Decisions

The Assistant Director (Legal and Democratic Services) submitted a report to provide members with details of proposals to introduce common, minimum standards for Private Hire and Hackney Carriages Vehicles, Drivers and Operators licensed by Licensing Authorities across Greater Manchester (GM).  The report set out proposals to consult across GM on the proposed GM minimum standards.

The proposed minimum standards relate to the four key areas identified by GM Licensing Network Group and aim to raise standards across GM with a view to a more consistent approach to taxi licensing across the region.

TfGM will host the GM minimum standards consultation on behalf of all GM Licensing Authorities and will procure an outside agency to do the analysis of responses.

It was agreed:

1.   To note the contents of the report.

2. To authorise a consultation on the proposed GM Minimum Standards in autumn and support the proposal that Transport for Greater Manchester administers the consultation process.

                   Delegated decision:

                   That the Minutes of the Licensing and Safety Panel meeting held on 6 June 2019, be approved as a correct record and signed by the Chair.

Delegated decision:

That in accordance with Section 100(A)(4) of the Local Government Act 1972, the press and public be excluded from the meeting during consideration of the following items of business since it involved the likely disclosure of information relating to individuals who hold Licences granted by the Authority or Applicants for Licences provided by the Authority.

Julie Gonda, Interim, Executive Director, Communities and Wellbeing, attended the meeting to provide members with updated performance information for the better care fund and improved better care fund.  The presentation provided information in respect of the BCF metrics which include:

•      Non-elective admissions - reduction in non-elective admissions

•      Permanent admissions - rate of permanent admissions to residential care per 100,000 population (65+)

•      Effectiveness of reablement - proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

•      Delayed transfers of care (DToC) - delayed transfers of care (delayed days) from hospital

As well as the IBCF the local metrics related to areas of spend

•      DToC for reason 'awaiting package of care’

•      DToC for reason 'awaiting residential home’

•      Time taken to grant DOLS application

With regards to each of the BCF metrics, the Interim Executive Director reported that  a revised target has been established for non-electives admissions, a number of remedial actions have been put in place.

The Interim Executive Director reported that a targeted piece of work is currently been undertaken to address the permanent admissions to residential care and it is envisaged that this would reduce the numbers significantly.

The figures for the effectiveness of reablement are very close to the target. There does however continue to be high number of complex cases entering the system.  The DTOC figures indicate that they are reducing though still not on track.

The Interim Executive Director reported that there would be an additional £5.4m from the IBCF which will allow some additional capacity in reablment.

It was agreed:

The Health and Wellbeing Board will continue to receive quarterly Better Care Fund and Improved Better Care Fund performance updates.

Kath Wynne-Jones, Interim LCA Executive attended the meeting to provide members of the Board with an overview of work being undertaken to transform urgent care.  The presentation contained information in respect of:

• LCA key priorities
• Integrated neighbourhood teams
• Successes so far
• Home first priorities
• Integrated virtual hub
• Urgent treatment centre at FGH

The LCA Executive reported on the development of the Paramedic Green Car scheme.  In October the car had attended over 170 incidents and 77% cases resulted in people being able to be treated at home rather than a hospital admittance.

Responding to a Member’s question the LCA Executive reported that there is workshop this week on finalising solution for IMT/ Workaround for the next 12 months, including a Global Digital Exemplar scheme.

The Chair asked about Assistive Technology.  The LCA Executive responded that some of the technological facilities were being looked at in light of the Integrated Neighbourhood Teams and these will be built on when the teams are in place.

Responding to concerns raised by the Healthwatch representative in respect of newspaper reports that included FGH’s A&E in a list of potential Emergency department’s earmarked for closure. Dr Schryer, Chair of Bury’s CCG reported that he was not aware of any plans to close the A&E department at Fairfield.  Steve Taylor, PAT confirmed this and reported that FGH A&E was and continues to be one of the best performing departments in the region.

It was agreed:

Kath Wynne Jones, Locality Care Alliance be thanked for her attendance.

Warren Heppolette, Executive Lead, Strategy & System Development, Greater Manchester Health & Social Care Partnership attended the meeting to provide members with an overview of work being undertaken by the Health and Social Care Partnership.  The presentation included information with regards to the partnership’s aims, “where we are now?” The building blocks for transformation; neighbourhood working and expected developments in Bury.

