To approve as a correct record the minutes of the meeting held on 11 January 2023.

Decision

To approve the minutes of the meeting held on 11 January 2023 as a correct record.

Report of Deputy Chief Executive and City Treasurer

This report sets out the latest forecast revenue budget position, and the next steps.

Each scrutiny committee is invited to consider the current proposed changes which are within its remit and to make recommendations to the Executive before it agrees to the final budget proposals 15 February 2023.

The Committee considered the report of the Deputy Chief Executive and City Treasurer that set out the latest forecast revenue budget position, and the next steps.

Following the provisional finance settlement announced on 19 December the Council was forecasting a balanced budget for 2023/24 and 2024/25. The risk had moved to the next spending review period 2025/26 where a shortfall of £57m was forecast. This reduced to £40m after the proposed use of £17m smoothing reserves.

The report further described that in November 2022 scrutiny committees were presented with cuts and saving options totaling £42.3m over three years for consideration. The provisional settlement on 19 December reflected a change in government policy and provided more funding than initially expected. This had given the opportunity to review the quantum and phasing of savings. It was now proposed that options of £36.2m were progressed. The settlement also gave some scope for targeted investments which would put the council in a more sustainable position to face the next spending review in 2025.

The Executive Member for Finance and Resources paid tribute to the Deputy Chief Executive and City Treasurer and her team for all of their hard work in bringing forward the suite of budget reports following the settlement announcements. He stated that the budget settlement needed to be considered in the context of over a decade of austerity that had been imposed on Manchester. He stated that the result of this was that the Council’s budget had reduced by £428m in total over this period. He commented that the decision to cut local authority funding was a result of ideological decisions taken by the Government, noting that the Government had failed to recognise or apologise for the instability they had caused to the national economy. He further referenced the impact of inflation, population growth in the city and the cost-of-living crisis that all impacted on budgetary pressures. He commented that the Government had failed to communicate their financial decisions for the city, noting the recent experience of announcements of the Levelling Up bids.

The Executive Member for Finance and Resources stated that the funding decisions of the Government had effectively forced the Council to increase Council Tax. He advised that the Council was able to deliver a balanced budget and Council Tax would be used to support the most vulnerable residents in the city; support the social care sector and invest in the future of the city.

The Executive Member for Healthy Manchester and Adult Social Care reiterated the need to consider the suite of budget reports in the context of more than a decade of austerity and repeated cuts to funding. He stated that, despite the lack of appropriate funding for NHS Services and Adult Social Care, both nationally and locally, Manchester Council had remained committed to supporting the most vulnerable residents in the city. He also paid tribute to the work of the City Treasurer, the Deputy City Treasurer and the officers for bringing forward these reports.

Some of the  ...  view the full minutes text for item 8.

Report of Director Public Health

This report provides a further update to members on the priorities for the services in the remit of this committee and details the changes to the initial revenue budget options proposed by officers in November 2022.   

The Committee considered the report of the Director of Public Health that provided a further update to Members on the priorities for the services in the remit of this committee and details the changes to the initial revenue budget options proposed by officers in November 2022.   

Key points and themes in the report included:

·         Describing the final proposals for the Public Health budget programme 2023-26;

·         Providing an overview of the services within the remit of this scrutiny committee and the key priorities;

·         Describing the budget growth assumptions in the Medium Term Financial Plan (MTFP); and

·         Providing an updated set of proposals for further savings for 2023-26, developed in the context of the financial challenge facing the Council, for final comments by Health Scrutiny.

Decision

To note the report.

Report of the Executive Director of Adult Social Services

This report provides a further update to members on the priorities for the services in the remit of this committee and details the changes to the initial revenue budget options proposed by officers in November 2022.

The Committee considered the report of the Executive Director of Adult Social Services that provided a further update to Members on the priorities for the services in the remit of this committee and detailed the changes to the initial revenue budget options proposed by officers in November 2022.   

