Councillors and committees

Agenda and minutes

In light of recent events and following the latest Government advice on the Coronavirus, the Council has cancelled all its scheduled council and committee meetings until 11th May 2020. At present the law does not permit local authorities to hold 'virtual' Committee meetings but the Council is committed to maintaining full transparency in the decision making process during this period and an update on how its governance will work will be provided shortly.

The Council will keep its arrangements under continual review, having regard to guidance as it emerges.

You can view the individual reports for this meeting by selecting the headings from the numbered list of items at the bottom of this page. Alternatively you can view the entire agenda by selecting 'Agenda Reports Pack' below.

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Venue: Guildhall, Kingston upon Thames

Contact: Marian Morrison 020 8547 4623  email:  marian.morrison@kingston.gov.uk

Items
No. Item

QUESTION TIME

Questions were taken as part of the discussions on the SWL in patient mental health consultation and Gosbury Hill GP-led Health Centre items.

22.

Apologies for Absence

Minutes:

Apologies for absence were received from Councillor Mary Clark and Councillor David Fraser attended as substitute.

 

Apologies were also received from Patricia Turner, Advisory Member, Kingston Voluntary Action and Dr Emma Whicher, Medical Director, South West London and St George’s Mental Health Trust. Dr Martin Humphrey attended on Dr Whicher’s behalf.

23.

Declarations of Interest

Minutes:

Councillors Andrew Day, Rachel Reid and Shiraz Mirza declared personal interests in agenda item 8 – Gosbury Hill GP-led Health Centre as they are members of South of the Borough Neighbourhood Committee.

24.

Minutes

Minutes:

Resolved that:  the minutes of the meeting held on 3 September 2014 are confirmed as a correct record.

25.

Gosbury Hill GP-led Health Centre PPTX 413 KB

To consider a verbal update on the Walk in Centre

Minutes:

The Chief Officer of Kingston Clinical Commissioning Group gave a presentation on the Gosbury Hill facility.  Ms Michaelides confirmed that the Kingston Clinical Commissioning Group did not hold the contract for the centre;  this was held by NHS England.  NHS England holds contracts for GPs, Dentists, Pharmacists and Ophthalmic Opticians.  However under new regulations, it could be possible for any walk in elements to revert to KCCG  control if the contract were amended. 

 

Ms Michaelides stressed that the Gosbury Hill Centre was not a “walk in centre” where patients could receive immediate attention, but a GP-led Health Centre which offered appointments both for patients who were registered with the centre and anyone else  i.e. non-registered patients.  The service operates from 8AM to 8PM every day.  The centre does not treat injuries but does see urgent patients on the same day.  Generally 15 to 25 appointments are offered Monday to Friday and 36 – 40 at weekends. 

 

Key performance indicators relate to the registered list, but not to all the other activity at the Centre.  There have been two contractual breaches concerning non-compliance with core hour requirements.  However, patient satisfaction levels are generally high and the Centre provides the best access in Kingston.

However, performance against the Quality Outcomes Framework was at the lower end of Kingston practices’ performance.

 

In response to a range of questions from members Ms Michaelides confirmed that there were various routes for obtaining appointments at the Centre.  The number of registered patients could increase by patient recommendation, but GPs are not allowed to advertise services.  The CCG was aware of the levels of discontent about the GP service provision in that area i.e. the poor state of the Orchard Hill facilities.  Ms Michaelides explained that there were plans to relocate the GP-led health centre to the Surbiton Health Centre to provide an urgent care service and SHC is designed to accommodate such a service.  This would fit well with the diagnostic facilities available.  However, until the Kingston Wellbeing Service is successfully relocated this move would not be possible.  Ms Michaelides confirmed that it was her intention to meet with patients and residents of the Gosbury Hill area as soon as there is some positive progress.

 

Councillors and members of the public in the gallery made a number of important contributions to the debate including the on-going concerns about the health centre and the poor state of the Orchard practice facility.  Whilst it was  noted that the there had been improvements at  the Orchard practice  following take over by the Churchill Medical Centre, Councillor Thompson (former Chair of the Panel) described a situation where care had not been provided to a local resident who had fallen outside.  It was also pointed out that Council Winter Help leaflets had previously referred to the Centre as a “Walk in Centre” which was misleading.  Furthermore at least two clinical rooms vacated by health visitors were unused and this was a missed opportunity in health care provision.  Ms Michaelides stated she  ...  view the full minutes text for item 25.

