Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 12 June 2012.

The Minutes (copies of which had been circulated) of the meeting held on 12 June 2012 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

There were no call-ins to consider.

To consider an update from the Director of Nursing, Stockport NHS Foundation Trust.

The Care Quality Commission (CQC) undertook an unannounced compliance review of Stepping Hill Hospital in May 2012. The review identified some ‘moderate concerns’. Representatives of the Foundation Trust will attend the meeting to provide an update on their response to these findings.

A copy of the review report can be found on the CQC website at:-

http://www.cqc.org.uk/sites/default/files/media/reports/RWJ_Stockport_NHS_Foundation_Trust_RWJ09_Stepping_Hill_Hospital_20120530.pdf

Judith Morris, Director of Nursing and Midwifery at Stockport NHS Foundation Trust, attended the meeting and provided an update to the Scrutiny Committee on the recent findings of a Care Quality Commission (CQC) Inspection of Stepping Hill Hospital Medical Assessment Unit.

The report of the unannounced inspection in March 2012 had identified areas for improvement against three out of four of the CQC’s Essential Outcomes. In response to the findings the Trust had produced an action plan to address the concerns raised and to improve general awareness of the staff at the Hospital about the outcomes.

The following issues were raised:-

·        Particular concern was expressed about the findings connected to the  management of medicines. It was stated that the Unit was going through a process of transformation which meant there were new members of staff on duty at the time, although as registered nurses staff should not have allowed these issues to have arisen. The Trust had taken immediate action to rectify these problems.

·        In relation to staff awareness, it was suggested that producing written material or guides was not always effective since staff may not read them. It was reported that the Trust had put in place a rigorous system of internal inspections and audits, similar to those carried out by the CQC, as a means of familiarising staff with the process but also to ensure standards were being met and action taken to address any concerns before the need for external intervention. It was commented that the changing inspection regime of the CQC would need to lead to a cultural change to meet this challenge.

·        The Hospital had a positive record on incident reporting and Trust sought to create a culture of reporting.

·        NHS commissioners also had a role in checking quality and compliance as part of their own processes.

RESOLVED – (1) That Judith Morris be thanked for her attendance.

(2) That the Scrutiny Committee would welcome a report to a future meeting on the process by which NHS Stockport/ Clinical Commissioning Group monitor quality and standards of the services it commissions.

To consider an update from Stockport Foundation Trust.

Following the transfer of community health services from NHS Stockport to Stockport NHS Foundation Trust earlier in the year, representatives of the Trust will attend the meeting to provide an update to the Scrutiny Committee on the development of the new service.

Teresa Emery, Community and Hospital Integration Programme Manager and Carole Spencer, Director of Planning & Business Development at Stockport NHS Foundation Trust, attended the meeting and made a presentation on the integration of Community Health Services with the Foundation Trust’s activities since its transfer in April 2012.

The presentation covered the development of new pathways of care and ways of working around a vision of providing greater integration of health services and increased delivery of these services outside of the hospital setting.

The model being developed was focussed around locality based multi-disciplinary teams working with GPs to deliver generic pathways of care but able to draw in specialist support as necessary and with increasing integration with social care provision. The focus of these teams would be on anticipatory care, including discharge planning, to ensure that where suitable patients could be cared for outside of hospital and in a setting that would better aid their treatment and recovery.

There had been a pilot run in Marple working with GPs and Care Homes using the integrated model which had proved useful in identifying areas of refinement before the model was rolled out to other localities in Stockport.

The community based service model represented a different mechanism for the delivery of services and would mean some services would close at the hospital. It was recognised that this was often a difficult message to give to the public but would where this was necessary it would be to improve delivery and outcomes.

The following issues were raised:-

·        There had been concern amongst staff of the existing Community Health Services about the impact of the transfer prior to it taking place. These had been mitigated through briefing sessions and discussions with staff of both organisations. The management structure of the Trust had also been reorganised to ensure that the transfer of the Community Health Service created an integrated health care provider rather than being a ‘bolt on’ to the work of the Trust.

·        Ensuring that GPs were aware of and used the system to its fullest would be a challenge. There was often some degree of variability in the service offered through different GP practices but ensuring some degree of standardisation was an ongoing process.

·        Further integration with Social Care provision was vital to ensure that this approach achieved real benefits. Often the failure in service delivery was at the interface between acute and social care, particularly around out-of-hours discharges. There was a need more generally across the health and social care economy to provide greater flexibility in the provision of services.

·        The increasing localisation of service provision should mean that residents living on the periphery of Stockport Borough and who were registered with GP practices in other boroughs would now be referred to these locally provided services, even if they would previously have been referred to hospitals other than Stepping Hill.

·        There was an ongoing challenge across the health and social care economy around data sharing and ICT integration, but it was important that solutions were affordable, achievable, contributed to improving outcomes and were determined by the needs of the service rather than leading the direction of transformation.

·        The transfer of Community Health Services from Tameside, Glossop and High Peak to Stockport NHS Foundation Trust had given the Trust increased procurement power but also had provided some opportunities to share best practice. The experience had demonstrated that Stockport was in a strong position with the integration of acute and community services.

