Agenda and minutes

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

The Minutes (copies of which had been circulated) of the meeting held on 25 October 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 interest was declared:-

Personal Interest

There was no call-in to consider.

Representatives of the Stockport NHS Foundation Trust will attend the meeting to update the Scrutiny Committee on the implementation of the Trust’s Financial Improvement Plan and provide an update on developments with Urgent Care.

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

Ann Barnes (Chief Executive), Sue Toal (Acting Chief Operating Officer) and Feroz Patel (Director of Finance) from Stockport NHS Foundation Trust attended the meeting and made a presentation on (i) the Trust’s ongoing work to improve urgent care flow and improve performance against the 4-hour admission target, and (ii) the implementation of the Trust’s Financial Improvement Plan.

The first part of the presentation covered the following areas:-

·         The challenges at Stepping Hill were reflective of national and Greater Manchester trend, with the health and care system under increasing pressure.

·         The types of work being done to address performance relating to the target included preventing unnecessary admission at the Hospital included enhanced triage arrangements, expanded ambulatory care provision, ‘decongestion’ of the Emergency Department during surges in attendance, and streaming patients more quickly to appropriate clinicians. This had been facilitated through external support and excellent internal engagement with staff. The new building at the hospital had improved the flexibility within the site to deploy staff where needed.

·         Performance had been on an upward trajectory since September, and it was anticipated that performance in November will have been at 80% of target.

·         There was an ongoing challenge of increasing attendances, and significantly finding appropriate facilities/ support into which acute patients could be discharge. A whole economy approach was needed to address this latter challenge, although the Trust itself was taking steps such as planning discharge on admission and ‘discharge to assess’.

Councillors asked questions and made comments, including:-

·         How sustainable were the initiatives/ improvements that had been put in place? In response, it was stated that these initiatives were not short term fixes but were expected to provide long term sustainable improvements. Provision had been made to allow the hospital to better respond to increases in demand.

·         Concerns were expressed about ‘discharge to assess’ and where the balance was between discharging and not when a patient had complex needs. In response it was stated that the process was not intended to discharge patients into a permanent care setting, but rather into a more natural environment for them so as to better understand their needs, be that in their own home or an intermediate setting, rather than an acute hospital bed which often led to additional challenges such as deconditioning.

·         Had there been a culture change at the hospital that had contributed to the changes? In response it was acknowledged that this was the case, which had partly been the result of changes in leadership. The new building had allowed for the co-location of urgent care facilities to improve responsiveness.

·         How engaged and supportive were staff in the change process? In response it was stated that those staff immediately affected or involved had been very supportive as they were able to see the benefit of the changes, although it was acknowledged that work would continue to involve staff in the transformative agenda. The physical changes to the configuration of the hospital had also contributed to the sense of improvement as the quality of the accommodation now matched the high quality of the staff.

·         How was the Trust managing the expectation of patients, given the changing focus? In response it was stated that working with the Emergency Care Improvement Programme and their Safer Start campaign, the hospital were using the steps to better understand the needs of patients and for staff to overcome their natural inclination to ‘keep hold’ of patients beyond the point at which their hospital stay was beneficial.

·         Was there sufficient capacity within the processes to cope to the expected winter surge in demand? In response it was acknowledge that the scheme had only recently begun, and recruitment was ongoing, but that early indications were that over the course of the winter the hospital would be able to ‘hold its own’.

·         What was the scope for horizontal integration to share capacity with other local hospitals in the area when Stockport  ...  view the full minutes text for item 4.

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

Following the publication of the Stockport Health and Wellbeing Board’s refresh of the Joint Strategic Needs Assessment, (www.stockportjsna.org.uk) the Health and Wellbeing Board agreed that to review and refresh the Stockport Joint Health and Wellbeing Strategy, which is one of its statutory duties.

The attach report sets out the process followed in refreshing the Strategy, a copy of which is attached at Appendix 1.

The Scrutiny Committee is invited to comment on the Strategy prior it its publication.

Officer contact: Eleanor Banister, 0161 474 2447, eleanor.banister@stockport.gov.uk

The Deputy Director of Public Health submitted a report (copies of which had been circulated) inviting the Scrutiny Committee to comment on the Stockport Joint Health & Wellbeing Strategy for 2017-2020 that had been endorsed by the Health & Wellbeing Board. The Strategy was based on the outcomes and priorities of the recent Joint Strategic Needs Assessment and reflected the fast changing landscape within the health and social care economy. The Strategy had been subject to consultation with local partners and complemented their priorities.

The Executive Councillor (Health) and Chair of the Health & Wellbeing Board (Councillor Tom McGee) attended the meeting to respond to questions from councillors.

The following comments were made/ issues raised:-

·         There had been positive feedback from partners about a stakeholder engagement event in October, although it may not have been long enough to capture their contribution, and there was a general lack of engagement in the work of the Health & Wellbeing Board from blue light services. In response, it was commented that the Board was continuing to evolve, but it was important to ensure focussed engagement to maximise the attendance of partners who were often short of capacity. Having a productive relationship with partners in practical, everyday activity was of more tangible importance than membership of the Board.

·         The format of the Strategy had captured well the complex issues involved. In response, the Executive Councillor paid tribute to the Public Health team for their hard work in preparing the Strategy.

·         The centrality of housing to health and wellbeing was stressed. This link was acknowledged, and comment was made that Stockport Homes were well engaged with Public Health and very community focussed. Other social landlords operating in Stockport were not as well engaged.

·         The previous Strategy had been subject to wide and comprehensive stakeholder engagement, and a pocket guide had also been produced. The challenge was for partners to inform and engage the public on the Strategy and the wider health and care agenda. In response, the value and importance of communication was acknowledged, particularly in relation to Stockport Together and the concerns being expressed about the future of services.

·         The Strategy was a good indication of the breadth of local ambition for improving health and wellbeing of residents. Those ambitions and initiatives nevertheless needed to be kept under review.

RESOLVED – (1) That the Joint Health & Wellbeing Strategy 2017-2020 be noted.

(2) That the Scrutiny Committee would welcome a further update on the development of the Community Investment Fund.

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 an item be included on the agenda for the next meeting on Suicide Prevention and that representatives of the Coroner and Samaritans be invited to the meeting.

(3) That the Deputy Director of Public Health be requested to submit a report on diabetes to the February 2017 meeting.