Agenda and minutes

Apologies for absence were received from Councillors Ahmed, Barrett, Bhutia, Paterson and Price.

(During this period, the Conservative and Labour and Co-operative political groups had informally agreed, due the Coronavirus pandemic, to run meetings with reduced number of participants. This was to reduce risk, comply with Government guidance and enable more efficient meetings. Therefore the apologies given reflected that informal agreement of reduced participants.)

To approve the record of the meeting held on 16 June 2020.

The record of the meeting of the Committee held on 16 June 2020 was agreed and signed by the Chairman as correct.

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)

There were none.

Other interests

There were none.

At previous meetings the Committee received briefings on the development of an Integrated Care System (ICS) across Kent and Medway and the establishment of a single Kent and Medway Clinical Commissioning Group (CCG) from April 2020.  This briefing provides a summary update on the CCG establishment.

Discussion

The Accountable Officer of the Kent and Medway Clinical Commissioning Group (CCG) introduced the report. The single Kent and Medway CCG had been established on 1 April 2020 with the focus so far having been responding to Covid-19 and co-ordination of the multi-agency response. One of the corporate objectives of the CCG was the establishment of an Integrated Care System (ICS). The new executive was almost fully in place with only the Director of Digital Transformation yet to be appointed. A staff consultation on the new organisational structure had recently closed. Engagement had also taken place with the Primary Care Network (PCN) Clinical Directors in relation to the proposals. The Clinical Chair of the CCG said that having a single CCG in place had made co-ordination of the multi-agency response to Covid easier. He advised that work was being undertaken looking at vulnerable groups and the BAME population to identify how their Covid risk could be reduced with work also taking place to ensure that elective and emergency services would be able to continue effectively over the winter period.

Members raised a number of questions, which included:

Funding, risks, services and staffing – concern was expressed that the new arrangements would be too costly and it was emphasised that Medway needed to retain a fair and equitable share of funding in view of the prevalence of health inequalities. It was also asked how risks would be managed effectively, how it would be ensured that provider changes did not adversely impact patients and whether significant staff redundancies or redeployments were expected.

The Accountable Officer said that there were no plans to reduce Medway’s share of funding and disadvantaged communities may have more resources targeted at them. The development of the ICS would see more joint working between organisations to promote integrated care. Service delivery had not been impacted by the merger of CCGs with existing contracts being maintained. A risk-based approach would be used to drive organisational change. The development of the digital agenda had been a significant step. There had been a small number of redundancies so far with expressions of interest invited for some further voluntary redundancies. The number was expected to be small with many staff transferring to new roles.

Funding and Healthy Living Centres – It was questioned whether service reconfiguration involving some services being centralised and therefore no longer being provided in Medway would affect funding for the Medway population. It was also asked whether the CCG still aimed to develop GP services at Healthy Living Centres. The Accountable Officer said there were no plans to reduce funding available for treatment of Medway residents. The Integrated Care Partnership established for Medway and Swale was committed to working at a local level to redesign and improve services.

Commissioning, use of digital and engagement and BAME communities – it was asked how lessons were being learned from previous commissioning activity and how relationships would be built with the voluntary sector. It was also asked how digital engagement  ...  view the full minutes text for item 185.

This paper seeks to provide a progress report on:

·       the development of the Kent and Medway Integrated Care System;

·       the development of the Medway and Swale ICP (M&S ICP); and

·       the anticipated next steps for the development of the ICP.

Discussion

The Senior Responsible Officer for the Medway and Swale Integrated Care Partnership (ICP) introduced the report. The ambition was for the ICP to ensure the provision of more integrated health and care services across the system. A Partnership Board had been formed in July 2019 with the development of local care being a priority. This included the development of Healthy Living Centres. Preparations were currently taking place to deal with winter pressures, a possible second wave of Covid-19 and EU Exit. The ICP had set itself three objectives to measure success against. These included embracing use of digital technology, ensuring appropriate and safe hospital discharges and ensuring that the outcomes of one patient were improved each week. The Chief Executive of MFT added that the development of the ICP would help to ensure that the needs of people in Medway and Swale were prioritised and that money spent benefitted patients. The Director of Communications at MFT said that the development of the ICP had recognised the importance of the patient voice but that engagement work had needed to be paused due to Covid. It was recognised that there was a need to consider how engagement could be undertaken virtually and to look at how face-to-face engagement could resume. A regular bulletin had been produced on engagement activity and this could be circulated to the Committee.

