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 Penny Graham had been nominated as the representative for Healthwatch Kent on the Joint Board and that owing her new position on Medway’s Children and Young People Overview and Scrutiny Committee, Margaret Cane had resigned from her position as named substitute for Healthwatch Medway on the Joint Board. 

Apologies for absence were received from Councillor Alan Jarrett (Leader, Medway Council), Mr Paul Carter, CBE  (Leader Kent County Council and Cabinet Member for Health Reform) and Mr Roger Gough (Cabinet Member for Children, Young People and Education, Kent County Council), Dr John Allingham (Kent Local Medical Committee), Matt Dunkley, CBE (Corporate Director for Children, Young People and Education, Kent County Council), Matthew Scott (Kent Police and Crime Commissioner) and Penny Southern (Corporate Director Adult Social Care and Health, Kent County Council).

To approve the record of the meeting held on 9 October 2018.

The record of the meeting held on 9 October 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 presents a ‘deep dive’ into the current situation in relation to overweight and obesity across Kent and Medway. The report references national policy and initiatives and covers the prevalence data for Kent and Medway and the range of services and interventions.

Discussion:

The Director of Public Health for Medway Council presented the Joint Board with a detailed review of the prevalence of overweight and obesity in Kent and Medway. He noted that this was a significant problem caused by complex personal, social and environmental factors. He explained that a whole system approach to weight management was required, including different interventions targeted at different segments of the population.

The importance of considering factors such as making adaptations to the physical environment and facilitating other means of transport, like cycling, to encourage individuals to increase their physical activity levels was emphasised. He added that it was important to make a healthy choice the easy choice. An example of how the Local Authority could assist in this endeavour was by prohibiting fast food establishments from opening within 400m of a school.

He drew the Joint Board’s attention to the data set out in section 3 of the report, which provided a review of the prevalence of overweight and obesity in children and adults in Kent and Medway, benchmarked against national performance. It was noted that prevalence was generally higher in disadvantaged communities. The Director of Public Health also highlighted trends in relation to bariatric surgery admissions in Kent and Medway. It was noted that nationally the rate of bariatric surgery admissions had decreased from 2011/12 to 2016/17. The same trend had been observed in Kent whilst in Medway, the rate had remained statistically stable.

The Joint Board was advised that weight management services were categorised into four tiers. Examples of Tier 1 and 2 services and interventions implemented in Kent and Medway were drawn to the attention of the Joint Board and were set out at paragraphs 3.26 to 3.46 of the report. Tier 4 services included bariatric surgery. It was recognised that there was a pressing need to focus on Tier 3 specialist weight management services.

Members raised a number of points and questions, including:

Workplace - A Member observed that there was a disconnect between leaving full time education and taking up employment. It was explained that at school there was an expectation that young people would engage with sports, but once individuals left school and entered the workplace, the opportunity for this was reduced. As such, there was an argument to persuade employers to help create active habits. In response, Medway’s Director of Public Health explained that the impact of work on health was well recognised and employers were encouraged to support a healthy workplace. He added that Medway Council’s Public Health Team ran a workplace health award scheme which encouraged employers to improve staff physical activity by, for example encouraging staff to change the way they travel to work and encouraging staff to use stairs. He noted that Kent County Council also employed workplace initiatives. It was recognised that more could be done.

Accessibility - In response to concerns expressed regarding accessibility to physical activity and leisure services for children and young people with Special Educational Needs (SEN), Medway’s Director  ...  view the full minutes text for item 638.

This report presents a ‘deep dive’ into the implementation and outcomes of the NHS Health Check Programme across Kent and Medway. 

Discussion:

Kent County Council’s Director of Public Health introduced the report which presented a detailed review of the implementation and outcomes of the NHS Health Check Programme in Kent and Medway. It was explained to the Joint Board that the Health Check was a national cardiovascular screening programme which sought to assess an individual’s risk of developing cardiovascular disease and take appropriate action where required.

