Agenda and minutes

Apologies for absence were received from Councillor Clarke. 

To approve the record of the meeting held on 17 January 2019.

The record of the meeting held on 17 January 2019 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)

There were none.

Other interests

There were none.

This report and attached appendix sets out a response to an issue, raised by Councillor Purdy, relating to the Kent and Medway Wheelchair Service.

Discussion

Councillor Purdy introduced her Member item. She had requested inclusion of the item on the agenda due to the length of time that some people were having to wait for a wheelchair to be provided or for repairs to their wheelchair. The item would also provide Members with the same opportunity to consider the matter as the Kent Health Scrutiny Committee, which had previously considered reports on the Kent and Medway Wheelchair service.

Representatives from the East Kent CCGs and Millbrook Healthcare introduced the report. This showed steady and continuous improvement in performance of the service but it was recognised that there was still significant further work to be undertaken by the CCGs and Millbrook Healthcare in order to provide the required service. Service users were being closely involved in this improvement journey. A Service Improvement Board was being established that would include a service user representative. Three events to engage with service users were due to take place in April and May and the information collected at these would feed into a Service Improvement Plan. The waiting list for assessment and equipment provision had reduced from 3,369 in August 2018 to 2,386 in January 2019. These figures included new referrals of around 120 clients a month. There had been a waiting list reduction for the fifth consecutive month. The average waiting time for repairs had reduced from 5.6 weeks in November 2018 to 2.9 weeks in February 2019 while the number of patients waiting for repairs had fallen steadily until January 2019 when it had stood at 132. It had then increased slightly in February due to staff vacancies. This was being addressed by Millbrook.

Questions asked by Committee Members were responded to as follows:

Activity level included in contract – A Member asked why the contract with Millbrook Healthcare had not correctly forecast demand and why in-depth work had not been undertaken to ensure that demand was correctly forecast. The Committee was told that this had been caused by Millbrook having inherited a bigger waiting list than was known about during procurement. Many of the patients on the waiting list were amongst those with the most complex needs. The data available from the previous nine contracts covering Kent and Medway had not been detailed enough. The CCGs had commissioned an independent audit to review the procurement process with the CCGs now acting upon those recommendations. All the Kent and Medway CCGs had agreed to provide additional funding to enable Millbrook to address the waiting list.

Available data, Medway specific data, Complaints Review and training – A Committee Member asked why adequate data had not been available ahead of the tendering process and said that the need for additional funding demonstrated that the commissioning process had gone wrong. The Member would have liked to have seen Medway specific data included in report. He also asked when the Complaints Review would be completed. Concern was expressed that the review of eligibility had not been undertaken earlier and also that  ...  view the full minutes text for item 891.

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

Discussion

A presentation was given to the Committee, the key points of which were as follows:

·      The hospital’s transformation programme was ‘Better, Best, Brilliant.’ Individual transformation projects were showcased, such as what staff were doing to improve the hospital, improvements to patient flows and discharge processes and work with community partners. An Outpatient transformation programme was due to take place over the next year.

·      Ensuring financial stability was a key priority. The deficit for the previous year was £66million and the Trust would hit its control total of £46million for the current year. The £21 million savings target had been achieved, helped by reductions in expenditure on agency staff.

·      In relation to Emergency Department performance, 82.8% of patients were seen within the target of four hours. This was 8% below the trajectory figure. There were challenges associated with patient outflows from the hospital which highlighted why integrated discharge was important.

·      In relation to the 18 week standard for referral to treatment time, the figure was 80% for the current month, down slightly from 81% in the previous month. Work was taking place with commissioners to identify how to improve performance to 92%. The percentage for cancer patients in December was 83.6%, which was below target by 2.1%. Significant specialist work was being undertaken, including looking at constraints for each pathway.

·      Performance for diagnostics was ahead of trajectory but below the constitutional standard. An additional MRI and CT scanner would be provided which would help to improve performance.

