Agenda and minutes

To approve as a correct record and sign the Minutes of the meetings held on 11 and 26 November 2013.

The Minutes (copies of which had been circulated) of the meetings held on 11 and 25 November 2013 were approved as a correct record and signed by the Chair subject to the inclusion under Minute 4 of 25 November 2013 of the following additional bullet point:-

“E-cigarette usage should be explored as the evidence base unfolds. Members recognised that many people had found them useful in their efforts to give up or reduce tobacco use.”

Councillors and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

The following interest was declared:-

Personal Interests

There were no call-ins to consider.

Representatives of Stockport NHS Foundation Trust will attend the meeting to update the Scrutiny Committee on the work of community health services since it transferred to the Foundation Trust from the PCT in 2011.

James Sumner (Chief Operating Officer) and Sarah Shingler (Associate Director of Integrated Care) from Stockport NHS Foundation Trust attended the meeting to provide an update to the Scrutiny Committee on the transfer of community health services from the Primary Care Trust to the Foundation Trust in April 2012.

Mr Sumner outlined the background to the transfer of community services in 2012, which had included both Stockport and Tameside PCT services. At the time of transfer, the services were aligned to existing services/ divisions within the Foundation. Due to other pressures within the hospital services, most notably in relation to emergency admissions, the Trust had felt that insufficient advantage had been taken of the opportunities of developing community services and alternative models as the organisation had become overly acute care focussed.

Due to a number of senior staff vacancies arising within the Trust, this presented an opportunity to restructure the organisation to give specific focus to community services through the creation of a specific  division within the organisation, which would bring together services provided across both Stockport and Tameside. It was hoped this new approach would assist with efforts of the Trust and the Clinical Commissioning Group (CCG) in diverting hospital admissions and manage emergency department demand. To this end, the Trust had appointed Sarah Shingler and Michelle Lee (Associate Director for Community Services).

The Trust was also seeking to improve the relationship with care providers to improve in-reach services, identify where earlier interventions were needed and where earlier discharge was possible. Similarly, improved care pathways were being developed for those in the hospital to optimise their treatment journey.

The work being undertaken by the Trust was in accord with the approach of the CCG who were seeking to commission integrated services that would more effectively manage those with complex needs and conditions.

The following additional comments were made/ issues raised:

·      Members queried the likely impact on service delivery of the proposed new model. In response it was stated that although Tameside and Stockport services were being brought together a separate identify and approach for delivery would remain as this reflected the differing demands of each area. Nonetheless, there would be opportunities for the sharing of best practice and innovation. It was anticipated that the new model would assist the Trust more generally in embracing new ways of working that were not so acute-sector focussed.

·      The Trust had been successful at improving discharge and avoiding ‘bed blocking’, particularly when working with social care. It was recognised that community services could and should have a greater role in making further improvements, particularly in recognising where there were opportunities for sub-acute care.

·      Concerns were expressed about the responsiveness of community services, and the need to ensure that they were flexible to the needs of patients. Examples of difficulties in obtaining appointments with District Nurses were given. In response it was stated that a review of district nursing had taken place and changes to the centralised delivery model had been made in recognition of the shortcomings.

RESOLVED – That James Sumner and Shingler be thanked for their attendance and presentation.

(2) That the Scrutiny Committee would welcome a presentation to a future meeting from Associate Director for Community Services, Stockport NHS Foundation Trust, on the Community Services Strategy.

David Mellor, Chair of the Children and Adult Safeguarding Boards, will attend the meeting to discuss safeguarding and in particular the issues around safeguarding in health settings.

More information about the work of the Safeguarding Boards can be found online at:

www.safeguardingchildreninstockport.org.uk

www.stockport.gov.uk/safeguardingadults  

David Mellor, Chair of the Stockport Safeguarding Children and the Adult Safeguarding Boards, attended the meeting to discuss with the Scrutiny Committee the work of the Boards and the particular safeguarding challenges related to health.

Mr Mellor provided the Scrutiny Committee with an overview of each Board and the level of activity taking place by each. In both cases, there was rising demand through increased referrals.

The Children’s Board was a statutory body, which included arrangements for funding its work, and involved approximately 35 agencies. The Adult Board was not yet statutory, although there was a Bill before Parliament that would provide it with a statutory footing. Currently, the only source of funding was from the Council, which was unacceptable if there was genuine commitment from all partners to protecting adults.

There had been an 18% increase in referrals to the Council relating to adult safeguarding concerns. This need not necessarily reflect a worsening situation but was more likely due to increasing awareness, particularly in the wake of the Francis and Winterbourne View Reports.

It was stated that Health Service partners were active and committed members of both Boards, in particular the CCG which was developing robust systems in relation to safeguarding. The Foundation Trust had experienced challenges in ensuring all staff had been trained and that here were appropriate supervision arrangements.

The following additional areas of challenge/ ongoing work were identified:-

·                    Significant work since 2012 to address Ofsted findings in relation to health checks for Looked After Children.

·                    Action Plan in place to improve pre-birth assessments.

·                    CAMHS service under significant pressure to provide specialist services to the high numbers of non-Stockport looked after children in placements in the borough.

·                    Pressures on School Nursing.

·                    Challenges in engaging with all GP practices.

·                    Child Sexual Exploitation remained a challenging area for partners, although lots of work had been done to mitigate risk and provide support to possible victims.

The following comments were made/ issues raised:-

·                The CCG had significantly increased its safeguarding provision and resource. It was taking steps to ensure that this activity was embedded across the organisation as well as ensuring there were effective systems embedded within the services it contracted. The Governing Body took an active interest in these issues and was very aware of the funding issues. Work was continuing with the Local Area Team of NHS England to ensure all GPs were being engaged.

