Agenda and minutes

Apologies for absence were received from Councillor Jan Aldous. 

To approve the record of the meetings held on 3 and 16 October 2018.

The records of the meetings held on 3 and 16 October were 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 (OSIs)

There were none.

Other interests

There were none.

The Committee has asked for a general update on the Eating Disorder Service. Eating disorders are serious, often persistent, mental health disorders associated with high levels of impairment to everyday functioning and development, and a high burden on families and carers. They can be associated with life-long physical, psychological, educational and social impairment and in some cases can be fatal.

Discussion

The new All Age Eating Disorder Service had been commissioned in late 2017 and had been fully operational since April 2018, with the service being fully staffed. It was fully compliant with National Institute for Health and Care Excellence guidance. Referrals to the service were higher than anticipated, which suggested that the new service was much needed. The provision of a single Kent and Medway service enabled a full range of professional expertise to be provided. Between October and April 2018, there had been 49 referrals to the service in Medway, which included 12 children. The contract was structured so as to enable full monitoring of activity in Medway.

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

Level of detail in report – A Committee Member expressed their disappointment in relation to the level of detail provided in the report. In particular, they would have expected details of the referral process, a breakdown of patient numbers by age and sex and information on how the service was being publicised. The Director of Operations at NELFT said that the focus had been on establishing the service and ensuring that it functioned as intended. Recruitment had been successful, with all roles having been filled. The service had been building knowledge and skills in the community. One particular challenge was that patients tended to present late once their eating disorder had escalated. Work was taking place with schools, higher education establishments and GPs to look at how to promote the service.

It was agreed that a report and presentation containing this information would be provided to a future meeting of the Committee and that a written briefing would be circulated to the Committee in the interim.

Transfer to new service and work with other services – In response to a Member concern that the rollout of the service had not been as seamless as had previously been suggested, the Director of Operations said that the rollout had gone as planned but that there had been a particular staffing skill related challenge as the previous provider had not provided a children’s service. This provision required the recruitment of staff with the correct knowledge and skills. In a well-run service, it would be expected that the number of patient discharges would be similar to the number of referrals. Current referral and discharge figures were misleading as many of the people entering the service had a relatively high level of need, particularly for child patients as there had not previously been a dedicated children’s service. The provision of a single service covering the whole of Kent and Medway enabled it to provide a multi-disciplinary team across a number of specialisms, such as cognitive behavioural therapists, dieticians, physical health experts and psychiatrists. It was considered that the service had sufficient capacity for Medway patients.

It was clarified that the 49 referrals quoted in the report were referrals to the service within Medway. The total number of referrals for the whole of  ...  view the full minutes text for item 627.

This report provides an update on progress towards setting the Council’s draft capital and revenue budgets for 2019/20. In accordance with the Constitution, Cabinet is required to develop ‘initial budget proposals’ approximately three months before finalising the budget and setting council tax levels at the end of February 2019. The draft budget is based on the principles contained in the Medium Term Financial Strategy (MTFS) 2018-2023 approved by Cabinet in September and reflects the latest formula grant assumptions. 

Discussion

The report presented the Council’s draft 2019/20 budget. This built upon assumptions that had been presented to Cabinet in the Medium Term Financial Strategy in September 2018. The budget was due to be approved by Council on 21 February 2019. The draft budget presented a £4.408million deficit for 2019/20, which was bigger than the deficit that had been set out in the Medium Term Financial Strategy. There were overspends in a number of service areas, which included Children’s Social Care SEND related placements. The Government’s October 2018 Budget had outlined the additional provision of £650million of funding, across the country, for social care. Officers estimated that the Council would receive an additional £2.6 million as a result, which would help to address the gap in the budget but this income had not been included in the draft budget.

The Council had been unsuccessful in its bid for 2019/20 Business Rate retention. This would have allowed the Council to retain all Business Rates generated in Medway rather than being required to pass 50% of the revenue to the Government for reallocation. The Council had successfully taken part in a pilot for 2018/19, which had been a boost to the financial position and the draft budget had assumed that the 2019/20 bid would be unsuccessful. It was noted that Medway’s Revenue Support Grant from the Government had reduced from £65million in 2009 to £6.3million for the next year as the Government moved towards making councils reliant on locally generated funding. The Government had confirmed that there would be no change to the council tax referendum limit or the new homes bonus, both of which had been assumed in the draft budget. Some local authorities were projecting that they would have to pay the Government more than they would receive in Revenue Support Grant. This was not expected to apply to Medway in the short or medium term. Lead Members and officers were currently working to produce a final draft budget to present to Council. There was a statutory obligation for this to be a balanced budget.

