Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 11 September 2018.

The Minutes (copies of which had been circulated) of the meeting held on 11 September 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.

No declarations of interest were made.

There were no call-ins to consider.

To consider a report of the Stockport Safeguarding Adult Board.

The report summarises the work of the Safeguarding Adults Board in Stockport during 2017/18, highlighting key issues in the borough.

The Scrutiny Committee is invited to consider and comment on the report.

Officer contact: Nuala O’Rourke, Head of Safeguarding and Learning, 0161 474 5659

Gill Frame, Independent Chair of the Stockport Safeguarding Adult Board, accompanied by Nuala O’Rourke, Head of Safeguarding and Learning, attended the meeting to present the Board’s Annual Report for 2017/18 (copies of which had been circulated) and to answer questions from the Scrutiny Committee.

Mark Fitton, Director of Adult Social Care and Dr Donna Sager, Director of Public Health, were also in attendance at the meeting and responded to questions.

The following comments were made/ issues raised:-

·           Clarifaction was sought on why the Oldham Safeguarding Board had been chosen as park of a peer programme. In response it was stated this had been at the suggestion of the Association of Directors of Adults Services (ADAS) and that this work had now been completed and had highlighted some areas for learning and improvement.

·           The recommendation made by the Board in relation to mandatory reporting on harm levels was welcomed and clarification was sought on whether there were any proposal to introduce this requirement to existing contracts. In response it was stated that the Council could not require a Section 40 investigation as part of existing contractual arrangements but it was an area the Council was seeking to strengthen. The value of learning from ‘near misses’ in indentifying areas for improvement and training was stressed.

·           Clarification was sought on whether the figures in the report relating to prevalance of a mental health condition in Stockport were high or low. In response it was stated that these were broadly in line with national averages, but lower than Greater Manchester average. Stockport had good primary care services for mental health.

·           A number of questions were asked in relation to falls prevention both in the community and in hospital. In response it was proposed to submit a report to the next meeting.

·           Clarification was sought on whether reviews of medication included efficacy as well as correct administration to assess the benefit to the patient in receiving them. In response it was confirmed that the Quality Care Inspection Team who visited care homes assessed the safety and efficacy of medication and would alert GPs if there was a concern.

·           Further information was requested in relation to circumstances where medication specified in a care plan was not administered. In response it was stated that there were instances when the administering of medication could be more distressing for the patients than the harm they would suffer from not taking it. In such circumstances a risk assessment would be undertaken.

·           Confirmation was sought on the number of care homes requiring improvement. In response it was stated that there were no inadequate care homes in Stockport, and performance was on an upward trajectory.

·           Assurance was sought on the implications of the decline in the number of Deprivation of Liberty Safeguards (DoLS) assessors. In response it was stated that social workers were undertaking best interest assessments but that many were doing this in their own time. Agreement had now been given to recruit two more assessors for one year before moving toward new safeguarding system.

·           Further information was sought on suggestions that care home managers would be undertaking DoLS assessments in the future. In response it was stated that the legislation before Parliament would allow for more assessment in such settings, although the Council and other had concerns that the best interest test no longer needed to be met and the onus was placed on care homes. It was also likely to have cost implications for residents.

·           Concern was expressed at the increase in the number of mental health referrals and whether there was too great a focus on older people to the detriment of younger adults who were more at risk of suicide. In response assurance was given that the Board was engaged in multi-disciplinary work to address issues relating to adults at risk of harm. It was also commented that there were young adults in care home  ...  view the full minutes text for item 4.

To consider reports of the Directors of Adult Social Care and of Public Health.

The Mid-Year 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 half of the year, with a particular focus on the second quarter (July to September). 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 Mid-Year 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 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 first half of 2018/19, with particular emphasis on the second quarter. The reports also included forecast performance and financial data for the portfolios, along with an update on the portfolio savings programmes.

Health Portfolio

The following comments were made / issues raised:-

·           Concern was expressed about the number of new cases of AIDS/ HIV in Greater Manchester and clarification sought on what the impact for Stockport of the £1.3m Fast Track Cities network programme, and whether this would also include the roll-out of PREP. In response it was commented that further details were available in a recent report to the Health & Wellbeing Board. Support for the roll-out of PREP was also echoed.

·           Assurance was sought that contingency plans were being made for a no-deal Brexit. In response it was confirmed that the Council and partners were following NHS England guidelines on preparations. It was further commented that there was anecdotal evidence of concerns amongst staff about the uncertainty over Brexit and local hospitals were under increasing staffing pressures, with wider Greater Manchester efforts to recruit more nurses likely to take some time to realise improvements.

