Agenda and minutes

Apologies for absence were received from Councillor McDonald with Councillor Johnson substituting.  

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 (OSIs)

Councillor Price declared an OSI in agenda item 6 (Sunlight Centre Surgery and Twydall Branch Surgery Proposal Update) as he was the Chair of Trustees at the Sunlight Centre. Councillor Price left the room during discussion of the item. Councillor Price also advised that there may be some discussion of Men in Sheds or the Wellbeing Café during the Director of Public Health Annual Report (agenda item 12) or Medway Mental Health Strategy (agenda item 11), both of which were related to the Sunlight Centre.

Other interests

There were none.

All upper tier and unitary authorities in England were required under the Health and Social Care Act 2012 to establish a Health and Wellbeing Board. 

The Medway Health and Wellbeing Board brings together key organisations and representatives of the public to work together to improve the health and wellbeing of the people of Medway.

The purpose of this report is to provide information to the Committee on progress made by the Health and Wellbeing Board since the last updated provided to the Committee in January 2017.

Discussion

The Committee was updated on the work of the Health and Wellbeing Board since the previous update to the Committee in January 2017. The Purpose of Board was to bring together key organisations and representatives of the public to improve the health of the people of Medway. Key activities of the Board included developing and facilitating the Medway Joint Strategic Needs Assessment (JSNSA) and the Medway Joint Health and Wellbeing Strategy; promoting greater integration, partnership and joint commissioning in the local healthcare system; considering commissioning plans and; producing the Medway Pharmaceutical Needs Assessment (PNA). The Board’s work was guided by Joint Strategy which had recently been refreshed and was due to be presented to Cabinet in November 2018. Since January 2017, the Board had looked at issues relating to all aspects of the JSNA. Some of the reports and issues considered included maternal smoking, dementia, the Kent and Medway Sustainability and Transformation Plan, Medway NHS Clinical Commissioning Group’s commissioning intentions and health inequalities. This illustrated the importance of the Board in bringing together partners and taking forward important initiatives.

A Member welcomed the opportunity that the Board provided for joint working but had been disappointed by the Board’s response to the issue of period poverty. She considered that the Council and partners needed to act to provide free sanitary products for girls. She also called on the Board to offer its support to the related Red Box campaign. The Member highlighted the significant work undertaken in relation to maternal smoking, including that the Portfolio Holder for Adults’ Services had chaired a group working with midwives at Medway Maritime Hospital. However, the Member said that there was not enough work being undertaken to ensure that people were aware of the importance of a good pregnancy or how to optimise fertility and how this could be achieved and suggested that this could be highlighted to Members. The Director of Public Health said that some work was taking place in this area and that there was a communications plan in place covering the work of Public Health.

The Portfolio Holder for Adults’ Services spoke about the work undertaken by the hospital with new mothers. Regular meetings took place to drive this challenging work, which centred on encouraging mothers to give up smoking during pregnancy and explain the associated risks. The number of people amongst this group in Medway had fallen as a result.

A Committee Member asked for an update on the Medway Young Persons Wellbeing Service since the contract having been awarded to NELFT in April 2017. It was agreed that a briefing note would be provided to the Committee and to the Children and Young People Overview and Scrutiny Committee.

A Member voiced concern that the Snapdragons children’s therapy service was no longer allowed to communicate with schools, which was a safeguarding risk, and also that there was a shortage of paediatricians. She also said that there was a shortage of school nurses. The Chief Operating officer of Medway NHS  ...  view the full minutes text for item 440.

Following consideration of a Member item at the Health and Adult Social Care Overview and Scrutiny Committee, on 15 March 2018, it was recommended that the Cabinet provide a further £17,500 to the Royal Voluntary Service (RVS) Centre. The Cabinet considered this recommendation on 10 April 2018 where it noted the progress made with RVS in covering a matching grant to cover costs over the 12 month period 2018-2019 and the Cabinet agreed that Council officers work with RVS in the preparation of a sustainable model of delivery for RVS and provide a six month progress report to Cabinet in October. 