A Committee Member asked what mitigation there could be to give confidence that essential services could be maintained in view of the budgetary pressures. The Head of Finance Strategy said that, in relation to the extra £2.6 million of funding for social care, there would be freedom for the Council to determine how to allocate this across children’s and adult social care. There was an ongoing process between Lead Members and Children and Adults to allocate funding. The Government had also announced that reductions in business rate relief would be cost neutral for local authorities.

In response to a further Member question, the Head of Finance Strategy said that the Chief Finance Officer and she would be available to attend scrutiny committee meetings when there was due to be discussion of budgets.

Decision

The Committee: 

i) Noted that Cabinet had instructed officers to continue to work with Portfolio Holders in formulating robust proposals to  ...  view the full minutes text for item 628.

The draft Task Group report considers the impact of social isolation and loneliness in Medway and makes a number of recommendations for actions that the Council and other organisations can take to reduce social isolation in Medway.

The Task Group hopes that the recommendations contained in the report will act as a catalyst to further tackling social isolation and loneliness in Medway and the negative impact that it has on health and wellbeing.

Discussion

The draft Task Group report highlighted key challenges and issues in Medway in relation to Social Isolation. The aims of the Task Group had included reviewing existing provision aimed at reducing Social Isolation both within the remit of the Council and amongst partner organisations and the community and voluntary sector. The Task Group had also considered national best practice guidance and how Medway could learn from it to further reduce isolation for residents. Evidence had been gathered from a wide range of people, including Council officers, other public sector organisations and a wide range of community and voluntary organisations. The Task Group had met with the then Minister for Loneliness to discuss the national perspective on social isolation as well as undertaking a best practice visit to Bracknell to see how lessons from work undertaken in that area could be applied in Medway.

The key findings of the Task Group were that significant work was already taking place across a range of organisations in Medway to reduce Social Isolation. Examples included activity within social care, libraries, adult education, commissioned services and arts activities. However, the 23 recommendations made by the report recognised that more could be done. One key theme was the need to raise awareness as partners were often not aware of what other organisations were doing to address social isolation. A recommendation had been made relating to how awareness raising could be improved, while another recommendation was that a public communications campaign should be undertaken. This would aim to raise awareness around the work of community organisations and partners in order to better support community connectedness, identify practical actions that could be taken and promote existing activity in a more co-ordinated way. The creation of officer and Member social isolation champions had also been recommended to help support awareness raising work with Councillors being seen, in their role as community leaders, as having a key role to play in raising awareness of social isolation. It had been recommended that this be highlighted as part of Member induction. Another recommendation was that more frontline staff should be trained to enable them to effectively signpost to sources of information and support.

The Task Group’s findings had also recognised the importance of social prescribing in reducing social isolation. This concept would see health professionals linking patients to workers who could look at a range of holistic non-medical needs, including isolation and signpost people to appropriate activities and further support as required. This work would also include the development of a directory of services.

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

Social Isolation Network and measuring impacts – A Member asked whether the Social Isolation Network would be sufficiently resourced to deliver the activity envisaged. It was also asked if the impact of reducing social isolation would be measured. Another Member asked what the current membership of the Network was and requested that a membership list be circulated to the Committee.

The Public Health Consultant  ...  view the full minutes text for item 629.

To advise the Committee of a petition received by the Council which falls within the remit of this Committee.

Discussion

Councillor Freshwater introduced his petition in relation to GP Surgeries for the Hoo Peninsula, the key points of which were as follows:

• The number of GPs in the area was effectively being reduced as significant planning applications in Medway continued to be approved.
• Peninsula residents were becoming increasingly frustrated that the Council was not acknowledging this situation.
• Councillor Freshwater felt that the planning process was ineffective as the Director of Public Health was not highlighting the health impacts and impacts on GP provision of planning applications being considered.
• Medway Council was not responsible for the provision of GPs but it was responsible for improving the health of the local population.
• A third of GPs were due to retire within the next five years and Medway NHS Clinical Commissioning Group (CCG) had not been able to provide data in relation to this. The Council was, therefore, taking decisions without having the relevant data available.
• Councillor Freshwater considered that the Director of Public Health’s Petition reply did not sufficiently address the issues raised.
• Some Peninsula residents were having to wait two and a half weeks to get a GP appointment. This situation would get worse as new houses were built. One case highlighted was that of a child with Scarlet Fever who had had to wait seven hours to be seen by a GP.
• Public Health had previously collected responses to 36 important questions in relation to health impact assessments but this had been discontinued.

