Agenda and minutes

To approve the record of the special meeting held on 6 August 2014 and the record of the meeting held on 19 August 2014.

The records of the special meeting held on 6 August 2014 and the meeting held on 19 August 2014 were agreed as correct and signed by the Chairman. 

Apologies for absence were received from Councillors Gilry, Christine Godwin, Griffin, Adrian Gulvin and Watson, Dr Ussher and Priti Joshi.  The Chairman welcomed Matthew Durcan, the new Healthwatch Medway substitute to his first meeting of the Committee.

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.  The Chairman took the opportunity of thanking the Deputy Director, Children and Adults for his services to the Committee and to the Council and other Members added their personal thanks and good wishes to him for his new position at Southwark.

Tribute was also paid, by a number of Members, to the Principal Officer, Mental Health who is also leaving the Council.

The representatives from Medway NHS Foundation Trust and Monitor were welcomed to the meeting and the Chairman, referring to the supplementary agenda, explained that he hoped to be able to conduct as much of the debate as possible in open session. He stated that, in the event of Members having questions on the exempt papers, they submit them to NHS Medway Clinical Commissioning Group outside of the meeting.

(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.

Members should also ensure they disclose any other interests which may give rise to a conflict under the council’s code of conduct.

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

Councillor Cooper declared a non-pecuniary interest in any reference to NHS Medway Foundation Trust by virtue of the fact three members of her family work at the Trust.

Councillor Etheridge declared a non-pecuniary interest in any reference to mental health as her son is in the care of mental health services.

Councillor Turpin declared a non-pecuniary interest in agenda item 11 Health and Lifestyle Trainers Service by virtue of the fact his sister is a trustee at Sunlight Development Trust.

The Chair of Medway NHS Foundation Trust will attend and set out her vision for the Trust.  This will be followed by an update on progress against the CQC action plan by the Acting Chief Executive.

A representative from Monitor will also be in attendance to respond to Members’ questions. 

Discussion:

The Chair of Medway NHS Foundation Trust set out her vision for the Trust and explained that she had joined the Trust last year as a non-executive director and Chair of the Audit Committee prior to being made Chair.

She stated that her aim was to ensure that the Trust was well lead, clinically lead, offering good quality care and working well with stakeholders.  She referred to the long journey that the Trust was on and emphasised that for some time the Trust had been internally focussed, having a silo mentality.  It has also been reactive rather than proactive with a disconnect between management and nursing staff and this needed to change. 

Numerous agencies had become involved with the Trust over the past year and she was keen to ensure that the various action plans drawn up in response were merged into one with measured improvements set for short and longer term.  The initial plan would be for a period of 18 months, this plan should be able to demonstrate clear improvements.  A 3-year plan would then build sustainability and the 5-year plan should bring stability.  She stated that leadership training would be put in place and the intention was for the clinicians to take responsibility for their area of work.  An experienced Emergency Department clinician had been brought into the Trust from Homerton Hospital to assist in this process and it was hoped his contract could be extended.  New appointments would be made on the basis of a year’s contract minimum.

Further recruitment was underway to appoint to the new management structure following the resignations of the Chief Nurse and the Director of Strategy and Governance.  The deputy Chief Nurse was covering the Chief Nurse post at present.  It was hoped that a new Chief Operating Officer would be appointed within the next week and that person would be responsible for the day to day running of the hospital. 

The Chair and Acting Chief Executive of Medway NHS Foundation Trust explained the following in response to Member questions:

• One of the key pieces of data being supplied to the Care Quality Commission on a daily and weekly basis was evidence relating to there being an assessment of every patient in A&E within 15 minutes of arrival
• Rather than needing more beds, the Acting Chief Executive felt that more use could be made of the cottage hospitals in Minster and Sittingbourne and Barts Hospital in Rochester for ‘step up’ facilities aswell as ‘step down’, particularly for patients with long term conditions and the frail elderly, to reduce pressure on the hospital
• The Chair agreed that the vision of the key important things for the hospital to concentrate on was shared by the Board and clinical staff
• The role of the Audit Committee at the hospital had been around controls and discipline and issues such as problems with mortality figures
• Although the latest written report from the Care Quality Commission had not yet been received the Acting Chief Executive  ...  view the full minutes text for item 389.

