Agenda and minutes

Apologies for absence were received from Board Members Councillor Howard Doe (incumbent Vice-Chairman), Martin Riley (Medway and Swale Integrated Care Partnership Senior Responsible Officer (SRO) Representative) and Dr Farnaaz Sharief, MBE (Primary Care Network, Medway and Swale Representative).

Apologies for absence were also received from invited attendees, James Devine (Chief Executive, Medway NHS Foundation Trust), Helen Greatorex (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust (KMPT)) and Dr Caroline Rickard (Kent Local Medical Committee).

The Chairman expressed sadness upon hearing the news of the death of His Royal Highness, Prince Philip, Duke of Edinburgh. He had dedicated his life to the service of our Country and to Her Majesty the Queen. On behalf of the Board, the Chairman extended condolences to the Royal Family at this time. A two-minute silence was held.

On behalf of the Board the Chairman then welcomed Dr Lee-Anne Farach to the meeting as Medway’s new Director of People – Children and Adults Services. He congratulated Dr Farach on her new role.

He also wished Ian Sutherland, Medway Council’s previous Director, a very happy retirement. Mr Sutherland was retiring after 38 years in public service; he joined Medway in 2014 as Deputy Director of Children and Adults and he was appointed as Director in 2017. It was said that Mr Sutherland had worked tirelessly to improve services in both Children and Adults Services and had been invaluable to the Board.

The Chairman also welcomed Darryl Freeman to the Board. Mr Freeman was Medway Council’s new interim Assistant Director for Children’s Social Care, taking over from Dr Farach.

In the absence of the incumbent Vice-Chairman, Councillor Howard Doe, Councillor Adrian Gulvin was elected Vice-Chairman for the meeting.

To approve the record of the meeting held on 16 February 2021.

The record of the meeting held on 16 February 2021 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 Vince Maple advised the Board that he was a volunteer in the vaccination programme at the Pentagon centre, Chatham.

This report provides an update on the Local Outbreak Management Plan (LOMP) including top-level outcomes of recent stress tests made since the last update was presented to the Board on 16 February 2021.

Discussion:

The Board considered an update on the Local Outbreak Management Plan (LOMP), which was introduced by the Director of Public Health. The Board’s attention was drawn to a request made by the Department of Health and Social Care (DHSC) to submit a revised LOMP. This was submitted before the deadline of 31 March 2021 and positive feedback had been received. 

It was acknowledged that, generally, there had been a sharp reduction in COVID-19 prevalence, however there was a need to be cautious as progress was made along the Government’s roadmap. Work was ongoing to support easing of restrictions and the LOMP provided the framework for this to happen safely in collaboration with partners.

With reference to additional surge testing in South London, the Board was assured that emerging issues were monitored, and testing could be quickly stepped up in Medway, as required. The Board’s attention was drawn to the successes of the asymptomatic testing programme; over 128,000 Medway residents had been tested. A proactive outreach programme continued to encourage Medway residents to take up the offer of testing and indeed vaccination. The Board was updated on the vaccination programme.

Reflecting on the challenge of pupils returning to school on 8 March 2021, the Board was advised that this had been well managed. There had been some increase in cases of infection in pupils aged 13-17, however, this was expected given the extra testing being undertaken. Corresponding cases of infection in households had not been evident. Infection rates had also since decreased.

In response to a request for more publicly available and detailed information on (1) the changes made to the LOMP, (2) the additional information provided by the Government following the review and (3) the results of ongoing risk management stress testing on the LOMP, the Board was advised that given the sensitive nature of some of the operational content, not all information could be shared in the public domain. However, a public facing version of the LOMP was due to be published on the Council’s website imminently and an undertaking was given to share this with the Board Member.

Regarding Government feedback on the LOMP, it was explained that most of the Government’s queries related to information already held elsewhere. The information was provided as points of clarification and together with the LOMP was assessed against the Government’s framework. The Government were assured of the LOMP.

With regards to risk management stress testing, it was explained that this was an iterative process. The LOMP was a live document, revised daily in response to emerging issues. The Director of Public Health undertook to discuss the detail further with the Board Member outside of the meeting.

