Agenda and minutes

Councillors Geoff Abell, Maureen Guariento, Keith Holloway and Julian Lewis-Booth

To approve as a correct record and sign the Minutes of the meeting held on 17 January 2017.

The Minutes (copies of which had been circulated) of the meeting held on 17 January 2017 were approved as a correct record and signed by the Chair subject to the replacement of the word ‘most’ with ‘not’ in the second sentence of bullet point 4 of Minute 6.

Councillors and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

The following interest was declared:-

Personal Interest

There were no call-ins to consider.

To consider a joint report of the Executive Councillors (Adult Social Care) and (Health).

The attached revised Stockport Together business case was considered by the Executive at its meeting on 7 February 2017 as part of the deliberations on the 2017/18 Executive budget proposals. The Business Case has been submitted for consideration by Scrutiny to allow members to comment and ask questions prior to the consideration of the proposed budget by the Council Meeting on 23 February.

Because of the cross-cutting nature of the Stockport Together programme, members of the Adult Care Services & Housing Scrutiny Committee have been invited to attend the meeting to take part in the discussions.

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 Executive Councillors (Adult Social Care) and (Health) was submitted (copies of which had been circulated) setting out the revised Stockport Together Business Case that had been considered and approved by the Executive on 7 February 2017 as part of the Executive’s 2017/18 budget proposals.

Representatives of the Adult Care Services & Housing Scrutiny Committee were also present at the meeting to participate in the discussion on this item in view of its importance to the remit of that Committee.

The Executive Councillors (Adult Social Care) and (Health) (Councillors Wendy Wild and Tom McGee), the Corporate Director for People and the Borough Treasurer attended the meeting to respond to questions.

The Business Case set out the rational for increasing contributions to the pooled budget for the next financial year in order to provide continuity of care through existing services while new models of care were implemented. Efforts of local partners to implement these proposals and thereby realise savings sooner had been delayed due to external assurance processes.

The following comments were made/ issues raised:-

·         An update was requested in respect of co-location of neighbourhood teams. In response it was stated that all neighbourhoods had a multi-disciplinary team operating, and it was anticipated that all would be co-located by the end of May 2017.

·         Further clarification was sought on prescribing costs referred to in the document. In response it was stated that this was reflective of improvements in care models reducing the costs pressures on the Clinical Commissioning Groups’ (CCG) prescribing budget.

·         Concerns were expressed that integration efforts in Stockport were now falling behind others in Greater Manchester and that previous suggestions of a ‘light-touch’ regulatory environment, given as part of the Devolution Deal, were not being followed. In response it was stated that the Devolution agreement would not negate the need for most regulatory oversight from NHS England and NHS Improvement, but that the framework that was emerging was proving onerous. It was also emphasised that developing the local model was in itself complicated and taking time.

·         Clarification was sought on whether the business case accounted for the costs associated with on-call staff. It was confirmed that this had, but that work would be undertaken to understand the case-law implications for local practice. It was further commented that work was underway with providers to re-profile staff to improve their productivity and avoid paying for staff while they were ‘sleeping’.

·         Clarification was sought on the salary level assumptions in the report. In response it was confirmed that in accordance with standard practice the assumptions were based on salary mid-points within the range.

·         Assurance was sought on progress with ICT improvements that would be needed to facilitate integrated models of care. In response assurance was given that work was ongoing to create a real-time single case management record. Progress had been made in creating a single ICT system across primary, community and hospital care and making improvements in the infrastructure to allow systems to be accessible across premises. A work stream within Stockport Together was also exploring opportunities for technical solutions to improve care and diagnosis.

·         Clarification was sought on Direct Access Physio. In response it was stated that a number of services were being considered for changes to the access arrangements to avoid the need for a GP referral, thereby improving waiting times, prognosis and reducing demand on GPs.

·         An update on ambulatory care was requested. In response it was stated that after since its establishment the numbers using the unit had now doubled to 49. Attendances at the Hospital were being mapped to establish how many patients could have benefited from being routed through this service.

·         It was queried what the fall-back position was in the event that the programme did not deliver. In response it was stated that partners were working hard to minimise problems but that it was to be expected that certain aspects  ...  view the full minutes text for item 4.

To consider a report of Healthwatch Stockport.

The report sets out the findings of a Healthwatch Stockport’s recent review into discharge from hospital.

Representatives of Healthwatch will attend the meeting to present the report and to update the Scrutiny Committee on responses to their findings.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Gavin Owens (Healthwatch Stockport), 0161 974 0753, info@healthwatchstockport.co.uk

Mike Bailey, of Healthwatch Stockport, submitted a report (copies of which had been circulated) outlining the findings of Healtwatch following a review into the discharge procedures from Stepping Hill Hospital. The review had been undertaken in response to a national Healthwatch request to gather evidence on issues related to discharge.

