Agenda and minutes

Apologies for absence were received from Board Member Ann Domeney, Assistant Director of Children and Adults and from invited attendee, Helen Greatorex, Chief Executive of the Kent and Medway NHS and Social Care Partnership Trust.

To approve the record of the meeting held on 20 February 2018.

The minutes of the meeting held on 20 February 2018 were agreed as a correct record.

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

There were none.

Other interests

There were none.

The purpose of the report is to update the Health and Wellbeing Board on the work of the Medway Safeguarding Children Board (MSCB) during 2017-18 and to provide members with an update on the MSCB Strategic Plan 2017-20.

The report has been written in accordance with the joint protocol between strategic partnerships in Medway and it follows the presentation of the MSCB Annual Report 2016-17 in November 2017. The MSCB Annual Report 2017-18 will follow later in the year.

Discussion

The report was one of two updates provided to the Health and Wellbeing Board each year on the work of the MSCB. This was in accordance with the protocol agreed by each of the boards. This mid-year update would be followed by the annual report, which was due to be considered by the Health and Wellbeing Board in November 2018.

A key issue highlighted to the Board was that of Child Sexual Exploitation (CSE). Prevalence in Medway was in line with what would be anticipated for a place of its size. National best practice was being fully utilised to address the issue. The level of CSE was impacted by a range of factors including whether there is a history of abuse, particularly sexual abuse and gang prevalence. It was considered that the local response was as effective as it could be.

A number of Serious Case Reviews (SCRs) were in progress or had been concluded. These are undertaken when it was acknowledged that there had been significant issues in relation to child safeguarding. The undertaking of reviews demonstrated an awareness of issues and was not necessarily a bad thing.

The most high profile case was in relation to the Medway Secure Training Centre. This review was still in progress so it would not be appropriate to discuss further but it was anticipated that the learning from the review would have implications across the country. This review is likely to be published by the end of September.

Two other serious case reviews were in progress with two more having recently published, each of which had common themes. The children involved had been less visible to public authorities than they should have been. Detailed case summaries, recommendations and agency responses had been published on the MSCB website. Neither of the cases were principally about actions that the Council had or had not taken. The reviews demonstrated that there was an issue with information about children moving into Medway not being passed on to local agencies quickly enough.

In line with Government legislation, the processes around children’s safeguarding had to be reformed by September 2019. The reforms, which provided more local freedom in relation to safeguarding arrangements, involved three key partners. These were Medway Council, Medway Clinical Commissioning Group and Kent Police. There was considerable agreement between the partners about what the arrangements would look like. Care would be taken to consider what was being planned in other areas.

Half of cases audited in Medway were good, while one third required improvement. Approximately 10% of cases had not reached a satisfactory level. There had recently been a peer review of safeguarding in Medway. Plans to employ a second Council auditor in this area were welcome, as audit activity was critical to help raise standards.

Recruitment and retention of staff was challenging as Medway was in direct competition with London Boroughs, who were often able to pay more. For the last couple of months, Medway had been adding a market premium to social  ...  view the full minutes text for item 935.

This report provides an update to the Health and Wellbeing Board concerning the mobilisation of the Medway Young Persons’ Wellbeing Service which NELFT has provided in Medway since 1 September 2017.

The report provides an update on the implementation of the new service and delivery model and key service transformation objectives / milestones for the next 12 months from 1 April 2018.

Discussion

The report followed a previous report to the Board in September 2017 at which time, the new provider NELFT had just commenced its contract for the delivery of Child and Adolescent Mental Health (CAMHS) services in Medway. These had previously been provided by the Sussex Partnership and in-house team at Medway Council. NELFT operated a similar service in Kent as well as the Kent and Medway All Age Eating Disorder Service. In relation to CAMHS services in Medway, there had been a significant amount of work to reconfigure services as well as work with staff in the service, including a staff consultation.

There was a need to get all staff working with children onto the same clinical record system, including enabling all staff to work remotely. All staff now had a laptop to facilitate this. NELFT was using Open Road for substance misuse services, all other services covered by the contract being were provided by an in-house team.

The new service model had gone live in April 2018 with there being significant service changes planned over the next few months. NELFT was considered to be more than a service provider. It was a strategic partner that was working with Medway NHS Clinical Commissioning Group and other agencies.

