Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 22 October 2013.

The Minutes (copies of which had been circulated) of the meeting held on 22 October 2013 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

There were no call-in items to consider.

To consider a report of the Assistant Chief Executive and the Specialty Registrar in Public Health.

The Council’s Smoking Policy was last reviewed in 2007 and since that time there have been a number of changes in smoking habits and attitudes to smoking including the increased usage of substitutes such as electronic cigarettes. This report identifies the issues and implications for the Smoking Policy and the Council’s overall management of potentially hazardous substances.

The Scrutiny Committee is asked for its views on the following:

Should the Council:-

(i)      Make any amendments be made to the Smoke Free Policy to include the use of electronic cigarettes.

(ii)     If amendments are to be made the following will need to be considered:-

a.      It is acceptable to use electronic cigarettes in Council Buildings.

b.      If it is unacceptable to use electronic cigarettes in council buildings whether this also applies to Council controlled public buildings

c.      What communications should be adopted to ensure all employees and members of the public are informed of any policy the Council approves including the use of signage.

Officer contact: Kathy Heaton, 0161 218 1436, Kathy.heaton@stockport.gov.uk

The Assistant Chief Executive (Strategy, Policy, Partnerships & Transformation) and the Speciality Registrar in Public Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider issues relating to the increased usage of electronic cigarettes and the implications of this on the Council’s smoking policies.

The following comments were made/ issues raised:-

·         Nicotine was a dangerous and additive substance and its use and the subsequent dependency should not be encouraged.

·         E-cigarettes were being used in locations where tobacco smoking would be prohibited, such as buses and in pubs, and their usage was re-normalising a practice that had taken a significant effort to de-normalise.

·         The impact of e-cigarettes and the inhalation of the substances they contained remained unknown, so a cautious approach should be taken.

·         While there was anecdotal evidence of individuals giving up smoking entirely after switching to e-cigarettes from tobacco, it was not conclusive and the products could not be marketed as such. The use of the e-cigarettes would also encourage the physical habits of smoking which many current and former smokers found difficult to overcome.

·         Some concern was expressed about the impact on those using e-cigarettes to reduce or stop smoking of being forced out of buildings into areas where tobacco smokers were congregating.

·         E-cigarette usage should be targeted along with tobacco usage in future smoking reduction campaigns, such as Stoptober.

·         The Council should take a lead in discouraging the use of these products and encourage other partners to take a similar stance.

RESOLVED – (1) That

(i)            this Scrutiny Committee believes that the Council’s Smoke Free Policy should be amended to prohibit the use of the electronic cigarettes in any Council building, including public buildings controlled by the Council;

(ii)          in the event that it is agreed to amended the policy to prohibit e-cigarettes in Council buildings, the Chief Executive be requested to write to partners who use Council buildings informing them of the intention to amend the policy, and to Transport for Greater Manchester to encourage them to change their policies to prevent the use of the e-cigarettes on public transport;

(iii)         the Director of Public Health be recommended to develop a communications strategy to discourage the use of e-cigarettes, and to include this in future Stoptober campaigns.

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

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

The Chair reported on the recent decision by NHS England to introduce the Greater Manchester Pharmacy Flu Pilot scheme to Stockport to increase flu vaccination rates by enabling residents to be vaccinated at community pharmacies. The Chair stated that concerns about the scheme had been raised with him by various professional groups and organisations in Stockport because very little notice had been provided to the Clinical Commissioning Group/ Council and because it was unclear that the scheme would improve up-take in Stockport, where vaccination rates were amongst the highest in the country.

The Chair further stated the he had previously raised the matter with the Director of the Local Area Team of NHS England, who had also been informed that this item was being discussed at the meeting.

Dr Watkins, Director of Public Health, and Dr Ranjit Gill, Chief Clinical Officer of Stockport Clinical Commissioning Group, were in attendance and outlined some of the local concerns about the vaccination pilot. The main areas of concern were:-

·         Stockport’s vaccination programme was planned well-in advance to ensure adequate supplies of vaccine were procured and that those at risk were contacted. This approached had served residents very well in the past. Changes to the programme jeopardised future planning and dis-incentivised participation by GPs.

