Agenda and minutes

1. Apologies were received from Mrs C Russell (substituted by Mr H Rayner), Dr G Sturley (substituted by Mr M Paul), Mr A Kibble (substituted by Mr D Sian) and Mr M Brice (Substituted by Mr A Hook) and Mrs Keen.
2. Mr R Gotham (Healthwatch) was in virtual attendance.

RESOLVED that the apologies and substitutions be noted.

1.    Mr Mochrie-Cox declared that he was Gravesham Borough Council’s representative at the Integrated Care Partnership that oversees the Integrated Care Board (ICB) work.

2.    During Item 6 Mr Hook declared that his professional work occasionally involved individuals receiving mental health care and he would therefore not participate in the debate.

RESOLVED that the declarations of interest be noted.

RESOLVED that the minutes of the meeting held on 2 April 2026 were a correct record and that they be signed by the Chairman.

Mr Dominic Cox (Deputy Chief Commissioning Officer), Mrs Claire Robson (The Company Secretary of the Kent and Medway Integrated Care Board) and Mrs Rebecca Fox (Director of Quality and Deputy Chief Nurse),

1)    The Committee received the report outlining the structural changes to the NHS Kent and Medway ICB Mr Cox introduced the item, which included the following key points:

a)    The purpose of the structural change was to enable a more strategic approach to commissioning services at both national and local levels. The revised structure would aim to support a more proactive and outcome-focused approach in the future.

b)    A greater consideration would be given to inequalities and population needs, and how these would be addressed with the move towards a more clinically led model of commissioning.  There would be increased engagement with partners. 

c)    The new model created more opportunities for joint working between the NHS and councils, including commissioning arrangements.

d)    The transition involved organisational and restructuring changes  providing opportunities for staff to move to different organisations, supporting an improved integration of services, staff would be supported throughout the changes.  

e)    Members were advised that some elements of the transition (including shared services such as procurement and digital) would not be fully established by 1 July. 

f)     The programme had operated as a transitional initiative but would now become the general operating model. Appropriate oversight would be maintained through the Integrated Care Board governance arrangements.

2)    In response to questions and comments from Members, the following points were noted:

a)    Further clarification was sought regarding the extent to which integration with local authorities had been considered within the proposals, as the report had referenced only limited collaboration.

b)    Members discussed issues relating to inequalities, noting that in addition to health inequalities, there were wider inequalities that required consideration. Clarification was sought on how the organisation intended to manage and reduce these inequalities.

c)    Additional questions discussed the approach to collaborative working with local authorities. Concerns were expressed about the current approach, including previous experiences of joint working, the pooling of budgets, and instances where there had been a lack of clarity over responsibilities. Additional points raised discussed how accountability would be maintained and whether sufficient safeguards would be in place before progressing further pooled budget arrangements.

d)    Mr Cox acknowledged the points raised and outlined that partnership working with local authorities remained an important priority. Work would be ongoing to address inequalities through collaboration, although the specific approaches and arrangements discussed would continue to develop over time.

e)    Referring to the development of neighbourhood health arrangements across Kent and Medway, Mr Cox outlined a proposed model and how it would be structured around different layers of care of delivery.

f)     Mr Cox outlined the proposed commissioning structure within the model, noting that this would include arrangements for primary care. He explained that single neighbourhoods would comprise groups of general practices operating within defined geographical areas, while multi-neighbourhood arrangements would cover larger populations of approximately 250,000 residents or  ...  view the full minutes text for item 270.

Mr Dominic Cox (Deputy Chief Commissioning Officer) and Mrs Rebecca Fox (Director of Quality and Deputy Chief Nurse) were in attendance of the item:

1)    The Committee received the report outlining the changes to commissioning fertility treatments in Kent and Medway.

a)    NHS Kent and Medway had reviewed its policy on NHS-funded treatment and implemented changes on 1 April, 2026. The Committee was advised that the revised policy was based on clinical evidence and had been subject to public engagement, with feedback considered as part of the process.

b)    It was discussed that that the changes aligned with national trends, with approximately 69% of all Integrated Care Boards having introduced similar amendments.

c)    Mr Cox acknowledged that planned communication with Members prior to the decision had not taken place and confirmed that engagement had been intended but did not occur and expressed regret for the oversight.

d)    The changes to the Policy would deviate further away from the current NICE (National Institute for Health and Care Excellence) guidelines.  Mrs Fox outlined the rationale for the changes, noting that they were made within an established commissioning framework and based on evidence relating to clinical effectiveness, outcomes and equality impact.

e)    Members were advised of the key changes to NHS-funded fertility treatment policy:

i)     reduction in the upper age limit for eligibility from 40 to 38

ii)    reduction in the number of funded treatment cycles

iii)   reduction in the number of embryo transfers.  .

2)    Members raised the following points:

a)    Concerns were raised on the lack of information depth captured in the papers provided.Members expressed alarm regarding the process by which the changes had been implemented, noting that the decision appeared to have been taken following engagement and was contrary to any feedback received from the public.

b)    Members commented on the perceived imbalance between clinically led decision-making and community input, noting that the impact of the changes on residents was substantial and that the revised policy did not align with NICE guidelines, representing a significant departure from recommended standards.

c)    The reduction of both the age threshold and the number of funded cycles /transfers went beyond what would be expected if based solely on clinical evidence. Members suggested that the combined changes could limit access to treatment and create a negative perception that the decision had been driven by cost-saving measures rather than clinical needs.

d)    Members questioned if changes to the IVF treatment impacted individuals on lower incomes disproportionately, potentially increasing inequality and suggested that the combined changes to eligibility and treatment offer should be subjected to greater scrutiny. Additional clarification on adequacy of consultation and the consideration of impacts on affected families was also raised.

e)    Presenters acknowledged the concerns raised and discussed the fertility effectiveness data had indicated that there was a significant decline in IVF success rates due to increasing age, measured by live births per embryo transfer. It was discussed that success rates were approximately 40% at age 35, reducing to around 20% at  ...  view the full minutes text for item 271.

