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  • Agenda item
  • Agenda item

    Verbal updates by Cabinet Members and Director

    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.

    Minutes:

    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 published new guidance in March 2019 which would support the work being done by the Growth, Environment and Transport directorate.  The draft Energy and Low Emissions Strategy would be considered by the Environment and Transport Cabinet Committee on 24 May, prior to being published for public consultation, which would start on 11 June and run for 12 weeks.

    Association of Directors of Public Health (ADPH) Workshop on Population Health Management and Integrated Care Systems – this sought to ensure that all those who needed a public health service were receiving it, rather than just those who requested a service. More information on this work stream would be made available to the committee at future meetings.

     

    4.            Mr Scott-Clark then responded to comments and questions from the committee, including the following:-

     

    a)    asked if there was any way to monitor what health checks universities would make, and what advice they would give to new students arriving, he advised that universities would normally advise new students to register with the medical centre on campus, at which point their health records would be transferred from their own GP.  The KCC public health team would run a promotion at the start of the new academic year to encourage students to update their vaccinations, particularly for MMR;

     

    b)    asked about what geographical gap might remain if 95% coverage were to be achieved, he advised that coverage across the county was even.  He added that much work went on to counter anti-vaccination lobbying as there was no evidence to support the assertion that the MMR vaccination was harmful in any way.  Health visitors also used their contact with parents to remind them to vaccinate their children;

     

    c)    asked how the vaccination service would cover the catching up of those who had missed vaccinations in the past, he advised that work to catch up was in addition to the ongoing vaccination programme. This presented a challenge but it was most important that as much of the population as possible had the vaccination as measles could be very serious if contracted in adulthood. Children were much more able to cope with the illness; and

     

    d)    asked about the use of social media to spread the message about vaccination, and if this was a good use of public money, he advised that, as social media was very widely used, it offered a good way of reaching a large number of people.  Messaging was sophisticated and programming could include the facility to display helpline numbers as pop-ups on screen, in the same way as that  used by advertising agencies to display material which related to users’ preferences.  Another speaker cautioned that, as young people tended to believe everything they read on social media, health messages always needed to be very carefully presented. 

     

    5.            The Leader and Cabinet Member for Health Reform, Mr P B Carter, CBE, gave a verbal update on health reform issues:

     

    6.                   Mr Carter highlighted the need to do more to articulate the significant and major changes which were going on, not just with the structure of the health service, but what this meant in terms of delivering better local care and community care. 

     

    7.                   He chaired the Local Care Implementation Board (LCIB), which was focussing on how the current changes could make a difference to patient care and patient outcomes.  Good progress was now being made and it was important to raise the profile of this work in the agenda of the Health Reform and  Public Health Cabinet Committee. He suggested that, at the committee’s 20 June meeting, it would be good to invite health partners and one or two GPs who sat on LCIB to explain how the implementation programme was progressing and set out the improved outcomes which were being sought from those changes, accepting that the workforce issue was the most major challenge. 

     

    8.                   The new structure would bring one integrated care system for the whole of the Kent and Medway area, which would be one of 43 such systems across the country, and an amalgamation of clinical commissioning groups to make one integrated care system (ICS), four integrated care partnerships (ICPs) across the county and a network of 42 - 43 primary care networks.

     

    9.                   The Sustainability and Transformation Partnership Board, at a recent meeting, looked at targets for delivering the primary care networks, and where GPs would be coalescing to make up those networks to build the health economy across the whole of the Kent and Medway area.  This would be set out at the committee’s next meeting, to raise understanding and set out the functions and purpose of the integrated care system, the integrated care partnerships and the primary care network. Federations and partnerships of GPs were coming together well, although there was still a lack of clarity around some areas.  The target date for these to be identified was the end of May 2019. An update could be made at the 20 June meeting so Members could understand the primary health and social care networks in their local areas. 

     

    10.               These networks would be serviced by multi-disciplinary teams (MDTs), made up of a combination of third sector, social care and other providers, including social prescribers, care navigators and pharmacists.  MDTs would be real rather than virtual teams, working together around GPs as a resource upon which GPs could call for support. These MDTs needed to recruit many more district nurses, physiotherapists and occupational therapists in order to be properly resourced. The primary care networks also needed to be properly resourced.

     

    11.               It was disappointing to learn that the additional investment of £23bn in local and primary care had been allocated only from 2022/23 onwards.   Funding needed to flow alongside the enthusiasm to support the MDTs and the new networks, with the appropriate resources and workforce, otherwise what had been planned and promised would not be able to come about and the public would be very disappointed.  Mr Carter was continuing his campaign to secure ongoing support for the restructure and was due to meet the Secretary of State for Heath, Matt Hancock, in the near future to seek to bring forward the promised investment and support the recruitment of a range of suitably-qualified staff, as this recruitment needed to be happening now.

     

    12.               Kent, particularly East Kent, was closer to having a primary care crisis than anywhere else in the country as it had the largest shortage of GPs. The number of GPs taking early retirement, and the resultant increasing age profile of the profession overall, was becoming a massive issue, for which there was no quick fix. This needed to be addressed alongside the establishment of the new structures.

