Issue - items at meetings - Chairman's Communications

84.1    Mr Brown introduced Mr David Watkins, his successor as LINk co-optee on the HOSC (Mr Brown is to be a member of the Shadow Health & Wellbeing Board (HWB) and may not be a member of both the HWB and the HOSC).

84.2    The Chair and committee members from all political groups welcomed Mr Watkins and thanked Mr Brown for his contributions to the HOSC over a number of years.

84.3    The Chair advised members that, should he be appointed as the Chair the committee replacing HOSC from May 2012, the Health & Wellbeing Overview & Scrutiny Committee (HWOSC), it is his intention to ask all Councillors and stakeholder groups to contribute ideas to the HWOSC work programme.

84.4    Members also expressed a wish for a paper detailing the preparations to commission a local Healthwatch organisation to be brought to the first HWOSC meeting.

71.1    The Chair informed members that, in response to a request from Brighton & Sussex University Hospitals Trust (BSUHT), he had written a letter to the trust confirming that the HOSC supported the 3T plans to develop the Royal Sussex County Hospital site. Its general support for the programme notwithstanding, the HOSC reserves the right to scrutinise aspects of the development.

56.1    There were none.

42.1    Mr Robert Brown, the LINk co-optee asked the Chair to consider the LINk’s request that the Council appoints HOSC members for at least 2 years in recognition of the complexity of the health agenda.

42.2    The Chair suggested that the LINk should write directly to political group leaders with this request.

29.1    Mr Robert Brown told members that he had recently been involved in an inspection at Knoll House intermediate care facility. During this inspection, the centre had been ‘marked down’ because of the poor condition of a service road (meaning patient transport could not always get all the way to the centre). However, this access road is owned by the city council rather than Sussex Community Trust, and Mr Brown felt it unjust that the trust should be penalised for

18.1    The Chair welcomed Denise D’Souza, Director of Adult Social Care and Lead Commissioner, People. Ms D’Souza addressed the committee on the issue of the failure of Southern Cross care homes.

18.2    Members were informed that:

• There are two Southern Cross care homes in the city (Bon Accord and Downs Christian), and another in West Sussex to which the city council regularly refers (Birchgrove).

• The council is still referring to two of these three homes. We are currently not placing people in the Bon Accord home while some quality issues are addressed, but do plan to place again in the future. Ceasing to place people in these homes would undermine their future viability.

• Currently it is the council’s view that all three homes are commercially viable, but there are contingency plans in place (working in partnership with NHS Brighton & Hove) to deal with any eventuality.

• The council is currently seeking to identify and negotiate with the landlords of these care homes. One landlord is definitely a care provider, so should be able to take over management of the home.

18.3    In answer to a question from Mr Brown about pressure being placed on Sussex Partnership NHS Foundation Trust by this crisis, members were told that there was potentially an issue with availability of ‘EMI’ beds for people with mental health/capacity issues (particularly given the recent closure of the ‘Swallows’ home in the city), but there was confidence that this could be managed.

18.4    In response to a question from Cllr Theobald on how the council assessed the commercial viability of care providers, the committee was told that this was a tricky issue, as independent providers were not necessarily obliged to provide financial details of the operations. However, the council works closely with providers to share information on an informal basis and has a generally good relationship with the sector in the city. Many providers in Brighton & Hove are relatively small scale businesses, and might be thought inherently less stable than larger concerns, although the failure of Southern Cross demonstrated both that large providers could fail and that the impact of their failure could be much greater than that of smaller organisations. There is an ongoing debate at a national level on how much financial information the independent sector should provide to social care commissioners.

18.5    In answer to a question from Cllr Theobald about care home residents having to be returned home to be cared for, the committee was told that this would not happen unless it reflected the express wishes of residents and their families. However, it might be that the council has to look at placing some people outside city boundaries, and talks are already underway with local providers to gauge their willingness to broaden their client range (e.g. to encourage more providers to offer Mental Health placements where it would be appropriate to do so).

18.6    In response to a question from Mr Brown as to whether the council would look kindly on local providers engaging in equity release schemes in the same way that Southern Cross had, the committee was told that this would depend entirely on the business models of individual providers: for some providers this might be a sensible mood; for others less so.

18.7    The Chair thanked Ms D’Souza for her contribution and invited her to return to provide an update in the Autumn.

3.1       The Chair congratulated the scrutiny team on its recent performance in the Centre for Public Scrutiny National Scrutiny awards – the team won the national award for ‘innovation’ and were runners up in ‘team of the year’.

3.2       The Chair drew members’ attention to a letter he had received from the Director of Adult Social Services concerning city residential care homes managed by the Southern Cross organisation. Members expressed concerns about matters including:

• Reports that Southern Cross planned to cut significant numbers of its staff nationally. Cllr Turton told members that he feared that these cuts would largely fall on direct care provider posts with a detrimental impact upon the care that residents received. Committee members therefore wished to know whether there were any cuts planned at the Southern Cross homes in the city; if so whether these cuts related to managerial or to care provider posts; and, if the latter, what steps Adult Social Care was taking to ensure that residents of these homes did not experience a drop in the quality of their care.

• Potential difficulties in finding suitable alternative placements for residents of the Bon Accord care home. Jack Hazelgrove, representing the Older People’s Council, noted that this home provides specialist placements for people with mental health issues. Members were keen to know how, in general terms, the council planned to re-house residents with particular health needs should this prove necessary.

• The fragility and opacity of the care home system in general. Mr Hazelgrove made the point that a system which relied heavily on a range of independent sector providers was seemingly very vulnerable to crises caused market forces or unwise provider business practices; and that it was difficult for stakeholders to assess the level of risk within this system with the very limited information available on the financial viability of providers etc. Members therefore sought assurance as to how the council ensured that this system was managed safely.

