Agenda and minutes

The Chairman advised that he had agreed to cancel the informal Health and Wellbeing Board meeting due to take place on Monday 13 March. An e-mail would be circulated to Board Members to confirm this.

The Board was asked to note that NHS England had advised that they would no longer be attending the Health and Wellbeing Board on a regular basis. Instead, NHS England would attend where specifically requested to in relation to an item on the agenda.

A number of Board Members were extremely disappointed at the decision taken by NHS England and the fact that no consultation had been undertaken in advance. It was agreed that these concerns would be raised through the appropriate channels.

Apologies for absence were received from Board Members Councillor Howard Doe, Councillor Vince Maple, Ann Domeney, Interim Deputy Director of Children and Adults and from Pennie Ford, NHS England.

Apologies had also been received from invited attendees Lesley Dwyer, Chief Executive of Medway Foundation Trust and from Martin Riley, Managing Director of Medway Community Healthcare.

Members of the Board expressed their disappointment than none of the four invited attendees were present and it was agreed that this would be considered further outside the meeting.

To approve the record of the meeting held on 2 February 2017.  

The record of the meeting held on 2 February 2017 was approved and signed by the Chairman as a correct record.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

There were none.

The Medway NHS Clinical Commissioning Group Two Year Operational Plan is closely aligned to the Kent and Medway Sustainability and Transformation Plan. The Operational Plan sets out the CCG’s plans for local implementation of the STP over the next two years.

Discussion

The Medway CCG Operational Plan 2017 to 2019 was introduced by the Chief Operating Officer of Medway NHS Clinical Commissioning Group (CCG). He advised that there was a statutory duty for a CCG to produce an operational plan, with Medway NHS CCG having produced a two year plan. There were a range of strategic drivers underpinning the plan, which included the Medway Joint Strategic Needs Assessment (JSNA), the Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP), the Medway Local Plan and local care arrangements. The Plan, which was also influenced by national priorities, was framed around nine ‘must do’s’ which had been set out by NHS England.

The Operational Plan included the following sections:

·         Sustainability and Transformation Plan – this section was replicated in all CCG operational plans across Kent and Medway

·         Finance and Quality, Innovation, Productivity and Prevention (QIPP)

·         Local care – this included the Medway Model, GP Forward View, Healthy Living Centres and prevention work

·         Primary care, community services, prevention, integration and coordinated care

·         Urgent and emergency care

·         Planned care

·         Cancer

·         Mental health

·         Learning Disabilities: Transforming Care

·         Improving Quality

·         Enablers – this includes areas of work such as IT and Estates which will facilitate improved services in relation to the other areas.

The Board raised a number of points and questions as follows:

Contents of Plan – A Member of the Board said that strategic plans should contain a clearly defined roadmap setting out what had already been achieved and future plans. Operational Plans should include milestones and conditions for success. They should set out activities and budgets for the time period covered by the plan. There should also be a list of objectives, detail of the activities required to deliver these and information in relation to quality standards and staffing and resource requirements. Plans should also set out an implementation timetable. There was no clear roadmap within the Operational Plan presented and the Member also considered that details of joint working required with other organisations should be clearly set out in the Plan.

In response, the Chief Operating Officer advised that the contents of the Plan were somewhat constrained by NHS England requirements. It was noted that although no detailed budgetary information had been included in the main Plan, there was some budgetary information in one of the appendices. The Plan did also contain some clear deliverables and timescales, planned care being one example.

Housing Needs – A Member said that some good joint work had taken place in relation to estates. It was requested that more detail of joint working in relation to this be included in the Plan. There was an opportunity for the Council to facilitate the provision of new accommodation at some premises in order to help meet the need for 30,000 new homes to be built in Medway during the next few years. The Member suggested that the development of Extra Care accommodation could be explored and that this should be at the forefront of future development  ...  view the full minutes text for item 819.

In May 2016, following a far reaching and extensive review, the Housing (Demand, Supply and Affordability) Task Group made a number of recommendations to help manage demand and improve the supply and affordability of housing in Medway.  The Task group considered three key issues of enquiry and heard evidence from a number of sources and those working in the field.

This report and attached action plan (Appendix 1) summarises progress against each recommendation.

