Agenda and minutes

Apologies for absence were received from Ann Domeney, Interim Deputy Director of Children and Adults, Helen Greatorex, Chief Executive of Kent and Medway NHS and Partnership Trust and from Martin Riley, Managing Director of Medway Community Healthcare.

To approve the record of the meeting held on 3 November 2016.

The record of the meeting held on 3 November 2016 was approved and signed by the Chairman as a correct record.

There were none.

Disclosable pecuniary interests

There were none.

Other interests

Councillor Gulvin declared an other interest in item number 10, the Strategic Assessment and Draft Community Safety Partnership 2016-2020, as he was the Chairman of the Community Safety Partnership. Councillor Gulvin remained in the room during discussion of the item and supported officers in introducing the report.

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was publically published on 23 November 2016. This report brings the draft plan to the Board for information. Work is ongoing regarding the STP programme and a more detailed case for change will be published for public consultation in 2017.

Discussion

The Senior Responsible Officer for the Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) introduced an update on it. He was supported by the Programme Director.

The close working and co-operation of all Kent and Medway health providers and local authorities was considered to be a significant achievement of the STP to date. The strategic direction of the Plan would be developed over the next few months. It was noted that Medway and Kent were currently facing difficulties in coping with the pressures that winter was putting on the health system and that a mechanism would need to be developed in order to ensure that the system was better able to cope next winter. The sharing of good practice across Medway and Kent would be key to this.

The three key aims of the STP were to reduce inequality, raise quality performance and address financial challenges. In order to achieve this, interventions would be targeted in four key areas, which were Care Transformation, Productivity, Enablers and System Leadership.

The STP submission made to NHS England and NHS Improvement on 21 October 2016 had represented more of a Strategic Direction of Travel than a detailed plan. A submission of more detailed proposals was required by the end of the financial year, with the aim being to launch a public Case for Change during March. This would set out why change was required.

Development of the STP was challenging as the majority of professionals working on it were also doing full time day-to-day jobs. Resources would be required in order to make the development and delivery of STPs sustainable in the long term and to help reduce the dependency on consultants.

The Committee raised a number of points and questions as follows:

Treatment Specialisms: A Board Member asked about plans for hospitals to specialise in providing particular treatments and the consequences if some hospitals may no longer provide particular treatments. The Member emphasised that there was a need for effective communication and engagement in the event that there was a future proposal to relocate services away from Medway Foundation Trust to other acute hospitals. Another Board Member said that they would want to be taken to the location that gave them the best chance of survival rather than to the place that was closest.

The Senior Responsible Officer considered that there was a cultural problem in terms of the high expectations of some people and a reluctance to take responsibility for managing their own health. This culture was contributing to the pressure on limited resources. There was a large population in the area surrounding Medway Maritime Hospital. Therefore, the case for Medway retaining services was perhaps stronger than it was in some other parts of Kent.

It was considered unlikely that there would be closures of whole hospitals, but changes in the services provided at certain hospitals was likely. There was already some specialism of services provided by acute hospitals. One example of this was that patients  ...  view the full minutes text for item 707.

The attached report (Appendix 1) sets out two items that were initially referred by the Health and Adult Social Care Overview and Scrutiny Committee to Cabinet. These referrals were considered by Cabinet, as a single agenda item, on 17 January 2017.

Cabinet noted the risks that falling GP numbers will present to Medway residents and the implications for Adult Social Care and agreed to emphasise to the Kent Police and Crime Commissioner the importance of street triage.

The Cabinet also agreed to refer both matters to the Health and Wellbeing Board for further consideration.

Discussion

The Chairman of the Board requested that questions relating to GP Services be asked after representatives from Medway NHS Clinical Commissioning Group had introduced the next item on the agenda, the General Practice Forward View. This was because the presentation was likely to cover the answers to such questions.

In relation to Street Triage, the Chief Executive of the Kent and Medway NHS and Social Care Partnership Trust (KMPT) had advised, since publication of the agenda, that Medway CCG had agreed to provide funding for Street Triage provision in Medway from April 1 2017, with KMPT funding provision until then.

The Interim Director of Children and Adult Services introduced the items referred by Cabinet in relation to GP Services and Street Triage. He noted that it was particularly pleasing to hear that the CCG had agreed to fund Street Triage. There had been some cases recently where inappropriate use had been made of section 136 powers which allowed the Police to remove a person to a place of safety, in the event that there were concerns for their mental health and wellbeing. Street Triage would help to reduce the need for these powers to be utilised. The Accountable Officer from Medway CCG highlighted that Street Triage was an example of partnership working and the aim would be to increase this in the future.

