Agenda and minutes

Apologies for absence were received from Councillors Anang, Cook, Crozer, Jackson and Wildey.

To approve the record of the meeting held on 17 October 2023.

The record of the meetings of the Committee held on 17 October 2023 was 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 10 (Kent and Medway NHS and Social Care Partnership Trust (KMPT) and Medway Council Joint Briefing) as he was employed by the Trust. However, he understood this item was being deferred until the January meeting.

Other significant interests (OSIs)

There were none.

Other interests

There were none.

This paper presents the Kent and Medway Integrated Care Strategy. The interim strategy was approved by cabinet in December 2022 and this version is an update that incorporates extensive feedback from consultation.

Discussion:

Members considered a paper which presented the Kent and Medway Integrated Care Strategy. The interim Strategy had been approved by Cabinet in December 2022 and this version was an update that incorporated extensive feedback from consultation. 

The following issues were discussed:

·       Consultation – regarding a comment that the number of respondents from Medway was low in comparison to the size of the population, the Deputy Director of Public Health commented that he felt engagement had been successful in Medway. There had been extensive engagement during the development of the Medway Joint Local Health and Wellbeing Strategy, which focused only on Medway, with online surveys and focus group discussions.

·       Outcomes – in response to queries about how the Strategy would be delivered and how outcomes would be measured, the Deputy Director of Public Health advised that there would be a joint delivery plan which would action the aspirations in the Strategy. There would also be indicators so that the Council could see if the desired outcomes had been achieved at a strategic level. There were Operational plans which had their own metrics to show if outcomes were being delivered. Information on this could be reported to the Committee. The Director of Public Health added that this was a Kent and Medway wide strategy. The Joint Local Health and Wellbeing Strategy was the primary mechanism for delivery in Medway. The importance of monitoring performance in Medway was emphasised.

·       Values – a point was made that a value-based strategy would always deliver better outcomes and the values underpinning the Strategy were not clear.  Officers advised the core value was people needing to be at the centre of what the three partners did and the Strategy outlined what it aimed to achieve.

·       Support for the workforce – in terms of what support was offered such as help with housing and schools, the Deputy Director of Public Health commented that the workforce was an important part of the Strategy. One of the shared outcomes was about how to support and grow the workforce.

·       Voluntary and community sector (VCS) – an assurance was sought that the VCS would have an equal voice in the Strategy. Noting the health status of the gypsy and travellers community was much poorer than that of the general population, how the Strategy addressed this was questioned. The Deputy Director of Public Health advised that the VCS were part of the Strategy and there was a voluntary sector alliance. The Council was working with the VCS on a number of initiatives to improve health and wellbeing. Communities were being asked what issues were important to them and they would be involved in the solutions.

·       Medway Healthwatch – the Committee was advised that Healthwatch had been involved in the development of the Strategy and were pleased with the document, which had evolved since last year.

·       Digital services – it was noted that the Strategy stated that digital services were good but were not accessible for everyone and there should be alternatives.  ...  view the full minutes text for item 435.

This report sets out the Draft Capital and Revenue Budgets for 2024/25. 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 2024. The Draft Budget is based on the principles set out in the Medium Term Financial Outlook 2023-2028 (MTFO) considered by the Cabinet on 26 September 2023. 

(Agenda items 6, 7 and 8 were discussed together.)

Discussion:

Members discussed the draft capital and revenue budgets 2024/25 and also the second round of the capital and revenue budget monitoring process for 2023/24.

In response to a query about the impact of £36m of cuts on communities, the Chief Finance Officer advised that this figure represented the draft budget projected gap. Budget gaps had been closed in previous years but there would be difficult choices to make this year. The Council was lobbying the government for more funding and also a fairer distribution for the sector, given Medway was one of the twenty lowest funded councils per head of population in the country.

With regard to how the impact on residents of savings or increases in council tax were monitored, the Chief Finance Officer advised services would produce equality impact assessments to accompany any budget proposals. The increase in council tax was expected to be just under 5% and details of what increase in bills this represented could be provided.

Officers were asked for their thoughts on the recent immigration measures introduced by the Government on the Council and its partners in delivering social care. The Director of People and Deputy Chief Executive advised it was too early to say but the new measures were likely to impact on different occupations, particularly care staff.

