Agenda and minutes

To receive apologies for absence and notification of any substitutes present

Apologies for absence had been received from Mr D Butler.  Mrs P T Cole was present as a substitute for Mr Butler.

The Leader, Mr P B Carter, had given apologies but would attend the first part of the meeting before leaving for another meeting.

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

There were no declarations of interest.

To consider and approve the minutes as a correct record.

It was RESOLVED that the minutes of the meeting held on 13 March 2019 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 Health Reform, the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health.

1.            The Cabinet Member for Adult Social Care and Public Health, Mr G K Gibbens, gave a verbal update on the following public health issues:

27 March, spoke at the Introduction to Public Health course – this course sought to spread awareness of public health issues and had attracted a good attendance from district and borough councils, voluntary organisations and others. The course had involved some discussion of health inequalities.

16 April, visited the One You Shop at Ashford Park Mall – the town-centre location of this provided encouraging evidence that it was starting to raise public awareness of healthy living.  Health monitoring such as blood pressure checks were offered.

23 April, observed the Community Hub Operating Centre and Multi-Disciplinary Team Meeting at Northgate Medical Centre in Canterbury – he had visited with Mr Carter and welcomed plans to expand the site to provide a minor injuries unit in central Canterbury.  This would enhance health facilities to cover those with more complex needs and avoid the need for local people to travel to accident and emergency departments. The centre offered an MDT with a good range of professional involvement.    

12 May ‘oysters to cloisters’ cycle ride - he would attend this annual ride from Whitstable to Canterbury and planned to hand out literature about the Release the Pressure campaign, which was displayed around the meeting room in connection with item 11 on the agenda (minute 49, below).  

2.            In response to a question, Mr Gibbens confirmed that he was always willing to visit events around the county to promote the public health agenda.

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

One You Shop, Ashford – the scheme referred to by Mr Gibbens was a  good example of partnership working between the County Council, Ashford Borough Council and the Kent Community Health NHS Foundation Trust (KCHFT).  Footfall at the central location was being monitored and was proving to be a good location.

Measles – statistics provided by Public Health England had shown that, in the last 12 months, there had been 54 cases in the Kent and Medway area, mostly occurring between April and September 2018, with 34 of those being in Medway.  Vaccination was key, and the aim was to achieve 95% coverage in order to reach the whole population. Vaccination consisted of two separate doses, both of which needed to be administered to achieve immunisation. Take-up of the first dose was 90% but for the second was only 70% on average. A push to raise awareness of the need for vaccination and boost take-up rates would be made before the start of the new academic term in September, as the arrival of large numbers of new students at universities and colleges often brought a rise in cases. GPs were also offering a catch-up service for those who had not received both doses.        

Air quality – work was continuing on air quality and Public Health England had  ...  view the full minutes text for item 43.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, giving an overview of service delivery.  The committee is invited to comment on and endorse the progress made and the ongoing activity to deliver continuous improvement. 

Mrs V Tovey, 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)    it would be possible to make available information about which schools had taken part in healthcare marketing events;

b)    parents would be invited to attend appointments about their child’s needs, as relevant, so support could be offered for the whole family;  

c)    a key point which had emerged from engagement work was the issue of how the service could engage with children who had been excluded from school. A dedicated outreach team sought to encourage them, and children at special schools, to access the service, and having a single point of access would help with this; 

d)    use of the evidence-based Lancaster model, described in the report, was not mandatory, but completion in school time and running workshops had proved beneficial to encourage uptake;

e)    although the range of services covered within the current contract did not specifically mention gambling addiction, young people could seek help with any issue. The school nursing service could help by signposting;

f)     Mrs Tovey undertook to share further details of the equity work completed for areas of deprivation and from the Health Challenges group with Members outside the meeting. Mr Scott-Clark added that the Public Health Observatory was undertaking some work to see if the service was meeting the needs of those in the most deprived areas, and data suggested that the most needy did indeed received the most service;

g)    achieving timely access to services was important.  Kent’s target was 12 weeks for Tier 2 and referrals for Tier 1 were commonly seen within 4 weeks. The single point of access offered a triage service which could fast-track urgent cases; and

h)    one of the services with which school nursing teams worked was the bladder and bowel service.  There were many reasons why children and young people could experience continence issues, and case study 2 in Appendix 4 of the report referred to continence issues.

