Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 13 September 2016.

The Minutes (copies of which had been circulated) of the meeting held on 13 September 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 was declared:-

Personal Interests

There were no call-ins to consider.

Professor Ray Tallis of the Stockport NHS Watch Group, will make a presentation the Scrutiny Committee to highlight the group’s concerns about the effect of Government policies on the NHS, and about the transfer of care into the community.

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

Professor Ray Tallis, Emeritus Professor of Geriatric Medicine at Manchester University, attended the meeting to represent Stockport NHS Watch and to make a presentation to the Scrutiny Committee highlighting the group’s concerns about the effect of Government policies on the NHS, and about the transfer of care into the community.

The presentation covered the following areas:-

·         The background to the NHS Watch group.

·         The perceived threat to healthcare in Stockport from underfunding, reorganisations, loss of accountability and privatisation.

·         The ‘attack’ on the health and wellbeing of residents in Stockport through staffing reductions and bed closures at Stepping Hill Hospital to address their budget deficit; concern about the plan to reduce the size of the hospital, and the role of KPMG; concern that the Stockport Together Business Case could mean reductions in outpatient and GP appointments; a £130m cut in health and social care up to 2020.

·         The ‘attack’ on capacity to scrutinise changes through ‘spin’ of reductions as improvements in care.

·         Concerns that little evidence that enhanced community care could reduce pressure on hospital; there was insufficient capacity for GPs and district nurses to provide this care; costs were often higher; exaggeration of the problem of inappropriateness of elderly patients in hospitals was ageist.

·         In relation to the proposed Multi-Specialty Community Provider (MCP), no evidence that integration will reduce costs or improve care for some time; could block access to specialist medical care; centrality of GPs to the model but these already under pressure.

·         The development of the Stockport Together and other programmes was surrounded by ‘spin’, was blurring the lines of accountability, with insufficient consultation, and leading to potential for privatisation of public services.

·         Concerns about the process for developing Sustainability and Transformation Plans (STPs) and the danger of no clear definition of mandatory core services.

·         The Scrutiny Committee should be worried by reorganisation necessitated by progressive under-funding; evidence base was lacking; cuts being spun as improvements; threat to comprehensive care free at the point of need; increasing privatisation inevitable; distance from government responsibility.

·         Examples where local authorities had resisted the development of STPs and used the powers of Scrutiny Committees to delay cuts.

The following comments were made/ issues raised:-

·         The underlying issues and concerns in the presentation were recognisable to the Committee.

·         Providing effective health and social care also required prevention and public health, which some people did not appreciate, and these services had also been subject to financial reductions. Also important was social care, and the funding challenges were not confined to the NHS but also for social care.

·         Concerns were expressed about the work of NHS Improvement with Foundation Trusts with financial challenges, and whether this was sustainable change or whether it would lead to sub-optimal or negatively impacted outcomes. It was queried whether sufficient independence was given to the Trusts involved to make genuine and meaningful change. Consultants were often taking money out of the system without providing effective solutions.

·         Concern was also expressed about the potential negative impacts of the creation of a large Greater Manchester Health Trust that might subsume local Trusts.

·         In order to affect proper transformation, there needed to be sufficient resources in the system.

·         Good community care was not a cheap option, and the changes proposed locally would take time to implement but would ultimately prevent more costly hospital care.

·         The challenge was in addressing shortfalls in core funding, and local solutions needed to be found, and where energies should be directed.

The Director of Public Health (Dr Steve Watkins) responded to the issues raised in the presentation. He acknowledged that the funding for the NHS was insufficient, and highlighted a range of evidence for this view. In particular he emphasised the cuts to funding for public health and prevention which he believed to be short-sighted. He also agreed that there was no evidence that marketization within the NHS was more effective, and in fact evidence suggested  ...  view the full minutes text for item 4.

To consider a joint report of the Interim Provider Director; Director of Services for People (SMBC); Deputy Chief Executive (SFT); Medical Director (Pennine NHS FT); Interim Chief Executive (Viaduct)

The four Providers of Health and Social Care in Stockport have reached a milestone in the Joint commissioner led procurement process to identify the potential organisational form of a Multi-speciality Community Provider (MCP) in Stockport. The purpose of this document is to present the options that have been considered by Providers, including the relevant information required to support members of each partner provider organisation (Stockport NHS Foundation Trust, Stockport MBC, Viaduct Health and Pennine NHS Foundation Trust) in identifying a preferred option.

This document provides an overview of the strategic context in the development of a MCP in Stockport and outlines the appraisal undertaken by providers leading to a recommendation of a preferred option for the MCP form.

The Scrutiny Committee be recommended to consider the proposed recommendations to the Council’s Executive:-

(1) It is the recommendation of this options appraisal that the option to form A New Neighbourhood Led Accountable Care Trust should be considered by all providers for approval to progress to a Full Business Case (FBC) including  legal agreements, regulatory and financial due diligence.

