Agenda and minutes

To approve the record of the meeting held on 26 January 2012 and the record of the special meeting of 1 March 2012.

The record of the meeting held on 26 January 2012 and the record of the special meeting held on 1 March 2012 were agreed and signed by the Chairman as correct. 

There were none. 

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. 

A request was made for clarification about the recent Cabinet decision relating to the Balfour Centre to explain whether or not the consultation on the future of the centre had been reopened.  The Assistant Director, Adult Social Care stated that the service users, carers and families and staff would be consulted on the option put forward by Medway Community Healthcare prior to a report going back to the Cabinet.  A proposal was put forward that there should be a recommendation to Cabinet to extend the consultation period on the same terms as previously to enable further ideas to be put forward.  On being put to the vote this was lost.

(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 declared a personal interest as she is a member of the Medway NHS Foundation Trust, the South East Coast Ambulance Trust and Medway Older People’s Partnership.

Councillor Igwe declared a personal interest as he is a mental health practitioner working for the prison service and the NHS.  He also declared a personal interest in the Member item by virtue of his part in the campaigning on behalf of the surgery being kept open.

Councillor Christine Godwin declared a personal interest in any reference to Kent and Medway NHS and Social Care Partnership Trust as her husband is a non-executive director there and in Medway Older People’s Partnership by virtue of being chair of the Partnership.

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

Councillor Murray declared a personal interest as her daughter works for NHS Medway.

The Chairman, Councillor Avey, declared a personal interest in the Member item by virtue of the surgery being in his ward and he had campaigned on behalf of the surgery being kept open.

This reports sets out the outline business case for the proposed merger of Medway NHS Foundation Trust with Dartford and Gravesham Trust. 

Discussion:

The Chief Executive of Medway NHS Foundation Trust updated Members on the outline business case for the proposed merger of Medway NHS Foundation Trust with Dartford and Gravesham NHS Trust.  He explained that the Co-operation and Competition Panel had begun their assessment of the case for merger, which was the first step in the formal approvals process.  The consultation period had been extended until the end of April 2012.

He set out the reasoning behind the proposed merger that he emphasised was being put forward by the two trusts on the basis of sustainability, financial viability and improved clinical practice.  He stated that there had been a national policy direction which was to shift healthcare from the acute settings into the community and that this impacted on the whole health service.

He responded to Members’ questions in relation to a number of key points which included:

• Financial modelling of the trusts/offset of debt
• Learning from the review of the merger in Bristol
• Impact on staff and staff losses
• Impact on Medway residents/whether there would be delays on waiting lists
• Explanation of the health profile of Medway residents compared to other areas
• Whether the residents of Medway would be displaced at the two hospitals owing to an influx of patients from outer London
• The compatibility of the IT systems between the trusts

The Chief Executive of Medway NHS Foundation Trust explained that there would not be any disadvantage to Medway residents in his view there would be more opportunities to access services locally, which at present are only available in London.  In response to the financial issues he stated that the government had indicated their support to trusts that are struggling with Public Finance Initiative debt and it was hoped that Dartford and Gravesham NHS Trust could receive its fair share of funding from this.  As far as staff were concerned he stated that in areas such as HR and administration there would be job losses but he hoped that redeployment could be offered to a number of the more junior staff. 

The Director of Public Health referred to the health profile in Medway and emphasised the importance of embedding prevention into every pathway.  She saw the proposed merger as an ideal opportunity to improve the health of Medway residents.  The Chief Executive of Medway NHS Foundation Trust accepted this and agreed to include prevention of ill health in the developing business case for the merger.

In relation to the IT systems it was stated that there was some compatibility of systems but the main information technology for both trusts was nearing the end of its life so there was an opportunity to look at procuring compatible systems.

Decision:

The Committee thanked the Chief Executive of Medway NHS Foundation Trust for attending the meeting and requested an update in six month’s time.

This report sets out a response to the issues raised by Councillor Igwe regarding the proposed closure of Marlowe Park Medical Centre in Strood.    

