Agenda item

Interviews with:

·  Dr Bob Bowes, Chairman of the West Kent Health and Wellbeing Board, and;

·  Alison Broom, Chief Executive of Maidstone Borough Council and Board member of the West Kent Health and Wellbeing Board.

The Chairman welcomed Dr Bob Bowes, Chairman of the West Kent Health and Wellbeing Board (WKHWB) and Dr Jones, GP from Maidstone and member of the WKHWB and thanked them for attending.

Dr Bowes delivered his presentation explaining it was focused on the issues faced by the HWB.  He began by explaining where the WKHWB sat in the structure.

The Kent HWB (KHWB) was established as a result of the Health and Social Care Act 2012. However, it was explained the structure of HWBs best suited a unitary authority system and not a county the size of Kent with a mixture of unitary, district and borough councils.  As a result KHWB created local HWBs in Kent as sub-committees co-terminus with the local Clinical Commissioning Groups (CCG).  This allowed for local say and local steer on strategy at CCG level.

Dr Bowes went on to explain:

·  The Children’s Health and Wellbeing group was yet to be formed, but would provide reports to WKHWB;

·  No reports, as yet, had been received from local authorities with a health and wellbeing remit. This was something that needed to be done to ensure there was alignment with the services provided;

·  The WKHWB had no budget, no authority and no staff to help with administration etc.

·  The major influence in the delivery of services sat with the providers of the service because this was what mattered to the public.  Dr Bowes suggested, as resources were so scarce, strategic bodies such as the CCGs and HWBs, should have a higher public profile and public awareness of what they do.

·  The WKHWB had difficulties in receiving a population needs assessment data set that was credible, comprehensive and made sense of the needs of the local community.

Questions raised by Dr Bowes presentation included:

·  How much influence should providers have on the services they delivered?

·  Are providers delivering on WKHWB’s strategy?

·  How aligned were the providers and local authorities strategies with the WKHWB’s strategy?

·  How did the WKHWB focus it’s instructions to the providers given the enormity of the needs?

Dr Bowes’ outlined the responsibilities of the WKHWB.  These included:

·  Bringing democratic legitimacy to the commissioning of health and social care.  It was explained that having elected members sitting on the WKHWB was extremely powerful and brought a sense of public ownership and accountability;

·  Preventing ill health by promoting good health to reduce inequalities.  This had the lowest spend but resulted in the highest savings. However, preserving services meant continuous fire fighting. Better engagement and joining up with district and borough councils, who provided preventative services, was needed; 

·  Integrating health and social care commissioning, ensuring commissioners achieved integrated delivery.  Also that, commissioners’ strategies were aligned with the Kent County Council (KCC) Health and Wellbeing Strategy. This was an important role and one only the WKHWB could carry out.

The last slide of Dr Bowes’ presentation showed a graph of the causes of death by Maidstone Ward.  The graph showed Park Wood was in the top quintile for deaths through circulatory disease, cancer and other diseases.  This information was from the Population Needs Assessment.

Dr Bowes pointed out that some of the more affluent Wards showed inequalities in how young people died.  He felt that by addressing some of the issues that caused this would be a success for the borough.

The Chairman welcomed Dr Tony Jones, Maidstone GP to the meeting and asked him to make comment.

Dr Jones explained he had been involved in health and wellbeing for a number of years and represented the local voice of the residents on the WKHWB.

Dr Jones felt in his experience the work of WKHWB and Maidstone Borough Council (MBC) was closely aligned.  He also stated that KCCs decision to constitute local HWB with CCGs was a good decision for local service provision.

Dr Jones stated he would like to explore practical opportunities to work with MBC on health promotion and inequalities at an informal, local level that would make a difference to residents of the borough.

Dr Bowes reported WKHWB had Task and Finish Groups working on specific issues in the borough, such as:

·  Mental Health and Child and Adolescent Mental Health Service

·  Child Obesity

·  Alcohol misuse – including licencing, accident and emergency and ambulance services

·  Drug and tobacco control

Sarah Robson, Community Partnership Manager, MBC reported that information from the WKHWB was filtered down to her team and regular update meetings were held with Alison Broom, Chief Executive, MBC.  The MBC Health Inequalities Action Plan had been developed picking up on the priorities of the Task and Finish Groups and MBC action plans and wider plans (ie Community Safety Unit Plans) were aligned accordingly.

