Agenda and minutes

Apologies were received from Councillor Matt Fearn, with Councillor Sylvia Griffin attending as substitute, from Councillor Dan McDonald, with Councillor Andy Stamp attending as substitute, from Councillor Ann-Claire Howard, with Councillor Gloria Opara attending as substitute and from Dan Hill of Healthwatch, with Paddy Powell attending as substitute.

To approve the record of the meeting held on 23 August 2016.

The record of the meeting held on 23 August 2016 was agreed and signed by the Chairman as correct.

There were none. 

Disclosable pecuniary interests

There were none.

Other interests

There were none.

The Chairman welcomed Councillor Jan Aldous, who had recently been elected to the Council, as a new Member of the Committee.

A pilot service to support people that have reablement potential to return home from hospital and regain their independence has been in place for the six months April – September 2016, until the new intermediate care contract commenced service delivery on 1 October 20126.

This report informs Members about the success of the service, and how the changes in support to return home are being embedded from 1 October onwards.

Discussion

The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund and the Director of Planned and Urgent Care at Medway Community Healthcare introduced an update on the pilot scheme that supported patients to return home from hospital and regain their independence. The pilot had taken place for a six month period from April to September 2016.

The pilot had included new ways of working, with a key feature being that reablement of the patient was delivered in the patient’s home rather than in a hospital ward or community bed. This freed up hospital beds, relieving pressure on Medway Foundation Trust.

Following the conclusion of the pilot, a new Intermediate Care contract had commenced on 1 October, with Medway Community Healthcare as the lead provider. Following determination that a patient was safe to be discharged from hospital, they would be seen by an Occupational Therapist within two hours. Following this assessment, a reablement package was put in place for up to six weeks to enable the patient to regain full or as near to full independence as was possible. Many patients did not require the provision of longer term care packages.

The Committee raised a number of points and questions as follows:

Overall Success: A Member of the Committee stated that the figures provided in relation to the pilot demonstrated that it had been a success.

General performance: It was questioned how Delays to Transfer of Care were quantified and it was noted that 940 people had been referred to the Home First pathway, compared to a target of 875. It was also asked whether there were readmissions following the ending of support. The Director of Planned and Urgent Care advised that lessons had been learned from the pilot with regard to facilitation of the enablement package. There were no readmission figures available to provide to the Committee. It was recognised that some patients did not have a suitable home situation to enable them to be discharged there.

Support Criteria: In response to a question about whether there were criteria for determining when intensive support provided should cease, it was advised that this depended on the individual needs of the patient and what they wanted to achieve. It was recognised that being fully independent was not possible in every case.

Service Commissioning: It was confirmed that, following the successful pilot, Medway Community Healthcare had been commissioned to provide the service that had been implemented from October 1.

Ongoing Assessment: In response to Member concerns that patients could deteriorate following their initial assessment and that they may not have appropriate support at home, the Committee was advised that assessments were undertaken by an occupational therapist on a weekly basis. 90% of patients were going home with a social care package and medical support could be provided in the short term. Where patients required long term care and there had been no significant improvement within six weeks, they would be handed over to long term care teams. 77% of patients  ...  view the full minutes text for item 434.

A presentation will be given to the Committee by Geraint Davies, Acting Chief Executive of South East Coast Ambulance Trust (SECAmb). The main focus of the presentation will be on the Care Quality Commission’s (CQC) inspection findings, published on 29 September 2016, which gave the Trust an overall rating of ‘inadequate’ and work that the Trust is undertaking as part of its Recovery Plan to address the issues identified.

Discussion

The Chairman advised the Committee that the visit to the NHS 111 Call Centre that had been due to take place on 10 November had needed to be postponed. This and a proposal to establish a regional sub-group to undertake scrutiny of South East Coast NHS Ambulance Trust (SECAmb) had been included as part of the Work Programme item on the agenda (item number 11).

The Acting Chief Executive of SECAmb, introduced a presentation to the Committee, which had been included in the agenda. The main focus of the presentation was on the Care Quality Commission’s (CQC) inspection findings, published on 29 September 2016 and work that the Trust was undertaking as a result. The inspection had given the Trust an overall rating of inadequate. As a result, it had been placed in special measures. The individual areas of ‘Are services at this trust safe?’ and ‘Are services at this trust well-led?’ had also been rated as inadequate. Two areas, ‘Are services at this trust effective?’ and ‘Are services at this trust responsive?’ had been rated as ‘requires improvement’, while ‘Are services at this trust caring?’ had been rated as good.