Key points and themes in the report included:

·         Providing an overview of Adult Social Care services and key priorities;

·         Providing a detailed overview of the budget, including:

·           The financial requirements to conclude the existing three-year Better Outcomes Better Lives savings programme;

·           The budget growth assumptions for the service as set out in the Council’s Medium Term Financial Plan (MTFP);

·           An updated set of proposals for the necessary savings for 2023-26, developed in the context of the financial challenge facing the Council, for final comments by Health Scrutiny, with notable changes from the previous proposals; and

·           Detail of the additional funding announcements made in the Autumn Statement and included in the provisional finance settlement and the recommendations made for how this funding was deployed.

Decision

To note the report.

Report of the Deputy Medical Director, NHS Greater Manchester Integrated Care (Manchester Locality) and Associate Director Primary Care, NHS Greater Manchester Integrated Care (Manchester Locality)

This report provides an overview on the provision and access to General Practice services across Manchester.

The Committee considered the report of the Deputy Medical Director, NHS Greater Manchester Integrated Care (Manchester Locality) and the Associate Director Primary Care, NHS Greater Manchester Integrated Care (Manchester Locality)

that provided information and an overview on the provision and access to General Practice services across Manchester.

This report built upon the information presented to Health Scrutiny in September 2021 specific to access to General Practice; and provided the context, services in place that were currently providing access to General Practice, as well as describing the challenges and pressures General Practice was facing and plans to make sure patients could get access to their GP Practice and appropriate care.

Key points and themes in the report included:

·         Providing an introduction and background;

·         Information on the introduction of Integrated Care Systems;

·         Information on the implications of these arrangements both in a national and Manchester context;

·         Noting that there were 83 GP Practices in Manchester that provided access to primary medical care services and the contractual requirements;

·         Information relating to the Primary Care Network Enhanced Access;

·         Information on the Greater Manchester Clinical Assessment Service;

·         Information on the GP Out of Hours service;

·         Providing an update on current access and provision, noting that the Covid pandemic had resulted in a significant shift in the way that patients accessed services at their GP Practice;

·         Describing that as part of winter planning 2021/22, Manchester Health and Care Commissioning (MHCC) had established a pilot to provide access to additional GP appointments by an online video consultation provider (Livi), funded via the national Winter Access Fund (WAF) allocation;  

·         Winter pressures and surge planning;

·         General Practice Pressures, with information on Primary Care Situation Reporting;

·         Discussion of the additional issues that had impacted upon General Practice in Manchester over recent years adding to the increase in demand and pressure;

·         Information on recovery, highlighting some of the work underway and planned to support this; including workforce recruitment and retention and Primary Care Quality Recovery and Resilience Scheme (PQRRS) which aimed to reduce unwarranted variation, tackle inequalities in health outcomes and support general Practice in recovery; and

·         Conclusions.

Some of the key points that arose from the Committee’s discussions were: -

·         Recognising the important and hard work undertaken on behalf of residents by all Manchester GPs and Practice staff;

·         Welcoming the information provided in relation to NHS Greater Manchester Surge Hubs and if the intention was to continue with this model;

·         Welcoming the information within the report, however the anecdotal evidence from residents was that it was still very difficult to secure a GP appointment;

·         Condemning any aggression or threats to GPs and Practice staff;

·         The information for the public relating to Walk In Centres needed to be updated on the website as this still referred to modifications introduced during the pandemic;

·         The Committee had argued against the closure of Walk In Centres in Manchester, commenting that additional Walk In Centres would have taken the pressure off GP Practices;

·         The need for planning of GP Practices when developing new housing  ...  view the full minutes text for item 12.

Report of Director of Primary Care & Strategic Commissioning, NHS Greater Manchester         

This report provides an overview on the provision and access to NHS Dental Services across Manchester.

The Committee considered the report of the Director of Primary Care & Strategic Commissioning, NHS Greater Manchester that provided an overview on the provision and access to NHS Dental Services across Manchester.

