Agenda and minutes

To approve as a correct record and sign the Minutes of the following meetings:

The Minutes (copies of which had been circulated) of the meetings held on 4 and 19 September 2012 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

To consider call-in items (if any).

There were no call-in items to consider.

To consider a report of the Corporate Director for Corporate and Support Services

At its meeting on 7 September 2012 the Executive agreed a set of savings proposals for consultation. This was in response to the medium term forecasts and indicative savings requirements contained in the report of the Corporate Director for Corporate and Support Services which was considered by the Executive at its meeting on 20 August 2012.

The Executive have agreed that each scrutiny committee should receive a report which includes details of the savings propositions relating to their remit. This report provides scrutiny committee members with an opportunity to review and comment upon both the overall approach being taken by the Executive and the relevant specific savings measures listed below:-

Portfolio:  Lifelong Learning and Achievement.

·                Services for young people. Prevention Cluster

·                SEN and free school bus passes Intervention Cluster

Portfolio:  Children & Young People

·                Early help and prevention. Prevention Cluster 

Portfolio: Adult Care Services

·                Adults Residential and Home Care Price Freeze: Procurement and Third Party Cluster

·                Adult Social Care Income Yield, Independence and Personalisation Cluster ,

·                Disability Review (Making Choices, Having Control ) Independence and Personalisation Cluster

·                Reablement,  Independence and Personalisation Cluster

·                Quality Management  Independence and Personalisation Cluster

The Scrutiny Committee is recommended to comment upon both the overall approach being taken by the Executive and the specific savings proposals detailed in the report for submission to the Scrutiny Co-ordination Committee which will compile a composite report for submission to the Executive.

Officer contact: Steve Houston, 0161 474 4000, steve.houston@stockport.gov.uk

The Leader of the Council (Policy, Reform & Finance) submitted a report (copies of which had been circulated) setting out the Executive’s response to the medium term financial forecasts and indicative savings requirements for 2013/14-2016/17. The report also detailed the Executive’s specific savings proposals for 2013/14 that related to the Scrutiny Committee’s remit.

The Leader of the Council referred to a recent update provided to members of all scrutiny committees summarising changes to the financial assumptions of the Medium Term Financial Plan in light of changes announced to the grant regime which resulted in the Council needing to make additional savings. The Leader of the Council emphasised that there remained a number of assumptions within the Plan that could not yet be finalised.

The Service Director (Transformation & Commissioning), the Head of Financial Management and the Strategic Accountant (Adults & Communities) summarised the individual savings proposals contained in the report.

The Executive Councillor (Health & Wellbeing) was also in attendance to respond to questions.

The Chair reminded the Scrutiny Committee that the proposals contained in the report would be considered by the Adults & Communities and Children & Young People Scrutiny Committees that would consider the wider impactions of the proposals on service delivery and that the comments of this Committee should focus on the possible impact on health.

The following issues were raised/ comments made on the specific proposals contained in the report:

·         The risk of providers withdrawing their service/ provision following a price freeze for residential and home care provision was highlighted. It was acknowledged that this was a risk, although experience in other sectors was that in the event of providers withdrawing others would take their place. It had also been stated that in proposing the freeze, the Executive had been satisfied that the rate was sufficient to provide a good standard of care. The collaboration with the Care Quality Commission to maintain standards was welcomed.

·         The rationale for reducing management capacity in ISSK was queried in view of the need to expand reablement services (which councillors welcomed), and in particular given the need to manage sickness absence. It was suggested this may impact on the ability to deliver savings in the longer term; could lead to higher rates of readmission to hospital which would in turn impact on the prognosis of patients and increase costs in the longer term. In response it was stated that appropriate management capacity was needed, not simply capacity, and that changes in the management structure were designed to ensure that it was able to deliver the ISSK recovery plan.

·         Further clarification was sought on the profile of current and future savings relating to reablement.  In response it was acknowledged that the current target for 2012/13 was unlikely to be achieved and therefore no further targets had been set for 2013/14.  It was hoped that the agreed action plan and delivery of greater capacity / value for money of the service would allow for the current targets to be met in 2013/14 with additional savings to be made from 2014/15.

In relation to the overall approach to savings, the Chair emphasised the value of prevention, particularly through Public Health work, in terms of outcomes and longer term savings and stressed the need to protect this activity in spite of pressures on funding.

RESOLVED – That the comments of this Scrutiny Committee on the Medium Term Financial Plan Executive Savings Proposals be referred to the Scrutiny Co-ordination Committee for consideration in conjunction with the comments of the other scrutiny committees.

This item has been placed on the agenda at the request of Councillor Paul Porgess.

Representatives of the Council, NHS Stockport and the Pennine Care NHS Foundation Trust have been invited to the meeting to provide an update on issues relating to psychiatry services for those with Learning Difficulties.

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

The Chair reported that this item had been included on the agenda at the request of Councillor Paul Porgess.

