Agenda and minutes

The Committee held a minute’s silence in memory of the victims of recent tragic events in the UK.

Apologies for absence were received from Councillor Mark Joy, with Councillor Gloria Opara attending as substitute, from Councillor Sam Craven with Councillor Adam Price substituting and from Councillor Dan McDonald with no substitute attending. Apologies were also received from Christine Baker of the Medway Pensioner’s Forum.

To approve the record of the Committee meeting held on 16 March 2017 and the record of the Joint Meeting of Committees held on 17 May 2017.

The records of the Committee meeting held on 16 March 2017 and of the Joint Meeting of Committees held on 17 May 2017 were approved and signed by the Chairman as correct records. 

There were none. 

Disclosable pecuniary interests

There were none.

Other interests

There were none.

The Committee will be provided with an update on the progress being made by the South East Coast Ambulance Service following the ‘inadequate’ rating given by a Care Quality Commission inspection undertaken in 2016, including implementation of a Recovery Plan and initial feedback following the recent re-inspection.

Discussion

The Chief Executive of South East Coast Ambulance Service NHS Trust (SECAmb) introduced a presentation to update the Committee on the Trust’s improvement journey. He was supported by the SECAmb Customer Account Manager for Kent.

The key points raised during the presentation were as follows:

·         The Trust had a new Chairman and Chief Executive and was currently advertising for other executive director positions.

·         Performance was fairly good in relation to the eight minute maximum target response for red 1 calls.

·         The Care Quality Commission (CQC) had inspected SECAmb around a year previously, rating the Trust as inadequate. It had been placed in special measures as a result.

·         A Recovery Plan was being implemented to address the concerns raised by the CQC. Areas being looked at included effective signposting to other services, strengthening of partnership working, reviewing ambulance responses and looking at call triage. The Plan was due to be delivered over five years with basic improvements being realised in year 1 and consolidation taking place in year 2.

·         A further inspection had taken place from 15 to 18 May which had focused on whether services were safe, well led, effective and caring. It had looked at key parts of the organisation including 999 and 111 services and urgent care. Initial findings suggested that there had been significant improvement since the previous inspection. The CQC had identified that staff were caring and often went above and beyond what was expected of them.

·         Areas that needed to be addressed included medicines management and making patient records electronic.

·         Other quality areas being strengthened included use of software system Datix, risk management and safeguarding. SECAmb was delivering safeguarding level 3 training compared to other ambulance services who only provided this training to level 2.

·         SECAmb had been experiencing difficulties with recording some 999 calls due to static on the line. This was being addressed with 99.6% of call recordings now being of an acceptable quality.

·         The Trust had relocated its headquarters from Banstead to Crawley with the Lewis emergency operations centre also having moved to Crawley. The emergency operations centre in Banstead was also due to be relocated with the centre in Coxheath being retained.

·        The Trust had a £7.1 million deficit. The deficit target for the current year was £1 million. A £15 million cost improvement programme was being delivered.

·        There was currently a ratio of 50:50 of ambulances to medical cars in the emergency response fleet but it was considered that 70:30 ratio was required.

·         Winter pressures were acknowledged to be challenge. SECAmb would be working in partnership to forecast demand for the next winter and to ensure sufficient capacity. It was noted there had been improvements over the last winter compared to previous winters.

·         There had been some adverse media attention in relation to bullying and harassment of staff. An in-depth study had been commissioned with a report due to be published by the end of July. There had already been increased staff engagement with staff having taken part  ...  view the full minutes text for item 77.

This report provides an update to the Committee on the new Intermediate Care and Reablement Service with examples of learning from the first six months of the contract’s operation.

The report also details some potential developments which are being explored as a result of that learning to streamline and improve the service people receive when they are ready to leave hospital and return home.

Discussion

The Director of Children and Adults Services informed the Committee that the update provided was in relation to the importance of Home First and how it had been embedded in intermediate care and reablement services. This was part of the broader strategy of increasing the range of options for care outside hospital on the basis that a person’s own home was the best setting.

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 the report. A report had previously been presented to the Committee in November 2016. This had provided feedback on the Home First pilot project that ran between April and October 2016. It had been agreed that a further report would be presented to the Committee once the first six months of operational data was available.