Discussion:

Councillor Igwe introduced his Member item by expressing his disappointment at the lack of engagement from NHS Kent and Medway with the ward members and the Committee on developments in relation to Marlowe Park Medical Centre.  He stated that the imminent closure of the Medical Centre had only come to his notice through the local media and from the GP and patients concerned.   He also pointed out that none of the affected ward members had been invited to attend the public meeting held to discuss the issue with patients of the surgery.

He reminded representatives of NHS Kent and Medway of their duty to consult with the Committee on substantial variations and service developments encapsulated in the protocols between the NHS and Medway Council.  He also emphasised the need for ward members to be alerted to any similar emerging issues in their wards before such time as they are made public.  Councillor Igwe then referred to the recent developments whereby the contract with the GP concerned had been given a three-month extension and asked whether this was as a result of the Member item?

The Chairman also referred to what he felt were very unsatisfactory arrangements for the public meeting.

The Co-Medical Director for NHS Kent and Medway apologised for the recent unfortunate sequence of events and the difficulties involved in early disclosure of such information as they had been the subject of protracted confidential negotiations.  He accepted that there was a duty to notify ward members and to consult the Committee and undertook to ensure that any similar events are brought forward sooner.  He stated that a procurement exercise would need to take place at which the GP in question would be welcome to bid for the contract.  Discussions were ongoing about an extension beyond the agreed three months for a further period of between 12 and 15 months.  He admitted that the Primary Care Trust had underestimated the numbers of people likely to attend the public meeting and agreed that the arrangements had been unsatisfactory.  Lessons had been learnt from the process.

Councillor Igwe, and other Members of the Committee, emphasised the need to ensure continuity for the patients at the surgery who had received confusing correspondence and experienced uncertainty during this period.  He urged the Primary Care Trust to deal with the matter with utmost care.

A request was then made for further details on the impact of competition rules, which exist for General Practitioners particularly in the light of the NHS reforms.  The Chairman proposed that an all Member briefing should be added to the work programme, detailing the impact of the Health and Social Care reforms, at which this could be addressed.

Decision: 

(a)   That there is a report back on progress on developments at Marlowe Park Medical Centre in three months time;

(b)   An all Member briefing is to be arranged on the implications and impact of the Health and Social Care reforms, taking into account the comments above.

The Programme Lead for Commissioning Development and Safe Workforce from NHS Kent and Medway will attend the meeting to give a presentation to the Committee on how the trust assures itself about the quality of service providers.

Discussion: 

The Associate Director of Nursing and Quality, NHS Kent and Medway and the Programme Lead for Commissioning Development and Safe Workforce, NHS Kent and Medway gave a presentation on how the Trust assures itself about quality of services provided. 

They stated that to support the quality assurance process there are bi-monthly provider Clinical Quality Review meetings for Medway Community Healthcare, Medway NHS Foundation Trust and Kent and Medway NHS and Social Care Partnership Trust.  These groups report into clinical commissioning groups, the cluster quality committee and up to the cluster board.

The agendas for the quality review groups focus on topics such as reviewing key performance indicators, safeguarding, infection control, serious incidents, safe care, privacy and dignity, complaints, Care Quality Committee quality and risk profiles, quality accounts, NICE guidance, clinical audit, mortality, the enhancing quality programme and other areas of quality and safety such as pressure ulcers, falls and transfer of care for example.

There are other mechanisms to enable commissioners to evaluate the safety and quality of NHS service providers. In Autumn 2011 a programme of deep dives was initiated with providers across NHS Kent and Medway. This commenced with acute providers and Medway NHS Foundation Trust was the first organisation to be evaluated. The initial stage was an internal commissioner review of hard and soft intelligence such as the quality focus within the Trust; the senior management team’s commitment to quality; medicines management; safeguarding; workforce; communications; openness to challenge; patient experience; staff surveys; clinical effectiveness; external reviews.

