To consider a report of the Deputy Chief Executive.
The Annual Portfolio Performance and Resource Reports (PPRRs) for the Adult Social Care and Health Portfolios are presented for consideration by the Committee. Following positive feedback across all Scrutiny and Cabinet Members to the streamlined format of the Third Update Reports, this report follows a similar approach.
As an Annual Report, whilst focusing on highlights and exceptions over the last quarter of 2018/19 (January to March), it also rounds up the latest position across all projects, programmes and activities within the Portfolio Agreement, along with the full set of performance measures reported during the year. It also includes out-turn performance and financial data for the Portfolio where this is available.
Scrutiny Committee is asked to:
· consider the Annual Portfolio Performance and Resource Reports;
· review the progress against delivering key projects, priority outcomes, targets and budgets for 2018/19;
· highlight any significant issues or changes to be fed back to the Cabinet alongside the Corporate Performance and Resource Report; and
· identify how areas of strong performance and good practice can be shared in other services.
The Cabinet Member for Adult Care & Health submitted the final two portfolio performance and resources reports for the Adult Social Care and Health portfolios (copies of which had been circulated). The Annual Reports provided highlights and exceptions over the final quarter of 2018/19 and a summary of the position on all projects, programmes and activities within the Portfolio Agreement, and the out-turn performance and financial data for the portfolios.
The Director for Adult Social Care and the Director of Public Health also attended the meeting to respond to questions.
Adult Social Care
The following comments were made/ issues raised:
· An update on Stockport Together was requested.
· In response, it was confirmed that the Health & Wellbeing Board was overseeing this work, and that partners remained committed to integrated working. It was further commented that the Chair of the Board had recently restated the Council's commitment to Stockport Together.
· A further update was requested in relation to activity in Greater Manchester (GM). In response it was stated that the GM Whitepaper report elsewhere on the agenda provided a response to some of the element of the NHS 10 year plan, although GM aspirations differed slightly from the national model, and further consideration as needed to understand the implications of these commitments. Partners in Stockport were committed to the current alliance model and discussion were ongoing on developing a single commissioning approach.
· Reference was made to an event in December 2018 and a recent follow-up event about learning disabilities that highlighted a number of areas for local authorities and health partners to improve health outcomes for service users. The discussions at these events mirrored those had at this Scrutiny Committee during last year when discussing the good work being done locally to improve the health of those with learning disabilities.
· Members welcomed improvements in residential care ratings.
· Further comment was sought on why performance on the permanent admission of older people into nursing care remained a risk. In response it was stated that the Council’s aspiration was to improve the number of residents remaining at home. It was important to reduce resident’s stay in acute settings as this had a deleterious effect of those aged over 75, and this was one of the key elements of the new models of care It was also suggested that demographic pressures may also be effecting performance. In response to these comments a councillor expressed concern about the potential for rushing patients out of beds to quickly, and another asked whether lower than expected performance was also reflected in the budget overspend. In response it was stated that the aim was to reduce the need for hospital care, rather than reduce the care offered when needed. In relation to budgets and costs it was stated that the pressure was not simply a function of activity levels, but also rising costs.
· It was queried whether there was a correlation between of suitable housing for those with mobility issues and the number of admissions. In response it was acknowledged that the significant demographic challenge for Stockport was putting pressure on housing supply, and that there were lots of older people who were “property rich but resource poor”. A number of GM initiatives were underway to try to address these challenges, including the retendering of support accommodation and the development of the All Age Living Prospect to ensure that needs of older people were taken account of in new developments.
· Concern was expressed that in relation to target ASC 5.1 ‘Domestic Abuse re-victimisation rates’ that the factors influencing this target were outside the control of the Council alone. In response this was acknowledged and assurance given that there was a multi-agency approaching taken to this area with focussed work being undertaken.
· Clarification was sought on whether the recommendations of a previous scrutiny review in relation to the continuation of funding for dementia cafes and drop-ins had been implemented. In response it was stated that no decision had been taken to cease funding these activities, but that many were community led and the Council would encourage and support that. It was further commented that the Stockport Local Fund had also supported a number of these schemes.
· What were the key learning points from the Heatons Pilot? In response it was stated that a key issue to have emerged was that bring together the large number of groups doing very specific things was a powerful way of sharing resources, learning and finding synergies. GPs were also aware of lot of patients whose needs were not medical, but they were unclear about how to find them community support. The role Wellbeing Coordinators had been created to bridge this gap and provide this support. Bringing community based support groups into the Practice had increased linkages and training receptionists to help signpost patients to other facilities and services had also been positive. Councillors welcomed this activity and commented on the positive feedback received from residents.
· Disappointment was expressed that ward councillors had not been involved in the roll-out of health champions. In response it was stated that this process had been a practice, or bottom-up led process.
· Concerned was expressed about the role of Health Champions in health interventions ad whether this was best managed by a health professional. In response it was confirmed that no health champion was involved in clinical work. The Health Champions were envisaged as a broadening of the family of services within general practice. Roll-out of the initiative had given demonstrated the need to ensure capacity to support the practice. It was suggested that councillors may wish to visit a practice to learn more about the initiative.
· Councillors welcomed the reduction in alcohol admissions for under 17s. In response it was stated that the reasons for this reduction in the persistent problem were not clear, and some evidence suggested alcohol consumption had increased. While challenges remained, it seemed that young people’s attitudes to alcohol were changing.
· Concern was expressed that while uptake of immunisation at ages one and two was good, take-up drops at five years, and it was queried whether this was connected to anti-vaccination messages and what monitoring of this was done locally. In response it was stated the Council did not monitor social media, but that GPs would often inform Public Health team of particular issues. It was commented that the legacy of the MMR scandal was still being felt, and may explain why parents did not choose to have their child immunised. There had recently been outbreaks of measles in GM and mumps in Stockport.
· Was there any link between declining improvements in mortality rates and ‘austerity’ or was there any evidence that a reduction in the wealth disparities had a correlation with improved outcomes? In response it was stated that there was national evidence to demonstrate the correlation between income and health outcomes, although it may be too early to demonstrate a statistical link with ‘austerity’. The polarised nature of the borough this may explain the health inequalities.
· In relation to clean air it was suggested that closer phasing of traffic signals to reduce the amount of idling time of traffic would provide a simple contribution to improving air quality.
RESOLVED – (1) That the 2018/19Adult Social Care and the Health Annual Portfolio Performance and Resources Reports be noted.
(2) That the Director for Public Health be requested to submit an item to a future meeting with more detail in relation to ASC 5.1 ‘Domestic Abuse re-victimisation rates’.
(3) That the Director for Adult Social Care be requested to provide an update on the co-location of the multi-disciplinary teams.