SECAmb recognised its failings and was already delivering a Recovery Plan, which it was anticipated would address the issues that been identified by the CQC. The Plan had been submitted to NHS Improvement and had been endorsed by the CQC. The Trust would be re-inspected within six months. The Acting Chief Executive considered that a realistic target was for this to give the Trust a rating of ‘requires improvement.’ The expectation was that SECAmb would be able to come out of special measures within 12 months. Six health scrutiny committees and 22 clinical commissioning groups covered SECAmb’s geographic operational area. These organisations would all be seeking assurance in relation to the improvement journey ahead. It was noted that the Trust had agreed an overall budget deficit of £7.1 million.

The Acting Chief Executive also advised that a Patient Impact Review published in relation to a Red 3 Pilot had found no evidence of patient harm which could be attributed to the pilot. In relation to public access defibrillators, the SECAmb Board had agreed to undertake a review into the impact of system issues.

The Committee raised a number of points and questions as follows:

Management of the Trust: In relation to Member concerns about management at the Trust, the Acting Chief Executive advised that the previous Chief Executive and Chairman of the Trust had resigned in March 2016 when its failings had become apparent. Interviews for a new permanent Chief Executive were due to take place on 16 November 2016 and it was anticipated that there would be a four to six month transition period.

Other Staffing Issues: A Member raised concerns about the 44% staff turnover at the Trust, that approximately one third of call handler job posts were vacant and that the staff appraisal completion rate was 60%, which she considered meant that  ...  view the full minutes text for item 435.

This report sets out the current challenges facing GP services in Medway and outlines both national and local initiatives to address these challenges and to develop services in a way that provides improved care and access for local patients.

Discussion

In relation to the Risk Management section of the report, the Chairman advised that although there were no direct risks to the Council arising from the contents of the report, he considered that the Council would be potentially exposed to risk in the event that declining GP numbers made it increasingly difficult for residents to get an appointment or care from their GP.

The Senior Contracts Manager, Primary Care Commissioning at NHS England South (South East) and The Accountable Officer at Medway Clinical Commissioning Group, introduced the report. The report set out the challenges facing GP services in Medway and outlined both national and local initiatives to address these challenges and to develop services in a way that provided improved care and access for local patients.

There were around 600 local GP practices in Kent, Surrey and Sussex. General Practice was facing unprecedented challenges, both nationally and locally. These challenges included increasing workloads, recruitment and retention challenges, which was partly due to an increasing number of GPs being aged over 60 and therefore, approaching retirement. Within Medway, 38.6% of GPs were aged over 60. There were 51 practices in Medway and of these, 13 were run by ‘single-handed’ GPs. The age of some practice buildings was also a challenge.

Some practices had needed to close their lists to new patients for a year, while others had placed a cap on the number of new patients for a period of time. There had also been cases of some practices with multiple branches closing a branch, while other practices had merged with a neighbouring practice and a few had resigned their contracts completely. Rising operating costs were problematic, particularly for smaller practices that could face the same operating costs as a larger practice. There was an increasing reliance on locums due to difficulty in filling vacancies. While the use of locums enabled patients to be seen, locums cost more than their partner or employee counterparts and did not undertake other work associated with the running of a practice.

More positively, it was noted that of 45 GP practices in Medway visited by the Care Quality Commission, 82% had received a good rating.

Following the publication of the General Practice Forward View and the Five Year Forward View, there would be a review of General Practice contracts to ensure consistent funding for all practices. Development of local primary care services would be supported through a National Estates and Technology Transformation Fund. There would also be pilots in relation to new models of care with a better integration of primary care with other local health services.

Nationally, there was due to be £2.4 billion of investment in general practice by 2020/21, a 14% real terms increase. A £500 million national sustainability and transformation package would support GP practices. It had been determined that 18% of the current level of GP appointments would not be needed if care provision was structured in a different way. Over £900 million of capital investment was due to  ...  view the full minutes text for item 436.

This report informs the Committee of progress made since the Chief Executive and the Chairman of the Trust attended the June 2016 meeting of the Committee. The report focuses on the improvement plan put in place following the Care Quality Commission’s (CQC) January 2016 inspection report on the Trust and the progress made to date. The Trust currently remains in special measures, with a further inspection due to take place on 29/30 November. The report also responds to a number of specific questions raised by the Committee at the June meeting.

Discussion

The Chairman advised the Committee that a further inspection of Medway NHS Foundation Trust (MFT) was due to take place, starting on 29 November. Ahead of this inspection, a summary of the scrutiny that the Committee had undertaken of MFT during the previous year had been submitted to the Care Quality Commission (CQC). This submission had been included as part of the work programme item on the agenda.

