Apologies for absence were received from Councillors B Berry, T Johnson, J McManus (Chair) and T Pilgrim; and Dr Sue Wells, Wirral Clinical Commissioning Group.

Councillor Moira McLaughlin in the Chair.

The Chair proposed, and it was unanimously agreed that item 15 on the agenda (Any Other Urgent Business) be considered immediately after item 3 on the agenda (Minutes) given the importance of recent unannounced changes to the services provided at Eastham Walk-In Centre.

Members are asked to consider whether they have any disclosable pecuniary interests and/or any other relevant interest in connection with any item(s) on this agenda and, if so, to declare them and state the nature of the interest.

Members are reminded that they should also declare whether they are subject to a party whip in connection with any item(s) to be considered and, if so, to declare it and state the nature of the whipping arrangement.

Councillor P Gilchrist declared a personal interest in proceedings by virtue of his position as a nominated governor representative on the Cheshire and Wirral NHS Partnership Trust.

To approve the accuracy of the minutes of the meeting held on 28 June 2017.

With reference to Minute No. 5, Councillor T Norbury advised that he had not yet received the information he requested regarding the number of people who had been fully discharged from the CGL service. Subject to the information being provided, it was:

Resolved – That the minutes of the meeting of the committee held on 28 June 2017, be confirmed as a correct record.

The Chair introduced an item of urgent business, and explained that the matter appeared at her request and that of Councillor Julie McManus. The Chair informed that after many years as a councillor (most of that time involved with health and social care) this was the first time she had known this happen, and how the action by the Clinical Commissioning Group (CCG) had resulted in very significant public concern, with a petition signed by around 5000 people, all 4 Wirral M.P.s were asking questions and expressing concern, as were the local councillors and colleagues on the Scrutiny Committee for Cheshire West and Chester Council.

The Chair further informed that it was very important that decision makers were held to account for the decisions they make and that health providers had a statutory responsibility to submit plans that may significantly change the delivery of service to this committee for scrutiny in advance of the proposed change, and that not to do this should only happen in exceptional circumstances.

The Committee noted that this plan had not been submitted in advance, and that no request by Wirral CCG had been made to include it on a future agenda. Members also noted that the Chair and Cllr McManus were not convinced by the explanation given to them on Friday 1 September when they had been called to a meeting with the CCG and Wirral Community Trust to be told that the planned closure was to take place on Monday 4 September. The explanation having been given being that the urgency was the need to protect the safety of patients and staff. Councillors McLaughlin and McManus were also unconvinced that sufficient consideration had been given to the negative  impact the closure would have on people living in Eastham, particularly as the same day the closure took place, the only direct bus route from Eastham to Arrowe Park had been withdrawn.

The Chair expressed the concerns of the Overview and Scrutiny Committee that the recognised deficiencies in performance for the A&E service at Arrowe Park Hospital did not provide substantive grounds for the withdrawal of the Eastham Walk-In service, and begged the question as to why information had not been provided to Members on this matter and why earlier actions had not taken place by NHS management to address the issues at Arrowe Park.

The Chair called upon Mr Simon Banks, Chief Officer Wirral CCG to address the Committee on the reasoning behind the recent change to the services provided at Eastham Walk-In Centre.

Mr Banks informed the Committee that the urgency of this matter had arisen from the necessity of speed under the Trust’s duty of care under the Health and Social Care Act 2012, and that the decision had been taken in consultation with the Chief Executives of both the Wirral Community Trust and Arrowe Park Hospital. The decision had not been taken lightly and was scheduled for review at both Eastham and Arrowe Park on a week by week basis.  ...  view the full minutes text for item 17.

The Chair introduced Ms Gillian Fryer (Business Improvement Consultant at Midlands and Lancashire CSU) and Ms Debbie Thwaites (Director of Improvement Consultant at Midlands and Lancashire CSU) who informed that the 5 Clinical Commissioning Groups (CCGs) in Cheshire and Wirral have entered into an agreement with Midlands and Lancashire Commissioning Support Unit (MLCSU) to use a Dynamic Purchasing System (DPS) provided by a company called Adam HTT Limited.

The Chair asked why the information about Dynamic Purchasing had not been provided to the Committee in advance of its introduction. The Committee was informed that the Adam DPS was an automated procurement system to modernise the way in which Nursing Care placements for both Nursing Home and Care at Home - for patients who have continuing healthcare (CHC) needs and have qualified for CHC funding – and a renewal of the NW framework, utilising the procurement process. 

