Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 17 July 2013.

The Minutes (copies of which had been circulated) of the meeting held on 17 July 2013 were approved as a correct record and signed by the Chair.

Members and officers to declare any interests which they have in any of the items on the agenda for the meeting.

No declarations of interest were made.

A representative of the Democratic Services Manager reminded all members of the requirements for them to complete an entry for the Register of Member’s Interests and to notify the Council’s Monitoring Officer of any changes to those interests.

To achieve any announcements from the Chair on matters related to the activity of the Board.

The Chair reported that a planned meeting of the Greater Manchester Clinical Commissioning Group had been postponed.

To consider updates on the following key strands:-

·         Health and Social Care Integration – a joint report of the Chief Operation Officer, Stockport CCG and the Service Director (Adult Social Care), Stockport Council

·         Primary Care Strategy

·         Healthier Together

Two documents considered by the Greater Manchester Health & Wellbeing Board in August relating to the Primary Care Strategy and Public Service Reform are attached for information.

(i)            Health & Social Care Integration

A joint report of the Chief Operating Officer, Stockport Clinical Commissioning Group and the Service Director (Adult Care Services), Stockport Council was submitted (copies of which had been circulated) updating the Board on progress at a local and Greater Manchester (GM) level with the Health and Social Care Integration Programme. The report outlined the drivers for integration, as well as the challenges and opportunities this would present to organisations involved.

A report considered by the Greater Manchester Health and Wellbeing Board on health and social care reform was also considered (copies of which had been circulated).

The following issues were raised/ comments made:-

·         Further work was being done to understand the financial costs of the new models of delivery, as well as the likely savings these new interventions were likely to generate. Releasing funding from hospital services in isolation would not meet the future funding gap, nor would the smaller projects designed to improve outcomes and make efficiencies, such as extending the rapid response service.

·         A whole economy approach was needed to address the future funding needs of health and social care, to view each organisation’s resources as an integrated resource, and to set the governance arrangements accordingly.

·         Announcements had recently been made about further central government funding to support Emergency Departments to address additional pressures. The purpose was to make sustainable improvements, rather than to ‘cope’ in the short term.

·         Even if the assumptions of both the integration of health and social care and of Healthier Together programmes were correct, then the improvements and savings this would release may not be enough to meet the future funding gap. Therefore other strategies were needed. At a GM level, having a consistent approach to thresholds and standards of care had been identified as a further mechanism, building on existing thresholds and standards, such as those in NICE Guidance.

·         Nationally there was a push for consistency on eligibility criteria to avoid a ‘postcode lottery’ in care. An individual’s eligibility was most often down to a professional judgement, so the issue of contention would become what type of service/ combination of treatments was provided to an eligible person. The best models were designed to make sure decision-making on that issue were as close to the person as possible, but these also needed to be evidence-based decisions. The implication of this was that services which were ‘much loved’ may need to be discontinued if there was no evidence that there were improving outcomes.

·         As part of the process of reform, it was important to ensure residents had sufficient ‘health literacy’ to make informed decisions about what were appropriate services to access. One possibility was to have ‘inductions’ for new residents when registering at a new GP.

(ii)          Primary Care Strategy

Rob Bellingham (Director of Commissioning) Local Area Team of NHS England, attended the meeting to provide the Board with an update on the development of a Greater Manchester strategy for the commissioning of primary care services.

A copy of a presentation made to the Greater Manchester Health and Wellbeing Board on the Primary Care Strategy was also considered (copies of which had been circulated).

The presentation focussed on the following issues:-

•      Need to reduce unwarranted variation in outcomes and care pathways

•      Extending access to primary care

•      Ensure focus on self-management, wellness and prevention

•      Need to ensure integration with other services and organisations

•      Addressing workforce issues

•      Potential for increased efficiency

It was stressed that the Primary Care Strategy was closely aligned with the Health and Social Care Integration and Healthier Together Programmes.

The following comments were made/ issues raised:-

·         A recurring theme from public consultation was access to GPs. Although this was an important issue for the public, it was not within the scope of the Strategy to address nationally agreed contracts. Any improvements to access would need to be negotiated within the  ...  view the full minutes text for item 4.

To consider a report of the Deputy Director of Public Health

One of the key changes resulting from the reorganisation of the NHS in April 2013 was the creation of new national structures for Public Health, including Public Health England (PHE). Part of the remit of PHE is to become a leader for Knowledge and Intelligence (KIT) for Public Health nationally, building on the previous work of the Public Health Observatories and working with local areas.

Since April 2013 there have been a number of national tools published which aim to highlight and profile different areas of Public Health work and set the challenge for improving outcomes for the next few years. The attached report aims to summarise the key profiles released and highlight issues for Stockport.

Officer contact: Dr Vicci Owen Smith, 0161 474 2435, vicci.owen-smith@stockport.gov.uk

A report of the Director of Public Health was submitted (copies of which had been circulated) summarising for the Board a range of key public health profiles produced in recent months and highlighting particular issues for Stockport. The report also contained some broad conclusions drawn from the profiles and highlighted areas that would be addressed further in the future JSNA.

