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: firstname.lastname@example.org
Apologies for Absence
Apologies were received from Councillors Raju Pandya, Shiraz Mirza, Rachel Reid and Patricia Turner, Advisory Member. Councillors Chris Hayes and Lorraine Rolfe attended as substitutes for Councillor Pandya and Rachel Reid respectively.
Declarations of Interest
There were no declarations of interest.
To confirm the minutes of the meeting held on 29 January 2015
Resolved that: The minutes of the meeting held on 19 January 2015 were agreed as a correct record and signed by the Chair.
To note the update on the consultation and KCCG’s decision on 3 March 2015 (to be reported at the meeting) and to agree further scrutiny on the local development of Home Treatment and Community Services to support the proposals
The report updated the Panel with the consultation outcomes and the discussion at the Joint Overview and Scrutiny Sub committee held on 24 February. The report detailed the proposed changes to bed numbers which were detailed in the “Proposed modernisation of mental health in patient services in South West London: for decision”.
Tonia Michaelides on behalf of the five CCGs gave a verbal update on the outcome of the consultation and the consideration by the CCGs. The consultation responses were collated by Participate, an independent organisation, and have been presented in a report considered by the CCGs (and the JHOSC). The CCGs have listened to views put forward and have changed some of the recommendations including flexibility for a 7th adult acute ward as there were concerns about the number of beds. Detailed modelling will be undertaken by the autumn to determine whether or not this additional provision will be required.
Ms Michaelides reported that all five CCGs have agreed to increase total expenditure by an additional £20M by 2019/20 to provide a total of £157M. The additional funds will support further the development of Home Treatment Teams and ensure that appropriate levels of community services are in place prior to implementation of the inpatient changes.
The National Deaf adult services had been proposed to relocate to Tolworth Hospital but CCGs now appreciate that a community supporting deaf clients has developed in the Springfield area and these services will remain at Springfield. The CCGs are also looking to retain outpatient services at Barnes and St Mary’s hospitals which will help with concerns around travel.
CAMHS services are commissioned by NHS England (not CCGs), and following further examination it has been concluded that the cost of retaining services at Springfield, particularly building upgrades, would be prohibitive and additional planning consent was unlikely to be granted. Relocation to the Tolworth Hospital site will enable provision of out door space. LB Kingston have confirmed that they would be willing to support the educational component following relocation to Tolworth.
NHS England will make their final decision 17 March 2015 on the location of the CAMHS and the JHSOC will consider the consultation outcomes at its meeting on 19 March.
Ms Michaelides stated that whilst the consultation process has been completed this was just the beginning of the 10 year transformation project.
Resolved that: the update is noted.
The Royal Eye Unit, Kingston Hospital NHS Foundation Trust
Mr Hooman Shafarat, Consultant Ophthalmologist, will update the Panel on the care provided by the Unit
Mr Hooman Sherafat, Consultant Ophthalmologist and Clinical Director of the Royal Eye Unit, gave a detailed presentation on the work of the unit. He last visited the Panel 2 years ago. The service manager and matron were unable to attend this meeting.
The REU accounts for 10% of the hospitals outpatient and day case activity. It has a total expenditure of £6.8M and an annual budget of £11M. It sees over 3,500 patients a year including 20% of paediatric attendances at the Hospital and 10.5% of the Hospital’s day case activity.
The REU is a stand alone unit and offers general ophthalmology services, and expertise in minor operative procedures including cataracts, glaucoma, low visual aids services and vitreoretinal services. It is part of the SW Thames on call services and South West Thames rotation for ophthalmology training. There are now closer links with the diabetic screening service.
During the past two years both the management team, governance and the consultant body have been strengthened. There are now 7 consultants and dedicated consultants for paediatric, glaucoma and intravitreal retinal surgery. During working hours there is always a consultant available in case of emergency or where there is a need for senior input, and whilst they are not always available on site they are on call. The REU operates on weekdays between 8.30am and 4.00pm. Out of hours services are provided St George’s. This collaborative approach was required as a result of the introduction of the European working directive.