The Executive Lead, Strategy & System Development reported that there are real signs of progress, as evidence by the stabilisation and subsequent reduction in emergency bed days as well as improvements in mental health services as a result of improved investment and better connectivity.  Establishment of the LCA has accelerated locally over the last few months.

Responding to a Member’s question, in respect of the low profile of drug services/support within GM; the Executive Lead, Strategy & System Development reported that this is an area currently not addressed across GM to the level it could or should be.  The Director of Public Health reported that a GM plan is under development.

In discussion that followed members discussed the support for those that require mental health support as well as that of drug and alcohol services.  The Chair of the Clinical Commissioning Group reported that it is envisaged that the integrated neighbourhood teams will be able to effectively provide support to deal with specific local issues, including drugs, where applicable.

It was agreed:

The Executive Lead, Strategy & System Development be thanked for his attendance.

Steve Taylor; Chief Officer/Managing Director Bury & Rochdale Care Organisation reported that on average over the last 18 months the readmission rate is 6.1% within a 30 day period. The greatest percentage is not within the frail elderly cohort, rather the 19-64 age group and in general medicine and reported a 4.8 days average re-admission length of stay.

It was agreed:

Steve Taylor; Chief Officer/Managing Director Bury & Rochdale Care Organisation will provide a report for consideration at the next meeting of the Health and Wellbeing Board with regards to re-admission rates; the report will include information in respect of the reasons for the admittances, as well as comparative data/national averages.

Dr Jeff Schryer, Chair of Bury CCG’s clinical commissioning board presented a report providing an overview of the work undertaken by the Transformation Programme Board.  Work undertaken has included:

• Locality Care Alliance (LCA) Update
• Locality Plan Investment Agreement
• Transformation Performance and Finance Reporting
• One Commissioning Organisation (OCO) Update
• Devolution Difference Roadshow

The CCG Chair reported that the Transformation Board is made up of Commissioners and LCA. It is a collaborative board the emphasis has recently transferred from agreeing programmes/money to a focus on proactive new ways of working including commissioning strategically based on outcomes.  There is now a clear budget and plan, which includes £4.6m that must be spent by end of March 2019.

It was agreed:

Health and Wellbeing Board is recommended to note the work of the Health and Care Transformation programme Board

Mandy Symes; Interim Strategic Lead – Strategy and Development

        Kathy Batt; Safeguarding Board Chair attended the meeting to present the Annual Safeguarding reports for both Children and Adult services.  An accompanying report circulated to members prior to the meeting provided information in relation to the following areas:

• Key achievements
• Facts and figures
• Deprivation of liberty applications
• Plans for 2018/19
• Safeguarding arrangements in Bury
• Supporting and coordinating safeguarding in Bury.

Kath Batt reported she had been appointed to act as an independent chair for both the Children’s and Adult boards. The Boards have held development days to look at their functions and role and they reported that there was a consensus reported that there is duplication in membership and in some cases, ‘cases’.

A new structure, is currently being developed, with an executive group and shared sub-groups, going forward there will be one report from the integrated board.

Responding to a Member’s question the Independent Chair reported that there had been some issues with regards to attendance and involvement of some partners/stakeholders.  Greater Manchester Police is undergoing structural changes including the removal of their specialist public protection role, this has caused difficultly in terms of attendance. In respect of the Children’s Board and attendance, there has been on occasion problems with attendance from representatives of Pennine Care this has improved since the publication of the annual reports.

Councillor Walker questioned the degree to which ‘inappropriate handling’ and ‘inappropriate contact’ was prevalent; the Independent Chair reported that there has been issues in relation to children with challenging behaviour.  In particular when a child may have been restrained by a member of staff. To tackle this a whole training programme outlining how to do restrain properly has been developed with an emphasis on restraint being a last resort.

Dr Schryer wanted to ensure that there was mental health representation especially in relation to adults on the Board; the Independent Chair confirmed that this would be the case.

The Chair asked what levers are there in the system, especially with providers, to make sure that staff training is provided and procedures/protocols are in place to prevent incidents.  Responding, the Interim Assistant Director outlined that the contracts would insist/require providers to have appropriate polices in place on a range of issues, including moving and handling, DOLs and safeguarding.  Further assurance is provided via staff within the provider relationship team, the quality assurance framework, good contacts with CQC, as well as the Council provided training for providers, on request.

The Director of Public Health reported that the recently undertaken CQC inspection on safeguarding and Looked after Children had been positive.

It was agreed:

The Independent Chair and the Interim Assistant Director be thanked for their attendance.

