The Scrutiny Health & Social Care Sub-Committee met on Tuesday 12 March 2024 to discuss updates on the Pharmacy First scheme and elective care waiting lists at Croydon University Hospital. The committee also reviewed the Adult Social Care and Health Directorate's budget and transformation progress, received an update from Healthwatch Croydon, and discussed its work programme.

Update on Pharmacy First Scheme

The Sub-Committee received an update on the readiness of pharmacies in Croydon to deliver the government's new Pharmacy First scheme, which launched on 1 February 2024. This initiative allows community pharmacists to supply prescription-only medicines for seven common conditions without a GP visit, aiming to free up approximately 10 million GP appointments annually across England and Wales. In Croydon, 66 community pharmacies have signed up to the scheme, with 270 registered across South West London, representing 95% of pharmacies in the region. The scheme aims to improve patient access to care by enabling pharmacists to treat conditions such as sinusitis, sore throats, earaches, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections in women. Public messaging promoting the service ran from 19 February to 31 March. The Sub-Committee was informed that a phased rollout and a soft launch are in place to manage demand, with efforts to create capacity by training and upskilling pharmacy staff. Digital solutions are being implemented to ensure a consistent approach to referrals, with GP triage tools being updated. Pharmacies will continue to use the National Care Records Service (NCRS) and are expected to gain enhanced access to GP records through GP Connect Access Record within weeks. The scheme replaces the Community Pharmacy Consultation Service (CPCS) with no changes to GP referral processes.

Croydon University Hospital - Elective Care Waiting Lists

An update was provided on the management of elective care waiting lists at Croydon University Hospital. Between July 2023 and January 2024, 18,780 patients received elective day case or inpatient care, an increase of 5.2% compared to the previous year and 10.8% compared to pre-pandemic levels. While patients waiting over 52 weeks for treatment increased by 21% since August 2023, this number has reduced since October 2023. Patients waiting over 65 weeks have reduced by 27% since Summer 2023, and those waiting over 78 weeks have decreased by 79%. The hospital aims to have no patients waiting over 65 or 78 weeks by 31 March 2024, with no patients currently waiting over 104 weeks.

The Sub-Committee heard that South West London (SWL) has the shortest patient treatment list in London, with Croydon having the smallest waiting lists within SWL, approximately 34,600 patients awaiting treatment as of 11 February 2024. This is attributed to the work of clinical teams and the dedicated Croydon Elective Centre, which remained operational during the second wave of the COVID-19 pandemic.

Challenges persist in certain specialties, including gynaecology, Ear, Nose, and Throat (ENT), dermatology, pain management, maxillo-facial surgery, and trauma and orthopaedics. To address these, extra clinics and increased staffing levels are being implemented, and the number of patients waiting over 52 weeks in gynaecology services has already been halved. A new 'Head and Neck' hub opened in October 2023 to support ENT patients, and a new Intensive Care Unit (ICU) and High Dependency Unit (HDU) opened in December 2023 to support elective flow.

Winter demand from acutely unwell patients continues to impact bed capacity, leading to the flexing of surgical beds for medical patients. To mitigate the impact on elective activity, 12 additional beds have been opened within the Elective Centre for short-stay patients. Industrial action has also affected elective activity, with approximately 1,400 operations and outpatient appointments rescheduled between December 2023 and January 2024.

The hospital is investing £15 million in elective care, including the construction of two new elective theatres and a recovery area at Croydon University Hospital, expected to open in Spring 2025. This will increase capacity to treat an additional 100 patients per week.

The first of two new Community Diagnostic Centres opened at Purley War Memorial Hospital in February 2024, offering services such as respiratory screening, echocardiography, ambulatory ECG monitoring, and blood pressure monitoring. A second centre is planned for New Addington in early 2025.

The Sub-Committee also received an update on sexual health services, noting the online booking service implemented since 2018 to improve access, with staggered appointment times to avoid congestion. A door release system is in place for safety, and a small number of walk-in appointments are available for emergency or vulnerable patients. Postal STI testing kits are also available. The sexual health team actively engages in local and national events to promote sexual health awareness and reduce stigma, including outreach work and participation in the Croydon Pride festival.

Adult Social Care and Health Directorate Budget, Savings and Transformation

The Sub-Committee reviewed the financial performance and transformation progress of the Adult Social Care and Health (ASCH) Directorate for the 2023-24 financial year and its Medium Term Financial Strategy (MTFS) for 2024-2027. Annette McPartland, Corporate Director for ASCH, highlighted improvements in data collection and the Directorate's progress in meeting savings objectives, despite challenges posed by inflation and increasing service demand. She stressed the importance of ensuring savings delivery does not compromise resident safety and wellbeing.

A significant budget increase from £129.8 million to £141 million was explained as a result of transferring a team and its budget from the Housing Directorate to ASCH, due to the team's social work focus and alignment with ASCH's Care Act responsibilities.

