Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 15 July 2015.

The Minutes (copies of which had been circulated) of the meeting held on 15 July 2015 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.

To consider a report of the Chief Finance Officer and the Corporate Director for Corporate and Support Services.

The report details monitoring information for the Better Care Fund (BCF) for the period April to June 2015, as required by NHS England.

The Board is recommended to:

(i)         Note quarter one BCF performance and approve the 1^st BCF monitoring report for reporting to NHS England on 28 August.

(ii)       Note that the forecast position assumes all underspends at quarter one are planned to be fully committed by year end.

(iii)      Note that the Health & Wellbeing Integrated Commissioning Board will be asked to discuss how NEL spend in excess of the £0.917m contingency is to be funded by the BCF and make a recommendation to the next Health & Wellbeing Board.

Officer contact: Marc Brady (CCG), 0161 426 5900

A joint report of the Chief Finance Officer (Stockport Clinical Commissioning Group) and the Corporate Director for Corporate and Support Services (Stockport Council) was submitted (copies of which had been circulated) providing the Board with the quarter one monitoring report of the Better Care Fund (BCF), covering the period April to June 2015. The report would be submitted to NHS England following consideration by the Board.

It was highlighted that although the fund was currently underspent there was a forecast overspend at year end due to projected increases in activity over the winter months.

It was also highlighted that discussions were ongoing between the Clinical Commissioning Group (CCG), the Council and Stockport NHS Foundation Trust (FT) in relation to the contingency for Non-Elected Admissions (NEL) as changes to the level of tariff for the recharging of this activity had been introduced by NHS England after the Plan had been submitted and it was projected that there would be a shortfall within the contingency based on current levels of activity. While attendances at the Emergency Department were reducing, the number of non-elective admissions was increasing, and further work was needed to identify and understand the causes of this.

The following comments were made/ issues raised:-

·         The forecasted overspend was queried given the underspend in the first quarter. It was clarified that this underspend was due to levels of activity connected to the Rapid Response service (which included elements of district nursing), but it was anticipated that this activity/ demand would increase later in the year, particular in relation to winter pressures.

·         In relation to queries about NEL, it was stated that admission rates were high in a number of other Trusts in Greater Manchester and possibly nationally, but rates were traditionally higher in Stockport in any case. It was also queried whether the assumptions underlying the planning of the BCF on the achievable reductions in these admissions were incorrect. It was confirmed that further investigation was needed to determine the cause of this trend and to understand its impact.

·         It was reported that as part of the Stockport Together programme investigations into the pressures within the system it had been found that there were significant numbers of people with manageable chronic conditions who were spending longer than needed within the hospital setting despite provisions within their care plans that would mitigate the need for admission.  It was also found that there were a range of intermediate care services being provided and further work was underway to rationalise and integrate these services.

·         It was clarified that delays in investment outlined in the report were due to procurement exercises being carried out for these services.

RESOLVED – That in relation to the Better Care Fund (BCF):-

(i)        quarter one performance be noted and the 1^st BCF monitoring report be approved for reporting to NHS England on 28 August;

(ii)       the forecast position, assuming all underspends at quarter one were planned to be fully committed by year end, be noted.

(iii)      the intention to ask the Health & Wellbeing Integrated Commissioning Board to discuss how Non-Elective Admissions spend in excess of the £0.917m contingency was to be funded by the BCF and recommendations being made to this Board be noted.

To consider a joint report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group).

Officer contact: Barbara Mitchell (Council) / Gina Evans (CCG), 0161 474 4401/ 0161 426 9000

A joint report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group) was submitted (copies of which had been circulated) providing the Board with details of the Learning Disabilities Partnership’s Self-Assessment of how well local health and social care partners support people with Learning Disabilities to stay healthy, be safe and enjoy fulfilling lives. The report identified areas of key challenge for partners, and provided an action plan for addressing these.

The Self-Assessment had been subject to Peer Review and had been considered by the Clinical Commissioning Groups’s Quality and Provider Committee.

The following comments were made/ issues raised:-

·         Healthwatch had been satisfied that the engagement exercise used to inform the self-assessment had been robust. The wellbeing work identified in the Action Plan had also been successful.

·         Service users had expressed concerns about the care package assessment in light of the end of the Independent Living Allowance.

·         Concerns were expressed about the level of safeguarding assurances received from the Boards of service providers (B4 in the self-assessment). It was clarified that unless 100% of providers were able to provide appropriate documentary evidence of their company Board’s having accepted Safeguarding Policies then the assessment criteria could not be marked as fully complied with. Assurances were given that commissioners were confident that these settings had sufficient regard to safeguarding and the larger providers in particular had robust systems in place, following visits to these placements. Members expressed concern that many of the recent high profile problems with safeguarding and LD had centred on large-scale organisations and institutions and suggested that as commissioner the Council and/or CCG should insist that providers ensure this information is available and that this be a requirement of their contract.

·         It was suggested that a high proportion of missed hospital appointments were those of people with LD, and it was queried what providers were doing improve this. It was confirmed that partners were working with providers to address this, as well as working with NHS services to ensure that adjustments were being made to their services and process to make them more effective.

·         Feedback from service users was captured on the ‘Improving Health and Lives’ website, but this often provided a polarised picture of any given provider. Service users were free to terminate their contract if they were unhappy with their service and this was monitored by the Council/CCG.

·         Transitions remained a challenge although progress had been made, one measure of which was that the number of complaints had reduced. Further work was needed to ensure compliance with the Children & Families Act and implementation of all its requirements, although this was reflective of national challenge.

·         Rates of routine health checks for adults with LD were disappointing given how beneficial these checks were. This low rate was not reflective of specific health screenings where those with LD had a higher rate of uptake. It was suggested that the lower rates reflected under-reporting as GPs had provided assurances that those with LD were being seen. Further work was planned with GPs to improve data collection, particularly those with low returns. It was also suggested that further thought be given to this measure as it should not be assumed that those with LD were any more willing to be summoned to health check than any other person.

RESOLVED – That the Learning Disability Self-Assessment be noted and the Action Plan be approved, subject to the inclusion within the Action Plan of steps to ensure confirmation of strategic priority being given to safeguarding by the Boards of all providers (relating to Measure B4 in the Self Assessment).

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.

RESOLVED – (1) That the report be noted.

(2) That the following items be included on the Forward Plan:-

·         Greater Manchester Health & Social Care Locality Plan for Stockport – November 2015

·         Response to the Comprehensive Spending Review – November 2015

·         Stockport Together and Vanguard Update – November 2015

·         Greater Manchester Health & Social Care Plan – January 2016