Agenda and minutes

The Committee observed a minute’s silence to mark the 70^th anniversary of the Holocaust.

The Chairman also referred to the fact that Councillor Etheridge had left the Committee and welcomed Councillor Irvine following the reallocation of Committee seats at full Council the previous Thursday.

An apology for absence was received from Councillor Kearney. 

To approve the record of the meeting held on 11 December 2014.

The record of the meeting held on 11 December 2014 was agreed as correct subject to the removal of Dr Barnes’ name in the list of attendees. 

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.

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

There were none.

This report provides an overview of the current context in which this service is commissioned.  It then considers progress made during the last year and challenges faced.

Discussion:

The Mental Health Social Care Commissioning Manager introduced a report on the review of progress in relation to the Medway Mental Health social work team and objectives.  A DVD was shown illustrating the views of stakeholders about the purpose of the service where they were asked what good would look like in respect of the mental health service and Members of the Committee commended the DVD and report.

He reported good progress had been made with the community mental health team at Kent and Medway NHS and Social Care Partnership Trust (KMPT) in terms of joint working and communication.  Reference was also made to the fact that, with effect from April, the Approved Mental Health Practitioner (AMHP) out of hours service would be transferring back from Kent County Council to Medway Council and work was ongoing with partners around that transfer.

The Mental Health Social Care Commissioning Manager introduced to the Committee the new Head of the Mental Health Service in Medway who had started earlier this month.

In response to questions he confirmed that the Mental Health Young Person’s Transitions Forum had been established and met four times.  He also confirmed that the secondment of a mental health staff member to Early Help Service/Medway Action for Families was still planned to take place.  Reference was made to research undertaken by Healthwatch Medway with service users and carers around what bad looked like and put forward some of the points made.  The Mental Health Social Care Commissioning Manager stated that more was now being done to involve carers and that each social worker was now responsible for ensuring that carers assessments were carried out.  The Healthwatch Medway representative at the meeting agreed to share his findings and to pass on contact details of some of his contacts he had made through the South East gender initiative.

Discussion then took place around the decision taken at the previous meeting to recommend the Cabinet to reinstate 2 Whole Time Equivalent (WTE) posts in the Mental Health Social Work Team.  The Interim Deputy Director, Children and Adult Services explained that difficult decisions had to be taken when budgets were constrained and this had meant a reduction in back office staff to protect front line workers.  Some Members felt that this was counter-productive as it meant the front line highly qualified staff were spending valuable time fulfilling an administrative role rather than using their time with service users.  Members were keen to ensure that the Cabinet understood that the earlier recommendation to reinstate two WTE posts had been a unanimous decision. 

The Committee also made the point that the demands on the mental health social work team had recently increased due to the obligations for the Council in the new Care Act 2014.

The Chairman, in response to a question, provided clarification that as the recommendation from the last meeting had not yet gone to Cabinet, the Committee wished to reinforce the earlier recommendation.

Decision: 

The Committee thanked officers for the report  ...  view the full minutes text for item 705.

This report has been requested to provide the Committee with an update on the outcome of the 9 December 2014 Care Quality Commission Inspection visit, information on Winter Pressures and measures in place to deal with these at the hospital, together with an overview of the current position on delayed discharges from the Council’s perspective. 

Discussion:

The Chairman reminded Members that there were three topics of focus for this meeting which were as follows:

• An update on the outcome of the 9 December Care Quality Commission (CQC) inspection visit
• Information on winter pressures and measures in place to deal with these
• An overview of the current position on delayed discharges from the Council’s perspective

CQC inspection visit

The Acting Chief Executive, Medway NHS Foundation Trust gave an update on the CQC inspection and referred to the 18-month implementation plan, which would be considered at the 29 January 2015 meeting of the Trust Board.  He stated that there were five themes in the plan, each owned by a lead Board member (shown in brackets below), which were:

• Leadership and management, (Acting Chief Executive) 
• Workforce (Director of Workforce)
• Emergency flow (Chief Operating Officer)
• Data quality and governance (Director of Health Informatics & Director of Corporate Affairs)
• Quality improvement (Chief Nurse/Medical Director)

On the first assessment of progress against the Implementation Plan he estimated 80% of the actions predicted had been delivered.  The CQC had still expressed concerns about the flow of patients through the hospital and the use of additional areas of the hospital to cope with the demand.  They had also put forward the need for the acute Trust to work more closely with partners across health and social care in an attempt to reduce demand and improve discharge planning and flow.  A visit by the Emergency Care Intensive Support Team had helped in suggesting ways of improving flow through the hospital from A&E to discharge.

It was stated that funding had now been received for the refurbishment of the Emergency Department, which was good news for patients and staff.  In response to a question the Chief Operating Officer, Medway NHS Foundation Trust stated that it was likely the refurbishment would take around 18 months to complete. 

In response to a request from Members the Acting Chief Executive, Medway NHS Foundation Trust undertook to share the Implementation Plan with them to enable the Committee to monitor progress.

