Agenda and minutes

Councillor Wildey was elected Chairman for the municipal year 2021/22.

The Chairman announced that the election of vice-chairman was being dealt with as urgent business so that the Committee could elect a vice-chairman at this meeting and could carry out their responsibilities without any delay.

Councillor Purdy was elected Vice-Chairman for the municipal year 2021/22.

Apologies for absence were received from Councillors Barrett, Bhutia, McDonald, Price and Thompson.

(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 11 March 2021.

The record of the meeting of the Committee held on 11 March 2021 was agreed and signed by the Chairman as correct.

There were no other urgent matters to announce.

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.

or text

Members are asked to consider a paper from the Medway NHS Foundation Trust on recent inspections by the Care Quality Commission.

Discussion:

Members consider a paper from the Medway NHS Foundation Trust on recent inspections by the Care Quality Commission.

Dr Sulch, Chief Medical Officer, introduced the report and clarified that the statement in the paper that the Care Quality Commission (CQC) had lowered the rating of the Emergency Department (ED) to inadequate was incorrect as this rating in fact related to the performance of the Trust as a whole.

Dr Sulch commented that the Trust’s Patient First approach was designed to improve patient flow, reduce ambulance handover delays and the time spent waiting in ED and to improve the quality of patient care. There had been a significant reduction in the time patients waited more than 60 minutes in an ambulance before they were handed over. Numbers of people visiting the ED since Easter were now much higher. The average time patients waited in an ambulance had improved significantly since the winter. The average times for patients wating for a decision to admit and also from then to a bed being available were still too high and the Trust was committed to improving this. In total, patients spent an average of 8-9 hours in the ED before being allocated a bed. The new Interim Chief Executive had made it clear performance needed to improve significantly.

Members raised the following issues:

·       Ambulance Station – reference was made to a visit in December 2020 and the disorganised nature of this area with no records being kept of which ambulance was in which bay. Dr Sulch responded that ambulance movements were monitored via a white board, which would become an electronic system. There was now better oversight with a clear focus on any patient identified as deteriorating, who was now brought straight into the hospital.

·       Positive staff comments – the positive comments made by staff to the CQC inspectors were welcomed, noting that this had not always been the case in the past where the CQC had consistently highlighted staff not taking management action seriously enough. Dr Sulch commented the aim was to make the hospital a genuinely clinically led organisation.

·       Communications – with reference to the consultation on the future of healthcare, what this was trying to achieve and how it related to other consultations in Medway was queried. Dr Sulch commented the Trust’s clinical strategy needed to be refreshed and seen in the context of the wider health system it was a part of.

·       Attendance at Emergency Department – the increase in the numbers of people attending the ED was noted but seen as connected to the difficulties in obtaining a GP appointment and the number of staff working on the vaccine programme. Whether data existed to identify the sources of people attending the ED was queried. Dr Sulch commented there was evidence some patients were presenting later with conditions and complications not seen for many years and the reasons for this were being explored. The MedOCC service picked up about 30% of those who attended ED who did not need  ...  view the full minutes text for item 74.

Members are asked to consider a paper which provides an overview to the NHS response to the pandemic and includes work being delivered by a wide range of NHS partners.

Discussion:

Members considered a paper which provided an overview to the NHS response to the pandemic, including work being delivered by a wide range of NHS partners.

The Executive Director for Health Improvement/Chief Operating Officer of the Kent and Medway Clinical Commissioning Group (CCG) introduced the report and highlighted the way the NHS bodies locally had worked as a team in response to the pandemic and to deliver the vaccination programme. The whole system was under pressure and was looking to see how things could be done differently.

Members discussed the following issues:

·       Vaccination programme – the difference between first and second dose uptake in Cohort 1 and also the differences in doses by vaccination centre were queried. Members were advised that some people had received their second dose in a different venue to the first. Recording of where vaccines were administered was now more sophisticated and Members were assured every dose was recorded and there was no double counting. Some people had opted to go to a primary care centre to avoid travelling to one of the further away vaccination centres. In response to a point that there should be a dedicated vaccine workforce, the CCG accepted this in principle but noted the model was moving towards vaccination centres which were less clinically led.

