Agenda and minutes

To approve the record of the meeting held on 31 March 2015 and the Joint Meeting of all Committees held on 27 May 2015.

The record of the meeting held on 31 March 2015 and the record of the Joint Meeting of all Committees held on 27 May 2015 were agreed as correct and signed by the Chairman. 

An apology for absence was received from Councillor Fearn.

There were no urgent matters.  However, following a request from the Chairman it was agreed to move agenda item 5, Member item – Care in the Community to later in the meeting, to follow the report on acute mental health inpatient beds to allow partners at the meeting to have their items dealt with first. This was agreed.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

This report has been requested to enable the new Chief Executive, Lesley Dwyer, to attend her first meeting, with the Chair of the Trust, Shena Winning and the Chief Operating Officer, Morag Jackson, to update the successive Committee on progress against the implementation plan put in place following the inspections by the Care Quality Commission.

Discussion:

The Committee extended a warm welcome to Lesley Dwyer, the newly appointed Chief Executive of Medway NHS Foundation Trust (MFT) and also paid tribute to the sterling work of the Acting Chief Executive, Dr Phil Barnes, for all he had achieved whilst covering the post including his expertise in bridging the gap between clinical and managerial staff.  They requested their thanks to be passed to him.

The Chair of MFT gave a brief update on progress and explained that while the new Chief Executive had only been in post since May she had been kept involved in developments at the hospital.  She also stated that Dr Barnes would continue at the Trust as Medical Director.

The Chief Executive of MFT then set out the background to her being appointed to the Trust and explained the experience she brought to the role in tackling similar issues in Australia with a failing Trust and undertaking a journey of improvement.  She stated that it would be important to plan beyond the 18 month Improvement Plan and to bring partners, stakeholders, service users and staff with them, and to embed a spirit of optimism in what was being achieved.  This was particularly important leading into a further inspection in August by the Care Quality Commission.

In response to a request, an offer of a visit to the hospital by Committee Members was agreed and the Chief Executive of MFT undertook to contact Democratic Services to plan the event.

The Chief Operating Officer of MFT referred to improvements at the Trust over the past few months in particular:

·         There had been improvement and stabilisation of the senior team at the hospital

·         With regard to the four hour waiting target at Accident and Emergency, since the introduction of a frailty pathway, this had improved considerably and the Trust was now in the top 30% in the country in achieving this target

·         The new paediatric unit at the hospital was open and well received

·         The Trust had engaged a new “super-buddy”, one of the London teaching hospitals, Guy’s and St Thomas’ Hospital, to assist them in areas where it had been identified help was needed

·         There were still some workforce shortage issues and this was being addressed partly by considering some overseas recruitment and supporting local staff by creating a hospital based ‘bank’

The Chief Executive of MFT responded to a number of questions as follows:

Relationship between clinicians and management

·         Although the troubled relationship between clinicians and management at the hospital had improved this area still required further work.  The appointment of a Chief Quality Officer at the hospital was helpful in this regard. 

·         The Trust was at the forefront of most hospitals in appointing a Chief Quality Officer and part of her role would be to identify useful information (rather than data) to enable the Trust to understand what worked and what did not and to learn from best practice

New Patient Administration System

·         The new Patient Administration System was working very successfully and  ...  view the full minutes text for item 50.

This report sets out the response from Kent and Medway NHS and 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 Chairman stated that it was proposed to reduce holding the Trust to account to alternate meetings to endeavour to introduce a more meaningful dialogue.  He also suggested it might be helpful for a representative from the Committee to engage with the Trust and report back to the Committee.

The Director of Transformation, Kent and Medway NHS and Social Care Partnership Trust (KMPT) and Chief Clinical Officer, NHS Medway Clinical Commissioning Group (CCG) stated that the advance notice of questions for the meeting had been very helpful. 

The Director of Transformation, KMPT then explained that the Trust was committed to working closely with NHS Medway CCG, as their commissioners, to deliver a high quality service.  The Chief Clinical Officer, NHS Medway CCG explained that historically the commissioning of acute beds had been undertaken by Kent and Medway PCT but was now being commissioned by NHS Medway CCG and had to be contained within necessary financial constraints.

In relation to the table on page 68 of the agenda he stated that, since the introduction of a new contract with NHS Medway CCG, the risk in relation to out of area placements now rested purely with the CCG.

He discussed the importance of catering for the high number of patients with a personality disorder and referred to the success of the new unit in Medway.  Reference was also made to the high number of section 136 detentions in Medway but research showed that 80% of people, who would normally have been admitted to hospital, could be de-escalated in 48 hours.  These detentions had a significant impact on the Crisis Resolution Home Treatment Team who were spending 4 hours per patient assessing such cases which meant they were prevented from undertaking their main role in supporting people at home.

