Apologies for absence were received from Councillor Tony Cottier and Karen Prior (Chief Officer, 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 of the Committee were requested to declare whether they had any disclosable pecuniary interests and/or any other relevant interest in the item on this agenda and, if so, to declare it and state the nature of such 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 Adult Care and Health Overview and Scrutiny Committee meeting held on 29 January 2019.

The Committee was requested to approve the accuracy of the minutes of the meeting of 29 January 2019.

Resolved – That the minutes of the meeting of 29 January 2019, be approved.

Wirral Community NHS Foundation Trust (WCFT) Officers David Hammond, Assistant Director for Partnerships and Strategy and Mark Greatrex, Chief Finance Officer introduced their report that provided information on the Trust’s decision to give notice on its phlebotomy subcontracts with 22 GP surgeries.

The report informed that WCFT had provided phlebotomy services since 2011. The most recent service model, running until 30 June 2018, focused activity for 42 of Wirral’s 51 practices at four hub sites plus appointments at Marine Lake Medical Practice in West Wirral and provision for housebound patients. The hub model was a response to high volumes of activity and a desire to provide an efficient service to minimise waiting times. This service had been contracted with WCFT directly by Wirral CCG.

In 2017, Wirral CCG decided to provide phlebotomy services differently, dividing budgets amongst practices. Since 1 July 2018, with the introduction of a new specification, each practice held an individual contract with Wirral CCG to provide phlebotomy and WCFT’s direct contract with Wirral CCG for phlebotomy services ended at the same time.

The Assistant Director for Partnerships and Strategy informed that waiting times and staffing under the new arrangements had been monitored and actions taken to redeploy staff, but despite this waiting times for appointments were longer than anticipated and had not reduced significantly. The WCFT believed this was not acceptable and had not provided a good service to patients.

The Assistant Director for Partnerships and Strategy further informed that following development of proposals for an alternative model to improve capacity, and agreement (in principle) with 20 of the 22 contracting practices, the new model was presented to the Wirral Primary Care Co-commissioning Committee (PCCC) in January 2019.

Members noted that despite the proposed model not being supported by the PCCC, the WCFT to the decision to serve notice on its contracts to cease services on 30 June 2019, in the belief that without changes to the model, the Trust would net be able to provide a sufficiently high quality of service to patients. 

Members questioned the WCFT Officers, expressing concern over the service, questioning whether patients had been consulted and sought assurances on the adequacy of future services.

The Chief Finance Officer responded, explaining that GP Practices were currently deciding on how they would offer phlebotomy services to their patients from 1 July 2019.

The Assistant Director for Partnerships and Strategy informed that the position was clear as to why the change was required and that 7 models of service delivery were currently in operation.

Members sought reassurance from the WCFT and the Wirral Clinical Commissioning Group (CCG) about the future provision of the service and asked if contingency plans were in place. Simon Banks, Wirral CCG informed that both organisations were working together to ensure an acceptable solution could be found, but this also required the co-operation of Wirral’s 2 GP Federations.

Members sought further reassurances concerning staff, noting that the WCFT had placed the dedicated and hardworking phlebotomy staff on redundancy notice.

The  ...  view the full minutes text for item 60.

Matthew Gotts, Principal Accountant introduced the report of the Director of Finance and Investment (S151) that set out the financial monitoring information for the Adult Care and Health Overview and Scrutiny Committee. The report provided Members with detail to scrutinise budget performance for this area of activity. The financial information covered the period as at the close of Quarter 3 2018/19.

The report had been drawn from the relevant sections of the most recent Cabinet financial monitoring reports and had been combined with additional service information to produce a bespoke report on areas falling under the responsibility of the Overview and Scrutiny Committee. The report included information on performance against the revenue budget (including savings, and performance against the capital budget.

The Principal Accountant apprised Members of key points in relation to the budget, namely:

• Adult Health and Care is still forecast to balance its budget by year-end, with no significant changes to the forecast position from Quarter 2;

• Additional financial pressures on the service anticipated at £2.5 million, comprised of two elements:

(i)  £0.7 million part-year effect of increased demand for services in 2018/19 – to be fully mitigated through continued delivery of the agreed savings plan; and

(ii)  £1.8 million additional demand anticipated over the winter period – predominantly in the home care market. This will be mitigated by Wirral’s allocation of the Chancellor’s announced £650 million extra funding for social care in 2019/20, of which £240 million is specifically ring-fenced for adult social care.