Depending on their needs, reablement of patients either took place in their own home or in an intermediated care bed. These beds were provided in two locations, Britannia Court and Platters Farm. There was a two hour target for patients to be assessed following notification being received that they were ready to be discharged from hospital.

The Committee was advised that some figures contained in the report were incorrect. The report stated that the Home First service had a capacity of 150 referrals per week with an average number of patients received of 96 per week. These figures should have been 150 and 96 per month.

Since commencement of the service, a total of 801 patients had received reablement at home while 203 received it in a community based bed. The average length of stay in a bed was 21 days. 73% of service users had improved their independence with 27% showing little improvement. 98% of patients had their service in place within 24 hours while 84% of patients referred to the service were discharged within six weeks. Where the service was not in place within 24 hours, this was due to patient choice.

It had been determined that more in depth assessment of some patients needed to be performed outside hospital. It was envisaged that this would take place in a discharge hub. Work was being undertaken with partners to determine how the discharge hub would operate and which patients it would help.

Every patient accessing the Home First service received a personalised plan. Patients who showed little improvement would be referred on for long term care via long term care teams. Patient surveys had been undertaken with 39 completed questionnaires representing a 92.1% response rate. 66.67% would recommend the service to others. 79% were more confident in undertaking personal tasks as a result of the service provided while 87% had achieved their personal goals.

Questions and points raised by the Committee were responded to as follows:

Benchmarking: In response to a Member who asked what the statistics in relation to users of the reablement service were being compared to, the Committee was advised  ...  view the full minutes text for item 78.

This report updates the Committee on the review and redesign of urgent care across North Kent. The redesign of these services has previously been determined to be a substantial development of or variation in the provision of health services in Medway, triggering a statutory obligation on the relevant NHS bodies and health service providers to consult with overview and scrutiny.

The attached report from NHS Medway Clinical Commissioning Group (CCG) updates the Committee on the development of the proposals since the last update was presented to Committee in January 2017.

Discussion

The Chief Operating Officer at Medway NHS Clinical Commissioning Group introduced an update on the Medway Integrated Urgent Care Redesign. The Committee was informed that consultation in relation to some of the changes being proposed as part of the redesign was due to take place in July. There were two main parts of the redesign, face-to-face services and non face-to-face services. The non face-to-face services were being re-procured through working with colleagues at the Swale and West Kent Clinical Commissioning Groups.

It was noted that £1million was being invested in primary care and that GP services were being built around hubs and healthy living centres. Minor illness clinics were being integrated into Healthy Living Centres to improve capacity. It was anticipated that this would reduce demand for walk in centres during the hours of operation of the clinics. Minor illness clinics would be based in each of six centres in Medway. It was planned for the existing walk in centre at Balmoral Gardens, Gillingham to be relocated to Medway Maritime Hospital. This would be a 24 hour facility compared to Balmoral Gardens that was currently open 12 hours a day. Locating services in a single place was considered to make navigation of patients between services easier and would also facilitate better quality of care.

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

Service demand and capacity: A Member noted that the walk in centre located in Canterbury Street had only been relocated to Balmoral Gardens ten months previously. They were concerned that waiting times for patients could increase and questioned how there could be confidence that demand for walk in centres would be reduced. The Chief Operating Officer said that demand was expected to reduce during the operating times of the Healthy Living Centres as some patients would visit these instead. The walk in centres were also targeted at people who were not registered with a GP. It was hoped that the new system would help to meet the GP Forward View priority of patients being able to obtain same day access to a GP appointment.

Consultation: The Healthwatch representative considered that the report presented was comprehensive and said that a meeting was due to take place between NHS Medway Clinical Commissioning Group and Healthwatch Medway to discuss how Healthwatch could assist with the consultation process. Another Committee Member was concerned that there was a danger of consultation ‘burnout’ due to the number of consultations taking place during the summer. It was confirmed that list of consultation events would be provided to the Committee.

Availability of data and staffing: A Member of the Committee considered that the report was not comprehensive enough as it lacked quantitative data. She noted the current difficulty across Medway of obtaining a GP appointment, which could sometimes take up to six to eight weeks and questioned how it would be ensured that the services provided would be adequately staffed. The Committee was informed that minor illness clinics were being piloted in  ...  view the full minutes text for item 79.

