Agenda and minutes

The Chairman announced that, as the Cabinet Member for Adult Social Care and Public Health had to leave the meeting early to attend an event in Gravesend to celebrate the 550th anniversary of the birth of Guru Nanak, the three items on Smoking and Tobacco Control had been placed first on the agenda and would be considered together.  

To note that Mr B H Lewis has replaced Dr L Sullivan on the Committee.

Members noted that Mr B H Lewis had joined the committee in place of Dr L Sullivan.

To receive apologies for absence and notification of any substitutes present

1.            Apologies for absence had been received from Mr D Butler, Miss E Dawson and Mrs L Game.

2.            Mr D L Brazier was present as a substitute for Mrs Game.

To receive any declarations of interest made by Members in relation to any matter on the agenda.  Members are reminded to specify the agenda item number to which it refers and the nature of the interest being declared

1.            Mr B H Lewis declared an interest in agenda item 12 as he had worked in the gambling industry for many years.

2.                   The Chairman, Mr G Lymer, declared that he served on Cancer Back up, East Kent Cancer Action Group, at the Kent and Canterbury Hospital and the Macmillan Cancer Welfare Benefits Steering Committee with the Citizens Advice Bureau, Canterbury and Ashford.

To consider and approve the minutes as a correct record.

It was RESOLVED that the minutes of the meeting held on 28 September 2018 are correctly recorded and they be signed by the Chairman. There were no matters arising.

The Committee is asked to note that the following dates have been reserved for its meetings in 2019/20:

All meetings will take place at County Hall, Maidstone, and will commence at 10.00 am

1.            The Democratic Services Officer advised the committee that, since publishing the list of reserved meeting dates in the agenda pack, it had been necessary to change some of them. Members had been sent a revised list of dates before the meeting.   

2.            It was RESOLVED that the dates reserved for meetings of the committee in 2019/2020, as set out below, be noted:

To receive a verbal update from the Leader and Cabinet Member for Health Reform, the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health.

Public Health

1.            The Cabinet Member for Adult Social Care and Public Health, Mr G K Gibbens, gave a verbal update on the following issues:

Key Developments in the Sustainability and Transformation Programme:

a)     Appointment of Simon Perks as Director for System Transformation, progressing work on developing Integrated Commissioning and one Kent and Medway Clinical Commissioning Group.

b)     Development of Winter Pressure Plan for Kent and Medway – Ivor Duffy had been appointed as Operations Manager.

Kent and Medway Care Record was moving to Phase 2 of the project, which would start to work on procurement. The care record would be a new umbrella database which would draw relevant information from existing systems and make it available to those who needed to use it, including doctors, nurses, care workers and paramedics, and, most importantly, individual patients.

Local Care – two deep dives to take place in November and December 2018, to review the plans for spending £32million of additional Government spending. New governance arrangements would start in January 2019, placing more accountability on local implementation, and with a revised senior leadership group chaired by Paul Carter.

Attended the National Children’s and Adults Social Care Conference in Manchester on 14-16 November 2018. Kent would seek to make Kent a good place in which to grow old.

2.            The Chairman asked that, to support his early departure, any questions on his updates be directed to him outside the meeting.

3.            The Director of Public Health, Mr A Scott-Clark, then gave a verbal update on the following issues:

Local Government Association publication on sector-led improvement in public health. Mr Scott-Clark reminded the committee that he chaired the Association of Directors of Public Health, South East network.

Department of Health and Social Care publication ‘Prevention is Better than Cure’ included funding for a ten-year plan to raise the profile of preventative medicine.

Health Reform

4.            The Leader and Cabinet Member for Health Reform, Mr P B Carter, gave a verbal update on the following issues:

He welcomed the additional Government funding, in the current and next financial years, for children’s services and adult social care and to support earlier discharge from hospital.  Meetings with clinical commissioning groups were awaited and would discuss how additional resources for the current financial year were being and could be invested to enhance local care.  The ambition was to grow the £33million investment in the current financial year to £100million of additional resource in the medium term, and this new funding must be used to improve staffing, for example advanced-skills district nurses and community therapists of all types, to support enhanced community and local care. Spending must also be carefully monitored and audited.  The new Secretary of State for Health, Matt Hancock, appeared to share the County Council’s aim to reduce hospital admissions and hasten hospital discharge, and this was to be welcomed. The County Councils Network, which Mr Carter chaired, was currently running a campaign to secure for local care, community care and primary care a larger  ...  view the full minutes text for item 7.

