Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 27 November 2018.

The Minutes (copies of which had been circulated) of the meeting held on 27 November 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 report of the Director of Public Health.

This report paper presents The Active Communities Strategy (ACS) which has recently been developed to promote physical activity in Stockport. There are a number of supporting plans to the ACS. This report also presents the recently revised Walking and Cycling Plan. 

The intention is to consult widely on these two specific strategies/ plans before they are finalised and presented to Cabinet for endorsement.

The Scrutiny Committee is asked to consider and comment on the proposed approaches.

Officer contact: Dr Donna Sager, 0161-474-3928, donna.sager@stockport.gov.uk

The Director for Public Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider and comment on the Active Communities Strategy, developed to promote physical activity in Stockport. Also included in the documentation was a revised Walking and Cycling Plan.

The Cabinet Member for Health (Councillor Tom McGee) attended the meeting to respond to questions from the Scrutiny Committee.

·           Councillors welcomed the engagement with Park Run and recognised the opportunities this provided for residents. In response it was stated discussion were taking place exploring how the opportunities could be expanded into deprived areas and for GP referrals.

·           The importance of having safe cycling routes, segregated as far as possible, was emphasised. Providing information to assist the public in planning a safe routes, possibly through an app solution, should be considered.

·           Clarification was sought on what coordination there was between Public Health and schools to encourage participation in initiatives such as ‘Park and Stride’. In response it was stated that such schemes were often coordinated by Traffic Services, but that experience suggested that the schemes were most effective when led by parents and schools to ensure best

·           Concern was expressed about the poor visibility of cycle parking/storage at transport hubs in the UK compared to those in other European towns, and it was suggested that such facilities should be given greater prominence in Stockport, particularly the new interchange. It was further commented that the wider infrastructure needed to support cycling, such as showering facilities, was often lacking and employers should be encouraged to make provision.

·           The public were often unclear about the funding for cycling schemes and assumed that such investment was from ‘Council Tax’, rather than grant funding etc., and so was less supportive because they assumed this detracted from spending on essential services.

·           The condition and security of footpaths was often discouraging to the public.

RESOLVED – That the report be noted.

To consider a report of the Director of Public Health.

The Annual Public Health Report (APHR) is an independent professional report which the Council is statutorily required to commission from its Director of Public Health. This report is a joint report of Dr Steve Watkins (Director at the time of commissioning) and Dr Donna Sager (appointed as Director in September 2018).

The new material in this report focuses on the following issues:-

•     Transport and health

•     Loneliness and social isolation in older people

•     Self-care

•     Health Protection update

•     Have improvements in mortality slowed down?

The Scrutiny Committee is invited to comment on the draft report prior to submission to the Cabinet.

Officer contact: Dr Donna Sager, 0161 474 3928, donna.sager@stockport.gov.uk

The Director of Public Health submitted the 25^th Public Health Annual Report (copies of which had been circulated) that provided a commentary and analysis of significant issues affected the health and wellbeing of residents in Stockport and providing recommendations for improvements to the Council and other partners.

Dr Stephen Watkins, Consultant in Public Health (and formerly Director of Public Health) also attended the meeting as he collaborated on the production of the report.

The following comments were made/ issues raised:-

·         Councillors welcomed the report and the recommendations.

·         Concern was expressed about the reducing life expectancy and the implications this had for the deprived communities in Stockport.

·         Further comment was sought about the evidence of the impact of ‘austerity’ on mortality. In response it was stated that the data indicating a reduction in life expectancy in Stockport had been viewed cautiously, but there were clear trends nationally indicating similar reversals. There was little international comparative information available and while there were arguments being made for a link with ‘austerity’, there were also counterarguments although it could not be ruled out as an explanation. Studies from Greece had suggested such a link, but the situation in Greece was more acute than in the UK.

The Chair, on behalf of the Committee, thanked Dr Watkins for his contributions to the report and for his significant contribution to Stockport over a number of years.

RESOLVED – That the report be noted.

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

The Cabinet has developed a four year medium term strategy based around five cross-cutting themes. These frame the choices the Council need to make about its budget both next year and in future years, the five themes are:

•        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.

