Agenda and minutes

To approve the record of the meeting held on 11 November 2013.

The record of the meeting held on 11 November 2013 was agreed subject to the addition of the names of Cllrs Shaw and Maisey to those in attendance. 

Apologies for absence were received from Councillor Kearney, Barbara Peacock and Richard Iddenden. 

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)              Disclosable pecuniary interests and other interests

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.

(B)            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.

Disclosable pecuniary interests

There were none.

Other interests

Dr Green, declared an interest, under item 5, Petition – St Mary’s Medical Centre, Strood, as he explained that his GP practice boundary overlapped with that Medical Centre.

This report advises the Committee of a petition, presented to the Council and referred to at the last meeting including the response of NHS England to the petitioners. 

Discussion:

On behalf of the petitioners, Joanne Halcroft Scott, introduced a petition seeking the Committee’s support in resolving the contractual issues, which had arisen at St Mary’s Medical Centre in Strood to ensure continuity of care at the practice.  She stressed the importance of building on the good work of Dr Pancholi following a period of turmoil for the practice.

She explained that Dr Pancholi and Dr Oshinusi hold the GP practice partnership but that a legal case had been brought against Dr Oshinusi.  He had been found not guilty of the charges but would be subject to a further hearing with the General Medical Council.  In the meantime the Care Quality Commission have refused registration to Dr Pancholi and Dr Oshinusi. 

The Area Team Director, NHS England (Kent and Medway) as commissioner of primary care in Kent and Medway explained the constraints under which NHS England was bound legally in respect of contracting with the Drs at that practice.

Discussion took place regarding what, if anything, the Committee might be able to do to support the petition.  A suggestion was made that the assistance of the Health and Wellbeing Board might be sought to bring pressure to bear via NHS England (Kent and Medway) on the General Medical Council to conclude Dr Oshinusi’s case prior to the appeal hearing with the Care Quality Commission in March 2014.

Decision:

It was agreed that the Chairman of the Committee would request the Health and Wellbeing Board to write to NHS England to urge the General Medical Council to conclude their hearing for Dr Oshinusi before the Care Quality Commission conduct their appeal into the practice registration in March 2014. 

This report sets out a response to an issue, raised by Councillor Purdy, requesting information on the patient transport service. 

Discussion:

Councillor Purdy set out the reasons behind bringing this Member item by stating that it was as a result of great concerns, which had been brought to her attention regarding the unacceptable service provided for patient transport which had let down Medway residents by not collecting them on time or too early for appointments.

The Chief Officer, West Kent Clinical Commissioning Group apologised to the Committee, accepted the criticism of the service and both he and the Managing Director of the provider of the service, explained that mistakes had been made in the procuring of the service initially which meant that the reality for the provider was very different from the service commissioned.  Some of the errors related to an incorrect number of staff, which had to be TUPE’d over to the provider, which the provider was not expecting.  The details of the actual journeys and timings had also been seriously under-estimated.  He stated that since the provider took over the new contract there had also been delay in addressing the problems hence both commissioner and provider had to accept a proportion of blame.

There was great concern expressed by Members of the Committee that the consequence of these errors was a very poor service to the residents of Medway.  Assurances were sought as to when the necessary remedial action would be put in place and a good service provided.

The Chief Officer, West Kent CCG, explained that there would be a re-negotiation of the contract with NSL Transport to take account of the substantial changes needed to the service.  Responding to Members’ questions he stated that consideration had been given to re-tendering but it was felt that this would not be helpful and cause further delays.  He had been assured of NSL Transport’s good reputation in other areas of the country and felt that the service should remain with them.  He also confirmed that while there would be two members of the original commissioning team involved in the re-negotiation there had been other, very experienced, staff brought in to join them.

The Chief Officer, West Kent Clinical Commissioning Group, noted the risks of going to procurement too early before details of contract activity were known and accepted that Members of the Committee would want to keep the matter under review.

The Committee thanked Councillor Purdy for bringing the Member item and requested regular updates on progress.

Decision: 

It was agreed that a written briefing would be provided by West Kent Clinical Commissioning Group to the Committee by February 2014 followed by an update at the April 2014 meeting.

This report presents the Council’s draft capital and revenue budgets for 2014/2015 relative to this Committee. 

Discussion:

The Finance Manager for Children and Adult Services introduced the capital and revenue budget report for 2014/2015.  He updated the Committee by stating that the budget position had improved since the Medium Term Financial Plan had been drawn up and that the predictions were now that there would be a budget gap of £4.8m for next year rising to £17m for 2015/2016.

Members were invited to comment on the areas of savings identified in the report on page 36.

Responding to a question raised, the Director of Public Health undertook to share with the Committee the 32 categories of public health activity referred to under the four headings in the report (page 35).

Following a further question it was stated that the fees and charges work was ongoing and should be ready shortly.

