Agenda and minutes

The Chairman of the Joint Board advised Members of recent updates to the Membership of the Joint Board. It was explained that owing to Simon Perks’ new position at the Kent and Medway Sustainability and Transformation Partnership (STP) as Director of System Transformation, the Joint Board Member, Ian Ayres, had nominated Stuart Jeffery to be his named substitute.

Apologies for absence were received from Councillor Aldridge, Dr John Allingham (Kent Local Medical Committee), Andrew Scott-Clark (Director of Public Health, Kent County Council), Matt Dunkley, CBE (Corporate Director for Children, Young People and Education, Kent County Council), Catherine Foad (Healthwatch Medway), Steve Innet (Healthwatch Kent), Chris McKenzie (Assistant Director of Adult Social Care, Medway Council), Matthew Scott (Kent Police and Crime Commissioner) and Dr Robert Stewart (Clinical Design Director for the Design and Learning Centre for Clinical and Social Innovation).

To approve the record of the meeting held on 28 June 2018.

The record of the meeting held on 28 June 2018 was agreed and signed by the Chairman as correct.

Members are invited to declare the existence and nature of any interests in relation to any agenda item in accordance with the relevant Council’s Code of Conduct.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

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.

This report provides the Joint Board with an opportunity for discussion on the position of the Joint Board in response to emerging national views on system wide leadership and governance. It focuses on the Care Quality Commission’s reviews across 20 Health and Social Care systems and explores recommendations made by CQC following their critical review of wider partnership working in other areas. The report also sets out changes expected in the immediate future that may impact on the work of the Joint Board.

Discussion:

The Policy and Relationships Adviser (Health) at Kent County Council presented the Joint Board with the findings from a number of recent national reviews of progress made towards integration of Health and Social Care systems in England. As well as progress made, these reviews examined the challenges of integration, ways in which national and local bodies were managing these challenges and the consequential impacts on service users. The Joint Board’s attention was drawn to the conclusions and recommendations from the following three key reports:

1.    The Care Quality Commission (CQC) report ‘Beyond Barriers: How Older People Move Between Health and Care in England’;

2.    The National Audit Office report ‘The Health and Social Care Interface’; and

3.    The report compiled by NHS Providers ‘Key Questions for the Future of Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICSs).

The Joint Board was advised that one of the conclusions drawn from these reviews was a need for system wide leadership, either through a Health and Wellbeing Board (HWB) or a Sustainability and Transformation Partnership (STP) Programme Board. The CQC report also noted that within the Health and Social Care systems it had reviewed, it was difficult to identify where system leadership came from and that, in general, Health and Wellbeing Boards were not fulfilling their potential and were underused where Sustainability and Transformation Partnership footprints did not align. However, these bodies could be effective in bringing together local leaders to plan and deliver services.

Across the Kent and Medway footprint it was explained that system leadership had developed and, in particular, the Kent and Medway STP Programme Board was strong and inclusive, with representation from both Local Authority areas and on each of the component workstreams. In addition, the Kent and Medway Joint Health and Wellbeing Board had been established and had a programme of work in place that broadly reflected the recommendations made by the CQC and set out within the report.

In relation to the vision expressed by the CQC, a Member commented that neither the Joint Board nor the STP Programme Board was empowered to make decisions on behalf of the health and social care system. He added that in this respect it made it very difficult for health and social care to come together in decision-making. In response, the Joint Board was advised that, in the context of the current national planning and regulatory frameworks, local systems have had to find workarounds. NHS Providers have expressed this concern in their report, particularly owing to the expected scale and pace of integration required. However, it was added that whilst it was not within the gift of the Local Authorities’ Health and Wellbeing Boards, the Joint Board or the STP Programme Board to make decisions on behalf of the system, Kent and Medway were in a strong position if there were any future changes in legislation or national guidance.

With reference to recent decision-making on a key decision for Medway by one part of the system,  ...  view the full minutes text for item 407.

This report presents the Joint Board with six indicators forming a subset of the Prevention Dashboard. The report also sets out context and progress for each indicator.

Discussion

Medway Council’s Director of Public Health presented the Joint Board with a subset of six high-level indicators which had informed and been drawn from the priority areas within the Kent and Medway STP Prevention Action Plan. The indicators, as set out in Appendix 1 of the report were:

·         Smoking prevalence 18+ (%)

·         Smoking at time of delivery (%)

·         Physically active adults (%)

·         Adults overweight or obese (%)

·         Obesity in children aged 10-11 (%)

·         NHS Health Checks invitations offered.

The Director of Public Health highlighted the financial impact of addressing these challenging areas, noting for example that the cost in Kent and Medway to treat adult obesity was £151 million per annum. He stressed the importance of prevention to reduce morbidity and mortality and the need to be efficient with available resources.

The Joint Board’s attention was drawn to particular focus areas where the data indicated that further intervention was needed; one example given was the need to increase physical activity among adults in Gravesham (the rate of physically active adults in Gravesham in 2016/17 was 61.4% compared to a target rate of 70%). The Joint Board was advised that the actions to improve outcomes in these six focus areas were set out in section 3 of the report and it was explained that detailed work programmes accompanied each area.

