Agenda item

To consider a joint report of the Executive Councillors (Adult Social Care) and (Health).

The attached revised Stockport Together business case was considered by the Executive at its meeting on 7 February 2017 as part of the deliberations on the 2017/18 Executive budget proposals. The Business Case has been submitted for consideration by Scrutiny to allow members to comment and ask questions prior to the consideration of the proposed budget by the Council Meeting on 23 February.

Because of the cross-cutting nature of the Stockport Together programme, members of the Adult Care Services & Housing Scrutiny Committee have been invited to attend the meeting to take part in the discussions.

The Scrutiny Committee is invited to comment on the report.

Officer contact: Michael Cullen, 0161 474 4631, Michael.cullen@stockport.gov.uk

A joint report of the Executive Councillors (Adult Social Care) and (Health) was submitted (copies of which had been circulated) setting out the revised Stockport Together Business Case that had been considered and approved by the Executive on 7 February 2017 as part of the Executive’s 2017/18 budget proposals.

Representatives of the Adult Care Services & Housing Scrutiny Committee were also present at the meeting to participate in the discussion on this item in view of its importance to the remit of that Committee.

The Executive Councillors (Adult Social Care) and (Health) (Councillors Wendy Wild and Tom McGee), the Corporate Director for People and the Borough Treasurer attended the meeting to respond to questions.

The Business Case set out the rational for increasing contributions to the pooled budget for the next financial year in order to provide continuity of care through existing services while new models of care were implemented. Efforts of local partners to implement these proposals and thereby realise savings sooner had been delayed due to external assurance processes.

The following comments were made/ issues raised:-

·         An update was requested in respect of co-location of neighbourhood teams. In response it was stated that all neighbourhoods had a multi-disciplinary team operating, and it was anticipated that all would be co-located by the end of May 2017.

·         Further clarification was sought on prescribing costs referred to in the document. In response it was stated that this was reflective of improvements in care models reducing the costs pressures on the Clinical Commissioning Groups’ (CCG) prescribing budget.

·         Concerns were expressed that integration efforts in Stockport were now falling behind others in Greater Manchester and that previous suggestions of a ‘light-touch’ regulatory environment, given as part of the Devolution Deal, were not being followed. In response it was stated that the Devolution agreement would not negate the need for most regulatory oversight from NHS England and NHS Improvement, but that the framework that was emerging was proving onerous. It was also emphasised that developing the local model was in itself complicated and taking time.

·         Clarification was sought on whether the business case accounted for the costs associated with on-call staff. It was confirmed that this had, but that work would be undertaken to understand the case-law implications for local practice. It was further commented that work was underway with providers to re-profile staff to improve their productivity and avoid paying for staff while they were ‘sleeping’.

·         Clarification was sought on the salary level assumptions in the report. In response it was confirmed that in accordance with standard practice the assumptions were based on salary mid-points within the range.

·         Assurance was sought on progress with ICT improvements that would be needed to facilitate integrated models of care. In response assurance was given that work was ongoing to create a real-time single case management record. Progress had been made in creating a single ICT system across primary, community and hospital care and making improvements in the infrastructure to allow systems to be accessible across premises. A work stream within Stockport Together was also exploring opportunities for technical solutions to improve care and diagnosis.

·         Clarification was sought on Direct Access Physio. In response it was stated that a number of services were being considered for changes to the access arrangements to avoid the need for a GP referral, thereby improving waiting times, prognosis and reducing demand on GPs.

·         An update on ambulatory care was requested. In response it was stated that after since its establishment the numbers using the unit had now doubled to 49. Attendances at the Hospital were being mapped to establish how many patients could have benefited from being routed through this service.

·         It was queried what the fall-back position was in the event that the programme did not deliver. In response it was stated that partners were working hard to minimise problems but that it was to be expected that certain aspects would ‘go wrong’, but it was important to learn from these occurrences. The importance of ensuring a robust governance framework was in place was emphasised.

·         Concerns were expressed that the involvement of NHS Improvement would not help overcome the challenges that this innovative programme was facing and that by providing sufficient space for trial and error this would be more useful for the NHS in the longer term.

·         An absolute commitment of all partners, including senior clinicians within those organisations, to taking steps to reduce unnecessary activity was vital to the success of the programme. This included not only reducing the number of unnecessary appointments but also the number of clinic follow-ups.

·         Ensuring public understanding and support for these changes would be a challenge.

·         Further progress reporting to the Scrutiny Committee was important.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to circulate the Stockport Together update being considered at the Health & Wellbeing Board on 22 February 2017 to members of the relevant scrutiny committees for information.