Agenda and minutes

To approve the record of the meeting held on 3 June 2010.

The record of the meeting held on 3 June 2010 was agreed and signed by the Chairman as correct. 

Apologies for absence were received from Councillors Harriott and Murray. 

The Chairman will announce any late items which do not appear on the main agenda but which he/she has agreed should be considered by reason of special circumstances to be specified in the report. 

The Chairman announced there were no urgent items however he welcomed Christine Baker, representative of Medway Pensioner’s Forum, to her first meeting of the committee as a non-voting co-optee and stated that he intended taking the agenda item on phlebotomy after the report on dermatology.

(a)               Personal interests under the Medway Code of Conduct.

A Councillor who declares a personal interest in a matter, including the nature of the interest, may stay, speak, and vote on the matter.

(b)               Prejudicial interests under the Medway Code of Conduct.

A Councillor who declares a personal and prejudicial interest in a matter, including the nature of the interest, must withdraw from the room and take no part in the debate or vote on the matter.

Councillors who have declared a personal and prejudicial interest may make representations, answer questions and give evidence before leaving the room but only if members of the public are allowed to attend for the same purpose.

If an interest is not declared at the outset of the meeting, it should be disclosed as soon as the interest becomes apparent.

(c)               Whipping – the Council’s constitution also requires any Member of the Committee who is subject to a party whip (ie agreeing to vote in line with the majority view of a private party group meeting) to declare the existence of the whip and the nature of it before the item is discussed.

Shirley Griffiths, LINk Co-ordinator, declared a personal interest by virtue of being a member of Medway NHS Foundation Trust, a member of South East Coast Ambulance Trust, Medway Older People’s Board and a GP Patient Forum Member.

Councillor Sheila Kearney declared a personal interest by virtue of being a member of Medway NHS Foundation Trust and South East Coast Ambulance Trust. 

The report advises Members of the committee of the current work programme and allows them to adjust it in the light of latest priorities, issues and circumstances.  It gives Members the opportunity to shape and direct the committee’s activities over the year.  It also details the outcome of a work programming meeting and scoping meeting and review of the LINk protocol. 

Discussion:

The Overview and Scrutiny Co-ordinator introduced the work programme and drew members’ attention to the appendix setting out the suggested scoping for the themed meeting on 19 August 2010 on safeguarding vulnerable adults.  The committee was recommended to set up a one off task group to consider recommendations from that meeting.

Councillors Avey and Gulvin volunteered to be part of the task group and it was agreed that the Labour group and Liberal Democrat group representatives would be determined via the group whips.

Decision: 

The Committee agreed:

(a)               the scoping for the themed meeting on safeguarding vulnerable adults set out in Appendix 2 to the report;

(b)               that a small task group is set up comprising Councillors Avey and Gulvin plus one Labour group and one Liberal Democrat representative agreed through the group whips to consider the findings of the themed meeting;

(c)               to note the views expressed at the work programming meeting reflected in paragraph 6 of the report.

This report sets out changes to the dermatology service in Medway.  The new service will be required to provide clinics in all three localities in Medway, using facilities such as the Healthy Living Centres, Health Centres and the Community Hospital.

Discussion:

The Deputy Chief Executive, NHS Medway gave an overview of the report and stated that she felt this report and the one on phlebotomy, although not substantial variations or service developments as such, were important issues to bring to the committee.

The Practice Based Commissioning Manager, NHS Medway, then explained the business case proposed for the dermatology service in order to enhance and extend the existing service into the community to increase the number and range of skin conditions dealt with.

She stated that the service specification being developed was for a multi-disciplinary service model, consisting of weekly consultant clinics, 2 GPs with special interest (GPwSI) clinics per week and a full time specialist nurse.  This model would provide capacity for approximately one third of the total Medway activity – approximately 1800 new appointments and 3000 follow-ups.  Members were informed that there had been some slippage with the dates outlined in the report but she hoped a full service could be in place by May/June 2011.

Responding to members’ questions it was explained that:

·        the service would cover the whole of Medway

·        specialist training would be given to the staff involved in the service

·        there would be back-filling in the GP surgeries where a GP with special interest was involved

·        the expansion of the service would be funded within the existing budget

·        there would be a reduction in the need for hospital appointments which constituted a saving in budget

·        the level of training would be dependent on the existing experience of the staff but would involve the GP specialist working alongside a consultant until both were satisfied of the competency of the GP specialist.

Decision: 

Members welcomed the improvement and expansion of the dermatology service.

The aim of this report is to examine the opportunities for the development of more community based phlebotomy services.

Discussion:

The Deputy Chief Executive, NHS Medway, explained the background to the review of the phlebotomy service and the recognition of the pressures at the hospital in particular and the resultant queues which did not constitute a good experience for patients.

The Commissioning Manager, Planned Care, NHS Medway, then gave a more detailed introduction to the service changes.  She set out the issues with the current service and in particular the poor access and choice in terms of clinic provision, particularly for those patients living in more rural areas like the Isle of Grain.

