Agenda and minutes

The Committee is asked to note the Membership as published on the agenda front sheet.

The following was noted by the clerk:

• Mr Cole had been appointed as the West Kent representative from Sevenoaks District Council. His KCC position would be filled by Mrs Cole.
• There remained three district and borough vacancies.
• Mr Streatfeild was the new Liberal Democrat Group member.
• The Conservative Group had one vacancy.

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.

Mr Cole declared that he was a district representative of the Dartford, Gravesham and Swanley and West Kent Integrated Care Boards forums.  

It was noted that the approval of the minutes from the 28 March 2023 was missing from the draft minutes and that the clerk would include this. 

RESOLVED that the minutes from the meeting held on 10 May 2023, subject to the amendment above, were a correct record and they be signed by the Chair.

In attendance for this item: Serena Gilbert, Interim Managing Director, Kent and Medway Cancer Alliance

1. The Chair welcomed the guest and, with the report taken as read, Ms Gilbert welcomed any questions from the Committee.  
2. A Member asked if more granular data could be provided than that which was found in the report. Ms Gilbert said it was possible to present the data at Trust and Tumour site level which would provide insights on specific cancers. But it was noted that national standards applied to all cancer types no matter the rate of growth. The Member followed up and asked if there were any cancer types that experienced under or late detection and required additional focus. Ms Gilbert said that lung cancer was an area of focus as the longer waits were associated with worse outcomes, even when meeting the national standard. In Kent and Medway, the Lung Health Check Programme had been launched, which invited those at risk to attend a one-off screening to help with early diagnosis. 
3. A Member asked how long those who fell outside the target wait time were expected to wait. Ms Gilbert said there was no additional target wait time, but that efforts would be focussed on making accessible appointments for them. It was noted many of those not seen within the target wait time were because they were unable to make any of the times offered. The number of referrals had greatly increased post-pandemic, but despite the increased pressure on the service, there were efforts being made to see all patients within a reasonable time. 
4. Asked by a Member what preventative work was underway, Ms Gilbert said there were proactive screening programmes, outreach campaigns to raise awareness as well as plans being considered by the Integrated Care Board (ICB) on diet, health and exercise. The Chair asked if prevention advice could be circulated to Council Members after the meeting so that it could be shares with local communities. 
5. A Member asked about the underperformance against the target of ‘maximum 31 days for subsequent treatment where the treatment is radiotherapy’. Ms Gilbert said this was an ongoing area of concern. An external company had audited all oncology (and immunotherapy) services and the ICB were in the process of reviewing the recommendations. Capacity was noted as a key reason, with a recruitment drive for staff to provide radiotherapy ongoing. The Cancer Alliance had also funded administrative roles to assist with non-clinical work. Ms Gilbert noted that whilst there was no deadline in place to achieve the expected targets, she would share the timeline after the meeting. 
6. It was said that work was ongoing between the Cancer Alliance and GP surgeries to address the backlog in cases since the pandemic and ensure the most urgent cases were identified and addressed. More data was being provided to GPs to see how they were performing against national averages. 
7. Members questioned the apparent lack of flexibility in patient communication, with post being the most common method of receiving information  ...  view the full minutes text for item 127.

In attendance for this item: Justin Chisnall, Director of Patient Pathways, NHS Kent and Medway.

1. The Chair welcomed the guest and asked Mr Chisnall to introduce his report and provide any updates since its publication. Mr Chisnall said there were no further updates and welcomed any questions from the committee. 
2. Recognising the importance of full integration between acute NHS providers, Adult Social Care and the voluntary sector, the Chair asked how the procurement would achieve that. Mr Chisnall explained the proposal from the ICB was for the establishment of transformation boards, bringing together partners to develop a programme of integration together. For that reason, contracts awarded on 1 April 2024 would be on the same terms as the current contracts. Mr Chisnall explained that strategic expectations would be developed for the transformation by way of a prospectus. Whilst these would align objectives to ensure  strategic continuity across Kent and Medway, it was also important to reflect the needs at place level. It was confirmed that the prospectus on the expectations for the transformation boards would be ready to be circulated prior to HOSC’s briefing about  hospital discharge on 28 September 2023.
3. A Member asked about social prescribing interventions going forward. Mr Chisnall said that social value provisions of the providers would be considered as the contract progresses. Part of the transformation partnership processes would be to offer services beyond the traditional NHS model and work with the voluntary sector. It was noted that workforce issues remained a challenge going forward. 
4. Asked if social prescribing interventions offered by voluntary organisations were integrated with GPs, and what level of communication was there between these services. Mr Chisnall noted a social prescribing strategy had recently been completed across Kent and Medway. He said that currently there were different processes in different areas but that the strategy would simplify this going forward. 
5. Mr Chisnall provided further details on the communications and engagement plan. It was noted that during the continuity stage, there would be engagement with the public to inform the developmental process and will draw on past work from CCGs?. There would be a link with Healthwatch to help inform governance and programme management and effectively engage with the public going forward.  
6. Asked if there would be a single provider and what impact this would have. Mr Chisnall said no prejudgment on future providers would be made before the procurement process. The procurement would commence upon the expiration of the 3 contracts, bidders would have to demonstrate the ability to deliver continuity and how they would work in partnership with stakeholders currently in the system along with a track record of joint working across Kent and Medway as well as other areas. 
7. A Member asked if there was enough time for a full recommissioning by March 2024. Mr Chisnall acknowledged there was insufficient time for a full consultation in that time, but that was one of the reasons the procurement would be for a continuity of service, rather than substantial change. He accepted  ...  view the full minutes text for item 128.