Winter pressures

The Acting Chief Executive, Medway NHS Foundation Trust then set out detail about the winter pressures and pressure on the system during the past six weeks which had been felt nationally but particularly in Kent.  He explained the measures, which had been necessary during that period including the cessation of elective surgery but emphasised that all urgent surgery including cancer treatment as well as day surgery had continued as normal.  There had been a large increase in frail elderly being admitted during that period and stated that the level of acuity, which is not routinely measured, had been unprecedented.  The aim was to ensure that the frail elderly did not remain in hospital longer than they needed to particularly as evidence showed that for patients over 75 who are bed bound they lose 10% of muscle mass per week which equates to a year of aging.

Reference was made to the success  ...  view the full minutes text for item 706.

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

Discussion: 

The Interim Director of Operations, Kent and Medway NHS and Social Care Partnership Trust (KMPT) introduced the report on the acute mental health inpatient bed review update and responded to Members’ questions.

He stated that the situation regarding acute beds was similar to that of the hospital in that failure to discharge patients puts pressure on the system and brought about the need for out of area placements.  He informed the Committee that the operational work had reduced bed usage by 8 beds compared to the previous year and stated that it was better to concentrate on community support rather than admitting people to a hospital bed. 

In relation to the Emergency Care Intensive Support Team (ECIST) who were assisting the hospital with improving patient flow it had been agreed that the Team would work with KMPT to see if there was anything, which could be done to improve patient flow as far as mental health was concerned.  KMPT were the first mental health trust to make use of this Team and he was hopeful that they would be able to improve the whole system, as they are expert at getting health economies to work better together.  He referenced the increased use of section 136 detentions by the Police and hoped that the ECIST work could assist in reducing the number.  A request was made for data at the next meeting on the number of section 136 detentions locally per head of population compared to other areas.

As far as page 46 of the report was concerned a request was made that in future a glossary of terms is provided.  In explaining the single point of access he stated that in future trained mental health nurses would respond to calls to the Crisis team to undertake telephone triage which should give a better patient experience and earlier intervention.

Responding to a question it was stated that a bed would always be found where there was a need for one and that work was ongoing to try to find other ways of dealing with the top 20 users of services who tended not to be the most ill as they were using 7% of the resources.  Concern was expressed by Members at the amount of funding used on out of area placements and It was felt that this money could have been used to refurbish A block but the Chief Clinical Officer pointed out that the aim was to keep people out of hospital. 

Reference was made to the fact that that back in 2013 the Independent Review Panel, endorsed by the Secretary of State, had put forward recommendations around acute mental health inpatient beds in Medway including the suggested closure of A block (which was deemed unsafe), the development of 174 acute inpatient beds and the strengthening in the community support.  Serious concern and disappointment was expressed that in spite of these recommendations the 174 beds had still not been found and A block was still in use.

The  ...  view the full minutes text for item 707.

This report presents an update of the draft Dementia Strategy, which was originally presented to Health and Social Care Overview and Scrutiny Committee on 30 September 2014. The report outlines the consultation that has taken place and further work that will be undertaken to ensure that the actions outlined in the strategy are progressed.

The report provides an opportunity for Overview and Scrutiny Committee Members to be consulted on the final draft before it goes to Cabinet on 10 February 2015.

Discussion:

The Acting Deputy Director, Children and Adult Services introduced the Dementia Strategy and the Interim Dementia Lead responded to Members’ questions.

Members welcomed the Dementia Strategy and the local Dementia Action Alliance.  Reference was also made to the benefit of Dementia Friends and the point was made that it was important that the community worked together to understand dementia and support those who have dementia.  The challenge for GPs in identifying dementia was referenced.  Healthwatch Medway undertook to make contact with NHS Medway CCG to assist them in capturing information relating to patients who are lesbian, gay, transsexual and those undergoing gender reassignment.

The Interim Dementia Lead, in response to a query, confirmed that there was not a separate section in the Strategy relating to carers, as they were a thread that ran through all the commissioning intentions.

She also stated that NHS Medway CCG funded support to care homes to avoid inappropriate admissions.  In terms of partners being committed to following through the actions in the Implementation Plan the Interim Dementia Lead explained that the post of Dementia Lead was a joint appointment between the CCG and Local Authority and that there was a real commitment on behalf of partner organisations.  Voluntary sector organisations were also assisting with pre-diagnosis support for people but the role of GPs was key to diagnose dementia.

The Healthwatch Medway representative welcomed the person-centred approach throughout the Strategy and offered assistance with making contacts with hard to reach groups.

Decision: 

(a)   The Committee noted the update on the changes to the Dementia Strategy and the actions outlined in the revised draft Strategy made to improve the quality of life for people living with dementia in Medway;

(b)   The Committee referred the Dementia Strategy to Cabinet on 10 February 2015 for approval.

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:

Consideration was given to the work programme.

Decision: 

The report was noted.