Agenda item

This report outlines the results from consultation exercises undertaken with service users, their families and carers, and providers on the following draft IIS business cases:

·                     Preventative commissioning strategy

·                     IPS Children and Family Services

·                     Integrated Care – Adult Social Care and Health

·                     0-25 SEND Review

·                     Learning Disability Review

The Scrutiny Committee will be asked to comment on the report prior to its consideration by the Executive on 16 December 2014.

Update: 21 November 2014

Previously the Scrutiny Committee has received reports on the Investing in Stockport business case working papers and members have previously commented on the Investing in Stockport Preventative Commissioning Strategy in which a number of high level proposals were identified for the Public Health contribution to the Business plan.

The Business Case for Public Health has now been revised and is included for further consideration. They include two areas:-

•             Drug and Alcohol service re- commissioning.

•             Further services and contracts in Public Health

Officer contact: Steve Skelton, 0161 474 3174, steve.skelton@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) and appropriate project leads attended the meeting to answer questions.

The following comments were made/ issues raised:

Preventative Commissioning Strategy

·         Interesting feedback had been received from the focus groups in relation to the danger of ‘bureaucratisation’ of services.

Integrated Prevention and Safeguarding Services

·         Responses were less positive where they related to Children’s Centres for which responsibility was transferring. In response it was stated that many of the concerns had been about the future of services once responsibility had been transferred. As mitigation there would be a Partnership Agreement with the receiving organisation to ensure the maintenance of service.

·         The weight given to responses was queried, particularly in relation to the mitigation measures. Were mitigation measures proposed for all responses or only where there were a number of similar concerns? In response it was stated that the responses had been themed but that all feedback had been captured. No weighting was given, and any legitimate concern would have been considered and mitigation measures proposed if appropriate.

Integrated Health & Social Care

·         Concerns were expressed about how far the existing integrated hub was providing genuinely integrated services or whether there was simple co-location. In response it was stated that progress had been slower than hoped in respect of integration, and that there was not a completed integrated care model in place yet that could be rolled out to other localities. It was also emphasised that irrespective of progress, clients would notice better service.

0-25 SEND Review

In relation to the Short Breaks Consultation:-

·         The breakdown of responses in the report was useful.

·         Queries were raised in relation to the eligibility criteria that would be used should the Proposals be agreed. In response it was stated that it was proposed to limit eligibility to those who met the social care threshold. It was further proposed to make limited reductions in service in the first year of implementation allow existing clients to access alternative services. It was also emphasised that the Learning Disability Partnership’s local offer was now on-stream that would allow clients and new users to find other opportunities and services. This information was co-produced with carers.

·         Comments had been made that this service had a preventative role in avoiding families reaching crisis point and requiring more costly interventions. In response it was stated that this potential risk was recognised and mitigation measures were proposed in the report.

·         There was a query about the potential to change threshold levels and the enforcement of these thresholds. In response it was stated that this had been considered, but it was proposed to target the short breaks service to those in most need.

·         It should be recognised that there will be some families who will lose out on a service from which they previously benefited.

·         A question was asked about take-up of service and whether any eligible families failed to take up services. In response it was stated that the Aim Higher programme had led to an expansion of provision that went unused. The Service had worked hard to refocus this provision to ensure that capacity was being utilised. As a result, there were very few people failing to attend.

·         The report was comprehensive and the feedback message seemed clear.

In relation to Educational Psychology Service consultation:-

·         The waiting times for referrals to the service was queried. In response it was stated that there were no waiting times as such and that it was for the school to prioritise its pupils for the time with the Service. It was planned to explore ways to better inform and advise schools about how best to prioritise. It was also emphasised that the proposals would ensure that the Council’s Statutory Responsibilities were being met.

·         Concerns were expressed that the service changes may lead to delays in referrals on to CAMHS.

·         The Scrutiny Committee had previously made recommendations in relation to the Educational Psychology Service and its work with CAMHS Services. Would these proposals impact on those recommendations? In response it was stated that these were outside of the scope of the current proposals, but that part of their aim was to ensure greater consistency between schools to ensure appropriateness of the contact time with pupils.

In relation to the Early Years Provision Consultation:-

·         Did the relatively low response rate to the consultation reflect general satisfaction with the service and the proposals? In response it was stated that it was not possible to draw such a conclusion, but that there was a general confidence amongst service users in the work of the Early Years Team and the increasing co-ordination with the Integrated Prevention and Safeguarding Service.

·         A question was asked about the roll-out of free nursery places to 2 year olds. In response it was stated Stockport was one of the best performing Local Authorities in Greater Manchester in this respect.

The Scrutiny Committee noted the positive feedback to these proposals.

Learning Disability Review

·         The proposals must be predicated on the assumption that service users could afford the new provision.

·         There was a need to ensure that local GPs and other agencies were aware of this new provision.

The Scrutiny Committee then gave consideration to the revised Business Case for the Preventative Commissioning Strategy (copies of which were circulated). The revised Business Case included a further £1.5m of savings from a range of public health activities that would then be reinvested into other services to support the delivery of the Stockport Health Promise.

The following general comments were made/ issues raised:-

·         It would be beneficial to work in conjunction with the Clinical Commissioning Group to ensure that any re-commissioned or reconfigured services complemented their activity.

·         Greater Manchester Fire and Rescue Service were expanding their community activities, including the development of a CRIT Team to support accident prevention that may provide opportunities for joined-up service delivery.

·         It was important to emphasis doing things ‘smarter’.

In relation to the specific proposals for the re-commissioning of drug and alcohol services, the following comments were made/ issues raised:-

·         It was queried whether it was possible to reduce spend in this area and reconfigure services but achieve better outcomes/do more. In response it was stated that the current system was heavily biased toward treatment and clinical services. The proposal was to move away from this to models that were less medicalised and therefore not as expensive, so there was scope for greater activity.

·         Concerns were expressed about the ability to prevent the escalation of those with emerging alcohol or drug misuse problems due to the unwillingness of the individuals to seek help. In response it was stated that families and carers were often more willing to flag problems than the individuals themselves. It was also suggested that there may be safeguarding triggers introduced.

·         There was a key role for primary care services in this area, and this formed part of the development of the Greater Manchester Primary Care Strategy.

·         There was a query about whether detox services should be expanded. In response it was stated that the failure rate of detoxification activity, particularly residential detox, so the service had already introduced greater checks on the appropriateness of referrals and placed greater emphasis on aftercare to support sustained recovery.

·         Concerns were raised about the impact of reductions on the activities of MOSIAC and START and whether this would improve outcomes. In response it was stated that MOSIAC services were being aligned with the Integrated Children’s Safeguarding and Prevention Service so that wider causes and problems were also being addressed. In relation to START it was stated that work was underway to address inappropriate referrals from other agencies, particularly those from the Criminal Justice System.

·         One of the opportunities presented by the GM Devolution proposals was for greater co-ordinated action on alcohol misuse.

·         There were risks inherent in moving to new and potentially untried providers, and in TUPE’ing staff.

·         The comments made by officers at the meeting had provided greater reassurances in relation to these proposals.

RESOLVED – (1) That the report be noted.

(2) That the comments of the Scrutiny Committee in relation to the Investing in Stockport Business Case Consultation reports be forwarded to the Executive for consideration.

(3) That the Director of Public Health be requested to report back to the Scrutiny Committee on the impact of changes to the Drug and Alcohol Services following 12 months of their implementation.