Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 26 June 2018.

The Minutes (copies of which had been circulated) of the meeting held on 26 June 2018 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 joint report of the Director of Adult Social Care and Deputy Director of Public Health.

The First 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 in the first quarter of the year (April to June). They include forecast performance and financial data (where this is available) for the Portfolios, along with an update on the portfolio savings programmes.

The Scrutiny Committee is asked to:

·         Consider the First Update Portfolio Performance and Resource Reports;  

·         Review the progress against delivering key projects, priority outcomes, targets and budgets for 2018/19;

·         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: Peter Owston / Paul Graham,  0161 474 3274 / 4674, peter.owston@stockport.gov.uk / paul.graham@stocckport.gov.uk

The Cabinet Members for Adult Social Care and for Health submitted the Annual Portfolio Performance and Resources Reports (copies of which had been circulated) summarising progress in delivering priorities, reform programme and other key projects and outturn positions for the Adult Social Care and Health portfolios at the end of the first quarter of 2018/19.

Adult Social Care

The following comments were made/ issues raised:-

·         Clarification was sought on the timescale for extending social care operating hours. In response it was stated that discussions were ongoing with unions but it was hoped that the service would begin from 1 September 2018 based on staff who had volunteered for new working patterns. Concern was expressed about the time take to resolve disagreements with Trade Unions. In response it was stated that the aim was to implement a model of care that staff were also supportive of. Working with the Union a number of amendments had been made to the model to address their concerns.

·         In relation to temporary residential placements being made permanent it was anticipated that performance would return to target. It was also stated that in cases where places were being made having been in acute care it was not always desirable to make these permanent.

·         Did retirement housing developments have an effect on deferring of demand for residential care? In response it was stated that the impact was difficult to assess but ensuring a range of options for over 65s was welcomed.

·         Clarification was sought on whether proportionately more patients were delayed in Manchester hospitals than Stepping Hill. In response the challenges of data collection were emphasised but given the lesser usage of hospitals other than Stepping Hill delays for these small numbers had a disproportionate impact on statistics.

·         Clarification was sought on the counting of domestic abuse re-victimisation. In response it was stated that the Police were increasingly recording such incidents as crimes which had the effect of increasing the figures for such incidents although there was actually a reduction overall.

·         Further information was requested in relation to the CQC Ratings for nursing care and the Council’s target. In response it was acknowledged that the target was challenging. There was often a time delay in the CQC Rating process so that improvements were not reflected as speedily. Given the smaller bed base the Council was better able to provide support to providers compared to those in the residential care sector. If the Council chose not to commission from poor performing providers this would also effect proportion of beds available and performance target.

·         Disappointment was expressed that the Governments Green Paper on social care funding had again been delayed. It was stated that the proposals would only relate to older people but adult social care served a wider cohort.

·         Clarity was sought in relation to the role of the Ambulance Services and the provision of wrap-around care. In response it was stated that the report made reference to the ‘Pathfinder’ scheme that allowed ambulance crews to make an assessment of need for hospital or refer to other services such as Mastercall. This work was now linked into the general crisis care team to help assist keep people at home.

Health

The following comments were made/ issues raised:

·         The positive work of local GPs was discussed, including the provision of allotments and other similar preventative and wellbeing iniatives. The recent awarding of Gold Awards to four practices in Stockport for Bowel Cancer Screening was welcomed and the benefit of practices sharing good practice emphasised.

·         Clarification was sought on whether there remained any plans for an Accountable Care Organisation in Stockport or Greater Manchester. In response it was stated that partners locally had abandoned such plans and moved ahead with a contractual alliance model. Any change in that position would be subject to formal NHS consultation processes.

·         Would the Heatons Placed-Based integration model be adopted elsewhwere in the  ...  view the full minutes text for item 4.

To consider a briefing note from the Director of Adult Social Care.

The report sets out the background to health inequalities for those with learning disabilities, as requested at the last meeting of the Scrutiny Committee.

Officer contact: Mark Fitton, 0161 474 3198, mark.fitton@stockport.gov.uk

The Director for Adult Social Care submitted a report (copies of which had been circulated) setting out the background to health inequalities for those with learning disabilities. The report had been requested by the Scrutiny Committee at its last meeting.

Barbara Mitchell, Service Manager for Learning Disability Services, attended the meeting to present the report and answer questions from the Scrutiny Committee.

The following issues were highlighted:-

·           The health outcomes set out in the report were poor but it was in the context of those with learning disabilities (LD) often having physiological issues that reduced life expectancy. Nevertheless people with LD were now living longer lives than previously.

