Agenda and minutes

Health Reform and Public Health Cabinet Committee
Tuesday, 15th January, 2019 9.00 am

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

Contact: Theresa Grayell  03000 416172

Webcast: View the webcast

Items
No. Item

16.

Apologies and Substitutes

To receive apologies for absence and notification of any substitutes present

Additional documents:

Minutes:

Apologies for absence had been received from Mr A Cook and Mrs L Game. 

 

Mr R J Thomas was present as a substitute for Mr Cook and Mr M J Northey as a substitute for Mrs Game.

 

The Director of Public Health, Mr A Scott-Clark, was also unable to attend and was represented by the Deputy Director, Dr A Duggal.  

 

 

17.

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 it refers and the nature of the interest being declared

Additional documents:

Minutes:

The Chairman, Mr G Lymer, declared that he was a member of the Macmillan Cancer Backup Committee and a cancer backup team operated by the NHS.    

18.

Minutes of the meeting held on 22 November 2018 pdf icon PDF 158 KB

To consider and approve the minutes as a correct record.

Additional documents:

Minutes:

It was RESOLVED that the minutes of the meeting held on 22 November 2018 are correctly recorded and they be signed by the Chairman. There were no matters arising.

19.

Verbal updates by Cabinet Members and Director pdf icon PDF 49 KB

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.

Additional documents:

Minutes:

Mrs V Tovey, Senior Commissioning Manager, and Ms S Bennett, Consultant in Public Health, were in attendance for this item.

 

1.            The Cabinet Member for Adult Social Care and Public Health, Mr G K Gibbens, referred the committee to the contract monitoring report on the Health Visiting service which had been considered at the 22 November meeting but for which Members had had no time to ask questions. He summarised briefly that the report had set out the performance of the service, which was good overall, with targets for developmental reviews having been achieved, set out the innovative partnership approach of the County Council and the service provider, the Kent Community Health NHS Foundation Trust (KCHFT) and the development of the new infant feeding service. He explained that he had wanted to give Members the opportunity to ask any questions they had about the health visiting service.

 

2.            Members made the following comments:-

 

a)    concern about staffing levels, often expressed previously, was repeated, as the shortfall and vacancy levels across the whole NHS was an ongoing problem. Reassurance was sought that sufficient new staff were coming into the service and being trained to the appropriate level to support the service effectively. Mrs Tovey explained that the shortage of health visitors was a national problem as places had been cut centrally by Health Education England.  Kent was addressing the challenge in a number of ways, including development of a conversion course for existing nurses to be qualified to take on a Band 5 role within the team. She emphasised that staff being trained as health visitors were experienced nurses rather than new graduates.  Funding would be offered to help relocation costs, to encourage staff to take on a role in Kent, and incentive payments would be offered for areas where there is less demand to work and higher vacancies. These initiatives seemed so far to be working well to increase workforce capacity in addition to work to maximise public-facing time with clients, for example, by reducing staff travel time. Some health visiting services were now delivered in children’s centres and parent feedback indicates satisfaction with this approach as this would give them the chance to meet other new parents; and 

 

a)     concern was expressed that reduced funding for children’s centres would have an impact on this arrangement. Mr Gibbens clarified that there had been no cuts to children’s centres but changes had been made to the way in which they were commissioned. He emphasised that the health visiting service dealt with all families with a child under the age of five and was concerned with children’s development.  It affected no other area of health care.

 

3.            The Deputy Director of Public Health, Dr A Duggal, gave a verbal update on the following issues:-

Association of Directors of Public Health Annual Conference – this took place in early December and included a drive to encourage associate membership. All the County Council’s consultants were encouraged to become associate members. 

Public Health Ringfenced  ...  view the full minutes text for item 19.

20.

Update on Local Care pdf icon PDF 984 KB

To receive a report from the Leader and Cabinet Member for Health Reform, giving an outline of the implementation of Local Care within the Kent and Medway Sustainability and Transformation Partnership and the key areas in development and those enablers required to deliver Local Care at pace.

Additional documents:

Minutes:

Ms J Frazer, Sustainability and Transformation Programme Lead, Adult Social Care and Health, was in attendance for this item.

