Agenda and minutes

Apologies for absence were received from Councillors Adeoye, Thompson and McDonald.

To approve the record of the meeting held on 18 January 2022.

The record of the meeting of the Committee held on 18 January 2022 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

Councillor Cooper disclosed the following interests:

·     Agenda item 6 – her step Grandson was employed as a call handler with SECAmb.

·     Agenda item 8 – she was a governor at Rivermead School which, although not mentioned in the report, specialised in Autistic Spectrum Disorders and Asperger’s Syndrome.

·     Agenda item 9 – she was a Trustee of the Medway Afro Caribbean Association which was mentioned in Annexe 1 to the report and was also a befriender for Medway Voluntary Action.

Councillor Purdy in relation to agenda item 5 disclosed that she was a Trustee of the Foetal Alcohol Syndrome Trust.

This report provides an update on Medway’s approach to supporting healthy pregnancy. It details some of the initiatives, targets and outcomes being delivered locally and sets out some of the key undertakings in the next 12 months.

Discussion:

Members considered a report which provided an update on Medway’s approach to supporting healthy pregnancy. It details some of the initiatives, targets and outcomes being delivered locally and sets out some of the key undertakings in the next 12 months.

The following issues were discussed:

·       Team Connect – a point was made that the numbers of vulnerable people  engaging with Team Connect seemed low given the relatively high birth rate in Medway. What more could be done to engage with this group was questioned. Members were advised that Team Connect focussed on vulnerable families and cases were increasing generally. The Team decided whether further support was needed and, in general, outcomes for women with vulnerabilities were good. The Team worked closely with Children’s Services and other partners.  

·       BAME women – noting that BAME women were more likely to experience problems during pregnancy and birth, what efforts had been made to offer support was queried and also whether this had made an impact. The Head of Midwifery reported that BAME women often had other comorbidities and there were pathways in place to support them during pregnancy and after. During the pandemic this group had been a priority for continued face to face appointments.

·       Pre-natal care – whether more work could be done on this was questioned and Members were advised that regular screening took place to identify babies at risk and ensure an appropriate birth plan was in place. There were several methods by which health and wellbeing key messages were communicated in addition to the Bump Birth and Beyond Website, including pre-conception counselling, advice delivered through GP appointments and conversations between parents and health visitors about planning for the next baby. 

·       Smoking and vaping – in response to a question about to what extent the dangers of this in pregnancy were known, Members were advised that nicotine replacement therapy was offered first to help pregnant woman to stop smoking. The national guidance on vaping was that it was not risk free but was less risky than smoking. The smoking at delivery target tended to fluctuate, which was why the 16% target had not been reduced.

In response to a query whether permission was required to carry out carbon monoxide monitoring and whether this could mean smoking rates were higher than thought, Members were advised that this took place at 32 weeks and was offered to everyone, with a good take up of over 80% and a high level of referrals to the smoking cessation team.

An undertaking was given to examine whether it would be possible to provide a breakdown of the age ranges of those classed as smoking at delivery.

·       Caesarean sections – with regard to the  statement that that the proportion of caesarean sections in Kent and Medway between 2017/18 -2019/20 had been statistically higher than the England average required further exploration, Members were advised that this rate had risen in the last 10 years. In Medway the number of first-time mothers in this group  ...  view the full minutes text for item 738.

This report updates the committee on the South East Coast Ambulance Service NHS Foundation Trust, with a focus on key developments since the Committee was last updated in November 2020.

Discussion:

Members considered a report which updated the Committee on the South East Coast Ambulance Service NHS Foundation Trust (SECAmb), with a focus on key developments since the Committee was last updated in November 2020.

