Agenda and minutes

Apologies for absence were received from Councillor Clarke with Councillor Griffin substituting, from Councillor Craven with Councillor Shaw substituting and from Councillor Fearn with Councillor Joy substituting.

To approve the record of the meeting held on 19 June 2018.

The record of the meeting held on 19 June 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 (OSIs)

Councillor Price declared an OSI in agenda item 5 (Proposed Closure of the Sunlight Centre GP Surgery) as he was the Chair of Trustees at the Sunlight Centre. Councillor Price left the room during discussion of the item.

Other interests

Shirley Griffiths of the Medway Pensioners’ Forum declared an other interest in agenda item 5 (Proposed Closure of the Sunlight Centre GP Surgery) as she was a patient of one of the surgeries affected by the proposals and also a member of the patient forum.

The Chairman advised the Committee that he and other Committee Members had met with Medway NHS Clinical Commissioning Group (CCG) to discuss concerns in relation to when and how the CCG informs the Committee about possible substantial developments of or variations in the provision of health services in Medway. He had also written to the CCG to express these concerns and it was therefore particularly disappointing that the Committee had not been formally notified of the proposals in relation to proposed GP surgery closures in Gillingham.  

A Committee Member added that they were very unhappy that the Committee had not been properly informed by the CCG. She also advised the Committee about an issue in relation to Kent and Medway Wheelchair service which she felt should have been brought to the attention of the Committee.

The issue has been raised by Councillor Stamp and will be considered by the Committee as a Member item.

This report advises the Committee of a proposal under consideration by Medway Clinical Commissioning Group to close the Sunlight GP Surgery in Gillingham. In the view of Medway Clinical Commissioning Group this is not a substantial service reconfiguration.

Discussion

Councillor Stamp introduced his Member item, the key points of which were as follows:

·      A petition against the proposed closure of the Sunlight Centre Surgery had been signed by nearly 1,000 people. A separate petition was against the closure of the DMC branch surgery in Twydall.

·      Pubic engagement by the CCG had been completely inadequate. Councillor Stamp had received the letter sent to patients of the affected practices on 3 August 2018 which had given just six working days for a response. This was not long enough, particularly during the summer when many people would be away and many students would have returned to their parents’ house. This short engagement period was completely unacceptable.

·      The CCG had stated that it did not consider the proposals amounted to a substantial variation in health services and that, therefore, a full consultation process was not required. A proposal to close two GP surgeries that would affect almost 26,000 should definitely be considered to be substantial.

·      The CCG should have worked with the Committee and referred the issue as matter of course rather than it having had to be brought to the Committee as a last minute Member item. Alternative options should have been presented and a full options appraisal undertaken. This referral should have taken place several months previously and the Committee and the public should have been provided with full details and the rationale for the proposals.

·      There had been no assessment of how the proposals would impact on mental health, social isolation, accessibility or patient care and there should have been an assessment of how well each location was served by public transport. There had been little consideration of the needs of patients.

·      The decision about whether or not to close two GP surgeries was due to be taken on 29 August 2018. It was not clear that those making the decision would have sufficient information available to enable them to make an informed decision. It was concerning that the decision would be made in  private with no transparency or accountability.

·      There were already GP vacancies at the Balmoral Healthy Living Centre with patient lists being oversubscribed. It was therefore not clear how the surgery would cope with additional demand. The issue of GP shortages was a national issue which should not be used as justification locally to close surgeries.

·      Poor patient feedback had been cited as one of the reasons for the proposed closures but this was not borne out by the feedback at the public meeting, at which patients had talked of their positive experiences as patients of the Sunlight Centre. The CCG had not shared patient feedback to substantiate its claim.

·      There was a significant lack of detail in the Committee report with no supporting evidence to substantiate the claims made. It had been claimed that the proposals would reduce health inequalities but no evidence had been provided in relation to how this would be achieved.

·      There were more than 7,000 patients registered at the Sunlight  ...  view the full minutes text for item 292.

This report sets out a response to an issue, raised by Councillor Freshwater, in relation to GP provision on the Hoo Peninsula.

