Agenda and minutes

To approve the record of the meeting held on 21 August 2012.

The record of the meeting held on 21 August 2012 was agreed and signed by the Chairman as correct. 

To receive apologies for absence. 

Apologies for absence were received from Councillors Christine Godwin and Mackness. 

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 member need only disclose at any meeting the existence of a disclosable pecuniary interest (DPI) in a matter to be considered at that meeting if that DPI has not been entered on the disclosable pecuniary interests register maintained by the Monitoring Officer.

A member disclosing a DPI at a meeting must thereafter notify the Monitoring Officer in writing of that interest within 28 days from the date of disclosure at the meeting.

A member may not participate in a discussion of or vote on any matter in which he or she has a DPI (both those already registered and those disclosed at the meeting) and must withdraw from the room during such discussion/vote.

Members may choose to voluntarily disclose a DPI at a meeting even if it is registered on the council’s register of disclosable pecuniary interests but there is no legal requirement to do so.

In line with the training provided to members by the Monitoring Officer members will also need to consider bias and pre-determination in certain circumstances and whether they have a conflict of interest or should otherwise leave the room for Code reasons. 

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

Councillor Murray declared a personal interest by virtue of her daughter working for the NHS.

Shirley Griffiths declared a personal interest by virtue of being a Member of Medway NHS Foundation Trust and South East Coast Ambulance Trust and as a trustee of Medway Crossroads Carers Trust.  

This report updated the committee on the proposed integration between Medway NHS Foundation Trust and Dartford and Gravesham NHS Trust. 

Discussion:

The Chief Executive of Dartford and Gravesham NHS Trust provided the committee with an update on the integration with the trust and the Medway NHS Foundation Trust (FT).  The trusts were expecting to shortly receive a formal response from the Co-operation and Competition Panel (CCP) endorsing the integration proposal.  The Business Plan was being finalised as updates were required following efficiency, inflation and population forecast updates.  Heads of Terms were also being finalised between the trusts, commissioners and the Department of Health (DoH).

Members then asked a number of questions, which included: -

·        Concerns relating to the Dartford and Gravesham NHS Trust’s private finance initiative (PFI) and how this could affect Medway;

·        Concern about compatibility of systems between the trusts, particularly around information held in Human Resources and patient records;

·        Concern that some clinical services would be centralised and provided at one site only;

·        Clarification about consultation with community and voluntary organisations;

·        Concerns that the Business Plan was a live document and so was difficult to fix the intended direction of travel for the integrated trust;

·        Clarification about new services and what developments the integrated trust might look to make.

In relation to the PFI, the Chief Executive confirmed that one element of the Heads of Terms was to ensure that the PFI monies were secure.  With regard to the compatibility of systems, it was assured that the electronic imaging systems used were already compatible throughout Kent and there was also a common system used for patients with cancer.  The patient administration system was not yet compatible.  Medway’s system was at the end of its natural life and would be replaced in the near future and Dartford and Gravesham NHS Trust would replace its system with whatever is purchased by Medway NHS FT.

The Chief Executive also confirmed that there were no plans to move clinical services at either of the two sites as the intention was to maintain access to services and to move staff rather than patients.  It was envisaged that corporate functions would be centralised and based at the Medway site due to it being more flexible and cheaper.

The Integration Director from Medway NHS FT explained that they had worked with CVS Medway to obtain contact details for local community and voluntary sector organisations and had made email contact with those provided but undertook to ensure contact was made with the Medway Housing Forum, the Sunlight Trust and the Pensioners Forum.

The Chief Executive explained that the trusts were investigating what work is referred outside of the two trusts and were taking views about some tertiary work that could be provided by the integrated trust, provided the right investment and expertise were in place.

In relation to the future name of the integrated trust, Members gave the view that Medway and other communities within the area should feature in the name.  In response, the Integration Director explained that the integrated trust intended to keep the hospital names affiliated to the areas in which they were  ...  view the full minutes text for item 463.

This report updates the committee on podiatry services, following issues raised at the committee’s June meeting. 