This report provided the context of current provision and services which were in place that were currently providing access to NHS dental services, as well as describing the challenges and pressures dental services were facing and initiatives to support patients in both improving their oral health and to access appropriate care through NHS dental services.

Key points and themes in the report included:

·         Providing an introduction and background;

·         Information on General Dental Care, Specialised Dental Services and Secondary Care Dental Services;

·         Discussion on the impact of Covid, noting that the risk of cross-infection was significantly increased for services operating in and around the mouth;

·         Information on the national contracting and performance arrangements;

·         Patient feedback information and analysis;

·         Information on the actions to improve access to NHS dental services, noting that all NHS General Dental Practices continued to prioritise patients in pain, children, patients who were deemed as high risk, such as those receiving treatment for cancer, and those who were mid-way through a course of treatment; 

·         Information on access to Urgent Dental Care services; noting that there were 13 Urgent Dental Care sites across Greater Manchester, with provision in the City of Manchester;

·         Information on Secondary Care Dental services;

·         Information on the initiatives to address health inequalities, including the Dental Home for Looked After Children;

·         An update on the Healthy Living Dentistry (HLD) project;

·         Child Friendly Dental Practice (CFDP) Scheme; and

·         Projects to improve oral health, noting that oral health was particularly poor in Manchester and across Greater Manchester.

Some of the key points that arose from the Committee’s discussions were: -

·         Recognising the challenge presented by the pandemic to the delivery of dental services;

·         Patients who had not accessed dentists during the pandemic should not be penalised and removed from a Practice’s patient list;

·         Noting and condemning the national contract arrangements that resulted in Practices only being funded to deliver NHS services for 55% of the adult population;

·         Residents experienced difficulties in registering with NHS Dentists;

·         Recognising the importance of oral health on wider health outcomes;

·         Further data was requested in relation to children’s oral health;

·         Support the call for water fluoridation in Manchester as a means of improving oral health, noting the positive outcomes this had delivered in Birmingham; and

·         What was being done to support access for vulnerable residents.

The Head of Primary Care (Greater Manchester), NHS Greater Manchester stated that the frustrations and challenges articulated by Members were not unique to Manchester and were a national issue. In response to requests for additional Manchester specific data following the meeting he advised that this would be provided. In response to a question regarding the numbers of children accessing NHS Dentistry, he advised that in Manchester this was 52.2% of children compared to the national average of 46.9%, commenting that children were a priority group in  ...  view the full minutes text for item 13.

Report of Director of Primary Care & Strategic Commissioning, NHS Greater Manchester

This report provides a brief overview on the provision and access to community pharmacy services across Manchester, supporting the recently published Pharmaceutical Needs Assessment for Manchester.

The Committee considered the report of the Director of Primary Care & Strategic Commissioning, NHS Greater Manchester that provided an overview on the provision and access to community pharmacy services across Manchester, supporting the recently published Pharmaceutical Needs Assessment for Manchester.

This report provided the context of current provision and services which were in place that were currently providing access to community pharmacy, as well as describing the challenges and pressures facing these services.

Key points and themes in the report included:

·         Providing an introduction and background; noting that the needs of the population of the City of Manchester for pharmacy services were determined by the locally developed Pharmaceutical Needs Assessment (PNA)

·         Noting that the PNA assessment had been recently reviewed, and the Manchester Health and Wellbeing Board had endorsed the publication of the latest PNA on 25 January 2023;

·         Discussion of the main issues, including current provision, opening hours, advanced and enhanced services;

·         Future service provision; and

·         Consideration of the pressures in service delivery.

Some of the key points that arose from the Committee’s discussions were: -

·         Recognising and welcoming the range of services delivered by community pharmacies and the important role these played in local communities, particularly during the response to the pandemic; and

·         Reiterating and recognising the importance of this service in the context of health equity.

Decision

To note the report.

Report of Healthwatch Manchester

This report provides information on a mystery shopper exercise undertaken by Healthwatch Manchester on all Manchester GP practices to review access to Patient Participation Groups by Manchester citizens.

