Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 27 September 2017.

The Minutes (copies of which had been circulated) of the meeting held on 27 September 2017 were approved as a correct record and signed by the Chair subject to an amendment under Minute 8 ‘Stockport Together Update’ to deletion the first sentence of the second paragraph after the final bullet pointed list and its replacement by:-

“It was also commented that the Clinical Commissioning Group remained concerns about the system’s ED performance and that Winter was likely to be very challenging.”

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

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

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

No announcements were made.

Ann Coffey MP will attend the meeting to discuss ongoing efforts nationally and locally to address CSE.

The Chair reported that Ann Coffey MP, who was due to contribute to this item, was no longer able to attend the meeting.

Jane Crombleholme sought assurances, in light of media coverage about Child Sexual Exploitation (CSE) in the region, that partners were taking appropriate steps to minimise the risk to looked after children in the care of Stockport Council and to those in the care of other local authorities but living in the borough.

Andrew Webb reported that should the Board request it, a report could be submitted to a future meeting summarising previous reviews into CSE in Greater Manchester. He also reported that the Mayor of Greater Manchester had commissioned an independent assurance review of systems to protect children from CSE.

Gill Frame, Chair of the Local Safeguarding Children Board, stated that in both a peer review in 2016 and the most recent Ofsted inspection of Children’s Service it had been found that children in Stockport were protected well from CSE.

It was also suggested that Sara Rowbotham, the sexual health worker from Rochdale who was the involved in exposing the extent of CSE in that borough be invited to the meeting when the matter was next discussed.

RESOLVED – That consideration of this item be deferred to a future meeting to allow for the Corporate Director for People to prepare a report summarising recent inspections and assessments of services to protect children from exploitation.

Gill Frame, Independent Chair of the Safeguarding Children and Safeguarding Adults Board will attend the meeting to present the 2016-17 Annual Reports for those Boards and to highlight significant areas of work, particularly those relevant to the work of the Health & Wellbeing Board.

Gill Frame, independent Chair of the Children and Adults Safeguarding Boards, and Nuala O'Rourke, Head of Safeguarding and Learning at Stockport Council, attended the meeting to present the 2016/17 Annual Reports of the Boards in accordance with best practice.

To consider the Annual Report of the Safeguarding Children Board.

Officer contact: Una Hagan, 0161-474-5657, una.hagan@stockport.gov.uk

In relation the Children’s Board Annual Report, Gill Frame highlighted the following challenges:-

·         Refining and refreshing data to ensuring that early warning signals were acted upon.

·         There had been a significant increase in looked after children being accommodated within Stockport by other local authorities leading to pressures on local services, in particularly on health assessments.

Some successes of the noted in the report included:-

·         Improvements in early interventions.

·         Positive feedback from independent reviews of Operation Phoenix and a Peer Review relating to CSE. Partners had also changed their operations to provide daily monitoring.

·         There were no Serious Case Reviews (SCR) commissioned this year, and one learning review. An Action Plan had been developed to address the common themes to have emerged from previous SCRs.

Board members raised the following issues:-

·         In relation to child deaths, concern was expressed that 40% of those were from areas of deprivation despite this only being 9% of the Stockport population, suggestion a link with inequality. In response it was stated that the Board had challenged partners on the issue of child deaths in priority areas, and Public Health had developed an action plan in response to this issue. It was further commented that the risk factors contributing to these deaths were complex, including safe sleeping, maternal weight, although maternal smoking was the key risk factor and this more prevalent in our deprived communities. Public Health was working to ensure all agencies gave a consistent message around smoking for mothers and the programme of providing incentives to quit smoking had demonstrated impact.

·         Queries were raised about the consistency of attendance at the Board and its subgroups and whether this was likely to impact on general Board performance and effectiveness. In response it was stated that Board attendance was generally good and positive but there were challenges for subgroups, and these had been reviewed to reduce overlap and remove other barriers to participation.

·         Were partners learning the lessons from serious incidents so that children were safer as a result? In response it was stated that locally the Board had developed an action plan from the SCRs to ensure common themes were addressed and that this action could be audited. It was also a national challenge to ensure that learning was shared and acted upon as there were too many instances of similar failings and issues taking place in different places despite the outcomes of SCRs. The Government was also reviewing the efficacy of the SCR process.

·         The Children and Social Work Act 2017 had removed the statutory requirement for a local safeguarding children boards and there a need for partners locally and at Greater Manchester to consider what mechanisms would be needed to ensure children were kept safe.

·         It was confirmed that the current Board arrangements in Stockport would continue until such time as new arrangements were agreed, but there were concerns about the capacity and resource available to ensure proper audit and quality assurance was carried out.

·         Further information was requested on the impact of the correlation between special education needs/ disabilities and other mental health needs. In response it was stated that the importance for those involved in safeguarding was the increased risk of those young people engaging in risky behaviours and increased risk of exploitation. The SSCB would shortly be considering the CAMHS Transformation plan.

