Councillors and committees
Agenda and minutes
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Venue: Guildhall, Kingston upon Thames
Contact: Marian Morrison 020 8547 4623 email: email@example.com
To consider questions from the gallery on items which are not on the agenda
Mr Rob Robb from the Patient Participation Group at the Orchard Practice, Chessington, asked about the reduction in community beds from 35 to 25 in the move from Tolworth Hospital to Teddington Memorial Hospital and whether in view of winter flu there are any plans for Kingston Hospital to reduce the number of its beds. The Chair pointed out that the community beds question had been discussed at the last meeting. Fergus Keegan confirmed that the move of beds from Tolworth Hospital to Teddington Memorial Hospital has not yet taken place and this was likely to happen in the new financial year. He confirmed there were no plans to reduce the number of beds at Kingston Hospital.
Mr Robb added that the South of the Borough Neighbourhood Committee was lobbying TfL to review transport in area to ensure there are better connections for the NHS and to help alleviate the need for parking at Kingston Hospital.
James Giles asked about publicity arrangements for the new NHS complaints advocacy service and made a suggestion that details could be included on the RBK website. Marian Morrison explained that publicity about the new provider (PohWer) had been discussed at a recent contract review and locally Kingston Voluntary Action had included details in their latest newsletter which was widely circulated.
Apologies for absence and attendance of substitute members
Apologies for absence were received from Councillors Geoff Austin, Mary Clark and Shiraz Mirza. Councillor David Glasspool attended as substitute for Councillor Austin.
Apologies were also received from Stephen Taylor, Director, Adult Social Care and Jane Bearman attended on his behalf.
Declarations of Interest
There were no declarations of interest.
To agree the minutes of the meeting held on 12 October 2017
Agreed that: The minutes of the meeting held on 12 October 2017 were confirmed as a correct record.
To note the report, scrutinise and make any recommendations
The Panel had agreed to consider progress with the Suicide Prevention and Self-Harm plans in response to a letter dated 4 April 2017 from Dr Sarah Wollaston, Chair of the Parliamentary Health Committee, to Chairs of Health Overview and Scrutiny Committees. The Committee’s third progress report “Preventing suicide in England” was published in January 2017. One of the recommendations was that “health overview and scrutiny committees should also be involved in ensuring effective implementation of local authorities’ plans. This should be established as a key role of these committees”.
The officer report provided detailed information about two recent Kingston Strategies, firstly the Kingston Suicide Prevention strategy (launched in 2016) and secondly, the Thrive Kingston mental health strategy for adults and prevention for all ages (launched in 2017). The report also provided the context of these local strategies which include the NHS Five Year Forward View for mental health (2014) (FYFVMH), plus two Concordats for better mental health programme and for crisis care (Appendix 5).
Thrive Kingston is the local strategy for local mental health services for the whole of the Kingston community and provides the local approach to the wider Thrive London strategy. It was co-produced with over 200 people in the Kingston community including people with mental health conditions, their friends, carers and parents as well as health and social care professionals, commissioners and representatives of voluntary organisations (see Appendix 1). An update on the progress with implementation of the strategy was presented in Appendix 2.
In relation to suicide there are approximately ten cases each year in Kingston and this can fluctuate slightly. Due to the time taken for Coroners’ verdicts there is a time lag in the availability of confirmed data. The suicide rate per 100k population in Kingston broadly follows the national average. (Across London there are 4 - 5 suicides per week). Details of key performance indicators for suicide and related risk factors were presented in Appendix 3.
Dr Phil Moore, Deputy Chair of KCCG and Mental Health Clinical Lead, gave a presentation to the Panel explaining the Thrive Kingston strategy. He confirmed that this was in line with the national policy (FYFVMH) and provides a vision for mental health and wellbeing and a guide to shape the future provision setting out the policy for prevention, early intervention, self-care, treatment and recovery.
The Thrive concept is international and developed in New York. Thrive London has six key aspirations:
· A city where individuals and communities take the lead
· A city free from mental health stigma and discrimination
· A city that maximises the potential of children and young people
· A city with a happy healthy and productive workforce
· A city with services that are there when and where needed
· A zero suicide city
Thrive Kingston has five key themes and Appendix 2 to the report expanded on these themes (pages A18 to A25):
· Wellbeing and prevention
· Early intervention
· Community connection
· Access to Services
· Joined up Care
Priorities being progressed in 2017-18 are:
· Early years, children and family, ... view the full minutes text for item 25.
