Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 13 August 2014.

The Minutes (copies of which had been circulated) of the meeting held on 13 August 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-ins to consider.

Ann Barnes (Chief Executive) and James Sumner (Director of Operations), Stockport NHS Foundation Trust will attend the meeting to provide an update to the Scrutiny Committee on unscheduled admissions to Stepping Hill Hospital.

Details of the previous meeting at which this matter was considered can be found at http://democracy.stockport.gov.uk/ieIssueDetails.aspx?IId=13559&Opt=3

Ann Barnes (Chief Executive) and James Sumner (Chief Operating Officer), Stockport NHS Foundation Trust, attended the meeting to make a presentation to the Scrutiny Committee in relation to the Trusts performance against the 4-hour Emergency Department (ED) Target and their ongoing efforts to address increased attendances at ED.

The presentation covered the following issues:-

·         Recent review of governance had been undertaken, in particular the Trust Board’s Assurance structure.

·         Measures set out in the Action Plan previously considered by the Scrutiny Committee had been completed in most cases, although outstanding actions remained in relation to Information & Technology.

·         Current performance exceeded the 95% target and was in excess of the trajectory target, due to intensive work by the Trust in the preceding two months. The Trust believed there was a clear correlation between the measures being put in place and the improvements, although the Winter period would put increased pressure on the ED.

·         There was a general upward trend in ED admissions at Stepping Hill that reflected a regional and national trend. The deflection arrangements put in place by the Trust had been successful but deflected attenders had been replaced with new ones.

·         The Trust had introduced a range of indicators to monitor the system to be better able to respond to pressures.

·         Recruitment remained a challenge to the implementation of schemes and measures.

Ann Barnes also provided the Scrutiny Committee with an update in relation to the Trust’s transformation agenda, designed in part to reduce costs as a result of financial pressures in the NHS. The update included the following issues:-

·         Working in partnership with other NHS Trusts across the ‘South Sector’ to address common cost challenges.

·         The Trust was committed to a transformative approach to the financial challenges, to do things differently and more efficiently, rather than simply to do less.

·         Although there was a significant challenge, the Trust was broadly on target to meet its financial reduction requirements for the current year, although the increasing target in future years would be more challenging.

Councillors then asked questions / made comments, including:-

·         The improvements made were welcomed, but queries were raised about the consequence of missing the target during the Winter. It was suggested that although it was likely that performance would dip during the Winter period, this was likely to be the case across the South Sector.

·         Work with Mastercall to provide additional primary care support was welcomed.

·         Concerns were expressed that although the Trust had good and innovative ideas to respond to changing demands, it was not always able to implement them in a timely manner. In response it was stated that the Trust was now a more stable and robust organisation and the management team had been restructured to enable it to better implement change, which was moving at a considerable pace now.

·         The Clinical Commissioning Group was also investing in a range of services that should avoid admissions, including work with care homes.

·         While improvements were welcomed, concerns were raised about whether this was likely to increase demand as performance, and waiting times, improved.

·         There was no clear pattern to the increases in the attendances as numbers had reduced in previous years. Further communications could be undertaken to remind the public about seeking treatment from appropriate sources, but also to improve ‘front of house’ services to seek to divert attenders to primary care or pharmacists wherever possible.

RESOLVED – (1) That Ann Barnes and James Sumner be thanked for their attendance and presentation.

(2) That the Chief Executive of Stockport NHS Foundation Trust be invited to report back to the Scrutiny Committee in the New Year on performance in relation to the 4-hour admission target.

(3) That the Chief Executive of Stockport NHS Foundation Trust be requested to circulate the Executive Summary of the Trust’s recent Governance Review to Scrutiny Committee members.

To consider a report of Leader of the Council and the Executive Councillor (Corporate, Customer and Community Services)

At its meeting on 15 July 2014, the Executive received a Medium Term Financial Forecast that indicated a budget reduction requirement of £22.453m for 2015/16, and forecast a cumulative reduction requirement of £39.419m in 2016/17, rising to £64.5m by 2018/19. In response to those forecasts, and in line with its previous deliberations and statements of intent, the Executive agreed the strategic framework for Investing in Stockport (IIS), a single programme of sustainable growth and public service reform in the Borough over the medium term.

