Agenda and minutes

Councillor R Domleo, Portfolio Holder for Health and Well-being and Councillor A Thwaite (substitute).

P Lloyd, Head of Services for Adults,

M Flynn, Legal and Democratic Services,

D French, Legal and Democratic Services,

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

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.

There were no Members of the Public present who wished to address the meeting.

To approve the minutes of the meeting held on 20 May 2009.

RESOLVED:  That the minutes of the meeting of the Committee held on 20 May be approved as a correct record.

The Joint Scrutiny Committee established by the Councils of Cheshire East/Cheshire West and Chester/Metropolitan Borough of Wirral had its first meeting on 7 May.  The role of the Committee is to scrutinise the work of the Cheshire and Wirral Partnership NHS Trust – the provider of mental health, learning disability and drug and alcohol services across Cheshire and Wirral.

The minutes of that meeting are attached for the Committee’s information.

The Committee was informed that the Joint Scrutiny Committee set up by Cheshire East Council, Cheshire West and Chester Council and Wirral Metropolitan Borough Council had held its first meeting on 7 May and the minutes of the meeting were submitted for information. 

The Committee’s role was to scrutinise the work of the Cheshire and Wirral Partnership NHS Trust – the provider of mental health, learning disability and drug and alcohol services across Cheshire and Wirral.  The Committee had  also received a detailed briefing session on 18 June followed by a visit to one of the Trust’s facilities at Bowmere Hospital, Chester.  The next meeting of the Joint Scrutiny Committee had been arranged for 8 October.

RESOLVED:  That the minutes of the meeting of the Joint Scrutiny Committee held on 7 May be received.

Central and Eastern Cheshire Primary Care Trust (PCT) have produced a five year Strategic Plan.  The Plan focuses on ten outcomes that contribute to the ambition of the PCT to:

“work with others to achieve sustainable improvements in health and well-being of the population and to reduce inequalities of health”.

The Strategic Plan is attached for Members’ information and comment.  Fiona Field, Director of Governance and Strategic Planning at the PCT, will be present at the meeting to introduce the Plan and answer any questions.

Fiona Field, Director of Governance and Strategic Planning at Central and Eastern Cheshire Primary Care Trust (PCT) briefed the Committee on the PCT’s Commissioning Strategic Plan 2009 – 2014.  She explained that it was a requirement of the Department of Health that each PCT produce such a plan and that the version submitted to the Committee was a revised version of the plan originally written in October 2008; it was to be revised again in the near future.

The Plan outlined the strategic ambition of the PCT which was “to work with others to achieve sustainable improvements in health and well-being of the population and to reduce inequalities of health”.  There were eight local outcomes which related to areas where the PCT was struggling to achieve against targets or where performance was lower than expected which related to the following areas:

      Breastfeeding;

      Dignity and Respect for All;

      Transforming Urgent Care Services;

      Alcohol Harm Reduction;

      Cancer mortality;

      Stroke;

      Mental Health;

      Chronic Heart Disease.

There were also two National Outcomes which applied to every PCT relating to reducing health inequalities and improving life expectancy.  The Committee was advised that across Central and Eastern Cheshire PCT’s patch there was a difference in life expectancy of 13 years.

During discussion of the item the following issues were raised:

      Teenage Pregnancy – it was noted that the National Support Team had visited Cheshire East and a report on findings would be submitted to the Council shortly;

      Dementia services – a programme had been devised to ensure early diagnosis and improved quality of care and it was important to focus on services not buildings;

      The focus on Dignity and Respect for All was welcomed and that simple measures could make a difference such as calling older people by their title and surname rather than by their first name;

      The use of mystery shoppers and patient groups was a useful way of seeking views on services.

RESOLVED:  That the Commissioning Strategic Plan 2009 – 2014 be received and the outcomes supported.

A Care and Support Green Paper has been published and is part of the Government’s Ageing Strategy.  The attached briefing note has been produced by the Local Government Association and the Strategic Director People will verbally update the Committee on the main proposals in the Green Paper.

The Committee received a briefing produced by the Local Government Association on the Government’s Green Paper on the Care and Support of Disabled and Older People.

The Paper proposed the establishment of a National Care Service and sought views on a number of options for funding care and support in future, namely whether funding should be organised nationally or whether there should continue to be a partnership between central government and local government.

A full report on the Green Paper would be submitted to the next meeting of the Committee and the Committee would be invited to submit comments to the Cabinet who would be responding to the Green Paper on behalf of the Council.

RESOLVED:  That the report be noted.

The Central and Eastern Cheshire Primary Care Trust (PCT) has produced a Healthcare Sustainability Plan 2009/10.  The Plan shows how the PCT will respond to a number of significant financial challenges during the current year.  The challenging financial position has arisen mainly as a result of purchasing increased levels of acute hospital activity and also increased expenditure on NHS Continuing Care.  The Plan sets out a sustained focus on finances while delivering improved quality through innovative solutions in all areas of healthcare.

