Agenda and minutes

Members observed a minute’s silence in tribute to Jo Cox MP, who had been killed in her West Yorkshire constituency on 16 June.

On behalf of the Committee, the Chairman thanked Barbara Peacock, Director of Children and Adults, for all her work at Medway and wished her well in her new role as Croydon's new Executive Director for People.

 Apologies for absence were received from Councillor Fearn and Dr Ussher.

To approve the record of the meeting held on 17 March 2016 and the Joint Meeting of Committees held on 18 May 2016.

The record of the meeting held on 17 March 2016 and the Joint Meeting of Committees held on 18 May 2016 was agreed as a correct record and signed by the Chairman. 

There were none. 

Disclosable pecuniary interests

There were none.

Other interests

There were none.

This report informs the Committee of progress made since the Chief Executive and the Chairman of the Trust attended the March 2016 meeting of the Committee.

Discussion:

The Chief Executive of Medway NHS Foundation Trust introduced this report which informed Members of progress made since the report considered at the last meeting of the Committee held on 17 March (minute no. 874).

Members raised a number of questions and comments as follows:

·         Medical Model – in response to a comment that the reduction in the average length of stay on acute wards may not be a positive development as some people discharged themselves voluntarily, the Chief Executive advised that the figures did not include this group. However, the fact that some people voluntarily discharged themselves probably showed a breakdown in communications.  A Member asked for more information on how the Trust had achieved this reduction. The Chief Executive commented that this Model was a contemporary way of providing care and was based on an established model elsewhere. She undertook to provide more detail in writing about how the Model worked.

·         Home First – in response to a comment that there was a lack of confidence in community services being available to provide care to people when they needed it and that it had been a case of a redistribution of funds rather than an injection of funds into community services, the Chief Executive commented on the positive feedback she had received regarding this service. There was a need for the whole system to work together and provide support on a 24 hour basis as happened in acute services and a need to provide Home First at scale.

In response to a comment made about a negative experience of a , whose individual needs had not been met, the Chief Executive undertook to discuss this case with the Member outside the meeting but commented it appeared the circumstances, as described, suggested the constituent had not been cared for under Home First. 

·         Staffing – a Member asked how many nurses had left the Trust due to inadequate performance. The Chief Executive was unable to give figures but emphasised that staff were managed through a performance management framework. In terms of recruitment, she responded that the Trust was now attracting more interest when vacancies were advertised but would like to see more experienced nurses applying as opposed to people wishing to become a nurse. She was pleased to report that more staff were now remaining in employment each month than were leaving.

·         Emergency Department – a Member asked about the roadway improvements and access to the hospital from Windmill Road. The Chief Executive responded that this was part of the improvements to the department and the Trust would be working with the Council to address what was a bottle neck.

·         Next phase of the Recovery Programme -A Member commented she had been impressed on a recent tour of the hospital by the new facilities and it was clear that visible progress had been made. Other Members congratulated the Trust on the progress made whilst recognising that further improvements were still needed. A Member asked how confident the  ...  view the full minutes text for item 76.

This report advises the Committee of a proposal to relocate stroke community rehabilitation beds from St Bartholomew's Hospital.  In the view of NHS Medway CCG and Medway Community Healthcare this is not a substantial service reconfiguration.

The Director of Planned and Urgent Care at Medway Community Healthcare added that other sites had been looked at but Amherst Court was seen as the best option given it was a modern residential home with single en suite rooms, lounge and kitchen areas to help with rehabilitation, more parking spaces for visitors and available beds. The home had a very person centred attitude to care with an emphasis on social interaction. Drop in sessions were planned in the coming weeks for staff and patients to answer any queries they might have.

Several Members acknowledged the largely positive nature of the proposal but were critical that the Committee had not been informed of the proposals at a much earlier stage, particularly given the planned move would be taking place imminently in July/August. In response, the Company Secretary (CCG) apologised for any impression given that the Committee had not been involved. He assured Members he had presented the proposal at the earliest possible time given the formal agreement to use Amherst Court had only recently been secured. If the Committee decided the proposal was a substantial variation then the CCG had prepared for that situation and would adjust their timetable accordingly, albeit this would be an inconvenience. Once there was clarity about the wider review of stroke services in Kent and Medway, the CCG would be in a better position to consider the future of community stroke beds. The view of the CCG was that changes arising from this review would entail significant variations.

The fact that it was only a two year contract was a concern for some.  The Company Secretary commented that it was not unusual for NHS contracts to only last two years and in fact the previous contract had been for one year.

A Member expressed concern that, following a site visit by two Members of the Committee, patients with dementia currently at Amherst Court were having to move. An assurance was given that existing residents would not be disadvantaged and more detail on this was promised.