·         In relation to whether the waiting times for mental health support were reasonable, it was commented that there was a broader challenge around supporting mental wellbeing and equipping young people to be resilient and enabling the whole ‘system’ to respond better to support this. The Children’s Trust had also heard concerns from Head Teachers about inconsistencies in information provided to pupils where their needs fell short of CAMHS services. It was further commented that the Greater Manchester Health & Social Care Partnership Transformation Fund was funding work to develop GM-wide, consistent, cost-effective mental wellbeing support.

RESOLVED – That the  ...  view the full minutes text for item 5.(i)

To consider the Annual Report of the Safeguarding Adults Board.

Officer contact: Lee Woolfe, 0161-474-3590, lee.woolfe@stockport.gov.uk

In relation to the Adult’s Board Report, Gill Frame highlighted the following issues:-

·         The Board was now statutory, and has been developing, including reviewing membership and governance.

·         One of the previous year’s Serious Case Reviews (SRC) was now complete and available on the website.

·         A peer review would be undertaken in January 2018 with colleagues in Oldham.

·         Quality assurance processes were under development that would then be used to audited partner agencies.

Members of the Board raised the following issues:-

·         Had the training for the Police on mental health led to a change in how they dealt with adults with mental health issues, particularly out-of-hours? In response it was stated that there had been a longer term change from treating those with mental health challenges as perpetrators to focussing on their vulnerability. There remained an issue with people being taken to hospital as place of safety as this created a bureaucratic burden but had little other value. It was further commented that there had been a significant shift in Greater Manchester in the last few years, through the Crisis Concordat, toward much closer working between mental health services and the police.

·         Assurance was sought that despite some of the CQC ratings for social care provision locally, steps were being taken to ensure adults in social care settings were safe. In response it was stated that the Council was working closely with care home providers through its Quality Team and Equip Team and increasingly through good multi-agency partnership working to address issues that might present safeguarding concerns.

RESOLVED – (1) That the Safeguarding Adults Board Annual Report for 2016/17 be noted.

(2) That Gill Frame and Nuala O'Rourke be thanked for their attendance and presentation.

Warren Heppolette, Executive Lead for Strategy & System Development at the Greater Manchester Health and Social Care Partnership, will attend the meeting to present the Partnership’s Annual Report.

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

Warren Heppolette, Executive Lead for Strategy & System Development at Greater Manchester Health & Social Care Partnership, attended the meeting to present the Partnership’s Annual Report for 2016/17 (copies of which had been circulated) and provide an overview of the 2018/19 challenges and priorities.

The presentation covered the following issues:-

·         The vision of the Partnership and its key objectives

·         Significant activity and delivery in 2016/17, including financial information

·         Use of the Transformation Fund

·         Reflections and lessons learned from the first year

·         Key achievements so far for 2017/18 including the current position with the developments with the locality integration programmes

·         The key priorities and challenges for 2017/18.

Members of the Board then discussed the report and presentation and the following comments were made/ issues raised:-

·         Given that all 10 local economies were pressing ahead with plans for health and social care integration, it was noteworthy that Stockport seemed to be the only locality that faced organised opposition to those plans, particularly since Stockport Together predated Sustainability and Transformation Plans that had been the cause of national concern. In response it was also commented that there was not necessarily opposition to the idea of cooperation but that there seemed to have been a conflation with a debate about the levels of health service funding.

·         The scale and pace of change taking place in Greater Manchester was significant, and partners were adapting to circumstances as they arose. In response this was acknowledged and it was stated that there were examples of the Partnership acting in the absence of evidence but creating that evidence base in the process.

·         While the benefits of Greater Manchester wide working and cooperation were obvious there was a danger that partners would end up at odds with each other, such as in recruiting staff. In response it was acknowledged that there may be challenges to collaboration but it was important to put people and place over organisational needs, although in the case of the workforce this was a particular challenge and decisions were likely to negatively impact others.

·         The response from the Partnership to address the challenges at Pennine Acute Trust was a positive model, but there was a concern that this was not the only Trust in Greater Manchester with challenges and did the Partnership have capacity to support them all?

·         The workforce needs were being addressed through a range of initiatives, and working between the Partnership and the GM Mayor was helping to create further opportunities through universities and increasingly through the work to Further Education and skills.

·         It was important to understand Stockport activity in the broader Greater Manchester context but this should not mean always following their lead but rather choosing a path that best suited local needs.

RESOLVED – That the Greater Manchester Health and Social Care Partnership Annual Report 2016/17 be noted and Warren Heppolette be thanked for his attendance and presentation.

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

Following the publication of the Stockport Health and Wellbeing Board’s Joint Health and Wellbeing Strategy 2017-2020 in February 2017, the Board committed to producing a regular annual review of the strategy.

This is the first annual review of the Stockport Joint Health and Wellbeing Strategy. It described actions that have been undertaken and highlights key achievements from the last year from across the Stockport Health and Care partnership.

