Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 24 November 2022.

The Minutes (copies of which had been circulated) of the meeting held on 24 November 2022 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-in items to consider.

To consider a report of the Senior Commissioner for Children & Maternity (GM ICS – Stockport Locality).

The report provides an update on Stockport Maternity Services.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Jennifer Connolly on 0161 474 2442 or email: jennifer.connolly@stockport.gov.uk

The Senior Commissioner for Children & Maternity, Greater Manchester ICS – Stockport Locality submitted a report (copies of which had been circulated) which provided an update on Stockport Maternity Services.

The Cabinet Member for Health and Adult Social Care (Councillor Keith Holloway) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/issues raised:-

·         In relation to poorer outcomes for black and minority ethnic communities, it was queried what steps were being taken to improve the data quality around these outcomes and whether the work to improve outcomes for black and minority ethnic communities included greater continuity of carer.

·         In response, it was stated that relating to the data a business analyst had been supporting maternity services and grow the digital team within midwifery in order to produce more, detailed data to provide assurance. With regard to continuity of carer, following the Ockenden report, there were some concerns around midwifery staffing and the safety of other services and a letter from Government suspended the full roll-out of continuity of carer across the whole population to focus predominantly on vulnerable families and minority ethnic groups. 

·         Welcomed the work to support asylum seeking women and families and women that do not speak English as a first language in Stockport.

·         Requested that a future report on maternity services in Stockport include information comparing the outcomes women who are not asylum seekers but are from a minority ethnic background to understand the differences of outcomes.

·         In relation to the increase in caesarean sections, it was queried how planned caesareans were managed in line with emergency caesareans.

·         In response, Members were informed that there were two theatres within the maternity unit and one theatre within the main hospital. The planned elective caesarean section list was staffed by a team specifically and on delivery there was a team waiting for any emergency caesarean sections.

·         It was queried at what point had there been no maternal deaths.

·         In response, it was confirmed that tableaux reporting began in 2020.

·         It was queried why there had been an increase in induced method of onset.

·         In response, it was stated that there was a national driver within the maternity improvement programme which was focussed on reducing deaths and where a risk had been detected women would be induced at different stages dependent on their pathway. As a result, the induction rate had risen nationally, however the safety of babies had improved.

·         Requested clarification in relation to the CQC January 202 inspection action ‘the trust should work to reduce the increasing number of instances where the service is closed to admissions.’

·         In response, it was reported that at that time the maternity unit was declaring a divert in maternity services where the service was closed to individuals who were booked at Stockport to have a baby due to issues around staffing. However, this had been improved and additional staff had been recruited.

·         It was noted that historically residents within other authority boundaries had elected to use maternity services within Stockport and queried whether this was still the case.

·         In response, it was confirmed that women had a choice where they preferred to birth and for the last three years, Stockport had provided care for women who had booked at Macclesfield due to them suspending their intrapartum care at the start of the pandemic.

·         Recognised that policies and improvements since 2016 and queried whether adequate funding was in place.

·         In response, it was stated that maternity services were commission paid for through a national tariff arrangement and as part of the transformation programme there was a commitment to review the funding arrangements. However, staffing levels were comparatively strong and permission had been granted to recruit to any turnover.

·         Requested assurance in relation to the recommendation of the Ockendon report that the staffing establishment at night on the ante/postnatal ward was now in line with safe staffing.

·         In response,  ...  view the full minutes text for item 4.

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

Within this report and appendix we provide a further update on our strategic approach in responding to the review of the medium-term financial plan. This follows on from the report presented at the Cabinet meeting on the 28th September 2022 and scrutiny committees during October. In particular it includes updated proposals within the appendix for scrutiny comment ahead of budget council in February.

The report outlines the budget proposals being considered by the Cabinet to address financial and demand challenges, enable longer term transformation, and ensure the delivery of shared strategic partnership ambitions.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Holly Rae on 0161 474 3014 or email: holly.rae@stockport.gov.uk

The Cabinet Member for Adult Social Care and Health submitted a report (copies of which had been circulated) providing an update on the strategic approach in responding to the review of the medium-term financial plan. This followed on from the report presented at the Cabinet meeting on 28 September 2022 and scrutiny committees during October. In particular, it included updated proposals within the appendix for scrutiny comment ahead of the Budget Council Meeting in February.

The report outlined the budget proposals being considered by the Cabinet to address financial and demand challenges, enable longer term transformation, and ensure the delivery of shared strategic partnership ambitions.

The Cabinet Member for Health and Adult Social Care (Councillor Keith Holloway) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         In relation to supporting carers to look after their own health and wellbeing and to care effectively and safely, it was queried whether this included unpaid family carers and how this offer was going to be delivered.