This report advises the Committee of a proposal under consideration by NHS Medway Clinical Commissioning Group (CCG) to reconfigure and re-commission emergency and urgent care services. This Committee will be asked if the changes are substantial from a Medway perspective, Kent County Council HOSC will also be asked the same question. If both agree that the changes are substantial a joint HOSC will need to be established.

Discussion:

The Chief Operating Officer gave an introduction to the report on the Emergency and Urgent Care Review and Redesign and set out the national context for undertaking the review which was the NHS England ‘Transforming Urgent Care Services’ document. 

She referred to the fact that the current system for urgent care was fragmented and that it was planned to design a single front door 24/7 urgent care model ensuring more integration between health and social care services.  A clinical audit had been completed in July/August and a clinical reference group and patient group set up to help in the design of the model.  Stakeholder engagement would be commencing shortly and as the plans were considered by the NHS Medway Clinical Commissioning Group (CCG) to be substantial a joint HOSC would be likely, as the changes affect North Kent as well as Medway.  There would be a 12 week consultation period but the end result should be much easier access for the public and simplified navigation to the appropriate services.

In response to questions the Chief Clinical Officer explained that the plans were part of the CCGs 5 year strategy and confirmed that the CCG does not commission primary care; this was the role of NHS England.

Members queried the fact that the face to face consultations with the public had taken place in Sittingbourne and Gillingham and may not capture the needs of people from more rural areas of Medway such as the Peninsular.  The Chief Operating Officer explained that there had been a consultation with 1,000 people in the emergency department during a three week period in September which would ensure a wider, broad spectrum, of people were consulted.

Decision: 

(a)   It was agreed that the plans for urgent and emergency care constitute a substantial variation of services for Medway;

(b)   A request was made for the CCG to consult with officers in Democratic Services in relation to the timeline for the consultation.

The report sets out the response from Kent and Medway NHS Social Care Partnership Trust and NHS Medway CCG in respect of the request at the last meeting for regular updates on the position with the acute mental health inpatient beds review.

Discussion:

The Mental Health Commissioner, NHS Medway CCG introduced the briefing from the CCG in relation to mental health commissioning and explained that the commissioning of mental health had been simplified now the commissioning was being undertaken across the North Kent area.

She explained that the Personality Disorder Unit in Gillingham was proving to be very successful and referred to the setting up of a single point of contact, which would make access to services easier for the public.

In relation to the monitoring of KMPT’s contract the Chief Clinical Officer stated that, as with all contracts, there were good and poor aspects but he felt the relationship between the CCG and KMPT had greatly improved.  In response to a further question he stated that the bed numbers shown in the charts in the appendices were the current capacity at the time of the data being captured.

Concerns were expressed by some Members at the numbers of people being sent out of area for acute beds.  The Mental Health Commissioner stated that once the 174 acute beds were available this should be less of an issue.

The Director of Operations, Kent and Medway NHS and Social Care Partnership Trust (KMPT) introduced the appendices to the report produced by KMPT, some of which were in response to questions asked by the Committee at the last meeting.  In response to a question about section 136 agreements he explained the measures taken by the Police in attempting to use a place of safety in the area rather than detaining people in a cell.

Responding to a query about the poor results of the recent users survey he stated that KMPT were very disappointed with the results and explained some of the analysis of the findings to Members. 

In relation to personality disorders he stated that research had been completed in America and this was being analysed to see if the learning could be used to benefit KMPT service users in Medway and Kent.

He then referred to move of Emerald ward to Maidstone and invited Healthwatch Medway to be part of the patient experience group within the project.