Discussion

Councillor Freshwater introduced his Member item in relation to GP Provision on the Hoo Peninsula. He felt that there was a lack of transparency about the plans for GP provision on the Peninsula as the population increased and that Medway NHS Clinical Commissioning Group (CCG) was not providing information about how this demand would be met. There were 2,000 new homes in the process of being approved or built, with a further 2,000 to be approved before the new Local Plan had been approved. The total resulting population increase would be around 9,000. Councillor Freshwater was asking for additional information to be included in a Health Impact Assessment but had not received satisfactory responses to his requests. Health Impact Assessments were being considered as part of the Local Plan consultation which had been considered by Cabinet in March 2018. However, it was not adequate to wait for the Local Plan process to be concluded as houses would already have been built.

Councillor Freshwater was also disappointed that a number of questions he had raised in the report had not been answered by the CCG or by officers. CCG projections and planning assumptions to 2021/22 had been based on 267 new dwellings on the Peninsula equating to 641additional people. However, these estimates were considered to be well below the number of dwellings that would actually be built and this would have a significant negative impact on the provision of healthcare.

Councillor Freshwater requested the completion of a health impact assessment for all new planning applications of 25 or more dwellings on the Hoo Peninsula and questioned why there appeared to be resistance to undertaking a health impact assessment as part of a planning application.

The Director of Primary Care Transformation at NHS Medway CCG advised that the CCG used population projections based upon its joint work with the Council. It was acknowledged that a large number of houses were due to be built. Work would be taking place with the Council’s Planning and Public Health Services to ensure that this was fully taken into account when planning future primary care provision on the Peninsula. Initial discussions had taken place with a building consortium on the Peninsula in relation to healthcare provision and work was also taking place with the emergency services to consider wider service provision.

The CCG considered that there would be sufficient GP capacity on the Peninsula for the next two years. After this, there would need to be physical expansion. Councillor Freshwater had raised an issue which had resulted in patients of one practice on the Peninsula having to travel to Gillingham to access a GP. This had been a physical building issue and had now been resolved. All GP lists on the Peninsula were currently open for new patients to register and there were no capacity issues. Work would be needed to address workforce challenges in relation to the number of GPs and nurses required in order to maintain capacity but this was a Medway wide  ...  view the full minutes text for item 293.

This report sets out the model of care for Adult Community Services which NHS Medway Clinical Commissioning Group (Medway CCG) is planning to re-procure. There will be seven key changes to services for local people which have been developed as a result of engagement with clinicians, staff, patients and local residents.

In January 2018 the Health and Adult Social Care Committee agreed that the changes presented constituted a substantial variation to services.

Discussion

Extensive public engagement had been undertaken in 2017 and earlier in 2018 with the public, clinicians and staff. This had assisted in the design of the revised model for the provision of community health services. The Case for Change, previously presented to the Committee in January 2018, had been updated to reflect revisions to the model.

Seven key changes would be presented as part of further public engagement planned for September and October. These would aim to make services less fragmented and more joined up with more services to be provided locally and closer to where people live. Improvements to multi-disciplinary working would be proposed as well as the creation of a single point of contact for patients. The process was about redesigning services and providing them in a different way rather than reducing them and to reduce the impact on secondary care by strengthening support provided in the community.

The Committee was asked to provide feedback on the seven key changes set out in the draft public consultation document. The engagement would be widely publicised, with 20 focus groups being used to target hard to reach communities. The CCG would also ensure that housebound people could have a say. There would also be three public meetings on 20 September 2018, 8 October and 19 October 2018, details of which would be circulated to the Committee. NHS England had been positive about the proposed approach and had recommended some minor changes to the draft document.

A number of questions were raised by Member of the Committee which were responded to as follows:

Centralising of Services and related challenges – In response to a Member question about the timescales for the proposals, the capacity of the healthcare system for the centralisation of services, what work was being undertaken with staff to prepare them for the changes, the technological barriers to change and concern that it would be impractical to only provide services from a small number of locations, the Committee was advised that the CCG would be looking to provide the most common services within each of the six localities. Over 70% of clinical appointments currently took place within two localities – Gillingham and Rochester. It was envisaged that the proposed changes would actually increase the number of appointments taking place within the other four localities, with many patients having to travel less distance than they currently did. 

In relation to the workforce, there was a need to look at a revised model. Work was taking place with existing providers to upskill staff with regards to long term conditions. Procurement was due to take place from January 2019 with a go live date of April 2020. It was anticipated that the proposals would reduce overall patient travel and it was noted that 78% of the population would be within a 20 minute public transport journey of one of the healthy living centres. It was recognised that IT systems did not interface with each other and there was a need to  ...  view the full minutes text for item 294.