·         In response, it was confirmed that unpaid family carers were a focus of the support offer and arrangements were in place for a carers assessment to guarantee services were able to identify the needs of an unpaid family carer to ensure that they were able to continue to provide those caring responsibilities. The council acknowledged the crucial role of family carers in supporting residents to remain safely and securely in their own homes. Work was underway to understand and develop the support offer to informal carers, particularly around supporting them to access the right information and advice including accessing non-means tested benefits such as attendance allowance.

·         Welcomed the partnership work with the voluntary and community sector to support unpaid carers.

·         Requested that a level of detail in relation to young carers be given as part of the update on the carers review.

·         Welcomed the recharge to Greater Manchester Integrated Care for in house learning disability clients.

·         In relation to the out of area placement review, it was queried how taking a proactive approach and providing more of appropriate care locally in the long term sat alongside this proposal.

·         In response, it was stated that the short term strategy was aimed to reduce costs and improve outcomes and longer term strategy was focussed on creating the environment. It was acknowledged that one of the main issues in adult social care nationally was the lack of suitable housing in local areas. In Stockport there was a shortage in a range of accommodation which had been identified and formed part of future plans which included both a housing and support offer for individuals once placed. The strategy included a long term plan to build a holistic offer for a range of accommodation across Stockport with a mix of tenures and considerations around stimulating the local market and opportunities for individuals to manage their own support. It was noted that there was a number of Stockport residents who were funded to live out of area which had been identified through their reviews as an opportunity to improve the quality of their care by providing it within the borough.

·         It was queried how many children fulfilling a caring role had been identified by the council and how they were supported.

·         In response, it was stated that there was a young carers support service in Stockport through Signpost for Carers which had been operating for a number of years and provided enjoyable opportunities for children and young people away from their caring responsibilities. Based on the 2011 census data it was estimated that there were around 32,000 unpaid carers across Stockport and approximately 2,114 of those were under 25 years old. It was noted that more accurate, up to date data would be available through the 2021 census.

·         In relation to the demand management element of the proposed savings, it was acknowledged that the  ...  view the full minutes text for item 5.

To consider a report of the Director of Adult Services.

In December 2021 the Government published a white paper, People at the Heart of Care, that outlined a 10-year vision that puts personalised care and support at the heart of adult social care. 1Following the publication of the White Paper, the Department of Health and Social Care announced the Market Sustainability and Fair Cost of Care Fund for the primary purpose of supporting Local Authorities to prepare their markets for the impact of charging reform. 

The Cost of Care Report (Annex B) details the outcome of the exercises undertaken with the Care Home (age 65+) market and the Domiciliary Care (age 18+) market, collating, and producing a median average of the costs incurred by those providers submitting in delivering care.

The Market Sustainability Plan (Annex C) describes the Council’s assessment of the current sustainability of local care markets, the assessment of the impact of future market changes and the Council’s plans for these markets to address the sustainability issues identified, including how fair cost of care funding will be used to address these issues over the next 1 to 3 years.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Jon Wilkie on 07970 318461 or by email on jon.wilkie@stockport.gov.uk

The Director of Adult Services submitted a report (copies of which had been circulated) which provided the Stockport Fair Cost of Care report and Market Sustainability plan. In December 2021 the Government published a white paper, People at the Heart of Care, that outlined a 10-year vision that puts personalised care and support at the heart of adult social care. Following the publication of the White Paper, the Department of Health and Social Care announced the Market Sustainability and Fair Cost of Care Fund for the primary purpose of supporting Local Authorities to prepare their markets for the impact of charging reform.

The Cost of Care Report (Annex B) details the outcome of the exercises undertaken with the Care Home (age 65+) market and the Domiciliary Care (age 18+) market, collating, and producing a median average of the costs incurred by those providers submitting in delivering care.

The Market Sustainability Plan (Annex C) provided the Council’s assessment of the current sustainability of local care markets, the assessment of the impact of future market changes and the Council’s plans for these markets to address the sustainability issues identified, including how fair cost of care funding would be used to address these issues over the next 1 to 3 years.

The Cabinet Member for Health and Adult Social Care (Councillor Keith Holloway) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/issues raised:-

·         In relation to the inflationary uplift prices, it was queried when calculations had been made.

·         In response, it was stated that the source data was based on 2021/22 information submitted by providers which was used as the basis for the fee setting process in terms of providing inflationary uplift for 2022/23, recognising the challenges in terms of consumer price inflation (CPI). The 2022/23 data was then used as the basis for the fee setting exercise and cost of care analysis for 2023/24 using the current rate CPI of approximately 10%.

·         It was requested that an item relating to recruitment and retention across primary social care be programmed into the Scrutiny Committee’s work programme for the 2022/23 municipal year.

·         It was queried how information around health outcomes was shared with other services within the council to inform decisions around economic development and planning.

·         In response, Members were informed that the joint strategic needs assessment includes the regular updating of data which informs partnership plans. In some areas there were specialist housing frameworks used to inform planning decisions that feed into local plans. Whilst Stockport was not yet at that point, there had been work to development a joint project that would consider the required planning environment, needs assessment across health, housing and social care, opportunities in existing developments, and funding models and business cases. In addition, the funding awarded for the housing strategy seeks to connect the wider part of adult social care, health outcomes and tackling inequalities with the environment that everyone lives in.

