Agenda and minutes

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

To approve as a correct record and sign the Minutes of the meeting held on 28 July 2015.

The Minutes (copies of which had been circulated) of the meeting held on 28 July 2015 were approved as a correct record and signed by the Chair.

In relation to Minute 5 the Chair reported that the Chief Coroner had responded to the letter sent on the Scrutiny Committee’s behalf following the last meeting and the discussion on the Deprivation of Liberty Safeguards. The Chief Coroner had stated that he shared many of the concerns expressed by the Scrutiny Committee and that he would be providing additional guidance to coroners in the near future. Furthermore he would be pressing Ministers to bring forward more limited legislation in advance of the Law Commission review to seek to address the most pressing difficulties arising from the Supreme Court judgement.

There were no call-ins to consider.

To consider a joint report of the Corporate Directors for People and for Corporate Director Corporate and Support Services.

At its meeting on 18 August 2015, the Executive received a report which included a Medium Term Financial Forecast for the period 2016/17 to 2020/21. That report illustrated the level of resources likely to be available in 2016/17 and the resulting budget position should the previously identified level of cash limit reductions be achieved.

In response to those forecasts, and in line with its previous proposals and statements of intent, the Executive brought forward a set of proposals for 2016/17. These have been informed by the strategic framework and are designed to address the budget reduction requirement.  At the meeting on 18 August Executive Councillors agreed to present to each scrutiny committee the relevant proposals relating to each committee’s remit, including the specific detailed business cases.

The Health and Wellbeing scrutiny committee is therefore receiving the following:

•        The Executive Report; Stockport Together – Integrating Health and Social Care

•        The Preventative Commissioning Project Update

•        The Information, Advice and Guidance Business Case

This Committee is asked to comment on the aspects of the attached reports, including the overall approach being taken for the intregration of Health and Social Care; in particular the plans for service change prior to entering into an agreed pooled budget.

The Scrutiny Committee is asked to comment on:

•        The attached business cases and project updates

•        The overall approach being taken to the development of the Council’s model of Integrated Health and Social Care, and

•        The proposed approach to pooling Health and Social Care budgets as outlined within the specific Health and Social Care report.

Officer contact: Andrew Webb or Steve Houston on 0161 474 3808 or 0161 474 4000

A joint report of the Corporate Directors for People and for Corporate and Support 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 August 2015. The Executive had brought forward a set of proposals and statements of intent, in accordance with the Investing In Stockport strategic framework, that sought to respond to the required budget reductions. The Executive agreed to seek the views of scrutiny.

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

·         Preventative Commissioning Strategy – project update

·         Stockport Together: Integrated Health and Social Care – report and business case

·         Information, Advice & Guidance - business case

The Executive Councillor (Health & Wellbeing), the Deputy Director of Public Health and representatives of Corporate Director for Corporate and Support Services and Service Director (Adult Social Care) attended the meeting to present the proposals and to answer questions.

The following comments were made/issues raised in relation to the following proposals or updates:-

Preventative Commission Strategy – Project Update

·         Most of the savings requirement had already been achieved in the previous year, but the remaining £0.5m needed from the Public Health portfolio would be achieved through a combination of efficiencies; natural wastage; merger of a range of lifestyle-related services; bringing the Workforce Development Service back in-house; tariff deflation on contracts with Stockport Foundation Trust (FT).

·         The Scrutiny Committee had previously been broadly supportive of the reconfiguration of services where it could be demonstrated that different models of delivery could achieve better outcomes.

·         There would be further opportunities to integrating health visiting into other Council services once commissioning responsibilities passed to local authorities in October 2015.

·         Concerns were expressed about the impact on service users of applying the tariff deflator on FT contracts. In response it was stated that this was a standard part of NHS contracts designed to ensure efficiencies were made within NHS spend, usually through management efficiencies. It was not anticipated that this reduction would impact on frontline services.

