The Chair paid tribute to ex-Mayor of Wirral and Labour member for Bebington, Councillor Walter Smith, who had recently passed away. The Chair informed that Councillor Smith had been involved in local politics for more than 40 years first as a member of Birkenhead County Borough Council, and subsequently as a member on Wirral Metropolitan Borough Council. She added that Walter Smith embodied all the ideals of a public servant, giving selflessly of his time and commitment to his ward and to Wirral. The Committee, and those members of the public in attendance for the meeting, stood for a minute’s silence in tribute to his memory.

Apologies for absence were received from Councillors W Clements and T Norbury, and Karen Prior (Healthwatch Wirral).

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.

Members were asked to consider whether they had 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 were reminded that they should also declare whether they were 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. The following declarations were made:

To approve the accuracy of the minutes of the meeting held on 13 September 2017.

Resolved – That the minutes of the meeting of the committee held on 13 September 2017, be confirmed as a correct record.

Mr Simon Banks, Chief Officer NHS Wirral CCG introduced his report that provided an update with regard to the recent decision to temporarily suspend the walk in centre (WIC) service at the Eastham clinic to facilitate a joint system wide response to the urgent patients’ safety concerns at the Arrowe Park Hospital Emergency Department.

Mr Banks’ report informed that the NHS Wirral Clinical Commissioning Group (CCG) Governing Body had discussed the Eastham clinic WIC service at their public meeting on 7 November 2017 with representation from local residents and Alison McGovern MP. The Governing Body had agreed that, just over two months after the suspension of the WIC service, a plan to resume the provision needed to be agreed with Wirral Community NHS Foundation Trust, as a matter of urgency, whilst also maintaining clinical streaming at Arrowe Park.

The Chief Officer NHS Wirral CCG updated the Overview and Scrutiny Committee that over the past two months, significant whole system progress for A&E had been made in the achievement to ensure that over 90% of emergency patients were treated, admitted or transferred within 4 hours. He also reported that there was still further progress and improvement required to meet the 95% mandated standard.

Members were keen to question the Chief Officer on the relationship between the initial transfer of staff from Eastham clinic WIC, the impact on waiting times and the proposals for the re-provision of WIC services at Eastham. Mr Banks informed that although the treatment times for A&E patients had stabilised, there were significant challenges expected to maintain the levels through the coming winter period. He added that the challenges were exacerbated by the difficulties experienced in the recruitment and retention of qualified staff, both nationally and locally.

Karen Howell, Chief Executive Wirral Community NHS Foundation Trust informed the Overview and Scrutiny Committee of some of the complex issues associated with the retention of trained staff and the direct impact on local service provision.

An extensive debate took place, with Members questioning Mr Simon Banks, Chief Officer NHS Wirral CCG and Karen Howell, Chief Executive Wirral Community NHS Foundation Trust on the specific key problem area of NHS staff recruitment and retention. Members questioned Mr Banks and Ms Howell on the actions being taken to address the staffing shortfall, and methods used to avoid key members of staff moving to larger city NHS Trusts that had been identified as more attractive employment career options.

The Chief Officer NHS Wirral CCG informed the Overview and Scrutiny Committee of the direct link and shared challenges associated with the Eastham clinic WIC and that of the next agenda item on the subject of transformation of urgent care on the Wirral.

Members questioned Mr Banks and Ms Howell on the initial decision to close and how the relocation of staff had impacted the Eastham clinic WIC budget i.e. the transfer of staff to WUTH A&E (a potential saving) and the expected return or replacement of staff. Members further questioned  ...  view the full minutes text for item 32.

Mr Simon Banks, Chief Officer NHS Wirral CCG introduced his report that informed that NHS Wirral CCG in partnership with Wirral Council, including the Health and Wellbeing Board and the Adult Care and Health Overview and Scrutiny Committee, together with other stakeholders had undertaken a comprehensive review of local urgent care services. This had identified a compelling case to transform urgent care services locally.

Mr Banks’ report further informed that locally, NHS Wirral CCG had identified that many people were confused about what was offered in relation to urgent care, (other than A&E). It was perceived that people’s lack of knowledge about other options (versus the ease and familiarity of accessing A&E), combined with the fear and stress of being ill resulted in people resorting to the ‘default’ of A&E. Current performance data had shown that there were many people attending A&E whose condition could have been treated elsewhere; such as by general practice or in a walk in centre.

The Committee was apprised that the performance of the A&E system in Wirral had not been satisfactory and the CCG had identified clinical concerns due to the deteriorating performance against the constitutional 4 hour target waiting time.

The Chief Officer NHS Wirral CCG informed that the formal consultation, scheduled for 4 weeks between 27 November 2017 and 5 March 2018 had been deferred until the New Year. The deferral would allow further work on the mandated elements of urgent care system reform ahead of the planned consultation. He added that a full presentation of the proposals would be provided to the Overview and Scrutiny Committee as part of a pre-consultation phase and would include a specific workshop on the subject and a visit to a functioning Urgent Care Centre. 

