Agenda and minutes

Mr Chard declared he was a Director of Engaging Kent.

The Chair declared he was a representative of East Kent authorities on the Integrated Care Partnership.

RESOLVED that the minutes from the meeting held on 30 November 2022 were a correct record.

This item was taken after item 5.

In attendance for this item: Vincent Badu (Chief Strategy Officer, K&M ICB) and Ellen Schwartz (Deputy Director of Public Health, KCC – virtual)

1.         Mr Badu introduced the item, explaining that the interim strategy was developed in partnership with local councils and set out how the local population’s needs would be met and how health inequalities would be reduced. It was a statutory duty to have a Strategy in place, but it was recognised that the 12-week turnaround had not allowed for significant engagement, which was now commencing. The Strategy was predicated on working together to focus on the wider determinants of health, including the prevention of poor health. Part on ongoing engagement was seeking input around how the strategy should be prioritised in local places, acknowledging that areas had different needs. A clear logic model was being followed for measuring impacts and identifying improvements achieved.

2.         The ICB was investing an annual budget of £5.4m to reduce health inequalities. The money would be delegated to Health and Care Partnerships to support the delivery of those parts of the strategy at a local level.

3.         Ms Schwartz spoke of upstream prevention throughout the life course of an individual. This involved identifying groups of people and understanding their needs and how to address any inequalities.

4.         A Member questioned whether the Strategy conflicted with KCC’s Community Services consultation. Mr Badu had not been closely involved in that programme but recognised that across the public sector there were challenges with resources. He said it was right to prioritise focus and use resources differently, whilst recognising that supporting preventative services reduced people’s need to access secondary care. A whole system approach was needed.

5.         A Member asked how the Committee could best support the strategy. They thought having a debate around priority areas could offer constructive outcomes. Mr Badu supported the idea of focussed discussions at HOSC.

6.         The Chair spoke of the importance of early engagement with HOSC about upcoming changes, whether that be an informal briefing or formal presentation at committee.

7.         Mr Badu expected the final strategy to be published in Autumn 2023. Public Health were leading on the related Local Health and Wellbeing Board plan.

8.         Dr Rickard from the Local Medical Committee raised several points:

a.         Housing developments such as Otterpool Park were referenced in the Strategy, but it was not set out how General Practice would be provided.

b.         She did not feel the Strategy adequately reflected capacity and workforce constraints, nor how those challenges would be addressed.

c.         Patient flow was mentioned in the Strategy, particularly around demand on Emergency Departments exacerbated by Primary Care and inappropriate referrals leading to full hospitals. Dr Rickard did not feel this was entirely accurate as there were capacity issues across the healthcare system, with elective backlogs and a workforce crisis all contributing. She hoped to see more detailed projections on how the Kent Medical School would alleviate workforce issues.

9.         Mr  ...  view the full minutes text for item 101.

In virtual attendance for this item: Louise Clack (Programme Director, Mental Health Urgent and Emergency Care K&M ICB), Dr Adam Kasparek (Psychiatry Liaison Consultant, Deputy Clinical Director of Acute Services, KMPT) and Matt Tee (Executive Director for Communications and Engagement, ICB)

1.         Ms Clack explained that in Summer 2022 the Kent & Medway Integrated Care System had been awarded capital funding ringfenced for safety improvements to the mental health urgent and emergency care pathway. The proposals set out in the paper were to change the current Section 136 (S136) pathway and the existing Health Based Place of Safety (HBPoS) base and estate. The changes fell under the “Kent and Medway Mental Health and Emergency Care pathway transformation programme”.

2.         Due to a tight turnaround for the submission of the bid there had been no opportunity for formal consultation. Those informally consulted included SECAMB, Kent Police and those with lived experience. The ICB were actively engaging key stakeholders and intended to take the proposal to public consultation in the near future.

3.         Members were informed there had been a reduction over time in the use of S136 suites, largely due to investment in a police advice line.

4.         The ICB wanted to reduce the amount of time service users spent in a place of safety and improve their overall experience. It was also hoped the changes set out in the report would improve the recruitment and retention of staff.

5.         A Member noted that there were currently 5 places of safety across 3 sites (2 in Maidstone, 2 in Canterbury and 1 in Dartford), and the proposal was to maintain 5 places but all at 1 Maidstone site (Priority House). Maidstone had been identified as the most suitable location due to its accessibility and affordability. Ms Clack confirmed that capital works would be required at Priority House to make room for the additional places.