In response to concerns around complacency in the wake of the COVID-19 vaccination programme as restrictions eased and owing to testing, the Director of Public Health explained that whilst much of the population was vaccinated in key, at risk, groups, there would still be cohorts of individuals who could be infected. Also, asymptomatic testing  ...  view the full minutes text for item 878.

The Medway Joint Adult Learning Disability Strategy 2019 - 2024, developed by Medway Council and Medway Clinical Commissioning Group, brings national and local legislation together and ensures that the needs of people with learning disabilities sit at the heart of all we do in addressing inequalities and improving outcomes. The pandemic has resulted in many changes across the workforce therefore a review is required to ensure the Strategy and its actions remain relevant. The review will also consider proposals from Kent and Medway Clinical Commissioning Group for a new All Age Learning Disability and Autism Strategy.

Discussion:

The Board considered a report, introduced by the Assistant Director Adults’ Social Care, which presented an update on the Joint Adult Learning Disability Strategy 2019-2024.

The existing Medway Joint Adult Learning Disability Strategy 2019 – 2024 was developed by Medway Council and Medway Clinical Commissioning Group and brought together all key statutory and partner organisations within Medway as well as national and local legislation to address inequalities and ensure person centred, accessible, services were available to residents.

It was explained that individuals with a learning disability often had poorer mental and physical health than others and they encountered greater barriers to accessing health and care services. This had been brought to the fore by the COVID-19 pandemic and had prompted a review by Department of Health and Social Care (DHSC).

Owing to the impact of the pandemic and noting that the Kent and Medway Clinical Commissioning Group were developing a new All Age Learning Disability and Autism Strategy, the Medway Joint Adult Learning Disability Strategy 2019 – 2024 would be reviewed to ensure it remained fit for purpose. This was welcomed. An all-age approach to supporting individuals with learning disabilities and autism was also welcomed, particularly as it renewed focus on the transition from child to adult.

In response to a request, the Assistant Director undertook to provide the Board with an interim update in summer 2021, which would provide details of any proposed changes to the Strategy, ahead of a formal report in November 2021.

In response to concerns expressed around ensuring vulnerable individuals were supported to manage any changes resulting from a revised Strategy, with reference to experience from managing both children’s and adults’ facilities, the Assistant Director assured the Board that it was recognised that any changes would need to be made gradually without causing any significant impact to individuals, particularly to those with complex learning difficulties. It was suggested that elected Members be involved to a greater extent.

As part of the ongoing review, a request was made to consider including detail within the Strategy around multi-generational learning disabilities.

Decision:

The Health and Wellbeing Board:

a)    noted the report,

b)    agreed that a full update be presented to the Board on 18 November 2021, and

c)    agreed to request an update in the summer on progress made.

Following the Medway Healthy Weight Summit on 11 March 2021 and participation from Network members, this report provides some context around the Medway obesity data and a summary of priorities for the coming year.

Discussion:

The Board considered a report, introduced by the Head of Health and Wellbeing, which provided details of the 2021/22 priority action areas to tackle obesity. The actions set out in paragraph 3.3 of the report had been produced collaboratively by the Healthy Weight Network and were reliant on partnership working. Drawing on updated data since the Board considered a report in February 2020, the Head of Health and Wellbeing emphasised that to tackle the wicked issue of obesity, a sustained long term, system-wide, approach was needed. This was echoed by the Director of Public Health and the Chairman of the Board.

In response to comments and questions around creating balance when encouraging individuals to lose weight without negatively impacting their mental health, and the nuances around the language used, the Director of Public Health was mindful of avoiding unintended harm. The Board was advised that individuals ought to be encouraged to access the range of existing support services and be empowered to make a change to lose weight, as necessary, without experiencing shame or challenge to their own wellbeing/ self-image. Referring to successful stop smoking marketing, the Head of Health and Wellbeing also described that there needed to be a balance of carrot and stick. Research had suggested that communications could be targeted differently toward different audiences. An example of a successful weight management intervention, Man vs Fat, was given, where the word ‘Fat’ could be judged to be very direct.

In response to questions about joining up activity to support a reduction in obesity and ensuring longevity, it was explained that in a recent ‘call to action’, elected Members were provided with information on Ward level activity related to tackling obesity and ideas around actions they could take. It was recognised that the knowledge and reach provided by elected Members to engage with the community was beneficial.

