Agenda and draft minutes

Apologies for absence were received from Councillors Cook and Hyne. 

To approve the record of the meeting held on 14 March 2024.

The record of the meeting held on 14 March 2024 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

Cllr Browne declared that she worked for a charity that provided services within the Medway area but it was not specifically mentioned in the agenda and she was not involved in any bidding of contracts or operational services that related to the business on the agenda and therefore she would continue to take part in the meeting.

Other significant interests (OSIs)

Cllr Crozer declared that he was Chair of Trustees at AMAT UK, which worked with the Substance Misuse Service, he therefore took no part in the discussion of item 7 and would leave the room if AMAT UK was specifically mentioned.

Other interests

There were none.

The Committee paid tribute to James Williams, the Council’s Director of Public Health, who had very sadly passed away in May. The Chairperson, the Opposition Spokesperson, the Acting Director of Public Health and the Director of People and Deputy Chief Executive all paid tribute to James, recognising his transformational approach to public health delivery, his inspirational leadership and his humble and caring nature and fantastic humour, all of which he would be remembered so fondly for.  A minute’s silence was then held in James’ memory.

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

The 2022-23 report focuses on the challenge and benefits that can be gained from investing more effort into community engagement and the development of local networks. It provides examples of successful outcomes in terms of physical and emotional health and wellbeing for local people through this approach. The report evidences the opportunities to improve population outcomes and reduce expenditure on health, social care and related services. The primary recommendation is that more needs to be done to empower communities to build upon, and use, local resources and assets.

Discussion:

The Acting Director of Public Health introduced the “Power of the Crowd”, the Annual Report of Medway’s previous Director of Public Health (DPH) for 2022-23. He explained that DsPH had a statutory duty to produce an annual report setting out their professional view about the health of the local area. This report had focussed on the challenge and benefits of investing more effort into community engagement and developing local networks.

Members then raised a number of questions and comments, which included:

·        Collaborative working – in response to a question about how collaborative working was maximised and advertised across the community and voluntary sector, it was explained that through the Integrated Care Partnership, which includes the Integrated Care Board (ICB), Medway Council and Kent County Council and through the Swale and Medway Integrated Care Partnership, Medway Council worked in partnership to maximise opportunities for collaborative working.

·        Women’s health – reference was made to the menopause in particular and the need for this be explicitly addressed. It was explained that the next meeting of the Health and Wellbeing Board would be dedicated to women’s health, bringing together the ICB, Public Health and clinicians to talk about key issues, the National Women’s Health Strategy and how it was implemented locally.

·        Food poverty and food waste – in response to a question about what work was being done to address the imbalance of food wastage and food poverty, it was explained that there were a number pieces of work and research taking place on this issue, which included looking at local people’s perceptions around food and the natural environment and how that could be used to inform the development of Medway’s local food policy.

·        Communication with residents – the Committee were supportive of the report and wanted to know how it was being communicated to the wider population.  It was explained that there was a communication strategy in place and that weekly messaging via various social media opportunities took place, alongside the Better Medway website. New opportunities for engagement and communication were always explored and officers would consider whether there was an opportunity to provide regular briefings to Ward Members to assist them in disseminating information to their constituents.

·        Involvement of people with lived experiences – in response to a question about how engagement and collaboration took place with those with lived experience, it was explained that as part of the development of the Joint Local Health and Wellbeing Strategy, engagement with people had taken place. This had included online surveys as well as focus group discussions to ensure views were gathered from people that were less often heard. In addition, reference was made to the Heath Determinants Research Collaboration with the University of Kent, which had set up a Public Advisory Group to look at how Public Health were communicating and how this could be improved. Emerging trends from findings of engagement were continuously considered in order to stay current and relevant in meeting the needs of Medway.

·        Gamification model – a  ...  view the full minutes text for item 79.

This update report presents the Kent and Medway Integrated Care Strategy Delivery Plan which sets out key strategies and activities that partners across Kent and Medway will lead that will contribute to delivering the Integrated Care Strategy. The report also includes the framework that will be used by the Integrated Care Partnership to monitor progress on delivery of the six outcomes of the integrated care strategy.

Discussion:

The Acting Director of Public Health introduced the report which updated the Committee on the Kent and Medway Integrated Care Strategy Delivery Plan. He explained it was an illustrative document at a strategic level, setting out key strategies and activities that partners across Kent and Medway would lead on to contribute to delivering the Integrated Care Strategy.

Members then raised a number of questions and comments, which included:

·         Meeting Medway’s needs – concern was raised that because the strategy covered the whole of Kent and Medway, there might not be sufficient focus on Medway.  In response officers explained that the Council worked with Integrated Care Board and Kent County Council colleagues as a system and through the partnership the Council was able to and did advocate the required needs for Medway. 

·        Family hubs – Members sought further information about the family hub model.  Officers explained that the hubs covered a variety of places across Medway and enabled professionals to work together and embed services within the community.  Opportunities to provide some adult services at the hubs during quieter periods were also being explored. Officers undertook to provide more detailed information on the family hubs to the Committee via a briefing note.

