The Chair informed that, alongside the Mayor of Wirral and other Councillors, she had that day joined with hundreds of local school children to welcome Holocaust survivor Lady Milena Grenfell-Baines to the borough as part of a visit organised by the Holocaust Educational Trust.

The Committee observed a minutes silence in memory of all those affected by the Holocaust and similar more recent events in places such as Bosnia, Cambodia, Rwanda and Darfur.

The Chair advised that, with the agreement of the Committee, agenda item 8 (Pooled Fund Arrangements Scrutiny Workshop Report) would be considered immediately following agenda item 3 (Minutes) due to attendance of the Chair of the Children and Families Overview and Scrutiny Committee who had attended the Joint Workshop meeting held on 9 January 2019, and was attending the meeting to respond to any specific questions Members may have regarding the workshop falling under the remit of his Committee.

Apologies for absence were received from Councillors Gerry Ellis and Moira McLaughlin.

Apologies were also received from Val McGee Chief Operating Officer Wirral Community NHS Trust, Suzanne Edwards Associate Director Cheshire and Wirral Partnership NHS Trust, Mel Pickup Chief Executive Warrington and Halton Hospitals NHS Foundation Trust and Karen Prior Healthwatch Wirral.

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 what they were.

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 27 November 2018, and the Call-In meeting held on 27 November 2018.

Councillor Muspratt requested that her declarations of interest should reflect that one of her daughters was employed within the NHS, and another worked as a GP (minutes 31 and 34 refer).

The Chair requested that minute 32, first paragraph under evidence from Call-In Witnesses, be amended to insert the words ‘two local’ before ‘MPs had advised against signing….’

Subject to the above corrections:

Resolved – That the minutes of the meeting held on 12 September 2018, and the special meeting held on 12 November 2018, be approved.

Councillor Julie McManus, Chair introduced the Joint Overview and Scrutiny Chair’s report on the subject of the Pooled Fund Arrangements. The report provided feedback from the joint workshop of the Adult Care and Health Overview and Scrutiny Committee (AC&H OSC) and the Children and Families Overview and Scrutiny Committee (C&F OSC) held in January 2019. The workshop had been convened to allow Members from both Committees to undertake pre-decision scrutiny on proposals regarding the Section 75 funding arrangements for the period of April 2019 to March 2020. Councillor Tom Usher Chair (C&F OSC) was also in attendance to answer any questions arising from consideration of this item.

The report provided an overview of the Section 75 pooled funding proposals, a summary of Member comments and workshop discussions and listed 6 specific conclusions and recommendations in respect of the following:

• Pooled fund budget performance reporting;
• Exploration of the development of performance reporting on waiting times for social care services;
• Continuing Healthcare monitoring;
• The production of clear guidelines outlining governance and decision making processes;
• Consideration to be given to holding a scrutiny session to examine ‘The NHS Long Term Plan’; and
• Improved engagement with service users or those close to service users, and continued use of external stakeholders where relevant.

Members questioned the Director of Adult Care and Health on a number of points that included the Section 75 arrangements for Urgent Care and proposed transfer of services, procedures for the engagement of staff and Trade Unions, and others involved with the delivery and receipt of ‘front line services’.

The Director of Adult Care and Health informed that the Section 75 ‘Pooled Funding Proposals’ was one of a number of Section 75 agreements, and had no connection to the Urgent Care Review. 

Councillor Tom Usher, Chair of the Children and Families Overview and Scrutiny Committee informed that the workshop had provided a useful opportunity for dialogue with front-line staff and qualified practitioners who had attended. 

A Member commented that it had been useful to hear from health professionals, but questioned the procedures for inviting and/or the involvement of advocacy groups in the process.

Councillor Usher advised that, as Councillors, Members were best placed to approach patients or anyone who could provide information on a particular issue and act as a conduit for the relaying of ideas and views.

Councillor Julie McManus added that such invitations would be made via the Chair, to ensure that a balance of views were gathered.

