Agenda and minutes

Apologies were received from Councillor Howard, Councillor O’Brien, Councillor Mackness, Dr Mike Parks (Medical Secretary Kent Local Medical Committee), Lesley Dwyer (Chief Executive Medway NHS Foundation Trust), and Malcolm McFrederick (Acting Chief Executive, Kent and Medway NHS and Social Care Partnership Trust).

It was noted that Caroline Selkirk and Ian Sutherland were attending a meeting of the Sustainability and Transformation Plan Steering Group and would join the meeting later. Item 5 would be deferred to a point in the meeting after they had arrived.

To approve the record of the meeting held on 15 March 2016.

The record of the meeting held on 15 March 2016 was agreed subject to a the correction of a typographical error at minute number 855/2016, Emergency Care Improvement Partnership (ECIP) Improvement Support for the Medway Health and Social Care Community.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

There were none.

The Chairman announced that a letter from NHS England regarding changes to the Esplanade Health Care GP Surgery in Rochester had been forwarded to Board members. Comments on the planned changes were requested by 9 May. The Chairman advised that a meeting of the GP Practice Commissioning Panel had been arranged for 20 May to discuss the planned changes and it was agreed that the Chairman would attend that meeting on behalf of the Board.

This report provides an update on the current development of the Kent and Medway Sustainability and Transformation Plan. 

Discussion:

The Accountable Officer, Medway CCG, introduced a report updating the Board on the development of the Kent and Medway Sustainability and Transformation Plan (STP). She advised that, following discussions at the Medway and Swale Sustainability and Transformation Plan and between the CCG and Medway Council representatives, she had written to the Senior Responsible Officer for the STP with comments for inclusion in the Plan. These included revised governance arrangements with equal representation from Kent County Council and Medway Council at both elected member and officer level. In addition, Council and CCG representatives had developed a Medway chapter for inclusion in the Plan.

Members of the Board raised a number of points, including:

·         The Chairman praised the collective effort to move the STP forward.

·         Anything that could be done collectively to improve staffing and recruitment would be welcomed.

·         As well as the local plans, there was a need to consider clinical pathways on a broader scale.

·         As requested by the Board at its meting on 15 March, the Chairman had written to the Local Government Association to express concerns about the STP process. This letter, and the response, would be circulated to members of the Board.

Decision:

The Board noted the report.

This report provides a summary of Medway’s draft Joint Transformation Planning Template and an outline of the immediate actions set out in the Plan to be undertaken this year.

Discussion

The Assistant Director, Partnership Commissioning, introduced the report which explained that NHS England had established 49 Transforming Care Partnerships (TCP) across England including the Kent and Medway TCP. In May 2016,  Kent and Medway would submit separate three year Transforming Care Plans with a single Finance and Activity Template, Risk Register, a joint Executive Summary and a governance structure that included a joint Kent and Medway Strategic Transformation Executive to oversee local Transforming Care Boards. The report provided a summary of Medway’s draft Joint Transformation Planning Template and an outline of the immediate actions set out in the plan to be undertaken this year.

Members of the Board raised a number of points and questions which were responded to, including:

·         With regard to a business case and strategy for local accommodation and respite solution for children and young people with mental health issues, the Council had talked to the market and engaged with parents and carers about the provision of personal budgets.

·         Lord Crisp’s report had recommended that the practice of sending patients long distances should be phased out by October 2017.

·         Parents sometimes preferred that their children were placed in more specialist provision rather than the most local provision.

·         Advocacy was crucial; GP’s sometimes became the advocate informally. It was explained that this was one of the work streams and a provider/engager event was planned on how this might be shaped going forward.

·         The report was endorsed by Healthwatch, which supported the principle that people should be given more choices as well as control over their own health and care services.

Decision:

The Board:

(a)          supported this important agenda going forward and supported the Council and Clinical Commissioning Group to comply with statutory duties;

(b)          supported the local draft Transforming Care Plan and recommended the separate, but aligned approach with Kent as part of the Transforming Care Partnership; and

(c)          agreed that a progress report be presented to the Board in 6 months time.

This report seeks the Board’s support for the development of proposals to enable a system-wide approach to reduce the risks to, and to improve the effectiveness of, a variety of types of care for patients/clients through the encouragement and enablement of smoking cessation before treatment, or during it, as clinically appropriate.

Discussion:

The Interim Director of Public Health introduced a report seeking support for the development of proposals to enable a system-wide approach to reduce the risks and improve the effectiveness of a wide range of care for patients through the encouragement and enablement of smoking cessation before treatment, or during it, as clinically appropriate. There was considerable evidence to suggest that effective treatment for a wide range of illnesses was reduced where patients were smokers.

Members of the Board raised a number of points including:

·         The smoking cessation team had developed a programme for the use of carbon monoxide monitors for patients attending antenatal care and cardiology services. This initiative had increased the referral rate to the stop smoking service.

