Agenda and minutes
Venue: Committee Room 1 - Wallasey Town Hall
Contact: Patrick Sebastian 0151 691 8424
Apologies for Absence
An apology for absence was received from Councillor Samantha Frost; Councillor Kate Cannon attended as deputy. Apologies for absence were also received from K Prior, Wirral Healthwatch.
Member Declarations of Interest
Members are asked to consider whether they have any disclosable pecuniary or non-pecuniary interests in connection with any item(s) on the 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 in respect of business on the agenda generally:-
To consider any other business that the Chair accepts as being urgent.
The Chair advised of the acceptance onto the agenda of an urgent item of business relating to the Wirral University Teaching Hospitals NHS Foundation Trust’s financial challenges which, following a recent article published in the Wirral Globe and Liverpool Echo newspaper, was a topic of importance to all residents of the Borough. The item would be considered immediately following the consideration of agenda item 4 ‘2017/18 Quarter 4 and Year End Wirral Plan and Health and Care Performance’.
To approve the accuracy of the minutes of the Adult Care and Health Overview and Scrutiny Committee meeting held on 20 March 2018.
That the minutes of the meeting of the Adult Care and Health Overview and Scrutiny Committee held on 20 March 2018 be confirmed as a correct record.
The Director for Health and Care introduced his report providing -
· the 2017/18 Quarter 4 (January - March 2018) performance report for the Wirral Plan pledges under the remit of the Committee, presenting a description of progress in Quarter 4 and available data in relation to outcome indicators and supporting measures;
· the Wirral Plan – People (Adult Care and Health) 2017-18 Year End Report summarising improvement of performance against measures and Wirral Plan delivery of Pledge strategy actions at year end; and
· the Adult Social Care and Health Performance Overview, submitted at the request of the Committee to enable effective scrutiny and presenting key performance across health and social care.
Further to the submitted report, the Director drew attention to and commented on matters addressed in the performance summary –
· the reported improvements in performance with regard to the percentage of Wirral residents aged over 50 in employment and the ‘Employment rate aged 16-64 - Equality Act core or Work Limiting Disabled’ measure were noted. The Committee was advised that work continued to improve the latter measure which fell short of national and North West averages. Employment was noted as a key issue for health and wellbeing as people in employment were less likely to be poverty;
· The success of the Wirral Metropolitan College's Supported Internship Programme was noted, and the important links with the College were acknowledged;
· The slight decrease in the percentage of adults with a learning disability who live in stable and appropriate accommodation was noted and, while ahead of the national average, the Committee was advised that more work was to be done on this area; and
· The summary statements relating to domestic abuse issues and the Age Friendly Pilot were noted to the Committee.
The Director responded to queries from Members on matters contained within the submitted performance reports. Relating to the ‘Older people live well’ Pledge and issues raised by Councillor Christina Muspratt, the Director noted that information relating to the proportion of residents aged 50+ volunteering on a regular basis arose from a survey and acknowledged that some people surveyed may not regard activities they undertook as ‘volunteering’. With regard to the small percentage increase in the Proportion of residents aged 50+ satisfied with housing choice in their local area, it was advised that the Council was engaged in development of extra care housing schemes that may impact on this issue. Comment was also made that the reported declining performance against the measures for people aged 50+ years who felt safe when out in the dark and for reporting as feeling healthy might be related to the severe weather conditions when surveyed in December. The Director noted comments related to health, acknowledging the need for focus on this area.
Relating to the ‘People with disabilities live independent lives’ Pledge and indicators, the Director acknowledged the decline in performance with regard to the ‘gap in progress between pupils with a SEN statement / EHCP and their peers at Key Stage 4’ measure was ... view the full minutes text for item 5.
Wirral University Teaching Hospital NHS Foundation Trust's financial challenges
The Chair welcomed Janelle Holmes, the recently appointed Chief Executive of the Wirral University Teaching Hospital NHS Foundation Trust, to the meeting.
