Agenda and minutes

(1)       The Chairman welcomed Pennie Ford, Director of Assurance and Delivery at NHS England who was attending as substitute for Ms Cox and was also presenting agenda item 5.

(2)       Mr Gough thanked Healthwatch Kent for their contribution to the development of the draft Work Programme (agenda item 8).

To receive apologies for absence and notification of any substitutes

Apologies for absence were received from Ms Cox, Dr Cocker, Mr Gibbens, Dr Martin and Mr Perks.  Ms Ford and Mr Lymer attended as substitutes for Ms Cox and Mr Gibbens respectively.

To receive any declarations of Interest by Members in items on the agenda for the meeting

There were no declarations of interest.

To receive and agree the minutes of the last meeting

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

To receive a briefing that describes the actions taken by the Health and Social Care system to prepare for and respond to winter

(1)       Ms Ford introduced the report which described the actions taken by the health and social care system to prepare for and respond to winter.  Ms Ford said that over Christmas and New Year in 2014/15 there had been severe pressure on the health and social care system; the key vehicles for winter preparedness and response were the systems resilience groups established in 2014; and the report provided a summary of the high level assurance that was now in place.

(2)       Ms Ford drew particular attention to: the System Resilience Group Assurance ahead of winter; surge management plans and exercises; the winter communication plan to reduce pressure on frontline services; and the winter resilience room that had been in operation between 17 December 2015 and 29 January 2016.

(3)       Ms Ford also said that the industrial action by junior doctors planned for January had been postponed and might take place in February. 

(4)       Each of the CCGs provided an update on the experience over Christmas and New Year 2015/16. 

North Kent

(5)       In north Kent, as predicted, there was increased pressure, particularly on acute services, over the Christmas period.  The Darent Valley Hospital held up last year.  This had continued in many respects this year, however, there had been deterioration in the Accident & Emergency position despite a reduction in activity levels.  SECamb had seen an increase of 9% in the total number of calls received and the emphasis on “see and treat” and “hear and treat” had contributed to a 1% reduction in conveyance rates to the Darent Valley Hospital. The number of ambulance conveyances had reduced from an average of 450 per week for the first 2.5 weeks of January 2015 to an average of 400 for the same period in 2016.

(6)       It was considered that problems were likely to be the result of intra-hospital pressures and work was underway to understand the reasons. Efforts were also being made to understand the reasons for the increase in Delayed Transfers of Care from 1.7% in November/December 2015 to 2.74% in January 2016.

(7)       Primary care and ambulance services had coped well across DGS and Swale with providers of the out of hours service being able to fill all shifts; the 111 service had also coped well particularly as 50% of calls from Yorkshire and the north of England had been re-directed to the south as part of business resilience plans in response to flooding.

(8)       Ms Davies also said it was worth noting that the A&E Department at the Medway Hospital had remained “green” in the two weeks to Christmas and was one of the last hospitals nationally to declare “black” on 5 or 6 January 2016.

(9)       Overall, primary care, community services and the out of hours service were robust and had performed well, while there were lessons to be learned in relation to acute services.

West Kent

(10)     Admissions to hospitals in Maidstone and Tunbridge Wells had remained level with a normal seasonal increase in the  ...  view the full minutes text for item 194.

To receive a report setting out the implications for the Kent Health and Wellbeing Board of new planning guidance issued by NHS England requiring local areas to draft place-based five year Sustainability and Transformation Plans, changes to the Better Care Fund and the financial settlement for the NHS announced in the Chancellor’s Autumn Statement

(1)       The Chairman said that agenda items 6 and 7 (New Models of Care - Progress Report – Presentation) were closely related and would be considered together. 

(2)       Mark Lemon (Strategic Relationships Adviser) introduced the report on the New Planning Arrangements for Health and Social Care by giving a short presentation a copy of which is available on-line at Appendix 1 to these minutes. 

(3)       Mr Ayres spoke about the planning footprint from a health perspective.  He said the Strategic and Transformation Plans differed from previous plans and needed to be developed by system and by place as well as demonstrating that both individual organisations and the system as a whole could balance their budgets.  There had been some discussion about the options for planning footprints including footprints designed to ensure the viability of acute providers such as an “A21 Corridor” as well as the development of footprints at a Kent level, at CCG level, at joint CCG level such as “East Kent”, or on a “Health Economy” level of north, east and west Kent.