Ann Radmore, Chief Executive will present an update from the hospital
Kingston Hospital submitted a report to the Panel to update on the following areas: performance, fire safety, car parking, progress against the areas identified by the Care Quality Commission – the 7 “must do” (of which 6 have been addressed) and 42 “should do” items (39 now addressed/being progressed). The remaining “must do” item concerning system improvements to monitoring equipment maintenance and safety checks is being progressed and an automated tracking system will be in place in mid-December.
The three outstanding “should do” items require significant capital investment which has not been identified so far and the CQC is aware of this:
· Consider how the environment and facilities in the ITU/CCU could be improved.
· Review maternity service bed capacity in order to address the increasing activity
· Review the environment of the chapel and multi-faith facilities
Ann Radmore, Chief Executive attended the meeting, gave a presentation and answered a number of questions.
The Trust has continued to perform well on cancer targets and the referral to treatment target (RTT) and has been exceeding the national targets for each. It is achieving well on digital development and is the 4th hospital in England to achieve HIMSS level 6. The Hospital also performed well on the Family and Friends Test – 95% of people would recommend the hospital to others.
Ann Radmore stated that performance in A&E in October was 92.6% seen within 4 hours, just below the national target of 95%. She explained that the Trust does achieve the 95% standard about twice a week. The capacity in the emergency department’s Major and Resuscitation area is being increased to create a further 7 spaces and the new urgent treatment centre (UTC) opened on 27 November.
The “Red Bag” Scheme piloted in Sutton has now been introduced in nursing homes in Kingston and Richmond enabling patients admitted to hospital to take their red bag with them. This contains important information on a resident’s health and a number of essential belongings which also aid discharge.
Ann Radmore confirmed that progress has been made on the provision of seven day services and extended consultant physician care is available on wards across the week with two consultants at weekends. This is aiding the ability to make discharges at the weekend.
Implementation of the fire safety plan is progressing especially with regards to increasing compartmentalisation within the hospital buildings. Significant investment will be needed to undertake these works, however two wards in Esher Wing have been completed. It is expected that the changes will be completed in the next 18 months. Mock evacuations /training exercises had taken place jointly with the London Fire Service. During discussion it was suggested that there was a need for more Fire notices directing people where to go.
Car parking at the hospital is being reviewed to explore whether it would be possible to increase the amount of onsite parking but currently several spaces have been temporarily lost due to the UTC and A&E extension works but 12 ... view the full minutes text for item 26.
Update on preparations for the winter demand
Fergus Keegan, Director of Quality, Kingston & Richmond CCGs will update the panel on plans for this winter
Fergus Keegan, Director of Quality and Engagement at Kingston and Richmond CCGs gave a detailed presentation on the preparations for winter.
This year’s winter plan builds on work of last year and is aligned with the DH, PHE and NHSE’s third national integrated “stay well this winter” campaign. The presentation gave information on relevant statistics, the focus for Stay Well this Winter, the local communications plan, primary care access and the role of the A&E Delivery Board which is chaired by Ann Radmore.
The national campaign brief is “to ensure that people who are most at-risk of preventable emergency admission to hospital are aware of and, where possible, are motivated to take actions that may avoid admission this winter”. The campaign seeks to educate at-risk groups about the actions they can take to stay healthy (C2DE adults aged 65+, people with long term conditions and carers and to improve the update of flu vaccine.
Key statistics in the past year:
· Emergency admissions via A&E at Kingston Hospital – increased by 12.2%
· Ambulance journeys (KCCG patients) - increased by 3.7%
· A&E attendances (all) at Kingston) Hospital - increased by 0.55%
· A&E attendances (KCCG patients – increased by 1.1%
· RBK Delayed Transfers of Care – reduced by 63% comparing Sept 17 with Sept 16
· Flu immunisation 65+ for KCCG (Sept 16 to Jan 17) 66.1% and for year to date 61.4%
· People registered with Kingston GPs – 209,409 – increased by 2.4% (includes small numbers of people from outside Kingston)
· GP appointments over past year – 811,522
· Extended Primary care hub appointments April – Sept 17 – 14,942
· (this increases GP appointment capacity by 3.6% over a year)
In terms of overall A&E attendances:
· Total A&E attendances at Kingston Hospital (Oct 16 – Sept 17) 117,198
· 65% (65,202) patients from other CCGs
· 44% (51,996) patients from KCCG
· 22,805 KCCG patients (30%) attended another A&E
Fergus Keegan stated that Kingston has not seen the same level of growth in A&E attendances compared with other hospitals but a higher proportion of over 85s need to stay in hospital and they have greater health needs. Kingston Hospital has a clinical decision unit which provides a safe area for people who need to stay longer than 4 hours. This enables more time for observations and prevents people being sent home in the middle of the night.
