Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 31 May 2011.

The Minutes (copies of which had been circulated) of the meeting held on 31 May 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.

No declarations of interest were made.

To consider call-in items (if any).

There were no call-in items to consider.

A representative of Stockport Managed Care Consortium attend the meeting to discuss progress with developing GP lead commissioning in Stockport as part of NHS Reform.

The Scrutiny Committee is invited to discuss issues raised during the presentation.

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

Dr Ranjit Gill, Chair of Stockport Managed Care Consortium, attended the meeting to update the Scrutiny Committee on preparations for GP lead commissioning in Stockport as part of the reform of the NHS.

Stockport had been selected as one of a number of Pathfinder pilot area/ early implementers of GP commissioning, building on the Practice Based Commissioning that had already been taking place in Stockport.

Dr Gill highlighted the following issues:-

• It was proposed that the current SMC would cease to be a company from March 2012 and would become a sub committee of the Primary Care Trust cluster, which would be possible as a result of legislative changes. This would allow for transitionary arrangements and structures to be created to transfer functions from the existing PCT to the future commissioning structure.
• A scheme of delegation had been agreed with the PCT Cluster Locality Board for Stockport which would allow £400m to be commissioned through the new structures.
• To facilitate patient involvement in commissioning and oversight each Practice would have a ‘Patient Reference Group’ (PRGs) through which practices seek feedback on services but also provide information about decision making. In many cases this engagement would be ‘virtual’ and take place through electronic means.
• Practices would be clustered for a particular locality, with each practice nominating a lead who would then elect a Locality Chair who would then form part of the Oversight Group which would monitor the decisions of the commissioning Executive. A member of one of the PRGs would also be elected to this Oversight Group, which would also include a representative from Health Watch and from the Council.
• A Group composed of clinical leads would also be formed to advise the Executive on its commissioning decisions.
• The Executive itself would include GP Executive Members and directors of the commissioning organisation. Following the Listening Exercise it was also planned to include at least one member of public, care, health professions (such as a consultant and nurse from a hospital out of area) and a representative of Public Health to reflect the challenge of reducing inequalities.

Councillors asked questions and made comments on the presentation, and the following issues were raised:-

• The involvement of the public in discussions and decisions about commissioning should make explicit the limits of what the NHS could provide. In practice, engaging the public and in particular vulnerable service users may be difficult.
• The key to improving outcomes would be to improve lifestyles and ‘anticipatory care’, which would mean more effective use of resources.
• It was important to ensure that Stockport gained from the changes to the NHS. Meeting the projected £80m shortfall in funding and improving outcomes at the same time would be a test of the success of the changes.
• Stockport had a culture of GP engagement in commissioning which would help ensure a smooth transition to the new arrangements.
• It was anticipated that the cost of the new commissioning arrangements would be less than the current cost of most PCTs. The ambition was to build on the strengths of existing GP practice and to integrate more IT, information and community services across the borough and to shift the balance of spending away from reactive hospital spend to preventative/ community based spending.
• It was recognised that there were very good facilities in many communities, but there remained serious inequalities. The challenge was to work more collaboratively with partners to address the wider determinants of ill health.
• It was important to involve groups and individuals not currently engaged who should be engaged. Ensuring transparency and openness in decision making would help the public understand the consequences of these decisions.
• Continuing the integration of services between health services and the Council was vital to ensure improving outcomes. The changes to the NHS structure should not detract from this work.

RESOLVED – (1) That Dr Gill be thanked for his attendance  ...  view the full minutes text for item 4.

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

A representative of the Stockport NHS Foundation Trust has been invited to the meeting.

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

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

James Sumner (Associate Director for Surgery and Critical Care at Stockport NHS Foundation Trust) accompanied by Ann Barnes (Director of Operations & Performance, Stockport NHS Foundation Trust) and Mark Chidgey (Associate Director of Performance and Market Management, NHS Stockport) attended the meeting and made a presentation about referrals for surgical treatment and waiting times at Stepping Hill Hospital.

The presentation covered the following issues:-

Background

-         The Department of Health standard for waiting times between referral and treatment was 90% of patients being treated within 18 weeks, with an additional standard of 95% within 23 weeks. Where this was not complied with it was expected that this be due to medical complexity or patient choice.

-         Stepping Hill had one of the largest orthopaedic services in the locality and high demand for the services on offer.

Challenge for Stockport

-         The recent difficult winters resulted in an increase in injuries and illness, many of which resulted in orthopaedic referrals, putting added pressure on services. The flu outbreak had resulted in the closure of services for a period which contributed to the backlog.

