Agenda and minutes

Apologies for absence were received from Board Members Dr Peter Green - Vice Chairman of the Board and Clinical Chair of NHS Medway Clinical Commissioning Group, from Dr Antonia Moore – Elected Clinical Member, NHS Medway Clinical Commissioning Group and from Ann Domeney, Deputy Director, Children and Adults Services.

Apologies for absence were also received from invited attendees Martin Riley of Medway Community Healthcare, with Heidi Shute attending in his place, from Dr Mike Parks of Kent Local Medical Committee and from Helen Greatorex of KMPT.

To approve the record of the meeting held on 12 September 2017.  

The record of the meeting held on 12 September 2017 was approved and signed by the Chairman as a correct record.

There were none.

Disclosable pecuniary interests

Ian Sutherland, Director of Children and Adults Services declared a disclosable pecuniary interest in agenda item number 6, Medway Time Credits as his wife was the Chair of the Spice Board of Trustees. Mr Sutherland left the room during discussion of the item.

Other interests

There were none.

The purpose of this paper is to share the Medway End of Life Care Strategy for Adults with the Health and Wellbeing Board. This sets out the vision for end of life care for the next three years (2017 to 2020) and has been agreed at both the Clinical Commissioning Group (CCG) Commissioning Committee and Governing Body meetings in September 2017.

Discussion

The report was introduced by representatives from NHS Medway Clinical Commissioning Group. An End of Life Programme Board had been established. There were three key workstreams. These included a focus on developing an End of Life Strategy, improving partnership working and organisational processes across the wider health economy and improving communications and engagement with patients, families and their carers.

Work had been undertaken to standardise advanced care planning.

Engagement had taken place with carers’ groups and other stakeholders to find out how care should be provided. This had included two public forums and an event targeted at BME and East European and traveller communities. Written guidance had been produced for carers and families.

Areas of focus informing the development of the End of Life Strategy included ensuring that  healthcare professionals received adequate training, creating new models of care, improving systems to ensure that people received consistent high quality care and that they were supported to die in the place of their choice.

A Board Member shared the personal experience of an elderly family member who had died after spending a number of hours lying on the floor in significant pain. Although the development of an End of Life Strategy was welcome, the Member felt that it would not ensure that similar situations were avoided in the future. Poor communication between organisations had been a significant factor in the case of the Member’s relative and it was considered that the  outsourcing of out of hours care to Medway on Call Care (MedOCC) was a weakness due to a resulting difficulty in communications. The Member also felt that medical ethics had been misguided with visiting GPs having not been willing to administer painkilling medication..

The CCG representatives advised that the situation described was something that it was hoped to avoid through implementation of the Strategy, the creation of a Pallative Care Register and through advanced care planning. Gps should help the patient with appropriate pain management. Feedback from key professionals had been taken into account and had informed Strategy development. It was recognised that engagement with GPs in relation to end of life care was an area that needed to improve.

A Board Member said it was clear that there would not be a universal offer at end of life and asked what the key issues and gaps were that needed to be

Addressed to ensure that services and outcomes reflected the needs of the local population. The Member also wanted to understand what the drivers for change to End of Life Care priorities were and to be provided data to demonstrate whether the required changes were on target. The Medway Clinical Commissioning Group representatives agreed to provide further information in relation to this for circulation to the Board.

Another Board Member noted that there had been a positive response to God’s Waiting Room,  a play about End of Life that had been presented by the CCG, and asked whether it would be repeated. The Member also wanted  ...  view the full minutes text for item 469.

Medway Time Credits is designed to tackle social isolation through encouraging volunteering and participation. Medway CCG is piloting this approach as part of Involving Medway – a project to improve community engagement in health.

Medway Time Credits was launched in May 2017. This report sets out the CCG approach to the project, the activities undertaken so far and explores lessons and evaluation results from other parts of the country as well as some initial findings from Medway.

