Agenda and minutes

To receive apologies for absence and notification of any substitutes present

Apologies were received from Mr Kennedy, Ms Hamilton and Mr Beaney. 

1. Mr Ross proposed, and Mr Shonk seconded that Mrs Game be elected Chair of the Health Reform and Public Health Cabinet Committee. No other nominations were received. 
2. RESOLVED that Mrs Game be duly elected Chair of the Health Reform and Public Health Cabinet Committee.

1.    Mrs Cole proposed, and Mr Shonk seconded that Mr Cole be elected Vice Chair of the Health Reform and Public Health Cabinet Committee. No other nominations were received. 

2.    RESOLVED that Mr Cole be duly elected Vice Chair of the Health Reform and Public Health Cabinet Committee. 

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

There were no declarations of interest. 

To consider and approve the minutes as a correct record.

RESOLVED that the minutes of the meeting held on 11 July 2023 were correctly recorded and that a paper copy be signed by the Chair. 

1. The Cabinet Member for Adult Social Care and Health, Mr Dan Watkins, provided a verbal update on the following:

Suicide Prevention – The Hope Community Art Exhibition, where art representing hope was used to raise awareness for suicide prevention, went on a regional tour following its launch at Margate’s Turner Contemporary. The exhibition had been organised by the Kent and Medway Suicide Prevention team, local artists and community groups it had also been co-produced by those who had experienced poor mental health. After the launch in July, it had visited Maidstone, Chatham and Tunbridge Wells. The exhibition aimed to highlight the help available to anyone living with suicidal thoughts urges to self-harm or the loss of a loved one who had taken their own life. Mr Kennedy, one of the Councils mental health champions, spoke at the launch event. Mrs Bell, the former Cabinet Member for Adult Social Care and Public Health, had visited the Maidstone event. Mr Watkins then gave a list of support options provided by the Council including: 

• Release the Pressure –  Release the pressure - Kent County Council
• Live Well Kent and Medway – Welcome | Live Well Kent
• Every Mind Matters – Every Mind Matters - Kent County Council

Weather Warnings - Mr Watkins noted that a yellow heat health alert had been put in place for early September. Mr Watkins added that the alert was required as vulnerable people were at increased risk and local NHS services expected to be under increased pressure. It was said that Members were encouraged to share awareness information provided through the Councils social media channels.

Bird Flu Restrictions – Mr Watkins said that the last of the control measures in Elham, Folkstone and Hythe had been lifted, which had previously been in place since July 2023. The 10-kilometre surveillance zone, which restricted the movement of birds and bird products without special permission, had also been lifted. Mr Watkins noted that the risk of avian influenza to public health was low, but encouraged residents to help reduce its spread by not touching dead or sick birds with their bare hands and if they find one or more dead birds of prey, swans, geese, ducks or 5 or more dead gulls or wild birds of any species to report it to the Department for Environment, Food and Rural Affairs (DEFRA).  

2. Dr Ghosh provided an update on the following:

Covid-19 Update 

• Dr Ghosh noted that Public Health continued to monitor national data on the number of cases, hospital admissions and, when applicable, the number of deaths. An escalation through each data point would be a cause for concern, but that was not occurring at this time. It was said however that there had been an increase in the number of cases but was starting from a low base. In Kent, the number of cases had gone increased by 201 over the last 7-day period compared with the previous 7 days, an increase of 6.9%. 
• It was noted that the United Kingdom  ...  view the full minutes text for item 276.

Wendy Jeffreys, Consultant in Public Health, was in attendance for this item.  

1. Mr Watkins gave a brief overview of both Family Hubs – Start for Life decisions that were being presented at the meeting. It was noted that the funding was from the central government to expand the county's offer in perinatal mental health and infant feeding.  

2. Wendy Jeffreys then provided further details. The importance of early parent and infant bonding was highlighted, and the funding would be used to train and support the workforce in attachment theory, trauma-informed practice and response and parent infant relationships. There would also be measures to support cases where an intense need was required. It was said that there was a lack of local data on the level of need and work was ongoing to assess this. Nationally 15% of babies in the general population required specialised parent infant relationship interventions. It was said there would be a co-creation of a parent and infant relationship and perinatal mental health strategy which the Council did not currently have but was a Department for Education requirement. Ms Jeffreys said that this work would be implemented as part of wider children’s and young people’s strategies which were currently being developed. 

