Agenda and minutes

Health Reform and Public Health Cabinet Committee - Tuesday, 24th September, 2019 10.00 am

Venue: Darent Room, Sessions House, County Hall, Maidstone. View directions

Contact: Theresa Grayell  03000 416172


No. Item



Additional documents:


The committee noted that Mr P J Messenger had joined the committee as an Independent Member.  Mr Messenger was welcomed to his first meeting of the committee.


Apologies and Substitutes

To receive apologies for absence and notification of any substitutes present

Additional documents:


Apologies for absence had been received from Mr D Butler and Miss E Dawson.


Mr N J D Chard was present as a substitute for Mr Butler.


Declarations of Interest by Members in items on the agenda

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 their interest refers and the nature of the interest being declared

Additional documents:


Mr N J D Chard declared that he was a Director of Engaging Kent.


Mr I Thomas declared that, in relation to any mention of plans for a new hospital site at Canterbury, he was a Member of Canterbury City Council’s Planning Committee, and, in relation to the item on gambling, that he served on the City Council’s Licensing Committee.


Mr A Cook declared that he also served on Canterbury City Council’s Licensing Committee.


Under agenda item 9 (minute 64, below), Mr B H Lewis declared that he had previously managed a betting shop for many years.



Minutes of the meeting held on 20 June 2019 pdf icon PDF 213 KB

To consider and approve the minutes as a correct record.

Additional documents:


It was RESOLVED that the minutes of the meeting held on 20 June 2019 are correctly recorded and they be signed by the Chairman. There were no matters arising.


Verbal updates by Cabinet Members and Director pdf icon PDF 179 KB

Additional documents:


1.            The Cabinet Member for Adult Social Care and Public Health, Mrs C Bell, gave a verbal update on the following public health issues:-


20 August - Visited Kent Community Health Foundation Trust (KCHFT) Services at Tonbridge Cottage Hospital to see services and meet staff and members of the multi-disciplinary team (MDT). She also accompanied a health visitor on her rounds and visited a baby clinic to see an infant feeding session. This visit had shown how well services were working. The Trust had subsequently been awarded an ‘outstanding’ rating. 

17 September - Kent and Medway Joint Health and Wellbeing Board Workshop. This had discussed the role of the Joint Board. Work would continue on the case for change, which would be published in autumn 2019, and the priority areas of work for the Joint Board would be drawn from the case for change. A primary school teacher had recently spoken about young children not being ready for school, in terms of toilet training and speech development.  This lack of preparedness could be due to lack of access to a health visitor or GP. 

World Mental Health Day on 10 October – Ms Marsh outlined the events taking place at County Hall to mark the day and undertook to send out to Members the details of events.  A series of summits was to take place to raise public awareness of mental health issues and the first of these had recently taken place in Margate. This had been very well attended by a range of participants.  Contributions made by public participants at these summits would be used to draft an action plan.  The Sustainability and Transformation Partnership (STP) had allocated £600,000 to establish four ‘safe havens’ which could offer out-of-hours help for people with mental health problems and their carers, and additional funding would be made available for staff training in dealing with mental health issues. A new crisis café had been established, run by volunteers. 


2.            The Leader and Cabinet Member for Health Reform, Mr P B Carter, gave a verbal update on the following issues:-


Sustainability and Transformation Programme


Mr Carter said that he had received much good feedback from Members about the usefulness of the presentations by the panel of NHS clinicians and senior officers at the committee’s June meeting, setting out the Government’s changed arrangements and local implementation plans.


He had stated that, when he stood down as Leader, he hoped to continue in a role of promoting the local care vision, not just in Kent but nationally, to see how integrated care was being delivered in other parts of the country and ensure that local government could continue to play a role, alongside NHS colleagues, in the delivery of good community health and social care services. Part of the work that he hoped to pursue at a national level was to influence Government to achieve a greater proportion of NHS funding going into primary care, community care and preventative care, to reverse the reduction  ...  view the full minutes text for item 61.


