Agenda and minutes

The Chairman referred to the recent sad death of Councillor Tashi Bhutia, a long-standing Member of the Committee. A minute’s silence was held in memory of Councillor Bhutia.

Apologies for absence were received from Councillors Ahmed, Murray, McDonald, Prenter 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 15 June 2021.

The record of the meeting of the Committee held on 15 June 2021 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

In relation to agenda item 9 (Council Plan Performance Monitoring and Risk Register Review Quarter 4 2020/21),Councillor Cooper disclosed that she was a volunteer for Medway Voluntary Action and a Trustee of Medway African and Caribbean Association.

Whipping

There were no declarations of whipping.

This paper provides an update on the ‘Eradicating mental health dormitory wards in Kent and Medway’ programme, including the programme timeline, the integrated impact assessment, implementation planning, the consultation plan and timeline and proposed visits to better understand community-based mental health services in Medway.

Discussion:

Members considered a report on the ‘Eradicating mental health dormitory wards in Kent and Medway’ programme.

The following issues were discussed:

·     Consultation – in response to a comment about the number of unconfirmed activities in the timetable (paragraph 7.4 of the report), Members were advised that this was due to the need to submit the paper before the consultation started. A full list of dates and times would be sent to Members. In response to a point that the draft consultation document should have been submitted to the Committee, Members were advised that the tight timetable had prevented this, but the draft consultation document had been informally shared with Members before the public launch and the feedback received had been incorporated.

·     Proposals and reasons for change – in response to a request for more clarity on the reasons for change, Members were advised that the proposal was to relocate Ruby Ward to a new location on the Maidstone Hospital Site owned by KMPT. The number of beds would increase from 14 to 16. The new site would allow enhancements not possible at the Ruby Ward site, including more space for therapeutic activities, access to outside space and en-suite private rooms. The privacy and dignity of patients would be significantly enhanced, and the environment would be more conducive to support people to get better and be discharged more quickly. Whether KMPT had sufficient staff to achieve these ambitions was queried and KMPT advised that the Trust had secured national funding to improve therapeutic services and recruit gym instructors etc.

A comment was made that the proposal represented the closure of Ruby Ward and, given the highest number of users came from Medway, the new unit should be located in Medway, albeit the new unit would result in a better service. As the new unit would be a mixed sex ward, whether this meant a reduced service for women was queried as well as whether there would be sufficient beds in the future given likely demographic changes. In response, KMPT advised that the number of beds would increase from 14 to 16 beds, so overall the bed base would increase across Kent and Medway. Ruby Ward was female only, but KMPT operated a flexible bed base with admissions on a needs basis.

A point was made that it was disappointing another mental health facility appeared to be moving out of Medway, although it was acknowledged the new facility would be an improvement. There was a need now for patients and families to understand what was happening, a proper transition programme and free or heavily subsidised transport.

·     Location of the new unit – concern was expressed at the possibility of the new unit being located adjacent to a psychiatric ward as this would be detrimental for patients and visitors. KMPT advised that the new unit would be a psychiatric ward for older people and would be located on a site with other psychiatric wards.

·     Ruby Ward staff - questions and concerns  ...  view the full minutes text for item 245.

This paper provides an overview of MCH’s current position of community health services provision.

Discussion:

Members considered a report which provided an overview of Medway Community Healthcare’s (MCH) current position of community health services provision.

The following issues were discussed:

·     Flow and discharge - there were comments that this remained a challenge and reference was made to reports of people being sent home without the right care package. MCH advised no patients were left at home without any health provided care. The cause of the problem was lack of providers and in house staff providing packages of care which were delaying discharges from Medway Maritime Hospital and MCH was working with partners to address this. Another challenge was on occasions patients remained in community beds longer than they should. There had been an improvement in flow and discharge, but it was not at the pace MCH would like, this was Kent and Medway issue not just local and the system were looking at ways to address this together.

·     Feedback – in response to a request, an undertaking was given that future reports would contain cases of negative feedback and what had been done to try and resolve these.

