Agenda and draft minutes

 An apology for absence was received from Councillor Mark Prenter.

To approve the records of the meetings held on 7 August and 20 August 2024.

The records of the meetings held on 7 August and 20 August 2024 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

There were none.

Other significant interests (OSIs)

There were none.

Other interests

Councillor Mandaracas explained that she was a trustee of the Sunlight Centre, which ran a dementia café.  However, the reports did not have any direct reference to dementia cafes or the Sunlight Centre and therefore she was able to take part in the discussions.

This report provides information on population statistics, the current dementia diagnosis rate in Medway and development plans that are being undertaken to support the achievement of the national directive to achieve 66.6% diagnosis rate of the predicted prevalence. The report also provides information on the Ageing Well dementia transformation plan to develop community-based memory assessment services working in collaboration with KMPT specialist memory assessment services.

Discussion:

The Deputy Director Out of Hospital Care (Community Services) and the Dementia Clinical Lead from NHS Kent & Medway introduced the report which provided information on population statistics, the current dementia diagnosis rate in Medway and development plans that were being undertaken to support the achievement of the national directive to achieve 66.6% diagnosis rate of the predicted prevalence. It was explained that, in agreement with NHS England, an interim target of 63% diagnosis rate by March 2025 had been set and that there had been significant improvement in the rate since April 2024. Jointly funded Dementia Co-ordinators had been introduced to become the primary contact for patients and carers and to ensure co-ordinated services were wrapped around the patient and their families. 

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

• Diagnosis rate – in response to a comment that, although the improvement was welcomed, the rate of diagnosis remained at an unacceptable level, it was acknowledged that more work was needed but that following a long period of static or reducing rates of diagnosis, the marked improvement was a positive sign that the work being implemented was making a positive impact.
• Dementia co-ordinators – in response to a question about how many Dementia Co-ordinators existed, it was explained that there was 1 per Primary Care Network (PCN).  Reference was made to an evaluation of feedback received about post diagnostic support both before and after the introduction of Dementia Co-ordinators and it was undertaken to circulate this to the Committee.
• Reliance on GPs – concern was raised that there was a reliance on upskilling GPs to carry out assessments, despite the level of GPs per population being low in Medway.  In response, comment was made that in many cases, dementia was preventable and that therefore there was more to be done as a society to empower people to keep well and live healthy lives, as well as building age friendly communities. It was added that diagnosing patients in the community, with not just GPs but a combination of wider health care professionals to be able to look at the whole person, had shown to improve diagnosis rates and also led to improved management of the condition.
• Infrastructure – reference was made to the infrastructure needed, across the system to make Medway dementia friendly and how leaders were working jointly across organisations.  In response it was clarified that there was a system wide dementia oversight partnership board in place, chaired by the clinical lead for dementia to work collectively on improvements system wide.

Decision:

a)    The Committee noted the contents of the report and that in August 2024 Medway achieved a significant improvement in the dementia diagnosis rate to 61.4%.

b)    The Committee requested information about Dementia Co-ordinators, in terms of numbers and the outcome of the evaluation relating to patient experience since their introduction.

c)    The Committee requested information about the ongoing impact and implementation of the recommendations from the Task Group that looked into Dementia Friendly  ...  view the full minutes text for item 347.

The report provides an update on specific topics requested by the Committee and aims to provide some assurance of the on-going work and progress on dementia diagnosis, the provisions for the new Ruby ward and the plans for Kent and Medway NHS and Social Care Partnerships Trust (KMPT) to develop a new identity and branding.

Discussion:

The Director of Transformation and Partnerships and the Director of Communication and Engagement from Kent and Medway NHS and Social Care Partnership Trust (KMPT) introduced the report which provided three updates.  In relation to the Trust’s identity and rebranding it was explained that the Trust was looking to change its name to Kent and Medway Mental Health NHS Trust from April 2025. In relation to the relocation of Ruby Ward and the transportation offer it was explained that a volunteer drivers scheme was in place and that demand for dial-a-ride had been minimal. Visiting hours at the majority of KMPT wards had also been extended to improve accessibility and flexibility for families to visit their loved ones which had been positively received. Lastly an update was provided in relation to the Memory Assessment Service, improvement of which was being implemented across three phases. Outcomes would include improved rapid diagnosis and an increase in those able to assess and diagnose.

Reference was also made to the Royal College of Psychiatrists’, national audit of dementia which had found that nationally, there was an average of 15 days discrepancy between the less and most deprived areas accessing memory assessment services.  Work was therefore ongoing to improve access for those from the most deprived areas.  Lastly, confirmation was provided that the backlog caused by the Covid-19 pandemic had been eliminated in October 2023.

