Councillors and committees
Agenda and minutes
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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
There were no questions.
Apologies for absence and attendance of substitute members
An apology for absence was received from Councillor Paul Bedforth and Councillor Maria Netley attended as substitute.
Ann Radmore Chief Executive, Kingston Hospital Foundation Trust, Andrew Osbourne Homecare Transformation Lead and Dr Gareth Hull, General Practitioner, were welcomed to their first meeting of the Health Overview Panel.
Declarations of Interest
There were no declarations of interest.
To agree the minutes of the meeting held on 12 January 2017
AGREED that: The minutes of the meeting held on 12 January 2017 were confirmed as a correct record.
A verbal update from Ann Radmore, Chief Executive, Kingston Hospital NHS Foundation Trust
Ann Radmore, Chief Executive of Kingston Hospital NHS Foundation Trust gave an update on progress made by the Hospital. Kingston performs on the A&E target as a good average when compared to hospitals in London and London hospitals perform better than the rest of the country. The Trust is working with the CCG to make changes both in hospital and out of hospital to help lift performance further. Key points from the presentation included:
Performance and financial position:
· A&E performance for February 2017 against the 95% target was 87.1% and for March to the 9th 92.8%.
· Delayed transfers of care as at 10 March are 28 across the 6 boroughs. The largest single factor is access to neuro rehabilitation.
· 18 week performance for January was 94.8% above the 92% target and the number of cancelled operations was small during this winter
· Cancer performance exceeded all targets in January and Kingston was the best performer in London for the 62 day target.
· The forecast end of year deficit is £7.1M compared to the 2016/17 deficit of £4.2M. Reasons for the deteriorating position are:
o Changes to non-elective (non-planned cases) income/case mix
o Financial effect of the tariff change
o Unfunded costs of opening additional beds and delayed discharges
o Cost improvement plans have not delivered as much as expected
CQC Inspection and progress with the “must do” actions: Ann Radmore reminded the Panel that Duncan Burton had previously brought a report on the Hospital’s response to the CQC inspection in January 2016. The report of the inspection identified seven “must do” items which related to systems and processes. Audits and walkabouts have been undertaken to test progress on the 7 “must do” and 42 “should do” areas. She confirmed that good progress had been made and a further report has been submitted to the CQC this month and the CQC is happy with the progress made. Good progress has also been made with the forty two “should do” items. 33 of the 42 have either been completed or are due to be completed in 2016/17 but the remainder will take longer or require funding to complete as funding needs to be identified. The most significant actions which require funding are reviewing maternity capacity, A&E capacity and improving the ICU environment.
Staff survey: There has been a significant improvement about how staff feel about working at the hospital and the Trust scored in the top 20% of all acute hospital on 13 of the indicators and it also has the best overall outcome in south west London. Notable indicators are:
· 75% staff would recommend the hospital to others
· 69% of staff would recommend the hospital as a good place to work
· 94% feel that their role makes a difference to patients
· 82% of staff believe that care of patients is the organisation’s top priority.
Estates Strategy: The Trust is commissioning a new estates strategy and this will reflect the South West London 5 year ... view the full minutes text for item 49.
To scrutinise the report on current service provision and future plans and request a future update on progress and performance
Andrew Osborn, Home Care Transformation Lead, introduced his report on Reablement. The Home Care Transformation project has been established to develop a new care pathway to promote a person’s independence and their ability to stay at home. One of the ways the Council can improve independence is to offer Reablement support. Reablement is viewed as a prevention service and under the Care Act 2014 it is provided free of charge and can last up to six weeks. It is defined as:
“Providing personal care, help with daily living activities and other practical tasks, to encourage people to develop the confidence and skills to carry out these activities themselves and continue to live at home. It tends to be provided to people who have just been discharged from hospital or are otherwise entering the care system following a crisis and will be in the person’s home”.
The NHS provides similar support known as Intermediate Care which is a short-term intervention for people who might otherwise have a prolonged stay in hospital or inappropriate admission to hospital or residential care. This support can either be provided in the person’s own home or in a bed-based setting. Reablement formally is a Council responsibility. The service was transferred to Your Healthcare in 2013. A review is underway as it is part of the Kingston Co-ordinated Care programme.
The key performance measure for Reablement is the number of people who leave the service fully independent. Performance in Kingston has varied between 20-30% over recent years, which is low compared with other councils. The national benchmark is 60%. Your Healthcare has developed an integrated approach to Reablement and Intermediate Care and following analysis, reporting on independence has improved and the overall performance level of fully independent people and is now 46%.