26.

Annual Report of the Director of Public Health PPTX 3 MB

Dr Jonathan Hildebrand, Director of Public Health will give a presentation on this year’s Annual Report focussing on Mental Health

Minutes:

Dr Jonathan Hildebrand, Director of Public Health gave a presentation on the Annual Report which was launched earlier in the day.  The full report is available on the Council website. Limited hard copies of the full report and a shortened version are available.  The report is arranged around a number of themes relating to mental health including environment, physical health and lifestyles parents and children, adults including older people and recommendations are put forward for each area.

 

Key points from the presentation included:

The Kingston population is expected to increase by a further 10,000 by 2018 and the largest increase will occur in the 70-79 age group.  Whilst people are living longer, the number of years where people live with ill health is significant – 18 years for men and 20 years for women.  This is longer than in some other European countries including Scandinavia. 

 

Deprivation gives rise to differences in lifespan which is closely associated with circulatory disease. 

 

25-50% of adult mental ill health may be preventable by early intervention in childhood or adolescence.  The health of people who have mental health problems is generally less good and people with serious mental health problems can die some 15 years earlier than in the general population.  People with mental health problems are more likely to smoke and evidence suggests that 42% of tobacco is consumed by people with mental health conditions.

 

Kingston residents show higher levels of admission for inpatient mental health services that other boroughs and it is hoped that commissioning changes will lead to increasing care provided in primary care.

 

Looking more specifically at dementia, carers of people with dementia are more likely to be depressed and in turn people with depression are more likely to develop dementia.  Depression is often associated with long term conditions and there is evidence to suggest  that people with cancer who also have depression have less life expectancy.  There are 12,000 residents who have co-existing long term and mental health conditions. 

 

Dr Hildebrand also confirmed that the Health Checks will emphasis the link between vascular disease and dementia.

 

Discussion was wide ranging.  Dr Hildebrand confirmed that whilst CPNs attached to GP practices was a good model of care, it was expensive and the liaison between these professionals could be managed in different ways.  GPs are being offered training in mental health care to increase capability. 

 

Overall there is an imbalance between the spend on mental health and physical health care which requires a national change of view and policy.  Ms Michaelides advised that the CCG is exploring the Better Care Fund and integration to develop a more multidisciplinary care team approach to skill set and health care delivery.

 

Information was also given on the roles of police, school nurses in supporting children and adults requiring mental health support.  Dr Hildebrand drew attention to the need to avoid blame of family members and parents in relation to children’s mental health problems and family members need to be offered appropriate support. He acknowledged that  ...  view the full minutes text for item 26.

27.

Dementia and the role of the local voluntary sector in supporting care and carers in the community pdf icon PDF 134 KB

To consider the report and scrutinise

 

Additional documents:

Minutes:

The report outlined background to the topic and detailed the help and support to carers provided by the Council and voluntary organisations in Kingston including Kingston Carers’ Network, Staywell (formerly Age concern Kingston), Alzheimer’s Society Kingston and Kingston Voluntary Action.  Recommendations for action were also proposed around Health Checks emphasising that vascular problems could link with dementia, encouraging local GP surgeries to assess their practice’s dementia friendliness, improving availability of information such as the Dementia “Prescription” and identifying funding to provide further support for carers in the voluntary sector, such as admiral nurses.

 

Kingston Council’s Carers Support and Service Development Co-ordinator is instrumental in a much of the support for carers and organisations involved in this area including staff training, help with carers’ budget management, assisting carers with enquiries and partnership working to shape, develop and support local services.  The Council also contributes financially in a number of ways including annual carers’ days, annual grants to voluntary organisations such as Kingston carers who provide support, funding posts such as the wellbeing and inclusion worker, part time volunteer co-ordinator and Dementia Advisor at the Alzheimer’s Society Kingston.

 

Carers are also supported through personal budgets, funded respite breaks, the relief care scheme enabling carers to have up to 72 hours of support such as sitting services or direct payment enabling them to arrange their own support. The council also provides training for carers eg in moving people safely.