Establishment of a single Clinical Commissioning Group for Kent and Medway - oral item

Additional documents:


Glenn Douglas, Chief Executive, Kent and Medway Sustainability and Transformation Partnership and Accountable Officer for Kent and Medway Clinical Commissioning Groups, and Michael Ridgwell, Deputy Chief Executive,

Kent and Medway Sustainability and Transformation Partnership, were present for this item at the invitation of the committee.


1.            Mr Douglas and Mr Ridgwell presented a series of slides which followed on from the presentations given to the committee at its June meeting.  These outlined the NHS Long-Term Plan, how this was being applied in Kent and Medway, key areas of action and the way in which the development of local care would be supported, using integrated care partnerships, primary care networks and a single clinical commissioning group. They then responded to comments and questions from the committee, including the following:-


a)    the developments outlined in the presentation were welcomed by committee members;


b)    the leadership of Mr Carter in promoting the local care agenda had put Kent’s achievements ahead of other local authorities in the country, but what was needed now was to make innovative practices work successfully at a local level via the primary care networks;


c)    the public needed to be helped to understand the new arrangement and be directed to the most effective pathway within it to access treatment, and for some this would need a major education project;


d)    Thanet had been described as a beacon of innovative practice in the way in which its GPs organised themselves, but local experience in districts also showed that it could take a week to get an appointment with a GP and that access to dentistry services was also a struggle. Local people wanted to have a guarantee of being able to get an appointment with a GP or dentist when they wanted one. Mr Carter clarified that, due to the problem in recruiting GPs to replace those retiring or leaving practice, Thanet’s ratio of doctors to patients was currently low, leading to a wait for appointments. This situation required an innovative approach to the use of the available resources, for example, triaging patients to be seen by a practice nurse or physiotherapist, where possible, to free up a GP’s time to see the patients who needed to see them.  This could reduce waiting lists, despite a wait to recruit new GPs. The development of multi-disciplinary teams would support this, as long as sufficient therapists and others could be recruited;


e)    the establishment of multi-disciplinary teams was welcomed but the importance of GPs in the delivery of local care should not be underestimated. It was also important to bear in mind that, in health care, services should be able to be configured to fit the needs of a local population; one size did not fit all;


f)     asked if pharmaceutical companies could collude or collaborate on service delivery, for example, for depression and anxiety, for which the use of drugs had increased steeply in recent years,  Mr Ridgwell explained that there were statutory regulations to ensure that companies could not  ...  view the full minutes text for item 62.


19/00064 - Delivery and Transformation of Public Health Services pdf icon PDF 462 KB

Additional documents:


The Chairman advised the committee that, as this and the exempt report later in the agenda (item 12) contained much detailed information, he was minded to take both reports together in a closed session at the end of the meeting.  It was important that Members had the opportunity to gain a full understanding of the issues before being able to comment on them and consider the recommendations, and to do this they would need to be able to have a frank discussion and explore all of the available information. This could only be done effectively in a closed session.



Update on Kent County Council approach to Gambling Addiction: follow up from November 2018 paper on Gambling Addiction and Public Mental Health pdf icon PDF 231 KB

Additional documents:


Ms J Mookherjee, Consultant in Public Health, was in attendance for this item.


Mr B H Lewis declared that he had previously managed a betting shop for many years.


1.            Ms Mookherjee introduced the report and outlined work which had been started since the issue had last been reported to the committee in November 2018, including a pledge by Simon Stevens, Chief Executive of NHS England, of funding to raise awareness, online briefings for front line staff and work with district council colleagues. She responded to comments and questions from the committee, including the following:-


a)    the work streams set out in the report were welcomed as they were raising the profile of problem gambling and its damaging effects.  It was important that gambling per se was not demonised but that suitable measures were available to address problem gambling;


b)    in response to the concern that there was no centre in Kent to which those with a gambling problem could refer themselves, or be referred, Ms Mookherjee advised that the County Council had no control over what, if any, provision was made to treat this area of addiction. The addiction service in general was fragmented;  


c)    the view was expressed that addiction to gambling was as harmful as addiction to drugs or alcohol.  Ms Mookherjee replied that, from a public health point of view, any addiction was harmful;


