Agenda and minutes
Venue: Committee Room 1 - Wallasey Town Hall. View directions
Contact: Patrick Sebastian 0151 691 8424
Apologies for Absence
Apologies for absence were received from Councillors Moira McLaughlin and Paul Hayes (Councillor Lesley Rennie present as deputy for Cllr Hayes).
Phil Gilchrist in the Chair.
Declarations of Interest
To approve the accuracy of the minutes of the Adult Care and Health Overview and Scrutiny Committee meetings held on 26 June 2019 and 24 July 2019.
To receive the draft minutes of the Wirral and Cheshire West and Chester Joint Overview and Scrutiny Committee meetings held on 1 July 2019 and 30 July 2019.
The Committee was requested to approve the accuracy of the minutes of the meeting of 26 June 2019 and the special meeting of 24 July 2019.
The Committee was also requested to note the content of the draft minutes of the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee meetings held on 1 July 2019 and 30 July 2019.
Resolved – That
1) the minutes of the Adult Care and Health Overview and Scrutiny Committee meetings held on 26 June and 24 July 2019, be approved; and
2) the minutes of the Wirral & Cheshire West and Chester Joint Health Scrutiny Committee meetings held on 1 July and 30 July 2019 be noted.
Anthony Middleton, Chief Operating Officer Wirral University Teaching Hospital (WUTH) introduced his report that provided Members of the Adult Care and Health Overview and Scrutiny Committee with a progress briefing on the 30-bedded Transfer to Assess (T2A) facility, Grove Discharge Unit (GDU), that came into operation at the end of November 2018.
The Chief Operating Officer’s (WUTH) report informed that the 30-bedded Transfer to Assess (T2A) facility, Grove Discharge Unit (GDU), came into operation at the end of November 2018, operating under the direction of Tamaris-Four Seasons Healthcare to fulfil the purpose of providing a sub-acute model of care. The contract was a 2-year tenure with the mutually agreed option of a 2-year extension. The 30-bedded Nurse-led Unit on the Clatterbridge site was flexible and responsive to the needs of individuals who were medically optimised and no longer required care in an acute setting. The unit also helped to manage the on-going urgent care pressures by freeing up capacity on the Arrowe Park site.
Members were apprised that the unit provided a much more flexible approach than was standard with, for example, a Unit Manager being onsite 24hrs a day. The Adult Care and Health Overview and Scrutiny Committee also noted that occupancy level for the unit was virtually 100% at all times.
The Chief Operating Officer informed that high levels of satisfaction were being received from patients and since the establishment of the unit key performance indicators were being met. He added that although effective, the service was not cheap, but reviews were underway to explore different models across varied wards.
There followed an in-depth question and answer session where Members sought clarification on a number of matters relating to the contract, support provided in respect of Social Care (and by whom), inspections, staff surveys and patient outcomes.
The Chief Operating Officer responded accordingly and stated that the contractual arrangement with Tamaris-Four Seasons Healthcare and NHS England had not raised any immediate concerns, staffing levels had been maintained and there was no hold on procurement at present. He informed Members that the existing two-year contract was scheduled for renewal in November 2020.
In response to questions on who provided support for Social Care matters Mr Middleton advised that this responsibility fell to the Council’s Social Workers who were now co-located with NHS staff. He further informed the Committee that staff feedback across a variety of service areas had flagged a number of matters requiring action at the month-end reporting period, but since production of the report and at the time of the Overview and Scrutiny meeting there were no outstanding actions.
A Member asked for further details re patient outcomes i.e. transfer into residential nursing care and actual percentages, whether more than one team dealt with admissions and if the same criteria was used. Mr Middleton replied, stating that most patients were expected to go from hospital to home, and were not treated as ‘total’ discharges. He added that roughly 50% of patients were cared for at home with ... view the full minutes text for item 21.
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 & Scrutiny Committee. The report provided Members with detail to scrutinise budget performance for this area of activity. The financial information covered the final position for 2018/19 and the financial information as at Quarter 1, 2019/20.
Information 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 & Scrutiny Committee. The report included the following:
· 2018/19 Outturn Information.
· Performance against the revenue budget (including savings).
A Member sought clarification regarding a £200k deficit within the pooled fund with Wirral CCG at the end of 2018/19. The Committee was informed that this had been caused by £1.0m unbudgeted cost pressures in the CCG, mitigated by a budget surplus of £0.8m in the Better Care Fund (BCF), and as per the legal agreement between the two parties, the net deficit was shared equally between the two partners, i.e. £0.1m for Wirral CCG and £0.1m for Adult Care & Health. The Director of (Adult) Care and Health informed that the budget line for Continuing Healthcare included individuals with complex healthcare needs and those with social care packages based on need – and the structure of the pooled fund meant that these costs were shared equally by the CCG and the Council.
A Member then sought clarification on reference to ‘managing demand’ for services and did that equate to rationing? The Principal Accountant informed that managing demand referred to adapting services to move people home, or keep them at home, and/or provision of assistive technology – significantly more cost effective than some alternatives or past practice.
In response to a question on savings targets, the Principal Accountant explained that work was ongoing to provide continued monitoring of service against the commissioned contract, ensuring targets were achieved, without detriment to service users.
The Director (Adult) Care and Health then apprised the Committee on the key areas of the budget allocations with specific reference to Wirral’s spending in support of people with learning disabilities, older people and helping to support people in their own homes.
A Member questioned the Officers on the reported budget underspend regarding the Better Care Fund (£0.8m) stating that given demand on the service, she would have expected 100% spend. The Director of (Adult) Care and Health informed that information regarding why BCF money could not be used in its entirety i.e. areas of slippage against contract, would be provided to Members in a briefing note following the meeting.
