Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 28 November 2017.

The Minutes (copies of which had been circulated) of the meeting held on 28 November 2017 were approved as a correct record and signed by the Chair.

Councillors and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

The following interests were declared:-

Personal Interests

There were no call-ins to consider.

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.

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

At the 14 November Cabinet meeting, an update on the Council’s Inclusive Growth and Reform Programme was provided. This update specifically outlined the challenging position facing Adult Social Care and Public Health services and introduced a series of proposals for addressing these.

The proposals had been subject to public consultation or staff consultation as appropriate and the results set out in the appendices to the report.

The Scrutiny Committee is asked to consider the latest draft proposals, results of the public consultation and EIA, and comment on proposed plans for mitigation.

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

A joint report of the Cabinet Members for Adult Social Care and for Health was submitted (copies of which had been circulated) inviting the Scrutiny Committee to consider consultation feedback on detailed proposals for savings from within the Adults Social Care and Public Health services, developed in response to the challenging financial position fac3ed by the Council. The proposals had been considered by the Scrutiny Committee at its previous meeting, and had since been subject to appropriate consultation with service users, stakeholders and the public.

The reports included feedback from the consultations exercises and Equality Impact Assessments.

The Cabinet Member for Health emphasised the difficult choices facing the Council to meet the financial challenges, and the aim of the Cabinet to do that while minimising the impact on services users. He welcomed suggestions for alternative proposals to make the necessary savings.

The following comments were made:-

Redesign of Lifestyle Services

·         Concern was expressed about the discontinuance of the cook and taste sessions in deprived areas, particularly given the modest sums involved. In response it was stated that there had been a mixed response to the proposal from the consultation, with some respondents questioning whether this was an appropriate use of Council resources. Assurance was given that alternatives were being explored, and that there were similar programmes being provided elsewhere.

·         Was the Council doing all it could to address smoking in pregnancy? In response the importance of this issue was acknowledged and the progress made in reducing prevalence was highlighted. It was stated that support for this service was a ‘red line’ for the Cabinet. It was further commented that addressing this issue was a Greater Manchester priority and that Stockport was ahead of other areas in its provision.

Stockport Local Assistance Scheme

·         Concerns was expressed about overreliance on online forms for seeking support and assistance, as the most vulnerable were less likely to be able to access online tools and there remained challenges with people contacting the Council by telephone. In response, the point was acknowledged and assurance was given that this would be taken into account with service design.

Adult Social Care Changing Policy

It was clarified that the consultation remained live. A summary of responses so far was given.

·         It was regrettable that the Council was in a position that required such measures to be considered.

·         It was positive that the consultation responses indicated that people recognised that the proposal was for those who could pay more would pay more.

·         What mechanisms were in place to prevent those who could not afford to pay being disadvantaged? In response it was clarified that the Council had a robust financial assessment system to determine eligibility. It was not proposed that all users would pay for services, and significant numbers would not pay. Service users were encouraged to have the financial assessment as they may also be eligible to receive Council contributions to their care costs.

RESOLVED – That the report be noted.

To consider a joint report of the Borough Treasurer and the Corporate Director for People.

This Report is presented in the context of an Adult Social Care Joint Commissioning Strategy and outlines the commissioning proposals for two of the most significant areas of externally commissioned service provision for adults with care needs: care homes in Stockport and home support to enable people to live in their homes for longer. Expenditure on these accounts for £38.5m and the decision making on this could account for an additional £2.7m. The Report outlines the key commissioning activities for each area of service in turn and proposals for fee rates for 2018/19. It also identifies risk factors for each service area.

This Report follows a Fee Options Paper which was submitted to CLT in October 2017 where different models and options were outlined and guidance was sought by officers on the way forward.

The Report is designed to be considered in the context of budget setting proposals and is intended to clarify the fee changes position for 2018/19 to allow for early implementation at the start of the financial year. This will provide financial certainty to the market and support care providers with their cash flow. It will also prevent internal inefficiency caused by the need to make back payments as well as conforming to good commissioning and procurement practices.

The Scrutiny committee is asked to provide comment on the approach and proposed fee increases for 2018/19 ahead of this paper being presented to cabinet for approval in February 2018.

Officer contact: Emma Bowe, 0161 218 1026, emma.bowe@stockport.gov.uk

A representative of the Corporate Director for People submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider proposals for the setting of fee rates for care homes and home support, setting this within the wider commissioning and budgetary context.

The Cabinet Member for Adult Social Care (Councillor Wendy Wild) attended the meeting to respond to councillors’ questions.