Councillor Phil Gilchrist moved, duly seconded, and agreed that an additional recommendation be added to ensure that both Overview and Scrutiny Committees be kept apprised of matters from a service user / patient perspective, and that ‘Members of the Adult Care and Health, and the Children and Families, Overview and Scrutiny Committees be kept fully informed of the experiences gained during the operation of these arrangements and any modifications or variations that are made’.

Resolved – That

(1)  the joint report of the Adult Care and Health and the  ...  view the full minutes text for item 49.

Mr Anthony Middleton, Chief Operating Officer Wirral University Teaching Hospital NHS Foundation Trust introduced his report that set out details on the arrangements for provision of a managed service contract to run a 30 bed Transfer to Assess Unit sited at Clatterbridge Hospital. The report summarised the process and activities undertaken to identify a supplier to provide a managed service contract for the provision of T2A services to the Trust. The report further detailed the major milestones in the tender process and the key factors that led the project group to recommend the award of the contract to Cedar Court (Tamaris Healthcare - Four Seasons Group Holdings Ltd).

Mr Middleton informed that in Wirral there were a total of 102 ‘Transfer to Assess’ (T2A) beds across 7 sites. The purpose of the beds being to provide assessment and therapy services for those patients who may require longer term support upon leaving hospital. The beds were also a step up provision for the community to avoid unnecessary hospital admissions. He further informed that it is highly frustrating both for patients and the clinical teams employed at Wirral University Teaching Hospitals that at any one point in time there were over 100 patients who had been medically assessed and therefore able to be discharged from an acute medical bed, but due to capacity constraints elsewhere these patients remained in hospital. He added that although unacceptable, this was not disproportionate and similar to nationally reported figures, but placed severe pressures and logistical challenges for staff.

Mr Middleton explained that Wirral Hospitals had determined that the model for the 48 bed requirement would be one of additional provision of acute medical and surgical capacity to the tune of 18 beds as well as a new model for 30 beds to allow a clinical staffing solution matched to the patients. The latter would operate along similar lines to that of care homes provision but with additional therapy, GP and community geriatrician input. This would therefore not require hospital consultant medical staff, nor registered acute nursing staff - needed for those patients with the most acute needs. 

The Overview and Scrutiny Committee was apprised that a formal tendering process was undertaken to identify potential suppliers for the provision of  T2A Services in the Summer of 2018. Six suppliers had participated in a pre-market engagement session and the OJEU contract notice was published on 4th August 2018 via the Trust’s tender management portal Pro-Contract. 2 suppliers submitted tender bids and on the basis of the tender analysis and evaluation process, the Trust board of directors awarded the contract to Cedar Court (Tamaris Healthcare - Four Seasons Group Holdings Ltd).

Members questioned Mr Middleton on aspects of the tendering processing with particular focus and concern regarding the contract award criteria and weightings (60% specification compliance and 40% cost). Mr Middleton explained that these aspects of the contract tender had been worked up by a project group and panel to ensure the most appropriate service outcomes.

In response to  ...  view the full minutes text for item 50.

Neil Skitt, Head of Corporate Communications Cheshire and Merseyside Health and Care Partnership introduced his report that provided Members with an update on works of the Partnership currently in progress. Mr Skitt was accompanied by Gerald Meehan, Non-Exec Director Wirral Community NHS Foundation Trust and Dave Sweeney, Executive Implementation Lead. Mr Skitt’s report provided information on the following 9 key projects:

• Pop up’ community birthing centre;
• Headache pathway - reducing referrals by 20%;
• Primary Care;
• Transforming Care Programme;
• Estates Strategy;
• Launch of Digit@ll  - Cheshire and Merseyside Digital Roadmap;
• Workforce Programme;
• Prevention framework - launched across Cheshire and Merseyside; and
• Transformation Fund.

Members were invited to ask questions, and partnership officers responded accordingly depending on their areas of responsibility.

A Member sought clarification on the partnership structure, meeting calendar and how work of the partnership had progressed in the Merseyside Region.

Mr Skitt informed the Adult Care and Health Committee that regular meetings were taking place and that although work of the programme review group had paused, work on the progress for the 9 areas was being shared and progress reports on the improvement of patient care in Merseyside was being incorporated into the 5 Year Strategy document planned for publication in Autumn 2019. 

