Issue - meetings

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

The Council Cabinet endorsed a number of outline business cases in July 2017 subject to public consultation. This report sets out in detail the response to the consultation and both recommends the adoption of the Business Cases and proposes a process to monitor and review their implementation prior to any decisions being taken to remove capacity from the cute hospital.

The Cabinet is asked to:

•     Consider and scrutinise carefully the feedback from the public consultation, the updated equality impact assessments (EIAs), the views of the Adult Social Care & Health Scrutiny Committee and the proposed response.

•     Approve the recommendation at 4.5.2: Approve the approach described in the previously endorsed outline business cases and proceed to implementation subject to recommendations as set out in Section 5 of this report.

•     Adopt a series of recommendations regarding our approach to implementation in light of the feedback and as set out in section 5.1.2: Adopt the 7 recommendations arising from the public’s feedback.

•     Approve the proposals to review progress as described at section 6.1.2: The Health & Care Integrated Commissioning Board (HCICB) will consider in public a report on progress in addressing the recommendations as set out in section 5 of this paper and the EIA action plans. This report will be presented in September 2018 and reviewed again in July 2019.

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 the response to the consultation on the Stockport Together outline business cases on new models of care. The report recommended the adoption of the Business Cases and proposed a process to monitor and review their implementation prior to any decisions being taken to remove capacity from the acute sector.

The Cabinet Member for Health emphasised the significance of the decision before the Cabinet and its long term commitment for the Council in delivering vital services through new models of care, partly as a means of addressing future shortfalls in funding for health and social care but also because these would be improvements to how care is provided.

The Cabinet Member referred specifically to the consultation feedback, and questions raised about the validity of the process. He stated that the process had been undertaken following the Consultation Institute Guideless to ensure it was robust. He also highlighted that three quarters of responses had been supportive of the business cases by a ratio of 3:1. He acknowledged that there was a more finely balanced response to the issues around bed management but that various tests would need to be met before any decisions taken on bed capacity.

The Cabinet Member further reported on issues and caveats raised by the Stockport Clinical Commissioning Group in their consideration of the report, including the need for greater resident involvement; ensuring involvement with minority and hard-to-reach groups; third sector involvement in the new models, and mental health investment.

The Cabinet Member also highlighted the workforce challenge facing partners, in terms of numbers, skills and culture change; the challenges of data and information sharing, particularly where third sector organisations were involved.

The Deputy Leader of the Council and Cabinet Member for Adult Social Care thanked councillors, particularly from the Scrutiny Committee, for their input and engagement with the development of the programme over a number of years.

The Leader of the Council stressed the need to ensure the plans for implementation were able to respond to changing circumstances and evidence. He acknowledged that there were risks, particularly financial ones, in the new models of care but that these were being managed and were unavoidable if partners were to address the serious financial and demographic pressures ahead.

Cabinet Members paid tribute to the work of officers across a range of partner organisations for their hard work in developing the business cases thus far.

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

·           the feedback from the public consultation, the updated equality impact assessments (EIAs), the views of the Adult Social Care & Health Scrutiny Committee and the proposed response be noted;

·           approval be given to the recommendation at 4.5.2 to approve the approach described in the previously endorsed outline business cases and proceed to implementation subject to recommendations as set out in Section 5 of this report;

·           that the seven recommendations arising from the public’s feedback set out at Section 5.1.2 onward be approved

·           approval be given for progress to be reviewed as described at section 6.1.2 and for the Health & Care Integrated Commissioning Board to consider in public a report on progress in addressing the recommendations as set out in section 5 of this paper and the EIA action plans in September 2018 and reviewed again in July 2019 be approved.

To consider a report of the Corporate Director for People.

During October and November 2017, the Council and Stockport Clinical Commissioning Group carried out a public consultation on the underlying strategy and policy set out in full in the Stockport Together outline business cases which had originally been published in June 2017.

This report sets out the history of the development of Stockport Together and its Business Cases, incorporating both the detail of the overarching principles on which future service design has been built, and a number of areas of implementation that require further consideration. It highlights a number of specific issues on which an opinion from the Scrutiny Committee is requested.