Councillor David Jones, Leader of the Council submitted a report setting out details of plans to purchase the freehold of a commercial property in Prestwich.  The property is located on the site where the Council is planning to develop the new Prestwich Village scheme.  The opportunity to acquire a key piece of real estate would greatly assist the speed and practicality of delivering the Prestwich scheme.

It is proposed to utilise the fund established to create an ‘Investment Property   Acquisition Fund’.

Delegated decision:

Cabinet agrees to:

• Subject to final agreements being reached on works being carried out to the building, that the Council formally acquire the freehold of 458 Bury New Road, Prestwich.

• Note the site is key to the strategic, economic and regeneration objectives for the area; 

• Approve borrowing the resources required for this property at an assumed rate of 2.5%.

• Authorise the Chief Executive, Director of Regeneration and Growth, Assistant Director of Legal and Democratic Services to negotiate and finalise the detailed arrangements in respect of the purchase, and to progress the legal work associated with it;

• Authorise the Director of Regeneration and Growth to utilise the ‘Investment Property Acquisition Fund’ for the acquisition of the property

Reason for the decision:

The risks associated with the investment have been fully considered as part of the due diligence process.  This has been carried out by external property advisors. The scope, details and conclusions of this work are set out in Part B of this report.

The Cabinet Member for Environment and Operations submitted a report setting out details of the annual residents parking scheme.  Bury Council currently has 11 residents parking zones across the Borough. The first residents parking scheme was introduced approximately 20 years ago.  Around 6,000 permits are now issued per annum.   

In order to provide a transparent framework for determining the appropriateness of a scheme, a policy has been developed that sets out the process in relation to considering residents parking requests.

The revised residents parking policy provides a more comprehensive guidance that officers can follow.  It provides clarity regarding the minimum figures of support that should be achieved in order to progress and implement a scheme. 

Delegated decision:

Cabinet agrees to:

·           Adopt the residents parking policy contained in Appendix 1 so that over 50% of the properties affected must be in favour of a scheme for it to be implemented.

• A minimum of 10 properties must indicate support to initiate the Council to investigate a residents parking scheme request.

• The costs and fees associated with all residents parking schemes are reviewed annually as part of the budget setting process with the objective of being cost neutral.

• Each scheme will be reviewed every 5 years to ensure that they continue to be supported by the local community and demonstrate value for money.

Reason for the decision:

The proposal will help to address under-recovery of administration costs. 

Other options considered and rejected:

1. Continue to implement schemes where the majority of consultation responses are in favour, regardless of the level of response.

2. Continue to investigate residents parking schemes on request without any evidence of wider public community support.

3. Not review existing schemes to determine if they continue to be supported by the community and represent value for money.

Councillor David Jones, Leader of the Council submitted a report setting out details of the Supplementary Planning Document (SPD)

6.  The document provides more detailed guidance to support Unitary Development Plan Policy H2/3 and sets out a range of requirements for alterations and extensions to residential properties.

Since the current version of SPD6 was adopted, there has been changes to procedures, design standards, legislation and national planning policy which need to be reflected in the Supplementary Planning Document.

Members are therefore being asked to approve the updated version of SPD6 for a four-week period of consultation in order to establish stakeholder views on its content. Following consultation, all representations received will be fully considered and changes made where appropriate.

Delegated decision:

Cabinet agrees to:

Approve the updated Supplementary Planning Document 6 together with the proposed consultation measures outlined in this report.

Reason for the decision:

The revised SPD6 provides up-to-date guidance in respect of alterations and extensions to residential properties and consultation will ensure that all interested parties have the opportunity to comment on its content before it is formally adopted.

Other options considered and rejected:

Option 2

That Members seek revisions to the proposed content of the updated SPD6 report prior to consultation and/or Members seek revisions to the proposed measures for undertaking consultation - Members to specify the nature of any revisions to be sought.

Councillor David Jones, Leader of the Council submitted a report setting out details of the Greater Manchester Full Fibre programme. The report provided an overview of the capital funding successfully secured by GM of £23.8m.  The funding will connect full fibre to over 1,300 GM Public sector sites.  These include Local Authority, GM Fire and Rescue, Health and Social Care partnerships (CCGs) sites across the region.

The capital funding for this project was earmarked as part of the agreed 2019/20 budget setting. 

Delegated decision:

Cabinet agrees to:

•             Approve Bury Council’s involvement with and investment into this programme.

