Agenda item

To consider a report of the Corporate Director for People.

The partner organisations across Stockport (Stockport NHS Foundation Trust, NHS Stockport Clinical Commissioning Group, Pennine Care NHS Foundation Trust, Stockport Metropolitan Borough Council and Stockport’s GP federation, Viaduct Health) are working alongside GPs and voluntary organisations to develop a single strategic plan to improve health and social care services across the borough. The Scrutiny Committee is being consulted on the proposed Integrated Service Model and draft business cases that have been developed to move this project forward.

The Scrutiny Committee is invited to comment on the report.

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

Andrew Webb, Corporate Director for People and Senior Responsible Officer for Stockport Together submitted a report (copies of which had been circulated) providing the Scrutiny Committee with an opportunity to comment on the Business Case Introduction for the new integrated service model for health and social care, developed through the Stockport Together collaboration between the Council, Stockport Clinical Commissioning Group, Stockport NHS Foundation Trust, Pennine Care NHS Foundation Trust and Viaduct Health.

Councillor Tom McGee (Executive Councillor (Health)), Ann Barnes (Chief Executive of Stockport NHS Foundation Trust) and Dr Steve Watkins (Director of Public Health) attended the meeting to answer questions.

Andrew Webb outlined the background to the establishment of the Stockport Together Programme, and provided an overview of the models being developed in the four work streams. Partners in Stockport had also been awarded £19m from the Greater Manchester Transformation Fund to help deliver the new models and while maintaining existing services.

The Council and Clinical Commissioning Group had also entered into new joint commissioning and budget pooling arrangements that would support the development of the integrated service model.

Once agreed, the Business Plans would become the implementation plan for partners and would make them more resilient and allow them to live within their budgets. It would also ensure that people were receiving appropriate services through a ‘single service’, but this would have implications on how the separate organisations operated in the future.

Challenges remained for partners to ensure accountability for their resources and activity, as well as through individual organisation’s monitoring and inspection regimes. The process was seeking to re-write the relationships between providers, and between services and the public.

Councillors asked questions and made comments on the proposals. These included the following:-

·      What affect would the recent announcement of the award of the Transformation Fund have on the business cases? In response it was stated that the continuation of the ‘Vanguard’ process was fundamental to the planning of the models, and would be used to support change management, but most significantly to allow the dual running of new and existing services. Because of this the majority of the resources would be allocated to patient care, but the mechanisms for its use would provide sufficient flexibility to allow partners to respond to changing circumstances as the programme developed.

·      How much reliance did the programme have on the voluntary sector, and how much of that was from non-commissioned services? In response it was acknowledged that the voluntary sector was central to the Healthy Communities work stream, and that this involvement was for the most part through the Targeted Preventative Alliance. It was also commented that there would always be community led, non-commissioned activity within the community in response to perceived need, organised through the good will and altruism of the public. Within the Neighbourhood model there was an expectation that professionals within these areas would also commission services from the voluntary sector to respond to and reflect the particular needs of the community they served.

·      Concerns were expressed that previous reductions in funding to the voluntary and third sector had undermined goodwill. Concerns were also expressed about the capacity of the Targeted Preventative Alliance (TPA) to respond to increasing demand as the programme developed, in particularly whether the training provided to staff was sufficient as there was evidence from mystery shopping conducted by Healthwatch Stockport that the public were being given unhelpful and potentially misleading information when seeking advice. Further concerns were also expressed that Healthwatch was unable to get reliable and timely data from the TPA on the types of enquiries they were receiving, as had been the case with its predecessor organisation, and that a potentially useful and mutually beneficial process for identifying patterns and feedback was being lost. In response, the value of feedback from Healthwatch was acknowledge and a request made for the mystery shopping information to feed into future commissioning decisions and to respond to the concerns raised. It was further commented that the lack of a Council for Voluntary Services, or similar umbrella body for the voluntary sector in Stockport hampered efforts to co-ordinate activity. It was commented that no model used previously had worked particularly well, but there was nevertheless a need to co-ordinate some of this activity. The dependence of some groups on funding could create a competitive element that impeded collaboration between groups.

