Agenda and minutes

Apologies for absence were received from Councillor Howard with Councillor Saroy substituting and from Councillor Shaw with Councillor Price substituting. Apologies were also received from Councillor Steve Iles. 

To approve the record of the meeting held on 22 August 2017.

The record of the Committee meeting held on 22 August 2017 was approved and signed by the Chairman as a correct record.

There were none. 

Disclosable pecuniary interests

There were none.

Other interests

There were none.

This report updates the Committee on progress being made by the South East Coast Ambulance Service following it’s CQC rating of ’inadequate’, key actions undertaken by the Trust in its Unified Recovery Plan, and the findings of the Professor Duncan Lewes report into the culture of Bullying and Harassment at the Trust.

Discussion

The report was introduced by the Regional Operations Manager - East for South East Coast Ambulance (SECAMB). The Care Quality Commission (CQC) inspection undertaken in May 2017 had given SECAmb a rating of inadequate. This was disappointing but it was pleasing that the organisation had been rated good for caring. The CQC had been concerned that progress made since the previous inspection in 2016 had been insufficient, particularly in relation to governance and structural challenges. SECAmb had taken steps to address the issues facing it since the May inspection. This included the ongoing delivery of an organisational plan to address the 10 key areas that needed to be most urgently addressed. A new Chief Executive had started with SECAmb on 1 April 2017, with the Chief Executive and majority of the executive team being new to the organisation.

In early October 2017 the CQC had arrived at six SECAmb locations for a surprise inspection. This had included a review of progress made to address the serious concerns raised in the May inspection with regards to medicines management.

SECAmb had voluntarily commissioned Professor Duncan Lewis to produce a report looking at bullying and harassment of staff within the organisation. It had been considered to be important for these findings to be made public. Significant work had taken place on the organisational structure of the Trust. There was now significant interaction between the executive team and frontline staff. This included a programme of listening events to generate organisational learning.

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

CQC inspection rating: In response to Member concerns about the inadequate inspection rating and lack of progress made, the Regional Operations Manager advised that additional staff were needed to meet demand. The staffing level for paramedics and ambulance staff was adequate with the Trust being in a better position than a number of other trusts. Adequately staffing call centres was more of a challenge as this was a difficult job that was not well paid, with equivalent work elsewhere tending to be better paid. It was not possible to increase the pay for these roles as salaries had to be in accordance with the NHS pay framework. It had been agreed to recruit more staff than required into these roles to allow for turnover and staff subsequently moving into other roles. Adequate numbers of clinicians were needed within the call centres to analyse calls and determine how urgent a response would be required.

A new computer aided dispatch system had been implemented during 2017. This had replaced an old, unreliable system. The transition to the new system had been smooth and had been welcomed by staff. It had been challenging to train control room staff given that the control room had to remain operational. A national Ambulance Response Programme was due to go live on 22 November. This would enable calls to be prioritised more effectively. An update on this would be included in the next report provided to the  ...  view the full minutes text for item 394.

This report provides the Committee with a performance update on the non-emergency Patient Transport Service (PTS) for Kent and Medway, which is delivered by G4S.

Discussion

The Accountable Officer of West Kent Clinical Commissioning Group introduced the report. The new patient transport contract for Kent and Medway patient transport services had commenced, with G4S as the provider, in July 2016. Mobilisation of the contract for transport to London hospital trusts had followed in February 2017. The delay of the London mobilisation had been due to there being a lack of accurate activity data available. This had been more problematic than expected due to the unpredictability of journeys into London. It was considered that the renal transport element of the contract was running well.

Performance for the main part of the contract was not good with most failings being connected to transport to London hospitals and hospital discharge. A new G4S management team had started in February, although some key members had been replaced in the last month. The working relationships between hospitals and G4S had been strengthened and these were now considered to be good. New ways of working were being developed to manage patient transport.

There had been significant issues with regards to complaints management, which had resulted in G4S being issued a performance notice. The backlog of complaints had now been cleared and the process for managing complaints improved. A performance notice had also been issued in relation to quality of information. This area was now also improving. There had been difficulties with regards to the eligibility of patients for transport. Work had been undertaken to clarify eligibility criteria and there had not been any significant issues of patient eligibility for transport for approximately five months.

