Agenda and minutes

Councillor R Bailey, Cheshire East Council;

Councillor R Wilkins, Wirral Council (substitute Member)

The Chairman referred to the recent sad death of Councillor Allan Richardson of Cheshire East Council, who was a Member of this Committee.

Councillor Dorothy Flude paid tribute to Councillor Richardson and made particular mention of his helpful nature and dedication to the role of Overview and Scrutiny.

To provide an opportunity for Members and Officers to declare any personal and/or prejudicial interests in any item on the agenda

RESOLVED:  That the following declarations of interest be noted:

      Councillor D Flude, Personal Interest on the grounds that she was a Member of the Alzheimers Society and Independent Advocacy;

      Councillor P Lott, Personal Interest on the grounds that she was a Member of the Local Involvement Network; and

      Councillor D Roberts, Personal Interest on the grounds that her daughter was an employee of the Cheshire and Wirral Partnership NHS Foundation Trust.

To approve the minutes of the meeting held on 7 May 2009 as a correct record.

RESOLVED:  That the minutes of the meeting of the Committee held on 7 May be confirmed as a correct record.

To consider a report on proposed Procedural Rules for the operation of the Joint Scrutiny Committee.

The Committee considered a report setting out draft Procedural Rules for consideration.

The Procedural Rules covered various matters including membership and co-option, arrangements for Secretarial and Proper Officer support, quorum, Work Programme and urgent business.  The Rules proposed that the Chair and Vice Chair should be appointed annually and the authority that did not hold either of these positions should nominate a Spokesperson. 

During discussion of the item Members discussed the importance of ensuring that the Committee received regular updates outlining the impact of any proposals on service users, carers and staff.  The Committee also requested an update on the impact of the Talking Therapies programme which the Committee had received an earlier briefing on.  The Committee also felt that consideration should be given to changing the name of the Committee so that it was clearly understood what the Committee was scrutinising.

RESOLVED:  That

(a) the Procedural Rules as submitted be approved and adopted subject to a minor amendment under the heading of Work Programme to clarify that the Work Programme is a rolling programme;

(b) the Procedural Rules, as amended, be submitted to the three constituent Councils;

(c) consideration be given at the next meeting to amending the name of the Committee to reflect more clearly the role of the Committee; and

(d) an update report be submitted to the next meeting on the Improving Access to Psychological Therapies scheme.

Ian Davidson, Interim Chief Executive of the Cheshire and Wirral Partnership NHS Foundation Trust, will verbally update the Committee on the following matters:

      The impact of the current financial climate;

      Emergency management action undertaken in relation to Bollin Ward, Macclesfield;

      Learning Disability Supported Housing Network – transfer of contract to three providers for Congleton, Macclesfield and Central Cheshire/Knutsford;

      Consultation by the Partnership Trust and the Primary Care Trusts in relation to the eligibility criteria for health respite care;

      Current developments – Greenways, Macclesfield, new build at Wirral and relocation of alcohol services in Wirral.

The Committee considered a verbal update report from Dr Ian Davidson, Interim Chief Executive of the Cheshire and Wirral Partnership NHS Foundation Trust on the following matters:

Impact of the current financial climate

Ros Preen, Director of Finance, briefed on the current financial position.  She explained that Foundation Trust status had been successful for the Trust for various reasons in that it had enabled investments to be made, enabled greater engagement through membership, greater focus on longer term planning and contracts that were “legally” binding. 

There were a number of key financial drivers impacting on the Trust including an on-going driver for efficiencies and a reduction in resources for the Health Services.  It was also important to note that Payment by Results did not apply to mental health and that the service was very staff intensive, more so than in the acute sector. 

The Trust was planning efficiency savings but it would not be possible to meet these by back office savings alone.  There were increasing costs in meeting continuing care needs and specialist services.  Commissioners’ funding issues would impact on providers who would be expected to show increasing Value for Money with a risk that funding could be reduced.  The Trust would need to respond quickly in such cases.

Dr Davidson explained that demand for the Trust’s services had increased due to the growth in the older person’s population, with two major mental health issues affecting older people – dementia and depression.  For most people care in their own home was most appropriate with support from community services but some would need hospital provision so it was important to have the correct mix of both types of care.

He outlined that 2 of the Primary Care Trusts that were major commissioners of the Trust’s services were currently in financial balance – Wirral and Western Cheshire – but Central and Eastern Cheshire PCT was predicting a financial overspend if remedial action was not taken and had devised a Sustainability Plan to address the financial situation.  As a result of these difficulties the Central and Eastern Cheshire PCT had advised the Trust that they would not be able to pay £1m previously agreed and this was currently under discussion between the PCT and the Trust.

The Trust did not own buildings nor was it given rental funding.  Commissioners would determine a Mental Health Programme Budget and would then commission services from the Trust and other providers. 

Emergency Management Action

Dr Davidson briefed Members on a Trust Board decision to temporarily close Bollin Ward, Macclesfield Hospital.  This was due to the Trust spending more on delivering mental health services in Central and Eastern Cheshire PCT than it received in income from the PCT.  The level of funding from the PCT had been an issue for several years and the PCT was committed to resolving this but in the meantime the Trust could not afford to overspend alongside the efficiency savings it was required to make.  The closure of Bollin Ward was  ...  view the full minutes text for item 10.

To consider a report of the Cheshire and Wirral Partnership NHS Foundation Trust.

