Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 21 February 2017.

The Minutes (copies of which had been circulated) of the meeting held on 21 February 2017 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

There were no call-ins to consider.

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

Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Strategic Partnership, has been invited to attend the meeting to discuss the work of the partnership and to answer questions from the Committee.

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

Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Strategic Partnership attended the meeting to update the Scrutiny Committee on the work of the Partnership in overseeing the devolved powers and resources for health in Greater Manchester.

The update focussed on the following broad areas: System Performance, Quality, Finance, Transformation.

System Performance

Overall performance was good, although it was recognised that there were significant challenges in specific areas, such as ED admission targets and delayed discharges. Partners in Stockport were commended for their ongoing efforts to address this latter issue.

Greater Manchester was the only area in England in January 2017 to have met the cancer waiting time standard, and had done so consistently since 2011.

Other highlights included elective care performance and waiting times for mental health services.

Quality

The development of the Cancer plan was highlighted, and ongoing work to implement the Mental Health Strategy.

Finance

It was forecast that spending in Greater Manchester overall would be in balance. Partners in Stockport were again commended for their financial recovery activity.

Transformation

·         6 of the area in Greater Manchester had received funding from the Transformation Fund to support local integration plans.

·         Work was also ongoing to implement the Primary Care Strategy and support the expansion of access to GP services.

·         The population health plan had also been developed and preparations were being made to deliver the priorities of the Plan.

It was emphasised that the drivers for the Partnership were to deliver real change in health in the conurbation, diverting resources from costly acute provision to more effective preventative activity and to integrate services wherever possible.

The following comments were made/ issues raised:-

·         What were the Partnership’s plans to address health inequalities? In response it was stated that reducing inequalities would be the ‘litmus’ test for the success of the Partnership’s work. This involved both population-level work and targeted intervention in the most deprived communities. In particular the importance of early interventions prior to birth and early years and addressing workless by tackling mental health and musculoskeletal conditions was emphasised.

·         When the Memorandum of Understanding for the devolution of health funding was signed there was significant emphasise placed on prevention, but was this emphasis maintainable in light of the requirements of NHS England centrally?

·         The solutions to the problems in acute and emergency activity were closely linked to the work around integrating health and social care, and it was disappointing that Stockport Together was not progressing more rapidly. In response, it was stated that it was expected that two thirds of the Transformation Fund was likely to be spent on community care programmes, and the Partnership was committed to the vision and delivery of Stockport Together.

·         As the activity of the Partnership was expanding, was there a danger that this would draw too many people into this activity to the detriment of activity in localities?

·         The early indications from the development of clinical assessment services, working with the North West Ambulance Service had been positive. Concerns were expressed that should Greater Manchester make any changes to the commissioning arrangements for ambulance services that this facility may be lost. In response, it was stated that the value of the clinical assessment services was highly likely to form part of critical and emergency care provision in the future.

·         How does the Partnership convince the public, some of whom are wedded to old models of care? In response it was stated that the focus of such debates should be clinical evidence and the significant evidence that the consolidation of specialisms was most effective. This had to be balanced against considerations of access, but ultimately the aim was to ensure people were treated to get better.

·         Is transformation the biggest challenge of the work of the Partnership?

·         How much latitude was there to ‘test’ innovation in care? In response, the challenge of risk was acknowledge but assurance was given that  ...  view the full minutes text for item 4.

At the suggestion of the Greater Manchester Joint Health Scrutiny Committee, this update is being presented to all Greater Manchester constituent authority scrutiny committees for their information.

Following the development of the GM Mental Health and Well-being Strategy, this paper describes the means of securing leadership and oversight to implementation. The proposed governance arrangements are aimed at driving collaboration across commissioning and provision at the same time as maintaining the leadership and inclusive approach which supported the development of the strategy.

In addition this paper provides an update on progress to date and highlights key requirements necessary for successful implementation.

Representatives of the Greater Manchester Health & Social Care Partnership will be in attendance to present the report and to answer questions.

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

Warren Heppolette, Executive Lead for Strategy & System Development, Greater Manchester Health & Social Care Partnership, attended the meeting and presented an update on the Greater Manchester Mental Health & Wellbeing Strategy (copies of which had been circulated) that had previously been considered by the Greater Manchester Health Scrutiny Committee but referred to the 10 district Scrutiny Committee’s for their information.

The following issues were highlighted:-

·         As part of the Devolution Agreement there was a desire from partners that mental health should be one of the key commitments.

·         As part of the implementation of the Strategy, a partnership Board had been established, with an implementation executive.

·         There had been an initial focus on gaps: ADHD Services, crisis care, dementia, suicide prevention.

·         A greater challenge would be to shift the focus of mainstream services to give greater emphasis to mental health, and to provide greater transparency on spending to better understand future investment need.

·         The evidence of the link between poor mental health and poor physical health was clear.

The following comments were made/ issues raised:-

·         What more could be done to address recruitment problems? In response it was stated that devolution would not provide a solution to this, but would allow for better indication of workforce deficits and to focus training efforts to compensate.

·         The importance of children receiving early mental health support was emphasised and concerns about the unwillingness of parents to seek support from their GP for fear of stigma. In response it was highlighted that the Children & Young People Scrutiny Committee had recently completed a review of CAMHS and would be considering their Transformation Plan, which should address some of the concerns raised. It was further commented that children’s needs were often complex and involved a lot of partners, all of whom could contribute to each other’s efforts. Schools in particular were a valuable partner in these efforts.

·         The Greater Manchester Strategy complemented and reflected the local commitment to mental health, such as increased investment from the CCG, renewed work on suicide prevention and crisis care. The significant reductions in the number of people in mental health crisis being kept in police cells was evidence of positive local working.