Concerns were raised about the impact of government intentions to reduce the number of asylum seekers and refugees in hotels on ASCH. The Council has established a multi-agency board to monitor the spending of an additional grant, with risks associated with its renewal. The Council also has a budget for individuals with no recourse to public funds, who receive minimal support.

The Sub-Committee discussed the risk of providers exiting the market, noting that while Croydon has a large care market, risks exist regarding budgeting, inflation, and the National Living Wage. The commissioning team engages with providers through a Providers' Forum. The Council has safeguarding responsibilities if a large provider leaves the market.

The increasing cost of care packages was also discussed, with the Council using the CareCubed system to ensure value for money. While this system supports negotiations with providers, it is less effective for determining the cost of care for older people. A Market Sustainability Investment Fund is available to support work on inflationary uplifts.

The review of care packages was acknowledged as a demanding but essential process to ensure individual needs are met, particularly for young people transitioning to independent living. The significant impact of housing on ASCH was highlighted, with a focus on strengthening the link between the two directorates, especially for mental health and ensuring tenancy sustainment and accessible housing.

The Sub-Committee was assured that residents can communicate concerns about their support through a complaint process, escalating to the Local Government Association if necessary. The responsibility for care costs of individuals placed in Croydon from other boroughs lies with the originating local authority, though Croydon incurs safeguarding costs.

Regarding the forthcoming Local Government Association Peer Challenge Review, officers stated there would be no immediate financial implications, as the budget is already set. Any identified areas for improvement might lead to resource reallocation rather than increased budget.

The development of digital services, including a virtual ward, is expected to deliver savings through prevention and early help. A review is underway to identify technological opportunities within the directorate, with exploration into artificial intelligence (AI) to support staff efficiency. An example from Swindon Borough Council demonstrated AI producing an easy-read document in 10 seconds, compared to a week for an officer. Reassurance was given that AI would support, not replace, practitioners, and that residents' needs and accessibility would be prioritised.

The Sub-Committee inquired about the timeline for the technology review and available solutions, including telecare. The technology review is in its final stages before procurement, and telecare is available through the careline. Concerns about potential fear of AI among residents were addressed, with assurances that AI would be used to support processes and not for diagnostic purposes, allowing practitioners more time with residents.

The voice of residents is being incorporated into digital innovation through the Resident Voice Group and other stakeholder bodies, with a commitment to coproduction.

Staff shortages, particularly for occupational therapists and commissioning staff, were identified as impacting core areas like care package reviews and the identification of cost-effective solutions. An Assisted Supported Year in Employment programme is in place for newly qualified social workers to improve retention.

The use of higher-cost agency staff was acknowledged due to winter pressures, with assurances that this is short-term and funded through additional pressures funding. Efforts are underway to benchmark staffing costs, convert agency staff to permanent roles, and explore apprenticeship schemes.

The Sub-Committee challenged officers on the potential impact of staff shortages on the transformation programme, with assurances that resources would be reallocated if necessary.

The number of younger adults in nursing care was discussed, with clarification that not all nursing homes are for older persons and that placement in a care home is a last resort.

Key performance indicators (KPIs) for the new Transformation Programme are being developed, with a new reporting framework from the Department of Health and NHS England requiring more client-level data.

The impact of inflation on the transformation programme is being managed through close work with governmental bodies and the Local Government Association, with the National Living Wage being a significant factor. A star chamber process is used annually to identify budget savings and prepare for inflation and market changes.

The Sub-Committee concluded that while there was some assurance regarding the current year's budget, areas of the forthcoming year's budget, such as the transformation programme, still had unknowns and would require further scrutiny.

Update from Healthwatch Croydon

Gordon Kay, Co-optee for Healthwatch Croydon, presented two reports: Asylum Seekers Experiences and GP Websites Mystery Shop. The Sub-Committee discussed sharing best practice examples with GP practices across Croydon, with Healthwatch Croydon working with other Healthwatch organisations across South West London and identifying Croydon-specific challenges.

Regarding residents without a permanent address registering with GP practices, it was explained that practices generally cannot refuse registration, only refer patients to a different practice in specific circumstances. Residents unable to register should contact Healthwatch Croydon's signposting service. Data sharing agreements are in place between relevant shareholders.

Scrutiny Work Programme 2023-24

The Sub-Committee reviewed its completed work programme for 2023-24 and considered potential areas for scrutiny in 2024-25. Members discussed how to develop the work programme to avoid replicating the work of other ASCH-related bodies and the methodology for selecting scrutiny areas. It was agreed that the Sub-Committee would meet informally to agree on topics for the next meeting, and the LGA Peer Review challenge would be added to its agenda. The following items were added to the work programme: accessing sexual health clinics, immunisation, prostate cancer check-ups, and menopausal services. The Sub-Committee resolved to note its work programme.