Decisions

The Maximising Occupancy in Supported Housing Consultation Document sets out the council's proposals to review supported housing vacancies, and the procedure that will guide decisions about non-viable supported households. The consultation document is presented to Cabinet for approval of an eight-week public consultation.

The Cabinet approved the recommendation(s) as set out in the report.

In line with the county council's procurement rules this report sets out a recommendation to approve the commencement of the following procurement exercises:

(i)  Gully emptying service

(ii)  Spray injection patching

(iii)  Reactive and planned improvement works

(iv)  Security and alarm service and maintenance

(v)  Heating, ventilation and air conditioning service and maintenance

(vi)  Provision of community transport services

(vii)Provision of a Minor Aids and Adaptations Service in Lancashire.

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

Design work and the progression of the planning application is ongoing for the dualling of the A582 and B5253 South Ribble Western Distributor.  To maintain programme milestones and to ensure the scheme can be delivered, it is essential that the county council has possession of all the necessary land.  Negotiations are ongoing with the landowners however, agreement may not be achievable in time or at all.  Consequently, it may be necessary to use Compulsory Purchase powers available to the county council, in particular under the Highways Act 1980, to acquire the land.

Additionally a Side Roads Order under the Highways Act 1980 will also be required to enable alterations to be made to the existing highways and private means of access. 

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

The Cabinet approved the recommendation(s) as set out in the report.

This report relates to the replacement of County Councillor Charlie Edwards by County Councillor Cosima Towneley as Lead Member for Health and Adult Services.

Reasons for Urgency

This decision is urgent and cannot await the next meeting of Cabinet on 7 November 2019. The reason for this is to enable the Lead Member change to be made effective from 1 October 2019.  This decision is therefore being taken on behalf of Cabinet by the Leader of the Council in accordance with the provisions of Standing Order 34(1).

The Leader of the County Council approved the recommendation(s) as set out in the report.

Following the introduction of the Care Act 2014, the county council has undertaken to review all adult social care policies, practice and guidance to ensure compliance. The following new policy, procedures and guidance document is now presented to Cabinet for approval:

• Cross-Border Placements

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

A Digital First Strategy for Lancashire County Council has been developed to enable the organisation to deliver its digital first vision and ambitions. The strategy, set out at Appendix 'A', now requires approval in order for it to be officially launched to staff and published externally for our service users.

The Cabinet approved the recommendation(s) as set out in the report.

In line with the county council's procurement rules this report sets out a recommendation to approve the commencement of the following procurement exercises:

(i)  Provision of a Crisis Service in North Lancashire

(ii)  Operated and non-operated vehicles and plant hire - Dynamic Purchasing System.

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

Report will provide an update for Cabinet following the independent review of the City Deal.

The Cabinet approved the recommendation(s) as amended.

On 24 July 2019, the Department for Transport announced two competitive bidding processes; Local Highway Maintenance Challenge Fund and Local Pinch Point Fund. This report requests approval of the proposed bid and expression of interest to the Local Highway Maintenance Challenge Fund and local contributions that would be required should the submissions be successful.

This is deemed to be a Key Decision and the provisions of Standing Order C19 have been complied with.

The Cabinet approved the recommendation(s) as set out in the report.

The Chair welcomed the following officers from the Healthier Lancashire and South Cumbria Integrated Care System (ICS): Andrew Bennett, Executive Director for Commissioning, Peter Tinson, Chief Operating Officer for Fylde Coast Clinical Commissioning Groups (CCGs) and Neil Greaves, Head of Communication and Engagement.

Andrew Bennett presented a report proving a high-level overview of the partnerships in the Lancashire and South Cumbria Integrated Care System and the progress toward developing a five year strategy in response to the NHS Long Term Plan.

Jenny Hurley, representing Protect Chorley and South Ribble Hospital from Cuts and Privatisation campaign group made deputations to the committee in response to the report. The deputations raised concerns expressed by the campaign group regarding the potential merger of eight Clinical Commissioning Groups (CCGs) to one and requested that detailed plans and the result of a public consultation be presented to a future meeting of the committee.

Mary Whitby, representing Save Ormskirk and Southport Hospital campaign group also made deputations to the committee in response to the report. The deputation requested that the committee rejected the five year plan and merger of the eight CCGs in favour of a public consultation.

Members requested clarification on a number of issues as detailed below:

·  Concerns were expressed regarding the wide ranging implications of the plan and lack of specific detail regarding the direction of the strategy and its local impact.

In response NHS colleagues stated that a series of NHS reforms from 2012, had highlighted the requirement for NHS bodies to work closer together. In addition ongoing feedback from patients had described that they received fragmented care. The strategy aimed to form partnerships and working relationships to improve the patient experience. It was emphasised that the strategy was not designed to centralise services, but to support the planning of healthcare at a neighbourhood level and high level expenditure at a strategic level. It was emphasised that 41 primary care networks had been successfully established and were engaging with the strategy.