·           Every case of someone with LD who died over the age of 14 was has subject to review.

·           There remained instances of people with LD receiving less services, support or treatment because they had LD and professionals made decisions out of sense of what was best for them.

·           The CCG had bid for money for a new Primary Healthcare Facilitator post to help improve services, such as working with GP practices where health checks were low and to provide training and raise awareness of LD patients’ needs.

·           Performance was improving in relation to Annual Health Checks but the 95% target was challenging. The importance of Health Checks for service users was always stressed as they could identify very simple but serious issues.

·           Health Action Plans were a contractual requirement for providers.

·           Social isolation was an issue for those with LD, often because of difficulties in making and sustaining relationships.

The following comments were made/ issues raised:-

·           The report was welcomed and reassurance taken from it that processes were in place support people.

·           Concern was expressed that young people once reaching 18 were often less well supported and their health often deteriorated. In response it was stated that Education Health and Care Plans were better at picking up on health needs, though they sometimes gave less weight to an individual’s wider care needs. It was also important to recognise that young people reaching 18 were often less receptive to being told to worry about their health.

·           It was commented that the number of young people with learning disabilities who were surviving, living longer and having a better quality of life was on upward trend but that the squeeze on public finances was likely to make this more challenging.

·           Concerns were expressed about the inconsistency of health checks for those with learning disabilities. Given the level of involvement of services for young people with learning disabilities it was surprising that it was not easier to keep track of them. In response it was stated that proper coding of patients by GP practices should prompt them to follow up on health checks. Families and carers would often follow up services.

·           Were those with learning disabilities in supported employment provided with support for health planning by their employers? In response it was stated that if extra support were needed Pure Innovations would assist.

·           The Valuing People Partnership Board was a useful form for services users to help shape and influence provision.

RESOLVED – That the report be noted and Barbara Mitchell be thanked for her attendance.

To consider a briefing note of the Director of the Adult Social Care.

The briefing note sets out the background and current issues surrounding Deprivation of Liberty Safeguards. This update was requested at the last meeting of the Scrutiny Committee.

Officer Contact: Mark Fitton, 0161 474 3198, mark.fitton@stockport.gov.uk

The Director of Adult Social Care submitted a briefing (copies of which had been circulated) on the current issues surrounding Deprivation of Liberty Safeguards and the challenges for the Council in complying with its legal duties.

Nuala O’Rouke, Head of Safeguarding and Education attended the meeting to present the briefing and answer questions from Councillors.

The following issues were highlighted:

·           The Council had a small central team of officers who would carry out assessments plus staff in neighbourhood teams trained to do this work.

·           A Best Interest assessment could take between 7-14 hours. A mental health assessment was also required that involved input from a consultant psychiatrist. The combination of these two assessments was necessary to agree to deprive someone of their liberty. There was a requirement to reassess at least every 12 months.

·           Due to the volume of applications these were triaged based on need. There were currently 194 high priority cases.

·           Following both internal and external legal advice it has been agreed that it were better not to begin an assessment unless there were capacity to sign it off as there were a legal higher risk if an assessment identified a particular need that was not then acted upon.

·           Much of the activity associated with an assessment was of little value to the individual, but the triage was done on basis of the need of the patients not about the risk to the Council.

·           Additional staffing capacity had been provided to attempt to reduce the back-log of applications and to support frontline colleagues in undertaking assessments. Attempts were also made to use the process to add value, such as tying it in to other reviews.

The following comments were made/ issues raised:-

·           Was there an explanation for the increase in DoLS applications? In response it was stated that numbers fluctuated but the high number was likely to reflect the older and aging demographic profile of Stockport.

·           Anticipated changes to the law would reduce the bureaucratic burden of the process and allow the process to be mainstream activity. There was a balance to be struck between investment now to address the back-log and the likely reducing burden.

·           What were the safeguards to the appropriate use of a DoLS? In response it was stated that the process was about assessing best interest and the impact on the individual of depriving them of their liberty. There was always an independent representative that was part of the process who was able to refer the case to Court of Protection if they believed the deprivation of liberty inappropriate.

·           Previously in was the case a person subject to a DOLS dying would trigger a coroner’s inquest but this was no longer the case unless there were other factors that warranted it.

·           While an application was being processed would a care provide proceed as if a DoLS were in place? In response it was stated that this was likely the case although there were a range of other safeguards and processes that monitored individuals in care homes.

