Councillors and committees
Agenda and minutes
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Venue: Guildhall, Kingston Upon Thames
Contact: Marian Morrison, Democratic Services Officer Tel: 0208 547 4623/email; firstname.lastname@example.org
Questions and Public Participation
A 30 minute question and answer session at the start of the meeting – advance notice of questions is encouraged.
There were no questions 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 Councillors Margaret Thompson and Rowena Bass. Councillors Alison Holt and David Cunningham attended as alternates respectively.
Apologies were also received from Jane Wilson and Siobhan Clarke and Sally Brittain and Grant Henderson attended as alternates respectively. Apologies were received from Dr Anthony Hughes, Dr Pete Smith and Stephen Taylor.
To confirm the minutes of the meeting held on 13 September 2018
Dr Liz Meerabeau sought clarification of the MESCH approach referred to in Minute 25 of the last meeting. The Director of Public Health provided the following information:
The Maternal Early Childhood Sustained Home-visiting (MECSH) approach is to reduce inequalities by improving the health and social wellbeing of vulnerable families with new babies, while also strengthening child and community health service provision through the integration and coordination of services, particularly via health visitors.
1. the above paragraph be added to Minute 25; and
2. the minutes as amended were confirmed as a correct record and signed by the Co-Chair, Councillor Liz Green (in the Chair).
To note the updates and the work programme
The following information was presented in the Partners’ Update report:
· Mental Health Time to Change Hub – this is a forum for local people and local public, private and voluntary organisations to come together to end the stigma and discrimination experienced by people with mental health problems.
· Mental Health Champion (MHC) lead Councillors - following approval at Council on 18 October, MHCs are being appointed for each strategic committee. The Health and Wellbeing Board will receive updates regarding the work of MHCs as part of the implementation of the Thrive Kingston Mental Health Strategy.
· Preventing and reducing the impact of drug and alcohol misuse – an update on the work of the Kingston Wellbeing Service which works in partnership with Moving on Together to support recovery. An event took place at Surbiton Health Centre on 27 September to celebrate recovery month. A clip from a video was shown.
· Health protection – winter preparedness – Local health partners have developed winter plans to deal with increases in respiratory and cardiovascular illness and promotion of stay warm in winter and flu vaccinations campaigns are underway with vaccination being delivered in a staged way. There were initially some vaccine supply problems. The “Haven” winter night shelter will be open from 8pm to 7.30am nightly until March 2019 operated by the Kingston Churches Action on Homelessness. There are some concerns about the number of people accessing this service.
· Health Protection Committee – the setting up has been deferred due to senior staff losses.
· Public Health Workforce – recent organisational change has led to the public health function being brought under the new Communities directorate along with a number of other functions. The introduction of a new organisational structure has led to the loss of three senior colleagues and thanks were noted for their professionalism and commitment.
· Connected Kingston – this will become publicly available in January 2019 and an application to the Local Digital Fund will be made to enable further developments.
Kingston Hospital NHS Foundation Trust:
· Performance Targets - the Hospital is continuing to perform well on cancer targets, the 18 week referral to treatment time and A&E performance is around 90% seen in 4 hours.
· Delayed transfers of care – the numbers of patients who have been delayed in in hospital for more than 6 days and more than 231 days have been falling.
· Winter plans have been approved by the A&E Board and submitted to NHSE
· Transformational projects on theatre productivity and outpatients are progressing
· Workforce Developments – the Trust received a national award from the Skills for Health, Health Heroes for Health and Wellbeing and staff retention
· A new Mental Health Assessment Unit adjacent to the emergency department is being progressed with phase 1 opening on Christmas Eve and phase 2 during 2019.
Kingston Clinical Commissioning Group:
· Health and Care Plan engagement – an engagement event is taking place on 21 November
· Over the counter medicines publicity has been developed and will be made widely available ... view the full minutes text for item 33.
