Councillors and committees
Introduction to the Health Overview Panel
Short introductions will be given by the following officers on health scrutiny, health and social care:
· Gary Marson, Team Leader, Democratic Services - the function of Health Scrutiny.
· Iona Lidington, Director of Public Health
· Stephen Taylor, Director, Adult Social Care
· Tonia Michaelides, Managing Director of Kingston & Richmond CCG
A short introductory video from the King’s Fund will also be shown.
Introductions to Health Scrutiny, Health and Social Care were given by:
· Gary Marson, Team Leader Democratic Services
· Iona Lidington, Director of Public Health
· Stephen Taylor, Director Adult Social Care and Community Housing
· Tonia Michaelides, Managing Director, Kingston and Richmond Clinical Commissioning Groups
Democratic Services - Gary Marson explained that the concept of health scrutiny was introduced in 2001 and the objective is to hold the NHS and Local Authorities to account on health and social care and has an important focus on health inequalities. A further aim is to strengthening the voice of local people and ensure voices taken into account. Health Scrutiny proactively seeks information about performance to enable challenge and it can also be strategic and make recommendations for improvement. It employs constructive engagement rather than confrontational methods. It does not deal with individual complaints but opens discussion on overall quality. As a last resort, concerns can be referred to the Secretary of State and there is a need to demonstrate all steps are taken. A summary of the role and responsibilities of the Panel is included in the agenda front sheets for each meeting.
Public Health – Iona Lidington gave a detailed presentation and explained that Public Health’s duty is to improve the health of the population and outcomes are based on the premise that “prevention is better, and cheaper than cure”.
Mandatory services include sexual and reproductive health services, children’s health visiting services, children’s height and weight measurement, NHS Health Checks, provision of healthcare public health advice to NHS Commissioners (Clinical Commissioning Groups) and provision of advice on health protection, environmental hazards and extreme weather events and protecting the health of the local population. Public Health also produces a range of borough based statistical information (available by neighbourhood and ward) plus needs assessments including the Joint Strategic Needs Assessment.
Public Health is funded by a ring fenced government grant totalling just over £10m in 2018/19. The Public Health grant has a number of conditions attached to it. LAs must:
· use it only for meeting eligible expenditure incurred or to be incurred by LAs of the purposes of their public health functions as specified in Section 73B(2) of the National Health Services Act 2016
· have regard to the need to reduce inequalities between the people in its area with respect of the benefits that they can obtain from the LA’s health service
· have regard to the need to improve the take up of and outcomes from, its drug and alcohol misuse treatment services.
This year’s Public Health Annual Report is on Air Quality and will be launched on 21 June.
Kingston’s resident population is 176,107 people. The number of those registered with Kingston GP practices is higher at 209,515 as this include people living close to the borough boundary. One third of residents are from Black, Asian and Minority Ethnic communities. Overall Kingston has a young population with a median age of 36.2 years and almost 22% are aged 0-17. However, the cohort of very old and frail with multiple illnesses is increasing. Life expectancy is 81.7 years for men and 84.9 for women. Years of good health are 69 years for both men and women. Details of causes of ill health were given and the prime cause is hypertension. There are four main determinants of health and wellbeing: socioeconomic factors account for 40%, with health behaviours at 30% followed by clinical care at 20% and the built environment at 10%. Mental health disorders are the largest burden of disease in England (23%) and affect 1 in 4 of the population at any one time.
Adult Social Care and Community Housing – Stephen Taylor
Stephen Taylor circulated to Panel members copies of a diagrammatic representation of the scope of Adult Social Care and Community Housing. He explained that the Directorate has just over half of the Council’s budget and is seeking to secure the maximum outcomes from it. The document also outlined the key stages and actions which are leading to help people to stay independent i.e. new health and social care integration approaches in community teams plus access to information particularly around self-help. The directorate has strong links with public health on prevention and trying to reduce the increasing needs of those seeking services. Stephen Taylor drew attention to the key role the Health Overview Panel can play particularly in challenging the pace of progress of service integration.
There has been much focus on keeping people out of hospital where appropriate, and enabling discharges to be made as quickly as possible. Kingston is the highest performing Council for reducing delays in transfers from hospital and is also a National Beacon site.
The Council has also in the past 12 to 18 months reduced the number of people in residential care homes by around 25% and this has been achieved by providing increased support to people in their own homes.
Stephen Taylor referred to the significant challenges for housing; considerable need but very little vacant housing stock. However Kingston has strong partnerships and commitment from senior officers in local health and care organisations.