A Member commented on the financial constraints and affordability, another Member commented on the pressures and implications of overspending in one area at the expense of others, as had been clearly demonstrated in the Overview and Scrutiny Committee’s earlier deliberation regarding the Eastham clinic Walk In Centre. 

Resolved – That

(1)  the report be noted; and

(2)  the deferral of public consultation to June 2018 be noted.

Mr Simon Banks, Chief Officer NHS Wirral CCG introduced his report that informed how place based care used a defined set of resources to provide the best possible quality of care and health outcomes for a defined population. Placed based care was being developed in response to the challenges the Wirral health and care system faced of constrained funding, increasing demand, fragmentation of services and the need to deliver better health, better care and better value for Wirral’s population. His report added that placed based care would be shaped by a single, integrated health and care commissioner for Wirral through a formalised partnership between NHS Wirral CCG and Wirral Council.

The Overview and Scrutiny Committee was informed that there were many levels of “place” in Wirral, and it was the intention of NHS Wirral CCG and Wirral Council, through the new integrated commissioning arrangements, to start with the ‘footprint’ of one Wirral population and then move through a four hub model (based on the four Parliamentary constituencies) into eight or nine localities with populations of 30,000 to 50,000 people. These localities include the registered lists of 52 General Practices. In addition there was also a need to engage with ‘place’ beyond Wirral, specifically partners in West Cheshire and further afield across Cheshire and Merseyside for access to specialist or specialised services.

The Committee requested that report writers take account of published guidance in relation to the use of Plain English, and agreed unanimously that the request be formally included in the Adult Care and Health Overview and Scrutiny Committee’s recommendations.

A Member expressed unease at reference within the report that stated that the Wirral health and social care system was not sustainable in its current guise, with demand on the system continuing to increase.

Following further discussion and debate on key areas such as variation of life expectancies across the Borough and the causes, and the complexity of the NHS funding formula and spending allocations - that included reference to integration of commissioning as considered by Cabinet at its meeting on 27 November 2017 - an additional recommendation directed to the Cabinet was tabled:

Proposed by Councillor Ian Lewis

Seconded by Councillor Lesley Rennie

[insert additional recommendation at 3]

“That a copy of the PwC (Price Waterhouse Cooper) report be published, subject to the redaction of any commercially sensitive information.”

(Cabinet Minute 62, 27 November 2017 refers)

Following a show of hands the additional recommendation was carried (13:0) with one Abstention.

Resolved – That

(1)  The report be noted;

(2)  Future reports to the Adult Care and Health Overview and Scrutiny Committee adhere to published guidance on the use of Plain English; and

Recommendation to Cabinet

(3)  that a copy of the PwC (Price Waterhouse Cooper) report (27 November, 2017 - Integrated Commissioning Hub, report appendix) be published, subject to the redaction of any commercially sensitive information.

Ms Jo Watts, Senior Commissioning Manager – Mental Health, Wirral CCG introduced her report that provided an update in respect of IAPT.  The report provided a summary of the current position in respect of IAPT service delivery in Wirral, the steps being taken by the CCG to address the current performance and the plans for the future service model to ensure safe and effective care.

The report informed that IAPT services had been provided by Inclusion Matters Wirral (IMW), South Staffordshire & Shropshire NHS Foundation Trust since July 2015. The contract was awarded following a competitive tender process for a three year term with the option to extend for up to two years. The current provider sub contracted aspects of the IAPT service to Cruse UK for Bereavement support and Age UK for Community Counselling. Until April 2017, Cognitive Behavioural Therapy was provided through a sub contract arrangement by Peninsula Healthcare until IMW ended the contract and transferred staff and provision into the main IAPT service.

During the term of the contract, there had been a number of performance discussions with the provider specifically relating to the waiting times, quality and performance relating to access and recovery standards. There had also been additional investment both locally from the CCG and NHS England to support waiting list initiatives, whilst an improvement in performance was initially achieved; this was not sustained on a longer term basis.

In line with the continued failure to achieve the national IAPT standards, the CCG had made the decision not to extend the current provider contract and to commence a procurement process.

It was noted that a Member of the Scrutiny Committee had requested a report regarding service provision, and that until recently Members had not been fully apprised of the detail regarding waiting times that had, in the main, exceeded 8-9 months. A Member expressed concern that the waiting times did not truly reflect the problems faced by the service, commenting that there had been many people who had not even reached the waiting list due to issues of signposting from partner organisations and GP surgeries.

The Committee noted that the initial actions to address the current failings would focus on the pre-existing backlog and that the new contract (that included some additional funding) was also aimed at dealing with the management of new cases.

Members requested that once recommissioned the Adult Care and Health Overview and Scrutiny Committee be provided a copy of the contract specification.

Resolved – That the report be noted.

