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: email@example.com
Questions were asked by Mr Karl Kember concerning a range of topics. These are summarised in the Annex to the minutes.
Dr Jonathan Hildebrand, Director of Public Health
South West London and St George’s Mental Health Trust
Dr Emma Whicher, Medical Director
Jonathan Mason, Service Director, Kingston and Richmond Team
Kingston Hospital NHS Foundation Trust
Dr Jane Wilson, Medical Director
Duncan Burton, Director of Nursing and Patient Experience
Moira Ford, Board Lead, Foundation
Dr Naz Jivani, Chair of the CCG Governing Body
Julia Gosden, Director of Commissioning
Tony May, Commissioning Manager
Kathryn MacDermott, Head of Primary Care Development
Apologies for Absence
Apologies for absence were received from Councillor Shiraz Mirza and Grahame Snelling, Advisory Member.
Declarations of Interest
Declarations of interest were made by Councillors Andrew Day and Rachel Reid in relation to the item on Gosbury Hill as they are both members of the South of the Borough Neighbourhood committee. (Councillor Reid is chair of that committee.)
Minutes of the meeting held on 11 June 2015
To approve the minutes of the last meeting
The minutes of the meeting held on 11 June 2015 were agreed as a correct record and signed by the Chair.
To consider the report and discuss
The report provided the Panel with an overview of Kingston Hospital’s performance against the 4 hour A&E standard. The standard is that 95% of patients should be assessed, treated and discharged or transferred to the appropriate setting for their unscheduled care needs within 4 hours of arriving at A&E.
Kingston Hospital has been one of the top five performing trusts in London for most of 2014, however, performance deteriorated from the end of November 2014 and monthly targets were missed from December 2014 to July 2015. During this period there had been a marked increase in emergency admissions over this period.
Performance from August to date has been above target at 95.3% and there has been a slight reduction in attendances since July.
The Hospital has undertaken an indepth analysis with commissioners of demand and capacity at the hospital to understand the reasons for the drop in performance. The NHS England Intensive Support Team has also undertaken a whole systems review which included looking at health and social care services in Kingston, Richmond and Surrey. Tripartite meetings have taken place with NHS England and Monitor and actions agreed.
It has been identified that patient flows within the hospital and to services in the community have not been sufficiently robust which has resulted in delays for discharging medically fit patients and delays to other transfers of care. The hospital has worked to improve patient flow, enhanced the nursing model in A&E and made further efforts to recruit to consultant posts.
Other developments include the implementation of an unscheduled care whole systems improvement programme which will speed decisions and intervention to ensure best care, and cross locality discussion with adult social care and community health providers to enable greater integration of discharge support.
In response to questions from members the following responses were given:
In relation to how performance can be sustained in coming months, Dr Wilson believed there was a good chance of continuing to achieve the target, but she pointed out that during winter there is a greater burden of ill health. Duncan Burton confirmed that NHSE and Monitor require additional reporting when performance slips. He added that Monitor was also investigating the current deficit situation.
Julia Gosden confirmed that winter planning has commenced and the Systems Resilience Group (SRG) would meet on 17 September. A self assessment was being undertaken locally across adult social care, community and voluntary sector to help focus on where greater attention was needed.
Ms Gosden explained that the SRG has oversight of performance of emergency care, planned care and cancer care and the group includes colleagues from KHT, the community, adult social care South West London and St George’s. It has a membership of around 18 different organisations , and is chaired by the CCG. The purpose is to understand issues and improve. The Whole System Performance Group which is hosted by KHT reports to the SRG.
A request was made for information to assist the Panel understand patient throughput and ... view the full minutes text for item 16.
To note the report, discuss and make any recommendations
The 7 day working initiative has been developed in response to recognition that outcomes for patients admitted to hospital on Fridays and at weekends is less good than during the week. 7 day working has received particular attention following the government’s election in May 2015. The focus has primarily been on hospital care and 10 national clinical standards have been developed (see annex 1 to the report). These cover the following areas:
· Patient Experience (all health and social care sectors)
· Time to first Consultant Review (emergency admissions)
· Multidisciplinary Team Review (emergency patients)
· Shift handovers
· Intervention/Key Services
· Mental Health
· Ongoing review
· Transfer to Community, Primary Care and Social Care
· Quality Improvement
There are further, more detailed clinical standards for hospitals in London.
There is recognition that seven day services need to be implemented in a way that does not increase the overall cost of healthcare but that this could lead to a reduction in the number of hospitals providing certain services.
In addition to the progress being made by Kingston Hospital, other local approaches to 7 day working are being developed by Adult Social Care, Your Healthcare, Primary Care and South West London & St George’s Mental Health Trust. Partner organisations in Kingston are committed to implement 7 day services in order to reduce acute admissions, improve discharges, especially at weekends, reduce delayed transfers of care and enhance patient experience and much progress has been made by the local System Resilience Group (SRG). A number of key points include:
Kingston Hospital is continuing to progress 7 day services with attention currently on acute services and standards relating to clinical outcomes, safety, patient experience and efficiency. Emergency cover is available on site in A&E, Acute Assessment Unit, Emergency Surgery, Paediatrics, Maternity , Anaesthetics/ITU and Radiology. Extending hours of cover is incorporated into job plans of newly appointed consultants and an emergency surgical team is being established. Consultants are available 7 days a week in paediatrics, surgery, medicine, maternity, imaging, A&E plus therapists and pharmacists although in some cases cover is part day. Whilst good progress has been made on the London adult emergency Clinical Standards a number of outstanding areas remain.