The current climate requires greater innovation. One area of focus has been an annual leave policy which has the effect of reducing cancellations. Quality performance had improved and the service is consistently meeting 18 week target achieved by operating weekend clinics. There are a range of performance measures and activities including review meetings ensuring quality is achieved. There is also a five year strategy plan. Space is a constraint and weekend working is one way to increase service capacity.
The additional work being undertaken provides logistical/capacity challenges and weekend working has been introduced. The unit would benefit from electronic patient records and interface with ophthalmic diagnostic equipment. There are plans to extend the role of nurses to undertake some clinical duties such as intravitreal injections.
Links have also been developed with the Thomas Pocklington Trust providing a different angle on the needs of patients. Contributions of volunteers from the Trust have been helpful in the Unit particularly in relation to form completion. There are other external links with diabetic eye screening services, Kingston Eye Network, Queen Mary’s and New Medical which provides support for chronic eye conditions, Collison’s a low vision aids provider.
Improvements to signage are being explored and a suggestion has been put forward to include colour coding in corridors and pathways even beyond the boundary of the hospital.
Members welcomed the consultant presence in the unit during opening hours.
In response to a question, Mr Sherafat explained recent IT networking improvements have been helpful but there was still more ... view the full minutes text for item 52.
Officers from the Pocklington Trust will present their 2nd annual report on the Vision Strategy
The report detailed the implementation phase of the local partnership focussing on three projects – the creation of a VI (Visually Impaired) Parliament, a volunteering service in the Royal Eye Unit at Kingston Hospital and partnership working focussing on employment and social enterprise. Keith Valentine explained that whilst the charity was operating in all 32 London Boroughs its impact in Kingston had been far greater than elsewhere.
The Pocklington Trust, an endowed charity, originally came to the Panel in 2013 and presented its first report in 2014 which detailed planned actions for 2014/15. The Action Planning Group is composed with representatives from the Council, KCCG, the Local Optical Committee, Kingston Association for the Blind, Kingston Hospital Royal Eye Unit and meets on a quarterly basis.
The VI Parliament (the first in the UK) was launched in September 2014 and currently has five local VI people who are MPs representing the wider VI community. Each MP has a specific area of interest – health, transport, education, employment and leisure and social events. It is planned to appoint a further five MPs with further specialisms. MPs meet monthly and there are quarterly public meetings. Areas of involvement include the International Day of Disabled Persons, Community Ophthalmology Review and Procurement Steering Group, First Route Learning bus, Public Transport Liaison Meeting, TPT Services Committee and Tri-borough Area Consultation Event.
The volunteering service at the REU was launched in September 2014. Three are now 13 volunteers who cover a morning or afternoon shifts during the week. Ongoing recruitment is expected to increase the number to 22 volunteers shortly. The service provides low-level emotional and practical support to VI people and so far over 400 people have been helped. The service relies on strong local working relationships at the REU and relevant statutory and local organisations. The REU has found the service helpful and it has gained insight into the effects of sight loss on daily living. Volunteers have provided input in to REU leaflets and have received positive feedback from patients.
University of Cambridge has been commissioned to undertake an evaluation of this pilot service and the work of the VI Parliament and the report is expected in June 2015.
Partnership working to undertake projects addressing employment and social enterprise opportunities for people with sight loss is in its early stages. This will involve linking with local statutory and voluntary organisations such as Kingston Association for the blind, Kingston first, Job Centre Plus, the Chamber of Commerce, local colleges and the university. Objectives include developing opportunities for work placements, increasing employment and employability of VI people in the local area and raising awareness with employers.
Members welcomed the report and the progress made by the Pocklington Trust. A number of areas requiring improvements were suggested including around transport, for example, taxis often refuse to take guide dogs and do not call at the pick up address to provide required assistance. Theatres do not always offer audio described performances.
In response to a question about ... view the full minutes text for item 53.
Dietary intake and activity will be the focus of the Annual Report of the Director of Public Health for 2015. The attached report on obesity provides an opportunity for this Panel to consider this area and make recommendations.
This report provided background on childhood obesity and relevant services in Kingston.
