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.

Watch key Council meetings here

Venue: Guildhall, Kingston upon Thames

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

Items
No. Item

35.

Apologies for Absence

Minutes:

Apologies were received from Councillors Mary Clark and Shiraz Mirza.  Councillor Geoff Austin attended as substitute for Cllr Clark.

36.

Declarations of Interest

Minutes:

Councillors Andrew Day and Rachel Reid declared personal interests in agenda item 7, Appendix C, Transport Links from South of the Borough to nearby Hospitals and Surbiton Health Centre as they are both members of the South of the Borough Neighbourhood Committee, and Councillor Reid is Chair of that committee.

37.

Minutes

To agree the minutes of the last meeting held on 19 November 2014

Minutes:

Resolved that:

 

The minutes of the meeting held on 19 November 2014 were confirmed as a correct record.

38.

New Parking Arrangements at Kingston Hospital pdf icon PDF 85 KB

To note the report, discuss and made recommendations

 

Additional documents:

Minutes:

A new car parking scheme using automatic number plate recognition (ANPR) was introduced in the autumn at Kingston Hospital which has lead to a number of concerns being raised locally, in the local press and in on-line local conversations in the South of the Borough area, particularly for holders of Blue Badges.

 

The advantages of the new system are that it provides greater flexibility and different payment options, including pay and display, payment on exit either on site or remotely by phone or on line up to midnight on the day of parking.  It also offers a 20 minute grace period for drop off or pick up of people.  A person using pay and display who stays longer than the initial pre-paid period can pay the additional cost on exit.

 

Concerns have been raised about signage, lack of clarity of the need for blue badge holders to register vehicles prior to using the car park and the difficulties encountered by blue badge holders where the badge is transferred to an alternative vehicle.

 

The Trust confirmed that it was making a  number of improvements including:

·        Improving communications with patients

·        Raising staff awareness about assisting patients

·        Improving signage and lighting close to payment machines

·        Installation of a change machine

·        Reviewing the appeals and cancellations letters with Parking Eye

·        Potential change of parking charging periods

·        Review of assisting parking and discounted parking permits

 

Members noted that the Hospital had provided a statement which had been circulated to members of the committee and copies were available at the meeting.  This demonstrated that the Hospital was taking urgent action to  address concerns and explained that the Hospital was sorry about  the incorrect issue of fines to a number of patients and visitors and the anxiety and distress caused.  It also explained the additional actions  being take  by staff to register blue badge holders.

 

The Director of Nursing and Patient Experience explained the reasons for introducing the new arrangements which were  to respond to the many complaints about parking, including about the pay and display system and also to ensure that the car park is not used by commuters using the nearby train station.  Due to the traffic flows nearby, it was not be possible to introduce a barrier system.  The Director confirmed that all parking fines would be cancelled for blue badge holders and that communications were being increased to explain that blue badge holders need to register to use the car park.  Banners would be in place shortly to explain how the system works and letters would be sent out to patients routinely.  Patients will review these actions and look at the parking arrangements to ensure that arrangements are appropriate to patient needs. The Hospital has also agreed to look at all potential fines prior to issue to ensure that these are appropriate and will refund all fines which have been issued to blue badge holders.

 

 

During discussion it was pointed out that the signage was not clear about being able to choose whether  ...  view the full minutes text for item 38.

39.

Transport Links from South of the Borough to nearby Hospitals and Surbiton Health Centre pdf icon PDF 106 KB

To note the report, discuss and made recommendations

Additional documents:

Minutes:

The question of transport links for people living in the South of the Borough Neighbourhood had been identified as a concern by the Neighbourhood Committee for some time.    Barry Allen, Neighbourhood Manager reported that the Neighbourhood Community Plan, produced by local residents highlighted concerns about this issue and this was confirmed by Councillor Reid the Chair of the Neighbourhood.    

 

The Health Overview Panel was particularly interested in examining transport links to nearby hospitals and health centres.  The report provided detailed background on bus and train links and provided information from the NHS about patient contacts and length of in-patient stays to help provide an indication of the numbers of journeys which might be made both by patients themselves and by carers and relatives visiting providing support.  A particular concern was the poor level of direct service between Hook and Epsom.

