Health and Wellbeing Board


3 September 2019


7:30 pm 9:51 pm



Members of the Board




Councillor Liz Green (Co- Chair); Councillors Kim Bailey *, Rowena Bass, Emily Davey, Ed Fram and Diane White *


Representatives from Kingston CCG, Healthwatch and the Voluntary Sector:

Dr Nazim Jivani (Co- Chair), Dr Phil Moore *, Dr Peter Smith *, Dr Liz Meerabeau, Patricia Turner


Council Officers (non voting):

Dr Jonathan Hildebrand, Sue Redmond, Nick Whitfield


Advisory Members (non voting):

Ed Montgomery – Your Healthcare, Tonia Michaelides – Kingston CCG,  Dr Mark Potter * – South West London and St George’s Mental Health Trust, Jane Wilson – Kingston Hospital NHS Trust, Gwen Kennedy * - NHS England and Dr Anthony Hughes * - GP Chambers


* Absent




1.            Questions and Public Participation



The following questions were asked:


Health effects of 5G – Louise Tassell asked whether the Board is aware that:


·         Glastonbury, Frome and Brussels have halted their 5G technology rollout due to health concerns


·         Vast independent research shows adverse non-thermal effects from EMF exposure including clear evidence for cancer causation that meets the /Bradford Hill Criteria


·         ICNIRP state that their safety guidelines relied upon by PHE do not cover non-thermal


Ms Tassell requested that for these reasons the Board and the Council should formally review these areas prior to 5G rollout to ensure there is no harm to constituents.


The Director of Public Health confirmed that PHE had been researching this area since 2000 and Guidance updated 16 May 2019.  The strength of EMF radiation reduces with distance and levels of exposure are small. Evidence has been examined internationally and the view is that exposure is below international guidelines.  There are some areas where levels can be exceeded and barriers would prevent access to these.  PHE will advise on any actions required and the Council would follow national guideline.  The Leader requested that a briefing be circulated to members of the Board.


Public Health Grant – Michael Keen, Chief Executive Officer, Kingston & Richmond Local Pharmaceutical Committee


The Board was requested to consider the importance of the community pharmacy public health services such as sexual health, quit smoking, drugs and alcohol in illness prevention.  These are funded by the Public Health Grant, and any budget reductions would lead to cuts in service provision and lead to significant expenditure arising from future health care needs e.g. illness associated with smoking.


The Director of Public Health responded that there is a need to prioritise within a shrinking budget.  She acknowledged that a wide range of service delivered via community pharmacies but there could be other methods of delivery, for example, by services offered within a cluster of practices


Budgets - Shane Brennan, Chief Executive, Staywell Kingston


Shane Brennan drew attention to the increasing pressures in communities particularly on the ability of GPs to refer and requested greater progress in integration and decision making.  Whilst identifying the need for early intervention and prevention is good the question arises about how these needs can be met.

The Co-Chair confirmed that there will be increasing partnership working and the prevention agenda very important.  Past planning has been short term and there is a need to look ahead long term.  The Medical Director, Kingston Hospital added that in the past there has been a choice between prevention and acute care and there is a need to look more holistically in future integration.





2.            Declarations of Interest



There were no declarations of interest.





3.            Apologies for Absence and Attendance of Substitute Members



Apologies were received from Councillors Kim Bailey and Diane White, Dr Phil Moore and Stephen Taylor.  Elizabeth Brandill attended on behalf of Stephen Taylor.


The meeting was chaired by Dr Naz Jivani, Co-Chair.





4.            Minutes



RESOLVED that:  The minutes of the meeting held on 28 March 2019 were confirmed as a correct record and signed by the Co-Chair, Dr Naz Jivani.





5.            Partners' Updates and the Work Programme


Appendix A

The Partners’ Updates included contributions from Public Health Adult Social Care, Achieving for Children, Kingston CCG, Kingston Hospital NHS Foundation Trust, Kingston Voluntary Action and Healthwatch Kingston.