·      The Trust had managed to fully comply with the limits of the NHS Agency Staff Cost Cap and was one of the only trusts in Kent and Medway to have achieved this.

·      The response rate to the staff survey was 40%, which was below the national average of 44%. Three of the metrics had the same performance as previously while figures for six had declined. Responses indicated above average performance for appraisals and provision of a safe environment. Morale was a new national indicator with work taking place to understand what influenced this measure.

·      The ‘You are the Difference Programme’ was ensuring that staff had the tools to deliver high quality care and create the right culture at Medway.

A Committee Member said that the results of the staff survey were mixed. She asked how much awareness there was of the issues faced and how the Trust was addressing them. She highlighted national concerns about access to cancer care and treatment and asked how much confidence there was that Medway would be able to avoid some of the difficulties that other areas were experiencing, particularly in view of Medway having relatively low take-up rates of cancer screening. The Member also asked how the savings made had been achieved, for the Trust’s view on the decision of the Kent and Medway Stroke Review not to establish a Hyper Acute Stroke Unit (HASU) in Medway and whether the Trust was ready to deliver a HASU should the decision be changed, in view of the Council’s  ...  view the full minutes text for item 892.

This report updates the Committee on improving outpatient services across Medway and Swale. This in line with the Medway Model and community service redesign, which will enable care to be delivered closer to people’s homes. The improvement programme will be bringing services together, this will enable health and care staff to work more closely together and develop services that focus on the needs of the patients.

This report from NHS Medway Clinical Commissioning Group (CCG) updates the Committee on the progress of the programme since the previous paper on the Community Service Redesign and the Medway model that was sent to the Committee in January 2019.

Discussion

The Committee had previously considered reports on the Community Services redesign and information on the Medway Model. The report now under consideration outlined how proposals to improve outpatient services in Medway fitted into that model. There had been significant feedback showing that patients wanted care to be provided closer to their home than at present. The current outpatient model was condition led, with patients allocated a set number of appointments based on their condition. The aim of the proposals was to make services patient led and needs focused. Consultants would have direct access to GPs to help eliminate unnecessary referrals.

The CCG was working with partners, such as Medway Foundation Trust, the Council and Primary Care Networks to consider how consultants could spend time in community hubs, rather than in the hospital, so that consultant appointments could be provided in the hubs. Consultants and GPs would work in a multi-disciplinary team to enable patients to see the correct professional at the right time and in a non-hospital setting. Rheumatology, neurology, elderly care, clinical haematology and respiratory services would be included in the first phase of the proposed changes. Patient engagement would be used to inform the redesign of specific pathways. These redesigned pathways would benefit patients and free up consultant and clinician time. Appointments would be patient led with patients being able to request appointments to meet their needs rather than being allocated a fixed number of appointments in a period. Where appropriate, use would also be made of telecare services. Patients would be able to access crisis support quickly rather than having to first attend the Accident and Emergency Department.

Questions asked by Committee Members were responded to as follows:

Use of telecare and engagement – A Member expressed concern that not everyone was willing or able to use electronic services and asked what confidence those taking part in engagement could have that their views would be listened to in view of the outcome of the Kent and Medway Stroke Review.

The Committee was assured that services would be matched to the needs of the population and that other options would be available for those unable to make use of technology. There was an aspiration to design services that fitted with the needs and wishes of the local population. No groups had yet been identified that would be disadvantaged by the proposals.

Outpatient Services – In response to a Member who asked for clarification of where patients would attend for outpatient appointments in the future and also, how it would be ensured that services were provided in a single visit, it was confirmed that most patients would be seen in community hubs. Discussions were taking place with the Foundation Trust about how to relocate rheumatology appointments and provide the necessary x-ray facilities in a community setting. Mobile units were being considered. The aspiration was for a range of services to be provided to patients on a single visit. It was noted that this was not always possible currently  ...  view the full minutes text for item 893.

The report provides an update on the work of Kent and Medway NHS and Social Care Partnership Trust (KMPT).

