Apologies for absence were received from Councillors A Jones, G Ellis, M McLaughlin and I Williams. Apologies were also received from Mr Graham Hodkinson, Director for Health and Care.

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 meetings held on 30 January 2018 and 13 February 2018 (special meeting).

Councillor Tony Norbury requested a correction in respect of Minute 47 (30 January 2018). Members noted that, in respect of the report item ‘Social Care and Health Integration for Older People’, the Adult Care and Health Overview and Scrutiny Committee had requested that the views of the trade unions be incorporated into a report to a future meeting of the Committee. Members instructed that this matter be actioned with immediate effect. 

Resolved – That, subject to the above correction, the minutes of the meetings of the committee held on 30 January 2018 and 13 February 2018 (special meeting) be confirmed as a correct record.

Ms Abigail Cowan, Medicines Optimisation Pharmacist - Midlands and Lancashire CSU introduced her report jointly written with Karen Prior, Chief Officer and Elaine Evans, Project Officer from Healthwatch Wirral. Ms Cowan delivered a presentation that set out the background to, and an update on (including patient feedback) the roll out across Wirral practices of the patient led repeat prescription ordering scheme. The presentation informed that the scheme had been introduced to:

• improve patient safety issues particularly with regards to stockpiling medication;
• ensure patient and GP practice ownership  when ordering medicines;
• improve the communications between GP practices, community pharmacies and patients; and
• reduce the amount of wasted or unused medicines within the NHS.

Ms Cowan’s presentation, supplemented by her report provided information on the aims of the scheme, the roll-out across the Wirral (at the time of report 52 Wirral GP practices were live), the Clinical Commissioning Group (CCG) operational plan and lessons learnt. Ms Cowan informed the Adult Care and Health Overview and Scrutiny Committee that a number of recommendations had been formulated by Healthwatch Wirral as a result of the actions undertaken to date and from patient feedback. Recommendations included:

• Assurances need to be gained from GPs that they are accurately informing patients of the changes or that patients are being informed by the pharmacy.
• Housebound patients should be made explicitly aware of the exemptions by their GP.
• Issues associated with patients accessing the online service should be addressed.
• GP's who only prescribe 1 month supply of medication could consider prescribing 2 months as this may result in a reduction of their workload.
• Adjust patients prescription items, where possible, to ensure that all items run out at the same time thus reducing multiple visits by the patient to the practice to request repeat medication.
• Practices to continue to inform patients that they may not necessarily need to collect their medication from the practice as their pharmacy may continue to collect and deliver medication for patients.
• Continue completing medication reviews to address any issues and to compliment the scheme.
• Continue and improve public engagement as it was evident that some patients were not aware of the new patient led prescription ordering system.
• Encourage patients or their carers to monitor their medication to enable them to be more efficient when requesting a further supply. 
• Consider allowing patients who cannot use the suggested methods of ordering, and may have difficulty in attending the practice, to phone the practice to order medication.

Members noted that engagement and consultation would continue and that although a significant amount of work has been carried out to date to ensure patients were aware of the new scheme, the independent review by Healthwatch Wirral recommendations showed that further work was needed to improve the process and support patient care.

Members questioned Ms Cowan on a variety of points, namely issues arising from implementation of the procedure for controlled drugs and delays arising, inconsistency between the management and delivery of the system between GP practices. Members sought assurances that  ...  view the full minutes text for item 56.

Mr Simon Banks, Chief Officer NHS Wirral Clinical Commission Group (CCG) and Ms Karen Howell, CEO, Wirral Community NHS Foundation Trust (WCT) introduced a report by the Director of Commissioning, Wirral CCG that detailed current progress to date for the delivery of the Community Phlebotomy Service. The report informed that in April 2017 GP Members demonstrated a high level of interest to deliver a GP practice-led provision. Subsequent GP member and public engagement had been undertaken during May 2017. Findings from this engagement were used to inform the new service design. In December 2017, NHS Wirral CCG’s Governing Body approved the proposal of a GP practice led approach, subject to additional assurances being received from all GP practices, in addition to the completion of outline implementation plans. 

Mr Banks informed that the commission was now about to enter the mobilisation phase, and was working towards a 1 July 2018 start date.

