Agenda and minutes

Apologies for absence were received from Councillor Howard with Councillor Griffin substituting and from Councillor Fearn with Councillor Williams attending. 

To approve the record of the meeting held on 14 December 2017.

The record of the meeting held on 14 December 2017 was agreed and signed by the Chairman as a correct record. 

There were none. 

Members are invited to disclose any Disclosable Pecuniary Interests or Other Significant Interests in accordance with the Member Code of Conduct.  Guidance on this is set out in agenda item 4.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

This report details the areas covered by the Portfolio Holder for Adult Services which fall within the remit of this Committee.

Discussion

The Portfolio Holder for Adult Services attended to answer questions on the service areas that he was responsible for that fell within the remit of the Committee. The questions raised were responded to as follows:

Hospital discharge– The issue of inappropriate discharge from hospital had been raised with Medway Foundation Trust (MFT) and a Council team was supporting this work to ensure that vulnerable patients were only discharged when appropriate post discharge plans were in place. The Portfolio Holder had visited the hospital a few times to see what staff were doing to ensure timely discharge and that patients were discharged into an appropriate environment.

Availability of Community Beds – A Member was concerned that there were insufficient beds available to meet winter demand and suggested that the Council should have some community beds within its control in order to help meet this demand. The Portfolio Holder explained that extra bed capacity had been identified but that it was not financially viable for there to significant numbers of beds that were used for only a few months of the year. Appropriate bed capacity had been identified in the community for patients who could not be discharged to their own homes. The situation was being managed and the Council was working with MFT to ensure capacity was used most effectively.

Staff training – The Portfolio Holder provided assurance that Council staff would be given appropriate training to enable them to undertake changing roles, that they would be given the support required and that they would have the opportunity to speak up if they felt that they did not have the training and support needed. There was not considered to be a blame culture at the Council.

Mental Health provision – The Portfolio Holder considered it regrettable that Medway residents had to go to Maidstone or Dartford to access mental health provision. There had been significant improvements locally with people no longer having to travel up to several hundred miles for treatment, but there was a need for acute services to be provided in Medway and the Portfolio Holder would continue to make the case for this. The Portfolio Holder considered the Council’s non-acute mental health provision to be good.

Social Isolation – The Portfolio Holder was pleased that a Minister for Loneliness had been appointed and that this was a local MP but felt that it was an area that also needed to be tackled locally from the ‘bottom up’. The availability of public transport played a role in social isolation. A local case was noted where Arriva had removed a bus services which had led to social isolation. The Council had been partially successful in lobbying for the service to be reinstated. The Committee was informed about the Developing and Empowering Resources in Communities projects taking place in

Walderslade (WALT) and on theHoo Peninsula (wHoo Cares). These included work to help address social isolation. One example of this was WALT providing lunch for  ...  view the full minutes text for item 667.

This report updates the committee on progress being made by South East Coast Ambulance Service to improve its CQC rating through its Delivery Plan in line with CQC expectations, as well as the organisational developments that have taken place since the Committee was last updated.

Discussion

The Chief Executive of the South East Coast Ambulance Service (SECAmb) introduced the report. The Operations Unit Manager and Regional Operations Manager of SECAmb were also in attendance.

The latest Care Quality Commission (CQC) inspection of the Trust had found the 999 emergency service to be inadequate overall. The NHS 111 service had been judged to be good, with the 111 service having received an outstanding rating in the well led domain. The Trust was working to ensure that it had a comprehensive improvement plan in place to address the areas identified by the CQC and it was considered that good progress had been made. Priority had been given to recruiting the leadership team and a comprehensive action plan had been agreed with the CQC

Since the CQC’s unannounced inspection visited in October 2017, previously issued improvement notices in relation to medicines management and 999 call recording had been lifted. A further inspection was likely to take place in Summer 2018.

