Councillors and committees
Agenda and minutes
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, Democratic Services Officer Tel: 0208 547 4623/email; firstname.lastname@example.org
Questions and Public Particpation
A 30 minute question and answer session at the start of the meeting –advance notice of questions is encouraged.
A written question had been received from Mr V Patel concerning detailed information about waiting lists and requesting a response within three months of this meeting (by 13 December 2018). The Co-Chair read out the question and advised a response was bring prepared. No questions were received from the gallery.
Declarations of Interest
Members of the Board are invited to declare any disclosable pecuniary interests and any other non- pecuniary interests (personal interests) relevant to items on this agenda.
There were no declarations of interest.
Apologies for Absence and Attendance of Substitute Members
Apologies were received from Dr Phil Moore (KCCG), Dr Anthony Hughes (GP Chambers), Dr Mark Potter (SWLSTG), Tonia Michaelides (KCCG) Siobhan Clarke (Your Healthcare), and Robert Henderson (AfC). Dr Annette Pautz (KCCG) attended the meeting.
Julia Travers, Director of Commissioning KCCG attended on behalf of Tonia Michaelides. Grant Henderson attended on behalf of Siobhan Clark, Your Healthcare. Dr Amanda Boodhoo attended to present the Annual report of the Kingston and Richmond’s Child Death Overview Panel.
To confirm the minutes of the meeting held on 12 July 2018S
The minutes of the meeting held on 12 July 2018 were confirmed as a correct record and signed by the Co-Chair, Dr Jivani (in the Chair).
To receive the updates and consider the work programme
The report provided the following updates:
· Mayor’s Health Inequalities Strategy for London was launched on 3 September. It aims to make the capital a healthier and fairer city for all Londoners and includes measures across five key areas to help address stark disparities in health i.e. Healthy children, Healthy Minds, Healthy Places, Healthy Communities and Healthy Living.
· Updates were also given on progress with Connected Kingston, Sector Led improvement event on Alcohol related harm reduction on 26 September and the public health feedback to the consultation on the review of the Borough’s Gambling Policy.
Adult Social Care:
· Details of the Local Provider Alliance participants (to support the delivery of Kingston Co-ordinated Care)
· Excellent progress in reducing Delayed Transfers of Care (DTOCS)and reduction in admissions to residential and nursing home care
· Success of the Home to Decide initiative being piloted. This provides two weeks of care for people discharged home whilst decisions about future care arrangements are made.
· Maximising independence initiative which provides up to three weeks of reablement support following discharge
· Strength/asset based approach – 100 staff have attended an 8 week programme to build resilience skills in families prior to prescribing statutory services.
Kingston Clinical commissioning Group’s report:
· The CCG received a rating of “good” in NHS England’s annual assessment of CCGs’ performance. Whilst the CCG achieved financial balance and exceeded its financial control total for 2017/18 it was awarded an amber rating as it had not achieve the required 90% of the Quality Innovation, Productivity and Prevention (QIPP) target. The CCG received “outstanding” ratings for cancer and maternity clinical priorities.
· Over the Counter (OTC) Medicines – there is now a South West London approach on which OTC medications should not routinely be prescribed and guidance for GPs and patients is being shared with practices.
· Health London Partnership “Ask about Asthma” campaign is taking place in September
· South West London Partnership – appointment of an independent chair – Cheryl Coppell and Provider representative – Ann Radmore, Chief Executive of Kingston Hospital.
· Finance – the CCG is on target to meet its in year 0.4% surplus (£1.06M)
Kington Hospital NHS Foundation Trust
· Good performance on cancer targets and the 18 referral to treatment (RTT) targets. RTT performance is expected to reduce as the hospital is undertaking additional work on patients who have waited unacceptably long with other providers. The A&E performance target is continues to be below the required 95% of patients seen within 4 hours, however there have been improvements in delayed transfers of care (DTOCS) (those who have been in hospital for more than 7 days).
· The Trust is working on two major transformation projects – theatre productivity and outpatients (changes to patient care pathways and administrative processes).
· Good improvements have been made in recruitment and retention overall but there are some problems with junior doctor appointments (this is a national problem).
· Winter plans are being finalised.
· The recent CQC inspection was reported under a separate agenda item.
South West London & St George’s Mental ... view the full minutes text for item 19.