At its most recent meeting on 12 August the Executive brought forward a set of proposals informed by the strategic framework and designed to address the budget reduction requirement.  Executive Councillors agreed that there should be a report to all scrutiny committees in the next cycle outlining the proposals relating to each committee’s remit.  Confirmation of which proposals fall within the remit of which Committee is provided at Appendix 1.

The business case working papers (that will be circulated ‘to follow’) that were made available to the Executive Councillors accompany this report have been updated to include additional information in relation to the potential risks and impacts associated with the proposed changes. 

All scrutiny committees are being requested during this cycle of meetings to comment upon the approach being taken by the Executive to address the need to make substantial savings over the next two years, and the specific proposals brought forward for consultation. 

It is recommended, therefore, that the Scrutiny Committee comments upon both the overall approach being taken by the Executive and the specific proposals detailed in the accompanying documents, where they fall within the remit of that Committee.

Officer contact: Steve Houston / Laureen Donnan; 0161 474 4000 / 3180

A joint report of the Leader of the Council and the Executive Councillor (Corporate, Customer & Community Services) was submitted (copies of which had been circulated) detailing the Executive’s proposals to respond to the Medium Term Financial Forecast considered by the Executive In July 2015. At its meeting in August, the Executive endorsed for consultation a set of proposals, in accordance with the Investing In Stockport strategic framework, that sought to respond to the required budget reductions but also to target investment to ensure the best outcomes for residents in the Borough.

The accompanying documents to the report provided further detail on the following Investing In Stockport proposals:-

·         Preventative Commissioning Strategy

·         Integrated Prevention Service Children and Family Services

·         Integrated Care – Adult Social Care and Health

·         0-25 SEND Review

·         Learning Disability Review.

The Executive Councillors (Adult Care Services), (Children & Young People) and (Health & Wellbeing) and appropriate project leads attended the meeting to present the proposals and to answer questions. The Corporate Director for Corporate and Support Services also attended the meeting to answer questions from the Scrutiny Committee.

The following comments were made/issues raised in relation to the following Proposals:-

Preventative Commissioning Strategy

·         Changes to the indicative savings requirements contained in the report reflected the ongoing discussions within the Council and with partners on the scope of integration.

·         An argument could be made that, in the face of the current financial challenges, investment in prevention was not appropriate since savings may not be realised in the short term, and may not be realised by the Council. In response it was stated that there was clear national evidence of the value of preventative activity, although it in the context of one year budgeting this may not be apparent. It was also the case that some savings made be accrued to organisations other than the Council, but that within the context of an expanding pooled budget with the Clinical Commissioning Group, this would reduce the strength of the argument against preventative investment.

·         The ‘pruning’ of contracts that were no longer fit for purpose was to be welcomed, as was the overall direction of the proposals.

·         It was important to engage with local 3rd Sector organisations in the transformation of these services as they often had valuable local knowledge and experience. There was a danger that recommissioning services and making the specifications more restrictive may price out these local organisations and the market becomes dominated by large national charities. In response it was stated that the Council had engaged the Greater Manchester Council for Voluntary Organisations to ensure that it was reaching as many local 3rd Sector groups as possible to ensure wherever possible their valuable contribution could be protected. The Council was also exploring opportunities for ‘alliance contracting’ to encourage smaller organisations to share the risk associated with contracts so they would not be priced out of the market.

Integrated Prevention Service Children and Family Services

·         It was queried whether the Troubled Families Pathway work provided sufficient evidence that the approach detailed in the proposal.

·         Concerns were expressed about the impact on schools of the renegotiation of Service Level Agreements and whether this amounted to passing the cost of services on to schools. In response it was stated that it was hoped this process would encourage more effective buy back of services from schools, some of which could be aligned to Pupil Premium monies.