·         The pilot scheme had been introduced with very little notice and without sufficient time having elapsed since the start of the vaccination programme to determine that there was unmet need.

·         The provision of vaccinations to those at risk was most appropriately done under the supervision of their GP. Without that, opportunities to optimise treatment for those at risk would be lost, particularly at a sensitive time of the year when there was increased pressure on services.

The following comments were made/ issues raised:-

·         The priority for all involved should be to increase vaccination levels and prevent avoidable infection and escalation of conditions. In principle any provider that could deliver and improve take up and access should be appropriately rewarded, including community pharmacies. The concern was that the pilot had not been co-ordinated with the existing programme and would mean that GP practices were taking the risk and others may be benefitting. The lack of co-ordination reflected badly on the NHS as an organisation.

·         Encouraging take up of vaccinations by those outside of ‘at risk’ groups should be encouraged and there was a clear role for community pharmacists in this. The lack of co-ordination and communication was disappointing and avoidable, and could impact on levels of uptake this year.

·         Given the national drive toward more consistency of care and GPs taking more responsibility for vulnerable patients, there was a danger of diminishing the role of the GP in that care by encouraging vaccination by other providers.

RESOLVED – That

(i)            NHS England be informed of this Scrutiny Committee’s concern and disappointment with their lack of consultation and communication with the Stockport Clinical Commissioning Group and Public Health Service prior to the implementation of the Greater Manchester Pharmacy Flu vaccination pilot in Stockport;

(ii)          NHS England be requested to ensure that meaningful consultation and engagement take place with NHS and Council partners in Stockport as part of the planning of the flu vaccination programme for 2014/15, and

(iii)         in the event that partners fail to cooperate on the development and implementation of next year’s programme, that the matter be referred to the Secretary of State.

Following the conclusion of the programme of extraordinary meetings of the Scrutiny Committee to consider the Child and Adolescent Mental Health Services (CAMHS) Review, the Scrutny Committee is invited to give consideration to any conclusions it has drawn and possible recommendations to be included in the final report which will be submitted for consideration in the New Year.

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

The Chair gave a brief overview of the work undertaken to date in relation to the CAMHS Scrutiny Review, including highlights from the three extraordinary meetings held in the Autumn. The Chair identified headline issues that could form recommendations in the Final Report, including:-

·         Integration of Tier 2 and Tier 3 services and specialist services

·         Promoting mental wellbeing among young people

·         ‘Plugging gaps’ in services, particularly in the transition from children to adult services.

It was also suggested that a further recommendation be considered to request that the issue of children and young people’s mental wellbeing be included in future Joint Strategic Needs Assessments.

RESOLVED – That the Democratic Services Manager be requested to circulate a draft of the CAMHS Review Final Report, with the provisional title, ‘Mind the Gap’, to members of the Scrutiny Committee in advance of Christmas to allow for feedback prior to its submission to the Scrutiny Committee in January 2014.

Monitor's, the health service regulator, has published a ‘Statement of Issues’ (copy enclosed) relating to its investigation into the commissioning of specialised cancer surgery services in Greater Manchester. The investigation was begun in August 2013, following complaints by University Hospital of South Manchester NHS Foundation Trust and Stockport NHS Foundation Trust.

The two hospitals claimed that NHS England and its predecessor in the North West of England adopted a process for selecting future providers of cancer services that was not based on quality of services, patient outcomes or patient preferences.

After examining the evidence received to date, Monitor has decided the investigation should concentrate on:

·         Compliance with the Procurement, Patient Choice and Competition Regulations which came into force on 1st April 2013

·         Compliance with the competition condition in the NHS provider licence for foundation trusts (and equivalent obligations for NHS trusts).

·         Whether the process put in place by NHS England to select future providers was consistent with the rules.

·         Whether the involvement of providers in this process was consistent with the rules.