This report is a progress update on how RVS is proposed to become sustainable, either by introducing a new model of delivery to bring Medway in line with their national practice or by securing a more affordable property to deliver services from ahead of consideration by Cabinet on 23 October 2018

Comments from this Committee will be included in the report to Cabinet.

Discussion

The report set out progress made on ensuring the future sustainability of the RVS Older Persons’ Centre in Chatham. The provision locally is centred around a community café with there being a variety of drop in facilities provided for vulnerable older people. The aim of the offer was to reduce social isolation and loneliness.

Following a review of grant funded arrangements, the Council gave notice to RVS  that grant funding would no longer be provided for the Centre post March 2018. This was on the basis that grants paid to RVS and to other voluntary organisations were not compliant with procurement and contract regulations and it was not possible to evidence whether good value for money was being achieved. The Council had since embarked on recommissioning VCS services in Medway. 

Notice was given to RVS that grant funding, amounting to £35,000 per year, of which £18,000 was attributed to rental fees for the premises, could cease in March 2018. Following a campaign by RVS, service users and volunteers, Cabinet agreed on 10 April 2018 to invest a further £17.5k to match fund the centre until March 2019. Funding was agreed on the basis that officers and RVS would work together to develop a sustainable plan to enable RVS to continue services.

RVS and the Council’s Partnership Commissioning team were are working collaboratively to achieve a sustainable plan for the Centre to continue operating once grant funding ends. The preferred option being to relocate the Centre to more cost effective premises that are easily accessible and has good transport links.

Council Officers identified a number of property options which included renting and sharing office space with other partner organisations. RVS investigated these options but they were ruled out due to cost, inaccessibility and not being suitable for runing a café.

RVS had engaged with 14 property agencies and reviewed 47 buildings, 45 of which were not suitable. Of the two suitable properties, one had already been leased before negotiations could be completed. RVS had now identified a property with a business case due to be developed. If agreed, RVS would seek to fundraise to take forward the proposals.

A Committee Member said that they had been pleased to hear about a possible partnership development with a local housing association. It was hoped that the new building would be better than the existing premises and the Member felt that the housing association should provide the funding to refurbish the building. She commended the work of RVS staff, both locally and nationally in order to achieve sustainability. A Community Coordinator had been appointed to promote the role of volunteers. It was clear that few volunteers would be existing service users as they tended not to want that level of commitment. The Member considered the Older Person Café to be very important and it was therefore important that the new facilities offered this and that if the identified venue proved to be unsuitable there should be more work undertaken to help RVS find  ...  view the full minutes text for item 441.

The report updates the Committee on work undertaken since the Member item considered by Committee at the August 2018 meeting in relation to the reconfiguration of GP services in Gillingham. This included a proposal to close the Sunlight Centre GP Surgery and the DMC Branch Surgery in Twydall. The report also includes further information in relation to the proposal.

The Committee determined that the proposals amounted to a substantial service reconfiguration and requested that the CCG delay the decision, that had due to be made by the Primary Care Commissioning Committee (PCCC) on 29 August 2018 and that the CCG should commence an extended consultation period.

At the 29 August meeting, the PCCC postponed the decision and agreed to undertake an extended period of engagement with patients, stakeholders and with this Committee. 

Discussion

The Committee was updated on the proposal, discussed extensively at the August 2018 meeting, to reprocure GP service contracts currently spread over five sites as a single contract, with GP provision at three sites. This would have seen the Sunlight Centre in Gillingham closing, with the service relocating to the Balmoral Healthy Living Centre and the closure of the branch surgery at Twydall. Medway NHS Clinical Commissioning Group (CCG) had undertaken patient engagement with the Committee having determined the proposals to be a substantial development or variation of health services in Medway.

