Agenda and minutes

To approve the record of the meeting held on 19 December 2012.

The record of the meeting held on 19 December 2012 was agreed and signed by the Chairman.

Following a reference to minute 675 Local Changes to Primary Care, it was agreed that in future any changes to GP practices should be forwarded to the Democratic Services Officer who would circulate to all Members of the Council for information. 

Apologies for absence were received from Councillor Mackness and Christine Baker, Medway Pensioner’s Forum. 

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 no urgent matters but the Chairman took the opportunity to send the Committee’s good wishes to Councillor Paul Godwin, who had recently been unwell, for a speedy recovery. 

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. 

There were none. 

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

Discussion:

Prior to the Chief Executive of Medway NHS Foundation Trust giving a presentation updating Members on the proposed merger with Dartford and Gravesham Trust, the Chairman asked for a quick update on a recent legal finding against the Trust.

He stated that, following a patient incident in May 2009, where a patient had fallen from a window, the Health and Safety Executive (HSE) had issued a notice to improve window safety across the Trust, specifically to place window restrictors on every hospital window and ensure adequate measures were in place to prevent falls from them.  These actions had been implemented by the Trust promptly within the required timeframe and full compliance was signed off by the HSE at the time.

The HSE subsequently took the decision to prosecute and the Trust had pleaded guilty.  A fine of approximately £40,000 had been imposed which was a lower figure than could have been set, based on the quick response of the Trust to the requests and the financial position of the Trust.

Responding to a question he stated while the Trust had insurance against clinical negligence claims they did not have insurance to cover such incidents.  He felt that the level of fine reflected this fact.

He then updated the Committee on the current position with regards to the proposed merger with Dartford and Gravesham NHS Trust and stated that plans were submitted to Monitor in December.  There was an anticipated board-to-board meeting between the hospital board and Monitor on 1 March 2013 with a recommendation back to the hospital board by the end of March 2013.

In relation to the concerns expressed by Members earlier, he stated that the hospital trust, along with Mark Reckless, MP and Tracey Crouch, MP had met with the Minister to discuss the promise of funding offered in relation to the PFI debt from Dartford and Gravesham NHS Trust.  He stated that he was now assured that the funding would be forthcoming.

He stated that plans were in place to recruit to the potentially merged Hospital Board in anticipation of a merger.  In addition to this there had been an ongoing dialogue between the relevant Clinical Commissioning Groups, namely Medway, Swale and Dartford and Gravesham to ensure alignment with the clinical strategy and services provided.

The Committee thanked the Chief Executive for his reassurances and asked a number of questions to which he responded as follows:

·        In relation to the Chief Executive’s confidence in Monitor agreeing to the merger he stated that he could never be sure of Monitor’s response but he hoped their approval would be forthcoming. 

·        With regard to availability of specialist staff he explained the measures already put in place to increase the availability of specialist staff 24/7

·        As far as impact on staff, pensions, terms and conditions etc. it was stated that Medway staff were not affected in this regard on the basis this was effectively an acquisition by Medway.  He stated that for staff at Dartford and Gravesham would be  ...  view the full minutes text for item 787.

This report provides an update on hospital mortality statistics for Medway NHS Foundation Trust (MFT) and an overview of clinical governance systems and indicators of clinical quality at the Trust. A Hospital Mortality Working Group has been established to oversee an improvement in the mortality statistics at MFT and provide the Board of MFT assurance that all aspects of quality of care and factors that may affect or contribute to the current mortality rates are addressed. 

Discussion: 

The Public Health Intelligence Manager introduced the first section of the report relating to the Dr Foster mortality report which had identified Medway NHS Foundation Trust as being tenth worst ‘hospital standardised mortality ratio’ (HSMR) in the country out of 145 hospitals.  He explained how the crude hospital mortality rate was calculated and how the hospital compared with trusts from a similar cluster identified by the Office for National Statistics.  The crude mortality rate was improved and converging with the national average.

He stated that the HSMR was a ratio of the number of deaths observed divided by the number of deaths expected.  The number of deaths expected was calculated by applying national mortality rates to the characteristics of patients eg age, deprivation and risk of death based on what was recorded in the patient’s notes.

Having looked at the possible causes of the high HSMR the Public Health Intelligence Team concluded there was no link with deprivation but could possibly be an issue with coding.  It was also vital that the correct information was recorded in the patient’s notes to ensure issues such as co-morbidities (other conditions the patient has) were appropriately documented.

He stated that the most recent monthly HSMR was always at least 3 months behind. Hence the problem might be resolved but the Trust could still end up with a high HSMR when the next Dr Foster report was published in November 2013.

Responding to a Member query he stated that it was not possible to track national mortality statistics to see any emerging trends as these were not available until later in the year.  He also confirmed that the coding used at the hospital was that recommended by Dr Foster but acknowledged that more needed to be done to ensure consistency of recording across the hospital.

Dr Smith-Laing, then introduced the information relating to the governance measures which the hospital has in place to ensure board to ward governance signifying that the hospital took the issue very seriously.  He also emphasised that the serious incident system had been greatly strengthened with additional training in root cause analysis for fifty people across the Trust.  He stated that the quality of the reports had improved but there was still an issue about timeliness.  A Patient Safety Programme had been introduced earlier this year which encouraged staff to take seriously the threat of sepsis. 

