Agenda and minutes

To elect a Chairman of the Health and Wellbeing Board for the forthcoming year.

Councillor David Brake was elected as Chairman for the forthcoming year.

To elect a Vice-Chairman of the Health and Wellbeing Board for the forthcoming year.

Dr Peter Green was elected as Vice-Chairman for the forthcoming year.

Apologies for absence were received from Board Members Councillors Doe and Potter, Ian Ayres (Managing Director for Dartford, Gravesham and Swanley, Medway, Swale and West Kent Clinical Commissioning Groups), Ann Domeney (Deputy Director, Children and Adult Services) and Dr Peter Green (Clinical Chair, NHS Medway Clinical Commissioning Group).

Apologies for absence were also received from invited attendees Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust), Helen Greatorex (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), Martin Riley (Managing Director, Medway Community Healthcare) and Dr Mike Parks (Medical Secretary, Kent Local Medical Committee).

To approve the record of the meeting held on 17 April 2018.

The minutes of the meeting held on 17 April 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

Ian Sutherland, Director of Children and Adults Services declared a disclosable pecuniary interest in agenda item 10 (Suicide Prevention Update) because his wife is Chief Executive of the charitable organisation Samaritans. He left the meeting during consideration of this item.

Other significant interests (OSIs)

There were none.

Other interests

There were none.

This report presents Medway’s draft Joint Health and Wellbeing Strategy, which covers the period 2018 to 2023, to the Health and Wellbeing Board for consideration. The Strategy contains a proposed vision and a set of priorities structured around five key themes. The priorities have been chosen after reviewing feedback from community engagement events, evidence from the Joint Strategic Needs Assessment (JSNA) and input from health and social care professionals and wider stakeholders, including the voluntary sector.

Discussion

The Director of Public Health introduced Mr Wiltshire, a local resident and service user who gave an account of his experience using healthcare services in Medway. The Board was advised that Mr Wiltshire’s testimony linked to a range of key themes within the draft Joint Health and Wellbeing Strategy (JHWS), set out at Appendix A of the report.

Mr Wiltshire drew particular attention to the stop smoking service. He explained that the service had given him the tools and support to stop smoking and he expressed his thanks to the Public Health team and the clinical professionals involved.  

It was explained to the Board that the previous Health and Wellbeing Strategy (2010-2015) had been reviewed in light of the Joint Strategic Needs Assessment (JSNA) and additional evidence obtained from partners, key stakeholders and local people during a series of engagement events. As a result of this process, it was considered that the themes within the previous strategy remained important and relevant. The themes of the draft JHWS were: 

1.         giving every child a good start;

2.         enable our older population to live independently and well;

3.         prevent early death and increase years of life;

4.         improve mental physical health and wellbeing; and

5.         reduce Health inequalities.

It was added that three strategic initiatives had also shaped the draft Strategy. These included the Local Plan, the Council Plan and the Kent and Medway Sustainability and Transformation Partnership (STP). The Board was advised that in turn the Strategy would influence these strategic initiatives.

Drawing reference to the Council Plan priority “maximising regeneration and economic growth”, which recognised that employment was an important factor in health and wellbeing, a Member asked a question about employment in Medway. The Board was advised that a Skills Board (Members and Officers Board) had been established which focussed on skills development and access to universities, colleges and training providers. It was also noted that a Skills Plan for Medway had been drafted which encouraged organisations to establish businesses in the Medway area. The Director of Public Health undertook to provide the Board with further information on the Skills Board.

A Member commented that the draft JHWS signified an opportunity to match available resources to Medway’s needs and stated that he would welcome aligning the Council Plan Key Performance Indicators (KPIs) with the JHWS when the Council Plan was next refreshed.

Clarification was sought on the content of and completion date for the Carers Strategy referenced within the draft JHWS. The Board was advised that the Partnership Commissioning team were leading on this area of work and the Consultant in Public Health undertook to update the Member on progress.

With reference to the Local Plan, it was recognised that the design of cities helped shape the health of the population, for example changing parking standards might influence a shift towards healthier modes of transport such as walking or cycling. The Board was advised that the draft Strategy had taken account of the emerging Local Plan and had  ...  view the full minutes text for item 133.

This report provides the Health and Wellbeing Board with an update to the report presented to the Board on 27 June 2017. The report includes a summary of progress against the Transforming Care (TC) programme and outlines the challenges faced by the TC Partnership over the coming year if it is to achieve the target (agreed with NHS England) that Kent and Medway would reduce their inpatient total to 57 or below by March 2019.

Discussion

The Programme Lead, Partnership Commissioning presented an update to the Board on the progress of the Kent and Medway Transforming Care Programme and set out the challenges faced by the Programme over the next year. The Board was also reminded that the aim of the Transforming Care Programme was to discharge individuals with a learning disability, autism or challenging behaviour from inpatient secure hospitals.

