Agenda and minutes

Apologies were received from Councillor Naushabah Khan, with Councillor Tristan Osborne attending as substitute and from Councillor Matt Fearn, with Councillor Mark Joy attending as substitute. Apologies had also been received from Dan Hill of Healthwatch, with Paddy Powell attending as substitute and from Christine Baker of the Medway Pensioner’s Forum. Councillor Aldous had advised that she would be late to the meeting.

To approve the record of the meeting held on 15 November 2016.

The record of the meeting held on 15 November 2016 was agreed and signed by the Chairman as correct. 

There were none. 

Disclosable pecuniary interests

There were none.

Other interests

There were none.

This report provides Members with an update on the provision of Patient Transport Services in Kent and Medway.

Discussion

The Accountable / Chief Officer for NHS West Kent Clinical Commissioning Group introduced the report. The new transport provider, G4S, had taken over the contract from NSL. The new contract commenced on 1 July 2016 and had followed a robust procurement progress, which had considered lessons learned from the previous contract. Mobilisation on the first day of the new contract had gone well, with the call centre being able to meet the demand. The service required further improvement, but it was considered that the service at launch was already better than that provided by the previous contractor.

The target for patient pick up from hospital under the new contract was one hour, compared to three hours under the old contract. Performance standards were not yet being met but the quality of the service was improving each month. There had been initial difficulties in relation to the transport of renal patients. This had been addressed within the last month. There were still patients who were not being collected on time and some delays in discharge from hospital. Hospitals had more confidence in the service provided, with some starting to stand down their own ambulances as a result.

The relationships between hospital trusts and G4S were generally much better than they had been under the previous provider and complaint numbers had dropped month on month. No complaints from MPs had yet been received in relation to the new provider. Review of performance data had been built into the contract, with no significant issues having been identified during the review undertaken after three months of the new contract.

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

Transport to London Hospitals: In response to a Member question, the Accountable Officer advised that patient transport services had previously been commissioned by the London hospital trusts to collect patients from within Kent and Medway and take them to London hospitals. This was due to change so that the Kent and Medway transport provision would collect patients travelling to London hospitals. This was because the previous provision had been poor.

Performance data and complaints: A Member asked whether there was any performance data in relation to the new contract available for the Committee to review and what the nature was of complaints received so far. Complaints tended to focus on delays in being picked up or taken home. Three months of performance data was available but it would not be made publically available at this stage as it was considered that a longer time period was required to make analysis of the data meaningful. It was proposed that data would be released once six months worth was available. The Committee agreed that a written update on the performance data should be provided ahead of a possible update being presented to the Committee.

Care Quality Commission Inspections – The Accountable Officer advised that the Care Quality Commission would inspect the patient transport service at some point. It was not known when this would be,  ...  view the full minutes text for item 554.

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was publically published on 23 November 2016. This report brings the draft plan to the Committee for information. Work is ongoing regarding the STP programme and a more detailed case for change will be published for public consultation in 2017.

Discussion

The Programme Director for Kent and Medway Sustainability and Transformation Plan (STP) apologised that the Senior Responsible Officer for the STP, who was also the Chief Executive of Maidstone and Tunbridge Wells NHS Foundation Trust, had been unable to attend the meeting. The Programme Director then introduced the report.

Guidance that introduced the concept of Sustainability and Transformation Plans had been provided by NHS England on 22 December 2015. The guidance asked for the plans to do three key things. These were to look at health inequalities and how they could be reduced, to look at the quality and performance of local care organisations and to consider how the finances of health provision could be made sustainable. Partnership working would be key to the future effective delivery of services.

The Kent and Medway STP was proposing significant changes, including in relation to the quality agenda, especially given that a number of local health providers were currently in special measures.

Across Kent and Medway, there had been a £105million deficit in NHS funding at the end of 2015/16, with a deficit of around £125million across organisations providing health and social care. The STP was focused on four themes, which were care transformation, enablers of care, productivity and system leadership. Care transformation was about preventing ill health, intervening earlier and bringing care closer to home. Enablers of care included investing in estates, digital infrastructure and the workforce needed to underpin high-performing systems. Productivity included finding efficiencies in services, procurement and prescribing, while system leadership would see the development of the structures to deliver the other elements and would involve organisations coming together to deliver improvement. It was acknowledged that the reduction in costs for non-clinical areas, such as back office functions, were not as effective as they should be.

