Issue - meetings

To consider a report joint report of the Cabinet Members for Adult Social Care and for Health.

We have been working together with partners and with the public and patients to test and trial new ways of working that improve people’s experience of treatment and care and their outcomes. The results of this initial work are encouraging. These Outline Business Cases describe how we can by working together more closely deliver these new models of care and associated benefits to many more people on a permanent basis. It is important that before we propose making these changes permanent that we hear from a wider group of patients and the public to ensure that our thinking is right and is shaped by their experiences and expectations. It is equally important that as the work on the design of the new service models continues to progress, the Boards of all the Partners remain sighted and able to comment on and influence the content ahead of final approval being sought.

The final approval of these Outline Business Cases is subject to our learning from a period of wider patient and public involvement. We anticipate the Boards of each Partner organisation receiving Final Business Cases for discussion and proposed approval in late 2017.  In the meantime funding from the Greater Manchester  Health & Social Care Partnership will enable us to continue to develop and test our thinking. Changes will not happen overnight and there will be continual adjustment of ideas as we implement them. This is just one of many stages at which we will need patients and the public to be involved if the people of Stockport are to have the best health and care services available so they can live healthier and happier lives.

The Cabinet is invited to

1.      endorse the Outline Business Cases as the current description of the approach of the Stockport Together partners to design and delivery of new models of care.

2.     note that the cases will remain in outline and be finalised for approval, anticipated late 2017 as a result of learning from a period of wider patient and public involvement and continued input from clinicians and professionals working across health and care.

3.     support the continuation of the Greater Manchester Transformation Funding being invested in testing the thinking locally and in refining and developing the services for the benefit of patients.

Officer contact: Andrew Webb, 0161 474 3808

A joint report of the Cabinet Members for Adult Social Care and for Health was submitted (copies of which had been circulated) inviting the Cabinet to consider a series of Outline Business Cases for new models of health and social care, developed as part of the Stockport Together Programme for health and social care integration.

The Outline Business Cases focussed on the following areas:-

·         Summary Economic

·         Neighbourhood Model

·         Intermediate Care

·         Enablers

The Cabinet Member for Health outlined the background to the development of the Stockport Together programme, including

·         the Cabinet’s previously stated commitments to improving health and outcomes for those using local services and to reduce long-standing inequalities;

·         the financial constraints on local partners and funding future challenges;

·         demographic pressures on services currently and the projected ongoing challenge this would create, in particular a cohort of older people with complex needs creating demand on acute services;

·         the ambition of the Programme to fundamentally change the way certain services were delivered;

·         the concerns of particular groups about the possible impact of changes of access and quality of care, and of the achievability of the Programme.

The Cabinet Member emphasised that the Programme was not seeking to deny or reduce access to health services, but to ensuring that those in need received the right service from the right professional in the most appropriate place to receive that service, thereby releasing resources and time for reinvestment.

Specifically in relation to the Outline Business Cases, the Cabinet Member highlighted:-

·         the other partners within the Programme had considered and commented on the Outline Business Cases and endorsed them, subject to various caveats;

·         the Council’s Scrutiny Committees had considered their content and been supportive;

·         it was important to ensure that the new models of care were implemented as soon as possible to realise savings and to release Transformation Fund resources;

·         a number of ‘listening’ events had taken place and would continue to take place over the coming weeks;

·         final decisions on the business cases would be taken at the turn of the year, and these finalised documents may be very different following public and professional consultation;

·         further consideration on organisational and governance form would take place in the future and be subject to further public consultation.

The Cabinet Member in summation emphasised that ‘doing nothing’ was not an option open to partners and that although services would change as a result there remained significant uncertainty and risk.

The Leader of the Council commented on the significant funding challenges facing partners and the Council in particular, emphasising the significant national underfunding of social care, about which the Council and its partners could do little to change. He further stated that the proposals were not simply about responding to reduced resources and increased demand, but also about improving the quality of care being provided.