Childhood obesity services became a responsibility of Local Authorities following the transfer of Public Health to Local Authorities in April 2013. Whilst Kingston has relatively low prevalence of childhood obesity compared with other parts of the country for Reception age children (4-5 years) and Year 6 age children (10-11), local data shows that there is a doubling of prevalence between these two groups. In Kingston 17.2% of reception children and 28.5% of Year 6 children are overweight or obese. The report also detailed the increase in prevalence in underweight children which in Kingston is 1.2% at Reception age and 2.4% at Year 6. The prevalence of overweight and obesity in children was detailed in Annex 1 to the report.
Obesity is linked to deprivation and levels are high in Norbiton, Chessington North & Hook, Chessington South and Old Malden for Year 6 children. Obesity is also more prevalent in minority ethnic communities in Kingston. It is associated with the increased consumption of energy dense foods high in fat and sugar and an increasing sedentary lifestyle.
Health risks associated with obesity include type 2 diabetes, cardiovascular disease, some cancers and mental health/self esteem.
Childhood obesity is a complex issue requiring multifaceted interventions using behavioural approaches aimed at changing diet and physical activity patterns to achieve long term changes. A summary of the services for child weight management in Kingston was presented in Annex 2 to the report.
The report detailed the interventions which include: the Healthy Child programme (infant feeding etc); a pilot post-natal weight management programme for women (including advice for babies); Healthy Start programme, Cook and Eat in a range of settings and Health Link workers in secondary schools plus a range of physical activity programmes for different age groups. Other approaches relate to the environment including planning policy, green spaces and allotments, active travel, leisure and facilities and trading standards. Organisationally there are a range of relevant objectives within the Kingston Plan, the CCG commissioning strategy and Kingston’s public health strategy.
The report put forward 21 recommendations (see paras 41 to 61 on pages B9 and B10). The report noted the read-across between the recommendations and those in the LGA’s report on Tackling the Causes and Effects of obesity, January 2015. Key recommendations for Kingston include:
· Continued investment in preventative and treatment interventions is required in Kingston to help reduce the number of children carrying excess weight and in particular to reduce the doubling of prevalence between Reception Year and year 6;
· Consideration of investment in the Kingston Healthy Catering scheme and supporting the Social Supermarket scheme;
· Increasing support to families with children aged 0-5 as parents have flagged a lack of monitoring and support between the last health visiting checks and measurement in Reception year;
· Increasing the uptake of Healthy Start by eligible families;
· Further development of communications and marketing to raise awareness;
· Public Health should be introduced as an integral part of planning and ... view the full minutes text for item 54.
To consider detailed information about variations between the four Neighbourhood areas in Kingston
Neighbourhood profiles were developed from the recent Pharmaceutical Needs Assessment. These set out a range of health, demographic and socioeconomic indicators for each of the four neighbourhoods. The report provided a synopsis of the profiles which were attached in full at the annex to the report.
Kingston as a whole compared to England has a lower death rate. Notable differences between Neighbourhoods are detailed below:
Kingston Town – there are fewer people with long term illness or disability but higher percentages of overcrowded households and pensioners living along. Binge drinking is higher in this neighbourhood and the incidents of cancers is also slightly higher. Child development and education indicators are similar to the Kingston average and long term unemployment is higher.
Maldens and Coombe - has a higher BME population and higher number of people who cannot speak English well or at all. The percentage of low birth weight is higher than the Kingston average. More people have a long term illness or disability than in the rest of Kingston but there are lower percentages of overcrowding and pensioners living alone. Breast cancer is significantly higher in this Neighbourhood than England as a whole but premature deaths are lower than the Kingston average. GCSE achievement is higher than the Kingston average.
South of the Borough – has the lowest BME population of the four neighbourhoods. Income deprivation and child poverty are higher but deprivation for Older People is lower. More people have a long term illness or disability which may account for a higher percentage of carers. GCSE achievement is lower than the Kingston average.
Surbiton – also has a low BME population. Both people affected by income deprivation and GCSE achievement is higher than the Kingston average. Child poverty is lower than the Kingston average, but the number of older people in deprivation is higher.
In response to a question as to why adult obesity figures and binge figures are based on old data (2008), Dr Hildebrand explained that the information came from Public Health England and this was the latest available data. For the majority of the indicators covered in he PNA assessment more up to date data was used. Dr Hildebrand confirmed that he would raise the matter of out of date data with Public Health England (PHE) at a forthcoming meeting with PHE.
