Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 19 January 2023.

The Minutes (copies of which had been circulated) of the meeting held on 19 January 2023 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 Interest

There were no call-in items to consider.

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

The Quarter 3 Update Portfolio Performance and Resource Report (PPRR) for the Health and Adult Social Care Portfolio are presented for consideration by the Committee.

The Portfolio Report are based on the 2022/23 Portfolio Performance and Resource Agreements (PPRAs), which were considered by the Committee on 8 September and approved by Cabinet on 28 September 2022.

The Quarter 3 update focuses on highlights and exceptions in relation to delivering the portfolio priorities since the Mid-Year Report presented to the committee on 24 November 2022. It includes forecast performance and financial data (where this is available) for the portfolio, along with an update on the portfolio savings programme.

The Scrutiny Committee is recommended to:-

(a)  Consider the Quarter 3 Update Portfolio Performance and Resource Report;

(b)  Review the progress against delivering key projects, priority outcomes, targets and budgets for 2022/23;

(c)  Highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues;

(d)  Highlight any significant issues or changes to be fed back to the Cabinet alongside the Corporate Performance and Resource Report;

(e)  Identify how areas of strong performance and good practice can be shared in other services.

Officer contact: Gaynor Ward on 0161 474 8186 or email:  gaynor.ward@stockport.gov.uk or Paul Graham by email: paul.graham@stockport.gov.uk

The Director of Adult Social Care and Interim Director of Public Health submitted a joint report (copies of which had been circulated) providing the Quarter 3 Update Portfolio Performance and Resource Report (PPRR) for the Health and Adult Social Care Portfolio. The Quarter 3 update focussed on highlights and exceptions in relation to delivering the portfolio priorities since the Mid-Year Report was presented to the committee on 24 November 2022 and included forecast performance and financial data (where this was available) for the portfolio, along with an update on the portfolio savings programme.

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:-

·         Concerns were raised in relation to the red status and downward trend of the performance indicators relating to the percentage of adult social care facilities rated as good or outstanding, percentage of nursing beds in Stockport rated as good or outstanding and percentage of residential care beds in Stockport rated as good or outstanding.

·         In response, it was commented that whilst the indicators were not showing signs of improvement, there were challenges in relation to the volume of inspections and inspection regime of the CQC which meant that the CQC rating was not necessarily reflective of the improvements that had been made. It was commented that as part of the adult social care transformation programme improvements had been made to support care homes within the borough which included supporting staff retention of registered managers and adequate resources in relation to the workforce to reduce the reliance on agencies.

·         In relation to the drug treatment programme, it was queried if additional support was provided to residents who did not complete the programme.

·         In response, it was stated that a new provider had been appointed for the drug and alcohol treatment programme and access was managed through the in-house service in the public health team, it was noted that residents who wished to be readmitted to the programme were able to do so and would be readded to the waiting list.

·         Members noted the lack of financial sustainability as a context to the report and the restrictions this had on future financial planning.

·         Members requested additional information in relation to the funding, responsibility and accountability of the National Diabetes Prevention Programme and whether there was any geographical data.

·         Concerns were raised in relation to the red status and downward trend of the performance indicators relating to the number of high and medium priority DOLS referrals awaiting assessment and the percentage of safeguarding cases where risk is reduced or removed and queried the steps being taken to address the issue.

·         In response, Members were advised that the service recognised there was further work required in relation to DOLS referrals and an action plan had been devised which committed investment of additional resources for a short period in order to improve the outcome. In relation to safeguarding, work was ongoing around recording including training associated with training.

·         Members requested expanded commentary in relation to the ongoing work around DOLS referrals and safeguarding cases in the Quarter 4 report noting any improvements made and ongoing actions.

·         Members noted the waiting lists in relation to the weight management intervention programme.

·         Requested information around the CQC standards and inspection framework be shared with the Committee.

·         Members noted the data quality issues relating to the percentage of safeguarding cases where the client outcomes were wholly / partially achieved and queried impact this was having and when the data quality issues would be resolved.

