Meeting documents
Social Care, Health and Inclusion Overview and Scrutiny Committee
Thursday, 8th November 2007
Present
Chair
A Bridson
Councillors
IO Coates, SR Mountney, PTC Reisdorf, DE Roberts, PA Smith, GCJ Watt
Index to Minutes
- Minute 30 - WELCOME
- Minute 31 - DECLARATIONS OF INTEREST
- Minute 32 - MINUTES
- Minute 33 - ORDER OF BUSINESS
- Minute 34 - INFORMATION ITEM: YOUR DOCTOR, YOUR EXPERIENCE, YOUR SAY
- Minute 35 - INFORMATION ITEM: PREMISES DEVELOPMENT PROGRAMME
- Minute 36 - DEVELOPING LOCAL INVOLVEMENT NETWORKS ON WIRRAL: UPDATE
- Minute 37 - FINANCIAL MONITORING 2007-08
- Minute 38 - CAPITAL PROGRAMME MONITORING REPORT
- Minute 39 - ADULT SOCIAL SERVICES PROJECTED BUDGET 2008-2011
- Minute 40 - ANNUAL COMPLAINTS REPORT
- Minute 41 - LEARNING DISABILITIES TASK FORCE ANNUAL REPORT 2006-07
- Minute 42 - DISCHARGE FROM HOSPITAL
- Minute 43 - INFORMATION ITEM: CHESHIRE AND WIRRAL JOINT SCRUTINY COMMITTEE MINUTES
Minute 30 - WELCOME
Minute Text :
The Chair welcomed John Webb to his first meeting in his new role as Director of Adult Social Services.
Minute 31 - DECLARATIONS OF INTEREST
Minute Text :
Members were invited to:
(a) to consider whether they had a personal or prejudicial interest in any matters to be considered at the meeting and, if so, to declare them and state what they were;
(b) to declare, pursuant to paragraph 18 of the Overview and Scrutiny Procedure Rules, whether they were subject to a party whip in connection with any matter to be considered and, if so, to disclose the nature of the whipping arrangement.
No declarations were made.
Minute 32 - MINUTES
Minute Text :
The Director of Corporate Services requested that the minutes of the meetings of the Social Care, Health and Inclusion Overview and Scrutiny Committee held on 11 September and 23 October which were received by Council on 29 October, 2007, be received.
Minute Decision :
Resolved - That the minutes be received.
Minute 33 - ORDER OF BUSINESS
Minute Text :
The Chair suggested, and it was agreed, that the order of business be varied and items 10, 11 and 7 on the agenda be considered next.
Minute 34 - INFORMATION ITEM: YOUR DOCTOR, YOUR EXPERIENCE, YOUR SAY
Minute Text :
Further to minute 12 (19/6/07) the Director of Primary Care and Provider Services, John South and PCT Primary Care Medical Directors, Drs Mantgani, Mukherjee and Roohi, submitted a report on the national GP survey 'Your Doctor, Your Experience, Your Say' which was conducted on behalf of the Department of Health by Ipsos MORI. This was the largest ever survey of its kind aimed at patients treated by General Practice. The survey began in January 2007 with final returns submitted by 7 April 2007. This paper confirmed the results, which were published on 23 July 2007, and presented the response of Wirral PCT particularly where performance fell below the national average.
29,388 local residents/patients were targeted and 14,333 responded, a 49% response rate (5% above national average). The results for Wirral Practices overall were positive with many individual practices scoring above national average levels, and in some cases well above average. However, it was recognised that despite this result, development work was needed in each of the following categories where a result indicated a number of practices that scored below national average:
% satisfaction with telephone access - 13 Practices
% satisfaction with 48 hour access - 12 Practices
% satisfaction with advanced booking - 39 Practices
% satisfaction with appointment with specific GP - 27 Practices
% satisfaction with opening times - 11 Practices
In overall terms, in three out of five indicators, the PCT was above average. In one category, the PCT was only 1% below average. However, with regard to pre-bookable appointments, the PCT scored well below average. The report gave details of individual practice performance as compared with the England average.
The report went on to describe the most effective way to analyse and subsequently improve performance by utilising the PCT’s three Locality Directorates, Birkenhead, Bebington and West Wirral and Wallasey. This would involve developing Local Action Plans sensitive to the needs of each locality and enabling a mixture of locality solutions and one to one work with individual practices.