The following comments were made/ issues raised:-

·                The positive work to improve quality of provision was welcomed.

·                Was there confidence that there was sufficient capacity for EMI beds given the particular pressure of this facility? In response it was acknowledged that this was a challenge, and that paying over the uplift may be required due to demand from the high percentage of private fee payers.

·                The adoption of an Ethical Framework was welcomed as this would provide a measure of stability to the sector.

·                Clarification was sought on whether Individual Budgets were discouraged in the context of care home. In response it was stated that the Council did not discourage the use of Individual Budgets but that many older people tended not to want to take on the burden of individual budgets. It also presented a challenge for individuals with a personal budget to achieve the value of money for care that the Council could achieve.

·                Would efforts to consolidate provision through recommissioning of services encourage the use of Individual Budget where services users felt this was the only mechanism to maintain their placement at a chosen provider? In response, the challenge for users and the Council was acknowledged, but it was also stated that experience from other local authorities would assist the Council in minimising the disruption or finding mechanisms for users to remain in their placement

·                Further information was sought on how the Council would encourage new provision in the sector, given the challenges facing it. In response it was stated that it was prudent to target areas of specific need, but because there was demand in the borough this would attract providers. It was further commented that care home provision faced a specific challenge because of the need for land or property requirements for development and this was relatively scarce in Stockport. Nevertheless, officers from across the Council were considering ways to encourage increased provision.

·                The investment in the workforce was welcomed.

·                How were the Council going to attract new provision, given the challenges facing the sector? In response, the Council was bringing together a group, working with partners, to set out a ‘prospectus’ for providers to make it easier for them to understand the needs in the local market. It was also commented that the demand in Stockport would always be an inducement to providers.

·                Was there sufficient resource to implement the changes, given the surcharges being paid to providers? In response it was stated that part of the aim of the current proposals was to ensure that the homecare market was on a more sound footing before taking a more radical or innovative approach to residential and nursing care, including working with partners in Greater Manchester.

RESOLVED – (1) That the report be noted.

(2) That the Corporate Director for People be requested to provide members with further information in respect of the number of residents in receipt of Individual Budgets.

To consider a report of the Director of Public Health.

The Annual Public Health Report is an independent professional report of the Director of Public Health to the Council, the NHS and the people of Stockport which the Council is statutorily required to commission and to publish.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Dr Stephen Watkins, 0161 474 2450, Stephen.watkins@stockport.gov.uk

The Director of Public Health submitted his draft 24th Annual Public Health Report (copies of which had been circulated) that provided commentary and analysis of significant issues affected this health and wellbeing of residents in Stockport and providing recommendations for improvement to the Council and other partners. The comments of the Scrutiny Committee were sought before the finalisation and publication of the report and the submission to partners for their formal consideration.

The following comments were made/ issues raised:

·         Suggestions included in the report in relation to the universal design of new homes were welcomed, as this would not only provide better quality of life for residents but reduce the financial costs to the Council of retrofitting or modifying properties. It was also commented that there were insufficient numbers of two bedroomed bungalows being built that many with people with disabilities needed as they provided a room for carers.

·         There were good examples from countries of to encourage active lifestyles and social interaction in an ageing population that could usefully be explored for local needs.

·         Greater emphasis was needed in Council policy on making the public realm more people and walking friendly, particularly through making new developments and the highway ‘greener’. In response it was stated that there was evidence that walking in green environments had an even greater benefit than walking in an urban environment due to its positive psychological impact.

·         A reconsideration of the how traffic could be slowed was needed as the use of speed humps created air quality concerns. In response it was stated that placing speed humps closer together was more effective at reducing traffic speed and reducing deceleration and acceleration between humps, which would also reduce emissions.

·         There was a need to raise public awareness of the dangers of anti-biotic resistance and the need to reduce the expectation of their prescription for minor ailments where they had little or no effect.

·         The restatement of the Hyperloop proposal was welcomed.

·         The commentary on homelessness in the report was welcomed as it provided a useful antidote to negative media coverage. It needed to be remembered that for each statistic there was an individual and their family. The work of Stockport Homes in this area was welcomed.

RESOLVED – That the report be welcomed.

To consider a report of the Corporate Director for People.

The Final Update Portfolio Performance and Resource Reports (PPRRs) for the Adult Social Care and Health Portfolios are presented for consideration by the Committee. These provide a summary of progress in delivering the portfolio priorities, reform programme and other key projects during the third quarter of the financial year (October to December 2017). They include forecast performance and financial data (where this is available) for the Portfolios, along with an update on the portfolio savings programmes.

