Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 25 May 2016.

The Minutes (copies of which had been circulated) of the meeting held on 25 May 2016 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

There were no call-ins to consider.

To consider a report of the Director of Public Health.

This report outlines the outcome of the recent consultation on the Public Health Staffing Restructure and presents the Final Business Case (Appendix A).  Health and Well Being Scrutiny Members previously considered the Draft Business Case on the 5th April 2016. The report was noted with an acknowledgement that an update will be provided to the Scrutiny Committee upon conclusion of the consultation.

The responses to the consultation have indicated a high level of staff engagement in the proposed Public Health Staffing Business Case and staff have indicated that they have felt listened to in the process and their amendments have been, in the majority of cases, reflected in the new structure.

The Scrutiny Committee is asked to comment on the Final Business Case prior to it being presented to the Executive on the 19 July 2016, and note that the Business Case proposes changes in terms and conditions of a number of staff.

Officer contact: Donna Sager, 0161 474 2436, donna.sager@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 final Business Case for the restructure of the Public Health Service. The Business Case, which was considered by the Scrutiny Committee in April, had been subject to extensive consultation and discussion with staff, trade unions, and the Royal College of Nursing, and was being submitted for consideration prior to submission to the Executive in July 2016. The Business Case had been developed in response to reductions in the Public Health Grant from the Department of Health announced in February 2016.

The Executive Councillor (Health) (Councillor Tom McGee) attended the meeting to respond to questions from the Scrutiny Committee.

The followings questions were asked/ issues raised:-

·         Clarification was sought on the protection period for staff moving from NHS to Local Authority Terms and Conditions. It was stated that this would last for two years.

·         Clarification was sought on whether staff could remain within the NHS pension scheme following transfer. It was stated that an application had been made and it was anticipated that this would be accepted.

·         Was there confidence that desired outcomes could be delivered with the new structure? In response it was stated that the new structure would give priority to the preventative agenda. It was acknowledged that the future would be challenging, but there was confidence that the Service could continue to deliver improvements in outcomes.

·         Given that much of the Public Health work was targeted at population level, staffing numbers were important. In response it was acknowledged that delivering the public health agenda would be challenging. It was important to work with partners, such as pharmacies, to access the wider population.

·         Had staff been engaged with the consultation and been constructive? In response it was stated that Managers in the service had an open door policy, but that the team was relatively small which had meant everyone had engaged in the process, including the Union Representative. Every effort had been made to respond to and act upon the feedback received. .

·         What had been the effect on staff moral? In response it was stated that staff moral had been negatively impacted, although they recognised the need for changes. They also had concerns about the future of their work, roles and terms and conditions. There was recognition of the benefits of the new model, although there was understandable anxiety about change.

·         There were references in the Business Case to reductions in activity and further clarification was sought. In response it was stated that because most of the Public Health budget was committed through contracts, savings had to be sought from non-contractual activity and by prioritising those areas of work where the most impact can be demonstrated. It was also important to ensure that as many partners and front line staff elsewhere in the Council were engaged with and furthering the Public Health agenda.

·         Was the current round of reductions sustainable given future reductions? In response it was stated that the service had worked on a three year financial plan and every opportunity to generate income or make savings would be explored, including working with partners, or commissioning and providing services with other local authorities.

·         The importance of reducing inequalities was stressed, as was the long term challenge this represented, and the need for nuanced programmes to effect behavioural change. The comments were acknowledged, but it was stressed that tackling the disparity in ill-health life expectancy should also be a priority gap. It was also commented that there was often a geographical clustering of inequalities across a range of health indicators.

·         Given the scale of the reductions in staffing, where were the pressures on the service likely to be? In response it was acknowledged that there would be pressures, but there was confidence that the new structure and the dedication of staff would be able  ...  view the full minutes text for item 4.