There was a strict timeline for reprocurment with a new contract needing to be put in place to maintain the provision of GP services at these locations after the end of March 2019, irrespective of whether GP services were procured for three or five sites. The Primary Care Commissioning Committee had taken the concerns of the public and the Committee into account and had decided to reprocure services for all five GP sites and to undertake extended public engagement and consultation with regards to future provision. The CCG had been advised that it was not appropriate to undertake engagement and consultation until after the new contracts had commenced. In view of this and the Medway Council elections in May 2019, the decision had been taken to delay engagement until Summer 2019. Any resulting changes to GP provision at the five sites would now not take place until at least April 2020. The CCG would continue to update the Committee at regular intervals throughout the process.

A Committee Member welcomed the announcement that GP services would be reprocured for all five locations and hoped that the Committee and the public would be fully consulted on future proposals. Another Committee Member welcomed the decision, noting that the campaign by the public to retain services demonstrated the strength of feeling locally. She commended the CCG for having taken this and the Committee’s views into account. The Member emphasised the need for all the relevant information to be fully considered and health scrutiny legislation to be fully complied with ahead of future decisions being taken and asked for assurances that services would not be removed from any of the five GP surgeries ahead of a final decision being taken. The Director of Primary Care Transformation at the CCG provided assurance that services would be maintained at all five sites and acknowledged that further work was required if Balmoral Garden was to be able to host additional services in the future.

A Member of the public said that telephone calls to the DMC branch surgery in Twydall were now being redirected to Balmoral Gardens. The Director of Primary Care Transformation was not aware of this change and undertook to investigate further with the GP practice.

Decision

The Committee welcomed the decision made by Medway NHS Clinical Commissioning Group to reprocure services at all five existing GP locations covered by the current contracts and noted that services would continue to be provided  ...  view the full minutes text for item 442.

This report at Appendix 1 submitted by Kent and Medway CCG informs the Committee of the work being undertaken by the East Kent Transformation Programme and, in particular, considers the out-of-area patient flows to East Kent Hospitals University NHS Foundation Trust (EKUHFT), i.e. the patients from outside the east Kent area that use the services provided by the Trust. The greatest impact on the Medway population will potentially involve four specialities; Haemophilia outpatient services, Renal Inpatients, Primary Percutaneous Coronary Intervention and Paediatric surgery (dental extractions).

The Committee is asked to discuss and note the contents of the report and indicate whether the changes in location of East Kent services represent a substantial development of, or variation to the health service for residents of Medway.

At its meeting on 21 September 2018, Kent County Council HOSC determined that it was a substantial variation. If this Committee agrees that the proposed changes represent a substantial change to, or variation of the health service in Medway the matter will have to be dealt with by the Kent and Medway NHS Joint Overview and Scrutiny Committee.

Discussion

Transforming Health and Care in east Kent involved reviewing the delivery of health and social care services provided in that area. Two options were being considered which would see differing configurations of services at William Harvey Hospital, Ashford, Queen Elizabeth the Queen Mary Hospital, Margate and the Kent and Canterbury Hospital, Canterbury. A range of specialist services would be impacted by changes. Services that would be impacted, for which more than 5% of the total number of patients treated came from Medway, included coronary procedures, renal inpatient services and haemophilia outpatient surgeries. Services which fell just below the 5% threshold included paediatric surgery and vascular services. The impact of the proposed changes on travel time for the Medway population had been considered with a detailed analysis of travel times based on Super Output Areas (SOA) having been provided to the Committee as a supplementary agenda. This considered the differences between the William Harvey Hospital and Kent and Canterbury Hospital for the ten most impacted SOAs in Medway. A simpler analysis of train travel times had also been provided.

The Chairman advised that the Kent Health Scrutiny Committee had determined the proposals to amount to a substantial variation to the health service in Kent and that, therefore, if Medway also deemed them to amount to a substantial variation, the matter would need to be further considered by the Kent and Medway Joint Health Scrutiny Committee.