Stockport Together

‘Plan B’ proposals

·         It was commented that the proposals represented significant risks for future service delivery and the reductions in service could lead to similar costs being borne elsewhere with adult social care, such as the reduction in size of the hospital social work team leading to fines caused by delayed discharge. In response it was acknowledged that these proposals carried risks but that changes in the model of care that would come about with the Stockport Together proposals would in time mitigate these risks. It was also commented that previous budget reductions meant that further reductions were likely to result in existing activity being limited.

·         In relation to discharge from hospitals, concerns were expressed that as well as the potential for delayed discharges there could also be an increase in inappropriate early discharge and whether, given the difficulties already experienced in this area, further reductions would exacerbate this problem. In response it was stated that discharge processes were being changed in any case to ensure that discharge was arranged on the basis of medical fitness. It was also reported that a ‘community ward’ was being created to cater for vulnerable older people whose medical condition fell short of admission but who could not be appropriately ‘discharged’.

·         Given the work going into Stockport Together and previous integration projects it was important to get an understanding of its impact and effectiveness. Stockport Together would be subject to further decisions moving forward but there remained unresolved issues around governance and its links with Greater Manchester devolution.

·         Questions were asked about the process for bringing out-of-area Learning Disability (LD) placements back to facilities within the borough, in particular what the process would be should the individual not wish to leave their current setting. In response it was stated that only a relatively modest proportion of the total number of  ...  view the full minutes text for item 4.

To consider a joint report of the Corporate Directors for Corporate and Support Services and for People.

The report provides the Scrutiny Committee with details of the 2015/16 Section 75 / pooled fund agreement between the Council and Stockport Clinical Commissioning Group (CCG).  The agreement is scheduled for approval by the Council’s Executive on 6 October 2015.     

In addition the report highlights the in principle agreement to significantly increase the value of the pooled fund in 2016/17 and the work to be completed to ensure that the future S75 agreement recognises the larger and more volatile areas coming into view. 

The Scrutiny Committee is invited to comment on the report.

Officer contact: Michael Cullen, 0161 474 4631, Michael.cullen@stockport.gov.uk

A joint report of the Corporate Directors for People and for Corporate and Support Services was submitted (copies of which had been circulated) containing a proposed Section 75 Partnership Agreement between the Council and Stockport Clinical Commissioning Group to cover the 2015/16 financial year that had been revised to take account of the Better Care Fund arrangements.

The Scrutiny Committee had discussed issues relating to the Section 75 agreement and the pooling of budgets during consideration of the Investing in Stockport Programme: Executive Proposals report at agenda item 4 above (Minute 4 refers).

The following additional comments were made/ issues raised:-

·         Clarification was sought on whether the pooling arrangements/ S75 agreement was able to manage the likely risks associated with the 2016/17 pooled proposals. It was responded that it was believed that the arrangements were adequate for the 2015/16 pool, but further work would be undertaken to ensure the arrangements were revised in time for the 2016/17 pool. It was commented that as the Council hosted the pool these would be subject to regular reporting through the portfolio performance reporting process.

·         Future portfolio reports should include specific reference to the pooled budgets.

·         It was anticipated that further guidance would be issued in relation to the monitoring/ auditing of pooled budgets in light of the increasing usage of these agreements.

RESOLVED – That the revised Section 75 Agreement for 2015/16 be noted and the Executive be informed of this Scrutiny Committee’s concerns about the arrangements for the scrutiny of the management of the pool and the need for appropriate reporting for the 2016/17 pool.

To consider a report of the Director of Public Health.

This report outlines the rationale for the development of the strategy, summarises some of the key evidence base and gives an overview of the key objectives within which the strategy’s action plan has been developed.

The Scrutiny Committee is invited to note the Strategy.

Officer contact: Russ Boaler, 0161 474 3941, russ.boaler@stockport.gov.uk

The Deputy Director of Public Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to consider the Physical Activity Strategy for 2015-18.

The Strategy was accompanied by an Action Plan that would be monitored annually, and would complement the existing Stockport Joint Health & Wellbeing Strategy and the developing Greater Manchester Physical Activity Strategy.

The Strategy was not solely concerned with encouraging people to be physical active but also to address the risks associated with being sedentary.