The Scrutiny Committee is requested to focus its attention on the sections of the report covering:

·                Changing the way we plan and organise services: this will focus on key principles including the integration of health and social care; the integration of physical and mental health services; and the underlying shift of resources from acute hospital provision in order to further address parity of esteem for mental health and strengthen integrated community based services including primary and social care.

·                Neighbourhoods: the way in which physical health, social care and mental health services are organised at a neighbourhood level. This will focus on the geographical appropriateness of the neighbourhoods as described and their role as the principle organisational construct of the future model of care.

·                Hospital beds: the test to apply, if the strategies result in the need to decommission acute hospital beds. This will focus on how the partnership will apply the tests set out by NHS England prior to any bed closures if they should arise.

Further, the Scrutiny Committee is asked to note and acknowledge the change in the previously announced process whereby the decisions were to be made in January; in particular to move the decision of Council Cabinet back from the 17th January to the 6th February. It is believed this is appropriate given the scale of the response, the issues raised in the consultation and thus the delay in production of the report. It allows decision makers time to consider the views and recommendations of this Committee.

Officer contact: Andrew Webb, 0161 474 3808, andrew.webb@stockport.gov.uk

The Corporate Director for Place submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider the feedback from the consultation undertaken on the Stockport Together Draft Business Cases on new models of care. The consultation exercise had been undertaken during October and November 2017 and had attracted responses from the public and stakeholders.

The Chief Operating Officer and the Director of Strategic Planning & Governance at Stockport Clinical Commissioning Group attended the meeting to answer questions.

The Cabinet Members for Adult Social Care (Councillor Wendy Wild) and for Health (Councillor Tom McGee) were also in attendance to respond to questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         The consultation had been very extensive. Officers were thanked for their work, in particular for responding to the needs of the public in providing additional consultation session.

·         Assurances were sought about concerns expressed in the consultation that work would be carried out by less well qualified professionals. In response it was stated that the development of the new models of care had included an analysis of the activity done by those within the system to determine whether this was being done appropriately or whether professionals’ time could be freed up to concentrate on activity only they could do. The skills available through the neighbourhood teams underpin the planning of the proposals and the question posed was concerned with who was best placed to do particular activities, not what was cheapest.

·         The new models seemed adequate to cope with demand during normal conditions, but were they able to respond to significant increases in demand, such as a flu pandemic? In response it was stated that the physical capacity at the hospital was not a concern as ‘mothballing’ bed capacity was a normal element of winter planning. A series of tests or criteria would be need to be met before any decision was made on permanent removal of capacity in the acute sector although it was planned to retain as much flexibility/ redundancy as possible.

·         While there was general agreement that people remaining at or returning to their home was best, was there sufficient community based services to support them there? In response it was stated that the business cases set out the range of intermediate care services and other measures to underpin the aim of keeping people out of hospital.

·         The consultation feedback suggested a concern about the loss of hospital beds. Clarification was sought on whether it was proposed to reduce bed capacity because demand was gone, or because demand managed elsewhere, and whether or not retaining redundancy was expensive. In response it was stated that the context for Stockport Together was the significantly higher rates of both urgent and non-elective admissions that demonstrated there was scope for improvement and it was planned to invest £16m in non-hospital services. It was stated that there were a series of measures or tests that would have to be met before any decision on mothballing of bed capacity would be taken, and it was not expected this would be considered before three years had elapsed following close monitoring of the efficacy of the system.

·         The consultation also highlighted a concern that more affluent residents would be more able to influence localised decision making to get better care than those from less affluent areas. What checks and balances would be in place to prevent this? In response, the risk of this was acknowledged but partners went to considerable efforts to ensure the consultation was not dominated by one particular group or area of residents. The polarisation of the borough was a pre-existing factor that lead to the development of an outcome focussed, 8 neighbourhood model to ensure that services could be more responsive to the differing needs of communities, while providing consistency where appropriate. The role of Scrutiny in ensuring consistency was stressed, as was the need to provide  ...  view the full minutes text for item 4