Agenda and minutes

The Chairman opened the meeting and announced that Ms Issie Ferris was in attendance as an observer.  Issie was studying at the University of Exeter and was working at County Hall for a week as an intern with Democratic Services.

The Chairman advised the committee that he would need to leave the meeting at about 12.00 noon and that the Vice-Chairman would preside over any remaining business.

To receive apologies for absence and notification of any substitutes present

Apologies for absence had been received from the Leader, Mr P B Carter.

There were no substitutes.  

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 that she was the Chairman of Thanet District Council’s  Cabinet Health Advisory Group, working on the Sustainability and Transformation Programme.

Mr I Thomas declared that he was a Member of Canterbury City Council’s Planning Committee, which may prove relevant if discussion of the potential new Kent and Canterbury Hospital and or new Medical school were to arise during the meeting. 

To consider and approve the minutes as a correct record.

It was RESOLVED that the minutes of the meeting held on 1 May 2018 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, the Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health.

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

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

Update on new Infant Feeding Service – the new service had started on 1 June 2018 and provision was moving forward well. The Kent Community Health Foundation Trust (KCHFT) had won a national award for the way in which it supported its volunteers.

Joint Kent and Medway Health and Wellbeing Board – the first meeting of the new joint board would take place on 28 June in Medway.  Wiltshire’s Health and Wellbeing Board had recently been criticised by the Care Quality Commission (CQC) for not working sufficiently closely with the Sustainability and Transformation Programme (STP) and the NHS. The comments made by the CQC showed that Kent was ahead of some other Health and Wellbeing Boards. Mr Oakford undertook to share an article and the CQC report with the committee and these are attached below:

Article: http://www.salisburyjournal.co.uk/news/16306679.Concerns_raised_over_council__39_s_management_of_health_and_social_care/

CQC report (in which, the main section about the Health and Wellbeing Board is on page 11): https://www.cqc.org.uk/sites/default/files/20180611_local_system_review_wiltshire.pdf

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

Sustainability and Transformation Programme (STP) Prevention workstream – a report about this would be considered at the first meeting of the new joint Health and Wellbeing Board.

Measles – sporadic outbreaks had now occurred in Surrey and Sussex as well as in Italy and Eastern Europe.  Public Health England had advised teenagers to be immunised to avoid passing on the virus when gathering in large numbers, for example, at festivals, and this message appeared to have been noted.

Air Quality – the development of the County Council’s Energy and Low Emissions Strategy was being led by consultants and the public health team was working with the Growth, Environment and Transport Directorate.  Workshops for Members would take place in August and September and a public consultation on the Strategy was expected in Spring and Summer 2019.

3.            It was RESOLVED that the verbal updates be noted, with thanks.

To receive a report from the Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, setting out work undertaken by NHS colleagues and Public Health to address NHS and Social Care and Public Health workforce and training issues, which the Cabinet Committee is asked to note and endorse.  

Ms G Walton, Executive Support Manager Older People and Physical Disability and Design and Learning Centre Programme Manager, was in attendance for this item.

1.            Dr Duggal introduced the report and emphasised that there were two aspects to workforce planning; work undertaken by NHS and social care partners, over which the Council Council had no direct control or influence, and work undertaken by the Council Council. Dr Duggal advised the committee that she served on the STP workforce workstream group. Ms Walton added that she was involved in the STP group, looking at the social care agenda. The STP had a development plan to focus on six areas and identify work for the future.  The Local Workforce Action Board (LWAB) was co-chaired by Anne Tidmarsh and an NHS lead, and included Dr Duggal, so this supported good health and social care links. Mrs Tidmarsh had also been confirmed as the Senior Responsible Officer for the STP workforce work stream.  Dr Duggal and Ms Walton responded to comments and questions from the committee, including the following:

a)  the importance of liaising between health and social care to upskill the whole care workforce was emphasised. Ms Walton confirmed that she was working with Clare Maynard in the County Council’s Adult Social Care Directorate to implement the strategy which already existed to ensure that this happened effectively;

