Agenda and minutes

Health and Wellbeing Board
Tuesday, 25 April 2017 4.00pm

Venue: Meeting Room 2 - Level 3, Gun Wharf, Dock Road, Chatham, Kent ME4 4TR. View directions

Contact: Jon Pitt, Democratic Services Officer 

No. Item


Chairman's Announcement


The Chairman informed the Board that, following the announcement by NHS England that it would only be attending future Health and Wellbeing Board meetings on a request basis, a letter had been sent to NHS England to request clarification. This was in view of the fact that NHS England remained a permanent voting member of the Board and was required to join the HWB for the purpose of participation in the preparation of the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy. It was also noted that the 2012 Health and Social Care Act required NHS England to appoint a representative to join the HWB for consideration of any matter relating to the exercise or proposed exercise of NHS England Commissioning functions in relation to Medway.


The letter sent to NHS England had stated that it would be preferable to have a named individual from NHS England as a voting Member of the Board to secure continuity of engagement and requested that if this was not possible, for confirmation of whether NHS England had relinquished its seat as a voting member of the Board. No response to the letter had been received by the date of the Board meeting.


Apologies for absence


Apologies for absence were received from Dr Andrew Burnett, Interim Director of Public Health, from Ian Sutherland, Director of Children and Adults and from Dr Antonia Moore of Medway NHS Clinical Commissioning Group.


The Chairman advised the Board that the meeting would have been Andrew Burnett’s last before leaving the Council. This followed the appointment of a new permanent Director of Public Health. On behalf of the Board, the Chairman noted his thanks to Andrew for his hard work and the contribution he had made to the public health agenda in Medway and to the work of the Board.


Record of meeting pdf icon PDF 116 KB

To approve the record of the meeting held on 14 March 2017.


The record of the meeting held on 14 March 2017 was approved and signed by the Chairman as a correct record.


Declarations of disclosable pecuniary interests and other interests

A member of the Board need only disclose at any meeting the existence of a disclosable pecuniary interest (DPI) in a matter to be considered at that meeting if that DPI has not been entered on the disclosable pecuniary interests register maintained by the Monitoring Officer.


A member disclosing a DPI at a meeting must thereafter notify the Monitoring Officer in writing of that interest within 28 days from the date of disclosure at the meeting.


A member may not participate in a discussion of or vote on any matter in which he or she has a DPI (both those already registered and those disclosed at the meeting) and must withdraw from the room during such discussion/vote.


Board members may choose to voluntarily disclose a DPI at a meeting even if it is registered on the council’s register of disclosable pecuniary interests but there is no legal requirement to do so.


Members should also ensure they disclose any other interests which may give rise to a conflict under the council’s code of conduct.


In line with the training provided by the Monitoring Officer members will also need to consider bias and pre-determination in certain circumstances and whether they have a conflict of interest or should otherwise leave the room for Code reasons.


Disclosable pecuniary interests


There were none.


Other interests


There were none. 


Urgent matters by reason of special circumstances

The Chairman 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.


Sustainability and Transformation Plan - Transforming Health and Social Care In Kent And Medway pdf icon PDF 145 KB

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was published on 23 November 2016. This report updates the Board on the progress made since the last update presented in February 2017.


The presentation to the Board will focus on the ‘Our Case for Change’ document published on 24 March 2017 and the emerging service model, particularly proposals in relation to local care.

Additional documents:




The update on the Kent and Medway Sustainability and Transformation Plan (STP) was introduced by its Programme Director and by the Accountable Officer of NHS Medway Clinical Commissioning Group (CCG). Medway Council’s Head of Communications and Marketing was also in attendance for the item.


The Board was informed that the update provided would need to change slightly due to the purdah period for the forthcoming general election. Consequently, there would not be discussion of the presentation that had been included in the Board papers. It was proposed that this would be added to the agenda for discussion at the Board’s next meeting in June 2017.


The Board was shown an information video in relation to the Medway Model. The key points included in the video were as follows:


·         The Medway Model was vital to enable the NHS locally to meet demand. It was about ensuring that services were integrated and that the right care was provided in the right place to the right person.

·         Collaborative working between GP practices was being piloted with digital transformation being a key aspect as part of the move towards provision of services from 8am to 8pm seven days a week. Digital transformation included the rollout of online appointment booking.

·         Care Navigators would act as co-ordinators of services provided to patients. The Navigators would be part of a multi-disciplinary team.  Two pilots were being planned to enable people to be proactively targeted to help them to stay well and to identify needs before they reached crisis point.

