Agenda and minutes

To approve the record of the meeting held on 23 June 2011.

The record of the meeting held on 23 June 2011 was agreed and signed by the Chairman as correct. 

Apologies for absence were received from Councillors Griffin and Watson. 

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. 

There were none. 

(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.

Councillor Igwe declared a personal interest as he is a mental health practitioner working for the prison service and the NHS.

Councillor Iles declared a personal interest as she is a member of the Medway NHS Foundation Trust.

Councillor Kearney declared a personal interest as she is a Member of the Medway NHS Foundation Trust and also the South East Coast Ambulance Service NHS Foundation Trust.

Councillor Murray declared a personal interest as her daughter works for maternity services.

Shirley Griffiths declared a personal interest as she is a member of the Medway NHS Foundation Trust and the South East Coast Ambulance Service NHS Foundation Trust. She also declared a personal interest in Agenda Item 8 (Review of Elm House and King’s Road, Chatham) as it is her doctor’s surgery.

This report sets out proposals for the establishment of a shadow Health and Wellbeing Board (HWB) in Medway from April 2012 in response to the Health and Social Care Bill and following a facilitated event with key stakeholders in Medway on 11 July 2011.  Members are asked to comment prior to its submission to Cabinet.

Discussion:

The Director of Public Health introduced the report advising that the establishment of a Health and Wellbeing Board was required by April 2013.

The committee was advised of proposals to establish a shadow board, in the form of a Cabinet Advisory Group, until such time as the main board was established. Further work was required to set up appropriate governance arrangements, particularly with regard to its relationship with other key partnerships.

Members were also advised that an initial work programme for the board was set out in paragraph 4.3 of the report.

The committee acknowledged that the work of the Health and Wellbeing Board represented a significant additional responsibility for the Council and requested that as part of the board’s key roles and responsibilities, the needs of Medway’s residents and local requirements would remain paramount over national strategies.

A Member of the committee requested that the Kent Fire and Rescue Service should be included as one of the organisations with whom the Health and Wellbeing Board would need to engage.

Another Member voiced concern that the board would have no decision- making powers. The clinical commissioning groups would have to listen and take account of what the board said but it would not be mandatory. The view was expressed that the work of the board could be compromised without a budget. If the Council wanted to set up and manage the board effectively, it would need resources to support it. Currently, it would be an extra burden for staff to service and manage the board. She asked the Committee to request formal feedback from the Cabinet on how the work of the Health and Wellbeing Board was to be resourced in the future.

The Director of Public Health and the Deputy Chief Executive of NHS Kent and Medway advised that the board would bring together the work currently carried out across a number of groups and partnerships in Medway and would align existing work programmes. This would not involve extra work for staff, as this work was being carried out already. Also, there were different ways the board could steer the clinical commissioning groups such as through the Annual Assessment and initial commissioning processes and it could also feed any problems to the national commissioning board which did have the power to enforce matters at a local level.

With reference to the proposed composition of the shadow board, Members considered that input on the board from the Council should include representation from the two main opposition groups.

Decision:

The Committee agreed the following requests relating to the shadow phase of the board :

i)    that whilst there will be national strategies and priorities for the board to accommodate it is hoped that the work of the board will predominantly focus on meeting the needs and priorities identified at a local level in  Medway;

ii)   that the Kent Fire and Rescue Service should be included in the list of groups and organisations to be included in the board's engagement strategy;  ...  view the full minutes text for item 268.

This report sets out the first quarter performance against the Council Plan 2011-2012. 

Discussion:

The Director of Children and Adults introduced the report informing Members that this was the first report shown in a revised format with measures related to social care and health.

The Committee was advised that Appendix 1 to the report contained the key headlines with the performance regarding hospital-delayed discharges continuing to be very good. The biggest challenge was to move service users on to personal budgets and self-directed support and the systems and structures were now in place for this. Another challenge was the target for adults with learning difficulties in employment, as this was a fragile group of service users with very particular needs that had to be handled sensitively.