 

1.            The Leader, Mr P B Carter, introduced the report and highlighted the latest developments in local care in the Kent and Medway STP footprint. He chaired the Local Care Implementation Board (LCIB), for which the Government’s arrangements had recently been streamlined. The newly-constituted LCIB would meet shortly.   It was well known that, in the vision for health and social care integration and transformation, the health economy had become divided into ‘local care’ and ‘hospital care’. His focus was on local care, on which he had been tasked to work with health colleagues.  In the integration of primary care, community services and social care, the voluntary sector would have an important role to play. He had previously told the committee about efforts to secure commitment to an extra £32m of revenue resource for the local care model, hopefully rising to an extra £100m in the medium term. 

 

2.            It had been very encouraging that, on the same day on which the NHS launched its 10-year plan, the Secretary of State for Health, Matt Hancock, had alluded to his wish to see a greater proportion of the £20+bn going into the NHS being spent on local and primary care.  Mr Carter said his priority was to explore how the £32m in the current financial year would be spent, in the hope that Kent could recruit more district nurses and therapists to work with GPs.  Ms Frazer and her team had met with Kent and Medway health economy and primary care practitioners and those who delivered local care.  Mr Carter said he had been much encouraged that GPs had coalesced around more than 40 primary care networks across Kent and Medway and had bought into the concept of being supported in those networks by multi-disciplinary teams (MDTs). Within MDTs, £32m would increase trained staff to increase support for GPs in primary care networks.  Money was starting to be invested in various ways, including in care navigators to help connect patients to third sector services. He said he would like to see a workforce plan to focus on more district nurses, physiotherapists, occupational therapists and mental health practitioners in outreach work in patients’ own homes and residential and nursing homes. This coverage had been inconsistent in the past. 

 

3.            The biggest issue remained the recruitment, retention and training of staff to address the skills shortage across the health service. Having now secured extra funding, the challenge was to use it to recruit staff needed in the MDTs, including those delivering social care services.  He was keen for the Cabinet Committee to have a further report setting out how the social care aspects would sit within MDTs to facilitate triage and assessment to help patients access the services they needed as soon as possible.  The LCIB hoped to be able to identify how many patients had been able to avoid hospital admission by accessing services  ...  view the full minutes text for item 20.

21.

Contract Monitoring Report - Sexual Health Services pdf icon PDF 317 KB

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 the performance, outcomes and value for money of the sexual health services commissioned by the County Council, on which the committee is asked to comment. 

Additional documents:

Minutes:

Mrs V Tovey, Senior Commissioning Manager, and Ms W Jeffreys, Public Health Specialist, were in attendance for this item.

 

1.            Mrs Tovey introduced the report and highlighted key areas of the ongoing transformation work, which was responding to the findings of the needs assessment. This included an increased digital and online presence and a newly-awarded nine-year contract at a very good price for an online condom scheme. The County Council worked closely with NHS partners to offer integrated services and optimum choice and to achieve best value for public money.  All services were performing well against targets and feedback from users had been good.

 

2.            Mrs Tovey and Ms Jeffreys responded to comments and questions from Members, including the following:-

 

a)    young people, and in particular young women, were reported to have problems accessing sexual health services in Sheppey as the service had moved from the healthy living centre to a local hospital, which was harder to travel to. Ms Jeffreys explained that, in response to the needs of young people on the island, there had been targeted work to increase awareness in schools and colleges of the Get It programme, safe relationships and chlamydia infection for year 11 and sixth form pupils in schools, more GPs offering LARC contraceptives and pharmacies offering contraception and chlamydia treatment over the period of the current contracts. Condoms and contraception (excluding those which need oxygen therapy to be administered) were still available at the healthy living centre and condoms from other outlets.  The service was moving generally to offering more services online, following feedback from young people, although these services would be accessible by over-16s only,  with an opportunity for younger people to be able to access advice directly from the service;

 

b)    asked about charges for services provided for people living outside Kent, Mrs Tovey explained that a cross-charging policy was agreed and implemented across the south east but there was ongoing discussion  with neighbouring authorities about the level of such charges and how they would be managed.  However, she added that the proportion of out-of-county activity in Kent was currently declining;

 

c)    Ms Jeffreys explained that the figures presented in Appendix B to the report were diagnostic rates per 100,000 of the population.  Kent’s rates of syphilis whilst increasing, were following the pattern seen across England; and

 

d)    asked about Kent’s shortfall in screening rates, compared to those of its statistical neighbours, Ms Jeffreys explained that this shortfall was in the number of females  attending the integrated service for a first  appointment and taking up the offer of asymptomatic screening for  sexually-transmitted infections, an issue identified in the process of conducting the needs assessment. Specific key performance indicators would be built into the service remodel to monitor this activity.