The Programme Director of the Kent and Medway Sustainability and Transformation Partnership advised that for service users in East Kent, the changes proposed covered the whole of their healthcare provision, where as for Medway, only a relatively small number of patients would be affected. It was therefore the view of Sustainability and Transformation Partnership that the proposals did not amount to a substantial variation in the health service for Medway residents.

A Committee Member said that quality of care and accessibility should be the most important factors in determining the location of services. The Member accepted the prevailing view that larger scale, specialised health services would be better able to provide services and that the changes in travel times for Medway patients travelling to East Kent hospitals would be relatively small but she was concerned about other services, such as stroke and vascular service, which if current proposals came to fruition, would move away from Medway Maritime Hospital. As the largest urban area in the South East, outside London and with a growing population, it was important for services to be provided locally. It was therefore important for Medway to be fully included in the decision making process for the East Kent proposals. Consequently, the Member considered that the proposals amounted to a substantial variation to the health service in Medway. The Member was also concerned about the future accessibility of Ashford in view of the likelihood of sections of the M20 between Maidstone and Ashford being closed at times for lorry parking, a particularly in the event of a no deal Brexit.  ...  view the full minutes text for item 443.

The report provides an update on progress since the Trust last attended the Committee in June 2018.

Discussion

Medway Maritime Hospital had received a rating of requires improvement in its most recent Care Quality Commission (CQC) inspection, the same rating as in the previous year. The report highlighted the improvement journey of the hospital with progress having slowed during the previous winter. The most recent inspection had not inspected any areas that had previously been rated as good. A Well Led inspection and use of resources assessment had also been undertaken by the CQC with the rating for Well Led having reduced to requires improvement. The safety of services had been maintained and improvements made previously sustained.

It was anticipated that performance would improve sufficiently in the next year to enable the hospital to achieve a good rating. The last inspection had identified 12 must do actions for the hospital to take with there also being 28 should do actions. These were being progressed. The CQC was due to inspect End of Life Care, with the Trust looking forward to being able to demonstrate the significant improvements made. The improvements being made by the hospital were being guided by its transformation plan, ‘Better, Best, Brilliant.’ One target for the current year was to reduce the average length of patient hospital stays by two days.

The hospital had established an Acute Frailty Unit which enabled frail, elderly patients to be cared for in the best environment possible, with the required medical expertise available. 80% of this group were being discharged to an appropriate setting for that person within 48 hours of the patient having been identified as being ready for discharge. Work was also taking place to meet the target of seeing Emergency Department patients within four hours of admission. In relation to ambulance handovers, the Trust now had the best performance of any of the acute trusts across Kent, Surrey, Sussex and Medway.

MFT aimed to position itself in the Kent and Medway healthcare system as a specialist emergency centre. It was acknowledged that acute hospitals were not always the best environment for the provision of extended health services. In relation to dermatology services, MFT had provided notice to the CCG that the service was considered to be fragile and could not meet the demand for referrals. There was currently a national staff shortage in dermatology. Work would continue with Medway CCG until the end of March 2019 to investigate how the identified issues could be resolved. There was also a need for the hospital to look at how it could continue to deliver stroke services as the recommended option was developed for the provision of hyper acute units at three hospital sites in Kent and Medway, the preferred option for which did not include Medway. In relation to vascular services, a need had been identified for the establishment of a single arterial centre in Kent. There was now a proposal for interim provision at the Kent and Canterbury Hospital in Canterbury. This was disappointing as MFT considered that it could have hosted the service, particularly in  ...  view the full minutes text for item 444.

The report informs the Committee of the review of pathology services across Kent and Medway.

Discussion

The report set out the proposal to establish a single Pathology service in Kent and Medway as part of the National Pathology Network Strategy. The Strategy described configurations of networks of pathology providers and challenged them to say how stable pathology services could be created. A decision had been taken to create a service for Kent and Medway rather than investigating establishment of a shared service with south London.