Update on Outcome of CQC inspection of Kingston Hospital NHS Foundation Trust
Miss Jane Wilson, Medical Director will give a verbal update
The Medical Director, Kingston Hospital, provided a verbal report on the Care Quality Commission’s Inspection of Kingston Hospital earlier this year and advised that the report is available on the CQC’s website.
The Trust received an outstanding rating for the quality of care overall and outstanding for being well led. The progress with dementia care was highlighted. The inspection included listening events with both staff and patients, on-site visits to several service areas including the emergency department, medical inpatient areas and outpatients. A short list of actions was identified by the CQC.
There was also an assessment of the Trust’s Use of Resources by NHS Improvement (NHSI) which looked at a vast range of elements. Only four other Trusts have undergone this assessment process so far and the two inspections will be combined in the future. The overall rating for Use of Resources was good.
The Panel congratulated Kingston Hospital on the inspection results.
In response to a question about staff recruitment and retention Miss Wilson said that whilst there was is uncertainty around the impact of Brexit and there is some turnover of staff from the EU especially nursing staff, recruitment and retention had improved and the costs of temporary staff had reduced.
In response to a question about the financial situation Miss Wilson advised that there are difficulties as the Trust’s reference costs are the 7th lowest in the country. Regulators have recognised that the change in proportions of hospitals’ elective and emergency work mix makes brings financial difficulties due to the lower income from emergency treatments compared to elective treatments when the proportion of emergency treatments rises.
RESOLVED that: Update is noted and the Trust is congratulated on its achievement.
Voting – Unanimously in favour
To agree recommendations for the appointment and support of Mental Health Champions
The concept of Mental Health Champions stems from the “Thrive Strategy” which includes a recommendation “to increase the awareness and capability of policy makers to recognise risks to mental wellbeing and to respond in a way that reduces that risk”. A number of mental health champions have been appointed by schools and work places and the Board’s support for the proposals detailed in the report was sought. There has been much interest from councillors and it is therefore proposed to appoint a Mental Health Champion for each of the Council’s strategic committees. The report also proposed that the Health and Wellbeing Board will support and receive updates on the work of the individual Champions.
The Director of Public Health explained that a mental health diagnosis can result in 15 years less life expectancy for people. Housing, planning and sport plus other areas of the Council’s responsibilities can impact on people’s mental wellbeing and much can be achieved by ensuring a joined up approach to strategies and decisions which will reduce risk. The aim of the Champion role is to be a leader and an advocate. Public Health will provide training and assist with the making of connections for the work and portfolios for each of the strategic committee.
The Director of Public Health referred to a number of Kingston Public Health strategies and plans in place concerning mental health and the role Champions could have in helping to deliver these via the Strategic Committees. The ring fenced public health grant will support this initiative.
The following comments were made by members of the Board:
The Leader stated that she had been had received a large number of volunteers for the proposed Committee Mental Health Champions and this area was different from the other report elements which form committee reports i.e. equalities. Some of the considerations which need to be made are less obvious for environment and finance areas of the council.
A member (former Chair of Health Overview Panel) welcomed the approach and the importance of thinking about health and mental health in all we do. She also welcomed the inclusion of health implications on reports, an approach which had been supported by the Health Overview Panel.
1. The Royal Borough of Kingston signs up to the prevention concordat;
2. The report is referred to Council on 16 October 2018 to make appointments of five Mental Health Champions to the following Strategic Committees:
· Children’s and Adults’ Care and Education
· Environment and Sustainable Transport
· Community Engagement
· Strategic Housing and Planning
· Finance and Contracts;
3. Reports will be taken to each of the above five Strategic Committees to provide guidance about the role of each individual Committee’s Champion;
4. The Health and Wellbeing Board supports and will receive regular updates on the work of the Member Mental Health Champions on each of the Council’s strategic committees who will undertake roles as described in paragraph 5;
5. The Health and Wellbeing Board supports the process for RBK to take the steps ... view the full minutes text for item 21.
A presentation will be given by Julia Travers, Director of Commissioning, Kingston & Richmond CCGs
The report provided an introduction to the new Local Health and Care Plan for 2019-21 which will be published in the Spring 2019. It is part of the South West London Sustainability and Transformation Partnership and is being developed on behalf of the Health and Wellbeing Board by health and care partners in Kingston and Richmond with input from other organisations including the voluntary sector. It will describe the local vision, priorities and actions to meet the health and care needs of the local population across the themes of Start Well (children and young people), Live Well (adults) and Age Well (older people). It will deliver improvements in the health and wellbeing of local people.
