Agenda and minutes

Health Reform and Public Health Cabinet Committee - Friday, 6th March, 2020 10.00 am

Venue: Council Chamber, Sessions House, County Hall, Maidstone. View directions

Contact: Theresa Grayell  03000 416172


No. Item



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The committee noted that:-


a)    Mr M J Northey had joined the Committee to fill the long-standing Conservative vacancy; and


b)    since publishing the agenda, Ms E Dawson had left the committee and formal notice has been given by the Leader, via the Whip, that the Conservative membership of the committee had been reduced by one, to 9 Members. 



Apologies and Substitutes

To receive apologies for absence and notification of any substitutes present

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Apologies for absence had been received from Mr D Butler, Mrs L Game, Mr S J G Koowaree and Ms D Marsh.


Mr M J Angell was present as a substitute for Mrs Game, and Mr I S Chittenden as a substitute for Mr Koowaree.


The Chairman recorded his and the committee’s best wishes to Mr Koowaree for a quick recovery to full health. 



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

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There were no declarations of interest.


Minutes of the meeting held on 14 January 2020 pdf icon PDF 303 KB

To consider and approve the minutes as a correct record.

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It was RESOLVED that the minutes of the meeting held on 14 January 2020 are correctly recorded and they be signed by the Chairman. There were no matters arising.



Verbal updates by Cabinet Member and Director pdf icon PDF 191 KB

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


Launch of “Beside You” online resource for infant feeding – this was a service delivered by Kent and Medway in partnership with the midwifery service, PSB Breastfeeding and the La Leche League, aiming to support mothers who wished to breastfeed for as long as possible, and to raise awareness of issues around breastfeeding in public. The project would seek to make optimum use of social media. 

Attendance at Public Health Commissioning Team meeting – this covered campaign work and monitoring of the effectiveness of past work. The main area of investment was with the Kent Community Health NHS Foundation Trust (KCHFT), with whom the County Council had several large contracts totalling some £37.5m.  The inclusion of young people in the commissioning team was encouraging to see as good healthy habits were best established when young and young people could encourage their peers. The visit had also included a session on postural stability, which had been most interesting. 

Public Health campaigns – good communications were vital to achieving effective campaigning, and social media was used extensively. National guidance on how to deal with the Coronavirus would be shared with all Members, so they in turn could share it with their local communities.

Public Health champions – those who championed public health issues in their local communities were celebrated and had been presented with certificates to thank them for their work in spreading positive health messages and encouraging others to take responsibility for their own health. Mrs Bell recorded her thanks to the county council staff who had taken part in this initiative. 


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


Public Health Budget 2020/2021 – he had expected to be able to report this by now but the figure had yet to be announced by the Government. It was hoped that this would become clear in the budget announcement on 11 March. Providers had been advised that, to ensure continuity of service provision, the previous year’s budget arrangements would be rolled over until the new budget was known.   

Kent Association of Local Councils Health and Wellbeing Conference – this event had demonstrated that there was much energy and enthusiasm among parish and town councils to support health and wellbeing issues and to work with the County Council to deliver initiatives. It had been suggested that the Kent Association of Local Councils could have a seat on the Health and Wellbeing Board.

COVID-19 (Coronavirus) – on 2 March he had written, setting out the latest public health advice on coronavirus, to all County Council Members, to district and parish councils, via the Kent Association of Local Councils, and to Kent MPs. Guidance and information to the public was changing daily, to reflect the unfolding situation as cases of coronavirus were confirmed; as the future spread was unknown, a dynamic response needed to  ...  view the full minutes text for item 94.


Contract Monitoring Report - One You Kent (Adult Healthy Lifestyle service) pdf icon PDF 382 KB

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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)      the One You programme was seeking to change people’s behaviours in a sustainable way. Many goals would be long-term, for example, smoking. Some people continued to smoke even during a stay in hospital, surely an ideal place to be encouraged to give up. Mrs Tovey advised that pharmaceutical therapies were prescribed to inpatients to help them quit smoking while in hospital;


b)      asked about vaping being advocated as a safer alternative to smoking, Mr Scott-Clark clarified that vaping was only suggested as a step-down as part of a route to quitting, not as a long-term alternative to smoking.  Although vaping was known to be much less harmful than smoking, its use was still an area of concern and something to be addressed as an addiction;


c)      concern was expressed at the number of young people smoking, and the need for education programmes at schools to be frank in setting out the dangers and antisocial nature of smoking. The Chairman suggested that children be shown a comparison between a healthy lung and a smoker’s lung, and have emphasised to them how unpleasant a smoker’s breath, hair and clothes would smell;


