Councillors and committees

Agenda item

Update on key roles, drivers and changes for Kingston health and social care partners

To consider the attached report and ask any questions. 


The report includes contributions from:

Kingston Clinical Commissioning Group

GP Chambers

Kingston Hospital NHS Foundation Trust

South West London and St George’s NHS Mental Health Trust

Healthwatch Kingston

Your Healthcare

Adult Social Care – Kingston Co-ordinated Care


The Chair introduced this item by stating that the Panel can achieve maximum effectiveness if members are up to date on the local health and social care framework and organisational developments.  The Chair stated that she had requested health partners to submit position statements which were included in the published agenda and asked them to give brief introductions on key challenges and changes and what they considered the Panel could usefully look at as part of its work programme.  She added that she hoped some health partners would stay for the discussion on work programme.


Kingston Clinical Commissioning Group – Tonia Michaelides, Managing Director of Kingston CCG and Richmond CCG 

The new shared operating model is the most significant recent change.  The South West London Sustainability and Transformation Plan (STP) has brought about a shared operating model across the six CCGs but they all remain independent statutory bodies.  However, to make the transformation they need to work collaboratively and on 1 April 2017 SWL transformational alliances have been formed between Kingston and Richmond, Merton and Wandsworth.  Sutton is expected to join with Merton and Wandsworth in April 2018.  There is still local leadership with three Managing Directors across the alliance.  


Budget – This year’s allocation is £248M.  The CCG successfully met its financial obligations in 2016/17, and a £9M savings plan needs to be delivered during 2017/18.  KCCG’s funding allocation is based on the registered population i.e. the total number of residents who are registered with local GPs.  However, the resident population is 30K larger than the registered population. 


Sustainability and Transformation Plans – have been drawn up in each of the 44 footprint areas in England in response to the NHS 5 Year Forward View.  The SWL STP was not formally published but came into the public domain in October last year.  The key priorities which the STP identified are to improve accessibility to GPs, to provide more care and treatment in the community, to provide improved support for people with long term conditions, to treat mental and physical health together, to improve the buildings where health care is provided and with more effective systems hospital care can be delivered more quickly to those who need it. Further information about the new narrative will be available in the next couple of months and this will cover the delivery of an improved local service and how it will be easier to get local treatment.


The following information was provided in response to questions:

Sarah Blow is the one accountable officer across the five CCGs and is also the senior responsible officer for the delivery of the STP.  She would be happy to come to the individual HOSC meetings of the 5 councils.  Tonia Michaelides agreed to provide the panel with a summary of the accountability for the STP.  This covers a number of other legal responsibilities, including safeguarding.


A member sought further details about proposals to introduce Care Navigators.  It was explained that they are health and social care professionals and will be able to signpost patients through the health and social care system.


Mr Robb (in the gallery) drew attention to the notice that had been given by South West London and St George’s to the CCG to move 35 community care beds from Tolworth Hospital.   He expressed concern that the number of beds could reduce and go out of borough - 25 in Teddington and 10 to home care - and he requested that the Panel scrutinise this.  Councillor Reid confirmed that this had been raised at the meeting on 6 July of the South of the Borough Neighbourhood and that she as Neighbourhood Chair had agreed to write to the CCG about this.


Tonia Michaelides confirmed that there was no need for these beds to be moved before the end of the financial year 2017/18.  A short term solution is being considered until a longer term arrangement is decided.  She confirmed that the CCG had brokered beds at the Teddington Community Hospital in individual cases and that she would be happy to come back to Panel with the CCG’s proposal and to talk through the process.


A member commented that many positive changes are being introduced locally eg prescription renewals can be done over the phone and cutting down on on appointment time.  


In response to a question about the local performance on the dementia diagnosis target, Tonia Michaelides explained that this was the CCG’s most challenging target.  Performance had fallen as the way the indicator is calculated has changed from the registered GP population to the larger resident population.  The National Support Team has visited on two occasions and has been invited for a further visit.  The CCG has implemented all the suggested actions.  The CCG is of the view that the estimated prevalence figure for Kingston is not accurate but the CCG needs to demonstrate that all actions have been taken.  A member asked whether late presentation could account for the difference but Tonia Michaelides stated that this was not different to other CCG areas.


