Agenda and minutes

To receive apologies for absence and notification of any substitutes present

Apologies for absence had been received from Mr P B Carter and Mr K Pugh. 

Mr K Gregory was present as a substitute for Mr K Pugh.

As the Chairman was unable to attend for the first part of the meeting, the Vice-Chairman took the chair.

To receive any declarations of interest made by Members in relation to any matter on the agenda.  Members are reminded to specify the agenda item number to which it refers and the nature of the interest being declared

Mrs L Game declared an association to one of the interested parties listed in the exempt appendix to agenda item 6, as the Chairman of the Queen Elizabeth the Queen Mother Hospital advisory group working on the Sustainability Transformation Plan and as a member of a patient participation group.

Ms D Marsh declared that she was a Registered Mental Health Nurse.

To consider and approve the minutes as a correct record.

It was RESOLVED that the minutes of the meeting held on 30 June 2017 are correctly recorded and they be signed by the Chairman.  There were no matters arising.  

To receive a verbal update from the Leader and Cabinet Member for Traded Services and Health Reform, Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health.

1.            The Cabinet Member for Strategic Commissioning and Public Health, Mr P J Oakford, gave a verbal update on the following issues:-

Infant feeding consultation – this had previously been delayed to ensure that the consultation covered fully the contribution of the Health Visiting service to community infant feeding programmes and to reflect the input of focus groups of mothers, with whom Mr Oakford and Mr Scott-Clark, the Director of Public Health, had met recently.  Once these groups were happy with the consultation document it would be re-issued and the public consultation would go ahead. 

Kent Health and Wellbeing Board – this Board had a role to play in the delivery of the Sustainability Transformation Plan and to ensure that sufficient emphasis was placed on preventative and local care. The establishment of a combined Kent and Medway Health and Wellbeing Board would support this aim and discussion with Medway Council was ongoing.

2.            Mr Oakford responded to comments and questions from the committee, including the following:-

a)     the importance of good public consultation was emphasised, as starting, suspending and then re-starting a consultation would not help build public confidence in the County Council’s processes.  Consultation material should be checked very carefully before being issued.

3.            The Director of Public Health, Mr A Scott-Clark, gave a verbal update on the following issues:-

Sustainability Transformation Plan Prevention Work – as Director of Public Health for Kent, he formally chaired, jointly with a representative of NHS England, the partnership which oversaw the emergency planning and assurance role.

NHS Emergency Response Assurance Process – this process ensured that all NHS organisations were ready and able to respond to a public health emergency situation, for example, an epidemic, and would provide public assurance of their ability to do this. A report on these two subjects would be made to a future meeting of the Cabinet Committee.

Foreign Mosquitoes – a mosquito larva and egg had been identified in Kent and had been dealt with promptly by working with NHS England and using a drone operated by the Kent Fire and Rescue Service, the first such recorded use by a local authority.  Mr Scott-Clark advised the committee that, although mosquitoes which were not native to the UK could transfer disease between people, they did not carry disease from other countries.

4.            Mr Scott-Clark then responded to comments and questions from the committee, including the following:-

b)    diseases which could be transferred by non-native mosquitoes were dengue fever and chikungunya, which were endemic in other parts of the world, and albopictus, which was not native to Europe but was now endemic there; and

c)    due to the effects of global warming,  it was possible that a broader range of diseases could now be carried and transferred to countries in which they had not previously been seen, and this was a concern for public health authorities. Mr Scott-Clark advised the committee that mosquitoes were not able to fly further than about 300 metres but instead had  ...  view the full minutes text for item 19.

The Vice-Chairman asked Members if, in debating this item, they wished to refer to the exempt appendix which accompanied agenda item 6, and if they wished to pass a motion to exclude the press and public from the meeting.  Members confirmed that they did not wish to refer to the exempt information and discussion of the item was thus able to take place in open session. 