·  With regard to the proposed merger of eight Clinical Commissioning Groups (CCGs) into one, members raised the issue of the practicality of addressing constituents' concerns to one single commissioning body for 1.7 million people in the ICS and asked how local accountability could be assured. It was maintained that this was already difficult with the current arrangement. Members also suggested that NHS reforms had frequently changed direction and it would be beneficial for the residents of Lancashire if decision making remained closer to home to allow for the specific priorities for individual areas to be developed.

NHS officers stated that there would be a plan to develop a case for change that was likely to recommend a single CCG, which would support work in the neighbourhoods/primary care networks to engage local people and address individual needs. This process included the submission of a formal request and a consultation to identify and address risks. The case for change had yet to be set out and local voice and representations would have to be answered at this stage. The consultation around CCGs would address at what level specific decisions would be taken and this would depend on the level of impact, i.e. if it was at local level or ICS wide.

·  In response to queries raised regarding the democratic deficiency of the NHS decision making process, it was confirmed that there were strong opportunities for councillors to work closely with the neighbourhoods. GPs were already working closely with councillors in some areas and there was an expectation that nationally appointed GPs would lead the board of local partnerships and involve councillors. This collaboration would be designed in to the model.

·  In response to comments it was clarified that the ICS was sensitive to the nuanced relationships in the partnerships with voluntary community, faith and social enterprise sector networks and was working on building these collaborations. A leadership group had been developed to include representatives from this sector in partnership meetings to ensure their involvement and so that they can contribute to decisions.

·  Members highlighted the recurring problem of a shortage of suitable staff being trained and how this would be addressed to ensure deficits in service provision were diminished, rather than relying on volunteers who provided additional support and should not be a replacement for NHS services.

·  In response to a question, Andrew Bennett stated that there were a number inaccuracies in the deputations and clarity regarding these could be provided.

·  Members commented that it was clear that the public needed better and more sustainable healthcare and acknowledged that the plans were currently at the strategic level.

It was moved by County Councillor Eddie Pope and seconded by County Councillor Alan Schofield that the published five year strategy be presented to the Health Scrutiny Committee at its next scheduled meeting on 5 November 2019.

The following amendment was proposed by County Councillor John Fillis and seconded by County Councillor David Whipp:

Due to lack of clarity regarding public accountability and the questions/concerns that have not been addressed, the committee was unable to support the five year strategy at the present time until further detail and more information was included. The committee would be prepared to consider future proposals and additions to the plans at its meeting on 5 November 2019.

On being put to the vote the amendment was LOST. Whereupon it was;

Resolved: That

The published five year strategy be presented to the Health Scrutiny Committee at its next scheduled meeting on 5 November 2019.

The Chair welcomed Karen Partington, Chief Executive, Lancashire Teaching Hospitals; Dr Gerry Skailes, Medical Director, Lancashire Teaching Hospitals; Denis Gizzi, Chief Officer, Greater Preston and Chorley and South Ribble CCGs; Helen Curtis, Director of Nursing and Quality for the CCGs, Jayne Mellor, Director of Transformation for the CCGs, Dr. Sumantra Mukerji, Chair of Greater Preston CCG and Jason Pawluk, Our Health Our Care Programme Director, NHS Transformation Unit.

Jason Pawluk presented a report which provided an update from the Our Health Our Care programme on the future of acute services in Central Lancashire. This update described the progress made relating to the formal assurance process required by NHS England with regard to proposals for significant service change (stage 2).

The 13 options for service change for emergency care services for the residents of Chorley and South Ribble and Greater Preston CCGs being considered were distributed and are attached to these minutes.

Jenny Hurley, representing Protect Chorley and South Ribble Hospital from Cuts and Privatisation campaign group made deputations to the committee in response to the report. Jenny stated that the report didn't address downgraded services in other areas of Lancashire and didn’t take into account growing populations in the area. A question was also raised as to why other Hospital Trusts (Blackburn and Wigan) were getting new staff for their A&E departments and Lancashire Teaching Hospitals was not. The deputation requested a full analysis of the impact that a reduction of services would have and full public engagement at all stages of the process.

Members requested clarification on the areas detailed below:

·  In response to a question it was confirmed that the first 'do nothing option' would leave services as they were now; the second option would leave services as they were in conjunction with a transformation of the acute services to improve efficiencies and the third option would increase accident and emergency provision at Chorley and South Ribble hospital to the requirements of a type 1 facility.

·  Members requested assurance that the Our Health Our Care Programme would assimilate with the Integrated Care System (ICS) five year strategy. It was confirmed that the strategy was a set of proposals coming from the Integrated Care System and not a decision from it. However, the Committee was informed that Clinical Commissioning Groups (CCGs) were GP membership organisations and any constitutional proposals or request for change (including proposals to merge CGGs) would have to be endorsed by members. It was noted that a proposal to merge the two CCGs (Greater Preston and Chorley and South Ribble) in the central Lancashire area had been recently rejected by the respective CCG boards.