The following comments were made/ issues raised:-

·         What more could the Scrutiny Committee do to champion non-sedentary behaviour, given the committee meeting itself was inherently sedentary? It was commented that the public sector had a key role in leading by example, including the introduction of standing desks, etc. and that because of the significant impact this activity had on health it was vital to promote physical activity. It was suggested that this Committee could consider having ‘standing agenda items’ during its meetings.

·         It was important to encourage schools to open their facilities for wider community use, but this needed to be handled appropriately so that schools understood the benefits to them and the wider community, as well as ensuring the facilities were used effectively.

·         There were many physical activities that were free, but given the reduced investment in park facilities etc., this may discourage people from using them as their quality deteriorated. This was likely to lead to a consequential cost elsewhere in the public sector, such as the health service. Minimal investment may therefore lead to significant benefits.

·         It was commented that there were a significant number of health professionals whose own health was less than ideal and this meant that the message to patients was often less well received.

·         While the aims of the Strategy were laudable and obviously beneficial, the challenge would be to convince people to change their lifestyles and behaviour.

·         There was clear evidence of the mental health benefits from physical activity.

RESOLVED – That the Physical Activity Strategy be welcomed.

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

This three part report presents the latest analysis of Healthy Life Expectancy data and provides a summary of programmes which make an important contribution to the Council’s commitment to narrowing health inequalities.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Donna Sager or Sarah Clarke on 0161-474-3928 / 2456, donna.sager@stockport.gov.uk / sarah.e.clarke@stockport.gov.uk

The Deputy Director of Public Health submitted a report (copies of which had been circulated) updating the Scrutiny Committee on the latest analysis of Healthy Life Expectancy data for Stockport, and providing a summary of programmes which make an important contribution to the Council’s commitment to narrowing health inequalities.

The following comments were made/ issues raised:-

·         Councillors discussed the importance of promoting wellbeing with the Council’s workforce, as well as in other organisations, and it was reported that the Council had established a new Health & Wellbeing Steering Group to promote this agenda within the workforce.

·         In relation to statements within the report about support to various community groups being withdrawn it was clarified that this was part of a broader effort to refocus services and make more effective use of resources. This would involving seeking to make these groups self-sustaining through a ‘lighter touch’ support as currently many had become static and dependent on Council intervention to do simple activities that limited the scope to support newer groups or initiatives.

·         The Chief Executive of NHS England had emphasised the poor healthy life expectancy within Greater Manchester so it was hoped that this would lead to investment as part of the devolution agenda to address this issues.

·         Tackling health inequalities and inequalities in healthy life expectancy would need community-based solutions, rather than population level solutions. It also needed to be recognised that there was often significant variations between specific ethnic and other communities that needed tailored solutions.

RESOLVED – That the report be noted.

To consider a report of the Democratic Services Manager.

The report sets out a proposed scope for the Scrutiny Review - Support for those with dementia and their carers, subject to final agreement of the Scrutiny Work Programme by the Council Meeting on 17 September 2015. The report also sets out some proposed dates.

The Scrutiny Committee is invited to comment on and agree the Scope and the proposed dates for the Review Panel.

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) inviting the Scrutiny Committee to consider a draft scope for the proposed review into support for those with dementia and their carers.

RESOLVED – (1) That, subject to the approval of the 2015/16 Scrutiny Work Programme by the Council Meeting, the draft scope for the Scrutiny Review – ‘Support for those with dementia and their carers’ be approved, to be undertaken by a Review Panel comprising all members of the Scrutiny Committee.

(2) That the first meeting of the Review Panel take place on Wednesday, 30 September 2015 at 5.30pm.

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 meeting and any relevant Forward Plan items.

The Chair reported on receipt of a letter from Mastercall Healthcare indicating the organisation’s intention to move to new premises off Bramhall Moor Lane from their current location on the A6. Councillors expressed concern about the accessibility of this location and their wish to understand further the reasons for the proposed move and for selecting the new site. The Chair also reiterated the Scrutiny Committee’s previous resolution to invite Mastercall to a meeting to discuss their vital role in providing out-of-hours care.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to invite representatives of Mastercall Healthcare to the next meeting.