It was recognised that pathology had an aging workforce and that there was a need to invest in technology. Delivering an effective service rather than financial savings was the key driver for the establishment of a new service. Regular engagement was being undertaken with staff to keep them informed as the proposals were developed. It was acknowledged that there was a need to create a more secure and sustainable workforce. It was considered that it was most likely that a hub and spoke model would be developed but no preferred option had yet been identified. An outline business case had been developed with a full business case due to be developed in December 2018. Expertise from NHS England and the Royal College of Nursing was being utilised to support development of the proposals.

Progress had already been made in relation to send away blood testing services. It had been identified that trusts across Kent and Medway were paying different prices for this service. These contracts had been renegotiated so that all trusts would pay the same.

A Committee Member highlighted recent problems experienced by the existing shared Medway and North Kent Pathology service, which had included blood tests going missing and delays in results being provided. The Member questioned what the impact of a centralised service would be on blood tests where results were required urgently. It was also suggested that there needed to be communication with the public about the issues encountered and the rationale for change.

The Chief Executive of Medway Foundation Trust said that the North Kent Pathology Service had experienced problems. This was a joint venture between Medway and Dartford designed to merge their pathology services. It was acknowledged that some of the difficulties the service had experienced should have been foreseen with it having been predominantly Medway patients affected by the difficulties. The merger had involved chemical pathology moving from Medway to Dartford in June 2018. Four serious issues had been identified. Affected patients had been telephoned and written to with affected tests having been redone. No patient harm had yet been identified. Some of the problems had been caused by IT systems not being able to communicate with each other. Work was being undertaken with NHS England and NHS Improvement in relation to development of an action plan. It was likely that the Programme Board would ask for an independent review to be undertaken to investigate the problems.

It was confirmed that any centralisation of pathology services would require acute testing to be retained at each hospital site. This would be the case for  ...  view the full minutes text for item 445.

This report updates the Committee on the development of a single Strategic Commissioner across all eight Kent and Medway Clinical Commissioning Groups (CCGs).

Discussion

There was a need for a well governed strategic commissioner across Kent and Medway and it was recognised that a permanent arrangement was needed to reflect the scale of changes in Kent and Medway. There had been significant concern expressed at the June 2018 meeting of the Committee about an apparent lack of transparency in relation to the development of the strategic commissioner and lack of information previously made available to the Committee. It had been agreed that the Committee would receive updates as often as required. It was considered that the plans to develop the strategic commissioner were robust but that progress had slowed down in the previous six to eight months with other areas having made more progress than Kent and Medway. Three design workshops had taken place, made up of members of all the Kent and Medway CCG governing bodies with a resulting next steps discussion paper currently being considered by the CCGs. It was anticipated that much of the early work in the development would be delivered by existing staff of the CCGs with the steering group to oversee work made up of clinical chairs, the two managing directors for the Kent and Medway CCGss and Councillors from Medway and Kent County Council. A key challenge would be moving to strategic arrangements while retaining full transparency and accountability for services.

The Steering Group was due to meet to more clearly define what the future arrangements of commissioning should be with the pace of the work needing to increase to implement the plans, including the development of an Operating Framework. It was anticipated that the Strategic Commissioner would be in place in shadow form by summer 2019 for it to become fully operational from April 2020. Its development would be overseen by a joint committee with it being anticipated that this would meet in public.

A Member of the Committee welcomed the increased transparency and potential for improved efficiency and reduced duplication as long as the needs of the local population were fully taken into account, including the relatively high health inequalities in Medway. In relation to the legal duty under the Health and Social Care Act to recommission services worth more than £650,000 every five years, it was questioned whether there had been a calculation of the services that exceeded this value and whether existing providers were disadvantaged by the process and how fairness in tendering processes was being ensured.

