Agenda and minutes

Apologies for absence were received from Councillor Aldous, with Councillor Josie Iles substituting and from Councillor Howard with Councillor Opara substituting. Apologies were also received from Councillor Bhutia and from Councillor Wildey with no substitutes in attendance.

The Chairman announced that Christine Baker had resigned from Medway Pensioners’ Forum and would therefore no longer be a Member of the Committee. The Committee expressed its thanks to Ms Baker for her contribution  to the work of the Committee and it was noted that Ms Baker had asked for her thanks to be given to Committee Members and officers for all their help and support over the years.

Lesley Dwyer, Chief Executive of Medway Foundation Trust, was congratulated in her absence for having been named one of the top 50 NHS Chief Executives in the country by the Health Service Journal. She was further congratulated as Medway Foundation Trust’s Human Resources and Organisational Development Team had been crowned ‘HR Team of the Year’ at the Kent Chartered Institute of Personnel Development’s (CIPD) annual awards.

To approve the record of the meeting held on 18 January 2018.

The record of the meeting held on 18 January 2018 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 significant interests

There were none.

Other interests

There were none.

This report provides a briefing on how the transition from children’s to adults services is managed for children receiving specialist social care services, the options that are available to young people and how Medway Council continues to develop and strengthen its transition pathway.

Discussion

The agenda item was considered by the Committee to highlight the challenges facing young people when transitioning from children’s to adult services that were provided by the Council.

Mrs Keith and her son George, a user of Adult Social Care Services, addressed the Committee. The key points of this were as follows:

·         George had attended Bradfields School, having left in June 2016. There had been no discussion about what activities and interests he could pursue when he left school and it had been expected that some information would have been provided about the services available and a list of local groups and places that the young person could go to.

·         It had been very difficult to get information about the services available with Mrs Keith only having found out about Direct Payments by chance.

·         George not had not had a social worker since he was 8. Initial contact with the Council had been difficult as Council staff had not been particularly friendly in the past. More recently, there had been quick contact with a social worker and a meeting arranged with Direct Payments also being progressed.

·         An application had been made in June 2017 for George to have a Continued Healthcare Assessment but this had still not been undertaken.

·         There was a lack of continuity in the provision of social workers and there was inadequate support for families who were just about able to cope on their own.

·         After a year without physiotherapy, George was now receiving regular physiotherapy at Medway Maritime Hospital. This was very good but the year without physiotherapy had caused him great difficulty.

·         George was now attending Carers Relief sessions and Botra as well as the G beats nightclub. These services had changed George’s life and had enabled him to reconnect with old friends.

Officers apologised for the difficulties that had been experienced by George and his family. Significant changes were being made with the young person being put at the centre of the transition journey. Social workers in the 0-25 team worked with young people from the age of 14 with there being an expectation of there being multiple transitional meetings before the young person left education.

In January 2018, the 0-25 team had moved from Adult Social Care to become part of children’s services. This team was now integrated with the Special Educational Needs (SEN) team, the Educational Psychology team and with  physical and sensory support. This integration would help to assist young people with the transition to adulthood. As part of the recent restructure of Adult Social Care, there had been investment in three social work posts which would specifically focus on the transition from children to adults. Under the SEND code of practice the Council was required to provide an independent advice and information service. This included a website to highlight services available. Other services to assist with the transition included Flight, which was two flats that could accommodate four young people for up to two years to enable them to  ...  view the full minutes text for item 856.

This report sets out a response to an issue, raised by Councillor Murray, concerning the future of the RVS Older People’s Centre.

Discussion

Councillor Murray introduced the Member’s item on the future of the RVS Older People’s Centre. The Committee was asked to note that the Save the Centre Committee was an independent group that was not connected to RVS. It was recognised that the Council no longer wished to provide grant based funding, preferring instead to contract services and establish targets that could be monitored.

Councillor Murray said that the grant for the Centre had been withdrawn suddenly with there having been no time to put alternative and more sustainable arrangements in place, although the small funding reprieve in the Council budget was welcome. The RVS Centre had a commitment to help the Council to reduce social isolation and help people to maintain good health and independence in later life. The Centre was also good value for money and had the ability to make the three conversations model for social care work well.