A question was raised about whether the cut off age for breast screening (75 years) is appropriate as many women live longer lives and screening could help reduce future treatment costs.  Tonia Michaelides explained that Public Health England has the responsibility for screening and targets are set nationally, not locally. 


A member suggested that the Panel should consider how well we perform as a borough on screening and what can be done to ensure uptake.  


Kingston GP Chambers - Dr Anthony Hughes, Chair

The GP Chambers works with GPs in order to provide responsive services for population.  Much work has been done to develop services in the community and examples are the additional services which operate at winter, the diabetic service. Chambers also provides over fifteen community clinics using GPs with a specialists interest (GPwSI). The clinics cover specialist areas including diabetes, dermatology, urology, neurology and dementia support and are provided in the community so that patients don't have to go to the hospital. GP Chambers has also worked closely with a range of health partners – the CCG, the Kingston and Richmond CCG Transformation Board, the SWL Confederation, Your Healthcare, and secondary care services to provide solutions to a range of matters including the appropriate use of A&E, diabetic care and IT.  


Dr Hughes suggested that current challenges are to work with other services to provide healthcare in a streamlined comprehensive way.  90% of the healthcare workload is delivered by GPs but with only 10% of the budget with the reverse being the case for hospitals.  A key area is how services react to changing demand.  Many more patient consultations, probably up to 30%, can be undertaken by phone or Skype.


A member drew attention to the difficulty residents of New Malden have in obtaining primary care appointments and also that no winter GP hub was provided there.  She also pointed out that elderly people in New Malden have difficulty in travelling to other areas. Dr Hughes explained that the GP Chambers, i.e. the GPs they represent, are providers of services not commissioners and this is a question for the commissioners. 


Mr Robb (in the gallery) asked whether near-patient testing for INR bloods would be introduced for patients in Kingston particularly for Warfarin treatment. 

(Note:  Near-patient testing is an investigation taken at the time of a consultation with instantly available results to make immediate and informed decisions about patient care INR blood tests measure how quickly blood clots and shows the effectiveness of anticoagulant doses.)


Tonia Michaelides explained that this question had also been discussed at the Governing Body.  Treatment for this condition is changing rapidly and INR is likely to be obsolete soon with the new medications coming along.  


Kingston Hospital Foundation Trust – Duncan Burton, Director of Nursing and Patient Experience

Duncan Burton explained that the workforce is one of the biggest challenges for the hospital.  However the results of the recent staff survey were good and the hospital has lower vacancy rates than others.  There is a particular concern about 14% of staff who come from Europe and the Hospital is towards the top list of providers with largest EU staff nos.  The future position of EU workers is a cause of anxiety for staff and their partners. Kingston is also high cost area. 


Finances - The budget is on track at the end of Quarter 1 but the Trust has been given a £12M cost improvement target.  Overall the finances are becoming increasingly challenging.  


In relation to future areas for scrutiny, Duncan Burton proposed that the Panel could consider requesting an update with the recommendations of the CQC inspection especially focussing on those areas which require capital funding.


South West London and St George’s Mental Health Trust – Dr Mark Potter Medical Director. 

Dr Potter stated that the Trust was experiencing similar challenges to Kingston Hospital – finance, recruitment and retention.  The estates modernisation programme, funded by the sale of land at Springfield to reprovide buildings at both Springfield and Tolworth, is on track. 


There have been recent changes to the Trust’s management structure and a key driver for this is to bring about consistency in services across the Trust.  The CQC have re-rated the Trust as good following re-inspection and the Trust will continue to make progress on actions. The quality of care issues identified on Lilacs are being progress now that a new consultant is in post.  Progress is also being made on delayed transfers of care and this has been assisted by the additional input from social work from all five borough Teams.  Dr Potter stated that the Trust wishes to engage with Kingston Coordinated Care.  


