Agenda and minutes

In the absence of the Chairperson and Vice-Chairperson, it was agreed that Councillor Louwella Prenter would chair the meeting.

Apologies for absence were received from Councillors McDonald and Shokar.

To approve the records of the meetings of the Committee held on 22 August and 20 September 2023.

The records of the meetings of the Committee held on 22 August and 20 September 2023 were agreed and signed by the Chairperson as correct. 

The Chairperson will announce any late items which do not appear on the main agenda but which he/she has agreed should be considered by reason of special circumstances to be specified in the report. 

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

Councillor Hamandishe declared a Disclosable Pecuniary Interest in agenda item 7 (Kent and Medway NHS and Social Care Partnership Trust (KMPT) 2023-2026 Strategy Briefing) as he was employed by the Trust.

Later in the meeting, Councillor Browne declared a Disclosable Pecuniary Interest in agenda item 9 (Section 136 Pathway and Health-Based Place of Safety Service Improvement) when reference was made to the awarding of a contract to Hestia, as she was employed by the latter.

Other significant interests (OSIs)

There were none.

Other interests

There were none.

The annual report provides information on the number, type and other information on adult social care complaints received during the period April 2022 - March 2023. It also highlights some examples of the positive things people have said about the provision of adult social care in Medway over the same period and the service improvements Medway Council has made because of lessons learnt from complaints.

Discussion:

Members considered the annual complaints and compliments report which provided information on the number, type and other information on adult social care complaints received during the period April 2022 - March 2023.

The following issues were discussed:

·       Localities and complaints - it was clarified that adult social care worked across three localities. Locality 1, which had received the highest number of complaints, was the area where most providers and the acute trust were located.

·       Total number of people supported – in order to provide context for the number of complaints received, a Member asked what the total number of contacts was for adult social care. The Assistant Director – Adult Social Care replied the service supported about 5,000 people.

·       Communications – noting that poor or a lack of communication was a significant factor in the number of complaints, what was being done to improve communications was queried. The Assistant Director – Adult Social Care advised that staffing was a major factor as a number vacancies in front line social care were filled by locums. She was looking at how this area could be fully resourced and moving to an allocated care model where a social worker worked with a specific person, meaning greater continuity of care which should help to improve communications.

·       Complaints about financial issues – a Member queried whether this related to billing issues or fraud. The Assistant Director – Adult Social Care advised some complaints related to billing and incorrect information where the team had not been informed by providers in a timely manner. A system was being implemented where care providers could upload correct care information as it was provided. Financial assessments could also give rise to complaints.

·       Upheld complaints and financial redress – A Member queried the rationale for how assessment figures were calculated. Members were advised this would depend on the details of an individual case, whether injustice had been caused and the time and trouble taken to make a complaint. If the issue being complained about could not be put right, then a financial remedy would be appropriate.

·       Complaints from ethnic minorities – regarding the number of complaints from ethnic minorities and whether any barriers existed to making complaints, the Assistant Director – Adult Social Care advised the Council was aware the number of people from ethnic minorities supported was lower than it should be, some of which was due to cultural issues. More needed to be done with regard to hard-to-reach groups and to look at whether there were any barriers. Therefore, the number of complaints from this group was lower.

·       Pre-covid complaints figures – regarding the comparison of complaints received by year, whether the pre-covid figures were available was queried. Members were advised this information was available, but not to hand. There had been a steady decrease in the number of complaints in recent years.

·       Timeliness of response – whether the aim of replying to social care complaints within 20 working days was appropriate was queried. Members were  ...  view the full minutes text for item 304.

This annual report provides an account of the role of the Deputy Leader of the Council who has responsibility for Adult Social Care and Public Health. It details their ambitions for their areas of responsibility, how they have and will undertake political challenge and leadership and what their priorities and ambitions are for the year ahead.

Discussion:

Members considered a report which provided an account of the role of the Deputy Leader of the Council, who had responsibility for Adult Social Care and Public Health.

The following issues were discussed:

·       Recruitment of social workers and agencystaff – noting the recent recruitment of seven newly qualified social workers, whether recruitment would continue with the aim of replacing agency staff was queried. How long agency staff remained with the Council was also questioned. The Deputy Leader commented that the intention was to recruit as many newly qualified social workers as possible, noting that they needed supervision. Staff had been asked to bear with the Council while efforts were made to improve the budgetary situation and review the MedPay scheme. By showing staff they were supported and valued, this was a way to reduce the number of agency staff. However, agency staff were also seen as a valued part of the workforce.