Other Cabinet Members acknowledged the significant financial, organisational and cultural challenges of the Programme but also emphasised the importance of seeing patients and people who used services as being at the core of this agenda.

RESOLVED – That in relation to the Stockport Together Outline Business Case:-

(1)          the Outline Business Cases as the current description of the approach of the Stockport Together partners to design and delivery of new models of care be endorsed, subject to the following caveats:-

(i)     the need to focus on

·           reducing health inequalities

·           ensuring mental health and parity of esteem were prioritised by all partners

·           having a workforce with the right skills allied with the right approach to recruitment, training and retention

·           prevention, or where this was not possible early intervention

·           quality of care

(ii)    and further consideration of

·           how to generate the cultural change needed

·           whether there was sufficient capacity to deliver the Programme

·           clearly defined commissioning targets and plans to which all within the system worked toward

(2)          the cases remaining in outline and being finalised for approval, anticipated late 2017 as a result of learning  ...  view the full minutes text for item 5

To consider a report of the Corporate Director for People.

Stockport Together partners have been working together and with the public and patients to test and trial new ways of working that improve people’s experience of treatment and care and their outcomes. The results of this initial work were encouraging.

These Outline Business Cases describe how partners can by working together more closely deliver these new models of care and associated benefits to many more people on a permanent basis. It is important that before proposing making these changes permanent that partners hear from a wider group of patients and the public to ensure that their thinking is right and is shaped by public/patient experiences and expectations.

The final approval of these Outline Business Cases is subject to the learning from a period of wider patient and public involvement.  In the meantime funding from the Greater Manchester Health & Social Care Partnership will enable the continuation to of the development and testing of the proposals. Changes won't happen overnight and there will be continual adjustment of ideas as the plans are implemented. This is just one of many stages at which there is a need for patients and the public to be involved if the people of Stockport are to have the best health and care services available so they can live healthier and happier lives.

Recommendation

The Scrutiny Committee is invited to consider the draft Outline Business Cases included in this agenda and make comments as part of the consultation on these proposals.

Officer contact: Andrew Webb, 0161 474 3808

The Corporate Director for People submitted Outline Business Cases (copies of which had been circulated) describing how partners would by working together more closely deliver these new models of care and associated benefits to many more people on a permanent basis. It was important that before proposing making these changes permanent that partners hear from a wider group of patients and the public to ensure that their thinking was right and was shaped by public/patient experiences and expectations.

The Scrutiny Committee considered the Economic Case and the Enabler Outline Support Plan.

Stockport Together partners had been working together and with the public and patients to test and trial new ways of working that improved people’s experience of treatment and care and their outcomes. The results of this initial work had been encouraging.

The final approval of these Outline Business Cases was subject to the learning from a period of wider patient and public involvement.  In the meantime funding from the Greater Manchester Health & Social Care Partnership would enable the continuation to of the development and testing of the proposals. Changes wouldn’t happen overnight and there would be continual adjustment of ideas as the plans are implemented. This was just one of many stages at which there was a need for patients and the public to be involved if the people of Stockport are to have the best health and care services available so they can live healthier and happier lives.

The Leader of the Council (Councillor Alex Ganotis) attended the meeting to answer members’ questions.

The following comments were made/ issues raised:

·         There was a need to continually re-evaluate and review the business cases to ensure the changes were working and saving were being realised.

·         The business cases were very detailed and this Scrutiny Committee would welcome reports which concentrated on specific detail rather than overarching reports.

RESOLVED – (1) That the Outline Business Cases and the consultation on these proposals be noted.

(2) That regular reports be submitted to this Scrutiny Committee in relation to the financial & Governance arrangements.

To consider a report of the Corporate Director for People.

Stockport Together partners have been working together and with the public and patients to test and trial new ways of working that improve people’s experience of treatment and care and their outcomes. The results of this initial work were encouraging.