Further work will take place to align hospital and community services to avoid avoidable admissions and facilitate better discharge arrangements. Winter monies have been agreed for some 7 day schemes.
Adult social care works with Kingston Hospital Staff on AAU, A&E and the wards providing information and advice from 10am to 4pm at weekends enabling timely and safe discharge from home.
Last winter GPs provided services at weekends across 4 practices in the four neighbourhoods. Learning from this indicated that it would be better to target this differently and offer two walk-in sites in the borough with additional extended hours across a number of GP practices.
Your Healthcare has modelled staffing requirements and the introduction of new rotas has enabled greater capacity across the working week. There is now a single point of access between 8am and 8pm ... view the full minutes text for item 17.
To consider the draft Consultation Plan for the proposed 8 week consultation due to commence on 15 September 2015.
The views of the Panel were sought on the draft plan for public consultation for changes to services at Gosbury Hill GP led health centre in Chessington. The preferred option of the consultation was that this service is relocated to Surbiton Health Centre as a walk-in GP service open on Saturdays, Sundays and Mondays for 12 hours per day.
The draft consultation plan set out a range of consultation activities which would take place during the 8 week consultation period, including availability of publicity material and a number of consultation events. These would include consultation opportunities at South of the Borough and Surbiton Neighbourhood Committee meetings on 8 October 2015.
Dr Jivani outlined the consultation plan. He explained that there would be two separate consultations which would run side by side:
· As the current GP led health centre has a small list of patients, NHS England undertake consultation with those patients to explain how the service would change and that the list would need to be dispersed to nearby GP practices
· Consultation by Kingston Clinical Commissioning Group on the proposal to relocate the unregistered population element to Surbiton Health Centre.
The GP led health centre had been introduced by Kingston Primary Care Trust in 2007 to improve access to GP services. However, uptake has been much less than elsewhere. It was confirmed that action had been taken to try and increase footfall at the centre and it had also been advertised as part of winter planning and at bank holidays. The proposal to relocate the service and offer initially 36 hours at weekends and Mondays were expected to alleviate the pressure on A&E and provide more effective use of resources.
Responses to the consultation would be collated, and considered by the CCG Governing body during November. Outcomes would be presented at the November meeting of this Panel and a range of post decision information would be available, including social media.
In response to questions Dr Jivani confirmed that nearby practices have the capacity to take the 2,000 patients currently registered at the Gosbury Hill GP led health centre. Kathryn MacDermott added that the patients would be invited to participate in the wider consultation. If the consultation outcome is in favour of relocation then at that point patients will be offered a choice to move to the remaining two practices at Gosbury Hill or nearby.
It was confirmed that the consultation would cover the whole of the Borough but focussing mainly on South of the Borough and Surbiton and also capturing views of travellers and Refugee Action.
The CCG governing body would consider the consultation plan at its meeting on 8 September and a press release about the consultation would follow this decision which would be in line with CCG Governance procedures.
A number of views were put forward by Councillor Margaret Thompson from the gallery on behalf of Mr Colin Dance including about future use of the Gosbury Hill premises (a range of services had been provided previously), ... view the full minutes text for item 18.
Appointments to the South West London Joint Overview and Scrutiny Committee
To note the following appointments to the SWL Joint Overview and Scrutiny Committee made by Council on 14 July 2015:
Agreed that: the following appointments to the SWL Joint Overview and Scrutiny committee made by Council on 14 July 2015 are noted:
Members Cllr Andrew Day Cllr Raju Pandya
Alternates 1 Cllr Yogan Yoganathan Cllr Linsey Cottington
Alternates 2 Cllr Linsey Cottington Cllr Margaret Thompson
To consider the minutes of the meeting held on 24 June 2015
A number of questions were asked by members.
Dr Hildebrand explained that the difference between actual and expected winter deaths was accounted by higher proportions of older people living in large, poorly heated homes. He confirmed that Public Health England held evidence to support this and that there was locally a programme of initiatives to assist with this.
In response to concern about the closure of Fuchsia ward Dr Jivani stated that one patient remained. He confirmed that a number of local nursing homes, with gold standard, had the expertise to care for people with dementia and that 150 his own patients were looked after very well in these homes. Dr Jivani added that dementia is flattening out and there was a need for greater investment at Kingston Hospital for dementia care.
In response to a request that the Panel consider the serious case review Dr Hildebrand agreed to check whether this area fell within this Panel’s remit. He confirmed that the details of the case were now in the public domain and available on the local Child Safeguarding website.
Agreed that: the Minutes are noted.
To agree the proposed items for the November meeting.
Agreed that: the following items would be discussed at the meeting on Tuesday 24 November 2015:
Outcomes of the consultation on the changes at Gosbury Hill Health Centre
Kingston Hospital Foundation Trust Financial Deficit – actions to remedy and potential effect on services in year and beyond
Winter Planning – focus on managing urgent admissions, beds, staffing and patient transfers/discharges