Apologies for absence were received from Councillor Christina Muspratt and Karen Prior, Chief Officer Healthwatch Wirral.

To approve the minutes of the meeting of the Adult Care and Health Overview and Scrutiny Committee held on 16 September 2019 as a correct record.

Resolved – That the minutes of the meeting held on 16 September 2019, be approved.

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 2, 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:

• Performance against the revenue budget (including savings / overspends); and
• Performance against the capital budget.

The Principal Accountant highlighted key areas within the report that included demand for services as being the key driver of cost in Adult Care and Health: with increased demand for adult social care services being seen predominantly in the care at home sector, where the volume of home care and supported living services provided in the last twelve months had increased by 6% and 8% respectively.

Members were also apprised that there was a combined total of £4,500k known budget challenge facing the pooled fund in 2019/20, mostly relating to pre-agreed savings targets and demographic growth across learning disability and mental health services in Adult Care & Health and Wirral CCG. Work was ongoing to quantify the mitigation identified against these pressures. 

The Principal Accountant added that the ringfenced Public Health grant continued to be forecast to balance to budget.

When questioned on the reason for the increased demand on services the Assistant Director, Health and Care Outcomes informed that the year on year increase related to key areas of an ageing population, demographics, mental health support, and complex needs. These were also affected by an increase in volume of hospital discharges and need for domiciliary care at home.

A Member questioned how the service could offer reassurance about maximising care and wellbeing within budget. The Assistant Director, Health and Care Outcomes explained how by focusing on optimum level of care, proportionate to needs a balance of care helped ensure ‘independence and wellbeing’ for those in receipt of care, avoiding more costly interventions.

A short discussion followed on the subject of winter pressures, winter care and reduction in the number of long stay beds that would result in a rise in level of home care and how this could be tackled.

Members noted that the CCG and the Council were working together to do whatever was possible to increase capacity across services under their remit. It was further noted that Wirral had an above national average elderly population.

Resolved – That the report be noted.

Further to minute 21 (16 September 2019), Dr Liz Bishop, Chief Executive - Clatterbridge Cancer Centre NHS Foundation Trust introduced her report that provided a progress briefing on the development of a new comprehensive cancer centre - expanding The Clatterbridge Cancer Centre services into central Liverpool by 2020. Members were apprised that the new hospital was part of a £162m programme of capital investment to expand and improve cancer care in Cheshire and Merseyside, and that part of a programme that would also see investment in the current cancer treatment sites in Wirral and Aintree, with both sites continuing to provide outpatient cancer treatments.

Dr Bishop informed the Adult Care and Health Overview and Scrutiny Committee that Clatterbridge Cancer Centre-Liverpool was scheduled to open in May 2020, part of progress in the Trust’s plans to transform cancer care across Cheshire & Merseyside.

Dr Bishop explained that the new specialist cancer hospital in Liverpool - The Clatterbridge Cancer Centre – will be an 11-floor specialist cancer hospital located in the heart of Liverpool, next to The Royal Liverpool University Hospital and The University of Liverpool and would form part of the ‘Knowledge Quarter’ development. The development of the new hospital was progressing to plan and the Trust was making preparations to take control of the building in February 2020 prior to beginning to deliver services to patients from May 2020.

Members were apprised that the new hospital will be in addition to the existing Clatterbridge Cancer Centres in Wirral and Aintree and was part of the plan to bring ambulatory cancer care closer to home, alongside co-locating to an acute site for the sickest patients. The new hospital would provide inpatient cancer care for Cheshire & Merseyside as well as ambulatory cancer care for Liverpool. The move date for haemato-oncology in-patients to the new build was yet to be confirmed. Dr Bishop informed that it was estimated that around 90% of patients from Wirral and West Cheshire would continue to attend the Wirral site. Patients would only need to travel to Liverpool for inpatient care i.e. the more complex treatments, or if their treatment was part of an early-stage clinical trial. All outpatient chemotherapy would continue at Wirral, as well as radiotherapy for common cancers.

The satellite radiotherapy unit at Aintree would continue, with radiotherapy for common cancers and the specialist stereotactic radiosurgery service for brain tumours. Chemotherapy clinics at Aintree and other locations across Merseyside and Cheshire would also continue, as would out-patient clinics.