In response to questions,( some of which he had received prior notice of) he stated the following:

The high level of section 136 detentions in Medway and availability of beds for both sectioned and voluntary admissions

·         Training was being undertaken with the Police to provide education in an attempt to reduce the number of section 136 detentions

·         The crisis pathway hostel, which was available 5 days and 4 nights a week, had reduced attendance at Accident and Emergency by 80%

Cost of new build of an 18 bedded ward

·         The cost of building an 18 bedded ward to the required standard would be £6m and the operating/running costs would be £1.5m a year to provide the right therapeutic care and the required level of staffing

·         KMPT could only ever supply what they are commissioned by the CCG to provide

Out of area bed usage

·         If a bed was not available locally KMPT would attempt to find the nearest available bed but this could sometimes mean it was a long way from Medway.  KMPT would then attempt to repatriate the person as soon as possible to Medway

Action taken in response to the notice to improve issued by the Health and Safety Executive

·         Improvements  ...  view the full minutes text for item 51.

This report sets out the response to an issue raised by Councillor Purdy regarding care in the community. It describes the range of community services which provide care and support to eligible adults in need in their own homes and in other settings. The report explains how individuals and their carers who seek assistance from Medway Council have their needs assessed and what services can then be provided to meet and review their assessed needs.

Discussion:

Councillor Purdy introduced her Member item in relation to care in the community and explained the reasons behind requesting the item.  She thanked the Deputy Director, Children and Adult Services for his comprehensive report but stated that, from her contact with Medway service users she had concerns about the appropriateness of some of the care provided.  She referred to the need for close monitoring of the care services to ensure value for money but also quality of service to the public.  A number of examples were given of occasions when the quality of care provided were not at an acceptable level, for example people receiving meals at appropriate times.

Other members of the Committee, including the representative from Medway Pensioner’s Forum, gave similar examples and felt that more detail was needed as the elderly, in particular, were often reticent about complaining in case services were withdrawn or made worse.

A question was asked about the significant increase in demand for Deprivation of Liberty Safeguarding and what impact this had had.  The Deputy Director, Children and Adult Services explained that there had been an 18 fold increase in demand last year which the Council had addressed by investing in the service.  He stated that there had, however, been an impact on other services including the officers who were involved in best interest assessments.

The Deputy Director, Children and Adult Services welcomed the Member item and stated that he was keen to ensure that any intelligence and feedback on the service was made known to him.  He assured Members that quality assurance was very important but he was keen for there to be a triangulation of information about quality and value for money.

Councillor Purdy put forward the suggestion that this could be a suitable topic to put forward for an in-depth scrutiny review.  Other Members considered that more information would be useful ahead of coming to that conclusion.

Decision:

The Committee requested that a more detailed report from the Deputy Director, Children and Adult Services be programmed for the next meeting setting out how quality and value for money was monitored.

The report provides information on the number, type and other information on adult social care complaints received during the period April 2014-March 2015. It also highlights some examples of the many positive things people have said about the provision of adult social care in Medway over the same period and the service improvements the Council has made as a result of this feedback.

Discussion:

The Deputy Director, Children and Adult Services introduced the annual report on adult complaints and compliments and drew attention to a number of highlights in it.  Responding to questions he stated

Page 87 paragraph 6.7 Complaints received

·         That the complaints listed rolled over at the end of the year but these were still in the same accounting period

Re-forming of the Learning Disabilities Partnership Board and Councillor involvement

·         the Learning Disabilities Partnership Board was being reformed and consideration would be given to representation on that Board by Councillors

Deadline for statutory complaint responses

·         in relation to response times for complaints there was no statutory requirement to respond within 10 days and that this timing had been chosen to fit with the corporate standard.  Consideration could be given to extending this to 20 days

A view was put forward that the report was very detailed and could perhaps be simplified for the next report.  Other Members, however, considered  the current content was necessary and helpful.

It was proposed that the extension of responses to complaints of 20 days should be recommended to the Assistant Director, Communications, Performance and Partnerships.

Decision:

The Committee recommended to the Assistant Director, Communications, Performance and Partnerships to consider extending the deadline for responses to complaints to 20 days.

This report provides Members with an update on the Care Act in Medway and outlines the next steps and actions going forward

Discussion:

The Interim Programme Manager for the Care Act gave a brief introduction to the key changes set out in the Care Act, spoke of the changes made to meet the Council’s obligations from 1 April 2015 and preparations for the second wave of reforms that take effect from 1 April 2016.

Decision:

The report was noted.

Discussion:

A copy of Appendix 2 to the work programme was tabled at the meeting as that Appendix had been omitted in error from the agenda papers.

The Democratic Services Officer drew attention to paragraph 5 of the report which set out the process for the selection of the next round of scrutiny task group topics.  She explained that the matter would be considered next at Business Support Overview and Scrutiny Committee on Thursday evening and if that Committee agreed with the proposal of commencing the round with the housing task group, this should start in late August/early September.  She encouraged Members to contact her with any suggestions about task group topics prior to 23 July 2015 as they would need to be discussed the following day at the pre-agenda meeting.

Decision:

The Committee agreed that:

(a)  The work programme should be amended to reflect the following:

-       Attendance to be arranged for alternate meetings only for KMPT (their next attendance to be 1 October 2015)

-       A report be added to the business for the next meeting setting out more detail relating to care in the community

(b)  Members send any suggestions for in depth scrutiny task group topics to the Democratic Services Officer by 23 July 2015.