Members congratulated staff on the timeliness of social care assessments but expressed disappointment about the assessments of carers themselves. Officers advised that the numbers used for this target were very simplistic and did not reflect the picture accurately, as a fairly high number of people refused the offer of an assessment. However, the council accepted that performance in this area was not good enough as carers were the key to successful outcomes for service users.  The Committee was informed that officers were very optimistic that performance for this target would improve and they would push ahead with further work and projects at the Carers Centre.

A Councillor informed the committee that at another overview and scrutiny meeting earlier in August, Members had been told about a contract that had included the provision of six apprenticeship schemes within the contract and he wondered if the employment of adults with learning difficulties could be included in the procurement process of other, large contracts commissioned by the Council. The committee and officers were keen to progress this idea further.

The committee also asked the Assistant Director, Adult Social Care, about the low performance of the target for the number of social care clients receiving self-directed support. He advised that there had been a change at national level with regard to the reported target, which made the Council’s figures look worse than they had previously. He stated that the only way to achieve the target was for the offer to all users to be either a direct payment, where a person could manage their own budget or a personal budget, where the Council informed a user on the cost of their care package but the council managed the budget on behalf of the user. The directorate spent £74.5 million each year, so it was good for people to know how much was being spent and on which services.

Decision:

The Committee agreed to:

(a)   note the outcomes achieved against priorities;

(b)   note its concern for support for carers;

(c)   requested further statistics for personalised budgets in the next report including the number of people who had refused this offer;

(d)   recommend to the Procurement Board that any appropriate commissioning of a service includes the provision of employment for people with disabilities and learning difficulties as part of the contract, where possible  ...  view the full minutes text for item 269.

The report provides information on the number and type and other information on adult social care complaints received during the period April 2010 to March 2011. It further highlights examples of the many positive things people have said about the provision of adult social care over the same period. 

Discussion:

The Director of Children and Adults introduced the report advising Members that a single, more customer focused approach to complaint handling across health and social care had been introduced at a national level which was intended to resolve cases quickly, and in a manner that best met the needs of the complainant.

The Director of Children and Adults emphasised the importance of learning from complaints, particularly if the complaint was about communication issues within the council and embed the changes into how the services ran in the future. She assured Members that the examples described in the report showed that the complaints were about individual failures and not system-wide problems.

Decision:

The committee noted the report and that the directorate was taking on-board the mistakes being made and learning from them.

NHS Medway’s future plans for its estates including the potential relocation of staff and services from Elm House Clinic, Chatham and Kings Road Clinic, Luton.  Both clinics are poor environments for patients and staff, are unsuitable for the delivery of modern day healthcare, do not fully comply with Disability Discrimination Act (DDA) requirements and are very inefficient in energy use.  This also restricts opportunities for future service delivery improvements.  This report sets out the completed protocol questionnaire for a service variation and outlines the options being considered.

The Deputy Chief Executive, NHS Kent and Medway, introduced the report advising that the proposals were being put forward in order to meet the needs of the service users. This report was part of the formal consultation process following consultation with staff and providers of services at these locations.

The Assistant Director of Community Commissioning advised that the report detailed how NHS Medway had set out to relocate the services provided from these buildings, the timetable and processes used, and from that how the consultation document had been formed. Leaflets have been made available at the clinics and on-line and the staff at the clinics have also been encouraged to talk to users about it.

The committee was advised that the proposal, as currently being consulted upon, replaced every session currently available at Elm House and Kings Road clinics with another session elsewhere in Medway and so there was no loss of service. The distances of how far the proposed clinics were relocated from Elm House and Kings Road was set out on page 59 of the agenda. The committee was also advised that Equality Impact Assessments had been completed for each of the services, and were included in the agenda. These contained information that was currently known for each service which would be constantly informed, and updated, throughout the consultation process. Currently, it was not envisaged that a full impact assessment would be required for any of the services.

The Chairman asked how assured NHS Medway was of the geographical profiling of current service users at these clinics, particularly with reference to services in Strood. The Deputy Chief Executive responded that, in general, Strood residents did not access these services.