This report provides an overview of NHS Medway Clinical Commissioning Group’s (Medway CCG) Community Services Re-Procurement Programme (CSR). The aim of this programme is to transform the way in which community services are delivered. Our focus is to create integrated community based care organised around the needs of our patients; improving quality and efficiency through designing and delivering clear outcomes measures.

All of the community services commissioned by the CCG have been reviewed to determine the services within the scope of this programme. This is detailed within a Project Initiation Document (PID) which also sets out the scope and objectives of the Programme within Medway and how it will operate for its duration. The PID was reviewed and approved at the CCG’s Governing Body in May 2017.

A twelve week formal public consultation is included within this programme and therefore, this report is presented to the Health and Adult Social Care Overview and Scrutiny Committee for information and agreement of future updates.

It is proposed that the Committee will be asked to agree at a future meeting whether or not the proposals amount to a substantial development of or variation in the provision of health services in the local authority’s area.

Discussion

The Senior Programme Manager at Medway NHS Clinical Commissioning Group (CCG) introduced the Community Services Re-procurement Programme report. This provided an overview of the planned re-procurement of community health services, which was currently in its early stages. Services would be re-procured as contracts expired to ensure that they aligned with the Medway Model. The work was considered to be critical for the successful future delivery of out of hospital care.

A Project Initiation Document had been submitted to the CCG Commissioning Committee and Governing Body in May. This included the scope and programme objectives. It was noted that Medway Community Healthcare was currently the main provider of services. A due diligence stock take review would be undertaken to baseline current services, create a clear picture of current service provision and to fully understand the financial situation. Following this exercise it would be determined which services should be re-procured.

The work was a large process which would be overseen by NHS England.  Public consultation was due to take place in 2018, followed by tendering in October 2018, with a go live date for the new contracts of April 2020.

A Committee Member said that they would like to see a timeline for the contracts due to be recommissioned and for a financial appraisal of how the recommissioning would be undertaken to be provided. In response, the Senior Programme Manager advised that with a couple of exceptions, all the contracts that were potentially part of the recommissioning work were due to expire in March 2020. There was a need to fully understand current services before designing something new. In response to a Member question about staff contracts, it was confirmed that affected staff would be on differing contracts and that where services were recommissioned resulting in a provider change, TUPE rules would apply.

Decision

The Committee noted the Community Services Re-procurement programme and agreed that it would be determined at a future pre-agenda meeting when the next update should be provided to the Committee.

On 16 March 2017 the Health and Adult Social Care Overview and Scrutiny Committee (HASC) endorsed a decision to recommission adult substance misuse services for Medway.

It was agreed that officers would provide HASC with an update on the findings of the needs assessment that has informed the options for a future delivery model for substance misuse services in Medway.

This paper provides an overview of a proposed model for service delivery that has been developed through consultation with key stakeholders.

In the view of Public Health, the proposals do not amount to a substantial development of or variation in the provision of health services in the local authority’s area.

Discussion

The Director of Public Health introduced the update on the re-commissioning of Adult Substance Misuse Treatment Services. The Committee had previously been presented with a rationale for the recommissioning at its March 2017 meeting. The current report set out the proposed model for the new service. The aim was to move away from the current integrated treatment model as although service users could be treated effectively, there was a tendency for relapse following treatment. The re-commissioning would see the establishment of a separate recovery service which would provide support once people had completed their initial treatment. This could, for example, support people to find and maintain employment.

A Committee Member noted that the number of opiate users in Medway was high compared to other areas and asked whether the figures were improving. They also asked whether opiate users from other areas were being drawn to Medway. In response, the Head of Public Health Programmes advised that numbers of opiate clients had been quite stable in Medway and the needs audit had not uncovered any significant unmet need or new users moving into the area. It was anticipated that the creation of a dedicated recovery service would help to reduce the number of opiate clients in treatment over time as fewer clients should relapse.

A Member asked what work was being undertaken with housing services, particularly in relation to support for homeless persons. Officers advised that supporting street homeless persons was a priority within the new contract and work was taking place with supported housing providers.

The Programme Manager for Substance Misuseinformed the Committee that the Blue Light project had been running in Medway for two years. This worked with people with a wide range of complex needs. A meeting was due to take place the week after the Committee meeting specifically in relation to support for street homeless persons. Housing services were an integral part of the project.