Discussion:

The Operations Director from Medway Community Healthcare (MCH) introduced to the committee her update on podiatry services.  Key issues in her introduction were: -

·        Waiting times had been reduced and the average waiting time was now 16 weeks, however, the trust were investing resources to further reduce this – diabetic patients were seen within 48 hours;

·        A central booking system had been introduced which provided patients with the soonest available appointment at any clinic.  Some patients took the next available slot and others chose to wait for a slot at their local clinic;

·        Ongoing care for patients was a concern in that sometimes patients were continuing to be seen by the service when there was no longer a clinical need and this had contributed to waiting times.  The trust did not provide a social toenail cutting service and in such cases, patients were being referred to Age Concern and that organisation charged £10 for this service.

Members of the committee then made comments and asked questions which included: -

·        Concern that waiting times did need to be reduced further, acknowledging the impact long waiting times can have on patients’ health and wellbeing;

·        Concern about some inconsistencies in dealing with referrals of patients on warfarin from GPs;

·        Concern about the capacity of community and voluntary sector organisations to identify when problems with feet are an underlying sign of another condition, such as diabetes and to refer appropriately to the relevant service;

·        Acknowledgement that it is just not the older population who are high users of the podiatry service;

·        Clarification of the status of the recommendations agreed by MCH, detailed in the report;

·        Concern that the LINk had not been involved in any of the focus groups held by MCH;

·        Confirmation on staffing levels;

In response to concerns about inconsistencies, the Operations Director confirmed that the trust was holding a number of focus groups with staff, which would be continued to ensure messages were reiterated and consistent among all staff.  In relation to contact with the Medway LINk, the Operations Director undertook to look into this issue.  In relation to staffing levels, there were 22.6 full time equivalents.  Additional locums had been in place to clear the backlog to reduce waiting times but this would be kept under review and if needed, additional permanent staff would be employed.

Members requested an update on progress following the planned evaluation of progress by MCH in December.  In response the Operations Director undertook to provide this and also undertook to discuss the wider issues raised at the meeting with the commissioners.

Decision:

That an update on progress against the service improvement plan for the podiatry service be provided to the committee via a briefing note, following MCH’s formal evaluation of progress in December.

This report updates the committee on the NHS Kent and Medway’s proposals relating to a review of vascular surgery across Kent and Medway and requests the committee to decide whether or not the proposals are a substantial variation.

Discussion:

The Associate Director, South of England Specialised Commissioning Group (SCG) provided an update to Members on the Vascular Review explaining that the process had been slowed down to review work already undertaken.  She confirmed that for Medway, the number of patients affected would be 86, however, it was envisaged that of those 86, some would need procedures, which could be continued to be provided locally, through the hub and spoke model that was consistent with national models.  Furthermore, she confirmed that the Kent Health Overview and Scrutiny Committee had considered the proposals and had decided that the review was a substantial variation.

Members then made comments and asked questions, which included: -

·        Confirmation of the figures and percentages provided for Medway;

·        Indication of timescales;

·        Confirmation of the impact of a decision by the committee that the proposals are a substantial variation.

In response, the Associate Director confirmed that the SCG would be in a position to report with a recommended approach in mid/late November 2012.  The Associate Director also undertook to check and confirm the figures and percentages quoted for Medway.  Furthermore, she confirmed that a decision by the committee that this issue is a substantial variation would mean that officers would need to look at consultation and there would be a significant increase in the timeline.

Decision:

The committee agreed that the vascular review was a substantial variation.

This report informs the committee on the NHS Kent and Medway proposals relating to the relocation of the Canterbury Street GP practice and walk-in centre to Balmoral Gardens Community Healthy Living Centre. 

Discussion:

The Assistant Director, Primary Care Provider Services and Head of Medical Quality, from NHS Kent and Medway introduced the report and explained that the GP led walk-in centre and practice based at Canterbury Street, Gillingham had been set up in a modular clinical building in 2008, with an intention to build purpose built accommodation on the site.  This was no longer possible and it was therefore recommended to move the service to the Balmoral Gardens Healthy Living Centre (HLC), which was approximately one mile away.  The building had a substantial amount of space at ground level, which was currently used as office space that would be relocated.  There was no proposal to change the service provision or times, only the location.

