Agenda and minutes

Apologies for absence were received from Shirley Griffiths of Medway Pensioners Forum.  

To approve the record of the meeting held on 13 December 2018.

The Committee agreed the following changes to the draft minutes, to correct inaccuracies, of the ‘Draft Capital and Revenue Budget 2019/20’ report considered at the December 2018 meeting:

In the second sentence of the 1^st paragraph of the minute, the Council budget date was corrected to 21 Feb (from 22 February). In the next sentence, the draft budget deficit figure had been corrected to £4.408 million (from £3.189 million). A change to the wording of the final sentence of the first paragraph was also agreed to make clear that expected additional Government funding of £2.6 million for social care had not been included in the draft budget.

Subject to the above changes, the record of the meeting held on 13 December 2018 was agreed and signed by the Chairman 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 (OSIs)

Cllr Price declared an OSI in agenda item 8, Primary Care in Medway Update, as he was the Chair of Trustees at the Sunlight Centre, which hosted a Medway GP practice. However, no specific mention was made of the Sunlight Centre and he was therefore able to remain present at the meeting during the discussion and decision on this item.

Other interests

Cllr McDonald declared an interest in agenda item 5, Attendance of the Portfolio Holder for Adults' Services, as he had, through his employment, been involved in the development of the Better Together Leadership Consortium.        

This report details the areas covered by the Portfolio Holder for Adults’ Services which fall within the remit of this Committee.

Discussion

Committee Members raised a number of questions which were responded to as follows:

Budget Deficit, Extra Care Housing and liaison with mental health – A Member raised concerns about the size of the budget deficit, the impact of this on services, particularly for vulnerable people and also the need for increased Extra Care housing as 1,500 people in Medway were eligible with there only being 239 units available. The Member also asked what discussion had taken place with the Kent and Medway NHS and Social Care Partnership Trust (KMPT) to ensure that the impact of service change was minimised.

The Portfolio Holder said that a ‘deep dive’ was being undertaken into both statutory and non-statutory services in order to see where there was scope for change. There was a need to provide value for money. Medway had previously always managed to identify funding to support voluntary sector provision but it was not possible to yet say what changes would be made.

It was acknowledged that there was a gap between current Extra Care Housing needs and provision and that the provision of Extra Care housing could make a significant positive impact on lives. New provision included Rogallo Place, near Rochester Airport and Atlas Place on St Mary’s Island. A future scheme was planned for Rochester Waterfront. One challenge to the provision of Extra Care housing was that was that developers were able to sell properties after planning permission had been granted. The provision of such housing was a high priority. In relation to KMPT, discussions were taking place about the establishment of a Safe Haven in Maidstone to accommodate people, from across Kent and Medway, detained under Section 136 of the Mental Health Act. 

The Director of People, Children and Adults’ Services said that Adult Social Care (ASC) had faced significant pressure, although the provision of additional funding for Winter Pressures had been useful and had enabled demand to be managed more effectively. The introduction of the Three Conversations approach in ASC would help to increase early intervention. Additional funding of £2.6 million for Children and Adult Social Care was due for the next year, some of which was ring-fenced for winter pressures.

Winter Pressures, Three Conversations Model and housing targets – A Committee Member highlighted Winter Pressures and the risk of an increased number of patients being discharged from hospital early. She also asked how ASC, using the Three Conversations Model, was working with partners to avoid possible duplication and suggested that there should be higher targets for the provision of affordable housing.

The Director of People advised that Medway Maritime Hospital, Adult Social Care and Medway Community Healthcare worked in partnership to plan discharges. It was acknowledged that activity had previously been fragmented. Work was taking place with Medway NHS Clinical Commissioning Group to create an integrated discharge service. This would help to avoid duplication. ASC already had access to the Rio mental health software package that mental health professionals used. This helped to facilitate joint working  ...  view the full minutes text for item 716.

In accordance with the Care Act 2014, the Kent and Medway Safeguarding Adults Board is required to publish an Annual Report each financial year. The 2017-18 Annual Report (Appendix 1) sets out the responsibilities and structure of the Board and then details how the multiagency partnership is delivered against its five priorities for the year. The report also provides safeguarding activity information and summarises the Board's priorities for 2018-2019.

Discussion

The report was introduced to the Committee, the key points of which were as follows:

·         The KMSAB budget of £203,000 included contributions from Medway and Kent Councils, the NHS, the Kent Police and Crime Commissioner and a voluntary contribution from Kent Fire and Rescue.

