Agenda and minutes

The Chairman commented on the very sad news that Hannah Jackson, a Staff Nurse at Medway Maritime Hospital, had passed away recently.

Hannah has been described as a much-loved colleague who was dedicated to caring for others and she will be greatly missed by everyone who knew her.

On behalf of the Committee the Chairman offered his sincere condolences to Hannah’s family and friends and also all the other NHS and social care workers and residents who have lost their lives in recent times. 

The Chairman then called for a minute’s silence.

Apologies for absence were received from Councillors Ahmed, Barrett, Bhutia, McDonald and Paterson.

(During this period, the Conservative and Labour and Co-operative political groups had informally agreed, due the Coronavirus pandemic, to run meetings with reduced number of participants. This was to reduce risk, comply with Government guidance and enable more efficient meetings. Therefore the apologies given reflected that informal agreement of reduced participants).

To approve the record of the meeting held on 12 November 2020.

The record of the meeting of the Committee held on 12 November 2020 was agreed and signed by the Chairman as correct. 

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.

Whipping

There were no declarations of whipping.

At its meeting on 18 August 2020 the Committee received briefings from the Kent and Medway Clinical Commissioning Group (CCG) on the concerns affecting both the dermatology and primary care contracted services run by DMC Healthcare (DMC) across Medway. Since the last briefing both the dermatology and primary care contracts with DMC have been terminated by mutual agreement and alternative service provisions put in place. In circumstance where contracts are discontinued prematurely the CCG conducts a formal review. This report details the findings of the final review for dermatology and the initial draft ones covering primary care which are still works in progress.

Discussion:

Members considered a report from the Clinical Commissioning Group (CCG) on the findings of the final review for dermatology and the initial draft ones covering primary care. This followed a briefing at the August 2020 meeting of the Committee on concerns affecting both the dermatology and primary care contracted services run by DMC Healthcare (DMC) across Medway. Since then both the dermatology and primary care contracts with DMC had been terminated by mutual agreement and alternative service provisions put in place.

The CCG reported these arrangements were working well and they would continue to be actively supported and monitored. In circumstances where contracts were discontinued prematurely the CCG conducted a formal review, in accordance with good organisational learning and development practice.

In terms of the dermatology service, the CCG reported that the interim provider had moved forward very quickly and over 12,000 patients had been seen with the backlog cleared. Targets had been met and there were waits of around 6-8 weeks for routine appointments, which was expected to be below 6 weeks by the end of January 2021.

In relation to primary care services, the CCG commented that they were trying to address long standing recruitment and retention problems in these 5 practices. There were still some remaining governance issues to resolve.

The CCG Accountable Officer acknowledged that mistakes had been made but assured Members the CCG was committed to learning from these and making improvements, as well as listening to stakeholders, so this would not happen again. The new arrangements put in place were delivering improvements in services. An assurance was given that there would be proper engagement with stakeholders when developing services in the future. The now larger CCG meant that there could be tensions between scale and local focus, but it was felt a larger organisation was better placed to respond to the problems that had been identified.

The following issues were discussed:

·       Assurances offered by the CCG – the point was made that whilst the CCG seemed to be addressing the problems it was difficult to not be wary of the assurances offered given that the CCG had made similar assurances to the Committee previously that the dermatology service was working well in spite of concerns expressed by the Committee and the public and patients. The CCG was asked if any other contracts had gone wrong where this had not been anticipated. The CCG advised that most contracts were with very large providers. Given the number of contracts it was inevitable that issues would arise, but Members could be assured by the fact that the suspension of a contract was rare.

·       DMC contract – reference was made to the CCG’s comment that 4 submissions had been received to run the dermatology service and DMC’s perception that they were the only organisation in the running and had been faced with an unrealistic time to improve the service. How the contract with DMC had never been signed was also questioned. The CCG responded that DMC had  ...  view the full minutes text for item 541.

This report introduces the Kent and Medway Safeguarding Adults Board’s (KMSAB) Annual Report for April 2019–March 2020.

Discussion:

The Interim Chair of the Kent and Medway Safeguarding Adults Board  (KMSAB) introduced the Annual Report for April 2019–March 2020. The Annual Report set out the responsibilities and structure of the Board and detailed how the multi-agency partnership delivered against its priorities for the year. The report also provided information pertaining to Safeguarding Adults Reviews, funding arrangements and safeguarding activity information. The Interim Chair advised that the Independent Chair of the Board had recently resigned.

The following issues were discussed:

·       Increase in safeguarding concerns – the 12.8% rise in concerns in 2019/20 compared to the previous year was highlighted, accepting there had been a campaign to raise awareness. Whether all concerns raised were investigated was queried. The Interim Chair advised that all concerns were looked at initially and a decision was reached on each referral. About 50% of referrals were classified as safeguarding concerns. In all cases, the action taken was recorded.