In response to Member questions, Dr Bishop informed that

staff, who came from all over the region, would be largely given choice of location to work and where not the case, travel plans were in the process of being established – to include car parking and a shuttle bus (also available to patients). Dr Bishop advised that parking arrangements were being made with the Royal – given the staff’s unsocial hours and shift working – she added that excess travel costs to staff would be covered as part  ...  view the full minutes text for item 30.

Elizabeth Hartley, Assistant Director Early Help and Preventionand Wendy Monnelly, Head of Service introduced their report that provided the Adult Care and Health Overview and Scrutiny Committee with an overview of provision to support children, adults and families affected by domestic abuse. The report set out the national and local context, described findings of an in-house review and outlined next steps to improve services and reduce the detrimental impact of domestic abuse on Wirral residents.

The report provided a detailed summary and statistical breakdown of the issue of domestic abuse in Wirral, with specific focus on the impact on families with children.

The Committee was also apprised of the National Impact and the positive impact of early intervention and dealing with the issue in one place.

The Assistant Director Early Help and Prevention informed Members of the departmental plan and findings of Ofsted Inspection, which had identified domestic abuse as a priority area. The Chair stated that she was pleased to see development of a strategy in this area but expressed concern that 85% of victims of abuse had been identified as having sought help 5 times from professionals.

The Assistant Director informed that there was limited access to the ‘perpetrator programme’ that must be self-funded by the perpetrator unless referred by the Court.

A Member commented that although the report focused primarily on the impact on children, domestic abuse also happened to adults. She questioned if there was an integrated front door arrangement for adults, with support and recognition of the problems. The Head of Service advised that specific training was being developed to help address the ‘5 time’ issue and 40% of high-risk victims of abuse reported mental health difficulties.

Further discussion took place with the Officers responding to questions from Members. 

The Chair clarified that future reports to theAdult Care and Health Overview and Scrutiny Committee should contain sufficient information on the progress and improvements to the service, and not just rely on statistical performance indicators.

Resolved – That

1)  the report be noted; and

2)  further reports be presented to the Adult Care and Health Overview and Scrutiny Committee on a quarterly basis to monitor progress and ensure improvement of services.

Julie Webster, Director for Health and Wellbeing introduced the Public Health Annual Report (PHAR) 2019, an independent annual report, and a statutory requirement. The PHAR had been considered by Cabinet at its meeting held on 30 September 2019 (minute 32 refers) and by Council at its meeting held on 14 October 2019 (minute 71 refers). The report informed that engaging with cultural activities had several positive benefits; it helped people to recover from illness, both physical and mental and helped preventing illness and keeping people well.

The 2019 Report, Creative Communities, explored the role of culture as a means of improving health and wellbeing, presented local examples of those bene?ts and called for everyone in Wirral to be part of a Borough of Culture legacy that left people happier and healthier.

The Adult care and Health Overview and Scrutiny Committee noted that the PHAR was an important vehicle to identify key issues, flag up problems, report progress and inform local inter agency action. The purpose of the PHAR was to draw attention to local issues of importance which had an impact on population health. Since the Council took back responsibility for Public Health in 2013 it had published five reports on:

• Social isolation
• Healthy schools and children
• Domestic violence
• The roles of the Council and NHS in promoting health and wellbeing
• Problem gambling

The Committee was informed that these reports had led to action in the reduction of people smoking in the Borough to levels below the national average; increased support for people who were feeling socially isolated plus significant activity across a range of partners to highlight and reduce the damage caused to local communities from alcohol abuse and gambling.

The 2019 Report sought to influence the developing narrative around social prescribing and how the Council engaged and worked with local people to support them to live healthier lives.

The Director for Health and Wellbeing informed Members of the strong relationship held between the Council and grass root organisations such as Age UK and Open Door and explained how Wirral’s tenure as ‘Borough of Culture’ had played a significant role as part of, and integral to, healthcare of residents.

A Member commented that in terms of public health she had been surprised that engagement in cultural activities had been the focus of this year’s annual report, and felt there should be more focus on poverty, housing, and age/health inequalities – all of which were significant issues that needed to be addressed and reported.

The Chair highlighted that there didn’t appear to be any reference to fuel / food poverty, and although not dismissing report, because there were benefits evident, she felt the annual report needed to report on and address such key issues as a priority.