·         While it was important that the potential for poor outcomes from surgery was explained to patients who were smokers, they should not be given the impression that surgery would be denied to them because they smoked. There should not be a perception that this initiative was financially driven; it was directly linked to improving the safety and effectiveness of care.

·         This initiative should be non-stigmatising; most people needed a number of attempts to quit smoking.

·         Relapse prevention needed to be built into stop smoking programmes.

·         It was important that people were aware that smoking caused secondary illnesses.

·         A Medway-wide position on the use of e-cigarettes was needed.

 Decision:

The Board:

(a)       recommended that Board members identify how they might encourage and enable commissioners and providers, including GPs, to make it possible for many more people to quit smoking in sufficient time before planned surgery, and to quit smoking to increase the effectiveness of other care; and

(b)       encouraged commissioners and providers to:

(i)            explore the implications of a systems-wide approach for contracts and service provision;

(ii)           undertake a diversity impact assessment; and

(iii)         undertake modelling to develop a robust business case for this approach.

This report seeks the Board’s comments on the Kent and Medway Safeguarding Board Annual Plan for 2016-17.

Discussion:

The Interim Principal Officer, Safeguarding Adults introduced a report setting out the Kent and Medway Adult Safeguarding Board Annual Plan for 2016-17. The Plan was informed by six key principles of safeguarding adults. For each of these principles, Board members noted the actions required and the outcomes to be achieved.

It was reported that a multi-agency Medway Safeguarding Adults Executive Group (MSAEG) was being established to strengthen the delivery and local oversight of the strategic priorities for safeguarding adults in Medway. This would enable more effective alignment with other boards that operated locally.

Members of the Board raised a number of points and questions which were responded to, including:

·         In response to a suggestion that there be links to the work of the Medway Towns Soroptimists on raising awareness and support for those at risk of human trafficking to reduce duplication of effort, it was explained that a scoping exercise was underway to identify what activity was ongoing. 

·         In response to a question on why the Medway NHS Foundation Trust and Medway Community Healthcare were not members of the MSAEG, it was reported that targeted work had been undertaken with providers on deprivation of liberty safeguards activity.

Decision:

The Board reviewed, commented on, and noted the Kent and Medway Safeguarding Adults Board Action Plan 2016-17.

This report provides an update on the work of the Medway Safeguarding Children Board during 2015-16 and on the Business Plan for 2016-17.

Discussion:

The Medway Safeguarding Children Board (MSCB) Business Manager introduced a report on the work of the MSCB during 2015-16 and the Business Plan for 2016-17. The six priorities of the Business Plan, which were reviewed annually, were noted together with the actions for 2016-17.

Members of the Board raised a number of points and questions which were responded to, including:

·         Considerable work was underway, particularly through the multi agency team, to establish the extent of child sexual exploitation in Medway. Further information would be provided in the Annual Report to be presented to the Health and Wellbeing Board in November.

·         The Secretary of State had reviewed the role and functions of safeguarding boards including whether a bigger regional footprint was required. National guidance was expected in the Summer.

·         In response to a question about the partner members of the MSCB, it was clarified that the Youth Offending Team were members but did not contribute to the pooled budget. 

Decision:

The Board considered, commented on, and noted the update report.

This report updates the Board on the work of Medway Children’s Action Network and its plans for 2016.

Discussion:

The Assistant Director, Partnership Commissioning, introduced the report which updated the Board on the work of Medway’s Children’s Action Network (CAN) and its plans for 2016. It was noted that a key priority for CAN was around early help for children, young people and families. The partnership approach to early intervention had been strengthened by the establishment of an early help steering group in March 2016 which brought together operational managers of the relevant services.

 In response to a question about early intervention, it was explained that responsibility for early help was no longer regarded as solely the Council’s responsibility and an action plan had been developed from the system-wide early help strategy.

Decision:

The Board noted the progress with Medway’s CAN’s action plan.

This report summarises progress made on the Looked After Children Strategy Action Plan and outlines the programme of work for the Corporate Parenting Board in 2016-17.

Discussion:

The Assistant Director of Children’s Services introduced a report which summarised progress made on the Looked After Children Strategy Action Plan and outlined the programme of work for the Corporate Parenting Board in 2016-17. The Board noted the seven objectives contained within the work plan.

 The report was welcomed as it provided clear data against which performance could be measured.

Decision:

The Board noted the progress made and supported the continued implementation of the Looked After Children Strategy.

This report seeks the Board’s comments on the future work programme for the Board.

Discussion:

The Board reviewed the current work programme and noted that the theme of the next meeting on 28 June would be mental health. It was suggested that, in addition to the reports from Medway Council and Medway CCG on mental health services in 2016/17, there should also be a report from Kent and Medway NHS and Social Care Partnership (KMPT). This would complete the picture and would generate a whole system discussion.

Decision:

That the work programme be amended to include an item on KMPT mental health services in 2016/17 for the meeting on 28 June 2016.