There were sixty practices that had contracts with the PCT to provide medical services to Wirral residents. They were all separate businesses in their own right, being both independent from each other and from the PCT, this being a contractual relationship. The next national patient survey would be undertaken in early 2008. In preparation for that and to achieve improved performance the report outlined the steps to be taken.
In response to questions from Members, John South and Dr Mantgani made the following comments:
- All surgeries offered advance appointments but details of how they were offered did vary across practices.
- Not all practices had email facilities for making appointments but this was something that would be developed in the future.
- There was a Quality and Outcomes Framework (QUOF) for practices which meant that payments to practices were not just based on providing services but also on a certain level of standard being achieved.
- Practices had and were making significant changes to ensure that 24 and 48 hour targets were met.
- A variety of methods, including posters, leaflets and advertisements in local newspapers, were being used to publicise the different aspects of access available.
Kathy Doran, Chief Executive of Wirral PCT, suggested that an update to the Committee could be provided in the Spring and then this time next year, with the 2008 survey, an objective view would be available.
Minute Decision :
Resolved -
(1) That the results of the National Patient Survey and the plans to address issues relating to pre-bookable appointments in particular, be noted.
(2) That further reports be submitted to this Committee in Spring of next year and in 12 months time.
Minute 35 - INFORMATION ITEM: PREMISES DEVELOPMENT PROGRAMME
Minute Text :
Doug Baker, Head of Capital Projects and Premises Management, Wirral PCT, submitted a report on premises infrastructure, the improvements being made and those planned. The level and range of medical services needed to keep pace with patient and public expectations for NHS services. To do this the PCT had three challenges to:
- ensure primary healthcare services could meet the changing expectations of patients and the public
- ensure that it shifted the focus of services towards promoting good health as well as treating disease
- manage long-term conditions e.g. diabetes, heart disease and obesity
Since 1997 there had been £21.4 million invested in completed improved primary care premises on Wirral. Schemes to the value of £16.6 million were currently underway. Funding had been agreed for additional schemes to the value of £9.5 million. Discussions were ongoing regarding a potential additional £42.6 million.
In response to a question from Councillor Mountney, Kathy Doran, Chief Executive Wirral PCT informed the Committee that in respect of the rejected planning application for the Warrens site, Thingwall, she had written to the Council Chief Executive and outlined three options which the PCT could pursue:
(i) They were minded to appeal and were having a meeting with Counsel next week about this option.
(ii) They were interested in submitting a planning application for other parts of the site where the nurseries were and were in discussion with Council officers about this.
(iii) They could resubmit the original application with new information.
Doug Baker informed the Committee that there was a joint property group forum to discuss all premises development across both health and social care and the PCT were happy to work with council colleagues to develop joint buildings fit for the 21st century.
Minute Decision :
Resolved - That this Committee notes the considerable improvements made and planned with regard to primary care estates with much improved facilities for patients.
Minute 36 - DEVELOPING LOCAL INVOLVEMENT NETWORKS ON WIRRAL: UPDATE
Minute Text :
The Director of Adult Social Services submitted a report which gave details of the development of Local Involvement Networks (LINks). LINks would provide a stronger voice for local people in the planning, commissioning and provision of health and social care services and would commence in areas where the local authority had responsibility for social services in April 2008.
The main changes from the current system of patient and public involvement forums were:
- LINks would cover social care as well as health care.
- LINks were a broad network covering health and social care services across a local authority area, rather than being linked to specific NHS trusts or PCTs.
- LINks would be supported and administered by host organisations commissioned and contracted by local authorities, rather than by forum support organisations commissioned through the Commission for Patient and Public Involvement in Health which would be disbanded in April 2008.
The report gave details of how LINks were being developed in Wirral.
In response to comments from Members, Christine Heron, Joint Commissioning Manager, stated that each local authority would be issued with a grant to commission a host organisation which would have to be an independent provider. The grants had not yet been allocated although it was anticipated that Wirral would receive between £150,000 and £190,000. The budget would be organised entirely by LINk and would have to be used for staffing, expenses for volunteers, training and research. The Council was responsible for developing a contract specification, tendering and letting the contract, and performance managing the contract against the specification. A report would be submitted to Cabinet on the outcome of the tender.
Audrey Meacock, of the Clatterbridge Centre for Oncology PPIF, addressed the Committee and spoke of the need for a seamless transition from PPIFs to LINks.
