Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 25 February 2014.

The Minutes (copies of which had been circulated) of the meeting held on 25 February 2014 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.

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

Representatives of Stockport Clinical Commissioning Group, Pennine Care NHS Foundation Trust and Unison have been invited to the meeting to discuss future plans for mental health services.

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

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

The Chair informed the Scrutiny Committee that he had been in discussions with representatives of the Stockport Clinical Commissioning Group, Pennine Care NHS Foundation Trust and Unison in relation to changes to funding and configuration of mental health services in 2014/15 and beyond. He had invited these three organisations to the meeting to outline the background to this issue.

Pennine Care NHS Foundation Trust

Stan Boaler, Service Director for Mental Health (north and south) stated that feedback from stakeholders indicated that current service provision was not meeting the needs of users. This was within the context of increasing demand for services and decrease resources. It was no longer sustainable to continue to provide services in the same way and they would need to provided differently. The Trust was already exploring opportunities for innovation to improve service delivery.

Stockport Council

Nick Dixon, Commissioning Manager, Mental Health and Substance Misuse, stated that the Council had been engaged in developing preventative services and services to support people to step-down from more intensive interventions. Co-produced services had been successful on a small scale and further consideration was being given to ‘scaling-up’ these services.

Clinical Commissioning Group (CCG)

Dr Ranjit Gill, Chief Clinical Officer, outlined some of the financial challenges facing the NHS in both the national and local context. It was stated that in comparison to other clinical commissioning groups in Greater Manchester and in the 10 closest comparators, Stockport was one of the least well funded. Health care in Stockport was also heavily skewed toward more costly hospital care at the expense of primary and community based care. The CCG was in the process of rebalancing the system away from hospital care and reinvesting resources to more preventative and non-acute provision, including mental health services. Specific, targeted investment was planned for mental health services for 2014-16.

Health & Wellbeing Board

Councillor John Pantall, Chair of the Board, emphasised the role of Board in influencing the commissioning decisions of local partners, and the recognition of the need to reduce demand for acute care to release resources for reinvestment. It was also recognised that mental health was traditionally given less priority than physical health although this was changing. The upcoming refresh of the Joint Strategy Needs Assessment would give consideration to the mental health needs of the borough.

UNISON

Angela Rayner, Stockport Branch Secretary, stated the willingness of Unison to engage with both Pennine Care and Stockport CCG to respond to the challenges facing the organisations, and welcomed the proposed Review. She emphasised the desire of members to engage with the Review to ensure the best services could  be provided. It was also stated that staff had outstanding grievances lodged in relation to workload, staffing and support and that these would need to be addressed, regardless of any other services changes.

The following comments were made/ issues raised:-

·        Members welcomed the commitment to engagement and consultation with all stakeholders and emphasised the need for genuine dialogue.

·        It was stressed that the current mental health system was skewed too heavily toward the medicalization of mental health to the detriment of community solutions and to recovery. This needed to be redressed.

·        It was important to ensure that the workforce was engaged, and that they themselves had good mental wellbeing to ensure that they could deliver change.

·        The CCG recognised that there were gaps in current service provision and in meeting the needs of particular groups, and that the CCG would be differentially investing in those services, with a focus on prevention.

·        It was stated that while the proposed CCG investment was welcomed, staff and users nevertheless remained concerned about future provision.

·        Careful consideration needed to be given to engagement with service users and the third sector, as well as the Police.

·        The concern of the Scrutiny Committee was to ensure the best  ...  view the full minutes text for item 4.

At 6.37pm the meeting adjourned.

At 6.40pm the meeting reconvened.

Reducing rates of smoking in pregnancy is a key priority for the Public Health Department of Stockport Council and for Stockport NHS Foundation Trust. Key stakeholders are committed to reducing the local inequalities that exist and ensuring that all Stockport babies have access to the best start in life.

The report provides a summary of why smoking in pregnancy is an important health issue, current NICE guidance, an update and analysis of the data and an update on more recent work and future plans in this area.