Members raised a number of questions which included:

Care close to home and engagement – in order to ensure that people could be cared for at home or close to it, it was suggested that there needed to be better training for and engagement with the domiciliary care sector. It was suggested that digital engagement could be beneficial but that barriers to this needed to be addressed through the provision of equipment and appropriate support. In relation to patient engagement, patients needed to be confident that their views would be taken seriously and acted upon and concern was expressed that young people were not represented effectively during engagement activity.

The Senior Responsible Officer recognised that there was a need to enhance joint working between organisations and to support people with IT in the home. A Care Wheel was being piloted and some service users were being provided tablets. Work with wHoo Cares on the Hoo Peninsula involved the provision of IT support for patients. The Chief Executive said that more work was needed to consider how care would be provided, how to utilise the workforce and support services and how to strengthen the offer of care providers and Health Living Centres. The Director of Communications said that there was already engagement activity with young people via schools and the Youth Council but that it was recognised that a new, more creative approach was needed. Communications and engagement colleagues from across the sector and Healtwatch were working together to progress engagement activity. The Director of People – Children and Adults said that work had been undertaken with domiciliary care providers in relation to areas  ...  view the full minutes text for item 186.

The report provides the Committee with an overview of the COVID-19 response and restart of NHS services.

Discussion

The NHS Restart Programme for the restart of services in Kent and Medway reflected national priorities to restart referrals, urgent and critical care and to catch up backlogs of patients waiting to be seen. Other focus areas included ensuring sufficient capacity to care for those infected with Covid-19 in the future and meeting the increased demand for rehabilitation and mental health services for patients who had previously had Covid-19.

It was suggested that it would have been useful for the report presented to contain more specific data and information on priorities and milestones for the restart activities identified and that this was needed in order to help the Committee ascertain how much more work was required to facilitate the full restart of services. It was also asked how it had been determined whether the overall risk of harm to a patient would be increased or decreased by asking them not to attend an appointment during the height of the Covid outbreak. It was stated that there were examples of vulnerable people within the community who had not been offered any support at the height of the pandemic.

The Executive Director of Health Improvement said that data was available and that there was a requirement to provide this to NHS bodies. It would also be presented to the CCG Governing Body and further data could then be shared with the Committee. The Covid-19 pandemic had been unprecedented and had necessitated new ways of working. Patients had been asked not to visit a GP or hospital for a period of time during the pandemic but when they had been encouraged to return, many had chosen not to. There was a need develop confidence and provide help and support for vulnerable groups. The Chief Executive of MFT said that detailed recovery plans were under development and that the details would be shared. Initial modelling showed that the full recovery of services would take into 2021/22.

It was asked how it would be ensured that supply chains for medicines would be protected in the event of a second wave of Covid and whether there was confidence that NHS 11 would be able to cope with demand. The Executive Director said that nationally the NHS had taken a number of steps to ensure the availability of medicines and that contingency plans continued to be developed. There had been some short-term supply issues with some drugs but comparable alternatives were available.

In response to a question that asked where NHS111, urgent care and mental health services would be able to meet demand, the Kent and Medway CCG Deputy Managing Director (Medway) said that in relation to NHS111, a Clinical Assessment Service was increasing the number of clinicians available to the service and that the required number of clinicians and call handlers would be available when the service went live on 1 October. Nationally, more callers potentially requiring urgent care would be encouraged to contact NHS111 for them to be directed to the most appropriate service.  ...  view the full minutes text for item 187.

This report provides an update to the Committee on Primary Care provision across Medway. It provides an update on the Kent and Medway Primary care Strategy and describes the local primary care response to COVID.

Discussion

The Executive Director of Health Improvement highlighted that Primary Care Networks were a key element of Integrated Care Partnerships. 47,000 additional primary care appointments would be available each year via improved access. It was highlighted that the DMC Healthcare run St Mary’s Island group of practices and St Werburgh had had their registrations removed and that a handing back of the contracts had been agreed for this and for the Kings Family practice that was also run by DMC Healthcare. An interim service run by Medway Practice Alliance had been put in place while engagement was undertaken with local practices to consider longer term options.

Members raised a number of questions which included:

Issues with GP Services, staffing, data use and DMC Healthcare – there were some issues in relation to the interim GP services, broken ECG machines being highlighted as an example. It was pleasing that there had been recognition that people with learning disabilities needed particular support and also that a multi-disciplinary team had been developed for people with co-ocurring conditions such as drug and alcohol abuse. It was asked whether there were sufficient staff in place to provide services and whether there was the expertise to make effective use of data analytics. In relation to the DMC Healthcare surgeries, it was asked how the situation had been allowed to escalate in view of there having been problems for a significant period of time and why the Committee had not been made aware of issues sooner. There was concern that performance data that had been requested, which was said to have shown improvement, had not been provided and it was questioned whether there had been any such data. It was also suggested that patient concerns and complaints had not been taken seriously and assurance was sought from the CCG that there would not be a similar occurrence in the future.

