Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 26 January 2016.

The Minutes (copies of which had been circulated) of the meeting held on 26 January 2016 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.

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

Following representations made by Healthwatch Stockport, the Chair has invited representatives of Stockport NHS Foundation Trust, Stockport Clinical Commissioning Group and the Council’s Adult Social Care Service to discuss the current pressures facing urgent and acute care in Stockport, and the pressures on discharge from hospital.

Attached is some information on Delayed Transfers of Care provided by Healthwatch that had been supplied by the Public Health Service.

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

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

The Chair reported that he had received representations from Healthwatch Stockport expressing concerns about the deterioration in performance at Stepping Hill Hospital in relation to the 4-hour admission target and the potential impact this had on patient care. In light of these concerns he had agreed to include this item on the agenda.

David Kirk and Gavin Owen, of Healthwatch Stockport, attended the meeting to outline their concerns. They acknowledged the positive relationship they had with health and social care partners who kept them informed of performance issues, but stressed that they remained concerned that there were system-wide problems in the Urgent Care provision that were impacting on patient experience and care, and putting unnecessary pressure on staff. These problems were not solely within the responsibility of the Foundation Trust but were connected to issues around delayed discharge (DETOC) to intermediate care and other nursing facilities.

Data from the Council’s Public Health Intelligence Team and NHS England was also provided to highlight the issues.

Mark Chidgey (Director of Provider Management at Stockport Clinical Commissioning Group) on behalf of the Chair of the System Resilience Group (SRG), acknowledged the worsening Emergency Department performance at Stepping Hill Hospital but stressed that partners on the SRG were working to address this and related health system-wide issues. He confirmed that external agencies had been engaged to provide root-cause analysis of the situation and provide recommendations that the SRG would consider.

Mark Fitton (Director of Operations, Adult Social Care, Stockport Council) reported on work to address nursing care bed and assessment capacity that was impacting on DETOC, including empowering frontline staff to make decisions that would speed up discharge. A wider review of community bed capacity was also underway.

James Sumner (Chief Operating Officer, Stockport NHS Foundation Trust) confirmed that delayed discharge was the biggest challenge facing the Trust, and was impacting on the elective admission capacity within the hospital. He emphasised the need to prevent avoidable admissions wherever possible, as well as way to improve processes within the hospital that impacted on ‘internal flow’. He acknowledged the short-term pressure on health and social care partners but stressed that the Stockport Together programme was the longer term solution to these challenges.

Councillor John Pantall (Executive Councillor for Independence & Wellbeing, Stockport Council) emphasised the complexity of the interplay of different organisations and other factors and the need for a holistic solution.

The following comments were made/ issues raised:-

·         Clarification was sought on the role of the System Resilience Group (SRG) and its capacity to effect change. In response it was stated that the role of the SRG was to bring all partners together to develop and monitor system-wide solutions and to take collective responsibility. It was emphasised that the root analysis was seeking to understand the reasons for the deterioration in performance in Stockport, and to understand the particular challenges for this economy.

·         In relation to the data provided by Public Health on the reasons for DETOC, further information was sought on the reasons for the high percentage of delays caused by patient or family choice (61.2% in 2015/16 to date). In response it was stated that wherever possible professionals tried to avoid having patients making long term choices about care while in an acute setting. Adult Social Care did seek to help patients make timely choices. It was also acknowledged that that there was a delicate balance between seeking to discharge and moving a patient too quickly to an inappropriate setting that prompted a further move that could be disruptive to care. The issues with capacity in community care settings needed to be addressed, including supporting some care homes to improve the quality of provision to create capacity. It was suggested that improved advocacy provision may assist patients and carers to  ...  view the full minutes text for item 4.

To consider a report of the Leader of the Council and the Deputy Leader.

The Scrutiny Committee will be invited to consider and comment on the revised business cases for the following Investing in Stockport proposals:-

·         Information, Advice & Guidance

·         Health & Social Care (‘Plan D’)

Officer contact: Holly Rae; 0161 474 3014; holly.rae@stockport.gov.uk

A joint report of the Leader of the Council and the Deputy Leader of the Council was submitted (copies of which had been circulated) providing an update on those Investing in Stockport proposals considered by the Scrutiny Committee in December 2015, following completed consultation with members, stakeholders and the public. The proposals had been brought forward by the Executive to respond to the financial challenges facing the Council and in response to the forecasts provided by the Corporate Director for Corporate and Support Services.

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

·                   Health & Social Care (including the integration of health and social care, the redesign of the mental health and support work service, and the remodelling of the Stockport Learning Disability Services)

·                   Information Advice and Guidance

The Executive Councillor (Independence & Wellbeing) (Councillor John Pantall), the Director and Deputy Director of Public Health and representatives of the Corporate Director for Corporate and Support Services and Service Director (Adult Social Care) attended the meeting to present the revised proposals and to respond to questions from the Scrutiny Committee.