The following issues were discussed:

·       Change in activity profile and acuity of calls – whether the Trust had failed to plan for this was questioned. Members were advised that a review had identified a shortfall in the Trust’s 999 funding. Since then the Trust had recruited more front-line staff and, as a result, there were more ambulances available, although ensuring they were available at the right time and in the right place was complex. Covid had presented unique challenges such as staff absences and reduced activity as many members of the public were reluctant to add to the service’s pressures or did not want to be taken to hospital. Covid had also led to difficulties in forecasting levels of activity and had impacted on how patients accessed care, with greater numbers using the 111 service. The Trust was looking at the level of resources needed for the predicted levels of demand. In terms of the increase in Category 1 and 2 calls, much of this was due to elective care delays and this had placed more pressure on Category 3 and 4 calls, leading to longer wait times. There had been a shift in activity profiling with an increase in category 2 calls, which required a quicker ambulance response time, for which the Trust was not set up for.

·       Staffing -in terms of whether an underinvestment in staff had led to high levels of staff absence, the Trust felt the environment of the Emergency Operations Centre (999)  in Coxheath and the NHS 111 Operations Centre in Ashford sites had not affected staff wellbeing but did impact on efficiency. The new centre in Medway would mean that the staff from the 999 centre (Coxheath) and the NHS111 staff (Ashford), as well as the Medway ambulance crews were co-located, which would increase efficiency and joint working.

·       111 Service – differing views were expressed about the effectiveness of this service, ranging from it was failing the public to it being generally appreciated.  The Trust accepted not every patient was dealt with in a timely way. There was a shortfall in 111 staff and the Trust was recruiting call handlers in advance of receiving funding for this. The Trust advised it received very little negative feedback from the public on the 111 service.

·       Medway Make Ready Centre – whether the new site was large enough to accommodate the planned number of staff was queried. An assurance was given that there was sufficient space and the new site could accommodate all the staff re-locating there. The site would be on 4 levels and staff were located in one room, making communication much easier than before. There was a dedicated floor for training, welfare rooms and a space for occupational health. An update on this would be  ...  view the full minutes text for item 739.

This report provides Members with an overview of MCH’s current position of community health services provision.

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

The following issues were discussed:

·       Blitz clinics – in response to a comment expressing disappointment at the number of people who did not attend for their appointment, the Director of Operations at MCH stated that lessons had been learnt and these clinics were now oversubscribed. The reasons why people did not turn up were being examined and there was now an appointment text reminder system.

·       Complaints and compliments – it was clarified that the complaints relating to the care co-ordination centre mainly related to appointment letters not being received. A point was made that those services which were well used tended to have low level of complaints.

·       Community nursing – it was clarified that the adult community nursing service operated on a 24/7 basis.

·       Car parking – Members asked if their request that the Council consider MCH’s request for an extension to the 4-hour parking limits to allow services to increase their clinic times to help reduce the backlog further be expedited.

·       Neighbourhood nursing team – in response to a comment about patients being discharged with higher needs due to pressures on hospital discharges and whether the team supported social care staff with this, Members were advised that the neighbourhood nursing team had a mixed skills base and  worked with adult social care and primary care colleagues to make sure care was as personalised as possible. This model was to be rolled out to all localities and an undertaking was given to provide Members with an update on the timing of this.

·       Nutrition and Dietetics – in response to a comment about the big increase in waiting times for the clinic and whether there were any plans to recruit additional staff, the Head of Operations advised that the team was very small and although there was a national shortage of specialists the team was at full establishment. The backlogged cases tended to be more routine in nature.

·       Workforce – an update on this would be included in the next report to the Committee.

Decision:

The Committee agreed to note the report.

This report provides an update on progress and next steps on contracting arrangements for the Kent and Medway adult neurodevelopmental health pathway for autism spectrum conditions (ASC) and Attention Deficit Hyperactivity Disorder (ADHD)

Discussion:

Members considered a report which provided an update on progress and next steps on contracting arrangements for the Kent and Medway adult neurodevelopmental health pathway for autism spectrum conditions (ASC) and Attention Deficit Hyperactivity Disorder (ADHD).

The following issues were discussed:

·       Physical clinical venues – in response to a question whether there would  be more venues in Medway, Members were advised that the physical venues in Medway would not be limited to the Lordswood Healthy Living Centre. In response to comments that the staff working in the venue were unaware of  autism services offered there and a request for how often the centre was used for this service, officers undertook to provide Members with this information but commented the new model would not be fully operational until April.