Discussion

The report provided details of strategic mental health work taking place across Kent and Medway in relation to the Sustainability and Transformation Plan, as well as local work being undertaken by KMPT services. Mental health had a high profile on the national agenda. Nationally, £2 billion of funding had been announced for mental health. It was not yet known how much of this Medway would receive.

Mental Health was a significant part of the NHS Long Term Plan. Priorities highlighted in the Plan included prevention, child mental health, access to talking therapies, mental health crisis response, pregnant women / new mothers and suicide prevention. In relation to suicide prevention, the rate in Medway had reduced by more than the national average. The Medway Early Intervention team was performing well and consideration was being given as to how it could link with acute partners in relation to crisis response access to mental health. KMPT had recently received the results of a Care Quality Commission (CQC) well led inspection. This has been very positive with ratings having improved in nine inspection areas and the overall rating having been good. The caring domain had been rated as outstanding.

The Ruby Ward at Medway Maritime Hospital, which deals with older female patients, had had its estate judged by the CQC to be not fit for purpose. This would be renovated as part of KMPT’s Estate Plan. The plans to relocate mental health services from Canada House in Gillingham and Elizabeth House in Rainham, to a new facility at Britton Farm, Gillingham were progressing. Public consultation was being planned, with it being anticipated that a Consultation Plan would be ready to share later in spring 2019. A Councillor visit was due to be arranged in the summer to the KMPT hub in Ashford.

Work was being undertaken to consider how to provide mental health intervention at an earlier stage, especially in relation to primary care. KMPT aimed to work with NHS 111 to enable people to use it as a single access point rather than having to contact multiple organisations in order to get information or a referral. A good relationship had been established with the CCG mental health GP lead, who was helping with GP engagement plans. Staffing mental health services remained a national challenge with 30,000 mental health practitioners being required. It was expected that KMPT would be able to meet its financial targets while maintaining high quality services.

Questions asked by Committee Members were responded to as follows:

Support when a crisis recurs – A Committee Member expressed concern that there was a lack of support available for patients when a mental health crisis recurred. Intensive therapy and monitoring would come to an end and it was then challenging for people to regain access to services. Recognition and awareness of mental health difficulties amongst GPs also tended to be low. In response, the Chief Operating Officer of KMPT said that access to mental health care when in crisis was included  ...  view the full minutes text for item 894.

The NHS Long Term Plan sets an expectation that Integrated Care Systems will be established by April 2021. Work has commenced across Kent and Medway in designing an integrated system including changes to existing organisational forms, functions and the anticipated benefits that these changes will have in better meeting the health needs of the population. 

This paper sets out:

-       Progress to date in developing an integrated model; 

-       Outputs from two co-production workshops held across the system on future organisational forms and functions;

-       High level timeline for transition to a shadow form and end state by April 2020; and

-       Key next steps.

Discussion

The development of a Medway System Commissioner was a clinically led piece of work. The Case for Change for the Kent and Medway Sustainability and Transformation Plan (STP) had identified a number of challenges. It was noted that, left unchecked, health budgets would need to grow at around 5% each year to provide the full range of services, with only 1.5% of this being attributable to population growth. Key themes for the STP included intervention, prevention, addressing health inequalities and the health of the population. While there was lots of expertise in the healthcare system, this was not always used as effectively as it could be. In order to address the challenges there needed to be a cultural shift. The framework of the current system was based on the development of internal markets for health services and was therefore not suited to increased partnership and integrated working.   Four integrated care partnerships would be created across Kent and Medway as well as constituent primary care networks working under these. None of these bodies, nor the System Commissioner had a statutory basis. The statutory bodies remained NHS England and the Kent and Medway clinical commissioning groups. Integrating the budgeting and commissioning of health and social care would be challenging and the timeline specified by NHS England, which required Integrated Care to be established across STP footprints by April 2021, was considered ambitious.

