Agenda and minutes

Apologies for Absence were received from Councillors D Flude, A Knowles and J Wray.

M F Flynn, Legal and Democratic Services

D J French, Legal and Democratic Services

P Lloyd, Head of Services for Adults

F Field, Director of Governance and Strategic Planning, Central and Eastern Cheshire Primary Care Trust

P Ferguson, Deputy Director of Service Development, North West Ambulance Service (NWAS)

C Hall, Assistant Director Foundation Trust Delivery, NWAS

S Smith, Assistant Director Corporate Communications, NWAS

The Vice Chairman, Councillor Gordon Baxendale, referred to the sad death on 6 September of Councillor Allan Richardson.  Councillor Richardson had been the Chairman of the Committee and had been a long standing Councillor representing the needs of his local community for more than 60 years.

All present stood for a minute’s silence in memory of Councillor Richardson.

To provide an opportunity for Members and Officers to declare any personal and/or prejudicial interests or members to declare the existence of a party whip in relation to any item on the agenda.

There were no declarations made.

In accordance with Procedure Rules Nos.11 and 35 a total period of 10 minutes is allocated for members of the public to address the Committee on any matter relevant to the work of the Committee.

Individual members of the public may speak for up to 5 minutes but the Chairman will decide how the period of time allocated for public speaking will be apportioned where there are a number of speakers.

Note: In order for officers to undertake any background research it would be helpful if questions were submitted at least one working day before the meeting.

Mrs Hughes asked a question relating to future health care provision in Scholar Green and the likelihood of the proposals for new health care premises to progress and the implications for local residents if the existing premises and provision were to remain.

Fiona Field, Director of Governance and Strategic Planning, Central and Eastern Cheshire Primary Care Trust undertook to provide Mrs Hughes with a written answer.

To approve the minutes of the meeting held on 29 July 2009.

RESOLVED:  That the minutes of the meeting of the Committee held on 29 July be approved as a correct record subject to an amendment to the portfolio holder title for Councillor R Domleo to read Portfolio Holder for Adult Services.

To receive a presentation from the North West Ambulance Trust on various matters including:

      The Foundation Trust application;

      Update on Community First Responders and Co-responders Scheme;

      Response times.

The Vice Chairman welcomed the following representatives of the North West Ambulance Service (NWAS) to the meeting:

      Paul Ferguson, Deputy Director of Service Development

      Carol Hall, Assistant Director Foundation Trust Delivery

      Sarah Smith, Assistant Director Corporate Communications.

The representatives briefed the Committee on various current issues that related to the Ambulance Trust:

Taking Healthcare to the Patient – this was a Department of Health initiative to transform ambulance services.  There were a number of strands:

      Call Connect – this was designed to improve the speed of responses and NWAS had invested in Emergency Control Centres, increased staffing levels especially call handling staff, improved technology and increased the levels of front-line operational resources.  There was now a performance target for Emergency Response times that was measured from the time that the 999 call was connected.  The target was that 95% of calls were answered within 5 seconds, NWAS reported that more patients were receiving a response within target;

      Hear and Treat – this had led to increased use of paramedic assessment for minor calls within Emergency Control Centres, an Advanced Paramedic Role had been developed, an alternative call categorisation and prioritisation system had been developed (NHS Pathways), a Regional Operational Control Centre had been established to oversee operations such as monitoring activity levels and service pressures and a new Operational Support Control Centre had been introduced in Carlisle;

      See and Treat – a Clinical leadership programme had begun and higher education programmes introduced for existing and future paramedics; 42 new Advanced Paramedics had been recruited, Care Pathways had been improved for Heart Attack and Stroke patients in line with clinical networks and a capacity management/health control system had been developed in partnership with Primary Care Trusts (PCTs) to assist in directing patients to appropriate care.

P Ferguson then briefed on performance in relation to Central and Eastern Cheshire PCT.  He explained that NWAS had shown consistent Category A8 and A19 performance despite a continuous increase in 999 call volume.  This had been due to the introduction of Call Connect.  The overall Category A performance for the PCT was 66.5% with the overall NWAS performance being 74.8%.  A Performance Improvement Plan had been developed in conjunction with the PCT and a number of challenges identified including growth in activity and hospital turnaround times.

S Smith briefed on the unannounced inspection by the Care Quality Commission (CQC) in July of the NWAS infection control procedures.  The CQC had issued NWAS with a warning notice on cleanliness followed by an inspection report outlining specific areas where the Trust had to make improvements.  A number of measures had been put in place including identifying Infection Control Champions (from among existing staff), the recruitment of a Specialist Paramedic of Infection Control and £100,000 investment into deep cleaning of vehicles.  A number of actions were planned including an audit of vehicles for cleanliness, a deep clean of all vehicles by end of September 2009, an increased and regular programme of deep cleaning of ambulances  ...  view the full minutes text for item 18.

To consider a report of the Strategic Director People on the issues and recommendations arising from the recent visit of the National Support Team in relation to Teenage Pregnancy in Cheshire East.  This report is also on the agenda for the meeting of the Children and Families Scrutiny Committee on 14 September 2009.