She outlined the proposals for the service, which were aimed at:

·        Improving access to a quality phlebotomy service that is closer to home (including a greater choice of clinic locations and appointments at times that are more convenient to patients)

·        Improving patient choice of phlebotomy providers

·        Improving patient experience

·        Reducing waiting times for patients and delivery pressures on providers

In response to members’ questions it was stated that, at present, there was no contractual method whereby patients could have blood taken out of area, for people who commute to work, but that this could be looked at as a possibility.  Equally the suggestion of using a mobile unit for the service could also be examined.

Discussion took place around difficulties experienced by some people with regards to fasting blood tests and the discomfort caused by delays.  It was stated that in such instances patients were advised to increase their fluid intake, which then assisted with the process.  An example was given of a person attending the phlebotomy clinic at the hospital with their daughter with learning disabilities who had experienced problems due to having to wait for a long period. The Commissioning Manager, Planned Care, agreed to look into this to find out if it would be possible for patients in that situation to be seen more quickly.

Decision:

The Committee:

(a)         welcomed the proposals for the phlebotomy service as outlined at the meeting;

(b)         requested a briefing note on the possibility of a mobile clinic and the option of having blood taken elsewhere and the results relayed back to Medway.

This report updates members on the  proposed new model of care in the community for dementia that is fully integrated with health and social care services.

Discussion:

The Head of Commissioning for Older People, NHS Medway, introduced a report on the strategic outline case for dementia care, which covered the entire pathway of care.  The intention was to develop a clinical pathway that bridges the current gaps between primary, community and secondary care services.  The case for change was outlined along with the commissioning intentions for the future and it was stated that with the development of enhanced community services the person with dementia and their carer should be able to be cared for at home for as long as possible.

Responding to a question about signposting to dementia services, the Assistant Director, Adult Social Care, reminded the committee that there was now a dementia website, 24 hour telephone line and a team of specially trained dementia advisers set up in Medway to assist dementia sufferers and their carers.  He also explained a number of useful aids and adaptations for people’s homes, which had been developed for people with dementia and advocated the role of extra care housing which was very suitable for people with dementia.  Unlike sheltered housing extra care housing offered 24 hour on site social care support.  In response to a question he offered to provide a briefing note on whether an article could be placed in Medway Lifeline magazine giving further details.

The LINk co-ordinator pointed out that not everyone accessing the hospital with mental health or learning difficulties was made aware of the specialist MAST (crisis) team working there.  The Head of Commissioning for Older People undertook to investigate this.

The Head of Commissioning for Older People then confirmed, in response to a query, that the National Institute of Clinical Excellence guidance used for dementia had been recently updated.

The Director of Children and Adults emphasised the importance given to the role of carers at a recent themed meeting of the committee and advised that there would be a report back in the autumn on progress.

In relation to the plans for intermediate care the Head of Commissioning for Older People confirmed, in response to a query, that these should be in place by 2011/2012.  Some members of the committee expressed concern about people with dementia who live alone and do not have the support of a family nearby.  The Assistant Director, Adult Social Care, explained that if a person in that situation became unable to continue living on their own their case was carefully analysed by staff, trained in Deprivation of Liberties and safeguarding, and a decision then taken about the best care for that person.

Decision:

The Committee:

(a)       welcomed the report outlining the strategic business case for dementia; and

(b)             requested a briefing note from the Assistant Director, Adult Social Care in relation to the possibility of placing an article in Medway Lifeline magazine about adaptations which may assist people with dementia.

Further to the committee’s request this is an update on the success of the primary angioplasty service lead by NHS Eastern and Coastal Kent.  As part of this update a powerpoint presentation will be shown.

Discussion:

The Director and Senior Service Improvement Project Manager from Kent Cardiovascular Network gave a presentation updating members on the implementation of the new primary angioplasty service for Kent and Medway which had been in operation since 12 April 2010.

The committee was informed of the stringent planning, which had been undertaken before the service commenced and the benefits of the service to residents of Kent and Medway.  219 patients had been transferred to William Harvey Hospital, 46 of which were Medway residents, 156 have had primary angioplasty (pPCI) of which 31 were Medway residents, and 45 have just had an angiogram and not proceeded to angioplasty

 For these people their stay in hospital had been considerably shorter and the feedback from the patients was overwhelmingly positive.

Members were informed that the Network would be undertaking a full and in-depth review of the service at 6 month and 12 month intervals.

The Primary Angioplasty Implementation Manager, responding to member queries it was explained that unless the patient had other health problems it was not normally necessary for them to undertake physiotherapy following primary angioplasty.

Decision:

The committee thanked those who had attended the meeting for their presentation and stated that they were impressed with the success of the service so far.

In accordance with the agreed LINk protocol this item sets out the draft Medway LINk Annual Report for Members’ consideration. 

Discussion:

The LINk co-ordinator and Cate Boland from Medway LINk responded to members’ questions in relation to the following views of their annual report:

·        Training for people on mystery shopping

·        It was accepted that further clarification would be helpful on the issues which the LINk could deal with, possibly by giving anonymised examples of what had or had not been dealt with, along with the outcome

·        The point was made that, to avoid delay, the moderating panel now meets in the morning with the co-ordinating group in the afternoon in order that finance can be released on the same day for investigations if required.

Decision:

The committee noted the report, the review of the protocol and the interaction between Medway LINk and adult social care.