 

An analysis of 2011 Census data looking at  car ownership in the South of the Borough by age and gender identified that whilst car ownership is higher than in the rest of the Borough, people aged 65+ are less likely to have their own cars and there is a gender difference where women aged 65+ are more likely (one in three) to have no access to cars in their household.

 

TfL provided a response to the issues raised in the report.  It confirmed that it had worked closely with the NHS on the recent Better Services Better Value health care reconfiguration exercise and has also agreed to work with Kingston Borough officers and NHS colleagues to look at the impact of healthcare changes on transport needs to better understand the specific issues faced by people accessing healthcare.  Ian Price, Neighbourhood engineer confirmed he had met with TfL earlier in the week and further discussions on the matter will take place at South of the Borough Neighbourhood meeting in April. 

 

TfL stated that it is not possible to run a direct bus link for every journey and interchange is accounted for in service design.  Journeys involve no cost for freedom pass holders and for others the maximum daily bus fare is capped at £4.40 i.e. three journeys. 

 

TfL provided comment on the current bus routes to NHS hospitals and facilities and noted that the route 467 between Hook and Epsom is just hourly with no evening or Sunday service.  It estimated the additional subsidy required to run the bus to Epsom Hospital would be approximately £130,000 pa and stated that this would  not represent good value for money.

 

Councillor Margaret Thompson, former chair of the panel (in the gallery) drew attention to a circular bus route in the Derbyshire area which links up local hospitals plus bus and train stations and the fare costs the equivalent of one hour’s parking.  A member of the public contributed to the discussion.  He pointed out that the 467appeared to be  used by few people and suggested that the 71 could be routed round the Silverglade industrial estate. 

 

Councillor Pandya put forward a suggestion that  ...  view the full minutes text for item 39.

40.

Update on Winter A&E Performance at Kingston Hospital

A verbal update will be given by Duncan Burton, Director of Nursing and Patient Experience and Tonia Michaelides, Acting Chief Officer, Kingston CCG and Members of the Panel are invited to discuss

Minutes:

Duncan Burton and Tonia Michaelides updated the Panel on how the health system in Kingston was coping over the winter period. 

 

It was confirmed that the Hospital had been very pressured and it had not been possible to exceed 95% of patients being seen in A&E within 4 hours.  Patients were being moved through the system as soon as their clinical condition allowed  and the hospital was working closing with Clinical Commissioning Groups. Simon Pearce confirmed that  5th January had been  a very challenging week but the system worked as well as possible, under great pressure.  He confirmed that many of the patients in A&E are very elderly with complex needs. 

 

In response to a question, Mr Burton explained that it is difficult to discharge patients over the Christmas and New Year as the services  are less available.  However, Kingston Hospital has not had to declare a major incident during this period and KHT had taken patients form other hospitals to assist pressures elsewhere.  He confirmed that nursing vacancies are the lowest they have been in the last two years but this hospital does continue to recruit overseas.  The Nursing establishment was increased in April in anticipation of pressures later in the year and these posts had been recruited to.     He added that KHT is one of 4 hospitals with extended consultant hours in A&E. He commended hospital staff who had worked over and above their contracted hours and were to be congratulated on their achievements. 

 

Tonia Michaelides confirmed the pressures were being felt across the local area and the NHS as a whole.  Investment had taken place outside hospital to enable GP clinics to operate at weekends and this has resulted in a drop of attendance at A&E for minor conditions.  There had been an increase in admissions for frail elderly patients with long term condition and there is a need for community beds.  There was a balance to be achieved between safe discharges and  in ensuring that patients do not stay in hospital for longer than needed as this could be detrimental to their wellbeing.

 

During discussion the problem of encouraging older people to access services such as Staywell to help them stay at home was discussed.  It was noted that there are now named GPs for people over the age of 75 who regularly review these patients. 

 

In response to a question from Councillor Pickering (in the gallery)  Ms Michaelides confirmed that Systems Resilience Groups were undertaking work under the Better Care Programme to develop new models of care to avoid unnecessary  A&E attendance and hospital admissions.  A number of practical changes have been identified some of which had been introduced eg seven day a week access to  Occupational therapy to ensure prompt assessment prior to discharge and to devise and introduce new models of care.

 

Councillor Abraham pointed to the important role of Hobkirk House and the excellent care and support that it provided.   Simon Pearce confirmed there was a  ...  view the full minutes text for item 40.