b)  concern was expressed about the high turnover of health service staff, and a question asked about how pay levels and more prescriptive job descriptions might be used to help reduce this. Kent could lead the way in being an attractive employer where people wanted to stay. Dr Duggal acknowledged the importance of achieving a good range of work skills and work-life balance and explained that part of the LWAB’s work aimed to attract and retain good staff in Kent. Ms Walton added that work was ongoing on modelling a social care career pathway, and a campaign to raise the profile of the career and recruit more care sector staff would be starting shortly, using Government funding gained through the LWAB. She undertook to share the plan and strategy for this work with Members when these were ready;

c)  concern was expressed that the plan to attract new GPs from overseas might be made more difficult by the fact that many overseas workers no longer felt welcome in the UK, and a question was asked about how they would be housed. Dr Duggal agreed that this was an important practical point; 

d)   concern was expressed that the new medical school, if opened in 2020, would take until 2026 to produce its first graduates, and those people would then need to be retained in Kent.  Dr Duggal explained that past experience had shown that graduates tended to stay on in the area in which they had studied, so having a medical school based in Kent should benefit staff retention rates for Kent;

e)  asked why people left health and social care careers, and about the importance  ...  view the full minutes text for item 81.

To receive a report from the Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, setting out an overview of the Postural Stability services commissioned by the County Council and providing details of the purpose, performance, outcomes and value for money of the contracts, which the committee is asked to note and comment on.

Mrs V Tovey, Public Heath 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 if community venues, including adult education centres, would be used for classes, Mrs Tovey explained that this would certainly be possible.  Mr Scott-Clark added that the aim was to deliver the service as close to GPs’ practices as possible;

b)    asked if, as useful feedback, the reasons for people dropping out of courses were recorded, and if this was followed up, Mrs Tovey explained that people dropped out for a variety of reasons.  Some went into residential or nursing homes, others had to stop due to illness or poor health, while others passed away. Many participants gave a reason if the drop out was planned but providers could not always follow up people who dropped out;

c)    an aim of the postural stability service was to increase confidence, balance and posture and prevent falls, allow people to live independently for as long as possible and avoid needing a residential or nursing home placement. Dr Duggal explained that the service would prioritise frail elderly clients. Mr Scott-Clark highlighted the financial savings available to social care and public health budgets by avoiding home placements and further falls but emphasised that the greatest savings would be to service users and their families in terms of distress and poor health;

d)    the cost of classes varied as block purchasing attracted discounts, so prices quoted in the report were average.  Transport could be provided to assist people to attend, for instance, from rural areas, and costs fluctuated based on course locations;

e)    it was reported that, in some areas, equipment delivered to a client sometimes failed to be collected once it was no longer needed, and to tighten up on collections of old equipment would help to eliminate waste in the service.  Mrs Tovey advised that this service was not funded via public health;

f)     the longer a client could manage to attend a class, the more benefit they would gain from it.  The aim was for people to join in as close to the start of the 36-week programme as possible.  Figures showed that, on average, 68% of participants were still attending at the end of the 36 weeks; and

g)    Mrs Tovey explained that there were options about where to place the service to optimise access to it and streamline referrals as far as possible. To have it placed in-house with public health would allow optimum flexibility and support the alignment of related services, for example for older people, giving one point of contact.

2.          It was RESOLVED that the commissioning and provision of postural stability services in Kent and the work to improve the  patient experience and service efficiency be noted and welcomed.

To receive a report from the Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, setting out recent suicide prevention developments and highlighting £667,978 of new funding which has been secured for suicide prevention work across the Kent and Medway STP area in 2018/19.  The committee is asked to note the recent progress and make comments and suggestions to strengthen future delivery.

Mr T Woodhouse, Suicide Prevention Specialist, was in attendance for this item.