How the Board could be sure this increase in cases was due to the campaign to raise awareness was questioned. The point was made that in terms of safeguarding concerns per 100,000 adults, Medway was below average and perhaps this showed there was more to do to raise awareness. The Interim Chair commented that there was always more that could be done to raise awareness. Next year’s report was likely to show an increase in numbers due to the restrictions in place during the pandemic and an increase in mental health problems. The Board had the resources to manage an increase in numbers. The Director added that demographic changes were also expected to lead to an increase in concerns. In 2019/20 domestic abuse had led to a significant increase in referrals. The comparator table included in the report largely comprised counties and this would be looked at.

·       Self-neglect – a concern was raised that there was very likely to be a significant increase in cases of self-neglect as a result of the pandemic. The Interim Chair agreed with that assessment, adding the Board and adult social care staff were focused on identifying people who needed help but were not asking for it. An additional 6 social workers had been made available to prepare for the expected surge in demand. The Director added that less than 1% of referrals were self-referrals. Often people who were at risk did not consider themselves to be vulnerable.

·       Oversight and management of risk when multiple agencies were working with an individual – how a lead was selected and monitored in these situations was queried. The Interim Chair responded that the agencies would decide on a lead organisation to take responsibility and the latter would then allocate the role to an individual.

·       Transition to adulthood – it was noted that one of the completed safeguarding reviews mentioned in the report covered the transition from a young person to adulthood. The Interim Chair commented that the Board was looking to identify young people around the age of 14 to ensure there was a plan  ...  view the full minutes text for item 542.

Medway’s Council Plan 2016/21 sets out the Council’s three priorities. This report and appendix summarise perrformance in Quarter 2 20/20/21 on the delivery of the priority relevant for this Committee: Supporting Medway’s people to realise their potential.

Discussion:

Members considered a report which set out how the Council performed in Quarter 2 against the priority in the Council Plan 2016/21 relevant to the Committee: Supporting Medway’s people to realise their potential.

·       Performance – staff were commended for meeting targets to the extent they had given the pandemic.

·       Funding – The Director commented that the Association of Directors of Adult Social Services had expressed concern at a national level about funding for adult social care. The agreement on the social care precept was encouraging and the adult social care grant had been secured and significant additional covid related investment funding would probably continue until well into the new year. While efficiencies would still be needed those could not be at the cost of safety and quality of service.

·       Financial risks – noting the number of high risk/priority areas in the Strategic Risk Register, it was suggested that there was an opportunity for the Council to use capital investment to purchase its own facilities. The Council was now acquiring a large amount of property and this could be looked at instead of reliance on the private market. The Director advised that he was in the early stages of looking at an accommodation strategy and the opportunities this could bring and he would welcome a discussion with Members on this.

·       Cyber security risk – reference was made to the possibility of a cyber security attack affecting the telecare service and the security of the arrangements for providers and service users was queried. The Assistant Director – Adult Services commented that the telecare service was delivered through phone lines so risks were small. There was a pilot which involved more information about individuals being held and that would be looked at to confirm it was secure in the event of a cyber-attack.

·       Support for vulnerable adults living independently – in response to a question about how the Council supported this group during the pandemic, the Director commented that there had been a reduction in numbers entering permanent residential care. This was probably due to concerns about covid transmission in care homes during the first wave. There had been an increase in people asking for support to return to their home from residential care. This might change as the second wave so far had not seen the same rates of transmission in care homes as in the first wave.

·       Foetal alcohol spectrum disorder – concern was expressed about the extent of this problem and potential difficulties in supporting young people into adulthood. The Director stated this was an important issue and alcohol use in pregnancy was higher than he would like it to be. Work was ongoing to look at the transition pathway to see if affected children could be identified earlier, although some may not meet the threshold for adult social care and other ways of supporting them would need to be looked at. This issue would be discussed further with Members at an agenda planning meeting. A briefing note on  ...  view the full minutes text for item 543.

This report presents the Council’s draft capital and revenue budgets for 2020/21. 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 2021. The draft budget is based on the principles contained in the Medium Term Financial Strategy (MTFS) 2021-2023 considered by the Cabinet on 17 November

Discussion:

The Committee considered a report regarding the Council’s draft capital and revenue budgets for 2020/21.

The Head of Finance Strategy advised that the key points from the Government Spending Review announced on 25 November were:

·       The Government would fund covid related pressures in 2021/22

·       The Council would have the flexibility to levy a 3% adult social care precept.

·       New grant funding would be made available for children’s and adult social care.

·       Further funding to help with homelessness

·       A levelling up fund of £4 billion.

The possibility of using capital investment to meet increased demand in adult social care was referred to. The Head of Finance Strategy advised that the capital programme had increased significantly in recent years as interest rates were low. Any invest to save opportunities would follow the current prudent approach to borrowing.

Decision:

The Committee:

a)    noted that Cabinet has instructed officers to continue to work with Portfolio Holders in formulating robust proposals to balance the budget for 2021/22 and beyond.

b)    noted the proposals outlined in the draft capital and revenue budgets in so far as they relate to the services within the remit of this Committee.

Discussion:

Members considered a report regarding the Committee’s current work programme.

Decision:

The Committee agreed changes to the Work Programme as set out in paragraph 3 of the report, subject to the Annual Public Health report coming to the March 2021 meeting instead of January.