This report updates the committee on progress being made by South East Coast Ambulance Service (SECAmb) 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 report detailed progress made since the CQC inspection undertaken in 2017. It was considered that significant progress had been made since then.

Since September 2017, there had been monthly deep dive inspections in relation to key themes with one of the key areas of success being in relation to medicines governance. Learning had been undertaken in conjunction with a lead NHSI pharmacist and this would be used as an exemplar process for other ambulance services. A key area of concern was bullying and harassment. Significant work had been undertaken to address this including  behavioural development training for the leadership team, with first line supervisors now also receiving this training. Areas of concern identified in the staff survey were being addressed. This had included delivering meaningful appraisals and objective setting to 92.5% of staff in the last year. Results of the latest staff survey had been more positive than for the previous year with a further staff survey due to be undertaken later this year.

The Ambulance Response Programme was a national initiative. Since November 2017 response times for all ambulance services were being measured in a different way. The Programme breaks responses down into four key categories: Category 1 - immediately life threatening, Category 2 -emergency, Category 3 - urgent and Category 4 - less urgent. SECAmb’s performance for categories 1, 2 and 3 was in line with performance of peer services across country. The target response time for a Category 1 call was 7 minutes. SECAmb was narrowly missing achieving this target. Performance was within the upper quartile nationally for category 2 but there were significant challenges regarding Category 4 performance. This was due to SECAmb prioritising categories 1 and 2.

A Demand and Capacity Review had identified that SECAmb had significant gaps in its ability to deliver against national targets. A plan was being put in place to address this which would increase the number of double crewed ambulance vehicles in the SECAmb fleet by between 50 and 100. The workforce would be increased by over 200 whole time equivalents. Over 1,000 additional staff would need to be recruited by 2020/21, including 150 staff in Medway. The Review had identified a need to deploy specialist paramedics and paramedic practitioners, who would work in zoned or targeted areas in order to provide senior clinical oversight.

A number of questions were raised by Members of the Committee which were responded to as follows:

Staff survey and bullying and harassment – It was recognised that the response rate to the staff survey of 44% and the 45% satisfaction with the handling of bullying and harassment was disappointing. SECAmb was going through a process of rebuilding staff trust. The appointment of a full executive team would help this process with there only having been one substantive executive team member in place in September 2017. Additional support had been brought in to address concerns raised. Dedicated 1^st line supervisors would be entirely staff focused with 50% of their time dedicated  ...  view the full minutes text for item 295.

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 process of rebalancing the patient transport contract to account for demand that was in excess of the level of activity included in the original contract had now been completed. This was a similar process to the demand and capacity review that had been undertaken by SECAmb. Additional funding had been put into the contract from the start of the current financial year.

The average time taken to answer the phone when patient transport was being requested had reduced from five minutes in April to 40 seconds, with the target being 20 seconds, which it was anticipated would be achieved. 80% of outpatients transports were now arriving at hospital on time with 90% being taken home on time. 98% of patients were spending the target time or less on board the vehicle. Less than 0.5% of journeys resulted in a complaint. For every 400 journeys booked in advance there were 2,600 booked on day of discharge which showed the challenges the hospital system faced. Having such a high proportion of journeys booked on the day made planning vehicle and staff availability extremely challenging. Work was taking place with commissioners, G4S and hospitals to try to address this. This included looking at how to better spread discharges throughout the day.

Ten new patient transport vehicles had been delivered during the previous month with three additional vehicles for Medway hospital due to become operational in the next week. Significant work had been undertaken with dialysis patients, with a relationship manager having spent time at hospitals to understand patient needs so that these could be factored into the specification for new vehicles. Patients who had had problematic journeys previously had also been visited.

A patient transport standard specified that no more than 1% of patients should wait longer than four hours to be taken home from hospital. The service had experienced significant problems with long waits. Much progress had been made but there was still more to do. The latest figures showed that 0.1% of patients booked in advance had experienced a long wait as well as 0.8% of patients booked on the day.

In response to a question from a Committee Member, it was confirmed that escorts were allowed to accompany patients on transport vehicles. The number of patient escorts was approximately 25,000 per year. Facilitating escort journeys could be challenging but there were no plans to restrict accompaniment.