• Pooled funding – of which Adult Health and Care is a contributor, was currently forecasting a deficit position due to increased demand for services. Work is ongoing between the Council and Wirral CCG to manage this, including income generation and cost reduction. However, there was potential risk that a pooled fund deficit at year end could result in a liability to the Council of £0.5 million.

Overall, the Principal Accountant further highlighted that the cost pressures associated with fee rate increases, demographic growth, pre-agreed savings and the loss of Adult Social Care Grant and reduced ILF Grant had resulted in a predicted net budget gap of £5 million (equivalent to 3%-5% of the overall budget). He informed that Members and Officers were looking at this significant challenge, and that £3 million savings had already been identified with a further £2 million expected in consequential / follow on savings.

Members questioned the Principal Accountant on matters relating to the budget pressures, the management of pooled funding and requested that a summary report on the year-end figures be brought back to the Committee in June.

The Principal Accountant and the Director of Adult Care and Health responded, detailing the arrangements for pooled funding (as covered under a Section 75 agreement) and how the Council was working to help individuals become more independent, by the delivery of appropriate care packages. The Director of Adult Care and Health informed that in this fashion savings could be made without impacting on individuals care. He added that it was  ...  view the full minutes text for item 61.

The Director of Adult Care and Health introduced his report that provided the 2018/19 Quarter 3 (October – December 2018) performance for the Wirral Plan pledges under the remint of the Adult Care and Health Overview and Scrutiny Committee. The report provided an overview on progress in Quarter 3 and 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 report summary provided information on the following key areas:

• Neighbourhood leadership teams – established across 9 areas of Wirral, led by GP coordinator to work proactively with partner organisations to support people with their health and care needs;
• Age UK event to help reduce isolation, and encourage new circles of support to assist people to maintain independence;
• Ensuring people with disabilities have stable and appropriate accommodation;
• Provision of 4 extra care homes schemes to provide 75 units of extra care by the end of 2019/20;
• Merseyside Jobcentre Plus had increased the number of employers signed up to being Disability Confident;
• Wirral Zero Tolerance towards Domestic Abuse Conference and launch of website www.Itsneverokwirral.org ;and
• MARAC cases continued to rise, and the Family Safety Unit was now fully staffed to deal with demand of new cases.

The Director extended apologies from Mark Cambourne, Lead Commissioner Community Services & Resilience (Safer Wirral Service) who was unable to attend the meeting to answer questions on Domestic Violence, but informed Members that an in-depth session on the subject was proposed for a future date.

A Members welcomed the opportunity to discuss this matter in detail at a workshop or future meeting of the Committee but expressed concerns that this topic had been an area of great concern for a considerable length of time. The Director concurred and informed that the service continued to work hard on this matter and regular reporting to the Healthcare Performance Panel had confirmed consistent improvement and continued investment. He added that the involvement of Elected Members and other partners, had led to more open and transparent debate on the subject. The Director further informed Members that issues surrounding domestic abuse (including highlighting attacks on grandparents) were also being tackled using safeguarding legislation.

Members debated the issue of inadequate care homes, and what actions the Council was taking to address this matter, and the positive benefits of Member visits and training. Members also highlighted the difficulty of putting CQC ratings into perspective without such visits taking place. 

The Chair informed the Committee that the Healthcare Performance Panel had placed requests to have sight of published CQC reports relating to Wirral Care Homes. She added that she also would pick up the matter of Member Training (delivered by Healthwatch).

Resolved – That the report be noted.

Simon Garner, Lead Commissioner - All Age Independence introduced his report that informed how Extra Care Housing provided opportunities for older people, and older people with learning disabilities, to have greater choice and control to live as independently as possible. His report informed that Extra Care Housing wasn’t simply about providing a home with the right support and care, but also how it provided a lifestyle and a place that was integrated in its community, thereby reducing isolation and increasing participation.

The report further informed that Extra Care Housing provided an improved quality of life for individuals compared with living in residential care, and set out the key national policy drivers, the needs of the population of Wirral, and how the Council was approaching the challenge to meet needs. 