To note the report and provide comments on the CAMHS Transformation Plan refresh priorities
The report, introduced by Doreen Redwood, Lead Children’s Health Commissioner, K&R CCGs, provided information to the Board about the Child and Adolescent Mental Health (CAMHS) Transformation Plan 2018 Refresh.
The NHS Five Year Forward View 2015 included the aim to ensure sustainable improvements are made in children and young people’s (CYP) mental health outcomes by 2020 and the Transformation Plan provides the local vision, the priorities, service improvements and actions to address the mental health needs of children and young people and parents/carers of the local populations.
The Plan is refreshed annually and is submitted to NHSE and the CCG receives an allocation of £377K to support the programme. This year’s assurance process is lighter touch and focusses on addressing new areas introduced in the key lines of enquiry: Transparency and governance, understanding local need, workforce, collaborative and place based commissioning, health and justice, improving access to psychological therapies for children and young people, eating disorders, data, crisis care. The Plan is developed using participation methods including engagement with children, young people, parents and carers.
During the three years that the Transformation Planning process has been in place there have been achievements in the following areas:
· Training in school
· Introduction of on-line counselling, support and advice
· Increase in support for eating disorders
· Increase in support in A&E
· Recruitment of more people
· Increasing the uptake of support
Challenges to delivering the plan are:
· Waiting times which have not reduced as planned
· Difficulties recruiting
· Increasing demand for services
· Increasing admissions to hospital
· Developing the right help for CYP with learning disabilities and challenging behaviour
2018/19 ambitions, priorities and delivery have been developed using the five outcomes identified in “Future in Mind” guidance issued in 2015 i.e.
· Promoting resilience, prevention and early intervention
· Improving access to effective support – a system without Tiers
· Care for the most vulnerable
· Accountability and transparency
· Developing the workforce.
The report identified priorities under each of these and Board’s views were sought.
During her introduction Doreen Redwood stated the strategic approach in South West London is to reduce in-patient admissions for CYP and locally we have a community based service. Tonia Michaelides added that there is a greater emphasis on preventing the development of mental health problems.
The Board heard that there were challenges. Pre- and post diagnostic support for Children with Autistic Spectrum Disorders (ASD) and Attention Deficit Hyperactivity disorder (ADHD) is a challenge and an improved pathway is being developed to make access easier. Waiting list pressures are not unique to Kingston and an increasing demand for services can often follow successful service provision. The national target of increasing access to treatments to 32% may not be achieved but progress has been good so far.
A question was asked by James Moore in the Gallery. He suggested there is a shortage of in-borough places for children with SEND and asked for details of the numbers who do not have in borough service. Ian Dodds responded that there was a reliance on out of borough ... view the full minutes text for item 34.
To approve the strategy and ensure it is taken forward in HWB partner organisations’ own organisation strategic plans
The report, introduced by Elizabeth Brandill-Pepper, Corporate Head of Service, Specialist Commissioning, set out Kingston’s five year Joint Health and Social Care Strategy for Children, Young People and Adults with Learning Disabilities (LD). Approval of the strategy (attached at Annex 1) is being sought by the Children’s, Adults’ and Education Committee on 22 November and the Board was requested to endorse it and was asked to ensure that the strategy is reflected within members’ own organisation’s strategic plans.
The Strategy has been produced in three versions – a full technical version, a summary and communication document and an easy read version.
The All Age Learning Disability Strategy replaces the earlier Learning Disability Strategy which expired in 2017. It has been co-produced on the basis of local needs outlined in the Learning Disability Joint Strategic Needs Assessment (JSNA), the Special Educational Needs and Disability JSNA and extensive engagement work with families and carers. The strategy aims to “increase independence, improve access to mainstream services and community assets thereby leading to increase cost efficiency and value for money”. It is aligned with the three LD outcome measures in the joint NHS, Adult Social Care and Public Health outcome Framework, other national drivers and the Marmot Review (which considers inequalities in health outcomes which for people with learning disabilities can mean that their lives are up to 20 years shorter than average). The Strategy identifies key interventions for early years, transition and adulthood and these are framed around themes of maximising independence, strengthening the pathway from education to employment, being part of Kingston and having good health. The Strategy also focusses on improving choice about where people live i.e. away from institutional care and within the community.
