Agenda and minutes

The Chief Executive of the Stockport NHS Foundation Trust will attend the meeting to discuss ongoing efforts to reduce unplanned admissions and reduce A&E waiting times.

The Chief Executive (Ann Barnes) and the Acting Director of Operations & Performance (James Sumner) from Stockport NHS Foundation Trust attended the meeting to update the Scrutiny Committee on efforts to improve performance in relation to the healthcare standard requiring 95% of patients be admitted or treated and discharged within 4 hours of attendance to the Emergency Department of the hospital.

Stepping Hill Hospital had approximately 7,500 patients attend its Emergency Department each month, of which approximately 25% would be admitted. In the year to date attendance had increased by 3.9% and an increase in admissions of 7.6%, peaking during the winter period at 30-40% admissions. This pressure had required additional bed capacity to be found.

A hospital which had two successive quarters of not meeting this standard would trigger intervention by the NHS regulator Monitor. In the case of Stepping Hill Hospital, performance had been below this target for three consecutive quarters and had resulted in Monitor notifying the Trust at the end of January that it was in breach of its Authorisation. Leading up to this and since the notice was issued, the Trust had been having regular meetings with Monitor as part of the delivery of a rectification plan to address both the below target performance and to address more long term pressures on unscheduled care.

The Plan that had been agreed anticipated compliance with the 95% target by September of this year. The Plan was based on the assumption that the winter pressure on admissions would continue, therefore it was hoped that because of the prudence built into the Plan’s assumptions, compliance could be achieved earlier.

The Trust had been subject to a range of external reviews in addition to those by Monitor, all of which had found that the Trust’s Plans were sound and that appropriate progress was being made.

The following comments were made/ issues raised:-

·         In response to questions about failing to fully implement the Plan, it was stated that for each measure contained within it there were a range of contingencies to ensure that compliance would be achieved. The Plan had also been developed to ensure that the measures within it would have a long term impact, be sustainable and that improvements would result from the measures, not simply because of changing levels of demand. The difficulties being experienced by the Trust should be seen in the context of a national trend of worsening performance.

·         The Plan had been developed with the assumption that levels of demand would remain high, and had not factored in any of the other actions being taken by the Trust or the Clinical Commissioning Group to address unplanned admissions, such as the Stockport One project. Members welcomed the focus on reducing demand and prevention rather than reactive care, although it was recognised that it would take time to overcome a public culture of prioritising hospital care.

·         There was no clear pattern to Emergency Department admissions and as such no ‘quick fix’. GPs were provided with feedback as to the distribution of people presenting. The Trust was confident, supported by the opinions of other bodies, that they had correctly identified the causes for reduced performance and the remedy.

·         The difficulty of being seen to ‘turn people away’ to more appropriate care opportunities, such as GPs and pharmacies, was recognised. Careful management and working closely with other providers was important to ensure appropriate care was provided but also that the public were not using this as a bypass to a GP appointment. The Trust’s involvement in community care meant that it was better placed to prevent avoidable escalations for those with existing conditions.

·         In response to questions, it was stated that the three most important practical actions the Trust was taking were: (i) improving discharge from hospital and ensuring a senior doctor take responsibility for moving patients through their care pathway; (ii) increasing in-reach capacity; and (iii) recruiting additional  ...  view the full minutes text for item 1.

To approve as a correct record and sign the Minutes of the meeting held on 7 March 2013.

The Minutes (copies of which had been circulated) of the meeting held on 7 March 2013 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

There were no call-ins to consider.

The Director of Nursing and Midwifery, Stockport NHS Foundation Trust, will attend the meeting to discuss the Trust’s 2012/13 Quality Accounts.

The Scrutiny Committee is invited to comment and make representations prior to publication of the Accounts.

Officer contact: Judith Morris (Stockport NHS Foundation Trust), 0161 419 5014

The Director of Nursing & Midwifery, Stockport NHS Foundation Trust attended the meeting and submitted a copy of the Trust’s 2012/13 Quality Report (copies of which were circulated) as required by the NHS Regulator Monitor. The report gave an overview of performance in the past year in relation to quality achievements and improvements in patient care and experience.

RESOLVED – That members of the Scrutiny Committee be requested to provide comments or observations on the Stockport NHS Foundation Trust Quality Report 2012/13 to the Democratic Services Manager by 30 April 2013 and that, in consultation with the Chair, a formal response to the Report be prepared and submitted.

Gillian Easson, the recently elected Chair of the Stockport NHS Foundation Trust has been invited to the meeting to discuss the future strategic direction of the Trust.

