Agenda item

To consider a joint report of the Director of Adult Social Care and the Deputy Director of Public Health.

Policy priorities for 2018/19 were set out within the Council Plan, which was adopted at the Budget Council Meeting in February. This incorporates the shared outcomes from the Borough Plan alongside specific priorities of the Cabinet.

These priorities are articulated within the Portfolio Agreements, which form the basis for regular in-year reporting. Portfolio and Corporate Performance and Resource Reports (PPRRs and CPRRs) will assess progress against key objectives, priorities, outcomes and budgets, enabling Scrutiny Committees to hold the Cabinet to account and for the Cabinet to identify current and future risks to delivery.

This report presents the draft 2018/19 Agreements for the Adult Social Care and Health Portfolios for consideration and comment by the Committee.

Scrutiny Committee is asked to review and comment on the draft Portfolio Agreements.

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 draft Portfolio Agreements for 2018/19 (copies of which had bene circulated) that articulated the Policy Priorities of the previously approved Council Plan and which would form for the basis for the regular quarterly performing.

The Scrutiny Committee was invited to comment on each draft Agreement prior to their formal adoption by the Cabinet.

Health & Wellbeing Portfolio

The Cabinet Member for Health (Councillor Tom McGee) introduced the draft Agreement and highlighted the following issues:-

·           Ongoing commitment of the Cabinet to address health inequalities.

·           A commitment to early intervention and prevention to reduce costs of later interventions.

·           Public Health Observatory data included an increase in infant mortality, although this was a three year rolling average and may not be reflective of current trends. Assurance was given that each case was subject to a case review.

The following comments were made/ issues raised:-

·           Concern was expressed by data relating to infant mortality showing higher than average rates in Stockport. In response, assurance was given analysis of these deaths was undertaken and action plans developed to address any trends.

·           Although teenage pregnancy and rates of smoking in teenagers were both reducing, there remained a challenged with those in reducing rates of both in deprived communities.

·           In relation to the high rates of residents being hospitalised for alcohol related reasons it was stated this was a long term concern in Stockport and had been the subject of much analysis, however there was no single cause but may be reflective of particular recording practices at the hospital, a more precautionary approach taken by the hospital in relation to injuries, and the relative affluence of the borough (allowing greater access to alcohol for younger people).

·           Concerns were expressed about the impact of reductions to lifestyle services on efforts to reduce health inequalities. In response the challenges of ongoing and in-year reductions in the Public Health grant was emphasised and inevitable impact this would have on the ability to provide preventative services. It was also stated that resources were being made available through the Stockport Together Programme to invest in prevention initiatives such as social prescribing. Nevertheless, the Cabinet Member acknowledged that these reductions would harm efforts at reducing inequalities and so there had to be increased targeting of services to those most in need.

·           The impact of pollution on health inequalities in the Town Centre was queried. In response it was stated that analysis of air quality indicated it was concentrated around the major roads across the borough. It was also stated that there were often other factors involved and in some cases the likelihood of chronic conditions could be identified when a person left school, although this could be remedied with often simple behavioural changes.

·           In relation queries about increasing mortality in some female cohorts it was stated that this was part of a national trend although no conclusive explanation was available.

·           The accuracy of data in relation to smoking prevalence was discussed. It was commented that for some cohorts the data was based on self-reporting which made the data less reliable.

·           It was commented that some people with psychiatric conditions found smoking therapeutic reasons and vaping may be a less harmful alternative and that provision should be made for them to smoke even if in hospital. In response it was acknowledged that those with chronic needs should be given consideration and compassion but that such an approach would need to be nationally driven.

·         There was discussion about the appropriateness of vaping as a smoking cessation aid and whether public health professionals had been too slow to recognise it value. In response it was commented that caution was still needed as there was little evidence of long term impact of vaping on health, particularly during pregnancy. It was further commented that some of the solvents used in vaping devices were considered hazardous substances in other contexts and prohibited.

Adult Care Services

The Cabinet Member for Adult Social Care (Councillor Wendy Wild) introduced the draft Agreement and highlighted the following issues:-

·           Demographic assumptions underlying service planning was included in the report.

·           Benchmarking data was now included in the report.

·           Significant financial pressures facing the portfolio.

·           A commitment to continue to submit information to the Scrutiny Committee on adult social care complaints.

·           Ongoing work to redesign community mental health services.

·           Recent relaunch of Operation Strive.

·           A continuing commitment to report to this Scrutiny Committee on the use of the Disabled Facilities Grant.

The following comments were made/ issues raised:

·           Concerns were expressed that there were no mandatory health checks for adults with learning disabilities. The concerns were acknowledged and assurance was given that the Council was working with partners to address this.

·           Further information was requested in respect of the new case management system for adults and children’s services. It was confirmed that the Liquid Logic system was currently used by eight other local authorities in Greater Manchester. Although it would not be possible to have a single system across social care and health services it would be possible to establish a ‘one view’ health record for acute and community care.

·           Concerns were expressed about the low take-up rates for some carers services. In response it was stated that there were problems connected to data quality that were being addressed but also some services were provided by organisations other than the Council. A commitment was given to report back to the Scrutiny Committee at a future meeting.

·           Given previous issues with recruitment, were there now sufficient support workers now operating in the community to deliver Stockport Together? In response the challenges with recruitment were acknowledge, and in particular the high turnover of staff. It was also commented that similar jobs in the health service did not always suffer similar problems and could be a branding issue. Working with the GM Health Partnership to increase the value placed on care workers was an important stand of this work.

·           Further information was requested in respect to the Deprivation of Liberty Safeguards (DoLS). In response it was reported that the workload in respect of DoLS was increasing, but in light of expected changes in the law it was important for the Council not to overcommit resources, but rather weigh the risk around compliance.

·           Concerns were expressed about rates of mortality amongst those with learning disabilities. In response it was acknowledged that those within this cohort often had co-morbidity factors and that while improvements had been made there remained significant challenges.

·           Further information was requested in relation to the Steady in Stockport service. In response it was reported that most referrals were from GPs and care/ nursing homes and housing providers. Self-referrals were uncommon as people tended to be reluctant to do so as it may be seen as admitting decline in their independence. Often a fall could have a significant impact on a person’s confidence.

·           It was suggested that greater information on private care provision would be useful as it would give a more thorough view of demand for services. In response it was commented that by its nature it was difficult for the Council to measure and monitor uptake of private provision if placements were not made through the Council.

·           The previous commitment of the Scrutiny Committee to seek views of service users was reiterated.

·           Further information was requested in relation to the match funding grants for residential care. In response it was stated that this facility was to support capital spending care homes. The Council’s Equip Team actively supported care homes to assess their needs. The frequency of CQC inspections meant that there was often a delay between the investment and the impact on the CQC rating. It was confirmed that in the last financial year, £109k had been spent and the £49k currently available was the balance carried forward.

RESOLVED – (1) That the draft portfolio agreements for the Adult Social Care and Health portfolios be noted.

(2) That the Director of Public Health be requested to submit information to a future meeting in relation to indicative timescales for lifestyle changes having an impact on health outcomes.

(3) That the Director of Adult Social Care be requested to submit further information to a future meeting on the following:-

·           Mortality rates and Learning Disabilities.

·           Deprivation of Liberty Safeguards.

·           Take-up of carers services.