Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 16 July 2014.

The Minutes (copies of which had been circulated) of the meeting held on 16 July 2014 were approved as a correct record and signed by the Chair.

Members and officers to declare any interests which they have in any of the items on the agenda for the meeting.

Members of the Board 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

Disclosable Pecuniary Interest

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

The Chair reported that he had attended a recent NHS Commissioning Summit and had taken the opportunity to ask questions of senior officials at NHS England and the Care Quality Commission (CQC). He added that he had made a comment to the CQC that commissioners could include more in contract specifications in relation to their expectations of providers.

To consider an update on Healthier Together.

The Board will invite members to provide an update on progress with the consultation on the Healthier Together proposals.

The Chair invited the Board to discuss the Healthier Together programme with the views of the Board being submitted as part of the consultation that was shortly to draw to a close.

The Clinical Commissioning Group (CCG) representatives stated that they would not be voting in relation to this item because they did not feel it appropriate as the CCG was one of the sponsors of the Healthier Together programme.

Tony Stokes (Healthwatch Stockport) submitted a report (copies of which were circulated) providing the Board with an update on Healthwatch Stockport’s involvment with the Healthier Programme and summarising the concerns raised by members during the consultation. The report also posed the Board a series of points that Healthwatch believed the Board needed to be satisfied had been met in preparing its response. The work of Healthwatch Stockport in relation to the transportation implications of the proposals was also highlighted.

The Chair reported that the Stockport NHS Foundation Trust Governors had recently met and had a lengthy discussion about Healthier Together. The Foundation Trust was planning on submitting a joint response on behalf of both the Board and Governors. The issues highlighted by the Governors had reflected the concerns summarised in the Healthwatch Stockport submission.

The Chair stated that the Health & Wellbeing Board were supportive of overall aim of the Healthier Together programme in seeking to minimise avoidable deaths.

The following comments were made/ issues raised:-

·         Concerns were expressed about the level of public involvement in the consultation, because of the timing of the consultation and the language used in the documentation. Anecdotally, there appeared to be a high degree of cynicism on the part of the public about the openness of the process and their ability to influence the outcome. Given the scale of the change needed the consultation period appeared to be relatively short. Because so much of the consultation was web based, this may have impacted on the level of engagement. It would have been more engaging for the public to have had the opportunity to participate in a dialogue about the important issues underlying the proposals and for case to be made more explicit about the benefits of reducing the hospitalisation of the health economy, increasing the focus on primary care, and integrated health and social care. The consultation questionnaire could have given the impression that decisions had already been taken as respondents were presented with a stark question about their preferred hospital configuration.

·         Insufficient focus has been given to the non-hospital strands of the Programme, namely Primary Care and Integration. The variability in outcomes between hospitals was not unique to that setting, but was also reflected in primary and community care, but there was less data available on mortality rates to evidence the case for change.

·         Centralisation of specialised services was not a new process and had been achieved successfully in a range of areas, such as stroke and cardiac care, and through outreach work from other hospitals, such as dermatology, and this should be continued where there was evidence of its efficacy. The labelling of ‘specialist’ and ‘local’ hospitals was therefore unhelpful and confusing.

·         In relation to health and social care integration, there was a significant culture shift required but it was important to ensure that user experience was central to developments in this area.

·         There was a tension between the public’s desire to have the best possible care even if this meant the need to travel, and the convenience of local services. It was a flaw in the consultation that residents were being asked to give a view about the best strategic direction of the health system when they were not well equipped to do so.

·         There remained value in persisting with a general hospital model but to continue with the concentration of specialist services as has already been underway. Efforts to reduce avoidable deaths and improve quality were not solely about  ...  view the full minutes text for item 4.

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

The report outlines the approach taken to compile the latest submission of Stockport’s Better Care Fund Plan (BCF) which is due for submission to NHS England by the 19th September 2014. The latest submission requires further detail and analysis of how the BCF will be used and the impact this will have on headline measures regarding emergency admissions as well as the impact on Adult Social Care.

The draft submission templates will be circulated ‘to follow’.

Stockport Health & Wellbeing Board is recommended to:

(a)  Note and Comment on the draft Better Care Fund Plan;

(b)  Approve the Stockport’s draft Better Care Fund Plan for submission to NHS England.

(c)  Delegate responsibility to the Chair and Vice Chair of the Health & Wellbeing Board to approve any further amendments to the submission prior to the 19th September as identified by the Director of Adult Social Care (SMBC) and Chief Operating Officer (Stockport CCG).

Officer contact: Tim Ryley; 0161 426 5573; Tim.ryley@nhs.net 

Tim Ryley, Director of Strategic Planning and Performance, Stockport Clinical Commissioning Group, attended the meeting to provide an update to the Board on the development of the Better Care Fund Plan. The Plan would be submitted to NHS England on 19 September 2014. The latest iteration of the submission was provided to the Board along with a summary of the key issues and outstanding items (copies of which had been circulated).