Local Authorities had a statutory obligation to offer an NHS Health Check to 100% of eligible people over a period of five years and seek continuous improvement in the number of people having an NHS Health Check each year. Public Health England (PHE) aspired to achieve a national take up rate in the region of 75% of the eligible population receiving a health check once every 5 years. The overall Kent and Medway performance was set out at paragraph 3.19 of the report. 

It was emphasised that the NHS Health Check Programme was a critical element of the prevention workstream because it aimed to prevent diseases with a cardiovascular component such as heart disease, stroke, type 2 diabetes, as well as dementia and, in general, prevent people progressing to frailty. The programme also provided a significant opportunity to address health inequality and reduce early death.

The Joint Board was advised that Kent and Medway had invited the whole eligible cohort. He explained that the focus now needed to be on how individuals could be encouraged take up the offer of a Health Check and ensuring that GPs undertake the necessary diagnostic work, referring individuals to the appropriate lifestyle support to manage their health risk. 

In response to a question regarding the services available for individuals aged 75 and over, above the upper threshold of eligibility, and a question asking how routine health testing could be normalised at earlier age, i.e. below the age of 40, the lower threshold for eligibility, the Joint Board was advised that the age range was nationally mandated. With respect to the query on the upper threshold, Kent County Council’s Director of Public Health considered that at the age of 70 most individuals would already be on the GP register and therefore likely to be receiving adequate support. Referring to the prevalence of cardiovascular disease in the poorest communities, he explained that with respect to the lower threshold, starting Health Checks at the age of 40 would provide two opportunities to provide health interventions (it was noted that in disadvantaged communities healthy life expectancy was as low as age 52). He expressed a view that for some populations where the cardiovascular risk was high, the age range should be lowered. However, he noted that the challenge in this respect would be affordability.

A Member commented that Health Checks had a positive impact on the health of an individual and were cost effective for the health service in the long term as ill health was prevented. As result, it was considered that this was a useful argument to lower the age threshold.  ...  view the full minutes text for item 639.

This report provides an update on: Local Care governance, in line with progress and alignment to Strategic Commissioning development; Local Care deep dives; progress on an Implementation and Local Care Delivery Framework; actions for winter pressures and details of how Local Care is supporting carers and care navigation.

Discussion:

The STP Local Care Lead summarised amendments made to the governance arrangements for Local Care. This included the establishment of a new, smaller strategic Local Care Board which would be comprised of senior leaders from key organisations involved in the commissioning and delivery of Local Care services across the Kent and Medway health and social care system. She explained that the existing Local Care Implementation Board (LCIB) would not be disbanded, as this Board had been invaluable in bringing together a wide range of organisations. However, it was noted that the focus of LCIB would be amended. It was considered that this Board would be a “learn and share” Board, in which practical information to support the delivery of Local Care could be discussed. Owing to the emergence of Primary Care Networks (PCNs), the STP Local Care Lead also explained that the Local Care Workstream was working to align to the newly formed Primary Care Board with the delivery of Local Care.

The Joint Board was advised that the Local Care deep dives for East Kent and Medway, North and West Kent, set out at section 4 of the report, were held on 23 November 2018 and 11 December 2018 respectively. The STP Local Care Lead undertook to circulate a more detailed update from the deep dives to the Joint Board, but summarised the key themes which had emerged, this included:

·         Workforce challenges - It was explained that attendees concluded that a holistic workforce plan across the Kent and Medway STP was required. They asked whether there were suitable and sufficient resources working in an integrated manner on pathways for discharge/transfers of care and they established that there was a need to align resources to, and improve Multidisciplinary Team/s (MDTs) working. A need was also established to utilise the existing workforce better and to consider whether it could be made easier for staff to rotate across organisations, i.e. a staff “passport”. It was considered that the latter could help with the recruitment and retention of staff.