In attendance for this item: Sukh Singh, Director of Primary Care, NHS Kent and Medway, Dr Ash Peshen, Deputy Medical Director, NHS Kent and Medway and Dr Jack Jacobs from the Local Medical Committee.

1.    The Chair welcomed the guests, who confirmed there were no updates to provide since publication of the report. 

2.    The Chair welcomed that GP appointments were up 7% compared to pre-pandemic levels along with the continued recruitment drive within GP practices. Mr Singh explained that the increased workforce numbers reflected the appointment to new roles within general practices and across the wider workforce. The Chair asked if the numbers on the entire workforce cohort across Kent and Medway were available, Mr Singh said this could be shared after the meeting. 

3.    A Member raised a point on the accessibility of GP appointments, especially face-to-face appointments. Concern was expressed that e-consult and digital offerings were too difficult for many to access leaving them no option but to try A&E or other avenues. The Member asked if the nature of GP contracts (i.e. private suppliers as opposed to employed by the NHS) was a reason for the inaccessibility of primary care services for many, and would further integration with the NHS help to resolve this and make GPs more customer focussed. Dr Peshen responded that GPs must move from their traditional model and take advantage of the opportunities presented by technological advances. There were three aspirations:

3.1. Good, consistent access to services - recognising the different needs of patients requiring ‘transactional’ or continued care. Dr Peshan cited the widening role of pharmacists in treating patients as well as the potential for ‘access hubs’ to reduce the burden of transactional care on GPs.

3.2. Proactive care, including social prescribing.

3.3. Prevention

4.    Addressing a question around poorly performing surgeries, Mr Singh explained that action plans were developed alongside the ICB teams when the Care Quality Commission (CQC) rated a surgery as inadequate or requiring improvement. There was also a proactive GP Support Improvement Programme which helped prevent GPs from getting to the stage of CQC intervention. There was a need to better understand demand so that plans could be put in place to address that demand. 

5.    Concern was expressed over the difficulty to recruit salaried GPs, could more be encouraged to join a partnership rather than on locum contracts.

6.    Responding to a concern about the apparent difficulty in contacting GP surgeries over the phone, Mr Singh said that work was ongoing with practices to implement a call-back functionality. Members were also concerned about the role of receptionists in determining whether a patient saw their GP. Dr Jacobs noted that receptionists were hard working professionals who  operated in a challenging environment and often faced verbal abuse from patients. Mr Singh noted that the ICB offered a training programme for receptionists. It was important to provide them with support so that they have what they need to fully provide their service to patients. 

7.    Members  ...  view the full minutes text for item 129.

In attendance for this item: Martin Riley, Managing Director of Medway Community Healthcare and Steve Reipond, Director for UEC and System Flow, Medway & Swale Health and Care Partnership 

1.    The Chair introduced the guests invited them to introduce the paper. 

2.    Mr Riley and Mr Reipond said that following an internal report, the ICB had commissioned an external audit of three sites. A final report was expected by the end of July which would inform the next steps. It was also noted that the Minster-in-Sheppey ward went live in January 2023, which had been later than planned. The acute community ward offered 22 beds, for acute care in the community with consultant cover during the working week and regular clinics. Eligible patients were referred to the ward by the local acute hospital allowing care to be provided closer to home. 

3.    The Chair asked about the walk-in centre at Sheppey and if the reconfiguration would make access harder for patients. In response, Mr Riley and Mr Reipond said that the audit would provide insights into the level of demand and there would also be work undertaken with patients to improve their primary care offer.

RESOLVED to

      i.         note the report and

     ii.         an update be provided at the appropriate time on progress made. 

In attendance for this item: Taps Mutakati, Director for Strategic Change, NHS Kent and Medway, Sara Warner, Engagement Lead, NHS Kent and Medway, Rachel Bulman, Project Manager, NHS Kent and Medway, Cheryl Lee, Service Manager, KMPT, Louise Clack, Programme Director, NHS Kent and Medway and Philip Hall, Project Manager, NHS Kent and Medway.

1. The Chair noted that the Committee had already declared the proposal a substantial variation of service. The Decision Making Business Case (DMBC) would go to the ICB in September for approval, and the meeting presented the final opportunity for the committee to make formal comments on the proposal for inclusion in the DMBC.  
2. A Member asked for further details of what mitigations had been put in place to prevent a single site from becoming a single point of failure. In response, Ms Bulman said that the interior would be designed to ensure that each suite was capable of being individually isolated to allow the remaining suites to stay open. Lessons had been learnt from a site in Maudsley on how to prevent the whole building from being shut down and that the structure and physical environment was an important means of ensuring this. It was noted there would be a robust escalation and de-escalation area.
3. The Chair requested that HOSC’s concerns over the risk of the single site of failure be documented in the DMBC. The Chair requested images of the Maudsley site at the next discussion on 5 October 2023. 
4. A Member asked if the public consultation results had been published and how many people were involved. It was confirmed that the consultation would be published imminently. 490 people had direct involvement and 230 took part in interviews, focus groups and small discussions. There was also a workshop with the partnership and a large-scale conference on health and welfare in Dartford. 59 people took part in an online survey. It was noted that overall, the response was felt to be very strong for a small and focussed service. The Chair asked that a link to the published results be circulated. 
5. The Chair invited the guests to return to the next meeting in October with the decision of the ICB.

RESOLVED that the Committee note the report and request their concerns over a single site becoming a single site of failure be recorded in the DMBC.

1. A Member asked that a follow on the Primary Care item be scheduled for Q1 2024. 
2. RESOLVED the Work Programme was noted and agreed.