The following comments were made/ issues raised:-

·         Stockport’s relative performance in comparison to its comparator group was often worse because of the polarisation in Stockport.

·         Concerns had already been raised about levels of smoking in pregnancy, and levels of breastfeeding beyond four weeks were also below expectations. There was a danger that as public health issues were becoming more mainstream within midwifery services, more specialist programmes of interventions were losing focus. Further consideration should be given to these issues as part of the re-specification of maternity services.

·         Work was underway to create an integrated locality model with a single management structure for preventative services. This would allow better co-ordination and targeting of resources, and would be heavily informed by the public health outcomes described in the report.

RESOLVED – That the report be noted.

To consider a verbal update on the recent request from the Department of Health to undertake a second self-assessment of the implementation of the Government’s Autism Strategy. The Department of Health is currently undertaking a review of the Strategy, developed in 2010, and has requested each local authority/ Health & Wellbeing Board to undertake a self-assessment by 30 September 2013.

Officer contact: Karen Kime, 0161 474 3574, Karen.kime@stockport.gov.uk

Karen Kime, Project Lead for Autism, Stockport Council, attended the meeting to update the Board on work to implement the requirements of the Autism Act, and to respond to a review of the success of the Autism Strategy.

The update highlighted the following issues:-

·         The national Adult Autism Strategy was launched in 2010 to address the needs of the some of the most disadvantaged individuals in the county. The Strategy, although focussed on adults, cut across a range of services and the work in Stockport had been a partnership effort.

·         The Department of Health was undertaking a formal review of the implementation of the Strategy, and Health & Wellbeing Boards were expected to consider the results of the local review.

·         In Stockport, there were particular strengths around training and awareness, and work placements through the Asperger’s service. Transition between children’s and adult’s services was a key issue to be addressed.

·         It was likely that from 2017 Autism would be a clinical priority for GPs.

The following comments were made/ issues raised:-

·         Were professionals sufficiently skilled to identify the early markers of autism?

·         The Disability Review should develop a pathway that would address some of the concerns around transition.

·         Adults with autism who believed they did not need services presented a particular challenge for services.

RESOLVED – That the update be noted the Autism Self-Assessment be submitted to the January 2014 meeting of the Board for further consideration.

To consider a report of the Safer Stockport Partnership.

Attached is the final report of the recent Domestic Homicide Review carried out following an incident in February 2012 which was the subject of a review in accordance with Section 9 of the Domestic Violence, Crime and Victims Act 2004.

The Review makes a number of recommendations to a number of agencies, including this Board, namely that:-

“The local Health and Wellbeing Board should review the feasibility of establishing a referral system between GMP and General Practice where domestic abuse and alcohol misuse present significant risk to individuals and families. “

Officer contact: Helen Boyle, 0161 474 3145, Helen.boyle@stockport.gov.uk

A report of the Safer Stockport Partnership was submitted (copies of which had been circulated) summarising the findings of a Domestic Homicide Review that had undertaken following an incident that had taken place on 3 February 2012 which had safeguarding implications. The report made a range of recommendations to public sector partners, including a recommendation to the Board relating to improved working between GPs and Greater Manchester Police in identifying those at risk of domestic violence or alcohol misuse.

It was confirmed that the CCG had already identified the issues raised in the report and were addressing them in so far as it was within its power to do so. It was stated that to affect the level of change suggested by the report would be beyond the remit of the Board or the partners and needed to be done through the GP commissioning framework which was the responsibility of NHS England.

RESOLVED – (1) That the report be noted.

(2) That Stockport Clinical Commissioning Group and the Local Area Team of NHS England be invited to consider the issues raised by the Domestic Homicide Review.

To consider the Forward Plan of agenda items for future meetings of the Health & Wellbeing Board.

The Chair submitted a report (copies of which had been circulated) setting out a forward plan of agenda items for future meetings of the Board.

RESOLVED – (1) That the report be noted.

(2) That the Board would welcome a report to a future meeting on the resources being made available to partners in Stockport from the Department of Health to support the integration of Health and Social Care.

The final report of the “Review into the quality of care and treatment provided by 14 hospital trusts in England” led by Sir Bruce Keogh can be found on the NHS website at http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf

Further information relating to the review can be found at http://www.nhs.uk/NHSEngland/bruce-keogh-review

The Chair reminded the Board that the final report of the “Review into the quality of care and treatment provided by 14 hospital trusts in England” led by Sir Bruce Keogh had been published and was available on the NHS website at http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf

The Review, while not directly related to any facility in Stockport, included Tameside General, and so could have an impact on Stockport.

Details of the Independent Review “A promise to learn – a commitment to act: Improving the Safety of Patients in England” (the Berwick Review) undertaken by the National Advisory Group on the Safety of Patients in England can be found on the Government’s website at:-

https://www.gov.uk/government/publications/berwick-review-into-patient-safety

The Chair reminded the Board that the Independent Review “A promise to learn – a commitment to act: Improving the Safety of Patients in England” (the Berwick Review) undertaken by the National Advisory Group on the Safety of Patients in England had been published and could be found on the Government’s website https://www.gov.uk/government/publications/berwick-review-into-patient-safety