Mr Dominic Cox (Deputy Chief Commissioning Officer) and Mrs Rose Waters (Service Director for Forensic and Specialist Directorate) presented the item:

1)    Mr Cox introduced the item, which was about a proposed pathway redesign which would see Bedgebury Ward in Maidstone decommissioned.  The officer explained that a recent review had identified that the existing model was not aligned with national expectations for rehabilitation and was not delivering the most appropriate outcomes for service users and their families.

2)    Mrs Waters provided further detail, noting that Bedgebury Ward was a 10-bed unit located within a medium secure setting, which limited its effectiveness as a rehabilitation environment. 

3)    Members were advised that:

a)    The proposal was to redirect resources towards a more proactive, community-based model of care, including assertive outreach and more intensive multidisciplinary support, in line with recognised best practice.

b)    The unit had opened in 2016 but had not been fully utilised as part of a typical rehabilitation pathway and was not regarded as a high-quality setting. Admissions and transfers to the unit had already been paused, reflecting concerns about its suitability.

c)    Additionally, the unit’s location had limited opportunities for patients to reintegrate into the community, including maintaining contact with family and social networks, which were key components of a successful and effective rehabilitation.

d)    The established Forensic Outreach and Liaison Services (FOLS) would be supporting patients on discharge pathways from secure settings. Discharge planning had involved partnership working with local authorities, including care needs assessments and panel considerations, with a range of outcomes identified based on individual need, such as supported or independent living, rehabilitation units, or residential care options.

e)    There were currently five patients within the Bedgebury unit. All five patients were on established discharge pathways and would not require the new assertive outreach provision.Discharge planning was progressing appropriately.  It was anticipated that all patients would be discharged by early 2027.

f)     The Committee was informed that the proposal was to reinvest resources into community-based support, including the development of an assertive outreach service to support patients transitioning from secure settings to the community. 

g)    The new model aimed to:

i)     provide care closer to home

ii)    improve rehabilitation outcomes

iii)   reduce reliance on inpatient step-down beds

iv)   better align with national clinical models and best practice. 

4)    In response to questions and comments from Members, the following points were noted:

a)    Members queried how patients would be supported during the interim period between the cessation of admissions to the Bedgebury unit and the implementation of the new community-based arrangements in the Autumn, seeking assurance that appropriate care would be maintained during this transition. Mrs waters confirmed the individuals would continue to be supported by the FOLS team.

b)    In response, Members were advised that that resources would be reinvested into a community-based model, including multidisciplinary and assertive outreach support, as the current service was not aligned with best practice.

c)    Officers emphasised that this represented a redesign rather than a reduction in service, aimed  ...  view the full minutes text for item 272.

Mr Dominic Cox (Deputy Chief Commissioning Officer) and Mrs Claire Robson (The Company Secretary of the Kent and Medway Integrated Care Board)

1)    The Committee received a report about the response to the recent Meningitis B outbreak, and Mr Cox highlighted the following aspects of the report:

a)  a coordinated local response had been delivered in March 2026 involving Kent County Council, the NHS, UK Health Security Agency, education providers and the venue concerned. It was highlighted that strong collaboration had enabled effective management of the incident.

b) A declaration of a major incident and activation of the NHS’s role as a Category 1 emergency responder and had resulted in the swift implementation of a mass antibiotic prophylaxis programme and vaccination response.

c) Responses had been clinically led with strong joint leadership from the Council and NHS, ensuring it was safe and evidence based. Additionally, the response had been rapid, well-coordinated and supported by proactive communication. Approximately 13,500 antibiotic treatments and 12,000 vaccinations delivered across multiple sites, and the overall scale and effectiveness of the mobilisation were highlighted as positive, proactive and organised.

d) Officers discussed areas for improvement, including the need to strengthen coordination between local and national partners in the event of a future incident. Further discussion raised that workforce resilience required further consideration, as responses of a large scale could place significant pressure on a small number of staff. Ongoing reflections were being undertaken across the NHS and partner organisations to address the challenges encountered.

2)     Members responded to the report with the following:

a)    They raised concerns that the East Kent Hospitals University Foundation Trust was not present at the Committee to discuss the incident. Concerns on how long it took the organisation to flag the incident and how other organisations were also not present to discuss their role in the incident.

b)    Members raised that awareness of the meningitis outbreak among students appeared to have arisen only after a video circulated showing an emergency response, rather than through formal communication and expressed worries regarding the timeliness and urgency of the University’s response and if there had been shortcomings on how the incident was communicated.

c)    Conversely, Members praised the speed in which KCC and the administration had dealt with the incident and it was discussed that the recommendation go beyond noting the report by formally recognising the efforts of those involved in delivering the response, and by recording the Committee’s sympathies for the friends and families of the individuals who had died, as well as those affected by the incident

d)    Following a question, officers confirmed that a formal debrief was either underway or pending to identify lessons learned and address gaps, noting the complexity of multi-agency coordination and information-sharing constraints.

e)    Additionally, it was discussed that social media had supported the official response through community awareness, and that Members sought reassurance on whether the overall outcome reflected system effectiveness or favourable circumstances.

f)     In response Mr Cox explained that the UK Health Security Agency  ...  view the full minutes text for item 273.