The joint report of the Wirral CCG and Midlands and Lancashire CSU report further informed that NHS England had established a programme to look at how Continuing Healthcare services can be improved and that one of the goals of the programme was to make best use of resources. One of the recommendations was for more innovative procurement, one method being Dynamic Purchasing Systems like the one offered by Adam.

The Chair asked about the number of placements administered under the scheme on the Wirral, noting that currently 20 providers were involved and 44 Care Home Packages were being administered (19 on which were in Wirral).

Member asked a number of questions relating to the Issues of vulnerable adults and how valid the 3 choice ‘options’ were in practice and whether if the options were either not available or turned down, would funding be withdrawn and the recipient would essentially become self-funding.

Members also asked how any new providers would be assessed by the CQC prior to being added into the ‘dynamic’ system and what procedures were in place to deal with complaints – particularly bearing in mind that the CQC inspected to a minimum standard set and limited choice to a basic standard would not assist with the wish to see standards pushed up.

Following a series of more detailed questions about concerns regarding the handling of individual case scenarios, experience of the system and concerns that any limitations on choice would impact on the most vulnerable, Members requested that a further report including detail of the numbers of people accessing the system and the homes offered i.e. case studies be provided to a future meeting of the Committee (it was noted that the personal nature of such data would necessitate the use of exempt reporting).

Resolved – That

(1)  the report be noted; and

(2)  a further more detailed report on the implementation of the Dynamic Purchasing Scheme and practical examples of how it functions in practice be presented to a future meeting of the Adult Care and Health Overview and Scrutiny Committee.

Cheshire and Wirral Partnership’s short break (respite) service and potential changes in light of the Transforming Care programme.

The Chair informed of a request from the Wirral Clinical Commissioning Group (CCG) that although publicly circulated the report not be discussed in detail at this meeting.

She informed that the original request had been raised by Councillor McManus to the Cheshire and Wirral Partnership NHS Foundation Trust (CWP) regarding a statement to Members from the CWP relating to potential problems with service delivery at Thorn Heys in August.

Mr Simon Banks, Chief Officer Wirral CCG addressed the Committee and informed that the service had suffered from the lack of staff, but this and other matters – including the future of short breaks - were under review. He informed that there was further work to be done involving families of care users and the local authority.

With the agreement of the Committee, the Chair moved that the matter be deferred to a fuure meeting of the Adult Care and Health Overview and Scrutiny Committee to enable more work to be undertaken by the Wirral CCG for more detailed scrutiny of the issue.

Resolved – That scrutiny in the matter of Short Break (respite) Services be deferred to a future meeting of the Adult Care and Health Overview and Scrutiny Committee. 

Mr Gary Rickwood, Senior Public Health Manager, Public Health introduced the report of the Director for Health and Wellbeing that provided an update on the implementation of recommendations resulting from a scrutiny review set up to examine the issues arising from the Cumulative Impact of licenced premises and fast food takeaways on public health. 

He informed that the review had been commissioned by the former Policy and Performance Coordinating Committee and referred to Cabinet by the People Overview and Scrutiny Committee at its meeting on 8 September 2016. The findings and recommendations were approved by Cabinet on 3 October 2016.

The Adult Care and Health Overview and Scrutiny Committee was apprised of progress against each of the report recommendations, as follows:

Recommendation 1: The Council’s Leadership is encouraged to lobby for a Public Health licencing objective in the Liverpool City Region and where possible at national level to ensure public health outcomes are given greater priority in licencing decisions.

Outcome: This recommendation is being lobbied for nationally, however a recently published Lords Licensing Act Select Committee report on the 2003 Licensing Act did not recommend this as an action. The report does however recommend “a radical comprehensive overhaul” of the 2003 Licensing Act, a response from Government is awaited.

Recommendation 2: The Council’s Statement of Licensing Policy is refreshed to accommodate the renewed priorities as set out in the Wirral Plan.  It was also recommended that consideration be given to introducing a Cumulative Impact Policy in areas where there is strong evidence to suggest such a policy would address the negative impact of over-saturation of licenced or off-licenced premises.

