The Committee received and noted that the Medium Term Financial Plan report, including proposed financial savings for 2015/16 had been considered by the Mayor in Cabinet on 3rd December 2014 and had then “Called In” by Councillors Rachael Saunders, Shiria Khatun, Ayas Miah, Rachel Blake and Khales Uddin Ahmed. This was in accordance with the provisions of rule 16 of the Overview and Scrutiny Procedure Rules in Part 4 of the Council’s Constitution.

The Call-in requisition signed by the five Councillors listed above gave the following reasons for the Call-in:

·         The proposed cut of £800,000 from the budget threatens to have a severe impact on the service provided and, as such, further consultation is vitally important.

·         This call-in will give the Mayor the opportunity to re-examine, consider and consult on the proposal to reconfigure sexual health services in the borough.

In addition to the business papers presented to the Overview and Scrutiny Committee, the Committee also considered:

1.         The views and comments made by Councillor Rachael Saunders in presenting the call-in;

2.         The information provided by Councillor Alibor Choudhury Cabinet Member for Resources and Councillor Abdul Asad Cabinet Member for Health and Adult Services;

3.         The information provided by Robert McCulloch-Graham, Corporate Director Education, Social Care and Wellbeing, Dr Somen Banerjee, Interim Director Public Health and Chris Lovitt, Assistant Director Public Health.

4.         A representation by Dr Vanessa Apea, Consultant Physician GUM/HIV, Barts Health NHS Trust; Teresa Battison (Network Manager, NELNET - London sexual health and HIV clinical network); and Mark Santos, Director, Positive East regarding the Savings Proposals.

Councillor Rachael Saunders gave a presentation to the Committee outlining the reasons for the Call In and the concerns highlighted.  Councillor Saunders then responded to questions from the Committee.  Councillor Alibor Choudhury; Councillor Abdul Asad; Robert McCulloch-Graham; Dr Somen Banerjee and Chris Lovitt then responded to concerns raised.  Their responses to questions raised are summarised below:

The Committee:

•           Recognised the principle of reducing demand on acute services by better utilising primary care, but noted concerns from professionals about the feasibility of effecting behavioural change in the numbers of users necessary to achieve the savings, given the needs and preferences of these groups.

•           Expressed concern at the consultation that had been undertaken with professionals, who were not aware of the extent of the savings proposed at the time.

•           Noted that there had been an approximately 30% increase in cost and activity of acute GUM services paid for by GUM PBR tariff since transfer of commissioning responsibilities to the council in April 2013 (12/13) and projected cost for year end 14/15 - This however has not been reflected in a commensurate increase in the Public Health Grant from the Department of Health which creates ongoing and  significant cost pressure on other areas of the public health grant due to this increase in activity and cost.

•           Noted that savings are based on seeking to reduce the increasing demand on acute/specialist services through prevention and reconfiguration of those services within the community.  It was noted that if the reconfiguration is successful then the savings for 2015/16 will be achieved.  However, if the sexual health costs are not contained then it will mean that the balance of savings will have to be made up from elsewhere within the ESCW budget.

•           Was informed that there has been an increase in activity in Primary Care during 2014/15 and the non-contract Public Health budget spend will be used so as to fund the preventative campaigns.  The intended aim was to address behavioural change and to look at getting the most beneficial deal for LBTH from those providers.  In addition, it was noted the TH Clinical Commissioning Group is working with providers to develop the primary care provision of sexual health services and to address associated costs.

•           Noted that, whilst work is being undertaken to encourage patients to seek treatment within LBTH and to ensure that this treatment is provided in both a caring and sensitive fashion, consideration needs to be given to addressing any potential barriers to developing effective provision within the proposed time frame.

•           Noted the view that the proposals will not be straight forward as they will require the use of a range of levers and an increase in activity, but that the system as it is currently structured is not sustainable.  Therefore, the investment in early intervention is expected to reduce demand on acute/specialist services.  The rationale behind this decision, it was noted, is considered to be logical and has been judged by the council to carry with it an acceptable level of risk.

•           Was advised that LBTH has already taken action to develop the capacity of Sexual Health Services to address the increase in demand.  This has seen a shifting of activity to Primary Care and community services especially the screening of sexually transmitted infections (STIs), increasing uptake and access to contraception.  In addition, it was noted that there has been a development of good relationship with those providers of acute/specialist care.  However, it is recognised that there is a need to strengthen the dialogue with these providers around addressing the challenges currently faced.

When determining to refer the matter back for reconsideration, the Chair Moved and it was:-

RESOLVED to refer it back to the Mayor and request that he consider that:

1.    Whilst the overall aim of the proposal was not unreasonable, it was unrealistic to achieve this level of saving within the timeframe set out in the report;

2.    The total saving should be phased over two to three years,

3.    This longer period should be used to better involve service providers in achieving the saving, and

4.    There should be a review of the progress on the reconfiguration of the services in six months’ time.

Action by:

David Knight – Senior Democratic Services Officer