Agenda and minutes

(1)       The chairman welcomed Deborah Tomalin (Head of Commissioning at NHS England) to the meeting.

(2)       Mr Gough reminded all board members that they had been invited to attend the Health and Wellbeing Strategy event on 17 June at the Detling Showground to consider progress on the objectives of the strategy and discuss how recent developments such as the Five Year Forward View, the Care Act and the Better Care Fund might inform the way forward.  He said 276 people had been invited and that Noel Plumridge (commentator and broadcaster) would facilitate the event.

(3)       The chairman also said that Joanna Fathers, a colleague on the KCC graduate scheme, was working on behalf of the Board to review how the local health and wellbeing boards had developed with particular reference to their relationship with the Kent Board and also to look at how the Kent Board might develop its relationship with the voluntary sector.  He said she was arranging meetings with some HWB members, chairs of the local boards and others to collect views and observations with a view to presenting reports at the Health and Wellbeing Board on 16 September 2015.

To receive apologies for absence and notification of any substitutes

(1)       Apologies for absence were received from Dr F Armstrong, Cllr A Bowles, Mr Carter, Dr Cocker, Dr Lunt, Dr Kumta, Dr Martin, Mr Perks, Cllr Pugh, Dr Stewart and Cllr Weatherly.

(2)       Dr Philpott attended as substitute for Dr Armstrong.

To receive any declarations made by members of the board relating to items on the agenda

Dr Bowes made a declaration of interest in Item 7 – Commissioning Plan for NHS England as he was GP with a contract with a GMS contract.  It was noted that the GPs present also had a similar interest.

To agree the minutes of the meeting held on 18 March 2015

Resolved that the minutes of the meeting held on 18 March 2015 are correctly recorded and that they be signed by the chairman.

To consider issues relating to the health and care workforce required to deliver the Five Year Forward View and the broader changes needed to establish a sustainable health and care sector across Kent

(1)       The chairman welcomed Philippa Spicer (Local Director of Health Education England) and Tristan Godfrey (Policy Manager- Health) to the meeting.  Mrs Spicer said that the purpose of the paper being considered by the board was to provide more information about the work of Health Education Kent Surrey and Sussex and drew the board’s attention to the strategic planning framework set out in section 3 and the skills development strategy set out in section 5.  She also said that more work was needed in relation to the health and social care integration agenda and the transformation of the workforce to meet the requirements of the shared vision of the future.  She concluded by referring to the paper by the chairman proposing the establishment of a task and finish group to consider strategic workforce issues.

(2)       The proposal to establish a workforce task and finish group was generally welcomed.  Comments were made about: specific local difficulties in recruiting GPs; the need to address immediate and short term difficulties recruiting other professional staff to ensure that Kent was able to recruit and retain a significant share of the national supply of doctors; the need to re-balance the commissioning of education and move away from annual planning cycles; and the value of the strategic workforce planning programme bringing HE KSS, the universities of Kent and Surrey and 10 CCGs across the region together.

(3)       Resolved that:

(a)       The actions set out in the report from Health Education Kent Surrey and Sussex and actions to support the transformation of the workforce to meet a shared vision of the future be noted;

(b)       A task and finish group be established to look specifically at strategic workforce issues and authority to agree the practical arrangements be delegated to the chairman, in consultation with other members of the board.

To note the progress being made to establish a Growth and Infrastructure Framework for Kent and Medway and provide comment on how best to engage with the health sector in debates about growth; about future health provision; and funding for health

(1)       The chairman welcomed Barbara Cooper (Corporate Director for Growth, Environment and Transport), Paul Crick (Director of Environment Planning and Enforcement), Mike Gilbert (Assistant Accountable Officer – Dartford Gravesham and Swanley CCG) and Dr Su Xavier (Consultant in Public Health Medicine – Dartford and Gravesham CCG) to the meeting. 

(2)       Mr Crick gave a presentation (available on-line as an appendix to these minutes) which outlined the projection for population growth across the county for the next 30 years and the funding required for the associated infrastructure.  He said the Office of National Statistics projected a population increase of 305,000 by 2031 and KCC’s projection was 293,000 based on district local development plans bringing the total population of Kent and Medway to just over 2 million.  The infrastructure to support this increase in population would require £6.5 billion investment of which 67% had been secured leaving a funding gap of just over £2 billion. He concluded by referring to alternative service delivery models, the need to test and review such models and have a robust and informed discussion with Government.

(3)       Mr Gilbert and Dr Xavier gave a presentation on the development of Ebbsfleet Garden City and wider housing development in north Kent with particular reference to the impact on health care services (available on-line as an appendix to these minutes).  Mr Gilbert referred to the work to date and outlined the proposed development areas and the predicted growth in population.

(4)       Dr Xavier drew attention to the impact of demographic changes on health servicesand said there was a once in a life time opportunity to influence the wider determinants of health such as environmental surroundings, transport to health services, leisure facilities and other services.  She also said that even before the proposed Paramount development was considered there were concerns about GP capacity, the growing demands on A&E, mental health and community services as well as the importance of planning to meet future needs. 

(5)       Mr Gilbert said CCGs did not receive capital funding, funding for GPs was based on patient registrations and there was, on average, a 2-3 year lag between registration and receipt of funding.  He also said that work being done to assess the impact of the Ebbsfleet development at a high, strategic level, had identified a significant gap in both revenue and capital funding. Further more detailed work was planned for the summer.

(6)       The chairman thanked the presenters and said the Dartford Gravesham and Swanley Health and Wellbeing Board had considered these issues at a meeting the previous month where concerns about the adequacy of funding, the challenges and opportunities for new models of care and the opportunity to plan for health and healthy lifestyles had been identified.