Outcome: The Liverpool City Region group progressing joint work on licensing are developing a reference guide for anyone writing a Statement of Licensing Policy. The agreed document was in final draft stage and will be shared with local areas by September 2017. The Council’s Statement of Licensing Policy has been updated to include a Cumulative Impact Policy for a defined area in Birkenhead town centre. Further work was required to update the policy to include the Wirral Plan priorities. The Cumulative Impact Policy is now in place, its impact on anti-social behaviour and alcohol related injuries will be evaluated. 

Recommendation 3:  The Panel recommends that a statutory Supplementary Planning Document is urgently developed and consulted upon (thus becoming a material consideration), in line with the approach taken in St Helens, as part of the preparation of the Council’s Core Strategy Local Plan.

Outcome: Discussions had begun with the planning team. Evidence will be gathered from a Public Health perspective over the coming months and officers from the Planning team will be working on the revised Supplementary Planning Document. Discussions were taking place as to how Public health can input into this process.

Recommendation 4: The panel encourages the planning and public health teams to work closely together to address the borough’s public health issues in relation to poor diet and obesity, as outlined in the 2020 pledge to support Wirral Residents  ...  view the full minutes text for item 20.

Mr David Jones, Complaints Manager, Wirral Borough Council introduced his report that informed of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 and the statutory requirement on the Council to produce and publish an Annual Report which provided information on the quantity of the complaints received and the performance of the Complaints process.

The report covered complaints made in respect of Adult Social Care in the year 2016-17. Members noted that the total number of complaints registered in 2016-17 was 195. Members further noted that this was lower than in previous years and that there may have been a number of reasons for this change, including improvements in the service and more complaints being dealt with directly by providers.

The Committee was apprised that Social Care received complaints on a wide range of issues across all teams, including the delivery and assessment sides of the process. A significant number of complaints had related to commissioned services. Encouragingly, despite the pressures upon teams, there had been relatively few (12) complaints about delay in the assessment process.

The Service was to look to enhance its mechanism for capturing dissatisfaction and recording complaints concerning adult social care services, whether they are directly provided or commissioned, so that the Council can act to put things right quickly

The Committee noted that further work will be undertaken to capture the actions that have been taken to improve services as a consequence of complaints. Mr Jones informed that following consideration by Members the report was to be published on the Council Website.

Resolved – That the report be noted.

The Chair introduced the report of the Director of Health and Care that set out the Council’s plans and priorities in moving towards an increasingly integrated model of care, building upon developments, achievements and learning from the past couple of years. 

The report informed that, in June 2017, social care delivery teams transferred to Wirral Community Trust and that focus was to now refine and develop delivery approaches to ensure the principles of BCF, such as single lead professional shared systems and effective 7 day community services, were embedded. An outcome focussed commissioning approach with contract monitoring arrangements was in place  with close monitoring for year 1, utilising an open book accounting approach.

The Committee was apprised that it was the intention to move to an integrated commissioning entity by April 2018, and work was well underway to consider a new operating model, alongside a due diligence exercise for pooling of resources. Recommendations were due to be considered by Cabinet and Governing Body in November 2017. Discussions and developments were also underway to move to Accountable Care System by April 2019. ‘Aqua’ were supporting providers with these challenges, with commissioners developing prospectus in the later part of 2017/18 to shape the integrated commissioning intentions for Wirral, advising providers of key priorities and outcomes. 

The Director of Health and Care informed that a submission was scheduled for delivery to NHS England on 11 September 2017, with four key areas to be agreed nationally. Namely, building on best practice, reducing the length of hospital stays, investing heavily in facilities outside of hospitals and increasing the number of dementia trained nurses.

The Chair thanked the Director of Health and Care for his summary presentation and asked that the Committee receive the report.

Resolved – That the report be noted.

Mr Andrew Roberts, Senior Manager Financial Management introduced the regular report of the Assistant Director: Finance and Section 151 Officer that set out the projected revenue and capital monitoring position for 2017/18 as at the close of quarter 1 (30 June 2017).

The Senior Manager, Financial Management informed the Adult Care and Health Overview and Scrutiny Committee that, at this early point in the year the application of £2 million of the originally identified sum of £5.4 million from the Revenue Budget Contingency was anticipated to be sufficient to meet the projected level of spending.