The Director of System Transformation at the Kent and Medway Sustainability and Transformation Partnership said that the new arrangements would aim to ensure consistency of outcomes across Kent and Medway in view of the increasing health inequalities experienced over the last five years. It was considered that there needed to be a different approach to commissioning, moving away from the current quasi market system to one where providers are required to work together to meet the needs of communities under a contractual framework set by the Strategic Commissioner. The current commissioning system had resulted in  ...  view the full minutes text for item 446.

The Medway Adult Mental Health Strategy 2018 to 2023 has been developed by NHS Medway Clinical Commissioning Group and Medway Council. It sets out our vision for improving outcomes for people with mental health problems in Medway over the next five years.

Discussion

The draft Adult Mental Health Strategy had been jointly developed by Medway NHS Clinical Commissioning Group and Medway Council. The development of the Strategy was important in view of the prevalence of mental health issues amongst the population, the increasing population and an increasing severity of need. The Strategy set out the case for change based on a needs analysis undertaken by the Council and feedback from stakeholders. The key focus of the Strategy was on the strengthening of preventative services. This included providing high quality responsive services to support people in crisis and supporting people to live well and manage conditions. The Strategy highlighted the importance of developing mental health services as part of the development of the Medway Model and ensuring that mental health is given the same priority as physical health services as part of development of local care services.

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

Factors affecting mental health – A Member highlighted a number of contributory factors that could lead to poor mental health, such as homelessness, unemployment, housing difficulties, relationship problems and debt and emphasised that mental health was a wider social issue than just being health specific. The Member was concerned whether there were sufficient resources available locally to tackle the challenge. The Head of Mental Health Commissioning at the CCG agreed that mental health was a wider concern than just being a health problem. The aim was to ensure the provision of adequate community services as well as acute services. One aim of the Strategy would be to increase the number of people seen by Medway Talking Therapies. Currently, 19.8% of people diagnosed with depression accessed the service. The 2021 target was for this to increase to 25%. Funding for services was challenging with the aim being to find new ways of providing services.

Grant funding had been used to support homeless people with mental health problems. This saw a social worker spending half their time working with homeless people to help them access mental health services. The charity Porchlight now employed two employment advisors specifically for Medway using grant funding, while the Meghan Community Interest Company offered peer support.

Local Plan – In view of the forecast population increase in Medway and a decreasing number of GPs, a Member asked whether information from the Strategy would be included in the Medway Local Plan. It was confirmed that the CCG was working closely with the Council in the development of the Local Plan and to ensure that the correct health services were available once the Local Plan was agreed. The Chief Operating officer of the CCG did not recognise the figure quoted by the Member that the number of GPs in Medway would reduce by 25%. The Council’s Local Plan lead officer had attended several CCG events in advance of production of draft Local Plan and had been fully involved in providing information to support Plan development.

Increasing demand for services –  ...  view the full minutes text for item 447.

This report presents the Director of Public Health’s Annual Report for 2017-18. The theme of the report is health protection - Protecting the Health of Medway’s Population: now and for the future. The Committee is asked to note the report, findings and recommendations.

Discussion

The Committee was informed that the Director of Public Health is statutorily required to produce an annual report setting out issues that impact on the health and wellbeing of the local population. Health protection had been identified as the focus for the 2017/18 report which covered nine areas - Infectious Diseases and Foodborne Illnesses; Seasonal Flu; Screening; Emergency Preparedness; Sexual Health and Blood Borne Viruses; Tuberculosis; Health Care Associated Infections; Air Quality and Vaccinations.

There had been 140 recorded outbreaks of infectious diseases in Medway in the last five years, which were mainly linked to gastrointestinal diseases. The majority of the outbreaks were associated with noro-virus. Encouraging uptake of seasonal influenza vaccination was one way of reducing winter pressures on the health and care system. Uptake rates had increased locally. Last year had seen a number of significant outbreaks of seasonal influenza nationally and regionally, but there had been relatively few institutional outbreaks in Medway compared to other areas. This was considered to be due to strong partnership working. A new type of flu vaccination had been introduced for over 65s. This vaccine has been found to be more effective in this age group. The challenge was to persuade groups, such as pregnant women and those with chronic health conditions to get themselves vaccinated. There was a target of 100% of staff working in an acute hospital setting to be vaccinated. The Council was committed to ensuring all key frontline care staff were vaccinated and 29% of the social care workforce had been vaccinated so far, which was a significant improvement compared to the previous year. Vaccination programmes were funded by NHS England and supported by Public Health England with the Director of Public Health being responsible for holding these bodies to account to ensure effective provision for the Medway population.