A suite of proposals have been developed by Cabinet which forms the first phase of this programme for 19/20. Scrutiny has since received a series of updates on the development of these proposals. This report forms the latest update and in line with the update provided to committees in November, particular includes consideration of proposals for 2019/20, prior to Cabinet decision-making in February.

The Scrutiny Committee is invited to comment upon the proposals appended to this report.

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 (copies of which had been circulated) inviting the Scrutiny Committee to consider the Cabinet’s proposals to address the Medium Term Financial Plan forecasts. The report included the results of consultation exercises or interim feedback where those consultations were ongoing, as well as Equality Impact Assessments.

Proposal 3: Support Funds Co-ordination

The Cabinet Member for Adult Social Care welcomed the constructive feedback received from the public, stakeholders and councillors during the consultation and confirmed that the Cabinet was not intending to proceed with the proposals to remove the Stockport Local Assistance Scheme from 2019/20 pending a further review of funding options.

Scrutiny committee members welcomed the amendment to the proposal and the commitment to further review funding sources.

The following issues were raised:-

·         Concern was expressed at the high proportion of the total SLAS cost being administrative/ staffing costs (38p in every £1 spent) particularly given the Council’s success in reducing such costs in other areas of activity. Councillors nevertheless acknowledged that many users of the scheme may require more intensive, non-automated support. It was suggested that consideration should be given to options to share back-office support with partners offering similar support.

·         Surprise was expressed about the proportion of funds used to pay for school uniforms and it was suggested that the Council should encourage schools to consider the affordability of their uniform requirements.

·         The unanimity of support for the scheme from those engaged with the focus groups across a range of backgrounds was emphasised. It was commented that the model of consultation should be form a model for future engagement.

·         Further information was sought on alternative options or models for the delivery of the SLAS as referenced in the report. In response it was stated that further work would need to be undertaken and it was unlikely that there were organisations or providers locally who would be in a position to take up this service. A commitment was given to submit any further options or proposals to a future meeting. It was also commented that this proposal should be seen within the context of the aspirations for a strategic commissioning of services.

·         The quality of the report and the level of analysis was commended.

·         It was commented that the feedback and analysis indicated that there may be shortcomings in the signposting to the SLAS and therefore unmet needs in the borough.

Proposal 5: Stockport Local Transport:

(i)            Town Centre Metro Shuttle Bus

The Director of Public Health reported that the consultation for this proposal was ongoing and that to date the number of responses had risen to 550. She confirmed that the majority of responses either disagreed or strongly disagreed with the proposals and that the comments received were within the following broad areas (in descending order of frequency):-

The impact of the removal of the shuttlebus on

·         older residents

·         residents with disability and mobility difficulties

·         residents on low incomes

·         the Town Centre economy

The following issues were raised:-

·         It was commented that the shuttle-bus was currently the only bus directly serving Stockport Rail Station and that Transport for Greater Manchester should be approached to discuss alternatives. In response it was confirmed that discussions were ongoing and it was highly likely that the route of at least one existing service would be altered to serve the station.

·         While the loss of the service was regrettable given the financial pressures on the Council it was difficult to justify continuing to subsidise this service that could be provided on a different model.

(ii)       Free School Bus Passes

·         Concern was expressed about the impact of the proposed changes on the educational opportunities and experience of some the most deprived communities in Stockport.

Proposal 6: Support and Governance

·         Proposals to protect frontline library services were welcomed, particularly in view of the opportunities libraries provided to residents who might become isolated.

General  ...  view the full minutes text for item 6.

To consider a report of the Borough Treasurer.

The report outlines the 2019/20 fee setting proposals for the most significant areas of externally commissioned services within Adult Social Care. The following services are included within the scope of this report.