The Health and Wellbeing Board is asked to agree that Medway Time Credits should be further explored as a joint opportunity between the council and the CCG to support the key joint objective of improving mental and physical health and wellbeing of Medway residents. This will include:

·         To agree shared priorities

·         To actively support development of the ‘spend’ network, including with Council facilities

Discussion

The report was introduced by the Accountable Officer of NHS Medway Clinical Commissioning Group and by representatives of Spice Time Credits. Delivery of a pilot scheme in Medway had commenced in May 2017. The scheme was a partnership with the Medway consortium, which was a group of voluntary sector groups. It aimed to encourage both regular and one off volunteering. Over 20 groups and service providers had been trained in how they could trade in time credits and how  time credits could be used to incentivise new volunteers and expand existing provision. 10 groups were now active and trading within Medway with 93 volunteers currently registered as time credit members. Over one third of this cohort was new to volunteering. The pilot deliberately focused on a small area in order to develop the service model.

Additional support was being requested to enable reduced price or free  access to Council venues. Consultation events and workshops were taking place to support potential volunteers to become involved. An annual evaluation would be undertaken to monitor the effectiveness of the scheme and the evaluation process would be strengthened.

Spice Time Credits had originally started in Wales and had been operating in England for five years. There had been rapid growth with the scheme now encompassing 16 council areas. Each programme varied to suit local needs.  A total of 35,000 people had earned time credits to date and 1,300 organisations were involved. 78% of participants felt that they could contribute more through time credits, 16% were interested in establishing new community groups, 63% felt less isolated, 49% had made new friends and 19% felt that their mental health had improved.

The Board raised a number of points and questions, which were responded to as follows:

One off compared to long term volunteering and support from Council - There was a mix of one off volunteers and those making a longer term commitment. For some groups, one off volunteering was essential, while for others, a longer term commitment was valued. The key to Spice Time Credits was that it gave individuals the opportunity to give time when it best suited them. Identifying and promoting spend opportunities was a key challenge and support from Councillors in this regard would be welcome.

Work required to earn a time credit and volunteer checks– It was confirmed that an equal amount of volunteer time was required to earn a time credit regardless of the activity being undertaken. This recognised that everyone had something to give. Volunteers were recruited directly by participating organisations. These organisations were responsible for undertaking any background checks required, although the Spice Time Credits organisation was able to signpost organisations to sources of appropriate guidance when needed.

Quality checking – Time credits were not given out for work that was not considered to have value. Participating organisations signed a community partnership agreement and reported back to Spice quarterly. Agreement was reached with each organisation about which activities they would issue spice time credits for  ...  view the full minutes text for item 470.

NHS England Screening and Immunisation Teams have responsibility for commissioning and performance managing childhood immunisation services. Medway Council has a role in oversight of population health, including assurance (independent challenge and scrutiny) of immunisations arrangements and supporting partnership working in this area.

The aim of this report is to update the Health and Wellbeing Board on current and future actions planned by NHS England to improve childhood immunisation rates in Medway.

Discussion

The Director of Public Health introduced the report which set out the current situation in relation to the immunisation for children in Medway. A report had previously been presented to the Children and Young People Overview and Scrutiny Committee on 15 October 2017. An identified issue had been whether  NHS England was correctly recording the number of people who had been immunised in Medway. NHS England was due to present an update to the December 2017 Committee regarding the data. It was noted that a Medway specific immunisation Board had been created, which was due to meet for the first time in December 2017. Work was being undertaken to remind the public of the benefits of being immunised.

A Member questioned whether a Medway specific figure was available for the uptake of immunisations. The Director of Public Health advised that the presentation made to the Children and Young People Overview and Scrutiny Committee in October had highlighted a discrepancy between NHS data and locally produced figures. Work was being undertaken to determine the correct figures. It was proposed that the Board be provided an update at a future meeting and that this also include ward level data. 

In response to a Member who questioned that the report presented said that there were no financial implications for Medway Council, officers said that there were no direct financial implications to the Council in the context of the child  immunisation programme. However, it was acknowledged that there would be wider financial implications if children contracted diseases as a result of not having being immunised. In relation to the concerns that the that the re-procurement of childhood immunisation services in Medway suggested that existing services would stop, officers advised that this reflected how services were being provided nationally.

Decision

The Board noted the assurance report, which provided an update on children’s immunisations.

This paper aims to provide members of the board with an overview of the maternity transformation work that is taking place across Kent and Medway, including the development of a Kent and Medway “Local Maternity System” and the Kent and Medway Local Maternity System Transformation Plan, which is appended.