 

3.     It was RESOLVED that:-

 

a)    the commissioning and provision of sexual health services in Kent,

 

b)    service improvement initiatives being undertaken to improve quality and outcomes, and

 

c)    progress to date on the implementation of the commissioning strategy which includes the  ...  view the full minutes text for item 21.

22.

Smoking Needs Assessment: Key Findings pdf icon PDF 162 KB

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, which sets out the approach being taken to improve health and reduce health inequalities. The committee is asked to endorse this approach and support the enhanced Smoking Plus model and the revised ambition to reduce the number of smokers in Kent by 2022.

Additional documents:

Minutes:

Ms C Mulrenan, Public Health Speciality Registrar, was in attendance for this item.

 

1.               Ms Mulrenan introduced the report and explained that, since reporting to the November meeting of the Cabinet Committee, the ambition to reduce the number of smokers in Kent had been increased from 45,000 to 58,500. Another issue which had arisen at the November meeting was the absence of chewing tobacco from the needs assessment, which, Ms Mulrenan explained, was because smoking tobacco contributed a far greater burden of ill health locally, nationally and globally.   Smoking tobacco was the biggest risk factor for ill health, far greater than chewing tobacco, so this was the focus of the needs assessment.  Ms Mulrenan undertook to supply a link for the Tobacco Dependency Needs Assessment for inclusion in the minutes of the meeting:

file://invicta.cantium.net/kccroot/users/shq/shq6/MulreC01/Desktop/Smoking%20Needs%20Assessment/Smoking%20NA%20Final/Tobacco%20Dependency%20NA%20Final%20accessible%20merged.pdf.

The Smoking Plus model presented the best chance of reaching national targets for smoking quits, together with initiatives such as smoke-free school gates, shops, prisons, etc.

 

2.               Ms Mulrenan and Dr Duggal responded to comments and questions from Members, including the following:-

 

a)  asked if sufficient information was available about people’s reasons for smoking, Ms Mulrenan explained that, although the majority of the population now understood that smoking was not a healthy choice, this knowledge would not necessarily lead to people making a healthy choice by avoiding smoking. The smoking ban in shops, pubs and workplaces in 2007 had made a difference in encouraging some people to stop smoking and it was hoped that the various smoke-free initiatives would continue to encourage quitters. Some groups resisted quitting, however, and it was known that some 30% of manual workers were smokers. It was believed that the current service model did not appeal to all groups and that the proposed three-tier model would offer alternatives to those smokers who did not wish to access traditional smoking cessation services. Dr Duggal added that more targeted work was needed to tackle pregnant women who smoked.  GPs would be sent a ‘script’ to support them in having a conversation with smokers to raise the issue of them quitting;

 

b)  concerns was expressed that, as vaping was not permitted indoors in many premises, and people were required to go outside, once outside they might then choose to smoke a cigarette instead.  If people could vape inside, more might turn to it.  Ms Mulrenan pointed out that vaping had been shown to be 95% less harmful than smoking and was a useful aid to quitting smoking. A Kent and Medway STP paper had recently been drafted in support of smoking cessation services taking an ‘e-cigarette friendly approach’ for those who wished to use e-cigarettes as a quitting aid. Dr Duggal added that Public Health England was currently lobbying the Government about vaping being permitted indoors. Vaping had not been mentioned in the 2007 smoking ban as it had not been a recognised practice at that time;

 

c)  concern was expressed that many medical staff, to whom many people would look as role  ...  view the full minutes text for item 22.

23.

Childhood Obesity pdf icon PDF 162 KB

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out an overview of childhood obesity in Kent, the services available to support families and areas of consideration for future action.  The committee is asked to endorse the work going on and agree to a further report to the committee on joint working between agencies to tackle obesity.   

Additional documents:

Minutes:

Ms S Bennett, Consultant in Public Health, was in attendance for this item.