A short discussion took place, with Members expressing views on such matters as a more ‘back to basics’ public health report – covering obesity, alcohol, housing, dental care, and vaccinations – with supporting data to be provided. Other issues raised by Members  ...  view the full minutes text for item 32.

Jacqui Evans, Assistant Director, Unplanned Care and Community Care Market Commissioning introduced her report that provided an update position for the Adult Care and Health Overview and Scrutiny Committee on the recent Better Care Fund (BCF) submission for Wirral, currently part of the regional and national assurance process, and intentions with regards planning for Winter 2019/20.

The report informed that Wirral continued to use the Better Care Fund (BCF) to drive integration and prioritises transformational change and development of services which ultimately improved patient outcomes, supporting the move to financial sustainability within an integrated system. Priorities directly support the planned and unplanned elements of the Council’s 5-year plan. The report further informed that the key focus had been on supporting the development of 7-day community intermediate and neighbourhood services which promote step up and step-down support, facilitating people remaining in their own homes as long as possible and mitigating the need for acute care.

Members noted that whilst the BCF had supported a fundamental shift in Wirral, with a stark reduction in the need for long term care (20% reduction in the past 2 years) and a 17% growth in domiciliary activity in the past 18 months, there remained challenges in some areas, notably Length of Stay (LOS) in acute and community bed-based settings.

The report also informed that work was well underway to improve pathways and strengthen Wirral’s community services to reduce the numbers of people attending the Emergency Department (ED) and being admitted. The BCF was seen as core to system priorities, supporting the new 2019/20 requirements with a focus on Same Day Emergency Care (SDEC) and reducing the numbers of long stay patients.

The Assistant Director, Unplanned Care and Community Care Market Commissioning updated the Adult Care and Health Overview and Scrutiny Committee on key elements of her report, and outlined the key challenges faced by the BCF in the coming months.

Members questioned the Assistant Director in detail on areas such as system sustainability, access to mental health service provision, funding allocations and general levels of service provision in areas of deprivation, and specific details regarding additional GP appointments and the management thereof.

The Assistant Director responded accordingly but highlighted the workforce challenges faced in Wirral and successes in avoiding high numbers of hospital readmissions, with 85% of people remaining at home 91 days after discharge.

The chair thanked the Assistant Director, Unplanned Care and Community Care Market Commissioning for her report.

Resolved – That the report be noted.

The Director of Adult Care and Health introduced his report that provided the 2019/20 Quarter 2 (July – September 2019) 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 2 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 3 key areas:

• Older People Live Well
• People with Disabilities Live Independent Lives
• Zero Tolerance to Domestic Violence

The Director of Adult Care and Health reported success in some areas, and a satisfactory ‘flat’ response in the majority of areas – based on survey results undertaken during the period in question.

The Chair provide a brief update to the Committee on the outcome of a workshop session that had been held since last meeting.

Resolved – That the report be noted.

The Chair introduced the report of the Head of Intelligence, Statutory Scrutiny Officer that provided an overview of the Health and Care Performance Panel meeting held on 9 October 2019 and 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 included updates on the following key items, namely:

• All Age Disability and Mental Health Service Update – provided by Jason Oxley, Assistant Director Health and Care Outcomes.
• Park House Improvement Plans Update and Care Home Complaints.

The Chair informed the Adult Care and Health Overview and Scrutiny Committee that options for improving performance and contract compliance in Care Homes and review of Health and Care providers was to be scheduled as a matter for consideration by the Committee under its work programme, to be reviewed in terms of a revisit of past recommendations.

Resolved – That the report be noted.

The Chair 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 16 September 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 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 remainder of the 2019/20 municipal year was attached as Appendix 1 to the report. The report also contained a list of topics for future consideration, work programme activities with suggested dates / deadlines.

A Member requested that the Urgent Care Transformation Update be brought forward from its scheduled March slot to be considered by the Adult Care and Health Overview and Scrutiny Committee at its January 2020 meeting.

The Chair also expressed concern over budget scrutiny and suggested that a provisional date be agreed for the Committee to consider this matter at a special meeting in also in January 2020.

Subject to the above suggested amendments to the scheduled Work Programme, it was:

Resolved – That the report be noted.