·         The Safeguarding Adults Executive Group had been established in 2016 to bring together senior representatives from key agencies. This worked collaboratively to deliver strategic priorities and to strengthen delivery, practice, oversight and governance.

·         Agreed aims of KMSAB were to ensure partnership accountability; raise public awareness of engagement; make safeguarding personal; to quality assure work;to measure effectiveness of what we do; share learning from other people’s experience and; ask for feedback about what we do.

·         In July 17, the Board agreed three safeguarding priorities for 2018 – 2021 - prevention, quality and awareness. A Business Group had been added to the KMSAB structure between the Board and its four working groups.

·         A Safeguarding Adults awareness campaign took place in October 2017 with the theme ‘respect not neglect.’ A number of awareness raising sessions were held.

·         Three large learning events were held in March 2018, based upon feedback from the awareness campaign. These attracted a total of 460 multi-agency attendees.

·         A new multi-agency training programme for safeguarding launched in May 2017. 761 staff were trained between June 2017 and April 2018.

·         Four Safeguarding Adult Reviews were completed in 2017-18 with a number of agencies also being involved in two additional out-of-area reviews that were led by other local authorities.

·         Identified challenges included the need to: improve quality of record keeping in relation to ASC; improve care and case coordination and management; strengthen safeguarding management and leadership and; enhance collaborative working.

·         There continued to be an increase in safeguarding enquiries in Kent and Medway. There had been 10,329 concerns raised in Kent and 1,281 in Medway during the year with there having been a 28.4% (283) increase in Medway compared to the previous year. Formal safeguarding enquiries in Medway had increased from 308 in 2016/17 to 491 in 17/18. The increases were attributed to operational improvement and Medway’s promotion of safeguarding awareness and the provision of training.

·         Safeguarding enquiries dealt with within 90 day increased from 37% in 16/17 to 64% in 17/18. Cases where risk was removed increased from 32% to 49% and cases where risk was reduced decreased from 53% to 43%. Levels of self-neglect were increasing.

·         In Medway, the highest proportion of cases were ‘not substantiated’ at 30.6% (124 cases), down 1.5% from 2016-17. 121 cases were substantiated and 52 were partly substantiated.

·         The number of Deprivation of Liberty Safeguards (DoLS) authorisations outstanding reduced from 131 to 66. Six staff had undertaken training to support completion of timely assessments and shortened DoLS annual renewal assessments were being piloted.

A Committee Member thanked the Independent Chair of KMSAB for the quality and depth of the report presented and said that it was pleasing that ‘real name’ pseudonyms had been used in the report  ...  view the full minutes text for item 717.

This report advises the Committee of a proposal under consideration by KMPT to relocate existing mental health services from Canada House, Gillingham and Elizabeth House in Rainham to Britton Farm, Gillingham as both Canada House and Elizabeth House are considered to be unfit for use. KMPT is recommending that the Committee agrees that the proposal does not amount to a substantial development of, or variation to, the health service in Medway. The scheme has been developed as part of the Medway STP process (strategic estates group) in partnership with Medway Council.

Discussion

KMPT considered the proposals to relocate two mental health services from Elizabeth House in Rainham and Canada House in Gillingham to Britton Farm in Gillingham to be a good opportunity to strengthen services locally. The existing premises were no longer fit for purpose with relocation to Britton Farm enabling the use of newly refurbished premises in a town centre location. The development would be in partnership with the Council, which owned the Britton Farm site. Continuing to invest money to run Canada House and Elizabeth House was not considered to be sustainable.

It was anticipated that the improved design and layout of the new facility would enable the expansion and improvement of services. The new site would also have plenty of parking, which was not the case at many existing locations. Existing separate younger and older adults services would be integrated on a single site. Similar hub developments had already been undertaken in Ashford and Maidstone over the last five years. A development was underway in Canterbury with a future one planned for Tunbridge Wells. It had been challenging to find a suitable location in Medway. The opportunity at Britton Farm had been identified through the Sustainability and Transformation Plan process and KMPT involvement in the Strategic Estates Group. Besides addressing KMPT needs, the development would also help the Council to bring a vacant site back into use and would be more efficient, effective and better equipped than other existing KMPT sites in Kent and Medway. The relocation would help to strengthen partnership working. There was the opportunity to offer hot-desking to social care colleagues and open the building up to use by third sector organisations. KMPT was concerned about possible delays and loss of the building if it was required to undertake full public consultation due the Committee determining the proposals to be a substantial development or variation to the health service in Medway.