The Committee considered a report of the Strategic Director People on issues that had arisen from the visit of the National Support Team following sustained underperformance in the reduction of teenage pregnancy rates across Cheshire. 

Lorraine Butcher, Head of Services for Children and Families, explained to the Committee that the Government’s Teenage Pregnancy Reduction Strategy 1998 had set a target for Local Authorities to reduce by half the numbers of conceptions among under 18 year olds by 2010.  In Cheshire the rate had not reduced by a sufficient amount.  Under 18 conceptions were focused in small geographical areas with the pattern of conception being significantly greater than would be expected in these areas indicating that deprivation was only one of a number of responsible factors.  Such “hot spot” areas had historically received prevention services but rates had remained steady or increased.  Some areas had shown high levels of single or repeat terminations and there was concern for vulnerable groups such as care leavers. 

The National Support Team had produced a formal report after the visit with the key recommendations being:

      An Executive Board to be developed and chaired by the Directors from the Council and the Primary Care Trust to lead, drive forward and performance manage the teenage pregnancy prevention strategy;

      A Senior Strategic post be recruited to the Council to lead on teenage pregnancy prevention – this was funded by Government grant;

      As part of the Children’s Trust arrangements, data should be disseminated in an accessible and relevant format by all and between all partners, to better inform planning, targeting and performance management of the strategy;

      The Council and PCT communications leads to be responsible for the urgent development of a Teenage Pregnancy Communication Strategy and Action Plan;

      There should be an explicit and detailed young people’s Sexual Health Needs Assessment to inform the design and delivery of young people’s contraception and sexual health services as part of a strategic commissioning plan;

      There should be a radical overhaul of current Contraceptive and Sexual Health (CASH) provision to ensure it meets young people’s needs.

During discussion of the report the following issues were raised:

      The data was always out of date by about 14 months so it was difficult to immediately assess the impact of any preventative measures;

      The Teenage Pregnancy rate was based solely on age and did not take into account marital status as evidence showed that outcomes were poorer for children of Teenage Parents;

      Sex education was to be compulsory in secondary schools from September 2010.  It was thought to be more effective if delivered by young people, school nurses and school health advisors rather than teachers and there was some evidence to suggest that relationship and sex education was effective during Primary School;

      For some young people, teenage pregnancy was a deliberate choice and it was important to take into account aspirations of young people when considering strategies to address the issue.

RESOLVED:  That the recommendations made by the National Support Team as listed above  ...  view the full minutes text for item 19.

At the last meeting of the Committee on 29 July 2009, Members received a copy of the Central and Eastern Cheshire Primary Care Trust (PCT) Healthcare Sustainability Plan.  The Plan showed how the PCT would respond to a number of significant financial challenges during the current year.  Members were briefed on the Plan and given the opportunity to ask questions.

Fiona Field, Director of Governance and Strategic Planning at the PCT, will be present at the meeting to update the Committee further on the Strategic Plan and additional redesign proposals in East Cheshire.

Fiona Field, Director of Governance and Strategic Planning, Central and Eastern Cheshire PCT, updated the Committee on the current position with the PCT Healthcare Sustainability Plan.  Members had received a full briefing to the previous meeting on the Plan and had received a copy of the Plan itself.  The Committee was advised that the Plan was delivering the savings anticipated but the PCT was still in a challenging financial position. 

Financial agreements were in place with the two Acute Hospital Trusts and there were regular consultations between the PCT and the Hospital Trusts regarding commissioning of services.  The Knutsford project was to go out to consultation shortly with Congleton early in 2010.  Fiona Field agreed to check the position with the Congleton project in the event of a General Election being called during the consultation period.

RESOLVED:  That the update report be noted.

The Committee has been receiving regular updates on the situation regarding Pandemic Flu. There has been a national decline in cases of Swine Flu but the Department of Health has advised there could be a mini peak this month.

Fiona Field, Director of Governance and Strategic Planning at Central and Eastern Cheshire Primary Care Trust, will verbally update the Committee on the latest position in relation to Pandemic Flu.

Fiona Field, Director of Governance and Strategic Planning at Central and Eastern Cheshire Primary Care Trust (PCT), briefed the Committee on the current position with Pandemic Flu. 

She explained that within the PCT patch there were 34 Anti Viral Collection Points as a number of Community Pharmacists were now offering this service.  The number of cases of Pandemic Flu was now decreasing and to date 4000 doses of anti viral medication had been issued within the PCT patch.  It was expected that there would be a second wave during the Autumn/Winter.

The programme of mass vaccination was likely to begin around Christmas time with certain groups of people being classed as a priority:

      Pregnant women;

      People with chronic illnesses;

      Those who were front line staff in health and social care.

The vaccination would comprise two injections given a certain length of time apart.

The PCT would be seeking venues in which to offer the vaccination as primary care premises would not be adequate for the large numbers of people attending.  It was also important to try to make arrangements for people who worked during the day so as to minimise disruption.

The Committee was advised that the United Kingdom had a good track record of thorough testing of drugs and the only known reaction to the vaccination was soreness in the arm that received the injection.