The Chair introduced the urgent business by referring to a recent article in the Wirral Globe newspaper that, in reporting financial issues related to the Trust, had indicated that there was “significant doubt” about the future of the Trust. Given the importance of the hospitals coming under the Trust to the people of Wirral, it was considered appropriate for this Committee to receive a report from the Trust.
Ms Holmes thanked the Committee for the invitation to report on this issue. The Committee was advised that there were no concerns about the future operating of hospitals on the Wirral. The report in the Wirral Globe, and a like one in the Liverpool Echo, had drawn from budgetary information in published Board papers. The Board each year had to plan a financial position, and this year forecast an expected deficit of £25M on a £340M budget; nationally, 43% of acute providers were forecasting deficits. The Trust had an agreed plan with Regulators which included a need to draw down finance, and work was underway with the wider health economy, including the Clinical Commissioning Group (CCG) and other providers, to develop a local plan to address the deficit and issues leading to the deficit.
Simon Banks, Chief Officer of the Wirral CCG, advised that the position of the Trust was not unique, and that similar issues in a scenario of increasing demand for health and social care and related resources affected the whole health economy. Healthy Wirral looked across organisational boundaries to deliver services and reduce costs by closer working and integration to deliver affordance health and social care services. Mr Banks offered to attend the Committee later in the year to report on Healthy Wirral, sustainability and delivery, and progress in addressing financial challenges.
Councillor Moira McLaughlin, noting previous financial concerns at the Trust and related recovery plan, hoped that information could be provided to the Health and Care Performance Panel for scrutiny.
Councillor Phil Gilchrist, in noting the national overspending / deficits predicted, queried whether local Trusts would be required to make good the money spent. Mr Banks reported that Regulations required health bodies to achieve a breakeven position. The financial challenges being faced meant that old ways of working were no longer appropriate and that all organisations needed to work together to make a sustainable model.
That the reports be noted, and the Committee receive a report on Healthy Wirral from Wirral Clinical Commissioning Group later in the current year.
Urgent Care Review - Pre Consultation
Mr Simon Banks, Wirral CCG will update Members on matters relating to the Urgent Care Review.
Simon Banks, Chief Officer, Wirral Clinical Commissioning Group advised that it had been intended to bring the Urgent Care Review consultation paper to this meeting of the Committee. However, NHS England had a number of requirements to be fulfilled before papers could be released for consultation. Pending NHS England agreement, it was anticipated that consultation would run 17 July – 23 October 2018. The consultation paper would be brought before the Committee or the Health and Care Performance Panel, as the Council considered appropriate. In making introductory comments, Mr Banks also thanked those Members who had contributed to the prior consideration of this matter earlier in the year.
The delay had not prevented an £18M capital bid being submitted for improvements in urgent care under the Health Wirral banner that had been submitted as second of five priorities from the Cheshire and Wirral prioritisation process to NHS Improvement.
Councillor Gilchrist noted that, at the informal session held earlier in the current year, Members had been interested in an up to date picture of services, feeling this would be useful data for the consultation. Mr Banks advised that such detail had been in a consultation draft, and that NHS England’s requirements for the content of consultation documents were rigorous.
That the report be noted and the Urgent Care Review consultation be considered in due course.
Re-establishment of Health and Care Performance Panel
The Chair of the Adult Care and Health OSC will update Members on matters relating to the re-establishment of a Health and Care Performance Panel.
The Chair sought agreement to the re-establishment of, and appointment to, the Health and Care Performance Panel to enable a more detailed consideration of performance and other key matters than could be given in a Committee meeting.
That (1) the Health and Care Performance Panel be re-established on the basis of a membership drawn from the political groups comprising four Labour members, two Conservative members and one Liberal Democrat member.
(2) the following appointments were confirmed to the meeting –
Labour Group (four) – Chair, Vice-Chair, Councillors Cottier and Muspratt;
Liberal Democrat Group (one) - Councillor Gilchrist
Conservative Group (two) – to forward nominations to the Chair.
Councillors Moira McLaughlin and Wendy Clements introduced the report and recommendations of the Continuing Healthcare (CHC) Review Task and Finish Group. The scrutiny review had sought to understand, assess and give consideration to the CHC framework and how it was applied locally, the Task and Finish Group being established to, among other things, evaluate the impact of CHC on clients and their families, focussing on both the process and the funding outcomes.