·         Primary Care – It was explained that attendees expressed support for the development of PCNs and the Local Care workstream working in collaboration with PCNs. It was added that the optimum conditions for PCN development needed to be defined and the importance of GP continuity was stressed.

·         Investment and Implementation – It was explained that whilst £32M was actively being invested in Local Care, attendees considered that there was a need to secure a sustainable investment for Local Care going forward. A need was also expressed to increase the scale and pace of implementation. Enquiries were also made into how organisations could work towards a shared finance and risk framework.

·         Estates – It was explained that attendees considered the possibility of a one public sector estate and working with local authorities to solve some of the estates funding challenges for the NHS. Further considerations included how best use could be made of non-acute beds, including extra care housing and what was the Kent  ...  view the full minutes text for item 640.

This report provides an update on the establishment of the Strategic Commissioner for Kent and Medway and what this means for the wider system and development of an Integrated Care System and Integrated Care Partnerships across Kent and Medway.

Discussion:

The Accountable Officer for the Kent and Medway CCGs and the Kent and Medway STP Chief Executive provided an update on the establishment of a Strategic Commissioner for Kent and Medway and provided details on the expected implications for the wider system and the development of an Integrated Care System and Integrated Care Partnerships across Kent and Medway.

It was explained that there was an expectation that within the next iteration of the NHS 5 Year Plan, Sustainability and Transformation Partnerships (STPs) would transform into Integrated Care Systems (ICSs). In most cases it was expected that these ICSs would follow the existing boundaries of their STPs, however, not in all cases, for example Frimley. Nationally, there had been a debate on how ICSs could incorporate provision and regulatory functions and the thoughts were further developing.

The Joint Board was advised that the Strategic Commissioner would operate at a Kent and Medway level, facilitating commissioning at scale of core services. It was explained that at present discussions were ongoing regarding how to achieve cooperation for commissioning across Kent and Medway and what functions would be retained at a local level or transferred to the strategic Kent and Medway level. It was noted that it had been agreed that one of the first remits of the Strategic Commissioner function would be cancer care. It was added that in the longer term the Strategic Commissioner may also have regulatory functions as well as commissioning functions, as the NHS landscape changes. It was noted that the Strategic Commissioner would commission outcomes.

These outcome based procurements would be commissioned from Integrated Care Partnerships (ICPs), a group of providers who respond to a required outcome as specified by the Commissioner. It was noted that across Kent and Medway these partnerships had already started to emerge through the utilisation of aligned incentive contracts. West Kent was considered the most advanced. The Joint Board was advised that East Kent had not yet utilised these types of contract but the CCG and providers were working together and it was considered that the next steps would be enter into some form of aligned incentive contract. With respect to Medway and Swale, the Joint Board was advised that providers in both areas were working together and that the current assumption was that these two areas were likely to form a partnership, although there was some further thought to be given to this, as there was some merit for Swale joining with West Kent.

The last tier in the emerging arrangements would be Primary and Local Care Networks, which were set out in further detail at paragraph 4.3.4 of the report.

With respect to Local Authority engagement, the Accountable Officer for the Kent and Medway CCGs and the Kent and Medway STP Chief Executive expressed a view that Upper Tier Local Authorities should be engaged at all levels of the new arrangements. It was noted that lessons could be learnt from Local Authority commissioning.

It was added that the Kent and  ...  view the full minutes text for item 641.

Following the STP collaboration in the delivery of the statutory duties of Kent County Council, Medway Council and the Clinical Commissioning Groups (CCGs) as underpinned by the Case for Change, this report outlines the rationale and approach to undertaking the Joint Strategic Needs Assessment (JSNA) for Kent County Council.

Discussion:

Kent County Council’s Director of Public Health introduced the report which sought support for a proposal to develop the Kent and Medway Case for Change to incorporate Kent and Medway’s Joint Strategic Needs Assessment (JSNA) and thereby better reflect the needs of the Kent and Medway population. It was explained that that following the publication of the NHS 10 year plan, the Case for Change would need to be revisited and as the Case Change would drive NHS commissioned services, a strategic JSNA would provide greater clarity on the needs of the Kent and Medway population.