A Committee Member said that the fact that healthcare was free of charge to the end user, while social care was not, would make integration and pooling of budgets difficult. The Kent and Medway STP representatives said the requirement for Integrated Care Partnerships to be in place by 2021 did not necessarily mean that health and social care would be integrated at that point. Integration was an aspiration but not a requirement. The Assistant Director of Adult Social Care said that social care was working with health colleagues in order to facilitate more collaboration between the two systems, but that there was significant work required for full integration to be achieved. Social care teams were participating in Integrated Locality Reviews to consider how to achieve better integration. Enabling providers to work together more effectively was an alternative to full scale integration. Publication of the Government Green Paper on Adult Social Care had been delayed a number of times. It was anticipated that this would set out expectations for integration of health and social care.

The STP representatives said that better collaboration could enable users of health and care services needing to use fewer organisations in order to be provided with their full range of services. An example highlighted was of a service user visited in their home by representatives of five organisations within a short space of time. It was suggested that better collaboration could reduce the number of organisations providing a direct service to this individual while the service user could benefit from more personalised service provision.

A Committee Member said that strengthening links and cooperation between health  ...  view the full minutes text for item 895.

The existing Medway Carers’ Strategy 2015-2017 was developed to ensure the Council was Care Act compliant and able to demonstrate its commitment to carers. The Council’s legal duty to assess and identify the eligible needs of carers and the important contribution that carers make to supporting our strategic priorities, has led to the development of the draft Medway Joint Carers’ Strategy 2019-2024.

The strategy has been coproduced with carers and in consultation with stakeholders. It describes how health and social care services, provider organisations and the voluntary sector will work together over the next five years to respond and meet the needs of carers in Medway.

The strategy aligns with the overall objectives defined within the Council Plan, the Health and Wellbeing Strategy for Medway and “Getting Better Together”, the Adult Social Care Strategy for Medway.

The success of implementing this strategy lies firmly in a collaborative and joined up approach. A clear governance and performance framework will help to drive the strategy forward through the development of a joint delivery plan that measures whole system benefit.

Discussion

The Council had a statutory responsibility under the Care Act to assess the needs of carers and to separately assess the needs of those in receipt of care. The Medway Joint Carers’ Strategy would support the Council and Medway NHS Clinical Commissioning Group (CCG) to work jointly with carers to support them effectively. It was considered that figures for the number of young carers locally were likely to underrepresent the true picture. The figures showed that of 64,000 under 18’s in Medway, there were 660 young carers. There were also 1,600 aged 16 to 25. One driver of the Strategy was the need to identify carers that the Council was not aware of.

The underpinning vision had not changed since the previous Carers’ Strategy but the health and social care system had. The new Strategy reflected these changes. It had been co-produced with carers and stakeholder engagement had been undertaken. A Carers Service for new older and younger carers had been established. The service, which had launched in January 2019 using Better Care Fund funding, was provided by Carers First. It formed part of the wider voluntary and community sector consortium contract.

The six key priorities set out in the Strategy were:

1.    Identification and recognition of all carers in Medway 

2.    Provision of good quality Information, advice, guidance and support

3.    Access and involvement in assessment and support planning

4.    High quality carers support services

5.    Support to maintain physical, emotional health and wellbeing

6.    Respecting the expertise that carers have

A Committee Member commended the co-production of the Strategy and emphasised that work was needed to identify hidden carers. He also emphasised the social isolation that many carers faced. The Member asked what steps were being taken and how the CGG was being involved in development of the Strategy.

The Head of Health Improvement said that CCG colleagues were engaged in Strategy development. The Strategy would be presented to the Local Care Strategy Group and other CCG forums over next six months to develop an action plan. Updates on Strategy delivery would be provided during the five year period that it covered.

A Member, who had had experience of being a carer shared his experience with the Committee. He highlighted the following:

·         The development of a local induction pack for people becoming a carer would be welcome.

·         Taking on caring duties while working was challenging.

·         Carers benefitted from receiving training about managing a crisis soon after becoming a carer but it was also difficult for many carers to leave their home to attend.

