Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 23 November 2016.

The Minutes (copies of which had been circulated) of the meeting held on 23 November 2017 were approved as a correct record and signed by the Chair.

No declarations of interest were made.

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

No announcements were made.

The Board will be shown a short video about LifeLeisure’s SMILE exercise concept: Simple Movements Improve Life Everyday.

Ross McGuigan, Adult Participation Officer from Life Leisure, attended the meeting to make a short presentation on SMILE: Simple Movements Improve Life Everyday. The program sought to encourage older people, some with limited mobility, to remain active through low intensity exercise to reduce risks of become infirm.

The presentation set out the evaluation of the pilot of the programme. Participants had been overwhelmingly positive in their views of the programme. Life Leisure were exploring how to expand the scheme and provide sessions in a range of locations, including the hospital.

A short video was also shown, available at www.youtube.com/watch?v=Wbv_5hCY-_w

Members welcomed the programme as a low-cost but effective preventative scheme.

RESOLVED – That Ross McGuigan be thanked for his attendance and presentation.

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

The annual report provides information for all those involved in the work of, or who are interested in Safeguarding Vulnerable People in Stockport. The report summaries the progress that has been made against the objectives set in the Board’s Strategic Plan for 2015/17 ; it highlights the key achievements and the challenges that have been faced as a Board and it also sets the scene for the following year.

The Board is invited to comment on the report.

Officer contact: Lee Woolfe, 0161 474 3590, lee.woolfe@stockport.gov.uk

Gill Frame, Independent Chair of the Stockport Adult Safeguarding Board, and Lee Woolfe, Safeguarding Adults Business Manager, attended the meeting to present the Board’s Annual Report for 2015/16 (copies of which had been circulated) that set out the key activities and achievements of the Board and priorities for the future.

The following issues were highlighted:-

·         2015/16 had been a challenging year for the Board as the existing Chair had stepped down as had a number of senior officers.

·         The Board were revisiting their priorities to focus on the most significant issues and challenges.

·         During 2015/16 there were no serious case reviews, although one had been commissioned during the current year.

·         There had been significant work on training and awareness raising connected to safeguarding of vulnerable adults.

Members commented on the significance of mental health in the work of safeguarding, and the connections this had to vulnerability more generally. In response it was acknowledged that mental health was significant issue, particularly where users fell short of criteria for intervention. The challenge for partners was to ask themselves what they were doing to address these issues.

RESOLVED – That the report be noted and that Gill Frame and Lee Woolfe be thanked for their attendance and presentation.

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

The purpose of this Annual Report is to review the work of Stockport Safeguarding Children Board (SSCB) and to provide an outline of the main activity and achievements of SSCB from 1st April 2015 to 31st March 2016. It seeks to make a transparent assessment of the performance and effectiveness of safeguarding activity in Stockport. The report seeks to identify gaps in services and any challenges ahead. The publication of this report also provides the means by which SSCB can be held to account.

The Board is invited to comment on the report.

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

Gill Frame, Independent Chair of the Stockport Safeguarding Children Board, and Una Hagan, Board Performance and Development Manager, attended the meeting to present the Board’s Annual Report for 2015/16 (copies of which had been circulated) that set out the key activities and achievements of the Board and priorities for the future.

The following issues were highlighted:-

·         2015/16 had been a challenging year with five serious case reviews, and the Chair standing down.

·         The key priorities for the Board were quality assurance, learning, transition, and acting as a critical friend to the Stockport Family programme.

·         This coming year would focus on drawing together the themes to have emerged from the serious case reviews into an action plan.

The following comments were made/ issues raised:-

·         Concern was expressed about the number of Serious Case Reviews and whether this should be a cause for concern? In response it was stated that there was a rigid criteria for determining whether an incident should be subject to a Review, some of which might not otherwise have been subject to such a process. There had been no such reviews in the previous six years. It was further clarified that the number of reviews did not reflect a significant problem with bad practice, but that each Review nevertheless provided an opportunity to learn, which was a key priority for the Board.

·         Further information was sought on the higher than national average levels of injuries for children requiring hospital admission. In response it was stated that analysis of the data indicated that each was an appropriate admission and that the likely cause of the higher rate was due to more robust coding of this data locally. It was confirmed that the data was nevertheless monitored for trends.

·         Clarification was sought on whether data was collected about the length of time children were missing from home. In response it was confirmed that this was collected, but caution needed to be taken with this data more generally as it often masked the range of contributing circumstances. In part the reporting of children ‘missing’ was due to a risk averse procedure, particularly in relation to care homes, when children were in effect ‘absent’ although they were known to be at their parents’ home. It was also confirmed that there was a steering group of partners that tracked the children involved to work with those at risk or prone to becoming missing.

·         The proportion of mothers who smoked at the point of death of their child was disappointing given the lower rates of smoking mothers generally in Stockport. In response it was confirmed that work was ongoing to address some of these issues, building on work in the North West to reduce neonatal deaths.