The Chairman advised the committee that agenda items 8, 9 and 10 would be discussed together as their content was closely related, and this would allow Mr Gibbens to attend for these items and then leave the meeting early. The recommendations for the three reports would be considered separately at the end of the discussion.   

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out and seeking the committee’s endorsement of work to reduce the number of smokers in Kent, including a needs assessment and review of support services.  

Ms D Smith, Public Health Specialist, was in attendance for this and the following two items.

1.               Ms Smith and Mr Scott-Clark introduced the reports for this and the following two items and highlighted the following key points:-

Stop Smoking Services:

a)    statistics for quits cited in the stop smoking report were based on self-reporting and were therefore estimates, although more was known about the numbers seeking to quit and the methods they sought to use;

b)    Kent generally had a good rate of smoking quits, 51%, and this compared well to the national average;

Smoking in Pregnancy:

c)    work being undertaken had so far produced a number of successes and it was planned that this work would be rolled out across the county;

Illicit Tobacco in Kent:

d)    the public health team was working together with trading standards colleagues to tackle the supply of illicit tobacco in Kent; and

e)    it was known that this supply was closely linked to organised crime.

2.               They then responded to comments and questions from Members, including the following:-

a)    smoking was not the only way to ingest tobacco but other forms of tobacco such as chewing tobacco and snuff were not mentioned in reports about smoking.  These methods still involved nicotine and still caused cancers. Smoking was by far the most prevalent method of taking tobacco into the body. Other methods could be looked into as part of future work but were not expected to be as significant an issue as smoking.  Vaping had been identified by Public Health England as being 95% as safe as smoking, and other chemicals in cigarettes were more responsible than nicotine for causing cancers. NHS England supported the inclusion of vaping as part of a programme to stop smoking; 

b)    concern was expressed that children, girls in particular, were still taking up smoking, many of them at school. The cost of tobacco products must surely be difficult for children to afford.  Campaign work should target young people and dissuade them from starting to smoke.  Illicit cigarettes were often very cheap, and suppliers would target children   Although work was being done with schools to address the problem, one good way to stop children from smoking was to dissuade their parents from smoking, using campaigns such as smoke-free school gates; 

c)    the costs per head of quitting services delivered in Kent and Surrey varied due to the amount of therapy each quitter was given, some requiring more than others, and the number of quitters coming to the services to be served within the finite resources and funding available.  Surrey received less funding per head than Kent and, as a result, operated a smaller overall service than Kent. Stop Smoking services were a major indicator of health inequalities across the south east;

d)    asked how a health visitor would approach the task of talking to a pregnant woman about giving up smoking, it was explained that a mother would be asked if she was aware of the dangers smoking  ...  view the full minutes text for item 9.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out and seeking the committee’s support for a proposal to commission an advice service for pregnant women to encourage them to stop smoking.   

Having discussed the report with those for items 8 and 10, it was RESOLVED that:-

a)     the contents of the report be endorsed, and Members’ comments, set out in minute 9 above, be noted;

b)     the proposal to commission the Home Visiting Stop Smoking Advice service across Kent, to support pregnant women who smoke to quit, be supported; and

c)      the beneficial role of midwives with a lead for Stop Smoking in Pregnancy be acknowledged and promoted and the committee recommend that they be a permanent fixture of NHS-commissioned maternity services in Kent.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out and seeking the committee’s support for a regional approach to tackle illicit tobacco in Kent and a  proposed partnership approach between Public Health South East and Trading Standards South East to develop a regional plan to reduce the supply and demand of illicit tobacco.

Having discussed the report with those for items 8 and 9, it was RESOLVED that:-

a)    the contents of the report be endorsed, and Members’ comments, set out in minute 9 above, be noted;

b)    the proposal of a partnership approach between Public Health South East and Trading Standards South East to develop a regional plan to reduce the supply and demand of illicit tobacco be supported;

c)    the issues and concerns that illicit tobacco poses to Kent be acknowledged; and

d)    a further paper on the progress of a regional approach to tackle illicit tobacco be submitted to a future meeting of the committee.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out and seeking the committee’s support for ongoing activities to deliver statutory obligations, meet performance expectations and ensure value for money, and work to support the integrated transformation of the Health Visiting service.  

