Agenda and minutes

To approve as a correct record and sign the Minutes of the meetings held on 15 February and 14 March 2011.

The Minutes (copies of which had been circulated) of the meetings held on 15 February and 14 March 2011 were approved as a correct record and signed by the Chair.

Councillors and officers to declare any interests which they have in any of the items on the agenda for the meeting.

Councillors and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

The following interest was declared:-

Personal Interest

To consider call-in items (if any).

There were no call-in items to consider.

A representative of the Coeliac Society has been invited to the meeting to discuss the work of the organisation.

The Scrutiny Committee is invited to comment on the presentation.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

Lorna Gardner (Dietician at Coeliac UK), Barbara Kirkham (Cheshire Coeliac Group Co-ordinator), Ken Coxley (Cheshire Coeliac Group) attended the meeting and made a presentation the work of the Coeliac Group both nationally and locally.

The Coeliac Group campaigned on behalf of those with Coeliac disease which was an autoimmune condition triggered by gluten, a protein found in wheat, rye and barley. Treatment required a strict gluten free diet. If left untreated the condition could lead to poor growth in children, osteoporosis, infertility and increased risk of small bowel cancer.

The presentation focussed on treatment for sufferers and in particular the problems and issues arising from inconsistencies and changes to the prescribing approach of general practitioners. A national prescribing guide had been developed in 2004 by a number of national bodies and reviewed in 2010. Recent changes to the policy in Stockport had caused concern amongst members of the Cheshire Group and discussion had been ongoing with NHS Stockport to resolve the issues. In particular, members had been concerned that a number of popular choices of foods had been removed which many felt had an adverse impact on their quality of life and meant sufferers were not able to enjoy a balanced diet. There was also concern that there had been inadequate consultation on the changes.

Roger Roberts (Associate Director Commissioning - Long Term Conditions and Medicines Management, NHS Stockport) also attended the meeting and confirmed that discussions were ongoing with the Coeliac Group about resolving their concerns. He also confirmed that the cost prescribing some gluten free products, in particular fresh bread, significantly exceeded the cost of the product. There was ongoing work to explore other options and models for the provision of fresh gluten-free produce. It was also confirmed that the NHS Stockport Board had recently agreed to reintroduce pasta onto the list of products available via prescription.

Members welcomed the dialogue that was now taking place between NHS Stockport and the Coeliac Group.

RESOLVED – (1) That Lorna Gardner, Barbara Kirkham and Ken Coxley be thanked for their attendance and presentation.

(2) That the Chief Executive (NHS Stockport) be requested to provide an update to the Scrutiny Committee in September 2011 on discussions with the Coeliac Group in relation to prescriptions for gluten free produce.

A representative of NHS Stockport will attend the meeting to update the Scrutiny Committee on NHS Reform.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Richard Popplewell, 0161 426 5001, Richard.popplewell@stockport.gov.uk

Deputy Chief Executive and Director of Primary Care and Partnerships (NHS Stockport) attended the meeting and updated the Scrutiny Committee on recent developments with NHS Reform.

The following was highlighted:-

• The submission of a joint response from the Council and NHS Stockport to the Department of Health’s Listening Exercise for the Health Bill.
• Creation of a Greater Manchester PCT Cluster with representation from all the local PCT Boards. There remained a degree of uncertainty about the relationship to the Greater Manchester Board and local organisations.
• Ongoing work with the Stockport Managed Care Consortium in preparation for the GP Commissioning Pathfinder and the abolition of PCTs from 2012-13. Much of the detail of this process was still unavailable. There was particular work taking place to ensure appropriate clinical engagement in commissioning and the mechanisms for electing GPs to the consortium board.
• Early implementation of the Health and Wellbeing Board. Work was ongoing to resolve concerns about the interface with existing joint commissioning arrangements.
• More details were expected on the arrangements for the transfer of public health functions to Local Authorities.

The Executive Councillor (Adults & Health) reported that there discussion between local authority representatives and the new PCT Cluster to ensure the concerns of ensuring a sufficiently local focus to the work of local PCTs. He also reported that the Greater Manchester Health Commission were considering the role of that body within the new health framework.

Councillors expressed concern about the relationship between Stockport and the PCT Cluster to ensure the local needs of Stockport were being met, in particular in the work to tackle inequalities and to ensure community input. Concern was also expressed that the NHS Reforms may hamper the work already underway, and recommended by the Marmott Review, to integrate services rather than to increase competition between local service providers.

The Chair stressed the need to ensure ongoing dialogue between the Scrutiny Committee and the emerging local partners, in particular the GP Consortium, and to ensure there was robust oversight of these arrangements and the work of NHS Stockport/ PCT Cluster during this transition.

RESOLVED – That the report be noted.

A representative of NHS Stockport will attend the meeting to report on progress with Transforming Community Services.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Richard Popplewell, 0161 426 5001, Richard.popplewell@stockport.gov.uk

The Deputy Chief Executive and Director of Primary Care and Partnerships (NHS Stockport) provided an update to the Scrutiny Committee on the progress with ‘Transforming Community Services’.

It was reported that a proposal was being progressed to transfer community health services to Stockport NHS Foundation Trust. The Deputy Director Planning & Business Development (Stockport NHS Foundation Trust) explained that it anticipated that there would be great value in integrating primary and secondary care services as part of the wider approach to the integration of health and social care services in Stockport.

Members enquired as to other options for the transfer of community services, including the development of a Social Enterprise model. It was commented that the Strategic Health Authority had not favoured this approach and that the time frame involved in the transfer precluded this option. It was stressed that the focus of the project to ensure a seamless service rather than organisational form.

RESOLVED – That the report be noted.