d)      Mr Scott-Clark commented that an effective way to get young people to stop smoking was to get their parents to stop smoking. He reassured the committee that vaping was not known to be used by young people as a route into smoking. Mrs Tovey added that measures to make smoking less normal, for example, smoke-free school gates, aimed to help encourage parents to quit smoking;


e)      a view was expressed that young people may not follow the lead of their parents in giving up; young people tended more to rebel against what their parents did and wanted them to do. It might be possible to channel this rebellious nature in some way to support anti-smoking campaigns. Mrs Tovey advised that selling cigarettes in plain packaging had had an effect on the number of young people buying them, and that young people who had given up and were enthusiastic about not smoking could be used to advocate among their friends;   


f)       using psychology with the public rather than lecturing them could have a greater impact, for example, in campaigns such a ‘what the bump’, about smoking during pregnancy.  It was important to consider that parenthood started not at birth but at conception, and both parents should start to look after their health before considering parenthood. Mrs Tovey added that, via digital and services and the health visitor and midwifery services, expectant parents would be supported through pregnancy to make healthy changes to their life style;


g)      the dangers of passive smoking were still a concern, as was the danger of those giving up smoking adopting potentially more damaging habits instead. Asked about the number of hardcore smokers who resisted giving  ...  view the full minutes text for item 95.


Risk Management: Health Reform and Public Health pdf icon PDF 214 KB

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1.            The Chairman asked Members if, as there had already been much discussion of the risks in the public health work area in previous items, they were happy to forego any discussion of this item and refer any questions of detail to Mr Scott-Clark via email.  Members agreed that they were happy to do this and it was RESOLVED that the risks presented be noted.



Health Inequalities in Kent pdf icon PDF 1019 KB

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1.            Dr Duggal introduced the report and added that, since the report had been published with the agenda, the Marmot report had been published, advocating the use of the population intervention triangle method. For men in Kent, there was an average of 6.5 years’ difference in life expectancy between the most and least wealthy, and for women, an average of 4.2 years’ difference. Measures to address health inequalities were included in the prevention work stream of the sustainability and transformation programme.


2.                  Asked what could be done to address areas of the county in which health inequalities were higher than the average, for example, Sheppey, which had an average of 10 years’ difference, and Thanet, which, in Margate and Cliftonville, had the highest rate of deaths in under-75s as well as a range of problems around poor quality and contaminated housing and access to GP services, Dr Duggal advised that the range of issues presented in Thanet required a multi-disciplinary approach, including the district council housing provider and the health visiting service, working with local residents’ groups. Mr Scott-Clark added that a working party would be set up to address health inequalities, and this would include NHS and district council partners. He undertook to liaise with the Chairman and local Thanet Members to address the issues presented in Margate and Cliftonville, but reminded Members that other areas of Kent also experienced similar issues and deprivation. Members asked to have regular feedback reports on the progress of this work and Mr Scott-Clark undertook to report back to future meetings. He also offered to respond in writing to any further questions Members had about the subject. 


3.                       It was RESOLVED that the information set out in the report and given in response to questions be noted, with thanks.




Illicit Tobacco in Kent pdf icon PDF 233 KB

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Ms D Smith, Public Health Specialist, was in attendance for this item


1.                  Ms Smith introduced the report and summarised the progress of the campaign to address the illicit supply of tobacco in Kent. She responded to comments and questions from the committee, including the following:-  


a)      asked if imported cigarettes would automatically be checked to see if they were counterfeit, Ms Smith explained that counterfeit and imported cigarettes shared some risks in that neither was regulated in terms if content and safety. Some non-regulated cigarettes presented a fire risk as they would not auto-extinguish and their presence in the market undermined the authorised tobacco industry as well as depriving the Government of tax which would be payable by legitimate producers. As tax on cigarettes rose, there was a risk that users would switch to using cheaper, counterfeit cigarettes;


b)      asked how people would know how and where to obtain illicit tobacco, Ms Smith explained that Kent was unique, compared to the rest of the UK, in having known shops where it could be bought.  Public health was working with trading standards partners to monitor and tackle sales of cigarettes to under-age children and to issue Closure Orders to offending premises. However, such activity took time to organise and offenders would use their contacts to re-stock and resume sales by some other means, with plenty of willing customers for their cheap products;


c)      asked if counterfeit cigarettes were produced exclusively outside the UK, Ms Smith undertook to look into and advise Members outside the meeting but advised that many were known to be imported from Eastern Europe; and


d)      asked what penalty would be handed to people caught importing illicit tobacco, and if penalties could be more obviously advertised to deter offenders, Ms Smith advised that penalties were mainly financial.  She undertook to liaise with trading standards partners to explore what more could be done to publicise penalties. 


