Agenda and minutes

To approve as a correct record and sign the Minutes of the extraordinary meetings held on 29 September, 8 October and 6 November 2014.

The Minutes (copies of which had been circulated) of the meeting held on 29 September, 8 October and 6 November 2014 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

Councillors and officers are invited to provide feedback from the previous meeting and the discussions with service users, carers and volunteers.

Representatives of the Clinical Commissioning Group have also been invited to the meeting to address concerns raised in respect of access to services.

The Chair invited those at the meeting to provide feedback and reflect on the Scrutiny Committee’s recent engagement with Alcohol Treatment service users and carers.

A representative of the Democratic Service Manager also provided an update from the Clinical Commissioning Group (CCG) in relation to a number of points raised at the engagement session that the Scrutiny Committee had sought comment on related to the CCG activity. This included the following points:-

Dual/double diagnosis

An assessment of an individual patient be able to identify a person’s key problems and needs, including where alcohol dependency was masking an underlying mental health problem. The key to overcoming this was the effectiveness of the assessment process.

Delay in accessing IAPT and other therapies

IAPT, Self Help Services provide an e-Therapy dual diagnosis package called Breaking Free, it is targeted at people with mild to moderate conditions.

·         100 treatments are available on an annual basis

·         There is open referral to this service, i.e. people can self-refer, this is seen as the preferred method because it demonstrates motivation to engage

·         Referrals to the service are low

·         The service report good recovery targets and very good patient experience

·         Waiting times to access step two/services for people with mild to moderate problems are low, i.e. 99% of people can access Self Help Services within 4 weeks

In relation to Step 3 IAPT services, for Cognitive Behaviour Therapy (CBT) and counselling this continues to be challenging, largely based on the length of time people were in treatment, however good progress around waiting times had been made.

·         60% of people can access CBT within 18 weeks

·         455 of people can access counselling within 18 weeks (this is a much smaller service and the wait is longer)

·         Access to secondary care psychological services requires people to be care co-ordinated and this therapy takes place as part of a care package. 

Councillors expressed concerns that an 18 week wait was significant and would make ‘early’ intervention a challenge.

The following additional comments were made/ issues raised:-

·         The role of the GP in identification of those with alcohol abuse problems. It was commented that there was often variability in awareness amongst practices and engagement with training provided by Public Health. It was not possible to monitor whether GPs raised alcohol consumption during consultations, but data did show that there were some practices that never made referrals to the Healthy Stockport service.  In relation to the training of GPs, it was suggested that within a practice it may be that an individual GP specialised in a particular areas, so that not all GPs within the practice were as aware of alcohol issues as others. It was queried that if GPs were not referring to the Health Stockport service or to START, then what were they doing to address patients with unsafe drinking levels?

·         The issues raised in relation to benefits and advice from DWP was not within the remit of this Scrutiny Committee but the local MPs could be asked to write to the relevant Minister. Further detail was needed from colleagues at Pennine Care NHS Trust to understand the detail of these problems.

·         The role of the family was particularly important, particularly in identifying problem drinking, convincing relatives to seek help, and providing ongoing support through treatment and recovery. They could often act as an ‘ally’ to both the user and for those working within services.

RESOLVED – That in relation to the feedback from service users and carers, that further information be sought on the following issues for inclusion within the Review Final Report:-

·         Clarification from the CCG on the maximum waiting times for IAPT and CBT.

·         Whether the CCG had data on training and monitoring of GPs in relation to alcohol misuse.

·         Further details from Pennine Care NHS Foundation Trust on problems encountered by service users in relation to benefits payments and support from DWP and Job Centre Plus.  ...  view the full minutes text for item 3.

A copy of the Greater Manchester Alcohol Strategy is enclosed.

Officers from the Public Health Team will provide the Committee with an update on the implications of the Strategy for Stockport and work underway to support it.

A representative of the Director of Public Health submitted the Greater Manchester Alcohol Strategy (copies of which had been circulated) and highlighted the key issues relevant to Stockport.

The following comments were made/ issues raised:-

·         There was a lot of emphasis in the document on the economy and a strategic considerations rather than the impact on an individual’s health.

·         There were examples locally of successful engagement with licensees through Pub Watch schemes, particularly in Hazel Grove, but this was highly dependent on their willingness to drive the agenda. The Police were key to their success, particularly in supporting the work through enforcement. Enforcing the law in respect of not selling alcohol to those already drunk was a difficult task.

·         Dealing with offenders, or those in custody, was an area where working across Greater Manchester could make an impact. The development of lifestyle assessments being done in the custody suite was an example of good practice being shared across the area.

·         There were examples of services being commissioned through GM frameworks to get better value, such as residential detox, but there was always need for locally tailored services.

·         The Strategy currently lacked a detailed action plan, and this was being prepared.

RESOLVED – That the Strategy be noted and the Review Final Report include a recommendation to Public Health England seeking clarity on the likely impact of Priorities 6-11 on Stockport.

(Note: the Chair was of the opinion that this item, although not included on the agenda, should be considered as a matter of urgency in accordance with Section 100B(4)(b) of the Local Government Act 1972 in order that the matter could be considered promptly as part of the current Scrutiny Review)

A representative of the Democratic Services Manager submitted a Public Health England profile for Liver Disease (copies of which had been circulated). The profile indicated that the rates of mortality for liver disease were significantly higher in Stockport than the national average. The Profile also posed 5 key questions for local decision makers.

RESOLVED – That the report be noted and the following questions be posed to the relevant departments:-

·         Question 3 – ‘Are the links between availability of alcohol and alcohol related harm explicitly considered in local licensing policy, and when reviewing new licensing applications?’ referred to the Public Protection Service.

·         Question 4 – ‘Are local health and social care staff trained to routinely provide early identification of problem drinking and provide brief alcohol advice?’ referred to Adult Social Care, Children & Young People Services, and Stockport Clinical Commissioning Group.

The Scrutiny Committee is invited to consider the next steps for the Review and any tentative conclusions it may wish to draw for inclusion in the Final Report.

The Chair invited those present to identify the key messages that should be included in the Scrutiny Review Final Report.

Reference was made to the simultaneous work to develop new models of alcohol service delivery as part of the Investing in Stockport process.

The following issues were identified:-

·         Access to psychological therapies;

·         Role of licensing;

·         Training for professionals;

·         The need for a simple message on safe levels of drinking;

·         More information on the national review of drinking guidelines.

It was also suggested that instead of including recommendations within the final report, these be posed as questions to relevant agencies.

RESOLVED – That the Democratic Services Manager be requested to prepare a draft final report for the Alcohol Review to the next ordinary meeting of the Scrutiny Committee.