Agenda and minutes

To approve as a correct record and sign the Minutes of the meetings held on 25 November and 4 December 2014.

The Minutes (copies of which had been circulated) of the meetings held on 25 November and 4 December 2014 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.

Ann Barnes (Chief Executive) and James Sumner (Director of Operations), Stockport NHS Foundation Trust have been invited to the meeting to provide an update to the Scrutiny Committee on unscheduled admissions to Stepping Hill Hospital.

Details of the previous meeting at which this matter was considered can be found at http://democracy.stockport.gov.uk/ieIssueDetails.aspx?IId=13559&Opt=3

Ann Barnes (Chief Executive) and James Sumner (Director of Operations), Stockport NHS Foundation Trust, attended the meeting to make a presentation to the Scrutiny Committee in relation to the Trust’s performance against the 4-hour Emergency Department (ED) Target and their ongoing efforts to address increased attendances at ED.

Mark Chidgey (Director of Quality & Provider Management), Stockport Clinical Commissioning Group (CCG) and Terry Dafter (Director of Adult Social Care), Stockport Council, also attended the meeting to provide input into the discussion from the perspective of their respective organisations.

The presentation covered the following issues:-

·         In November 2014, the Hospital were continuing to implement the measures set out in the Trust’s Action Plan to address unscheduled care, and performance was fairly consistently above or just below the 95% target.

·         From the second week in December the Hospital experienced unprecedented pressure. This pressure was not related to increased attendances at ED, nor because of significant increases in inappropriate attendances but was due to the increase demand from frail, elderly patients with respiratory conditions. Many of these patients also had complex needs requiring social care support (between 40-50%, up from the usual 20%).

·         The challenge for the hospital and other parts of the economy was to create sufficient capacity to allow for patients to be appropriately discharged. The problems with waiting times encountered by the ED, reported in the national press, were largely a consequence of the lack of ability to discharge to other appropriate care.

·         The hospital responded to the pressure by making provision to accommodate additional medical patients using winter resources and with additional areas, as well as additional staff being used to meet the demand.

·         The Trust ensured daily monitoring was in place to maintain safety and review provision. A conscious choice was made to prioritise the safety of patients over the performance target.

·         The Trust, CCG and the Council collaborated to address discharge challenges to create capacity and ease the pressure on the Hospital and ED.

·         Although the immediate pressure had subsided for the Hospital and for primary care, there remained risk for the remaining months of winter should the weather worsen or in the event of a flu outbreak.

·         Given the nature of the problem, the Trust and partners had coped well with the additional, unprecedented pressure.

Terry Dafter echoed the points made in the presentation, in particular the unprecedented nature of the pressure. He emphasised that the medical needs of the patients, the average age of whom was 90, meant that they could not be deflected from hospital to other services. Adult Social Care Services had also experienced severe pressures as a result of the respiratory illness affecting its service users.

Mark Chidgey stated that the pressures experienced by the Hospital had been reflected across the local health system with significant additional pressure on primary care and GPs. The CCG had worked with the Trust to ensure quality and safety were maintained and that the Trust’s contingency plans had been implemented and were fit for purpose.

Councillors asked questions and made comments on the presentation and issues around ED and the pressures on admission. These included:-

·         Given the national pressures on hospitals and EDs, why was performance at Stepping Hill the worst nationally? In response it was stated that as part of the ongoing work to address unscheduled care, improving discharge had been identified for action under phase 3 of this project. Because this issue had not been systematically addressed prior to this winter Stepping Hill Hospital faired proportionately worse than other hospitals. The Trust nevertheless stood by its approach of prioritising safety over achieving the 4 hour target as this was in the best interests of patient safety.

·         Was consideration given to declaring a major incident as other NHS trusts/ hospitals had done in response to the particular illness/ pressure? In response it was stated that actions taken by the Trust in terms of staffing levels etc.,  ...  view the full minutes text for item 4.

To consider a joint report of the Leader of the Council (Policy, Reform & Finance) and the Executive Councillor (Corporate, Customer & Community Services)

The revised draft Business Cases for the Investing in Stockport Proposals for Preventative Commissioning Strategy and Health & Social Care Integration are being submitted to the Scrutiny Committee for consideration and comment as part of the consultation.

The Scrutiny Committee is invited to comment on the draft business cases.

Officer contact: Holly Rae, 0161 474 3014, holly.rae@stockport.gov.uk

A joint report of the Leader of the Council and the Executive Councillor (Corporate, Customer & Community Services) was submitted (copies of which had been circulated) detailing the outcome of consultations undertaken on the Draft Business Cases for the Executive’s Investing in Stockport Proposals, previously considered by the Scrutiny Committee.

The Executive Councillor (Health & Wellbeing) (Councillor John Pantall) and Service Director (Adult Social Care) attended the meeting to answer councillors’ questions.

In relation to the Preventative Commissioning Strategy, the Scrutiny Committee considered this in conjunction with item 6, ‘Drug & Alcohol Services Redesign Consultation’.