•           Residential and Nursing Care Homes

•           Homecare provision offered within an individual’s home

•           Day Care services

•           Learning Disability Services

The report is designed to be considered in the context of budget setting proposals and describes the proposed fees for 2019/20. This will allow for implementation at the start of the financial year and will provide financial certainty to the market, supporting care providers with their cash flow, as well as supporting the process for assessment of client contributions. It will also prevent internal inefficiency caused by the need to make back payments as well as conforming to good commissioning, procurement practices and will meet both policy and legislative requirements.

The Scrutiny Committee is asked to provide comment on the approach and proposed fee increases for 2019/20 ahead of this paper being presented to Cabinet for approval in February 2019.

Officer contact: Vincent Fraga, 0161-474-4401, vincent.fraga@stockport.gov.uk

A representative of the Borough Treasurer submitted a report (copies of which had been circulated) outlining the 2019/20 fee setting for the externally commissioned adult social care services, including residential and nursing care homes, homecare, day-care and learning disability services.

The Cabinet Member for Adult Social Care (Councillor Wendy Wild) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         Clarification was sought on vacancy rates, particularly in relation to nursing and managerial posts in care homes. In response it was stated that analysis of vacancies was done at a Greater Manchester level and shared with localities. CQC Inspections often highlighted an over-reliance on agency staff in nursing homes as a key challenge for quality and a cost pressure. Specifically in relation to managerial posts it was stated that there tended to be a correlation between consistency in a facility’s manager and its quality.

·         Further information was requested in relation to turnover of staff in care homes and concerns were expressed about the impact this had on quality of care, particularly for vulnerable residents. In response it was stated that anecdotally there were lots of examples of providers training staff who would then quickly move on to a job in a non-care field. It was stated that more systematic feedback from providers could be south.

·         Assurances were sought in relation to impact on residents/ service users through the increased fees. In response it was stated that service users would not feel any impact as the payments made were based on their ability pay, determined through a financial assessment. It was hoped that the uplift in fees would help to mitigate some of the impact of top-up fees. Ultimately the uplift would be of benefit to residents as it was better reflective of the costs of the providers.

·         The uplift in fees was welcomed, as was the positive general message from the report about positive engagement with providers.

·         Clarification was sought on whether the increase in fees would have an impact on the financial assessment level at which contributions would begin. In response it was stated that this would not be the case, but that previous decisions had sought to phase in changes to how homecare charges were made to ensure they were meeting more of the costs and were therefore more sustainable.

·         The general ‘direction of travel’ set out in the report was welcomed, particular the increased use of incentives to encourage improvements in provision. Specific mention was made of activities for residents as this had a significant potential impact on a resident’s wellbeing.

·         Further information was sought on the Ethical Care Framework. In response an undertaking was made to provide a report to a future meeting.

·         Comment was made to references in the report to non-recurrent funding was. Disappointment was expressed that the much anticipated green paper on adult social care funding had not yet been published.

RESOLVED – (1) That the report be noted.

(2) That the Director for Adult Social Care be requested to submit a report to a future meeting on the impact of the Adult Social Care Ethical Commissioning Framework.

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

The Third Update Portfolio Performance and Resource Reports (PPRRs) for the Adult Social Care and Health Portfolios are shorter, and more data-driven, than previous reports, providing highlights and exceptions reflecting progress in delivering the portfolio priorities and budgets since the Mid-Year Report. They include forecast performance and financial data for the Portfolios, where new data is available, along with an update on the portfolio savings programmes.

The new format for the reports has been developed following consultation with the Cabinet Member for Reform & Governance and Scrutiny Committee Chairs. This is linked to proposals contained within the Support and Governance MTFP work stream (presented to Cabinet on 18 December) which include a reduction in capacity for the Policy, Performance and Reform function.  The intention is that this lighter touch report format for Quarter 3 will provide officers with the time to prioritise development of a future, less resource intensive, approach to Performance and Resources reporting and management whilst ensuring that it can continue to provide the level of oversight required for effective scrutiny and decision making.

With a reduced level of detail being provided within the reports, councillors are asked where possible to direct any questions or requests for further information in advance of the meeting via Democratic Services to enable the timely provision of additional information.

