Agenda item

To present performance against Priority 2 of the Council Plan 2015-2020 for the period 1 April 2017 – 31 March 2018.

Members were presented with progress on the Council Plan performance indicators for the period 1 April 2017 to 31 March 2018. There were sixteen comprehensive indicators for Adult Social Care and fourteen for Public Health. Senior officers were present to answer any detailed service questions.

Members focused on the ‘exceptions’ commentary reports where indicators were significantly off target. The Chairman referred to the number of drug users successfully completing treatment for sustained recovery. Opiate drug user performance was significantly off target and substantially so for non-opiate drug users.

Mr Paolo Pertica, Head of Community Safety Strategy explained that there were different methodologies for measuring drug treatment outcomes. The National Drug Treatment Monitoring System (NDTMS) in the North West was monitored by John Moores University which received data from all drug service providers within the region. In addition to that, performance monitoring also took place by those commissioning the service locally.

He clarified that some of the targets referred to in the exceptions commentary such as ‘Number of drug users successfully completing treatment - Opiates and Non-opiates’ -  were set using inaccurate baseline data provided by the previous contracted provider. However, even if the baseline data had been correct, such percentages of successful completions would have been extremely ambitious and rarely seen anywhere in the country. Similarly, such ambitious outcomes were not known in most countries in Europe and elsewhere in the world.

Mr Pertica explained that the previous contracted service had been decommissioned and a new provider appointed to deliver the service, which had a more holistic approach to sustained recovery. In-depth analysis was currently taking place between the commissioners of the service, Public Health and the new provider to ensure that any inaccuracies with data recording were rectified, accurate baselines set and new realistic, achievable targets agreed.

Members noted that the numbers of people successfully completing alcohol treatment was less than half of the target of 500 people and had been based on the inaccurate data. They also noted that successful outcomes through the new service provider had increased but were still no more than national average levels. Members felt that the target needed to be more ambitious and also record numbers of people who sufficiently recovered to lead normal lives.

Mr Pertica agreed that targets needed to be ambitious but also realistic. He clarified that high numbers of people with drug and alcohol problems was often associated with a number of contributory factors such as deprivation, unemployment and poor housing. He added that whilst the effectiveness of drug and alcohol treatment had improved considerably in recent decades, there was still no simple solution to help those with drug and alcohol problems to achieve abstinence, and that was the case not just in the UK but throughout Europe and most countries worldwide. 

However, Mr Pertica reported that a number of people did complete treatment successfully each quarter and some of them were able to secure full time employment and pursue constructive and productive drug-free lives. He re-iterated that total abstinence might not be a realistic objective for all those undergoing treatment, and referred to countries such as Portugal and Switzerland where more harm reduction approaches had been adopted and had proven successful in supporting people who, although not completely drug free, were still able to live fulfilling and productive lives.

In response to a query, Mr Pertica explained that it was difficult, using tracking surveys, to follow up levels of sustained recovery of people undergoing drug treatment months or years after they had left treatment. He re-iterated that it was more important people were able to lead normal lives rather than achieve total abstinence. Members agreed with this sentiment.

Although not part of the Council Plan performance indicators, the Chairman expressed concern on the high numbers of emergency admissions due to alcohol misuse. He cited Scotland where minimum alcohol pricing had been introduced to help tackle the problem and also that Newcastle had introduced a form of alcohol ‘tax’. Mr Pertica stated that the Director of Public Health, Dr Arif Rajpura, had been very supportive of introducing a Minimum Unit Price (MUP) for a number of years. However, this was not supported across the country and was a national decision for central government to take. Councillor Cross added that pricing was a complicated concept needing a wider area approach, e.g. across the north-west region / Lancashire sub-region otherwise people could just go across local borders for cheaper alcohol. The economic impact on local businesses also needed to be considered. The Government had been lobbied but so far had shown no inclination for pricing controls.

Members queried the low take-up of NHS health checks and emphasised the importance of preventative work. Ms Liz Petch, Consultant in Public Health explained that insight work with local residents had taken place, led by the Blackpool Clinical Commissioning Group, to establish why people were not taking up health checks which were for early detection of health issues. Findings showed two main misconceptions associated with attending the NHS Health Check – If people felt well, they queried the need for attending a health check; and they had concerns about putting unnecessary time pressure on busy GPs. People needed to understand the purpose of the early detection programme as many health harms could have hidden symptoms, e.g. high blood pressure or atrial fibrillation.

Ms Petch reported that a new campaign was being developed emphasising that people were not wasting NHS time by taking up health checks and that they should attend when called for an appointment and could be saving valuable NHS resources over time.

The Chairman referred to data errors for chlamydia (sexual health) screening. Ms Petch explained that these had been due to issues with laboratory test submissions which had been resolved and improved results were now expected.

The Chairman also queried what had been the final numbers of people successfully quitting smoking against the target of 686. Councillor Amy Cross, Cabinet Member for Adult Services and Health explained that the previous specialist service had been decommissioned in April 2017. The service had underperformed on some of the key performance indicators during the contract duration and, mainly, as it had not been meeting the requirement of the service specification or the needs of the population, as identified through insight work with residents.  Interim support had since been provided by GPs and pharmacists from October 2017. Members noted that there had been limited support available to people between April 2017 and October 2017.

Councillor Cross added that a better support service had been sought led by a comprehensive review of people’s needs and identifying the best value for money support options available for the most productive outcomes.

Members expressed concern that commissioned contracts were not always scrutinised effectively and that poor contract provision needed to be addressed. Councillor Cross explained that she held contract leads (Adult Social Care and Public Health) to account for ensuring robust contract monitoring and quality outcomes.  She added that commissioning leads were developing a more effective evidence-based approach to commissioning and managing contracts.

Members queried why there had been no performance target for ‘delayed transfers of care’ (solely due to Adult Social Care as opposed to the healthcare sector). Ms Karen Smith, Director of Adult Services explained that as a new data item it was hard to establish an appropriate performance level and new national guidance was awaited in this area. She added that having effective actions was paramount and substantial work had been developed. Work was also taking place with the Government’s national team which needed to meet national targets to secure funding payments.

She explained that precise numbers of delays solely due to Adult Social Care involved cross-referencing figures with Blackpool Teaching Hospitals to establish where there had been delays solely due to the health sector and also where there was shared responsibility. In response to Members’ concerns that the current data didn’t provide practical information, Ms Smith re-iterated that this was a national issue but ‘direction of travel’ work could still take place and as part of the proposed Scrutiny Review on ‘delayed transfers of care’.

Members expressed concern that mortality rates from preventable causes were at their highest for a decade. Ms Petch explained that comprehensive consideration needed to be given across systems and sectors so work was ongoing. Ms Petch reported that she had been working closely with the Blackpool Clinical Commissioning Group and Blackpool Teaching Hospitals, to identify risks and what was needed for successful outcomes such as preventing diabetes, Coronary Heart Disease and stroke.