2.         It was RESOLVED that the progress made to transform services and ongoing activities to deliver continuous improvement be noted and endorsed.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out recent work on health inequalities and plans to develop a new strategy to address health inequalities in Kent, incorporating a new health inequalities framework which is due to be published by Public Health England in the near future. The committee is asked to comment on and endorse the contents of the report.

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

a)    variations in life expectancy were now widening where they had previously been narrowing.  Data to show the pattern across the county had been used as the basis of an action plan, and areas of high variance, for example, Swale, would be used to pilot work to address health inequalities;

b)    one issue which must surely contribute to health inequalities in Kent was the practice of London boroughs of resettling high numbers of families in Kent, which placed a strain on local services. Dr Duggal agreed that a whole-system approach was needed, with links between services and the Government taking a leading role, although it would take a long time to address the issues currently facing Kent.  The NHS 10-year plan included a section addressing health inequalities experienced by specific sections of the community, for example, travellers and those with learning disabilities; and

c)    the list of areas for action drawn up by Michael Marmot, which were set out in the report, included improving access to healthy foods, but access to projects such as the summer kitchen, which encouraged children to prepare and eat healthy foods in the long school holidays, were not helped by the availability of local bus services. Dr Duggal pointed out that work was ongoing to tackle the placing of fast food outlets, particularly near schools, and Mr Scott-Clark added that, by 2021, all primary care networks would need to have an action plan to address health inequalities, and this would bring an opportunity to address such issues.

2.    It was RESOLVED that:-

a)    the content of the report be endorsed and Members’ comments, set out above, be noted; and

b)    further reports on the progress of work to address health inequalities be presented to future meetings of the Cabinet Committee.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out work across Kent County Council to encourage activity and the use of green spaces for physical activity, which the committee is asked to comment on and endorse.

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

a)    the use of sensory rooms as a space in which office staff could take  a break from their desks and computer screens was a new idea and would be investigated as part of ongoing work;  

b)    the promotion of cycling among school children, to reduce car journeys to school, was being supported by an initiative run by the Growth, Environment and Transport directorate and could be supported by the public health team.  The use of good quality second-hand bikes would also make the point to young people that not everything needed to be new to be good, and learning how to repair and restore an old bike could be a rewarding project for a young person;

c)    the perception of there being green space was as important as the space itself; having a view from a window was important. Mr Scott-Clark added that there was a recognised ‘hierarchy’ of healthy environments in which to take exercise, with ‘blue space’ (for example, walking near the sea or a lake) being first, forests second, green space third and urban environments fourth. Visiting a gym was still helpful as a way of improving fitness but spending time out of doors was more beneficial for a person’s mental and general health; and

d)    it was important to be realistic, however, about people’s ability to travel to and exercise in coastal or rural areas. Some people could not afford transport or were physically unable to travel to and access such places. People would do as much as they could to increase healthy activity but it had to be a matter of personal choice and personal capability. 

2.         It was RESOLVED that the information set out in the report be noted and that Members’ comments, set out above, be taken into account.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, giving an update on how the Six Ways to Wellbeing tool is currently being used. The committee is asked to comment on and endorse the progress made and comment on and suggest ways to strengthen future delivery.