The Kent and Medway STP had been identified as one of four national pathfinders in relation to productivity. These were looking at how resources available for frontline care could be maximised.

There were four sub-themes within the Care Transformation theme. The most significant of these was local care. This was about the provision of appropriate care in the community, close to the patient’s home. There were a number of hospital patients in Kent and Medway who were not best served by being in an acute hospital bed. Work had been undertaken in relation to patients, particularly elderly patients, who did not have a clinical need to be in hospital and investigating alternatives to support patient need.

The ability for investment to be made in local care was limited. The aim was to be able to prioritise money being spent on local care by reducing the reliance on acute provision. Current acute provision was quite thinly spread in some areas. One example was stroke care, with all seven acute hospitals in Kent currently providing this. A more effective and efficient service could be delivered through the provision of specialist services at fewer sites.

The same was also true for vascular provision, with  ...  view the full minutes text for item 555.

There is a national agreement that the Health and Social Care economies must work together to improve the outcomes for individuals who require additional support, whatever stage of life they are at.

Those providing help for people have, for some time, acknowledged that technology will play a larger part in providing that support. The Council and health partners are committed to delivering a local digital roadmap which is a key part of the Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP). Technology enhanced care services form an important part of that.

This report begins to explore some of the options that are available now for technology enhanced care services and will be possible in the near future.

Discussion

The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund introduced the report. This provided an overview of current work, the activity that would soon commence and some of the longer term plans in relation to Technology Enabled Care Services (TECS).

TECS were an enabler within the Sustainable Transformation Plan. The services were currently being used by around 1,500 private patients, 1,000 of whom were supported through Adult Social Care, as well as a further 1,500 people in other types of accommodation. These services were supporting people to be cared for at home rather than in hospital, which was generally the preference of patients. Telecare enabled health and social care services to engage with people remotely through the provision of real time patient information. Patients were enabled stay in their home longer through the management of long term chronic conditions.

A trial was currently running in Medway, which used a smartphone and other equipment to enable a community nurse to log in and get real time patient information. This could be used to determine whether a visit was necessary, thereby giving the practitioner more time to visit patients who needed this the most. The system also enabled GPs to receive an electronic discharge notification when a patient was discharged from hospital.

There had also been some roll out of preventative services, such as a community Geriatrician initiative. This practitioner, based in a practice in Gillingham, had gone through all the records of frail and elderly people and called them in for an in-depth needs assessment at the surgery. Couples would be seen together. The geriatrician was able to access records, including details of hospital admissions. A further trial was due to take place in the New Year.

Medway NHS Clinical Commissioning Group had invested in software that enabled existing software systems to interact with each other and to facilitate the sharing of information between healthcare professionals working for different organisations.

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

Shared software systems and financial savings associated with telecare provision: In response to a Member who asked why shared information systems were only now being developed when other industries had used such systems for years and how it could be known whether savings would be made through the use of telecare when this had not been accurately tested in Medway, The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund advised that such systems had not been developed sooner due to information governance considerations. Health services had been provided on the basis that information would only be shared with other parties where patients had explicitly given their consent. The sharing of patient information was extremely sensitive, with there still being significant hurdles to overcome. The establishment of systems that could interact with each other and which share only the information that the patient had given permission to be shared would take time. In relation to savings, it was widely accepted that savings could be  ...  view the full minutes text for item 556.

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 2 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; however data for one of these is not expected until after publication of this report.

Discussion

The Interim Assistant Director of Adult Care Services introduced the Council Plan Quarter 2 2016/17 Performance Monitoring Report. Medway was the third best performing local authority in the South East for Delayed Transfers of Care. Work undertaken to support healthy weight was highlighted. The Cabinet Member for Adult Services, Councillor Brake, had chaired the third annual Healthy Weight Summit in September 2016. This had brought together a number of partners and initiatives. Tackling obesity was particularly important because it contributed to a number of long term health conditions.

Activities taking place within Medway had been highlighted within two Local Government Association (LGA) publications in the last 12 months. There were a number of initiatives aimed at reducing social isolation. These initiatives featured joint working with partners, such as Kent Fire and Rescue. One initiative was ‘Men in Sheds’. This was contributing significantly to reducing social isolation and supporting the mental health of men participating in the scheme. Public Health was participating in a South East Public Health England Social Isolation Action Learning Set.

