Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 6 June 2019.

The Minutes (copies of which had been circulated) of the meeting held on 6 June 2019 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 Stockport Clinical Commissioning Group.

The report seeks to describe the current status of the Improving Specialist Care programme, formerly known as Theme 3 – Standardising Acute and Specialised Care Programme. The content of this briefing is based on the verbal updates provided to Greater Manchester Joint Health Scrutiny Committee on 14 March 2019.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Noreen Dowd, 0161 426 9903

Gillian Miller, Associate Director of Commissioning, Stockport Clinical Commissioning Group, attended the meeting to present a report (copies of which had been circulated) updating the Scrutiny Committee on the Greater Manchester Improving Specialist Care Programme, formerly known as Theme 3 – Standardising Acute and Specialised Care Programme. The clinically led Programme sought to address variation in care across different hospitals, as well as pressures on staff and resources.

The Programme had eight specialist services within scope:-

·         Benign Urology services

·         Cardiology services

·         Respiratory services

·         Musculoskeletal/Orthopaedics services

·         Paediatric Surgery services

·         Breast services

·         Vascular services

·         Neuro-Rehabilitation services

Each service would be subject to differing models of care depending on service and patient need, and these would be subject to clinical agreement and engagement.

The following comments were made/ issues raised:-

·         The proposals were similar to previous exercises in relation to stroke services that had resulted in the creation of a series of specialist, high quality sites. That had been successful.

·         Concern was expressed about patients having to travel across Greater Manchester to access services previously available at their local hospital and the inevitable increase in journeys and emissions, and that without appropriate transport infrastructure in place there was a danger that vulnerable residents would miss appointments, increasing waste and reducing outcomes. In response it was stated that the models had been designed to provide as even a distribution as possible of access to a service that would provide both surgical and screening services. The consequence was likely to be that for some of the services in scope would not be available at all sites, but for others may be delivered on a ‘hub and spoke’ model. For other services change would not necessarily impact delivery but instead be an increased emphasis on standardisation and following best practice guidance. Modelling was currently being undertaken by TfGM on travel patterns for patients and users of these services, including the pattern of users of services accessing via blue light transport.

·         Further comment was made that previous modelling on patient transport had suggested that relatives were travelling from as far away as Nottingham to ensure that relatives were able to attend appointments that were relatively short distances from their home. It was therefore important that appropriate appointment procedures were in place and central to the modelling process.

·         Clarification was sought on the governance arrangements for the Programme and on timescales for delivery. In response it was stated that the Joint Commissioning Board (made up of NHS and Local Authority representatives) would take the decision on future models of care, but that discussions were ongoing about future commissioning arrangements. It was anticipated that there would further engagement over the detailed models of care over the autumn with a decision taken by the end of the year.

·         The importance of communication between providers was identified as a key concern, particularly in light of proposals to have ‘hub and spoke’ models of delivery. This point was acknowledged and assurance given that there were ongoing work streams in relation to ICT. Once decisions had been taken on sites etc., further detailed work would be undertaken on communications infrastructure. The stroke service was cited as an example of where communications had been successfully integrated.

·         Comment was sought on whether GPs would have sufficient capacity for the potential extra work for localised follow-up from specialised services. In response it was stated that it remained the expectation for some of the services in scope to have localised follow-up services delivered through the ‘hub and spoke’ and in other cases decentralised services would remain in local hospitals. There was separate but complementary work being undertaken on transforming primary care to create greater capacity to meet public need.

·         Clarification was sought on the difference between this Programme and that of Healthier Together. In response it was stated that Healthier Together was a separate, but related piece of work focussing on particular areas of acute care. This  ...  view the full minutes text for item 4.

To consider a joint report of the Director of Adult Social Care and the Director of Public Health.

Policy priorities for 2019/20 were set out within the Council Plan, which was adopted at the Budget Council Meeting in February. This incorporates the shared outcomes from the Borough Plan alongside specific priorities of the Cabinet.