·                The number of private children’s care homes in Stockport presented a number of challenges and had been subject to a Review by the Children & Young People’s Scrutiny Committee. These children deserved the best service, regardless of their origin, but it had to be recognised that they put additional pressure on services. There were also approximately 79 Stockport looked after children placed outside the Borough and there would be ongoing consideration about the appropriateness of these placements.

·                The Adult Board had been able to engage with acute providers and the Foundation Trust was a member of the Board. Although there was regular reporting, it was currently reliant on the willing co-operation of the Trust/ providers.

·                Recent convictions and high profile cases of adult abuse and neglect had helped in raising the profile of adult safeguarding. Importantly the convictions would also act as a deterrent.

·                The rigidity of the eligibility criteria for access CAMHS had been a source of concern and had led to serious problems. The work of the Council in developing a 0-25 approach to services to overcome problems with transition would assist with this.

·                Concern was expressed about the ongoing difficulties with training and engagement with GPs. While it was recognised that GPs were under increasing pressure, it was vital to ensure that they were trained to get safeguarding basics right.

RESOLVED - (1) That David Mellor be thanked for his attendance and presentation.

(2) That the Chief Operating Officer of the Clinical Commissioning Group be requested to circulate a copy  ...  view the full minutes text for item 5.

To consider a joint report of the Service Director (Adult Care Services) (Stockport Council) and the Chief Operating Officer (Stockport CCG)

The Better Care Fund (previously referred to as the Integration Transformation Fund) was announced in June as part of the 2013 Spending Round. It provides an opportunity to transform local services so that people are provided with better integrated care and support. The report sets out the proposals that will go forward as part of the bid from Stockport.

The Scrutiny Committee is invited to comment on the report before it is considered by the Executive and Clinical Commissioning Group Board.

Officer contact: Terry Dafter, Service Director (Adult Social Care), 0161 474 4401, tery.dafter@Stockport.gov.uk

A joint report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group) was submitted (copies of which had been circulated) containing a draft of the joint Council/ CCG bid to the Department of Health for the Better Care Fund (previously known as the Integration Transformation Fund) that would form the basis of local plans to further integrate health and social care services. The Bid would be submitted to the Council’s Executive and CCG Board in early February before sign-off from the Health & Wellbeing Board (which would had been delegated to the Chair and Vice-Chair because of the timescales involved).

The following comments were made/ issues raised:-

·         Members welcomed the commitment in the document to data sharing and emphasised the importance of doing this across the economy. The Stockport One work had provided important lessons on how and what should be shared. Data protocols would need to be developed to support the technical solutions.

·         Members welcomed the efforts being made and thanks were expressed to those involved from both the Council and CCG for their efforts and leadership in seeking to make such a significant change. Members commented on the potential difficulties in overcoming professional and legislative barriers to closer working, as well as meshing together differing working and organisational cultures.

·         Concerns were also expressed about the impact of the proposals on the financial stability of the acute sector. The involvement and support of the Foundation Trust was welcomed.

RESOLVED – That the report be noted and the proposed direction of travel for the Better Care Fund as detailed in the draft plan submission be supported, subject to the following comments:-

·         the importance of data sharing and appropriate data governance arrangements;

·         the need for robust mechanisms to ensure performance requirements were met; and

·         the importance of these propels in contributing to changes to the culture of health and social care, particularly around 7-day working.

To consider a report of the Director of Public Health.

Included with the agenda are the overview and key messages (Levels One and Two respectively) of the 21^st Annual Public Health Report for Stockport for 2013/14.

The full analyses report (Level Three) has not been included in the agenda due to its size, but can be viewed online at http://democracy.stockport.gov.uk/documents/s35926/21st%20PH%20Report%20-%20Level%203%20-%20Full%20Analyses.pdf

The Scrutiny Committee is invited to comment on the report.

Officer contact: Dr Steve Watkins, 0161 474 2436, stephen.watkins@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) providing an overview and the key messages from the 21st Annual Report of the Director of Public Health.

The Director highlighted that the health of the population of Stockport was broadly in line with national averages, although there remained significant inequalities.

Members welcomed the report and the analysis contained therein.

The following comments were made/ issues were raised:-

·         Members discussed the large scale public health challenges in the UK, and whether these had been tackled or were currently being tackled through legislative or infrastructure changes. Members commented that the issues still to be addressed, such as physical activity or healthy lifestyles, required a different approach to the ‘big’ challenges of the past, such as sanitation etc. In particular, members identified challenges to overcome institutional and commercial interests (sugar and salt in food) or to overcome ingrained behaviours (physical activities).

·         Improving healthy life expectancy was also identified as a particular challenge. Encouraging older people to remain physically active was emphasised, as was giving them opportunities to remain in work (if they wanted) or to volunteer and engage in social activities. Poor mental wellbeing was a key factor, and deprivation was a significant cause of poor mental health.

·         Members also discussed whether there was a likelihood of future generations having lower life/health life expectancy because of current levels of physical activity and poor diet. It was stated that there was conflict evidence but there was a growing body of opinion supporting this view.

RESOLVED – That the annual report of the Director of Public Health be welcomed.

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

The Chair will provide a brief update to members on developments since the last meeting in relation to the 2014/15 Flu Vaccination Programme.

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

The Chair reported back correspondence and meetings that had taken place in response to concerns raised locally about the current flu vaccination programme in Stockport.

It was reported that while a final resolution had not yet been reached, significant progress had been made between NHS England and local NHS Groups to overcome concerns and safeguard elements of the local provision that had proven to be so successful in the past.

RESOLVED – (1) That the update be noted.

(2) That the Democratic Services Manager be requested to make arrangements for an item on an agenda later in the calendar year to discuss the vaccination and immunisation programme 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 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 relevant Forward Plan items.

RESOLVED – That the report be noted.