A programme had been put in place to address the concerns raised by the Lewis report into bullying and harassment at the Trust. Engagement had been undertaken with staff and arrangements made to help staff voice concerns. A Learning from Honest Mistakes programme had been implemented and a Wellbeing Hub established. This brought together a range of staff support services into a central place. It was noted that there was a zero tolerance approach to inappropriate behaviour.

A new computer aided dispatch system for ambulance had gone live in summer 2017 and there had been a reduction from three to two emergency operation control centres. The Ambulance Response Programme had gone live on 22 November. This included increasing phone triage time to ensure that the most appropriate response was provided to the patient. In relation to ambulance response times for the sickest category 1 and category 2 patients, there had been good performance in Medway. However, performance was not good for response times for less seriously ill category 3 and 4 patients. Work was taking place with local clinical commissioning groups to address this.

SECAmb’s overspend had been £7million in the previous year. For the current year, it was on track to achieve its £15.1 million cost improvement programme and an agreed cost deficit of £1million, with the deficit being eliminated by the following year.

Members of the Committee asked a number of questions which were responded to as follows:

Ambulance Response Times Performance data – In response to Member questions about why a data table in the report was based on percentages while another was based on response times and concerns about some of the response times, the Committee was informed that the Trust was working to ensure that there were the resources available to meet demand, particularly for non life threatening patients, where performance was currently the most challenging. The data tables were based upon national reporting requirements. Percentages had now been replaced by times, as specified by national reporting standards. It was  ...  view the full minutes text for item 668.

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 NHS West Kent Clinical Commissioning Group introduced the report. A G4S representative was also in attendance. The Committee was informed that considerable progress had been made in relation to patient transport in the last three months. The number of complaints about the service had reduced significantly. The healthcare system as a whole was facing significant winter pressures at present but patient transport was not a significant part of the problem.

Training of staff in relation to complaints handling was due to be completed by  early February and it was anticipated that the backlog of complaints would be clear by this point. Concerns were now limited to the ability of G4S, as provider of the service, to collect patients within target timeframes with it being acknowledged that much work was still required in this area. Progress had been made with patients no longer experiencing very long waits for transport.

The original contract had underestimated demand for the service. In particular, there were more patient escorts than anticipated and patients were sicker than predicted. There had also been an increase in some renal activity. Work was being undertaken regarding performance measurement as the analytics had not differentiated between a collection time target being narrowly missed and one that was missed by a significant margin.

G4S was working with local hospitals to look at patient discharges and ensure that they were spread throughout the day. A dedicated discharge vehicle was located in Medway and a dedicated patient discharge lounge had been introduced at Medway hospital. Overall performance of patient transport was gradually  improving with a CQC inspection of the business in October 2017 having had a positive outcome. Staff providing the patient transport service were caring and compassionate and there had been independent validation that the core service was good.

It was noted that 10% of the Kent and Medway non emergency patient transport journeys(30,000) were to London Hospitals.

Members of the Committee asked a number of questions which were responded to as follows:

Other providers – G4S worked with local providers such as hospitals and mental health providers. It was sometimes necessary to supplement patient transport capacity with other private providers. These providers were fully checked and accredited and came from a small pool of well know providers.

Adjustment of contract – In response to Member concerns that the original contract had underestimated the demand for patient transport and that winter pressures had not been adequately taken into account, it was confirmed that remodelling work was being undertaken to identify how much patient transport activity was required that was over and above what had been included in the original contract. Where demand was in excess of the contract, additional funding would be required for this activity. The existing contract had been based upon the data and forecasts available.

It was important to ensure that the transport needs of patients were fully understood to ensure that an appropriate vehicle attended and that resources were not used unnecessarily. Education  ...  view the full minutes text for item 669.

This report provides an update on the NHS Medway Clinical Commissioning Group (Medway CCG) Community Services Re-Procurement Programme (CSR) following previous updates provided in June 2017 and October 2017.