It had been announced that Shena Winning had stepped down from her position as the Chairman of the Trust. She had been replaced by Dr Peter Carter OBE, who had assumed the role of Interim Chairman.

Committee Members requested that Sheena Winning's service be officially recognised by the committee as she had stepped up to her role at a very difficult time and provided support for the CEO while Lesley Dwyer settled into the role.

The Chief Executive of MFT, The Director of Finance and the Lead Matron for Discharge at Medway Maritime Hospital, introduced the report. The report updated the Committee on progress made on the Trust’s improvement journey since its Chief Executive and then Chairman had attended the Committee in June 2016.

Further progress had been made on implementation of the new Medical Model, which had been introduced in March 2016. It was acknowledged that previous attempts to improve quality had not always had the desired impact. However, significant improvements had now been realised and MFT was confident that this would be satisfactory to enable the Trust to come out of special measures, which it had been operating under for the previous three and a half years. It was anticipated that the Trust would receive a ‘Requires Improvement’ rating in the forthcoming inspection. The Trust considered that some of its services, including neo-natal and children’s services, were already good. The Chief Executive had confidence in both the management and clinical leadership of the Trust to continue the improvement journey.

The Chief Executive considered that Medway Martime Hospital was now safer than it had ever been. Mortality rates, which had been one of the highest in the country in January 2014, were now in line with national averages with key lessons having been learned from previous patient deaths. A ‘call of safety’ had helped to ensure the safety of services and that staff were supported to carry out work. The hospital had previously had to resort to providing care to patients in hospital corridors. This was no longer happening. Waiting times for cancer patients were also being normalised. Other positive changes made had included ensuring that complaint logs were reviewed systemically to identify lessons to be learned, increasing engagement with the community, making the hospital cleaner and the introduction of a smoke free policy across the whole hospital site. Patient satisfaction had improved with 85.2% of patients now recommending the hospital.

Within the Emergency Department, the Medical Model was helping to reduce waiting times. 82% of patients were seen and treated within four hours, compared to 73% in March 2016.  ...  view the full minutes text for item 437.

The report provides an update on the work of Kent and Medway NHS and Social Care Partnership Trust (KMPT). This includes details of current activities and priorities, successes, challenges and opportunities.

The Committee has previously been provided with regular updates on the acute mental health inpatient beds review. This report provides an update on inpatient beds and also covers the wider work of the Trust.

Discussion

The Chief Executive of the Kent and Medway NHS and Social Care Partnership Trust (KMPT), introduced the report. The report provided details of the Trust’s current activities, priorities, successes, challenges and opportunities. The Committee had previously been provided with regular updates in relation to mental health bed provision. Following discussion with the Chairman of the Committee, it had been agreed at a pre-agenda meeting held on 6 October 2016 that future reports submitted to the Committee would include a wider update on KMPT’s work.

The Committee was advised that a Whole System Mental Health Workshop had taken place on 12 October 2016. The Chief Executive of KMPT had found this to be a very positive experience. Following this, a report had been presented to the Medway Health and Wellbeing Board on 3 November and a Mental Health Strategy was now due to be developed.

The Trust had worked to reduce the use of private inpatient acute mental health beds to a maximum of 15 by the end of October 2016.This was down from 76 beds in June. A plan was in place to ensure that this reduction was sustained and medical professionals were involved in this work.

The Committee raised a number of points and questions as follows:

Engagement and Service Improvement: In response to a question about public engagement undertaken, it was confirmed that a variety of engagement had taken place. There were five engagement representatives for each of the five main towns in Medway, with patients being consulted on the development of services. Improvements had been made with regard to accident and emergency provision, with Medway Maritime being the only acute hospital in Kent with 24/7 mental health provision. Recruitment was being looked at and a detailed improvement plan was under development.

Personality Disorders and Street Triage: A Member asked what provision was available for the treatment of personality disorders since the closure of a unit and about the provision of street triage. The Member was also concerned that services were not being promoted. The Chief Executive advised that there was some provision locally in relation to personality disorders and that there was some street triage provision in Dartford but that this was not able to cover the whole of Kent and Medway. Street Triage involved mental health workers going out on patrol with police officers. This could help to avoid the need for the Police to use Section 136 powers which allowed them to remove a person to a place of a safety where there were concerns for their wellbeing for mental health reasons. Consideration was being given as to how to work with commissioners, the Police and patients to improve provision. It was noted a mental health crisis hospital admission could be for up to 72 hours.