A representative of the Democratic Services  Manager reported that the Chair of the Stockport NHS Foundation Trust was now unable to attend the meeting and had tendered her apologies.

RESOLVED – That consideration of this item be deferred and the Democratic Services Manager be requested to arrange for a suitable alternative meeting date.

To consider a report of the AGMA Executive

The attached report is being provided for information to keep the Scrutiny Committee informed of the agreed approach being taken across Greater Manchester in relation to delivering a substantial reduction in unplanned and avoidable admissions to hospital and other institutions such as residential care, and securing improved quality and outcomes from hospital services.

The Scrutiny Committee is invited to note the content of the report and make comment.

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

The Democratic Services Manager submitted a report (copies of which had been circulated) that had been endorsed by the AGMA Executive in relation to the priorities for health and social care reform in Greater Manchester, namely to deliver a substantial reduction in unplanned and avoidable admissions to hospital/ care facilities and to improve the quality and outcomes from hospital services.

The following comments were made/ issues raised:-

·         The report highlighted the importance of integration of health and social care services, though it did not prescribe a model. There were significant gains to be made through integration which partners needed to consider. This report should also be seen in the wider context of the Healthier Together project.

·         There appeared to be a contradiction in the report between the acute crisis in funding and the aspiration to widen expectations.

·         The financial challenges facing the NHS were different to those facing local authorities, but both organisations could benefit from integration in reducing spending, as recent evidence demonstrated there was no direct correlation between spend and outcomes.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to invite representatives of the Healthier Together Project to a future meeting to discuss progress with the initiative.

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

The Chair will report on a recent initiative between the Police, Local Authority and local businesses in Ipswich to reduce alcohol-related street disorder by limiting the sale of high strength larger.

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

The Chair referred to a recent article published in the Independent Newspaper about an initiative in Ipswich between the local council, Police and retailers to limit the sale and availability of high strength lager in shops in the Town Centre. The result had been a marked decrease in alcohol related disorder. The Chair invited the Committee to consider whether a similar initiative might be worth pursing in Stockport.

Members commented on the success of the initiative but recognised that Stockport had a different geographic and demographic profile to Ipswich which would make its application to Stockport difficult. Members also discussed the likelihood that the Government would not pursue Minimum Unit Pricing for alcohol and that there may be a need to reconsider local options.

RESOLVED – (1) That the report be noted.

(2) That the Chair be recommended to contact the Police and Crime Commissioner and the Leader of the Council in relation to the issues raised in the Independent Newspaper article with a view to exploring whether there was scope to undertake a similar initiative to that tried successfully in Ipswich in relation to restricting the availability of high strength lager.

To consider the selection of Scrutiny Review Topics for 2013/14.

Scrutiny Committees are being invited to consider potential Scrutiny Reviews to be undertaken during the 2013/14 municipal year.  This will facilitate the approval of an initial Scrutiny Work Programme at the Council Meeting on 27 June which would enable the Reviews to commence much earlier than in previous years.

There would be a further opportunity for the selection of any additional topics following the commencement of the new Municipal Year which could take into account the outcome of the consultation on the Executive Savings proposals.  Once the Scrutiny Committees have had the opportunity to undertake any further appraisal of their review topics, the Scrutiny Work Programme may be further considered at the Council Meeting on 12 September for the remainder of the 2013/14 Municipal Year.

The Scrutiny Committee is recommended to give consideration to the selection of Scrutiny Review Topics for the 2013/14 Municipal Year.

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

A representative of the Democratic Services Manager invited the Scrutiny Committee to consider potential Scrutiny Review topics to be undertaken during the 2013/14 municipal year.

A representative of the Democratic Services Manager also reported on an issue raised by the Bramhall & Cheadle Hulme South Area Committee on 11 April 2013 in relation to the identification of a problem for a child, young person or family, including bullying or harassment through a multi-agency response. The Area Committee had recommended that this Committee give consideration to the development of the multi-agency safeguarding and support hub which aimed to ensure better and more intelligent information sharing between key public sector agencies.

RESOLVED – (1) That consideration of Scrutiny Review topics for 2013/14 be deferred until the next meeting.

(2) That a further update be provide to a future meeting on the multi-agency approach to bullying and harassment. 

The Executive Councillor (Health & Wellbeing), representatives of the Council, Stockport Clinical Commissioning Group and other stakeholders to provide verbal updates on NHS reform, as appropriate.

RESOLVED – That consideration of this item be deferred.

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 – That the report be noted.