Resolved – That the report be noted.
Councillor Gilchrist introduced the report of the Head of Intelligence, Statutory Scrutiny Officer that provided an overview of the Health and Care Performance Working Group (Panel) meeting held on 19th August 2019. The report provided feedback to members of the Adult Care and Health Overview and Scrutiny Committee around key discussions and areas of interest resulting from the meeting. The report summarised the items considered by the Health and Care Performance Working Group that included:
· Chronic conditions – patient story – that updated Members on the difficulties of living with Chronic Fatigue Syndrome (CFS) otherwise known as ME.
· Park House – Care Quality Commission (CQC) Inspection and Care Home Complaints – a report on actions taken to improve Care Homes rated as ‘inadequate’ by the CQC.
· Wirral Health and Care Quarterly Performance – that set out Wirral health and care quarterly performance statistics. Areas that were highlighted to Members included the Accident & Emergency (A&E) 4-hour standard, Referral to Treatment (RTT) targets, Improved Access to Psychological Therapies (IAPT) waiting times and Healthcare Acquired Infection rates.
· Health and Care Integration Update – that stated the current position of integration between health and care services in Wirral, along with an overview of current performance and the impact on those accessing services.
· Local Government Ombudsman (LGO) Report – Domiciliary Care - Members sought assurances that action had been taken to ensure the circumstances surrounding the complaint could not happen again, and that all necessary safeguardsand contingency planning had been implemented.
With reference to the Health and Care Integration Update, Councillor Gilchrist requested that all Members of the Adult Care & Health Overview and Scrutiny Committee be given sight of the Association of Directors of Adult Social Services (ADASS) peer review referred to in the Working Group meeting summary of actions.
A Member pointed out that the Working Group had requested a timeline of actions in relation to the Park House Care Home improvement plan that had not been received. Other Members expressed further concerns regarding the general standard of Nursing Home Care - with 20 homes requiring improvement. The Director of (Adult) Care and Health stated that this was a national issue, and where care provision did not meet standards and quality of care was not good enough, the Council would look at ceasing of contracts.
Councillor Gilchrist informed Members that the next meeting of the Health and Care Performance Working Group was scheduled for 9 October.
Resolved – That the report be noted.
Councillor Gilchrist introduced the report of the Director for Health and Care (DASS) that provided the 2019/20 Quarter 1 (April-June 2019) performance report for the Wirral Plan Pledges under the remit of the Adult Care and Health Overview and Scrutiny Committee. Also included at Appendix 1 to the report was an overview of the progress in Quarter 1 and available data in relation to a range of outcome indicators and supporting measures. The Adult Social Care and Health Performance Overview was included at Appendix 2 to the report and included additional performance information that had been requested by Members to enable effective scrutiny.
Councillor Gilchrist invited Mark Camborne, Assistant Director – Safer Wirral Service and Jason Oxley, Assistant Director Health and Care Outcomes to present information on the key areas of Domestic Abuse and All Age Disability respectively.
The Assistant Director – Safer Wirral Service delivered a presentation that informed on action against the Council’s 2020 Pledges in support of action to tackle Domestic Abuse. The presentation covered the following key points:
· Merseyside Police call out times – dispatch rate.
· The number of incidents which were reported to the police.
· Overall number of incidents reported to the police that went on to be classed as a crime.
· The varied categories of domestic abuse – that also included stalking, harassment and violence without injury.
· Crimes solved i.e. a positive outcome - a charge or caution of the perpetrator.
· Instances where the victim declines support, and possible actions
· Protection Notices – used in cases as an intervention to protect the victim if prosecution was not possible.
· Zero tolerance measures.
The Assistant Director – Safer Wirral Service provided summary background statistics for each point and provided information on changes to reporting e.g. where there have been changes in the Home Office counting rules which resulted in more than one crime being recorded against one victim i.e physical assault and coercive and controlling behaviour. Members were apprised that previously it was the most serious offence that was ‘crimed’ against once victim.
A further example included the criming of neglect against children, where previously one neglect would be crimed against poor home conditions, this was now reported against each child within the household.
Members also noted that peaks in reported domestic abuse incidents were recorded around Christmas time and high profile public campaigns re domestic abuse. In each case additional staff were engaged to enable a swifter response.
The Assistant Director – Safer Wirral Service informed that a workshop session was being scheduled for Members in the near future.
Members thanked the Officer for his report and offered their continued support in helping to tackle the issue of domestic abuse, in all its forms.
The Assistant Director Health and Care Outcomes introduced his interim report focussing on the subject of the All Age Disability Service, to be the subject of a detailed report to the October meeting of the Health and Care Performance Panel. He informed that the integrated service aimed to ... view the full minutes text for item 24.
Councillor Gilchrist introduced the report of the Head of Intelligence (Statutory Scrutiny Officer) that provided an update regarding progress made since the last Committee meeting held on 26 June 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 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 the Committee with a summary of work that had recently been concluded alongside a number of forthcoming key activities that included a performance review workshop, follow-up report on the Urgent Care Transformation and the NHS Long Term Plan.
Councillor Gilchrist summarised the areas of work, as appended to the report, for future consideration by the Committee. These included:
· Domestic Abuse.
· Winter Preparedness – Better Care Fund / Winter Pressure Arrangements.
· Clatterbridge Cancer Centre – provisional date May 2020.
· 5g - Impact on Public Health.
· Urgent Care Treatment – provisional date January 2020.
· Pooled Fund Workshop – dates to follow.
A Member requested that when considering the matter of Winter Pressures/Preparedness, specific review of the increased number of Winter deaths (particularly significant in the areas of Wirral South and Birkenhead) be included.