·         In response, it was commented that the data quality issues related to the use of the system and the information recorded by officers was not being transferred to the necessary fields. Members were assured that the service were seeking improvements around training officers in this area.

·         Concerns were raised in relation to underspend  ...  view the full minutes text for item 4.

To consider a report of the Director of Adult Services.

The report outlines the 2023/24 fee setting recommendations for the most significant areas of externally commissioned services within Adult Social Care.

The Scrutiny Committee is recommended to note, comment and endorse the approach set out in this paper; prior to consideration Cabinet on 14 March 2023.

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

The Director of Adult Services submitted a report (copies of which had been circulated) outlining the 2023/24 fee setting recommendations for the most significant areas of externally commissioned services within Adult Social Care.

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 queried what steps were being taken to manage the risk of providers not paying their employees the Real Living Wage.

·         In response, it was commented that the risk was managed through the relationships with the providers and monitoring and where pay related issues were reported either by individuals or trade unions the service had discussed this issue with the provider which had rectified the issue.

·         It was queried how Stockport compared with neighbouring boroughs.

·         In response, it was noted that Stockport compared favourable with its neighbouring boroughs and the fees were in excess of that paid by other Local Authorities and the percentage uplift was in the region of other Local Authorities.

·         In response to a question if all council contacts stipulated the Real Living Wage, it was commented that all fees accommodated the Real Living Wage and whilst this could not be specified, there was an expectation that providers paid the Real Living Wage.

·         Members requested additional information in relation to the Human Resources impact.

·         In response, it was stated that there was a requirement that the council not only set the fees but understood the implications that it may which included the impact on the workforce required to deliver a sufficient supply and quality of care. Current actions that were being pursued to mitigate this risk included job fairs, robust training and supporting recruitment.

RESOLVED – That the report be noted.

To consider a report of the Director of Public Health.

The report presents the Mental Health and Wellbeing Strategy to the Committee for endorsement.

The Scrutiny Committee is recommended to endorse the strategy and offer comments to aid its implementation.

Officer contact: Judith Strobl on 0161 474 2535 or email: Judith.Strobl@stockport.gov.uk

A representative of the Director of Public Health submitted a report (copies of which had been circulated) presenting the Mental Health and Wellbeing Strategy to the Scrutiny Committee for endorsement.

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:-

·         Welcomed the strategy and inclusion of intersectionality of mental health including health inequalities.

·         Commented on the importance of a robust system to support the intersection of mental health and learning disabilities and requested the wording around learning disabilities be strengthened.

·         Requested that additional detail is provided within the strategy around partnership work and the role of the police.

·         Requested that clearer targets be considered to strengthen the report.

·         In response to a question in relation to the extension of the existing suicide reduction programme, it was commented that the suicide prevention action plan had been signed off by the Health & Wellbeing Board which included ten priorities that followed the theme of suicide safer communities.

·         Welcomed the commitment to ensure that the support for mental health and wellbeing was designed for neurodiversity and queried the support that was available.

·         In response, it was commented that there was a Greater Manchester All-age Autism Strategy and the intention of the system was to be more responsive to and provide support based on need rather than diagnosis.

·         It was noted that the mainstream school approach was to place children with autism in the same classroom as children with emotional behavioural difficulties.

·         Requested additional information around the support available for people who were unable to leave the house due to their mental health and whether the support available was accessible.

·         In response, it was stated that there were a number of options available through GPs which included support for basic self-care, online or in person one to one or group therapy such as Qwell for adults and Kooth for children and referrals to mental health services.

·         In response to a query around whether there was a 24 hour mental health helpline, it was commented that there was a 24 hour NHS crisis line through Pennine Care which was in addition to the local arrangement with Open Door which also had a 24 hour helpline and a physical drop in service. In addition, leaflets had been distributed to frontline services to support signposting recognising different peoples needs.