It was recognised that the provision of funding was challenging. Centre volunteers helped to fundraise by running a café, which made about £30,000 a year, with Centre users also helping to raise funds for other charitable causes. The move to a new delivery model could not take place in a matter of months. RVS currently paid £18,000 in rent per year for the Centre. Relocating the Centre would be difficult as there were few suitable alternatives, particularly as the Centre was already ideally located in central Chatham. The Centre had two paid staff who organised and supported volunteers and facilitated the general management of the Centre.

A number of Centre users, volunteers and other representatives of the Centre and RVS addressed the Committee, the key points of which were as follows:

Nikki Williams, volunteer – Had been recovering from mental health difficulties when she discovered the Centre, subsequently becoming a volunteer. Her volunteering role included 1 to 1 tuition for mobile phone and tablet users and helping in the café. Centre users considered themselves to be a family and did not want to be split up. They were also concerned by the possible relocation of the centre. Ms Williams had been forced to stop working following an injury last year. She considered that attending the centre had helped her enormously since and that it had possibly saved her life.

Lillian Lyons, centre user and volunteer– She had previously volunteered at Age Concern before becoming a volunteer at the RVS Centre when it had opened eight years ago. The Centre was excellent in helping people to overcome loneliness and to find friends and activities and she would be devastated if it were to close. As Ms Lyons was unable to lift heavy items, staff at the centre did her weekly shopping and delivered it to her.

Jenny Woodman, Centre user, volunteer and befriender – discovered the centre following the death of her daughter and was now a volunteer helping with knitting/crochet, bingo and the book club. She had also become a befriender, although this scheme had been withdrawn  ...  view the full minutes text for item 857.

This paper provides an update on the progress made to update the Medway PNA to conform to statutory requirements. The Council has conducted a 60-day consultation on its revised draft PNA. There was a good response to the consultation and several issues were identified. The PNA has been updated to reflect feedback received and the PNA is now ready for final sign-off by the HWB.

Discussion

The Committee was advised that each Health and Wellbeing Board was required to produce a Pharmaceutical Needs Assessment (PNA) every three years. Medway’s existing PNA had been published in March 2015, therefore the new document was due to be published by the end of March 2018. The PNA took into account factors such as forecast demographic changes and houses due to be built.

The PNA would be used by the NHS in order to determine whether it would be appropriate to permit the opening of a new pharmacy or when considering requests to modify existing services. Medway had contracted a specialist to produce its PNA. Although it was not formally required for there to be a public consultation, this was considered to be good practice. Following discussions with NHS England, it had been decided to update the existing PNA rather than undertaking a new full assessment.

A 60-day consultation on the draft PNA had been undertaken during December 2017 and January 2018 ahead of the refreshed PNA being published in March 2018.

There had been a good response to the consultation and the PNA had been updated to reflect the consultation feedback. Three key concerns had been identified from the consultation feedback. Concerns had been raised about a GP practice on the Hoo Penisula, which had stopped dispensing, with regards to the provision of services in the Cuxton and Halling area, in view of new development; and in relation to whether the planned London Resort theme park could lead to increased demand for pharmaceutical services. In relation to the London Resort, it was not anticipated that this would lead to increased demand for pharmaceutical services during the next three years (the life of the PNA). Cuxton and Halling had been determined by NHS England to have the characteristics of a rural area and was a controlled locality which meant that there were limitations on pharmacies moving into the area. If this status were to change then it would be possible for a new pharmacy to be established. In relation to the Hoo Penisula, one dispensing practice, which had 3,000 patients, had stopped dispensing. A delivery service was being provided by three pharmacies in Hoo St Werburgh to mitigate the closure. Consequently, it would be recommended to the Health and Wellbeing Board that provision on the Hoo Peninsula and in Cuxton and Halling be kept under close scrutiny over the next three years and recommendations made to NHS England to change the PNA if there were significant changes in those areas during the next three years.

A Member questioned Cuxton and Halling being continued to be classified as a rural area in view of the developments in the area. The Member was also concerned about the lack of a 24-hour dispensing pharmacy in Medway or in Kent. Another Member was concerned that the process for getting prescriptions out of hours was not well enough advertised. They highlighted a case where a patient had incorrectly been advised that they  ...  view the full minutes text for item 858.