Members were apprised that In May 2017, a survey of all GP member practices was undertaken to determine their preference for an in-house or alternative delivery model i.e. to continue with the existing hub delivery model. Overall 55% (29) practices wanted to provide their own in-house service and 42% (22) opted for a hub service model. 3% (2) had no preference.

Members questioned Mr Banks and Ms Howell on a number of key areas of concern regarding the service, in particular the matter of waiting times. Ms Howell informed that generally wait times for the phlebotomy service were in the region of 20 minutes. The Chair stated that feedback to Councillors disputed this figure, with wait times under the current arrangements having been reported in excess of one and a half hours in some cases, resulting in staff having been verbally abused. All agreed that this was not an acceptable position, and although patients may not all wish to utilise the same options (pre-booking of appointments or walk-in and wait) a further report to the Overview and Scrutiny Committee in September would be helpful to provide information about service performance after the 1 July 2018 start date.

Resolved – That

(1)  the report be noted; and

(2)  a further report on the performance of the Community Phlebotomy Service be presented to the September 2018 meeting of the Adult Care and Heath Overview and Scrutiny Committee.

Mr Jason Oxley, Assistant Director Health and Care, Wirral Council introduced his report that described the approach that would be taken to the future commissioning of health, care and support services for people with a disability in Wirral. The report informed that nationally, there was a Transforming Care Programme which described the need to develop alternative support for people with a disability in order that they can receive the support that they need to live independently in their own homes and within their own communities with less of a focus on acute hospital based services. The report further informed that this brought forward an opportunity to develop an increased preventative offer.

The Adult Care and Health Overview and Scrutiny Committee was apprised that work was underway to bring together a range of resources from Wirral Clinical Commissioning Group (CCG) and the Local Authority to create a single commissioner for Wirral. Working through formal shared arrangements and a Committee in Common, this body would ensure that the Council and the CCG could effectively deliver their Health and Care functions in a more joined up way. This body would be responsible for commissioning health, care and support services to meet the needs of people with a disability in Wirral (among other functions), and would contribute to delivering the All Age Disability Strategy, the Wirral Plan Pledges and the Transforming Care Programme agenda.

The report outlined some key areas where the Council intended to commission differently to both improve the offer to local people and to manage the increasing cost of adult social care.

Members questioned Mr Oxley on a number of key areas, with a primary focus on the following:

• Young adults with disability, transition arrangements, respite care / care arrangements when specialist residential schools are closed.

• Outcome of the exploration of opportunities for better sharing of information between all agencies in the partnership to provide more seamless and holistic support to disabled people and their families – deadline September 2016.

• Involvement / engagement with the organisation ‘Autism Together’, not listed in the documentation.

• Actions taken in the monitoring of, and response to, Care Quality Commission (CQC) inspection reports for nursing homes and care homes.

• Protocols and procedures in place to protect individual service users from abuse / criminal neglect arising from lack of staff training, inadequate employment checks or excessive workloads.

Mr Oxley responded to the points raised, informing that improvements to transition arrangements were needed, and that there would be a focus on better care planning and a more joined up commissioning approach to support this group of people.. He added that if Members were aware of specific issues relating to individual cases he would be keen to hear about them in order to expedite improvements and/or address any issues.

Mr Oxley informed that at present about half of the registered care  homes on the Wirral were rated as 'Outstanding' or 'Good' with the other half being rated as “requires improvement” or “inadequate”, and that the Council and CCG have  ...  view the full minutes text for item 58.

Verbal Update.

Ms Suzanne Edwards, Service Director, Cheshire and Wirral Partnership Foundation Trust, Mr Andy Styring, Executive Director of Operations, CWP and Mr Tom Parry, Transformation Project Manager, CWP attended the meeting to jointly provide Members with a verbal report on the respite services provided at Thorn Heys.

The matter had been brought before the Adult Care and Health Overview and Scrutiny Committee in response to a request from Members following accounts that the respite services were to close temporarily.

Ms Edwards informed the Overview and Scrutiny Committee that a communication had been issued setting out the reasons for the temporary suspension of services. She informed that Thorn Heys was a 6 bed respite unit registered with the Care Quality Commission (CQC). She added that under current arrangements the type of care contracted required a registered nurse to be onsite 24 hours a day, seven days a week. Given that there had been uncertainty over the service for a while, and much debate over the model of care to be provided, there had been significant issues relating to the retention and recruitment of staff. This had resulted in the temporary closure notice being issued.

