Agenda and minutes

Apologies for absence were received from Councillors Adeoye and Chrissy Stamp.  

It was noted that James Williams, Director of Public Health, had given his apologies for this meeting owing to his attendance at a regional meeting on Coronavirus at the same time.

To approve the record of the meeting held on 16 January 2020.

The record of the meeting held on 16 January 2020 was agreed by the Committee and signed by Chairman as correct subject to the following:

Minute no. 566 (Disclosable Pecuniary Interests or Other Significant Interests and Whipping) – it was agreed to amend second line under other significant interest (OSI) as follows: replace “owned” with “leased”.

Minute no. 569 (Development of Single Kent and Medway Clinical Commissioning Group) – it was agreed to amend the decision by adding the following to the end of the sentence: “…, whilst expressing reservations about the development of a single CCG.”

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 details the areas covered by the Portfolio Holder for Adults’ Services which fall within the remit of this Committee.

Discussion:

Members received an overview of progress on the areas of work within the terms of reference of this Committee and covered by the Portfolio Holder for Adults’ Services, Councillor Brake as set out below:

Community Care

Adults’ Mental Health and Disability Services (including Learning and Physical Disabilities)

Older People

Public Health – Lead Member, including Health and Wellbeing Boards

Adults’ Partnership Commissioning (25+) and Better Care Fund

Health and Health Partnerships

Councillor Brake responded to Members’ questions and comments as follows:

IMPOWER list of high performing Councils for Adult Social Care – in response to a question asking for more information on the recent announcement regarding Medway’s inclusion in the 15 highest performing Councils in the country, the Portfolio Holder stated that the Council had been recognised as achieving greater than average outcomes from a less than average spend per head. This meant that residents who used these services were receiving better outcomes and the council was making best use of public funds. He stated that it was not possible to know where the Council had been ranked because IMPOWER had published the list in alphabetical order.

Coronavirus (COVID-19) – a number of Members expressed concerns about matters relating to Coronavirus (COVID-19), such as the availability of hand sanitisers on Council premises, the exposure of staff at customer facing premises such as the community hubs and Kingsley House, the capacity of the voluntary sector and requested information on the Council’s response to the issue.

The Portfolio Holder stated that he shared the concerns of Members and he advised the Committee that the Council, through the Director of Public Health, was receiving advice from Public Health England on a daily basis. He repeated the advice which had been provided about everyone washing their hands with soap for 20 seconds and that the advice had not stated that the provision of hand sanitisers was required.

At the end of the discussion on this item, the Director of People – Children and Adults Services informed the Committee that it was had not been possible for the Director of Public Health (DPH) to attend this meeting owing to his attendance at a regional meeting on Coronavirus at the same time. He explained that the DPH was the Council’s lead on this issue and was part of the county-wide Local Resilience Forum and that, in addition, the DPH was due to attend a Tactical Response Group meeting the following day.

The Director informed the Committee of a school in Medway which had decided to close earlier in the week owing to a case of Coronavirus. He stated that some organisations were deciding to take measures beyond what was required which was understandable. He also informed the Committee that he would be attending a regional meeting of Directors of Adult Social Care to discuss a number of issues. He also confirmed that there were no current plans to withdraw the provision of services and there was no evidence of providers withdrawing services, however, there may  ...  view the full minutes text for item 764.

This report updates the committee on the South East Coast Ambulance Service Foundation Trust, with a focus on key developments since the Committee was last updated in June 2019. These key areas include: CQC reporting, award of the NHS 111 CAS contract, performance and performance recovery, and key senior appointments.

Discussion:

This report updated the Committee on the performance of the South East Coast Ambulance Service Foundation Trust (SECAmb) with a focus on key developments since the Committee was last updated in June 2019.

Three SECAmb representatives were in attendance for this item and the Associate Director of Operations gave an overview of their work and highlighted a number of key issues. These included SECAmb coming out of special measures in 2019, changes to the leadership team, the award of the 111 Clinical Assessment Service contract for a period of 5 years, an overview of performance including hospital handover delays. She also gave an update on staffing, clinical education, electronic record keeping and the Trust’s estate.

SECAmb representatives responded to Members’ questions and comments as follows:

111 Service – In response to questions regarding how SECAmb intended to improve the 111 service, the Strategy and Partnerships Manager stated that they would be taking on the service in Medway, Kent, and Sussex from April 2020 for a period of 5 years and that it would be possible to develop seamless 111 and 999 services as they both used the NHS Pathways triage tool and together with other changes he was confident that the public would see an improved service.