He further informed that there were a number of in-year cost pressures forecast for 2017/18 and that they will be contained through a combination of effective demand management, income generation and improved processes as a result of the new Integrated Service with the Wirral Community Foundation Trust which commenced on 1 June 2017. Members noted that the ongoing pressures to reduce costs, combined with budgetary commitments to existing and future care packages were currently being offset through demand management and contingency actions as well as utilisation of available grant funding.

Within Public Health the regular review of commissioning intentions and management of agreed contracts are forecast to be underspent by £0.2 million. 

Resolved – That the report and appendices be noted.

The Chair introduced the report of the Director of Health and Care that provided the 2017/18 Quarter 1 (April – June 2017) performance report for the Wirral Plan pledges under the remit of the Adult Care and Health Overview and Scrutiny Committee. The report, which was included as Appendix 1, provides a description of the progress in Quarter 1 as well as providing available data in relation to a range of outcome indicators and supporting measures. 

The report also included further performance information that has been requested by Members to enable effective scrutiny.  The Adult Social Service Performance Overview was included as Appendix 2 and included a range of key indicators highlighting Wirral’s performance against North West average values where available.

Resolved – That the report be noted.

Councillor McLaughlin introduced the joint report of the Chairs of the Adult Care and Health OSC (Cllr Julie McManus) and the Children and Families OSC (Cllr Tom Usher) that informed of the joint workshop involving members of the two Overview and Scrutiny Committees.

The report informed that as part of their work programme, members had previously agreed to scrutinise proposals arising from the Council’s Transformation Programme. This form of pre-decision scrutiny gave non-Cabinet members the opportunity to influence developing proposals. It was, therefore, agreed to hold a workshop to provide members the opportunity to review the proposals being developed by the All Age Disability and Mental Health Service Transformation Project. The report summarised the findings of the workshop, which was held on Wednesday 2 August 2017.

The workshop enabled a review of the outline business case that formed part of Wirral Council’s Strategic Transformation Programme. The business case related to the All Age Disability and Mental Health Service Transformation Project. As the scope of the project had potential implications for recipients of both children and adult services, all members of the Adult Care and Health Overview and Scrutiny Committee and the Children and Families Overview and Scrutiny Committee were invited to attend. Eleven committee members attended the session. The Director of Health and Care and the Assistant Director of Health and Care Outcomes led a presentation to explain the details of the outline business case, followed by a question and answer session to give members the opportunity to comment on the proposals. 

The report informed that full details of the proposals for change were available in the outline business case for the All Age Disability and Mental Health Service Transformation Project. The Outline Business Case set out a proposal to transform the Council’s Mental Health Service and the Disability Teams across Children’s and Adult Services to develop integrated pathways to work more closely with key partners to drive forward integration and service efficiencies. Members noted  that National policy for ‘All Age Disability Integration’ and ‘Health and Social Care Integration’ provided the national direction for change as a key driver for local transformation across services.

Resolved – That

(1)  the report be noted;

(2)  the report be referred to a future meeting of Cabinet; and

(3)  the Full Business Case is developed to ensure that the key points made by Elected Members, detailed in the report, are addressed.

The Adult Care and Health Overview and Scrutiny Committee considered the September 2017 Policy Inform Briefing Paper that included an overview of ongoing and recent national legislation, potential implications for the Council, and emerging policies.

The Policy Inform Briefing Paper outlined the key features of the policies and legislation that had emerged from the Queen’s Speech 2017 and provided an update on the developments of recent legislation and highlights any emerging implications. The Policy Inform briefing also alluded to any potential implications for Wirral Council.

Resolved - That the contents of the September 2017 Policy Briefing papers be noted.

The Chair introduced her report that set out the process of developing and managing the scrutiny work programme for the Municipal Year. The report informed Adult Care and Health Overview and Scrutiny Committee, in cooperation with the other three Overview and Scrutiny Committees, was responsible for proposing and delivering an annual scrutiny work programme.

The Chair highlighted a number of key points pertinent to her report, namely:

• that work would continue on two task and finish groups as described in the report (Respite Services task and finish group; and Continuing HealthCare task and finish group); and

• a Spotlight session was to be held on Thursday 12 October when Simon Banks (Chief Officer, Wirral CCG) was scheduled to lead a discussion on the structure of the NHS, the implications of national policy, current local challenges and future priorities.

Resolved – That the proposed Adult Care and Health Overview and Scrutiny Committee Work Programme for 2017/18 be approved.