Members were informed that the management and staff at Thorn Heys, CWP and Local Authority Officers and patients and their families had worked together to address the issues faced and had been able to offer a number of alternative solutions for care provision.

As a result Ms Edwards was pleased to announce that Thorn Heys would re-open on 5 April 2018, and the CWP would be working with the Local Authority and CCG for the commissioning of short break respite care. She added that further discussions would also be taking place with the CQC to deliver alternative solutions to care provision at Thorn Heys.

Members questioned the CWP Officers on a number of matters, namely:

• Actions taken to engage new staff;
• Levels of care to be provided under the new arrangements; and
• Assessments of those currently in receipt of care.

The Committee was apprised that initially staff had been attracted as temps/ agency workers and had been offered permanent contracts. Newly qualified staff had also been attracted as a result of improved career / training opportunities. Ms Edwards informed that by working differently but still within the constraints of the National Agenda for Care, assessments of those currently in care would have the assurance that they would receive the same level of care as that received at home.

The Chair thanked the Cheshire and Wirral Partnership Foundation Trust for their attendance and their verbal 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 provided Members with detail to scrutinise budget performance for the area of activity that formed part of the People Theme as at the close of quarter 3 (31 December 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 and information regarding key areas of note i.e.

• Quarter 3 overspend £1.5m
• Cost pressures of £5.4m
• £3.9m in year savings and one-off actions achieved
• Managing demand through review of care packages

The Senior Manager Financial Management’s presentation also 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 as follows:

A copy of the Senior Manager Financial Management’s presentation is placed on the Council’s website here:

http://democracy.wirral.gov.uk/ieListDocuments.aspx?CId=819&MId=6121

Resolved – That

(1)  the quarter 3 revenue budget forecast be noted; and

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

Mr Jason Oxley, Assistant Director Health and Care introduced the report of the Director for Care and Health (DASS) that provided the 2017/18 Quarter 3 (October - December 2017) performance for the Wirral Plan pledges under the remit of the Adult Care and Health Overview and Scrutiny Committee. The report provided a description of the progress in Quarter 3 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 had been requested by Members to enable effective scrutiny. Detailed graphics / information on the Adult Social Care and Health Performance Overview were also included as an appendix to the report.

Mr Oxley informed that the report had been further developed following Member feedback and included key performance data covering the areas of health and social care.

Members were apprised of a number of improvements made since the last report to the Overview and Scrutiny Committee, particularly in the following areas:

• The percentage of Wirral residents over 50 in employment had improved for a fifth successive quarter and continued to close the gap between Wirral and the average across the rest of the country.

• The health related quality of life for people with long term conditions had improved for residents since March 2016. Wirral was closing the gap on the average across the country.

• The introduction of pre-payment cards had a positive effect in quarter 3 which saw the number of adults reported to be in receipt of personal budgets increasing from 651 at Quarter 2 to 899.

A Member questioned Mr Oxley on how meaningful the data and sample group relating to some areas under report might be - e.g. percentage of older people (aged 50+) who feel safe when out in the local area after dark. Mr Oxley informed that Member’s comments would be passed back to the officers who dealt with the data sets and their collection. A written response was requested by the Chair.

Resolved – That the report be noted.

Ms Karen Howell, CEO, Wirral Community NHS Foundation Trust (WCT) updated the Adult Care and Health Overview and Scrutiny Committee on the plans for reinstating full opening of Eastham Walk-In Centre by May 2018.

Ms Howell informed that following the recent temporary alteration to services at Eastham Walk-In Centre, it been operational with reduced hours with services available between 1pm and 5pm Monday to Friday, and between 12 noon and 4pm Saturday and Sunday, since 2 January 2018.

Members were apprised that this arrangement had enabled support to the WCT for a period of time to recruit and appropriately train staff, to enable reinstatement of a full service in May 2018.

The Adult Care and Health Overview and Scrutiny Committee noted that plans had been progressing and that the following actions had been taken:

·  Recruitment had commenced

·  Training was on track

·  Discussions and plans were underway to enable full reinstatement of services in May.

·  It was the Trust’s intention to move to full opening hours of 8 hours a day, 7 days.

Ms Howell informed Members that as a result, she was able to confirm that full re-opening of the reinstated services, with timings as above, would take place on 8 May 2018.