With respect to the indicator ‘NHS Heath Checks invitations offered’, a Member requested that data be included on Learning Disability (LD) Health Checks. It was explained that this would give the Joint Board a fuller understanding of the position across the whole population of Kent and Medway. In response, the Joint Board was advised that other health partners, namely GPs, rather than Local Authority Public Health Teams tracked LD Health Checks and that it may be difficult to obtain this data. However, the Director of Public Health undertook to review whether data on LD Health Checks could be incorporated. Concerning the likelihood for individuals with LD to have more adverse health outcomes, the KCCs consultant in Public Health explained that this was currently under review and could be presented to the Joint Board at a future meeting.

In response to a question asking whether the comparative data provided for each indicator could reflect similar demographic areas at borough and district level rather than England, the Director of Public Health advised the Joint Board that other comparators could be incorporated and that this would be reviewed.

A view was expressed that more detailed data was required in respect of the indicators and should include, narrative on what the data showed, whether the required outcomes were being achieved, lessons learnt from interventions that had worked and those which had not and information on expenditure. With reference to an example in Manchester, where the careful consideration of data helped target interventions to improve outcomes for men in the most deprived areas, it was explained that the Joint Board should use this more comprehensive data to focus preventative interventions and target commissioning in the  ...  view the full minutes text for item 408.

This report provides the Joint Board with an overview of the current position and key actions in Kent and Medway in respect of the Sustainability and Transformation Partnership (STP) Prevention Action Plan priority area ‘reducing tobacco usage prevalence’.

Discussion:

Kent County Council’s Consultant in Public Health set out a detailed review of reducing tobacco usage in Kent and Medway, which was one of the priority areas within the Kent and Medway STP Prevention Action Plan. The Joint Board’s attention was drawn to the data, set out at section 3 of the report and on page 29 and 30 of agenda item 6 (Prevention Dashboard Progress). It was noted that the priority areas were Canterbury, Gravesham and Thanet, as well as smoking prevalence amongst young people and routine and manual workers across Kent and Medway. It was explained to the Joint Board that the actions to reduce smoking were set out in sections 6 and 7 of the report with a list of recommended further actions set out at Appendix 1 of the report.

It was clarified that bullet point number 3 at section 6 of the report should read, “Kent County has a Tobacco Control Alliance…”

With reference to examples, a Member commented that given the impact of smoking on the health of the population, not enough was being done to reduce smoking prevalence in Kent and Medway and insufficient detail was provided in the report concerning current and future actions. In particular, the Member expressed disappointment with respect to the rates of smoking at the time of delivery (SATOD). Noting that in quarter 1, the rate SATOD in Dartford and Gravesham was below the England average, a Member commented that lessons learned from what they had done well should be shared, if appropriate.

In response to a question regarding examples of good practice in Kent and Medway, the Joint Board was advised that Kent County Council had funded a pilot programme of specialist midwife posts to help with reducing SATOD. This pilot delivered very good results, as had the campaign ‘What the Bump’. It was added that this campaign would be rolled out across Kent and that with respect to the pilot programme, Kent County Council’s Director of Public Health and the Local Maternity System had requested the CCGs to scale up the programme to all maternity services in Kent and Medway. It was also noted that Medway’s ‘Grow My Brain’ campaign had been submitted for an LGC award.

Medway’s Director of Public Health reiterated the need for a whole system approach to scale up smoking cessation programmes. He noted that in Medway, smoking cessation activities had reduced smoking prevalence from 25% to 17% over a short period of time, which was a step in the right direction. He added that when people had accessed Quit Services, the quit rates were good, however some cohorts within the population did not want to access such services. It was considered that focus needed to be on encouraging this cohort of individuals to access quit services, addressing tobacco control and preventing smoking among young people.

Members also recognised the importance of the social and economic context when addressing smoking cessation. In response to a question concerning integrated partnership working to  ...  view the full minutes text for item 409.

This report provides the Joint Board with a summary of the progress implementing Local Care across Kent and Medway between June and September 2018.

Discussion:

The STP Local Care Lead summarised the progress made implementing Local Care across Kent and Medway between June 2018 and September 2018. This included significant progress developing multidisciplinary team working, the impact of which had been demonstrated through Encompass Vanguard, the development of an Organisational Development (OD) toolkit and the development of a carers app to support anyone in a caring role by providing consistent training across the care sector.

It was also noted that the eight CCG localities had progressed their operational and financial plans in line with the Investment Case. However, these plans were all at different levels of maturity. As a result, the Local Care team was undertaking a series of ‘deep dives’ with each sub-system (east Kent, west Kent, Medway and north Kent) to establish an overarching outcomes framework, which would be presented to the Joint Board.

