Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 30 June 2015.

The Minutes (copies of which had been circulated) of the meeting held on 30 June 2015 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 Corporate Director for People.

The report provides the First Update Portfolio Performance and Resource Report for the Independence and Wellbeing Portfolio.  This provides an early update on progress in delivering the portfolio priority outcomes through the Investing in Stockport programme and other key projects during the first quarter of 2015/16. It includes forecast performance data (where this is available) and projected financial data for the Portfolio, along with an update on the portfolio savings programme. 

Scrutiny Committee is recommended to:-

a)    Consider the First Update Portfolio Performance and Resource Report;  

b)   Review the progress against delivering key projects, priority outcomes, targets and budgets for 2015/16;

c)    Highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues;

d)   Highlight any significant issues or changes to be fed back to the Executive alongside the Corporate Performance and Resource Report;

e)    Identify how areas of strong performance and good practice can be shared in other services.

Officer contact: Karen Kime on 474 3574 or email: karen.kime@stockport.gov.uk / Simon Finch on 474 4019 or email: simon.finch@stockport.gov.uk

A representative of the Corporate Director for People submitted a report (copies of which had been circulated) providing an update on progress in delivering the portfolio priority outcomes through the Investing in Stockport programme and other key projects during the first quarter of 2015/16 for the Independence & Wellbeing portfolio.

The Executive Councillor (Independence & Wellbeing) (Councillor John Pantall) attended the meeting to answer questions from the Scrutiny Committee.

A question was asked about the effectiveness of the winter flu vaccination programme and preparations for the upcoming winter. In response it was stated that final figures were not yet available but that early indications were that overall the take-up was less than previous years. It was suggested that this was due mostly to population increases, but that Stockport nevertheless had the highest or very high rates in Greater Manchester for a range of priority groups.

RESOLVED – That the report be noted.

To consider a report of the Service Director (Adult Social Care)

This report will set out the background to the introduction of the Deprivation of Liberty Safeguards, their implications and challenges with implementation.

This report had been requested by the Scrutiny Committee at its meeting on 27 May 2015.

Officer contact: Mark Warren, 0161 474 4401, mark.warren@stockport.gov.uk

Representatives of the Service Director (Adult Social Care) submitted a report (copies of which had been circulated) setting out the background to the introduction of the Deprivation of Liberty Safeguards (DoLS), their implications and challenges with implementation. The Scrutiny Committee had requested this comprehensive report following concerns raised about the impact of the implementation of the 2014 Supreme Court Judgement on families of those subject to a DoLS and the increased pressure on public services.

Representatives of the Service Director (Adult Social Care) were in attendance at the meeting to provide an overview of the situation and to answer questions from the Scrutiny Committee.

The following issues were highlighted:-

·         Operationally, the DoLS requirements were extremely resource intensive and were having a significant impact on the capacity of the adult social care service.

·         The DoLS requirements were also having a significant impact on vulnerable people, and particularly those subject to DoLS who die and were consequently considered to be in ‘State Detention’.

·         Over time the process for reviewing an individual’s DoLS assessment would get more, rather than less, intensive.

·         There were potentially a significant number of deprivations taking place in the community that were not yet known to Adult Social Care.

·         As case law around DoLS grew the Council was having to revisit its assessments and this was increasing the time and cost.

Ann Coffey MP, who had raised concerns about DoLS during an adjournment debate in Parliament on 17 June 2015, also attended the meeting. She highlighted the following issues:-

·         The matter had been raised in Parliament after she had been approached by constituents upset by the ‘state detention’ status given to their relatives. The Minister for Community and Social Care had responded positively about the concerns raised.

·         DoLS in themselves were a good means to safeguard vulnerable people but the 2014 Supreme Court judgement had lowered the bar for assessment, leading to the problematic ‘unforeseen consequences’.

·         The Law Commission Review would be a review of the law, rather than the practice, and it needed to be borne in mind that as well as the 2014 judgement the guidance issued by the Chief Coroner had resulted in those dying subject to DoLS being considered as having been in state detention. The Review had been brought forward by the Government following pressure from Parliament, but it was unlikely that any legislation would be enacted before 2017.

·         Locally, partners should be encouraged to develop protocols to streamline processes to minimise the burden of DoLS, including working with the Coroner to take a proportionate response, and working with local care providers to ensure applications for DoLS were appropriate as many providers were concerned about negative consequences of inspections if applications had not been made.

·         She had arranged for a meeting with the CQC, Coroner, Stockport Adult Social Care and large care providers to discuss ways to improve the local situation.

·         She had approached the Chief Coroner in relation to her concerns and he had agreed to revisit his guidance.