The Deputy Leader commented a reorganisation in 2019 had led to a reduction in staffing and resources. The aim was to return to the allocated model of care so someone would see the same social worker. Some agency staff had converted to permanent staff, and it was important to continue to highlight the benefits of this. Any agency staff who did not work to an acceptable standard were asked to leave early on in their employment. In response to a question about how many permanent staff had been lost compared to agency staff, an undertaking was given to provide this information to Members.

·       Increase in the over 65 population – a point was made that the document had conflicting figures for the estimated growth in the over 65 population by 2025 and what figure was used for budgeting was queried. The Assistant Director – Adult Social Care commented that the discrepancy was due to the local account document relating to a different time period to the holding to account paper. This was being rectified for the future. Budgeting was not based on these demographic figures but rather the number of people currently supported and the projected increase in the coming years.

·       Hypertension Heroes programme – the possibility of the team carrying out wider health checks was suggested, such as BMI and cholesterol. The Deputy Leader commented that wider health checks were provided through the Council, and this needed to be encouraged and widened. The Director of Public Health advised that training would be needed if the Hypertension Heroes were to carry out additional health checks. Whilst the suggestion could be looked at, he did not want to dilute the impact of NHS health checks, where data collected was sent straight to GP database. The Hypertension heroes signposted people to other services, which was probably the safest option. He undertook to look at whether the specialist NHS Health Checks team could offer further support to community events.

·       Working with the Integrated Care Board – a point was made that the ICB had made decisions that could be  ...  view the full minutes text for item 305.

The paper seeks to update the Committee on the previous KMPT Strategy, background to the current Strategy and monitoring of progress within the current Strategy.

Having earlier disclosed an interest in this item, Councillor Hamandishe left the room for the discussion and did not participate.

Discussion:

Members considered a paper which updated the Committee on the previous KMPT Strategy, the background to the current Strategy and the monitoring of progress within the current Strategy.

The following issues were discussed:

·       Staff retention and turnover – levels of turnover were queried, particularly at Executive level, and details of the Trust’s staff retention plans were requested. Members were advised that general staff turnover for June/July was 18% in Medway and further details would be provided to Members. This represented a reduction from the previous three months and was about average for comparable Trusts. The Trust had a retention and recruitment programme. The current Chief Executive would retire on 1 November and the new Chief Executive, the current Deputy with 6 years’ experience at the Trust, would take over. The Chief Operating Officer had been at the Trust for 2 years. Members were assured there was stability in the executive team.

·       Bullying – a Member asked whether bullying was an issue at the Trust. The Director of Partnerships and Transformation advised that bullying was monitored through the independent Freedom to Speak Up service. There was also an annual staff survey. He did not believe bullying was a problem, but more action was needed on equality and inclusion.

·       Mental Health Nurse Pilot – in response to why a pilot with the police had not continued, Members were advised there were some initiatives underway but some of this transformation sat with the ICB.

·       Ruby ward and mental health bed provision – a discussion took place about the new Ruby ward being built in Maidstone and the reasons for the closure of the ward at Medway Maritime. Members were advised the new unit would have more beds than the previous ward and were invited to visit the new unit, which it was hoped would open in early 2024. The Assistant Director – Adult Social Care added that there was a partnership approach towards moving from mental health beds to community provision.

·       Tackling racism – a Member referred to the statement in the Strategy about ethnic minority staff experiencing less racist violence and aggression and commented this was a poor choice of words as one member of staff experiencing less racism would mean the objective had been met. The Director of Partnerships and Transformation responded that a monthly reporting system sat beneath this and any staff experiencing racism was unacceptable. An assurance was given that Trust wanted to be as free from racism as possible. 

·       Baseline data – regarding what data was available in order to measure progress in meeting objectives and what benchmarking took place, Members were advised that benchmarking was built in. Underneath the Strategy there was more data and trajectories to measure progress. The Trust was still gathering data for baselines and acknowledged progress in some areas would be over a three-year period. A Member made the point that KMPT  ...  view the full minutes text for item 306.

This report seeks to update the Committee on the future of the Medway (and Swale) TIA service as requested at the 22^nd August 2023 meeting of the Committee. Specifically, the Integrated Care Board (ICB) was requested to advise the Committee on when the TIA service would be provided locally again and if this was not possible, why not. This report seeks therefore to provide an update on these matters.

Discussion:

Members considered a paper which updated the Committee on the future of the Medway (and Swale) TIA service as requested at the 22nd August 2023 meeting of the Committee. The Deputy Chief Medical Officer commented that the ICB was working hard to deliver what the Committee wished to see.