The report included a new section on budgets, requested by the Co-Chairs, which would be further developed to support the increasing integration approach.  The Council would need to identify £8M in new savings for 2020/21 and £232M in total by 2023.  Reference was made to the contribution which ASC and Community Housing would need to make to the Council’s overall deficit.  Current ASC and Community Housing formed 40% of the Council’s budget.  A long list of possible savings together with the associated impacts would be drawn up for Members’ consideration.  Savings in 2020/21 would focus on the core offer including the preventative offer but excluding statuary and mandatory services.  Further savings would be required between 2021 and 2023.


Children’s services were experiencing significant financial pressures and projected an overspend of £1.4M on general fund budgets for 2019/20 primarily relating to placements for children in care, supported accommodation for young people leaving care and for unaccompanied asylum seeking children


The ring-fenced Public Health Grant for Kingston had fallen year on year i.e. over 10% over the past 4 years.  It was unclear whether the grant would continue to be ring-fenced beyond the current year.


Kingston CCG expected to meet all financial targets this year, including the planned break-even position.  Kingston Hospital was experiencing challenges related to the increase demand for emergency and non-elective care but expected to deliver its financial plan.


The following areas were highlighted in the general updates:


Public Health:

·        Green Paper on Prevention “advancing our health: prevention in the 2020s” with further focus on childhood obesity, smoke-free society, introduction of a health index to rival GDP in government decision making.


·         Development of Neighbourhood Community Plans for each Neighbourhood


·         New public health duty to prevent and tackle serious violence


·        Measles cases (two in Kingston).  Most cases across South London were in unvaccinated or partially vaccinated individuals.


·        Annual Public Health Report was in development with a focus on place-based health


·        Funding awards for 10 integration projects for vulnerable and socially excluded refugees


·         Projects supporting the Korean community engagement with services


·         Mental Health First Aids courses


Adult Social Care:


·        Community catalyst CIC – supporting solutions for individual care and support needs


·         Supported employment


·         Dementia support and development service


Achieving for Children:


·         SEND transformation plan:


o   5 year Recovery plan submitted in June


o   SEND futures conference held in June


o   Parent Consortium - met on four occasions and exploring whether it can become the official Parent Carer Forum


o   Improved local provision has enabled reductions of children placed in independent sector and non-maintained special schools


o   Significant improvement in completion of timely EHCP assessments


·         Details of senior staffing changes


Kingston Clinical Commissioning Group:


·        Five primary care networks (PCNs) set up in Kingston and delivering extended hours provision.  Social prescriber and clinical pharmacist roles being appointed to each.


·        Healthy London Partnership was supporting a five year programme and funding for the development of organisational maturity for PCNs


·        The NHS Long Term Plan (LTP) required development of a five year strategy to take forward the LTP.  The strategy would reflect the Local Health and Care Plan and SWL clinical programmes. The draft strategy would be submitted by 27 September 2019 and it was anticipated that the final agreed version would be published by 15 November 2019.


·       The refreshed SWL Sustainable Transformation Partnership Plan focused on health and care organisations working at borough level and the six Borough Local Health and Care Plans will be published in September.


·         Moving Forward together – discussed elsewhere on the agenda.


·         Mental Health Training for line managers


·         Parliamentary Award for K&R CCGs – staff wellbeing


·         Annual report and AGM on 17 September.


Kingston Hospital NHS Foundation Trust:


·         Increasing demand for non-elective services continues to increase


·         Improved results in the National Inpatient survey


·         Bereavement bag launch


·        Refreshed organisational strategy for the next 3-5 years encompassing the NHS Long Term Plan and aims of “Patient First”


·         Kennet Ward renovation to become 3rd dementia friendly ward


·         AGM on 12 September


·         Brexit Plan is in place


·         Kingston Hospital is ranked no 1 for cancer in England


·         NHS Parliamentary Award for discharge support volunteers


Kingston Voluntary Action:


·         Connected Kingston developments


·         Food Poverty


·        Participation in several different mental health meetings.  The question of duplication of role and effort was discussed.




·         Annual report published in June

·         Details of recent Open Meetings


·        Progress by the five Task Groups – Community Care, Hospital Services, Mental Health, Learning disability and Youth Out Loud!


·         All Age Learning Disabilities Partnership Board


·         Thrive Kingston Mental Health Strategy Planning and \Implementation Group


·         Time to Change Kingston Hub


The work programme was agreed as follows:


19 November 2018


Progress update on the SEND Transformation Plan


Annual Report of the Child Death Overview Panel 2018/19


28 February 2020


Annual Report of the Director of Public Health – place-based approaches to health


RESOLVED that:  the report and the work programme is noted.