(Note: the Chair has agreed that this item be included on the agenda in accordance with Section 100B (4)(b) so that the Committee can consider the matter prior to the next scheduled meeting)

The Chief Executive of Stockport NHS Foundation Trust will attend the meeting to report on current issues and developments at the Trust that may be of interest to the Scrutiny Committee.

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

Ann Barnes (Chief Executive) and Andrew Burn (Director of Financial Improvement) from Stockport NHS Foundation Trust attended the meeting to report on the Trust’s involvement in the Financial Improvement Programme, being led by NHS Improvement.

The Trust had been invited us to take part in the programme which was aimed at those Trusts with sustainable financial challenges, and provided focussed support to identified challenges and implement measures to improve sustainability of the Trust. The Professional Services company KPMG has been assigned to the Trust to provide additional capacity and insight.

The Trust had completed the first phase of the programme during which an analysis was completed and recommendations developed, and this had been reported to the Board. Phase 2 had now begun with the implementation of the findings.

The challenge for the Trust was that each year it was required by NHS England to make savings, but this meant the Trust was then making a loss. It was hoped that through this Programme to make additional savings of approximately £16m to ensure the financial sustainability of the Trust.

Some of the key areas that the Programme Team were looking at included:-

·         length of stay

·         theatres

·         estate

·         delayed discharge (reduce delays to reduce cost and to improve patient experience)

·         spending thresholds

·         addressing absenteeism

·         reduced reliance on agency staff and better co-ordination of their use

·         reviewing budgeting process.

It was emphasised that these measures would not be to the detriment of operational activity at this hospital and that although being delivered quickly, proposals were quality assessed to ensure clinical considerations taken into account.

Councillors asked questions and made comments, including:-

·         What was the impact of the Programme on the Trust’s Five Year Strategy? In response it was stated that Strategy and its objectives remained in places, in particular the committmint to Stockprot Together and an integrated health and social care organisation, as well as a focus on cancer care and older people. The ‘complexion’ of the Trust was likely to change in the future, given the changes under consideration but the form of the organisation would follow from decisions about its function.

·         What steps were being taken to improve existing capacity within the Tryst’s management team to address the problems being encountered? In response it was stated that one of the reasons for the Trust getting involved with the programme was because KPMG would provide development capacity to enable the Trust’s staff to improve management practices.

·         Further information was requested in relation to work to improve delayed discharges. In response it was stated that KPMG were working closely with the Trust’s senior managers to address this area of work, and this included addressing activity on each ward; bringing activity forward in the day to ensure prevent conflict with other activity; working with Council staff to ensure practice and activity was effective. Early efforts had resulted in an increase in discharges and a positive trend in activity. Work was also underway to accelerating ‘front door’ activity to deflected inappropriate attendances and to ensure improved monitoring of patients to improve appropriate hand-off. Further comments were then made about the need for early conversations between hospital and social care staff, and the variability in practice between wards. The issues were acknowledged and assurances were given that these issues were being addressed through this work.

·         Had the ability to recruit of staff improved since the decision on Healthier Together, reducing the reliance on Bank and Agency staff? In response it was stated processes had now changed so that Bank staff were now arrange through a central office to provide greater co-ordination. Bank staff were, for the most part Trust staff so were desirable to use. The Trust was actively working to reduce the use of agency staff, and there were also national targets to do so.

·         What was being done to reduce/ discourage people from attending? In response it was stated that this was the  ...  view the full minutes text for item 5.

To consider a report of Corporate Director for People.

This report presents the draft 2016/17 Agreement for the Health Portfolio (Appendix 1) for consideration and comment by the Committee. For Health and Wellbeing Scrutiny Committee, this incorporates;

·         Public Health

·         Health and Wellbeing

Policy priorities for the year ahead are set out within the Agreement, incorporating the existing Council and Borough Plan priority outcomes alongside specific priorities of the new Executive.

The Agreement will form the basis for regular in-year reporting. Portfolio and Corporate Performance and Resource Reports (PPRRs and CPRRs) will assess progress against key objectives, priorities, outcomes and budgets, enabling Scrutiny Committees to hold the Executive to account and for the Executive to identify current and future risks to delivery.