These Outline Business Cases describe how partners can by working together more closely deliver these new models of care and associated benefits to many more people on a permanent basis. It is important that before proposing making these changes permanent that partners hear from a wider group of patients and the public to ensure that their thinking is right and is shaped by public/patient experiences and expectations.

The final approval of these Outline Business Cases is subject to the learning from a period of wider patient and public involvement.  In the meantime funding from the Greater Manchester Health & Social Care Partnership will enable the continuation to of the development and testing of the proposals. Changes won't happen overnight and there will be continual adjustment of ideas as the plans are implemented. This is just one of many stages at which there is a need for patients and the public to be involved if the people of Stockport are to have the best health and care services available so they can live healthier and happier lives.

The Scrutiny Committee is invited to consider the draft Outline Business Cases included in this agenda and make comments as part of the consultation on these proposals.

Officer contact: Andrew Webb, 0161 474 3808

The Corporate Director for People and Senior Responsible Owner for the Stockport Together Programme (Andrew Webb) submitted six outline business cases (copies of which had been circulated) setting out proposed changes to models of care for health and social care services.

Dr Viren Metha (Viaduct Health), Mark Fitton (Director of Operations, Adult Social Care, Stockport Council), Dr Donna Sager (Deputy Director of Public Health) and Keith Spencer (Director, Stockport Together Providers) attended the meeting to answer questions.

The Cabinet Members for Adult Social Care (Councillor Wendy Wild) and Health (Councillor Tom McGee) also attended the meeting to respond to questions.

The Cabinet Member for Health made introductory remarks, including:-

·         Local health and social care partners would be facing a significant shortfall in their finances in coming years of approximately £156m. All partners involved believed that it was therefore imperative that new models of care be implemented as soon as possible to ensure that savings could be achieved.

·         £19m of Transition Fund resources had been secured, but this was conditional on continued progress with development of the Stockport Together Programme.

·         At this stage the Outline Business Cases were in draft form, and comments were being sought prior to the publication of Final Business Case before the end of the year. Although the proposals may change in the intervening period going backwards or not doing anything was not an option.

·         There were a series of listening meetings taking place across the borough.

·         The concern at the moment was not about the organisational vehicle, but about getting right the delivery of better models of care. Governance arrangements would be revisited in due course and subject to a full public consultation.

Each business case was introduced and comments and questions invited.

Summary Economic Case

The following introduction was provided:

·         It was projected that by March 2021 partners providing health and social care services would have a collective cumulative deficit of £150m.

·         Irrespective of financial considerations, there remained an imperative to change and improve services from both patients and practitioners.

·         The aim of the programme was to develop joined up services that provided better care to our population.

·         It was acknowledged that progress on the development of the Business Cases had been less than anticipated but this was due to the level of detail and the need to develop models that were flexible enough respond to changing circumstances.

·         Prevention was the primary objective of the Programme, from preventing ill-health to preventing escalation to avoidable interventions.

·         The £19m investment from the Greater Manchester Transformation Fund was needed to facilitate the recycling of resources to support the neighbourhood model of care.

·         One of the key factors shaping the programme was the NHS internal market and tariff system, which was at variance with other partners cost models, and so models processes designed to allow us to move forward with those uncertainties still, so will double run. But can’t keep this going forever.

·         The modelling underlying the business cases assumed only half the savings required, in part because of non-recurrent funding, and likely reviews of Local Government and NHS funding arrangements. The assumptions were based on those areas where there was confidence that savings could be made.

The following comments were made/ issues raised:-

·         The document referenced activity paid for by the Clinical Commissioning Group to providers other than the local NHS Foundation Trust. How would the differing models being developed by neighbouring economies be accounted for? In response it was stated that analysis of the specialities involved had determined which would form part of the programme. Furthermore, the starting point for this programme had been general practice where referrals were generated.

·         There was emphasis placed on developing a skilled and integrated workforce but little detail. What was proposed? In response the importance of the issue was highlighted, and its centrality to the programme emphasised. It was also stated that the focus of partners was to identify those posts/roles  ...  view the full minutes text for item 4