Agenda item

To consider a joint report of the Director of Adult Social Care and the

Deputy Director of Public Health

The Annual Portfolio Performance and Resource Reports (PPRRs) for the Adult Social Care and Health Portfolios are presented for consideration by the Committee. These provide a summary of progress in delivering the portfolio priorities, reform programme and other key projects since the final update reports, with a focus on the fourth quarter of the year (January to March). They include out-turn performance and financial data (where this is available) for the Portfolios, along with updates on the portfolio savings programmes.

Where significant activity or decisions have been made since the end of the fourth quarter, these have been included to ensure that the reports remain timely. These will also be referenced within the First Update Reports for 2018/19.

Scrutiny Committee is asked to:

·         Consider the Annual Portfolio Performance and Resource Reports;  

·         Review the progress against delivering key projects, priority outcomes, targets and budgets for 2017/18;

·         Highlight key areas of and responsibility for taking forward corrective action to address any performance or resource issues;

·         Highlight any significant issues or changes to be fed back to the Cabinet alongside the Corporate Performance and Resource Report;

·         Identify how areas of strong performance and good practice can be shared in other services.

Officer contact: Karen Kime/ Emma Bowe, 0161 474 3574 / 218 1026, karen.kime@stockport.gov.uk, emma.bowe@stockport.gov.uk

The Cabinet Members for Adult Social Care and for Health submitted the Annual Portfolio Performance and Resources Reports (copies of which had been circulated) summarising progress in delivering priorities, reform programme and other key projects and outturn positions for the Adult Social Care and Health portfolios during 2017/18, and in particular during the 4th quarter.

The Cabinet Member for Health highlighted the following issues:-

·         Preparations were already underway for next Winter and the flu vaccination programme, a significant aim of which was to prevent avoidable hospital admissions.

·         Improvements had been made toward achieving the 4 hour admission standard at the hospital, although work was ongoing.

·         Prevention had been a key driver for activity in the previous year. There had again been excellent overall performance with flu vaccinations but this masked geographical variations in reaching target groups.

·         The Public Health Team was researching further increased levels of mortality, reflective of a national trend, and would be reporting back to the Health & Wellbeing Board in due course.

The following issues were raised:-

·         What were the consequences to the Pooled Budget of not achieving the seemingly impossible 4-hour admission standard for ED? In response it was stressed that this was a relatively arbitrary national standard that did not reflect the particular circumstances in Stockport, although considerable efforts were going in to achieve this standard. Locally there was an older and aging population, and increasing number of whom were attending ED, who often took longer to treat. The challenge was therefore to prevent attendance if their needs could be better met out of hospital. Once there it was important to optimise the flow through the hospital, and credit was due to partners for their efforts that had improved rates of Delayed Transfer of Care (DTOC). Overall there was a 40-50% greater demand of services than the system was designed for. It was further commented that there was a level of maturity in the local health and care economy that the focus of partners was now broader than DTOC but also length of stay. For residents over 75 there was a significant and rapid deterioration of physical wellbeing from a 10 day stay in a hospital. This may therefore have a significant longer term impact the pooled budget through more costly interventions. As partners developed further their integrated approach, in particular the case management system, this would allow for quicker identification of those in need for earlier, more cost effective, interventions that would impact positively on the pooled budget. It was also commented that more detailed analysis of this information would be provided to the Health & Care Integrated Care Board in due course.

·         What were the lessons to be learnt from GP practices who were best at achieving good take up of health checks and other early intervention measures, given the variability in performance against a number of indicators, and were there any reasons for that variability? In response it was stated that the differing sizes of practices and therefore differing staffing and resource levels may impact on performance, as well as errors in capturing data that might lead to underreporting. The extension of GP operating hours was also being targeted to early intervention and preventative activity and the Public Health team would also support outreach activity in workplaces and events (capacity dependent).

·         Was there a quantifiable impact of the flu vaccination programme and if someone were not in the target group should they be vaccinated? In response it was commented that vaccinations were more effective for children than adults, but that it would nevertheless reduce the severity of an infection regardless of age so everyone should be encouraged to get a vaccination. It was difficult to quantify the impact, or determine the likely effect on admissions without a successful programme. The vaccine used nationally in the previous two years had unfortunately been less effective than hoped resulting in severe pressure on health services, demonstrating the importance and impact of the programme.

