Agenda and minutes

(1)       Mr Chard declared a Disclosable Pecuniary Interest as a Director of Engaging Kent.

(1)      The Scrutiny Research Officer updated the Committee on the following actions that had been taken:

(a)       Minute Number 54 - Emotional Wellbeing Strategy. At HOSC on 10 October during the discussion about Emotional Wellbeing Strategy, West Kent CCG was asked to provide the Committee at its November meeting with details about the key performance indicators within the contract and how these would be measured.  Since the meeting, the CCG requested to postpone the item until 29 January 2016 as further work was required on key performance indicators in the service specification which would not be ready by 27 November meeting. The Chairman agreed to the request and the Emotional Wellbeing Strategy item was now scheduled for Friday 29 January 2016.

(b)       Briefings provided by the South East Coast Ambulance Trust (SECAmb) about the Red Three project and the use of defibrillators in reporting ambulance response time performance were circulated to Members on 6 and 13 November respectively. The Chairman with Health Scrutiny Chairs from Medway, Surrey, Sussex, will be meeting with representatives from SECAmb on 18 January at the South East HOSC Network for an informal discussion. It was proposed that the SECAmb be invited to attend the January meeting to give an update on winter resilience, the Red Three project and the use of defibrillators in reporting ambulance response time performance.

(c)        A Joint HOSC with Medway Council was established for the Stroke and Vascular Reviews. KCC had 8 Members on the Kent and Medway NHS Joint Overview and Scrutiny Committee: 4 Conservative, 2 UKIP, 1 Labour and 1 Liberal Democrat. The following Members were confirmed: Mr Brookbank, Mr Angell, Mr Lymer, Mr Birkby, Mr Crowther, Ms Harrison and Mr Daley. The proposed date for the first JHOSC was Friday 8 January.

 (2)      RESOLVED that the Minutes of the meeting held on 9 October are correctly recorded and that they be signed by the Chairman.

Roger Gough (Cabinet Member for Education and Health Reform, Kent County Council) and Tristan Godfrey (Policy and Relationships Adviser (Health), Kent County Council) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Gough began by outlining the report which covered the work of the Kent Health and Wellbeing Board in 2014/15. He explained that the Board’s core mandate included the production of the Joint Strategic Needs Assessment (JSNA) and the Joint Health and Wellbeing Strategy (JHWS); ensuring the commissioning plans of the CCGs and Kent County Council (social care and public health) reflected the needs and priorities of the JSNA and JHWS; and to promote the integration of health and social care. He noted that when the Board came into being in 2013, an initial short-term strategy was created; a long-term strategy for 2014 – 2017 was produced in 2014 with five main outcomes: children, prevention, long term conditions, mental health and dementia. He reported that the current strategy was reviewed with stakeholders at an event in the summer in preparation for the new strategy in 2017. A further event was held in September to evaluate how the JSNA could be of more value to commissioners. The Board was looking to ask commissioners to bring their commissioning plans earlier to the Board to provide assurance that the plans reflecting the needs of the JSNA and priorities of JHSW before sign-off. 

(2)       Mr Gough explained that the Board had overseen the introduction and implementation of the Better Care Fund (BCF) as part of its role to promote integration. He stated that the BCF was a mixed blessing; whilst it forced detailed thinking and collaboration by all health and social care organisations, it was a clunky process and there was lots of pressure for it to succeed. He noted that the Government had committed to the continuation of the BCF through extra funding announced in the recent Comprehensive Spending Review.  The Board was also involved in the development of the New Models of Care as part of NHS England’s Five Year Forward View and how they were being implemented in Kent. He reported that the Whitstable Medical Practice (Estuary View) had been one of 29 sites to be awarded Vanguard status. He stated that Vanguard status would have significant impact on how the CCG would operate in that area and the role of the Board going forward. He also noted that the Ebbsfleet development had been awarded Healthy New Towns status which would benefit from a programme of support. He also reported that the Board was tackling structural problems, such as workforce and housing developments, with partners including KCC, CCGs, district councils and Healthwatch.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A number of comments were made about the number of substantive items on the Board’s agendas relating to mental health and dementia, Mr Gough explained that the five JHWS’ outcomes were regularly  ...  view the full minutes text for item 57.