Appended to the report is a substantial variation questionnaire which is presented to the Committee to determine whether the revised model for community services constitutes a substantial variation to health services in Medway.

Discussion

The report was introduced by the Chief Operating Officer of Medway of NHS Medway Clinical Commissioning Group (CCG) and by the Senior Programme Manager. The CCG was requesting that the Committee determine whether the re-procurement proposals amounted to a substantial development of or variation in the provision of health services in Medway. The CCG was legally required to re-procure the community health services included in work. A wide range of preparatory work was being undertaken in advance of the re-procurement.

A variety of public engagement had taken place during the previous three months with further engagement activity planned. Significant engagement would be undertaken regardless of whether the proposals were determined by the Committee to be a substantial variation.

Six large stakeholder events had taken place, which a number of Committee Members had attended. Feedback from each event was analysed in order to shape the next event. Patient Panels had been hosted at some of the events. These had gathered views from patient representatives, Healthwatch Medway and Involving Medway. In addition to the engagement events, the proposals had also faced challenge from the CCG itself and from NHS England

The CCG was already trialling ways of delivering urgent responses to frail elderly patients in order to avoid unnecessary hospital admissions. New multi-disciplinary teams were being trialled and some Pace Clinics had been established to support elderly patients. Work was taking place with a variety of providers to look at how patients with long term conditions could be better supported. Community nursing services were being reviewed to make improvements and an End of Life Strategy was being implemented.

The CCG was currently identifying which schemes that should be commissioned.

Members of the Committee asked a number of questions which were responded to as follows:

Engagement - The Chief Operating Officer said there was a risk that, should the Committee determine that the proposals were a substantial variation, that  this could result in a need for formal public consultation which could make the work take longer than planned.

It was acknowledged that there was a need to ensure more critical challenge in future engagement activity. Staff were broadly aware of the re-commissioning process and work required but it could not be guaranteed that all staff were as aware as they could be. Staff engagement so far suggested that there was a broad agreement regarding what was needed.

An agency, ‘Involving Medway’ had been commissioned to work with hard to reach groups and as many such groups would be engaged with as was reasonably possible. It was agreed that details of the cost of the engagement process would be provided to the Committee. It was suggested that the voluntary sector in Medway could act as a facilitator for engagement with hard to reach groups.

Needs of older people – A Committee Member was very concerned that older people often could not get the treatment they needed or were faced with very long waiting times. She suggested that addressing this should be  ...  view the full minutes text for item 670.

This report follows the paper that was presented to the Children and Young People Overview and Scrutiny Committee in December 2017, advising of a review of the policies relating to the review of Assistive Reproductive Technologies that is to be undertaken by the eight Kent and Medway Clinical Commissioning Groups. 

In line with many health economies across England, Kent and Medway, CCGs are considering a range of difficult decisions to ensure that overall financial risks are minimised. CCGs have agreed to review the policies relating to ART.

Discussion

It was suggested that the decision to determine whether the proposals amounted to a substantial variation could be delayed until after the public engagement had been completed. However, the Committee agreed that the decision should be made ahead of this. It was considered that the proposals were potentially a substantial variation.

A Committee Member suggested that the risks of waiting too long to conceive should be highlighted as part of the Council’s Public Health programme.

Decision

The Committee determined that the Policy Review of Assistive Reproductive Technologies was a substantial development of or variation in the provision of health services in Medway.

In May 2017, following an extensive review, the Dementia Task Group review entitled  ‘How far Medway has gone in developing a Dementia Friendly Community?’ was agreed by Cabinet. As a cross cutting review, the report had previously been presented to the Health and Adult Social Care Overview and Scrutiny Committee, to the Regeneration, Culture and Environment Overview and Scrutiny Committee and to the Health and Wellbeing Board.

The recommendations made by the Task Group aimed to complement the wide variety of work already being undertaken by the Council and partners to implement the Council’s Dementia Strategy. The review had a particular focus on how Medway Council and its partners could lead by example to help make Medway a Dementia Friendly Community. This included services that the Council directly controls and those, which while not directly under the control of the Council, it could influence through partnership working.