Ms Jacqui Evans, Assistant Director, Unplanned Care / Community Care Market introduced her report, prepared jointly with Amanda Parry-Mateo - Integrated Lead, Quality and Safeguarding that outlined the measures being implemented to address the findings of the CQC report on its initial programme of comprehensive inspections in adult social care. The report informed that as CQC ratings can only be set by CQC, the local improvement plan would need to align with the next reporting cycle from CQC and as such this was a 3 year improvement program.

The Adult Care and Health Overview and Scrutiny Committee was apprised that results from the programme of more than 33,000 inspections, showed almost four-fifths of adult social care services in England were rated as good (77%) or outstanding (2%) overall. Nearly a fifth of services were rated as requires improvement.

Whereas it is noted that there has been a continual improvement in the number of Good rated homes nationally, regionally and locally, Wirral as part of the North West region was identified as being in the bottom 20% of local authorities in relation to the quality of Care as rated by CQC.

Members were informed that key points in relation to the reported ratings and the challenges facing adult social care services, included:

• An ageing population with increasing needs. The number of people aged 85 or over in England was set to more than double over the next two decades. More than a third of people aged over 85 had difficulties undertaking five or more tasks of daily living without assistance, and were therefore most likely to need health and care services.

• Difficulties in recruiting and retaining staff to care for people. In 2015/16 the overall staff vacancy rate across the whole of the care sector was 6.8% (up from 4.5% in 2012/13), rising to 11.4% for home care staff. Turnover rates had risen from 22.7% to 27.3% a year over the same three-year period.

• Rising costs of adult social care. Findings from the most recent Association of Directors of Adult Social Services (ADASS) budget survey had estimated that the National Living Wage would cost councils around £151 million plus at least £227.5 million in implementation and associated costs in 2017/18. This would affect both direct council costs and increased provider fees. 

The Assistant Director, Unplanned Care / Community Care Market further informed the Overview and Scrutiny Committee that the domiciliary care market in Wirral had experienced significant change over the past year, with the impact of the loss of 3 larger providers still being felt. She added that currently demand outstrips supply, primarily as a result of the difficulty experienced in recruiting new care staff. Members were apprised of a range of actions and work underway to address the situation.

In drawing the discussion to a close, the Chair re-iterated the Adult Care and Health Overview and Scrutiny Committee’s commitment to monitoring of the situation and visits to Wirral care provider facilities. The Chair encouraged Members to engage  ...  view the full minutes text for item 36.

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 2 (30 September 2017).

The report summarised information that had been drawn from the relevant sections of the most recent Cabinet revenue and capital monitoring reports and combined with additional relevant service information to produce a bespoke report for the Adult Care and Health Overview and Scrutiny Committee that included the following:

• Performance against the revenue budget (including savings, income and debt); and
• Performance against the capital budget.

The Senior Manager Financial Management provided Members with a summary presentation that set out the budgetary figures for 2017/18 as follows:

The Senior Manager Financial Management’s presentation provided members with a further breakdown of the key budget expenditure relating to Care, Older People (65+) Care, Learning Disability and Mental Health Care i.e. services user numbers and average costs. 

Resolved – That

(1)  the quarter 2 revenue budget forecast be noted; and

(2)  the performance of the capital projects within the purview of this Committee be noted.

Mr Graham Hodkinson, Director for Care and Health (DASS) introduced his report that provided the 2017/18 Quarter 2 (July - September 2017) performance report for Wirral Plan pledges under the People theme. The Quarter 2 report was included as Appendix 1 to the report, and provided a description of the progress in Quarter 2 that included available data in relation to a range of outcome indicators and supporting measures. 

The report also included further performance information that had been requested by Members to enable effective scrutiny. The Adult Social Care and Health Performance Overview was included as Appendix 2 to the report. The report had been further developed following Member feedback and included key performance across health and social care including Better Care Fund and the unplanned care system.

Resolved – That the report be noted.

The Adult Care and Health Overview and Scrutiny Committee considered the November 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 November 2017 Policy Briefing papers be noted.

The Chair introduced her report that provided an update regarding progress made since the last Committee meeting held on 13 September 2017. The report informed that the current work programme was made up of a combination of scrutiny reviews, workshops, standing items and requested officer reports. The Chair advised that the agenda report provided the Committee with the opportunity to plan and regularly review its work across the municipal year. The current work programme for the Committee was attached as an appendix to the report. The report also informed that the 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’s report highlighted a number of key points, namely:

Activity since the last meeting of the Committee

• Respite Services Scrutiny Review;
• Continuing Healthcare Funding (CHC) Scrutiny Review;
• All Age Disability and Mental Health Transformation Project;
• Spotlight session – Structure of the NHS; and

Future activity

• Budget Scrutiny 2018 / 19;
• Spotlight Session - Specialist Transport;
• Additional Committee meeting  - it was proposed to hold an additional committee meeting on Tuesday 13 February 2018 (6.00pm) at which members will receive a progress report regarding the Sustainability & Transformation Partnership (STP).

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