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
To consider questions from the gallery on items which are not on the agenda
Questions were asked by Mr Karl Kember. These are attached at Annex 1 to the minutes.
Apologies for absence and attendance of substitute members
Apologies were received from Councillor Maria Netley and Councillor Rachel Reid. Councillor Phil Doyle attended as substitute for Councillor Netley. Apologies were also received from Patricia Turner, Advisory Member, Kingston Voluntary Action.
Declarations of Interest
Members are requested to make any declarations of interest
Councillors Andrew Day and Shiraz Mirza declared interests in item 5, Chair’s Update on the Gosbury Hill Health Centre as they are both members of the South of the Borough Neighbourhood Committee.
To agree the minutes of the meeting held on 26 January 2016
Resolved that: the Minutes of the meeting held on 26 January 2016 were agreed as a correct record and signed by the Chair.
To receive an update on progress since the last meeting and a report on the visit to Teddington Walk In Centre on 10 February 2016
Councillor Andrew Day, Chair gave an update on actions undertaken since the last meeting on 26 January 2016:
1. Urogynaecology services at St George’s Hospital
Following consideration by Sutton, Merton and Kingston scrutiny committees, in the capacity as Chair of the SWL Joint Health Overview and Scrutiny committee, Councillor Andrew Day wrote to Miles Scott, Chief Executive of St George’s University Hospitals to put forward the recommendations of these three bodies.
Wandsworth CCG have been contacted in relation to this Panel’s recommendation which sought assurance from that concerns raised are appropriately addressed.
On 3 March the St George’s board discussed a report which proposed that the hospital and the CCG will undertake further work around the possibility of retaining the Urogynaecology service at St George’s.
2. Arrangements are being made for the Joint Overview and Scrutiny Committee to meet in June to consider the initial SWL Collaborative Commissioning proposals prior to consultation.
3. The JHOSC Sub Committee which has been considering inpatient needs of working age and older adults will meet again on Tuesday 15 March to consider further data concerning bed numbers and community capacity across all five boroughs.
4. Visit to Teddington Walk in centre – Councillors Day, Pandya, Netley and Cottington visited the walk in centre on 10 February. A report of the visit was forwarded to Kingston CCG for consideration as part of the future proposals for the Surbiton Walk in Centre.
5. Update on Gosbury Hill & Surbiton Health Centre – the CCG discussed a proposal at their Board on 1 March to give further consideration to how the proposed model fits with other planned developments for primary care, including weekend opening for GP surgeries and suggestions made in response to the consultation.
6. HOP participation in Enter and View Visiting – Councillors Andrew Day, Maria Netley and Linsey Cottington have now been trained for “enter and view” visits and will participate in Healthwatch’s programme of visits.
To consider recent locally evolving changes to the provision of services for end stage dementia including a small service element for late stage dementia at Fuchsias ward, Tolworth Hospital and its recent closure.
A request was made at the last meeting by a member to consider the closure of Fuchsia ward at Tolworth Hospital which had provided inpatient care for people with late stage dementia. A closure or variation of service may be considered as a “substantial variation” in accordance with the Health Overview and Scrutiny Regulations and Guidance. Neither the Regulations nor the Guidance define “substantial variation” and the Panel is required to decide any variations on a case by case basis. If a change proposal is considered to be a substantial variation then consultation is undertaken.
The report outlined recent local changes to the provision of services for end stage dementia including the Dementia Strategy.
The Health Overview Panel had previously discussed Fuchsias ward on several occasions. It had heard representations from relatives and carers requesting that care should continue to be provided at Fuchsias but it has also heard from service commissioners and providers that long term care in hospital settings is considered inappropriate. Although proposals had previously been put forward to move patients to other care settings, these actions were not progressed. As a result the number of patients diminished, the remaining patient passed away in October 2015 and the ward closed.
The report highlighted the fact that the original purpose of Fuchsias when it was introduced in 1993 was to provide care for people with dementia who also had challenging behaviours. As time has passed the care needs of that group of patients has changed and commissioners’ views were that people with end stage dementia needs are better cared for in other settings such as nursing homes. The report also noted Sir Roy Griffith’s report “Community Care Agenda for Action”, 1987, introduced the notion of community settings as being more preferable for people instead of long term institutional care. It was also noted that no new admissions to Fuchsias were accepted after 2008.
The report suggested that the decision to make no further admissions could be regarded as the point at which the service was “closed” and proposals to move patients to other settings were considered.
Prior to discussion by members, Officers made a number of points. Dr Emma Whicher stated that the understanding of dementia has changed and it is now around empowering and supporting with medications such as acetylcholinesterase inhibitors and other interventions to control behaviour. Cognitive behavioural services can help support interaction at home as these psychological approaches can help alleviate behavioural problems, distress and anxiety.
Jasmines ward, whilst providing in patient care for older psychiatric patients, is primarily for assessment particularly where there are other mental health co-morbidities. There is also a strong feeling from many families not to move relatives with dementia into residential care and to manage people in their own homes, although “home” in some circumstances may be a residential care setting. The very end stage of dementia is not an area of mental health expertise; it is physical deterioration and is better supported by GPs. Dr Whicher added that now ... view the full minutes text for item 50.
To note the activities being undertaken and provide any views or observations on the report, the actions described and recommendations.