To consider the 2011 Stockport JSNA

The report sets out the findings of the latest Joint Strategic Needs Assessment for Stockport, including the key priorities that the process has identified.

The Scrutiny Committee is invited to comment on the report.

Officer Contact: Sarah Newsam, 07891 949204, sarah.newsam@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) and made a presentation on the findings of the refreshed Joint Strategic Needs Assessment (JSNA) and the 20 Annual Public Health Report.

The presentation highlighted to following key areas:

• Overall year on year health improvement in life expectancy and heart disease
• But, increasing mortality in younger age groups attributable to alcohol
• An ageing population with underlying dimensions relating to demographic change and healthy life expectancy

The JSNA included five refreshed priorities:-

• Reducing the consumption of and harm relating to alcohol
• Improving and promoting mental wellbeing and resilience
• Reducing health inequalities
• Modelling and responding to future needs for complex packages of care
• Recognising the value / support of carers

It was proposed within the new Health Bill that these priorities would form the basis of a statutory Health and Wellbeing Strategy.

The following comments were made/ issues raised:-

• The Scrutiny Committee had a key role in ensuring that health providers and other services, including the new GP Consortium, were held to account for ensuring that these priorities were actioned, particularly in the context of reducing resources.
• Concerns about ensuring that current gains in mortality rates were maintained and broadened with improvements in lifestyle and prevention services and continued investment in these areas.
• The impact of the cost of providing social care and residential care for the elderly may impact improving outcomes. Preventative action and early intervention could help reduce costs although the increased emphasis on personalised care needed to be considered. The Scrutiny Committee needed to monitor the situation in respect of residential care.

RESOLVED – (1) That Dr Watkins be thanked for his attendance and presentation.

(2) That the Director of Public Health be requested to provide a regular update on the implementation of the priorities of the JSNA.

(3) That further consideration be given to the a mechanism for discussing the recommendations of the Commission on Funding of Care and Support (Dilnot Commission) in conjunction with the Adults & Communities Scrutiny Committee

This item has been placed on the agenda at the request of the Chair.

The Scrutiny Committee is invited to scope a possible piece of work around alcohol misuse.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

The Chair reported that he had invited Professor Petra Meier to a future meeting to discuss her work on alcohol related harm and to discuss possible options for a piece of review work by the Scrutiny Committee.

RESOLVED – That consideration of this item be deferred to a future meeting.

(Note:  The Chair was of the opinion that this item, although not included on the agenda, should be considered as a matter of urgency in accordance with Section 100B(4)(b) of the Local Government Act 1972 in order to ensure the Scrutiny Committee could make representations to the Health Select Committee prior to the closing date for such representations.)

The Chair and the Director of Public Health invited the Scrutiny Committee to discuss a possible response to the Parliamentary Health Select Committee’s current enquiry into the role of public health. A number of prompts were provided and suggested responses provided to be included in the response of the Council and NHS Stockport.

In relation to the following issues, members commented as follows:-

·         the creation of Public Health England within the Department of Health;

Members suggested that the independence of the public health function from the management of the NHS would be damaged should Public Health England become part of the civil service machinery of the Department of Health which would be responsible for delivery.

·         the abolition of the Health Protection Agency and the National Treatment Agency for Substance Misuse;

Members were unclear of the benefits of abolition of these agencies and in particular of the later specialist agency

·         the public health role of the Secretary of State;

Members again stressed the need for an independent public health voice.

·         the future role of local government in public health (including arrangements for the appointment of Directors of Public Health; and the role of Health and Wellbeing Boards, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies);

Members emphasised that vital role of public health to the business of local government and questioned which other body other than local authorities would be more appropriate. It was also suggested that there should be a regional dimension to the public health work.

·         arrangements for public health involvement in the commissioning of NHS services;

Members emphasised the vital need for Public Health involvement in commissioning to ensure that the priorities within Joint Strategic Needs Assessments were captured within commissioning priorities and plans. It was stressed that the Health and Wellbeing Boards needed to have real powers to influence commissioning to ensure these local evidence based priorities were being actioned.

·         arrangements for commissioning public health services;

Concerns were expressed about the proposed divisions between local and regional/ national commissioning and suggested that further detail needed to be provided. Members were supportive of a greater emphasis on preventative services linked to local priorities and through integrated arrangments.

·         the future of the Public Health Observatories;

Members welcomed the information provided by these publications and stressed the need for them to be retained.

·         the structure and purpose of the Public Health Outcomes Framework;

Members did not feel they had sufficient information to make specific comment on this issue.

·         arrangements for funding public health services (including the Health Premium);

Concerns were expressed about the need to ensure adequate funding for public health services, in particular those local services commissioned through local authorities and the need to prevent conflict between Public Health England and local authorities over limited resources.

·         the future of the public health workforce (including the regulation of public health professionals); and

Members stressed the need to put in place robust arrangements to ensure the future role was fit for purpose.

·         how the Government is responding to the Marmot Review on health inequalities.

Members emphasised the importance of linkages between local agencies and partners to delivery effective services to reduce inequalities. Members were concerned that introducing more competition into the NHS would limit opportunities for the integration between primary, secondary and local authority service delivery. Similarly, there was concern that GP consortia would not be able to effectively commission preventative services without the wider, and meaningful, input of local authorities, medical professionals and the community through robust partnership mechanisms that gave stakeholders powers to decide and hold to  ...  view the full minutes text for item 9.

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 3186 , jonathan.vali@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report (copies of which had been circulated) setting out the planned agenda items for the Scrutiny Committee’s next two meeting and Forward Plan items which fell within its remit.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to included in the Plan for future meetings:-

• Possible joint meeting with Adults & Communities Scrutiny Committee to discuss residential care for the elderly.
• Update on Mental Health Services, including an invitation to MIND.