There are 5 phases to the development of the Plan and the first phase has been completed:
· Case for improvement drawing on the JSNA, existing local plans and strategies
· Reviewing and engaging on the case for improvement
· Determining and agreeing priorities based on the case for improvement
· Determining and agreeing actions to inform local commissioning intentions, service developments and changes to deliver the priorities
· Articulating the benefits, impact and outcomes that the priorities will deliver for local people
A presentation was given jointly by the Directors of Commissioning, KCCG, Public Health and Adult Services, RBK. The context of the ongoing serious financial challenges particularly for the Council from 2018/19 to 2021/22 was explained together with the rising demand from a growing and ageing population with increasing complex needs. Kingston residents as a whole are healthier and more affluent than the average London borough but there is substantial variation across the population, with small pockets of significant deprivation. The Director of Public Health provided verbal detail on a number of elements including prevalence of obesity, illnesses such as cancer which is the leading cause of death in Kingston and diabetes. There had been one recent case of adult Measles locally. The Director of Adult Services outlined the steps being taken around maximising independence, strengthening communities/neighbourhoods to help support people plus prevention and early intervention.
The presentation detailed the priorities for the three Start Well, Live Well and Age Well themes including:
· Promoting the mental wellbeing and resilience of our children and young people
· Supporting parents to be confident to manage their child’s health particularly in times of crisis
· Helping young people transition to adult services
· Prevention of ill health and social care need
· Promoting and maintaining independence and social resilience
· Reducing inequalities for with learning disabilities, serious mental illness and carers
· “Health in all” approach to policies
· Support people to live at home
· Reduce loneliness and isolation
· Developing inclusive and friendly communities
· Support for dignified death in place of their choosing
An outline of discussions in Kingston about the three priority areas and details of next steps including engagement and a borough wide event in November were given.
The following questions and comments were made by members:
In response to a question about whether there would be an evaluation it was confirmed that the benefits and ... view the full minutes text for item 22.
To receive and comment on the Annual Report
The Care Act requires that the Health and Wellbeing Board considers the Kingston Safeguarding Adults Board Annual Report. It was also being presented to the Children’s and Adults’ Care and Education Committee. This year’s report was presented in a more concise format in order to be more accessible to the public and more detailed information is available on the Safeguarding Adults pages of the Council’s website.
The report included details of achievements from eleven partner agencies including the CCG, local hospitals, Police, Healthwatch. Two organisations were unable to provide reports due to changes in personnel and it is expected that this will be possible for next year’s annual report.
A total of 887 safeguarding concerns were raised during 2017/18 and 527 of these required Enquiries to be undertaken, showing a small increase on last year. Three Safeguarding Adult Reviews were commenced during 2017/18 and once completed, information will be included in the next annual report.
A total of 743 Deprivation of Liberty Safeguard requests were made of which 82% were from care/nursing homes and 18% from hospitals. 40% of requests were for repeat referrals.
RESOLVED that: the report is received and noted.
To receive the report and note the learning
The Child Death Overview Panel reviews all expected and unexpected child deaths in Kingston and Richmond and is chaired independently by Dr Amanda Boodhoo who introduced the annual report (which is confidential).
The number of deaths across Kingston and Richmond decreased on the previous year with a total of 21 in 2017-18 (10 in Kingston and 11 in Richmond). The majority of deaths were in children aged up to 12 months (80% of cases in Kingston). Multidisciplinary team reviews are held to identify actions to prevent future occurrences and formal meetings as part of the rapid response process attended by key professionals who know the family concerned, including the GP.
Sixteen case reviews were completed across the two boroughs (9 in Kingston and 7 in Richmond). Two cases were considered to have modifiable factors (fewer than last year).
Key themes for learning relate to neonatal deaths, safer sleeping (possibly related to temperature), communication, suicide, end of life care, risky behaviours and ethnicity. There is an ongoing work plan to consider how learning is embedded both from local cases and nationally.
A request was made for future annual reports to only present information for Kingston i.e. not Kingston and Richmond.