A Member questioned what actions were being taken to keep health service provision local.

Simon Banks, Chief Officer Wirral CCG informed that healthcare provision was being reviewed and developed co-terminus with the Local Authority boundaries, with the aim of ‘keeping it local’. He added that the Overview and Scrutiny Committee would continue to receive regular updates on progress.

In response to a question on the Merseyside Health and Care Partnership’s estate strategy, Mr Sweeney explained that a review of existing buildings had identified that some were not being utilised properly, and as with the Council’s own estate management procedures would be reviewed as a whole to ensure a best fit for planned services. Mr Banks added that work was ongoing, but was dependent on a number of factors that included – local planning, investment, capital bids and additional resources needed to deal with repairs backlogs.

The Chair thanked the Officers for their attendance and report.

Resolved – That the work of the Healthy Wirral partnership and the Cheshire and Merseyside Health and Care Partnership be noted.

Lorna Quigley, Director of Quality & Patient Safety Wirral CCG introduced the Annual Report of the Merseyside Safeguarding Adults Board (MSAB) that provided an overview of the work undertaken by the MSAB, its memberships and terms of reference.

Ms Quigley informed the Committee that the MASB had agreed a number of sub groups to take forward various work streams. These included:

• Safeguarding Adults Review
• Communications and Engagement
• Policy, Procedure and Practice
• Performance and Adult
• Quality Assurance
• Workforce Development

Ms Quigley further informed that the adult population across the geographical areas of Knowsley, Liverpool, Sefton and Wirral (who made up the MSAB) was approximately 982,354 and that Sefton and Wirral had the highest numbers of residents aged 85+.

Ms Quigley presented additional statistical information on the topics of safeguarding concerns for each local authority area, highlighting the types of abuse that were most prevalent and where safeguarding incidents took place i.e. own home, residential home of nursing home. Members were apprised of the actions taken to manage risks and most appropriate actions for individuals, central to the personalisation within adult safeguarding. The report concluded with a summary of the MSAB’s achievements during the year and aims and objectives contained in the Strategic Plan for 2018-2020.

Members questioned the Director of Quality & Patient Safety Wirral CCG on aspects of her report that included information that could be provided from the Health and Care Performance Panel and methods by which reporting of abuse was collated and acted upon.

Resolved – That the report be noted.

Mr Jason Oxley, Assistant Director Health and Care introduced his report that described the commissioning plan for health, care and support services for people with a disability in Wirral for 2019/20. The report followed a verbal update to the Adults Care and Health Overview and Scrutiny Committee (OSC) provided by Mr Oxley at the OSC meeting held in November 2018.

Mr Oxley reported that Wirral Health and Care Commissioning will ensure that the Council and the CCG effectively deliver their Health and Care functions and duties in a more joined up way, with services commissioned for people with a disability being funded from a pooled budget and commissioned jointly where this makes sense to do so. 

Members noted that Wirral Council currently supported over 700 people who have a learning disability and that Wirral Health and Care Commissioning, as a single commissioner, would enable the health and care system to use Wirral’s resources to jointly create a sustainable health and care system for people with a disability. 

Mr Oxley informed that both the Council and CCG faced financial pressures and required efficiencies to be delivered in 2019/20, the Council’s Medium Term Financial Strategy required a further £2million of efficiencies to be made in 2019/20, the third year of a four year efficiency target for disability services. He added that the Commissioning Plan for people with disability for 2019 included planned activities that would result in the following estimated efficiencies:

• Commissioning Accommodation-Based Support (£0.6m).
• Improving Performance and Promoting Independence (£0.4m).
• Standardising Practice and System Integration (£0.2m).
• Commissioning Preventative Services to Maximise Wellbeing (£0.1m).

Members questioned Assistant Director Health and Care on matters relating to the development and delivery of high dependency placements and independence at Spital Road, CQC registration requirements at the Fusion Centre, and a sustainable plan for residential respite i.e. number of beds available for planned and unplanned care.

Mr Oxley summarised that the new arrangements also provided a greater range of services, that included activity based providers in addition to commissioned bed-based care. 

Resolved – That the report and commissioning plan for people with a disability be noted.