RESOLVED – (1) That Teresa Emery be thanked for her attendance and presentation.

(2) That the integration of community health services and acute care, and the localisation of service delivery be welcomed.

To consider a report of the Chief Executive, Stockport NHS Foundation Trust.

Representatives of the Foundation Trust will attend the meeting to present the draft Stockport NHS Foundation Trust Business Plan for 2012/13 as part of the consultation process and invite feedback from the Scrutiny Committee.

Carole Spencer, Director of Planning & Business Development of Stockport NHS Foundation Trust attended the meeting and made a presentation on the background to the development of the Trust’s Business Plan for 2012/13, including the economic context, key priorities for the Trust and long term aspirations for service change.

A copy of the Business Plan for 2012/13 was circulated for information.

The following issues were raised:-

·        The long term aspiration, and measure of success for the Trust, was for fewer hospital beds as more services would be delivered locally and more anticipatory care provided to ensure that hospital admission was not required.

·        There was an increasing recognition that the pattern service delivery needed to change because demand was not confined to ‘9-5 weekday only’. This was linked to the wider agenda around changing the role of the hospital.

·        A perennial challenge with service change and integration was the reallocation of resources, particularly where costs were being born by partners that did not necessarily make the significant savings. There was certainly the will in Stockport between commissioners and providers to make integration and service redesign work through focussing on pathways of care and patient outcomes rather than on money.

RESOLVED – (1) That Carole Spencer be thanked for her attendance and presentation.

(2) That the Stockport NHS Foundation Trust Business Plan 2012/13 be noted and that any further detailed questions or comments on the content be directed to the Trust or via Democratic Services.

(3) That the Chief Operating Office of Stockport Clinical Commissioning Group be requested to report to the Scrutiny Committee in the Autumn on future business planning processes.

The Executive Councillor (Health & Wellbeing), representatives of the Council, NHS Stockport and other stakeholders to provide a verbal update to the Scrutiny Committee on NHS Reform as appropriate.

Attached is a progress tracker with implementing the Health and Social Care Act 2012.

The Executive Councillor (Health & Wellbeing), the interim Chief Operating Officer of Stockport Clinical Commissioning Group and the Service Director (Transformation & Commissioning), Stockport Council attended the meeting and provided an update on ongoing NHS reform.

A copy of a Progress Tracker for the implementation of the Health and Social Care Act 2012 was also submitted (copies of which had been circulated).

The following issues were highlighted:-

·        Continuing work on the transfer of Public Health functions and the integration of the Service within the Council.

·        The Joint Health & Wellbeing Strategy had been adopted by the Council’s Executive and the Clinical Commissioning Group Board. Work was now planned to disseminate the Strategy and its key messages.

·        Work was progressing with the development of HealthWatch, which would have a valuable role to play in engagement with patients and the public.

The Executive Councillor (Health & Wellbeing) gave a commitment to submit details of the Public Health budget for the Council to a future meeting of the Health Scrutiny Committee once the details of the final settlement were known.

RESOLVED – (1) That the report be noted.

(2) That the Assistant Chief Executive (Strategy, Policy, Partnerships and Transformation) be requested to submit further reports tracking progress with the implementation of the Health & Social Care Act 2012.

Members of the Greater Manchester Health Scrutiny Panel and the Pennine Care Joint Scrutiny Committee are invited to provide feedback to the Scrutiny Committee on recent meetings.

Also attached is a copy of the Greater Manchester Health Scrutiny Panel Annual Report for 2011/12.

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

Members of the Greater Manchester Health Scrutiny Panel and the Pennine Care Joint Scrutiny Committee were invited to provide feedback to the Scrutiny Committee on recent meetings and activities of these bodies.

A copy of the Annual Report of the Chair of the Greater Manchester Health Scrutiny Panel for 2011/12 was submitted (copies of which had been circulated).

Councillor Somekh reported that at the last meeting of the Greater Manchester Health Scrutiny Panel on 27 June 2012 the main item under consideration was the ‘Safe and Sustainable’ project (now known as ‘Healthier Together’), a clinically and professionally-led Strategy for new ways of providing health care services across Greater Manchester. A representative of the Democratic Services Manager reported that a representative of NHS Greater Manchester would be attending the next meeting to discuss this project.

Councillor Leck reported that the Pennine Care Joint Scrutiny Committee had undertaken a visit of the Children’s Acute Mental Health Service (CAMHS) which had been very useful and informative.

RESOLVED – That the reports be noted.

To consider reports of the Corporate Director for People.

The purpose of these reports is to provide a detailed overview of performance

which relates to the Health Scrutiny Committee.

The information is provided in the form of the Quarter 4 2011/12 Portfolio

Performance and Resources Reports for each of the Adults & Health, Children & Young People and Leisure.