·      What needed to be done to engage with wider public to ensure the ambitions of the programme did not fail, particularly within the context of the differing neighbourhood arrangements, priorities etc?. In response it was acknowledged that public engagement was central to the Healthy Communities work if the public were to take greater responsibility for their own health. It was anticipated that the neighbourhood working would provide opportunities for service users to provide feedback and for processes and approaches to be adapted in response. Current engagement was largely focussed on professionals because of the significant cultural change needed to empower staff within the new service models. The business cases had been subject to consultation with a citizens panel, that included service users, professionals and others, that had provided focussed feedback, particularly about whether the plans were broad enough to affect genuine change. It was also commented that the Business Case outline had been subject to consultation with the Foundation Trust Council of Governors.

·      Was there sufficient capacity within the workforce, particularly as it aged and given challenges in recruitment, to sustain these models of care into the future? In response it was stated that there were two phase to workforce development, with the first being investment in the relationships between organisations and removing barriers that exist currently to enable effective joint working. Secondly, new roles were being designed to ensure the workforce were doing the right things in the right place, but that this could create  problems as staff were drawn into the new roles at the expense of other parts of system. The challenge was recognised by partners but there were good links with local training providers to ensure long term capacity building was in place. It was also commented that there had been discussions amongst partners at a Greater Manchester level to explore a city-region wide workforce development programme to help plug gaps and deploy staff where needed.

·      The current focus of the programme was a specific cohort, but what plans were there to widen the work to the population level? In response an example was given of partners in Greater Manchester signing a Memorandum of Understanding with Sport England to invest in physical activity that will affect population level health, but which would also have a Stockport element. Whole population health had been identified as a key priority for the Health & Wellbeing Board.

·      How would the governance of the new service model fit into our existing local governance system? In response it was stated that discussions had taken place about options to use the Health & Wellbeing Board to bring together the partners involved in Stockport Together to seek to meet these new challenges, including Greater Manchester devolution issues. All of these partners had their own governance requirements, but it was hoped to move toward a joint arrangement though the Board. Nevertheless, all partners had rules they must to work to, and partners were working through these challenges. The role of existing governance arrangements may need to change in the future to reflect the new model.

·      It was important to ensure that the community and service users were aware of the changes being made so they would knew who to contact in the event of a problem, but also in the event they had a complaint.

·      Where there was variation between neighbourhoods this should not mean that service users were unable to access the same basic services in their locality and would have to travel unreasonable distances for simple procedures and treatment.

·      Clarification was sought on the graph set out on page 45 of the agenda supplement pack. In response it was stated that graph sought to demonstrate the cumulative financial impact of the Stockport Together work, in comparison to the impact of each organisation continuing its current activity. The impact of ‘do nothing’ was exacerbated by the increasing demand for services and the reducing resources available leading to a growing deficit, whereas it was projected that the new integrated approach would lead a surplus.

·      Given the work taking place across Greater Manchester, what was the scope for risk and pressure to be absorbed elsewhere in the city-region during periods of acute need, such as during the winter, given that each borough may have differing needs and demographic pressures? In response it was commented that Stockport Together sat within the Greater Manchester Health and Social Care Plan and was fundamentally part of the whole. Stockport and Salford were the most advanced in their efforts to integrate services. It was emphasised that the GM plan represented a definite plan, not an ambition. There was a work stream within this Plan for Acute Hospital Standardisation and Specialised Services, of which Healthier Together was the first iteration, and a key element of this was to explore how specialised hospital services could be more efficiently concentrated in particular centres. This work was being led by clinicians and was gathering evidence to prioritise future proposals. Stockport Together was seeking to identify that activity currently taking place within the hospital that was more appropriately done outside of that setting. The residual hospital activity would then be subject to a process of standardisation across GM to ensure all care was of the same high standard.

·      While it was recognised that steps were being taken to remove avoidable variability in hospital services, there needed to be a similar process for primary care.

·      Although there was a 5-year timetable for the project it needed to be flexible enough to respond to any changes in circumstances.

·      Existing patients and service users would be used to and expecting certain patterns to their treatment and in certain locations. It was important ensure that there was proper collaboration between providers and services to minimise the disruption and reduce the risk of patients being referred around the system.

RESOLVED – That the report be noted.