The Chair of the Scrutiny Committee has agreed to put this item on the agenda following receipt of correspondence from interested parties relating to this matter.

The Scrutiny Committee is invited to consider the enclosed Statement of Issues.

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

A representative of the Democratic Services Manager submitted a Statement of Issues (copies of which had been circulated) published by Monitor, the NHS regulator, about its investigation into the commissioning of cancer surgery services in Greater Manchester following complaints to Monitor by a number of local NHS Trusts.

Dr Ranjit Gill, Chief Clinical Officer from Stockport Clinical Commissioning Gorup, was in attendance at the meeting and highlighted some of the challenges facing commissioners in Greater Manchester to improve survival rates of Gastro-Intestinal and other cancers.

A copy of a letter from HealthWatch Stockport to Monitor was also submitted (copies of which were circulated) that expressed the organisation’s concerns about the level of consultation and engagement with service users prior to the commissioning decision.

Members commented on the importance of ensuring an improvement in outcomes and survival rates for the cancers in questions and the need to ensure that this was paramount in any commissioning decision, regardless of organisational concerns.

RESOLVED – That the Democratic Services Manager be requested to write to Monitor in respect of their investigation into commissioning of cancer surgery in Greater Manchester to express the view of this Scrutiny Committee that the interests of patients and the improvement in outcomes should be paramount and to reiterate the concerns raised by HealthWatch Stockport in relation to consultation.

The Joint Mental Health Overview and Scrutiny Committee for Pennine Care is currently undertaking a review of its Terms of Reference in light of the changes to the NHS resulting from the Health & Social Care Act 2012 and the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. The Joint Committee is seeking the views of all those health scrutiny committees within the footprint of the Pennine NHS Foundation Trust.

Enclosed is a copy of the letter to the Chair of this Scrutiny Committee, together with a copy of the revised terms of reference. For the Committee’s assistance a copy of the current Terms of Reference is also enclosed.

The Scrutiny Committee is invited to consider and comment on the Revised Terms of Reference for the Joint Mental Health Overview and Scrutiny Committee for Pennine Care and delegate to the Democratic Services Manager, in consultation with the Chair, authority to finalise any response to the consultation.

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

A representative of the Democratic Services Manager submitted a letter from the Joint Overview and Scrutiny Committee for Pennine Care (copies of which had been circulated) seeking views of the Scrutiny Committee on proposed changes to that Committee’s Terms of Reference arising as a result of the Health & Social Care Act 2012 and additional regulations.

RESOLVED – That Joint Overview and Scrutiny Committee for Pennine Care be informed that this Scrutiny Committee supported the proposed amendments to its Terms of Reference.

To consider a report of the Corporate Director for People.

The mid-year Portfolio Performance and Resource Report (PPRR) for the Health and Wellbeing Portfolio is presented for consideration by the Committee. This provides an update on progress in delivering the portfolio priorities and budgets during 2013/14, and includes performance and financial projections for the year.

Scrutiny Committee is asked to:

·         consider the mid-year Portfolio Performance and Resource Report;  

·         review the progress against priorities, performance and budgets for 2013/14;

·         highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues.

·         identify how areas of strong performance and good practice can be shared in other services.

Officer contact: Mike Harradine/ Simon Finch, 0161 474 4680/ 4019, mike.harradine@stockport.gov  / simon.finch@stockport.gov.uk

A report of the Corporate Director for People was submitted (copies of which had been circulated) providing an update on the delivery of portfolio priorities, budgets and capital programmes for the Health & Wellbeing Portfolio at mid-year in 2013/14.

The Executive Councillor (Health & Wellbeing) (Councillor John Pantall) gave a brief overview of issues relating to his portfolio.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to arrange for an item on a future agenda on Co-production of mental health services/ Nesta Project and its links with the personal health budgets.

To consider a report of the Democratic Services Manager.                                                          

The report sets out planned agenda items for the Scrutiny Committee’s next meetings 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 meeting and any relevant Forward Plan items.

RESOLVED – That the report be noted.