(4)       Ms Davies and Ms Carpenter gave presentations about the development of Strategic and Transformation Plans for the west and east Kent health economies which are available on-line as Appendices 2 and 3 of these minutes.

(5)       Mr Ayres said that “Mapping the Future” project, undertaken a few years ago, had set out the vision of a sustainable future for west Kent and the foundations to build that future had been put in place over the last two years.  This included:

·         Re-commissioning the out of hours service into a two-year contract bringing together a range of services with a view to procuring a fully integrated care service from 2017;

·         Developing Maidstone and Tunbridge Wells Hospital and the Kent Community Health Foundation Trust as a partnership of providers rather than as competitors;

·         Working with GP practices and the development of two emerging federations with a view to them being at the heart of community based service provision;

·         Running pilot programmes with Adult Social Care and other providers to align and integrate services with a view to procuring fully integrated services in a lead provider arrangement

(6)       Mr Ireland gave a presentation about the transformation of Adult Social Care which is available on-line as Appendix 4 to these minutes

(7)       There was general agreement that planning needed to be done: at the most appropriate level for the service; around natural populations rather than around acute service providers; and should focus on developing integrated primary and social care.  Concerns were expressed about the difficulties presented by seeking to extend the footprint beyond Kent and Medway. 

(8)       Dr Stewart said the Kent Integration Pioneer Steering Group had an important role, as a working group of the Kent HWB, to work with and across emerging new models of care including vanguards, integrated care organisations and federations.   New community services and professional blended roles based around GP practice configurations linked to the estates and workforce strategies to support independence could be  ...  view the full minutes text for item 195.

This item was considered with the previous item (The New Planning Arrangements for Health and Social Care)

This report sets out a suggested outline Forward Work Programme along with a proposal as to how to better focus the work of the Board by defining its key areas of activity

(1)       Tristan Godfrey (Policy and Relationships Adviser) introduced the report which included: a suggested outline Forward Work Programme; a proposal to better focus the work of the Board by defining its key areas of activity; and a suggestion for improving the co-ordination of future agendas.

(2)       It was suggested that the Board’s primary focus should be on setting out and achieving ambitious and innovative targets and an in-depth discussion was required to define and agree this ambition.

(3)       Resolved that:

(a)          An annual work programme for the Board in line with the approach set out in the report be agreed;

(b)          Amendments to the Forward Work Programme be suggested prior to final agreement of the programme on 16 March 2016 and its communication to the local health and wellbeing boards; 

(c)          The Forward Work Programme be a standing item on future agendas;

(d)          A lead officer to assist in the co-ordination of future agendas be nominated where appropriate.

To note the progress and improvements made during 2014/15, as detailed in the Annual Report from the Independent Chair of Kent Safeguarding Children Board

(1)       Mr Ireland introduced the report on behalf of Gill Rigg, Independent chair of the Kent Safeguarding Children Board (KSCB) .  The report described the progress made in improving the safeguarding services provided for children and young people in Kent during 2014/15 as well as the challenges for the following year.

(2)       Mr Ireland said the KSCB was waiting its Ofsted inspection which could happen at any time up to March 2017.  He also drew attention to the growing understanding and commitment in relation to child sexual exploitation (CSE) and to the issue of unaccompanied asylum seeking minors (UASM).   He said that currently there were 930 UASM in the care of the county with a further 500 accessing care leaving services. Discussions about a national placement scheme were continuing but there were concerns that number of UASM being cared for in Kent could increase rapidly if a scheme was not in place by April.

(3)       Resolved that the progress and improvements made during 2014/15, as detailed in the annual report from the Independent Chair of Kent Safeguarding Children Board, be noted.

To note the minutes of the Children’s Health and Wellbeing Board held on 15 September 2015 and 25 November 2015

Resolved that the minutes of the meetings of the Children’s Health and Wellbeing Board held on 15 September and 25 November 2015 be noted.

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

Canterbury and Coastal – 12 November 2015

Dartford, Gravesham and Swanley – 9 December 2015

Thanet – 19 November 2015

West Kent – 17 November 2015

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

Canterbury and Coastal – 13 November 2015

Dartford, Gravesham and Swanley – 9 December 2015

Thanet 19 November - 2015

West Kent – 17 November 2015