Health screening was challenging as the people most likely to attend screening were not those who were the most likely to experience health problems. One particular challenge was to increase the rate of bowel screening.

The Local Health and Resilience Partnership was responsible for ensuring the Kent and Medway health system was able to respond effectively to incidents that require an NHS response. This could include epidemics of communicable disease, winter pressures and adverse weather, for example summer heatwaves. The Director of Public Health liaised with the NHS to seek assurance and to test preparedness plans to ensure they were fit for purpose and could protect the population.

The rates of sexually transmitted diseases were relatively low in Medway with the highest infection rate being amongst 15 to 24 year olds. Services to tackle these diseases in Medway were considered to be good with the service having been retendered.

Medway had a low prevalence for TB and was well below the threshold of 40 cases per 100,000 population which was considered high. Latent TB and the need to increase understanding of it was one challenge face by Medway.

There was a need to ensure that patients could  ...  view the full minutes text for item 448.

Medway’s Council Plan 2016/21 sets out the Council’s three priorities. This report summarise how the Council performed in quarter 1 2018/19 on the delivery of the delivery of the priority relevant for this committee: Supporting Medway’s people to realise their potential.

Discussion

The report sets out performance in relation to the Council priority relevant to the Committee – ‘supporting Medway’s people to reach their potential.’ There had been good performance against the indicator for the percentage of long term packages that are placements and work was ongoing to embed the Three Conversations approach in Adult Social Care. This aimed to support people to be independent in their own homes and to reduce the number needing to move to residential or nursing homes.

The uptake of direct payments was continuing to increase. If the current trajectory continued, the target for uptake would be met at the end of the current financial year. The good performance in reducing Delayed Transfers of Care (DToC) attributable to Adult Social Care was highlighted. There had been significant improvement just before Christmas 2017. This had helped the healthcare system to cope with winter pressures with this performance having been sustained since. Medway was now seen as being an exemplar of good practice nationally. Through Better Care Fund (BCF) programmes additional initiatives had been developed to help sustain good DToC performance. This included the procurement of a home care bridging service to provide interim support while an ongoing package of support was being arranged.

A Member expressed concern in relation to performance for settled accommodation for adults with learning difficulties and for people with secondary mental health problems. This had long being an issue for the Council and the Member was concerned that there had not been significant improvement. She also noted that there was little in the Local Plan about mental health or developments to accommodate people with longer term mental health or learning difficulties.

The Assistant Director – Adult Social Care said that there was a focus on addressing all underperformance, particularly regarding clients with learning difficulties in settled accommodation. Extra Care schemes were currently limited to people aged 55 plus but consideration was being given to making future schemes available for younger adults with learning or mental health difficulties. An Accommodation Strategy had been developed to identify gaps in current provision and where additional provision could be developed to meet need.  Work was taking place with a range of providers locally to develop more supported living that would meet the needs of clients with learning disabilities. Work was also taking place to identify people who had needed to move out of Medway in order to obtain suitable accommodation with a view to supporting them to return. There was some mental health funding available to support the homeless. Work was taking place with housing with a dedicated social worker being part of the initiative to support clients with mental health difficulties. There was evidence that there had been good outcomes in the first month of operation.

A Member highlighted the case of a young man, with mental health difficulties, living away from home who had then returned to Medway and had been placed in housing that the young man or his family considered to  ...  view the full minutes text for item 449.

Discussion

Proposed changes to the work programme were highlighted to the Committee.

Decision

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