3. In response to comments and questions from Members, it was said: 

(a) A Member said that there was limited detail for the £3 million figure and how this had been calculated as it worked out at around £60 per child affected by disorganised attachment. It was asked that further detail be provided on the extent of the problem and the effectiveness of the funding. Dr Ghosh said the funding was nationally prescribed but would be used to build on work already ongoing. For context, it was noted that The Public Health grant is about £49 per person. It was said as part of the funding Public Health would continue to monitor and gain further understanding of the extent of the problem and effectiveness of the interventions. Ms Jeffries said that the extent of the need was unknown at this time, but more would be understood as the programme progressed. It was noted that this was the case nationally and not just in Kent. It was noted that the current focus would be on early interventions up to the age of 2, but in the future interventions for older children would also be considered. The Member asked that a report could come back to update on the progress and effectiveness of the programme. 

(b) A Member welcomed the report and the funding, as further research was needed in this area. It was noted that a review of how effective the interventions were would be helpful to inform future decisions. 

(c) It was recommended that a report would come back in 12 months on the progress of the programme.

(d) During the meeting it was noted that the figures in the report did not match. After the meeting, it was confirmed that the correct figure was £3,051,809. 

4. RESOLVED, subject  ...  view the full minutes text for item 277.

Wendy Jeffreys, Consultant in Public Health, was in attendance for this item. 

1. Dr Ghosh introduced the report.

2. Ms Jeffreys gave an overview of the decision. It was said that the enhanced infant feeding provision would continue to be provided by commission provider Kent Community Healthcare Foundation Trust. It was noted that the contract would be varied and the wording would be amended when the decision would be taken by the Cabinet Member. 

3. Ms Jeffreys said that the funding would enable the Council to focus on areas that had been neglected and allow greater opportunities for contact to be made with families during times when more support was required. There would also be ongoing work to help better understand the barriers faced by families in more deprived communities. It was noted that the co-creation of the 5-year infant feeding strategy had begun which would be adopted by the local maternity and neonatal system for Kent and Medway. Work was also ongoing to simplify messaging in this area. 

4. In response to comments from a Member, it was agreed to bring a report back in 12 months to update on progress.

5. RESOLVED, subject to the above, the Health Reform and Public Health Cabinet Committee agreed to:

1. APPROVE the service development for the Infant Feeding Service and wider workforce development, as detailed in the report. 
2. APPROVE the required expenditure to deliver this activity via Family Hub Grant Funding up to £1,256,332 for the period ending April 2025. 
3. DELEGATE authority to the Director of Public Health, in consultation with the Cabinet Member for Integrated Children’s Service and the Cabinet Member for Adult Social Care and Public Health, to take necessary actions, including but not limited to allocating resources, expenditure, entering into contracts and other legal agreements, as required to implement the decision.

Victoria Tovey, Head of Strategic Commissioning – Public Health, and Dr Connie Wou were in attendance for this item. 

1. Mrs Tovey noted that the overall performance was positive out of the 15 Key Performance Indicators nine were RAG rated Green and one Amber. Five Key Performance Indicators were not available at the time of writing this report.

2. In response to comments and questions from Members, it was said.

(a) The Chair asked what could be expected from the 5 KPIs for which data was not yet available. Mrs Tovey said that they were not aware of any concerns. 

(b) Asked about One You Kent and reported inconsistent buy-in from GP’s surgeries with some referring several individuals and others none at all. It was also noted that some patients were unaware that they were being referred. It was questioned how this scheme was funded and if it was per individual referred. Mrs Tovey gave an overview of One You Kent and noted that 6 district councils provided the service alongside Kent Community Health Foundation Trust. It was said that there had been national incentives for referrals but they would always expect that they were informed of referrals with consent, it would be of concern if people were not being told about referrals. Mrs Tovey said they would investigate any specific concerns outside the meeting. Mrs Tovey said there could be a review of promotional materials.  

(c) Dr Connie Wou gave further information on the weight management pathway and the work being done to improve the service. There was work ongoing to streamline the referral pathway and to ensure that people were aware of referrals. Dr Wou said they welcomed further specific details if there was a concern. 

(d) The Chair asked for this to be looked into and Mrs Tovey said it would be and reported back. 

(e) A Member raised a concern that the triage process was too long which was discouraging patients from taking referrals and that there were issues with the communication pathways between different agencies.  

(f) A Member asked if there was a way to self-refer as this would free up capacity at GP surgeries. Mrs Tovey said there were a lot of individuals that chose to self-refer, especially after public information campaigns. It was also noted that the One You Kent website signposts to self-help resources such as apps and services were provided by third parties such as GP surgeries themselves.  

(g) Asked about the KPI target figures and if these were relevant and proportionate to the whole population. It was also asked if absolute figures rather than percentages could be provided. Mrs Tovey said that the services were impacted by COVID-19 with services such as NHS Health Checks shutdown during the period, therefore many of the KPIs were set in response to this but it was noted that the services had caught up very quickly which was why so many were green. It was said that each year KPIs would be reviewed to drive  ...  view the full minutes text for item 279.