The Scrutiny Committee is asked to:

a)      Review the current levels of performance;

b)      Highlight key areas of, and responsibility for, taking forward corrective

          action to address any existing or forecast performance issues;

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

Officer contacts:

Adults & Health - Katy Forde, 07527 387232, katy.forde@stockport.gov.uk

Children & Young People – Michael Henry, 0161 474 3830, michael.henry@stockport.gov.uk

Leisure – Doug Holland, 0161 474 2976, doug.holland@stockport.gov.uk

A representative of the Democratic Services Manager submitted the Portfolio Performance and Resources Annual Reports 2011/12 (copies of which had been circulated) for the former Adults & Health, Children & Young People and Leisure portfolios to provide the Scrutiny Committee with the opportunity to comment on the performance of the portfolios in 2011/12.

The Executive Councillor (Health & Wellbeing) attended the meeting to answer questions from councillors.

Councillors discussed declining participation by young people in sports and physical activity.

RESOLVED – That the report be noted.

To consider a joint report of the Corporate Director for People

The new Executive portfolio roles and responsibilities were reported to the Council Meeting on 22 May 2012.  The refreshed Council Plan and Budget, approved by the Executive on 9 July, is supported by ten Portfolio Performance and Resource Agreements (PPRAs).  These set out in detail the priority outcomes, measures, budgets, projects and risks that will form the basis for Portfolio reports during 2012/13.

The PPRAs have been approved by Portfolio Holders and published alongside the Executive report of 9 July. They are now being considered by the relevant Scrutiny Committees.

The new Health & Wellbeing Portfolio falls within the remit of the Health Scrutiny Committee.

Scrutiny Committee is recommended to consider and comment on the Portfolio Agreement.

Terry Dafter on 0161 474 4401, terry.dafter@stockport.gov.uk or Donna Sager on 0161 474 3928, donna.sager@stockport.gov.uk

The Executive Councillor (Health & Wellbeing) submitted a report (copies of which had been circulated) providing details on the Portfolio Performance and Resource Agreement for the Health & Wellbeing Portfolio that set out the priority outcomes, measures, budgets, projects and risks which will form the basis for the Portfolio report during 2012/13.

RESOLVED – That the development of the Portfolio Performance and Resource Agreement for Health & Wellbeing be welcomed.

To consider a report of the Health Observatories

The document is the latest Health Profile for Stockport for 2012 compiled by the Public Health Observatory. The 2012 profiles give up-to-date information on important health issues such as childhood obesity, deaths from smoking, hospital stays due to alcohol misuse, and early deaths from cancer and heart disease.

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

A copy of last year’s report can be found at  http://democracy.stockport.gov.uk/documents/s1217/Health%20Profile%202011Stockport.pdf

The Scrutiny Committee is recommended to note the profile and identify any issues for further investigation/ reports to future meetings.

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’ for 2012 produced by the Public Health Observatory (copies of which had been circulated) providing an overview of key health indicators for Stockport.

Councillors discussed a recent briefing by the Greater Manchester Police Authority about the high proportion of those taken into Police custody also suffering from health problems, and mental health problems in particular. It was reported that Greater Manchester Police were investigating new ways to provide medical services to those in its custody to reduce the resources required for treatment and improving the service provided.

RESOLVED – That the report be noted.

The Department of Health (DH) has launched a consultation on local authority health scrutiny, including proposal to update the “arrangements and regulations for local authority health scrutiny and help to ensure that the interests of patients and the public are at the heart of the planning, delivery and reconfiguration of health services”.

Details of the consultation can be found on the DH website at

http://www.dh.gov.uk/health/2012/07/health-scrutiny/

The Scrutiny Committee is invited to consider if and how it might wish to respond to the consultation.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk / Gaynor Alexander, 0161 474 3186, Gaynor.alexander@stockport.gov.uk

A representative of the Democratic Services Manager reported on the publication of a Department of Health consultation entitled ‘Local Authority Health Scrutiny’ in advance of the Department refreshing the regulations for the scrutiny of health services by local authorities. The proposals contained in the consultation document covered areas such as publishing timetables for service redesign; amendments to the process for making referrals by local authorities to the Secretary of State; joint scrutiny arrangements; and equalities issues. The deadline for responding to the consultation was 7 September 2012.

RESOLVED – That the Democratic Services Manager, in consultation with the Chair, be requested to prepare a draft response to the Department of Health’s Local Authority Health Scrutiny consultation for consideration at the meeting on 4 September 2012.

To consider a report of the Assistant Chief Executive (Strategy, Policy, Partnerships & Transformation).

Officer contact: Gaynor Alexander, 0161 474 3186, gaynor.alexander@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report of the Assistant Chief Executive (Policy, Strategy, Partnerships & Transformation) (copies of which had been circulated) inviting the Scrutiny Committee to consider topics for possible Scrutiny Reviews to be undertaken in 2012/13.

RESOLVED – (1) That the report be noted.

(2) That the following topics be agreed for further consideration at future meetings or extraordinary meetings:

·         Dentistry services in Stockport

·         Young people’s participation in sport and physical activity

(3) That, further to previous resolutions of the Scrutiny Committee, in-depth consideration be given to mental health issues and that the following groups be specifically invited to contribute:-

·         Pennine Care NHS Foundation Trust

·         Greater Manchester Police – to discuss prevalence of mental health issues amongst those in police custody and as a contributing factor to the police being contacted by the public

·         LINk

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

RESOLVED – That the report be noted.