Officer contact: Duncan Weldrake, 0161 474 2443, Duncan.weldrake@stockport.gov.uk

A report of the Deputy Director of Public Health was submitted (copies of which had been circulated) providing the Scrutiny Committee with an overview of the activity of partners in addressing smoking during pregnancy. Representatives of Public Health and the Stockport NHS Foundation Trust attended the meeting to present the report and answer questions.

The following issues were highlighted:-

·        it was estimated that smoking contributed to 40% of infant deaths; increased the risk of premature birth by 12.5% and increased the risk of intra-uterine growth restrictions that was associated with immediate and longer term health consequences;

·        there was a clear correlation between rates of smoking in pregnancy and deprivation, with expectant mothers from the most deprived wards being 6 times more likely to smoke in pregnancy than those from the least deprived;

·        the Foundation Trust had a specialist midwife to whom all women who were smokers were referred, and ‘Stop Smoking Champions’ in all wards of the Hospital;

·        consideration was being given to increased monitoring of expectant mothers through an additional checks at the 36 week midwife appointment to allow for greater opportunities for intervention;

·        efforts were being made to broaden the message to expectant mothers to include other risk factors and to promote a ‘healthy pregnancy’.

Councillors asked questions and made comments on the following issues:-

·        Guidance on the use of e-cigarettes during pregnancy. It was stated that there was no evidence base for their use during pregnancy so they could not be recommended.

·        Opportunities for peer-led support in the most deprived communities. In was stated that it had proved challenging in the past to identify peer educators, but the re-launch of the Family Nursing Partnership may provide opportunities.

·        Members welcomed the proposals for developing a holistic approach to healthy pregnancies.

RESOLVED – (1) That the report be noted.

(2) That the Deputy Director of Public Health be requested to provide additional information to Scrutiny Committee members in relation to North West trends in smoking during pregnancy and the correlation to inequalities.

To consider a report of the Deputy Director of Public Health.

At the last Scrutiny Committee in February, there was a request for a report relating to an analysis of the figures for excess winter deaths (EWD) in Stockport, and the programmes that we are putting in place to address this issue.  This report addresses the concerns raised.

The Scrutiny Committee is invited to comment on the report.

Anyone wishing to discuss the report should contact Donna Sager or Eleanor Banister on 0161 474 3928 / 2447, donna.sager@stockport.gov.uk Eleanor.banister@stockport.gov.uk

The Deputy Director of Public Health submitted a report (copies of which had been circulated) providing the Scrutiny Committee with an analysis of the data for excess winter deaths (EWD) in the Stockport in 2012/13, and the measures in place to minimise these.

The Committee discussed whether there was any correlation between EWD and deprivation. It was stated that there was no clear link, although EWD affected those in older age cohorts, and the oldest residents tended to live in the more affluent areas where life expectancy was greater. It was suggested that those in affluent areas tended to be more isolated from their neighbours whereas those in less affluent areas were more likely to be known to the wider community who could offer assistance in extreme weather. It was stated that the Council was seeking to co-ordinate the activity of partners in these circumstances to maximise the opportunities to make contact with vulnerable residents.

RESOLVED – That the report be noted.

To consider a report of the Health & Wellbeing Scrutiny Committee.

In 2013/14, the Scrutiny Committee undertook a review of the Children and Adolescent Mental Health Service and issues related to children’s mental wellbeing. The Final Report from that piece of work, entitled ‘Mind the Gap’, has now been completed.

The Scrutiny Committee is invited to consider the Final Report of the ‘Mind the Gap’ Scrutiny Review and make any amendments prior to submission to relevant partners for their consideration.

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

A representative of the Democratic Services Manager submitted the final report of the Scrutiny Committee’s Review ‘Mind the Gap: mental wellbeing and mental health services for children young people in Stockport’ (copies of which had been circulated) that contained the findings and recommendations from the Review. The Scrutiny Committee were invited to make amendments to the report before submission to the Council’s Executive and the Stockport Clinical Commissioning Group Board.

A schedule of changes proposed to the report was also submitted (copies of which had been circulated).

The Chair thanked all those involved in the Review for their contribution.

RESOLVED – That the ‘Mind the Gap: mental wellbeing and mental health services for children young people in Stockport’ Final Report be approved subject to the proposed amendments contained in the schedule

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.