Mrs V Tovey, Senior Commissioning Manager, and Ms S Bennett, Consultant in Public Health, were in attendance for this item.

1.            Mrs Tovey and Ms Bennett introduced the report and emphasised that the service was performing well and represented good value for money, compared to other local authorities. Surplus funding would be re-invested and savings identified for 2019/20.  Drop-in sessions and breastfeeding support services were both working well, and health visitors were working intensively with vulnerable families.  

2.            The Cabinet Member for Adult Social Care and Public Health, Mr Gibbens, said he was happy for Members to come to see him at any time to ask any question or seek any further information arising from reports to the committee, and offered to set up a briefing session if any Members wished for one.

3.                  It was RESOLVED that ongoing activities to deliver statutory obligations, meet performance expectations and ensure value for money, and work to support the integrated transformation of the health visiting service, including implementation and delivery of the new infant feeding model, co-location with children’s centres and revised offer for vulnerable families, be noted.

Mr Gibbens left the meeting at the conclusion of this item.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, briefing the committee on problem gambling and the issues involved in tackling this in Kent, and seeking the committee’s comment and suggestions to strengthen future delivery.

Ms J Mookherjee, Public Health Consultant, was in attendance for this item.

1.            Ms Mookherjee introduced the report and Members then made the following comments:-

a)    data on the number of people addicted to gambling was not systematically collected in Kent, and there was no agreed definition of a ‘problem gambler’ other than the national guidance.  It was agreed that addiction to gambling needed to be understood in the same way as addiction to drugs or alcohol;

b)    large professional gambling outlet chains seemed to target the most deprived areas of the county in which to set up shops. Traditional bookmakers were being replaced by larger companies which had little relationship with their clientele;

c)    fixed-odds betting terminals (FOBTs) were a cause for concern as they took so much money from users while offering very limited pay-out. Tracey Crouch, MP for Chatham and Aylesford, had submitted a report to the Treasury seeking to have the play limit on FOBTs set at £2. It would be useful to be able to access the data used by Mrs Crouch;

d)    the Leader, Mr P B Carter, supported the comments made and added his concerns about the prevalence of gambling, as well as other addictions, including targeting workers in the construction industry.  He suggested that gambling should have a higher priority among public health work streams; 

e)     there was a huge difference between someone who could afford to enjoy an occasional ‘flutter’ at the races and those with a daily habit of spending their pay in betting shops instead of spending it on food and bills. The potential impact of gambling addiction on family life was huge;

f)     concern was expressed that the advertising campaign ‘When the fun stops, STOP’ was insufficient to convey the dangers and potentially-destructive nature of a gambling habit;

g)    online gambling sites had no upper stake limit and players could spend, and lose track of, a lot of money very quickly. Younger teenagers with good computer skills could access these sites illegally by making themselves appear older;

h)    reference was made to a planning application submitted for a betting shop in a small and mostly-affluent rural town in Kent which was approved despite much local opposition. In another location, a betting shop had been established next to a post office, surely encouraging people to spend in one the money they had just withdrawn from the other; and

i)     use of betting shops and gambling apps was now seen as a ‘normal’ and acceptable recreational activity, whereas visiting a betting shop used to be clandestine, and not something one would wish to be seen doing.  Members agreed that online gambling sites were advertised on television as being glamourous and fun, and a way of making like-minded friends. Advertising of such sites was currently run throughout the day but could be limited to after a ‘watershed’, in a similar way as adult content in television programming.

2.             Ms Mookherjee thanked Members for their comments and said that, now the County  ...  view the full minutes text for item 13.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out current information on Tuberculosis and Hepatitis C and seeking the committee’s support for the partnership approach taken by the County Council’s Public Health team.

1.            Dr Duggal introduced the report and the work being undertaken by Public Health England and the NHS to eradicate and prevent both.  In response to a question, Dr Duggal explained that a problem experienced with the supply of the tuberculosis vaccine in 2015 had been caused by a quality control issue and had not been repeated since. 

2.         It was RESOLVED that current information on tuberculosis and hepatitis C be noted and the partnership approach taken by the County Council’s Public Health team be endorsed.

To receive a report from General Counsel on the Committee’s work programme.

It was RESOLVED that the Cabinet Committee’s work programme for 2019/20  be agreed.