(2) It is important to stress that the completion of the FBC is part of the much larger procurement and regulatory process described above, the timescales for completion of which have yet to be confirmed.  Once approved by Provider governance processes, the FBC would therefore also be subject to the final outcome of the Joint Commissioning Procurement process and would require regulatory approval by NHS England and NHS Improvement.

(3) In addition, as outlined in section 4 in relation to support services, it is recommended that Stockport MBC and Stockport NHS FT:

·                Develop a specification for a structured programme that results in an option for an integrated support services;

·                Adopt the design principles and next steps identified in section 4 above to inform this programme;

·                Focus in the first instance upon support services in Stockport Foundation Trust and Stockport MBC;

·                Adopt a public sector led arrangement either through a partnership or public to public transfer in the first instance to enable effective support services to meet critical transformation requirements in the development of the care model; and,

·                Develop a detailed report for consideration by the Stockport Together Board and appropriate organisational governance along with a proposed approach to programme investment, governance, accountability arrangements and requisite third-party support.

Officer contact: Keith Spencer / Holly Rae, 0161 474 3014, keith.spencer@stockport.gov.uk / holly.rae@stockport.gov.uk 

A joint report of the Interim Provider Director, Director of Peoples Services (Stockport Council), Deputy Chief Executive (Stockport NHS Foundation Trust, Medical Director (Pennine NHS Foundation Trust ) and the Interim Chief Executive (Viaduct Health) was submitted (copies of which had been circulated) providing the an update on the process for identifying the preferred organisation form for the new Multi-speciality Community Provider (MCP) in Stockport, including an assessment of the options available.

Keith Spencer (Interim Provider Director) Dr Stephen Watkins (Director of Public Health) Dr Donna Sager (Deputy Director of Public Health) and Councillor Tom McGee (Executive Councillor (Health)) attended the meeting to respond to questions from the Scrutiny Committee.

A presentation was also made to the Scrutiny Committee, summarising the background to the development of the MCP and highlighting the key issues to have arisen through the Options Appraisal process.

The Executive Councillor (Health) emphasised that the Executive and partners unanimously were of the view that the MCP arrangements should avoid, as far as possible, any private sector involvement. He further stated that, with the exception of Viaduct Health, all other partners would be considering and deciding upon these proposals in public, although no date had yet been fixed for a final decision on the MCP form as each partner organisation needed to seek separate legal advice.

The following comments were made/ issues raised:-

·         On page 45 of the document (58 of the agenda pack) there was reference to ‘market opportunities’ and assurances were sought that this was in accord with previous assurances given about the MCP remaining a public sector body. In response, the Executive Councillor (Health) restated the commitment of partners to ensure the MCP remained a publically owned form, although he could not give a categorical assurance as future government policy may impact on this. It was further commented that the Health & Social Care Act prevented a distinction being made between public and private organisation in tendering process, supported by European Procurement rules, which prevented the possibility of private sector involvement ever being ruled out. However, given the nature of the services being tendered for, it was unlikely a private provider could successfully tender for this contract.

·         Clarification was sought on when the delivery of new models of care would begin. In response it was acknowledged that the delivery of care was the area of real importance. Investment from the Greater Manchester Transformation Fund was enabling changes to be made to services to deliver these new models, and from November the neighbourhood model would begin to be rolled out over the following 12 months. There had been a desire to ensure that the process of change and improvement in delivery was not dependent on progress with organisational change.

·         The report made little reference to the impact on wider health and care workforce of the options, but the turbulence of change was likely to negatively impact staff morale. In response it was accepted that the discussion of organisation form would cause worry for some staff, but the model being proposed would have the least impact on staff of all the options. It was further commented that consideration was being given to seconding staff into the MCP, rather than transferring staff via TUPE, as this would allow partner organisations to maintain control over their staffing.

·         Concerns were expressed that within the model being proposed, there was a danger of dominance by GPs. What was being done to ensure that there was a balance between different groups to ensure input was equally valued. In response, it was stated that as part of the development of the governance arrangements for MCP, consideration would be given to ensure wider engagement of stakeholders. It was commented that Foundation Trust status required involvement of others non-doctors in the governance arrangements. Comment was made that as part of the preventative work stream within Stockport Together, a lot of effort has been made to  ...  view the full minutes text for item 5.

To consider a report of the Leader of the Council (Policy, Finance & Devolution).

In August the Executive outlined how it will address the severe financial challenges faced by Stockport because of central Government cuts and significant local cost pressures, and set out a framework of principles that would shape engagement with residents and businesses In October the Executive received an updated Medium-Term Financial position and, in response, set out business cases for proposed changes to address the spending reduction requirement for 2017/18; a series of working papers explaining initiatives that will shape a future reform programme and address wider challenges over the medium-term, and confirmed an intention to raise Council Tax by 3.99% in 2017/18.

This report affords an opportunity to discuss the Executive’s proposed approach taken to addressing the medium-term, by reference to the published background papers and 2017/18 business cases that fall within the remit of each scrutiny committee.

The Scrutiny Committee is invited to comment on the report and appendices.