To receive a report from the Cabinet Member for Strategic Commissioning and Pubic Health and the Director of Public Health on a proposed contract award (for which, those expressing an interest are listed in an exempt appendix), on which the committee is asked to comment and either endorse or make an alternative recommendation.    

1.            Mr Gilbert introduced the report and explained that, having previously extended the contract with the current provider, a new contract was being procured through a competitive tendering process. Although substance misuse among young people was declining, it was still a challenging issue in some areas of the county, especially among vulnerable families and young offenders.  Re-tendering the contract offered opportunities to deliver services in new ways.  Expressions of interest had been received from a number of organisations and these were listed in the exempt appendix to the report.  These organisations had been invited to tender for the contract and tenders received were currently being evaluated.  This evaluation included consultation with representatives of the Kent Youth County Council. The Cabinet Member for Strategic Commissioning and Public Health would then sign the formal decision paperwork to award the contract in October and the new service would start in January 2018. Mr Gilbert, Ms Mookherjee and Mr Scott-Clark responded to comments and questions from the committee, including the following:-

a)    in response to a question about the committee having a further opportunity to comment before the contract was awarded, the Democratic Services Officer advised that, in accordance with the County Council’s decision making process, all Members would be sent notice of what the decision was proposed to be and would have an opportunity to comment on and ask questions about it.  They would then be sent notice of the decision having been taken and would have an opportunity to call-in the decision if they felt it had not been properly taken or the process had not been properly followed.  Only once these two stages had been completed, and once any call-in had been dealt with, could the decision be implemented;

b)    asked if spending on this service might have to increase to meet need, Mr Gilbert advised the committee that he was confident that the service required could be delivered to all those who needed it within the allocated budget;

c)    organisations tendering for the contract would not be required to use an information technology system imposed by the County Council to deliver the service and would be allowed to use methods they had developed and used successfully before, however, the County Council would monitor closely to see that services were being delivered to its satisfaction.  Particular attention would be paid to the efficient transfer of data from the current service to the new.  It was expected that staff delivering the current service would transfer to the new;

d)    asked how young people accessed drugs and alcohol, Ms Mookherjee explained that, although the national trend was for fewer young people to use them, and drug-related hospital admissions of young people under 18 had fallen, those who did use were indulging in increasingly risky behaviours, and the young people most at risk were taking the most risks.  Most young people experimented to some extent, for example, with steroids at the gym.  Patterns of use varied across the county but rates of usage were  ...  view the full minutes text for item 21.

The Chairman took the chair at this point, for the remainder of the meeting.

To receive a report from the Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, which the Committee is asked to comment on and endorse.

1.            Ms D Marsh, Deputy Cabinet Member for Adult Social Care, introduced the report as the Member champion for mental health issues and emphasised the need to achieve parity of esteem for mental and physical health.  She explained that the Time to Change initiative had been in place since 2007 and said that mental health was something that no employer could afford to ignore, as one in four British workers would suffer from anxiety or depression at some time in their career, and many working days were lost to this every year, although it was known that many people calling in sick did not give this as the reason for their absence from work.  She invited all Members to attend the vents taking place at County Hall on 10 October to celebrate World Mental Health Day. 

2.            Ms Mookherjee advised that there was a 25-year gap in life expectancy between those with poor mental health and those with good mental health. Time to Change had set out to address mental ill health and mental distress.  She added that mental health should not be celebrated just on one day but every day.  She and Mr Scott-Clark responded to comments and questions from the committee, including the following:-

a)    the close link between this and the substance misuse item preceding was emphasised, and surprise expressed at the revelation that those with poor mental health had 25 years’ less life expectancy.  Mr Scott-Clark added that those with poor mental health were also known to be four times more likely to smoke and hence were at risk of developing all the conditions which were caused by smoking;

b)    the stigma faced by people with poor mental health was likened to that experienced 100 years ago by those with leprosy;