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

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

a)    the Six Ways tool was intended for use as the basis for starting a conversation about wellbeing and how behaviours and actions could affect mental health.  Most of the Six Ways encouraged some form of engagement with a person’s environment and community. The headings were purposefully broad to encourage individual interpretation;

b)    a view was expressed that many people in deprived areas would have many more pressing concerns, like unemployment and debt. People in deprived areas simply would not relate to the headings.   Ms Mookherjee advised that the Six Ways tool was not intended to replace any other sort of support or advice on other issues, for example, debt, but was intended as a way of starting to address emotional issues which might otherwise lead to anxiety and depression;

c)    another speaker added that starting to address bigger issues in small daily doses was a good way forward. Projects supported by healthy living centres included a café, allotments, volunteering groups and training courses. These were all positive, useful ways of opening people’s minds to other ways of living. Ms Mookherjee agreed that connecting to others and starting to acknowledge and talk about mental health was a key starting point;

d)    Kent has added the sixth way, ‘care for the planet’, and this was welcomed. Connecting to other people to improve the local environment, for example by maintaining a local traffic roundabout or verges, would benefit society as well as the individual undertaking the activity; 

e)    the committee had been asked to suggest ways to strengthen future delivery, and one way to strengthen the connection would be to connect via community food banks, and for people whose only companion was a dog to connect daily with other local dog walkers; and

f)     asked if district and borough councils were linked in to the Six Ways tool, for example, in their community development programmes, Ms Mookherjee advised that local connections would be tailored to suit local projects.

2.            The Cabinet Member, Mr Gibbens, thanked members for their comments and suggestions and emphasised that the themes contained in the Six Ways were helpful as a basis for developing other ideas.  Ms Mookherjee added that people to whom she had spoken about the tool had understood it and its purpose.

3.            It was RESOLVED that the progress made on the Six Ways to Wellbeing be noted and endorsed, and Members’ suggestions for ways of strengthening future delivery be taking into account in future work.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out performance against key performance indicators and proposed amendments to four of the targets for 2019/20, to reflect changes in delivery mechanisms.  The committee is asked to note and comment on the performance and the proposed changes.

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

It was RESOLVED that the performance of Public Health-commissioned services in quarter 3 of 2018/19, and the proposed target changes for 2019/20, be noted.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out a review of recent campaign activity and details the future plans for Release the Pressure. The committee is asked to note progress and suggest ways to strengthen future delivery.

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

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

a)    asked how Release the Pressure compared to the service offered by the Samaritans, Ms Mookherjee advised that the latter were trained to listen but not offer advice or seek to intervene, whereas Release the Pressure would actively link callers to sources of further help.  Both services, however, shared the key principal of being non-judgemental;

b)    asked what support the County Council offered its own staff to cope with mental health problems, Ms Mookherjee advised that online training and e.learning were available. This training was provided free to users and was available also to district and borough councils.  Mr Scott-Clark added that discussion was going on with Corporate Directors to address mental health issues;

c)    work was going on among a number of agencies to find ways of encouraging discussion of mental health issues and ways of directing people to find help, for example, patients visiting their GP with mental health issues would need to have a co-ordinated programme of follow-up counselling and medication;

d)    the promotional material for Release the Pressure was praised, and had been noticed in a variety of locations, including the foyer of Sessions House;

e)    any contact made with Release the Pressure would remain confidential, in common with any frontline service, unless the patient was judged to be at direct risk of harming themselves or others. This was good clinical practice and was standard for any mental health service. Links and referrals made to other services would be made with the patient’s permission and only after they had had the purpose of the referral clearly explained to them;

f)     it was suggested that a link be made to housing associations and to the armed forces, to reach ex-servicemen and women re-entering civilian life, and Ms Mookherjee advised that good links were already in place with the armed forces and would shortly be established with district council homelessness teams. The police force was also very supportive of work to promote and protect good mental health;

g)    it was suggested that promotional material be displayed in all shopping centres, and the logo and a contact number could also be displayed on vehicles used by highways staff and community wardens, who visited every part of the county.  Ms Mookherjee added that discussions were going on to display promotional material in libraries, and also to promote it to the many contractors who visited council premises;

h)    a comment was made that the telephone number for Release the Pressure - 0800 107 0160 - wasn’t as easy to remember as the Samaritans’ number - 116 123 – but, like the Samaritans’, was free to call;

i)     a view was expressed that some people making their first contact with the service might prefer to do this by text rather than by having a conversation, while others would prefer to hear a  ...  view the full minutes text for item 49.

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

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