The current budget is £1.239M and approximately 500 people (approx. 50 per month) are referred to Your Healthcare by Adult Social Care every year. However, the criteria for access to the service are now tight so a person has to have quite developed needs to access the service.
Andrew Osborn pointed out that detailed conversation with clients and carers can lead to a better understanding of needs, how quality of life can be improved and how this can best be addressed. Wellbeing varies from person to person. When the service “gets it right” successes can be considerable.
Andrew Osborn and Stephen Taylor gave the following responses to questions posed by members of the Panel and the Portfolio Holder for Partnerships.
A comment was made that a hospital admission can provide a respite period for a carer and it was confirmed that that the Reablement service can provide support when that person returns home and look at what support the carer needs as well. It is expected to combine reablement with the long term care model and make further improvements. It was suggested that the Panel could look at the model for Home Care a future meeting. Further developments in the model will include greater ... view the full minutes text for item 50.
To consider the consultation and engagement plan for the Choosing Wisely Programme
The Kingston Clinical Commissioning Group (KCCG) requested the Panel to consider its communications and engagement plan for the Choosing Wisely Programme. The CCG Board met on 7 March 2017 to consider the engagement approach and the Panel received late material which set out some minor changes to the programme details agreed by the CCG Board and the latest version of the engagement plan.
KCCG has a gross savings plan target of £11.7M in 2017/18 which represents approximately 5% of the CCG’s total budget. The programme if implemented fully could realise savings of £1.05M.
The Choosing Wisely programme proposes that the following items will no longer available on prescription unless they are needed for medical reasons i.e. where patients have potentially serious medical conditions:
· Self-care medications for acute illnesses (such as colds and flu) that will get better over time (could save £100K)
· Some baby milks where alternatives can be purchased over the counter (could save £150K)
· Gluten free products (could save £46K)
· Vitamin D supplements (could save £5K).
The CCG is also proposing changes to:
· IVF (in vitro fertilisation) treatment eligibility criteria (could save £250K)
· How patients are supported to be as ready as possible ahead of planned surgery by addressing smoking and excess weight to ensure best possible outcomes
The CCG will use the engagement activities to communicate the recent changes to the CCG’s list of Procedures of Limited Clinical Effectiveness. Twenty two policies about procedures have been reviewed by the 6 SWL CCGs using the latest available clinical evidence and guidance and the local guidelines for these conditions have been refined.
The outcomes of the engagement programme will be considered at next meeting of the CCG Board on 23 May (prior to the Health Overview Panel meeting on 24 May).
Tonia Michaelides, KCC Chief Officer, and Dr Gareth Hull, Kingston GP, explained the Choosing Wisely Programme and addressed a number of questions. They confirmed that the same approach is being progressed by all 6 CCGs in South West London but no decisions have yet been made. They advised that it would be possible to flex the new approaches for exceptional circumstances.
In relation to criteria for IVF the CCG is seeking Kingston residents’ views about more targeted approaches i.e. to only offer IVF to couples where there has been cancer involvement or previous viral infection or perhaps not to offer IVF on the NHS at all.
Tonia Michaelides explained that a range of engagement platforms including Survey Monkey, paper surveys, direct approaches to relevant voluntary organisations such as the Coeliac Society, were being proposed and the CCG would welcome any suggestions from Panel Members about local groups to engage with or any other aspects which had been missed.
The following suggestions and comments were made:
· The importance of engaging with hard to reach groups e.g. Kingston Refugee Action and the MILLAP day centre and those that currently do not access the services under consideration eg younger people who may which to consider their need for IVF in the ... view the full minutes text for item 51.
To agree items for inclusion in the work programme for 2017/18 including:
Annual Public Health Report
CQC Inspection report of Your Healthcare
Update on commissioning the integrated diabetes service
Telephone access to GP surgeries
Please note that the work programme is subject to change.
The Chair reported that the Panel is undertaking engagement with health and social care and voluntary organisations seeking suggestions for areas which the Panel could consider during the next municipal year. We would welcome suggestions of topics where the Panel could make a contribution by scrutinising and acting as a critical friend. Currently our list of suggested topics includes:
· Annual Public Health Report
· CQC inspection of Your Healthcare
· Update on commissioning the integrated diabetes service
· Telephone access to GP surgeries
The Health Overview Panel will continue to consider any forthcoming consultations from health and social care partners.