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

22.

Apologies for Absence

Minutes:

Apologies were received from Councillors Raju Pandya and Shiraz Mirza.  Councillor Thay Thayalan attended as substitute for Councillor Shiraz Mirza.  Apologies were also received from Patricia Turner, Kingston Voluntary Action.

23.

Declarations of Interest

Minutes:

Declarations of personal interest were made by Councillors Andrew Day and Rachel Reid in relation to the Gosbury Hill item as they are both members of South of the Borough Neighbourhood Committee.

24.

Minutes

To approve the minutes of the meeting held on 3 September 2015

Minutes:

Resolved that:  the minutes of the meeting held on 3 September 2015 were agreed as a correct record and signed by the Chair.

25.

The Deficit at Kingston Hospital NHS Foundation Trust pdf icon PDF 254 KB

To consider the background and the Trust’s actions to remedy and whether there will be any potential effect on services in year and beyond

Additional documents:

Minutes:

The report provided background to the deficit at Kingston Hospital NHS Foundation Trust and details of the recovery planning discussed at KHT’s board in July and October 2015.  Information was drawn from publicly available documents from a range of relevant organisations to give the wider context.

 

Kingston Hospital gained Foundation Trust (FT) status in May 2013.  A prerequisite of gaining FT status is demonstrating financial viability.   In March 2015 the Hospital set a deficit budget at £8.8m.  Following the implementation of a range of actions, the end of year forecast deficit as at October 2015 stood at £6.1m.  The Trust acknowledged that the continuing high level of agency costs may undermine this. 

 

Cost pressures contributing to the deficit were identified by the Trust as:

·         the move from the national IT programme to a system funded by the Trust

·         the reduction in the numbers of junior doctors as they undertake more training in primary care and community settings

·         the implementation of the London Quality Standards

·         the move towards seven day working.

 

Steps to contain the deficit have included reductions in capital expenditure by slipping the capital plan, including the refurbishment of A&E, successful negotiation with commissioners on payments for over performance and faster billing to commissioners.

 

Monitor is the financial regulator of Hospitals and is investigating the Trust’s financial sustainability plus the A&E performance which has been problematic since November 2014.

 

The report to the Panel provided brief details of nearby Acute Trusts’ financial positions (Croydon University, Epsom and St Helier and St George’s University):  all have deficits.

 

A Monitor  Board report (February 2015) identified that the rise in emergency demand was impacting on the delivery of elective work and due to the tariff difference between  emergency and  elective activity,  payments were reduced.  A further Monitor report drew attention to the need for agency costs to ensure and maintain safe staffing levels. 

 

Mr Jo Farrar, Director of Finance provided the following information: 

 

The Trust had made a submission to Monitor and an investigation is in progress.  Kingston is one of 45 other FTs currently under investigation.  He confirmed that a detailed bottom up review of the capital programme had taken place.  Agreement had been reached with commissioners on a budget settlement to ensure that patient safety and quality of care can continue. 

 

He confirmed that the revised budget deficit stood at £6.1m, an improvement of £2.7m.  Actions taken had prevented the need to draw down on external finance in year. 

 

Mr Farrar understood that all acute trusts were now in deficit and Kingston’s position was less serious than many others. 

 

In response to questions from members Mr Farrar confirmed the following points:

 

·         Agency staffing costs are a challenge for every Trust, however Kingston has undertaken an effective recruitment campaign but there will be agency costs for some time.

·         Monitor has arrangements in place to measure agency spend against ceilings and guidance has been issued to agencies.

·         The current agency spend is around £18.5m, however, it is the agency premium  ...  view the full minutes text for item 25.

26.

Kingston Health and Social Care Systems Resilience Plan pdf icon PDF 126 KB

To consider the winter planning arrangements within the wider context of the Health and Social Care System Resilience Plan

Minutes:

The report was introduced by Tonia Michaelides.     Variations in demand in the health and social care economy occur throughout the year and winter pressures are now less marked than in the past.  The system needs to be able to respond effectively to any additional demands to ensure high quality care for the local population and the five weeks following Christmas are expected to be busy. 

 

Kingston’s System Resilience Group has many partners with representatives from the three lead commissioners and councils covering Kingston, Richmond and Surrey Downs.  The Group is chaired by the Chair of the Kingston CCG, Dr Naz Jivani.  The Group focuses on:

 

·         Urgent and emergency care performance

·         Planned care performance

·         Cancer waiting times performance.