In response to a question about there being no mention in the agenda report of a dementia ward at Tolworth Hospital, Dr Potter agreed to double check this point but he confirmed that there are currently two wards at Tolworth for older people. 


Mr Robb (in the gallery) – suggested that the Trust was not  providing the services patients want and that group therapy has replaced one to one therapy.  The Chair confirmed that the Panel hoped to look at mental health services as part of its work programme.  


Healthwatch Kingston– Grahame Snelling, Chair

Grahame Snelling highlighted that Healthwatch wishes to scrutinise how well the Mental Health strategy is being implemented and links to Social Care.  There has been recent involvement with the STP and Choosing wisely.  The organisation is also examining on whether it is performing its role properly and how well it is engaging.  He added that Healthwatch is always happy to meet people outside of these meetings.  The Chair commented that Healthwatch’s work on the mental health strategy will be valuable when we come to looking at that area.


Your Healthcare – Siobhan Clarke, Managing Director, Frontline Services

Siobhan Clarke stated that it receives 9% of KCCG’s budget to provide services and added that a lot is expected from this relatively small pot of money.  Your Healthcare works closely with RBK’s social work team, GPs, hospital colleagues and voluntary organisations.  The ethos is not “what’s the matter with you” but “what matters to you”. 


Your Healthcare is the provider for the 35 care beds at Cedars (Tolworth Hospital) which were referred to earlier.   This current service is highly rated.  Siobhan Clarke confirmed that Your Healthcare is yet to receive formal notice to relocate these but is aware that notice will be given.  Any arrangement with Teddington Hospital will be temporary and it was confirmed that it is important that this must be a Kingston based service.  


The main challenges for Your Healthcare are Kingston Co-ordinated Care, workforce and further resources.


A member raised a question about diabetes step gadgets which do not work properly and patients have been asked to buy their own.  Grant Henderson, Lead for Adult Services, thanked the member for bringing this to their attention.  He said that he was not aware that the equipment not working and agreed to look into this.  The response would be circulated to members of the Panel.  


A member asked a question about the Shared Lives project.  Diane Chalmers spoke about this.  Shared lives is an initiative for older people with cognitive impairment and offers 24 hour support for people in a carer’s home.  This approach was previously used successfully for people with learning disabilities and is being adapted for older people.  She confirmed that a meeting with RBK will take place in September to review service


A member pointed out that three contributors had highlighted the challenges of recruitment and staffing.  How will these challenges be addressed?  It was suggested that a number of approaches are being explored.  For example, volunteering can help draw in people to develop professional careers but affordable housing is key locally. Keyworker housing needs to be included in the development of new housing schemes.


Adult Social Care – Stephen Taylor, Director of Adult Social Care

Integration across social care and the NHS is developing rapidly and key challenges are to work around reducing finances by enabling people to be independent and supported at home.  A further challenge is to balance these approaches with the increasing complex needs of older people.  People with learning disabilities are living longer lives but their needs become more complex.  The plan is to commission services differently to ensure services are sustainable into the future, meeting needs on a long term basis and avoiding expensive individual placements where possible.


Home care is moving away from a “time and task” to a “person centred” model and together with other approaches are aiming to maximise people’s independence and self care for as long as possible.  Capacity is being built up in the voluntary sector to provide assistance within the Kingston Coordinated Care approach.  This approach links together Adult Social Care, Your Healthcare, Kingston Hospital, Staywell and other voluntary organisations plus Public Health to provide effective working.


Smaller dementia homes are closing and whilst providers are becoming increasingly large, they have higher fees.  The Council has taken the decision to build a 80 bed complex dementia care in Kingston and consideration is being given to identify housing and land estate to provide supported living services.


In response to a question about whether the localities teams were now in place it was confirmed that one has been formed in New Malden around Holmwood surgery and it offers the key elements of the system including single point of access. 


The Chair thanked the representatives of the organisations who had contributed to this item and provided written details.  She added that several ideas had emerged for consideration as part of  the work programme.


Agreed that:  the report and verbal updates are noted.

Supporting documents: