To consider a report of the Corporate Director for People.
The Final Update Portfolio Performance and Resource Report (PPRR) for the Health Portfolio is presented for consideration by the Committee. This provides a summary of progress in delivering the portfolio priorities, reform programme and other key projects since the mid-year report, with a focus on the third quarter of the year (October to December). It includes forecast performance data (where this is available) and projected financial data for the Portfolio, along with an update on the portfolio savings programmes.
Scrutiny Committee is asked to:
· consider the Final Update Portfolio Performance and Resource Report;
· review the progress against delivering key projects, priority outcomes, targets and budgets for 2016/17;
· highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues;
· highlight any significant issues or changes to be fed back to the Executive alongside the Corporate Performance and Resource Report;
· identify how areas of strong performance and good practice can be shared in other services.
The Executive Councillor (Health) submitted a report (copies of which had been circulated) detailing the Portfolio Performance and Resources Report for the Health Portfolio, providing an update on key activity in the third quarter of 2016/17, with a summary of progress in delivering the portfolio priority outcomes through the Council’s investment programmes. It also included forecast performance data and projected financial data for the Portfolio, along with an update on the portfolio savings programme.
The Executive Councillor highlighted ongoing work to train those working in the new Neighbourhood arrangements; there was an improvement in the uptake of flu vaccinations; there were examples of the positive use of the JSNA.
The following comments were made/ issues raised:-
· A further update on the ambulatory care deflection from A&E was sought, and whether these additional measures to ease pressure were leading to an increase in demand. In response, it was stated that the triaging at A&E had been effective and that it was important to ensure that resources were used most appropriately. It was also stated that attendances had decreased, but this could be due to a number of causes. The suggestions that attendances were linked to difficulties in getting GP appointments was difficult to analyse because of the variation in the methods that data was kept and sorted by practices.
· What could be learned from the recent closure of Bramhall High School due to flu? In response it was stated that it had demonstrated that Public Health systems and communications were robust and provided reassurance about their effectiveness should they be needed again. Questions still remained however about why the outbreak had occurred. In was further commented that there had been criticism of the decision to close but that the decision to do so had not been taken lightly, and was unprecedented in recent years in Stockport.
· Comment was sought on the implications of recent announcements by the Prime Minister on mental health spending, and the impact on Stockport Together. In response it was stated that not enough detail about the announcements was known to give a full answer. The CCG were required to, and had, increased their spending on mental health. It was important to ensure that spending was appropriate so as to ensure there was intensive support when needed but also the resources to intervene earlier to prevent longer term treatment.
· Stepping Hill Hospital was seen within the Greater Manchester Health & Social Care Partnership as being a ‘problem’ hospital because of productivity and targets, and therefore a concern about it being able to deliver its transformation plans. In response it was commented that in the recent spike in admissions, the hospital Trust did not declare an emergency unlike many Trusts in the country. The difficulties in achieving the 4-hour admissions target were not due to want of trying on the part of the Trust, but hospital staff were unwilling to compromise on care.
· What measures were planned to address the variability in GP practices? In response it was acknowledged that this was a challenge but was something that was being addressed through the work on reducing health inequalities. There were challenges in the intelligence and data available from practices as this varied depending on the recording methodology used. GPs accepted that there remained training needs for those reception staff that have responsibility for triaging calls from patients.
· An update was requested on the creation of new accountable care trust. In response it was stated that the Executive was keen to ensure all groups on the Council were supportive of the proposal, and a key element of this was to ensure sufficient democratic accountability when committing Council resources. Until the work on this was complete, the Executive would not be in a position to commit to this particularly option. Nevertheless, the aim was for a decision to be taken on the future arrangements within the current calendar year.
· An update on the implementation of Stockport Together was sought. In response it was stated that Neighbourhood Teams had already been created but that the significant challenge would be bring about cultural changes to working practices. Partners needed to work ‘smarter’ across a range of areas to improve the flow of patients through the system and to ensure appropriate monitoring for effectiveness and unintended consequences.
· Further detail was sought on the budget position. In response it was stated that recent government announcements had not provided additional resources, and so it was hoped that the budget pooling with the CCG would provide sufficient flexibility to make best use of available resource and avoid duplication. It was emphasised that the pooled budget was not a panacea, but was the best solution available, and preferable to having a solution to local health budget pressures imposed.
· Why were residents reluctant to take up health checks? In response it was stated that this was a complex picture with no single answer. The data collection methodology had changed, which may have accounted for some of the apparent deterioration in uptake. Further thought needed to be given to the times and locations of these checks to make them more attractive. Again there was variability in the amount of chasing of patients that GP practices would do, but there would always be individuals who would not take up the offer.
· Further comments were made that scare stories in the press may discourage people taking advantage of free health checks, particularly in light of concerns about false positives and the perception that these outweighed true positives, for example with breast cancer screening.
· There needed to be a better method of capturing all contacts with GPs and practices to better understand, and then manage, ‘failure demand’.
· Concerns were expressed that the current arrangements at GP practices meant that those contacting them were seen to be ‘wasting their time’, whereas other primary care providers such as pharmacists, dentists and optometrists often were more customer focused. The system was currently most geared up to cater for the ‘worried well’. In response, it was acknowledged that this often seemed to be the case, and that the unintended consequence that needed to be overcome was that treatable illness was incorrectly attributed to age.
RESOLVED – That the report be noted.