(This item was postponed at the meeting on 26 January 2016)
The report provided a summary of the main themes and points from the 2015 Annual Public Report which was launched on 25 November and is available on the Council’s website. Previous reports had focussed on older people (2013) and mental health (2014).
The report provided details from Kingston’s demographic profile:
· on average men in Kingston will spend about 16 years in poor health and for women this is about 18 years.
· 68% of the 1,122 deaths in 2013 were due to three disease groups - circulatory disease, cancers and respiratory disease.
· 44% of deaths of people below 75 years were caused by cancer.
The cause of many of these deaths relate to lifestyle factors which include Diet, Exercise and Alcohol.
Whilst Kingston has lower levels of childhood obesity than the London and England averages, being overweight still increases from reception year to year 6. Research demonstrates that the daily consumption of five portions of fruit and vegetable is much less than it should be and sugar intake is twice the recommended level of 5% of diet. Only a little less in terms of portion size together with increased consumption of fruit and vegetables can assist weight loss. Whilst older peoples’ calorie requirement diminishes it is important that a balanced diet is maintained to support health in later life. Malnutrition is a concern for about 3000 older people in Kingston.
Physical activity is important for all age groups because it reduces risk of developing over 20 chronic health problems including circulatory disease and dementia. It can also improve mood and self esteem. However, research shows that most of the population do not exercise to the recommended levels.
Alcohol misuse causes considerable harm to people’s health and to society. It can also present a problem for families where there are children in a household, impacting on parenting skills. High alcohol intake can have a significant health impact. It is estimated that in Kingston 33% of adults drink at levels which may cause harm to health and a range of interventions is available to local residents. New alcohol consumption guidelines are currently subject to consultation and these advise that both men and women should consume no more than 14 units per week, spread over 3 days or more. Older people’s tolerance to alcohol reduces with age but fewer people over 65 access alcohol treatment services and the report recommended raising awareness to improve uptake.
The report also highlighted other chapters in the annual report including progress with schools and ethnic differences. Many traditional ethnic diets are healthier but the benefits are lost in adopting English dietary customs. People from ethnic minorities generally consume less alcohol. There are variations between minority ethnic groups on physical activity.
The following points were raised in discussion:
In response to a question about the relationship between the policy on schools meals influencing behaviour Iona Lidington confirmed that Public Health were involved in the contract arrangements for the nutritional content of school meals. It is important that meals are ... view the full minutes text for item 51.
To consider the current services and future steps.
(This item was postponed at the meeting on 26 January 2016)
This report was requested by the Panel as diabetes is a significant and in many cases, preventable condition. The report described what diabetes is, the common symptoms and potential complications if the condition is not well managed. Complications can include peripheral vascular disease, lower limb amputations and eye problems. Type 1 diabetes is where the body does not produce insulin and this can be caused by genetics, a virus or injury. Type 2 generally occurs in people who are 30 years or older where they are morbidly obese, are inactive or where women have polycystic ovaries. Health checks can be helpful in detecting pre-diabetes states.
It is predicted that there are approximately 11,000 people in Kingston with diabetes. Of these 7,723 have been diagnosed and are included on GP diabetes registers. Prevalence of diagnosed diabetes varies from 2.4% to 8.5% across practices and can depend on a number of factors such as the number of older people, deprivation and ethnic group. Diabetes is more common amongst people of Pakistani and Bangladeshi origin.
In a recent national diabetes audit, Kingston CCG was placed 21st out of 211 CCGs and previously had ranked 61st. There is good practice in many Kingston GP surgeries, and work is underway to raise standards in other surgeries. Services include specialist diabetes nurses, Tier 3 for complex cases and Tier 4 hospital based services.
Current costs of treating diabetes for Kingston residents are of the order of £4m per year. Many of the lifestyle steps which are helpful in preventing diabetes relate to the themes in this year’s Annual Public Health Report – Eat well, Exercise more and Drink sensibly. The report also described current and planned health services for diabetes and an outline of findings from a consultation with local people about diabetes services in 2015.
Julia Gosden stated that the consultation results indicated that services were not as joined up as they should be and findings will be used to inform work on procurement of a better integrated pathway model for 2016/17 which would lead to improved patient management.
In response to a question about variations of prevalence between practices, it was confirmed that there was a range of factors. Higher prevalence was likely to be associated, for example, with larger numbers of older patients and people from some ethnic communities. The Fairhill Medical Practice had a low prevalence and this was due to the large student population serviced. Health Checks were useful in helping to identify patients with diabetes.
1. The Panel noted the activities being undertaken;
2. The Panel recommended:
a) Given the variation in recorded prevalence by GP practice, further work should be undertaken to understand the reasons for these variations; and
b) Noting the link between being overweight, obesity and diabetes, the Council needs to make health choices easier; and
3. The Panel request the CCG to give a future update on progress in commissioning the integrated diabetes service in a year’s time.
To consider the following suggestions for the 2016/17 work programme:
· South West Trains approach to disability particularly visual impairment
· Kingston Co-ordinated Care Programme
The following items would be included in the 2016/17 work programme:
South West Trains approach to disability (particularly visual impairment)
Update on the deficit at Kingston Hospital NHS Foundation Trust
Kingston Co-ordinated Care Programme
Community Mental health Team
GP Surgery to consider appointment systems
Surbiton Health Centre
A request was made for the Kingston Co-ordinated Care Programme to be taken early on in the year. Members were requested to put forward other suggestions for the work programme.