·         Members noted the wide range of services and approaches that were referenced within the strategy and commented on the change in culture of health and wellbeing.

·         It was noted that the health and wellbeing strategy had to be considered within the context of reduced policing, housing, cost of living, ambulance wait times and staffing concerns as the issues had an impact on residents mental health and wellbeing. 

·         Members commented on the importance of collaboration and a partnership approach in delivering the ambitions of the strategy.

·         It was requested that a future update item in relation to the Mental Health & Wellbeing Strategy including progress and performance be programmed into the Scrutiny Committee’s work programme.

RESOLVED – That the report be noted.

To consider a report of the Director of Adult Services.

The report provides information on the current challenges facing the adult social care workforce in Stockport across the whole sector and gives an analysis of the impact of workforce pressures on the supply of care and support in Stockport.

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

Officer contact: Anne Barlow by email: anne.barlow@stockport.gov.uk or Mihaela Hegarty by email: mihaela.hegarty@stockport.gov.uk

Representatives of the Director of Adult Services submitted a report (copies of which had been circulated) presenting information on the current challenges facing the adult social care workforce in Stockport across the whole sector and providing an analysis of the impact of workforce pressures on the supply of care and support in Stockport.

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 response to a question in relation to the size of the adult social care workforce in Stockport and number of vacancies, Members were advised that there were over 7,000 employees across Stockport working in adult social care which included the care market and there were 54 vacancies across the service out of a total of 652 vacancies across the council.

·         Members requested additional information about the Tameside trial in relation to the tasks undertaken by home care staff under the supervision of district nurses.

·         In response, it was commented that the trial in Tameside was considering the parts of the district nurses roles that home care staff could be responsible for to alleviate pressure. It was noted that there were questions and challenges around how this would affect the pay for the social care market. The outcome of the trial would be shared across the Greater Manchester authorities via the Social Care Partnership.

·         In relation to the various initiatives seeking to support retention of care and support workers in Stockport, it was queried whether data was available and how these initiatives were being monitored and measured.

·         In response, it was commented that there had been a recent recruitment fair at the Town Hall where ten home support workers were recruited as a direct result. In addition, there was ongoing work with Stockport College offering work trials, jump start programmes, engagement to encourage young people to consider adult social care as a career and work around retention such including a career development and talent manage programme.

·         Commented on the importance of fair pay but recognised that other factors such as working conditions impacted on recruitment and retention.

·         Members requested additional information around the secondment initiatives. In response, it was commented that not all employees had management aspirations but may want to stay within an organisation and continue to grow and develop. Secondment provided the opportunity for employees to try other work areas and had the potential to increase retention.

·         In response to a question in relation to the parity of esteem between NHS and adult social care careers, it was commented that there was an issue around image of NHS and adult social care careers and the service was exploring options to ensure that adult social care was viewed as a viable career and strengthening the engagement and branding around this.

·         It was requested that a six month update item relating to workforce and wellbeing across adult social care including the progress made be programmed into the Scrutiny Committee’s work programme.

RESOLVED – That the report be noted.

To consider a report of the Director of Adult Services.

The original Direct Payment policy for adults was launched in September 2021. Following the implementation of this policy, feedback from service users and carers, stakeholders and external and internal legal teams determined that the policy needed to be reviewed to ensure that it was legally compliant. A decision was taken to carry out a formal consultation on eight proposals, some of which were linked to recent case law. The primary focus was to ensure that our Direct Payment policy is legally compliant, whilst also taking the opportunity to seek feedback on the policy and its implementation.

The Scrutiny Committee is recommended to:-

a)    Review and comment on the new policy

b)   Note the outcome of the Equality Impact Assessment

c)    Note the implementation plans

Officer contact: David Eckersley on 0161 218 1754 or email: david.eckersley@stockport.gov.uk

A representative of the Director of Adult Services submitted a report (copies of which had been circulated) providing an update in relation to the Direct Payment policy for adults was originally launched in September 2021. Following the implementation of this policy, feedback from service users and carers, stakeholders and external and internal legal teams determined that the policy needed to be reviewed to ensure that it was legally compliant. A decision was taken to carry out a formal consultation on eight proposals, some of which were linked to recent case law. The primary focus was to ensure that our Direct Payment policy was legally compliant, whilst also taking the opportunity to seek feedback on the policy and its implementation.