Dr Hildebrand explained that in general the incidence of cancer is linked to deprivation but breast cancer is linked to affluence. This could be due to maternal age at childbirth which is usually later in affluent areas. The incidence of breast cancer is greater for older women. He added that screening is particularly important and survival for breast cancer is in general better for Kingston residents than the England average.
In response to a question about GCSE outcomes Dr Hildebrand believed the data reflected both state and private schools but agreed to confirm this was the case.
Resolved that: the report is noted
The Better Care Fund
Tonia Michaelides, Chief Officer Kingston Clinical Commissioning Group will give a brief presentation on the Better Care Fund in Kingston
Tonia Michaelides gave a presentation on Kingston’s Better Care Programme which represents a major and complex change for delivering care in Kingston. The Better Care Fund was introduced in 2013 to underpin progress towards integrated health and social care. The fund will be launched fully in April 2016 aiming to reduce non-elective admissions to hospital by 3.5% i.e. a saving of just £1M for KCCG. Kingston wishes to make transformational changes over and above this. This programme is aligned to the NHS 5 year View and is a local response to this.
The Better Care Programme is two fold – firstly, to support people to stay healthy and well and live independently as part of thriving communities and secondly, to provide care and support for those who have more complex needs. Partners to the project include the CCG, Your Healthcare, SWL & St Georges’, Kingston Hospital, Primary Care and the voluntary and community sector.
The first objective will be achieved by:
· enabling active and supportive communities by supporting self care,
· increasing support for people with dementia,
· supporting carers and
· developing options for home adaptations and housing.
The second objective - Supporting people with more complex needs will be achieved by
· coordinated care in Kingston
· risk stratification and case management to identify the most complex patients
· expanding Kingston at home
· providing 7 day services.
Tonia Michaelides referred to the care triangle where the top 2% of the local population i.e. 2,000 use most of the health and care resources in Kingston.
Work towards introducing these changes has involved listening to a range of health and social care service users and patients plus carers who have had a range of experience to gain new insights into future models of care in Kingston. Key messages from users are:
· To be understood
· To have control over care and choices
· Care to be better coordinated
· Care to be consistent in quality
Discussions have also taken place with staff.
The vision for co-ordinated care in Kingston is that
· People are supported to achieve the best possible quality of life and the goals that matter to them
· People are supported to connect into their communities, remain in control of their own lives and independent of service as much as possible
· People are provided with proactive care that improves their quality of life and where possible prevents their conditions worsening and their needs increasing
· A more coherent and understandable model of care including a lead care contact to provide support for developing a care plan and signposting to services. This will generally be the person the client sees the most and could be a doctor, a nurse etc.
Delivery will be achieved by combining health and social care budgets. From 1 April 2015 a total of £10M will be combined and health and social care will be looking to increase this in the future. (The total Kingston health and social care budget is in the region of £250M). There will also be greater alignment on health and social care ... view the full minutes text for item 56.
To note the minutes of the meeting held on 3 February 2015 and whether there are any items which should be considered at a future meeting of the Panel. Topics considered at the meeting include: the Pharmaceutical Needs Assessment, Joint Health and Wellbeing Strategy (future work will focus on children and young people), the Better Care Programme and the Section 75 Agreement between KCCG and the Council which enables pooled funds.
The minutes of the Health and Wellbeing Board held on 3 February 2015 were noted.
A member noted the lower cancer screening rates for breast and cervical cancers detailed in Minute 27 and requested that the Panel look at this area.
Members are invited to suggest topics for future meetings in the new 2015/16 Municipal Year.
The Work Programme was discussed. Suggestions from members included:
Schools Obesity programme update
Cancer screening uptake in Kingston (identified from the HWB minutes)
Air quality in Kingston
Other items included:
Gosbury Hill update
Children’s and Adult Autism strategy
Winter pressures/Systems Resiliance
Mental Health Services - Strengthening community support; Waiting times for MH treatment and Patient feedback
Visits to health and social care settings.
The Chair took the opportunity to thank all contributors to the work of the Panel during the course of the year. He particularly thanked Simon Pearce who was leaving RBK for his support to the Panel over the past years.