•             Agree to an investment of £469k capital from Bury Council plus additional capital to fund a dedicated Project Manager post on a 2-year fixed term basis.

•             Agree to the Inter Authority Agreement (IAA) that sets out the local authority role and processes for the implementation of the LFFN Programme and minimise disruption.

•             Grant delegated authority to the Cabinet Member for Finance and Housing, in consultation with the Council’s Section 151 Officer and Monitoring Officer to enter into a contract with the supplier for the fibre connection of public sites and premises in Bury under the GM Local Full Fibre Networks Programme.

•             Grant delegated authority to the Cabinet Member for Finance and Housing, in consultation with the Council’s Section 151 Officer and Monitoring Officer to approve the final capital funding commitment

Reason for the decision:

Accelerating investment in full fibre to the premises is a key priority of the GM Digital Infrastructure Plan which is part of the GM Digital Strategy approved by the GMCA in February 2018.

Councillor David Jones, Leader of the Council submitted a report setting out details of an outline business case for the potential transfer of additional services to Persona, the Council’s Local Authoring Trading Company (LATCo). 

The outline business case proposes that further work is undertaken, in the form of a detailed business case, to demonstrate the feasibility of transferring additional services to Persona.  An initial assessment as to which of the Council’s remaining adult social care services might be a best fit with Persona, has been undertaken and the suggested scope of services that would be considered within the detailed business case.

Delegated decision:

Cabinet agrees to:

·         Approve the request to produce a detailed business case.

·         Cabinet notes the proposed deadline of 30 September 2019 for the completion of the detailed business case, to present to Cabinet on 16 October 2019.

Reason for the decision:

The approval of the recommendation will facilitate the development of the detailed business case to support further decision making by Cabinet.

Councillor David Jones, Leader of the Council submitted a report setting out details of the findings of the Bury Town Centre Business Improvement District (BID) Feasibility Report undertaken on behalf of the Bury Town Centre Management Board (BTCMB).

The Feasibility Report recommendation is to proceed to the full BID Development and Campaign Phases which will include in-depth business/stakeholder consultation to develop the BID Business Plan and BID Proposal, followed by a BID Campaign and BID Ballot.  It is during this next stage that the BID Boundary, BID Levy Rate and any payment threshold/exclusions will be agreed and finalised.

Delegated decision:

Cabinet agrees to:

·         Support the Bury Town Centre Business Improvement District Feasibility Report Recommendations and the decision taken by Bury Town Centre Management Board to progress to the next stage of the Bury Town Centre Business Improvement District process.

·         To note the Council’s role in the Bury Town Centre Business Improvement District Development and Campaign Phases and to allocate the financial and staff resource required to support the process.

·         To approve the annual budget required to meet the  Council’s annual Bury Town Centre Business Improvement District levy payments should the Bury Town Centre Business Improvement District Ballot result in a ‘Yes Vote’ and to allocate the resources required to deliver the Council’s role and responsibilities throughout the duration of a Bury BID.

·         To Delegate Powers for detailed decisions relating to the Bury Town Centre Business Improvement District process to the Leader as Regeneration Portfolio holder.

Reason for the decision:

There is minimal investment required in relation to potential benefits as well as evidence of success in other areas. The proposals are in line with the Council’s growth agenda and therefore support financial sustainability.

The Leader and Cabinet Chair, submitted the Cabinet Financial monitoring report.  The report informs Members of the Council’s financial position for the period April 2019 to June 2019 and projects the estimated outturn at the end of 2019/20.

The report also includes Prudential Indicators in accordance with CIPFA’s Prudential Code.

Projections are based on current trends, information, and professional judgement from service managers and finance staff. The revenue budget projections highlight the fact that budget pressures exist in some key areas and it will be necessary to continue to maintain the high level of scrutiny, control and support around the Budget Recovery Boards and to further develop the savings pipeline.  The projected overspend of £0.996m represents approximately 0.7% of the total net budget of £138.862m. 

Delegated decisions:

Cabinet agrees to:

Note the projected financial position of the Council as at 30 June 2019.

Reason for the decision:

Successful budget monitoring provides early warning of potential major overspends or underspends against budgets which Members need to be aware of. 

This report draws attention to the fact that, based on prudent forecasts, several budget hotspots exist which will need remedial action.

Members and officers will be examining these areas in more detail at the joint JET / Cabinet meetings as well as at the themed Budget Recovery Boards.