In response to a question from a Member, it was clarified that stroke patients would have a discrete area at Amherst Court but would be welcome to use communal areas such as the café. There were benefits for both organisations in co-location and opportunities to learn from each other.

A Member  ...  view the full minutes text for item 77.

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

Discussion:

This report summarises the performance of the Council’s Key Measures of Success for Q4 2015/16 as set out in the Council Plan 2015/16.

Discussion:

The Deputy Director introduced this report which summarised the performance of the Council’s Key Measures of Success for Q4 2015/16 as set out in the Council Plan 2015/16.

Target PH11 (Number of users of opiates that left drug treatment successfully) – in response to a request for clarification of the commentary in relation to this target, the Interim Director of Public Health advised that the target measured success in terms of clients who had come off drugs and stayed off them for a period of time and were no longer a user of the service. He advised that performance was now on target. It was agreed that briefing note be sent to Members on this target.

Target ASC19 (Percentage of clients accessing services through a direct payment) – in response to a request for more information about the success of this target, the Deputy Director advised that there was a dedicated team in place to promote direct payments as well as promotional campaigns. Direct payments were seen as a more flexible way of meeting needs. The Council recognised that this was not for everyone but a growing number of clients were opting for direct payments. Performance had not been as good as other councils but it was pleasing to see that take up was now increasing.

Target AS13 3 (Permanent admissions to residential and nursing care homes per 100,000 population) – the Deputy Director clarified, in response to a question, that the figure of 3 admissions referred to related to a quarter.

Decision:  

The Committee:

a)     noted the Q4 2015/16 performance against the Key Measures of Success used to monitor progress against the Council Plan 2015/16, and:

b)     asked for a briefing note on Target PH11 (Number of users of opiates that left drug treatment successfully)

This report deals with the development of “Getting Better Together”, the Adult Social Care Strategy for Medway. 

Discussion:

Members then raised a number of points and questions which included: -

·         Purpose and readability of strategy - in response to a comment that the strategy represented an idealised vision of adult social care which was not always reflected on the ground, the Deputy Director commented that the strategy had been developed in response to requests from service users and employees for greater clarity about what the Council considered good quality social care to look like. It was important to effectively monitor performance and delivery against the strategy and he was keen to develop more qualitative measures. The Deputy Director highlighted that this would be overseen by the Adult Social Care Improvement Board chaired by the Leader. Some Members recognised the aspirational nature of the strategy and commented that if this led to improvements in adult social care then that was clearly a positive development. Whilst the high level nature of the strategy was accepted, some Members felt the document, whilst reading well in parts, was difficult to understand in places and could be repetitive (particularly the business opportunities sections of the Market Position Statement). The point was made that for use at a grass roots level it needed to be much simpler and easier to read. The Deputy Director commented that feedback so far on the strategy had been positive but he acknowledged there may be a need to provide separate material when talking to specific audiences. He saw the document as iterative in nature and there would be roadshows with staff and service users to secure broader engagement. The Deputy Director commented that he understood Members’ concerns and would take them on board.

·         Target Audience – the target audience was questioned and the point was made that if the strategy was meant to encourage people to think about the future and possible future care needs then probably another way of doing that was needed.

·         Older peoples care market/planning – a Member noted that the strategy acknowledged that the number of smaller care homes would decrease in the future but noted that planning applications for larger homes had been refused by the Council.  In response to a question about how the strategy could be used to address this within the Council, the Deputy Director replied that the strategy would support more integrated working  ...  view the full minutes text for item 80.

Discussion:

In response to a question about the timescales for the Dementia Task Group commencing work, Members were advised that discussion were taking place about the possible scope of the Group. Of the Task Groups that had been agreed for this cycle, the Dementia Task Group was next in line to begin work. 

Regarding the proposed update on various GP issues, it was agreed that the report should focus on waiting times for GP appointments and the future of the GP practice at Canterbury Street.

Decision:

The Committee agreed to:

a)            note the current the work programme attached at Appendix 1 to the report;

b)            agree the following additions to the Committee’s work programme:

·         waiting times for GP appointments and the future of the GP practice at Canterbury Street to be added to the work programme for August 2016

·         a progress report on Home First be submitted to the October meeting (to include the position on home nursing capacity)

·         an update on staffing at NHS 111, together with details of training undertaken, be submitted to the October meeting.

·         The Portfolio Holder for Adult Services be held to account at the January 2017 meeting of the Committee, to  align with scrutiny of the Medway Safeguarding Children’s Board

c)            Note that a Member visit to NHS 111 at Ashford will take place and agreed that an all Member briefing on dentistry take place in October 2016.