A Committee Member said that they did not consider the proposals to amount to a substantial variation in this particular case, although they acknowledged that there had been previous examples of service relocation causing difficulties.

Another Committee Member said that she agreed that Britton Farm would be a better location for services. However, she considered that the proposals did amount to a substantial variation and did not consider that the undertaking of a public consultation would prevent the development. Consultation would help to obtain feedback from patients and help to ensure that the development was as effective as possible. The wider Britton Farm development was being overseen by the Medway Development Company (MDC). The Member therefore felt that MDC should be held to account at scrutiny. Another Committee Member said that they did not consider the proposals to be a substantial variation but they did support scrutiny of MDC.

The Director of Estates, Facilities and Capital Planning at KMPT acknowledged that transition arrangements would be important to ensure that patients and staff were not disrupted. Engagement would take place with stakeholders irrespective of the  ...  view the full minutes text for item 718.

The report provides an update on the development of Primary Care in Medway.

Discussion

The Committee was advised that the report had been written before publication of the NHS Long Term Plan. However, the Medway Model and method of running primary care at scale fitted with the proposal in the long term plan. There were 49 GP practices in Medway, which ranged in size from 1,700 to 25,000 patients. Delivery of services at scale would enable more services to be provided locally with this concept being embodied in the Medway Model. This necessitated bringing services together, serving populations of 30,000 to 50,000. Data in relation to primary care was poor. NHS England, which had previously been responsible for commissioning primary care, had not collected data and there were not established systems in place for such collection. GP Practices were independent businesses who were not obliged to share data in relation to workforce, capacity and demand. This situation was changing with many practices now agreeing to share data. A NHS Digital workforce tool was due to go live in the current month with GP practices having signed up. This would improve the provision of data.

33% of GPs in Medway were already at a stage where they could chose to retire and there was a 10% vacancy rate. Workforce was the most significant risk to GP provision in Medway. There were two types of GP contracts. General Medical Services (GMS) contracts were lifelong contracts which could change hands between GPs, while Alternative Provider Medical Services (APMS) contracts enabled the CCG to purchase extra capacity in a particular area. This could be considered on the Hoo Peninsular to meet demand if existing practices were not able to expand to meet capacity.

The Local GP Federation had been awarded the Improving Access contract and it had been successfully implemented in three localities with feedback having been positive. Rollout was due to be extended which would include the Hoo Peninsular. A GP care home service had also been rolled out for GPs to work with specific care homes. December 2018 figures showed that there had been an 18% decrease in ambulance service attendance at care homes since implementation of this change.

There were currently six Primary Care Networks in Medway. A seventh would be added in view of growth on the Hoo Peninsular. An Estates Strategy was being developed which was due to be published in March or April 2019. This included a systemic review of all primary care estate. While workforce and estate challenges remained, positive changes had included the implementation of improved access, development of clinical leadership and the extension of capacity across Medway during the previous six months.

Committee Members raised a number of questions which were responded to as follows:

Healthy Living Centre Occupancy – It was confirmed that Healthy Living Centres were currently 40% to 50% utilised and that there was a cost for this estate whether or not it was occupied. The Community Health Services review and co-location of community services at Healthy Living Centres would help to address low occupancy  ...  view the full minutes text for item 719.

To advise the Committee of a petition received by the Council which falls within the remit of this Committee.

The petition and response was previously presented to the December 2018 meeting of the Committee. The Committee agreed that it would be further considered at the January 2019 meeting due to a Committee request for data to be provided in relation to GP provision and to align with presentation to the Committee of a separate report on GP Services in Medway.

Discussion

The Committee was advised that consideration of the report and petition had been deferred from the December 2018 meeting of the Committee to align with presentation of a report on Primary Care in Medway by Medway NHS Clinical Commissioning Group.

Councillor Freshwater introduced his petition in relation to GP Surgeries for the Hoo Peninsula, the key points of which were as follows:

• The number of GPs in the area was effectively being reduced as significant planning applications in Medway continued to be approved. 
• Councillor Freshwater felt that the planning process was ineffective as the Director of Public Health was not highlighting the health impacts and impacts on GP provision of planning applications being considered. It was requested that the Director of Public Health produce a health impact statement as part of all planning applications.
• Medway Council was not responsible for the provision of GPs but it was responsible for improving the health of the local population.
• A third of GPs were due to retire within the next five years and Medway NHS Clinical Commissioning Group (CCG) had not been able to provide data in relation to this. The Council was, therefore, taking decisions without having the relevant data available.

·         GP services had not increased in seven years despite there having been a significant population increase.