Members of the Board were pleased that funding would be provided for street triage provision in Medway but one Member was concerned that there was still no place of safety in Medway for people experiencing mental health difficulties to be taken to. This put pressure on resources, although it was acknowledged by another Member that Street Triage provision would help to relieve this pressure.

Decision

The Board considered and commented on the matters referred to the Board by Cabinet, which were as follows:

i)             The risk that falling GP numbers will present to Medway residents and the implications for Adult Social Care.

ii)            The importance of street triage in view of the Cabinet decision to emphasise its importance to the Kent Police and Crime Commissioner.

At the November 2016 meeting of the Health and Wellbeing Board, it was agreed, following a request made by representatives of NHS Medway Clinical Commissioning Group that the Medway Primary Care Development Plan would be presented to the Board at its next meeting. The Plan, which is entitled “General Practice Forward View” was due to be submitted to NHS England in December 2016.

Discussion

The General Practice Forward View was introduced by the Programme Director of Primary Care Transformation at Medway NHS Clinical Commissioning Group.

A national General Practice Forward View document had been published in July 2016. All Clinical Commissioning Groups had been asked to respond to NHS England to set out plans for local implementation in relation to general practice. This had included details of how the plans would align with the General Practice Forward View and with Sustainability and Transformation Plans. Medway CCG had made its submission to NHS England in December 2016.

At a national level, Primary Care had been in decline, with there being particular difficulty in recruiting and retaining GPs. There were 51 practices in Medway, with the majority of these being either single handed practices or practices where GPs were approaching retirement age. The General Practice Forward View was directly linked to the STP and to the Medway model. In order to increase resilience, consideration was being given with regard to how GP practices could work collaboratively to cover populations of around 30,000, or even up to 100,000.

There were three key elements to the Forward View:

1.    Rollout of the ten high Impact Changes – These are evidence based and nationally proven. Some local GP practices have already started implementing and sharing changes. A key aim is to promote self-care and reduce impact on other services, particularly acute services.

2.    Extended access – The intention was to start piloting extended access to GP Services in Medway, with the move to services being provided 8am to 8pm seven days a week. This would be piloted in one area in the first year, with the aim being to cover 50% of Medway after two years and 100% after three years.

3.    Workforce – Work was being undertaken to recruit and retain GPs. In order to achieve this, General Practice needed to be vibrant, modern and forward thinking. Newly qualified GPs tend to be drawn towards larger practices that had extended services rather than to smaller surgeries.

Two estates enabling programmes would facilitate the effective use of GP estates locally. Funding had been provided by the Central Estates Transformation Fund to enable the possibility to be explored of creating two additional GP hubs in Chatham and Strood. Expanding the use of IT would also be important. This would include collaboration between practices and interaction with patients.

Work was taking place to implement the Forward View with small collaborative working groups having been established. These would be developed further.

The Committee raised a number of points and questions as follows:

Difficulty obtaining GP appointments: A Board Member spoke of their personal difficulty in getting a GP appointment, which they had been told would be a three week wait. They had also had difficulty in obtaining a consultation for a family member. However, the care itself had been of particularly good quality. A Member of the Board, who was also a GP said that patients booking appointments and not  ...  view the full minutes text for item 709.

This paper outlines our proposed approach for the re-commissioning of Medway Council’s community child health services, which includes the 0-19 Healthy Child Programme (HCP), community paediatric health services and children’s therapy services. The proposals were approved in December 2016 by Medway Council’s Cabinet and the Medway NHS Clinical Commissioning Group’s (CCG) Governing Body. This is a collaborative piece of work between Medway Council and Medway NHS CCG and aims to secure improvements to the outcomes of children and families, by increasing service efficiency and integration.

The paper provides details of the planned approach of integration and its associated implications, to inform members of the Health and Wellbeing Board of the direction of travel relating to this commissioning work, and to encourage Board Members and their respective organizations to participate in the public consultation.

Comment is sought from Board Members on the proposed way forward from a strategic/local joined-up systems approach and commitment is sought from system leaders to enable the proposed approach to be put into practice.

Discussion

The Interim Director of Public Health introduced the report to update the Board on the recommissioning of Child Health Services in Medway. These services were split into two groups. Lot 1 included services commissioned by the Council, while Lot 2 included services funded by Medway NHS Clinical Commissioning Group but commissioned as part of partnership arrangements. The Council and the CCG had combined the two lots to provide a single framework to set out how services would be approached. Commissioning could take place to enable services in both lots to be delivered by the same provider or alternatively, each lot could be delivered by a separate provider.