The Care Quality Commission had visited the CQC a week before the Committee meeting. It was understood that this visit had not identified any serious issues of concern. Independent expertise had been utilised to review patient transport activity, including the suitability of the vehicle fleet and personnel requirements. The illness levels of patients being transported was increasing which would require an increased number of vehicles able to accommodate stretchers and wheelchairs.

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

G4S Representation: A Member was disappointed that no one from G4S was present at the Committee. The Accountable Officer advised that that the relevant person was new in post and therefore he had not considered it reasonable to expect them to attend. However, he would ask them to attend when the next update was presented to the Committee.

Difficulty in foreseeing significant issues and complaints: A Committee Member was very disappointed that it had not been possible to accurately predict the illness levels of patients being transported, particularly the poor condition of patients being transported to London hospitals. Other Members also raised this as being a concern and were particularly concerned given that across the healthcare system, the aim was now to keep people living in their own homes as long as possible. The inevitable consequence of this was that patients being transported would be increasingly frail.  Members expressed concern that the appointment of  ...  view the full minutes text for item 395.

This report provides an update on the NHS Medway Clinical Commissioning Groups (Medway CCG) Community Services Re-Procurement Programme (CSR), following an initial overview report at the Committee meeting in June 2017. This report includes a summary of the due diligence service reviews that are being undertaken, the Health and Social Care profiles for Medway completed by Public Health to provides a summary of the population profiles for each of the six local care teams, and provides an overview of early engagement activities.

Discussion

The report was introduced by the Chief Operating Officer of Medway Clinical Commissioning Group. He was supported by the Head of Commissioning. It was noted that this was the second update presented to the Committee on the recommissioning of community health services. There was a requirement for services to be reprocured as current contracts expired. The reprocurement was closely linked to the Medway Model and local care developments. Public engagement work had started with two meetings having already taken place. It was anticipated that the Committee would be asked to determine at a future meeting whether the proposals amounted to a substantial development of, or variation to, the health service in Medway.

Work undertaken over the last few months centred around the due diligence exercise. This would provide a comprehensive understanding of costs and service models currently in use which would then inform the remodelling and reprocurement of services. This work was due to be completed in October. Work was taking place with the Council’s Public Health team to understand local demographics and implications for the services provided. It was noted that due to the need to get NHS England agreement of the assurance processes it was expected that there would be a six week delay in public engagement activity compared to the timescales set out in the report.

A Member said that it was a big undertaking to reprocure such a wide range of services and that services needed to be procured so as to minimise delays in referrals and to avoid people falling into gaps between providers. There was also a risk of services deteriorating if there were too many providers in the market. The Member also felt that engagement sessions tended to be dominated by professionals and that other types of engagement events may need to be considered in order to successfully obtain feedback from the general public.

The Chief Operating Officer said that risks had been identified as part of the work undertaken to date and that there would be mitigations to reduce risk and ensure that appropriate resources were put into the reprocurement.

A Committee Member asked if further ward level data could be provided in addition to the data contained in the report appendix. It was agreed that this would be provided to the Member outside the meeting.

In response to a Member who questioned how the voluntary sector would be supported to deliver services, the Chief Operating Officer recognised that there was a particular challenge in relation to the care navigation scheme. There was a need to ensure that people providing care navigation were fully trained and had appropriate skills. The voluntary sector would have a role but it was important to build upon the existing core of volunteers and ensure that there was not too much reliance on voluntary sector.

Decision

The Committee noted the CSR programme update and provided feedback and agreed that the next update would be presented to the Committee in January 2018. This would ask the  ...  view the full minutes text for item 396.

This report provides an overview of the work of the Medway Community Support Outreach team.

Discussion

The Director of Children and Adults Services introduced the report. He advised that while the Kent and Medway NHS and Social Care Partnership Trust (KMPT) was the main provider of mental health services in Medway, the Council also provided services directly. The Community Support Outreach team was a key element of this provision as well as social workers. The Outreach team worked with people who had first time presentation of mental health to severe and ongoing mental health problems which impacted on their social and daily functioning.

The team delivered 21,000 hours of direct client contact between April 2016 and March 2017 with an average caseload of 104 people at any one time. Clients were supported to live independently in the community. This included people discharged from acute mental health hospitals and those subject to Community Treatment Orders (CTO). Clients were sometimes reluctant to have support due to their symptoms and illness.

A presentation on the role of the Community Outreach Team was given to the Committee. The key points of this were as follows:

·         The team had been established in 1989 with the name been changed and current name chosen by service users.