·         Medway CCG was working with the Fire Service to engage with the elderly and frail who were at the most risk of falling within their home. Visits and actions were being undertaken to reduce these risks with the aim being to reduce falls and, therefore, the number of people requiring acute care.

·         The CCG and Medway NHS Foundation Trust were looking at the possibility of setting up clinical hubs where the needs of frail and elderly people could be effectively managed. Six practitioners would be funded by the CCG to develop a frailty specialism.

·         The Medway Time Credit initiative enabled volunteers to receive time credits that could then be redeemed against various leisure activities.


The Board was provided with an overview of the Case for Change document. There were three stages to the Case for Change process. The first stage was the rationale for change (included in the agenda pack) which outlined why changes needed to be made to services. This was intended to detail what changes would be required. The second stage would set out the service models of the proposed changes while the third stage would present more detailed service configuration options ahead of consultation being undertaken.

The Case for Change document had been compiled following extensive engagement between a variety of health bodies, the Council and other partners. A detailed technical document had been produced following this engagement. The document being presented to the Board was a summary of the more detailed document. The  ...  view the full minutes text for item 920.


Better Care Fund 2017-19 pdf icon PDF 151 KB

This report notes the Adult Social Care Budget Package announced in the Spring Budget on 8 March 2017 and provides an update on the timescale for development of a Better Care Fund plan for 2017-2019.




The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund introduced an update on the development of the Better Care Fund (BCF) Plan for 2017-2019. Finalisation of the Plan had been delayed as the planning guidance had not yet been provided by NHS England. Consequently, the Plan was currently in outline form. It was not currently known when the guidance would be received. A detailed Plan would be presented to the Board following receipt of the guidance. It was noted that this might be later than the Board’s next meeting in June.


The Better Care Fund Plan had previously been produced annually but the next Plan would cover the two year period from 2017 to 2019. The outline funding allocations for the period were contained within the report.


In response to a Member question about personal care budgets, the Board was advised that there was a general move across health and social care services to increase the use of personal budgets and to ascertain how people qualifying for a personal care budget could best use it. This linked to the Three Conversations Model, part of the Adult Social Care Improvement Programme, that had previously been presented to the Board. The aim would be to move towards allocated personal budgets for those able to access them.


The Chief Executive of Medway NHS Foundation Trust (MFT) said that there was an expectation that funding would reduce pressures on acute providers. There would need to be agreement between the Council, Medway NHS CCG and MFT with regard to how funding would be allocated. The local Accident and Emergency Delivery Board would be required to give approval ahead of sign off by the Council. This would be a separate pot of funding from the main Better Care Fund.


In response to a Member question about performance monitoring, the Chief Executive of MFT said that performance would need to be jointly monitored and metrics developed to support this. It was hoped that performance would improve against the target for seeing all accident and emergency patients within four hours. Another key measure against which improvement was anticipated was the reduction of hospital Delayed Transfers of Care (DToC) to 3.5%.




The Board:


i)     Noted how past successes could be built upon to enhance the Better Care Fund and to inform the draft Better Care Fund (BCF) Plan for 2017-19.


ii)    Noted that a draft BCF plan for 2017-19 would be presented in June 2017 for endorsement by the Health and Wellbeing Board, subject to planning guidance having been received from NHS England to facilitate this.


Protocol Setting Out the Relationship Between Key Strategic Boards in Medway pdf icon PDF 88 KB

The report accompanies a revised and updated Protocol, which sets out the roles and responsibilities of the different strategic partnerships working across Medway Council in relation to safeguarding and wellbeing. The Health and Wellbeing Board is asked to note the Protocol and sign up to its implementation.

Additional documents:




The Interim Deputy Director of Children and Adults introduced the proposed revised Protocol Setting Out the Relationship Between Key Strategic Boards in Medway. This was a refresh of the Protocol that had originally been presented to the Board in November 2014. The Protocol had been introduced as part of improvements to strategic overview and safeguarding arrangements ahead of an Ofsted inspection.


The Protocol set out a framework for joint working between the following boards in relation to the safeguarding of both children and adults:


·         Medway Health and Wellbeing Board (HWBB)

·         Medway Safeguarding Children Board (MSCB)

·         Medway Council Corporate Parenting Board (CPB)

·         Kent and Medway Safeguarding Adult Board (KMSAB)

·         Medway Community Safety Partnership (CSP)


The Protocol set out:


·         The distinct roles and responsibilities of the boards.