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

A representative of the Borough Treasurer submitted a report of the Leader of the Council (copies of which had been circulated) inviting the Scrutiny Committee to comment on a series of working papers explaining initiatives that will shape a future reform programme and address wider challenges over the medium term. The report set out business cases for proposed changes to address the spending reduction requirement for 2017/2018. and confirmed the intention to raise Council Tax by 3.99% in 2017/2018, including the 2% social care levy.

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

The following general comments were made/ issues raised:-

·         The Executive had stated its intention to increase Council Tax by 3.99% in 2017/2018, including the 2% social care levy and had agreed to enter into a four year budget settlement with the Department for Communities and Local Government in order to provide the Council with greater certainty as it moved toward self-reliance.

·         The Council’s Audit Committee had upgraded the risk of the main investment and reform programmes, and Audit officers would prioritise these programmes as a result.

In relation to the Stockport Together Draft Business Case, and given the financial challenges facing partners in the health service, the risk of not achieving the savings was questioned. In response it was acknowledged that this would be a challenging target, particularly given the difficulties in achieving previous savings in this area and the need for rapid change, which the NHS was not known for. It was stated that not guarantee could be given that these savings could be made, but budgets would be subject to close monitoring to identify early any issues.

In relation to the Digital by Design (DbD) Working Paper, the following comments were made/ issues raised:-

·         Further detail was requested in relation to staffing reductions referenced in the Business Case. In response it was stated that there were no details available at this stage as to the impact on staff, but it was envisaged that should reductions be needed this could be achieved through redeployment etc., before redundancy was considered.

·         It was important that DbD achieved maximum impact in allowing residents genuine interaction with the Council via digital means, and the services had to be usable. Residents needed confidence that using digital reported etc., would be acted upon. If the services were designed properly, it would free up time for staff to deliver the services and in turn reduce time dealing with complaints.

·         There needed to be recognition that for some residents digital would not be appropriate, and that often those people most in need of contacting the Council would be least likely to be able to use the website.

RESOLVED – That the report be noted.

To consider a report of the Corporate Director for People.

The Mid Year Portfolio Performance and Resource Report (PPRR) for the Health Portfolio provides a summary of progress in delivering the portfolio priorities, reform programme and other key projects during the first half of the year, with a particular focus on the second quarter (July to September) of 2016/17. It includes forecast performance data (where this is available) and projected financial data for the Portfolio, along with an update on the portfolio savings programmes. It also includes analysis of longer term trends on a number of key measures.

The Scrutiny Committee is asked to:

·         Consider the Mid Year Portfolio Performance and Resource Report;  

·         Review the progress against delivering key projects, priority outcomes, targets and budgets for 2016/17;

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

·         Highlight any significant issues or changes to be fed back to the Executive alongside the Corporate Performance and Resource Report;

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

Officer contact: Karen Kime/ Emma Bowe , 0161 474 3574, 0161 218 1026, karen.kime@stockport.gov.uk  / emma.bowe@stockport.gov.uk 

The Executive Councillor (Health) submitted a report (copies of which had been circulated) detailing the Portfolio Performance and Resources Report for the Health Portfolio, providing an update on key activity in the first half of 2017, with a summary of progress in delivering the portfolio priority outcomes through the Council’s investment programmes.  It also included forecast performance data and projected financial data for the Portfolio, along with an update on the portfolio savings programme.

The Executive Councillor highlighted the recent success of bid by partners in Greater Manchester to take part in the national Diabetes Prevention Programme. He also highlighted the start of the annual flu vaccination programme begun, and although Stockport was a high performer, there remained people eligible or at risk not being vaccinated.

RESOLVED – That the report be noted.

To consider a report of Public Health England.

The annual health statistical profile for Stockport was published on 6 September 2016.

The Scrutiny Committee is invited to note the profile and identify any issues for further consideration.

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

A representative of the Democratic Services Manager submitted the recently published 2016 Public Health England Health Profile for Stockport (copies of which had been circulated) for consideration by the Scrutiny Committee.

Members discussed the following issues:-

·         There had been some changes to the measures since the last profile so it was difficult to compare ‘like-for-like’. The indicator relating to smoking in pregnancy had been dropped, but the Council and partners were aware of the challenge this behaviour still posed in Priority Areas.

·         Alcohol related indicators continued to represent a challenge.

·         These statistics often masked significant variation and successful activity.

·         As the Council and partners moved toward neighbourhood models there would be greater need for more of the statistical information provided at a neighbourhood level.

·         The difference in healthy life expectancy between the most and least deprived areas remained significant.

RESOLVED – That the 2016 Health Profile for Stockport be noted.

To note the Minutes of the meeting of the Greater Manchester Joint Health Scrutiny Committee held on 13 July 2016.

RESOLVED – That the Minutes of the Greater Manchester Joint Health Scrutiny Committee held on 13 July 2016 be noted.

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.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to make arrangements for future agenda items on the following issues:-

·         Prevention

·         Refreshed Joint Health & Wellbeing Strategy

·         Annual Director of Public Health Report