Delegated decision:

That the minutes of the meeting held on 25^th June 2019 be approved as a correct record and signed by the Chair.

Mike Woodhead in the Dr Jeff Schryer presented a report providing an overview of the work undertaken by the Transformation Programme Board.

It was agreed:

Health and Wellbeing Board is recommended to note the work of the Health and Care Transformation programme Board

Julie Gonda, Interim Executive Director Communities and Wellbeing presented an update report in respect of the decision by PCFT Board to concentrate its business solely on the delivery of mental health and wellbeing services.  The proposal is that the Northern Care Alliance under the legal entity of Salford Royal NHS Foundation Trust will be the designated interim provider for a period of two years.

The CCG commissions a range of community services.  The total contract value for these services in 2018/19 was circa £18 million.  Bury Council also commissions a range of public health services with a current contractual value of £5.6 million.

Questions were invited from those present and the following issues were raised:

Members discussed the risks associated with the transfer, the decision not to go out to tender, the wider transformation agenda and the move away from an internal market place within the NHS.

Dan Lythgoe, representing Pennine Care assured the Board that engagement with staff commenced before the decision was taken by the Trust to concentrate on solely mental health services.  The engagement has been undertaken jointly with representatives from the Northern Care Alliance. 

It was agreed:

That the Interim Executive Communities and Wellbeing be thanked for her attendance.

Jon Hobday Public Health Consultant presented to members an overview of the Tobacco control delivery plan. 

Tobacco is the biggest cause of preventable death in the UK today, and a key cause of inequalities in Bury. The ambition is to inspire a smoke-free generation and improve the health and wellbeing of all Bury residents. Reducing smoking prevalence in Bury is a key action in the Locality Plan, and a stated ambition in the Primary Care Health and Wellbeing strategy.

The Tobacco Control Delivery Plan outlines how – with a strategic, partnership-based approach – how key stakeholders can effectively impact tobacco use across the Borough: reducing ill-health and early deaths in the population and improving lives of Bury residents.

Questions were invited from those present and the following issues were raised:

The Director of Public Health reported that it is essential that support to stop smoking is embedded across partner organisations, from the acute sector to primary care and including the integrated neighbourhood teams.  In order to reduce smoking prevalence it is essential that there is systematic support to help people stop and targeted work is undertaken to tackle the illicit tobacco trade.

Members discussed e-cigarettes.  The Public Health Consultant reported that the recently undertaken child survey has provided interesting data in respect of teen smoking; 9% of children have tried cigarettes, 14% have tried e-cigarettes, 2% would consider themselves to be regular smokers and 4% would smoke e-cigarettes regularly.

Responding to a Member’s question, the Public Health Consultant reported that the target to reduce smoking in pregnancy from 11.6% to 6% is an ambitious target.  Every pregnant woman will be offered support across multiple formats. The Director of Public reported that historically engagement with maternity services has been problematic, the issues is now been driven at a wider GM level and as such there seems to be wider ownership of the issue.

It was agreed:

The Board approves the Tobacco Control Delivery Plan.

Tracy Evans Project lead, Bury Council, attended the meeting to provide members with updated performance information for the better care fund and improved better care fund.  The presentation provided information in respect of the BCF metrics which include:

•      Non-elective admissions - The admissions target of 5,662 for this period was not achieved with 5,874 actual admissions.

•      Permanent admissions - The admissions target was reviewed and a 20% reduction in permanent admissions into residential care was agreed. The target of 628 has been achieved with 570 admissions in this period. This is due to the positive impact of the care at home zones and the increased discharge to assess provision

•      Effectiveness of reablement - The target of 85.4% of customers still at home 91 days after discharge is designed to promote excellence in the service and reduce re-admissions. Although it has dipped slightly this period it is still on target.

•      Delayed transfers of care (DToC) - delayed transfers of care (delayed days) from hospital Performance on DTOC continues to reduce, although the target for this period has not been achieved. There were 516 delayed days in December, which equates to 17 delays per day.

There is no requirement to report iBCF to Better Care Fund this quarter, although information is still being collated through individual projects locally and regionally.

•      DToC for reason 'awaiting package of care’

•      DToC for reason 'awaiting residential home’

•      Time taken to grant DOLS application

Questions were invited from those present and the following issues were raised:

In response to a Member’s question, the Interim Executive Director, Communities and Wellbeing reported that there has been a great deal of work undertaken to reduce the DTOCs within mental health services, this has been a focused piece of work and is now embedded in practice within CMHT and the Irwell Unit and as a result, the DTOC remain low.