Members of the committee then made a number of comments and asked questions, which included: -

·        Confirmation of what the Canterbury site would be used for;

·        Concern about expenditure;

·        Lack of consultation with all relevant Ward Members;

·        Concern about the capacity of the Balmoral Gardens HLC for this service and concern for other services currently provided at Balmoral Gardens HLC if this service relocates to the site;

·        Confirmation of whether or not relocation would create an increase/decrease in the number of users;

·        That the walk-in centre at Canterbury Street helped to alleviate pressure on A&E by seeing patients that were not registered with a doctor locally and that moving it would increase pressure back to A&E;

·        Concern that there was not sufficient parking available at Balmoral Gardens HLC for both patients and staff, which would be worsened on market days.

The NHS Kent and Medway representatives confirmed that it was intended to dispose of the site at Canterbury Street.  It was explained that the Balmoral Gardens HLC had not been opened until 2010, so after the modular accommodation had been set up and that the facility currently located at Canterbury Street was rented at a cost of approximately £80,000 per year, which included maintenance.

In relation to the concerns about consultation with the relevant Ward Members the Democratic Services Officer confirmed that Democratic Services would discuss this issue with partners to ensure all relevant Ward Members are always consulted on issues before the proposals are placed in the public domain.

The representatives from NHS Kent and Medway confirmed that it was not anticipated that the move would create an increase or decrease in the number of users and that the future of the walk in centre needed to be considered further.  In response to concerns about relocation adding pressure to A&E it was stated that the walk-in centre was not a facility to treat minor injuries and so an impact on A&E was not envisaged.  In relation to car parking, it was confirmed that a large Council short stay car park was available near to the HLC and so it was considered that there would be adequate parking.

Decision:

The committee agreed that the proposed relocation of the GP practice and walk-in centre at  ...  view the full minutes text for item 466.

This report sets out a further update, following the last update received by the committee in October 2011, on progress with the implementation of the Carers’ Strategy Action Plan and actions arising from the themed meeting of the Health & Adult Social Care Overview and Scrutiny Committee held on 11 November 2011. This meeting reviewed actions from the first themed meeting, which took place on 23 March 2010 regarding support provided to carers in Medway.

Discussion:

The Assistant Director, Adult Social Care introduced the report which updated the committee on progress made against the Carers’ Strategy Action Plan.  Key issues highlighted included: -

·        Future requirement for local authorities to offer carers assessments and how it was expected this would increase uptake;

·        Additional resources through staff were being implemented to add capacity to ensure more assessments were carried out;

·        From January 2013 GPs would be able to refer carers for a one off payment of up to £400 to purchase respite care or other support services to meet the carers needs;

·        GP surgeries all now had a lead member of staff for carers and work was continuing to raise the profile and awareness of carers;

·        Officers were preparing for the carers survey, which had been developed by Government.  Carers would be invited to take part in the survey in November and officers undertook to work with the community and voluntary sector to reach as many carers as possible;

·        The Vectis card discount scheme was now available for carers.

Members of the committee then asked the Assistant Director, Adult Social Care a number of questions, which included: -

·        Training for carer leads in GP surgeries;

·        The role of Alexandra Nurses in supporting carers;

·        Take up of the Vectis card scheme by carers.

The Assistant Director responded to the questions, confirming that GP surgeries have regular training, which pick up issues around carers and surgeries had access to a key directory of local services, which the Council kept updated.  Additionally, he confirmed that it was important for carer assessments to be available from a number of sources, including the community and voluntary sector.

In addition, the Director of Public Health informed the committee that her team had recently completed a needs analysis for carers. GPs were also carrying out an audit of carers and she undertook to share these with the committee.

Decision:

The committee requested an update in six months.

This report outlines the development of the Medway Joint Health and Wellbeing Strategy in line with the requirements of the Health and Social Care Act 2012. The draft Medway Joint Health and Wellbeing Strategy 2012-2017 is attached for consideration by the Committee. 

Discussion:

The Public Health Consultant provided a presentation to the committee, which updated Members on the key aspects of the draft Joint Health and Wellbeing Strategy (JHWBS).