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

• Rebranding – reference was made to the necessity to rebrand and its associated cost.  In response it was explained that following extensive engagement it was clear that the Trust’s name was confusing and caused a lack of clarity for patients, staff and partners about what the Trust offered. In terms of the projected cost related to the rebranding, it was explained that the Trust was taking a pragmatic approach and using the opportunity to update poor signage that was already in need of replacing and updating to make it easier for patients to navigate and find services.
• Targets – in response to a comment about overall performance and future targets, it was explained that the strategic ambition set last year was that 95% of patients referred would be assessed and receive a diagnosis within 6 weeks.  It was reiterated that this was a stretching ambition but that this was important in striving for the best for its patients.  It was also considered that the target of 63% diagnosis rate by March 2025 (as referenced in the previous item) was achievable.

Decision:

The Committee noted the report.

This report, which gives an update from the Kent and Medway Partnership for Neurodiversity on the procurement of community services. Attached is a completed substantial variation assessment questionnaire for the Committee’s consideration.

Discussion:

The System Programme Lead for Learning Disability, Autism and ADHD, Kent and Medway Partnership for Neurodiversity, introduced the report which provided an update on a new proposed adult autism and ADHD care pathway. Attached to the report was a completed substantial variation assessment questionnaire for the Committee’s consideration. Reference was made to the significant increase seen nationally in referrals for autism and ADHD in adults as well as children. It was explained that the proposals did not include a reduction or negative impact for patients although the significant demand which continued to exceed the capacity within the service would remain a challenge.

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

• Support before diagnosis – concern was raised that too much emphasis was being put on support before diagnosis, rather than speeding up the diagnosis process. In response it was explained that a large proportion of the population were neurodivergent and identifying people and supporting them to self manage and access services without the need for a diagnosis was important. Often support needed before and after diagnosis remained the same. Therefore focussing on meeting the needs of the person which led to the referral rather than focussing on the diagnosis itself, was vital.
• Foetal Alcohol Syndrome Disorder (FASD) – in response to a question about whether FASD was included within the pathway it was confirmed that within children’s discussions, this was often looked at, however, it had not been raised in the context of adults, and this would therefore be taken away and explored.
• Data – in response to a query it was confirmed that the chart in the papers was not complete due to the high demand.  Over 31,000 referrals had been made in a two year period and so information on this was still being processed.  However it was confirmed that approximately 7000 of the referrals related to Medway residents.
• Change in providers – in response to a question about changes in providers, it was explained that under new procurement legislation, this service was being procured under the Right to Choose which would result in a larger number of providers being available but with greater oversight being built in with assurance around consistency in approach through an accreditation process. In relation to the community offer, it was explained this was currently provided by a number of organisations and it was therefore intended to bring this together, with intensive support services remaining the same. Services would continue to be delivered locally and providers would be expected to have a footprint in Medway.
• Gender – in response to a query about why more females were being referred compared to males, it was explained that there had been a perception that ADHD was prominently apparent in males but that was in fact not the case, but it did typically present in different ways between men and women. There was much more awareness in neurodiversity amongst females and that is what was likely to have caused the escalation in  ...  view the full minutes text for item 349.

The report seeks to provide an update on mortality rates at Medway NHS Foundation Trust, and work undertaken to progress improvements.

Discussion:

The Chief Executive and the Chief Medical Officer from Medway NHS Foundation Trust (MFT) introduced the report which provided an update on mortality rates at MFT and the work that was being undertaken to progress improvements. It was explained that work had been carried out to ensure accurate data quality and the next phase was to look at a case mix of patients. Reference was made to the context in which MFT sat, such as the area having low GP to patient ratios and a significant number of the population aged over 75 years.  It was explained that MFT was one of the best performing in relation to ambulance hand over but this led to a crowded Emergency Department (ED) so work was focusing on how the flow through the hospital could be improved to avoid patients experiencing long waits in ED.

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

• Treatment Escalation Plans (TEP) – in response to a question about how much progress had been made in relation to the integration of TEP onto Electronic Patient Records it was explained that there had been significant improvement and it was hoped this would be completed within 3-4 months.
• Risk adverse – in response to a question whether practices had become more risk adverse due to the rise in mortality rates, Members were assured that every patient received the correct care they required for their needs.
• System wide impacts – reference was made to how the wider system had some contributory factors to mortality rates at MFT, for example high demand and shortage of beds and patients coming to hospital who could be better treated elsewhere. Work was underway with other healthcare professionals to ensure patients were taken to the right place for treatment, which was not necessarily Medway Maritime Hospital and also to ensure provision was available in the community to be able to ensure timely discharges. A large contribution to this work was the development of the Single Point of Access out of hospital urgent care hubs, which in the first couple of months of implementation had seen an average reduction of 10-15 ambulance intakes a day at MFT where some patients could be treated better elsewhere, away from ED. MFT were doing all in their power to address issues within their remit but some solutions needed to be realised with a system wide approach.
• Monitoring of improvements – It was explained that there was a focus on improvements and making sure they were delivered in a sustainable way with clear monitoring to avoid inconsistencies.