The Committee considered a report on a Substantial Development or Variation in Service relating to reconfiguring services in Central and East Cheshire.  The reconfiguration was part of efficiencies to enable services to be provided in the most cost efficient way with no reduction in service to users and carers.  The proposals were not finalised but were likely to involve reconfiguration of beds in Central and Eastern Cheshire and Wirral.  However consultation would involve the whole area as any proposals would need to be considered across the whole of the Trust’s patch.

At this stage the proposals involved providing a separate ward on Wirral for service users with eating disorders by taking those adult beds out of Croft Ward on Macclesfield.  Currently Croft Ward had beds both for adults with eating disorders and older people with a functional mental illness, this mix was against best practice.  Removing the eating disorder beds would mean Croft Ward would not be viable.  There were two other small bedded wards for older patients with organic illness.  This provision of three older people’s wards across two sites meant there was little joint learning and development across older people’s wards.  It was proposed to manage all older people’s services in Central/East Cheshire in Crewe using two ground floor wards.  This would enable the provision of better accommodation and ensure that staff with specialist skills were co-located.  

Three adult wards were proposed in Central and East Cheshire – one in Crewe and two in Macclesfield.  The total number of beds in Central and East would be 84.

Alongside the reconfiguration, a new model of care was to be introduced called the Acute Care Model.  This model allocated one consultant to manage all inpatients, with other consultants concentrating on the majority of service users who lived in the community.  This would enable inpatients to see the consultant on a daily basis and benefit from increased access to senior clinical staff.  This model was already in operation in Wirral and West Cheshire and service users and carers were pleased with the increased availability of a consultant psychiatrist.

It was proposed that the changes be consulted on alongside proposals relating to inpatient reconfiguration in Central and Eastern Cheshire and would include four public meetings.

RESOLVED:  That the consultation process be endorsed and the proposals supported.

To consider a report of the Cheshire and Wirral Partnership NHS Foundation Trust.

The Committee considered a report on a Substantial Development or Variation to Service relating to the reconfiguration of Adult and Older Persons Mental Health Inpatient Services in Central and Eastern Cheshire.  The consultation would cover three key issues:

·        The need to invest to make significant improvements in the inpatient environment to meet current standards;

·        The proposal to provide all Adult and Older Persons inpatient Mental Health services from a single site;

·        The introduction of new ways of working which would see further investments in community based services and as a consequence a reduced requirement for inpatient beds.

The background to the proposal included:

·        A need to improve environmental standards, including single bedrooms and appropriate therapeutic and day care facilities;

·        Provide a specialist inpatient unit of sufficient critical mass with highly trained and well motivated staff to ensure consistent high standards of nursing and medical care;

·        Develop a plan in response to the requirement to vacate the Mental Health unit at Leighton for which the Trust had been served notice to vacate by Spring 2012.

Both the Strategic Health Authority and National Clinical Advisory Team had reviewed and supported the proposals.

The Trust and Central and Eastern Cheshire Primary Care Trust were proposing to undertake a full public consultation exercise from December 2009 – March 2010.  The PCT Board was to consider the consultation shortly.

RESOLVED:  That the public consultation process to date be noted and endorsed, subject to the Central and Eastern Cheshire PCT Board agreeing to proceed to the next stage of public consultation, the relevant Overview and Scrutiny Committees of Cheshire East and Cheshire West and Chester Councils be requested to consider the proposals as a Substantial Development or Variation in Service – Level 3 to be dealt with, if possible, at a joint meeting.

To consider a report of the Cheshire and Wirral Partnership NHS Foundation Trust.

The Committee considered a report on a Substantial Development or Variation in Service regarding the transfer of the Assertive Outreach function from separate teams to within Community Mental Health Teams. 

The Trust currently had four Assertive Outreach Teams who provided a service for service users who were hard to engage.  They were separate from Community Mental Health Teams (CMHTs) who were the cornerstone of community based mental health services and acted as a single point of access for secondary care.  Low use of hospital beds was seen as a measure of good CMHTs - within the Trust inpatient admissions were managed successfully in fewer than the national average beds.  Service users who required intensive case management were referred from CMHTs to Assertive Outreach Teams.  This transfer could cause disruption and uncertainty to service users and carers at a time of increased risk and was an inefficient way of working with duplication of assessment and paperwork.

It was therefore proposed to integrate the Assertive Outreach function into CMHTs, detailed work had been undertaken to ensure capacity and resource would be available to support service users.

Consultation would be undertaken with a range of stakeholders and including any service users or carers directly involved with the current service.  Subject to the results of the consultation, the change would be implemented in December 2009.

RESOLVED:  That

(a) the proposal be confirmed as a Level 2 change;

(b) the proposals and consultation process be supported: and

(c) a report be submitted to the Committee early in the new year with initial feedback on the impact of the proposals and the outcome of the consultation and a further report be submitted approximately six months after implementation listing financial impact and impact on service users and carers.

To consider a report of the Cheshire and Wirral Partnership NHS Foundation Trust.

The Committee considered a report on the development of the Soss Moss site, Nether Alderley, near Macclesfield.  The proposal was to build an additional 15 bed low secure unit for mental health or learning disability services as a first stage to the redevelopment of the whole site.  The proposals had been shared with local residents and the Parish Council who supported the proposals.

RESOLVED:  That:

(a) the proposals be confirmed as a Level 2 change; and

(b) the proposed redevelopment be supported.