant financial constraints. The government has proposed to cut an average of 20% from government spending over the next 4 years and reduce the government’s budget by £83bn.Local government has been particularly badly affected, with the largest proportionate share of spending cuts. Lewisham Council has implemented major organisational and service changes over the past three years, reducing its overall net revenue budget by £82m. £17m of savings agreed for 2014/15, with a further £85m of savings required by 2016/17 from the current revenue budget of £284m. It is against this background that the dependency on emergency services is seen to be most acute – as numbers of local residents grow, household stress intensifies and the most vulnerable residents face the biggest pressure on household budgets in living memory. All these factors have an influence on demand for local emergency services and associated risks to life and community well-being. Finance The London Fire Brigade’s funding has reduced by £52m in the last four years, while a further savings target of £45.4m over the next two years has been added. The London Fire Brigade aims to achieve this through reducing the number of fire stations, appliances and fire station staff in London. The Metropolitan Police Service is required to save £500m from 2013 to 2016. This follows savings delivered in 2011/12 of £146m and £70m 2012/13. These further savings will be delivered through changes to the rank mix of police officers and the policing model used, reductions in the cost of back office support, more efficient use of property and reductions in the cost of IT support. The NHS is required to make total savings of £20 billion per year by 2014/15 and trusts throughout the NHS have efficiency targets of around 4-6 per cent per year. The London Ambulance Service’s budget will have a reduction of £54m by 2015/16, which will largely be achieved by a reduction in London Ambulance Service staff posts. However the London Ambulance Service recently received £14.8 million of extra funding to deal with the increased demand for services. In addition to the pressures on the London Ambulance Service, there has been recent uncertainty about the status of Lewisham Hospital’s accident and emergency unit due to the appointment of a Trust Special Administrator to look at the problems associated with the South London Healthcare NHS Trust. Among the recommendations made by the Trust Special Administrator were some related to Lewisham Hospital, including proposals to close its accident and emergency unit. Lewisham Council strongly objected to the proposals and launched a successful legal challenge in the High Court against to 3 the decision to implement these recommendations. The government appeal against this ruling was unsuccessful. Assets The disposal and more efficient utilisation of assets forms a key part in the savings identified by the emergency services. However, their future use will be influenced by the planning frameworks and policies in place and planning protections for community facilities as set out in the London Plan and the Lewisham Core Strategy. The London Plan is the overall strategic plan for London, and includes a strong theme promoting and protecting community and other social facilities. The Lewisham Core Strategy places a strong emphasis on ensuring the provision and protection of appropriate social infrastructure. The London Fire Brigade’s approach to their assets includes savings related to their improved handling of assets, which includes closing some fire stations. The original plan included proposals to close New Cross and Downham fire stations, although under the revised plan only Downham station was earmarked for closure. The Metropolitan Police Service has a number of objectives related to their assets, including the development of Front Counters and Contact Points, creating a more efficient estate and selling off the New Scotland Yard. Within Lewisham, Brockley police station has already closed and Sydenham is due to close. The London Ambulance Service has three bases in Lewisham, all of which are due to stay open. The Trust Special Administrator proposals had potentially significant changes for the estate of Lewisham Hospital, including an almost 60% reduction in its size. However, these proposals have not been progressed due to the successful legal challenge. Perception There was a widespread and significant response to the London Fire Brigade proposals to close Downham and New Cross fire station, and to the Secretary of State for Health’s decision to downgrade the A&E and maternity services at Lewisham Hospital. Lewisham Council submitted a response to the consultation