Decision:

The Committee noted the report.

This report seeks to update the Medway HASC (Health and Adult Social Care Overview and Scrutiny Committee) on Stroke Provision as requested at the March 2024 HASC meeting. Specifically, the Kent and Medway Integrated Care Board (KMICB) was requested to advise the HASC on the transient ischaemic attack (TIA) service and the progress made to provide the service locally again.

Discussion:

The Deputy Director of Out of Hospital Care and the Integrated Stroke Delivery Network Clinical Lead from NHS Kent and Medway introduced the report which provided an update on Stroke Provision, in particular the transient ischaemic attack (TIA) service and the progress made to provide the service locally. There had been digital issues at MFT to implement electronic patient records (EPR), however that issue was now in a position to provide some elements but the pharmacy service element was still not resolved and therefore at the moment, some treatment for residents of Medway and Swale in relation to TIA, could still not be provided out of MFT.

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

·       Stroke review – reference to the stroke review, which had led to a remodelling of stroke services across Kent and Medway which resulted in two hyper-acute stroke units (HASUs) being established as well as TIA seven-day services being part of proposals.  A view was shared that stroke services should have remained in Medway and that a HASU should have been established closer to the most concentrated need (Gillingham and Chatham). In response it was explained that before the reconfiguration, stroke services across Kent and Medway had been inadequate and evidence demonstrated that larger specialist HASUs provided better care for stroke patients and this had been replicated in Kent and Medway as demonstrated in the table set out in the report. The point was also made that patient feedback had shown that they wanted to receive excellent care and were prepared to travel to receive it.

·       Pharmacy service – reference was made to the pharmacy service issue currently at MFT and whether this would be resolved.  In response, assurance was given that this was still a priority to get resolved.  It was explained that software was required which would take time to implement and embed but would be a long term solution.

Decision:

The Committee noted the report.

This report from the Integrated Care Board (ICB) provides an update on the procurement of adult and children’s community services. The update is attached at Annex A to the report.

Discussion:

A number of representatives from NHS Kent and Medway Integrated Care Board (ICB) introduced the report by providing a short presentation which included information about the background to the issue, engagement and communication undertaken and a financial overview of the proposals.

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

• Mitigate disruption – in response to a question about plans to mitigate any disruption caused from potential changes in provider, it was explained that built into the procurement was a six month transition period to ensure smooth transitional arrangements.
• Staffing – in response to a question about how the ICB were working with providers to address vacancies within the workforce, it was explained that the ICB took a supportive role in developing and bringing staffing groups and networks together and raised the profile of working for Kent and Medway to help address the shortage which was a national issue. In addition, the ICB worked with chief people officers across providers to develop a collaborative strategy for recruitment, including working with universities.  It was recognised this would be a continual challenge.
• Needs analysis – it was asked if there was more detail about the needs and impact on communities such as specific needs of neurodivergent children or children with disabilities or particular needs and how such groups had been specifically communicated with. It was explained that at this stage engagement had been broad and more specific and targeted consultation would occur as the transformation process progressed over the course of the contract.
• HASC involvement post procurement – clarity was sought as to how HASC could be involved and have a voice on transformation of service once contracts were agreed. The ICB confirmed that there would be a number of service change proposals that would be brought back to the Committee for co-development and full involvement as the transformation plans progressed, but the ICB did not know at this stage what the specific changes would be. Change was needed to improve the delivery and quality of some services and to deliver care in different ways and HASC would be consulted on changes as they were identified and developed.
• Discrepancy in transition pathways – reference was made to the discrepancy in transition between children’s and adults services, which for some children’s services was 18 in Kent and 19 in Medway.  It was asked how this impacted both in terms of finances and transition between the two. It was confirmed that through the new contractual arrangements the ICB would ensure consistency across Kent and Medway, recognising that this issue caused frustrations for patients who also welcomed a consistent approach.
• Substantial Variation (SV) status – reference had been made to the difference in opinion between the Committee and the ICB around whether the re-procurement of community services was an SV or not. The ICB were asked how, within the remit of an SV, could the two work together to move forward as it was accepted that continued improvement was needed.  The ICB  ...  view the full minutes text for item 352.

Discussion:

The Principal Democratic Services Officer introduced the report which updated the Committee on its current work programme.  She explained that officers would provide a briefing note in relation to the item being removed from the work programme about the impact of immigration policies.  She also explained that she and the Director of People had provided a presentation to the Integrated Care Board the previous week on health scrutiny and it was recommended that some development sessions be arranged between the Committee and the ICB, which would be planned in due course.

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 and noted that a briefing note on the impact of immigration policies would be provided.