Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 9 September 2014.

The Minutes (copies of which had been circulated) of the meeting held on 9 September 2014 were approved as a correct record and signed by the Chair subject to the following amendments to Minute 5 ‘Investing in Stockport – Executive Proposals’, section headed ‘Learning Disability Review’:-

·         Replace the final sentence of the first bullet point with ‘The development of Heys Court in Edgeley, which would provide specialist accommodation for clients with learning disabilities, was very promising.’

·         Remove ‘completion of the’ from the fourth bullet point.

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 to consider.

To consider a report of the Director of Public Health.

The report describes the current UK immunisation programmes and how these operate in Stockport, including the roles and responsibilities of the different local organisations, following the recent changes to NHS commissioning arrangements; an overview of local trends in immunisations rates and compared these to national benchmarks; a summary of proposed or anticipated future changes for the UK immunisation programmes; recent local developments in Stockport to help improve the delivery of our responsibilities, and highlighting a number of potential risks for the immunisation programme.

The Scrutiny Committee is invited to

·         comment on the report and the information contained within it

·         consider whether it feels assured that the proposed focus of local action, as outlined in section 6 of the report, will fulfil the local authorities’ responsibility for immunisation, as set out in section 2.5 of the report.

Officer contact: Sarah Turner, 0161 474 2441 Sarah.Turner@stockport.gov.uk   

The Director of Public Health submitted a report (copies of which had been circulated) updating the Scrutiny Committee on current UK immunisation programmes and how these operated in Stockport, including the roles and responsibilities of the different local organisations, following the recent changes to NHS commissioning arrangements; an overview of local trends in immunisations rates and comparisons with national benchmarks; a summary of proposed or anticipated future changes for UK immunisation programmes; recent local developments in Stockport to help improve the delivery of local agencies’ responsibilities, and highlighting a number of potential risks for the immunisation programme.

Sarah Turner, Senior Health Protection Nurse (Stockport Council) and Dr Graham Wardman, Screening and Immunisation Lead (NHS England Local Area Team) attended the meeting to answer questions from councillors in relation to the report and immunisation programmes in Stockport.

The following comments were made/ issues raised:-

·         The expansion of flu vaccinations to 5-year olds was highlighted, building on the successful programme with nursery age children.

·         The improvement in immunisation rates for Measles, Mumps & Rubella was highlighted. There remained a disparity in rates between the more deprived and more affluent areas, although the higher rates in deprived areas may be due to more targeted work to encourage uptake in immunisation programmes more generally.

·         Partners were undertaking targeted work in Priority Areas to improve vaccination rates, particularly with local GPs and through the Neighbourhood Management Teams. In many cases rates could be improved by providing additional nursing capacity.

·         Variability in vaccination rates between GP practices was of concern, particularly in relation to flu vaccination. Improvements in these rates need to be addressed both through work with the community to raise awareness but also for organisational and process issues. Co-ordinated working between NHS England and local Clinical Commissioning Groups and councils was key to understanding the needs of local communities and organisations. Stockport CCG took very seriously the variation in flu vaccination rates.

·         World Health Organisation (WHO) targets were around 95% coverage for immunisation as this was the base level for ‘herd immunity’. Commissioners in Stockport had instituted stretch targets in the past and these had proved successful in increase take-up.

·         The high rates of immunisation in Stockport meant that other areas and NHS England were looking to learn from the work in this area.

·         The take-up of Human papilloma virus (HPV) vaccinations in Stockport was good, with only one faith school not allowing it to be administered in its establishment, but this position was reviewed by the school annually. It was important to engage in dialogue with schools and governors to ensure that they understood the facts and benefits of the programme. Schools in Stockport were very willing to allow vaccination programmes to take place, despite the disruption to teaching, and Public Health colleagues were grateful for this.

The Director of Public Health updated the Scrutiny Committee on recent discussions between the Clinical Commissioning Group, Stockport Council (Public Health) and local pharmacies to shape future flu vaccination programme in Stockport (Minute 9 of 29 April 2014 refers). Agreement had been reached on a solution and it was hoped that the cooperative model being developed in Stockport could be rolled out to other areas.

RESOLVED – (1) That the report be noted and that in the view of this Scrutiny Committee the proposed focus of local action on immunisation as set out in Section 6 of the report fulfilled the Council’s responsibilities.

(2) That Sarah Johnson and Dr Wardman be thanked for their attendance and presentation.