The following issues were discussed:

·       Travel times and travel Assistance - in response to a query about whattravel assistance was available and whether the impact of further travel on patients with suspected TIA had been assessed, the Deputy Chief Medical Officer advised travel assistance was available if needed. In terms of the impact on patients, TIA was an early warning but was not a stroke. A TIA referral meant patients were placed onto preventative pathway to reduce the risk of progression to a stroke. Most patients are referred into the TIA pathway by their GP, others from the Emergency Department at Medway Hospital. The service then assessed the level of risk and advised on treatment and further investigation. Adding an additional journey should not jeopardise patients, but it was important this was monitored. Some treatment was delivered locally but some needed specialist surgery, which required travel. An undertaking was given to provide Members with details of who provided the travel assistance.

·       Patient feedback and monitoring - an update was requested on patient feedback received in respect of the multi-stakeholder working group set up to complete the emergency service transfer. Members were advised that the working group met fortnightly to work on a solution and monitor the existing situation and patient numbers.

·       Risks – in response to a query about what tools were usedtomitigate risks, Members were advised that risks were reported to the Kent and Medway Integrated Stroke Delivery Network (ISDN), which included representation from the Council. There were a number of targets in respect of TIA treatment and benchmarking information was available. 

·       Return of the service to Medway - Members were advised a decision on this would be made by the ISDN on 31 January. 

·       Increase in wait times - whether there had been an increase since the emergency service change was queried. Members were advised this information would be provided to the IDSN.

Decision:

The Committee agreed to:

a)    note the report and request an update at the March meeting, including whether there had been an increase in waiting times since the service change (to be preceded by a briefing note on the latter before the March meeting).

b)    ask the ICB to inform the Director of People and Deputy Chief Executive of the proposal on the future of the TIA service, prior to this being considered at the Integrated Stroke Delivery Network (ISDN) Programme Board on 31 January.

c)    delegate authority to the Director of People and Deputy Chief Executive to submit comments on the proposal to the ISDN Programme Board, following consultation with the Chairperson, Vice-Chairperson and Opposition Spokespersons.

This report serves to inform the Committee of the decision made by NHS Kent and Medway Integrated Care Board on 5 September 2023 to approve the Section 136 Pathway and Health Based Place of Safety Service (HBoS) Improvement Decision Making Business Case (DMBC). 

Discussion:

Members considered a report which informed the Committee of the decision made by NHS Kent and Medway Integrated Care Board on 5 September 2023 to approve the Section 136 Pathway and Health Based Place of Safety Service (HBoS) Improvement Decision Making Business Case (DMBC).  

The Programme Director for NHS Kent and Medway updated Members that a contract had been awarded to HESTIA, a third sector provider, for a 5-bed crisis house in Medway from December and the safe haven unit would be located on the MFT site and operate 24/7 from April. Councillor Browne disclosed an interest as an employee of HESTIA and left the meeting for the remainder of this item.

The following issues were discussed:

·       Centralisation of the HBPoS within Kent and Medway – Members were advised there were currently five assessment rooms across three hospital sites. This led to difficulties in retaining staff as the teams were very small. Staff were looking forward to working in a bigger team in a centralised unit.

·       Mental Health Nurse Pilot with the Police – why this had not been continued was questions and the Programme Director advised that, while the pilot had been helpful, the impact on reducing S.136 cases had not been as great as expected. KMPT were being commissioned to provide a one-hour urgent response service for the police and ambulance service.

·       Arrests and assessments - in response to a query when it was decided that a person would be arrested instead of being detained under S.136, Members were advised that each police custody suite had access to a mental health clinician who they could refer to. This allowed, where appropriate, for a person to be diverted from the prison system to the health system. The Assistant Director – Adult Social Care added that Advanced Mental Health Practitioner could also assess a person to see if they needed to be sectioned and that there were different routes to try and stop people being sent to a police station. Work was underway on looking at how to ensure the police only intervened in a mental health case when appropriate.

·       Mental health services in Medway – with reference to the loss of mental health beds in Medway, when Medway would receive the same level of service as other areas was queried. Members were advised that there were no acute inpatient facilities in Medway, but an assurance was given that Medway had the same level of community mental health services as in Kent. The NHS long term plan was to find alternatives to acute mental health beds, which should be last resort. The first crisis house would be in Medway in December and the first co-located safe haven from April.

·       Impact of proposal on police – Members were advised that travel impact assessments showed a likely reduction in ambulance and police travel time and that the police were in favour of the proposal.

Decision:

The Committee agreed to:

a)    note the decision made by NHS Kent and Medway  ...  view the full minutes text for item 308.

Discussion:

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

Decision:

The Committee agreed to:

a)    note the report and agree the work programme as set out at Appendix 1 to the report, subject to accepting the proposed changes, outlined in italic text on Appendix 1.

b)    discuss at the next agenda planning meeting whether to add to the work programme a report on the performance of the Integrated Stroke Delivery Network (ISDN), including stroke provision in Medway and an update on the hyperacute stroke units and SECAmb’ s performance regarding call out times for TIA cases.