The Lead Commissioner - All Age Independence apprised Members of how a significant delay on the Government decision regarding funding for Extra Care schemes as part of its review into supported housing schemes had caused a delay in delivery of Wirral’s plans. Mr Garner explained that despite this, the plan expected to deliver 300 additional units of Extra Care Housing by 2020 (exceeding Wirral’s original target). The Committee was further advised that the delivery of services did not follow a uniform solution pattern and used varied partners in this regard.

Members questioned the Lead Commissioner – All Age Independence on a number of proposed schemes listed in the report, on the style of buildings, interior layouts (number of rooms, kitchen, etc) and whether adequate access to urgent medical care, GPs and dentists had also been taken into account. 

Mr Garner provided Members with assurances on these key points.

The Chair suggested that if possible Members would welcome a site visit to the completed scheme(s), and congratulated Mr Garner for his work on delivering this project.

Resolved – That the report be noted, and the approach taken with regard to Extra Care Housing be endorsed.

Lorna Quigley, Director of Quality and Safety – Wirral Health and Care Commissioning introduced her report that informed the Adult Care and Health Overview and Scrutiny Committee on progress that had been made following recommendations from the May 2018 ‘Continuing Healthcare Scrutiny Review’.

The Director of Quality and Safety – Wirral Health and Care Commissioning further informed the Committee of progress against the individual recommendations as listed in the report appendix. These covered:

• Consistency of application of the CHC framework by training;
• Communication;
• Dynamic Purchasing System (DPS);
• End of Life Care;
• Learning Disabilities;
• All-age Disabilities: transition of young people; and
• Cost of Administration.

Thanking Ms Quigley for her report, the Chair also moved that Members endorse the addition of a future review to the work programme to explore the experience of young people moving into adulthood. Duly seconded it was:

Resolved – That 

(1)  the progress made to date in relation to the Continuing Healthcare Scrutiny Review, be noted; and

(2)  the addition of a future review to their work programme, to explore the experience of young people moving into adulthood, be confirmed.

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 provides information on performance across the year and identifies the priorities for improvement during the forthcoming year. The purpose of Quality Accounts was to ensure providers were assessing the quality of service they provide and working to continuously improve this, focussing particularly on:

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

The report further informed that for those Trusts providing services within the geographical area of a local authority, Health Overview and Scrutiny Committees were given the opportunity to comment on the Trusts’ draft Quality Accounts prior to publication of the final document.

The Chair confirmed that a Task and Finish Group had been established, comprising the Chair and Party Spokespersons of the Committee and that an initial meeting date had been set for 7 May 2019.

Resolved – That 

(1)  the Task and Finish Group, comprising the Chair and Party Spokespersons review the draft Quality Accounts of the local health partners;

(2)  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 overview of the Health and Care Performance Panel meeting held on 4 February 2019. The report provided feedback to members of the Adult Care and Health Overview and Scrutiny Committee.

The report included details of the following key discussions and areas of interest, namely:

• Infection Control;
• Better Care Fund – Priorities and Performance 2018/19;
• Domiciliary Care; and
• Red Bag Scheme Update

The Chair thanked Members for their involvement and engagement with the activities of the Health and Care Performance Panel.

Resolved – That the report be noted.

The Chair introduced her report that provided an update regarding progress made since the last Committee meeting held on 29 January 2019. 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 report provided the Committee with an opportunity to plan, review and evaluate its work across the municipal year. The work programme for the Adult Care and Health Overview and Scrutiny Committee for the 2018/19 Municipal Year was attached as Appendix 1 to the report. The report provided an update regarding progress made since the last Committee meeting held on 29th January 2019 and informed that the current work programme was made up of a combination of scrutiny reviews, workshops, standing items and requested officer reports.

The report also included a summary report of an Adult Care and Health Scrutiny Member visit to Wirral Evolutions – Pensby Wood Day Centre.

A Member commented on the excellent standard of care delivered at the Day Centre, and informed other Committee Members on details of the facility, interactive activities and how the staff made visitors very welcome. She added that the Day Centre had a very ‘positive’ feel and helped provide a better quality of life for those attending. Another Member expressed support for the team at Wirral Evolutions, praising their attention to detail.

Resolved – That the report be noted.

Being the last meeting of the Municipal Year, the Chair expressed thanks to Members, Officers and Health Providers who had been involved in the work of the Adult Care and Health Overview and Scrutiny Committee, and took the opportunity to wish Dr Sue Wells a happy retirement.

In turn, Members also thanked the Chair for her hard work over the past year.