Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 17 November 2015.

The Minutes (copies of which had been circulated) of the meeting held on 17 November 2015 were approved as a correct record and signed by the Chair.

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

The following interests were declared:-

Personal Interests

To achieve any announcements from the Chair on matters related to the activity of the Board.

The Chair made the following announcements:-

·         He had attended a Public Health England event on workforce development. The Chair noted the long timescales being discussed for workforce development, which was in contrast to some of the very immediate workforce needs of health and social care organisation.

·         He had attended the ‘soft’ launch of the Westbrook Facility in Stockport, funded through Public Health money, to support those with mental health problems.

·         He had attended an engagement session for carers of those with dementia being undertaken by the Health & Wellbeing Scrutiny Committee as part of their review. It was hoped this work could feed into the updating of the Dementia Strategy.

To consider a report of the Chair of the Stockport Safeguarding Children Board.

The Board is invited to consider and comment on the Annual Report from the Stockport Safeguarding Children Board.

Officer contact: Una Hagan, 0161 474 5657, una.hagan@stockport.gov.uk

The Chair reported that the Chair of the Stockport Children’s Safeguarding Board was unable to attend the meeting and recommended that the item be deferred until the next meeting to allow him the opportunity to attend and present the report.

The Corporate Director for People addressed specific issues members had in relation to the report.

The following general issues were raised:-

·         Clarification was sought on whether the Council  knew how many Looked After Children from other local authorities were placed in the borough. It was clarified that changes to Regulation now required placing authorities to notify the authority in which they were placed. There were approximately 269 children in Stockport, mostly in foster care and pre-adoption placements. Efforts were ongoing to improve work with these other authorities to ensure appropriate plans were in place for these children when using local services.

·         Further information was requested in relation to a review of Child Sexual Exploitation (CSE). In response it was stated that there were relatively low numbers of instances in Stockport in comparison to other parts of Greater Manchester, but CSE was a complex issue that could involve individuals and agencies across local authority borders. The Council and its partners were part of the Greater Manchester wide Operation Phoenix.

·         Further clarity was sought on references within the report to there being a lack of provision for the needs of children missing education (CME). In response it was stated that these children often had complex emotion needs and struggled to access mainstream provision all of the time, leading to additional vulnerability and risk.

·         It was commented that as part of the development of the next Joint Health & Wellbeing Strategy further consideration should be given to how safeguarding was addressed within the Strategy.

RESOLVED – That further consideration of this item be deferred and the Corporate Director for Place be requested to provide additional information in relation to the following issues:-

·         provision of services for children at risk of missing education;

·         work to improving the strategic response to children missing education.

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

As part of the preparation of the new Joint Strategic Needs Assessment (JSNA), consultation is being carried out on a range of thematic ‘products’ that will form part of the complete JSNA. The consultation on the draft Mental Health product is due to finish on 12 January 2016.

The Board is invited to consider and comment on the draft Mental Health and Wellbeing JSNA document.

Officer contact: JSNA Team, 0161 474 2449, jsna@stockport.gov.uk

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

The Chair invited the Board to consider the Mental Health briefing document produced as part of the Joint Strategic Needs Assessment (JSNA) (copies of which had been circulated) in light of the importance of mental health issues and with a view to submitting a response to the consultation.

The following comments were made/ issues raised:-

·         The variation between GP practices for rates of depression was surprising and potentially a cause for concern.

·         Further reference could be made in the document to the links between physical health and mental health and co-morbidity, linking with other JSNA documents.

·         The value of IAPT and similar services could be given greater emphasis in the document, including lack of knowledge of their availability. Reference could also be made to the impact simple lifestyle changes can have on mental health.

·         Reference needed to be made to self-harm in children as Stockport was an outlier in terms of prevalence.

·         Healthwatch feedback from psychiatric inpatients had reported difficulties in accessing treatment for physical conditions, some of which were exacerbated by the length of time taken for a consultation.

·         Feeback from service users provided to the Clinical Commissioning Group Governing Body had stressed the variability in understanding and knowledge of health and social care professionals and the impact this had on treatment choices and on advice given to service users.

·         Concerns were expressed that the deprivation gap was widening.

·         A query was made about access to bereavement counselling and where this would be addressed within the JSNA.

RESOLVED – That the comments of the Board in relation to the draft JSNA Mental Health briefing be forward to the JSNA Team for consideration as part of the consultation process.

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

The 37 NHS organisations and local authorities in Greater Manchester in December 2015 endorsed a final draft of its Plan ‘Taking Charge of our Health and Social Care in Greater Manchester’ that detailed the collective ambition for the region over the next five years as part of the devolution of health and social care spending to Greater Manchester.

The Board is invited to consider the draft Plan and make comments.

Officer contact: Andrew Webb, 0161 474 3808, Andrew.webb@stockport.gov.uk

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

A copy of the draft Greater Manchester Health & Social Care Plan and an executive summary were submitted (copies of which had been circulated) following its endorsement by leaders of the Greater Manchester (GM) councils and NHS organisations. The Strategy set out collective ambition for the city-region for the next five years as part of the devolution of health and social care spending to Greater Manchester.

The Corporate Director for People and Senior Responsible Owner for Stockport Together gave a brief overview of the draft strategic plan.

The following comments were made/ issues raised:-

·         Discrepancies in the document relating to the size of the Transformation Fund were queried. It was commented that details were still to be finalised but that GM partners had sought a Fund of £500m whereas NHS England were suggesting this figure would be closer to £450m.

·         Concerns were expressed about the lack of detail in the document in general. There was a need for clear timetables for the implementation of the ambitions set out in the Strategy.

·         The Devolution Agreement for GM was likely to be unique, in part because of the scale of the ambition and resources.

