Agenda item

This item has been placed on the agenda at the request of the Chair.

The final report of the Care Quality Commission’s Local Area Review will be circulated for the Scrutiny Committee’s information.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

A representative of the Democratic Services Manager reported that this item had been placed on the agenda at the request of the Chair.

A copy of the Final Report of the recent Care Quality Commission Local Area Review of Stockport Together was submitted (copies of which had been circulated). The report had highlighted a number of positives but also weakness in the current programme, particularly in relation to governance.

The Cabinet Members for Adult Social Care and for Health attended the meeting to respond to questions from Councillors.

The Cabinet Member for Health highlighted the positive findings of the Review in relation to the ambition and vision of Stockport Together. The concerns highlighted by the Review had not been unexpected but would form the basis of an Action Plan and would inform the Stockport Together delivery plans.

The following comments were made/ issues raised:-

·           There were significant financial pressures on all partners, and the Foundation Trust in particular, but the significant number of nursing vacancies need addressing given the possible impact on the quality of care. In response it was stated that each partner organisation would need to consider the implications of the review for themselves. The example of nursing vacancies was instructive of the challenges as the Trust had been criticised for overreliance on agency staff but by reducing their use had led to an increase in vacancies.

·           Clarification was sought on progress with developing an Action Plan. In response it was stated that Stockport Managed Care would be developing a clear timeline for the implementation of the new models of care, but that each partners would also need to be clear of their own actions. Further progress would be reported back to the Scrutiny Committee

·           What level of improvement was it believed the CQC would expect for the 6-12 months? In response it was stated that they were likely to expect effort being made to address the review findings but also to achieve some of the ‘quick wins’. Many of the issues that needed to be address were long term challenges and ingrained cultural issues.

·           It was noteworthy that the rate of GP referrals to hospital was double to comparable areas. In response it was stated that significant effort had been made and improvements made in this respect. GP practices were being encouraged to take greater ownership of care homes in their area to better manage these referrals.

·           How quickly could the governance issues be address? In response it was stated that the governance of Stockport Together had evolved over time but had not been rationalised. The Review had highlighted the need to have clearer lines of decision making. Greater clarity was needed to understand how partners could make decisions together and then commit to that process.

·         Concern was expressed that this report would actually slow the process of change by distracting from the central task by requiring a disparate series of issues to be resolved. There was a danger that the Council was being driven toward a model of integration that imperilled the Council’s financial situation to address NHS challenges those organisations were incapable of resolving and that the CQC approach took little account of the need to find bottom-up solutions to reduce the demand on the system and lead to long term sustainable improvement.

·         The report made a number of observations about the quality of the challenge provided by scrutiny and this required further reflection. It was also commented that concerns had been raised about the role of the Health and Wellbeing Board and this was linked to the role of this scrutiny committee. Clarity on the role of the Board would help give focus to the work of the scrutiny committee.

·         Assurance was sought that the Council had abandoned the Accountable Care Organisation proposal. In response it was confirmed that this was the case.

·         Concerns about the lack of trust, poor communication and staff engagement were raised and assurance was sought that managers were now doing everything possible to engage with staff. In response it was stated that ongoing engagement was taking place with both staff and Unison and it was the aspiration of leaders for staff to be involved in the development of new models of care.

·         The report highlighted concerns about the level of engagement with Healthwatch and the Community Representative Panel. What more would be done to ensure future public consultation had greater reach? In response it was stated that these findings were surprising to partners but that the points raised would be taken on board.

·         The CQC often took place in response to additional investment in adult social care and were originally seen as local authority reviews. Stockport had been successful at making this review focus on the system-wide approach taken. This needed to be mind when considering the place based commissioning process be developed and the need to put people at the centre of the work, rather than focus on organisational change.

RESOLVED – That the report be noted.