These priorities are articulated within the Portfolio Agreements, which form the basis for regular in-year reporting. Portfolio and Corporate Performance and Resource Reports (PPRRs and CPRRs) will assess progress against key objectives, priorities, outcomes and budgets, enabling Scrutiny Committees to hold the Cabinet to account and for the Cabinet to identify current and future risks to delivery.

Scrutiny Committee is asked to review and comment on the draft Portfolio Agreement.

Officer contact: Peter Owston / Paul Graham, 0161 474 3274 / 4674, peter.owston@stockport.gov.uk /

paul.graham@stockport.gov.uk

A joint report of the Director of Adult Social Care and the Director of Public Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider the draft Adult Care Services & Health Porftolio Agreement for 2019/20. The draft agreement further articulated the priorities set out in the 2019/20 Council Plan and would form the basis for regular in-year reporting through the Portfolio and Corporate Performance and Resource Reports reports.

The Cabinet Member for Adult Care & Health (Councillor Jude Wells) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         It was suggested that the narrative for each indicator should include further information about statistical confidence and long-term trends.

·         Concerns were expressed in relation to the mental health redesign refered to in the report. Because Stockport was already poorly funded there had been representations from services users seeking assurances about these plans. In response it was stated that the work had been commissioned to baseline CCG spend across the Pennine Care NHS Foundation Trust footprint (not including the Council’s approximately £6m spend on supporting those in the community, plus at least £1m in preventative spend). Assurance was given that there was no intention from the Council to disinvest in any services, but rather a desire to get the most from it’s spend.

·         Further information was sought on the evaluation of the national diabetes programme and lifestyle services for those who complete the programmes and those that do not. In response it was acknowledged that the national programme had weaknesses in its evaluation processes, although initial indications were that it had positive impact on those who completed the programme. Feedback from those who dropped out often cited convenience as the cause. It was often the case that people were unable to make sustainable changes in lifestyle without support.

·         Concerns were raised that the move toward digital services may cause problems for the most vulnerable members of the community. In response it was acknowledged that measures were needed to protect and support those unable to access digital services, but that the process of moving toward a digital offer was not one that would cease. It was also commented that it could not be assumed that because a person was older that they could not use digital services.

RESOLVED – That the report be noted.

To consider a report of the Deputy Chief Executive.

The report presents for comments suggestions for Scrutiny Review topic selection in 2019/2020 and for scrutiny work programming building on the recommendations of the Undertaking Scrutiny in Stockport Review undertaken by the Scrutiny Co-ordination Committee in 2018/2019.

The Scrutiny Committee is invited to comment on the report prior to its submission to the Scrutiny Committees in the July cycle.

Officer Contact: Jonathan Vali, 0161 474 3201, joanthan.vali@stockport.gov.uk

A representative of the Deputy Chief Executive submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to make suggestions for Scrutiny Review topics in 2019/2020 for inclusion in the scrutiny work programming. The report incorporated recommendations of the ‘Undertaking Scrutiny in Stockport Review’ undertaken by the Scrutiny Co-ordination Committee in 2018/2019.

RESOLVED – (1) That the report be noted.

(2) That the Scrutiny Coordination Committee be recommended to include the following topic in the Scrutiny Work Programme 2019/20:-

-       Diabetes – meeting the challenge of undiagnosed type 2 diabetes through measures to raise awareness, ensuring that people knew how to seek support, making best use of community facilities such as GP champions and peer support, and ensuring sufferers were equipped to manage their condition.

(3) That the Panel for the review include the following councillors:-

Councillor John Wright (Lead); Angie Clark, Chris Gordon, Dena Ryness

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 Deputy Chief Executive submitted a report (copies of which had been circulated) setting out planned agenda items for the next meeting and relevant entries in the Cabinet Forward Plan.

RESOLVED – (1) That the report be noted.

(2) That the Deputy Chief Executive, in consultation with appropriate officers and partners, be requested to programme the following items for future meetings:-

·         Permeant admissions to care and nursing homes

·         Deprivation of Liberty Safeguards and the introduction of Liberty Protection Safeguards

·         Viaduct Health and Primary Care Networks

·         Stockport NHS Foundation Trust