RESOLVED:  that the update report be received.

To consider a report of the Strategic Director People on some of the dimensions of the Think Family agenda and how this agenda might be taken forward by Cheshire East Council and by the whole system in Cheshire East.  This report is also on the agenda for the meeting of the Children and Families Scrutiny Committee on 14 September 2009.

The Committee considered a report of the Strategic Director People on the Think Family agenda which had been one of the Big Ideas underpinning the proposals for establishing two new Unitary Authorities in Cheshire.  The Big Idea had a number of strands:

      It was felt that the organising principles often used by Councils when setting up departments were artificial and irrelevant;

      There was an ambition to bring services together not on the basis of the ideas of the professionals but on the basis of experiences and perceptions of the people who use those services;

      In particular, it was believed that a fundamental experience of most people is that of being or having been part of a family.

When adopting a Think Family approach it was important to use “family” in an embracing and inclusive way that embraced families of every sort.  Think Family could be seen as an aspiration whereby the Council would not respond to people’s needs in a narrow way but rather would put services together in ways that reflected people’s lives. 

The report outlined a practical example of a Think Family approach – the People Directorate had submitted a bid in the context of the National Dementia Strategy, to become a Demonstrator Site for the development of Peer Support Networks.  Part of the Pilot would be about seeking involvement of grandchildren and great-grandchildren in Networks to enable greater understanding of what is happening to their relative, respond in appropriate ways and retain positive feelings and memories of their relative.  The experience of continued contact with children and young people would also be positive for a person with dementia.

The Appendix to the report listed a number of Think Family issues including Obesity whereby good work could be done in school but it was important to also focus upon the family environment.  

RESOLVED:  That the report be received and the Think Family approach be supported.

To consider a report of the Strategic Director People on the Care and Support Green Paper. 

The Committee considered a report on the Government’s Green Paper “Shaping the Future of Care Together”.  The Green Paper essentially addressed two large matters:

      The nature of the system for delivering care and support.  The Government recommended the development of a National Care Service in England which would ensure a consistent approach to standards and quantity of care and support in England.  Within this were two options for either a fully National Service whereby Central Government decided how much funding an individual should receive and a mixed services whereby a division of responsibility was maintained between local and Central Government;

      The funding for the system for delivering care and support.  Five funding models were set out in the Green Paper of which two the Government was inclined to discard as unaffordable.  The remaining three models upon which views were invited were the Partnership Model, Insurance Model and Comprehensive Model.  The Partnership Model would mean a guaranteed minimum of every individual’s care costs paid for by the State (regardless of income) with the remainder of costs met by the individual (subject to their means); the Insurance Model was an extension of the partnership model with the option of additional care costs covered through insurance; and the Comprehensive model requiring everybody over retirement age to pay into a state insurance scheme.

The report outlined the implications of a fully national system which it was felt would undermine what was the traditional role of the Local Authority to assess needs and commission services to meet them.  There was also a risk of raising public expectations about what every adult ought to get as a result of reform of the care and support system but if resources were not made available and difficult changes not pushed through, there was a risk of serious disappointment.

During discussion of the item Members welcomed the personalisation and consistent approach within the proposals and hoped the intended support to carers would materialise.

RESOLVED:  that the Cabinet be advised that this Committee:

      Welcomes the emphasis which the Green Paper gives to prevention and early intervention, believing that a sustainable future for Adult Social Care in Cheshire East will depend upon such an approach.

      Welcomes the encouragement given to joining up services, recognising that within Cheshire East significant work is under way on that agenda.

      Welcomes the commitment expressed to pushing forward the development of personalisation, noting that Cheshire East is already well advanced with the task of extending greater choice and control to people.

      Welcomes the ambition to achieve greater consistency, but deplores the idea of establishing a fully National system.

      Recommends that further consideration should be given to the development of a compulsory insurance model, built around a state based insurance scheme.

      Welcomes the attention given to the needs of carers, on the basis that investment in supporting informal carers will be crucial to the future of Cheshire East’s Adult Social Care Services.

      Urges that in the development of thinking about the future funding of care and  ...  view the full minutes text for item 23.

To consider a report of the Borough Solicitor on the Work Programme.

The Committee considered a report on progress with items identified for the Committee’s Work Programme.  A number of items had been progressed and regular updates were to be submitted to the Committee by North West Ambulance Services and on Social Care Redesign and Safeguarding of Adults.

The Committee considered the Action Plans arising from two of Cheshire County Council’s Scrutiny Reviews relating to Tackling Obesity and Tackling Diabetes and considered whether any further Scrutiny work would be appropriate.

Members noted the criteria against which any potential Scrutiny issues should be assessed.

RESOLVED:  That

(a) a Task/Finish Panel be established to undertake a Scrutiny Review of Diabetes and Obesity based on a 4:1:1:1 basis and a Scoping Report be submitted for consideration to the Mid Point meeting;

(b) a presentation be made to a future meeting on Diabetes; and

(c) a Scoping Report be submitted for consideration to the Mid Point meeting on a possible Scrutiny Review of Community Support Transport related matters.