It was agreed:

The performance information for the better care fund and improved better care fund be noted.

Jon Hobday, Public Health Consultant attended the meeting to provide an overview of the developments and a summary of the proposed next steps to the development of the Bury JSNA.

There is a work plan that is regularly reviewed which acts as the guide for what work needs to be prioritised, completed and added to the JSNA. This has been a new development and enables staff to prioritise which documents are updated.

As well as the new documents being added to the JSNA there has also been a number of behind the scenes developments including

-      Training of new staff.

-      Development of structural and presentation ideas of how the Bury JSNA can be more user friendly

The Public Health Consultant highlighted a number of proposed developments for 2019/20, including:

• A full refresh/update of the existing documents contained within the work plan, changes to the website are proposed.

• Development of more detailed neighbourhood profiles to support key decisions at a neighbourhood level.
• A move for the JSNA to fit more to the life course. There will be 3 main level summaries which will be categorised into Starting Well, Living Well and Aging Well, ensuring alignment with Bury’s Single Outcomes Framework.
• Integration of Piktochart infographics and Tableau dashboards embedded within the JSNA.

Questions were invited from those present and the following issues were raised:

Members discussed the expanding the role of the JSNA and current funding arrangements. 

The Director of Public Health reported that it is a statutory duty of the Board to produce a JSNA with good quality data and intelligence, this is currently undertaken with limited resources.  The Board should look to engage partners in giving greater consideration to how the JSNA is resourced, given the information is invaluable to the development of neighbourhood teams and commissioning as a whole.

It was agreed:

The Health and Wellbeing Board endorse the ongoing developments of the JSNA.

Michael Hargreaves Senior Commissioning Manager, Bury CCG attended the meeting to provide members with an update in relation

The Children and Young People’s Local Transformation Plan for Mental Health and Wellbeing is a “live” document which is required to be refreshed on an annual basis.

Given the substantial rewrite of the LTP in March 2017, which was approved by Health and Wellbeing Board in 2017 and 2018, it is recommended from the Bury LTP Implementation Group that the refresh for this year will be a lighter touch with updates for the most part limited to:

• The Action Plan
• Activity, Resource and Finance
• Monitoring and Measurement

This approach has been mirrored by the majority of other CCGs in Greater Manchester. 

The Senior Commissioning manager highlighted to Board members the following associated risks:

1. Delivery of identified schemes to ensure full and effective use of transformation financial allocations for 2019/20 and beyond. The CCG and LTP Implementation Group will need to work with wider partners to ensure timely delivery of agreed schemes and effective and timely use of the available resource.

2. There is a risk that some of the roles identified for investment may not be straightforward to recruit into. This risk is considered to be moderately low by our core providers but may require alternative planning if recruitment issues materialise.

3. There is a risk that due to resourcing challenges throughout the system some GM workstreams will not progress at the pace originally intended. This is being mitigated to an extent by the employment of a GM CYPMH Commissioning Lead on a full time contract. 

Questions were invited from those present and the following issues were raised:

Members raised concerns in respect of support provided to and in schools in the Borough. Responding, the Senior Commissioning Manager reported that the local development plan will improve capacity and knowledge in the system as well as providing a commitment to provide advice and support via the Healthy Young Minds service to those working in schools.

The Commissioning Manager reported that a commissioning strategy will be developed for all stakeholders, the strategy will include how services link together.  The Commissioning Manager acknowledged that service provision is not always seamless and there is confusion, as to which services are provided and by whom.

Members discussed the national target for treating children with a diagnosable mental health condition and the CCGs indicative trajectory of at least 32% of patients receiving treatment from an NHS community funding mental health service.  Responding the Commissioning Manager reported that this figure is only indicative and not a measure of the full range of support provided by other partners, including Healthy Young Minds and Early Break. 

It was agreed:

The Board agrees to:

·         Acknowledge that the refreshed document is a working draft and remains an iterative process leading up to final publication by the end of March.

·         Gives permission for the chair to sign-off the final refreshed plan with executive support from finance and commissioning to agree plan for final publication.

·         Note the identified risks.

Jon Hobday, Public Health Consultant attended the meeting to update the Board with regards to the Greater Manchester drug and alcohol strategy as well as the approach taken in the Borough to address the issues raised.

This will be the first ever Greater Manchester drug and alcohol strategy setting out a collective ambition to significantly reduce the risks and harms caused by drugs and alcohol and help make Greater Manchester one of the best places in the world to grow up, get on and grow old. 

The Public Health Consultant reported that it is estimated that expenditure on alcohol related crime, health, worklessness and social care costs amount to £1.3bn per annum - approaching £500 per resident.

Alcohol places a significant burden on public services, causes health problems such as cancer, liver cirrhosis and heart disease, affects the well-being of families, and is a major contributor to domestic abuse, violent crime and public disorder.

The Public Health Consultant reported that there has been a long term downward trend in drug and alcohol use amongst adults and young people.  Locally our treatment services are more recovery focused than they used to be and that more people are successfully completing treatment, but there is much more to be done.

Questions were invited from those present and the following issues were raised:

Responding to a question from the Chair, the Public Health Consultant reported that prevention and early intervention is imperative to tackling substance misuse.  Services, including the Bury Lifestyle Service, have been encouraged to look and identify early signs of alcohol and substance misuse.  Data is available to identify the neighbourhood hot spots where substance misuse in particular is a problem.  It is envisaged that the roll out of neighbourhood working will lead to the development of an appropriate and proportionate approach in tackling these issues.

In response to a Member’s question, the six priorities identified within the GM strategy will be adapted to the specific requirements/need in the Borough, good practice will be shared across the region.

It was agreed:

The Board notes the information in the presentation and would like to put on record its support for the regional and local work being undertaken to address drug and alcohol related issues.

It was agreed:

The minutes of the meeting held on the 12^th February 2019 be approved as a correct record.

Dr Jeff Schryer, Chair of Bury CCG’s clinical commissioning board presented a report providing an overview of the work undertaken by the Transformation Programme Board.  Work undertaken has included:

Transformation Models of Care

Primary features of these new services include:

• New standard operating procedures for MDT and Rapid Response
• More effective use of the current bed base to create capacity in the system

·         Understanding the future demand on intermediate care packages

and designing the model around this

·         Creating a single service for the intermediate tier

·         Mutually Binding Agreement

·         Estates for Integrated Neighbourhood Teams

It was agreed:

Health and Wellbeing Board is recommended to note the work of the Health and Care Transformation programme Board

It was agreed:

That this item will be deferred and considered at the next meeting of the Health and Wellbeing Board.

Dee Colam, Interim Assistant Director (Adult Social Care Operations) provided members with a follow up report in respect of the state of delayed transfers of Care in Bury.  Delayed Transfers of Care are a national Key Performance Indicator (KPI) for both the NHS and Adult Social Care (ASC).  The report included information in respect of delayed transfer of cares in the following areas and measures taken to address the problem:

Mental Health

Acute hospitals

Non-Acute Hospital

Winter Pressures Grant

Members discussed problems with recruitment to the Integrated Discharge Team.  The CCG Chair reported that this was becoming increasingly problematic however work is underway across Greater Manchester to address this issue.

Responding to a Member’s question, the Interim Assistant Director reported that the discharge to assess beds have been very successful at releasing capacity within the Acute sector. This service is now offered on four sites across the Borough, supported by a range of professionals.

It was agreed:

A further update will be provided to the Board in six months.

Chief Officer/Managing Director Bury & Rochdale Care Organisation, Steve Taylor attended the meeting to provide members with an update in relation to the current rates of readmission at Pennine Acute NHS Trust.  An accompanying report had been circulated in advance of the meeting, containing information in respect of the following areas:

• Fairfield General Hospital Readmission SPC chart April 2017 – November 2018
• Fairfield General Hospital compared with North Manchester General Hospital and The Royal Oldham Hospital
• Fairfield General Hospital – Breakdown of the reason for re admission (HRG based most recent 12 months)
• Readmission length of stay & bed days

Members discussed it there were any themes emerging from the readmission figures.  The Chief Officer reported that comparable data could be provided to the Board. 

It was agreed:

The Chief Officer/Managing Director Bury & Rochdale Care Organisation, Steve Taylor be thanked for his attendance and comparable national and regional information will be provided at a future meeting.