 

The report included details provided by the following local voluntary organisations and key points include:

 

Kingston Carer’s Network – currently supports 1,700 carers in Kingston of all ages.  The advice services covers a wide range of issues including benefits, NHS continuing care, house adaptations, powers of attorney and benefits claims and appeals.  It is also working with GPs to identify carers and the support offered to them and is developing processes to support hospital discharge processes. 

 

A further new development is a new befriending service to support carers breaks.  KCN also offers counselling, emotional support, wellbeing activities and support groups as well as discounted complementary therapies. 

 

KCN influences changes in law and policies which affect carers where possible.

 

Alzheimer’s Society Kingston – there are two key workers:

Dementia adviser who assists from the point of diagnosis onwards especially in signposting to appropriate services

Dementia support Worker – provides practical and emotional support and runs peer support and carer’s information groups

Other initiatives include CriSP a carer’s information and support programme which provides workshops for people caring for people with dementia on a range of topics such as money and legal issues and planning for the future.

 

Staywell – is the largest local charity providing care and support for older people and their carers and provides  a  large  range of community and person-centred services and support to people living with dementia and their families or carers.  Staywell works closely with Your Healthcare GPs and other voluntary groups.  The aim is to support people to get on with life, and achieve the best possible quality of  ...  view the full minutes text for item 27.

28.

Consultation on In patient Mental Health Services in South West London pdf icon PDF 67 KB

Kingston Clinical Commissioning Group, who are leading the consultation will introduce the consultation with support from South West London and St George’s Mental Health Trust.

Minutes:

The report outlined the consultation document on in patient mental health services in South West London.  The consultation runs for 12 weeks, and concludes on 21 December 2014. 

 

The consultation puts forward two options:

 

Option 1 – inpatient services on two sites – Springfield University Hospital and Tolworth Hospital.  Specialist services would be split across the two sites.

 

Option 2 – inpatient services on three sites - Springfield University Hospital, Tolworth Hospital and Queen Mary’s Hospital (Roehampton).  Specialist services would be split between Springfield and Tolworth Hospitals.

 

Option 1 is the preferred option because it would enable new build in patient facilities on the two sites. This would provide new ward designs which were more likely to lead to improved outcomes including reduction in incidents.  Option 2, whilst providing updated inpatient facilities on three sites, the day to day running costs would be much higher as a consequence of three site operations.

 

Option 1 proposes the relocation of inpatient services for Child and Adolescent Mental Health Services (CAMHS) to Tolworth Hospital.  This is proposed because the footprint for the new build is larger at Tolworth than that is available at the Springfield site. 

 

Tonia Michaelides explained that the consultation is being run by SWL CCGs and NHS England and is led by Kingston CCG.   Some of the current estate is 19th century  and the objective is to modernise this and to provide the best possible inpatient settings thereby providing parity of esteem.  Further action has been taken to widen the  consultation and letters had been sent to all people who had been in patients in the past year.  2,400 copies of the consultation document had been widely distributed.  She believed that 40 people had attended the first consultation meeting in Kingston in October and a further meeting was taking place in December, co-hosted by Healthwatch Kingston.

 

Members noted that evidence had been presented by Wandsworth Council’s Head of Hospital and Home Tuition Service and Head of Education Inclusion to the Joint Health Overview and Scrutiny Sub Committee (JHOSC sub) on 18 November.  LB Wandsworth provides the educational input into CAMHS and St George’s Hospital, Tooting. A strong case was made against the relocation of CAMHS to Tolworth Hospital on the grounds that there had been recent £4M investment in the services at Springfield, the new school opened in March 2014, the proximity to London which enabled educational visits by students to museums and easier transport links for people coming for the national CAMHS services.  National services accounted for almost 50% of CAMHS inpatient activity.

 

Members also noted that at the October meeting the JHOSC Sub had expressed general support for the consultation process and Kingston CCG had responded to a request from the Kingston representative to extend the reach of the consultation to local communities and organisations in Kingston. 

 

Presentations would be made to two Neighbourhood committees (South of the Borough and Maldens & Coombe) and a second consultation meeting would take place in Kingston in December.  ...  view the full minutes text for item 28.

29.

Sexual and Reproductive Health Services pdf icon PDF 111 KB

To consider the report and scrutinise.  Peter Taylor, Commissioning

Lead for Sexual and Reproductive Health will introduce the report.