·  Members asked what work was underway to engage with neighbouring health care services and hospitals, outside the central Lancashire area. It was confirmed that the Our Health Our Care Programme maintained a close working relationship with neighbouring CCGs and hospitals and were keen to work closely with them as with all the statutory consultees. NHS colleagues were aware of the concerns expressed by the chief executive of Wrightington, Wigan and LeighNHS Hospital Trust regarding the proposals. The proposed engagement timeline would align with the reduction of the range of the 13 options, when it would be easier to describe and understand what the impact on neighbouring services would be.

·  In response to a question, Jenny Hurley stated that NHS digital applications had positive points, however she had examples where patients had been advised that a digital application was the only option. Jenny also maintained that GPs use applications that follow an algorithm to give the most inexpensive treatment pathway which didn't necessarily provide the best and most cost effective outcome for the patient.

·  Members asked why the options didn't include plans to increase recruitment and training of staff, enhance service levels and improve patient access to GPs to reduce demand on accident and emergency services. Members emphasised that the options to close accident and emergency at Chorley and South Ribble hospital would see increased pressure on this service at other hospitals in West Lancashire, Blackburn, Wigan and Preston. A reduction or cessation of accident and emergency services in West Lancashire would create a gap in provision from Liverpool to north Preston. Concern was also expressed regarding the widely publicised lack of support for patients with mental health issues and how they are often reliant on acute services.

NHS colleagues confirmed that there were significant issues regarding staffing and there was not the resources to safely support the current level of provision. The service always strived to recruit to provide the correct workforce level. The aim was to try and work together to provide the optimum number of staff in the right places to ensure the correct pathways for patients. The objective was to provide safe quality care which couldn't be delivered with the current arrangements. It was stressed that this case for change was addressing accident and emergency services, however transformation was taking place across the whole remit of acute provision.

Members asked if the case for change was being considered due to lack of resources and investment in the NHS. It was clarified that difficulties in recruitment and retaining staff required the service to think differently about the continuum of care and how it can be provided using the resources more innovatively.

·  Members commented that the option of building a new super hospital which had been mooted previously should still be an option. It was explained that the option of a super hospital was being explored but was not included in the 13 options as this couldn't be publically consulted on.

·  Members highlighted that the traffic issues in and around the Royal Preston hospital site would need careful consideration, if the Chorley and South Ribble hospital accident and emergency service closed.

Resolved: That

The Health Scrutiny Committee at its meeting scheduled on 3 December 2019, receive analysis on:

1.  Staffing requirements for all options;

2.  Impact on neighbouring Trusts as well as the Royal Preston Hospital site;

3.  Mental Health service provision for all options;

4.  Financial information on all the options.

Resolved: That:

1. The appointment of County Councillors Peter Britcliffe and Stuart Morris as Chair and Deputy Chair of the committee for the remainder of the 2019/20 municipal year be noted;

2. The new membership of the committee following the County Council’s Annual Meeting on 23 May 2019 be noted; and

3. The terms of reference of the committee be noted.

Overview of matters presented and considered by the Health Scrutiny Steering Group at its meetings held on 14 May 2019, 17 July 2019 and 11 September 2019.

The report presented provided an overview of matters presented and considered by the Health Scrutiny Steering Group at its meetings held on 14 May 2019, 11 July 2019 and 11 September 2019.

Resolved: That the report of the Steering Group be received.

The Work Programmes for both the Health Scrutiny Committee and its Steering Group were presented to the Committee.

Resolved that the report be noted.

The Head of Fund presented a report on the final version of the Lancashire County Pension Fund Annual Report for the year ended 31^st March 2019 and highlighted a number of additional amendments which had been made since the draft report was presented at the previous meeting.

In considering the report members of the Committee highlighted some additional minor amendments and it was suggested that key messages from the Annual Report should be relayed to scheme members via a newsletter. It was also reported that the external auditor had concluded that the information in the annual report was consistent with the audited financial statements included within the statement of accounts.

Resolved:

1.  That the updates to the Annual Report for the year ended 31^st March 2019, as set out in the report presented, are noted.

2.  That the following additional changes be made to the Annual Report.

a)  amend the text in the foreword to clarify the relationship between the County Council, Preston City Council and the Fund in relation to the Park Hotel development.

b)  amend the wording on page 6 to clarify those co-opted members of the Committee who are elected representatives.

3.  That, subject to any further minor amendments, the Annual Report for the year ended 31^st March is approved for publication on or before the 1^st December 2019.