Decision

The Committee:

a)    Noted the proposed model for Adult Substance Misuse Treatment Services.

b)    Noted the emerging themes of service improvement.

c)    Considered the proposed development or variation to the health service, as set out in the report and Appendix 2 and determined that the proposalsdid not amount to a substantial development of or variation in the provision of health services in the localauthority’s area.

Medway’s three priorities are set out in the new Council Plan 2016/17. This report summarises how the Council has performed in Quarter 3 2016/17 against the priority most relevant to this Committee.

Discussion

The Director of Children and Adults Services introduced the report. This included information in relation to the progress of the Adult Social Care Strategy and the Three Conversations Model. The Three Conversations Model had been trialled in the ME4 and ME5 postcodes. It was being evaluated with a view to rolling it out across Medway. The Making Safeguarding Personal programme was now fully embedded into the work of Adult Social Care, with work having taken place over the last year to improve the safeguarding recording process.

In relation to adult safeguarding, the year end figures showed that 87% of individuals who were asked about their personal outcomes said that these outcomes had either been fully or partially achieved.

The target of 30% of clients receiving direct payments for their social care had not been met, with the end of year figure being 27.6%. Staff in the Financial Assessment teams had moved from the Council’s Customer Care service to Adult Social Care. It was anticipated that these staff would be able to support more clients to consider receiving direct payments.

There had been a reduction in the number of permanent admissions to care homes for both the 18 to 64 and 65 plus age groups. This was positive as the aim was to enable people to stay in their own homes wherever possible.

Figures for Delayed Transfers of Care (DToC) had shown improvement with the end of year figure likely to be 3.3 per 100,000 of population, compared to a target of 4. Medway’s figures for DToC were within the top quartile of local authorities in the South East and were average compared to Medway’s statistical neighbours. On the Friday prior to the Committee meeting there had been 22 Delayed Transfers of Care with none of these being attributable to Adult Social Care, the first time this had been achieved.

A carer satisfaction survey was undertaken every two years. This showed that satisfaction levels had fallen 6% compared to two years previously and were  10% below target. Some of the data was provisional so there could be some improvement but this was not expected to be significant. It was possible that the fall in carer satisfaction could be due to carers feeling under more pressure and stress. The Committee was also informed that work was taking place with the Carer Partnership Board to refresh the Carer’s Strategy.

A Committee Member agreed that the decrease in carer satisfaction could be attributable to carers feeling under pressure and questioned what could be done to address this and whether the opportunity of undertaking individual assessments of carers in relation to their needs was being fully exploited. Another Committee Member said that she was aware that some carers were disappointed that they had not received feedback after having been asked for their opinion.

The Director of Children and Adults Services advised that there was an improvement in the number of people accepting carer assessments and that the needs identified by these  ...  view the full minutes text for item 82.

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 informed that the process for selecting topics for the next round of Task Groups was underway. Possible Task Group topics in relation to the remit of the Committee would be discussed at the next pre-agenda meeting on 3 August. It was requested that Members who wished to put forward topics send them to the Democratic Services Officer.

The Joint Kent and Medway Health Overview and Scrutiny Committee (JHOSC) meeting that had been expected to take place on 3 July had been delayed as an update on the Stroke Review would not be ready by this date. Assurance had been given at an STP Steering Group meeting that the Committee would receive a full briefing and be consulted on all NHS configuration proposals, including stroke services. Medway Members of the JHOSC were planning to send a letter to those responsible for the review. The letter would set out concerns in relation to the delay and would also seek assurances regarding the work going forward.

Possible July dates for a visit to the Turning Point Recovery Hub in Gillingham had been circulated to the Committee. Due to limited Member availability it was suggested that the visit should instead take place in the Autumn.

Decision

The Committee:

a)    Agreed the work programme attached at Appendix 1, subject to the addition of an update on the Medway Integrated Urgent Care Redesign to the Work Programme for the October 2017 meeting.

b)    Noted the changes to the Committee’s work programme, as set out in paragraph 3 of the report.

c)    Noted the process for selection of topics for the next round of Scrutiny Task Groups in 2018/19 and agreed that all Members of the Committee be invited to submit ideas based on the criteria set out in paragraph 4 of  the report to the Democratic Services Officer ahead of the next agenda planning meeting for this Committee.

d)    Agreed that a visit to the Turning Point Recovery Hub in Gillingham should take place in the Autumn.