During further discussion the following points were made:

·  There was scope for joined up working with the Planning, Transport and Development Overview and Scrutiny Committee (PTDOSC) who were looking at developing a walking and cycling strategy.  It was agreed the PTDOSC could link with the doctors surgeries in Maidstone committed to the health benefits of cycling.

·  Youth obesity was acknowledged as an issue, as was youth malnutrition in not only deprived areas but affluent areas too.

·  Sport and play needed more work as the knock on effects of this encouraged greater health and wellbeing.

·  More help was needed for working on youth access to alcohol, tobacco and other substances including so called ‘legal highs’.  It was agreed there was potential for synergy for the HWB and licencing to work together on this.

·  Resident input at Ward member level, where Councillors got to hear from residents where service levels were not being met, may facilitate a missing tier of monitoring health services.

·  Working together at Primary Care level worked best around a core team, such as local medical practices, although a means of joining other activities around this would be needed.  Areas missing that would be of benefit to residents included:

o  Nursing capability for multiple, long term, complex conditions;

o  Integration between GPs and mental health services at practice level;

o  Co-ordination of health and social care at practice level.

·  Development of a federation of GP practices with multi-disciplinary teams in Maidstone was underway working on town wide health agendas.

·  Patient self-care, encouraging peer support and connecting people with similar conditions and life experiences could create a sense of community.  This was an area where the voluntary sector could assist.

·  Concern was raised that the WKHWB had no power or money.  Dr Bowes explained the Commissioners held the budgets.  The HWB could ask the Commissioners to focus on a particular area of health and wellbeing, for example if an area was identified as having a particularly high rate of cardio vascular health issues.  If the Commissioners failed to take action, the Health and Social Care Act stated the HWB could report it to the Secretary of State for Health.  However, although any such recommendations to Commissioners would make a difference, it was difficult to get the HWB in a position where it could make them.  The difficulty lay in; identifying a need because the subject was so large; focusing on what could be delivered, and then; developing an expertise and instruction set that made sense to the Commissioners.

·  The issue of Maidstone residents having to travel to Pembury Hospital for treatment, for example head injuries, and maternity services, raised concerns.  Dr Bowes explained, Maidstone and Tunbridge Wells NHS Trust had two hospitals (Maidstone and Pembury).  Services had become increasingly specialised and there was a need to provide these at scale by experts working together.  Two hospitals were not able to do this.  Pembury Hospital was successful in developing quality services that delivered good care.  Services had been centred for patient safety above convenience.

·  Dr Jones explained that both Maidstone and Pembury Hospitals had the capability of dealing with significant head injuries.  However, the ambulance trust were told to take significant injuries to Pembury. Not all head injuries would be classed as significant and could be treated at Maidstone.  This demonstrated a communication issue that needed to be addressed to ensure the right patients were taken to the right hospital.

·  Information from patients gathered during the Mapping the Future project, demonstrated patients would be prepared to travel any distant for elective, non-emergency, treatment in order to get the best care.

·  Cases where emergency treatment was required would be taken to the nearest service competent to deal with the emergency, which was not necessarily Pembury.

·  Concern was raised regarding the accessibility of HWB documents and minutes.  Councillors were made aware that the WKHWB was currently administered by MBC (this would change to another local member authority at the end of the year) and all minutes and related documents were available on the MBC website.

·  It was pointed out there was work being done that promoted health and wellbeing with support from parish councils and MBC, including running clubs, skate parks, youth clubs, all supporting health and wellbeing.

·  Suggestions going forward included working with residents and businesses on:

o  A ‘quality mark’ for businesses who refused to sell legal highs and alcohol to underage customers;

o  Promotion of competitive sports;

o  Joined up planning of public transport;

o  Providing the Public Needs Statistics in a format residents could understand easily;

o  Establishing referral methods for walking groups, fire, ambulance and other services to feedback observed concerns to medical professionals.

RESOLVED:

a)  That contact details for doctors surgeries in Maidstone who promote cycling and walking be passed on to the Planning, Transport and Development Overview and Scrutiny Committee for includion in their Cycling and Walking review;

b)  That access details for the Population Needs Assessment for the Maidstone Borough and other Health and Wellbeing statistics be made available to Councillors[1];

c)  That access details to the WKHWB agendas and minutes be made available to Councillors[2], and;

d)  That the Joint Kent Health and Wellbeing Strategy be made available to Councillors[3].