41.

Maternity Services at Kingston Hospital NHS Foundation Trust pdf icon PDF 81 KB

To receive a presentation by Maternity Leads at Kingston Hospital and discuss

Additional documents:

Minutes:

The report provided background on local maternity services, drawing form information  available on KHT’s website.  It also provided details from the South West London Commissioning Strategy in relation to future developments for maternity services.  Anna Dellaway, Head of Midwifery and Diana Fleming, Clinical Director of Midwifery gave a presentation on the Unit

 

Kingston deals with  5,800 births per year and about 2,500 of these are Kingston residents.  Kingston Hospital is the place of choice for maternity services for 85% of Kingston residents.  Care in the early stages of pregnancy is provided by midwives (from12/13 weeks)   and ante natal clinics are located at Kingston Children’s Centres and larger GP surgeries including Surbiton Health Centre.  The Hospital has a small unit for antenatal in-patients.  Antenatal care follows the National Institute Health guidelines.

 

The hospital offers the following options for birth – the new Homebirth Team launched in June 2014, the Malden Suite which offers midwifery led care, (where births are expected to be uncomplicated) and the Delivery Suite (where there are medical or obstetric needs including caesarean section or epidural).

 

The average length of stay is 2 days and 3-5 days for more complex cases.  Generally there is 1:1 care during labour itself.  95-98% of mothers have this and exceptions are when mothers is being induced in the antenatal ward.

 

During the presentation the Panel was informed that the current ratio of staff to births was 1:32.5 (aiming at 1:30) and there were no midwifery vacancies.  The midwifery team is strong  and there is good supervisory ratio for midwives and a business case had been drawn up for additional  consultant input  to make progress towards achieving 98 hour consultant cover  target on the delivery suite. 

 

Grahame Snelling confirmed that Health Watch had undertaken an “enter and view” visit to maternity services.  All parents who were interviewed said that Kingston was their place of choice and he congratulated the Hospital on this point.

 

The Unit works closely with GPs and offer shared care between midwives and GPs.  In response to a question about availability of antenatal care at the patients’ own surgery, it was confirmed that antenatal service in local GP services were limited as some GP surgeries were unhappy about having patients from other services attending and it has therefore been the approach to place antenatal clinics at children’s centres.  Other facilities can be accessed there – health visitors and support groups.

 

Responses to other questions were as follows.

 

In relation to still births, Kingston’s rate is lower than London as a whole.  There has been a slight spike this year  and Kingston’s rate is 4.8 per 1,000, whereas London’s is 5.6 per 1,000.  The Kingston population group of older mums does increase risks eg placental problems however mothers  in Kingston is more likely to ensure they are well and attend National Childbirth Trust (NCT) classes.  There is a small cohort who do require additional support and care.  The numbers of babies needing neonatal unit care has reduced. 

 

More than 90%  ...  view the full minutes text for item 41.

42.

Appropriateness of GP referrals to the Kingston Wellbeing Service pdf icon PDF 161 KB

To note the report, consider and discuss

Minutes:

The report by the Director of Public Health addressed a query raised at a previous meeting of the Panel about whether people in Kingston are receiving a timely and joined up service for their mental health needs and in particularly whether mental health referrals to Kingston’s Wellbeing Service (KWS) and Kingston’s Community Mental Health Team are appropriate. 

 

Service redesign and procurement led to the development of combining Improving Access to Psychological Therapies Service (IAPTS) and the Adult Community Drug and Alcohol services into an integrated Kingston Community Wellbeing Service.  The report considered referrals for the IAPT service, not the drug and alcohol services.

 

IAPTS provides a range of psychological therapies for people with relatively mild problems including anxiety and depression.  This service was previously operated by South West London and St George’s Mental Health Trust (SWLSTG).  The criteria for the referral to the KWS IAPT services was set out in Annex 2 to the report.

 

Redesign of the Community Mental Health Teams (CMHTs) operated by SWLSTG has also taken place. CMHTs provide more specialist health support for people whose problems are more complex and cannot be managed within primary health care.  The criteria for referral to SWLSTG CMHTs was set out in Annex 1 to the report. 