·         The challenge of preventing Child Sexual Exploitation (CSE) was significant. In response this challenge was acknowledged, but it was commented that children in Stockport generally received an excellent service that protecting children well from this threat.

·         Further information was requested in relation to work with the Coroner in relation to legal highs, online safety and the associated risk of suicide. In response it was stated that there was a case with the coroner at the moment that was connected to legal highs and that the link between suicide and legal highs would be explored. It was commented that there was a very small evidence base for the effect of legal highs on young people.

·         The lack of investment in mental health, alcohol and drug services was reflective of over investment in hospital services.

·         There remained challenges for partners in sharing information, particularly because of risk aversion from smaller providers who fear fines from the Information Commissioners. Partners, working through Stockport Together, should consider offering insurance to smaller providers to help overcome this reluctance.

·         Further information was sought on efforts to tackle cyber bullying. In response it was stated that there was an online safety sub-group looking to  ...  view the full minutes text for item 6.

To consider a report of theChief Finance Officer (CCG) and Borough Treasurer (SMBC)

The BCF data collection for Q3 2016-17 (attached as Appendix 1) focuses on budget arrangements, the national conditions for access to the funds, income and expenditure to and from the fund, and performance updates on BCF metrics.

The Q3 data collection is due to be submitted to NHS England on or before Friday 24th February 2017.  The last reporting date for 2016/17 will be Friday 26th May.

The Board is recommended to approve the submission of the Q3 BCF monitoring tool to NHS England on or before 24th February 2017.

Officer contact: Michael Cullen (Council) / David Dolman (CCG), 0161 474 4631, 0161 426 5616.

A joint report of the Chief Finance Officer (Stockport Clinical Commissioning Group) and the Borough Treasurer (Stockport Council) was submitted (copies of which had been circulated) providing the Quarter 3 2016/17 Data Collection Return for the Better Care Fund that was required for submission to NHS England.

The following issues were highlighted:-

·         The significant underspend on a number of budget areas was highlighted, particularly the Disabled Facilities Grant.

·         The overspend on Learning Disability tenancies was due to the complexity of the needs of service users, and the Council had agreed to meet those costs. 

·         Any recurrent underspends in the BCF would be redeployed in the 2017/18 fund.

·         The high levels of Delayed Transfers of Care were impacting on progress with reducing Non Elective Admissions.

The following comments were made/ issues raised:-

·         Members expressed surprise that there was an underspend on the Disabled Facilities Grant, given the demographic profile of Stockport and queried whether there was the possibility of allocating the resources in anticipation of need. In response it was stated that there were restrictions on what the grant could be used for as it was a capital resource, but there were plans to purchase equipment in anticipation of need.

·         Further information was requested in relation to underspend on the mental health budget. In response it was stated that the pilot programme funded from this budget had recently commenced but that it was expected to spend the resource allocated to it.

·         Clarification was sought on an apparent contradiction between the budget figures in table 1 relating to Rapid Response and the narrative at paragraph 3.1.4 in the report. In response it was stated that following a review of intermediate tier services a number of services had been combined, but that the report captured accounting information rather than information about the service itself. It was confirmed that the discrepancy was due to accounting practice rather than a problem with service delivery.

·         Further information on actions to prevent Delayed Transfers of Care was requested. In response it was stated that this would be covered during the update on Stockport Together (see Minute 10 below)

RESOLVED – That the Q3 BCF monitoring tool be approved for submission to NHS England on or before 23 February 2017.

To consider a letter sent to the chairs of Health & Wellbeing Boards highlighting the Government’s response to the independent Review of Choice in End of Life Care.

A copy of the response of the Chair is also attached.

Partners are invited to update the Board on relevant developments within their organisations.

The Board is invited to note the correspondence.

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

The Chair submitted a letter (copies of which had been circulated) from the Department of Health to local health and wellbeing boards highlighting the Government’s response to the independent Review of Choice in End of Life Care, and a response sent on behalf of the Board.

Dr David Waterman, Consultant in Palliative Medicine at Stockport NHS Foundation Trust attended the meeting and made a presentation on the work of the Trust to support patients in the last stages of life through the Specialist Level Palliative Care services. The presentation also explored the issues to emerge from the Independent Review and the response of partners locally.

The presentation highlighted that although Stockport had a higher percentage of people dying in their usual place of resident than the average for Greater Manchester and East Cheshire, it was below the national average and aspirational level. It remained the case that most people died in hospital.

The work to integrate palliative care into the Stockport Together programme was also highlighted, as were the wider aspirations to ensure people were able to plan for a good death.

The following comments were made/ issues raised:-

·         When someone subject to a rapid discharge because they were at end of life at a weekend when there were few GPs available, would their death require the involvement of the police because no GP was available to certify death? In response, it was acknowledged that weekend rapid discharge was a different process to that taking place during the week. Assurance was given that the hospital worked to reduce the impact of these differences, and with GPs and Out-of-Hours services to ensure that they are aware of an expected death in order to provide medical certification and avoid unnecessary and potentially distressing involvement of the police and the coroner. It was commented that in some cases there was unavoidable need to involve these agencies.