The Plan is attached for Members’ information and comment.  Fiona Field, Director of Governance and Strategic Planning at the PCT, will be present at the meeting to introduce the Plan and answer any questions.

Fiona Field, Director of Governance and Strategic Planning, at the Central and Eastern Cheshire Primary Care Trust, briefed the Committee on the PCT Healthcare Sustainability Plan 2009/10.  She explained that the PCT had a statutory responsibility to balance its budget and, although the PCT had inherited a deficit when it first came into being, it had maintained a balanced budget ever since. 

The PCT was now facing financial difficulties due mainly to the significant increases in levels of activity in secondary health care and also the increased amount of NHS Continuing Care provided.  The PCT’s current financial situation was not due to the national credit crisis.

The PCT had developed the Sustainability Plan with the intention that it would not be a “quick fix” but a sustained focus on finance, with a series of principles adopted in setting the 2009/10 budget:

      The budget was set at a balanced position with a small surplus as required by the NHS;

      All contracts with key providers had been agreed and signed off and activity agreed at the outturn (ie end of last year’s position);

      No further growth in activity above the 2008/09 level had been assumed;;

      The full estimated impact of Payment by Results had been included;

      Inflation had been added to all contracts;

      Funding for new developments had been kept to a minimum and only included the Elmhurst intermediate care facility, national specified costs to Specialised Services and the costs of the Leighton Hospital Urgent Care Centre;

      A reduction in some budgets including prescribing and PCT infrastructure costs.

The Plan set out a number of specific cost reductions that the PCT was confident would ensure services could be delivered and improved within allocated resources.  However, there was a Contingency Plan setting out changes that could be implemented if further budget savings were required.  A number of the proposed changes would require a notice period and formal consultation.

During discussion of the item the following issues were raised:

      The reduction of high cost out of area placements was welcomed;

      The reduction in contract cleaning hours related to the PCT’s offices only;

      Reduction in prescriptions would be achieved by the introduction of an IT system whereby GP’s attention would be drawn to cheaper alternative drugs that had the same outcomes;

      The proposed new premises at Scholar Green would not progress at the moment;

      The pilot Joint Equipment Retail service with the Local Authority was to be evaluated to assess its effectiveness in view of the increased costs of the service.

RESOLVED:  That the PCT Sustainability Plan be noted.

To consider a report of the Borough Solicitor on a project underway by Central and Eastern Cheshire Primary Care Trust on a redesign of beds outside of hospitals in Knutsford and Congleton. 

The Committee considered a report on the PCT’s proposals relating to redesigning services in Knutsford and Congleton.  The County Council had established a Task/Finish Panel to look into the proposals and it was recommended that a Panel be re-established to continue considering the redesign. 

The Committee was advised that Developers had been appointed for both the Knutsford and Congleton projects but sites had not been agreed.  However, the continuation of the projects was dependent on the PCT financial situation as the Sustainability Plan had identified the suspension of this project as part of its contingency proposals.

RESOLVED:  That a Task/Finish Panel be established to consider the proposals relating to the redesign of services in Knutsford and Congleton based on 6 Members on a 4:1:1 basis.

The Committee will be aware that Swine Flu has now been rated as a pandemic.  This is on the basis that the virus has spread globally. 

The Health Protection Agency has advised that the UK has now moved to a treatment phase to manage the current flu outbreak.  As a result GPs will diagnose cases on the basis of clinical observation rather than laboratory testing.  Everyone who has flu-like symptoms will be assessed by a doctor and if diagnosed with swine flu will be given antivirals to manage their illness.

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.

The Committee received an update on the current position relating to the flu pandemic.

Three antiviral collection centres had now been identified or set up in Cheshire East – Universal House, Middlewich (the PCT headquarters), Crewe (either the Oaklea Centre or Meredith Centre) and the Senior Citizens’ Centre, Macclesfield.  The PCT had worked with the Council regarding identifying suitable sites as it was not possible to use hospital or primary care facilities due to the increased risks of spreading infection.  All users of the Senior Citizens Centre had been consulted and alternative venues found for them to use.  There were also a number of Community Pharmacies issuing antiviral medicine.

It was not possible to confirm actual cases of Swine Flu as patients were no longer swabbed, the numbers of people issued with antiviral medicine at the centres in Middlewich and Macclesfield together with Community Pharmacies totalled 3362 at 28 July 2009.

A National Flu Helpline had been set up on 23 July where people who suspected they had swine flu could be taken through their symptoms, issued with a reference number which a “flu friend” could then take to a collection centre to collect medicine on their behalf.  

A Swine Flu vaccine was being developed in preparation for a mass vaccination programme to start in Autumn, with high risk groups targeted initially.  The vaccine would be given in two parts, 3 weeks apart.  The ordinary winter flu vaccine programme would continue as usual. 

RESOLVED:  That the update on Pandemic Flu be received and noted.