Discussion

The report was introduced by the Partnership Commissioning Programme Lead – Children and Families. A draft of the Kent and Medway Local Maternity System Transformation Plan had been submitted to NHS England. Feedback was awaited on any changes required to the Plan. This followed the undertaking of a national maternity review that had led to a number of recommendations. A Local Maternity System (LMS) had been created across Kent and Medway. The purpose of an LMS was to drive maternity services across the region. The LMS comprised health professionals from a number of different areas. The NHS had awarded approximately £75,000 of funding to the Kent and Medway LMS to be spent on recruiting a clinical chair and on project management and administration. The Plan reflected engagement with patients. The Plan had previously been presented to the Children and Young People Overview and Scrutiny Committee. The Committee had determined that the proposals did not amount to a substantial development of or variation in the provision of health services in Medway.

Some of the key issues that needed to be addressed included the needs of teenage mothers and smoking in pregnancy. A Maternity Group had been established to address smoking during pregnancy and a meeting had taken place with Public Health regarding the needs of teenage mothers.

A Board Member asked why no figure for stillbirths in Medway had been included in the Plan. Officers advised that the Plan was a draft and that there were two conflicting figures for stillbirths. Both figures were low but it was being clarified which figure should be used. The Member also said that he would welcome a paragraph being included in the Plan to state the dangers associated with drinking during pregnancy.

In response to a Member question about why Fetal Alcohol Spectrum Disorders (FASD) had not been included in the Plan, officers advised that there were no nationally reported statistics for drinking in pregnancy but that it could be investigated whether there was any relevant data that could apply to Medway.

It was suggested by a Board Member that maternity should be promoted as a career choice. The Chief Executive of Medway Foundation Trust (MFT) said that education was an important factor in attracting staff. Those entering employment in healthcare had a good chance of lifelong employment in the profession. MFT had focused on the recruitment of midwives and it appeared that it was the only maternity unit in the country that had a vacancy rate that was lower than would be expected. The Partnership Commissioning Programme Lead said that there would be a specific workstream of the Kent and Medway Maternity system in relation to education and training.

Decision

The Health and Wellbeing Board:

i)     Noted the national agenda in relation to transformation of maternity services.

ii)    Noted the Kent and Medway Local Maternity System Transformation Plan and suggested further areas for inclusion or refinement for future versions.

iii)  Offered support to the transformation of maternity services in  ...  view the full minutes text for item 472.

The purpose of this report is to provide an update to the Board on key Joint Health and Wellbeing Strategy (JHWS) indicators.

Discussion

The Public Health Consultant introduced the report that provided an update on the key performance metrics monitored as part of the Medway Joint Health and Wellbeing Strategy. It was noted that figures in relation to healthy weight and physical activity had not been updated since the last report presented to the Board.

The prevalence of smoking during pregnancy continued to be high, with rates having increased for the last four quarters running. A draft local Maternal Smoking Strategy had been developed to address this, with women who smoke during pregnancy being encouraged to engage with services. Smoking  prevalence also remained high amongst the general population.

In relation to obesity, there had been a reduction in rates amongst reception age pupils but an increase for year 6 pupils. With regards to premature mortality, there had previously been a decrease in the gap between Medway and the national average, but this had recently started to increase. Cancer mortality rates in Medway remained consistently high. In October 2016, Public Health England (PHE) had published the PHE Cancer Board five year plan and Medway’s Public Health team would be working with PHE to deliver the Plan locally.

The Current Joint Health and Wellbeing Strategy covered 2012 to 2017. Community engagement events were being developed with Medway NHS Clinical Commissioning Group to inform development of a new Strategy.

In relation to the ongoing situation regarding NHS England not providing data on breastfeeding, a Board Member asked what was being done to address this. The Member was also concerned about the increase in hospital admissions due to falls. The Board was informed that work with NHS England was ongoing to address the breastfeeding data issue. It was noted that the Royal Society for Public Health was using Medway breastfeeding work as a centre piece for a national programme. Work would be undertaken to provide statistics in relation to the Fire Services’ Falls Programme to provide figures for the number of people participating in the programme, prevention figures and to ascertain whether the number of visits undertaken as part of the programme was likely to see a significant reduction in the number of falls.

Decision

The Health and Wellbeing Board considered the indicator updates.