The Executive Councillor (Independence & Wellbeing) (Councillor John Pantall) attended the meeting and raised the following issues:-

·         The impact on individuals and their families was the primary cause of concern.

·         The problems experienced with care homes and DoLS had echoes of the difficulties experienced with improving end-of-life care, and would need to be addressed in part by changing the culture within these settings, as well as using contractual mechanisms. Ensuring residents had clear care plans should encourage only appropriate applications, and more could be done through contractual arrangements to require plans.

·         Greater clarity was needed by providers on the role of DoLS, and more generally on safeguarding, particular on what needed to be prevented.

·         Ensuring independent advocacy was built into Council process and activity was important to ensure the aims of DoLS were achieved.

The following general comments were made/ issues raised:-

·         Given the population profile in Stockport, as well  ...  view the full minutes text for item 5.

To consider a report of Healthwatch Stockport.

The report sets out the findings of a Healthwatch Stockport consultation exercise on what local people want from their local health and social care services. The findings of the report would inform the development of the Joint Strategic Needs Assessment, which will in turn inform service delivery and commissioning.

The Scrutiny Committee is invited to comment on the report.

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

Sue Carroll, Vice-Chair of Healthwatch Stockport, attended the meeting to present the organisation’s report “What would a good experience of a health or social care service look like to you? – JSNA Report” (copies of which had been circulated) that had been commissioned to provide public input into the development of the new Joint Strategic Needs Assessment (JSNA). The report presented the views of the public gathered from a range of engagement activity on their ideal health care system.

The following findings in the report were highlighted:-

·         Respondents supported the idea of joined-up and ‘holistic’ approaches to their needs, and stressed the need for a seamless transfer out of hospital and back into the community.

·         There were particular concerns expressed that GPs gave the impression of being unsympathetic toward LGBT young people.

·         Responses from the BME community overall were consistent with the general response, but particular concerns were raised about the lack of sensitivity experienced from services for those of Asian backgrounds when suffering mental health issues.

The following comments were made/ issues raised:-

·         Councillors and officers welcomed the report and useful information it provided, paying tribute to Healthwatch for the work they had done. The data would be of significant benefit in the development of the JSNA.

·         There were a number of areas identified in the report that could be addressed now. An example was better communication between the hospital and GPs about waiting times for referrals that might better inform clinical decisions, reduce waiting and unnecessary appointments and improve outcomes.

·         Improving communications would go a significant way to improving services and people’s ability to find the most appropriate service for their treatment, such as increasing awareness of the services available at community pharmacies or the minor ailments service.

·         It was important for GPs to regularly review patient’s medication requirements. The fact some pharmacists were being more proactive in reviewing and questioning medication they were prescribing was welcomed.

·         Unfortunately it would not be possible to capture within the JSNA all the qualitative data contained in the report, but the report itself would inform business planning.

·         In relation to the increased reliance on digital communication, concerns were raised about the accessibility for some patients. It was commented that many people would welcome the opportunities for digital communication if this meant better services and increased choice. The importance of training for staff was also emphasised.

·         Concerns were expressed about the expansion of access to GPs and the increasing demands this would place on them. Councillors commented on the need to ensure patients, particularly those managing long term conditions, were able to access appropriate care that may not need to be their GP but should be the person who can best look after their needs. It was also commented that there was considerable variability in experience and service across GP practices and the role of receptionists acting as gatekeepers in some practices was highlighted as a concern. Better use of triage and telephone consultation was suggested as being possible means to better manage demand for GP services.

RESOLVED – (1) That the “What would a good experience of a health or social care service look like to you? – JSNA Report” be noted and welcomed and Healthwatch Stockport be commended for their work in preparing the report.

(2) That the Chief Operating Officer of the Stockport Clinical Commissioning Group be requested to submit a report to a future meeting on the variability of GP services across Stockport.

The Deputy Director of Public Health to report at the meeting.

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

The Deputy Director of Public Health (Stockport Council) and the Clinical Director for Public Health (Stockport Clinical Commissioning Group) updated the Scrutiny Committee on the two recent public health campaigns:-

Stop Before Your Op

The Scrutiny Committee viewed a short video developed in conjunction with consultant clinicians at Stepping Hill Hospital that highlighted the increased risks for smokers of surgery for a variety of conditions. The campaign included work with GPs and surgeons to provide materials to reinforce the message with patients. The rate of smoking for pre-op patients would be monitored.

The following comments were made/ issues raised:-

·         The use of video was welcomed as this was often a more powerful message than text or still images. It was suggested that further thought be given to the language used and the possibility of using smokers/ former smokers to add weight to the message.