3.3       The Chair agreed to communicate these concerns to the Cabinet Member for Social Care and to the Director of Adult Social Services

64.1    The Chairman told members that he had recently met with Amanda Fadero, along with the Chairs of other Sussex HOSCs, to discuss proposals for a Sussex Primary Care Trust cluster (to which Ms Fadero has been appointed as Chief Executive). Notes from this meeting would be circulated to HOSC members. Another meeting has been scheduled for early summer and members are welcome to submit questions to scrutiny support officers who will pass them on to Ms Fadero.

64.2    The Chairman also drew members’ attention to a letter from Dr Richard Ford, Executive Director of Strategic Development, Sussex Partnership NHS Foundation Trust, setting out planned developments at the trust.

64.3    In response to a question from Cllr Allen on the implications for staff on commissioner plans to re-design mental health ‘access’ services, Dr ford told members that there were no direct implications, as all current access staff would be transferred (under ‘TUPE’ regulations) to the new providers.

64.4    In answer to a question from Cllr Rufus regarding patients being referred out of area, Dr Ford told the committee that 96% of referrals were being dealt with locally, but some referral out of area was necessary whilst the redevelopment of Mill View was taking place. These referrals were to other Partnership Trust facilities in Sussex so there was no additional cost incurred.

64.5    Cllr Marsh proposed, and members agreed that, that the best wishes of committee members be passed on to Lisa Rodrigues, Chief Executive of the Partnership Trust, who was currently in hospital for a planned operation.

64.6    Members also agreed to express their thanks to Dr Ford for his willingness to engage frankly with the committee on numerous occasions over the past four years.

64.7    The Chairman expressed his thanks to Cllr Allen for all his work as Deputy Chair, to all HOSC members for their diligence and to support officers.

64.8    Mr Brown thanked HOSC members for their positive working relationship with the Brighton & Hove LINk and expressed the hope that organisational memory would not be lost.

64.9    Cllr Deane and other committee members thanked the Chairman for all his work over the past years.

49.1    There were none.

35.1    There were none.

20.1    There were none.

3.1       There were none.

65.1    The Chairman formally welcomed Amanda Fadero to the meeting as Chief executive of NHS Brighton & Hove, replacing Darren Grayson in this position.

46.1    The Chairman congratulated Robert Brown on being recently awarded an M.B.E.

30.1    Darren Grayson, Chief Executive of NHS Brighton & Hove, introduced Alan McCarthy, the new Chair of NHS Brighton & Hove,  to members.

17.1    The Chairman announced that NHS Brighton & Hove had recently informed him of its intention to procure two city GP services: at Elm Grove and St James’ Avenue. These services will replace the existing GP practices currently operating in these locations.

Following recent media reports on breast cancer screening in the city, Councillor Peltzer Dunn sent letters to the Chairmen of NHS Brighton & Hove and Brighton & Sussex University Hospitals Trust (respectively the commissioners and providers of city breast cancer screening services) asking for more information on city services. Councillor Peltzer Dunn’s letters and the NHS trust responses are attached for information.

3.1       Following recent critical media reports on city breast cancer screening services, the Chairman asked NHS Brighton & Hove and Brighton & Sussex University Hospitals Trust (respectively, the commissioners and the providers of city breast screening services) to address the committee on this issue.

3.2       Councillor Sven Rufus had also asked a Councillor Question on this issue (see Item 6 on this agenda). Cllr Rufus agreed that his questions should be taken together with the Chairman’s.

3.3       Dr Peter Wilkinson, Deputy Director of Public Health at NHS Brighton & Hove (NHS BH), and Kate Parkin, Director of Screening at Brighton & Sussex University Hospitals Trust (BSUHT), presented a paper and answered members’ questions.

3.4       Dr Wilkinson told the committee that the key local issue was a shortfall in radiographers. This longstanding problem had been aggravated by the recent move from ‘one’ to ‘two view’ screening, which provides an improved screening service, but requires more radiographer input. This issue is being addressed, and improvements have been made, with the new screening centre providing a more attractive environment to recruit staff into, but there are still recruitment problems. It is anticipated that the development of a school of radiography as part of the University medical school will address this problem in the medium term.

3.5       In answer to a question as to whether the slippage in the screening regime may have had adverse consequences for any individuals, Dr Wilkinson told members that this was extremely difficult to ascertain, but there was a risk that someone with breast cancer could have been diagnosed later than they should have been due to delays in screening.

3.6       The Chairman noted that, although he was partly reassured by the explanation for why breast screening services had been performing poorly and by NHS trust plans to improve matters, he considered it necessary to revisit this issue in several months time in order to make sure that the anticipated improvements had in fact been made.

3.7       RESOLVED – that the committee should receive an update report on city breast cancer screening in 6 months time.

85.1    The Chairman informed members that a new Chief Executive for South Downs Health NHS Trust had been chosen. Simon Turpitt, Chair of the trust, told the committee that the new Chief Executive was Andy Paiton. Mr Turpitt thanked John O’Sullivan, the current Chief Executive, for all the excellent work he had done in the post.

85.2    The Chairman also informed members that the hoped for integration of South Downs Health and West Sussex Primary Care Trust community services had been confirmed. John O’Sullivan, Chief Executive of South Downs Health, told the committee that he was delighted that the integration was going ahead. Mr O’Sullivan offered to attend a Health Overview & Scrutiny Committee (HOSC) meeting prior to the formal integration with West Sussex (scheduled for July 2009) in order to discuss governance arrangements for the new organisation, particularly in terms of ensuring that a strong focus on the needs of Brighton & Hove residents was retained.

72.1    The Chairman congratulated Brighton & Sussex University Hospitals Trust on having been nominated for a national award as the most improved NHS trust in the South East region in terms of infection control.