The Scrutiny Committee is asked to:

·         Consider the Third Update Portfolio Performance and Resource Reports;  

·         Comment on the new approach and format of the reports as outlined above;

·         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; and

·         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

A joint report of the Directors for Adult Social Care and of Public Health was submitted (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 and up to the third quarter of 2018/19. The reports also included forecast performance and financial data for the portfolios, along with an update on the portfolio savings programmes.

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

The following comments were made/ issues raised:

·         Further comment was sought on possible causes for the increase in the number of instances of domestic abuse, acknowledging the small numbers involved. In response it was stated that improved reporting was the underlying cause, but that partners were monitoring the situation. Stockport Family had recently received grant funding to help provide more early-interventions.

·         Further clarification was sought on developments with government proposals to allow care home managers to be best interest assessors in relation to Deprivation of Liberty Safeguards. In response it was stated that officers in Adult Social Care had discussed their observations and concerns about the draft legislation with local members of parliament. There had been comment generally about the potential difficulties this provision would pose and revisions to the draft legislation was likely.

·         The continuation of the Stockport Star Awards was welcomed.

·         Additional funding for the diabetes programme was welcomed as the potential improvements in outcomes and reductions in dependence on services was significant.

RESOLVED – That the report be noted.

To consider a report of the Director of Adult Social Care.

The Local Account forms a key part of the approach to sector led improvement in adult social care, as it is designed to tell citizens how well the Council has done in delivering adult social care against its local priorities, referencing themes from the ‘Think Local Act Personal’ framework for personalised care and support. It also informs citizens of the challenges and the work planned over the coming year.

The Local Account for 2017/18 has been produced in conjunction with Healthwatch Stockport.

The Scrutiny Committee is asked to consider and comment on the Local Account.

Officer contact: Peter Owston, 0161 474, peter.owston@stockport.gov.uk

The Director of Adult Social Care submitted the Adult Social Care Local Account for 2017/18 (copies of which had been circulated) that was designed to inform the public about how well the Council had performed in delivering adult social care services against its local priorities, referencing themes from the ‘Think Local Act Personal’ framework for personalised care and support, as well as identifying challenges and the work planned over the coming year.

The Local Account for had been produced in conjunction with Healthwatch Stockport.

The Cabinet Member for Adult Social Care (Councillor Wendy Wild) attended the meeting to respond to the Scrutiny Committee’s question.

RESOLVED – That the Adult Social Care Local Account for 2017/18 be welcomed.

To consider a joint report of the Leader of the Council and the Cabinet Member for Reform & Governance

This report reprises the purpose and objectives of a place-based approach to commissioning that have been outlined in previous Cabinet reports and updates on recent developments to deliver such an approach, working both internally within the Council and with wider partners.

Due to the pressure on health and social care this report further outlines the Cabinet’s position on the consideration and development of a new Single Commissioning Function (SCF) for health and care in Stockport.  Across Greater Manchester the ambition is for single commissioning functions for health and social care and it is the view of the Cabinet that a SCF in Stockport is key to delivering the shared ambition of the Council and wider health and care system partners. This aims to create a more sustainable health & care system driven by improved health outcomes, reduced health inequalities and less reliance on bed-based care.

The Scrutiny Committee is invited to consider the report and the recommendation being proposed for the Cabinet and to comment on them prior to submission to the Cabinet.

Officer contact: Laureen Donnan, 0161 474 3180, Laureen.donnan@stockport.gov.uk

The Cabinet Member for Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider proposals to further the Cabinet’s aspirations for place-based commissioning, and in particular a single commissioning function for health and care in Stockport. While Stockport already undertook joint commissioning there was an aspiration from Greater Manchester Health & Social Care Partnership to develop single commissioning arrangements as a means of improving outcomes for residents.

Councillors discussed whether the Council was seeking to emulate the Tameside model. In response it was suggested that there were aspects of their arrangements that could be learned from. The Cabinet wanted to ensure that all councillors had the opportunity to discuss and assure themselves that this was the correct approach.

The Chair stated that the Scrutiny Committee understood the arguments for pursuing this commissioning model but that more detail would be welcomed.

RESOLVED – That the report be noted.

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.