·         The inter-relationships between the boards in terms of safeguarding and wellbeing.

·         The means by which we will secure effective co-ordination and coherence between the boards.


The Protocol also summarised the opportunities presented by the formal working relationships between the Boards it covered and specified timescales for each board to present their annual report and other key documents to the other boards.


A Member highlighted that the Protocol had originally been established following criticism from the Improvement Board that there was then no protocol in place to cover the relationship between the various boards. The Member also emphasised that it was important to provide challenge around the effectiveness of each board and how the different boards challenged one another. The Medway Children’s Safeguarding Board currently faced a challenging environment due to national legislation. The Member also requested that the  Children’s Transformation and Improvement Board should be added to the Protocol and that, as was the case for the other Boards covered by the Protocol, the chair of each board would be required to present an annual report to the Health and Wellbeing Board and vice-versa. Another Member said that further consideration needed to be given to how work was co-ordinated between the different boards.


The Board raised concerns that the refreshed Protocol had not yet been shared with other Cabinet Portfolio Holders. The Interim Deputy Director of Children and Adults said that the Protocol had not yet been shared with all the other boards or Portfolio Holders due to meeting timescales. She also suggested that each Board should identify their top safeguarding priorities that could then be amalgamated into a combined action plan. This request was agreed by the Board.




The Board noted and reviewed the Protocol and agreed that the Chairman would sign to evidence acceptance, subject to the Protocol receiving appropriate agreement from the other relevant Boards and the addition to the Protocol of the Children’s Transformation and Improvement Board.


Corporate Parenting Board Annual Report pdf icon PDF 384 KB

This report provides a briefing to the Health and Wellbeing Board on the role and challenge function of Medway’s Corporate Parenting Board, the key focus and achievements over the last 12 months.




The Interim Deputy Director of Children and Adults introduced the 2016-17 Annual Report of the Corporate Parenting Board (CPB). This covered the period from April 2016 to March 2017. It was acknowledged that much had changed since the report had been produced. The Board had agreed new Terms of Reference on 19 April. The CPB had three sub-groups, Education; Health of Children and Young People and; 16+ and Care Leavers. The latter of these had recently been established (February 2017). It covered a range of issues including accommodation, homelessness, employment and education.


Representatives from the Children in Care Council attended every CPB meeting. The Lead Member for Children’s Services, the Director of Children and Adults, the Interim Deputy Director of Children and Adults, the Head of Provider Services, the Head of Safeguarding and the Head of the Virtual School attended Children in Care Council meetings. Membership of the CPB had been reviewed with two foster carers an adoptive parent and a housing representative having been added to the membership. The Head of the Virtual School reported directly to the CPB. This role had recently moved from educational services to children’s’ services, which provided an increased opportunity for integration with the work of the Board.


The Looked After Children Strategy, published in 2015, set out the general areas of work that the Corporate Parenting Board would cover. The Strategy contained eight objectives. A draft Corporate Parenting Board Action Plan had been produced which would be discussed at the next CPB meeting.


A key focus area for the CPB was the accommodation available for care leavers. Feedback received from young people highlighted that there was limited choice. There was also concern about the emotional wellbeing of care leavers. There were plans to look at the possibility of group living for some care leavers. This work would be undertaken with the Portfolio Holder for Children’s Services and with the 16+ and Care Leaver Sub-Group.


An increasing percentage of Looked After Children (LAC) were being placed in foster placements, which was positive. The percentage of Medway Looked After Children in foster placements increased from 67.9% in March 2016 to 70.8% in March 2017. A priority work area was to increase the range of skilled foster placements available. There had also been a decrease in residential placements over the same period, from 8.8% to 8.2% of all looked after children in Medway.


Following Cabinet agreement in November 2016, Medway had entered into discussions with Bexley and Kent local authorities with regard to the establishment of a Regional Adoption Agency. It was noted that all local authorities were required to have entered into an arrangement by 2020.


A Board Member emphasised the importance of the Corporate Parenting Board making a difference to the lives of looked after children. He said that the Children in Care Council had been asked to establish what actions looked after children would like to see taken by Children’s Services. A survey had been undertaken with a number of suggestions having  ...  view the full minutes text for item 923.


Work Programme pdf icon PDF 126 KB

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.

Additional documents:




The Board reviewed the current work programme.




The Board noted the current work programme and agreed the following additions:


i)     To add an update on the Kent and Medway Sustainability and Transformation Plan to the Work Programme for June 2017.


ii)    To add an item on Air Quality to the Work Programme for a future meeting.