The proposed approach to the recommissioning had been approved by the Council’s Cabinet and by the CCG Governing body and had gone out to public consultation.

The report was being presented to the Board to raise awareness, provide an opportunity for the Board to comment and to seek the Board’s endorsement.

A Member of the Board emphasised his support for the proposed approach, while stating that the recommissioning of these services should be joined with Child and Adolescent Mental Health Services (CAMHS) recommissioning.

Decision

i)             The Board agreed the direction of travel and intentions relating to the commissioning work.

ii)            Board Members and colleagues from their respective organizations agreed to participate in the public consultation and to promote it to their own service users as appropriate.

This report provides an update to the report presented to the Health and Wellbeing Board on 3 November 2016. The Kent and Medway Transforming Care Partnership (TCP) Plan 2016-2019 was submitted to NHS England (NHSE) in May 2016 and refreshed and re-submitted in November 2016. The Plan, which included a Kent and Medway Executive Summary, Risk Register and Finance and Activity Template, as well as separate Kent and Medway local Transforming Care (TC) plans, were accepted.

Medway’s inpatient figures are increasing. We do not yet fully understand the reasons for the upward trend, although it appears that the lack of forensic outreach and adult ASC provision and Tier 4 CAMHS pathways may be contributing to admissions. Transformation grants received this year and a bid for next year address these concerns.

A TCP Finance Plan was required to be submitted to the NHSE Regional Team by 18 January 2017. A Business Case was also required by 18 January to detail how and when cost and responsibility will move through the system over the remainder of the three year TC programme.

Discussion

The Interim Senior Commissioning Officerintroduced the report to update the Board on the Transforming Care Plan, following the previous update provided to the Board in November 2016. Transforming Care Plans set out how people with learning disabilities or autism could be moved from of inpatient beds, which were often located outside Medway, into community based provision. At the start of January 2016 there had been 16 Medway inpatients, including two young people.

The resources made available through this change could be used to improve provision and therefore avoid further admissions to out-of-area hospital beds.

Careful financial planning was crucial with the Kent and Medway Transforming Care Partnership being required to submit a joint Finance Plan as well as a Business Case. The Finance Plan had been submitted on 18 January 2017, with the Business Case currently being under development. A sub-group had been established to oversee development of the Business Case and Finance Plan and to provide financial governance. This was led by the Chief Finance Officer (CFO) of West Kent CCG and would include the CFOs of all partner organisations. The first meeting of the sub-group was due to take place in February.

It was noted that the Transforming Care programme was overseen by NHS England, with Kent and Medway the only Transforming Care Partnership in the South East to have submitted a detailed Finance Plan so far. Feedback had just been received from NHS England, which as anticipated, was mixed. A second draft was due to be submitted by the end of March.

Close working was being undertaken with Sussex and Surrey, who were South East Transforming Care Partners, in order to identify needs as a region as this was likely to be more cost effective than individual procurement of provision.

The Committee raised a number of points and questions as follows:

Role of the Discharge Planning Group - The Discharge Planning Group was responsible for overseeing Care and Treatment Reviews (CTR), which were provided to patients who were ready for discharge. The CTR would make specific recommendations in relation to each discharge, with the review being  undertaken up to six months ahead of a planned discharge, in order to ensure that appropriate provision was in place. There had sometimes been delays in this process. A multi-disciplinary group had been established in order to ensure co-ordination between partners and reduce delays. In response to Member concerns that there needed to better co-ordination of the delivery of Disabled Facilities Grants and that the time between grant application and award was too long, officers advised that better co-ordination was one of the reasons for the establishment of the Discharge Planning Group. In addition to Disabled Facilities Grants, a Repatriation Fund was also available for patients who had been in hospital for a long period. The fund enabled bids to be made for grants of up to £15,000 that could help adaptations.

Medway Challenging Behaviour Service grant bid – The possibility of making a bid for funding for a  ...  view the full minutes text for item 711.

Community Safety Partnerships (CSPs) are under a duty to undertake an annual strategic assessment of crime and disorder in their area and formulate and implement a strategy to reduce crime and disorder, combat substance misuse, and reduce re-offending.

This report presents the current strategic assessment and the Community Safety Plan to cover the period from 2016 to 2020.

Discussion

The Head of Safer Communities introduced the report, supported by the Chairman of the Community Safety Partnership. It was noted that the Community Safety Partnership was a statutory body comprised of a number of organisations, including Medway NHS Clinical Commissioning Group and the Council’s Public Health directorate.