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:-

·         Welcomed the revised policy and thanked officers for their honesty.

·         It was noted that there were elements of the direct payments progress that required a social worker and queried the impact that would have on residents that had not been allocated a social worker.

·         In response, it was commented that there was an ongoing piece of work to understand the role of the duty social worker and team manager with respect to them being available for queries relating to direct payments.

·         It was queried what options were available to residents that weren’t confident with technology or unable to use the online platform.

·         In response, it was stated that it was intended to produce the policy documents in various formats to ensure that it was accessible and in terms of the interface there would be a web offer and staff would be available to support residents.

·         In response to a query around staff engagement to embed the culture of direct payments, it was commented that training and involving real people with real experience of the benefits of direct payments would be key to embedding the culture within the team. Members suggested that officers contact the Speaking Out group in relation to involving people with lived experience.

·         It was noted that there was a number of characteristics within the equality impact assessment where the data was not available and commented on the importance of data recording to measure whether a policy disproportionally impacted a socioeconomic group.

·         It was queried what safeguards were in place to ensure that the payments were spent in a meaningful way and by the people who would benefit the most.

·         In response, it was commented that there would be proper auditing as part of the provision of a direct payment, with an Audit team supporting people around the account and spending in line with their Care Act assessment and agreed outcomes. In addition, there would be a social work review on a regular basis to support people with their use of the direct payments.

·         Welcomed the use of direct payments as a means to empower individuals and give them more flexibility and control around their support package.

·         It was commented that whilst it was sensible to recommend that people set up a separate bank account to administer their direct payment monies, it was difficult to set up a bank account and queried whether support would be available.

·         In response, it was confirmed that the service would support residents who wished to set up new bank accounts for the direct payments and there would be a flexible approach ensuring alternative options for any resident unable to set up a bank account. It was noted that other councils operated a direct payment delivery method of providing a debit card facility which could be an option considered in the future.

·         In response to a question relating to community engagement and ensuring residents who this affected were made aware, it was commented that the service had corresponded with affected residents on multiple occasions throughout  ...  view the full minutes text for item 8.

To consider a report of the Assistant Director - 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.

Councillor Gary Lawson as Lead Member of the Scrutiny Review apologised for the lack of progress in relation to the Scrutiny Review on ambulance wait times and reported that the delays largely related to the current context around the ambulance service. It was reported that Councillor Lawson as the Lead Member met a representative of the North West Ambulance Service in December who had agreed to provide the Scrutiny Review Panel with the data that was requested and advised that the visits and shadowing opportunities discussed were unable to be accommodated until February at the earliest. Members were advised that the representative had since left the organisation, however there were ongoing discussions who would continue to support the Scrutiny Review. It was commented that in light of the delays there had been discussions as to whether to abandon the Scrutiny Review for the municipal year, however in view of the importance of the issue it was suggested that the Scrutiny Review on ambulance wait times be continued for the remainder of the municipal year and into the next municipal year.

The following comments were made/ issues raised:-

·         Concerns were raised in relation to the lack of progress in relation to the Scrutiny Review and welcomed the update that had been provided.

·         It was commented that Members were supportive of the suggested approach to the continuation of the Scrutiny Review.

·         It was noted that there had been a previous request from the Committee that Greater Manchester ICS senior colleagues be invited to a future meeting of the Committee to ensure accountability for the residents of Stockport

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:-

·         That Greater Manchester ICS senior colleagues be invited to a future meeting of the Committee.

·         Six month update relating to workforce and wellbeing across adult social care including the progress made.

·         Mental Health & Wellbeing Strategy update including progress and performance.