Voting – unanimously in favour





6.            South West London Clinical Commissioning Groups Configuration


Appendix B

Tonia Michaelides, Managing Director, Kingston and Richmond CCGs gave a presentation (reproduced in the agenda at Appendix B) entitled “Moving Forward Together” which provided details about the proposed CCG re-organisation in South West London to form a single  SWLCCG but also introducing Place Committees (sub committees of the CCG) for each Local Authority Area.


A diagrammatic representation of the proposed governance on page B15 of the Agenda showed a clear and important role for the Health and Wellbeing Board as setting strategic priorities for the Place Committee.  The Place Committee would be decision making and an executive arm of the Health and Well Being Board, a committee in common and chaired independently.  The Kingston and Richmond Partnership Board sat below the Place Committee.


The NHS Long Term Plan required savings in management costs of 20% and it was expected that this reorganisation would deliver these.  Kingston would be required to deliver savings in the region of £159K.  These savings would be invested in front line services, particularly the primary care networks and supporting changes in practices.  However the new system would enable greater local delegation of budgets and 80% of care would be planned and delivered locally in Kingston.  The proposals would do away with the purchaser/provider split and develop a collaborative system.


In discussion, the Chair of Healthwatch expressed concern that the Place Committee would not meet in public.  Tonia Michaelides responded that this question would need to be worked through.


The Kingston CCG members would be asked to vote on the proposal in September.  The timeline, set out on page B17 of the Agenda, indicated that the merger application would be submitted end September/early October and the SWL merger in April 2020.


RESOLVED that:  the Moving Forward Together/SWL CCGs re-configuration proposals be received and noted.





7.            Better Care Fund Planning 2019-20 National Requirements


Appendix C

The purpose of the Better Care Fund (BCF) was to promote integration across the local health and social care system with a focus on services in the community (out of hospital) and reducing delayed transfers of care (from hospital).  It had to meet the requirements set out in the National Conditions.  The Fund was a three year funding programme which began in 2017 and funding beyond 2020 would be known later in 2019.


The Planning Template was due to be submitted to NHS England by 27 September 2019.


The reporting requirements for 2019/20 included the Disabled Facilities Grant and Winter Pressures Funding allocations which had previously been reported separately.


The report set out the amount of the funding, details of the funding conditions and performance against the metrics since 2017; good progress had been made against:


·         Non elective admissions


·         Residential admissions


·         Re-enablement


·         Delayed transfers of care


The Joint Priorities had been agreed jointly between Kingston CCG and the Local Authority as follows:


·         Early discharge planning through the creation of a multidisciplinary discharge team and introduction of a weekly long length of stay meeting to track and resolve patients stranded in hospital


·        Introduction of a range of pilots that promoted people returning home and only placing individuals in a residential and/or nursing home as a last resort


·        Development of an integrated seven-day community service through the work of the Kingston Co-ordinated Care programme including an integrated intermediate care service re enablement and virtual bed model and single point of access


·         Introduction of a Trusted Assessor model


·        Enhanced support to care homes to prevent and manage avoidable admissions to hospital and ambulance call outs.


The Planning approach - In line with the SWL reconfiguration approach to Place based care it was proposed to establish a joint BCF Board to monitor system performance and expenditure.  The Board would comprise representatives from the Kingston CCG, Adult Social Care and Housing.  It would report to the Health and Wellbeing Board on an agreed basis.




1.    The changes to the BCF planning requirements for 2019/20 be noted;


2.    The submission date of 27 September 2019 be noted; and


3.    The joint priorities and planning approach be endorsed.


Voting – unanimously in favour





8.            Kingston Health and Care Plan 2019-2021


Appendix D

The Health and Care Plan (HCP) (attached at Annex 1 to the report, awaiting final design) informed local priorities for health and care integration in Kingston for the next two years and would also provide the local contribution to the delivery of the NHS Long Term Plan where it related to the content of the plan with a focus on the actions and impacts.


Kingston CCG had worked with local health and care partners in Kingston to co-produce the local HCP and public engagement had taken place in May 2019.  A summary of the feedback was attached at Annex 5 to the report.