Partnership working in Kingston and notably RBK’s adult social care team have enabled 63% reduction in delayed transfers of care compared to previous 12 months and Kingston is the 2nd best in London.
Flu vaccinations for Kingston’s NHS staff now stands at 71% (at 6 December 2017). This is an improvement on last year and has exceeded the target.
Fergus Keegan drew attention to the additional capacity that has been provided in primary care particularly at the primary care hubs. All together an additional 58K appointments are being provide plus a further 23K - 24K community nursing appointments. For ... view the full minutes text for item 27.
To consider the minutes of the Health and Wellbeing Board held on 14 September 2017
The minutes of the Health and Wellbeing Board held on 14 September included the following items:
· Update on the South West London Sustainability and Transformation Partnership
· Child Death Overview panel Annual Report 2016-17
· May of London’s Health Inequalities Strategy Consultation
· London Crisis programme – health based place of safety
AGREED that: The minutes of the Health and Wellbeing Board held on 14 September 2017 were noted.
Healthwatch Kingston had submitted a formal written request under statutory powers to the Chair of the Health Overview Panel to consider the specialised provision for people with complex Emotionally Unstable Personality Disorder (EUPD) in Kingston. The letter explained that a number of questions about provision of these services had been made to the Kingston Clinical Commissioning Group (KCCG) but the responses had been unsatisfactory. Currently Kingston residents have no access to specialist services for EUPD unlike other nearby boroughs. Instead a primary care based personality disorder (PD) service is being commissioned. The letter appended information about the engagement with KCCG and South West London and St George’s Mental Health Trust (SWLSTG), the NICE treatment guidelines for EUPD [including Dialectical Behaviour Therapy (DBT) and Mentalisation-based Therapy (MBT)], and the prevalence of both PD and EUPD in Kingston. It is estimated that there are 536 people in Kingston with EUPD
Grahame Snelling, Chair of Healthwatch, Kingston introduced the request. He stated that this was an important topic and Healthwatch were seeking to draw attention to the inequity in service provision for residents of Kingston with this condition compared to those in other boroughs. Whilst several representations to KCCG had been made Healthwatch were not satisfied with the responses received so far. Healthwatch were seeking answers to the following four questions:
· We would like to understand the rationale for the provision of PD services for residents in Kingston and in particular, more complex EUPD.
· “Thrive Kingston” is a 5-year strategy (we are currently approaching the end of year 1) and we would like to know when provision for Kingston residents with complex EUPD will be addressed in the remaining 5 years of the strategy.
· What provision will be made for people with complex EUPD until new arrangements are in place?
· Would the Health Overview Panel consider the link between this and suicide prevention?
Grahame Snelling added that the report considered for the earlier item on Mental Health Services and progression with the suicide and self-harm plans explained the ambitions of the Thrive Kingston strategy and Healthwatch had hoped this group will be represented in that documented in more detail.
Dr Phil Moore began by stating that we do not have a perfect Personality Disorder service in Kingston. He agreed that the prevalence in Kingston of people with EUPD was of the order of 500. Kingston has a number of services in primary care, primary care step-up support and SUN. The CCG recognises that this group of people is not well-served with current services. The CCG is therefore planning to undertake a three months’ demand and capacity review and expects to be in a position to report in April/May 2018 to enable plans to be made for the future.
In relation to the current service provision, the Serenity Integrated Mentoring Project takes people with the greatest need and who are the most chaotic. Police and other professionals undertake regular mentoring for these clients and the approach is based on project developed in ... view the full minutes text for item 29.
To note the work programme and agree the proposed changes:
The addition of Transport for Children and Young People with Learning Disabilities for the March meeting and the postponement of Air Quality to October 2018.
1. The work programme as amended was noted;
2. The items for the meeting on 28 March 2018 are:
· Main item – Progress with the Locality and Wellbeing Teams
· Transport for children and young people with learning disabilities
· Update on the Sustainability and Transformation Partnership
· Interim Update on KCCG’s demand and capacity review of services for Emotionally Unstable personality Disorder; and
3. The following members were appointed to the working group to develop the items: Councillors Bass, Netley and Clark, and Kate Dudley (Kingston Carers’ Network) and Stephen Bitti (Healthwatch Kingston).