·         The engagement with the Hospital on a public health campaign and the wider public health agenda was welcomed. It was recognised that this campaign was a new approach to delivering the message.

‘Stockport String’

The Scrutiny Committee were given a demonstration of a technique to identify the risk of heart disease that research suggested was more effective than the Body Mass Index (BMI). The technique involved using a piece of string to measure waist size at the point half-way between the hip bone and the lowest rib and comparing this to the person’s height. The waist size should be less than half of the height, otherwise this was an indication of increased risk. The use of string would allow ongoing monitoring and gave a more immediate visual result than using scales.

Councillors welcomed the initiative and the element of ‘fun’ of using the string that would make this more engaging than calculating BMI. Councillors also supported the suggestion of demonstrating the technique at a Stockport County match.

RESOLVED – That the update on public health campaigns be noted and further updates be welcomed.

To consider a report of the Director for Public Health.

Hypertension (high blood pressure) is one of the most important preventable causes of premature morbidity and mortality in the UK. It increases the risk of atrial fibrillation and is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Raised blood pressure is one of the main modifiable risk factors for cardiovascular disease. Many people who have high blood pressure are not aware of it. The report summarises the outcome of a pilot project using 7 health kiosks, placed in the community, as part of a ‘know your numbers’ campaign (April – October 2014) The aim of the project was to record and code blood pressure measurements for those patients registered with Stockport GPs who had not had a blood pressure recorded in their notes in the past five years and see how many attended the kiosk during the pilot period.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Dr Vicci Owen-Smith, 07810045578, vicci.owen-smith@stockport.gov.uk

The Clinical Director of Public Health (Stockport Clinical Commissioning Group) submitted a report (copies of which had been circulated) summarising the outcome of the Wellpoint Kiosk pilot undertaken in Stockport as part of the ‘Know Your Numbers’ hypertension campaign. The aim of the project was to record and code blood pressure measurements for those patients registered with Stockport GPs, particularly those who had not had a blood pressure recorded in their notes in the past five years.

Although the pilot had not resulted in the outcomes anticipated in respect of reaching target groups and because of problems with the data, the use of the kiosks had been significant and had demonstrated potential for further exploitation.

The following comments were made/ issues raised:-

·         Problems had been encountered with transferring data from the kiosks to GP records that meant that some of the impact may be underestimated, e.g., users making follow-up appointments with their GPs.

·         There had been some interesting activity with the kiosk in workplaces as colleagues were competing and supporting with each other to improve their ‘score’.

·         If the kiosks were to be used again consideration should be given to placing them in supermarkets as this might lead to even greater take-up.

RESOLVED – That the report be noted.

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

The report included in the agenda was considered by the Joint Health Overview and Scrutiny Committee for Pennine Care NHS Foundation Trust in relation to their proposals for the reconfiguration of the Community Mental Health Team. That Scrutiny Committee requested that the Stockport element of the proposal be circulated to this Scrutiny Committee for information.

The Scrutiny Committee is recommended to note the report.

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

A representative of the Democratic Services Manager submitted a report of Pennine Care NHS Foundation Trust (copies of which had been circulated) providing an overview of options being considered for the reconfiguration of the Stockport Community Mental Health Team. The report had been considered by the Joint Health Overview and Scrutiny Committee for Pennine Care NHS Foundation Trust as part of the Trust’s wider proposals on Community Health Team reconfiguration and had been referred to this Scrutiny Committee for information.

RESOLVED – That the report be noted.

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 relevant Forward Plan items.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to circulate to members of the Scrutiny Committee a copy of the recent CAMHS update report considered by the Children & Young People’s Scrutiny Committee.

(3) That the Director of Public Health be requested to submit a report to a future meeting on melanoma rates in Stockport.

To consider a report of the Democratic Services Manager.

The report details proposals for the selection of Scrutiny Review topics by Scrutiny Committees to be carried out during the 2015/16 municipal year.

The Scrutiny Committee is invited to consider the selection of Scrutiny Review topics to be carried out during the 2015/16 municipal year.

Officer contact: Craig Ainsworth on 474 3204 or email: craig.ainsworth@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report (copies of which had been circulated) requesting the Scrutiny Committee to consider the process for the selection of Scrutiny Review topics and to suggest a topic for a review to be carried out during the 2015/2016 municipal year.

RESOLVED – (1) That the Council Meeting be recommended to approve the inclusion of 'Dementia - support & information for carers' within the 2015/16 Scrutiny Work Programme.

(2) That further consideration be given to undertaking a short piece of work into the role of community pharmacies in the health and social care integration agenda.