Decision:

a)    The Committee noted that Cabinet had instructed officers to continue to work with Portfolio Holders in formulating robust proposals to balance the budget for 2024/25.

b)    The Committee noted the proposals outlined in the Draft Capital and Revenue Budgets in so far as they relate to the services within the remit of the Committee and agreed to forward their comments to the Business Support and Digital Overview and Scrutiny Committee in January.

c)    The Committee noted that the Cabinet had agreed to recommend to Full Council that in February 2024 when setting the Council Tax, the following changes are applied to Council Tax premia in line with the Rating (Property in Common Occupation) and Council Tax (Empty Dwellings) Act 2018, as set out in paragraph 8.18 of the report:

·            the 100% premium for long-term empty properties may be brought forward so that it can commence after being empty for one year rather than two with effect from 1 April 2024; and

·            a 100% premium may be charged for properties that are unoccupied but furnished (known as second homes) with effect from 1 April 2025.

d)    The Committee agreed to note that the Cabinet had agreed to recommend to Full Council that in February 2024 when setting the Council Tax, the following changes are applied to the Council Tax discretionary discounts, as set out in paragraph 8.18 of the report:

·            reduce the discount in respect of class C to 0% from the day on which a property becomes vacant, and

·            reduce the discount in respect of class D to 0%.

e)    The Committee agreed to note the results of the second round of revenue  ...  view the full minutes text for item 436.

This report presents the results of the second round of the Council’s revenue budget monitoring process for 2023/24. 

See minute number 436 for decision.

This report presents the results of the second round of the Council’s capital budget monitoring process for 2023/24.

See minute number 436 for decision.

Medway’s Council Plan 2023/24 sets out the Council’s three priorities and the measures used to monitor performance. This report and appendices summarise performance in Q2 2023/24 on the delivery of these priorities and the actions we are taking to improve performance.

This report also presents the Q2 2023/24 review of strategic risks which fall under the remit of this committee.

Discussion:

Members considered a report on performance in Quarter 2 2023/24 and also a review of strategic risks within the Committee’s remit.

Noting that the status of two of the performance indicators had been red for some time, it was suggested that these be looked into in more detail at a future meeting.

Decision:

Members agreed to:

a)   note the Q2 2023/24 performance against the measures used to monitor progress against the Council’s priorities.

b)   note the Q2 2023/24 Strategic Risk Summary.

c)   Review in depth Performance Indicator ASCOF 1C(2i) Percentage of clients receiving a direct payment for their social care service.

The aim of this report is to describe in high-level terms our patients’ in-patient journey from, admission to treatment and discharge from in-patient care to an alternative setting. This report seeks to highlight the current processes, challenges and the on-going improvement work which will deliver cohesive, patient centered mental health care to the people of Kent & Medway.

This item was deferred until the January 2024 meeting.

The report seeks to update the Committee on progress at Medway NHS Foundation Trust.

Discussion:

Members considered a report on progress at Medway NHS Foundation Trust, since the last update in January 2023.

The following issues were discussed:

·       Mortuaryarrangements - reference was made to the recent court case regarding the abuse of bodies at the mortuary at Tunbridge Wells hospital and an assurance was sought that the learning from the inquiry into this had been carefully considered. The Chief Executive of the Trust advised that following the release of the inquiry’s report, an analysis of who had access to the mortuary had taken place and measures had been strengthened. She assured Members that the Trust was confident the right measures were in place.

·       Industrial action – regarding improvements to the conditions of junior doctors, it was clarified that the industrial action related to their pay and conditions of employment, not workplace conditions. When the junior doctors had been on strike the medical teams had been flexible in covering shifts. The Trust had been clear on the significant impact this action was having and representations to the Government were being made via the Integrated Care Board.

·       Tele-tracking – in response to why there had been a delay in introducing this bed management system, the Trust’s Chief Executive advised this had been part of the strategic plan. The delay had been caused by wating for funding. The system was now making a significant difference in turnaround times.

·       No criteria to reside (NCTR) – regarding what the solution was to the pressures caused by patients with NCTR, the Chief Executive commented some of this was about what preventative measures the wider system could put in place to prevent admission. The Trust was also looking at discharge processes at a high level. There was a need to make sure the community model helped to minimise admissions and help to discharge effectively. The Assistant Director – Adult Social Care added that the low number of beds in care homes was also an issue as these affected discharges from the hospital.  The Council had been awarded some funding which had been used to secure assessment beds where long-term care needs could be assessed. If successful, the Council would bid for additional funding to expand this.

·       MedOCC – the Chief Executive clarified that this service was run by Medway Community Health Care and visits were included in the statistics for the Trust. On arrival at either MedOCC or the Emergency Department, patients were triaged to make sure they were in the right place. The Chief Executive agreed with a comment that anyone repeatedly visiting MedOCC should indicate to the team that something was wrong. There was a need to look at how primary care was supported and how it could work differently.