d)    people under 18 were not permitted to place bets in a shop but could easily do so by using online gaming sites. Reputable betting shops would turn away someone who was obviously under-age but concern was expressed that many current proprietors may not take such a responsible stance. Using online gaming sites, young people could become very involved very quickly. The Government could be lobbied to take some action to address the accessibility of online gaming.  Ms Mookherjee commented that online marketing of products and services which could potentially lead to harmful habits was often more sophisticated than public health online information and safeguarding campaigns. Although the County Council would always want to ensure that young people were kept safe online, it was simply not possible to tell who was using online gaming sites.  Mr Scott-Clark added that he had advocated to the Association of Directors of Public Health that problem gambling be viewed as a public health issue and that the Government be lobbied to change the rules and legislation around it;


e)    concern was expressed that advertising for gambling sites appeared on daytime TV channels and could be seen by young people, although it was encouraging that such advertising during live sports broadcasting had been banned. The danger of adopting and becoming hooked on risky behaviours early in life was emphasised. Adverse childhood experiences such as domestic abuse or family break up could leave young people vulnerable to adopting potentially harmful behaviours;  


f)     young people aged 16 were not permitted to vote in any election but could buy scratch cards;


g)    the part played by deprivation as a root  ...  view the full minutes text for item 64.


Performance of Public Health-commissioned services pdf icon PDF 367 KB

Additional documents:


Mrs V Tovey, Public Health Senior Commissioning Manager, was in attendance for this item.


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


a)    asked why the one service with a red rating – the number of mothers receiving an antenatal contact with the health visiting service – had been performing below target, Mrs Tovey explained that the national shortage of health visitors presented a challenge. Parents would be contacted by letter to encourage them to engage with the service, and the five mandated checks undertaken in a child’s early years showed good performance generally; and


b)    asked if these patterns varied across areas, Mrs Tovey said it was important that any local shortfall or difficulty was not overlooked but was identified and addressed. She explained that to include full regional information in future performance reports would make the total quantity of data impractical to process and report to each meeting but undertook to highlight in future reports any region in which performance caused particularly concern.


2.            It was RESOLVED that:-


a)    the performance information of public health-commissioned services in quarter 4 of 2018/19 and quarter 1 of 2019/20 be noted, with thanks; and


b)    future performance reports highlight any region in which performance caused particularly concern.


Work Programme 2019/20 pdf icon PDF 110 KB

Additional documents:


It was RESOLVED that the Cabinet Committee’s planned work programme for 2019/20 be agreed.


Motion to exclude the press and public for exempt item

Additional documents:


It was RESOLVED that, under Section 100A of the Local Government Act 1972, the press and public be excluded from the meeting for the following business on the grounds that it involves the likely disclosure of exempt information as defined in paragraphs 3 and 5 of Part 1 of Schedule 12A of the Act.



EXEMPT ITEM (open access to minutes)

Additional documents:


19/00064 - Delivery and Transformation of Public Health Services

Additional documents:


Mrs V Tovey, Public Health Senior Commissioning Manager, was in attendance for this item.


1.             Mrs Tovey introduced the reports for agenda items 8 and 12 and responded to questions of detail from the committee, including the recruitment and training of new nurses and retention and re-training of experienced nurses to take on new roles, for example, as health visitors and school nurses, to offer a new career pathway. The Care Quality Commission’s recent rating of Kent Community Health NHS Foundation Trust (KCHFT) as ‘outstanding’ would help to retain and attract new staff. Other questions included clarity of the conditions that were required to be met for the County Council and KCHFT to enter into this agreement. Mrs Tovey confirmed that the conditions were set out in section 12(7) of the Procurement Regulations and also referenced within the exempt report. Mrs Tovey informed the committee that independent legal advice confirmed the arrangement met these criteria for the delivery of public health services and advised that this would be subject to review during the five years to ensure the conditions continued to be met.


2.            It was RESOLVED that:-


a)    the context, risk and assurance associated with the proposed procurement approach for public health services be noted; and


b)    the decision proposed to be taken by the Cabinet Member for Adult Social Care and Public Health, to authorise the County Council to extend the collaborative arrangement with Kent Community Health NHS Foundation Trust, for the services listed in the report, until March 2025, be endorsed.