Medway Clinical Commissioning Group's Operational Plan is closely aligned to the Kent and Medway Sustainability and Transformation Plan. The Operational Plan sets out the CCG's plans over the next two years and this report provides some highlights of the delivery against this plan during its first 10 months.

Discussion

The Committee was provided with an update on the first ten months of delivery of the CCG Operational Plan. The Plan set out nine must dos that CCGs were required to deliver by central Government. Key highlights of activities undertaken in the period included progress on the development of local care, the roll out of Pace Clinics (support for older adults), work with Kent Fire and Rescue Service on assessing the risk factors related to falling in older people and development of primary care services in order to deliver the NHS GP 5 Year Forward View programme. There were currently four healthy living centres in Medway with a further two being required. Minor illness clinics had been established in Rochester and Rainham and would be rolled out across Medway. Care Navigation services were also being developed. Significant work had been undertaken in relation to urgent and emergency care. Front door screening had been started with Medway Community Healthcare and Medway Foundation Trust, to identify patients who could be dealt with in primary care.

There had been much positive partnership working to reduce Delayed Transfers of Care of patients fit for discharge from hospital to the community. This had included one week in December where no patients had been delayed. There had been a significant reduction in the number of patients waiting over four hours to be seen in Accident and Emergency due to joint working undertaken with MFT. There had also been a reduction in the number of patients waiting for procedures. It was also noted that the winter months had been better than expected in relation to the provision of emergency care in Medway.

Medway Maritime Hospital had the only Accident and Emergency Department in Kent and Medway that had a 24 hour liaison psychiatry service and a number of specific services had been recommissioned during the previous 12 months.

A Committee Member asked what progress had been made in relation to the Kent and Medway Sustainability and Transformation Plan (STP) and said that it would be useful to see a timeline and financial appraisal of the implementation. The Member also noted that Accident and Emergency patients at Medway Maritime Hospital who exhibited mental health concerns were being quickly triaged but could then wait up to six and a half hours to be seen further. The Member asked for assurance that the problem had not been transferred to another part of the hospital. The Member also asked for updates on General Practice issues in relation to the availability of appointments at the Thorndike surgery and in relation to the St Mary’s Island practice.

The Chief Operating Officer of Medway NHS Clinical Commissioning Group advised that the next item on the agenda was related to the STP. There was a clear timetable for the reprocurement of local care with a planned go live date of 2021 and work taking place in advance of that, such as significant engagement activity. There was also ongoing consultation in relation to the Kent  ...  view the full minutes text for item 859.

The report provides the Committee withan overview of the work being undertaken by the Clinical Commissioning Groups (CCGs) across Kent and Medway to look at options for developing a strategic commissioner function that works across multiple CCGs.

Discussion

The report set out changes that had taken place across Kent and Medway over the last few months, particularly in relation to the leadership and accountable officer roles of the clinical commissioning groups in Kent and Medway. There was a formal proposal to establish a strategic commissioner and share a single senior management team with one accountable officer (chief executive). Thanet and South Kent Coast CCGs were not currently participating in the formal arrangements. Meetings were taking place during March to ascertain what joint work and joining up of back office functions could take place over and above the current level of collaboration.

To prepare for the new arrangements the accountable officers of the CCGs were taking on additional transitional roles from February. These included, Caroline Selkirk, Medway CCG Accountable Officer becoming East Kent Managing Director;  Ian Ayres, West Kent CCG Accountable Officer becoming managing director for Medway, North and West Kent and Glenn Douglas, Senior Responsible Officer for the Kent and Medway STP becoming Accountable Officer for six CCGs across Kent and Medway. Patricia Davies, Accountable Officer of Dartford, Gravesham and Swanley CCG / Swale CCG had become Director of Acute Strategy and was also leading on the Kent and Medway Stroke Review, while Hazel Smith, Accountable Officer for South Kent Coast CCG and Thanet CCG had become Director of Partnerships.

A Committee Member was concerned that joint working between Medway and Kent could have a detrimental effect on Medway in the event that a majority Kent view was able to prevail when key decisions were taken. It was asked whether the arrangements could be ended if they were found not to be in the interests of Medway. The Member accepted that there were likely to be benefits associated with the bringing together of back office functions.

