Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 20 February 2018.

The Minutes (copies of which had been circulated) of the meeting held on 20 March 2018 were approved as a correct record and signed by the Chair.

Councillors and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

The following interests were declared:-

Personal Interests

There were no call-ins to consider.

To consider a report of the Chief Nurse & Director of Quality Governance, Stockport NHS Foundation Trust.

The report will be a draft of the 2017/18 Quality Report for the Stockport NHS Foundation Trust, which sets out the performance of the Trust against a range of priorities.

The report is being submitted late in draft form to enable the most up-to-date information to be presented to the Scrutiny Committee. Due to the timing of the meeting certain data will be missing from the report.

The Scrutiny Committee will be invited to consider the report and provide feedback.

Officer contact: Gareth Longstaff, 0161 419 4872, gareth.longstaff@stockport.nhs.uk

Alison Lynch, Chief Nurse and Director of Quality Governance and Helen Howard, Deputy Chief Nurse at Stockport NHS Foundation Trust, attended the meeting to present the draft of the Trust’s 2017/18 Quality Account (copies of which were circulated) as required by the Regulator, NHS Improvement. The report gave an overview of performance in the past year in relation to quality achievements and improvements in patient care and experience. Due to the timing of this meeting it had not been possible to include all relevant data within the documentation.

The following comments were made/ issues raised:-

·      Concerns were expressed about levels of staff satisfaction and the potential negative effects of the manager’s discussion guidance in relation to sickness absence by making staff fearful of taking time off when unwell. In response its was stated that the Trust was not aware of any concerns expressed about the new approach that had been introduced in order to regularise practice when reporting sickness by ensuring that notice was given to an employee’s line manager rather than a third party. It was also reported that the Trust experienced good attendance in particular work areas, but the Trust was engaged with NHS Improvement to address challenges around recruitment, retention and attendance.

·      The Trust’s focus on healthy eating was welcomed but assurance was sought that staff were able to take appropriate breaks and have access to healthy food during those times. In response it was stated that the Hospital had a fantastic canteen facility for staff, patients and families, although this was only available during the daytime. The Trust was committed to ensuring staff took appropriate breaks and senior management were working o make sure this policy was consistently applied. The beneficial effects of breaks on staff wellbeing and productivity were stressed.

·      Assurance was sought on whether work to improve discharge was leading to improvement. In response it was stated that a range of partners were engaged in activity to improve this multifaceted problem, and actions included measures such as planning discharge on admission.

·      Concerns were expressed about the spike in the number of patients waiting 12 hour for admission, and it was queried why there was no reference to ambulance turnaround times within the report. In response the poor performance in respect of breaches of the 12 hour wait was acknowledged as was the extremely poor experience this would be for patients and family members. Assurance was given that each breach was investigated and no medical harm was found to be caused to the patients as a result, although the harm caused by the poor experience was recognised and taken seriously by the Trust. Additional staff resources had been deployed in response and the Trust was endeavouring to avoid similar breaches in the future.

·      It was commented that there was no reference in the report on measures to address the high number of attendances to the hospital. In response it was stated that there was no specific target the Trust was able to use, but that narrative information would be provided.

·      In relation to efforts to reduce falls in hospital it was stated that the Trust was working to better implement the NICE guidance.

·      Clarification was sought on whether a 2% target of reducing use of anti-biotics was sufficient given the threat of anti-biotic resistance. In response it was stated that this was a target imposed on the Trust but that a 2% reduction would have statistically significant effect.

·      Concerns were expressed about performance in relation to microbial infections and sepsis, and clarification was sought on what measures were being put in place to address these issues. In response it was stated that a review of procedures and clinical governance had been undertaken, working with colleagues including those from Public Health. Improved measures included specialists undertaking rounds on wards.

·      The low rates of CDiff/ MRSA infections were welcomed.

·      Further information was sought on improving  ...  view the full minutes text for item 4.

Caroline Drysdale, Managing Director of Stockport Neighbourhood Care will attend the meeting to discuss the work of the organisation.

A copy of the most recent Newsletter, published in January 2018 has been enclosed for information.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

Caroline Drysdale (Managing Director) and Viren Mehta (Medical Director) of Stockport Neighbourhood Care (SNC) attended the meeting to provide an update on the work of the organisation.

A copy of the latest company newsletter was submitted (copies of which had been circulated) for the Scrutiny Committee’s information.

The presentation covered the following:-

·         SNC was operating under an alliance agreement that aimed toward integration of health and social care.

·         The primary focus was services for over 65s, the cohort that accounted for approximately 85% of NHS/ Social Care resources.

·         SNC were working to implement the four overarching Stockport Together business cases. The key element of these was to reduce pressure on the local hospital, preventing attendance and helping improving discharge. Delayed Transfers of Care rates from Stepping Hill Hospital were much improved and this reflected the measures partners had put in place.

·         SNC had a small re-ablement capacity to provide step down or step up support.

·         Much of SNC’s work centred around the Neighbourhood areas and providing wrap around care with enhanced case management that helped support people to staying their home.

·         SNC was implementing an ambitious 5 year transformation programme that was being closely monitored by GMHSCP.

·         The four partner organisations were coming together to work in a different way, concerned primarily with clients not the organisations. This was an important change in working culture.