In response to a question about national learning Dr Boodhoo explained that it can be difficult to identify themes at a borough level and trends can be identified more easily at CDOP regional level. She added that there are plans to change Safeguarding Boards to become partnerships with the police, health and local authority, and there will be new panels for child death. Latest guidance points to combining with other local areas and it is considered that Kingston and Richmond would be large enough.
A request was made for more detail about this to be presented to the Board when available.
1. The learning from the Child Death Overview Panel is noted;
2. The Board supports the LSCB by disseminating learning to partners and the general public regarding child safety; and
3. Information about future changes to the organisation of Safeguarding Boards is made known to the Panel, when available.
To endorse the strategy which co-ordinates multi-agency work to prevent and intervene in situations of neglect in Kingston (and Richmond)
Neglect is the most common type of abuse in the UK today and it can lead to poor health, educational and social outcomes and is potentially fatal.
The multiagency Kingston and Richmond LSCB Neglect Strategy was launched in June 2018 to encourage engagement with this type of child abuse which is hard to intervene to eradicate. Locally there have been a number of learning and improvement case reviews which have highlighted the challenges for local practitioners in working in situations of neglect. Themes in these reviews include poor supervision, children not being brought to medical appointments, numerous moves, lack of attention to children’s needs including hygiene and basic needs in children under the age of 5. About 10-13% of Kingston referrals to Children’s Social Care are for neglect but this is lower than in other parts of the country.
The Strategy included details about different types of neglect, the four strategic priorities of Governance, Prevention, Interventions and Evaluation, and ten key Principles, the first of which is “the child’s best interest must be the priority”. A number of social factors were also identified which can increase the likelihood of neglect including lack of a caring relationship and poor parental functioning. The document also promoted the use of the updated Neglect Toolkit and multi-agency training to be held later in the year will include the neglect toolkit. A conference is also planned for the autumn. Finally a number of measures of improvement and impact were identified including around Early Help Assessments and children’s attendance at medical and dental appointments.
The Portfolio Holder for Children’s Services commended the strategy and suggested that it needed to be taken forward by all schools, the housing department and other Council areas. The Professional Advisor for Kingston LSCB confirmed that the Board was doing its best to highlight the strategy and asked partner organisations to appoint a Neglect Champion to take this forward within individual organisations. She added that consideration was being given to develop a model for a compressed toolkit for use when concerns need to be escalated. The Board was also liaising with faith groups on the Strategy.
The Healthwatch representative asked whether Kingston had sufficient health visiting cover. It was confirmed that both school nursing and health visiting services are commissioned by Public Health and provided by Your Healthcare. Capacity modelling is undertaken and caseloads are smaller than in the past and it was confirmed that there are no known recruitment difficulties. Your Healthcare was recently rated as good by the Care Quality Commission. The Professional Adviser offered to discuss this further and provide more information if needed.
The Director of Public Health provided further reassurance and confirmed that there had been no disinvestment. The service operates a mesh model of health visiting with higher number of visits and targets those with greater needs.
Dr Pautz commented that there was a high number of children on plans in Kingston and quite a few looked after children. If a situation cannot be changed that ... view the full minutes text for item 25.
Urgent Items Authorised by the Chair
There were no urgent items.
Exclusion of the Press and Public
To exclude the public from the meeting under Section 100(A)(4) of the Local Government Act 1972 on the grounds that it is likely that exempt information, as defined in paragraphs 1 and 2 of Part I of Schedule 12A to the Act, would be disclosed and the public interest in maintaining the exemption outweighs the public interest in disclosing the information for the following item:
Case No 2 learning lessons review Kingston LSCB
The committee RESOLVED to exclude the public from the meeting under Section 100(A)(4) of the Local Government Act 1972 on the grounds that it is likely that exempt information as defined in paragraphs 1 and 2 of Part 1 of Schedule 12A to the Act, would be disclosed and the public interest in maintaining the exemption outweighs the public interest in disclosing the information for the following item.
Voting: unanimously in favour.
To consider the learning lessons
This item was postponed from the meeting held on 12 July 2018. The report alerted the Board to the local learning for agencies in Kingston, particularly around management of concerns for neglect in families, from the recent case review concerning Child O. The Board was asked to note the learning from the Learning and Improvement Case Review and to endorse the Neglect Strategy which is due to be launched in the autumn 2018.
RESOLVED that: the actions proposed were fully supported by the Board.
Voting: unanimously in favour.