1. Dr Ghosh introduced the update. 

(a) It was said that the report gave an overview of an intensive piece of work that would take about a year to complete which was a root and branch review of all Public Health commissioned services. 

(b) Dr Ghosh then provided four drivers behind why the work was required, 1) the impact of COVID-19, 2) the changed commissioning environment, 3) the Council’s financial position and the real terms reduction in the funding from the Public Health Grant next year and likely going forward and 4) two key contracts with major community health service providers were up for renewal in March 2025.

(c) Dr Ghosh noted the focus of the review would be on value for money, sustainability, alignment, innovation and technology.

(d) It was said that they were currently at stage 1, the data-gathering phase. 

2. Mrs Tovey provided a further update on the ongoing progress. A methodology had been employed to ensure that all services were reviewed robustly to fully understand strengths, weaknesses, opportunities and threats. It was said that workshops were being planned with key stakeholders, providers and users to review ongoing work and get ideas for innovations and improvements. Following this options appraisal process would take place. It was said that the transformation aimed to ensure that services were as preventative as possible and would help to reduce health inequalities in Kent. 

3. In response to comments and questions from Members, it was said:

(a) A Member expressed concern that the focus on financial savings would lead to the net effect of fewer services for Kent residents. More detail on the impact of the transformation on the population was requested. Mrs Tovey said they would always have to look at value for money and gave some examples of where efficiencies could be found. It was noted that impact on the population information could be provided going forward. Dr Ghosh added that they would always work within the Public Health Grant conditions and the context of an ageing population and the profile of comorbidities changing for the worse. Dr Ghosh said Public Health would be focussed on system-wide prevention interventions and other target areas going forward but efficiencies would be required to fund new opportunities. It was also said that the Council's financial position would affect the operation of Public Health.  

(b) Mr Watkins said that the review would identify which programmes were most effective and funding would be directed towards them. Mr Watkins highlighted that this work was vital to responding to the financial strains seen in Adult Social Care and Public Health. 

(c) A Member asked that text and email be the default communication method as this was cheaper than post. It was noted that post should remain an option when required for accessibility reasons. Mrs Tovey agreed and said certain services were much more digitalised than others but would aim to ensure it was the case system-wide going forward. 

(d) Mrs Tovey said that there would be mixed approach to include  ...  view the full minutes text for item 280.

Dr Connie Wou was in attendance for this item. 

1. The Chair introduced the update and gave some remarks on vaping that noted its positive uses but expressed concern that young people saw them as a fashion item due to their price, looks and availability. 

2. Dr Ghosh gave an overview. It was noted that there had been an industry-wide move amongst tobacco companies from investing in cigarette products to vapes due to a change in social norms. Dr Ghosh said that vapes required both a legislative and a local approach to prevent adverse effects of vapes on public health. 

3. Dr Connie Wou said that vapes were a very effective treatment for smoking but were not without risk. It was noted that there was some evidence of a rise in vape use amongst younger people and some of the health and environmental risks associated with vaping were detailed. It was noted that Kent, other local authorities and the Local Government Association had all recommended that action be taken on disposable vapes and that the Public Health team were acting proactively with partners and trading standards to tackle this issue. 

4. In response to comments and questions from Members, it was said:

(a) Asked for clarification on the figures from the Kent website (Crackdown on illegal vape sales and more support to stub out cigarettes ‘welcome’ - News & Features - Kent County Council) which mentioned Department of Health and Social Care funding of £ 3 million,  number of smokers in Kent and the cost of smoking-related issues for the county. Wou said they would review the statistics on the website before giving a response. The funding mentioned on the website is for a national initiative.

(b) Members said that the central government should be lobbied to add a tax or levy on vape sales at the point of purchase to cover environmental costs. 

(c) Asked that vape purchases be included in challenge 25. Dr Wou said it was being considered but new retailers may not be fully aware of the regulations and would need to make them aware as part of the process. Details on the fine handed to those retailers selling to underage people would be provided after the meeting. 

(d) A Member said that teenagers need to be educated on the health risks of vapes and that social media platforms could be the most effective way of communicating this. Another Member added that local sports personalities could be encouraged to raise awareness. Dr Wou said that work was ongoing to provide young people with the right information and was working with schools and parents to circulate this. It was noted that Public Health would work with the communications team to plan how to reach out to young people best.  

(e) It was said that a letter should be sent to the Prime Minster to ensure he keeps the pledge to crack down on legal loopholes and aggressive marketing strategies. It was also asked if countywide evidence and data had been  ...  view the full minutes text for item 281.

The Work Programme 2023/24 was noted.