Brain Injury Unit: In response to a Member question, the Chief Executive advised that there were currently no plans for the brain injury unit in Medway to be expanded.

Mental Health Provision: A Member felt that services should  ...  view the full minutes text for item 438.

Medway’s three priorities and three ways of working are set out in the new Council Plan 2016/17. This report summarises how the Council has performed in Quarter 1 2016/17 against the priority most relevant to this Committee: Supporting Medway’s people to realise their potential. There are six key measures of success and two key projects for this priority which fall under the remit of this Committee.

Discussion

The Interim Director of Children and Adult Services, introduced the report to provide an update on Council performance for quarter 1 2016/7 in relation to the measures relevant to health and adult social care. The Committee was advised that, although the report covered quarter 1, figures for quarter 2 were available. A quarter 2 performance update was due to be presented to the Committee at the December 2016 meeting.

The Committee was advised that work had taken place to raise awareness of social isolation, particularly with regard to persons living with dementia. The Fire Service would be helping to identify those who were socially isolated and refer them to the appropriate services.

In relation to the Adult Social Care Strategy, an engagement event had been held at the Brook Theatre in Chatham. An Implementation Plan had been developed and this was due to be considered by the Committee at a future meeting.

Figures for Delayed Transfers of Care showed that Medway had the third best performance of all local authority areas in the South East.

The pressure that winter placed on health and social care provision was an ongoing cause for concern, with work being undertaken to understand how these pressures could be reduced and demand met.

The quarter 2 report would consider the topic of direct payments to clients further and why the volume of these were not meeting targets. It was acknowledged that there needed to be a culture change amongst frontline staff with regard to direct payments. This would be addressed through the joining together of teams, with the aim being for an increase in uptake to be realised by quarter 4.

The Interim Director of Public Health advised that healthy weight performance targets were being met. A key part of this work was encouraging people to be physically active. Besides Public Health, a number of other Council services were also involved in this work.

Decision

The Committee noted the report and considered the Quarter 1 2016/17 performance against the Key measures of success used to monitor progress against the Council Plan 2016/17.

Discussion

The Chairman advised that the Councillor visit to the NHS 111 Call Centre in Ashford, that had been due to take place on 24 November, had been postponed as not enough Members had been able to attend. It was agreed that the visit would be rearranged with the aim being for it to take place early in the New Year, subject to a sufficient number of Members being available in order to make the visit viable.

A visit to Amherst Court was due to take place on 24 November with five or six Members due to be attending.

The Democratic Services Officer introduced the remainder of the Work Programme report which advised Members of the current work programme in light of the latest priorities, issues and circumstances.

The establishment of a regional scrutiny sub-group had been proposed to undertake scrutiny of SECAmb. It was also proposed that each health scrutiny committee would select two Members to represent it on the regional sub-group. Sub-group work would be reported regularly to each participating Council’s own scrutiny committee on a regular basis and participation in the sub-group would not affect the right of individual Councils to undertake their own scrutiny, should they so wish. The proposals were due to be discussed at the South East Regional Scrutiny Network meeting taking place on Friday 18 November. This meeting was also due to include an update on the Kent and Medway Sustainability and Transformation Plan. A Member proposed that the Committee should be represented by one Conservative and one Labour Member. The Chairman proposed that Councillors Royle and himself, both Conservative Councillors, should be appointed as the Committee’s representatives on the regional Sub-Group. The Committee agreed this proposal, but some Members of the Committee were not satisfied with this arrangement.

The Care Quality Commission (CQC) had announced that it would be undertaking an inspection of Kent and Medway NHS Social Care and Partnership Trust (KMPT) in the week beginning 16 January 2017. The Committee had been invited to share information relevant to the inspection. It was proposed that a summary of scrutiny undertaken by the Committee over the last year be submitted to the CQC.

Four meetings of the Dementia Task Group had taken place. These had included an introductory meeting, meeting with the Alzheimer’s Society, a visit to Crawley to see how it had became one of 12 towns to initially be awarded dementia friendly status and a visit to a Dementia Café. Future Task Group meetings would include a Diagnosis and Post Diagnostic Support Session and a Leading by Example session to consider how the Council could demonstrate leadership in making Medway a dementia friendly community. It was anticipated that the Task Group’s draft report would be presented to the Committee at its March 2017 meeting.

The next meeting of the Kent and Medway Joint Health Scrutiny Committee was due to take place on 28 November. This would receive updates on work undertaken since the last meeting on 4 August on  ...  view the full minutes text for item 440.