·        Indicators – in response to a question about the indicators and whether they were ambitious enough, officers confirmed that the indicators were realistic, based on data available from statistical neighbours, local data and trends and were set to demonstrate what could be achieved with intervention, whilst indicating success.

·        Transition from children to adult services – in response to a question on how young people were supported with their transition to adult services, the Assistant Director, Adult Social Care, explained there was a dedicated team in Adult Services which worked closely with Children’s Social Care which was now supporting young people from the age of 17, rather than 17 and a half, however it was recognised that more focus on this area was needed.

·        PTSD and unaccompanied asylum seeking children – in response to a question about how young refugees were supported with Post Traumatic Stress Disorder, it was explained that unaccompanied asylum seeking children were supported through Children’s Social Care and the Care Leavers Team and were able to access services to meet need in the same way as other children in care, whilst recognising there were capacity issues in the health service.

Decision:

The Committee noted the Kent and Medway Integrated Care Strategy Delivery Plan and requested a briefing note on family hubs.

This report presents the update requested by Overview and Scrutiny on 22 August 2023. It contains data that outlines the impact of the new adult substance misuse treatment service. It also details the work taking place to develop a collaborative approach with criminal justice partners, and work to improve the continuity of care between prison and community for people who use substances.

Discussion:

The Head of Public Health Programmes introduced the report which provided an update on the substance misuse treatment service.  He explained that progress was being made with good outcomes and the services had settled well since the contract commenced a year ago. There were risks relating to the uncertainty of future funding but that collaborative partnership working would help to safeguard the service.

Members then raised a number of questions and comments, which included:

·        Alcohol – concern was raised that despite being the substance that causes the most significant harm, there was not enough emphasis on alcohol. Officers confirmed that alcohol was the reason for more deaths in Medway than drugs and reassured the Committee that substance misuse encompassed alcohol too. There was also a specific alcohol pathway, treatment which was continuing to improve.

·        Individual Payments Scheme – the representative from Forward Trust (the service provider) explained that the project, which aimed to achieve sustainable employment for people in substance treatment, was due to commence in July and was already running successfully in other areas.

·        Staffing and vacancy rates – reference was made to the 13 vacancies quoted in the report. Officers undertook to provide exact staffing figures to Members but confirmed that the vacancy rate had reduced.  Recruitment had been a challenge due to a lack of trained substance workers and staff being deterred by fixed term contracts. The vacancy rate was impacting most on service’s outreach work. Following a further query, it was added that an opportunity escalator was in place where individuals that had completed treatment could work as peer support.  There were further traineeship opportunities once someone had abstained from substance misuse for 3 years. The Forward Trust representative undertook to provide the fall-out rate from the scheme.

·        Support for ex-prisoners – in response to a question about how ex-prisoners were supported by the service, officers explained there was a Continuity of Care Toolkit which enabled the service to work as a system, with the prison and probation services, to assess an individual’s pathway and identifying particular areas for that person that required support and solutions.

·        Young people services – officers explained that research was currently being undertaken to explore the reasons behind young people’s use of substances and that the service was looking to develop an all age service for young people, with an age appropriate response to service users.

·        Mental health support – a question was raised about how the service supported its clients to also access mental health services, as being a person who used substances could often be a barrier to accessing mental health services.  In response officers confirmed that there was a Co-occurring Condition Protocol in place. A survey was currently underway with frontline workers to gain their views and knowledge about the protocol and why they might not be using it. This would then lead into the development of pathways and through the mental health transformation, ensuring co-occurring conditions was recognised across the system. The Forward Trust representative added  ...  view the full minutes text for item 81.

This report seeks to provide a review and update of progress against Kent & Medway NHS and Social Care Trust’s (KMPT) organisational strategy for 2023-2026, following the strategy briefing made to the Committee in October 2023.

Discussion:

The Director of Transformation and Partnerships and the Chief Operating Officer and Deputy Chief Executive from the Kent and Medway NHS and Social Care Partnership Trust (KMPT), introduced the report which updated the Committee on the trust’s Organisational Strategy for 2023-26. He highlighted some of the key successes and challenges which included eliminating the backlog on dementia assessments caused by the pandemic, improvements in recruitment and retention, the opening of Ruby Ward and the embedding of safe havens.

Members then raised a number of questions and comments, which included:

·        Dementia – reference was made to the new model of care, the first pilot of which was taking place in June 2024 and it was asked how quickly it would impact change. The KMPT representatives explained that the pilot had begun in South Kent the previous day and innovative feedback had been received.  It was expected that the pilot would scale out at pace with a phased approach that would include a multi-disciplinary assessment across system colleagues to improve diagnosis rates, which they acknowledged were still not acceptable. It was also suggested that the next update from KMPT have a dementia focus.