·       GP appointments – with regard to the large number of appointments classified as unknown and what was being done to respond to concerns about the public accessing GP surgeries when the entrances were often physically closed, Members were advised the numbers classed as unknown were large, but this had been higher in the past. The CCG acknowledged it was more difficult to access GP surgeries than before and was working with surgeries on new ways to make them more accessible to the public. The CCG was also looking at how to avoid people discharged from hospital going to their GP for medicines. In response to a point that about 40% of people accessing GP services could be seen by someone other than a GP, it was noted that this had been a long-time ambition and whether the workforce was in place to achieve this was questioned. A comment was made that the triage system could be risk averse and often advised people to see a GP. The CCG accepted there was not sufficient capacity in primary care and was trying to mitigate this. An undertaking was given to try to provide a breakdown of GP appointments in Medway in future reports.

·       Cancer patients – the vaccine strategy for this group was queried and the CCG clarified that all cancer patients were being contacted and the vaccine take up rate was impressive. Trusts had worked well so these patients’ pathways were not disrupted.

·       Vaccine equality – an undertaking was given to provide Members with the data behind this.

·       Private health companies – concern was expressed about private companies promoting a free appointment with a private doctor as this could result in a person being delisted by  ...  view the full minutes text for item 75.

Members are asked to consider a paper which provides an update on;

 • the impact of COVID-19 on the demand for mental health services.

 • the transformation of the wider mental health services, in particular  the transformation of community mental health services and urgent and emergency care mental health services.

• the transformation of dementia services, including the redesign of dementia services for people with complex needs.

Discussion:

Members considered a paper which provided an update on the following areas:

•       The impact of COVID-19 on the demand for mental health services.

•       The transformation of the wider mental health services, in particular the transformation of community mental health services and urgent and emergency care mental health services.

•       The transformation of dementia services, including the redesign of dementia services for people with complex needs.

Members discussed the following issues:

·       KMPT crisis line – a reference was made to long waiting times for self-referrals and a recorded message people received when they telephoned the crisis line which advised them of alternative services before cutting off. The point was made that this would often be frustrating for people with mental health issues. KMPT responded that this recorded message asked colleagues in other services to email rather than wait for their call to be answered. This was due to a significant increase in demand for this service and allowed staff to concentrate on caring for patients. There were challenges around waiting times, partly due to demand. The plan was to transition to the 111 service to provide a more robust service. A new telephony system was being purchased due to some problems with the existing service. Members were assured that the recorded message on the crisis line did not direct people to go to their GP.

·       Performance – A comment was made that people had to often re-tell their stories when receiving treatment for a crisis and had to use different services. The CCG acknowledged the importance of people not having to re-tell their stories and commented that there were plans to reduce the number of assessments and make services more conducive to the needs of the individual. A point was made that service users often received support without any results and suffered from a “revolving door” situation and that the  transformation programme was a chance to offer people professional help at the right time. KMPT commented that the proposals were designed to enhance community services to bring help closer to where people lived. However, this could never be 100% effective. There was a need to move away from focusing on crisis care and to help people before they were in crisis. The proposals aimed to achieve that.

·       Talking therapies – a briefing note on the effectiveness of this service was requested in the light of negative feedback reported to a councillor. Demand for these services had dropped due to Covid but the expected increase in demand had only recently happened. An undertaking was given that the next update would include performance information on the voluntary and community services referred to in the report.

·       Move to Britton Farm – how the move to this venue had gone was questioned and a reference was also made to some service users seeking specialist medicine at Britton Farm in a distressed state. How KMPT linked up with other services in this situation was queried. KMPT commented the move to Britton Farm had  ...  view the full minutes text for item 76.

Members are asked to consider a paper regarding proposals for eradicating outdated dormitory accommodation for mental health inpatients in Kent and Medway and constructing a proposed new purpose-built facility.

Discussion:

Members considered a paper regarding proposals for eradicating outdated dormitory accommodation for mental health inpatients in Kent and Medway and constructing a proposed new purpose-built facility.

The Committee was advised that Kent County Council’s Health Overview and Scrutiny Committee had considered these proposals on 10 June 2021 and had decided they were not a substantial variation. Therefore, the matter would not need to be considered by the Joint Health Scrutiny Committee.