The Scrutiny Committee is asked to review and comment on the draft Portfolio Agreement.

Officer contact: Karen Kime / Susan Wood Policy, 0161 474 3574, 218 1032, Karen.kime@stockport.gov.uk / susan.wood@stockport.go.uk

The Executive Councillor (Health) submitted a report (copies of which had been circulated) detailing out the draft 2016/17 Agreement for the Health Portfolio, which set out the policy priorities for the year ahead and incorporating the existing Council and Borough Plan priority outcomes alongside specific priorities of the new Executive. The Agreement would form the basis for regular in-year reporting. The Scrutiny Committee were invited to comment on the draft Agreement prior to its adoption by the Executive.

The Executive Councillor highlighted the key priorities within the draft Agreement.

The following comments were made/ issues raised:-

·         References to parity of esteem were welcomed. In response it was commented that there had been historic under investment in these services but the CCG had committed to increase spending. The challenge for partners was that in order to increase spending resources had to be dis-invested from elsewhere, which took time. As large employers, the Council and NHS should be leading by example in relation to mental health support for its staff.

·         The value of increasing the take up of health checks was discussed. Although Stockport was a high performer, there was variability in GP activity in this area, and take-up was often by people who need them least. Health checks therefore needed to be used differently, such as changing payments to give GPs greater incentives to target those who have not had a check previously, or providing check in the workplace or in the community, or using innovative messages to target groups. Integrated commissioning would also be beneficial as it would allow the use of Stockport Together capacity that identifying those who have highest need and target them.

·         The challenge of tackling inequalities in life expectancy and health life expectancy was discussed.  It was acknowledged that these were longstanding issues but that using information and intelligence better would allow those most at risk groups to be identified and targeted for earlier intervention.

·         It was commented that providing more of the monitoring information by the 8 integrated neighbourhood areas would be a useful tool to identify unwarranted variation that might otherwise be masked.

·         There was a core of pharmacies who were actively engaged in the healthy living scheme and it was hoped this would encourage further take-up.

·         In relation to the measures in the Agreement, it was commented that there was a balance to be struck between high level, long term outcome measures and lower level output measures that gave an insight into local activity and effectiveness.

·         There was a need to ensure the public understood the development of neighbourhood teams and the benefits for their treatment and support.

·         There remained a lot of uncertainty about the impact of Greater Manchester developments and how this would impact on Stockport.

RESOLVED – That the report be noted.

To consider a report of the Democratic Services Manager.

The report outlines the process agreed by the Scrutiny Co-ordination Committee for the selection of Scrutiny Review topics for 2016/2017.

The Scrutiny Committee is invited to suggest topics for review as part of the 2016/17 Scrutiny Work Programme.

Officer Contact: Jonathan Vali, 0161 474 3201 or email: 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 the process for the identification of suitable Scrutiny Review topics and to suggest topics for inclusions within the Scrutiny Work Programme.

RESOLVED – (1) That the report be noted and the Democratic Services Manager, in conjunction with appropriate officers from the Council and other partners, be requested to consider the feasibility of undertaking a Review of one of the following areas, and to report back to the next meeting:-

·         Community Pharmacy provision – integration and maximisation

·         Reaching ‘Hard to reach’ Groups

·         Veteran and Armed Services health needs

·         Tackling Health Inequalities

·         Employer engagement and workforce health

·         Diabetes

(2) That the Democratic Services Manager be requested to place an item on the agenda for the next meeting for the Scrutiny Committee to identify which of its shortlisted topics it would wish to recommend for inclusion in the Scrutiny Work Programme.

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

RESOLVED – That the report be noted and the Democratic Services Manager be requested to make arrangements for the following items to be considered at a future meeting:-

·         Encouraging those with physical disabilities to remain active

·         Dementia Strategy