2.                  It was RESOLVED that the information set out in the report and given in response to questions be noted, with thanks, and the progress of work so far to address the illicit supply of tobacco in Kent be endorsed.



Suicide Prevention Programme update pdf icon PDF 796 KB

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


1.                  Mr Woodhouse introduced the report and highlighted the following:-

·         Suicide rates in Kent and Medway had fallen consistently since 2014 and latest figures, including 2018 data, showed that Kent was now close to the national average rate. However, the 130 cases a year was 130 too many.


·         Research had identified the main motivators – debt, domestic abuse, deprivation, family breakdown, social isolation, etc – and work with a wide range of partners would seek to mitigate these factors and provide access to support.


·         Kent’s current 5-year Suicide Prevention Strategy would be reviewed in 2020 and the revised document would give greater emphasis to the support which was available and successes which had been achieved, for example, the lowering of suicide rates, set out above. Members would have an opportunity to comment on the new draft strategy and would be asked to help promote it, once published.


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


a)      asked to what extent people’s debt problems could be linked specifically to the introduction of Universal Credit, Mr Woodhouse acknowledged that debt was a feature in suicidal ideation but it was unclear how much debt was related to Universal Credit rather than issues such as gambling, family breakdown or housing;


b)      the reduction in the number of suicides in Kent was welcomed, and the importance to mental health of having access to open green space, either private or public, was emphasised. Feeling unable to access or even see green space, or the perception that one did not have access, seemed a small issue but could have a large impact on people’s mental wellbeing; and


c)      asked where suicide prevention work would access sufficient funding if the public health grant were to be reduced, Mr Woodhouse explained that Kent had been one of eight pilot areas to receive dedicated funding from NHS England, initially for two years but then for a third year, and this funding would now be moved on to benefit other areas of the UK.


3.                  It was RESOLVED that the information set out in the report and given in response to comments and questions be noted, with thanks, and the progress made in reducing suicides in Kent be welcomed.




Kent and Medway Care Record (KMCR) Update pdf icon PDF 222 KB

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Mrs R Spore, Director of Infrastructure, and Mr A Day, Technology Commissioning and Strategy Manager, were in attendance for this item.


1.                  Mrs Spore introduced the report and explained that local authorities had been required to develop a method of sharing health and social care data in the best way to meet the requirement to share data under the Health and Social Care Act 2012, and the development of the Kent and Medway Care Record (KMCR) was Kent’s response to this need, as part of the NHSE Local Health and Care Record programme. Development of the KMCR had offered a way to review and improve the way in which client data was accessed, and to improve care outcomes and productivity. The procurement process had been completed in 2019, with Graphnet being the chosen provider.


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


a)      asked how data would be safeguarded from any unauthorised access or use, for example, commercial use by insurance companies, Mr Day advised that a key feature of the information governance was a checklist of safety measures.  The data would be stored in a secure cloud, rather than web, environment and would be encrypted in transit. Only those authorised to use it would be able to access it;


b)      asked about a data sharing programme established by the NHS about ten years ago, which had not worked successfully as the IT systems of the different NHS organisations had proved to be incompatible, Mr Day advised that, although there was some element of risk in any shared system, ensuring that data systems would join up successfully had been a priority. What was being proposed for Kent was already working well elsewhere in the UK. When a patient was away from home, anyone treating them, including paramedics and multi-disciplinary teams, would be able to see, in real time, at least a summary care record. The extent of the information able to be accessed would be increased in the future;


c)      Members sought to be reassured about what would happen to a patient’s data once it was sent to another organisation, and that it would be safe there. Use or misuse of a patient’s health records raised similar concerns to those related to the use or misuse of a person’s bank records.  Mr Day explained that potential users of the data would be required to meet Government cybersecurity standards before they would be able to access it, and must have a system which had been certificated as suitable for use with health data.  This would mean the new KMCR would be better than any sharing systems tried previously;


d)      asked what access a patient would be able to have to their own records, and to what extent they would know who was sharing that data, Mr Day explained that a patient would be able to access their data via an NHS app and would be able to update their own data, for example, by  ...  view the full minutes text for item 100.


Work Programme 2020/21 pdf icon PDF 109 KB

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The committee discussed its planned work programme in an agenda setting session after the main meeting.