Members discussed the following issues:

•       Consultation – in terms of when this would start, Members were advised that a range of dates were being considered with a likely early August start. In response to comments about a lack of progress since the Committee had recommended public consultation in March and what would happen if the outcome was to not accept the closure of Ruby Ward, Members were advised that there had been a lot of work needed with the regulator (NHS England) to get to this stage, including the development of a pre-consultation business case. The CCG were required to commission services across Kent and Medway and recognised that the timetable set by NHS England had caused some problems for Medway Members. The CCG acknowledged this would be a one option consultation, but its purpose was to understand the issues and concerns services users and their families had so that any disadvantages could be mitigated. The CCG stated they were genuinely open minded to any alternative options suggested that met the case for change and could pass the same evaluation criteria as other options considered to date. The CCG confirmed  the responses to the consultation would be independently analysed and would feed into a decision-making business case to be considered by the CCG governing body towards the end of this year. No decision had been made yet and the aim was to hear from those who would be most impacted. As part of the consultation, discussions would take place with groups likely to represent those most affected.

A comment was made that those most likely to need this service would by their nature often find it difficult to discuss the issues.

Medway Healthwatch were involved in the consultation process and had already commented that, as it was a one option consultation, the public should be given the opportunity to add comments and had asked that questions around travel be added.

A comment was made that it would still be difficult for many people to travel the 12 miles to Maidstone by public transport and levels of car ownership for the groups affected by this change were lower.

A point was made that there were high levels of diabetes and heart disease in Medway, and this was likely to lead to increased levels of dementia.

•       Investment in Medway – how much investment would occur in Medway should Ruby ward close was queried. In response, Members were advised that the proposals were about relocating not closing a service and Medway residents would still be able to access this  ...  view the full minutes text for item 77.

This report asks Members to consider the Adult Social Care Strategy, which sets out the objectives and focus for Medway Adult Social Care over the next 4 years.

Discussion:

Members considered a report regarding the Adult Social Care Strategy, which set out the objectives and focus for Medway Adult Social Care over the next four years.

Members discussed the following issues:

·       Shift from reactive to empowerment – the point was made that often by the time people approached the Council for help with adult social care, they would have done all they could to prevent care being need. The Strategy did not address that and assumed most people were in a position to offer help. Therefore, being told at the point they asked for help that the Council would empower them to do more would be a difficult message to convey. The Assistant Director – Adult Social Care responded that the data showed that when people asked for help they were often not sure where to go and often did not meet the criteria for adult social care. The reference to empowerment was more about acknowledging that and signposting people to the most appropriate place for help. Feedback from partners was they often referred people to adult social care as they did not know where to suggest.

·       “Just enough” support  and delayed need– noting the aim that ‘just enough’ support would be provided to assist people to build on their current strengths and develop their abilities to look after themselves without becoming overly dependent on social care support, it was suggested that it should be clarified that “just enough” did not mean the right level of care would not be provided. The point was also made that these phrases seemed negative. The Assistant Director – Adult Social Care acknowledged there had been some concerns about the “just enough” phrase during the consultation, but this  meant to convey what statutorily the Council had to do and what support others could provide. However, she would revisit the “just enough” phrase. The reference to delayed need, a phrase commonly used in the Care Act, was about what prevention could be put in place and not meant to suggest care itself would be delayed.

·       Paying for care – the lack of any reference in the Strategy to the need to pay for adult social care was highlighted. The Assistant Director – Adult Social Care acknowledged there should be a link to the charging policy.

·       Women carers – noting women took on the majority of caring responsibilities, it was noted there was no reference to their right to have their needs as carers assessed.

·       Transition to adulthood – what changes young disabled people would see when they became adults was questioned. The Assistant Director – Adult Social Care advised a programme had been set up to make transition from childhood to adulthood much smoother and that people were being captured at an earlier age than before. This would look at the needs of an individual and assess what the next steps were if they were eligible for care. If they were not eligible then the Council would look at what other support  ...  view the full minutes text for item 78.

This item advises Members of the current work programme and allows the Committee to adjust it in the light of latest priorities, issues and circumstances.  

 Discussion:

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

The Chairman paid tribute to Maggie Cane (Medway Healthwatch) who was attending her last meeting of the Committee and thanked her for her expertise and contributions during her time as a co-opted Member.

Decision:

The Committee agreed:

a)      that the update from Medway Community Healthcare be submitted to the August meeting.

b)      that a proposal to add to the work programme the outcome of a Government consultation on the development of a Women’s Health Strategy and look at local women’s health services be considered at the next agenda planning meeting.