A Committee Member asked what the process was for monitoring the contract and ensuring that improvement was sustained. The Committee was advised that the acuity of patients being transported had changed since the award of the contract and there had been a 3.5% increase in the number of patients requiring ambulance transport. Ongoing contract monitoring was undertaken with a detailed quality report produced on a monthly basis. This was rigorously challenged at a monthly contract review meeting. Full inspection CQC issued notices in relation to training had now been satisfied with evidence having been provided to the CQC.

The Managing Director  ...  view the full minutes text for item 296.

The report provides information on the number, type and other information on adult social care complaints received during the period April 2017 - March 2018. It also highlights some examples of the many positive things people have said about the provision of adult social care in Medway over the same period and the service improvements the Council has made as a result of lessons learnt from complaints.

Discussion

The report provided information on complaints and compliments received between April 2017 and March 2018. As part of the overall quality assurance framework it was important to understand where people were not happy with the services provided in order that these concerns could be addressed for all service users.

98 complaints had been processed during the year, an increase compared to the 83 handled during 2016/17 and 82 in 2015/16. It was acknowledged that performance in the last year was not as good as it should have been. Changes had been put in place to the way in which the handing of complaints was monitored. It was noted that performance had improved during the current financial year. For quarter 1, there had been improvement in the timeliness of performance with 67% of complaints having been handled within the agreed timescale. For June 2018, this figure was 80%. A significant proportion of complaints had been upheld which demonstrated that there were issues to address within Adult Social Care.

Financial issues and a lack of or poor communication were the two areas for which there had been the most complaints. The importance of ensuring that correct information in relation to cases and complaints was recorded on the Council’s software system and that this recording needed to be timely, had been emphasised to staff. Mobile working had been rolled out across all staff within adult social care with positive staff feedback having been received about its impact. Staff were now able to update records while working remotely. The number of complaints in relation to a lack of or poor communication was also a concern. One cause of this had been lack of staff capacity with work being undertaken to ensure that resources were allocated efficiently to help ensure more effective communication in the future. A number of staff had been specifically allocated to be the first point of contact for any new calls, contacts and e-mails. These were now responded to immediately. The Manager for Social Care Complaints attended Performance and Quality Assurance meetings on a regular basis to report back on complaint volumes and the nature of complaints received. She had also run some workshops with practice managers to cover the principles of complaint handling and how lessons are learnt from complaints.

A Committee Member was concerned that in January 2018, no complaints had been responded to within the target time of 20 days and that 10 complaints had been carried forward from 2017/18 to the current year. The Member asked what had caused the delay in responding to complaints.

Officers advised that the winter period had been particularly challenging with there having been high levels of staff sickness within the service that had impacted on the January performance. The Assistant Director of Adult Social Care was meeting with his Heads of Service each month to review outstanding complaints and ensure that they were actioned appropriately. There was currently only one outstanding complaint that had exceeded the 20 day target for  ...  view the full minutes text for item 297.

This report updates the Committee on the review and redesign of urgent care across North Kent and Medway. The redesign of these services has previously been determined to be a substantial development of or variation in the provision of health services in Medway, triggering a statutory obligation on the relevant NHS bodies and health service providers to consult with overview and scrutiny.

This report from NHS Medway Clinical Commissioning Group (CCG) updates the Committee on the guidance received since the last update was presented to Committee in August 2018.

Discussion

The Committee had previously been advised of proposals in relation to engagement events due to be held in  relation to the Urgent Care Redesign. Since then, a number of events had taken place in Medway as well as one in Swale. 68% of respondents to the engagement process generally agreed with the proposals. Some concerns had been raised, which had been taken into account taken into account by Medway NHS Clinical Commissioning Group (CCG). Key issues raised during the engagement had included a lack of parking, poor access, a lack of public transport and other infrastructure related issues as well as the need to ensure sufficient staff capacity and for staff to receive appropriate training.

£1million of funding had been made available to the CCG to invest in estate at Medway Maritime Hospital. This would help to ensure that the urgent treatment centre at the hospital had sufficient capacity. Investment would be  made in improving parking and providing an extra 600 GP appointments each week. Medway Community Healthcare was looking to join its out of hours GP appointment service with the provision at the hospital in order to improve resilience and reduce administration costs.