Matthew Drinkwater (Head of Emergency Preparedness Resilience and Response, NHS England – South (South East)), Mark Atkinson (Head of Urgent Care, NHS West Kent CCG), Bill Millar (Chief Operating Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) and Julie Hunt (Director for Performance Delivery, NHS Dartford, Gravesham & Swanley CCG and Clinical Programme Lead for Community Services, NHS Dartford, Gravesham & Swanley CCG and NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Drinkwater outlined the actions that were being taken across the health and social care system in Kent to prepare for winter. He stated that there were four Systems Resilience Groups in Kent & Medway: East, North, West and Medway & Swale. Kent County Council was a core member of each of these groups. NHS England had developed a South Surge Management Framework to ensure a consistent standard of plans; NHS England required all Systems Resilience Groups to prepare Surge Management Plans that were aligned to the Framework. NHS England had conducted a table top exercise with each Systems Resilience Group and presented them with feedback to ensure that lessons identified were learned ahead of winter. There was a national ‘Stay Well This Winter’ campaign  to ask the public to protect themselves as the cold weather sets in, by staying warm, stocking up on prescription medicines or checking in on friends and neighbours and taking up the offer of a seasonal flu vaccination,  which was  supported by Kent County Council. He noted that there were high rates of Delayed Transfers of Care at some NHS hospital sites in Kent and further work was required.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments.  Members enquired about Delayed Transfers of Care. Mr Drinkwater explained that Delayed Transfers of Care were a particular challenge at Maidstone and Tunbridge Wells NHS Trust where 7% of patients who were medically fit for discharge were still occupying an acute bed; in comparison to 3 – 4% in other areas. Mr Atkinson stated that the main reason for delay was patient choice with family members coordinating and finding a suitable place for their relatives. Discharges at the Trust had improved with the introduction of an Integrated Discharge Team which included KCC Social Workers to assist with transfers and the purchase of commercial beds. The Trust was also working with Age UK who provided a Home and Settle service to prevent readmission which had been commissioned using winter resilience money. He noted a further area for promoting the efficiency of discharge and throughput through the hospital was a reduction in the length of stay. He highlighted that the difficult winter period was to come and that as social care started to reduce, services would need to be realigned to promote discharge.

(3)       In response to a question about pandemic flu, Mr Drinkwater explained that NHS England had carried out a deep dive review of pandemic flu plans which  ...  view the full minutes text for item 58.

Dave Holman (Head of Mental Health Programme Area and Sevenoaks Locality Commissioning, NHS West Kent CCG) and Wendy Irons (Assistant Head of Specialist Assessments and Placements, NHS Dartford, Gravesham & Swanley CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Holman outlined the background to the planned service change. Mr Holman explained that Kent and Medway NHS and Social Care Partnership Trust (KMPT) gave notice on the current contract for the West Kent Neuro Rehab Unit (WKNRU) in April 2015 due to issues involving service quality, safety and cost. The unit was accessed by 29 patients in 2014/15 and was used as an intensive rehabilitation service for patients who had had a stroke or been involved in road traffic accidents; interventions were for approximately three months. On receiving notice, the CCGs explored a range of alternative providers such as the Raphael Medical Centre in Hildenborough, Strode Park Foundation in Herne and the Hothfield Brain Injury Rehabilitation and Neurological Care Centre in Ashford. He stated that as there was sufficient capacity with these alternative providers, the CCGs did not feel the need to reprocure. KMPT then informed the CCGs that there would not be safe staffing levels over the Christmas period and it was agreed the unit would shut on 24 December; emergency action was taken to bring forward the new service from April 2016 to December 2015. He stated that the decision was made without allowing time for full consultation with the HOSC because of a risk to safety and that the CCGs would continue to consult and provide regular updates to the Committee.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments.  In response to a specific question about the number of patients currently accessing the service and plans for their discharge, Ms Irons explained that there were 4 - 5 West Kent patients, 2 Medway patients and no Dartford, Gravesham and Swanley patients. Each patient had an individual discharge plan which identified length of stay, treatment completion date and referrals. Mr Holman noted that all the patients would be discharged by 24 December. He stated that it was a change of organisation providing the service rather than a service change and would have a positive impact on the patient due to a range of support and choice of service providers in the bespoke model.

(3)       Members enquired about the cost of the bespoke model and the locations of the alternative providers. Mr Holman explained that there was a financial envelope and the new service would not be more expensive than the previous service.  Mr Holman noted the large geographical area covered by West Kent CCG and Dartford, Gravesham and Swanley CCG. The alternative providers were located in Ashford, Herne and Hildenborough.

(4)       A comment was made about the care pathway for patients. Ms Irons stated a flowchart detailing the care pathway could be provided. She explained that a proportion of  ...  view the full minutes text for item 59.