• Councillor Freshwater considered that the Director of Public Health’s Petition reply did not sufficiently address the issues raised.
• Some Peninsula residents were having to wait weeks to get a GP appointment. This situation would get worse as new houses were built.  

Councillor Freshwater presented a completed Health Impact Assessment to the Committee, which set out 33 health related questions. Cllr Freshwater was concerned that such information was not being made available to Planning and that, therefore, planning decisions were being made without sufficient information being available. Cllr Freshwater outlined some recommendations to the Committee for it to advise the Council that it was not satisfied with the response to the petition from the Director of Public Health and to request that the need for additional GPs be investigated.

A Committee Member said that assurance had previously been given that there was a contractual mechanism through which GP services could be commissioned as required and that it was not feasible for the Director of Public Health to complete a Health Impact Assessment for all planning applications.

A Committee Member proposed that the Committee should note the report. He was also concerned that significant additional information had been provided by Cllr Freshwater to the Committee on the day of the meeting. Another Committee Member understood Councillor Freshwater’s concerns but said that the challenges in relation to GPs were a Medway wide issue.

Decision

The Committee considered and noted the petition referral request and the Director’s comments at paragraph 3 of the report.

NHS Medway Clinical Commissioning Group (CCG) wants to transform the way adult community health services are delivered across Medway, so that they are less fragmented, more joined up and with more services within local communities, closer to people’s homes.

There are seven key changes to services for local people which have been developed as a result of initial engagement with patients, clinicians, staff and local residents. In August 2018 the CCG consulted with the Committee on these seven key changes.

Following this, the CCG then undertook patient and public engagement during September and October. The report outlines the approaches taken during this engagement, the feedback received from local people and describes what the CCG will do to respond to the findings.  

Discussion

The Committee was provided an update on progress since the previous report presented in August 2018. Engagement had taken place in late 2017 to early 2018 with patients, the public and staff. Seven key changes to community health services were identified following the engagement with resulting plans having been shared in August. This had included the publication of a document detailing the seven key changes.

Further engagement was undertaken in October 2018. This included 276 responses to a survey aimed at clinicians, staff, patients and local residents. It had been ensured that housebound patients had the opportunity to participate. The majority of survey responses were from patients. The engagement also included discussions with GPs and practice managers, Face-to-face meetings, focus groups and interviews. A total of 400 conversations were undertaken with a range of stakeholders. An independent research company had been commissioned to analyse findings. The analysis showed that most people supported the proposed seven key changes and felt that they would improve services. The most important factors identified were the need for an increase in multi-skilled nursing, therapists supported by specialist teams and quicker response for patients with more complex and long term conditions. It was generally considered that the proposed changes would amount to a fairer way of delivering services with better access and co-ordination of care. 

Concerns raised included that changes may not be implemented until after the procurement that was due to take place in 2020. Medway NHS Clinical Commissioning Group representatives confirmed that changes were being made ahead of the procurement. One example was enabling clinical teams to work in a different way. GPs were working with health and social care to support people with complex and long term conditions and existing providers were making changes to service access, including introduction of central booking systems and co-ordination. Following concerns raised about centralised booking, relevant provider requirements would be strengthened in the procurement.

Workforce concerns had also been raised at the public engagement events. This included concern that there would not be enough staff. A Workforce Strategy was being developed which would help to address these concerns. A Workforce lead was working with all providers to address challenges and identify gaps in the workforce. It had been identified that the workforce needed to be better trained to enable identification of mental health issues and provision of better advice and signposting. The integration of community services with other services would be strengthened as would links with talking therapies.

Work was taking place with Medway Community Healthcare to ensure staff had skills to provide a wider range of interventions to patients with multiple long term conditions. The importance of workforce would also be strengthened in the tender documents. The CCG was investing an additional £1.5million to support revised community health services model.

A Committee Member was concerned that relatively few staff had participated in the engagement and that patients managing their own conditions had received the smallest support of any of the proposed seven key changes. The  ...  view the full minutes text for item 721.

Discussion

Proposed changes to the work programme were highlighted to the Committee.

Decision

The Committee:

i)    Considered and agreed the Work Programme, including the changes set out in the report and agreed during the meeting.

ii)   Agreed requests for additional reports on the Carers Strategy and Outpatients Services to be added to the Work Programme for the March 2019 meeting of the Committee.

iii)Agreed to defer update reports in relation to South East Coast Ambulance Service and All Age Eating Disorder Service to the June 2019 meeting of the Committee.