The plan described the local vision, priorities and actions to meet the health and care needs of the local population including those living, studying and working or registered with a GP in Kingston and to deliver improvement.  Actions would be focussed on where there was most need in the health and wellbeing of local people across the life stage themes of “start well, “live well” and “age well”. Each theme had a number of priorities.  Further priorities across all three of the life stages were around prevention and carers.


The Leader of the Council pointed to the need for publicity for the Plan, especially for the members of public who had contributed to the engagement.




1.    The Health and Care Plan for Kingston 2019-2021 be endorsed; and


2.    Regular updates on the action plans to implement the plan come to the Health and Wellbeing Board on a 6 monthly basis.


Voting – unanimously in favour





9.            Health and Wellbeing Strategy Update


Appendix E

The report provided a final update on the recommendations and actions within Kingston’s Joint Health and Wellbeing Strategy (JHWS) 2017 – 2019.  Many of the next steps would be picked up within the Health and Care Plan for Kingston 2019-2021.


The JHWS was the framework that underpinned the work of the Health and Wellbeing Board.  It did not capture every priority for improving health and care but rather focussed on the areas which required a collective Health and Wellbeing Board contribution to achieve the most impact.  It was promoted to the wider “Kingston family” of partners to encourage all organisations to work collaboratively towards achieving the shared goal of improving health and wellbeing for people of Kingston.


The combined information in the Joint Strategic Needs Assessment and the JHWS formed the basis for local decisions that drove service change such as investment and de-investment in services according to local needs and engagement with the local community.  Kingston Council, Kingston Clinical Commissioning Group and NHS England needed to have regard to the KHWS as they drew up their detailed commissioning plans.


The strategy had been refreshed and relaunched in March 2017.  The four priority areas where, by working together, the biggest difference could be made, were:


·         Children and young people


·         Mental health


·         Older people and people with long term conditions


·         Addressing the needs of socially excluded and disadvantaged communities


The Director of Public Health highlighted that progress had been made across all areas but greatest progress had been made for children and young people and mental health as these were considered the highest priority.  External funding had been received for children and young people and children’s mental health.


RESOVED that:  the report is noted.


Voting – unanimously in favour





10.         Public Health Outcomes Annual Update 2018-19


Appendix F

Public Health services in Kingston had performed well despite budget reductions amounting to 35% reduction over the past 4 years.  The report included the following comparative data:


·        compared with 16 neighbouring boroughs, Kingston had performed well in 7 of the 8 comparator indicators – childhood obesity, sexual and reproductive health, proportion of people living within Air Quality Management Areas, NHS health checks, drug treatment, tobacco control and Best Start in Life.  However performance for alcohol treatment was in the lowest quartile.


·        compared with local authorities with similar levels of deprivation, Kingston had performed well in 4 of the 8 comparator indicators – NHS health checks, childhood obesity, sexual and reproductive health tobacco control but was in the lowest quartile for alcohol treatment, drug treatment, Best Start in Life and proportion of people living in Air Quality Management Areas.


·        compared with all 150 local authorities Kingston had performed well for 6 of the 8 comparator indicators, but less well for alcohol treatment and people living in Air Quality Management Areas.


The report also provided Kingston summaries on the following:


·         Life expectancy and causes of death


·         Injuries and ill health


·         Behavioural risk factors


·         Child health inequalities


·         Wider determinants of health


·         Health Protection


During her introduction the Director of Public Health confirmed that the Strategy being in place had secured a number of grants and income streams to take forward progress on priorities.  She added during discussion that partnership working was helpful in ensuring successful outcomes and cited the example of joint training on infant feeding to ensure that different messages were not given by different professionals.  In response to a question about the metrics associated with Best Start in Life she confirmed that these were:


·         New birth visits at 6-8 weeks


·         Breast Feeding


·         School Ready


·         Age and Stages questionnaire


Members also heard that Public Health was undertaking a deep dive into infant mortality.  Whilst the number of deaths in Kingston was small there was a need for closer examination of the factors involved and a report would be brought to a future meeting of the Board.