A Member questioned Ms Howell if the issue regarding the underperforming A&E services at Wirral University Teaching Hospital (WUTH) Arrowe Park had been addressed, given that the reason for changes to services at Eastham Walk-In Centre had arisen due to the transfer of staff to support the WUTH A&E service. Members were informed that work continued in this area, but the transfer of trained staff had helped.

Members expressed their concerns over possible future alterations to services that might arise from the Urgent Care Review, but recorded their thanks to Ms Howell for the outcome of restored services to the Eastham Walk-In Centre.

Resolved – That the report be noted.

Mr Simon Garner, Lead Commissioner - All Age Disability introduced his report that identified learning assessment against the Local Government and Social Care Ombudsman report published in July 2017 entitled “The Right to Decide: Towards a greater understanding of mental capacity and deprivation of liberty”.

The report informed that the Mental Capacity Act (MCA) provided a legal framework that allowed others to take decisions on behalf of incapacitated adults (16+). The MCA had five principles that must be complied with by those using it. There were also a Codes of Practice that provided statutory guidance to professionals and others operating under the Act.

The report further informed of the Local Government and Social Care Ombudsman’s findings in respect of four key areas, namely:

·  Mental Capacity Assessments;

·  Best Interest Decisions;

·  Disagreements with the process and involving families; and

·  Deprivation of Liberty Safeguards.

Mr Garner highlighted a number of actions that had been taken by the Council as a result of the findings, the Overview and Scrutiny Committee further noting areas of good work also referred to in the report. He also confirmed that the Government had recently accepted the majority of the recommendations of the Law Commission’s report on Deprivation of Liberty Safeguards. 

In response to Member questions Mr Garner added that training events had been well attended by social care staff and providers of nursing, residential care and hospital services. He explained that Wirral had a programme of audit work, and that an audit on cases where the Mental Capacity Act applied was due to be undertaken in the next quarter. 

Resolved – That the ongoing work of the Council in respect of its duties under the Mental Capacity Act be noted.

The Chair introduced her report that informed that providers of NHS healthcare services in England, including the independent sector, were required to publish an annual Quality Account. The Quality Account provided information on performance across the year and identified the priorities for improvement during the forthcoming year and how those priorities will be achieved and measured, focussing particularly on:

• Patient Experience;
• Safety; and
• Clinical Effectiveness.

For those Trusts providing services within the geographical area of the Local Authority, Health Overview and Scrutiny Committees were given opportunity to comment on the Trusts’ draft Quality Accounts, prior to publication of the final document. The Chair’s report informed that although the Health Trusts have a duty to consult with Overview and Scrutiny Committees regarding the draft Quality Account, it was not mandatory for the Committee to formally respond. However, in order to hold health providers to account, to do so was regarded as good practice.

The Chair informed Members that having discussed the matter with the Vice-Chair and the Committee’s Party Spokespersons it had been decided that with the Committee’s agreement, a task and Finish Group comprising of the two Spokespersons, the Chair and Vice-Chair be established to review the draft Quality Accounts. 

Mr Simon Banks, Chief Officer NHS Wirral CCG offered support to the Adult Care and Health OSC in reviewing NHS provider Quality Accounts. He suggested that Lorna Quigley, as Director of Quality & Patient Safety would be best placed to assist Members in their task.

Resolved – That

(1)  a Task and Finish Group be established to enable Scrutiny Members to review the draft Quality Accounts of the local health partners;

(2)  the Task and Finish Group membership comprise of the Adult Care and Health Overview and Scrutiny Committee Party Spokespersons, the Chair and Vice-Chair; and

(3)  the Task and Finish Group Chair be authorised to approve the final wording of the responses to the Health Trusts.   

The Chair introduced her report that provided an update regarding progress made since the last Committee meeting held on 30 January 2018. 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 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;
• Five Year Forward View Update;
• Urgent Care Review – Spotlight session;
• Universal Credit;  and

Future activity

• Review of draft Quality Accounts

A number of Members proposed, and it was agreed that, consideration be given to the inclusion of an additional piece of work ‘Care Provision Across the Borough’ onto the Adult Care and Health Overview and Scrutiny Committee Work Programme, to allow detailed scrutiny of services provided by Care Homes.

Resolved – That the Adult Care and Health Overview and Scrutiny Committee Work Programme as amended be noted.