The Executive Director said that the CCG Governing Body would receive a report in relation to the DMC Healthcare run services and that the findings of this would be shared with the Committee. The CCG had encouraged the CQC to act once the extent of the problems had become clear. There had been some teething problems in relation to the interim service but feedback from patients suggested that they were getting a better service than previously. There was now increased scrutiny of primary care by the CCG nursing team and reports provided to the governing body now contained much more detail on primary care. The Acting Director of Health Improvement said that there had been significant joint working with organisations such as Medway Community Healthcare to ensure continuity of care for patients.

The Chief Nurse said that it was important to ensure that appropriate lessons were learned and that review of performance indicators was part of this processes, with a more sophisticated dashboard of indicators due to be developed. It was envisaged that more targeted support would be put in place when concerns were identified in the  ...  view the full minutes text for item 188.

Discussion

The Committee considered a report which advised that DMC Healthcare had been providing dermatology services to Medway patients since April 2019. On 22 June 2020 the DMC dermatology contract had been formally suspended by Kent and Medway Clinical Commissioning Group (CCG) due to serious concerns regarding patient care. The paper provided the background to this development and detailed the action the CCG had taken to ensure an effective interim service was in place.

Members raised a number of questions which included:

Dermatology contract and Harm Review – it was asked why DMC Healthcare had been awarded the North Kent contract for Dermatology Services given that there had been significant concerns about its performance in relation to primary care. It was also asked why DMC Healthcare had previously said they had incorrect information about patient waiting times and the acuity of patients and what performance monitoring would be undertaken of the interim provider, Sussex Community Dermatology Service (SCDS), to ensure that problems would not be repeated. In relation to the Harm Review process, it was asked when this would be complete and requested that details be provided to the Committee.

The Kent and Medway CCG Deputy Managing Director (Medway) had given notice on the North Kent Dermatology contract two years previously and that there had been seven months to re-procure the service. At the point of contract award, there was already a contract in place with DMC for the level 1 and 2 dermatology services with there having been no significant complaints or concerns raised about these services and there had also been good feedback about DMC provided primary care services at St Mary’s Island. The procurement process was conducted blind and therefore those making the contract award decision had made it on the basis of the tender scores, without having been aware of the identity of the provider. The CCG could not say why DMC Healthcare had felt that they had not been given correct information about patient waits or acuity. There was some uncertainty about the content of a public meeting that had taken place at the Sunlight Centre and who had been responsible for running the centre at the time. The Kent and Medway CCG Deputy Managing Director (Medway) said he had checked and could confirm that Medway Community Healthcare had been responsible for running the Centre at that point. Further details of this meeting would be provided outside the Committee.

The Chief Nurse advised that the Harm Review process had commenced with over 1,000 patients having been reviewed so far in the very urgent and urgent groups. For patients where risk of potential harm had been identified a 1^st stage review had been completed. The second stage of the process would look at patients waiting over 52 weeks or people with a potential cancer diagnosis who had experienced a 104 day wait. The whole process was expected to take several months. GPs had been asked to review patient lists as there was concern that these  ...  view the full minutes text for item 189.

Discussion

Members considered a report regarding the Committee’s current work programme.

A request had been made for a report on the Covid-19 response in care homes to be added to the Committee Work Programme. It was suggested that this should look at care homes within the context of the Outbreak Control Plan and preparedness for a second wave of Covid. It was also suggested that a report that Healthwatch was producing in relation to support for care homes be added to the Work Programme as well as a report on care in the community.

It was suggested that Covid support for care homes be incorporated into the Adult Social Care Strategy. The Director of People – Children and Adults undertook to consider how the Strategy should include specific coverage of considerations in relation to care homes.

The possibility of an extra meeting of the Committee being arranged was discussed. This would be further considered at the next agenda planning meeting.

Concerns were raised that Member integrity had been called into question during the meeting.

Decision

The Committee:

i)           agreed changes to the Work Programme as set out in paragraph 3 of the report and agreed during the meeting.

ii)          agreed that reports on the Covid-19 home response in care homes; a Healthwatch report in relation to support for care homes and a report on Care in the Community be added to the Committee’s Work Programme for consideration at a future meeting.