Similar area-based information would be provided to local Primary Care Networks/GPs in due course. This was welcomed, particularly as it was a key issue for the system. PCN colleagues had already identified obesity as one of the priorities they wanted the ICP and the wider system to work on. A keenness was expressed to pool resources to have one integrated plan and approach. The use of a consistent branding was welcomed. Indeed, linking to broader work on population health management, prevention and wider determinants of health was also welcomed.

With respect to campaigns going forward, subject to satisfying grant conditions, it was hoped that an announcement could be made on this soon. The Board was assured that there was a commitment to sustained, long term, action. This was evidenced in the Government’s recent White Paper.

Clarification was provided in relation to the financial implications set out within the report. No additional funding to undertake the priority actions was requested from the Local Authority or its partners. Actions committed to would be funded from within existing budgets. This had been reviewed by Medway Council finance colleagues. It was suggested that the wording  ...  view the full minutes text for item 880.

This report provides an update on the recently published NHS White Paper on Health and Social Care reform. It will enable the Board to debate the implications of the proposed transformation of NHS services and how to ensure this process is aligned to local governance and shape future arrangements for collaboration and engagement with the proposed new NHS body for Kent and Medway.

Discussion:

Before introducing this report, in relation to agenda item 7 (Whole Systems Approach to Obesity Priorities for 2021/22), the Director of Public Health confirmed that the cost to society of obesity was £27 billion per year. For the NHS alone, this cost was £6.1billion with over 30,000 deaths per year attributable to obesity.

The Board then considered a report, presented by the Director of Public Health, which provided details of the recently published NHS White Paper on Health and Social Care reform. The themes within the White Paper captured some of the challenges discussed by the Board, particularly how collectively, at a local level, the system could be brought together to have a greater impact. The primary changes detailed in the White Paper were set out in paragraph 1.1 of the report. It was said that the White Paper provided a good starting point from which the Board could discuss how it could support NHS transformation and facilitate a collective effort to deliver defined outcomes for Medway’s population. It was suggested that a development session be held in the future to take this forward, which was welcomed by Board Members.

With reference to the COVID-19 pandemic, where increasingly large benefits had been attained by supporting communities where the greatest need existed, a view was expressed that a key focus area should be embedding a Population Health Management approach. This was central to the role of an Integrated Care System. The impending legislative change provided a mandate for this.

Recognising the benefit of objectivity, in response to a request that an independent facilitator facilitate the development session, the Director of Public undertook to liaise with Democratic Services to review possible options. He added that additional support may be possible through the LGA or through the NHS system.

A keenness was expressed to frame the development session in the context of work already being undertaken within the ICP and wider system to deliver a practical policy direction. Reference was also made to the role of the Kent and Medway Joint Health and Wellbeing Board.

Concerning other changes not referenced in the report, the Board was advised that a UK Health Security Agency had been established. This body brought together Public Health England (PHE), NHS Test and Trace and the analytical capability of the Joint Biosecurity Centre to address health protection. An Office for Health Promotion had also been established to address wider determinants of health. The White Paper outlined that there would be future changes to the Adult Social Care, more detail would be made available by the Government in due course.

Decision:

The Health and Wellbeing Board:

a)    noted the update presented in the report,

b)    agreed to hold a future development session to take this matter forward,

c)    agreed to request that ahead of the development session, Board Members be provided with comprehensive background information to enable the discussion to focus on the way forward, and

d)    agreed that the format and facilitation of the development session be discussed  ...  view the full minutes text for item 881.

The report advises the Board of the forward work programme for discussion in the light of latest priorities, issues and circumstances. It gives the Board an opportunity to shape and direct the Board’s activities.

Discussion:

The Democratic Services Officer introduced the report which sets out the Board’s proposed work programme at Appendix 1. The work programme had been revised following the pre-agenda meeting held 16 March 2021 and discussions thereafter, details of which were set out in section 2 of the report. It was acknowledged that further updates to the work programme had been suggested throughout the meeting, these would be reflected in the relevant minute.  

Decision:

The Health and Wellbeing Board agreed the work programme attached at Appendix 1 to the report.