Responding to a question he agreed to send to Members details of the categories of the 39 complaints received over the period of a month.  He also undertook to respond to the Healthwatch Medway representative separately about the virtual ward upgrade and review of transport referred to in the appendix to the report.

Decision: 

(a)   The report was noted;

(b)   It was agreed that the Director of Operations would send to Members details of the categories of the 39 complaints received by KMPT over the period of a month.  It was also agreed that he would respond to the Healthwatch Medway representative about the virtual ward upgrade and review of transport referred to in the appendix to the report and invite a Healthwatch Medway representative to be part of the patient experience group involved in the Emerald ward project.

This is an information report providing an update to Overview and Scrutiny Committee members on the changes to dementia support services. It sets out the latest findings of the revised dementia chapter of the Joint Strategic Needs Assessment and makes recommendations that will improve the quality of life experienced by those people living in Medway living with dementia both now and into the future. 

Discussion:

The Assistant Director, Partnership Commissioning, and the Interim Commissioning Manager introduced the report on dementia services to meet future needs and responded to Members’ questions.

The Interim Commissioning Manager explained that he had spent the last five months talking about dementia and that September was World Dementia month.  He then set out the backdrop to the production of the dementia strategy and explained that the cost of dementia services was higher than the cost of treating cancer, heart disease and stroke.  Currently there were approximately 835,000 in the UK suffering from dementia, 700,000 people in England and 40,000 of those were 65 or below in age.  The cost is currently £26 billion a year but is set to rise.

Members were keen to ensure that the document was extended to include specific actions and costings and that these would be shared across all Committees of the Council and finally the Cabinet.  The Assistant Director, Partnership Commissioning confirmed that this document was the start of a process and that more detail would be available at a later stage.

Concern was expressed about the reference in the document to the National statement that GPs felt unprepared to deal with the new focus on dementia.  The Chief Clinical Officer explained that until relatively recently there had been no medical treatments for dementia, and that even now those treatments tended to slow decline rather than produce marked improvements.  Equally patients and families had often delayed seeking help.  In respect of vascular and mixed dementia, he referred to work the CCG were doing to reduce the risk of vascular dementia and referred to the Familial Hypercholesterolaemia work done by the CCG and recently published by HEART UK about the measures which could be taken to prevent dementia particularly following a diagnosis of vascular disease, diabetes etc. 

http://heartuk.org.uk/files/uploads/09-14_HEART_UK_Medway_report.pdf

He encouraged Members to do what they could to reduce the stigma of dementia in Medway and referred to a map of medicine tool used by local GPs, which helped them to navigate routes of referral and support to patients.

Following a Member request the Assistant Director, Partnership Commissioning agreed to include Parish Councils, possibly through the Rural Liaison Committee, in consultation on dementia services recognising their valuable role in community support.  Members were keen to ensure that the whole Council and the community of Medway take a joint responsibility for dementia services and dementia awareness.

Members emphasised the important role of carers particularly when they were no longer able to care for their relative at home and they were admitted to residential care.

The Chief Clinical Officer commended the document and stated that it was a good example of how partnership commissioning was working in Medway.

Further to a question the Director of Children and Adults stated that she did not believe details were available of any young carers who were living with someone with dementia but did suggest that there might be an opportunity to introduce the subject of dementia care into Personal Health Social  ...  view the full minutes text for item 392.

This report reviews the progress of the contract currently delivered through the supplier as highlighted within 1.1 of this report.

This Gateway 4 report has been approved for submission to Cabinet after review and discussion at Children and Adult Directorate Management Team and Procurement Board.  Cabinet will consider the report on

30 September 2014 but it has also been requested, by the Vice-Chairman, to be considered at this Committee.

Discussion:

The Deputy Director, Children and Adults introduced the Gateway 4 report on the outsourcing of Nelson Court and Robert Bean Lodge.  The Vice-Chairman of the Committee, who had requested the item for this Committee, explained that she felt the Committee needed to be better informed about the monitoring of adult social care contracts in particular where they have been outsourced.