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

Information, Advice & Guidance

·         Library usage in Priority Areas was traditionally lower than other parts of the borough. Further consideration should be given to providing promotional activities in the Town Centre or other location to capture those who might not use libraries.

·         It was important to keep the use of technical language to a minimum so as to allow access for those with lower literacy levels or confidence.

·         Queries were raised about the ability of residents to keep or print information or advice provided, either digitally or from the face-to-face activity. In response it was stated that through the procurement of ‘Better Off’ software, residents would be able to store information they had previously accessed within the system, to print off where needed. The Council had already reduced the amount of information it provided in printed formats in any case.

·         In relation to delays experienced by those seeking advice, it was commented that the Contact Centre had been able to address this demand through signposting to ensure that those with the greatest need were able to access face-to-face advice services.

Health & Social Care Proposals (‘Plan D’)

·         Concerns were expressed that many of the milestones in the Business Case were referred to as ‘under development’ despite being only four weeks from implementation.

·         In particular, concerns were expressed about the deliverability of proposals in relation to out-of-borough learning disability placements. In response it was acknowledged that returning placements to the borough may prove challenging, but that this would be done incrementally to minimise disruption. It was also commented that because of the significant costs of these placements even a low number of ‘returns’ could realise significant savings.

·         Councillors expressed concern and disappointment about the unanticipated reductions to the Public Health grant announced by the Government and the impact this might have on the ability of local health and social care partners to deliver their ambitious transformation programme. In response, it was stated that the flexibilities being developed by the expanded S75 Pooling arrangements, through Stockport Together and working across Greater Manchester, would allow opportunities to minimise the impact. Nevertheless, the potential negative impact was acknowledged.

·         Representatives of Healthwatch Stockport expressed concerns about the difficulties in responding to the consultation given the rapidly changing proposals. Councillors echoed these concerns.

·         Confirmation of the accuracy of the figures set out in the Integration Health & Social Care Section 6 ‘Investment Profile (2016/17 and beyond)’ Business Case. An undertaking was given to provide a written response.

·         Confirmation was sought on whether the Greater Manchester Health and Social Care Locality Plan had been considered by the Scrutiny Committee in October 2015, as stated in paragraph 3.2 of the covering report. In response it was stated that the matter had not been  ...  view the full minutes text for item 5.

To consider a report of the Deputy Chief Executive.

This Scrutiny Committee has been presented with aspects of the Investing in Stockport programme that are within its remit; most recently in the form of business cases for service reforms in late 2015.

To support Investing in Stockport the Executive, in August 2015, agreed to invest in the Digital by Design (DbD) programme, in order to:

·           Support services to implement the wide-ranging changes required to meet planned spending reductions over 2015-17

·           To improve customer and service user experience, and

·           To establish a platform to support further organisational change and spending reductions post-2017

DbD will develop digital services and ways of working that the vast majority of residents, and our workforce, will choose to access by preference, and which others will be assisted to use, including full assistance for the most vulnerable and elderly groups.

This report updates the Scrutiny Committee on progress with this programme and in particular sets out (at Appendix 1) those measures that will improve services and arrangements that are within the remit of this committee, or that have already done so.

The Scrutiny Committee is asked to:-

•     note and discuss the update provided and to request any further information as necessary.

•     note the aspects of the programme that are relevant to health and wellbeing services and provide comments on developments so far.

Officer contact: Steve Skelton / Paul James; 0161 474 3174 / 5430;  steve.skelton@stockport.gov.uk / paul.james@stockport.gov.uk

A representative of the Deputy Chief Executive submitted a report (copies of which had been circulated) updating the Scrutiny Committee on progress with the Digital by Design programme (DbD) to support services to implement the wide-ranging changes required to meet planned spending reductions over 2015-17 to improve customer and service user experience, and to establish a platform to support further organisational change and spending reductions post-2017.

The following comments were made / issues raised:-

·         In relation to the development of the locality hubs and issues with data-sharing, it was suggested that information governance was a more significant challenge than the technology solution. It was also reported that work was underway at a Greater Manchester level to address the challenges of information governance and Caldicott within the health and social care economy and it was hoped this would help with the development of the Stockport Together programme.

·         In working with partners about data sharing this was an iterative process, rather than working to a specification that prevented flexibility and innovation. The DbD Programme was also exploring ways to empower the public to choose to share data across partners.

·         Concerns were expressed that Healthwatch Stockport had been invited to participate in discussions about DbD but that there was little follow-up and so Healthwatch had not been able to engage. This failing was acknowledged and it was stated that alternative methods of engagement were being explored.

RESOLVED – That the report and developments with Digital by Design relevant to health and wellbeing services be noted.

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) inviting the setting out planned agenda items for the Scrutiny Committee’s next meeting and any relevant Forward Plan items.

RESOLVED – That the report be noted.