The Chief Operating Officer of Medway NHS Clinical Commissioning Group said that the rationale for establishing a Strategic Commissioner, besides being to reduce back office costs was to give better cohesion across Kent and Medway and to give the area a stronger voice in discussions with Government.

Committee Members expressed their disappointment that no one from the Kent and Medway Sustainability and Transformation Partnership was in attendance to present the report and answer questions. Members also wanted to understand the impact of the new arrangements on service provision and to see details of next steps and a timeline for the work.

It was agreed that there would be no further discussion of item as there was no one from the Kent and Medway Sustainability and Transformation Partnership in attendance to answer Member questions and give the information required on this important item. 

Decision

The Committee requested that a more detailed report on the establishment of a Kent and Medway Strategic Commissioner be brought to the next meeting of the Committee and further requested that a representative of the Kent and Medway Sustainability and Transformation Partnership attend the Committee.

Medway’s Council Plan 2017/18 sets out the Council’s three priorities. This report sets out the quarter 3 2017/18 performance summary against the Council priority relevant for this Committee: Supporting Medway’s people to realise their potential.

Discussion

Significantly improved performance in relation to Delayed Transfers of Care  (DEToC) was highlighted. The number that were attributable to Adult Social Care had fallen significantly with performance having been maintained during the challenging winter. In relation to the performance indicator for the Proportion of adults in contact with secondary mental health services in settled accommodation, performancewas below target but remained in line with the national average. The most recent available figure available since publication of the report showed that performance had improved from 60% to 65%.

A Committee Member was concerned that performance was below target for the above indicator as this covered a very vulnerable group of people. She noted that being in settled accommodation would better enable recovery and asked the extent to which the Kent and Medway NHS and Social Care Partnership Trust (KMPT) was assisting with the achievement of the target. The Member also requested that the Committee be provided with an update on the development and implementation of the Three Conversations model.

The Assistant Director of Adult Social Care agreed that vulnerable people with mental health challenges being in settled accommodation was important. Medway’s target was higher than the national average to reflect this importance. Work was being undertaken with KMPT and further information could be provided on this once the work had progressed further.

The Three Conversations Model was not a simple and straightforward change. It required significant cultural change within the workforce in terms of the way that Adult Social Care worked with clients and with partners, including the community and voluntary sector. Some work to embed the approach had been undertaken as part of the restructure of Adult Social Care but more work was required to embed the principles within the service. There was a need to work on how to embed Three Conversations principles within long term services and to consider how people could be supported to remain independent and live in their own homes for as long as possible. Support for people after discharge from hospital to recover well at home and sustain independence in their own homes was also important.

Decision

The Committee:

i)     Considered the Quarter 3 2017/18 performance  against the measures of success used to monitor progress against the Council’s priorities.

ii)    Requested that an update on the Three Conversations Model be provided to the June 2018 meeting of the Committee.

Discussion

The Committee was updated on the establishment of a new Joint Health Overview and Scrutiny Committee in relation to the Kent and Medway Stroke review. Following previous agreement by Medway’s Council, the Kent Council meeting had agreed the proposal. The new Joint HOSC would include Members from four Councils, these being Medway, Kent, East Sussex and the London Borough of Bexley. It had been agreed that Medway and Kent would have parity of Membership on the new Joint HOSC as well as on the existing Kent and Medway Joint HOSC. It was anticipated that the first meeting of the new Joint HOSC would take place in the autumn once the NHS had evaluated the results of the current public consultation. It was also expected that a further meeting of the existing Kent and Medway Joint HOSC would take place in early May to receive an update on the Kent and Medway Vascular Services Review as well as on the Policy Review of Assistive Reproductive Technologies in Kent and Medway.

The Committee was advised that the Social Isolation Task Group was due to commence its work in April.  It was requested that nominations be made for membership of the Task Group.

Decision

The Committee

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

ii)            Agreed that the Labour group nominations for membership of the Social Isolation Task Group would be Councillors McDonald and Shaw and that nominations for the Conservative group membership of the Task Group would be put forward following the meeting for these appointments to be approved through the Council’s committee membership appointment process.