An update was due to be provided to the Committee in January in relation to the Adult Social Care Strategy. Work was being undertaken to improve the performance of Adult Social Care and to make required efficiency savings over the next three years.

Decision                             

The Committee considered quarter 2 2016/17 performance against the Key measures of success used to monitor progress against the Council Plan 2016/17.

This report provides an update on progress towards setting the Council’s draft capital and revenue budgets for 2017/18.  In accordance with the Constitution, Cabinet is required to develop ‘initial budget proposals’ approximately three months before finalising the budget and setting council tax levels at the end of February 2017.

The draft budget is based on the principles contained in the Medium Term Financial Plan (MTFP) 2016/2020 approved by Cabinet in September and reflects the latest formula grant assumptions.

Discussion

The Chief Finance Officer introduced the report on progress towards setting the Council’s draft revenue and capital budgets for 2017/18. On 27 September, the Council’s Medium Term Financial Plan (MTFP) had been approved by Cabinet. The Plan had identified an £11.7 million deficit in the Council’s budget for 2017/18. On 22 November, a draft budget had been presented to Cabinet. By this stage, the gap had been reduced to £7.8 million due to work undertaken.

The budget was in the process of being submitted to the Council’s four scrutiny committees for comment prior to Cabinet presenting the budget to Council on 23 February 2017. Savings being proposed in Children and Adult Services were through the renegotiation of contracts with service providers, service user pathway redesign, improvement in reablement outcomes and review and recommissioning of a range of services. The Committee was invited to review the draft budget presented to it and to provide any comments.

A Member reiterated concerns raised at the Business Support Overview and Scrutiny Committee on 1 December that the budget proposals presented showed the budgetary gap and outlined proposed savings, but did not provide any detail. It was, therefore, not possible for the Committee to scrutinise the proposals effectively. Details of how the budgetary gap would be closed should have been provided. The Member considered that this omission was unacceptable and noted that it was the fifth year running that concerns had been raised. She advised that the Business Support Overview and Scrutiny Committee had agreed a recommendation to Cabinet that additional information should be provided, in future years, to Overview and Scrutiny Committees to enable them to review proposals.

The Member agreed with the proposal set out in the report that improvement in reablement could result in savings being made, but did not think that further savings could be made in relation to care homes.

In response to a Member question, the Chief Finance Officer advised that a 1% increase in Council Tax equated to £900,000 of revenue.

Decision

The Committee:

a)    Noted that Cabinet had instructed officers to continue to work with Portfolio Holders in formulating robust proposals to balance the budget for 2017/18 and beyond.

b)    Commented on the proposals outlined in the draft capital and revenue budgets in so far as they related to the services within the remit of the Committee and provided comments to be fed back to the Business Support overview and scrutiny committee in January.

Discussion

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

The Committee was advised that the Adult Social Care Improvement item would be considered at its January 2017 meeting and that the Annual Public Health report had been deferred until a future meeting.

At its last meeting, the Committee had agreed two recommendations to Cabinet. One of these related to the impact of falling GP numbers, while the other was in relation to the provision of Street Triage services. These recommendations were due to be presented to Cabinet on 17 January 2017.

The Dementia Task Group had held its final meeting on 8 December 2016. It was anticipated that the Task Group’s draft report would be presented to the Committee in March 2017. The report would also be considered by the Health and Wellbeing Board and by the Regeneration, Culture and Environment Overview and Scrutiny Committee ahead of being submitted to Cabinet.

A meeting of The Joint Kent and Medway Health Overview and Scrutiny Committee had taken place on 28 November. This received updates on the Kent and Medway Hyper Acute and Acute Stroke Services Review and the Kent and Medway Specialist Vascular Services Review. Further updates were due to be presented to the Committee in Spring and June 2017 respectively.

A meeting of the South East Regional Health Overview and Scrutiny (HOSC)

Network had taken place on 18 November 2016. The meeting received updates on the Kent and Medway Sustainability and Transformation Plan and on the establishment of a sub-group to scrutinise South East Coast Ambulance’s (SECAmb) improvement journey. The first meeting of this group was due to take place on 20 December with minutes and actions being reported back to each Council’s health scrutiny committee.

Decision

The Committee:

a)     Noted the current work programme attached as appendix 1 of the report.

b)     Agreed the suggested additions and changes to the Committee’s Work

Programme, as set out in paragraph 3 of the report.

c)      Agreed that an update on mental health and the development of a Mental Health Strategy be added to the Work Programme for March 2016.