The key issues identified in the summary

·         Setting the ambition for reductions in non-elective admissions.

·         Setting the ambition for other metrics.

·         Agreeing the distribution of the fund and impacts.

·         Agreeing risk sharing arrangements.

The following comments were made/ issues raised:-

·         The proposals had been subject to extensive discussion. The current iteration was a more realistic reflection of what was achievable. As a consequence this has meant that the Council has had to adjust its approach in its Medium Term Financial Plan.

·         Behind the figures contained in the submission the planned improvements in services, such as the falls service, would have a significant impact on people’s quality of life. The falls service was an example of relatively small investments having a significant impact on outcomes. Previous work by Age UK in this respect should be used to inform the development of the service.

·         It was useful to consider the BCF in the broader preventative agenda, particularly as the admission into hospital for an older person, particularly for a fall, was often the precursor to a decline in their overall health so admission should be seen as a last resort.

·         NHS England were likely to seek further reassurance about engagement and buy-in from stakeholders in the development of the plan, particularly in relation to the 3.5% admission reduction, as to fail to achieve this target will lead to further cost pressures. It should be borne in mind that there the plan required contingency funds to cover the costs of the Foundation Trust should they fail to meet the target, which would be a significant challenge for them.

·         What would the Board be able to do in the event of the 3.5% target not being met? The wider system needed to ensure that risk was being placed where it was appropriate.

·         Due to the overall financial profile of the local health economy, it was likely that the submission would be approved subject to conditions, due to the risks in the local health economy.

RESOLVED – (1) That approval be given to the draft Better Care Fund Plan for submission to NHS England, subject to the provisions of the additional note circulated at the meeting, and that the Chair and Vice Chair be authorised to approve any further amendments to the submission as identified by the Director of Adult Social Care (Stockport Council) and Chief Operating Officer (Stockport CCG) prior to the 19 September deadline.

(2) That the gratitude of the Board be extended to all those officers involved in the preparation of the Better Care Fund submission.

To consider a report of the Deputy Chief Executive (Stockport Council)

The current domestic abuse strategy covers the period 2012-14.  The Draft Domestic Abuse Prevention Strategy for 2015-16 is a new statement of Stockport’s approach to outcomes for adults, families and children and young people who experience domestic abuse.  The Strategy sets out the priorities established by the comprehensive ‘Review of Domestic Abuse Services’ carried out in 2013 and is guided by the best available evidence about the long term effectiveness of interventions.

The draft strategy and action plan is included in the agenda. The Strategy forms a framework to steer the work of all key partners in Stockport and provides a policy basis for the consistent commissioning and development of provision and services.

The Board is invited to comment on the draft Strategy.

Officer contact: Helen Boyle, 0161-474-3145, helen.boyle@stockport.gov.uk

The Corporate Director for People (Stockport Council) submitted a report (copies of which had been circulated) inviting the Board to consider a revised Domestic Abuse Strategy and Action Plan that was currently being consulted on. It was emphasised that there were approximately 5000 incidents of domestic abuse recorded by Police last year, 3000 of which were in setting with children.

The Strategy and Action Plan recognised the need for cooperation between agencies to provide better preventative services (including awareness raising in schools); to develop a series of interventions when abuse was identified (such as homeless referrals); and improvement in the treatment of perpetrators to prevent future incidents.

Oversight and governance of the Strategy and Action Plan would mirror that for Troubled Families pathway, which had been a successful approach to providing quicker and targeted intervention through multi-agency working.

The following issues were raised:-

·         Greater emphasis was needed on wider services that could contribute to the Strategy, such as district nursing, as the current Strategy had an understandable, but too narrow a focus on children’s services.

·         Significant improvements had been made in recent years to ensuring the response of agencies was more cohesive, and this was a development of that. Significant risk would remain in relation to sharing of information and communication between agencies.

·         It was important to ensure professionals and front line staff were supported as responding to domestic abuse and other problems could be overwhelming.

·         There were really deficiencies in the current regulatory system to identify risks to adults living in care homes and nursing homes. Efforts to encourage relationship building between the new health and social care locality hubs and local care homes to improve monitoring providing support  was welcomed.

RESOLVED – That the Domestic Abuse Strategy and Action Plan be welcomed and the Council Executive be recommended to approve the Strategy and Plan, subject to the comments of this Board.

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 planned agenda items for future meetings.

The Board congratulated the Clinical Commissioning Group for their recent for shortlisting for HSJ Award for Board Leadership.

The Chair reported that the Pharmaceutical Needs Assessment consultation had now gone live, and that he had written to a range of organisations encouraging them to participate in the development of the JSNA.

RESOLVED – That the report be noted.