A single point of access to the service had been created to answer calls. This included a senior clinician being available to help determine whether a case required immediate treatment, urgent treatment within a week or was routine. There had been a need to use temporary staff initially but there had been little negative feedback as a result. One challenge was making people aware that they could access the service directly without first needing to get a referral from their GP.

Crisis service provision in Medway currently accounted for a third of the total resource utilised in this area for all of Kent and Medway. This showed that demand in Medway tended to be higher than in Kent.

There had not been a permanent appointment to the post of Medway Team Manager to date. An experienced interim was currently in the role with a recruitment process being undertaken for the permanent role. The Team Manager was leading on joint working with other services, such as youth offending and early help and work was taking place with the Kent and Medway NHS and Social Care Partnership Trust (KMPT) to link to adult mental health services in order to ensure a smooth transition from adolescent to adult services. Work was also taking place with Kent Police. It was acknowledged that partnership working needed to be strengthened.

Work was being undertaken with South London and Maudsley (SLAM) NHS Trust to provide more services at Woodland House. The result of a funding bid to support the delivery of these additional services was awaited. Work to improve service delivery pathways was underway. A number of children were admitted to acute hospitals while waiting for a specialist bed to become available. This needed to be addressed as an  ...  view the full minutes text for item 936.

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

Discussion

All Members of the Council were corporate parents for Looked After Children in Medway. It was important to give LAC a good childhood and enable them to transition into adulthood. This required there to be good access to early intervention provision.

A new Looked after Children Strategy was being developed to replace the current strategy that covered 2015 to 2018. The number of LAC in Medway had remained fairly stable over the last year, with there having been a peak in October to November 2017 in the number of LAC entering or leaving the care system. There were currently 413 LAC against a target of 427, which demonstrated that interventions were working.

There were currently 29 foster carer placements and there would be a focus  on creating parent and child placements, specifically where parents had a learning disability, with a recruitment campaign due to take place in June. Plans for community based fostering were due to be implemented. There is a new framework for independent fostering agencies which would help ensure children were placed with better quality fostering agencies. Maximising permanency was key to improving outcomes for LAC, whether through Special Guardianship Orders, long term fostering or connective carer arrangements.

Medway had been successful in terms of the number of children adopted with levels being above national averages. A Regional Adoption Agency was due to be formed between Medway, Bexley and Kent. The aim was to place 135 – 150 children each year. £820,000 of funding had been granted.

The Virtual School had a new Headteacher. The Virtual School’s remit is being extended to improve attainment. Attainment of LAC at Key Stage 2 was similar to national figures for maths but was slightly below average for reading. Consideration was being given to how to support the virtual school to improve results. The percentage of pupils achieving at least the expected standard in English and Maths GCSE had increased in the last academic year. The rate of exclusions amongst LAC had increased slightly from 10% to 11%.

The percentage of in date health assessments for LAC for October to December 2017 was 94% and up to date dental assessments for the same period was 93%. Both of these figures met national targets but work was being undertaken to achieve 100%.

Children’s Services and Safeguarding now worked in four area based pods. This and the creation of a Multi-agency Safeguarding Hub, would facilitate better joint working and increased management support for staff involved in the safeguarding of Medway’s children. A First Line Leadership Programme had been introduced for managers who had responsibility for social workers.

A multi-agency action plan had been developed to address the needs of Medway’s Care leavers. An engagement event was due to take place in May to get views of partners and young people ahead of the Plan being reviewed.

A taskforce had been established to help address the issue of care leavers who were NEET (Not in Employment, Education or Training). This would include  ...  view the full minutes text for item 937.

Stopping smoking during pregnancy is the single most important change a woman can make to ensure her pregnancy avoids unnecessary complications and improve the probability of her baby being born full term and healthy.

The national Tobacco Control Plan seeks to reduce maternal smoking in England to 6% or less by 2022. The aim of the Medway Maternal Smoking Strategy group is to reduce smoking at time of delivery (SATOD) prevalence in Medway to 6% or less by March 2022. This will be done by achieving a year on year reduction that will result in incremental improvements to our SATOD rate from our current prevalence of 18.6% in Q4 2016/17, to 6% by Q4 2021/22.

In addition to stating this ambition, the Maternal Smoking Strategy highlights the range of partnership work that needs to take place in order to achieve this ambitious target. The Board is asked to review and endorse the strategy and commit to supporting the strategy group over the next four years.