Management Structure and staffing – In response to a question regarding the regular changes to the management structure and staffing and the need for continuity in supporting improvement, the Associate Director of Operations stated that she had been in post for four months and she was committed to being part of a cohesive leadership team and putting a strategy in place for the next 5 years. She stated that the recent review of the structure was in part related to the aim of achieving an excellent rating from the Care Quality Commission.

In response to a question seeking clarification as to whether the restructure had included new posts and/or new personnel, the Strategy and Partnerships Manager confirmed that the recruitment had been to existing posts.

In response to a question regarding turnover of staff generally, the Senior Operational Manager confirmed that this was a challenge owing to a number of reasons including, for example, agencies paying inflated sums for Paramedics.

Watling Street Ambulance Station – In response to a question seeking an update on the future of the site, the Senior Operational Manager stated that this site was now under Medway Council’s ownership as part of the One Public Estate programme. He referred to work underway to recommission the outpost in Commercial Road, Strood, whilst work was ongoing regarding the planning application for a new station in Medway.

Bullyingand harassment – In response to questions expressing disappointment that the issue of bullying was not covered in the report and the lack of public accountability, SECAmb representatives undertook to include this information in the next report to this Committee. The Associate Director of Operations advised the Committee of the steps of taken by the Trust to eradicate bullying and harassment. These included  ...  view the full minutes text for item 765.

This paper has been provided to update the Committee on the inpatient service provided at the Frank Lloyd unit, following the last report in October 2019.

The Frank Lloyd Unit is a Continuing Health Care unit located on the Sittingbourne Memorial Hospital site. Kent and Medway Partnership Trust (KMPT) is commissioned by all Kent & Medway CCGs to provide this service. The unit provides highly specialist care and treatment for patients at a very advanced stage of their dementia, who have a range of complex needs including behaviours that challenge.

Discussion:

This report provided an update to the Committee on the inpatient service at the Frank Lloyd Unit, Sittingbourne, which provided a continuing health care unit.

Adam Wickings, Deputy Managing Director, NHS West Kent CCG was in attendance for this item and he gave an overview of the proposals, including the CCG’s assessment that the proposals constituted a Substantial Variation (SV).

In response to a comment expressing concern regarding the apparent wish to move away from NHS continuing care, the Deputy Managing Director stated that there was a variety of views on this issue and the purpose of this exercise would be to find the best solution to the issue.

Decision:

a)    The Committee considered and commented on the report and proposed development or variation to the health service, as set out in the report and appendices 1 and 2 to the report.

b)    The Committee, in consideration of the CCG assessment that the proposaldoes represent a substantial development of, or variation to, the health service, agreed that it considered the proposals to amount to a substantial development of or variation to the health service in Medway.

c)    The Committee, having agreed that it considered the proposals to amount to a substantial development of or variation to the health service in Medway, noted that the matter will need to be considered by the Kent and Medway NHS Joint Overview and Scrutiny Committee.

The Committee has asked for a further update on the Eating Disorder Service following consideration of a report and presentation at the June 2019 meeting.

Eating disorders continues to be a 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 Chairman announced that Michelle Dewar from Medway Parent and Carer Forum was in attendance for this report in view of the significant number of eating disorder service users who were children and young people.

This report provided details of a further update on the All Age Eating Disorder (AAED) Service following consideration of a report and presentation at the June 2019 meeting.

Representatives from the Council and NELFT (the service provider) were in attendance and the Head of Children’s Partnership Commissioning, Resources and Youth Justice and the Director the Director of Operations, NELFT gave a brief update on the service since the last meeting they had attended.

Officers and NELFT representatives responded to Members’ questions and comments as follows:

Gender mix and referral to the service – in response to a question relating to the prevalence of men suffering from eating disorders (but not using the service) and how the service was being promoted to men given they were hard to reach:

It was confirmed that the service was aware of the issue related to low referrals of males;

The main point of access to the service was through a GP referral, however, it was recognised that there was still a stigma for men to come forward;

It was noted that some work was being undertaken on the issue in schools through PSHE lessons. With regards to accessing the service in general, it was stated that further work with GPs and schools was required as well as the need to make improvements to the digital offer.

Relapse support – In response to a question relating to the level of support for those who suffered from relapses, the Head of Service for AAED, NELFT, stated that that there was a relapse pathway in place and that they were discussing the development of an early intervention and relapse programme with Commissioners.

Referral times – in response to a question regarding referral times, the Head of Service, NELFT, stated that there was a target for 95% of children and young people to be seen within two weeks of a referral, however, there were some reasons why this was not always met, for example, capacity at certain times or non-attendance.