Minutes:

The report provided background on the range and status of Sexual and Reproductive Health Services (SRH services).  This service area became the responsibility of Local Authorities (LAs) as part of the transfer of Public Health to LAs and at £3.2M, SRH services account for 34% of the Public Health grant. 

 

Kingston performs generally well compared with other London Boroughs and England as a whole although there are three indicators where performance is unsatisfactory.  Positive outcomes are  rates of STIs in under 18 year olds have fallen consistently in the last four years and STIs across all ages are at their lowest in 3 years.  Unplanned pregnancies, teenage pregnancies and abortion rates have all reduced.  Details of key indicators are shown on page A6 of the report.  

 

The report explained that Kingston NHS commissioners have developed the concept of Kingston Integrated Sexual Health which has brought together the stakeholders across sexual health, reproductive care and abortion services, user representatives plus colleagues from youth services and school health.  This has had positive outcomes for reducing disease prevalence in the community and embedding prevention and education.

 

The local sexual health centre – the Wolverton Centre – is the clinic of choice for both Kingston residents (86% of Kingston residents seeking GUM care there) and people from other local authority areas. 

 

Prior to transition of services to Kingston Council, spending on GUM services was rising year on year and in 2012 reached 21% above planned expenditure.  These services are open access and it was necessary to take action to ensure sustainability.  A number of changes were made for 2013/14 including training in Primary Care with the overall outcome that commissioning arrangements enabled an increase of just over 6% activity whilst achieving a small end of year underspend on the budget.  Spending restraint has continued into 2014/15 and this could result in a 6.5% increase in specialist service activity which an increase in spending of 3.2%. 

 

The report also referred to work to address the needs of Looked After Children, programmes for “hard to reach” groups  and work with professionals around sexual exploitation and female genital mutilation. 

 

A number of points were raised during discussion:

 

Members made requests for information showing year on year trends for indicators and for a further report to be brought to the Panel in a year’s time including an action plan.  Grahame Snelling queried action being taken on multiple pregnancies where children need to be taken into care and referred to the Hackney Scheme on sexual exploitation which requires a joint approach.  It was confirmed that the Council is taking action in this area. Peter Taylor, Commissioning Lead for Sexual and Reproductive Health,  also confirmed that there are no clear solutions to the year on year rising demand for services, but the new commissioning arrangements had enabled contract cost reductions.

 

In response to a question about arrangements for advice and access to services for students in private schools Peter Taylor advised that the NHS School Nurse system did not apply  ...  view the full minutes text for item 29.

30.

Winter Planning in Kingston PPTX 1 MB

To consider a verbal update on this year’s winter planning arrangements

Minutes:

Owing to the lateness of the hour the presentation from the Chief Officer of the Kingston CCG was not given but would be circulated.  This included details of the additional funding form NHS England.   Tonia Michaelides did, however, confirm that arrangements were in place  for winter but there is no longer the seasonal variation in demand  seen in past years. The Lead Member for Health and Social Care referred to the joint arrangements between the CCG and the Council and she added that activity is currently high and acknowledged that there are already social care budget pressures. 

 

Resolved that:  the presentation is circulated to members of the Panel and Tonia Michaelides and Duncan Burton would respond to any individual queries.

31.

The London Ambulance Service Five Year Strategy 2014/15 to 2019/20 pdf icon PDF 62 KB

To note the report

Minutes:

The report provided a summary of the London Ambulance Service (LAS) 5 year strategy which had been send to Lead Members of Councils in London in September.  Tonia Michaelides advised that Kingston performance figures for the LAS could be provided and the CCG had some concerns about these.

 

Resolved that:  the report is noted.

32.

Item for Information - Minutes of the Health and Wellbeing Board pdf icon PDF 101 KB

To note the minutes of the Board meeting held on 9 September 2014

Minutes:

Resolved that:  the minutes of the last meeting held on 9 September 2014 are noted.

33.

Item for Information - Minutes of the South West London Joint Mental Health Overview and Scrutiny Sub Committee pdf icon PDF 32 KB

To note the first minutes of the first meeting held on 16 October 2014

Minutes:

Resolved that:  the minutes of the JHOSC sub held on 16 October are noted (as amended  by the Sub Committee on 18 November 2014).

34.

Work Programme pdf icon PDF 47 KB

Minutes:

Agreed that:  the work programme for the next two meetings on Thursday 29 January and Thursday 12 March 2015 is noted.