The Deputy Chief Executive, NHS Kent and Medway, responding to a question undertook to let Members know how people are referred to the Falls Team and whether or not this needed to be via their GP.

The LINk representative referred to some LINk work around Quality Accounts at Medway Maritime Hospital during which the amount of time allowed for feeding seemed to be insufficient.   She stated that she would send a copy of the report to the Associate Director of Nursing and Quality, NHS Kent and Medway who undertook to look into this.

Reference was made to the importance of quality training for staff and the Associate Director of Nursing and Quality stated that staff training was one of the key performance indicators for the trust, particularly around important issues such as safeguarding.

An undertaking was given to an update for Members at a later date.

Decision:

The Associate Director of Nursing and Quality, NHS Kent and Medway and the Programme Lead for Commissioning Development and Safe Workforce, NHS Kent and Medway were thanked for their presentation.

The report updates the Committee on progress made on the development of an integrated diabetes service model.   

Discussion:

The Director of Public Health gave a brief introduction to the diabetes update report and detailed the measures being taken to provide greater support in the community for people with diabetes. 

The Project Manager, NHS Kent and Medway then referred to a redesign of the service which had been discussed at a workshop held in March last year.  Members were told that the model will incorporate primary, community and secondary care services with the intention of improving the management of diabetes within Medway, supporting people with diabetes in Medway to live healthier and longer lives and to have the knowledge and information to self-manage their condition with confidence.

The Director of Public Health and Project Manager from NHS Kent and Medway responded to Members’ questions.  In relation to a query about deprivation the Director of Public Health stated that the increase in diabetes related to the ageing population and increased obesity rather than to an increase in deprivation.  Discussion took place around retinal screening and the Director of Public Health confirmed, in response to a question, that referral for treatment following retinal screening should be local and she could not explain why a member of the public, in the instance referred to, would have been sent to Ashford.

A Member drew attention to the reference within the report to care not being well co-ordinated between the community and hospital teams and pathways not being efficient.  He asked whether this was due to a lack of manpower and emphasised the importance of ensuring that the message about education and prevention in the community and in schools.

The Project Manager stated that there were sufficient numbers of staff and that care was now being better co-ordinated.

The Director of Children and Adults stated that SureStart in Medway was undertaking a lot of work in this regard particularly around the encouragement for families to prepare simple nutritious food.

Clarification was given as to the methods of screening used by GPs in that over a five year cycle the GPs would check those people aged 40-75 years for diabetes.

Decision:

Members thanked the Director of Public Health and the Project Manager, NHS Kent and Medway for their helpful presentation.

This report is asking the Committee to determine whether, for Medway, the proposals in the Kent and Medway wide review into mental health acute in-patient beds, are substantial variations or service developments.   If they are considered to be substantial then the Joint Health Scrutiny Committee between Medway Council and Kent County Council will need to meet.

Discussion:

The Director of Commissioning Adult Mental Health Services and Substance Misuse, NHS Kent and Medway and the Director of Acute Services, Kent and Medway NHS and Social Care Partnership Trust introduced the report relating to inpatient mental health in Kent and Medway.

Members were informed of the reasons behind the review into inpatient mental health beds, which originated from a national drive to significantly develop local services to support people in an acute phase of mental illness so their needs can be safely met in the best place possible.  The review was also necessary due to the fact that the existing provision in ‘A’ block at Medway Maritime hospital was not viable.  The Care Quality Commission compliance inspection in November 2010 had identified that ‘people were generally protected from harm although there was risk where the layout of the ward made de-escalation of violence difficult and there was no seclusion room on the ward’.