Healthwatch Kingston has been commissioned to provide chairmanship to the All Age Learning Disability Partnership Board which oversees the actions associated with the plan and the Partnership Board includes representation of people with learning disabilities and their families.
The following points were raised in discussion:
Members complimented officers on the three version
approach and some expressed a preference for the easy read document
and the version for people with leaning disability was particularly
welcomed. The Board was informed that the Council has a resource to
enable easy read versions to be produced and this approach will be
taken forward for other strategies, including the joint Autism
Grant Henderson, Your Healthcare, drew attention to some specific comments on an earlier version of the document which had not been reflected and he would welcome opportunities for further discussion.
Comment was made about the specialist support and assistance which people with LD may require when in touch with the Contact Centre and the general on-line approach to finding out about services may present a real barrier for them. In response Elizabeth Brandill-Pepper accepted that the Contact Centre could be an overwhelming place to visit and Peer Advocates (people with LD employed by Council to improve accessibility) are currently undertaking an audit of the Contact Centre and ... view the full minutes text for item 35.
To note the briefing on the recent Ofsted CQC Inspection outcomes
The report, introduced by Ian Dodds, Interim Chief Executive, Achieving for Children (AfC) and Charis Penfold, Director for Education Services, AfC, briefed the Board on the recent Office for Standards in Education, Children’s Services and Skills (Ofsted) and Care Quality Commission (CQC) inspection of services for Special Educational Needs in Kingston for people age 0 to 25. The inspection took place between 17 and 21 September 2018. The full letter dated 23 October 2018 was attached at Annex 1.
The purpose of the review was to judge the effectiveness in implementing the disability and special educational needs reforms as set out in the Children and Families Act 2014. As well as visiting a range of providers, meetings were held with leaders for health, social care and education. A letter setting out the findings of significant areas of weakness was sent to the Director of Children’s Services. The letter identified areas for further improvement and also highlighted areas of strength.
Areas of significant weakness were identified as:
· The overall poor quality and monitoring of Education, Health and Care (EHC) plans, including contributions from health professionals
· The timeliness of leaders ensuring that the annual review process and any subsequent amendments to EHC plans are consistently made in line with the SEN code of practice
· The strategic leadership and monitoring of the CCG’s work in implementing the 2014 reforms
· To ensure that there is a productive and positive relationship between parents and parent representatives, including a parent carer forum.
Areas of strength and good practice include:
· The single point of access (SPA) and the added value of the SPA supporting earlier identification of SEND needs and faster access to specialist support services
· Co-location of services
· Early years provision, including Portage for pre-school children and information sharing between professionals eg health visitors and nursery
· Parents value the support and input of professionals
Senior officers will be meeting the Department for Education on 20 November to discuss how the four areas of weakness will be addressed and actions being undertaken by Achieving for Children, Kingston Clinical Commissioning Group and Public Health were set out.
Kingston is required to submit a Written Statement of Action within 70 days of the receipt of the letter ie by 8 January 2019. The Statement of Action will be evaluated by Ofsted and the CQC within 10 days of receipt and Ofsted and the CQC will formally sign off the Statement of Action for the Local area. The intention is that the Written Sign off Statement will be brought to the next meeting of the Health and Wellbeing Board on 31 January 2019. The Board heard that Written Statements of Action can be lifted within 12 to 18 months by the Inspection Team and inspectors will return to see the progress made.
The Co-Chair and other members expressed disappointment at the letter. The Co-Chair drew attention to the fact that families had been raising issues for some time and these views should have been heeded ... view the full minutes text for item 36.
To endorse the arrangements, subject to the approval of the Children’s & Adults Care and Education Committee on 22 November 2018
The report, introduced by Ian Dodds, Interim Chief Executive, Achieving for Children (AfC), sought the Board’s endorsement for the governance arrangements for the Kingston Special Educational Needs and Disabilities (SEND) Transformation Plan 2018/19 - 2021/22, subject to approval at the Children’s and Adults’ Care and Education Committee at its meeting on 22 November 2018.