·        Safe havens – in response to a question about the one team approach in relation to safe havens and whether that model would continue in the long term, the KMPT representatives explained that it was a successful initiative and a positive model of sustainable partnership working that would be retained.

·        Community Mental Health Framework (CMHF) – the KMPT representatives explained that the CMHF would fundamentally change the way partners work to help the population.  It would provide a more holistic approach to meet people’s needs and would be less about a patient’s specific diagnosis. It was an opportunity to embrace individuals with a multi-agency approach at the front door where patients could be supported with difficulties they might be experiencing with employment, housing and benefits, as well as their mental health needs. It would also enable responses to be quicker.

·        Use of the term BAME – reference was made of the advice to stop using the term BAME (Black and Minority Ethnic) and to instead be more precise and it was asked what support and mentoring was provided to staff. The KMPT representatives confirmed that the Trust had already agreed to move away from BAME categorisation and was working alongside its Inclusion and Diversity Programme to explore how the Trust could support staff from diverse backgrounds.

·        Ruby ward – in relation to the opening of Ruby Ward (a 16 bed in-patient service), reference was made to the old Ruby Ward on the Medway Maritime Hospital site, which had previously closed. It was explained that during that closure process, KMPT had offered transport support for families from Medway to visit their loved ones and it was asked if this was still on offer. The KMPT representatives explained that work was still underway to ascertain the demand and in the interim some volunteers were able to provide a taxi service  ...  view the full minutes text for item 82.

This report sets out why Medway Council should consider adopting care experienced as a protected characteristic.

The definition of care leaver and care experienced are often used interchangeably. A care leaver is defined within the Children Act 1989, the Leaving Care Act 2000, and the Children and Social Work Act 2017. The duties towards care leavers are set out within these legislative acts, however, do not include the more recent terminology of care experienced, which to date has not nationally been agreed. For the purpose of this report care experience will be used to define people who have been looked after at some point in time by the local authority.

Discussion:

The 16+ Service Manager introduced the report which requested the Committee’s views on the Council adopting care experienced as a protected characteristic given the stigma and discrimination faced by care experienced people. She stated that Medway Council was aspirational for its young people and by implementing this suggestion, other Council services and its partners would need to specifically consider any impact on care experienced people.

Members then raised a number of questions and comments, which included:

·        Children in care figures – officers confirmed that at the time of writing the report, Medway had 167 open care leavers to the service and 475 children in care. These figures fluctuated daily.

·        Care leaver support – officers confirmed that some young people would not accept packages of support from the Care Leaving Service, through fear of discrimination, and gave examples such as young people in prison or even at school.

·        Leisure facilities for children in care – reference was made to a previous pledge to children in care, which had included a commitment to more leisure opportunities being made available to children in care. It was requested that information on the most current leisure offer to Medway’s children in care was provided. In response to comments, Members were advised that this information specifically did not fall within the remit of this Committee and therefore the information would be provided via a briefing note.

Decision:

1.             The Committee noted the comments of the Children and Young People Overview and Scrutiny Committee, as set out in the supplementary agenda and agreed that its comments be forwarded to Council for consideration at its meeting on 18 July 2024.

2.             The Committee also requested a briefing note in relation to the Council’s current leisure offer for its children in care.

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 how we performed in Q4 2023/24 on the delivery of these priorities and the actions we are taking to improve performance.

This report also presents the Q4 2023/24 review of strategic risks which fall under the remit of this committee (Appendix 2).

Discussion:

The Director of People and Deputy Chief Executive introduced the report which set out the performance in quarter 4 of 2023/24 on the delivery against the Council’s priorities that fell within the remit of this Committee. She explained that three indicators remained significantly below target, which were the same as previous reports, as were the reasons for their stubborn poor performance.

Members then raised a number of questions and comments, which included:

·        Dementia friendly settings – reference was made to the target around the number of new dementia friendly settings and the withdrawal of national Alzheimer’s Society support. The Acting Director of Public Health confirmed that Medway had been fairly successful in delivering, with partners, dementia friendly settings and this would continue with other partners engaged in the programme.

·        Social care – the Committee suggested that social care needed further focus in its forthcoming meetings and suggested a thematic approach to its work programme.

Decision:

The Committee noted the report and requested a briefing note to provide more information on dementia friendly settings.

Discussion:

The Principal Democratic Services Officer introduced the report and explained that the capital and revenue budget quarterly monitoring reports needed to be added to the next meeting on 20 August 2024. It was also confirmed that she would shortly be providing a rescheduled date for the visit to the South East Coast Ambulance Service site in Gillingham.

A comment was made about the lateness of the supplementary agenda for the meeting. The officer confirmed that this had provided minutes of another committee meeting held the previous week which, following drafting and clearances, were not available until that day to be shared with the Committee for its information. She confirmed that every effort was always made by the team to avoid last minute supplementary information but occasionally timings meant there would be occasions where information would be shared late.

Decision:

The Committee noted the report and agreed 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.