 

Performance for planned care and cancer waiting times has achieved the required standards but A&E performance of 95% of patient being seen within 4 hours has only been achieved on one occasion since November 2014.  However, whilst not meeting the standard, performance has improved and the department recovers more quickly when performance drops.  Targets around the 18 week referral to treatment time and for cancer have been met.

 

Meetings have been held with the Trust Development Authority, Monitor and NHS England and action plans have been submitted.  The focus is on discharge to care.

 

Locally £900K system resilience funds have been received for 2015/16 and this has been allocated for a range of schemes including weekend social work services, weekend GP hubs, enhanced GP services, community therapy and discharge to assessment.  These will be fully in place by 1 December 2015. 

 

A transformation programme is making whole system improvements to the patient pathway to ensure safe and timely discharge for patients of all ages with community support where required and enabling more effective throughput from A&E to wards.  The NHS England “Stay Well” campaign is being publicised giving consistent information across the nation and there are  with additional specific local messages.

 

The following points were raised in discussion:

 

·         Bed capacity for November to February has been increased by 10 but an adult additional ward can be mobilised if required.  Mortuary arrangements can also be increased.

·         It was confirmed that metrics are very detailed to provide excellent data for day to day management.

·         Whilst the 95% A&E target has not been met except in August, it was confirmed that the target was met on a greater number of days than previously.  Latest information held by Monitor shows that no hospitals are achieving the standard.  Kingston was the only hospital in London to achieve 95% in August 2015.

·         Demand for heath care is growing amongst the under 5s and working age adult population.

·         The CCG would be prepared to engage with local groups such as the Phoenix group in Chessington for over 55s about “stay well” advice.

·         The take up of the flu immunisation so far is below the previous year.  In 2014/15 72.9% coverage of people aged 65 and over was achieved.

·         Dr Hildebrand agreed to pass on concerns to  ...  view the full minutes text for item 26.

27.

Healthwatch Kingston's Enter & View Function pdf icon PDF 110 KB

To note the report, discuss and consider future arrangements for involving the Health Overview Panel in suggesting services to visit and members’ participation in the process

 

Minutes:

The report provided the Panel with an overview of Healthwatch Kingston’s work in respect of Enter and View visits to health and social care establishments.  It also put forward a proposal to involve members of the Panel who may be interested in participating in these visits.

 

Regulations governing Healthwatch provide Authorised Representatives of Healthwatch to enter health and social care premises to observe the nature and quality of services and to report findings and make recommendations to providers, the Council, NHS commissioners, the Health and Wellbeing Board, Health Overview Panel, Healthwatch England and the Care Quality commission as appropriate.  These visits are not a formal inspection or regulatory activity

 

Sites to visit are chosen and prioritised by Healthwatch Kingston’s Task groups and endorsed by the Board of Trustees.  These can be informed by various routes including concerns raised by members of the public and points identified in previous CQC visits.  Visits are generally announced but there are powers to make unannounced visits.  Enter and view training is delivered locally and follows the process designed by Healthwatch England.  There are 36 trained active affiliates with a range of backgrounds and experience including sensory and learning disability, refugee and young people.

 

Eight visits have been undertaken since April 2014 including to Kingston hospital, GP practices and Tolworth Hospital.  Further visits are planned to Kingston Hospital prior the CQC inspection in mid January and to other areas.  Details of all visits are included on Healthwatch Kingston’s website. 

 

Health Overview Panel members were invited to participate in Healthwatch visits but any member would need to undergo training and DBS checks.    (The number of HOP members involved would need to be limited to avoid any conflict of interest in the event of future Panel discussions relating to Healthwatch.)

 

Agreed that:

 

1.            The report is noted; and

 

2.            Councillors Sushila Abraham, Mary Clark, Linsey Cottington and Andrew Day participate in Healthwatch Enter and View visits, subject to training and DBS checks.

 

 

28.

Update on the Consultation on Changes to Services at Gosbury Hill GP led health centre

To receive a verbal update on the consultation

Minutes:

Tonia Michaelides gave an update on progress with the consultation which closed on 10 November 2015.  An independent organisation was reviewing the responses and the outcomes would be presented to the governing body where options would be discussed.  There had been approximately 400 responses.  A more detailed report would be presented to the Panel at the January meeting. 

 

Agreed that:  the update is noted

 

Declarations of personal interest were made by Councillors Andrew Day and Rachel Reid in relation to this item as they are both members of South of the Borough Neighbourhood Committee

29.