·     Contact by phone - Reference was made to long delays in getting in contact with some MCH services by phone. MCH advised there had been problems with the new call centre, but the service had been improved and was closely monitored.

·     Increase in waiting times for services – how MCH wasaddressing recruitment issues was questioned. MCH advised that there were only two key services whereby vacancies were problematic , community nursing and nutrition and dietetics. The community nursing service vacancy rate had improved slightly from 40% to 38%.  MCH were moving from large locality-based nursing teams to smaller neighbourhood teams, with the aim of improving outcomes for patients and working conditions for nurses. This was expected to help with recruitment. MCH was also looking at its back-office teams to see what roles could be released from clinical staff. In response to a question whether these smaller teams were more impacted by the high vacancy rate, MCH advised the model encouraged teams to work through problems themselves and the teams could be quite creative, such as more flexible shifts. MCH were looking at whether this model could be embedded across the organisation and an event with stakeholders was planned to highlight the benefits of the model. MCH would welcome a site visit from Members to better understand how the teams worked. The goal was for the teams to work closely and where possible base themselves with GP services. 

·     Sickness levels – in terms of whether levels were a concern, MCH advised that sickness levels were relatively stable, but higher than ideal. Stress and anxiety were the two main causes of sickness. How the health and well-being of staff was supported had been reviewed and staff had been made aware of what help was available and had issued a brochure of support in place so staff could access any support they feel appropriate.

·        Clinical assessment waiting times  ...  view the full minutes text for item 246.

This paper provides an update on KMPT services based in Medway and/or support the Medway population and an overview of the main care pathways for adults and older adults into KMPT mental health services.

Discussion:

Members considered a paper which provided an update on KMPT services based in Medway and/or support the Medway population; an overview of the main care pathways for adults and older adults into KMPT mental health services and an update on the Medway and Kent eating disorder service.

The following issues were discussed:

·     Pathways – in response to a comment about the complexity of the clinical pathways diagrams in the report, Members were advised that these were very high level and not used to communicate with the public. The Trust was redesigning its literature to make it clearer to patients what therapies they were likely to receive and what the possible outcomes could be.

·     Britton House – following a recent Member site visit to Britton House, there were a number of questions about working conditions and the general environment at Britton House. KMPT advised that there had been the normal teething problems when staff had moved into the building which had been addressed. However, a balance had to be struck between infection control and the rooms being inviting to service users and staff.  There had been some initial complaints from staff but none since and there was a staff consultation group in place to discuss issues. There was now a blended model of working with around 50% of clinical appointments moving to  a digital platform. This model had generally been viewed positively but KMPT recognised that a one size fits all model was not appropriate and through the review of the agile working programme take into consideration ongoing views of staff and patients to ensure improvements are sustained, safe and of a high quality.

·     Voluntary Sector - to what extent KMPT supported the voluntary sector, given its reliance on it to provide mental health services was queried. Members were advised that KMPT were rolling out a programme, starting in Medway and Swale, to redesign the community mental health offer for people with serious mental illness. This would involve the voluntary sector. NHS England understood the importance of a sustainable voluntary sector and the programme was an opportunity to think differently about how MCH used its resources.

·     Waiting times standards - a comment was made that the target of 18 weeks from referral to commencement of treatment with the Community Mental Health Teams was not very challenging. Members were assured that urgent care responses were either the same day or within 72 hours and anyone waiting for 18 weeks would have been already contacted and assessed. KMPT commented this standard is the same standard most mental health trusts are measured against however continually review to try to reduce wait times where possible.

·     Dementia diagnoses – Members were advised this rate had improved in recent months, but more progress was needed. A paper on this issue would be submitted to the Committee.

·     Specialist Perinatal Mental Health Services – in response to a question about how fathers were supported currently, KMPT advised that Covid had meant fathers could not be invited into the  ...  view the full minutes text for item 247.