Discussion

The proposed draft Strategy sought to reduce the smoking rate amongst pregnant women in Medway, prevalence for which was high compared to averages. The Strategy would be joint between the Council, Medway Foundation Trust and Medway NHS Clinical Commissioning Group (CCG). The Action Plan that supported the Strategy included a number of interventions to facilitate delivery of the Strategy.

This document would be continually updated. The Strategy would ensure that healthcare professionals had the chance to discuss with their patients, the issues around smoking during pregnancy and the support available.

Providing quality support and raising awareness of additional support available, would be key to achieving the aim of reducing the prevalence of smoking at time of delivery (SATOD) in Medway to 6% or less by 2022.

A Board Member considered that the Strategy was a good starting point but felt that it needed to go further given that the prevalence of smoking in Medway was relatively high. Achievement of a 6% reduction in SATOD would require a change in culture and education as well as sustained funding. Joint working and engagement with the CCG, Healthwatch Medway and with the general public would also be important. The Member also felt that there was not enough discussion about what a ‘good’ pregnancy looked like and said that there was likely to be a link between smoking in pregnancy and consumption of alcohol in pregnancy.

Stop smoking messages needed to be carefully targeted and included as part of a wider public health discussion in order to avoid the perception that people were being told what to do. The average age of a woman giving birth for the first time had increased to the early 30’s. The Member considered that the increasing average age of new mothers needed to be taken into account as those who had been smoking for a lengthy period could find it harder to quit and may need to be targeted in a different way to younger mothers. Officers agreed that stop smoking messages needed to be communicated as part of wider healthy lifestyle messaging, but that it was also important that healthcare professionals had the confidence to engage with pregnant women and also with their families, the latter which a Member had raised as being an important consideration.

In response to Member concern that those who were smoking were often those least able to afford the financial cost, The Director of Public Health acknowledged that more disadvantaged people were more likely to smoke, and have more difficulty stopping. Midwives needed to be supported so that they had the confidence to have conversations about healthy lifestyles. The Director was due to be attending a Directors of Finance CCG meeting with representatives of the Medway and Kent CCGs. This meeting was due to discuss smoking cessation and the making available of additional NHS resources over and above existing Public Health funding.

A Board Member highlighted that Medway Maritime Hospital was now a smoke free site. An Action Group had been  ...  view the full minutes text for item 938.

This paper provides an update on the progress made to update the Medway PNA to conform to statutory requirements. The Council has conducted a 60-day consultation on its revised draft PNA. There was a good response to the consultation and several issues were identified. The PNA has been updated to reflect feedback received and the PNA is now ready for final sign-off by the HWB.

Discussion

The Pharmaceutical Needs Assessment (PNA) had previously been considered by the Board in November 2017, before the start of the 60 day public consultation on the draft PNA. It had also been considered by the Health and Adult Social Care Overview and Scrutiny Committee in March 2018.

The PNA had been circulated to the Board for comment ahead of it being published on the Council website on 28 March 2018. This fulfilled the statutory requirement to publish the PNA by the end of March 2018.

Recent changes to legislation allowed the consolidation of existing pharmacies to be proposed. NHS England would notify the Health and Wellbeing Board of any proposed consolidations and there was then a statutory requirement for the Board to make a representation to NHS England within 45 days, stating whether or not it considered that the consolidation would create a gap in pharmaceutical services provision. The PNA Steering group had agreed they would provide the technical support to the Board to help in the response to such requests.

There had been a good response to the PNA consultation. Around half of the responses were from regular service users and it was therefore considered that the responses were representative of this group.

Three key concerns had been identified from the consultation feedback. Concerns had been raised about a GP practice on the Hoo Peninsula, which had stopped dispensing, with regards to the provision of services in the Cuxton and Halling area, in view of new development; and in relation to whether the planned London Resort theme park could lead to increased demand for pharmaceutical services.

In relation to the London Resort, it was not anticipated that this would lead to increased demand for pharmaceutical services during the next three years (the life of the PNA). Cuxton and Halling had been determined by NHS England to have the characteristics of a rural area and was a controlled locality which meant that there were limitations on pharmacies moving into the area. If this status were to change, it would be possible for a new pharmacy to be established. In relation to the Hoo Penisula, one dispensing practice, which had 3,000 patients, had stopped dispensing. A delivery service was being provided by three pharmacies in Hoo St Werburgh to mitigate the closure. Consequently, it would be recommended to the Health and Wellbeing Board that provision on the Hoo Peninsula and in Cuxton and Halling be kept under close scrutiny over the next three years and recommendations made to NHS England to change the PNA if there were significant changes in those areas during the next three years.

