Agenda and minutes

(1)       The Chairman welcomed Cllr Alan Jarrett and Mr Neil Davies from Medway Council and Glen Douglas (Chief Executive of the Sustainable Transformation Partnership) to the meeting.

(2)       He invited Cllr Jarrett and Mr Davies to comment on the proposal to develop joint health and wellbeing arrangements.  Mr Jarrett said he supported the proposals in principle.  He referred to the proposed membership, as set out in paragraph 3.2 of the report, and said he strongly supported the inclusion of representatives from district councils with a minimum of observer status.  He also said the Medway Health and Wellbeing Board would continue to operate, the terms of reference of the joint board were key to its success and should be written in a way that ensured any joint board did not acquire executive functions.

(3)       Mr Davies said a joint board would facilitate working with the STP.

To receive apologies for absence and notification of any substitutes

Apologies for absence were received from Cllr F Gooch, Dr S MacDermott, Dr T Martin and Mr A Scott-Clark.  Alison Duggal attended as substitute for Mr Scott-Clark.

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 20 September 2017 are correctly recorded and that they be signed by the Chairman.

(1)       Mr Douglas gave a presentation which is available on-line at Appendix 1 to these minutes.

(2)       Comments were made about the need to consider patient involvement and engagement in the new arrangements; the role of the HWB in having a strategic overview of the arrangements for and the delivery of local care; the reduction in investment in primary care as a proportion of the total NHS spent; the tension between central control and local autonomy particularly in relation to local care; and the relationship between the Case for Change and the Joint Strategic Needs Assessment.

(3)       Concerns were also raised that social care funding might be used to support the acute sector and that Better Care Funding might be withdrawn.

(4)       Dr Stewart said the Kent and Medway Integration Pioneer was a working group of the Health and Wellbeing Board and had developed into the Design and Learning Centre for Clinical and Social Innovation (DLC).  The DLC was now recognised as the Service Improvement and Innovation facility for the Kent and Medway STP in collaboration with Medway and Swale Centre of Organisational Excellence and the Academic Health Science Network.

(5)       Resolved that the presentation be noted.

To receive a discussion paper that sets out the reasons that a Joint Health and Wellbeing Board (i.e. a Joint Committee) with Medway Council could be established for the purpose of providing a mechanism for oversight of and engagement in those areas of the Sustainability and Transformation Partnership activity that relate to areas of common interest across both councils, particularly strategic commissioning, prevention and local care work streams.

(1)       David Whittle (Director of Strategy, Policy, Relationships and Corporate Assurance) introduced the report which provided the foundation for further discussion to support the Board in coming to an in-principle agreement to develop a joint arrangement.  He referred to Cllr Jarrett’s comments at the beginning of the meeting in support of such an arrangement and said that if it was the wish of the Board, terms of reference and other technical matters could be developed by officers.

(2)       Comments were made about the relationship of a joint board with local care providers and integrated commissioning as well as the opportunity to learn from Medway’s experiences in local care commissioning.

(3)       In response to questions and comments, Mr Whittle confirmed that the intention was to have representatives from the Strategic Commissioner function and a representative from each Accountable Care Partnership (ACP).

(4)       Comments were also made about the importance of arrangements for children and the 0-25 Health and Wellbeing Board in any new arrangements.

(5)       Resolved that:

(a)       It be agreed to recommend to County Council the creation of a Joint Board with Medway Council dependent on agreement from Medway Council, and further discussions with STP Leadership;

b)         The joint Board would focus on the Kent and Medway STP;

c)         Membership might include future representation from the strategic commissioner function and ACPs as new structures developed;

d)         Responsibility for agreeing Terms of Reference for the joint Board with Medway Council and STP Leadership be delegated to the Chairman.

To consider and make recommendations on the emerging headline messages and infrastructure costings for the update of the GIF

(1)       Katie Stewart (Director of Environment., Planning and Enforcement) introduced the report which provided an overview of the emerging Kent and Medway Growth and Infrastructure Framework (GIF) and asked the Board to make recommendations on the emerging headline messages and infrastructure costings for the update of the GIF.