There are significant personal well-being issues for residents connected with both the quality and availability of housing; for health care organisations in terms of discharging patients to suitable accommodation; and issues for staff in a number of local organisations being able to access affordable housing. Board Member comment and support is sought.

Discussion

The Head of Planning and the Head of Strategic Housing introduced an update on the progress made in relation to the recommendations made by the Housing (Demand, Supply and Affordability) Task Group in May 2016. The key points made by officers were as follows:

·         It was recognised that through the Local Plan, the Council needed to comply with the objectively assessed needs of different groups of people. Without this there was likely to be increased overcrowding.

·         There were between 6,000 and 7,000 planning applications for new homes in Medway that had been granted where construction had not yet taken place. There was a need to work with developers to address this.

·         The Government’s Housing White Paper had proposed reducing the lifespan of planning applications and allowing the success of developers in implementing previous approvals to be taken into consideration when future applications were considered. The possibility of compulsory purchases by local authorities of sites that were not being developed was also proposed.

·         The White Paper also set out funding for accelerated construction of housing. The Council had submitted an expression of interest for this funding.

·         The Council was working with developers to look at how the planning pre-application stage could be enhanced.

·         Work was being undertaken to upskill the local workforce to increase the amount of construction that could take place. Mid Kent College and Medway University Technical College were supporting this work. A Kent and Medway Protocol had been developed.

·         The Homebond scheme was supporting 125 applicants to access the private sector rental market each year. There was scope to develop this further, with work taking place with the Landlords’ Forum to develop the scheme.

·         The Council’s Housing Allocation Policy prioritised enabling social housing tenants living in a house larger than they needed to move to a smaller property.

·         Advice was provided to local people in relation to affordable home ownership.

·         60% of new housing in the UK was constructed by ten firms. There was a need to encourage more small and medium size builders to develop in Medway as large builders could not meet all local house building needs.

·         A benchmarking exercise had been undertaken with Kent to look at private sector rented standards. This had established that Medway had mid-range staffing levels per 1,000 tenancies in the private sector compared to other areas.

The Board raised a number of points and questions as follows:

Accommodation for looked after children - A Member highlighted that there was no reference to children or young people in the papers presented to the Board. He suggested that better collaboration was required between housing and children’s services, partly to reduce the need for people to be housed in relatively high cost private sector accommodation. Nationally, there had been a failure to ensure appropriate accommodation for looked after children and care leavers.

Another Member, who was Chairman of the Medway Property Board and Special Housing Projects Board said that work was being undertaken to address these concerns, with feedback received from looked  ...  view the full minutes text for item 820.

Medway is a demonstrator site for the National Diabetes Prevention Programme and has been commissioned by NHS England to support 300 clients in 2016/17 at high risk of developing type 2 diabetes, within its 12 week Healthy Way programme.

The programme is currently ahead of target and is producing positive outcomes in terms of reducing type 2 diabetes risk (through a reduction in the blood marker HbA1c) and reducing body weight.

The Board is asked to note the progress of the programme and continue to support the project board in delivering the programme objectives, particularly in terms of supporting prevention (in this case, the identification of people with pre-diabetes and thus at risk of developing diabetes) through both commissioning processes and provider care pathways.

Discussion

The Senior Public Health Manager introduced an update on the National Diabetes Prevention Programme. Medway had been given Demonstrator site status by the National Diabetes Prevention Programme. Locally, the work had been a success with Public Health Medway, NHS Clinical Commissioning Group (CCG) and primary care colleagues working together to demonstrate that Medway can be an innovator and leader in diabetes prevention. It was anticipated that targets would be exceeded in terms of both the number of people participating in the Diabetes Prevention Programme in Medway and in terms of the outcomes achieved. Public Health had been awarded a further year long contract by NHS England to continue to deliver the programme in Medway. An extra 400 people had been supported in the current year compared to the target. The aim was, over the next 12 months, to further improve the service and outcomes for those participating in the programme.

The Board raised a number of points and questions as follows:

Patient Outcomes – A Member asked what action had been taken in relation to the 21% of people who had participated in the Programme for six months who had not maintained their reduced risk. The Senior Public Health Manager advised that there would always be some people who were not able to sustain a reduced risk. These people had the option to repeat the programme.