Iona Lidington and Stephen Taylor provided further details in answer to a question about work to improve people’s independence. The Connect Well Kingston initiative enables health and care employees to pick up on people’s needs and provide information about self-help and further support or advice. A cultural shift in staff training is enabling staff to point to the strengths and resources people have within their families, networks and communities. Initiatives are being planned to help tackle loneliness in a range of ways including within libraries. Some initiatives are local and Kingston based but others will operate across south west London to take advantage of economies of scale.
Kingston CCG – Tonia Michaelides stated that and had worked in the NHS in South West London since 2003 and joined the CCG in 2011.
KCCG is a Membership organisation comprising 21 GP practices with 205K registered patients including a proportion of patients from across the boundary. CCGs are funded on the patient list unlike local authorities which are geographically based.
The CCG’s role is to plan and commission health services (with the exception of public health and specialist services) to meet the needs of local residents. The South West London CCG Alliance includes 5 CCGs and whilst most are federated (eg Kingston is paired with Richmond) none are merged. A key priority is to deliver the South West London Plan.
The CCG has a budget of £255M. £133M is spend on hospital care, mainly at Kingston Hospital. A key aim is to shift spend away from hospitals to strengthen community services.
Significant expenditure includes £30 on GP primary care, £22M on mental health, £22M on community health services, £21M on prescribing and £17M on continuing healthcare
The CCG has a total of 137 metrics and in the last year has achieved 105. It under achieved on 26 and failed 7. Those which were not achieved (in common with other CCGs) were:
· A&E waiting time > 4 hours (Kingston Hospital)
· Ambulance handover time (within 15 minutes) – London wide
· NHS 111 calls answered within 60 seconds
· Mixed sex accommodation – occasional breaches but clinical care comes first
· Proportion of patients referred to first outpatient services via e-referral service
· Proportion of QIPP schemes (Quality Innovation Productivity and Prevention)
· Increasing primary care capacity from 8am to 8pm, seven days a week
· Introduction of the Kingston Medical Services contract which will equalise services across practices
· Increasing GP access to expert advice to prevent unnecessary outpatient appointments
· Rollout of Macmillan social prescribing pilot
· Faster access to mental health care at Kingston Hospital A&E
· Developing a single point of access for mental health services
· Remodelling adult ADHD services
· Reducing waits for autism services
Kingston Co-ordinated Care – a mechanism to identify and support people with complex health and social care needs in Kingston utilising multidisciplinary teams developed around GP practices of approx. 8,000 to 12,000 patients.
Tonia Michaelides confirmed that the CCG had no concerns about care at KHT and the performance on A&E is good compared with many other hospitals. Paper or faxed referrals will no longer be accepted at Kingston Hospital from July and support to practices for the roll out or e-referrals will be available via a Help Desk.
The QIPP scheme targets were attained in 2017/18 and is now focussing on more difficult transformational areas. The CCG is working with partners to ensure progress with integrated systems which will help to make progress towards the targets.
Many outpatient attendances have been identified as unnecessary and GPs can now have direct conversations with hospital specialists which is helping to reduce unnecessary appointments.
Ms Michaelides is the Senior Responsible Officer for Mental Health in South West London. Whilst there has been greater investment in SWL mental health services, more investment is needed. Examples of progress include access in A&E to mental health specialists, introduction of the single point of access, the new retreat crisis house in Malden and the remodelling of ADHD and Personality Disorder services.
In response to a number of questions the following answers were given:
GPs are aware of the new system of e-referrals and this is a contractual requirement from 1 Oct. Most practices are already making good progress. Targets will be set for some other practices.
In response to a comment that there is still difficulty in getting GP appointments, Ms Michaelides referred to the high rates of failed appointments (DNAs) which are problematic but practices are being asked about how they utilise their appointment slots and there is now wider offer of telephone appointments. The CCG does take account of feedback from patients and on balance there is sufficient capacity. Whilst there is high demand for appointments on Monday mornings, it is easier to obtain afternoon and evening appointments.
In response to a question about how to release funds from hospitals Ms Michaelides confirmed that progress was beginning to be made, especially in relation to patients who may not need to be admitted to emergency beds and also earlier supported discharges. Further partnership discussions are now taking place about how best to manage people who are over 85s.
In response to a question about the Better Care Fund and whether this still existed, Ms Michaelides confirmed that this now exists in partnership with the Local Authority. Changes may be announced in a new Green Paper expected in the Autumn proposing a new 10 year plan for health and adult social care.
Agreed that: the information is noted