It was highlighted to the Board that the programme had recently entered its third year and over the duration of the Programme, eleven patients had been discharged and three admissions avoided. In addition, it was emphasised that in conjunction with colleagues in Kent, work had begun on a series of housing (accommodation) and support projects, supported by capital funding from NHS England and match funded from the Programme. It was noted that this stream of work would facilitate individuals in inpatient care to return to their community with the appropriate support.

In the context of this work, it was stated that a financial framework had been developed with partners in Kent to facilitate the transfer of funding from central government. However, the Board was advised that it was not clear whether there would be any additional funding at the end of the Programme in March 2019. It was added that the Government had revised its position on the proposed funding model several times.

The Programme Lead, Partnership Commissioning, also drew the Board’s attention to a series of other challenges affecting inpatient numbers, noting that a target had been agreed with NHS England to reduce the inpatient total across Kent and Medway to 57 or below by March 2019. The factors outlined to the Board which had impacted the inpatient total included an increase in the number of individuals being transferred from prison to a secure inpatient provision and volatile child inpatient activity.

With regards to children, the Board was advised that more robust support for children, families and their network of care was needed. The most current inpatient total was seventeen, of which four patients were children. It was noted that Kent and Medway had been identified by NHS England as an accelerator site for children and young people in the Transforming Care cohort and as a result additional funding was being made available.

Whilst noting that it was appropriate to focus on individuals, a Member sought clarification on the statutory responsibilities to support the families of children and young people in secure inpatient services and examples of good practice elsewhere in the country. The Board was advised that Children’s Services continued to provide a range of family support that included support for this complex cohort. It was also stated that national and international research recognised positive behaviour support as a model to train families and carers to develop the tools and techniques to support and respond to an individual appropriately. It was added that currently a training provider was being sought to provide positive behaviour support training for parents, carers and providers. It was  ...  view the full minutes text for item 134.

This report provides the Health and Wellbeing Board with an update on Medway’s Better Care Fund plan. The report presents the highlights from 2017/18 and developments for 2018/19.

Discussion

The Interim Head of Adults’ (25+), Partnership Commissioning and Better Care Fund presented an update to the Board on Medway’s Better Care Fund.

The Board’s attention was drawn to the highlights of 2017/18, set out at paragraph 3.1.1 of the report. Particular emphasis was given to the programmes initiated through the Better Care Fund to streamline discharge pathways and improve patient flow out of hospital. This included commissioning a range of intermediate care beds and the introduction of the Home First model. The Board was advised that there were now four discharge pathways, which was a reduction from nine and that the Home First model was successfully discharging 35 patients per week.

It was added that Medway was one of the best areas for reducing Delayed Transfers of Care (DToC), this reduction had been particularly noticeable since February 2017 and in April 2018 the average delayed discharge was 1.4 days. It was recognised that as a result of this achievement, other Local Authorities had approached Medway Council for advice on practice to improve DToC. The Director for Assurance and Delivery, NHS England, commended the outcomes under the Better Care Fund and stated that the DToC figure before Christmas was zero which was unprecedented. However, it was explained that improvement and support needed to continue as the DToC figure had since risen.

The Board’s attention was also drawn to the 2018/19 projects outlined in paragraph 4.2.2 of the report. It was explained that these programmes aimed to prevent admissions to hospital and support patients, where appropriate, to return home from hospital with a package of homecare support at the earliest opportunity.

With regards to learning from good practice, the Board was advised that the Better Care Fund team were part of the Better Care Fund network where good practice from other Local Authorities was shared.  Examples of good practice presented to the Board included the Leeds Better Care Fund programme, here 500 patients were on integrated discharge care plans. It was explained to the Board that the Medway team were investigating ways to move towards greater integration and joint care planning. Gloucestershire, Lincoln and Nottinghamshire also provided good examples of the use of joint health and social assessments and care plans.

A member expressed a number of concerns regarding private care providers. Concerns included a lack of continuity of carers, missing or late arrivals to appointments and insufficient time spent with patients over the course of their care. The Interim Head of Adults’ (25+), Partnership Commissioning and Better Care Fund advised the Board that under current commissioning arrangements the Local Authority spot purchased care from seventeen homecare providers. It was explained that many private clients would access the same providers. However, as part of service recommissioning the Board was advised that providers would be given greater certainly regarding the number of care hours and support that would be commissioned annually. This would enable providers to create more salaried posts for carers as opposed to retaining them on  ...  view the full minutes text for item 135.

This report provides the Health and Wellbeing Board with an update on new funding of £667,978 that has been secured for suicide prevention work across the Kent and Medway Sustainability and Transformation Partnership (STP) area in 2018/19. The report provides the Board with an overview of how the additional funding will be used.

Discussion

The consultant in Public Health outlined to the Board that £667,978 had been secured for suicide prevention work across the Kent and Medway STP for 2018/19. This work would build on the suicide prevention strategy and existing programmes delivered by the Public Health team, such as Mental Wellbeing Training and the Men in Sheds programme, set out at section 3 of the report.