This report updates Members on the Kent and Medway Suicide Prevention Strategy for Adults. It also includes the summary outcomes from local consultation and changes made in line with feedback receive

Discussion:

Members considered a report on the Kent and Medway Suicide Prevention Strategy for Adults, including the summary outcomes from local consultation and changes made in line with feedback received. Following Cabinet approval an action plan would be developed and brought to the Committee.

The following issues were discussed:

·     Data – a point was made that the Strategy would benefit from some data and statistics. Members were advised that the Joint Strategic Needs Assessment contained information about the number of suicides and this showed Medway was close to the national average and lower than the Kent authorities. The data on intentional self-harm leading to emergency admission showed Medway was lower than the national average.

·     Substance misuse – noting an increase in deaths from this and a reduction in funding for the service (both nationally and in Medway), how this was being address was queried. The Director of Public Health commented that the lockdowns had led to more people self-medicating. Alcohol rates had increased in Medway but the completion rate for people seeking alcohol treatment was close to the national average. He felt the key was to have an efficient service which delivered good outcomes rather than just focus on the cost of the service. The reductions in the funding had not impacted on the service’s effectiveness.

·     Innovative approaches to reduce suicide and self-harm among high-risk groups – some concern was expressed that this was qualified by the phrase “where funding allows”. The Director of Public Health commented this was a high-level strategy and mental health was one of the 9 system priorities in Kent and Medway. He added there was a need to look at how to support families and to work in partnership to tackle the wider determinants leading to suicide. How long someone remained as high risk was questioned, and the Director of Public Health responded this would depend on their individual circumstances.  

·     Neuro-development disorders – in response to a question, the Director of Public Health confirmed that the carers of this group of people were included.

·     Numbers of suicides in Kent and Medway – in response to a request for a breakdown of numbers, the Director of Public Health advised that the data existed but care was needed in analysing it due to a re-categorisation by the coroners service which may have led to an increase in numbers, although rates in Medway were low.

Decision:

The Committee agreed to recommend that Cabinet approve the Kent and Medway Adult Suicide Prevention Strategy on a page, as set out in section 4 of the report.

This report summarises performance in Quarter 4 on the delivery of the Council Plan priority relevant for this committee: Supporting Medway’s people to realise their potential. This report also presents the Quarter 4 2020/21 review of strategic risks.

Discussion:

Members considered a report which summarised performance in Quarter 4 on the delivery of the Council Plan priority relevant for this committee: Supporting Medway’s people to realise their potential. This report also presented the Quarter 4 2020/21 review of strategic risks.

The following issues were discussed:

·     Permanent admissions to care home – how more places could be provided and how this risk was being managed were questioned. The Assistant Director – Adult Social Care advised that the pandemic had led to an increase in placements and there were also pressures regarding recruiting and retaining staff, which was a national issue. The Council was working with partners to try and help with the latter.

·     Financial sustainability of providers – in response to concerns regarding the financial sustainability of providers leading to closures, the Assistant Director – Adult Social Care advised this has not been a particular problem in Medway and that on occasions CQC inspections can lead to closures. However, the Council was learning lessons from other councils where providers had experienced financial problems.

·     Direct payments – a comment was made that direct payments were beneficial but not well understood and how well they were supported was queried. The Assistant Director – Adult Social Care advised that the Council worked closely with families to make them aware of how direct payments worked and their options. There had been a decrease in take up of direct payments during the pandemic but this was now changing. The Assistant Director felt that there was a need to ensure that staff consistently considered direct payments as an option when assessing care needs. 

Decision:

The Committee agreed to note the Quarter 4 2020/21 performance against the measures used to monitor progress against the Council’s priorities, and to also note the amended Strategic Risk Register as set out in Appendix 2 to the report.

 Discussion:

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

A suggestion was made that the issue of the rise in deaths from alcohol and substance deaths and how local services were performing be added to the work programme. 

Decision:

The Committee:

a)      agreed the changes to the work programme as set out in paragraph 2.2;

b)      requested a briefing note on the role of the Primary Care Networks in Medway;

c)      agreed that a proposal to add to the work programme the issue of the rise in deaths from alcohol and substance abuse be discussed at the next agenda planning meeting.