·         The service is provided 365 days a year including evening, weekends and bank holidays with office hours of 8am to 8pm during the week and weekends 10am to 2pm. 

·         Needs based provision tailored to the individual needs of a client was provided by the service.

·         There was a low staff turnover within the service with this continuity, consistency and experience being an important strength both for the staff and to working to strengths based approaches for clients.

·         Robust induction training was provided to new staff.

·         The best outcomes were achieved through partnership working.

·         Outreach workers were matched to individual service users. The Outreach worker engaged with clients and listened to their needs, sometimes through the undertaking of several visits.

·         An overview of a number of clients who had been successfully provided services by the Community Support Outreach team was highlighted.

·         The service was able to work with clients on a short or longer term basis, from 6 weeks through to 18 months or longer.

·         The team had recently received an inclusion and diversity award at the Medway Council Make a Difference Awards 2017.

A Committee Member congratulated the Outreach Team on their work and emphasised that it was important for the Council and other organisations to work together to ensure that mental health issues were detected at an early stage.

In response to a Member who asked whether the team received adequate support from other Council departments, the Medway Community Support Outreach Team Manager said that her team were currently working with Housing and that the support provided had been good. Lots of strong relationships had been built between the service, other Council departments and external partners.

A Member asked whether there was scope for the service to be expanded, whether there was a possibility of obtaining a financial contribution from external organisations, how individuals  ...  view the full minutes text for item 397.

Medway's Council Plan 2017/18 sets out the Council's three priorities. This Committee is responsible for some of the performance measures within the Council priority - Supporting Medway's people to realise their potential. This report summarises how we have performed in Quarter 1 2017/18 for the 9 key measures of success which support this priority.

Discussion

The report was introduced by the Director of Children and Adults Services. The Committee was informed that the ‘3 conversations’ model of practice piloted in Adult Social Care had been completed and was now being rolled out across the service. The model aimed to simplify conversations with service users. More generally, services were being realigned based upon the Medway Model and there was movement towards direct working with GPs in the Primary Care Hub.

An additional £3.9 million of in year funding had been provided as part of an improved Better Care Fund offer. This funding would be allocated to three main areas, Delayed Transfers of Care (DToC), helping to create market stability in the independent care sector and for wider Adult Social Care provision. In relation to DToC, performance had already improved significantly. Work was taking place with health and care services to improve this further.

The Council had provided 2,701 long term service packages for older and disabled people. 858 (31.8%) compared to a target of 28% of these packages were for people in care placements rather than living in their own home. The Council was committed to supporting people to live in their own home for as long as possible.

Performance against the indicator for the percentage of adults with learning difficulties living in settled accommodation was significantly below target. Targeted work in relation to the Accommodation Strategy was taking place to address this. It was recognised that there was the potential for many people currently living in long term residential provision to move into their own accommodation. Review work was being undertaken with this client group. The number of permanent admissions to care homes was reducing. There had only been one admission in the 18-64 age group during quarter 1 and 58 admissions in the 65+ age group.

The Director of Public Health advised that there was evidence that a greater number of cases of flu were likely during the coming winter compared to average. This would place considerable demand on hospital services. An early approach to winter planning was required to ensure ability to cope with demand. The Council had established a seasonal flu task group in response. An action plan had been developed and public health messages spread via the Council’s website. NHS England had advised that staff working in care homes, including those employed by private providers, would be able to access a free flu vaccination. In response to a Member question about the effectiveness of flu vaccinations, the Committee was informed that extensive work was undertaken to try to identify the types of flu likely to be prevalent each year and to develop the vaccination accordingly.

Another Member asked why the target for the uptake of direct payments by Adult Social Care clients had been reduced. The Director of Children and Adults Services advised that the previous target had been considered to not be achievable and had been revised accordingly. It was considered that direct payments amounted to  ...  view the full minutes text for item 398.

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 it was anticipated that an informal meeting of the Kent and Medway NHS Joint Overview and Scrutiny Committee would take place at the end of October. This would provide an update on progress made in relation to the Kent and Medway Hyper Acute and Acute Stroke Services Review. This would be followed a formal meeting towards the end of November.  

Decision

The Committee:

a)    Considered and agreed the Work Programme, including the changes set out in the report and the additional items agreed during the meeting.

b)    Agreed that an update on the All Age Eating Disorder Service would be added to the Work Programme for consideration in early 2018.