·         Further clarification was sought on the Estates Group. In response it was stated that work was taking place at both GM and locality levels. It was emphasised that the estate strategy that emerged would follow the needs of the service delivery models.

·         Concerns were expressed about references to the pooling of adult social care precept resources. It was clarified that decisions on the levelling of the social care precept was a matter for each local authority and no decisions had yet been taken. The potential pooling of these resources was one possible option, but that this would be subject to further discussion, negotiation and agreement should local authorities deem it appropriate.

RESOLVED – That the Greater Manchester Health & Social Care Plan be noted and that further updates be provided as appropriate.

Representatives from the Council and the Clinical Commissioning Group will update the Board on preparations being taken in the health and social care economy in the event of very cold weather.

Officer contact: Donna Sager, 0161 474 3928, donna.sager@stockport.gov.uk

The Deputy Director of Public Health and the Chief Operating Officer of Stockport Clinical Commissioning Group (SCCG) updated the Board on preparations for cold weather conditions and on the current situation with implementing winter pressure escalation plans.

The update included the following:-

·         Delivery of the ‘Staying Well’ campaign locally, mirroring the national NHS-led campaign, but focussing on keeping warm, checking on neighbours and on flu vaccinations. This had received approximately 40,000 views on Facebook and 60,000 on the Manchester Evening News website.

·         Work with Greater Manchester Fire & Rescue Services and Greater Manchester Police to support vulnerable people in their home.

·         Successful work in priority neighbourhoods, such as Christmas parties, at which isolated older people were engaged and important health messages delivered.

·         There had been a reduction of approximately 5% in the uptake of flu vaccinations compared to the previous year, although work was continuing to promote this.

·         Improvements had been made to the winter escalation processes since last year, but the winter period had nevertheless been very busy.

·         There had been deterioration in performance against the 4-hour admission target at Stepping Hill Hospital, although overall demand was broadly in line with expectations.

·         There were particular pressures with the flow of patients through the hospital, due in part to the availability of nursing homes beds.

The Vice-Chair of Healthwatch Stockport raised concerns that had arisen from their work on discharges about the experience of patients in Stepping Hill Hospital and within the wider economy. These related to lack of escalation in the hospital, lack of care beds in the community, significant waits in ED (often in non-clinical areas) and lack of appropriate attention and treatment.

In response, the Corporate Director for People (Stockport Council) and the Chief Operation Officer (SCCG) gave assurances that professionals met regularly to address issues on a case-by-case basis. They recognised the pressure on nursing homes places, and domiciliary care availability, but stressed that this only resulted in delays to discharge in very few instances. It was emphasised that the work of Stockport Together was seeking to reduce the number the need to attend ED when treatment could be more appropriately provided in their home setting. A number of approaches were also being explored to improve flow through the system, but this presented challenges in resourcing a dual system.

The Chair suggested that the issues at the Hospital should be considered by the relevant scrutiny committee and the concerns identified by Healthwatch be forwarded to the JSNA Team for inclusion in the revised JSNA.

A further comment was made about a pilot scheme in Sunderland for providing new boilers on prescriptions. Early indications were that GP and hospital attendances had reduced.

RESOLVED – That the update be noted.

To consider a report of the Director of Public Health.

This report presents the health and wellbeing performance indicators previously agreed by the Health and Wellbeing Board. This report also summaries key updates from theme leads about progress towards achieving the Health and Wellbeing Strategy ‘we wills’. Commentary for the overall underlying principles has also been added and is aligned with reporting of the Stockport Together programme, this will develop further as the programme evolves.

The Board is invited to note the report and comment as appropriate.

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) providing the Board with data on performance during the second quarter of 2015/16 against a range of health and wellbeing indicators, and providing a commentary on trends and other issues related to the indicators.

The following comments were made/ issues were raised:-

·         Attention was drawn to the increases in delayed discharges in the second quarter.

·         The challenge of reducing alcohol-related admissions was highlighted. Comment was made about the small improvement in the rate of liver deaths, although it was suggested that this was a complex indicator and the downward trend was unlikely to continue.

·         Clarification was sought on the significant decrease in NHS health check take-up. It was clarified that there had been an expected decrease as there had been a change in the process for sending out invitations and that this was now done directly by GP practices. Data suggested that those who attended these checks were most likely to be in good health and so further targeting was needed to ensure take-up by those most at risk.

RESOLVED – That the report be noted.

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

Partners are invited to update the Board as appropriate on recent announcement from the Government in relation to the Better Care Fund.

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

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

A representative of the Corporate Director for Corporate and Support Services (Stockport Council) updated the Board on recent announcements about the future of the Better Care Fund. The update included the following:-

·         It had been announced that nationally a further £1.5B would be available in the BCF by 2021, with half of this resource coming from reductions in the New Homes Bonus.

·         A consultation was due to be undertaken by Department of Health on the new methodology for the distribution of the BCF, but there was an assumption that in order to minimise any inequalities arising from differing levels of social care precept that could be levied, the level of BCF available to any local authority would be offset against their expected Precept income.

·         By way of illustration, it was reported that assuming Stockport Council choose to levy the precept, there would be no resources through the BCF in 2017/18, but by 2019/20 there could be up to £6.3m available. This would be significantly less that other local authorities in Greater Manchester.

RESOLVED – That the update be noted and the Corporate Director for Corporate and Support Services be requested to circulate a note to members of the Board summarising the BCF announcements.

To consider the Forward Plan of agenda items for future meetings of the Health & Wellbeing Board.

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 a forward plan of agenda items for future meetings of the Board.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to include a standing item on all future agendas on ‘Greater Manchester Health and Social Care developments’ and for members to provide updates as appropriate.