6.         Asked if the Home Treatment team had the power to admit and prescribe, Dr Kasparek confirmed they did.

7.         Asked about accessibility for friends and family, it was explained that a place of safety was used for a timely assessment of need for a period of up to 24 hours (with a possible extension by 12 hours). Visiting was therefore rare and often not appropriate. The Pre-Consultation Business Case included a travel impact assessment. Under the current system, patients were taken to the HBPoS with immediate availability, regardless of where they resided.

8.         The current estate was outdated and lacking in resilience, it also did not meet recommended standards and best practice. National standards for HBPoS recommended that each suite had access to fresh air as well as offering a bedroom, a de-escalation space and access to a lounge area. Dartford and East Kent suites did not have access to fresh air and only offered one room that was not purpose built. Some service users had described the suites as worse than being in a prison cell.

9.         In terms of usage, 2  ...  view the full minutes text for item 102.

This item was taken after item 4.

In virtual attendance from NHS England for this item: Janet Meek (Regional Director of Commissioning (Specialised Services)), and Hazel Fisher (Director of Transformation and Programmes, Specialised Services).

1.         Ms Meek introduced the item, explaining that the current main Principal Treatment Centre (PTC) located at Royal Marsden Hospital did not have a Paediatric Intensive Care Unit (PICU) and therefore no longer met the standards required to host the service. The Hospital had decided to withdraw from the contract.

2.         NHS London had undertaken an options appraisal for the location of a future PTC. The shortlisted options were St George’s University Hospital and Guy’s and St Thomas’ at Evelina Children’s Hospital.

3.         The intended benefits of a relocation included better care on a single site, compliance with the standards, fewer treatment transfers and improved development opportunities for staff.

4.         Residents from a broad geography accessed the specialist services and NHS England were therefore consulting neighbouring HOSCs. The Committee were told 107 children from Kent and Medway accessed the service in 2019/20, which was a similar number to other affected counties. Both options would require travel to London, as the current location did.

5.         Ms Meek explained the NHS were entering the pre-consultation phase, scheduled for early June for a duration of 12 weeks. It was hoped there would be a decision about the new site by the end of October 2023.

6.         Asked why the data was not more recent than 2019-20, Ms Meek explained that due to the pandemic, those figures were the most accurate available. A data lake had been established pre-covid using 2019-20 data and this had been assured and validated by Trusts. Patient numbers remained fairly stable and the current numbers were not expected to have changed significantly since 2019-20. That assertion would be supported by NHS London carrying out deep dives into specific areas. The data lake exercise had been extensive and it was not felt that significant value would be added by carrying it out again so soon.

7.         A Member questioned the impact on travel and accessibility of the proposed sites. Ms Meek explained the use of shared care units which allowed children and young people to access some elements of their care closer to home. The options appraisals had included travel analysis. Ms Fisher added that public transport was not always the most appropriate option for patients and that transport and refunds for parking charges were offered where appropriate. These would be set out in the Pre-Consultation Business Case.

8.         Asked if there had been any conversations with Transport for London on behalf of those requiring regular access to care, as to whether they could be exempt from charges, Ms Meek said she would take the idea away to look into.

9.         Members asked what work had been undertaken with charities. Ms Fisher explained a stakeholder group had been established as part of the programme’s governance, and charities were represented on this. This would ensure they  ...  view the full minutes text for item 103.

1.         The final decision of NHS England Specialised Commissioning around an interim location for Vascular Services in East Kent and Medway was reported to the Kent and Medway Joint NHS Overview and Scrutiny Committee (JHOSC) in December 2022.

2.         Members of HOSC were asked to consider if they supported JHOSC’s recommendation not to refer to the Secretary of State.

3.         The Chair moved that the recommendation should be supported.

RESOLVED that the Committee endorse the recommendation of the JHOSC and support the decision of NHS England about the medium-term model of care for vascular services in East Kent and Medway.

1.         An informal briefing had been requested on this subject by the Committee.*

2.         Members of the Committee did not feel the written responses to previous questions had been adequately answered. One Member felt it supported the challenge that mental and physical health were not treated equally.

RESOLVED that the Committee consider and note the response and invite the NHS to attend with an update at an appropriate time.

*post-meeting note – the briefing was cancelled and formal attendance at the next HOSC meeting was requested.

1.         Members requested the following items be added to the Committee’s work programme:

·         Maidstone and Tunbridge Wells Trust – outcome of the investigation into the death of Tommy Kneebone to be reported in person to the Committee.

·         A further report on access to GP appointments and the broader issues associated with that. A representative of the Local Medical Committee to be invited to attend.

RESOLVED that the work programme be agreed.