Health and Wellbeing Boards (HWB) have a statutory duty to produce and maintain a pharmaceutical needs assessment (PNA) every three years, to be used by NHS England to agree changes to the commissioning of local pharmaceutical services. The last PNA was published in March 2015 and therefore the next is due by March 2018.

This paper outlines the planned approach to publishing a new PNA, and the two new statutory duties that the HWB has with respect to the consolidation of pharmacies. The planned approach includes a 60-day consultation period over December and January.

Discussion

The report was introduced by the Consultant in Public Health. The Board was advised that each Health and Wellbeing Board was required to produce a Pharmaceutical Needs Assessment (PNA) every 3 years. Medway’s existing  PNA had been published in March 2015, therefore the new document was due to be published in March 2018.

The PNA would be used by the NHS in order to determine whether it would be appropriate to permit the opening of a new pharmacy. Medway had contracted a specialist to produce its PNA. A 60 day consultation would be required. Although it was not formally required to be a public consultation, this was considered to be good practice. Following discussions with NHS England, it had been decided to update the existing PNA rather than undertaking a new full assessment. Regulations introduced in December  2016 required a Health and Wellbeing Board to respond to NHS England within 45 days when guidance is requested in relation to the consolidation of pharmacies. Consolidations were considered likely due to Government funding of pharmacy having reduced.

A 60 day consultation was due to be undertaken during December 2017 and January 2018 ahead of the refreshed PNA being published in March 2018. As there was no Medway Health and Wellbeing Board meeting scheduled for March, it was proposed that the PNA be published in March pending approval by the Board in April.

A Board Member asked whether there needed to be reference within the PNA that it would play a role in the development of the Local Plan. The Public Health Consultant advised that a PNA had been established and that the Council’s planning department was represented on this to ensure that likely developments over the next three years were taken into account.

In response to a Board Member question about existing capacity, officers advised that the PNA would provide information on current pharmaceutical provision and expected population changes over the next 3 years. The PNA would contain recommendations but NHS England was responsible for determining where any new pharmacies should be located.

A Member was concerned that the PNA could result in the Board having to consider wider retail arrangements rather than purely pharmaceutical needs. Officers provided reassurance that the PNA would only focus on pharmaceutical needs and provision.

Decision

The Board:

i)    Noted and approved the planned approach for the production of the PNA, including the 60-day consultation through December 2017 and January 2018.

ii)  Delegated authority to the Director of Public Health, to in conjunction with the Chairman of the Health and Wellbeing Board, to prepare and publish a Pharmaceutical Needs Assessment by the March 2018 deadline.

iii) Agreed that the completed PNA be presented to the HWB in April 2018 for the Board to agree its support.

The purpose of this report is to present the Medway Safeguarding Children Board (MSCB) Annual Report 2016-17 to the Health and Wellbeing Board. The MSCB Independent Chair publishes an annual report describing how agencies in Medway have worked together through the year and how effective the arrangements are in Medway to keep children and young people safe from harm, abuse or neglect.

The report summarises the progress that has been made in 2016-17 and the plans to develop this further in 2017-18.

Discussion

The report was introduced by the Director of Children and Adults Services. There was a statutory requirement for the Medway Safeguarding Children Board (MSCB) to produce an annual report. The 2016/17 Report, which had been published in September 2017, outlined the work of the Board during 2016-17. The Report had previously been presented to the Children and Young People Overview and Scrutiny Committee and to the Community Safety Partnership. Board Members included a range of partners agencies, Kent Police, Medway Council and the voluntary sector. The Board had an Independent chairman and a lay member to the represent the local community perspective.

The role of the MSCB was prescribed by the Government as follows:

·         To develop arrangements for safeguarding and promoting the welfare of children.

·         To communicate and raise awareness of the need to keep children safe.

·         To monitor and evaluate the effectiveness of what is done locally.

·         To participate in local planning of services for children.

·         To undertake reviews of serious cases.

The MSCB had particular concerns about the secure training centre located in Medway and also in relation to young offenders. A BBC Panorama programme looking at concerns relating to the secure training centre had resulted in significant national level action being taken.