·         In relation to the availability of care home beds, it was queried whether safeguards were in place to ensure that capacity could be managed should NHS England or the Government seek to transfer beds from hospitals to care homes.  

·         In response, it was stated that Directors of Adult Social Care and health colleagues were working carefully and closely at a local level to determine how to increase capacity if required. A number of beds had been purchased to support discharge to assess beds, commissioned by the local authority and NHS. In relation to the current funding that had been allocated, at a Greater Manchester level it had been agreed that Directors of Adult Social Care would co-ordinate the bed requirement on behalf of their locality. In addition, the council was exploring additional reablement capacity.

RESOLVED – (1) That the report be noted.

(2) Requested that an item relating to recruitment and retention across primary social care be programmed into  ...  view the full minutes text for item 6.

To consider a report of the Director of Strategy.

The report builds on the previous report dated 6th September 2022. It provides an update on the Integrated Care System arrangements and the proposal to formally establish and constitute the One Stockport Health and Care Board (Locality Board) as a hybrid committee to undertake delegations of the GM ICB and local partners such as the Council so that it can proceed to take its own decisions rather than such decisions having to continue to be taken via the ICB’s delegated authority which is in place to the Stockport Place Based Lead (Caroline Simpson).

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Vicki Bates on Tel: 0161 474 3219 or by email on vicki.bates@stockport.gov.uk

A representative of the Director of Strategy submitted a report (copies of which had been circulated) providing an update on the Integrated Care System arrangements and the proposal to formally establish and constitute the One Stockport Health and Care Board (Locality Board) as a hybrid committee to undertake delegations of the GM ICB and local partners such as the Council so that it could proceed to take its own decisions rather than such decisions having to continue to be taken via the ICB’s delegated authority.

The Cabinet Member for Health and Adult Social Care (Councillor Keith Holloway) attended the meeting to respond to questions from the Scrutiny Committee.

The following comments were made/issues raised:-

·         It was commented that at a previous meeting Members had requested that Greater Manchester ICB senior colleagues be invited to a future meeting of the Committee to ensure accountability for the residents of Stockport.

·         In relation to One Stockport Health and Care Board Priority 5 ‘Mental Health Learning Disability and Autism’, clarification was requested whether this would focus on mental health, learning disability and autism or mental health within the learning disability community.

·         In response, it was confirmed that the priority would address mental health, learning disability and autism.

·         It was suggested in relation to the roles of deputies, that the terms of reference be amended to include clarification around voting in the deputising arrangements.

·         Clarification was requested in relation to the scrutinising and governance arrangements.

·         In response, it was stated that scrutiny was a crucial part of the process and would continue to have a role. Whilst the Locality Board included the delegation of health monies and pooled budgets, aligned with the extra investment to support health and social care integration, the current decision making around the funding continued to follow the council’s governance processes.

·         Requested clarification in relation to the membership of the Locality Board.

·         In response, it was confirmed that the clarify was provided within the Terms of Reference.

RESOLVED – That the report be noted.

The Scrutiny Committee has the opportunity to consider the portfolio dashboard for the Adult Care and Health portfolio and raise any issues with regard to performance.

Members can view the portfolio dashboards on the Portfolio Performance Dashboard website.

The Scrutiny Committee had the opportunity to consider the portfolio dashboard for the Adult Care and Health portfolio and raise any issues with regard to performance.

The Cabinet Member for Health and Adult Social Care (Councillor Keith Holloway) attended the meeting to respond to questions from the Scrutiny Committee.

There were no issues raised.

To consider a report of the Assistant Director for Legal and Democratic Governance. 

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: Georgia Latham on 0161 474 3229 or email: georgia.latham@stockport.gov.uk

A representative of the Assistant Director - Legal & Democratic Governance (Monitoring Officer) submitted a report (copies of which had been circulated) setting out the planned agenda items for the Scrutiny Committee’s next meeting and any Forward Plan items.

The following comments were made/ issues raised:-

·         Members expressed disappointment in the number of updates and briefings requested by the Scrutiny Committee at previous meetings which had not been submitted to a meeting for consideration.

·         It was requested that any outstanding items following the 2022/23 municipal year be reflected in the Scrutiny Committee work programme for the 2023/24 municipal year.

·         In relation to the Scrutiny Review on Ambulance Wait Times, it was commented that Members were conscious of the timescale set for the review to be completed and keen to make tangible progress.

RESOLVED – (1) That the report be noted.

(2) That the Assistant Director - Legal & Democratic Governance (Monitoring Officer) be recommended to programme the following item into the Scrutiny Committee’s work programme for the 2022/23 Municipal Year:

·         Recruitment and retention across primary social care.