In response, the Director of Public Health said that it took ten years to train GPs and that while Primary care services would be transformed in the future, it was likely that GPs would still be at the centre of this. NHS England and Medway NHS CCG were responsible for commissioning primary care services rather than the Council and the Council had no direct control over the number of GPs serving each part of Medway. The Director had raised concerns about GP provision on a number of occasions and the CCG had outlined processes to mitigate against loss of primary care capacity. This challenge was not unique to Medway. The Medway Joint Strategic Needs Assessment set out the broad requirements for Medway and bespoke work was undertaken in relation to a number of issues that could impact on the local population. A refreshed Joint Health and Wellbeing Strategy had also recently been agreed.

Comprehensive dialogue took place with the CCG about how it could be ensured that appropriate resources were provided to meet the expected local increase in population. A dedicated Public Health officer was working with planning to scrutinise and review local development plans. A new Assistant Director had also recently joined the Council. The Director of Public Health would be having discussions with her about how to ensure that future development took into account the impacts on the health of the local population. The challenge was not just in relation to planning, with the Council also being responsible for the provision of infrastructure and  ...  view the full minutes text for item 630.

Medway’s Council Plan 2016/21 sets out the Council’s three priorities. This report summarise how the Council performed in quarter 2 2018/19 on the delivery of the delivery of the priority relevant for this committee: Supporting Medway’s people to realise their potential.

Discussion

Performance remained good in relation to Delayed Transfers of Care. However, there were areas for which performance was more challenging. This included the percentage of adults with learning disabilities in settled accommodation. Performance was below target for the proportion of adults in contact with mental health services in settled accommodation, although it was 7% above the national average for this indicator. Performance had improved from the previous to the current quarter. Quarter two performance was also below target for permanent admissions to care homes for the older population, although performance across the first six months was on track to be better than target. It was acknowledged that further improvement was needed in relation to the percentage of clients receiving direct payment for social care services.

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

Concerns in relation to overall performance – The Assistant Director, Adult Social Care advised that there were nine performance measures within the Council Plan for which performance was reported to the Committee. Performance against three was above target, two showed amber performance and four were below target.

In relation to the target for percentage of adults with learning disabilities in settled accommodation, performance for quarter 2 stood at 59%, compared to a target of 75%. Detailed analysis of this measure had been undertaken and mechanisms identified to get performance close to 70% by the end of the year. This included ensuring that a client’s accommodation status was accurately recorded and ensuring that all clients received a review each year. Clients had to be recorded as not being in settled accommodation where there had been no contact with them for 12 months, irrespective of whether they were actually in settled accommodation or not. Improvement beyond 70% would require a more strategic approach that considered how to support people with learning disabilities more effectively by ensuring that there were a range of options available as alternatives to residential and nursing care and that people were supported to live as independently as possible.

Work undertaken so far had included appointing transitions workers to support people in the transition from children’s to adult services. Work had recently started to promote and grow the Shared Lives Service as an alternative to residential and nursing care, with further promotional activity planned for early 2019. There was also a need to ensure the provision of adequate supported living accommodation as an alternative to residential or nursing care. Extra Care accommodation currently had a lower age limit of 55. Discussion was taking place with Housing Services to consider removal of this limit for future schemes to enable younger adults to be supported in this type of accommodation. It was acknowledged that making and sustaining significant improvements would take time.

Challenges making improvement difficult – The Assistant Director said that clients with learning disabilities often had complex needs, some of which were best met in a residential care or nursing care setting. Adult Social Care was planning to increase the  ...  view the full minutes text for item 631.

Discussion

Proposed changes to the work programme were highlighted to the Committee. Concerns were also discussed in relation to the Kent and Medway Wheelchair Service. These concerns included that the service was not considered by Members to have improved sufficiently and anecdotal evidence from service users that suggested that some were still waiting for a significant period for either initial assessment / equipment provision or wheelchair repairs.

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 a letter be sent on behalf of the Committee to Thanet / Medway NHS Clinical Commissioning Groups setting out concerns in relation to the Kent and Medway Wheelchair Service.

iii)Agreed that a further report and presentation on the Kent and Medway All Age Eating Disorder Service be added to the Committee Work Programme for the March 2019 meeting.