·         Clarification was sought on the risk associated with the proposals, particular around the availability of appropriate skills and knowledge in the workforce. In response it was stated that training and awareness-raising in relation to safeguarding was already taking place with front line staff in the Council and partner organisations.

·         Given the interdependency between Council activity and that of other agencies for the delivery of the proposals, clarification was sought on the mechanism for ensuing and monitoring this non-Council activity. In response it was stated that the Children’s Trust brought  ...  view the full minutes text for item 5.

To consider a report of the Corporate Director for People.

The report sets Portfolio Performance and Resource Report (PPRR) for the Health and Wellbeing Portfolio for the first quarter of 2013/14. This provides a summary of progress in delivering the portfolio priorities and budgets during the first quarter of 2014/15, and includes early forecast performance and financial data for the Portfolio. The reports also include a progress report and updated risk assessment of the portfolio savings programme. 

Scrutiny Committee is asked to:

a)      Consider the First Update Portfolio Performance and Resource Report,  

b)      Review the progress against priorities, performance, budgets and savings targets for 2014/15;

c)      Highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues;

d)      Identify how areas of strong performance and good practice can be shared in other services.

Officer contact: Gaynor Alexander, 0161 474 3186, gaynor.alexander@stockport.gov.uk/ Simon Finch, 0161 474 4019, simon.finch@stockport.gov.uk

A representative of the Corporate Director for People submitted a report (copies of which had been circulated) providing an update on the delivery of portfolio priorities, budgets and capital programmes for the Health & Wellbeing Portfolio during the first quarter of 2014/15.

The Executive Councillor (Health & Wellbeing) attended the meeting to answer questions from the Scrutiny Committee.

The following comments were made/ issues raised:-

·         A range of groups and stakeholder in Stockport had been contacted seeking their input into the development of the new Joint Strategic Needs Assessment. HealthWatch Stockport would be leading on the public engagement process.

·         Work was ongoing to finalise the Better Care Fund proposals prior to submission to NHS England in mid-September.

·         Concern was expressed about the delays in developing the Marple & Werneth integrated health and social care hub. In response it was stated that while progress had been slower than hoped for, the process had provided valuable learning for the development of the remaining locality hubs and had highlighted the need for robust project planning and professional development. It was emphasised that the work was achieving genuine integration rather than simply co-location of services.

RESOLVED – That the report be noted.

To consider a report of the Democratic Services Manager.

The report sets out the process for the selection of Scrutiny Review topics by Scrutiny Committees to be carried out during the 2014/15 municipal year.

Consideration of the topic selection was deferred from the last meeting.

A further report on a possible scope of a review on alcohol will be circulated separately.

The Scrutiny Committee is invited to consider the selection of Scrutiny Review topics to be carried out during the 2014/15 municipal year.

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) requesting the Scrutiny Committee to consider the process for the selection of Scrutiny Review topics to be carried out during the 2014/15 municipal year.

The Deputy Director of Public Health submitted a report (copies of which had been circulated) setting out a proposed scope for a possible review of alcohol misuse treatment services that would complement work needed to refocus the commissioning of services to support those recovering from alcohol misuse. This was timely because of the changing profile of those with alcohol dependency and to give greater focus to prevention and recovery.

The Deputy Director also highlighted the participation of local alcohol misuse treatment service users in a Recovery Walk in Manchester on the weekend of 13/14 September 2014.

RESOLVED – (1) That the Scrutiny Co-ordination Committee be informed that this Scrutiny Committee would wish to undertake a review of alcohol treatment and alcohol misuse prevention services and that this be included in the Scrutiny Work Programme for 2013/14.

(2) That the Scrutiny Committee welcome the involvement of Stockport alcohol treatment service users in the Recovery Walk taking place in Manchester City Centre on 13 September 2014.

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 items for the Scrutiny Committee’s next meeting and Forward Plan items that fell within the remit of the Scrutiny Committee.

RESOLVED – That the report be noted.