In making their presentation, the Councillors thanked former Councillor Alan Brighouse who had contributed much to the work of the Committee and who had chaired the Task and Finish Group; Karen Prior, Wirral Healthwatch, a member of the Group who could not be in attendance at the meeting; and to Alan Veitch, former Scrutiny Officer who had supported the Group.
CHC and NHS Funded Nursing Care (FNC) referred to services funded by the NHS due to an individual’s health related needs. Under CHC, the NHS funds 100% of care and healthcare outside hospital. Under FNC, the NHS pays for the nursing element of care, but accommodation costs are met wholly or in part by the service user and / or the local authority. During 2017, members became aware that Wirral was reported to be third lowest of 32 regional Clinical Commissioning Groups (CCGs) for numbers of people eligible for CHC funding while the Borough, compared to the national average, had a significantly higher number of joint funded care packages. Anecdotal concerns had also been raised in relation to the service user experience of the CHC process and the time taken to receive a decision.
The review had not looked at the national guidelines which determine eligibility for CHC, but had examined the application of those guidelines on Wirral. It had become apparent that decisions about eligibility were difficult to make at times, highlighting the importance of training and improved communication channels between the professionals involved. The pressure to control both the cost of providing CHC and its administration was acknowledged, but regardless of such pressures, there was a clear need to ensure that all changes were adequately scrutinised both before and after implementation.
The report of the Review Task and Finish Group contained the methodology and considerations given during the review leading to the following seven recommendations -
“Recommendation 1 – Consistency of application of the CHC framework by training
Members recognise that Wirral Clinical Commissioning Group (CCG) is not responsible for the staff training of other organisations. However, the CCG and all relevant health partners are requested to collaborate to ensure that all applicable staff receive the appropriate CHC training, where possible through joint sessions. This will enable frontline staff to pass on correct information to patients and families while operating with confidence to apply both the national CHC framework and local procedures. This should ensure that there is more consistency in the application of the framework.
Recommendation 2 – Communication
Wirral Clinical Commissioning Group is requested to consider options to improve communication processes between themselves ... view the full minutes text for item 9.
The Chair introduced her report considering the work programme for the Adult Care and Health Overview and Scrutiny Committee that should align with the corporate priorities of the Council, in particular the delivery of the Wirral Plan pledges which are within the remit of the Committee, and reflect the health scrutiny functions delegated to the Committee.
Members noted those matters considered within this meeting of the Committee and agreed for future consideration –
· Urgent Care Review – consideration of the consultation document (minute 7 refers);
· Urgent Care Review – report from the Wirral Clinical Commissioning Group (CCG) on Healthy Wirral and related matters (Minute 7 refers);
· Continuing Healthcare Review – demonstration and assurance from the CCG relating to the Dynamic Purchasing System (Minute 9 refers);
· Continuing Healthcare Review – As the All-age Disability Strategy develops, this Committee consider the exploration of the experience of young people moving into adulthood as a future review (Minute 9 refers); and
· Continuing Healthcare Review – the CCG action plan to be submitted for consideration by this Committee and to receive a six monthly update thereafter (Minute 9 refers).
Further to the proposed item relating to the Seacombe Birthing Centre scheduled currently for the September meeting of the Committee, Mr Banks, Wirral Clinical Commissioning Group, suggested that the presentation might best be provided by the Hospital Foundation Trust / Birthing Centre Management Team as service provider. The Chair further suggested that Members might like to hear from a service user at the Centre to gain an understanding of their experience. Mr Banks undertook to co-ordinate the suggested presentation of the item.
DECIDED – That
(1) the proposed Adult Care and Health Overview and Scrutiny Committee work programme for 2018/19, to be amended with the inclusion of the above matters considered at this meeting, be approved;
(2) a dedicated work programme planning session be convened for the Chair, Vice-Chair and Party Spokespersons to give further detailed consideration to the Committee work programme prior to the next scheduled meeting of the Committee.