Update from South West London and St George's Mental Health Trust pdf icon PDF 38 KB

To consider and discuss the report

Additional documents:

Minutes:

The report provided a detailed update on work underway in Kingston together with some wider national and regional context relevant to the successful delivery of mental health services. 

 

Highlights of local achievement include:

·         The consultation on the future of inpatient mental health services led by commissioners took place between 29 September and 21 December 2014.  This examined the future location of services for people in the five boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth.  State of the art facilities have been planned for Tolworth and Springfield and completion is expected by August 2021.

·         An award of £1.95M to pilot enhanced discharge from inpatient to community mental health care.

·         A series of activities in October challenging stigma and discrimination in October including schools outreach and input into ITV’s “changing Minds” week.

 

The national context included:

·         The work undertaken by the Mental Health Taskforce in developing a new five strategy for mental health which would be published imminently

·         Current national bed pressures with the need for people to be accommodated at our of area locations for inpatient.  The report pointed to the 39% decrease in beds from 1998 – 2012.

 

Local context:

·         The Trust has some of the lowest bed numbers in the country and lower numbers of community staff.  An independent review of demand and capacity was being carried out and outcomes would be available before the end of this year

·         A follow up visit by the CQC is expected in March 2014.

·         A Health Services Journal has named the Trust in the list of 100 best healthcare places to work

·         Details of other showcase and awards were given.

 

In response to questions from the Panel the following responses were given:

 

·         The S136 arrangements were outlined and Dr Whicher confirmed that police were more reluctant to retain people in police custody and people are taken to the S136 suite at Springfield.  Dr Hildebrand outlined a successful approach in Richmond where Community Psychiatric Nurses undertake street triage with the police.  This has led to a reduction in admissions to the S136 suite.  A similar approach will be piloted for Kingston.

·         An evaluation of bed requirements was underway and demand is being modelled for expected demand in 2021 when the new facility will be complete. Both Springfield and Tolworth will have similar capacity.  Dr Whicher confirmed that people are not discharged from inpatient care unless discharge arrangements are safe.  She added that housing requirements can present difficulties and intra agency work is underway.

 

Agreed that:  the update is noted

30.

Tolworth Community Engagement Steering Group - appointment of representative

This group has been formed by South West London and St George’s Mental Health Trust to engage with the local community about the new building and service developments at Tolworth Hospital.  Five Councillor appointments are being made – two each from Surbiton and South of the Borough Neighbourhood Committees and the Health Overview Panel.

 

Members are asked to endorse the appointment of Councillor Andrew Day to this Group.

Minutes:

This group has been formed by South West London and St George’s Mental health rust to engage with the local community about the new building and service developments at Tolworth Hospital.  One Councillor representative is being sought from the three nearby wards of Surbiton Hill, Alexandra and Tolworth & Hook Rise and a further representative was sought from the Health Overview Panel.

 

Agreed that:  Councillor Andrew Day is appointed to the Group.

31.

Item for Information - Minutes of the Health and Wellbeing Board pdf icon PDF 99 KB

To consider the minutes of the meeting held on 8 September 2015

Minutes:

A number of questions were asked by members and the following responses given:

 

·         Dr Hildebrand confirmed that there would be a £645K in year reduction in the Public Health grant for 2015/16.  This would impact on a range of public health activities and services are delivered, however whilst there would be reductions in the level of some services none would be cut altogether.

·         Tonia Michaelides confirmed that she is the Senior Responsible Officer for Mental Health Services in South West London and whilst the lead for commissioning mental health had moved from Kingston to Merton, Kingston would retain responsibility for strategic direction for mental health services.

 

Agreed that:   the Minutes of the meeting held on 8 September 2015 are noted.

32.

Work Programme

Tuesday 26 January 2016

 

·         Annual Public Health Report – Diet, exercise and alcohol

 

·         Diabetes Services in Kingston

 

·         Gosbury Hill Health Centre Consultation outcome

 

·         Winter Resilience Update

 

Thursday 3 March 2016

 

·         To be confirmed

Minutes:

Tuesday 26 January 2016

 

·         Annual Public Health Report – Diet, exercise and alcohol

·         Diabetes Services in Kingston

·         Gosbury Hill Health Centre Consultation outcome

·         Winter Resilience Update

 

Thursday 3 March 2016  to be confirmed