     

    13.               With Mr Gibbens, Mr Carter had attended an MDT meeting and discussion in Canterbury, which had included a discussion of cases of patients with complex needs, including weekly updates on the care they were receiving and where more support might be needed. Discussion included the need for services, including step-down care and other care and support to help patients leave hospital and live safely at home. He had been enormously impressed with the wealth of knowledge of the professionals involved in the MDT and the power of MDTs as a model of partnership working. Discussion had also highlighted the need for more investment from the County Council on the social care side, as an integral part of the structure. He was keen to explore with Mr Gibbens, Clair Bell and Penny Southern to make sure that the County Council was doing all it could to support the development of MDTs. He would seek a major report and discussion to cover this well at the committee’s next meeting and invite health partners and possibly the third sector along to talk about how they saw it rolling out. 

     

    14.               With Mr Gibbens, he had also recently visited Red Zebra in Whitstable, a social prescribing provider, and had been very impressed with their work.

     

    15.               Recent additional funding had been announced, as part of the NHS 10-year plan, to go into primary care networks, to fund social prescribing and a GP to be a lead clinician to support social prescribing and care navigation so these could be available to GPs, when and in whatever way they need to access them. It was important to look into how this money could be used as meaningfully as possible. The third sector would need more funding overall to allow it to play a full part, for example, in social prescribing, as part of the provision of good local care. 

     

    16.         Mr Carter responded to comments and questions from the committee, including the following:-

     

    a)        asked how the local care plan fitted with local district plans, and if the County Council could help secure section106 contributions from developers to support the development of health care facilities, Mr Carter explained that developer contributions was a much broader issue, which the County Council had been seeking to address for a while.  From land values per acre, which varied greatly across the county and rose to very high values in some areas of the county, the County Council was allocated only 3% - 12 % as a contribution, to fund the related infrastructure.  What would be more helpful and realistic would be 30 – 40%.  Primary care provision was also too low down the list of priorities, behind roads and schools, which the Council had a statutory duty to provide. Primary care provision did not have this statutory status.  Developers were supportive of the Council securing a higher percentage of the land value but it would be some time before this could start to happen. Mr Carter confirmed that he would continue to promote an increased percentage contribution. Another option to help build new surgery accommodation to support the new GP networks was to seek investment from the private sector, which could fund building and lease the premises back to the health service;

     

    b)        there was much vision and optimism in the plans for the new health structures but the County Council did not have the money to achieve what it needed to do.  Recruitment of doctors, nurses and carers was vital to support the new structures but would take much money, and that money was simply not forthcoming. Medical staff would take years to train and there was no guarantee that they would stay to work in Kent once they had completed their training.  Mr Carter acknowledged this concern and explained that much of the work going on in GPs’ surgeries was to make better use of existing resources. This could be done by using the practice nurse, pharmacist, physiotherapist, etc, to see some patients who did not necessarily need to see the GP, thus allowing better use of the GP’s appointment slots. The Kent Community Health NHS Foundation Trust (KCHFT) was setting up a nursing apprenticeship which would recruit trainee nurses and pay them a salary while they worked in placements for 3 days a week and studied for 2 days a week with the Open University. Canterbury Christ Church University would also need to offer a similar work-based degree course. Things were starting to happen now, although it would have been helpful if this could have started 12 -15 years ago. The NHS 10-year plan included an aim that a greater percentage of the NHS budget would be spent on primary care and local care.  It was encouraging that many practices were exploring new ways of working, supporting the MDT model and working with the third sector, pharmacists, etc;    

     

    c)         the work to address land value issues was welcomed, and the payment of bursaries for nurses could be re-introduced to encourage more nurses to train. West Kent benefitted from London weighting for GPs while East Kent did not, which was a disincentive for people to work as GPs in East Kent. It was now almost impossible for people to get a home visit from their GP but more use could be made of skype and other modern technology to make more efficient use of GPs’ time and to allow those who found it hard to travel to a surgery to access their GP remotely. Mr Carter gave an example of the Canterbury practice which had a permanent paramedic who would travel out to see patients who had made emergency calls and to either get them into hospital or arrange for a GP to visit later in the day. This system worked very impressively and the paramedic was one of the professionals on the local MDT; and  

     

    d)      it had proved difficult for this Cabinet Committee to access information on what was happening in the health economy, so it had been most helpful to hear Mr Carter’s update.  It would be most helpful to have a presentation at the next meeting to set out more detail on the health restructuring. Clinical commissioning groups used to update districts on a regular basis on what was happening but this practice seemed to have ended. Mr Carter agreed that more information was needed and hoped that this could be rectified at the next meeting. He hoped that one of two GPs who sat on the LCIB would be able to attend and tell the committee at first-hand what was happening.

     

    17.               It was RESOLVED that the verbal updates be noted, with thanks, and that the committee’s next meeting be dedicated to integrated care issues, with input from NHS partners.

     

     

    Supporting documents: