Agenda and minutes

Members are asked to declare any interests in the items under consideration and in doing so state:

(1) the type of interest concerned; and

(2) the nature of the interest concerned

If any member requires advice on declarations of interests, they are advised to contact the Head of Democratic Governance in advance of the meeting.

Councillor Kath Benson declared a prejudicial interest in Item 9 ‘Blackpool Teaching Hospitals Trust – Financial Deficit and Impact Upon Quality of Care’, the nature of the interest that she was an employee of Blackpool Teaching Hospitals Trust.

To agree the minutes of the last meeting held on 10 December 2015 as a true and correct record.

The minutes of the meeting held on 10 December 2015 were signed by the Chairman as a true and correct record.

To consider any applications from members of the public to speak at the meeting.

The Committee noted that there were no applications for public speaking on this occasion.

The Committee to consider the Workplan, together with any suggestions that Members may wish to make for scrutiny review.

The Committee considered the workplan and agreed:

1.             To approve the Committee Workplan.

2.             To monitor the implementation of the Committee’s recommendations/actions.

3.             To establish a Scrutiny Review Panel to consider all Quality Accounts received in 2016.

4.             To approve the scoping document of the Educational Attainment 2015 Scrutiny Review Panel.

5.             To widen the remit of the Public Health Scrutiny Panel to include a further meeting to consider the draft Health and Wellbeing Board Strategy and revised Joint Strategic Needs Assessment.

The Committee to consider the content of the Council’s Forward Plan, February 2016 – May 2016, relating to the portfolio of the Cabinet Secretary.

The Committee considered the item contained within the Forward Plan, February 2016 – May 2016 and noted that the ‘Adult Social Care Charging Policy’ had previously been named ‘Fairer Contributions Policy’. The decision had also originally been scheduled for December 2015, with the new anticipated date of decision February 2016. Members queried why the name of the policy had been changed and why the decision had been delayed. Ms Smith, Deputy Director of People (Adult Services) reported that the name had been changed to use clearer terminology and that proposed changes to the policy had been reconsidered resulting in the delay.

The Committee to consider the Executive and Cabinet Member decisions within the remit of the Resilient Communities Scrutiny Committee.  

The Committee considered Executive Decision number EX3/2016 ‘Healthy Weight Declaration’ and queried how the declaration was going to be achieved. Councillor Cross, Cabinet Member for Health Inequalities and Adult Safeguarding advised that the first step was to consider how a healthier lifestyle could be provided, for example changing the type of drinks and snacks on offer in vending machines in sports centres and promoting tap water to customers. She added that although members of the public could exercise free will, they could be presented with more informed options that would result in a healthier choice of lifestyle. In response to further questions, Councillor Cross advised that partnership working would be important in order to make an impact, but that the declaration was a Council led initiative.

In response to further questioning, Councillor Cross advised that healthy cooking classes were provided at Children’s Centres and through community groups and that support would be provided to the community groups in order to promote healthy cooking.

The Committee considered Executive Decision number EX5/2015 ‘Introduction of Milk Fluoridation for Primary School Children’ and queried if the number of children who were opted out of the scheme would be monitored and over what period. Councillor Cross advised that regular monitoring would be undertaken and reported that the inclusion of fluoride in the milk did not make it more expensive than the regular milk already provided through the free breakfast scheme.

Members further queried how schools would manage the logistics and ensure that children were given the correct milk. Councillor Cross advised that schools had a process in place and Headteachers would be able to amend the milk order to ensure the right level of delivery of milk both with and without fluoride.

In response to further questions, Councillor Cross reported that if parents were confident that their child was obtaining enough fluoride through the use of high fluoride toothpaste or diet then they could opt out of the scheme. She added that the milk contained a recommended level of fluoride and reassured Members that research provided by a number of health organisations had demonstrated that the level was safe.

The Committee agreed:

1.             To receive an update on the uptake of milk with fluoride in approximately six months.

2.           To receive a briefing note from Councillor Cross on the research undertaken on the safe level of consumption of fluoride for children.

The Committee is asked to consider the content of the report and highlight any areas for further scrutiny which will be reported back to the Committee at the next meeting.

Mrs Shaw, Head of Corporate Development, Engagement and Communications presented the Council Plan Performance Report Q2 2015/2016 and highlighted the key performance indicators relating to Resilient Communities.

The Committee noted the red indicator for ‘percentage of opiate drug users successfully completing treatment who did not re-present to treatment within six months’ and queried what was being done to improve performance. Councillor Collett advised that performance against the indicator had previously been higher, but had reduced in quarter two of 2015/2016. He added that a number of measures had been put in place to make improvements, but acknowledged additional work was required.

Members queried the potential impact of the closure of the two hospitals offering reablement services on the key performance indicators namely the ‘proportion of older people being offered reablement services’ and the ‘proportion of older people still at home 91 days after discharge to reablement or rehabilitation’. Councillor Collett advised that he did not foresee an impact and that the changes to service provision could be managed within resources. He reassured the Committee that regular monitoring would take place of the indicators.

The Committee discussed the concerning level of ‘prevalence of excess weight in Year 6 children (10 to 11 year olds) and queried if the food provided through free school meals at schools and the free school breakfasts provided by the Council had negatively impacted upon weight. Councillor Collett advised that the breakfast provided was a healthy breakfast and the meals offered by schools had been evaluated. He surmised that sugary drinks were a key cause of excess weight and were not offered by schools. Mrs Shaw added that an analysis had been undertaken and demonstrated that there was no correlation between the introduction of the breakfast scheme and an increase in weight. 

The Committee further discussed excess weight of children and Councillor Collett reported that a programme was in place in schools in order to educate children about healthy eating. However, Members were concerned that excess weight in children was not a new problem and that no progress had been made to date in reducing levels. In response, Councillor Collett advised that the Declaration of Healthy Weight had been made to provide a whole system approach to tackling childhood excess weight.

In response to further questions, Councillor Collett advised that there was a link between attainment and attendance at a good or outstanding school. He added that local authorities had limited jurisdiction to assist schools to improve once they had become academies, but advised that he had been involved in a number of promising meetings regarding school improvement.

Members considered that further work was required to consider targets, benchmarking against other authorities and how to track performance and suggested that a short panel meeting be held to undertake the work. Additionally, the Committee considered the data provided within the performance report and requested that targets be made clearer in future reporting in order to allow Members to measure progress more effectively.

The Committee agreed:

1.             To establish  ...  view the full minutes text for item 7.

To receive and consider a presentation on Blackpool Teaching Hospitals Trust Action Plan and Strategy for Financial Recovery.

Councillor Kath Benson, who had declared a prejudicial interest in the item, left the room for the duration of its consideration. Councillor Andrew Stansfield was in the Chair.

Mr Bennett, Director of Finance advised that Blackpool Teaching Hospitals NHS Foundation Trust had reviewed clinical and financial sustainability over the previous 12 months. He highlighted the key challenges as a growing financial deficit, higher than expected mortality rates as reported by the Keogh review in 2013, lower than desired Care Quality Commission (CQC) ratings, a growing demand for non-elective services, difficulties in meeting targets consistently and recruitment and retention of clinical staff. Mr Bennett advised that in order to provide a sustainable future the challenges must be addressed.

The Committee was informed by Mr Bennett that the Trust had established a number of working groups consisting of clinical and operational leaders in order to identify ways in which to address the identified challenges. He added that the working groups focussed on six subjects including urgent/emergency care and long term conditions/out of hospital care and that potential solutions had been divided into three timeframes. It was highlighted that some solutions could be achieved by the Trust and that others required a joined up approach with partners.

Mr Bennett advised that the outcomes of the working groups had been translated into six ambitions, each with a key measure of success. It was noted that the first ambition was to reduce the levels of mortality from the current level of 112 to less than 100 in three years, which was the current national average. In response, Mr Bennett reported that in addition to the six ambitions, seven work programmes had been developed including standardising care to deliver high quality to all patients and getting the most value from resources.

The Committee discussed the ambition in relation to staff satisfaction noting the considerable increase in target from 69% to 85% in five years and queried how the increase would be achieved. Mr Bennett advised that the Trust was implementing an organisational development programme to ensure that leadership was more clinically focussed and that it was envisaged that a more engaged workforce would improve patient satisfaction.

Members queried the work programme to standardise care, in particular relation to maternity services, and raised concerns that patient choice would be removed. The Committee was assured by Mr Bennett that standardised care would not remove patient choice and that the work programme related to the standardisation of outcomes and not the standardisation of the pathway.

The Committee queried how the Trust would achieve the target mortality rate whilst managing the financial pressures of the organisation. Mr Bennett advised that there would be financial consequences to achieving the target and that the predicted cost had been included in the financial plan. He added that achieving the mortality rate target would be difficult as the national average would also continue to reduce.

In response to questioning, Mr Bennett advised that the Trust was trying to address the recruitment and retention issue  ...  view the full minutes text for item 8.

To inform scrutiny of the work undertaken by Children’s Services on a day to day basis and to update on the progress and implementation of developments within the area to allow effective scrutiny of services.

Mrs Del Curtis, Director of People presented the Children’s Services Improvement Report and the Chairman invited questions from the Committee.

The Committee discussed the recent Ofsted inspection result of ‘requires improvement’ for  the newly established early years provider and queried if the setting was still taking new placements and if measures were being put in place to make improvements. Mrs Curtis advised that the provider was being given support in order to make the necessary improvements and she would investigate and report back through the Chairman with regards to whether the setting was accepting new placements.

Members considered the findings from Lancaster University that one in four women who had already had a child taken into care would have further children removed from them by the Family Court and questioned how the statistic could be improved. Mrs Amanda Hatton, Deputy Director of People advised that parenting classes were already provided and that BetterStart was providing intensive family support to prevent pregnancy until the woman was ready. She highlighted the success of Hackney Pause, a project that worked with women in similar situations in order to break the cycle and create a positive future. Mrs Hatton reported that initial outcomes from the Hackney Pause had been very successful and it was hoped that the Pause Project could be replicated in Blackpool, subject to funding being acquired.

In response to further questions, Mrs Curtis advised that approximately 82 expectant mothers would be eligible for the Pause Project in Blackpool, most of whom had had a number of children taken into care previously. It was considered that a successful Pause project was critical to the town.

The Committee queried how the project would be monitored and measured, should it be implemented. Mrs Hatton advised that should BetterStart agree to fund and implement the project, outcomes would be considered nationally and locally on a regular basis. The type of information to be considered as part of the outcome measures would include the number of pregnancies, the number of babies removed and customer feedback.

Members discussed the performance indicators used to record data relating to the Families in Need Service. In response to questioning, Mrs Hatton advised that performance information was recorded for cases that were both  ‘stepped up’ and ‘stepped down’ in order to establish that the cases that were ‘stepped down’ had been successful in the long term. The Committee requested that further data be circulated following the meeting relating to the performance in this area.

In response to a query regarding recruitment and retention, Mrs Curtis reported a much improved picture than had been the case previously with agency use significantly reduced. She advised that although the size of a social workers’ caseload was monitored, the cases were becoming more complex.

The Committee noted that a large family of nine children had recently been taken into care and queried how the service managed the risk of such occurrences. Mrs Curtis advised that there had been a number of similar cases in recent  ...  view the full minutes text for item 9.

To enable Members to discuss Social Care Placements in detail and undertake scrutiny of services.

Mrs Amanda Hatton, Deputy Director of People reported that Blackpool remained an outlier for the number of looked after children per 10,000 of population. She advised that a number of reviews had been undertaken to ensure that children were not being taken into care unnecessarily. Mrs Hatton added that although there were high levels of adoption and special guardianship arrangements in place, more work was required to increase reunification and ensure it was safe for children and young people to return home.

Mrs Hatton highlighted the current challenges as poor service provision from mental health and high levels of need, lack of in house foster placements and a rise in the need for mother and baby placements. In response to a question, Mrs Hatton advised that foster carers from other areas could not actively be recruited.

Members were advised by Mrs Hatton that a number of initiatives were being implemented in order to address the challenges, including the Vulnerable Adolescents Hub and consideration was also being given to whether it would be cost effective to provide in house intensive therapeutic support.

The Committee discussed the benefits to providing in house intensive therapeutic support to children and young people with complex needs and was informed by Mrs Curtis, Director of People that a business case for the proposal was being developed to determine viability. Members commented that they would not wish to see any child put at risk due to financial pressures and Councillor Cain, Cabinet Secretary reassured Members that any child who necessitated being taken into care would be.

The Committee gave further consideration to the cost of external providers and noted the potential increase in cost following the introduction of the living wage. It was noted that it was difficult to negotiate with providers due to high demand for a limited number of placements. Mrs Curtis advised that it was difficult to forecast the budget due to the cost of external residential placements in particular and added that the number of children with complex needs requirement such placements was also increasing. In response to a further question, Mrs Curtis reported that the majority of cases did not meet the clinical threshold for Children and Adolescent Mental Health Services (CAMHS), despite appearing to be mental health related.

Mrs Hatton highlighted a number of questions that were currently being asked of all social care placements to determine if appropriate support was in place, whether any child was ready to be returned home and if appropriate exiting procedures were in place. The Committee requested that an update be provided in approximately six months to report on the answers to the highlighted questions and the progress made in implementing any outcomes.

The Committee agreed to receive an update in approximately six months regarding the review of social care placements.

To inform the Committee of the work undertaken by Adult Services on a day to day basis in order to allow effective scrutiny of services.

Ms Karen Smith, Deputy Director of People (Adult Services) presented the Adult Services Overview Report and the Chairman invited questions from the Committee.

The Committee discussed delayed discharges and noted that 70% were attributed to health. Members requested that further information be sought from Blackpool Teaching Hospitals Trust as to the reasons why the discharges had been delayed. The Committee also considered that the figures provided did not include discharges from Lancashire Care Foundation Trust (LCFT) and requested that discharge information for LCFT also be sought. Ms Smith advised that a large amount of work was undertaken by all partners to ensure patients were discharged when appropriate.

Members considered the safeguarding information provided in the report and considered that it was not detailed enough to allow for effective scrutiny. In response, Ms Smith advised that she would expand the level of detail in future reports and include a trend analysis of incidents where appropriate.

The Committee reviewed the respite care provision available in Blackpool and queried the level of consultation undertaken prior to the closure of Hoyle House. Ms Smith advised that service users had highly valued the service and the consultation undertaken prior to the closure of the facility had informed the decision to allow service users to book respite beds in advance and balance pre-booking with emergency needs.

Members raised concerns regarding the limited level of provision of respite care for adults with learning disabilities as highlighted in the commissioning review and were advised that there was capacity within the current provision. Ms Smith further advised that the Shared Lives Scheme provided respite services.

The Committee further discussed the commissioning review that had resulted in a 12 month pre-booking pilot scheme being put in place to support respite provision in the private sector and requested regular updates detailing the monitoring of the pilot scheme including occupancy rates and how the results of the pilot would inform future respite provision.

In response to a further question, Ms Smith advised that previously one provider of respite care had been subject to suspension by the authority and had received an inadequate rating from the Care Quality Commission (CQC), however, a re-inspection had recently been undertaken and the provider now ‘required improvement.’ Following concern raised that sufficient improvement had not been made, Ms Smith advised the Committee that it was not possible to move straight from ‘inadequate’ to ‘good’ and that progress had been made.

Members discussed the CQC outcomes of regulated services in Blackpool and queried if homecare providers were inspected in the same manner. Ms Smith advised that homecare providers had not yet been inspected but were due to be. She further advised that homecare services were a particular focus of the Blackpool Adult Safeguarding Board and regular meetings were held with providers in order to consider repeat problems. Councillor Cross, Cabinet Member advised that she regularly met with Ms Smith to consider concerns and an overview of general trends would be provided to a future meeting of the Committee.  ...  view the full minutes text for item 11.

The Committee to consider the Pupil Referral Unit Scrutiny Review final report.

Councillor Benson, Chairman for the Pupil Referral Unit Scrutiny Review presented the final report of the Panel to the Committee.

The Committee agreed to approve and forward the final report to the Executive.

To note the date and time of the next meeting as Thursday, 17 March 2016 commencing at 6pm in Committee Room A.