The Head of Fund presented a report which updated the Committee on activity which supported the Fund in fulfilling its commitment to long term responsible asset ownership in line with the Investment Strategy Statement and the Responsible Investment Strategy.

With regard to the two items raised at the previous meeting the Committee was informed that it was not possible to calculate how much companies spent on lobbying against climate change mitigation as the detailed costs on individual topics/themes were not reported. However, as the Local Authority Pension Fund Forum was already exploring this subject it was suggested that a representative be asked to address the Committee to provide some reassurance that action was being taken on behalf of Local Government Pension Schemes in this area. 

Mr C Rule, Interim Chief Executive, Chief Investment Officer and Managing Director (Investments) confirmed that the Local Pensions Partnership managed investments in accordance with its own RI policy and that of the Fund. He referred to existing investments in green energy/social housing and low exposures in relation to fossil fuels and reminded the Committee that current investments complied with the targets set out in those policies.

The joint Responsible Investment Working Group proposed by the London Pensions Fund Authority was also discussed and it was reported that whilst the Committee had an agreed Responsible Investment policy in place the Authority had not yet agreed its own policy and so were not in a position to move forward with a joint Working Group.

Resolved:

1.  That a representative of the Local Authority Pension Fund Forum be invited to attend a briefing for members of the Committee at 10.00am on the 29^th November 2019 ahead of the next scheduled meeting.

2.  That Mr R Branagh, the Managing Director of the London Pensions Fund Authority, be invited to attend the next meeting of the Committee to discuss the joint Working Group on Responsible Investment.

3.  That the update on responsible investment activity, as set out in the Appendix to the report presented, is noted.

Angela Pieri, Senior Manager from Grant Thornton presented her report on the findings of the external audit of the Lancashire County Pension Fund Accounts for 2018/19. She reported that the accounts had been considered by the Audit, Risk and Governance Committee on the 29^th July 2019 which had noted the presentational adjustments to the financial statements and other issues raised by the auditor, none of which had an impact on the net asset statement or the Fund account.

In considering the report the Committee noted that the outstanding items highlighted in the audit findings report had now been finalised and a final unqualified audit opinion issued.

Resolved: That the findings of the external audit of the Lancashire County Pension Fund Accounts for 2018/19, as set out in the report presented together with the final unqualified audit opinion issued, are noted.

The Committee considered a report on the financial performance of the Fund during the 3 months to 30th June 2019 together with a comparison of the results with the approved budget for the same period.

Resolved: That the financial performance of the Fund up to the 30^th June 2018, as set out in the report presented, is noted.

The Local Pensions Partnership Annual Report and Accounts for the year ended 31^st March 2019, as approved by the Partnership Board on the 31^st July 2019, was presented to the Committee.

Resolved: That the content of the Local Pensions Partnership Annual Report and Accounts for the year ended 31^st March 2019, as set out at Appendix 'A' to the report presented, is noted.

The Head of Fund presented a report which updated the Committee on the findings of the review of all seven of the internal audits of the Local Pensions Partnership for 2018/19 as requested at the previous meeting. It was noted that substantial assurance had been given by the County Councils internal audit service with regard to the Authority's oversight of the Fund and the Partnership.

Mr T Richardson, Chief Risk Officer from the Partnership informed the Committee that four of the seven audits had resulted in an assessment of 'ineffective' and the Partnership's Senior Management Team was taking action across the group to address the matters arising from the audits and would submit regular reports to the Board.

Resolved:

1.  That the assurance from the Local Pensions Partnership's internal auditor, as set out in the report presented, and the action taken to date by the Senior Management Board in response to the issues raised are noted.

2.  That the County Councils Head of internal Audit liaise with the Chief Risk Officer from the Local Pensions Partnerships to produce a report for the next meeting to update the Committee on progress made in relation implementation of the Senior Management Board Action Plans.

Resolved: That the press and public be excluded from the meeting during consideration of the following items of business on the grounds that there would be a likely disclosure of exempt information as defined in the appropriate paragraph of Part 1 of Schedule 12A to the Local Government Act, 1972, as indicated against the heading of each item. It is considered that in all the circumstances the public interest in maintaining the exemption outweighs the public interest in disclosing the information.

The Chair presented a report on the workshop on the risk framework of the Fund which had been held on the 11^th September 2019 and attended by County Councillors K Ellard, T Martin, J Mein and A Schofield together with co-opted members Mr P Crewe, Councillor R Whittle and Councillor D Borrow.

It was reported that the workshop had included a lot of detail on the subject which had been crystalised by the pre Committee briefing given by Mr Lambert, one of the Independent Advisers.

Resolved: That the attendance by members of the Committee at the workshop on the 11^th September 2019 is noted and that such attendance be recorded in the Training Record for the Committee.

Resolved: That the Minutes of the meeting held on the 21^st June 2019 are confirmed as an accurate record and signed by the Chair.