He then informed Members that the Trust had been running Enhanced Revalidation for the last two years in paper format, which was now moving to a fully electronic format.

The Director of Public Health then discussed the action plan which had been developed following a meeting of a working group set up at the request of the Hospital to look into the HSMR data.  She stated that the working group comprised senior staff from the three North Kent CCGs, the Medical Director from the National Commissioning Board Area Team, Board and Governing Body representatives from the Hospital Trust and was chaired by herself.  ...  view the full minutes text for item 788.

This report follows from the development of the Medway Joint Health and Wellbeing Strategy 2012-17 (JHWS), which has now been approved by the Cabinet. The Health and Adult Social Care Overview and Scrutiny Committee requested that the delivery plans for the priority actions of the JHWS were seen by the Committee prior to final approval for discussion and comment

Discussion:

The Consultant in Public Health introduced the delivery plans for the priority actions of the Joint Health and Wellbeing Strategy and stated that one priority action had been agreed under each theme as a focus for action for 2013/2014.  She explained that there were five themes and each had a designated Board Member and officer as follows:

• Give every child a good start – lead Member – Cllr Wildey, lead officer – Marilyn Roe
• Enable our older population to live independently and well – lead Member – Dr Fargher, lead officer Wendy Alleway
• Prevent early death and increase healthy years of life – lead Member – Dr Green, lead officer Simon Truett
• Improve physical and mental health and wellbeing – lead Member – Cllr Mackness, lead officer Sallyann Ironmonger
• Reduce health inequalities – lead Member – Cllr Maple, lead officer Dr Julia Duke-MacRae

In relation to the second theme ‘enabling our older population to live independently and well’ the suggestion was made that that the Fire Service are very interested in working closely on the topic of dementia and Steve Griffiths from the Fire Authority was involved in the Prime Minister’s Dementia Working Group.  Councillor Adrian Gulvin undertook to let officers have Steve Griffiths’ telephone number outside of the meeting.

Reference was made to the very informative workshop on obesity and planning held the previous Monday.  Responding to a question Dr Green stated that it was possible to monitor the performance of GPs in recording BMI etc by means of the computer database and often GPs were given prompts to remind them to carry out this recording.  He also stated that the intention was that, although not everyone would be able to access certain services such as a diabetic nurse in every practice, the aim was for there to be an equality of service across Medway.

Decision:

(a)   The Committee noted the draft delivery plans for the priority actions of the Joint Health and Wellbeing Strategy for Medway 2012-2017;

(b)   The Consultant in Public Health was requested to investigate the inclusion of Fire Service support in the work of theme 2 relating to dementia.

 This report presents and update on the Council’s draft revenue budget for 2013/2014. 

Discussion:

The Chief Finance Officer updated the Committee on developments relating to the capital and revenue draft budget for 2013/2014 since the last meeting.

The Chief Finance Officer explained that there was now a £6 million budget gap as a result of a number of announcements from the Government since December.  He felt that the Medium Term Financial Plan had improved and was now more realistic.  The decision of the government to freeze Council tax had an impact on the current position as had the 41.2% reduction in Formula Grant over the CSR 2010 period.  It was stated that at one point it looked as though the budget deficit had been reduced to £1 million which made the prospect of a balanced budget more likely.  However, subsequent government announcements had worsened the position.  He stated that the budget was still being adjusted, as set out in paragraph 8.3 of the report, and would be discussed further at the next Cabinet meeting, and as such he was not in a position to preempt the Cabinet decision.

The view was expressed that it was difficult for the Committee to effectively scrutinise the budget with so little detail.  Discussion took place about alternative ways for the Committee to scrutinise the budget in a more timely and effective way.  The point was made that many reports coming to Committee stated that they had no financial implications when perhaps they did and it was important for the Committee to be robust in challenging such statements.

Reference was made to the fact that Members are at liberty to request a briefing with the Chief Finance Officer with regards to the budget position at any point and the fact that decisions taken throughout the year, such as outsourcing of Linked Service Centres, obviously had an impact on the budget and it may be more useful to scrutinise such decisions as they are taken in the light of the changing budget position.  A further suggestion was put forward that the Committee could look at the budget position at the points at which Council Plan monitoring is considered.

Decision:

The committee agreed to note the draft capital and revenue budgets for 2013/2014, proposed by Cabinet on 27 November 2012. It was also suggested that regular budget monitoring should be added to the work programme for the Committee at the points at which Council Plan monitoring were considered.

This report advises Members of the current work programme for discussion in the light of latest priorities, issues and circumstances.   

Discussion:

The Democratic Services Officer stated that in relation to the selection of a topic for in-depth scrutiny reviews for the forthcoming year she would be in contact shortly with the Chairman and spokespersons of the Committee with a view to organising a meeting on the week commencing 18 February 2013.  A request was made by the Chairman for initial suggestions to be emailed to him prior to that meeting.

The Chairman referred to the recent announcement of the Medway Clinical Commissioning Group’s authorisation and requested a briefing note setting out the Group’s response to a number of conditions set.

Decision: 

(a)   Members noted the content of the JHOSC record of 3 July 2012 in relation to acute inpatient adult mental health redesign;

(b)   It was noted that a meeting of the Chairman and spokespersons would be arranged for the week commencing 18 February to discuss topics for in-depth scrutiny for the forthcoming year

(c)   A briefing note was requested on the Medway CCG authorisation with details of the CCG’s response to the conditions set.