It was reiterated that Kent County Council’s and Medway Council’s JSNA development and publication process will continue to be maintained by each Local Authority separately.

Decision:

The Kent and Medway Joint Health and Wellbeing Board:

a)    noted the paper;

b)    noted that Kent County Council’s and Medway Council’s JSNA development and publication process will continue to be maintained by each authority separately; and

c)    recommended further discussion by the Health and Wellbeing Boards of Kent County Council and Medway Council on the proposal that the Case for Change for the STP could be developed to incorporate the JSNA’s for Kent and Medway in the longer term.

This report provides an update on the work of the Design and Learning Centre and how it is leading and supporting clinical and social innovation and providing support to the Sustainability and Transformation Partnership and the Joint Health and Wellbeing Board. Progress against the range of projects and programmes is detailed in the report including recent high-profile exposure on a national level.

Discussion:

The Clinical Design Director, the Design and Learning Centre for Clinical and Social Innovation provided a presentation on the work of the Design and Learning Centre (DLC). He explained in detail four key work pillars, these were:

1.    Innovation - The Clinical Design Director set out the innovation priorities which included:

·         working with the Kent and Medway Joint Health and Wellbeing Board and the Sustainability and Transformation Partnership (STP) across the priority area, Local Care;

·         working in collaboration with the Academic and Health Science Network (AHSN) to find innovative solutions to challenges set by the STP Clinical and Professional Board and social care; and

·         Using an agreed methodology to test the innovations and to roll out at scale / co-implementation if the evaluation proves positive.

2.    Learning and Development - The Clinical Design Director explained that the DLC was established as the Kent and Medway STP Learning Hub and he set out the learning and development priorities which included:

·         rolling out the Carers App;

·         developing an STP “offer” to the new Kent and Medway Medical School; and

·         working directly with the wider care sector and supporting recruitment, retention and new career opportunities for this sector as well as clinical staff including portfolio careers.

3.    External and International Funding - The Clinical Design Director set out the external and international funding priorities which included:

·         supporting innovation initiatives;

·         applying for further funding to pilot and evaluate new initiatives. It was noted that a series of funding bids had already been submitted including a bid of £10M for the Ebbsfleet Intergenerational Housing and Technology Project; and

·         the EU Buuertzorg Neighbourhood Care Model which had received £4.5M funding to enable health and social care teams to determine how best to meet the needs of their caseload across Kent and Medway.

4.    Engagement, Research, Analytics and Co-implementation - The Clinical Design Director set out the engagement, research, analytics and co-implementation priorities which included:

·         running innovation workshops and forums for key STP priorities including, Local Care, End of life, Carers App and Being Digital;

·         facilitating the wider academic, analytical and research network including the Medway and Swale Centre of Organisational Excellence (MaSCOE) for the Clinical and Professional Board and other stakeholders; and

·         co-implementing successfully evaluated solutions, reducing the need for more local pilots.

The Joint Board was advised that the DLC had a new collaborative arrangement, focussing on technologies and solutions to meet the challenges set by the Clinical and Professional Board. The first three challenges were across the Primary/ Local Care topic areas of diabetes, asthma and Chronic Obstructive Pulmonary Disease (COPD).

The Clinical Design Director drew the Joint Board’s attention to the DLC’s current successes, this included the ESTHER Care Philosophy. Detailed information on this initiative was set out at paragraphs 4.5 to 4.10 of the report and it was explained that it had been featured in the Guardian Social Care Supplement set at out at Appendix 1 to the report. Other successful projects included: the Being Digital Strategy, the aforementioned  ...  view the full minutes text for item 643.