·           In relation to the differing rates smoking in pregnancy attributable by deprivation is was asked what more could be done to reduce rates in Stockport’s most deprived communities. In response it was stated that it was often difficult to deliver the message as the most persistent cases were due to the very chaotic lives being lived by these expectant mothers. The Family Nursing Partnership was one of the mechanisms through which partners were seeking to address this challenge. A further bid had been made to access Greater Manchester funds to provide additional support workers. It was also commented that it should not be forgotten that nicotine was an extremely addictive substance. A further question was asked about whether the reductions in SureStart provision had had an impact of rates. In response it was stated that no link could be proven although there was evidence that outcomes for women were better if they could access support closer to where they lived.

·           Had the devolution of the NHS budget to Greater Manchester been a success, or was it a means to pass on responsibility for cutting resources? In response it was stated that the devolution process was complex, with 38 local bodies involved, although the Council received very little directly from the NHS. Those NHS bodies involved were likely to answer that it had been better than had it not happened, but it may take time for the impact to be felt. The process nevertheless required partners to work differently to address the growing funding gap between available resources and demand.

·           Comment was sought on the national shortage of EpiPens. In response it was stated that Public Health had received the circular from manufacturers and had provided appropriate advice to schools and GPs.

·           Clarification was sought on the graph showing alcohol related admissions and whether or not young people were drinking less. In response it was stated that Stockport continued to be an outlier for rates of admission, including for young people, although prevalence/consumption was falling. It was further commented that the number of individuals behind these statistics might also be quite small, but were involved in multiple admissions.

·           Concerns were expressed about the impact of public spending reductions was having on health and wellbeing of the public, and the ability of public bodies to respond to those needs.

·           What would the response be if someone presented to A&E who was drunk but feeling suicidal? In response it was stated at Stepping Hill there was a specialist nurse who supported those  ...  view the full minutes text for item 5.

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

The Cabinet have been preparing its medium term strategy in response to its medium term financial plan. The latest update was presented in October. This frames the choices the Council will make about its budget both next year and in future years aligned to five key themes:

·           Getting the most out of our spending

·           Improving Customer Experience

·           Making sure we have the right property in the right places

·           Sharing Services with other organisations

·           An organisation fit for the future.

This latest update is presented to scrutiny for consideration and is comprised of:

·           An overview report summarising the strategy and budget choices;

·           Appendix for each theme which outlines the strategic direction and ambition for each theme as well as a suite of proposals for 2019/20.

The Scrutiny Committee is invited to:-

·           comment upon the strategic direction of travel outlined in the overall report and across the five themes; and

·           comment on the report and the proposals presented within the report relevant to the remit of the Scrutiny Committee

Officer contact: Holly Rae, 0161 474 3014, holly.rae@stockport.gov.uk

The Cabinet Members for Adult Social Care and for Health submitted a report of the Cabinet (copies of which had been circulated) seeking the views of the Scrutiny Committee in respect to the strategic direction of travel outlined in the overall report and across the five themes and to comment specifically on the proposals presented in the report relevant to the remit of the Scrutiny Committee.

The following comments were made/ issues raised:-

·           The introduction of the five broad themes for the budget was welcomed.

·           Concerns were expressed about the proposals in respect of the Stockport Local Assistance Scheme. It was commented that the approach in Stockport had been innovative and targeted support where it was needed. Assurance was sought that vulnerable residents would continue to have access to financial support between presenting to services and receiving benefits. In response it was stated that the total projected saving would be £486,000 and that as part of the strategic commissioning proposals work had begun on a review of support and possible alternative funding streams. Commitment was given to providing further detail on the proposals to the next meeting. Members welcomed efforts to mitigate the impact of these changes be restated their concern about the significant impact removal of the scheme could have on the wellbeing of residents and ultimately lead to greater costs elsewhere in the Council.

·           Concerned were expressed that reducing Local Transport provision would impact on respite options for carers. Others commented that previous attempts to reduce budgets in this area had proven unsuccessful. It was commented that in so far as was possible, transport provision should move away from bespoke solutions to group or communal options as this had a social benefit for the users. Greater priority needed to be given to transport training.

·           Reservations were expressed that increasing the offer of online facilities was hampered by the limitations of the Council’s current website and comment was made that allowance needed to be made for people who were not able to use digital communications. Other members stressed the importance of facilitating those who could and wanted to access services digitally.

·           In relation to reduced investments in the public realm, it was commented that reductions in service levels must not lead to public health problems and greater costs, such as increased flooding because of less gulley cleansing. Enabling community groups to maintain or develop public open spaces should also be encouraged.

·           Concern was expressed about the scope for using procurement to build community wealth given the role of STAR and the Council’s current contract procedure rules.

·           The appropriateness of reducing spend in schools by £1.1m in view of the increasing birth rates and demand on school places was questioned.

·           Concern was expressed that ‘services at a premium’ would lead to a second class service for those who could not pay.

RESOLVED – That the report be noted.

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 planned agenda items for the Scrutiny Committee’s next meeting and any relevant Forward Plan items.

RESOLVED – That the report be noted.