The following comments were made/ issues raised:-

Health and Social Care Integration

·         The Marple and Werneth Hub had provided a lot of value experience on which to develop the model. However, it was recognised that there was no ‘one size fits all’ approach that could be rolled out across the borough. Further work was needed to understand the needs of communities within the hubs and how smaller teams would work to support them.

·         It was commented that other partners and groups could add value to the work of the hub, eg, Citizen’s Advice Bureau.

·         There remained some information governance and technological issues with sharing data within the hub. There were practical measures that could be taken but also further professional barriers that needed to be overcome.

RESOLVED – (1) That the report be noted.

(2) That in relation to the Health & Social Care Integration Business Case, the Scrutiny Committee believed that there remained significant amounts of detail to be decided and consequently significant risk remained in achieving large savings, the impact of which could not be properly assessed, particular in view of the increasing population of those falling within the purview of these services and with differing needs across different geographical communities.

(3) That the Democratic Services Manager be requested to circulate a copy of the JSNA population profile.

To consider a report of the Deputy Director of Public Health.

The purpose of this report is to brief the Scrutiny Committee on the current consultation on the proposals for redesign of Stockport’s drug and alcohol treatment system, including early responses, and to provide Scrutiny members with further opportunities to comment on the proposals.

The Scrutiny Committee is invited to comment on the proposals for service redesign.

Officer contact: Donna Sager, 0161-474-3928, donna.sager@stockport.gov.uk

A representative of the Director of Public Health submitted a report (copies of which had been circulated) updating the Scrutiny Committee on the current consultation being undertaken on proposals to redesign the local drug and alcohol treatment system. A presentation was also made giving the Scrutiny Committee the headline outcomes from recent focus group consultations with service users.

The following comments were made/ issues raised in relation to the consultation and the proposals generally:-

·         The qualitative feedback from service users was often more valuable than quantitative data, given that the primary concern of a service user should be their recovery.

·         Self-esteem was a key component to recovery, and peer support/ volunteering was a value means to improve this for service users. The work of CASU was an example of this.

·         Those seeking treatment could be concerned about their situation becoming known to their local community. It may be helpful to co-ordinate with other local authorities to provide opportunities for treatment out of the area.

·         The consultation showed that while there was broad support for greater focus on recovery and early intervention, there was also a reluctance to support the scaling back of funding to structured services, which was in contradiction to the first proposal.

RESOLVED – (1) That the report and consultation feedback be noted.

(2) That in relation to the Drug and Alcohol Redesign proposals that formed part of the Preventative Commissioning Strategy Business Case, it was recognised that the proposals would reduce structured treatment, but that the Scrutiny Committee nonetheless believed that the proposed focus on recovery and early intervention would outweigh any disadvantages of the proposed reductions in treatment.

To consider an update from the Democratic Service Manager.

The Scrutiny Committee will be invited to consider the initial conclusions and recommendations of the Alcohol Services Scrutiny Review.

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

The Chair invited the Scrutiny Committee to consider the possible conclusions and recommendations of the review of Alcohol Services. It was suggested that these be phrased in the form of questions.

Broadly, these were:-

·         What were partners doing to ensure front line staff were trained to identify those with alcohol dependency/ misuses issues and appropriately signpost to services? What more could be done to monitor referrals being made and whether questions were being asked during appointments with patients and clients?

·         Were partners ensuring that limited resources are targeted effectively at those cohorts most at risk?

·         Could partners do more to ensure those in treatment have more timely access to other mental health services, such as IAPT and counselling?

·         Were partners ensuring that support was provided to the family to those in treatment given the importance of family in someone’s recovery?

·         Were partners doing enough to provide practical support for people in recovery, e.g., help with housing, benefits etc.?

·         Could the Council and CCG be clearer in their public health messages about alcohol? Do the public understand how many units are safe?

·         Should the Council revisiting Minimum Unit Pricing and continue to lobby government for its introduction?

RESOLVED – That the Democratic Services Manager be requested to prepare the final report of the Scrutiny Committee’s Review of Alcohol Services for the next meeting on 24 February 2015 and that the conclusions and recommendations presented at this meeting form the basis of that report.

This item has been placed on the agenda at the request of the Chair.

Public Health England have recently published a report ‘Estimating Local Mortality Burdens associated with Particulate Air Pollution’. In view of previous discussion at the Scrutiny Committee in relation to air pollution in Stockport, the Chair requested that this be considered by the Scrutiny Committee with a view to exploring further opportunities to assess the scale of damage caused by air pollution to the health of residents in the Borough.

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

A report of Public Health England was submitted (copies of which had been circulated) setting out the results of a recent study of the impact of particulate air pollution on mortality in England. The Chair suggested that this report should form the basis of a future report to this Scrutiny Committee on the impact in Stockport of particulate air pollution.

RESOLVED – That the Director of Public Health be requested to submit a report to a future meeting on the impact of particulate air pollution on health and mortality in Stockport.

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 items for the Scrutiny Committee’s next meeting and Forward Plan items that fell within the remit of the Scrutiny Committee.

RESOLVED – That the report be noted.