Breakdown of age groups – in response to a question requesting further information on the breakdown of age groups, it was noted that this ranged from 5-64.  The service received very few young people under 8 and looked at other support but also those under 8 years old would consist of less than 5 children meaning that this would information would not be shared under GDPR guidance.

Members asked in the future the age break down could be 5-10, 11-17, 18-30, 31-64, 65+. This was agreed by the Service.

MARSIPAN risk assessment – in response to a question asking for a definition of MARSIPAN, the Head of Service for AAED, NELFT, stated that this was a NICE standard which provided an evidence based pathway to determine the level of need.

CAMHS –  ...  view the full minutes text for item 767.

The Social Isolation Task Group report considered the impact of social isolation and loneliness in Medway. It made a number of recommendations for actions that the Council and other organisations could take to reduce social isolation locally.

The attached progress report summarises progress against each of the review’s recommendations.

Discussion:

This report provided details of a review against each of the Social Isolation Task Group’s recommendations.

The Consultant in Public Health gave an overview on the report highlighting some of the key actions which had been undertaken.

Officers responded to Members’ questions and comments as follows:

Social Prescribing – in response to a question seeking clarity on the commencement of this work, the Consultant in Public Health confirmed that three officers (Link Workers) were now in post to support this initiative, which was focused on the 65+ age group.

Simply Connect – in response to a question asking whether there were alternatives available to the website, the Consultant in Public Health stated that there was a printed directory and a phone line as alternatives to the website.

Voluntary Sector – In response to a question relating to the work of the Voluntary Sector Task Group where, from the evidence the Group had considered, there was a fear that there may be a lack of capacity in the Voluntary Sector to support social prescribing, the Consultant in Public Health agreed that there was some risk in this area. However, other models were being looked at, for example, Bristol, as well as seeking further funding to support social prescribing.

Coronavirus (COVID-19) – In response to concerns that older people would have with regards to Coronavirus, and the role of the Consultant in Public Health in dealing with this issue, he confirmed that he was part of the Silver Command Task Group and he shared the concerns about older people becoming even more vulnerable at this time.

Technology to assist older people – In response to a question how technology could assist older people, for example, whether a bus pass could be replaced by a fingerprint, or whether the bus companies trained their drivers to spot people with dementia, the Consultant in Public Health referred to examples around the country but he could look into this with Arriva. The Public Health Projects Officer also provided an update on the role bus companies and their drivers could play in this area.

Engaging with BME Groups – it was requested that a talk be given to the Seniors Group at the Afro-Caribbean Association at the Sunlight Centre. In response to a question regarding the development of work on recommendation 18, the Consultant in Public Health referred to work with the Medway Diversity Forum and that further work was being undertaken on this issue.

Young People – in response to a question regardingwhat plans were in place to deal with young people were encountering social isolation, the Consultant in Public Health stated that a new JSNA was currently being compiled which would identify key priorities. The Public Health Projects Officer also provided some examples which highlighted the need for more work in this area. The Director of Place – Children and Adults Services also highlighted the issue of community care leavers given that social isolation was an issue for them, therefore, a care leavers  ...  view the full minutes text for item 768.

Medway’s Council Plan 2016/21 sets out the Council’s three priorities. This report and appendices summarise how we performed in Q3 2019/20 on the delivery relevant for this committee: Supporting Medway’s people to realise their potential. In accordance with the Council’s Risk Management Strategy, this report also presents the Q3 2019/20 review of the strategic risk relevant to this Committee.

Discussion:

This report provided details of the Council’s performance for quarter 3 as well as presenting a review of the strategic risks relevant to this Committee.

The Assistant Director, Adult Social Care, stated that the end of year report there would include some detailed analysis to enable some detailed discussion.

In response to comments which supported the need for further analysis together with some analysis on mitigating risks in this service area, the Director of People – Children and Adults Services stated there had been some deep diving to look at the data which would inform the debate regarding the qualitative analysis and performance.

Decision:

The Committee noted the Q3 2019/20 performance against the measures used to monitor progress against the Council’s priorities, and to note the amended strategic risk register as set out in Appendix 2.

Discussion:

This report proposed changes to the Work Programme.

Decision:

a)    The Committee agreed changes to the Work Programme as set out in paragraph 3 of the report.

b)    The Committee agreed to a report back on South East Coast Ambulance Service and the All Age Eating Disorder Service.

c)    The Committee agreed to add a report to the Work Programme on the Medway Clinical Commissioning Group comparing past to present data including factors such as GP numbers, numbers of surgeries and the numbers of acute beds.

d)    The Committee agreed to send a letter of thanks to Stephen Clark, Chair of the Medway Foundation Trust, ahead of his retirement.