The Committee considered the report of Healthwatch Manchester that described that a mystery shopper exercise on all Manchester GP Practices had been conducted by Healthwatch Manchester with the purpose to review access to Patient Participation Groups by Manchester citizens.

Key points and themes in the report included:

·         Providing an introduction and background;

·         Describing the main issues identified, concluding that access to Patient Participation Groups was generally poor and patients were not being involved in their local GP practises enough; and

·         Recommendations.

One of the key points that arose from the Committee’s discussions was: -

·         Was there any guidance to address barriers to inclusion and participation in Patient Participation Groups.

The Chief Officer, Healthwatch Manchester stated that NHS England had produced useful written guidance in relation to Patient Participation Group and this included consideration of inclusivity.

The Associate Director of Primary Care (Manchester Locality), NHS Greater Manchester Integrated Care commented that she had welcomed the report and was happy to work with Healthwatch with a view to progressing their recommendations.

Decision

To note the report and endorse the recommendations that.

1. Access to Patient Participation Groups (PPGs) needs to improve and that GP Practices:

- Adopt a clear method across the board of how a person can join the PPGs so that every Practice has the same process

- Make this process accessible to the wider population such as those who do not have access to the internet or those who were unable to visit the Practice

2. The GP Practices in Manchester who we contacted need to restart their Patient Participation Groups if they have not done so already. Where possible the previous members of each Practice’s PPG need inviting to this reformation as well as providing this opportunity to all other patients.

3. The staff in each GP Practice need to familiarise themselves with the role and requirements regarding Patient Participation Groups in order to support PPGs more effectively and efficiently.

Report of Deputy Director of Public Health

The report provides the Committee with an updated overview of progress and activity for addiction services commissioned by Manchester Public Health Team.

The Committee considered the report of the Deputy Director of Public Health that provided information and an updated overview of progress and activity for addiction services commissioned by Manchester Public Health Team. This report followed an initial report to Health Scrutiny on 12 January 2022. 

Key points and themes in the report included:

·         Describing that Manchester City Council (Public Health) commissioned services were:

·           Manchester Integrated Alcohol & Drug Service for adults provided by Change, Grow, Live (CGL).

·           Young Person’s Specialist Substance Misuse Service, also provided by CGL.

·           In-patient Detoxification and Residential Rehabilitation Services provided by various providers.

·           Primary Care Community Pharmacy Services provided by various providers.

·           Manchester Dual Diagnosis Liaison Service provided by Greater Manchester Mental Health NHS Foundation Trust.

·           Drug and Alcohol Social Work Team, delivered by Manchester City Council.

·           Be Smoke Free, which was a community level Stop Smoking / Tobacco Treatment Service.

·         Providing a description of each service’s offer;

·         An outline of performance and an overview of trends; and

·         Describing positive developments and challenges identified.

The Committee then heard from Lucy-Rose Graham and Katherine Miller who spoke of their individual experiences. They described their respective reasons and circumstances that resulted in them accessing the service; their experience of treatment and support; and the positive outcomes achieved.

Some of the key points that arose from the Committee’s discussions were: -

·         Thanking the two citizens for attending the meeting and sharing their experience with Members;

·         What key message would the citizens present give as a means of improving the services described;

·         Calling on the Government to adequately fund these important services, noting the positive impact they had on people’s lives;

·         Noting the proliferation of Vape shops on the high street and the increased occurrence of vaping witnessed amongst young people;

·         What was the approach to Nitrous Oxide, commonly known as laughing gas; and

·         What provision was made by the services to accommodate people for whom English was not their first language.

Lucy-Rose Graham and Katherine Miller both stated that increased publicity of the respective services would be welcomed, noting that it was important for people to access the correct services and means of support. Consistency of staff was also noted as being important, commenting that trusted relationships were formed during the recovery period.