·       Autism champion – whether the Council should appoint an autism champion would be looked at by officers.

·       Online services – noting that autistic people needed a wide range of services, how this could be provided remotely was questioned. Members were advised that online services were used where appropriate and some interactions needed to be face to face

·       Transition from young people to adult - given that change was the biggest issue for autistic people, an assurance was sought that this transition would be seamless. Officers advised that a lot of work was being done to make transitions seamless but no guarantee could be given this would be perfect. In terms of services to children an all-ages pathway was being developed.

·       Out of area care – an undertaking was given to provide Members with details of patients sent out of area for care, including numbers and locations.

·       Transition to the new Integrated Care System – a point was made about the importance of the transition to the ICS being seamless.

Decision:

The Committee agreed to note the report.

Directors of Public Health (DsPH) have a statutory requirement to produce public health reports. These reports are the DsPH’s professional statement about the health of the local community.

The 2020-21 report focuses on digital exclusion and the challenge of ensuring that all residents, in particular those who would gain most benefit are able to access digital services.

Discussion:

Members considered the Director of Public Health’s 2020-21 Annual Report which  focused on digital exclusion and the challenge of ensuring that all residents, in particular those who would gain most benefit are able to access digital services.

The following issues were discussed:

·       The report’s findings – a point was made that while the Annual Report was clear about the consequences of being digitally excluded, its recommendations were very generic and did not explain how these challenges could be overcome. It was felt a delivery plan was needed and Members should be provided with more detail on what action would be taken. Members were advised that the report was the first step in highlighting these issues. The next step would be to understand their effects and decide how to reduce the chances of being digitally excluded. A Member said that services should always be available via phone and that service users should always be able to speak to someone by phone, irrespective of the digital options available.

·       E-prescription service -  an undertaking was given to look into concerns about the possibility that this service could be abused.

·       Broadband connectivity – a comment was made about poor internet connection in the rural areas of Medway and an undertaking was given provide Members with the timescales of the rollout of Phase 2 of Full Fibre infrastructure in Medway which would reach these areas.

Decision:

The Committee agreed to:

a)      note the comments of the Health and Wellbeing Board, and;

b)      note the Annual Public Health Report 2020/21.

Medway’s Council Plan 2021/22 sets out the Council’s three priorities. This report and appendices summarise how we performed in Q3 2021/22 on the delivery of the priority relevant for this committee: Supporting Medway’s people to realise their potential.

This report also presents the Q3 2021/22 review of strategic risks.

Discussion:

Members considered a report on Council Plan performance in Quarter 3 of 2021/22 and also the Quarter 3 review of strategic risks.

A comment was made about the success achieved by the Directorate in the face of  a very difficult financial position. Officers acknowledged that the available resources played a big part in being able to achieve the targets in the Council Plan and performance had improved in Quarter 3. The 2002/23 budget included an increase of £5.5m for adult social care.

Decision:

The Committee noted the Quarter 3 2021/22 performance against the measures used to monitor progress against the Council’s priorities.

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. It gives Members the opportunity to shape and direct the Committee’s activities over the year.

Discussion:

Members considered a report regarding the Committee’s work programme, which included a proposal to recommend to the Business Support O&S Committee that it re-instates Physical Activity as the next Task Group, followed by GP appointments and access to services.

Some concern was expressed that an attempt was being made to supplant the decision of the Business Support O&S Committee that GPs should be the subject of the next Task Group, particularly given the fragile condition of primary care in Medway with disparities and poor service in some areas. There was also support for the proposal to ask for the decision to be re-considered on the grounds of timing, relevance and resources.

Decision:

The Committee agreed to:

a)     approve the proposed work programme, as set out at Appendix 1 to the report, and;

b)     recommend that the Business Support O&S Committee re-instates Physical Activity as the next Task Group, followed by GP appointments and access to services, for the reasons set out in paragraph 4 of the report.