c)    the Shed project, run in several locations across Kent, was commended  as an excellent social support mechanism for adults with mental health issues and Members were encouraged to support their local Shed schemes.  Ms Mookherjee added that Kent had the highest concentration of Shed projects in the UK;

d)    frontline Kent County Council staff had challenging workloads, and would need to be given as much support as possible to cope with heavy workloads and to avoid stress and anxiety arising from this. The work going on within the County Council to promote good mental health among staff was welcomed by the committee, and officers were congratulated on that work;

e)    a speaker asked where the most hits on the Release the Pressure website had come from and if these were from areas of greatest deprivation.  Ms Mookherjee undertook to evaluate the figures and advise the speaker outside the meeting;

f)     understanding and treatment of mental health conditions had progressed much since the 1980s, and people would hopefully soon be able to go to their GP and talk about being depressed without embarrassment or fear of being stigmatised.  However, sufficient and appropriate resources would need to be available to follow up a diagnosis of depression.  ...  view the full minutes text for item 22.

To receive a report from the Cabinet Member for Strategic Commissioning and Pubic Health and the Director of Public Health, which the committee is asked to comment on and endorse.

1.            Dr Duggal, Ms Spence and Mr Scott-Clark introduced the report and responded to comments and questions from the committee, including the following:-

a)    the public health services which the County Council had inherited in April 2013 had been of good quality, and Kent was the only authority to measure the performance  of its public health services by using a dashboard model;

b)    alongside the percentages for performance, it would be useful for Members to be able to see actual figures and the size of the sample from which these had been calculated. Dr Duggal advised that this information could be obtained from providers and included in future reports;

c)    disappointment was expressed that smoking rates were still high and that the habit seemed still to be resilient to campaign work.  Mr Scott-Clark advised that he served on the Tobacco Control Alliance, the work of which fed into the Sustainability Transformation Plan. Part of the Alliance’s work was to discourage young people from starting to smoke and hence remove the need for them to access support services to help them stop smoking in later life;

d)    the reporting of incidents as ‘minor’ or ‘serious’ was based on historic NHS classifications and used NHS definitions; and

e)    the value of the school nursing service was emphasised as this had a vital role to play in addressing childhood obesity.

2.         It was RESOLVED that the Public Health Quality Annual Report 2016-2017 be endorsed. 

To receive a report from the Cabinet Member for Strategic Commissioning and Pubic Health and the Director of Public Health, outlining Quarter 1 performance, on which the committee is invited to comment.   

1.            Mr Gilbert introduced the report and emphasised that only one of the services – the number of adults successfully completing drug and alcohol treatment - was performing below target.  He and Mr Scott-Clark responded to comments and questions from the committee, including the following:-

a)    the work of health visitors was praised and their vital contribution to helping to avoid social isolation was commended. They were delivering an excellent service under much pressure.  Mr Gilbert undertook to pass on these comments to health visitors;

b)    asked how performance targets were set, Mr Gilbert advised that these were set by the County Council as part of the Public Health Business Plan. However, targets tended to focus on trends rather than on specific numeric values;

c)    it would be most helpful to see the actual figures represented by the percentages listed, and Mr Gilbert undertook to do this in future reports.  He offered also to supply this information to Members outside the meeting;

d)    take-up rates of breastfeeding would only be recorded once reporting for 95% of the cohort was possible.  Rates reported would then be expressed as percentages of the 95%; 

e)    the ‘health check MOT’ roadshow targeted areas of deprivation and offered check-ups for anyone who wished one, even if they did not meet the age criterion of 50+. Face to face health checks were also offered to all County Council staff, and interactive health check kiosks were also available at County Council premises;

f)     work in youth hubs aimed to dissuade young people from starting to smoke but most services were targeted at existing smokers. A report on tobacco control was requested and would be made to a future meeting of the Cabinet Committee;

g)     one speaker said he had been surprised to learn that smoking was still permitted in young offenders’ institutions and suggested that enrolment on a stop-smoking programme could perhaps be made part a young person’s sentence. Mr Scott-Clark said this was a good idea and added that a project to establish smoke-free prisons had started in the South West of the UK and was spreading, although it was not known when this would arrive in Kent.  It had proved easier that expected to achieve smoke-free prisons as the use of tobacco as a stress reliever was well known.  Concern was expressed that any reduction in tobacco use might be replaced by the use of other substances; and

h)     the cost of tobacco was hopefully a disincentive to smoke, and the tobacco counters of supermarkets now featured covered shelving which kept products out of view.