Some Members expressed their disappointment at the possibility of not having an inpatient facility in Medway and felt that the lack of a Medway facility would increase admissions to Accident and Emergency.  The Director of Acute Services, Kent and Medway NHS and Social Care Partnership Trust stated that the Crisis Resolution Team at the hospital would provide a default position in this situation and that it was important to build a whole system approach which was sustainable.  The option being suggested was for Medway residents to use the facilities at the Willow Suite in Dartford.  Members did not feel this would be an acceptable solution and emphasised the need for more local (Medway) options to be considered.  The Deputy Chief Executive of NHS Kent and Medway stated that a decision had not yet been reached about the way forward and the main concern would be to ensure there is the right model of care to get the right services to those people who need it.  In the event of having to provide a new provision in Medway this would need to be at the expense of something else.

It was agreed that the changes substitute a substantial variation to services and Members felt it was important for the joint HOSC to understand the full data with regards to the use of the inpatient beds at Medway Maritime Hospital by Medway residents over the past few years.  It would also be important to be assured that whatever outreach facilities were put in place were robust and available at any time of the day or night.

Decision:

The Committee agreed that the review of acute inpatient mental health beds is a substantial variation for the purposes of convening the joint HOSC (health scrutiny committee) with Kent County Council.

This report is asking the Committee to determine whether, for Medway, the proposals in the Kent and Medway wide review into patient transport, are a substantial variation or service development.   If they are considered to be substantial then the Joint Health Scrutiny Committee between Medway Council and Kent County Council will need to meet.

Discussion:

The Deputy Chief Executive of NHS Kent and Medway introduced a report setting out details of a patient transport service review by stating that this was not a substantial variation or service development on the grounds that it was purely a procurement exercise.  In the event that there were subsequent changes to the service as a result of this they would be brought to the Committee in the usual way.

Members agreed that, at this stage, the issue was not a substantial variation or service development but wished to return to the issue at the point at which it was possible to test the robustness of the system.

Decision:

It was agreed that, for Medway, the procurement for non-emergency patient transport service is not a substantial variation or service development for the purposes of setting up the Joint HOSC with Kent County Council but that the item should be listed in the work programme for scrutiny at a later stage.

This report sets out quarter 3 performance against the Council Plan objectives for 2011/2012.   

Discussion: 

The Director of Children and Adults introduced the quarter three performance against the Council Plan objectives for 2011/2012 and responded to Members’ questions.

The Chairman, Councillor Avey, then informed Members that a reference had been made at the last meeting of Business Support Overview and Scrutiny Committee for this Committee to look at the erratic performance of NI 133 which relates to timeliness of services commencing post-assessment.

The Assistant Director, Adult Social Care explained the reasons for this indicator, which was best measured on an annual basis, varying across the different quarters which was due to the fact that there was always a time lag of 28 days from commencement of services post assessment which distorted the figures.  He also said that innovation in occupational therapy had also affected the figures but that it was not possible to have full assurance about the performance until the end of the year.

Reference was made to the change in housing benefit regulations and the impact that this would have on the need for services.  Disappointment was also expressed about the carers’ assessments still not being near to target.  The Assistant Director, Adult Social Care agreed that the performance in this regard was not as good as he would like but that concerted efforts were being put in place through a s256 agreement to improve the position.

A request was made that in future reports on NI130, social care clients receiving self directed support, details are given about the number of offers of self directed support which are made and those which have been declined.

Decision:

The report was noted.

Members are asked to consider whether to make any amendments to the work programme. 

Discussion:

The Democratic Services Officer stated that, as stated in the report, Supporting People needed to be brought to the Committee at its special meeting on 22 May 2012.  She also stated that she had received a request from Kent and Medway NHS and Social Care Partnership Trust for their application for foundation trust status to be considered by the Committee.  This would also need to be scheduled for 22 May 2012.

The review of Marlowe Park Medical Centre would be considered at the June meeting and a briefing for all Members on the Health and Social Care Act 2012 would need to be arranged.

Decision:

The Committee agreed to the following additions to the work programme:

• Supporting People report on 22 May 2012
• Kent and Medway NHS and Social Care Partnership Trust application for foundation trust status on 22 May 2012
• Marlowe Park Medical Centre update on 26 June 2012
• An all Member briefing to be arranged on the Health and Social Care Act 2012