(7)       During discussion the value of the work being undertaken to assess the implications of growth was acknowledged.  The need to engage in early and well-evidenced debate with central government and to lobby for some up front funding and assistance to meet the anticipated shortfall of over  ...  view the full minutes text for item 147.

To discuss and endorse the following commissioning plans:

·         NHS England (this plan was included in the printed packs for the meeting of the HWB on 18 March and has therefore not been reprinted)

·         Adult Social Care

·         Children’s Services

(1)       Deborah Tomalin (Director of Commissioning for NHS England South-East) introduced the NHS Commissioning Plan.  She said that NHS England (Kent and Medway) had prepared a direct commissioning strategy in March 2014 which had been updated in July 2014 and circulated to the Health and Wellbeing Board. She outlined the role of NHS England (Kent and Medway) including the direct commissioning for health and justice healthcare, prescribed specialised services, services for armed forces health, primary care services and public health.

(2)       Mrs Tomalin undertook to respond in writing to a query relating to the primary care budget.  She also said that at an operational level, NHS England worked with general practices experiencing difficulties sustaining services and worked at a strategic level through the 10-point workforce plan and the Five Year Forward View to create new models of care and to make general practice an attractive option for medical graduates both locally and nationally.

(3)       During discussion it was re-confirmed that the recruitment and retention of GPs would be considered as part of the work on workforce.  It was also suggested that there was a need to quantify the issues and to press for a policy change at national level. Mrs Tomalin answered questions relating to pressures in primary care particularly in relation to dentistry.  It was suggested that local health and wellbeing boards might want to understand the detail as it related to their local area.

(4)       Andrew Ireland (Corporate Director- Social Care, Health and Wellbeing) introduced a report which provided a summary of the Children’s Commissioning priorities in the context of Kent County Council’s 5-year vision and its transformation agenda. He drew particular attention to the plan to reduce residential placements by 200 annually, the success of the Enablement Service and the increasing partnership work to ensure services were aligned around the needs of children and families.

(5)       It was suggested that the commissioning plan should state more explicitly the work being done towards integration and through the Better Care Fund, however it was also considered that work undertaken to understand needs and provide feedback to the public would increase awareness and understanding of integration.

(6)       Mark Lobban (Director of Commissioning) introduced a report which provided a summary of Adults Social Care Commissioning priorities.  He drew particular attention to the intention of working holistically with Education Services, the focus on prevention through the development of early help services and the emphasis on support for children leaving care and special education as they made the transition from Children’s Services to Adult Services.

(7)       Resolved that the NHS Commissioning Plan, the Kent Children’s Commissioning Plan and the Kent Adults’ Commissioning Plan be noted.

To receive a report outlining changes for some of the indicators and highlighting those raising concerns or showing increasing good performance

(1)       Malti Varshney (Consultant in Public Health) introduced the report which provided an overview of the indicators in the Kent Health and Wellbeing Strategy, gave information about stress indicators and highlighted areas of concern and exception relating to breast feeding, vaccinations for MMR and flu, male suicide rates, bed occupancy rates which remained above 85% for all acute hospitals in Kent except the East Kent Hospital University Foundation Trust, A&E attendance  and the increase in non-acute “delayed days”.

(2)       Mr Scott-Clark (Director of Public Health) said work was underway with NHS England, Public Health England and the Director of Public Health in Medway to increase the uptake of MMR vaccinations and to plan for the next round of flu vaccinations. 

(3)       Comments were made about nursing capacity in the sub-acute sector, the difficulties agencies had in recruiting staff to deliver hospital discharge services and the consequent impact on the flow of patients through A&E. It was suggested that recruitment to this sector be considered by the task and finish group on workforce.

(4)       Questions were also raised about how to get the best value from the Assurance Framework report and it was suggested that elements of it should be considered by local health and wellbeing boards.

(5)       The need to consider plans for winter resilience and learn lessons from last year was acknowledged.

(6)       Resolved that:

(a)       Concerns regarding reporting and recording breastfeeding rates continue to be raised with relevant partners;

(b)       Assurance be sought from NHS England on actions for improving the uptake of 2-dose MMR vaccination amongst 5 year olds;

(c)        Assurance be sought from NHS England on actions for improving the uptake of flu vaccination in the target population;

(d)       Assurance be sought from CCGs and Social Care on plans for ensuring capacity and capability of local systems to address potential demands during winter 2015/16.

To note the report

(1)       Mr Scott-Clark (Director of Public Health) introduced the report which set out key excerpts of the JSNA chapter summaries that had been refreshed for 2014/15.  He said the report had been delayed because of pressure on previous agendas for meetings of the Health and Wellbeing Board.

(2)       Resolved that the report be noted.

To note the minutes of the meetings of the Children’s Health and Wellbeing Boards held on 3 February and 25 March 2015

Resolved that the minutes of the meetings of the Children’s Health and Wellbeing Boards held on 3 February and 25 March 2015 be noted.

To note the minutes of local health and wellbeing boards as follows:

Ashford – 22 April 2015

Canterbury and Coastal – 25 March 2015

Dartford, Gravesham and Swanley – 15 April 2015

South Kent Coast – 20 January 2015

Swale – 18 March 2015

Thanet – 12 February 2015

West Kent – 20 January 2015

Resolved that the minutes of local health and wellbeing boards be noted as follows:

Ashford – 22 April 2015

Canterbury and Coastal – 25 March 2015

Dartford, Gravesham and Swanley – 15 April 2015

South Kent Coast – 20 January 2015

Swale – 18 March 2015

Thanet – 12 February 2015

West Kent – 20 January 2015.