The Partnership was required to undertake an annual Strategic Assessment of crime and disorder in Medway, with an annual Community Safety Plan being informed by the evidence presented in the Strategic Assessment.

There was also a requirement for the Community Safety Partnership to be scrutinised by a statutory body each year. Accordingly, this had taken place at the Regeneration, Culture and Environment Overview and Scrutiny Committee in December 2016. A protocol covered the sharing of updates with the Health and Wellbeing Board and safeguarding boards.

The Chairman of the Partnership advised that an impact study was being undertaken in order to identify problems caused locally by excessive alcohol consumption. A report was due to be presented to the Council’s Licensing Committee in March to propose a way forward. Close work was being undertaken between the Council and the Police to ensure that documented proof of the issue was obtained, with a view to some restrictions being placed on the sale of cheap alcohol locally.

A Board Member, who was also a Member of the Community Safety Partnership, felt that the Annual Community Safety Partnership conference had been a very useful event that had provided a useful engagement mechanism in relation to the Community Safety Plan and its priorities. It was requested that Health and Wellbeing Board Members be invited to attend future events.

Members of the Board stated that they felt that the report was a good, comprehensive report.

Decision

The Board:

i)       Noted the strategic assessment and made comments and recommendations to the Partnership.

ii)     Noted that as a Policy Framework document, the

Community Safety Plan was adopted by Full Council on 21 July 2016.

This is a proposed Medway policy to support clinicians of all types and in all sectors to enable many more people to quit smoking so that they are less likely to develop the avoidable consequences of smoking and that any treatment they receive is less risky and more effective.

Slight adaptation of this policy may be required for its application in community, mental health and social care settings. Work will continue on the policy's appendix, which provides an overview of the evidence-base to support clinicians in discussion with their patients, prior to implementation.

Discussion

The Interim Director of Public Health introduced the report. The Health and Wellbeing Board had, in April 2016, unanimously supported the development of an initiative to encourage people to give up smoking. A policy had been developed, with the focus being on improving the safety and effectiveness of care. The Policy had been formally approved by both Medway Hospital NHS Foundation Trust and by Medway NHS Clinical Commissioning Group. Support would also be sought from the local community health and mental health trusts. Swale CCG had also indicated its intention to adopt the Policy and the Clinical Board of the Kent and Medway Sustainability and Transformation Plan had expressed interest in its adoption across the whole of Kent.

The Policy aimed to provide support and made a request to clinicians of all types and in all settings, to raise the subject of smoking cessation with patients and to refer them to stop smoking services. It was anticipated that the clinicians would discuss with patients the risks of continuing to smoke and the benefits of stopping smoking in the context of their clinical circumstances, whether the patient had a long term condition or was due for elective surgery. There was scope for surgery to be delayed, where clinically appropriate, pending the patient having attempted to give up smoking in order to reduce the considerable risks of being a smoker at the time of surgery. There would be the option for the patient to refuse to try giving up, to opt out during the process or, should they fail in an attempt to give up, to continue with their treatment. The patient would then in effect be giving informed consent to receiving treatment with this increased risk. The Policy also set out quantified risks of smoking and  benefits of quitting. It was noted that many of the benefits of stopping smoking were realised quite quickly.

The Health and Wellbeing Board was invited to comment on and support the Policy.

The Committee raised a number of points and questions as follows:

Medway Foundation Trust (MFT) Smoke Free Policy – A Member of the Board asked if lessons had been learned from the introduction of a smoke free policy at Medway Maritime Hospital. The Chief Executive of MFT said that support and guidance had been received from the Council’s Public Health Directorate. In general, it had proved harder to obtain the co-operation of  staff that it had been of patients. The subject had been approached gently with the emphasis at this stage being on encouragement and support. The hospital has being presented as an exemplar for other NHS organisations to follow. It was considered that the partnership working involved in the introduction of the smoke free policy had helped to make it a success. In relation to the Medway Quit Smoking Policy under consideration, it had already been endorsed by the MFT Board and was due to be submitted to the Clinical Council in order for it to be adopted as clinical policy.  ...  view the full minutes text for item 713.

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.

Discussion

The Democratic Services Officer introduced the Work Programme report. It was requested that an update on the Sustainability and Transformation Programme be added to the existing Work Programme in order to align with when an update was next due to be presented to the Health and Adult Social Care Overview and Scrutiny Committee.

Decision

The Board agreed the work programme attached at Appendix 1 and agreed an addition to the Work Programme of an update on the Kent and Medway Sustainability and Transformation Programme.