Points made in discussion included a query on the appropriateness of the quit smoking metric as, in many cases, stopping smoking could take up to a year or more.  The Director of Public Health explained that this was an NHSE metric and people were offered successive attempts to support the eventual outcome of stopping smoking.  The Director of Public Health agreed to pass on this observation.  Dr Jivani commented that it was important to identify the detail behind the performance in order to enable further progress to be made.


RESOLVED that: the report is noted.


Voting – unanimously in favour





11.         Kingston Adults Safeguarding Board Annual Report 2018/19


Appendix G

The Kingston Safeguarding Adults Board (KSAB) Annual Report for 2018/19 (Annex 1) outlined the progress made during the year in safeguarding adults at risk and was produced by the Chair in consultation with key stakeholder partners on the Safeguarding Adults Board.  A safeguarding case study was attached at Appendix 1 to the report and performance information and summary data at Appendix 2.  It was a requirement for the report to be received by the Health and Wellbeing Board. 


The report included contributions from the following partner agencies:


·         RBK Adult Social Care


·         Metropolitan Police


·         Your Healthcare


·         London Community Rehabilitation Company (CRC)


·         London Fire Brigade (Kingston)


·         Kingston Health Watch


·         National Probation Service


·         South West London and St George’s Mental Health Trust


·         Kingston Hospital NHS foundation Trust


·         Kingston Clinical Commissioning Group


Reports were not received from RBK Public Health or the London Ambulance Service NHS Trust.


As requested by the Health and Wellbeing Board last year, the report provided details on the KSAB strategic plan and stated that the Board had delivered on all its priorities including improved strategic engagement across partners.  It also included brief information on two completed Safeguarding Adults Reviews (SARs) (previously termed serious case reviews).  The Board had authorised the commencement of two further SARs and these would be reported in the Annual Report for 2019/20.  749 safeguarding concerns had been received with 307 of these resulting in “No Further Action”.  Information was also provided on Deprivation of Liberty Safeguards (DoLS) which were a statutory requirement for the Local Authority.


The Corporate Head of Safeguarding, Social Work and Hospitals presented highlights from the report around training topics, self-neglect and modern day slavery.  In response to a question concerning links between the child and adult safeguarding boards, she confirmed that there was good dialogue and referred to learning from serious case reviews across children’s and adults’ services.  In response to a further question about improved links with housing, particularly in relation to vulnerable tenants, and the homeless she confirmed that, again, there was a collaborative approach across departments.


RESOLVED that:  the Annual Report is received and noted.


Voting – unanimously in favour





12.         SEND Partnership Board Minutes


Appendix H

The Director of Children’s Services briefly introduce the Minutes and explained that the Partnership Board was not an open meeting.  The SEND Partnership Board was overseen by the Health and Wellbeing Board and Minutes of the former would, in future, be reported to Health and Wellbeing Board meetings.  She reported good progress on the SEND Transformation Plan and on the Written Statement of Action and reminded members that OFSTED would be re-inspecting SEND in 2020, probably in the spring.  She also reported that Richmond Council had commissioned a peer review by the LGA and this would inform progress in Kingston as the same team of staff served both Richmond and Kingston.


RESOLVED that:  the minutes of the SEND Partnership Board meeting held on 11 July 2019 be noted.


Voting – unanimously in favour





13.         Health Overview Panel Annual Report 2018/19


Appendix I

The report outlined the work undertaken by the Health Overview Panel during 2018/19 including:


·         Sustainability and Transformation Partnership


·         Kingston Hospital’s Review of parking for blue badge holders


·         CQC inspection of Kingston Hospital


·         Improving the Mental Health of Kingston Children and Young People


·         Referral from Healthwatch Kingston – Services for Emotionally Unstable Personality Disorder


·         Dental Services and Oral Health in Kingston


RESOLVED that:  the report be noted.


Voting - unanimous





14.         Appointment to Kingston CCG Primary Care Committee



RESOLVED that:  Councillor Kim Bailey be appointed as Council’s representative on the KCCG Primary Care Committee.


Voting:  unanimously in favour





15.         Urgent Items Authorised by the Chair



There were no urgent items.


A vote of thanks was given to Marian Morrison, Democratic Support Officer for her work supporting the Board as she would be leaving shortly.







Signed: ……………………………………..

Date: ………………………………………..