·         Clarification was sought on the reason for the status of healthy life expectancy performance between males and female related targets being different despite the actual figure being very similar. In response it was stated that while life expectancy had increased generally across the population, the gap between males and females, and between differing areas in the borough, remained. The efforts to reduce this gap required long term preventative and behavioural change activity. It was also recognised that performance against the female life expectancy target could be considered ‘below target’ but ‘within an acceptable range’.

·         What efforts were being made to reduce inappropriate use of anti-biotics? In response it was stated that most prescribing took place in general practice and ‘league tables’ of prescribing activity were produced and shared with GPs. This would then inform analysis of usage to understand the reasons for those decisions. A significant element of the campaign was to manage patient expectation. There was increasing media attention to the issue of the anti-biotic resistance but it was often the case that GPs were under pressure from patients to prescribe anti-biotics and difficult conversations need to be had in those circumstances.

·         Reductions in the Public Health budget and to lifestyle support services targeted support to priority groups. Was there monitoring of requests for support from those outside of priority areas/ groups to understand the level of demand that was not being met? In response it was stated that all such requests came through the Start service that would then signpost ineligible referrals to other services, often in the voluntary sector.

·         The schools flu vaccination programme had not been as successful as the GP led programme. Was is proposed to work with NHS England to increase local involvement in that programme to help improve up take. In response it was stated that the schools programme was had higher administrative burden that was falling on schools and discussion had taken place with NHS England with a view to ensuring that more of that burden fell to the Provider to allow the schools to encourage uptake. Despite these challenges Stockport had performed the best in Greater Manchester. It was also commented that following comments made at the Scrutiny Committee in the previous year, the programme had been targeted successfully at Special Schools to help overcome the additional challenges those young people had in getting their vaccinations through general practice.

The Cabinet Member for Adult Social Care highlighted the following issues:-

·         The section on Preventing Vulnerability provided an update on Wellbeing Networks that demonstrated the reach and breadth of the work being done.

·         Signpost for Carers had recently received a grant to produce a ‘Carers’ Card’.

·         The Dementia Action Week and the upcoming EDUCATE event due to take place the following evening. Thanks were also given to the community for support for the ‘Forget-me-not’ campaign.

·         Ongoing work with care providers to improve quality and prevent safeguarding issues arising.

The following comments were made/ issues raised:-

·         Concerns had been raised by Healthwatch about whether the impact on learning of young people who were carers was taken account of in the Carers Strategy. In response the importance of this issue was acknowledged. It was reported that the Council worked closely with Signpost for Young Carers to support these young people but there was a challenge in identifying them. It was important to ensure that Adult Social Care were aware of young carers to ensure they could access support from children’s services.

·         Clarification was sought on the new care home fee detailed in the report. In response it was stated that the new fee was inclusive of the recently approved increase that had been through a complex process to be set. The increase was reflective of the Council’s belief in the need to value the care workforce, but needed to be seen in the context of the wider challenges in Greater Manchester.

·         Clarification was sought the reasons for poor performance against measure ASCOF 2A.2 (permanent admission of older people to residential or nursing care homes). In response it was stated that it was believed that the increases in care home fees lead to an increase in the number of temporary placements becoming permanent. It was also commented that as this was an iBCF target it would be monitored closely.

·         In relation to the development of a ‘Fairer charging policy’ for working age adults with mental health difficulties, were the proposed charges new and would free provision cease? In response it was stated that the changes were reflective of the demands in the Care Act. This work was part of a larger review around Mental Health Services. Adult Social Care had traditionally never implemented the charging regime for mental health services that was in place for other service areas, but the Cabinet had committed to examining this to ensure Care Act compliance and that charges were levied fairly.

·         Clarification was sought in references in the report to Accountable Care Organisations (ACO) and competitive procurement, and whether the long term aim of the Stockport Together programme was an ACO. In response it was stated that there were no plans to procure services in the way suggested as part of the current service delivery models. Partners had moved away from the Multi-Speciality Community Provider model to an alliance agreement between statutory providers. There were no plans for the foreseeable future for an ACO or contract tendering. Changing from the current alliance agreement would require extensive consultation. Locally, the focus has shifted from concerns about form to be fixed on delivery and performance, including neighbourhood models of care, as was the tone of the recent CQC Local Review was on delivery.

·         Assurance was sort that with the recently increased fees for certain adult social care services those who could not afford fees would still receive services. In response, assurance was given that this would continue to be the case and clients would be offered financial assessments to assist with that.

RESOLVED – That the report be noted.