Minute Decision :
Resolved -
(1) That this Committee notes the progress made in preparing for Wirral LINk.
(2) That a further report be submitted to this Committee on establishing Wirral LINk.
Minute 37 - FINANCIAL MONITORING 2007-08
Minute Text :
The Director of Adult Social Services reported upon the current financial position of the Adult Social Services Departmental budgets. The report identified in-year financial pressures totalling £6.0m which the Departmental Management Team was confident could be managed to an overspend of £3.3m within the existing policy framework. Other options were being considered to contain this further with the aim of delivering as close to a balanced budget as possible.
The Director gave details of the main areas of concern which were community care, staffing budget, energy costs, service re-engineering savings and savings plan targets. Action to reduce the projected overspend included accelerating the changes in the in-house home care service, bringing forward the closure of one or more of the residential homes, reducing choice, and reducing the level of support provided to people at home. The clear aim was to try and reduce spending in the second half of the year to accommodate this projected overspend and minimise the impact on the Council’s balances.
This level of overspend was consistent with other Councils in the North West with Social Services responsibility and reflected the national pressures of increased demand and cost for adult social services. The Director of Adult Social Services would present a Strategic Plan for the future of the department to Cabinet early in the new year. The plan would identify function and form of DASS and address financial pressures for Wirral.
In response to comments from Members, the Director informed the Committee that there had been an increase in the number of older people in residential and nursing care that had been privately funded for a number of years, approaching the Council for funding as their savings were depleted. The Council had little option other than to accept financial responsibility in such cases, although an assessment could be made which might mean the Authority offering housing accommodation if it was felt appropriate to do so. As anybody could enter into residential / nursing home care if they self funded, there were a number there who had not gone through any assessment process. A dialogue had been opened with residential / nursing homes regarding assessments and their responsibilities.
Minute Decision :
Resolved - That the report be noted.
Minute 38 - CAPITAL PROGRAMME MONITORING REPORT
Minute Text :
The Director of Adult Social Services provided an update on the progress of Adult Social Services Capital Expenditure. The Capital Programme was formulated and planned on a three-year basis within the Council’s Capital Strategy and was based upon resources expected to be received from Central Government, contributions from other sources, and assumed the use of capital receipts generated from the sales of assets. The programme approved by the Council on 1 March 2007 was £3,680,000 in 2007/2008, and the Director provided details of progress on a scheme by scheme basis.
In response to comments from Members, the Director informed the Committee that Girtrell Court was currently being used for interim placements. All buildings needed to be fit for the future and standards needed to match those of other providers. There was currently a corporate examination of all the Council's estate taking place.
Minute Decision :
Resolved - That the report be noted.
Minute 39 - ADULT SOCIAL SERVICES PROJECTED BUDGET 2008-2011
Minute Text :
The Director of Adult Social Services submitted a report which outlined the key financial changes to the department’s budget anticipated for 2008 - 2011. Details were given of the provision for inflation, inter Departmental budget transfers, specific grants and time limited funding and savings. Cabinet had agreed no growth items relating to Adult Social Services.
The budget and council tax for 2008/09 was anticipated to be agreed at the Council on 3 March 2008. Prior to this the department’s budget presented in this report would be updated for changes to central establishment, administrative buildings and other recharges that would be revised to reflect changes arising from the budget process and further decisions made by Cabinet; for example following the announcements of the Local Government Finance Settlement.
Cabinet on 21 February 2008 would consider the Council’s overall budget for 2008-09 and service plans for all departments. The service plans would include full budget details including grant announcements, central establishment and other recharges.
In response to comments from Members, the Director stated that it was recognised that the way in which current services were delivered would have to change and the whole structure of the Department would need to be examined.
Minute Decision :
Resolved -
(1) That this Committee notes the Projected Budget 2008/2011 as it reflects the Adult Social Services Department.
(2) That this Committee be informed of any Cabinet decisions that affect the projected budget.
(3) That this Committee notes the Director is keen to have a thorough budget review of the Department and that there are no proposals to set Wirral’s eligibility criteria for care services at critical only.
Minute 40 - ANNUAL COMPLAINTS REPORT
Minute Text :
The Director of Adult Social Services submitted his annual report on the operation and effectiveness of the statutory Social Services Complaints Procedure for the year 1 April 2006 - 31 March 2007. The report outlined the background to the Social Services Statutory Complaints Procedure, information on lessons learnt from complaints and performance data for Adults Services, together with achievements for 2006/7, future developments and departmental monitoring. An appendix to the report presented information in a format required by the Guidance to the Local Authority Social Services Complaints (England) Regulations 2006. Over the course of the business year 2006/7, the Department had received, 352 compliments and 335 complaints.