·           Were care homes at legal risk if DoLS were not in place for a resident? In response it was stated that it was the Council who bore the risk once the application is made. The financial risks were relatively small so there would need to be a considerable pressure to warrant the expenditure required to clear the backlog. A DoLS assessment was not about the safety of an individual as there were other safeguards for that purpose, but instead was use to determine need based on the impact on individual.

·           Did Mental Health Act detention involve DoLS and was it open to the same challenge? In response it was confirmed that these were separate processes. In the case of depriving an individual of liberty in the realm of DoLS it had to be for treatment and because they were not able to object.

RESOLVED – (1)  ...  view the full minutes text for item 6.

This item has been placed on the agenda at the request of the Chair.

The final report of the Care Quality Commission’s Local Area Review will be circulated for the Scrutiny Committee’s information.

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

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

A copy of the Final Report of the recent Care Quality Commission Local Area Review of Stockport Together was submitted (copies of which had been circulated). The report had highlighted a number of positives but also weakness in the current programme, particularly in relation to governance.

The Cabinet Members for Adult Social Care and for Health attended the meeting to respond to questions from Councillors.

The Cabinet Member for Health highlighted the positive findings of the Review in relation to the ambition and vision of Stockport Together. The concerns highlighted by the Review had not been unexpected but would form the basis of an Action Plan and would inform the Stockport Together delivery plans.

The following comments were made/ issues raised:-

·           There were significant financial pressures on all partners, and the Foundation Trust in particular, but the significant number of nursing vacancies need addressing given the possible impact on the quality of care. In response it was stated that each partner organisation would need to consider the implications of the review for themselves. The example of nursing vacancies was instructive of the challenges as the Trust had been criticised for overreliance on agency staff but by reducing their use had led to an increase in vacancies.

·           Clarification was sought on progress with developing an Action Plan. In response it was stated that Stockport Managed Care would be developing a clear timeline for the implementation of the new models of care, but that each partners would also need to be clear of their own actions. Further progress would be reported back to the Scrutiny Committee

·           What level of improvement was it believed the CQC would expect for the 6-12 months? In response it was stated that they were likely to expect effort being made to address the review findings but also to achieve some of the ‘quick wins’. Many of the issues that needed to be address were long term challenges and ingrained cultural issues.

·           It was noteworthy that the rate of GP referrals to hospital was double to comparable areas. In response it was stated that significant effort had been made and improvements made in this respect. GP practices were being encouraged to take greater ownership of care homes in their area to better manage these referrals.

·           How quickly could the governance issues be address? In response it was stated that the governance of Stockport Together had evolved over time but had not been rationalised. The Review had highlighted the need to have clearer lines of decision making. Greater clarity was needed to understand how partners could make decisions together and then commit to that process.

·         Concern was expressed that this report would actually slow the process of change by distracting from the central task by requiring a disparate series of issues to be resolved. There was a danger that the Council was being driven toward a model of integration that imperilled the Council’s financial situation to address NHS challenges those organisations were incapable of resolving and that the CQC approach took little account of the need to find bottom-up solutions to reduce the demand on the system and lead to long term sustainable improvement.

·         The report made a number of observations about the quality of the challenge provided by scrutiny and this required further reflection. It was also commented that concerns had been raised about the role of the Health and Wellbeing Board and this was linked to the role of this scrutiny committee. Clarity on the role of the Board would help give focus to the work of the scrutiny committee.

·         Assurance was sought that the Council had abandoned the Accountable Care Organisation proposal. In response it was confirmed that this was the case.

·         Concerns about the lack of trust, poor communication and staff engagement  ...  view the full minutes text for item 7.

To consider a report of the Democratic Services Manager.

The report sets out a suggested process for the selection of scrutiny review topics and an explanation as to how the reviews will be supported.

The Scrutiny Co-ordination Committee is invited to comment on the report and subject to those comments refer the report to Scrutiny Committees for consideration.

Officer Contact: Stephen Fox on Tel: 0161 474 4306 or email: stephen.fox@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report (copies of which had been circulated) setting out a suggested process for the selection of scrutiny review topics and an explanation as to how the reviews would be supported.  The Committee was invited to choose a topic for their next review.

The Chair suggested that in light of the issues raised by the CQC Local Area Review report that the Scrutiny Committee undertake a review of how it undertook its role and duties.

RESOLVED – That the Scrutiny Co-ordination Committee be informed for the 2018/19 Scrutiny Work Programme this Scrutiny Committee would wish to undertake one or more pieces of focussed work arising from the CQC Local Area Review findings, including an exploration of the role of the Scrutiny Committee in providing oversight of the Stockport Together programme.

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

RESOLVED – That the report be noted.