A number of concerns had been raised by the Health and Adult Social Care Overview and Scrutiny Committee (HASC). The first of these was whether Cuxton and Halling should continue to be classed as a rural area in view of local developments. It was confirmed that NHS England was responsible for determining whether an area was rural for the purposes of the  ...  view the full minutes text for item 939.

The report notifies the Board of a report to Cabinet that requested that Cabinet agree a response to the public consultation on the proposed reconfiguration of Kent and Medway Hyper Acute and Acute Stroke Services. The report also invites the Board to consider whether it wishes to support the Cabinet response.

Discussion

A report to Cabinet had requested a Cabinet response to the public consultation on the proposed reconfiguration of Kent and Medway Hyper acute and acute stroke services. The proposals were currently out to public consultation, with the deadline for responses having recently been extended from 13 to 20 April. This had provided the Health and Wellbeing Board with the opportunity to formally respond to the consultation.

The consultation proposed five possible options for the location of three stroke units in Kent and Medway. Cabinet had agreed to support option D, which would see units located at Tunbridge Wells, Medway Maritime and William Harvey hospitals. The Board was asked to note the Cabinet response and consider whether it wished to formally support the Cabinet response or to provide additional comments.

A Board Member said that they were happy to support the recommendations and that they would strongly favour option D. The Member noted that a number of Members had spoken in support of this option. The need to have centres of excellence in order to improve care was well recognised and it had been evidenced that these centres would lead to better outcomes for patients across Kent and Medway.

A Member expressed their support for the proposed three centres of excellence. There was a clear case for Medway to host one of the three centres as Medway had the largest urban area in the south east outside London. The health needs and demographics of the Medway population also made them at more risk of stroke than those in some other parts of Kent. In addition, Medway Hospital already hosted stroke services. Option D would maximise the number of patients in Kent and Medway living within 30 minutes of one of the three proposed hyper acute stroke units.

Another Member agreed with the principle of creating centres of excellence and said that option D would provide good outcomes for Medway residents. The challenge would be persuading the public that this was the best approach. The Member also felt the consultation process had been good and that the consultation document was clear.

It was confirmed that following public engagement, Healthwatch Medway would be supporting option D.

The Clinical Chair of Medway Clinical Commissioning Group (CCG) explained that Medway CCG, along with other CCGs across Kent, Medway and Bexley were due to hold a joint meeting that would make a decision on which option to support. This would subsequently be presented to the Kent, Medway, Bexley and East Sussex Joint Health Overview and Scrutiny Committee. As Medway CCG was directly involved in the decision making process and had not yet seen any of the consultation responses, it would not be able to support any one option at this stage.

Decision

The Health and Wellbeing Board:

i)     Noted the Cabinet response to the public consultation on the proposed reconfiguration of the Kent and Medway Hyper Acute and Acute Stroke Services.

ii)    Formally supported the Cabinet response to the consultation, which had supported consultation option  ...  view the full minutes text for item 940.

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

A Board Member requested that an item on pharmaceutical needs in Medway be added to the work programme. It was requested that this include discussion of out of hours provision, including communications with the public, emergency deliveries and how to prevent unnecessary hospital visits.

The Director of Public Health advised that engagement would be needed with NHS England, which was responsible for the commissioning of pharmaceutical services. The Clinical Chair of NHS Medway Clinical Commissioning Group suggested that relevant Council Members and officers should meet with NHS England and the local Pharmaceutical Committee to discuss the issues raised and that this meeting should take place ahead of a report being presented to the Board. It was agreed that the Director of Public Health would work with Members to plan and make arrangements for this meeting to take place.

It was also agreed that a written briefing would be provided to Board Members in advance of the meeting. It was requested that this briefing include key statistics and baseline data to evidence how Medway compared to other areas.

Decision

The Board agreed the work programme attached at Appendix 1 of the report, subject to the following additions:

i)             An item on Pharmaceutical Needs in Medway be added to the work programme to be presented to a future Board meeting, subject to a meeting having first taken place with NHS England to discuss the issues raised.

ii)            An item setting out the outcomes of the Kent and Medway consultation on Improving Urgent Stroke Services in Kent and Medway be added to the work programme for the November 2018 meeting.