Mr Bailey highlighted the following issues from the report:-

·         The Review Team carried out interviews with a range of interested parties, including hospital staff, patients, GPs.

·         After the report was published in September 2016 there was an immediate and encouraging response from partners.

·         The Team’s observations suggested that most discharges were handled well, but that the process became more complicated for those with vulnerabilities.

·         The Review identified the need for improved training for staff in the Hospital, and the Trust had taken action to address this.

·         The main cause of the problems with discharge was found to be a lack of social care provision, but staffing shortages and training deficiencies were also identified.

·         The Review also found that vulnerable patients could become confused by range of professionals they interacted with, so there was a clear need to keep family members engaged.

·         Shortcomings had been identified in the way information is shared between wards.

·         Healthwatch were of the view that the discharge process should begin on admission.

The following comments were made/ issues raised:-

·         Delayed Transfers of Care had been a growing challenge, and often had complex reasons, including patient choice.

·         Understanding how discharge was handled from other hospitals, like Wythenshaw, would be useful given the significant number of Stockport residents who used these other facilities.

·         Further information was sought on implementing the action plan. In response it was stated that Healthwatch were participating in a sector wide working group looking to improve discharge. It was also commented that many care homes wanted to carry out their own assessments of patients being discharged to them as care plans often changed as a result. Discussions were taking place to explore the possibility of using ‘trusted’ assessors to bring independence to this process.

·         In response to questions about the cost of implementing recommendations, it was stated that the Stockport Together programme would address some of these issues, and that Healthwatch was supportive of the development of integrated teams.

·         Clarification was sought on the reference in the report to limiting the time of day of admitting patients to Marbury House. In response it was stated that the time scales for admission were not a matter for Healthwatch but for providers, but that greater thought needed to be given to what time of day this took place. Patients often felt compelled to leave hospital when they were signed-off by the doctor, although this might not be an appropriate time of the day to be moving into another setting.

·         Concerns were expressed about the sufficiency of intermediate care provision.

In response to the issues raised during the discussion, the Executive Councillor (Health) (Councillor Tom McGee) stated that if partners able to resolved the problems with Delayed Discharges then this would have been done. He emphasised the importance of hospital flow to the overall functioning of the health and care system; the challenges of ensuring patients were both physically and mentally fit before discharge; the need to ensure the hospital was consistently planning discharge on admission; the loss of care beds in Stockport in recent years, and the need to ensure communication within and with other organisations in the system was improved.

Councillors welcomed the work done by Healthwatch and suggested that in the event that progress is not made on addressing the recommendation contained in the report that this be raised with scrutiny members.

RESOLVED – That the report be noted and Mike Bailey be thanked for his attendance and presentation.

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

The aim of this report is to inform Scrutiny Members about Type 2 Diabetes, to explore the impact of this condition and highlight the activities that are taking place in Stockport to address this.

Scrutiny members are invited to assess their personal risk of type 2 diabetes in advance of the meeting: http://riskscore.diabetes.org.uk/start?_ga=1.205835029.722794865.1476350383

The Scrutiny Committee is asked to receive the report and consider how we can

•        Create a culture and environment that promotes the benefits of walking more and snacking less

•        Support the delivery of enhanced social media messages

•        Encourage professionals working in health and social care set an example to the public of Stockport by taking steps to reduce their risk – walking briskly (or equivalent physical activity) for at least 20 minutes a day and reducing their glucose intake

•        Ensure systematic identification of people at risk of Type 2 diabetes, developing a register of patients with non-diabetic hyperglycaemia

Officer contact: Vicci Owen-Smith, 0161-474-3928,

vicci.owen-smith@stockport.gov.uk

The Deputy Director of Public Health submitted a report (copies of which had been circulated) informing the Scrutiny Committee about Type 2 Diabetes, to explore the impact of this condition and highlight the activities that weere taking place in Stockport to address this.

The report only covered Type 2 diabetes, as Type 1 was to a significant degree a different disease, but Type 2 was largely a preventable condition. It was emphasised that risk was under-estimated and may be as high as 33%. Put simply, if people moved more, and snacked less, this would have a significant impact on the problem.

The following comments were made/ issues raised:

·         There was evidence to suggest that by engaging with those at risk of developing Type 2 diabetes this could dramatic reduce costs.

·         Further information was requested about the implementation of care provision through neighbourhood teams. In response it was stated that modelling on risk and deprivation, and capacity of neighbourhoods to absorb this work.