Members agreed that the buildings were no longer fit for purpose and had no future development potential but questioned whether the other clinics had the capacity to take on these extra services? Members also commented that they were pleased to see that there would be no staff reductions caused by the re-location of services but asked how and where the staff were to be relocated?

The Assistant Director of Community Commissioning responded that NHS Medway managed all the buildings where the services were to be relocated, so they could ensure that the space in each clinic was utilised to its maximum potential. Also, the service providers who currently managed the services in Elm House and Kings Road also managed services in the proposed buildings, which would help to make this a smooth transition of services.

Members also asked about the current Contraceptive and Sexual Health service (CASH) and what was being offered to residents, with some Members believing that existing services did not cater for the increasing sexual health problems of older women. The future of the welfare benefits system and how it would affect addicts was highlighted, where it was proposed that benefits would be withdrawn from an addict if they could not prove that they were seeking help for their addiction. Members asked how this was being  ...  view the full minutes text for item 271.

The Committee is requested to comment on the NHS Medway legacy document, which will need to be submitted to NHS South East Coast in September 2011.

Discussion:

The Assistant Chief Executive of Kent and Medway PCT Cluster introduced the report explaining that one of her roles was to ensure that this document  captured all essential information that successors to the PCT could take over. It was her objective to obtain all knowledge and experience from staff before the loss of posts and ‘corporate memory’, as people moved on to other positions as a result of the NHS reforms.

The National Quality Board required the legacy document to be collated and written and had given clear information about what should be included in the document. It was a reference document which would direct people towards finding more information and where that information was available. It would include a library of all consultations and why decisions had been taken. Members were advised that the version attached to the report was the first draft of the document and the Assistant Chief Executive was keen to know if there were any obvious omissions and/or what could be taken away and expanded upon in more detail.

Members advised that they had found the document difficult to read and could not compare like with like, as some facts and figures had been reported in different formats, particularly the financial information. Members thought that this was a very good opportunity to compare the health areas and benchmark work and outcomes, such as spend (of money) per head of population and whether the three different figures reported for each area were significant figures and differences.

The committee praised the glossary at the end of the document, which they had found especially useful.

The Assistant Chief Executive responded that a document such as this had not been compiled before and therefore she had started at a very low base of information. Information had been requested from the three PCTs and this was how they had reported it. She advised that she was confident that this would change as the document evolved, as it was being re-drafted every three months but she would take this point back to the three PCTs to ask whether the information could all be reported in the same way to allow comparison.

The Deputy Chief Executive of NHS Kent and Medway advised that the biggest factor applied to the level of funding for each PCT nationwide was weighted by the age of residents living in that area which is why each PCT received different levels of funding.

Decision:

The committee noted the first draft of the legacy document and requested that, in future, information was set out in a simpler, more understandable manner which allowed easy comparison between the three PCTs.  

Members are asked to consider whether to add or remove items on the current work programme and to refer to Business Support Overview and Scrutiny Committee the topic choices for a potential themed meeting or in-depth review task group. 

Discussion:

The Democratic Services Officer introduced the report advising that there were no new items on the Cabinet’s Forward Plan within the remit of this committee. Members were also asked to consider the two proposals, set out in Appendix 2, put forward by the Chairman and Spokespersons for  future in-depth review topics.

Members asked about the items on the work programme showing as “date to be determined” and asked officers to confirm which meetings these matters would be reported to as soon as possible. The Director of Public Health advised that the final item on the work programme – report on sexual health would be submitted to Members via a Briefing Note and not a report.

The committee also asked that a future report on ‘Chronic Pain and Diabetes’ was added to the work programme.

Decision:

The committee agreed:

(a)   to add a report on Chronic Pain and Diabetes to the work programme as soon as possible;

(b)   that the report on sexual health would be provided by way of a Briefing Note;

(c)   to forward to Business Support Overview & Scrutiny Committee the topics selected for future in-depth review as: mental health; and transition and personalised budgets.