The Programme Lead commented on the points made regarding vaping. She stated that there was a need for a distinction to be made between vaping as a means of stepping down from tobacco addiction and the use of vaping as a recreational substance. She described that currently the legislation surrounding vaping was very limited and primarily fell under the remit of Trading Standards. She commented that the restrictions placed on the promotion and marketing of tobacco was not applicable to vaping. She advised that work was underway with schools to address the issue and highlight the harms of vaping amongst young people and in addition to this the North West Task Force was currently considering this also.

The Commissioning Manager stated that the issue of Nitrous Oxide  ...  view the full minutes text for item 16.

Report of Director, Manchester Climate Change Agency and the Deputy Director of Public Health

In 2022, the Manchester Climate Change Partnership, supported by Manchester Climate Change Agency, updated Manchester’s five year Climate Change Framework (2020-2025) to provide more granular targets for staying within our carbon budget and to highlight the co-benefits of climate action, including tackling health inequality.

The Making Manchester Fairer plan was developed alongside the Framework refresh and so is aligned to it.

The Committee considered the report of the Director, Manchester Climate Change Agency and the Deputy Director of Public Health that described that in 2022, the Manchester Climate Change Partnership, supported by Manchester Climate Change Agency, updated Manchester’s five year Climate Change Framework (2020-2025) to provide more granular targets for staying within our carbon budget and to highlight the co-benefits of climate action, including tackling health inequality.

The Making Manchester Fairer plan was developed alongside the Framework refresh and so was aligned to it.

Key points and themes in the report included:

·         Providing an introduction and background to the Climate Change Framework;

·         Describing the purpose of the 2022 Climate Change Framework Update;

·         An overview and update on the city’s direct emissions;

·         Discussion of the city’s indirect, or consumption-based, emissions;

·         An overview of work by Manchester Metropolitan University and Manchester’s Climate Change Partnership Adaptation and Resilience Advisory Group;

·         Health and wellbeing, noting the link between health inequalities and climate change

·         The Making Manchester Fairer plan was developed alongside the Framework refresh and so is aligned to it; and

·         Recommended actions and key messages of the 2022 Update.

Some of the key points that arose from the Committee’s discussions were: -

·         Noting the impact poor air quality and pollution had on health;

·         Was air quality monitored;

·         Noting the importance and relationship between active travel and health outcomes;

·         The need to ban single use vape pens;

·         Was the NHS considering their carbon footprint and taking actions to reduce these; and

·         Noting the heatwave experienced in 2022 consideration needed to be given to providing cool banks, especially for older residents noting the impact that extreme heat had on health outcomes.

The Deputy Director of Public Health commented that the Making Manchester Fairer approach involved a collaborative approach across all directorates and partners, noting the consideration given to health outcomes that informed the Draft Active Travel Strategy. Members were advised that the Environment and Climate Change Scrutiny Committee would be considering the Draft Active Travel Strategy at the meeting of 9 February 2023. The Chair requested that the Scrutiny Support Officer circulate this report to Members of this Committee for information.

The Deputy Director of Public Health acknowledged the comments made regarding clean air and stated that there was a range of work to address this, especially working with schools and young people via the Neighbourhood Teams. In regard to the issue raised regarding cool hubs she advised that she would feed these comments back to the Health Protection Team.

The Director, Manchester Climate Change Agency advised that air quality was monitored in Manchester and actions around this specific issue were included in the Framework. She further stated that the relationship between health outcomes and active travel was fully understood and again was included in the Framework. In response to the comments made regarding Making Manchester Fairer when considering the previous agenda items the need for a just transition was fully understood and included in the Framework.

The Director, Manchester Climate Change Agency stated that the  ...  view the full minutes text for item 17.

Report of the Governance and Scrutiny Support Unit

The monthly report includes the recommendations monitor, relevant key decisions, the Committee’s work programme and items for information. The report also contains additional information including details of those organisations that have been inspected by the Care Quality Commission.

The report of the Governance and Scrutiny Support Unit which contained key decisions within the Committee’s remit and responses to previous recommendations was submitted for comment. Members were also invited to agree the Committee’s future work programme.

Decision

The Committee notes the report and agrees the work programme.