·         Was their sufficient capacity in the system to deliver this Strategy? In response it was acknowledged that Strategic activity needed to connect to practical work ‘on the ground’. The Strategic work was often being lead or delivered by staff working in a locality, and the challenge of ensuring sufficient resources for Greater Manchester activity and local activity was acknowledged.

·         Would partners across Greater Manchester be sharing ICT systems? In response, the challenge of information mamangement was acknowledged, and the shortcomings of the existing situation. It was planned to develop a solution that would allow all 36 partner organisations to share data through a single system, which would be vital to delivering new care models.

RESOLVED – That the report be noted and Warren Heppolette be thanked for his attendance.

To consider a report of the Chief Executive of Stockport NHS Foundation Trust.

The report will be a draft of the 2016/17 Quality Account for the Stockport NHS Foundation Trust, which sets out the performance of the Trust against a range of priorities.

The report is being submitted in draft form and due to the timing of the meeting, certain data is missing from the report.

The Scrutiny Committee will be invited to consider the report and provide feedback.

Contact: Judith Morris, Director of Nursing and Midwifery, 0161 419 5014

Judith Morris, Director of Nursing and Midwifery at Stockport NHS Foundation Trust, attended the meeting to present the draft of the Trust’s 2016/17 Quality Account (copies of which were circulated) as required by the Regulator, NHS Improvement. The report gave an overview of performance in the past year in relation to quality achievements and improvements in patient care and experience. Due to the timing of this meeting it had not been possible to include all relevant data within the documentation.

The following comments were made/ issues raised:-

·         Ensuring privacy dignity and compassion in care for all patients was important, and consistency could be a challenge. What was the assessment of the Trust position in this regard? In response it was stated that the Trust was positive, as borne out by the most recent CQC report and rating. A particular challenge for the Trust was to ensure high levels of care in the Emergency Department, but this was reflective of the wider challenges with Emergency Department performance.

·         The comments made in the Chief Executive’s introduction highlighted disappointment at the staff survey results, and clarification was sought. In response, it was reported that the comments referred to the question asked of staff about whether they would recommend the Trust as a place to work – this survey happened to coincide with the Trust’s Financial Improvement Plan, including a voluntary redundancy programme and changes to staff parking, which may have impacted on the results.

·         How had the Trust performed against last year’s priorities? In response, it was stated that although these remained important to the Trust, these elements of the work had been taken out of the Quality Account because they were being pursued through other work within the Trust.

RESOLVED – (1) That the Draft Stockport NHS Foundation Trust Quality Account 2016/17 be noted.

(2) That the Chair be authorised to provide a formal response to the Stockport NHS Foundation Trust Quality Account 2016/17.

To consider a report of the Corporate Director for People.

The report provides an updated version of Stockport’s dementia strategy for 2017 – 2020 includes actions to improve support for people with dementia and their carers in relation to prevention, diagnosis, services, living well in the community and end of life.

The Scrutiny Committee is recommended to comment on and note the report.

Officer contact: Maureen Hughes on 0161 474 3199 or email: maureen.hughes@stockport.gov.uk

Nicole Alkemade, Commissioning Lead for Older People at Stockport Clinical Commissioning Group and Maureen Hughes, Project Manager within Adult Social Care at Stockport Council, attended the meeting to present Stockport’s Dementia Strategy for 2017 – 2020 (copies of which had been circulated) that set out actions to improve support for people with dementia and their carers in relation to prevention, diagnosis, services, living well in the community and end of life.

The Executive Councillor (Health) (Councillor Tom McGee) also attended the meeting to respond to councillors’ questions.

The Scrutiny Committee had previously undertaken a Review into the support for carers and this work had informed the development of the Strategy.

The following comments were made/ issues raised:-

·         Many carers were older people who were often reluctant to ask for help. Sharing information with other carers was often a good way of sharing information, as was providing a single point of contact would be useful, and not being over reliant on digital services was important. In response, the value of the drop-in sessions was emphasised as it gave the opportunity for face-to-face contact. Providing information in a range of media was also recognised.

·         Clarification was sought on the future funding available to support groups, as concerns had been raised during the Scrutiny Review by some of these groups. In response it was stated that funding would not be removed, but it was important to ensure this resource was used effectively and to target those areas of greatest need. Additional funding had been secured to support the expansion of the drop-in groups and the CCG had committed resources to post-diagnosis support.

·         Promoting physical activity as a means of improving overall health and wellbeing could have a beneficial effect on those with dementia.

·         There had been a suggestion in the press recently that magnetite particles, found in diesel emissions, might be contributor to the development of dementia. In response it was stated that there was as yet no clear evidence to confirm such as link but the national Dementia Strategy had committed to improving research on the causes of dementia.

·         There was no mention in the Strategy about deprivation and how to address inequalities in access or outcomes. In response it was stated that establishing drop-in arrangements in priority areas had been identified as a need, as well as finding better ways of engaging with the BME community.

·         The Strategy recognised the importance of opportunities for respite, but there was little mention of the benefit of providing activities that were fun for people with dementia and their carers. What more could be done for people without a formal diagnosis? In response it was stated that the value of the Dementia Action Alliance would be to make accessing everyday activities, including those for fun, easier for those with and without a diagnosis. It was further commented that the importance of a diagnosis was that it would provide people with a clear path to getting the support they may need.

RESOLVED – That the report be noted and that Nicole Alkemade and Maureen Hughes be thanked for their attendance.

The Democratic Services Manager to report at the meeting.

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

A representative of the Democratic Services Manager reported on the tentative outcomes agreed by the Scrutiny Review Panel into the role of community pharmacies.

RESOLVED – That the Democratic Services Manager, in consultation with the Chair and the Scrutiny Review Panel Lead Councillor, be requested to finalise the Final Report of the Review into the role of Community Pharmacies for submission to the Executive.

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.