·         Concerns were expressed about whether GPs were doing enough to prevent diabetes related amputations. In response it was stated that amputations were caused by specific issues. NICE had 9 care targets but only 50% of patients in Stockport received this level of service, although care overall was good. Partners were doing good work with engagement and training, but demand out-stripped resources. It was important to ensure that all professionals appreciated the scale of the challenge.

·         Anecdotal evidence suggested that attendees at amputee clinics were almost exclusively there due to diabetes. This was a powerful message of the impact of diabetes and the dangers of poor lifestyle. In response, this was acknowledge, and it was emphasised that lifestyle changes did not have to be dramatic to have lasting benefits.

·         There were relatively simple things that could have an impact on health, and reduce diabetes risk, such as walking 10,000 steps per day. In response it was acknowledged that this was a good means of being active but that 10,000 steps could be difficult to achieve for many people.

·         There was ambiguity about what constituted being overweight, and what effect it could have. In response it was stated that clothing sizes had increased so while people were becoming bigger they would not necessarily realise it. 67% of the population was overweight, so a person’s peers were also likely to be larger, making it difficult to know what the new norm was. The Stockport String was a good way of raising awareness.

·         Given the greater risk of diabetes amongst the BME community, what more was being done to raise awareness, as leaflets were unlikely to be sufficient. In response, the challenge was acknowledged.

·         There needed to be a strategy to target those who did not engage with GPs, given how little is actually required to make a difference. In response, it was emphasised that there was a significant culture shift needed to make a healthy lifestyle easier to achieve.

·         The relative ease with which people could do some form of physical activity was discussed, particularly given the access to good quality outdoor space in Stockport. The primacy given to the car and driving, particularly to school, was highlighted as a particular challenge.

·         How would those hard to reach but high risk individuals be identified? In response it was stated that systematic analysis of GP records showed that 95% of people had visited the GP in last 2 years, providing opportunities to screen and intervene. Workplaces were another key area for targeting public health messages.

RESOLVED – That the report be noted.

To consider a report of the Deputy Chief Executive.

The final version of the 23rd Annual Public Health Report by the Director for Public Health is presented for consideration by the Committee. This report contains a series of recommendations. The Executive has responded to each of the recommendations directed towards the Council, either on its own or in partnership with other agencies with whom it shares a Public Health duty. In cases where the recommendation is directed towards another agency or agencies the Executive has noted that the Council is not being expected to respond to that recommendation. In total, the Executive has accepted 26 recommendations for further action to support the aspirations set out in the report.

The report will be reviewed again by the Executive when it meets on 14 March, alongside any comments made by the Scrutiny Committee.

The Scrutiny Committee is asked to:

·         Consider the 23rd Annual Public Health Report;  

·         Review the 26 recommendations of this Report which the Executive has accepted in its response, including two which are updates to recommendations made in the previous year’s report;

·         Highlight any significant issues or challenges with the proposed response to be fed back to the Executive; and

·         Highlight areas of good practice in existing work which can be offered in support of the Executive’s response.

Officer contact: Jovian Smalley, 0161 474 3589, jovian.smalley@stockport.gov.uk

A representative of the Deputy Chief Executive submitted a report (copies of which had been circulated) setting out the proposed response of the Executive to the recommendations contained in the 23^rd Annual Report of the Director of Public Health, the draft of which was considered by the Scrutiny Committee at its last meeting.

The Director for Public Health was also in attendance to respond to questions.

The following comments were made/ issues raised:-

·         The report recognised the importance of greenspace. Was there any response from Public Health Directors to the Greater Manchester Spatial Framework (GMSF)? In response it was stated that Directors of Public Health were statutory consultees and that colleagues had provided a Greater Manchester response. The response commented on value of greenbelt, and urban greenspace in particular, and stressed the need to ensure any greenbelt development was sympathetic to the surroundings and needs of the public. Public Health leads were also working with Natural Capital to develop indicators that could be used as part of GMSF that were measures of more than simply housing and economic indicators.

·         An effective way of improving character of an area was through tree planting, and replacing dead or diseased trees more promptly. A more effective and systematic approach was needed.

·         It was commented that flu vaccination rates for pregnant women were lower for those attending Wythenshaw Hospital. It was queried whether this was also reflected in higher rates of smoking in pregnancy? In response it was stated that this was monitored, and it highlighted the need for greater standardisation of approach across providers.

·         Concerns were expressed that much of the GMSF allocations in other parts of the conurbation were close to motorways, which would create air quality concerns. In response it was suggested that there was scope for Greater Manchester partners to lobby for improvements in this area.

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

RESOLVED – That the report be noted.