The NHS in Kent and Medway is establishing three Hyper-Acute Stroke Units (HASUs). This report sets out details of Medway Council concerns in relation to the matter. Medway Council believes that the sites that have been selected are not in the best interests of the health service in Kent and Medway. Furthermore, Medway Council believes that there were flaws in the way that the Joint Committee of Clinical Commissioning Groups was led to choose the selected sites.

Discussion:

The Chairman welcomed Rachel Jones, Senior Responsible Officer (SRO) for the Kent and Medway Stroke Review, who was present at the meeting to answer questions from Members in relation to the review of urgent stroke services in Kent and Medway. He thanked her for attending.

The Director of Public Health for Medway Council explained to the Joint Board that whilst Medway Council welcomed the creation of Hyper Acute Stroke Units (HASUs) there were some concerns in relation to the preferred option which had been selected by the Joint Committee of CCGs, option B. He drew the Joint Board’s attention to the concerns set out in section 3 of the report, in particular he questioned whether option B took proper account of population growth and disadvantage levels in Medway and other localities across Kent, namely Swale and the South Kent Coast.

He also highlighted the clinical implications for local hospitals who would not be designated a HASU under stroke reconfiguration plans, set out at section 4 of the report, as summarised from the 2016 review published by the South East Clinical Senate. In particular, he drew the Joint Board’s attention to issues around workforce, the potential impact on social care services and the implications for families and carers following removal of specialist stroke services from Medway. It was recognised that mitigation was proposed in the Decision Making Business Case (DMBC), however it was considered that these areas were particularly challenging to address.

Members raised a number of points and questions, including:

Methodology - with reference to the response from the NHS on Medway Council’s Freedom of Information (FOI) request, set out at Appendix 3 to the report, a Member expressed concern regarding a lack of transparency and explanation in relation to the decision. He noted that the methodology was amended 24 hours ahead of decision making and he considered that changes to the methodology had disproportionately impacted option D. In response, the SRO for the Kent and Medway Stroke Review explained that the final decision had not been made and she confirmed that the final decision on the location of the HASUs would not be taken until January 2019. She also advised that with respect to the amendments made to the selection criteria, refinement of the criteria from the Pre-Consultation Business Case (PCBC) was considered an accepted part of the process to reach a preferred option from the five original shortlisted options. She assured the Joint Board that a clear rationale and evidence base was needed to make a recommendation or levy for any change. She stated that amendments to the criteria had been presented to several forums ahead of the evaluation workshop, including the Joint Health Overview and Scrutiny Committee.

Population growth and deprivation - A Member reiterated concerns that the selection of the preferred option did not take proper consideration of the level of: deprivation in Medway, the largest conurbation in the south east, outside of London; population growth, particularly in light of government housing targets; or transport  ...  view the full minutes text for item 644.

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.

The report also advises the Joint Board of a request to appoint Dr Bob Bowes as a member of the Joint Board, in his capacity as Chairman of the Strategic Commissioner Steering Group.

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 2.3 to 2.4 of the report which had been reflected in the work programme set out at Appendix 1 of the report. She also noted that provisional meeting dates for the 2019/2020 municipal year were set out at Table 1 of the report.

It was explained that that a request had been received to appoint Dr Bob Bowes to the Joint Board in his capacity as Chairman of the Strategic Commissioner Steering Group. The Strategic Commissioner Steering Group was established in February 2018 and provides leadership and oversight to the strategic development and thinking around the Strategic Commissioner function. On this basis it was recommended that Dr Bob Bowes be appointed as a member of the Joint Board in his capacity as Chairman of the Strategic Commissioner Steering Group to represent the views of Kent and Medway colleagues on this Steering Group.

Decision:

The Kent and Medway Joint Health and Wellbeing Board:

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

b)    agreed to appoint Dr Bob Bowes as a voting member of the Kent and Medway Joint Health and Wellbeing Board in his capacity as Chairman of the Strategic Commissioner Steering Group; and

c)    noted the provisional Joint Board meeting dates for 2019/2020 as set out at paragraph 3.1 of the report.