 

During the past year the KWS IAPT service received a higher number of referrals (4308) compared to the IAPT service operated by SWLSTG. 75% of referrals came from GPs, nearly  20% were self referrals and 4% from the CMHT.  Review of the referral data demonstrates that inappropriate referrals to the KWS was 2.5%, whilst inappropriate referrals to the CMHT was 9%.  The CMHT estimated that in the previous year 8% of items referrals was inappropriate. 

 

Most of the inappropriate referrals to the KWS were due to patients being too young (i.e. they should have been referred to the Child and Adolescent Mental Health Service).   Other reasons were that a patient had substance misuse needs, patients  were already receiving services from SWLSTG or were out of area.  Both the KWB and CMHTs report that any inappropriate referrals are routed on to the appropriate provider and the GP is informed.  The report also noted that inappropriate referrals from GPs are higher in the north of the borough compared to the south. 

 

The Panel noted that in the view of the Director of Public Health the referral criteria for the KWS were very precise but those for the CMHTs were perhaps less so and this might account for the some of the inappropriate referrals.  Dr Hildebrand also noted the turn over in GPs and locums which meant that information needs to be continually provided to primary care.  In response to a question, the Director of Public Health stated that patients could in some circumstance receive different support from both the CMHT and the IAPTS. In other cases a need could be identified during IAPTS treatment  which required a referral to the CMHT to deal with a more complex problem. Dr Hildebrand confirmed that the report had  ...  view the full minutes text for item 42.

43.

Implementation of the Care Act pdf icon PDF 241 KB

To receive a brief presentation by officers of Adult Social Care and discuss

Minutes:

The Executive Head of Adult Services gave a presentation on the Care Act, which is being introduced in two phases in April 2015 and April 2016. The Act provides a significant policy change which  is intended to focus on people’s strengths and to secure personal wellbeing in the community  by supporting needs rather than on meeting needs in residential and other care settings.  Much of the detail in the Act is a consolidation of previous legislation and about one third is new law and practice. 

 

There are five main workstreams including funding reform, information and advice, prevention, carers’ assessment,  IT and communications with the public.  In Kingston a Supportive Strategy focussing on prevention has been developed to keep people well in the community.  Kingston Information Advice Alliance has been formed to ensure that people can obtain the information they need from a range of different local voluntary organisations.   The Act gives the same status to both carers and clients and assessments are now required for both.  A further change places Safeguarding Adults Boards on a statutory footing providing, for example, powers of investigation into cases of abuse.

 

The Act enables statutory duties to be delegated to other parties and arrangements have been made for Kingston Carers’ Network to pilot the undertaking of carers’ assessments on behalf of the Council.

 

Deferred payments schemes are being introduced under the Act and whilst Kingston has had a scheme for several years, changes  have been made to ensure compliance with the requirements of the Care Act. 

 

There will be a national campaign by the Department of Health to publicise the changes.  Healthwatch will assist locally with promulgation.

 

There are various models on the financial impact of the implementation of the Care Act and  the Birmingham City model suggests that  the impact for Kingston could be between  £2M-£3M.  The Government has stated that it will fund the impact. 

 

There are ICT requirements to set up systems to assess costs of eligible care needs which will be capped at £72K.

 

In response to a question Simon Pearce stated that for care provided in care homes, the state pays a lower rate than private individuals.  However, it is thought that the gap will close with time.  However under the Act the responsibility for care homes which fail will fall to Councils.

 

Resolved that: the presentation is noted.

 

 

 

 

44.

Minutes of the Joint Overview and Scrutiny Sub Committee Inpatient Mental Health Services in SW London - 17 Dec 2014 pdf icon PDF 53 KB

To note the minutes of the last meeting and discuss

Minutes:

Resolved that:   the minutes of the JHOSC Sub held on 17 December 2014 were noted.

45.

Item for Information - Minutes of the Health and Wellbeing Board pdf icon PDF 80 KB

To note the minutes of the last meeting and consider whether there are any items which should be considered at a future meeting of the Panel

Minutes:

Resolved that:   The Minutes of the Health and Wellbeing Board held on 2 December 2014 were noted.

46.

Urgent Items authorised by the Chair

Minutes:

There were no urgent items.

47.

Work Programme pdf icon PDF 44 KB

To note and amend the proposed work programme

Minutes:

Resolved that:  the work programme for the next meeting on 12 March 2015 was noted.