1.            Mr Woodhouse introduced the report and received the committee’s thanks for the work he and his team had put into developing the excellent suicide prevention strategy and the ‘Release the Pressure’ campaign work.  He then responded to comments and questions from the committee, including the following:-

a)       asked about police involvement and the justice system in terms of suicide awareness, Mr Woodhouse reassured the committee that services were very aware of the suicide risk of those in custody and confirmed that they would have access to mental health support. The police were looking at how to increase awareness through their staff training programmes;

b)  concern was expressed that success in preventing suicide was difficult to identify and measure;

c)   the need for quick access to qualified therapists was emphasised. Mr Woodhouse agreed that this was an important part of the service and explained that trained counsellors were available via helpline services, with callers being signposted to them.  This was more than the Samaritans were permitted to do via their helpline. He undertook to find out what work was being done on workforce development in relation to therapists, their caseloads and waiting lists and advise Members outside the meeting;

d)  concern was expressed about the difficulty of reaching men, who were most at risk from suicide but who were still traditionally not encouraged to talk about their feelings or seek help for mental health worries. Mr Woodhouse explained that the aim was to seek to raise awareness of non-traditional ways for men to talk about their mental health, for example by using online apps or webchats which could be accessed discreetly without having a conversation which could be overheard. Kent’s ‘Release the Pressure’ campaign, aimed at men, had been taken up by the City of London Corporation, and posters displayed at London stations, so they would be seen by thousands of daily commuters as well as London residents. Previous campaign work had involved football clubs.  Pubs would also be a place where men traditionally could go to unwind but the increase of drinking at home had led to many pubs closing and this networking opportunity being lost;

e)   several speakers related personal examples of people who had committed suicide. From these experiences, some Members had become involved in various mental health and suicide prevention work;

f)    the Suicide Prevention Steering Group was liaising with highways colleagues to address concerns about people using bridges and other structure as points from which to jump. Mr Woodhouse said arrangements were being made to display Samaritans contact details prominently at points which were known to be popular with those seeking to take their own life, for example, the Dartford Crossing. He added that Network Rail staff were also trained to identify and offer help to people loitering on platforms who may be intending to jump onto tracks;   

g)   people working in some occupations, for example, farming and construction, were known to be  ...  view the full minutes text for item 83.

To receive a report from the Deputy Leader and Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, setting out the roles and responsibilities of partners around childhood immunisations, the local picture of childhood immunisations in Kent and current and future actions planned by NHS England to improve immunisation rates. The committee is asked to note progress and endorse the approach being taken.  

1.            Dr Duggal introduced the report and added that she served on the panel which looked at improving the childhood immunisation programme and the measures being tried as part of this, including using health visitors to help encourage parents to have their children immunised and closer working with GPs.  She responded to comments and questions from the committee, including the following:-

a)     the aim was to immunise 95% of children, a rate which was achievable and should be sufficient to protect all children in the county.  Immunisation relied on the principal of informed parental choice, and had never been compulsory in the UK. Some religious groups resisted immunisation as they believed that enduring childhood infections would strengthen a child.  Past misinformation that the Measles, Mumps and Rubella (MMR) vaccine could cause autism was still remembered and had not helped improve immunisation rates. Mr Scott-Clark added that many studies had been undertaken in the USA and by the World Health Organisation to establish any link between the MMR vaccination and autism.  He assured the committee that there was no such link; 

b)    asked if the rate of immunisation take-up was affected by the economic prosperity of an area, Dr Duggal said this data should be possible to find and supply to Members outside the meeting;

c)    asked if parents were able to choose which immunisations their child received, and if some accepted some vaccines but not others, Dr Duggal undertook to check the availability of data and advise Members outside the meeting. Refusal to have children immunised would be recorded by a family’s GP, who would speak to the parents about their reasons for refusing and tackle the issue of an individual child’s need for the vaccines in question;

d)    asked how many children developed illnesses despite receiving immunisations, Dr Duggal undertook to look at national data held by Pubic Health England and advise Members outside the meeting. She explained that one reason for developing an illness could be that a child did not receive both instalments of a two-stage immunisation; and

e)    asked how the spread of misinformation on social media could be addressed, Dr Duggal advised that Public Health England was responsible for issuing official health advice and authorised campaign work.  She had personally countered misinformation when she had seen it on social media but not in an official capacity as a County Council representative.  Mr Scott-Clark added that a national committee of health professionals advised the Government on health issues and national policy setting and theirs was the most expert advice available.

2.            It was RESOLVED that progress made be noted and welcomed and the approach being taken to improve childhood immunisation in Kent be endorsed.

To receive a report from General Counsel on the Committee’s work programme.

It was RESOLVED that Cabinet Committee’s work programme for 2018/19 be agreed.