·         There needed to be preparation and training to enable carers to deal with end of life considerations.

·         The Member had been linked in with Medway hospice from early on. Care provided by the hospice had helped the cared for person to regain their dignity.

·         Both carer and cared for person had completed a questionnaire about attitudes to death. It had been good to have an open conversation about death.

·         It would be helpful to  ...  view the full minutes text for item 896.

This report provides an update on the Adult Social Care Transformation programme and outlines the 2018/19 Transformation Projects.

Discussion

The report updated the Committee on the Council’s Transformation Programme within Adult Social Care. Each of the Council scrutiny committees was receiving an update on the areas of the Transformation Programme relevant to their terms of reference. The focus of the report was Adult Social Care. Key themes included making financial savings through transformation, organisational change and use of technology, including mobile working. Investment in Transformation was leading to savings being made. It was confirmed that the Council was implementing the ‘Tell us Once’ programme, with it being anticipated that this would be running in six to eight weeks.

Questions asked by Committee Members were responded to as follows:

Blue Badge delays and customer choice – A Committee Member said that there was a need to improve communication with residents and that it had been the Council’s choice to make services digital. He highlighted poor and inconsistent communication in relation to Blue Badges for disabled drivers. Another Committee Member said that Blue Badges had to be applied for online, rather than via a paper form, which was not something she found easy. She had, therefore, had to ask someone to help her with her application. The Member had been told that it would take two to three weeks for someone to be available to help her to apply over the phone.

The Assistant Director – Transformation apologised that service users were finding the application process difficult. The use of online systems had been mandated by central Government and the system had been changed without notice. The concerns raised about communication were acknowledged. With regards to Council provided services, customers were not being forced to access them digitally. Assisted digital support was provided in Community Hubs with over 300 applicants for Blue Badges, or their carers, having been supported. It was anticipated that many of these would not need support in the future but this would be provided where required. The Assistant Director undertook to investigate the 2-3 week timeframe highlighted for the Member to be provided phone support with their application. Software had been purchased that would allow customers to log in and see the current status of all their transactions with the Council, including Blue Badges. The system would be rolled out from 1 April 2019, with as many as possible Council services being added to the system over the next year. The system also enabled automated messages to be sent to update customers on the status of their application. This would reduce the need for people to phone the Council for updates.

Adult Social Care Restructure and Shared Lives – A Member asked for an update on the restructure of Adult Social Care and on the Shared Lives Services. She sought assurances on what steps would be taken when difficulties were encountered by a client placed by the scheme.

The Assistant Director, Adult Social Care said that the substantive restructure of Adult Social Care had been completed 18 months previously. The service had changed its  ...  view the full minutes text for item 897.

Medway’s Council Plan 2016/21 sets out the Council’s three priorities. This report and appendices summarise how we performed in quarter 3 2018/19 on the delivery of the priority relevant to this Committee: Supporting Medway’s people to realise their potential.

Discussion

The report summarised 2018/19 quarter 3 performance for the Council Plan priorities relevant to the Committee. This included detailed information for each relevant performance indicator and a summary of overall performance. Performance was above target for five of the ten measures and below target for four. Performance had, however, improved for three of these.

Decision

The Committee considered the quarter 3 performance of the measures of success used to monitor progress against the Council’s priorities.

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.    Reports on Medway NHS Clinical Commissioning Group’s Operational Plan and a further report on Outpatient Services in Medway be added to the Work Programme for the June 2019 meeting.

b.    A report on Suicide Prevention and, subject to confirmation by officers from Public Health, a report on ensuring a good pregnancy, be added to Work Programme for the June 2019 meeting.

c.    Further update reports on the Kent and Medway Wheelchair Service, from Medway Foundation Trust and from Kent and Medway NHS and Social Care Partnership Trust be added to the Work Programme for the August 2019 meeting.

d.    The Director of Public Health Annual Report be added to the Work Programme for the October 2019 meeting.