-         There was an underlying high demand for these services, particularly around joint replacement.

-         Historically the number of patients waiting in excess of 18 weeks had been below target and a backlog had developed. On the 23 week measure, performance was better with the backlog reducing at a quicker rate.

Response

-         The Foundation Trust and NHS Stockport had agreed to commission extra surgeons and theatre space to ensure those patients who had been waiting the longest were treated.

-         Where patients were likely to be waiting beyond the 18 weeks they were being offered the option of treatment at a private hospital and every effort was being made to ensure that the cost was no more than Stepping Hill based treatment.

-         Work to reduce demand on the service through alternative provision, alternative treatment methods and choices at initial GP consultation.

Timetable

-         It was anticipated that the standard for treatment would be met by November 2011.

-         All patients were due to be contacted by the end of August, with 500 patients expected to be offered an alternative provider.

-         Ongoing work to put in place a sustainable long term solution.

-         The Department of Health’s Intensive Support Team had endorsed the plans.

Councillors asked questions and made comments on the presentation. The following issues were discussed:-

·         Contingency plans for another difficult winter meant that there would now be capacity for increasing demand for treatment for the coming year.

·         Clearer advice to patients on alternative treatments, such as physiotherapy, as the outcomes from surgery often did not meet patients’ expectations.

·         Short term performance against the 18 week target would deteriorate as those patients that had been waiting longest or were most in need were being treated first.

·         The current level of expenditure on these surgeries, irrespective of the current difficulties, was unsustainable and the need to focus on prevention was clear as it was across many of the activities in the public sector.

·         In some cases patients were choosing to delay surgery to get the surgeon they preferred which needed to be factored into an analysis of waiting times.

RESOLVED – (1) That James Sumner, Ann Barnes and Mark Chidgey be thanked for their attendance and presentation.

(2) That the Chief Executive of Stockport NHS Foundation Trust be requested to provide a written update to the Scrutiny Committee on progress with the improvement of waiting times to the 13 December 2011 meeting.

To consider a report of the Health Observatory.

The document is the latest Health Profile for Stockport for 2011 compiled by the Public Health Observatory. The 2011 profiles give up-to-date information on important health issues such as childhood obesity, skin cancer (malignant melanoma), deaths from smoking, hospital stays due to alcohol misuse, and early deaths from cancer and heart disease and the number of hospital stays due to self-harm.

More information and data on health trends can be found on the Public Health Observatory website at www.healthprofiles.info

The Scrutiny Committee is recommended to note the profile.

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

A representative of the Democratic Services Manager submitted the ‘Health Profile for Stockport’ produced by the Public Health Observatory (copies of which had been circulated) providing an overview of key health indicators for Stockport.

The key long term trend was the widening of the gap in life expectancy between the most affluent and most deprived areas of Stockport.

Other issues within the Profile report highlighted by members included higher than national average rates of smoking in pregnancy, tooth decay in young people, hospital stays for self harm and hospital stays for alcohol related harm.

Members discussed the profile and in particular the following issues:-

·         Many of the long term trends were connected to cultural and behavioural factors which would be challenging to overcome. Work with young people in schools and with particular cohorts of people was important, as was using social media.

·         There was a strong geographical dimension to the health profile, which reflected often complex and interrelated factors affecting behaviour.

·         Tackling often ‘rational’ but erroneous assumptions that the public may have about healthy lifestyles was needed as well as providing capacity for the public to help themselves, such as through opportunities for sport and exercise.

RESOLVED – (1) That the Public Health Observatory’s Health Profile for Stockport be noted.

(2) That the Democratic Services Manager be requested to invite a representative of local dentists to a future meeting to discuss oral health in Stockport and in particular the higher than national average levels of tooth decay for young people in Stockport.

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.

A representative of the Democratic Services Manager invited the Scrutiny Committee to consider possible topics for future scrutiny reviews having regard to the Council’s transformation agenda and how the Scrutiny Committee may feed into this process. The Corporate Director (Adults & Health) was available to assist the Scrutiny Committee with its discussions.

The Chair reminded the Committee that there remained an invitation to Dr Petra Meier of Sheffield University to attend a future meeting to discuss alcohol related harm.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to include an update item on NHS Reform on the agendas for the January and March meetings of the Scrutiny Committee.

(3) That the Corporate Director for People be requested to include information relating to alcohol and smoking in pregnancy in the update due to be provided to the next meeting on Teenage Pregnancy in light of the information contained in the Health Profile for Stockport.