A three year SEND Transformation Plan has been developed to respond to the significant financial pressures facing the service as well as addressing the service quality issues identified in the local area SEND inspection in September 2018 (see minute 36) and will be considered by the Children and Adults Care and Education committee on 22 November 2018.
The forecast cumulative overspend on the Dedicated Schools Grant for Kingston will reach £13M by the end of 2018/19. The funding of high needs education provision is a national issue and Kingston is not unique in experiencing these pressures. However, in Kingston the rate of increase in costs for SEND is of the order of 9% pa ie £2M pa and at this rate of increase the cost in 2022 will amount to £46M which is an unsustainable position, exceeding the Council’s General Fund and earmarked reserves. The objective is to ensure that the schools budget, including high needs, stays within the existing DSG funding allocation.
Whilst the SEND Partnership Board will drive the delivery of the plan, strong governance arrangements will be required which will also secure full engagement from partner organisations to promote constructive debate, scrutiny and challenge. The proposal is for the Health and Wellbeing Board to have accountability for the SEND Transformation plan and for the Children’s and Adults’ Care and Education Committee (CACE) to have formal constitutional responsibility for the Transformation Plan.
Following a request from Tonia Michaelides,
Managing Director Kingston Clinical Commissioning Group for lines
of responsibility for partner organisations it was agreed that KCCG
would need to be represented within the governance arrangements in
addition to the Council enabling decisions appropriate to the two
organisations to be taken by those organisations. The overall direction and accountability would be
held by Health and Wellbeing Board.
In response to a question about the separation of Kingston and Richmond children’s services under the leadership of two Directors of Children’s Services, Ian Dodds confirmed that there would be separate transformation plans submitted to the DfE and that the more local focus would enable the plan to be more effectively implemented by the local SEND Partnership, including involvement of the parent and carer community.
A comment was made that it would be helpful for proposed Partnership Board membership to be submitted as late material to CACE committee.
1. The Kingston Clinical Commissioning Group is included within the governance arrangements and captured in late material for CACE committee; and
2. The governance arrangements as amended are endorsed by the Board.
Voting: unanimously in favour
To review the proposal arising from the Board’s informal workshop held on 5 March 2018
The report on proposals for Working Arrangements for the Health and Wellbeing Board was introduced by Iona Lidington Director of Public Health.
A Health and Wellbeing Board workshop was held on 5 March 2018, a summary of proposals was considered by the Board later that month but progress was paused due to the change in Administration in May.
Themes identified during these discussions were:
· The Board should set the strategic direction of local preventative work and priorities in health and social care
· Relevant outcomes for the Board’s work are prevention of ill-health, improvement of wellbeing and reduction in health inequalities.
· The Board should not be limited to its statutory functions eg Joint Strategic Needs Assessment.
Other suggestions put forward were:
· Direct oversight of the commissioning of local public health, NHS and/or social care services
· Responsibility for local implementation of national and regional health and social care policies and initiatives
· Oversight and formal decision making responsibility for a small number of specific joint priority projects eg Kingston Co-ordinated care.
The proposal was that the Director of Public Health reviews the suggestions made in the workshop and develop a full set of proposals for the future of the Board in informal consultation with existing members and other partners. This will include identifying options and associated costs for new models of governance and reviewing evidence from the JSNA to support a priority setting process for the reconfigured Board in 2019.
It was also proposed that the Board be chaired by a lay chair but following discussion this suggestion was not taken forward by the Board.
1. The Board should hold formal meetings in public in the evening and informal daytime workshops on priority topics as closed sessions; and
2. The Director of Public Health be delegated to develop a formal set or proposals for changes to the Board’s Terms of Reference to be agreed at a future meeting and in line with the Constitutional Review.
Voting: unanimously in favour
Urgent Items Authorised by the Chair
There were no urgent items.