The following comments were made/ issues raised:-

·         ‘Maureen’s Story’ set out in the newsletter was instructive of the new approach. In that example Maureen would in the past have had the same conversation up to 25 times, all of which reduces clinical contact time. There was now also greater focus on making decisions about treatment  together. The traditional approach was to seek to ‘fix’ people but during this process patients may develop another problem. The aim was now looking to optimise patients for discharge back home where they would be more comfortable. There was also a programme of community prescribing that had seen a significant decrease in antibiotic prescribing and was being held up as an exemplar.

·         Reducing repetitive conversations was welcomed. This would be achieved through enhanced case management and undertaking a holistic assessment on behalf of all professionals, assessed by a multi-agency team. Work was ongoing to ensure appropriate data sharing arrangements.

·         Concerns were expressed about patients not being able to access Mastercall IV therapy at home but being made to stay in hospital. Integration of commissioning would allow for tactical commissioning of services to meet such needs more effectively.

·         Stockport already had good experience of joint working but embedding this  would take time. Nevertheless, the progress already made was welcomed.

·         Given the financial challenges facing the partner organisation, were SNC’s savings targets deliverable? Stockport Together aim was to close the financial gap between projected available spending power and projected demand. The challenge of the savings targets were recognised, as was the need to ensure quality of services.

·         Engagement with staff was recognised as vital to the success of the partnership working, as was embracing digital communication. Staff engagement had been positive, with many emphasising the need for a quicker pace of integration and others welcoming the return to a more localised, person centred pattern of working.

·         Challenges in responding to ‘cross-border’ cases of patients residents in Stockport but registered with a Manchester GP were recognised, although Greater Manchester working may assist with resolving this.

·         The significant challenges facing the social care workforce locally were reflective of the wider, regional and national care workforce challenges. SNC was committed to its direction of travel and would need to work through the four organisations governance arrangements. The importanc of making effective use of volunteers and non-registered staff was acknowledged. A key element of the success of SNC would be the culture change of the workforce.

·         SNC was currently at Year 3 of its 5 year plan, and had Transformation Funding into 2018/19, but SNC  ...  view the full minutes text for item 5.

To consider a report of the Corporate Director for People.

The Scrutiny Committee will be updated on the Care Quality Commission (CQC) System Review of Stockport Together partners taking place between during March and April 2017.

Further background information on the CQC process can be found on their website http://www.cqc.org.uk/news/stories/cqc-conduct-further-eight-local-system-reviews-health-social-care

A fact sheet for the public, prepared by the CQC is enclosed.

The Scrutiny Committee is invited to ask questions and comment on the presentation.

Officer contact: Sally Wilson, 0161-218-1648, sally.wilson@stockport.gov.uk

Mark Fitton, Director of Adult Social Care and Sally Wilson, Head of Intelligence & Service Redesign in Adult Social Care, attended the meeting to update the Scrutiny Committee on a Care Quality Commission (CQC) Local System review of Stockport Together. Copies of CQC documentation was submitted for information (copies of which had been circulated).

It was highlighted that this was a review, not an inspection; that the review would be a lengthy process; the main focus was to ensure that the system was safe, responsive, well-led; the review would examine outcomes and care journeys; the review was geared toward improvement and helping that process.

The following comments were made/ issues raised:-

·         Did staff receive training and support to implement the Stockport Together vision? In response it was stated that partners had a clearly articulated vision, but the vision changed over time and partners were committed to supporting staff on that journey.

·         The outcome of the Manchester and Trafford local reviews had been very constructive and this process should be helpful for Stockport partners.

·         It was important to have an honest assessment and self-reflection of Stockport Together by all partners. It was acknowledged that progressed had slowed, and perhaps partners had been overambitious, but that it took maturity to recognise the need to change and adapt.

RESOLVED – (1) That Sally Wilson be thanked for her attendance and presentation.

(2) That the Director of Adult Social Care be requested to submit a further update to a future Scrutiny Committee on the outcome of the CQC Local System Review.

A representative of the Democratic Services Manager will update the Scrutiny Committee on developments with the Scrutiny Review.

Officer contact: Jonathan Vali, 0161-474-3201, jonathan.vali@stockport.gov.uk 

A representative of the Democratic Services Manager reported that the Scrutiny Review Panel had now completed its evidence gathering in relation to its investigation of a whole system approach to obesity, but that it had not been possible to provide a draft final report for consideration by the Scrutiny Committee due to pressure of resources.

RESOLVED – That the Chair and Vice-Chair (as Lead Councillor for the Review) be authorised to approve the final report of the Scrutiny Review – ‘A Whole System approach to Health Weight’ for submission to the Cabinet.

To consider a report of the Democratic Services Manager.                                                          

The report sets out planned agenda items for the Scrutiny Committee’s next meeting and Forward Plan items that fall within the remit of the Scrutiny Committee.

The Scrutiny Committee is invited to consider the information in the report and put forward any agenda items for future meetings of the Committee.

Officer contact: Jonathan Vali, 0161-474-3201, jonathan.vali@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report (copies of which had been circulated) setting out planned agenda items for the Scrutiny Committee’s next meeting and any Forward Plan items that feel within the remit of the Scrutiny Committee.

RESOLVED – That the report be noted.