The MSCB had been commended for its LADO (local authority designated officer) service. The role of the LADO was to undertake investigations into allegations relating to professionals working with children.  There had been a substantial increase in LADO referrals, many of which related to the secure training centre and to the Cookham Wood young offenders prison.

Medway was within the 41% of most deprived areas nationally, although there was also some areas of relative affluence. 21.4% of children under 16 were living in poverty, which was worse than the national average. The rate of family homelessness was also worse than average.

There had been a reduction in the number of children subject to a child protection plan, Medway having previously had a higher than expected number of children subject to a plan. Initiation of child protection plans required delicate balancing between avoiding unnecessary interference in family life while ensuring that there was intervention where children were at risk.

Addressing child neglect was at the forefront of the MSCBs work following  national high profile cases. A Graded Care Profile was under development. This tool would help to ensure that health and care professionals were better able to detect cases of neglect. Work was being undertaken with young people to highlight issues around domestic abuse and information had been sent out to all Medway schools. Robert Napier School had used a drama production used to engage directly with young people. The MSCB was also working to address and reduce the risk of young people being sexually exploited online.

The undertaking of serious case reviews was a significant function of the Board. Two had been undertaken during the previous year in relation to the deaths of young people. In one case, a girl and her mother had  ...  view the full minutes text for item 475.

The Kent and Medway Safeguarding Adults Board provides strategic oversight to ensure that all member agencies are working together to help keep Kent and Medway's adults safe from harm and protect their rights. One of the duties placed on SABs is that they must produce an Annual Report. The KMSAB Annual Report for 2016-17 outlines the key achievements of the Board and its component agencies as well as detailing some of the challenges faced. The report also includes details of multiagency training, Safeguarding Adult activity data and analysis and defines the key priorities for 2017-2018.

The Annual Report was endorsed by the KMSAB on 15 September 2017.

Discussion

The Interim Director of Adult Social Care introduced the report. The Board was informed that the Care Act 2014 placed Safeguarding Adults on a statutory footing and also defined the responsibilities of local authorities and key partners.

Adult safeguarding boards also had a responsibility to ensure that people who did not have specific care and support needs were also safeguarded as appropriate. The three main functions of the Kent and Medway Safeguarding Adults Board (KMSAB) were to produce a Strategic Plan, to publish an annual report and to undertake any required safeguarding adult reviews. The Strategic Plan was currently being refreshed. Work had been undertaken locally to raise the profile of Medway to ensure that it had a strong voice within KMSAB.

Key achievements of the Board had included running a safeguarding awareness week in October 2016. This had been repeated recently. The awareness raising had resulted in an increase in safeguarding referrals. There had previously been a low uptake of safeguarding multi agency training. In order to address this, a training programme had been developed and a contract awarded for delivery of the training. Previous safeguarding outcomes had been utilised to inform design of the training. The number of commissioned safeguarding adults reviews had increased. As a result, a safeguarding adult review working group had been established to help ensure that reviews were carried out consistently and lessons learned.

Medway Council achievements had included the creation of a Medway Executive group, which was a subgroup of KMSAB. The subgroup was supported by Councillors, Medway Foundation Trust, Kent and Medway Partnership Trust, Kent Police and Kent Fire and Rescue. The focus of the subgroup was on outcomes for Medway residents.

The Deprivation of Liberty Safeguards (DoLS), which aims to ensure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom, continued to be a risk for KMSAB. Relationships had been developed and work undertaken to ensure that restrictions put in place were properly understood by staff at all levels. The number of  DOLS applications had increased with it being anticipated that the peek had been reached. Work was required in relation to thresholds for the commencement of further investigations.

The profile of domestic abuse had been raised, with Adult Social Care being provided with oversite of domestic abuse incidents. Efforts were also being made to ensure that safeguarding activity was personal to the affected individual. A survey had been undertaken of people who had gone through safeguarding and there had been a significant increase in the uptake of safeguarding training. Staff from the Council and partner organisations were attending external training and bringing back the learning to share with colleagues.

Safeguarding concerns raised had increased by 3% while the number of people whose risk has been reduced as a result of intervention was 57%. This was considered to be reasonably high given that individuals were able to chose whether to participate in an investigation about them. Analysis  ...  view the full minutes text for item 476.

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.

Decision

The Board agrees the work programme as attached at Appendix 1.