The Clinical Chair of Medway CCG considered the programme to have been a success and that it was a good example of joint working between the CCG and Public Health. Given that diabetes risk tended to increase with no intervention, achieving a 79% figure for people maintaining or improving their risk was considered to be very good. The Interim Director of Public Health said that Diabetes Prevention was important as diabetes was becoming more common, it being the commonest cause of blindness in those aged under 65 and the commonest cause of kidney failure.

Celebrating Success – A Board Member said that good news, such as the achievements of the Diabetes Prevention Programme in Medway, should be celebrated. He considered that this should provide confidence for more projects to be undertaken.

The Chairman agreed that the progress made had been good and congratulated colleagues on the work undertaken.

Decision

The Board noted the progress in delivering the NDPP locally and agreed to continue to support the Project Board, in delivering the programme objectives, particularly in terms of supporting prevention (in this case, the identification of people with pre-diabetes and thus at risk of developing diabetes) through both commissioning processes and provider care pathways.

The report asks the Board to consider the final report of the in-depth Task Group review on ‘How far Medway has gone in becoming a Dementia Friendly Community.’ The Board is asked to consider the findings and recommendations of the Task Group ahead of it being considered by the Health and Adult Social Care Overview and Scrutiny Committee on 16 March and by the Regeneration, Culture and Environment Overview and Scrutiny Committee on 28 March.

The recommendations aim to complement the wide variety of work already being undertaken by the Council and partners to implement the Council’s Dementia Strategy. The review has had a particular focus on how Medway Council and its partners can lead by example to help make Medway a Dementia Friendly Community. This includes services that the Council directly controls and those, which while not directly under the control of the Council, it could influence through partnership working.

Discussion

The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund introduced the report of the Dementia Task Group. The Councillor Members of the Task Group had undertaken external visits and participated in a number of evidence sessions. The report summarised the outcomes and recommendations arising from this work.

The key conclusions of the Task Group included the need for the Council to lead by example to ensure that its staff and services are dementia friendly. There was also support for the Test for Change Pilot in Rainham and the development of the Council’s existing Dementia Strategy. The importance of the Medway Dementia Action Alliance had also been recognised, including the need to work with the Alliance to ensure that the anticipated submission of an application for Medway to be recognised as a Dementia Friendly Community was a success. The review had also recognised the constraints on financial resources.

The Risk Management section of the covering report stated that there were no risks arising from the report. There had been discussions between system leaders to ensure that, in the event that there were specific changes to services, these would be incorporated within service development.

The Board raised a number of points and questions as follows:

Role of the Council in promoting a dementia friendly community: A Member considered that the Council had a key role to play in encouraging staff, Members and external organisations to be dementia friendly. It was suggested that contractors should also have a responsibility in this area and that this could be made a condition of contracts awarded by the Council. It was requested that further work be undertaken in this area.

A Board Member, who was also Chairman of the Procurement Board, said that he would ensure that the matters raised in relation to procurement were considered by the Procurement Board. He advised that Council suppliers had already been encouraged to sign up to the White Ribbon campaign that worked to stop violence against women. The Board Member was also Chairman of the Transformation Board and it was suggested that how to make digital transformation work for people with dementia could be considered.

Communications and Engagement: A Board Member said that the report was excellent. In relation to communications and engagement, he suggested that there should be a focus on effective communication with people living with dementia as well as on communication with carers.

Wording of Recommendation: It was requested that the word “diagnostic” be removed from recommendation 22. This was due to the fact that dementia could not be accurately diagnosed through a scan. Scanning was part of the process used to diagnose dementia and was used to rule out other causes of particular symptoms. The revised recommendation would read as follows:

“That the Partnership Commissioning Teams should work with Medway NHS Clinical Commissioning Group and Medway NHS Foundation Trust to seek to reduce waiting times for scans.”

The Healthwatch Medway representative on the Board advised that the Citizens’ Advice Bureau and  ...  view the full minutes text for item 822.

This 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 Board reviewed the current work programme. A Member noted the importance of the Protocol Setting Out the Relationship Between Key Strategic Boards in Medway, a review of which was due to be presented to the April 2017 meeting of the Board.

Decision

The Board noted the current work programme and agreed to add an update on Looked After Children.