2.         It was RESOLVED that the Quarter 1 performance of public health commissioned services be noted. 

To receive a report from the Leader and Cabinet Member for Traded Services and Health Reform and the Director of Strategy, Policy, Relationships and Corporate Assurance, to note progress and identify work streams about which the committee would like further information.

1.            Mr Whittle introduced the report and responded to comments and questions from the committee, including the following:-

a)    in response to a concern that, as work to implement the STP continued, sufficient and suitable back–up services would need to be in place, Mr Whittle agreed with the importance of such services being in place and assured the committee that much work was going on to ensure that they were in place by the time they were needed;

b)    Mr Scott-Clark explained that the STP for South East London was further advanced in its development than Kent’s because work on it had been going on for a longer time.  Mr Whittle added that public bodies in London had had to work more closely together from an earlier stage to develop their STPs, and  hence had longer to build relationships;

c)    The rating of Dartford, Gravesham and Swanley Clinical Commissioning Group as ‘inadequate’ had recently been addressed by the Health Overview and Scrutiny Committee. Disappointment was expressed that only five of the eight clinical commissioning group areas in Kent had been rated ‘good’;

d)    in response to a question about the complexity of the STP make-up and the hierarchy of systems, Mr Whittle explained that, although previous reforms of the NHS had separated the commissioner and  provider roles, the STP was now seeking to join these back together and reduce fragmentation. To this arrangement had now been added the social care aspects of service provision and the requirement for clinical commissioning groups to balance their budgets across the whole breadth of health and social care provision. A number of accountable care organisations were involved in the delivery of the STP, and a further complexity was that the policy frameworks of NHS England and Kent County Council were quite different;

e)    one speaker commented that the original commissioner and  provider split may prove in the long run to have not been worthwhile;

f)     the challenge of integrating legislation and practice was acknowledged;

g)    asked about the projects and work streams listed in appendix 2 to the report to address hospital performance, patient-focused change and transformation, Mr Scott-Clark explained that the chart shown belonged to the NHS and that the set of measures and services put in place by the Kent and Medway STP would look different. Music, art, singing and exercise were all known to be beneficial to patients with dementia and those recovering from cancer, and could reduce the need for other forms of treatment and hence save resources. Mr Whittle added that the STP had been built on structures and work streams, but these would generate practices and pathways which would aid frontline service delivery to patients; and

h)   report authors were thanked for the clarity of the information presented, which had helped new Members to start to understand the complex issues involved in the development and delivery of the STP.  It was hoped that future reports would continue this clarity. 

2.            It was RESOLVED that the information set out  ...  view the full minutes text for item 25.

To receive a report from the Head of Democratic Services on the Committee’s work programme.

1.            Members requested a report on air quality, to include pollution from traffic and petro-chemical industries in northern France as well as local campaigns to encourage motorists to switch of their engines when waiting in traffic near schools.  Mr Scott-Clark advised that, although air quality was a concern for the County Council as a public health authority, and representations or suggestions could be made on the impact of this upon public health, pollution from traffic and industry was the responsibility of district councils. The public health team would also need to liaise with the Growth, Environment and Transport Directorate to tackle issues of air quality.  Members who served as district councillors supported moves to address this and said that, if the County Council put forward solutions to address air quality, they would press their local councils to support these.

2.         It was RESOLVED that, with the addition of the item outlined above, the Cabinet Committee’s work programme for 2017/18 be agreed.