A Committee Member noted the need for the CCG to link in with the work that the Council was undertaking to help address congestion in the vicinity of the hospital.

Decision

The Committee noted and commented on the update provided on the Integrated Urgent Care Redesign.

This report presents Medway’s draft Joint Health and Wellbeing Strategy for 2018 -2023. The strategy contains a proposed vision and a set of priorities structured around five key themes. The priorities have been chosen after reviewing feedback from community engagement events, evidence from the JSNA and input from health and social care professionals and wider stakeholders, including the voluntary sector.

Discussion

The draft Medway Health and Wellbeing Strategy covered the period 2018-23 with each Health and Wellbeing Board having a statutory duty to produce a Strategy. The draft had been presented to the Board and to the CCG Governing Body in July 2018 for comment. It had been agreed that the new Strategy would be based upon a refresh of the previous 2012-17 Strategy. The five main themes of the Strategy were Giving every child a good start; Enabling our older population to live independently and well; Preventing early death and increasing years of healthy life; Improving mental and physical health and wellbeing and; Reducing health inequalities. The key strategic drivers of the Strategy included the Council Plan, the Kent and Medway Sustainability and Transformation Plan and the new Local Plan. Collectively, these documents created an opportunity to shape Medway to improve the health and wellbeing of residents.

The 2012-17 Strategy had not had not contained an explicitly stated vision. Based upon feedback from engagement events and discussion between the Council and CCG, the following vision was proposed for the new Strategy – ‘That lives of all people in Medway will be as full, healthy and meaningful as possible and that we will achieve this through making Medway a place people are enabled and encouraged to look after themselves and others and where services are accessible and delivered equally well across the area.’

The vision aimed to capture that individuals are responsible for their own health and wellbeing but that this does not happen in isolation and that there is a need to create an environment that enables people to make healthy choices. The draft Strategy proposed a small number of priorities which would focus on the areas for which there was the greatest need for support from the Health and Wellbeing Board. The draft would be updated to reflect feedback received so far and was due to be presented to the Health and Wellbeing Board in November.

In response to a Member question it was confirmed that social isolation would be an area of priority focus and that the findings of the Social Isolation Task Group would be factored in accordingly.

A Committee Member felt that the priorities of the Strategy should be more ambitious and aspirational and that there should be measurable targets associated with the priorities, which should clearly acknowledge the need to reduce health inequalities. In response, the Public Health Consultant advised that the current focus was ensuring that that the correct priorities were identified and that targets would be set after this.

Decision

The Committee considered and commented on the draft Joint Health and Wellbeing Strategy and its priorities, as set out in Appendix 1 to the report.

To advise the Committee of any petitions received by the Council which fall within the remit of this Committee, including a summary of the response sent to the petition organisers by officers.

Discussion

A petition had been received that fell within the terms of reference of the Committee. This related to the Royal Voluntary Service (RVS) Centre in Chatham. The petition called on the Council to:

“Reconsider their decision to remove the £35k grant they have provided to the Royal Voluntary Service for the past few years as the removal will force the closure of this much needed facility.”

As the petitioner had not requested that the matter be discussed at the Committee, the Committee was requested to note the petition and officer response as set out in the report.

The Committee was advised that an update report on the Royal Voluntary Service RVS Older People’s Centre was due to be considered by Cabinet in October. A Committee Member requested that an update be presented to the Committee in advance of this.

Decision

The Committee noted the petition response and appropriate officer action in paragraph 3 of the report and agreed that an update on the RVS Centre should be presented to the Committee at the appropriate time.

Discussion

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

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 the following changes to the Work Programme:

a.    A further update on the development of a Kent and Medway NHS Strategic Commissioner be added to be added to the Work Programme for the October 2018 meeting.

b.    An update on the implementation of the recommendations of the Dementia Task Group be provided to the Committee as a briefing note instead of being presented at a future meeting.

c.    An update on the work of the Health and Wellbeing Board be added to the Work Programme for the October 2018 meeting.

d.    A report on GP Services in Medway should be added to the Work Programme for the December 2018 meeting and for this to include key statistics in relation to GP provision in Medway.

e.    A report on wheelchair services in Medway be added to the agenda for the October 2018 Committee meeting.

f.     An update on the elements of the Council Transformation programme that fall within the remit of this Committee be added to the Work Programme for the December 2018 meeting.