This attached progress report (Appendix 1) summarises progress against each recommendation.

Discussion

The Programme Lead – Partnership Commissioning introduced the report. The Head of Performance and Intelligence was also in attendance to answer questions.

Good progress had been made on the implementation of the Task Group recommendations. These had included the Portfolio Holder for Adults’ Services being appointed as the Medway Dementia Ambassador. A series of  Dementia Friends awareness sessions had taken place for Members, officers and also externally e.g. in schools. Council employment policies would help support staff who were themselves diagnosed with dementia or who cared for someone with dementia. Work had been undertaken to raise awareness of the various services and support available for people with dementia. This had included an article in the ‘Medway Matters’ magazine last September.

The Task Group report had highlighted the need for post diagnostic support to be more accessible and for people to know where and when they could access support. There were now four dementia cafes in Medway. Drop-in clinics had been introduced to run alongside dementia cafes. These clinics provided easy access to a range of professionals for people with dementia and their carers.

 A second post diagnostic support group had been established at Elizabeth House in Rainham with Age UK and Admiral Nurses running a joint Carer Support Group at the local Age UK centre. Carers were able to attend a four week care support programme with the person they cared for being looked after at the same venue.

The proposed Rainham Test for change project had aimed to provide a dementia support worker in Rainham to work with GPs. As an alternative, support had been improved across Medway. The Council had worked with a range of other organisations to achieve this. Work had included developing Dementia Workers. These were existing employees of partner organisations who would take on an additional role, with the workers providing telephone support and home visits. A review of progress to date was currently being undertaken.

Medway CCG was working with partners to improve access to scans, facilitating quicker diagnosis and better post diagnostic support as well as better supporting people in hospital who had dementia.

Development plans such as the Strood Masterplan and the development of Extra Care Housing would consider people living with dementia. In relation to Extra Care Housing, this included colour schemes for way finding, use of textures as navigational aids and memory shelves.

The Task Group had highlighted a particular need to engage with Black, Asian and Minority Ethnic (BAME) communities that often had low levels of engagement with statutory services. The Programme Lead – Partnership Commissioning was due to accompany the Chairman of the Task Group to a meeting of the Medway Ethnic Minority Forum to highlight the dementia support available.

One Council service that supported people with Dementia was exempt borrower status for library users which would help to ensure that people with dementia were not fined for overdue books.

The Council was also encouraging local business and organisations to be dementia friendly. Letters had been sent  ...  view the full minutes text for item 672.

Discussion

In relation to the Kent and Medway NHS Joint Overview and Scrutiny Committee (JHOSC), the Committee was advised that a Kent and Medway Joint HOSC meeting was due to take place on Monday 22 January 2018 to discuss the consultation proposals and site options being put forward as part of the Kent and Medway Hyper Acute and Acute Stroke Services Review. Subject to agreement by the JHOSC, it was anticipated that the public consultation would commence at the end of January.

East Sussex and the London Borough of Bexley had both determined that the reconfiguration was likely to amount to a substantial development of or variation in the provision of health services in their respective local authority areas. This necessitated  the establishment of a new Joint HOSC comprising Members from Medway, Kent, Bexley and East Sussex. As the new JHOSC would not have been constituted by 22 January, Bexley and East Sussex had each accepted an invitation to attend the meeting and to present their view on the proposals. A further meeting of the Joint HOSC would be held following the conclusion of the public consultation in order for the committee to consider the proposed model and sites for hyper acute and acute stroke services provision.

The Committee was informed that the topic of the next overview and scrutiny Task Group was due to be Social Isolation and that further information would be presented to the Committee at its next meeting.

Decision

The Committee considered and agreed the Work Programme, including the changes set out in the report and the additional items agreed during the meeting.