Where significant activity or decisions have been made since the end of the third quarter, these have been included to ensure that the reports remain timely. These will also be referenced within the Annual Reports.

The Scrutiny Committee is asked to:

·         Consider the Final Update Portfolio Performance and Resource Reports;  

·         Review the progress against delivering key projects, priority outcomes, targets and budgets for 2017/18;

·         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 Cabinet alongside the Corporate Performance and Resource Report;

·         Identify how areas of strong performance and good practice can be shared in other services.

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

The Cabinet Members for Adult Social Care and for Health submitted the Portfolio Performance and Resources Reports (copies of which had been circulated) summarising progress in delivering priorities, reform programme and other key projects for the Adult Social Care and Health portfolios during the up to the third quarter of 2017/18. The reports also included forecast performance and financial data for the portfolios, along with an update on the portfolio savings programmes.

Adult Social Care Portfolio Performance and Resources Report

The Cabinet Member highlighted the following issues:-

·         The appointment of Caroline Drysdale as new the Managing Director of Stockport Neighbourhood Care.

·         Adoption of the Carers Charter by the Stockport Together partners.

·         Further discussion having taken place about the development of an Adult Autism Pathway and on how to raise awareness and widen access to training.

·         Ongoing work to improve quality in care home provision.

·         The significant financial pressures facing the portfolio.

·         Thanks to all staff across the health and care economy for their efforts over the Winter months.

The following comments were made/issues raised:-

·         Did the recent improvement of patient flow through Marbury House now mean that a similar facility was no longer needed? In response it was stated that the efforts made to reduce length of stay at the hospital was now showing improvements, although it was acknowledged that further work was needed.

·         Further comment was sought on efforts to address Delayed Transfers of Care (DTOC). In response it was stated there had been improved performance in relation to be DTOC and with patients who were Medically Optimised Awaiting Transfer (MOAT), which had been achieved partially through the Assess to Discharge process and the role of the trusted assessor to help patients and families make informed choices about out of hospital options for care. A significant amount of resource from adult social care had been put into ensuring timely and safe discharges.

·         Clarification was sought on references to Mental Health Service and Care Act compliance. In response it was stated that these issues were covered in the savings proposals considered earlier.

·         The increasing focus of the Cabinet Member on quality in care provision was applauded and comment was made that this was now beginning to lead to improvements in the sector. The ambition of the Cabinet Member to increase the number of care homes that were CQC rated ‘good’ or better was welcomed. In response, the Cabinet Member paid tribute to the work of officers and providers in working toward and achieving improvement.

Health Portfolio Performance and Resources Report

The Cabinet Member highlighted the following issues:-

·         The important development of the Healthy Ageing Strategy and associated activity.

·         Good flu vaccination rates in Stockport, but this masked variation. Those who had not yet had a vaccination but were eligible were encouraged to do so.

·         Ongoing work around suicide prevention. Committee members were invited to volunteer to take part in online training.

The following comments were made/ issues raised:-

·         Further information was requested in relation to Wellbeing Navigators. In response it was stated that that the public response had been overwhelming with the number of volunteers as health champions, and specifically in relation to the role of Wellbeing Navigators was not to replace access to clinical services but to take pressure off GPs by providing practice based ‘softer’ non-clinical support for issues such as self-esteem, relationship difficulties, and to signpost into community services where appropriate. Recruitment was currently underway for these posts.

·         Clarification was sought on the Paperweight Arm Band initiative. It was stated that this was a simple no invasive indicator of malnutrition or dehydration. This pilot would be rolled out shortly to nursing and care homes staff.

·         The recent visit of the Council Chief Executive to Stepping Hill Hospital and the Emergency Department (ED) to better understand the challenges was welcomed. In response it was commented that it was useful to provide a ‘fresh pair of eyes’. It was  ...  view the full minutes text for item 8.

To consider a report of the Democratic Services Manager.         

The report sets out planned agenda items for the Scrutiny Committee’s next meeting and Forward Plan items that fall within the remit of the Scrutiny Committee.

The Scrutiny Committee is invited to consider the information in the report and put forward any agenda items for future meetings of the Committee.

Officer contact: Jonathan Vali,  0161 474 3201, jonathan.vali@stockport.gov.uk

A representative of the Democratic Service Manager submitted a report (copies of which had been circulated) setting out planned agenda items for the Scrutiny Committee’s next meeting and any relevant Forward Plan items.

RESOLVED – (1) That the report be noted.

(2) That an update on healthy ageing and in particular on encouraging physical activity for older people be submitted to a future meeting.