The Board was advised that across both male and female cohorts the rate of suicide in Medway was similar to the rate nationally. Generally males were at a higher risk of suicide and within the male cohort, young and middle aged males had particularly high suicide rates. The Board was also advised that there was a national target to reduce the number of suicides by 10% by 2020/21, which roughly translated to 14 fewer deaths across Kent and Medway.

It was noted that the majority of the funding would be used for community based prevention and early intervention programmes which would be overseen by a multi-agency Suicide Prevention Steering Group. It was explained to the Board that there would be eight categories of intervention programmes and these were set out at paragraph 4.2 of the report.

A Member expressed a view that suicide was interrelated with mental health and funding might be more usefully spent on mental health care. It was explained to the Board that mental health was a risk factor for suicide but that there were a number of other different risk factors, for example unemployment and high levels of isolation.

Clarification was sought on the breakdown of funding across the eight categories of intervention programmes and the rationale for the distribution and prioritisation of funds. A view was expressed that owing to the amount of money available it might be spread thinly across all eight areas and it was suggested that it might be better to focus funding on key programmes. The Board was advised that the Steering Group had a good understanding of risk factors for suicide and based on the evaluation of evidence on effective intervention identified the eight categories of interventions. It was noted that one of the high risk groups were those who had contact with specialist mental health services and as a result circa £120,000 of the available funding would be spent on specialist mental health services in Kent and Medway to develop and implement a Zero-Suicide Action Plan. It was added that on 24 July 2018 Kent and Medway colleagues would be meeting with the national team who had expertise in suicide prevention and the intention was to work with them to ensure the prioritisation was correct. Whilst the breakdown of the funding was not available for the Board at the meeting, the Consultant in Public Health undertook to provide the Board with this additional information.

A Member commented that the Men in Sheds project based in Gillingham was very successful. However, concern was expressed that it was not accessible to residents in more rural areas of  ...  view the full minutes text for item 136.

This report presents the Health and Wellbeing Board with the Director of Public Health’s Annual Report for 2017-18. The theme of the report is health protection - Protecting the Health of Medway’s Population: now and for the future.

Discussion

The Director of Public Health presented the Director of Public Health’s Annual Report for 2017-18 and explained to the Board the theme of this years’ report was health protection. It was noted that the report was a retrospective evaluation of the previous year and that the report addressed nine key areas of health protection, which were:

1. Infectious diseases and food-borne illness;

2. Seasonal influenza;

3. Screening;

4. Emergency preparedness;

5. Sexual health and blood-borne viruses;

6. Health care associated infections;

7. Air quality;

8. Tuberculosis; and

9. Vaccinations.

It was added that these issues had a significant impact on the population and were areas where action was required to address future challenges to Medway’s health.

The Boards attention was drawn to the case studies within the report which illustrated good practice and the recommendations for system wide improvement and ideas on what people in Medway could do to protect their health.

In response to a comment about the different emphases of the recommendations i.e. to continue good practice versus stating something must or should happen, it was recognised by the Director of Public Health that wording of the recommendations had varied. He stated that the report was an amalgam of activity from a range of partners and that some areas of work had progressed well and further improvement should be encouraged to continue. He added that the report included Specific, Measurable, Achievable, Relevant and Time-bound (SMART) targets. He undertook to provide the Member with more detailed action plans in relation to the targets.

A Member expressed the view that the recommendations should be more positive in nature, for example the recommendation should actively encourage a specified action.

Clarification was sought regarding actions parents and schools should take when a child contracted norovirus, particular reference was made to schools requesting children visit their GP to obtain a sick note. In response, it was explained to the Board that the Public Health team had previously issued schools with guidance on the topic. This guidance advised schools that they should not request a sick note from a child absent from school as a result of norovirus, as it was recommended that the child does not visit their GP. The guidance also signposted schools to the School Health team which could offer further support. The elected Clinical Member, NHS Medway Clinical Commissioning Group added that there was a drive to promote self-care for self limiting illnesses and to encourage individuals to manage common illness in the home. In preparation for this year, the Director of Public Health undertook to issue further guidance to schools and at the request of a Member, he agreed to include this guidance within Medway Matters.

A member commended the 2017/18 Annual Report, principally the emphasis on health protection as this suggested health was the responsibility of Medway as a whole. The view was reiterated that Medway needed to be healthier by design and health and wellbeing embedded into strategic thinking.

In response to questions concerning how the  ...  view the full minutes text for item 137.

The report advises the Health and Wellbeing 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 Democratic Services Officer introduced the work programme report and advised the Board that following the pre-agenda meeting, the Director of Public Health had advised that the Joint Health and Wellbeing Strategy Monitoring Report, which is on the work programme with a date to be confirmed, could be scheduled for the meeting of the Board on 16 April 2019.

Decision

The Health and Wellbeing Board agreed the work programme attached at Appendix 1.