Members commended the direction of travel of the local care workstream. However, it was stressed that significant financial investment from the government into local care was needed, as well as a focus on outcomes. A Member expressed particular concern that hospitals countrywide, including in Kent and Medway, were planning for 30% less acute medical care patients, owing to the predicted success of preventative local care, without additional investment into this workstream. It was noted that the Kent and Medway CCGs had agreed to invest in local care. However, further concern was expressed in regards to the certainty of this sum of money. It was explained to the Joint Board that these ‘deep dives’ would provide some assurance in regards to the financial position, namely the amount of money available and where it was being invested. It would also result in a series of business cases, which could be exploited quickly if additional government funding was released. A view was expressed by a Member that money from health partners and local authorities should be pooled. 

Further assurances were given regarding concerns expressed over the expected reduction in acute medical care hospital beds. It was explained that all business cases that reduced the number of acute beds in any hospital would need to follow an assurance process which stated that any lost provision needed to be adequately resourced elsewhere before changes were made.

Decision:

The Kent and Medway Joint Health and Wellbeing Board:

a)    noted the progress of the Local care workstream;

b)    supported the approach for investment in local care, as set out in paragraph 3.2 of the report, with a view to receiving an outcomes framework, progress of which would be presented to the December 2018 meeting of this Joint Board;

c)    supported the Organisational Development (OD) approach, for the change in culture required to deliver local care; and

d)    agreed to schedule a ‘deep dive’ of the following areas on the work programme:

i)             support for carers; and

ii)            support for growing the voluntary sector.

This report updates the Joint Board on the development of a single Strategic Commissioner across all eight Clinical Commissioning Groups (CCGs).

Discussion:

The Accountable Officer for the Kent and Medway CCGs and the Kent and Medway STP Chief Executive updated the Joint Board on the progress and next steps towards the development of a single Strategic Commissioner across all eight CCGs.

The Joint Board was advised that an agreement in principle had been reached between the clinical chairs of each CCG for how they would work together as a Strategic Commissioner across the Kent and Medway footprint.

It was noted that a significant amount of work had been undertaken to determine how the Strategic Commissioner function would be structured, its responsibilities and how it would be accountable to the individual CCGs. It was also explained that a common approach to cancer care would be undertaken and that this would one of the first work areas.

With regards to next steps, the Joint Board was advised that further consideration would be given to the division of responsibilities at Strategic Commissioner level and local level. In addition, a report would be compiled outlining the vision for how the Strategic Commissioner fits within an accountable care system environment in Kent and Medway. It was anticipated that this would be completed by November and could be presented to the Joint Board at its meeting in December.

Decision:

The Kent and Medway Joint Health and Wellbeing Board:

a)    noted the update provided on the Kent and Medway Strategic Commissioner function; and

b)    agreed that a report outlining the vision for how the Strategic Commissioner fits within an accountable care system environment in Kent and Medway be presented at the next Joint Board Meeting on 14 December 2018.

The report advises the Joint Board of the forward work programme for discussion in the light of latest priorities, issues and circumstances. It gives the Joint Board an opportunity to shape and direct the Joint Board’s activities.

Discussion:

The Democratic Services Officer at Medway Council introduced the work programme report and drew the Joint Board’s attention to the recommended amendments to the work programme set out at paragraphs 2.4 to 2.7 of the report which had been reflected in the work programme set out at Appendix 1 of the report.

A view was expressed that the work programme should include items related to the outcomes for children and young people. It was recommended that specific proposals be discussed at the next agenda setting meeting on 8 November 2018.

The Chairman of the Joint Board referred to the outcome of the recent NHS review of urgent stroke services. Under the preferred option, Hyper Acute Stroke Units (HASUs) would be located alongside Acute Stroke Units at Darent Valley Hospital in Dartford, Maidstone Hospital and William Harvey Hospital in Ashford.

He explained that Medway Maritime Hospital had been excluded and yet had a critical role in the delivery of stroke treatment for over 500,000 people across Medway and Swale and this hospital currently cared for the largest number of stroke patients in Kent and Medway.

The Chairman also explained that whilst it was important to secure the best outcome for the whole population of Kent and Medway he was concerned and disappointed that Medway Maritime Hospital was not included in the preferred option, despite featuring in 3 of the 5 options initially presented for consultation and given the level of deprivation in the area.

He drew the Joint Board’s attention to the motion he had submitted to Medway’s Council meeting on Thursday 11 October 2018 which sought support for the matter to be discussed and debated within all appropriate forums, including the Joint Board.

The Chairman welcomed the opportunity to discuss the concerns Medway had at the next Joint Board meeting, in relation to the evaluation process and the underpinning methodology, which had led to the exclusion of Medway Maritime Hospital from the preferred option and undertook to discuss this further at the next agenda setting meeting for the Joint Board on 8 November 2018, following the debate on the motion at Medway’s Council meeting.

Decision:

The Kent and Medway Joint Health and Wellbeing Board:

a)    agreed the work programme attached at Appendix 1 to the report; and

b)    agreed to give further consideration at the agenda planning meeting on 8 November 2018 to scheduling:

                      i.        a report on the outcome of the NHS review of urgent stroke services for the next meeting of the Joint Board on 14 December 2018; and

                    ii.        specific proposals relating to children and young people.