The Deputy Director, stated that in the case of Nelson Court and Robert Bean Lodge the transition had been very successful and paid tribute to the staff there.  He confirmed that they had all undertaken specific training for dealing with residents with dementia but emphasised the difference between those people suffering from dementia who needed nursing care as opposed to residential care.

Reference was made to day services and the move towards personalisation.  The Deputy Director explained that Nelson Court was still offering support to some of the people who had formerly taken part in day services there.  He also confirmed that with the exception of one bed, which was for use in a crisis, all the beds at Nelson Court were available to people with dementia.

Members expressed an interest in an offer of an annual report setting out an overview of the quality of care, safeguarding, value for money and the direction of travel of care homes in Medway.

Decision: 

That an annual report, setting out an overview of the quality of care, adult safeguarding issues, value for money and the direction of travel of care homes in Medway, be added to the work programme for this Committee.

This report summarises the performance of the Council’s Key Measures of Success for the Council’s Key priority: ‘Adults maintain their independence and live healthy lives’ as set out in The Council Plan 2013/15, for the period April – June (Quarter 1) 2014/15.

This report includes progress reports on how we have performed against:

Key Measures of Success.

This report also includes feedback from our customers using GovMetric JKL, a customer satisfaction measurement system at the point of contact (phone, web and face to face).

The report was noted. 

This report advises Members of the forthcoming expiry of the Health and Lifestyle Trainers (HALT) contract with Sunlight Development Trust and a proposal to suspend procurement of this service whilst budget deliberations for 2015/16 are underway.

Discussion:

The Director of Public Health introduced the report on the Health and Lifestyle Trainers service and explained that as part of the budget setting process it had been decided not to continue with the contract, which expires at the end of November 2014. 

Councillor Price, as chair of the Sunlight Development Trust, addressed the Committee and urged them to reconsider this decision.  He emphasised that his chairmanship of the Trust was not a paid position but confirmed he had been involved with the Trust for many years as it was in his ward.  He referred to paperwork which he had circulated prior to the meeting setting out the benefits of the Health and Lifestyle Trainers service and referred to case studies of people who had found the service valuable.  He also referred to the fact that the Sunlight Development Trust would be faced with redundancy costs, if the service ceased, of between £7,000-£10,000.

Concern was expressed at the lack of information and financial implications contained in the report in particular the health risks of ceasing such as service in one of the most deprived wards in Medway.  Reference was made to performance indicators PH10 (percentage of people completing an adult weight management service who have reduced their cardiovascular risk) and PH13 (rate per 100,000 of self-reported 4 week smoking quitters aged 16 or over) and the importance of reducing health inequalities.  A suggestion was made that it may be possible to use section 106 monies to contribute towards the cost of the service.

Discussion took place about the required notice for ceasing the contract and the Director of Public Health stated that she would need to look into this outside of the meeting, as her understanding about what was required was different to that stated by Councillor Price.

Decision: 

(a) The Committee recommended to Cabinet:

(i)                 That an impact assessment is carried out and an assessment of the extent to which ceasing the Health and Lifestyle Trainers service will have an impact on the future targets of the Council and the future health of Medway residents;

(ii)               That no action be taken to cease the service until such time as the Council is in a better position to assess the impact.

(b) It was agreed that the Director of Public Health should investigate the       contractual position with regard to notice required to cease the Health and       Lifestyle Trainers service contract and, in the interim, provide a briefing       note to the Committee on timings for the decision on the service.

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 Chairman stated that at the last pre-agenda meeting there had been some discussion about the merits of timing items on the agenda in future in an attempt to reduce the length of meetings.  The Committee considered this option but did not feel it would be helpful.

Decision: 

The responses sent to KMPT in relation to the consultation documents on Communities of Excellence and People with Lived Experience, circulated outside of the meeting, were noted.