The committee then asked a number of questions and made comments, which included: -

·        A request for the committee to see the delivery plans for the themed priorities when drafted;

·        A suggestion that the Chairman discuss with other Overview and Scrutiny Chairmen in Medway to recommend that each committee takes responsibility for the relevant themes of the strategy to ensure the policies and budgets that they consider as pre-decision scrutiny are driving forward the themes set out in the JHWBS;

·        Cabinet to be advised that health and wellbeing should feature in everything the Council does;

·        How the priorities will be put into action;

·        Concern about levels of obesity and the impact other policies such as those relating to planning and licensing can have on healthy lifestyles;

·        Importance of partnership working – for example the Kent Fire and Rescue Service support dementia patients to stay in their own homes for longer.

In response the Director of Public Health explained that work was ongoing to develop a framework as to how the different committees would work and channels of accountability. 

In relation to timeframes for the delivery plans the Consultant for Public Health explained that the officer leads were drafting the delivery plans for the five themes.  Three were due to be reported to the next Health and Wellbeing Board and two would be reported to the following Board meeting and she undertook to report back on what delivery plans she could to the next meeting of this committee in December 2012.

Decision

(a)               The committee requested the Cabinet to note its comments and to ensure that health and wellbeing was inclusive to all committees and services run by the Council.

(b)               The committee requested that the delivery plans, for the five themes of the Joint Health and Wellbeing Strategy, be reported to this committee once drafted.

This report presents the Annual Public Health Report of the Director of Public Health for 2011/12.  The report focuses on health protection and makes recommendations for Medway Council and partners within the new public health system.

Discussion:

The Director of Public Health provided the committee with a presentation, which detailed the key aspects of the Annual Public Health Report.

The Committee then asked various questions and made comments which included: -

·        What the attributing factor was to the reduction in people smoking;

·        Concerns over sufficient supplies of flu vaccines and concern that some eligible patients were unaware that they could get the vaccine from their GP surgery;

·        Confirmation that the public health team were working closely with the local universities to offer sexual health advice and services;

·        Concern regarding the lower uptake of the measles, mumps and rubella (MMR) vaccine compared to other vaccines available;

·        How Members would be informed about the transition of public health to the local authority.

In response, the Director of Public Health stated that better education and cultural change were the biggest contributing factors for reductions in the number of smokers.  In relation to the flu vaccine, the Director confirmed that the vaccine was delivered to every practice but there was often crisis with suppliers themselves so vaccine providers were encouraged to join up to mitigate from shortages by sharing resource.  Additionally, the Director confirmed that all GPs should write to all eligible patients to inform them about getting their flu vaccine.  The Director also confirmed that the team worked closely with universities about sexual health services.

In relation to the MMR vaccine the Director confirmed that it was believed that the previous myths relating to the vaccine, which had been quashed, were still causing some parents to choose not to get their children vaccinated for MMR, as uptake was lower for this vaccine compared to others.  She also confirmed that cases of measles and mumps had risen dramatically as a result.  With regard to informing Members about the transition of public health to the local authority the Director undertook to provide a member briefing session on this once more details were known.

Decision:

(a)               The committee requested the Cabinet to ensure health and wellbeing is inclusive in all committees and services run by the Council.

(b)               The committee requested a member briefing in the future on the transition of public health services to the local authority.

To consider the committee’s work programme for 2012/13 

Discussion:

The Democratic Services Officer explained to the committee that the Kent Health Overview and Scrutiny Committee were considering a report from the trauma and critical care network at its meeting later that week and that it was suggested that this be added to the committee’s business for December.

Members of the Committee raised concern about the weight of some of the meeting agendas and suggested that considerations about additional meetings may need to be considered.  In response the Democratic Services Officer suggested that some items could instead be referred to tMembers via briefing notes and also that pre-agenda meetings should be used effectively to schedule items to the work programme as some meeting dates were very light and so re-distribution of some items may be possible.

Decision:

The committee agreed the work programme as set out at appendix 1 to the report, subject to the following additions: -

·        Integration between Medway NHS Foundation Trust and Dartford and Gravesham NHS Trust – December 2012/January 2013

·        Proposed relocation of the GP practice and walk-in centre at Canterbury Street, Gillingham – date to be determined

·        Health and Wellbeing Strategy delivery plans – December 2012

·        Trauma and critical care network – December 2012