The Director informed the Committee that he would be able to provide some general information separately on those issues reported to the Quality Assurance Unit from MPs and Councillors.
Minute Decision :
Resolved -
(1) That the report be noted.
(2) That this Committee is pleased to note that the number of compliments received by the Department exceeds the number of complaints.
Minute 41 - LEARNING DISABILITIES TASK FORCE ANNUAL REPORT 2006-07
Minute Text :
The Director of Adult Social Services submitted a report on the Learning Disability Task Force Annual Report 2006-07. The Report stated that some things had got better for some people with Learning Disabilities but that there was still more work to be done. The report had come from the work that the Task Force had done over the past year. It had focused on health, employment and hate crime, issues that the Task Force had felt the government needed to do more work on to make sure that people with learning disabilities had better lives.
In the coming year the Task Force would be looking at post-16 education, the ‘Getting a Life’ project and Valuing People: The Next Steps. In respect of the latter, the Director reported that the Government document updating the Valuing People White Paper, due to be published in November, had been delayed. Once published, a response would be shared with the Committee at the end of the three month consultation period.
The Director stated that he was pleased with the progress made with the ‘Steps to Employment’ programme which started in September 2006, and had identified 30 individual work placements and provided support and training for the participants. So far 14 people had been successful in taking up permanent posts, thus reducing dependence on Day Centres. The focus of the Day Centres was to help in achieving employment or meaningful occupation.
The Director also informed the Committee that Wirral's Learning Disabilities service had been short listed for a national award regarding health care for people with learning disabilities.
Minute Decision :
Resolved - That the report be noted.
Minute 42 - DISCHARGE FROM HOSPITAL
Minute Text :
The Director of Adult Social Services submitted a report which outlined the main issues of discharge from hospital, as reported at a seminar for Elected Members held on 10th October 2007. The report also made recommendations for future action.
As a result of the seminar, several recommendations were made for the work plan of the Overview and Scrutiny Committee. These included, the need to use examples of individuals’ experience in order to improve systems and services and to use the complaints received in order to learn for the future. Further information would also be required as to the reasons for re-admissions to hospital, the refusal of intermediate care beds by individuals and the level and type of communication for people undergoing the discharge process.
The results of a readmissions audit carried out by the Primary Care Trust into discharges from Wirral University Hospitals NHS Teaching Hospital Foundation Trust would be known in early 2008 and would also be presented to Committee. Many of the services which could provide alternatives to hospital admission or facilitate discharge were already in place. However, there was a need to build the flexibility of such services to ensure that they were fully responsive in all situations.
Sandra Wall, Vice-Chair of the Older People's Parliament, was invited to address the Committee and referred to schemes in Lancashire run by the Red Cross which acted as a very good halfway house and which had reduced admissions. There was a lot of interest in having such a scheme on Wirral.
In response to comments from Members, Kathy Doran, Chief Executive of Wirral PCT, informed the Committee that every person discharged from hospital was given a survey to fill in. Readmissions on Wirral were higher than in other areas and an audit was currently being carried out to try and ascertain the reasons for this, whether it was a single reason or a combination of reasons.
It was suggested that another seminar / workshop session could be held to look at peoples' experiences of discharge and the Director said that he could bring some proposals forward to the next meeting of the Committee.
Minute Decision :
Resolved -
(1) That the issues raised by the Elected Member Seminar be reported to this Committee throughout 2007/08.
(2) That the results of the audit carried out by the PCT be reported early in 2008.
(3) That all community based developments reported to this Committee include an analysis of the potential input on discharge from hospital.
(4) That in January 2008, this Committee considers: the individuals’ experience, the lessons learned from complaints and the communication improvements for individuals about the process.
Minute 43 - INFORMATION ITEM: CHESHIRE AND WIRRAL JOINT SCRUTINY COMMITTEE MINUTES
Minute Text :
The minutes of the Cheshire County Council / Wirral Council Joint Health Scrutiny Committee meeting held on 10 October, 2007 for the Committee's information.
Minute Decision :
Resolved - That the minutes be noted.
(Minutes Published: 16 November 2007)