Discussion took place about the underspend in adult social care and the Deputy Director, Children and Adults stated that this was a very modest sum and needed to take account of possible future demands.  The Finance Manager for Children and Adult Services referred to opportunities for the local authority in relation to the Integrated Transformation Fund (ITF also now known as Better Care Fund) but it was pointed out that this was not new money and had to demonstrate a health benefit.  In view of the fact that some of the money would be taken from the acute sector the Chief Clinical Officer, NHS Medway Clinical Commissioning Group stated that the Foundation Trust was fully sighted on this aspect.

Reference was made to a recent workshop held with key stakeholders, the voluntary sector and black and minority ethnic groups to look at ways in which smarter ways of working could be achieved.

Decision: 

The draft capital and revenue budget for 2014/2015 was forwarded to Business Support Overview and Scrutiny Committee.

This report advises Members of the decision of the Secretary of State following the reporting to him by this Committee of concerns relating to the proposed reconfiguration of acute mental health beds in Kent and Medway.  The decision to make this report to the Secretary of State was made by this Committee on 20 August 2013, as the Committee was not satisfied that the NHS consultation with the Kent and Medway Joint Overview and Scrutiny Committee had been adequate in relation to content or time allowed and the Committee also considered that the proposal would not be in the interests of the health service in its area.

Discussion:

The Head of Democratic Services introduced the response from the Secretary of State in relation to the reporting to him of the proposed reconfiguration of acute mental health beds.  She stated that the Committee followed a statutory process available to it in making the report to the Secretary of State.  The Secretary of State had taken advice from the Independent Reconfiguration Panel and accepted the finding of the Panel that a full review of the matter would not add any value and that the NHS implementation programme should be allowed to proceed as soon as possible.

She pointed out that the Secretary of State commended the work of the Joint HOSC and this Committee in drawing attention to concerns raised by the public and in providing assistance that led to a revision in bed numbers and highlighted the importance of the NHS in:

·        precisely what constituted a centre of excellence and how they would be delivered

·        clarifying for patients what they could expect to see as a result of the changes

·        providing more detail on a transport plan

·        keeping O&S Committees informed and able to comment.

The Chairman said he was sure the Committee would have been disappointed at the response and said he was minded to write to Secretary of State but would incorporate any findings from agenda item 10.  

Decision: 

(a)   The Committee noted the response from the Secretary of State for Health in relation to the reconfiguration of acute mental health inpatient beds and agreed to monitor the implementation of the reconfiguration at appropriate milestones, keeping under scrutiny the areas highlighted in the Secretary of State’s letter;

(b)   It was agreed that the Chairman would write to the Secretary of State taking into account any points raised later in the meeting to reflect the Committee’s views.

This report asks Members to consider the final report of the Review of Mental Health Services of the Scrutiny Task Group and agree the findings and recommendations of the Task Group for referral to the Cabinet on 14 January 2014.

Discussion:

Councillor Purdy introduced the report and summarised its key findings.  She thanked everyone who gave evidence to the review group.  She asked for an additional point to be included within recommendation 4 to ensure that the mental health awareness training was extended to schools (see below).

The Mental Health Social Care Commissioning Manager responded to Members’ questions.  He clarified that Kent and Medway NHS and Social Care Partnership Trust (KMPT) had already revised the name of the Medway Integrated Team to reflect the fact that it did not capture the function of the team.  The review task group had taken account of national guidance and other sources.  The recommendations being put forward would appear to be supported by the independent findings of the Care Quality Commission (CQC) both on their recent visit to Medway mental health services in October and in the most recent national user survey.  He explained that subject to the recommendations being accepted the recommendations a detailed implementation work plan would need to be developed with partner organisations.  The Chief Clinical Officer from NHS Medway Clinical Commissioning Group (CCG) welcomed the report and stated that it provided a good foundation and consensus to take forward the implementation through joint working.  He believed that more emphasis should be placed on prevention and early detection of mental illness and stated that the CCG will be happy to work with officers of the Council on implementation.  He also commended the work of MEGAN (an independent peer support group set up in Medway to reach mental health service users) and suggested their involvement in the implementation along with other service users and carers and their supporters.

The Deputy Director, Children and Adults believed the recommendations from the Task Group to be very helpful and could be taken forward without great resource implications.  He also felt it would be important to revisit the work undertaken in the light of the recommendations to see what impact had been achieved as a result of the implementation.

The Committee welcomed the findings, emphasised the importance of the mental health awareness training and agreed the recommendations contained in the report to Cabinet with the amendment to recommendation 4 as set out in bold below:

Training on mental health awareness should also be offered to all Medway schools to an identified member of staff in the school, preferably a teacher.

In accordance with standard protocols for scrutiny review’s it was agreed there would be a review of the recommendations after six months.

Decision:

The Committee agreed to refer the Report of the Scrutiny Review Group to Cabinet on 14 January 2014 with the following specific recommendations:

1.            Cabinet agree that an Appreciative Enquiry Conference be held in Spring 2014, hosted by Medway Council, to include all relevant agencies to establish a shared vision for the future of Mental Health Services in Medway.  This event should be jointly supported and funded by the Council, Medway CCG and the two NHS providers of mental health services in Medway;  ...  view the full minutes text for item 672.