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

The report sets a proposed response to the CleaR assessment on Stockport’s work on Tobacco Control. CLeaR (Challenge, Leadership, Results) is an improvement model which provides local government and its partners with a structured, evidence-based approach to achieving excellence in local tobacco control. The model comprised a self-assessment questionnaire, backed by an optional challenge and assessment process from a team of expert and peer assessors. Stockport opted to undertake the full assessment process.

The Health & Wellbeing Scrutiny Committee and is invited to comment on the response to the CleaR assessment prior to consideration of the report by the Health & wellbeing Board, and to recommend that they endorse the recommended responses to the CleaR Assessment.

Officer contact: Mary Brooks, 0161 474 2455, mary.brooks@stockport.gov.uk

A representative of the Deputy Director of Public Health submitted a report (copies of which had been circulated) informing the Scrutiny Committee of the outcome the CleaR assessment of tobacco control in Stockport, including the proposed response to their recommendations on improvements to local activity.

Overall the assessment process found that the work taking place between partners in Stockport was positive, but the assessment also made recommendations on improvements.

The following comments were made/ issues raised:-

·         In relation to the recommendation to re-establish a Tobacco Control Alliance, councillors emphasised the need for an effective partnership arrangement that could deliver meaningful leadership and change. There were concerns that the proposed membership was too broad and that without a tightly defined agenda the group would have limited impact. Further work to refine this response was suggested.

·         In relation to the recommendation to sign the Local Government Declaration on Tobacco Control, councillors discussed whether this was a tokenistic gesture. It was commented that Stockport was more active in its tobacco control activity than some authorities that had signed the declaration.

·         Councillors discussed the merits of implementing a ‘refusal book’ system when underage tobacco sales were refused and the details recorded. This would allow for greater monitoring of retailers in the same way as alcohol sales were.

·         There was discussion about the dangers of e-cigarettes and their potential merit as a tobacco substitute/ cessation tool.

·         Previous commitments to prohibiting smoking near council controlled play areas was discussed although the difficulties of enforcement were also highlighted.

·         The importance of targeted work was highlighted, particularly in relation to priority areas and of areas of deprivation, where rates of smoking and related harm were high. Councillors also discussed the balance between preventative work and cessation activity and its efficacy.

RESOLVED – (1) That the report and the findings of the CleaR Assessment on tobacco control in Stockport be noted.

(2) That the Health & Wellbeing Board be informed that in relation to the proposed response to the CleaR Assessment Recommendations, the Scrutiny Committee was of the view that:-

·           Any re-establishment of a Tobacco Control Alliance should ensure the group was outcome focussed and that consideration should be given to a more limited membership than proposed in the report;

·           The development of three year plan for tobacco control would be welcomed, but that further consideration be given to incorporating this within the Health & Wellbeing Strategy or Council Plan;

·           The value in signing the Local Government Declaration on Tobacco Control was recognised, but that this should only be done if there were to be a clear link with activity and outcomes;

·           Further consideration should be given to reviewing the level of spend on smoking prevention within the context of other substance misuse prevention and treatment expenditure.

(3) That the Health & Wellbeing Board be recommended to give further consideration to the following suggestions with a view to recommending them to the appropriate executive councillor:-

(i)     The introduction of a local policy for the provision of a ‘refusal book’ for underage tobacco sales for licensed premises and to explore collaboration with other Greater Manchester authorities to develop and implement such a policy.

(ii)    Undertaking a pilot project to prohibit the smoking of tobacco in the vicinity of Council play areas and to explore cost-effective means of enforcement of such a restriction.

To consider a report of the Director of Public Health.

Stockport Health and Wellbeing Board has a duty to prepare and publish a regular Pharmaceutical Needs Assessment (PNA) . We are undertaking a full update of the Stockport PNA in 2014/15, so that we can update our understanding of the priority needs and meet our statutory duties to publish by April 2015.

The PNA requires a statutory 60 day consultation with a limited range of stakeholders who must be served with a draft PNA for comment. The consultation launched on 12th September and is running until 17th November.

The purpose of the report is to provide the Scrutiny Committee with an opportunity to discuss and comment on the draft PNA document and also to examine the consultation process.

The Scrutiny Committee is asked to:

    (i)        consider and comment on the consultation process outlined in section 3;

  (ii)        to consider the content of the draft Stockport PNA 2015, particularly focusing on the following questions:

§  The document sets out the draft results of the pharmaceutical needs assessment for Stockport. Does it achieve this?

§  Is the Committee aware of any relevant information that has not been included which could affect the statements or conclusions in this document?

§  This document shows that pharmaceutical provision within Stockport is satisfactory with limited identified gaps. Does the Committee have any comments on this overall conclusion?