(2)       Sarah Platts (Strategic Planning Infrastructure Manager) outlined the approach taken to developing the GIF including engagement with the STP, the emerging narrative and costings.  The analysis showed a significant gap between the funding required and the anticipated contributions from central government, developer contributions and other sources.

(3)       Comments were made about the need to use the same language as being used in the STP; to avoid any implication that primary care practices might be forced into larger buildings; and to move away from the idea that the proposed hubs were physical buildings when it might be the way that services would beaggregated virtually to deliver services to populations of 40,000-50,000.

(4)       Comments were also made about the desirability of following other authorities who were considering radical ways of raising funds for infrastructure delivery; and the need to lobby government for adequate funding to meet current and future growth forecasts.

(5)       Resolved that the report be noted.

To receive a briefing that describes the actions taken by the Health and Social Care system to prepare for and respond to winter.  A copy of the correspondence is also attached

(1)       The Chairman welcomed Mr Duffy to the meeting.  Mr Duffy said that planning for winter 2017/18 had started towards the end of last winter.  Two debriefs had been held which had led to further work in relation to demand and capacity. Local A&E Delivery Board (LAEDB) plans for winter across Kent and Medway, had been assured as “Amber”, however the plans continued to be developed, refined and tested with support from NHSE/NHSI.  NHSE were also working with LAEDBs to produce a Kent and Medway Surge Plan in order to strengthen mutual aid agreements. He also said that each LAEDB would conduct a Surge Capacity Exercise ahead of winter.

(2)       Mr Duffy also said that all LAEDBs were promoting the nationally led “Stay Well this Winter Campaign” which was aimed at asking the public to protect themselves from the cold and included encouragement to be vaccinated against the flu.

(3)       Mr Duffy thanked the Health and Wellbeing Board for its continued support and said the Health and Wellbeing Board needed to retain good oversight of funds and to continue to work to deliver the required reductions in the delayed transfers of care which were key to providing capacity in the acute sector.  He concluded by saying robust plans were in place to manage this year’s winter pressures, a strong national communications plan was being supported and delivered locally, and LAEDBs had well-rehearsed plans to manage the impact of emergencies.

(4)       Comments were made about the plans in place in East Kent to respond to winter, the opportunity to further exploit information systems to help with the escalation process, the capacity of primary care to assist in  extreme emergencies, the role of the out-of-hours GP service.  Further comments were made about the fact that during times of pressure, it tended to be across the whole system including both primary and acute care, as more people were sick, they also tended to be sicker and to stay in hospital for longer; and there was a limited number of staff with the appropriate skills who could be called upon to respond to increased demand.

(5)       Resolved that the report be noted.

To receive and note the annual report for 2016/17

(1)       Members of the Board expressed surprise that a representative of the Kent Safeguarding Children Board was not in attendance to present the report.  Mr Ireland suggested a report providing an update on the recommendations made by Ofsted be received at a future meeting of the Health and Wellbeing Board.  He also outlined some of the potential changes to arrangements for safeguarding children arising from the Health and Social Care Act.

(2)       Resolved that the Chairman of the Kent Safeguarding Children Board be asked to attend the meeting of the Health and Wellbeing Board in January 2018 to present an update on actions since the Ofsted inspection and potential changes to arrangements for safeguarding children arising from the Health and Social Care Act.

To note the minutes of the 0-25 Health and Wellbeing Board held on 19 July 2017

Resolved that the minutes of the meeting held on 19 July 2017 be noted.

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

Ashford - 18 October 2017

Canterbury and Coastal – 5 October 2017

Dartford, Gravesham and Swanley – 25 October 2017

South Kent Coast – 16 May 2017

Thanet – 7 September 2017

West Kent – 15 August 2017 and 17 October 2017

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

Ashford - 18 October 2017

Canterbury and Coastal – 5 October 2017

Dartford, Gravesham and Swanley – 25 October 2017

South Kent Coast – 16 May 2017

Thanet – 7 September 2017

West Kent – 15 August 2017 and 17 October 2017

(1)       Mr Oakford said that this was Andrew Ireland’s last meeting and thanked him for his contribution to the organisation and for his personal support and patience.  He also wished him well for the future.

(2)       Resolved that from April 2018 the meetings of the Health and Wellbeing Board be held during the working day.