This report sets out the implementation plan for the acute services redesign received from West Kent CCG as the commissioners for acute mental health for Kent and Medway, in response to the recent reconfiguration proposals and as promised at the last meeting of the Joint Health Scrutiny Committee between Kent and Medway held on 30 July 2013.

Discussion:

The Chief Officer of West Kent Clinical Commissioning Group introduced the report with the Chief Executive, Kent and Medway NHS and Social Care Partnership Trust and the Chief Clinical Officer, NHS Medway CCG and

responded to the list of issues circulated in advance of the meeting.

The following points were made:

• There was confidence that the 174 beds could be found across the three identified sites but no assurances could be given that the stated number would be sufficient overall bearing in mind the unprecedented increase in demand for acute beds nationally over the past few months which could potentially be sustained
• The detailed implementation plan had been submitted to the Council within the required timescale
• Plans were underway for the crisis house in Medway but this was not to be a health facility as that would require complex regulation
• Regular performance monitoring meetings were held with NHS England about the plans
• In relation to out of area placements it was stated that, at that moment, there were 18 out of area placements across Kent and Medway, but only 5 related to Medway service users
• The concept of ‘centres of excellence’ was well understood by those commissioning and providing services but it was accepted that more needed to be done to relay that concept to the wider public and service users in particular
• There was now 24/7 support in A&E at Medway Maritime Hospital for people with mental health problems and a third support worker was starting work in January
• GPs were receiving support and training in relation to mental health issues
• Support groups in Medway – particularly MEGAN and Rethink were assisting with work on reaching hard to reach groups in the community to ensure people were supported with their mental health issues
• There were plans for the commissioning of acute mental health for Medway to be dealt with by Medway CCG in the future rather than West Kent CCG
• Following the reporting of the reconfiguration to the Secretary of State information had been requested from the NHS to triangulate evidence
• Clarification was given that beds could not be reserved or allocated to a particular area
• Recognition was given to the fact that if it had not been for the persistence of Medway Members on the Joint Health Overview and Scrutiny Committee the current planning would have been for a lesser number of acute mental health inpatient beds

The Deputy Director, Children and Adults referred to the need for multi-disciplinary working as social care was a vital element of any plans for people with acute mental health problems.  As such he felt there was a duty for partners to work together to meet the needs of these service users and their carers.

The Chief Executive of Kent and Medway NHS and Social Care Partnership Trust (KMPT) responded to a question regarding the bed usage in Medway, and level of occupancy and stated that she could provide a graph showing the usage at a later date.  She stated  ...  view the full minutes text for item 673.

This report summarises the performance of the Council’s Key Measures of Success for July to September (Quarter 2) 2013/2014 as set out in the Council Plan 2013/2015. 

Discussion:

The Deputy Director, Children and Adults gave a brief introduction to the Quarter 2 performance report and responded to Members’ questions.  He referred to the improvement in completing carers’ assessments but stated that still more work needed to be done and it would take a while before carers would feel the impact of the improvements.

Discussion took place about the low take up in relation to a health trainer and the Director of Public Health explained that there had been problems with the provider and staffing levels of the service, which were now being resolved but she also stated that there had been a low number of referrals to the service.  The stop smoking service was referred to and it was stated that the Stoptober campaign had been successful.  Reference was also made to Nelson Court and tribute was paid to the staff there.

Decision: 

Members noted the key measures of success used to monitor progress against the Council Plan 2013/2015.

This report presents the Annual Public Health Report of the Director of Public Health for 2012/13.  The report focuses on the health of school-aged children and makes recommendations for Medway Council and partners.   On this basis the main scrutiny of this item will take place at Children and Young People’s Overview and Scrutiny Committee on 10 December 2013.  Members of this Committee were also invited to a briefing, which took place that evening prior to the Children and Young People’s Overview and Scrutiny Committee.

Discussion:

The Director of Public Health gave a brief introduction to the Annual Public Health Report for 2012/2013, which related to the health of school-aged children.

The Director of Public Health was complimented on the helpful presentation made on 10 December 2013 to Members on the document and responded to further questions mainly in relation to childhood diabetes.

Decision: 

The Committee noted the Annual Public Health Report in relation to its impact on health and adult social care overall.

This item advises Members of the current work programme and allows the Committee 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. 

Discussion:

The Democratic Services Officer gave a brief introduction to the report.

Members requested that for those items showing “date to be agreed” on the work programme the Democratic Services Officer should contact report authors to finalise dates.

Decision: 

It was agreed that:

(a)   the Democratic Services Officer should contact report authors for those items on the work programme showing date to be agreed in order to finalise actual dates;

(b)   scrutiny of the work of the Health and Wellbeing Board should take place at 8 April 2014 meeting;

(c)   the support for carers item will be programmed for the June 2014 meeting;

(d)   the progress of the Integrated Transformation Fund was noted and that further updates would be received in due course.