In response to comments from Members about experiences of a poor service at MedOCC, the Chief Executive commented that work to improve emergency care included MedOCC. This was a priority, and it was important to improve the pathways. There was an opportunity to work much more  ...  view the full minutes text for item 441.

This report provides a summary of the recommissioning of the Support to Live at Home Service. The framework agreement(s) will commence on 1 April 2024 and end on 31 March 2028.

Discussion:

Members considered a report which provided a summary of the recommissioning of the support to live at home service. The framework agreement(s) would commence on 1 April 2024 and end on 31 March 2028.

The following issues were discussed:

·       Electronic Call Monitoring (ECM) System – it was clarified that this system allowed care workers to log when calls started and finished. Providers submitted invoices for the actual care they delivered. Work was underway to implement software which allowed electronic data to be submitted for invoices.

·       Staff welfare – the extent to which the Council monitored how care companies looked after the welfare of their staff was queried. Members were advised regular meetings took place with the care providers but the wider issue of the welfare of carers would be taken on board. Whether anything could be done to incentivise staff to gain more qualifications to progress into better paid work was queried. The Assistant Director – Adult Social Care commented that the Council recognised carers’ pay nationally was low and what could be done to support their progress was being looked at. Care providers were required to provide training which the Council monitored and was currently seeing where any gaps may be. However, the Council did not have the funding to provide any additional training identified.

In terms of whether carers experienced difficulties in travelling to service users’ homes to provide the prescribed hours of care given many did not drive, Members were advised providers were appointed to serve one locality. Carers then worked within this locality, which should help them to be as efficient as possible. The Council was aware of some cases of carers being asked to travel long distances in an unreasonable timescale. Providers were regulated by the Care Quality Commission, who would be looking at how staff were treated.

·      Continuation of care – the importance of this for service users was stressed by Members and concern was expressed that some people were being helped to bed at times that were not suitable to them. The Programme Lead Accommodation and Registered Services assured Members continuity of care was key. Where possible as small a number of carers as possible would see an individual. Service users were able to talk to their social worker about what care they wanted and at what time to be helped to bed should be a service user’s choice.

Decision:

The Committee agreed to note that:

a)     Cabinet will be recommended to award The Support to Live at Home Service contract(s) to the successful bidders that will be evaluated as the most economically advantageous against the Councils award criteria. 

b)     the Support to Live at Home Service will replace the current Framework Agreements for the provision of Homecare and Extra Care.

c)    a Gateway 3 report would be submitted to Cabinet on 16 January 2024. 

Discussion:

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

Decision:

The Committee agreed to amend 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, except that the proposal to submit an update on pharmacy and dentistry services to the January meeting be amended so that this update could be provided at the March 2024 meeting.

The purpose of this to update Members on the procurement of community services.

Discussion:

Members considered a report which updated the Committee on the procurement of community services by the Integrated Care Board (ICB).

Representatives from the ICB advised that since the Committee had agreed in September that the proposals constituted a substantial variation to health services in Medway, it was now proposed to extend the current contracts by up to two years with a six-month break clause. This would enable the contract extensions to end at the same time, likely to be September 2025 and allow for more time to engage with stakeholders and patients, including with the Committee. All three current contracts would expire within six months so to do nothing was not an option.

In September the proposal had been to include the transformational work in the contract. This was not possible now, but the ICB hoped to be able to work with the current providers to start to deliver transformation and efficiencies.

In response to comments that in September the Committee had been advised that it was not possible to extend contracts, the ICB commented that they had referred to the risks of not making a change to the current arrangements. The ICB had sought legal and contracting advice due to the potential challenge to the proposals and had acted carefully to maintain services. 

Concerns were expressed that the paper did not explain what the new service models or transformation work would look like. Given that services had been lost from Medway in the past, there was a degree of nervousness for Members when considering these proposals. The ICB advised that negotiations with three providers continued to take place, and the community prospectus would be shared with Members the following week. The current live procurement process meant it had been sometimes difficult to share information.

It was proposed that a decision on whether the proposals constitute a substantial variation to health services in Medway be deferred until the January meeting where wider discussion could take place.

Decision:

The Committee agreed to defer until the January meeting a decision on whether the proposals constituted a substantial variation to health services in Medway and would invite the ICB, the Chief Executive of Medway NHS Foundation Trust, the Council’s Deputy Leader and possibly one of the community service providers to attend this meeting for a wider discussion on the proposals.