Agenda item

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 percentage of the additional health service funding which was announced in the autumn conference season. 

Good joint working was continuing to build trust and new relationships between the County Council and its health partners to co-design a local care and community care model.  Many GPs did not necessarily want to replicate the leadership model, delivering multiple services around a GP practice, as in the successful, Canterbury-based ‘Encompass’ model. Multi-disciplinary teams would deliver joined-up community services, including social care support and social prescribing, for catchment areas of approximately 50-60,000 population, and GPs could call upon these services when required. This multi-disciplinary team model was currently developing well and Mr Carter supported this integrated health and social care approach.  Some GPs may want to take up the leadership model, and this could work well, but this option was not universally popular. The aim was to achieve seamless support around the patient, both in their own home and in the community, including social prescribing to address acute loneliness and social isolation. Where GPs did not want to adopt the leadership model, the County Council, as a strategic service commissioner, would need to provide the infrastructure to join up services to ensure that contractors were delivering good quality, integrated services which were available when GPs needed to call upon them. A report on the development strategy would be made to the County Council’s Health Overview and Scrutiny Committee on 23 November 2018.

5.            Members then made the following comments:

a)    reference was made to the existence of a few cottage hospitals in the county, and a suggestion made that these could play a useful role in providing respite care as a mid-way point between hospital and a patient’s own home, particularly for the elderly and frail.  However, what was vital to make any new system work was the recruitment, retention and training of a good workforce.  Mr Carter agreed with other speakers that the issue of workforce was a major concern. As fewer newly-qualified GPs replaced those retiring and leaving the county, Kent and Medway was currently 265 short of the national average number of GPs for its size, and addressing this shortfall was a big challenge. The medical school planned for Kent was a step in the right direction in addressing training, but this would take several years to produce its first graduate suitably-qualified district nurses and GPs, so the shortfall would need to be addressed in the meantime. Respite care and convalescence was a major area of work.  Mr Carter said he hoped that Community Trusts would shortly be able to report the number of beds in community hospitals which were occupied by patients who might be better accommodated elsewhere.  He had talked to the Corporate Director of Adult Social Care and Health, Penny Southern, about the possibility of using beds in residential homes for short-term/enablement and convalescent care before a patient returned to their own home, as long as district nurses, physiotherapists and occupational therapists were available to support them there;

b)    local care and community care needed to be available 24 hours a day, every day of the year, but at the moment many elderly frail patients were being admitted to hospitals as no other suitable service was available in the community.  The Sustainability and Transformation Partnership had estimated that 30% of hospital admissions were unnecessary, but this situation was sure to continue until suitable investment in community and local care was available to safeguard patients in the community and their own homes, and this could include short-term observation beds in accident and emergency departments.  In the Encompass model, it had been estimated that multi-disciplinary teams had reduced hospital admissions by 20%;

c)    a comment was made about the importance of, and the apparent shortage of, qualified pharmacists. Mr Scott-Clark advised that many pharmacists were being trained and could work independently of a chemist shop, and so would be removed from the dispensing role, but would be able to give pharmaceutical advice.  It was known that over-subscribing and over-medication for elderly and frail patients was an issue to be addressed, and this would be helped by having good clinical, pharmaceutical advice available locally;

d)    asked about the feasibility of having a pharmacy and GP surgery open to the public at a hospital site, possibly to save a patient needing to be admitted, Mr Carter said that this model had been piloted in Medway.  Some GPs were also offering extended opening hours, and if a GP hub were to be established, it would make sense for this to be as near a hospital site as possible;  

e)    the multi-disciplinary team model was welcomed as a way of relieving the immense pressure on GPs’ current workloads.  Many GPs seemed to work on a part-time basis, which made continuity difficult.   Mr Carter commented that technology could play a part in addressing this and was starting to help patients and professionals to navigate the care service and for patients to access services without needing to attend their GP’s surgery. The County Council needed to do all it could to support the development of the multi-disciplinary team model, and Mr Carter said he was optimistic that this was possible for the future;

f)     the Secretary of State for Health, Matt Hancock, had recently set out detailed plans of how the additional £3.5billion announced by the Prime Minister would be used. This included community-based 24-hour rapid response teams, including GPs, nurses and physiotherapists, to treat people at home, and a national programme in which health care professionals, including pharmacists and GPs, would be assigned to care homes to offer out-of-hours care;

g)    reference was made to ‘Waitless’, an online information service currently operating in East Kent, which gave real-time information on waiting lists at accident and emergency departments as well as real-time traffic information.  This was welcomed as an excellent scheme which the County Council should promote and publicise; and

h)    asked about how developer contributions were being used or could be used to provide health care facilities, Mr Carter commented that such facilities seemed to be low on the list of priorities when providing infrastructure for new and expanding developments. He commended a recently-published paper arising from work led by Oliver Letwin which set out recommendations to change the way in which developer contributions were used.  Mr Carter said he supported the report’s recommendations and hoped they may lead to increased allocations for health care services.  The Government’s response to the paper was currently awaited.

6.          It was RESOLVED that the verbal updates be noted, with thanks.