Chief Officer/Managing Director Bury & Rochdale Care Organisation, Steve Taylor attended the meeting to provide members with an update in relation to Pennine Acute NHS Trust’s triage arrangements and winter pressures.  An accompanying report had been circulated in advance of the meeting, containing information in respect of the following areas:

• A&E attendances by triage category
• A&E attendances time to triage
• A&E attendances
• A&E attendances Arrivals
• FGH Performance against Greater Manchester Performance

The Chief Officer reported that there has been a significant upsurge in the numbers of very urgent patients seen within A&E.  Monday 11^th February 2019 was one of the busiest days on record at FGH A&E with almost 260 patients triaged.  The system continues to be under significant pressure, but still manage to maintain patient safety.  This issue is not isolated to FGH but the whole system is struggling across Greater Manchester. 

Responding to a Member’s question, the Chief Officer reported that work has been undertaken to review ambulance attendances and admittances from Nursing homes and to try and support those nursing homes with high levels of 999 calls.  The use of the paramedic green car has deflected 87% of activity away from A&E but there still remains high demand in the system.

Responding to a Member’s question, the CCG Chair reported that a piece of work has been undertaken to assess what will be the health demand going forward taking into account predicated housing building as a result of the GMSF and other demographic factors.

It was agreed:

The Chief Officer/Managing Director Bury & Rochdale Care Organisation, Steve Taylor be thanked for his attendance.

Maxine Lomax Head of Safeguarding/ Deputy Director of Nursing and Dr Cathy Fines attended the meeting to present the Children Looked After, CQC Safeguarding Report.  The report is intended to brief the committee on the process and outcome of the recent inspection by CQC into the quality of provision and the implementation of the provision for children in need of protection and children who are looked after

The outcome of the inspection was a published 42 page report and 46 recommendations for commissioners and providers across the health economy of

Bury.

The key concerns that emerged were from the visits to Fairfield General A&E department and to the two Walk in Centre’s. There was an immediate request by the CQC, for an action plan to remediate the concerns identified at A&E. This was submitted, as requested by the end of the inspection. PAT have initiated an improvement board to monitor the action plan.  Additionally, there were concerns around the sustainability of the Walk in Centre’s, staff moral and systems and processes to safeguarding children. Pennine Care was made aware of the concerns immediately and the Head of Safeguarding for the CCG was informed. Pennine Care have provided some assurances around the WIC’s however, there are a number of recommendations within the report.

Questions were invited from those present and the following issues were raised:

Councillor Briggs raised a number of concerns with regards to the CQC report, in particular, poor leadership, IT problems, the use of fax machines for referrals and staff shortages, as well as delays in referring patients.  Responding to these concerns the Head of Safeguarding reported that faxed referrals were only used in two premises (A&E and the walk in centres) this practice has now stopped.  Seven inspectors, visited 14 services over a week long period, there is not the capacity in the system to provide that level of scrutiny and assurance. 

Responding to a Member’s question, the Head of Safeguarding reported that training is provided regularly, in some service areas where there is a high turnover of staff, ensuring that all staff have had up to date training remains a challenge.

Responding to concerns raised by the Chair with regards to whether there is sufficient workforce capacity to deliver on the CQC recommendations, the Head of Safeguarding reported that following on from the Ofsted inspection additional capacity has been provided by Pennine Acute NHS Trust.  The Pennine Care NHS Foundation Trust and the Local Authority has provided some additional funding for the Multi-agency Safeguarding Hub.

The Head of Safeguarding reported that it is the responsibility of the providers to manage and operate the services, when services are commissioned contractual standards will include requirements in respect of safeguarding.

Steve Taylor responding to concerns raised in the CQC report in respect of his organisation reported that as a Trust regular audits are undertaken, the systems have improved at the Trust as a result of the inspection and further improvements will be made as part of the integration and transformation agenda.

Dr Schryer responding to concerns raised in the report, acknowledged that the report highlighted a number of issues for consideration, three months has elapsed since the visit and a number of improvements and recommendations have been undertaken.

With regards to the walk in centres the Head of Safeguarding reported that the recruitment and retention issues as highlighted in the report have been addressed and the workforce has now stabilised.

It was agreed:

The representatives from Bury Clinical Commissioning Group be thanked for their attendance and a further update in respect of the action be considered in 6 months.

Councillor Simpson informed the meeting that following of from the discussion at the last meeting in respect of loneliness, as subsequent meeting of the task and finish loneliness group has taken place and an event has been arranged for Sunday 17^th March, members of the Board are encourage to attend.

The Director of Public Health will share with Councillor Walker the GM consultation document in respect of substance misuse services.

It was agreed:

The minutes of the meeting held on the 27^th November 2019 be approved as a correct record.