§  Does the Committee have any other relevant comments to add to this document?

Officer contact: Eleanor Banister, 0161 474 2447, eleanor.banister@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) providing the Scrutiny Committee with an opportunity to comment on the draft Pharmaceutical Needs Assessment (PNA) for Stockport. The Health & Wellbeing Board now had the statutory responsibility to complete and approve a PNA by April 2015, which would assess whether the current provision of pharmaceutical services met the current needs of the population and identify any gaps in service delivery. The Scrutiny Committee was invited to consider the draft PNA and make comment, and to address the questions set out in section 5 of the report.

Hazel Evans, Primary Care Pharmacy Advisor, attended the meeting to explain the background to the development of the PNA and to answer questions from councillors.

The following comments were made/ issues raised:-

·         Concerns were raised about the decrease in the number of pharmacies providing smoking cessation services. In response it was stated that the previous contract for this enhanced service had been restrictive in the therapy that could be provided as a consequence of which many providers had ceased to offer it, meaning the current number was more reflective of the extent of services being offered. In relation to Brinnington, it was stated that pharmacists were being trained to deliver an improved cessation programme, as it was recognised that the need in this area was greater.

·         Concerns were raised about pharmacies, particularly those with multiple sites, closing on Saturdays, and whether the move to seven day working in the NHS and extended GP hours would create difficulty for residents who were not able to access pharmacies in the Town Centre. In response it was stated that over 50% of pharmacies did open on Saturdays, but that in many cases this could not be regulated. Should a GP surgery open on a Saturday, it was likely that local pharmacies would respond to this new need/ market and open accordingly.

·         Members discussed the number of internet pharmacies and the regulations governing them. Concerns were also expressed about marketing tactics used by internet pharmacies to attract new customers, particularly where older and vulnerable residents were signing up to internet services but not realising the implications. Members stressed the valuable service community pharmacies provided to many residents, particularly around delivery/ pick-up and repeat prescriptions. It was also commented that community pharmacies could sometimes focus on the most profitable activities that were not necessarily those services most valuable to the community.

·         Concerns were raised about the security of communication between pharmacies and GP practices, particularly when this was done by fax.

In relation to the questions posed in the report the Chair, on behalf of the Scrutiny Committee, provided the following answers:-

The document sets out the draft results of the pharmaceutical needs assessment for Stockport. Does it achieve this?

Response: Yes

Is the Committee aware of any relevant information that has not been included which could affect the statements or conclusions in this document?

Response: No further comments.

This document shows that pharmaceutical provision within Stockport is satisfactory with limited identified gaps. Does the Committee have any comments on this overall conclusion?

Response: Potential gaps in relation to Saturday opening hours in the context of expanding GP operating hours.

Does the Committee have any other relevant comments to add to this document?

Response: See comments above.

RESOLVED – (1) That the report be noted and Hazel Evans be thanked for her attendance and presentation.

(2) That the comments and responses of the Scrutiny Committee to the Draft PNA be submitted as part of the consultation.

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

In September, Scrutiny Committees received a report on the Investing in Stockport business case working papers brought forward at the August Executive. At its meeting on 30 September the Executive brought forward a set of Draft Business Cases for those proposals with implications for the Council’s budget in 2015/16. A number of Draft Business Cases contain only minor changes to those original business case working papers.

The Executive agreed that there should be a further report to all scrutiny committees in the October cycle, sharing the Draft Business Cases, and providing scrutiny committees with an opportunity to provide final comments on those proposals relating to their committee’s remit.  The Draft Business Cases that were made available to the Executive Councillors therefore accompany this report. Confirmation of which proposals fall within the remit of which Committee is provided at Appendix 1.

The Scrutiny Committee is invited to provide final comments upon the specific Draft Business Cases in the accompanying papers.

Officer contact: Steve Skelton, 0161 474 3174, steve.skelton@stockport.gov.uk

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) containing the Investing in Stockport 2015/16 Draft Business Cases approved for consultation by the Executive on 30 September 2014 and providing the Scrutiny Committee with an opportunity to make further comment on the proposals.

RESOLVED – (1) The report and Investing in Stockport 2015/16 Draft Business Cases be noted, and the following views of the Scrutiny Committee be forwarded to the Scrutiny Co-ordination Committee:-

·         it remained the case that all five of the proposals were seeking to address challenging situations, and this was increasing in some cases;

·         that there was a challenge in balancing meeting of needs and being able to meet demand for services;

·         that many of the proposals were based on assumptions about deliverability that had yet to be articulated; and

·         there remained significant potential risks with implementing the changes contained in the proposals.

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.