·         One of the challenges for agencies in England was to develop a system that was better able to address the needs of those reaching end of life to avoid them being readmitted into hospital or attending A&E unnecessarily, and Stockport Together was working to achieve this. Working through the Neighbourhood Teams to help patients plan for end of life and for unexpected illness was a central aim of Stockport Together.

·         For some patients and families, dying in hospital would be their preferred scenario as there remained concerns and worries about dying at home. There was a need for a wider cultural shift in how people think about and talk about death.

·         Concerns were expressed about the capacity within the Palliative Care service. Assurance was given that the service had access to appropriate support out of hours, but comment was made that more resources was to be welcomed. Further comment was made, echoing discussions earlier in the meeting, that in order to invest more in Palliative Care, there needed to be disinvestment in other areas of hospital care.

·         For many patients, planning for their death was often very difficult, and required support from family and professionals. Training of clinical staff was important to ensure that they were able to have supportive discussions, particularly about clinical matters.

·         Tribute was paid to the work of Dr Waterman and his team for the service provided.

Dr Waterman reported that the Strategic Clinical Network Palliative Care Group was hosting an event on 11 May 2017 at the Whitworth Art Gallery of pieces themed about dying, designed to raise the profile of dying matters. The Stockport art installation would be on display in Stockport Town Centre in March 2017.

RESOLVED – (1) That the letter from the Department of Health and the response from the Board be noted.

(2) That Dr David Waterman be thanked for his attendance and presentation.

At the request of the Board, this is a standing item on the agenda.

Members and officers presented are invited to update the Board on developments with the transformation of health and social care services in Stockport and Greater Manchester.

The Chair reported that this item would be considered in conjunction with the Stockport Together Update.

At the request of the Board, this is a standing item on the agenda.

Members and officers presented are invited to update the Board on developments with the Stockport Together programme.

The Corporate Director for People submitted a report (copies of which had been circulated) providing the Board with an update on the progress with the Stockport Together Programme.

The following issues were highlighted:-

·         There were Greater Manchester wide problems with Delayed Transfers of Care, which were most acute in Stockport and Trafford as these borough had the highest number, and fastest growing cohort of older people with complex needs; challenges with procuring appropriate packages of social care as there were insufficient staff to meet the demands. Stockport partners had worked with NHS agencies to address some of these challenges, but there remained a higher number of people being admitted into hospital. Despite work to stimulate providers in the market there remained a greater demand than available supply. A range of short term measures were used to easy problems at the hospital, including involvement of the Greater Manchester Health and Social Care Strategic Partnership.

·         Although many of the efforts in place over this Winter had been a ‘sticking plaster’ it was still hoped that the Stockport Together initiatives would lead to long term improvements.

·         Further work was needed to develop a fully integrated discharge team to provide more rapid and effective decisions. This type of initiative was the real aim of pooling budgets.

·         More analysis was needed to understand how Stockport benchmarked against other areas for spend on social care and other similar services.

·         Although Stockport Council spent a significant proportion of its budget on social care, this had not kept pace with the growing population demand.

·         Stockport NHS Foundation Trust was shortly to launch its ‘Better at Home’ initiative to highlight the benefits of being out of hospital and active at home.

RESOLVED – That the report be noted.

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

The Chair invited the Board to consider Board membership for the next municipal year.

The Chair reported that he had received a number of requests to join the Board, but expressed concern that without careful management the Board numbers would become too large to be an effective body. He therefore proposed to hold additional events to address specific issues and to invite a wider group of partners.

A representative of the Democratic Services Manager also invited the Board to consider whether or not it wished to establish a sub-committee in order to more efficiently discharge its responsibilities for monitoring of the Better Care Fund.

RESOLVED – That from the 2017/18 Municipal Year:-

·         the membership of the Board be expanded to include a representative of the Stockport NHS Foundation Trust and the Pennine Care NHS Foundation Trust

·         a sub-committee of the Board be established to discharge the Board’s responsibilities for the monitoring and approval of Better Care Fund Quarterly returns

·         the membership of the Board and its role and responsibilities be kept under review.

To note the dates of future meetings:-

Wednesday, 24 May 2017 – 2pm

Wednesday, 27 September 2017 – 2pm

Wednesday, 31 January 2018 – 2pm

Wednesday, 11 April 2018 – 2pm

RESOLVED – That the dates of future meetings be noted.

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

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.

The Deputy Director of Public Health reported a paper had recently been published in the Journal of the Royal Society of Medicine about excess winter deaths in 2015 that suggested some of these deaths could be attributed to funding problems in health and social care. It was the case that there were deaths of those aged 85 in Stockport than should be expected. It was proposed to bring a report back to a future Board meeting with further analysis of the data for Stockport.

RESOLVED – (1) That the report be noted.

(2) That the Director of Public Health be requested to submit a report to a future meeting on excess winter deaths in 2015.