The Chair presented a report by a Scrutiny Officer informing of a Scrutiny Workshop held on 6 December 2019 when Members had considered the 2019/20 budget proposals being put forward in respect of its remit. Attached to the report at Appendix 1 was a summary report that detailed the proceedings of the Workshop.

The report informed that a consistent approach for the scrutiny of the 2019/20 budget proposals had been agreed by the Chairs of each of the Overview and Scrutiny Committees. It had been proposed that the previous format used for the 2018/19 budget scrutiny workshops be continued, with a separate workshop arranged for each of the four Overview and Scrutiny Committees.

Members noted that a list of budget proposals under the remit of the Adult Care and Health Overview and Scrutiny Committee were considered by the Chair and Party Spokespersons of the Committee, with agreement that all proposals put forward would be examined during the workshop.

The report further informed that a dedicated scrutiny workshop had been convened for Members of the Adult Care and Health Overview and Scrutiny Committee on Thursday 6 December 2018 in order to discuss the budget proposals for 2019/20. The outcome of the workshop deliberations at Appendix 1 to the report set out two key proposals, namely:

• Use of Grant Funding – proposing a review of contractual obligations in order to identify financial savings in current public health contracts to find approximately £800,000 for reinvestment into other Council services supporting the delivery of public health outcomes; and

• Mitigating Adult Social Care demand through maximising independence and wellbeing – whereby a number of savings plans and mitigations had been formulated to meet the cumulative gross budget deficit of £7.8m forecast for Adult Social Care in 2019/20. This included a focus on service delivery efficiencies, service quality improvements and income generation, as well as the use of national grants and funding.

The Chair sought views from Members of the Adult Care and Health Committee who had been unable to attend the workshop.

Resolved - That

(1)  the report on the Workshop (Appendix 1 to the report) be agreed as the Committee’s formal response to the 2019/20 budget proposals; and

(2)  the report and its appendix be referred to the Cabinet for consideration at the time when it is making recommendations to the Council in respect of the Council’s Budget for 2019/20.

The Chair introduced her report that provided an overview of the Health and Care Performance Panel meeting held on 3rd December 2018. 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:

• Actions from the previous Panel meeting held on 8 October 2018.
• CQC ratings, compliance and safeguarding. arrangements for Care Homes in Wirral.
• Suicide rates.
• Drug use in Wirral.

The report also included the following summary of actions:

Arrangements to be put in place for a Member visit to the Pensby Wood day service in order to observe the recent refurbishments. A briefing note on the capital investment and areas of improvement had been requested, for circulation to Members in advance of the next Panel meeting.

Updates on the ‘Red Bag Scheme’ and Domiciliary Care services to be added to the agenda for the next Panel meeting. A report on Infection Control to also be deferred to the next Panel meeting.

A potential Member visit to one of the ‘Wirral Ways to Recovery’ service centres to be added to the Panel work programme.

The Chair requested that Members contact the Scrutiny Officer to check availability for a future meeting of the Panel.

Resolved – That the report of the Health and Care Performance Panel be noted.

The Chair introduced her report that provided an update regarding progress made since the last Committee meeting held on 27 November 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 update 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 ad Scrutiny Committee for the 2018/19 municipal year was attached as Appendix 1 to the report.

The Chair informed that a request had been made for a follow up meeting of the Joint Overview and Scrutiny Committee (Wirral and Cheshire West and Chester Councils) that had been established to consider cross-boundary issues arising from the recent consultation on Urgent Care Treatment proposals.

Dr Sue Wells, Chair Wirral CCG informed that a significant amount of data had been collected and required analysis before the CCG could take the next step in the process. Work continued, and it might be inadvisable for the matter to be considered during Purdah, given that both Local Authorities were holding elections in May. The Chair suggested that a June meeting might be an appropriate time to re-convene the Joint Overview and Scrutiny Committee.

Members questioned Dr Wells with regard to funding available for the provision of additional GP appointments and nursing vacancies.

The Chair reminded Members that a number of Councillors had not completed Healthwatch training, and highlighted that this would need to done before reality check visits could be undertaken.

Resolved – That the report be noted.