 

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

 

a)    local initiatives sought to tackle childhood obesity, for example, the provision of bicycles so children could cycle to school, ‘fizz-free February’ to reduce sugar intake from fizzy drinks, ‘beat the street’ and the supply of vegetables to children at school, and these could be spread to other areas of the county in a co-ordinated programme;

 

b)    the County Council was committed to a programme of preventative measures to tackle childhood obesity, including those services delivered by the school public health service, which pursued a ‘whole school’ approach, including PE and active playtimes.  The Ofsted recommendation for the minimum amount of PE was two hours per week;

 

c)    asked if the school public health service included a visiting nurse who would inspect children’s teeth regularly, Ms Bennett advised that the aim of the school public health service, which was delivered by KCHFT, was to support schools to be healthier overall.  Pupils would be weighed in Reception and Year 6 and the statistics used to build on overall picture of the health of the school. The inspection of children’s teeth was not part of the service, but colleagues in Early Help were seeking to link a dentist to children’s centres to offer regular checks;

 

d)    obesity was known to exacerbate other health problems, and Ms Bennett was asked what the County Council could do to ensure that appropriate facilities were made available, for example, for children with complex needs.  Ms Bennett explained that the lack of Tier 3 services, to support people with complex needs, including social needs, was an issue on which the County Council had undertaken research to identify the level of need across the county and was lobbying the STP prevention group to increase provision;  

 

e)    the role of parents in safeguarding their children’s health was highlighted.  20% of children in Reception classes were obese, so this situation had arisen at home rather than at school; children consumed more meals at home than they did at school. Much was made of lifestyle choices but 3-year-olds did not make those choices. It was for a parent, not the state, to bring up their child. Ms Bennett advised that children’s centres gave talks to parents about healthy diet at the time when babies moved on to solid food, but engaging with parents was a challenge, generally. When a Reception-age child was weighed at school and found to be overweight, the child’s parents would receive a call from the school public health service, offering an appointment to talk and get advice about healthy eating, but this option generally had a low take-up. Some parents simply did not recognise the problem, as they had been brought up in the same poor food environment and had no better role model to offer their children;

 

f)      a comment was made that the report had  ...  view the full minutes text for item 23.

24.

Public Health Communications and Campaigns Update pdf icon PDF 94 KB

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out the recent campaigns and communications delivered through the County Council’s public health team and outlining some plans for 2019/20. Members are asked to comment on the progress and impact of campaigns in 2018/19.

 

Additional documents:

Minutes:

Ms G Smith, Campaigns and Communications Manager, was in attendance for this item.

 

1.            Dr Duggal introduced the report and explained that the public health team now included a marketing manager.  Dr Duggal and Ms Smith responded to comments and questions from Members, including the following:-

 

a)     Kent’s ‘One You’ campaign was a local incarnation of, and was linked to, the national ‘One You’ campaign and brought together many strands of activity.  More information on ‘One You’ work would be available to report to the Cabinet Committee later in the spring; and

 

b)     asked about the public health aspects of air quality, Dr Duggal advised that the Energy and Low Emissions Strategy had very recently been published and work on initiatives such as active travel were at an early stage. 

 

2.            It was RESOLVED that the progress on and impact of Public Health campaigns in 2018/19 be noted and welcomed.

25.

Performance of Public Health-commissioned services pdf icon PDF 94 KB

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out an overview of key performance indicators (KPIs) for Public Health commissioned services in the last quarter, on which the committee is asked to comment.

 

Additional documents:

Minutes:

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 2 of  2018/19 be noted and welcomed.

 

26.

Capital Programme 2019-22, Revenue Budget 2019-20 and Medium-Term Financial Plan 2019-22 pdf icon PDF 164 KB

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, setting out the draft capital and revenue budgets and Medium-Term Financial Plan, including responses to consultation and government provisional settlement. The committee is asked to note these and suggest any changes which should be made before the draft is presented to Cabinet on 28 January and full County Council on 14 February.

 

Additional documents:

Minutes:

Mrs J Blenkinsop, Finance Business Partner, and Ms K Sharp, Head of Commissioning for Public Health, were in attendance for this item.

 

It was RESOLVED that the draft capital and revenue budgets and Medium-Term Financial Plan, including responses to consultation and the Government’s provisional settlement, be noted.

 

 

27.

Work Programme 2019/20 pdf icon PDF 55 KB

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

 

Additional documents:

Minutes:

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