Councillor Porgess reported that in his role as Chair of the Valuing People Partnership Board, he had become aware of the concerns of parents and carers about the psychiatric support available to those with complex learning difficulties, and in particular the perceived lack of co-ordination between providers that was leading to episodes of mental ill-health becoming more severe than would otherwise have been had there been earlier intervention and prevention. Councillor Porgess also cited a number of examples.

Mary Edwards (Stockport Advocacy); Gina Evans (Joint Commissioning Lead, Mental Health, NHS Stockport); Barbara Mitchell (Service Manager, Stockport Learning Disability Partnership); and Dr Sudhir Salujha (Lead Consultant, Adult Psychiatry, Pennine Care NHS Foundation Trust) attended the meeting to provide an overview of the services available and to answer questions from councillors.

In response to the concerns raised by Councillor Porgess, it was stated that people with learning disabilities could access psychiatry that was commissioned for three programme activities (one session for an out-patient clinic, one session for home visits and a session for admin, research) and that was now staffed by one psychiatrist. It was recognised that this was not ideal, and that alternative support through mainstream Mental Health Services and out-of-hours emergency services was limited and difficult to access.

It was also stated that the Joint Protocol in place to respond to those patients with learning difficulties presenting with mental health problems would require a presentation with a co-morbid mental illness before admission to an acute ward. In many cases, this was not necessarily the most appropriate treatment especially in emergencies when non-medicalised interventions may be more effective. It was commented that patients often had difficult in receiving an even before a co-morbid diagnosis might be possible.

The shortcomings in the service had been recognised, and in response it was planned to establish a specialist Learning Disability Psychiatric Consultant post, although this needed to be seen against the background of a significant shortage nationally of Learning Disability Psychiatric specialists. It was emphasised that issues around access to learning disability psychiatric services needed to be considered in the context of the whole resource available for learning disability specialist health support.

Councillors asked a number of questions. The issues raised included:-

·         The increased prevalence of co-morbid mental health conditions for those with learning disabilities.

·         Demand for learning disability mental health services in Stockport was likely to be ‘average’, although other areas of Greater Manchester did not receive as much specialist support as Stockport.

·         Waiting lists for access to mental health services for those with learning disabilities could be up to six months, which could lead to significant further strain on individuals and families in the intervening period.

The Chair then summarised the issues highlighted in the debate:-

·         Improving access to emergency/ out of hours mental health services for those with learning disabilities;

·         Improving access to learning disability mental health and psychiatry services more generally;

·         Whether the issues raised needed to be considered as part of the wider Learning Disabilities Review; and

·         Recognition of the need to reshape the total learning disability mental health service resource to be more preventative and better able to respond to crises.

RESOLVED – (1) That Mary Edwards, Gina Evans, Barbara Mitchell and Dr Salujha be thanked for their attendance and presentation.

(2) That, in light of the key issues highlighted by the Scrutiny Committee, the Joint Commissioning Lead, Mental Health, NHS Stockport be requested to investigate options for re-designing the mental health services for learning disabilities and to submit an update report to the January 2013 meeting, including further information on the waiting lists for accessing psychiatry services and benchmarking data.

To consider a joint report of the Corporate Director for People and the Director of Public Health

The report provides a summary of the progress on the Public Health Transition to the Local Authority and to highlight the key next stages to secure an effective transition.

The Scrutiny Committee is invited to note the update and provide further comments on the opportunities for health and well-being that the Public Health transition will enable.

Officer contact Donna Sager, 0161 474 3928, donna.sager@stockport.gov.uk

The Director of Public Health and the Service Director (Transformation & Commissioning) submitted a report (copies of which had been circulated) providing a summary of progress with Public Health transition to the Council and highlighting the key next stages in securing an effective transition.

Councillors discussed the opportunities that the transfer of Public Health functions back to local authorities would provide in co-ordinating activity and also to re-evaluate local priorities. It was important to ensure that the public health message was embedded in a wide range of Council activities.

The Chair suggested further consideration should be given to requiring a ‘Health Impact Assessment’ be completed for every significant decision the Council took.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to include an item on the agenda for the 22 January 2013 meeting on Public Health opportunities and priorities and to make arrangements to invite members of other appropriate Scrutiny Committees to the meeting to take part in the discussion.

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

The Chief Operating Officer, Stockport Clinical Commissioning Group (CCG) attended the meeting and provided an update on progress with authorisation of the CCG as an NHS body and the transfer of staff and functions from the PCT to CCG and other new NHS organisations.

It was anticipated that authorisation would be achieved at the end of October. Consultation with staff was ongoing in conjunction with identifying which of the six possible destination organisations each post would be transferred to.

It was also confirmed that all positions on the CCG Board had now been filled.

RESOLVED – (1) That the update be noted.

(2) That the Chief Operating Officer, Stockport Clinical Commissioning Group be requested to provide the Scrutiny Committee with further details on the new members of the CCG Board and the details of the National Commissioning Board ‘area team’.

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 meeting and any Forward Plan items that fell within its remit.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to include on the agenda for the next meeting an item on ‘Support for Older People with Epilepsy’ and to circulate a copy of the Clinical Commissioning Group’s report on access to services for adults with epilepsy.