The report updates the priorities and plans the period up to 2020, and identifies areas where further joint work is needed; ensuring that the strategy remains relevant and reflects the developing programmes.

The Board is invited to:-

·         review, comment on and amend the JHSW year 1 review and approve for publication;

·         consider what joint work could be undertaken in 2018 to review social isolation in Stockport and to mobilise a harmonised response;

·         consider what joint work could be undertaken in 2018 to improve the support for mental health, focusing on young people, especially at transition points and complexities of people with dual diagnoses for whom it is still difficult to provide joined up services;

·         consider how it can contribute to the review of the Greater Manchester Spatial Framework and the Stockport Local Area Plan.

Officer contact: Eleanor Banister, 0161 474 2447, eleanor.banister@stockport.gov.uk

Donna Sager, Deputy Director of Public Health, submitted a report (copies of which had been circulated) inviting the Board to consider the first annual review of the Stockport Joint Health & Wellbeing Strategy. The Board had previously agreed to review and refresh the Strategy annually to keep pace with rapid change in the health and social care economy. In refreshing the priorities in the Strategy, partners and stakeholders had been consulted and these had been aligned with those contained in other significant plans and strategies including the Greater Manchester Population Health Plan.

At a special Board stakeholder event in September 2017 it had been suggested that the Strategy include a renewed focus on social isolation, mental health, and whether the housing stock met the needs of vulnerable tenants.

The following comments were made/ issues raised:-

·         Concerns had been raised with Healthwatch that for young people receiving mental health treatment there was often no equivalent adult service for them to transition into once they stopped being eligible for children’s services.

·         There were a number of websites for voluntary sector led community activities that were out of date, which would not be helping those feeling isolated, and made it difficult for others to signpost people to such activity. In response it was stated that as part of the Council’s Digital by Design programme Stockport Local had been developed, that was a directory of community group information available at www.stockport.gov.uk/groups although this still depended on groups keeping the information up-to-date. It was further commented that not all residents were computer literate, particularly those who were most vulnerable.

RESOLVED – That the refreshed Stockport Joint Health & Wellbeing Strategy be approved.

To consider a presentation from Sarah Ferguson, Interim CEO of Viaduct Health, on the emerging model for 7 way day working in Stockport.

Sarah Ferguson, Interim Chief Executive of Viaduct Health, attended the meeting and made a presentation on the development of the 7 day model for extended GP hours.

The presentation covered the following issues:-

·         National policy drivers to the provision of 7-day access, including the NHS England GP Forward View.

·         Greater Manchester policy commitments to extend access to primary care services as part of the broader ambitions to improve health outcomes in the conurbation.

·         The Stockport Together Programme and the commitment to reducing variation, extend access, increase focus on prevention and early intervention and improve support to those with long term conditions.

·         Analysis of survey data from patients about experiences of getting GP appointments that indicated that Stockport practices performed better than the national averages.

·         Aspirations for the local 7 day service included providing additional appointment capacity in the morning and evening and at weekends; access available through the new neighbourhood hubs; clinical triaging and acute visiting 7 days a week for those with urgent medical needs at risk of hospital attendance/admission.

The following comments were made/ issues raised:-

·         It was clarified that access would be to a GP, not necessarily a patient’s usual GP or even their usual practice. This was being facilitated through the use of the EMIS patient record that was being taken up across the local economy.

·         Viaduct had done significant work to develop these proposals in a short space of time, taking the Greater Manchester specification, but embedding it within the Stockport Together model. These proposals were a pragmatic solution working with the neighbourhood hub model in order to enable them to start to deliver services.

·         It was recognised that there would need to be a clear communications plan with clear, consistent messages.

·         Healthwatch was receiving anecdotal evidence that although surgeries were increasingly open on Saturdays no staff were available to answers the phone and there was a lack of advance booking availability. In response it was acknowledged that there may be a lack of non-clinical staff available during these extended hours but that the priority was for investment in clinical staff and provision, but the model would evolve. It was also acknowledged that there was more work to be done to reduce some of the variability in existing provision.

·         Clarification was sought on how these proposals fitted with the NHS 111 system. In response it was stated that these enhancements were designed to work with existing provision and appointments would need to be made through the practice number that would go through to NHS 111 and onto Mastercall. This would also ensure resilience for smaller practices.

·         Would the proposals result in 7 days’ worth of the same GP activity, or would the focus be on a different type of provision in the extended hours? In response it was stated that there would be a mixture of extended existing types of provision to provide greater convenience, but also using the capacity to focus on improving outcomes, such as the acute home visits.

RESOLVED – That the outline of the proposed model for 7 Day GP services be supported, but the Board would highlight the importance of a comprehensive communication strategy and ensuring those without access to technology were not disadvantaged when trying to access information and services.

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

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 a forward plan of agenda items for future meetings of the Board.

RESOLVED – That the report be noted.