Transcript

phone or other device, please turn it on to silent and move it away from the microphone as it may affect the audio system and distract speakers. Around the rooms are exit signs. Should the fire alarm sound during the meeting, please make your way to the nearest and safest exit. As far as I'm aware, there are no planned alarm tests this morning so we'll treat any activation as a real event. Agenda item two, apologies and substitutes. Do we have any apologies? Thank you, Chair. We oversee two apologies this morning from Mrs. Game and Mr. Tills. Mr. Ross and Mrs. Constantine will also join the Committee virtually. Are there any other apologies I should be made aware of? Thank you and just to share, I can say that Mr. Ross has joined. Can you hear us okay, Mr. Ross? No problem, thank you for joining us today. Members, we have some sad news and you may or may not be aware that we have introduced an additional item into this morning's agenda. It's the sad news that Mr. James Williams, who is the Director of Public Health for Medway, unfortunately passed away at the weekend. I would like to invite Dr. Ghosh to say a few words or more than a few words in memory and Mr. Williams. Mr. Ghosh. Thank you, Chair. So it is with a heavy heart that I pay distribute to James Williams. It cuts deep when a beloved colleague and a good friend passes away and it cuts even deeper when his life is cut short so brutally at the prime of his professional career and in such an untimely manner. I cannot believe actually that I am speaking of James in past tense here. He was a towering leader, not someone who would go unnoticed in a crowd for those of you who knew him and he had an indelible impact even on someone who met him for the first time. He often described himself as a proud Yorkshire man and I believe from experience that his favorite phrase was all that malarkey. An Olympian fencer thrice, he brought that dedication, zeal and energy to his calling in life as a public health professional and director of public health. He was a distinguished and accomplished public health professional and if that was enough, not enough, he was also a dedicated person in supporting young and budding fencing athletes and would often be spending weekends across UK and wider in fencing tournaments and camps. Those who knew him would have experienced his 200 watt smile, larger than life persona, this zest of life that he had and how he would communicate in his own imitable style. He had great humour, everyone remembers his jokes, some of them really silly but memorable nevertheless and he was ever willing to put himself out there for the cause of public health. Many people are remembered for professional integrity and achievement but what actually people remember is how people make them feel and he really made people feel important. He was also really kind and compassionate and while he could dazzle with his winning personality, he could touch hearts with his humanity, humility and kindness which is a rare and precious combination. Over my two years and some in Kent, James came to be a good friend of mine and I do feel robbed of that friendship and feel bereft. I learn a lot from him and take inspiration from him. I kind of imagine what his family are going through at this point and my heart goes out to them and I offer my heartfelt condolences to them personally and as well on behalf of the Kent Public Health Department. I know that colleagues in Medway are in a state of shock and his public health department who loved him very much are struggling to come to terms with his sudden demise. My thoughts and prayers and offers of support are also with you. So rest in peace my friend, it's a brilliant comment that lit up the skies but was extinguished so cruelly and abruptly. Rest in peace, thank you. Dr Gervish, thank you. Mr Watkins. Thank you Chair and thank you to Injun for his comments there and I'll just say a few more really echoing his words. I've only been in the role since August but were quite closely meeting with James quite regularly through the work we're doing with Medway on the Integrated Care Strategy and his passion for improving the health of Kent residents was absolutely clear for all to be seen and on a personal note as Injun said he just had this amazing energy and dynamism about him. So yeah it is truly a very sad loss and echoing really on behalf of everyone at KCC you know we wish his family and friends and colleagues since serious condolences for his sad passing. Thank you. Mrs Cole. Sorry, it's working now. Yeah thank you Chair. Dr Gervish mentioned that he's only been with us for two to three years and I just remember back during COVID when we were sort of between directs of public health that James stepped up as for Kent really and he was on the radio, he was on TV talking about COVID and all the public health messages and I never met him personally but seeing him on the TV was very dynamic director and I think he really served Kent well during that difficult time so I'd like to add my thanks to condolences to his family. Thank you. Thank you everybody and perhaps we can, apart from the notes that you've taken from the three members perhaps we can make an official comment if the committee is so agreed to record our sort of committee condolences to the family okay thank you. Item number, so now back home to the original agenda item number three, oh sorry. Yeah we'll try to send another link to Miss Constantine, thank you for alerting us. Back on to the main agenda item three, declaration of interest, are there any declarations of interest please. There are none, an item four, minutes of the meeting held on the 5th of March 2024, do members agree that these are a correct record and can I arrange to have a paper copy signed in due course. Thank you, can we just, I'm getting nods of heads, I will take that as an agreed thank you very much. Agenda item five, verbal update by the cabinet member and director of public health, so first of all to Mr Watkins please thank you. Thank you, so I've got three updates to give to the committee today. First one is about celebrating Kent's public health champions where we have 130 people working in Kent Council schools and charities as these champions and they endeavour to inspire others to look after their health and well-being and they spread the word amount local support available to residents help them make healthy choices as well as making friends whilst they do it. So these champions organise community activities, and local events to help raise awareness of free healthy lifestyle advice such as one new Kent and they signpost people to specialist support. All champions gain nationally recognised Royal Society for Public Health qualifications and currently some 40 champions qualify every year with the latest 18 volunteers completing their training just last month. I'd like to congratulate on new champions on getting through the qualification, empowering more residents to make healthy choices and to access local services can make a big difference and give more years of better health. If you'd like to promote this scheme you know anyone who comes to who's interested, actually if you look up the article on the new section of the KCC website you'll be able to see how to get them involved and send further information. This month is National Walking Month and we are encouraging the public to join in this annual celebration to boost fitness and well-being. It's also a good way of finding friends and swapping a short card drive for a walk or a wheel can save you money on fuel and cut traffic cues, something that many of us would wish for following our journey in this morning. Even a short stroll or wheel can brighten your day, it would be good for your health. Personally I signed up to Active Kent and Medways Travel Your Way Challenge this year to walk every day and followed the Try 20 Tips which are provided by Living Streets which is a charity I suspect many of you have heard of. So trying to hit my daily target, I'm on track, what is it, day 14, almost halfway there. Every step counts towards better health and certainly it's a bit of fun and I'd encourage all members to get involved. We're lucky to live in a county with lots of walking and wheeling routes to suit all ages and abilities. You can use the Kent Connected app to get free explore, kent guides and order survey map data to help you show the way. There are so many routes on there, there are loads in everybody's area so it's a great place to go and visit. Also they organise one UK walking groups where you can join a larger group of people enjoying the great outdoors. Finally on the MMR vaccine we've got additional catch-up clinics announced where under 19s can catch up on the measles, mumps and rubella vaccines ahead of the summer holidays. The clinics run by Kent Community Health NHS Foundation Trust, school age immunisation service and part of continuum efforts by local health leaders to drive up vaccine rates particularly for MMR because of the national rise in measles which I'm sure you're all aware of and we've covered in this committee before. Measles calls fever and rash and can lead to serious illness such as pneumonia, meningitis, blindness and seizures. It's 99% preventable through two doses of the MMR vaccine. Children are routinely offered the first dose of MMR at one year and the second dose of three years and four months for lifelong protection. To arrange an appointment at any of the KCH FT community clinics Kent Intermedway parents and carers should contact the school aged immunisation service. Contact details are available on our website. Thank you very much. Mr Watkins thank you for the updates and interesting information and as you whack so lyrical about the benefits of walking and this being the walking month you'll no doubt look forward to my email to you in due course responsible come undertaking so no thank you Dr Koch. Thank you chair. So I'll cover a couple of things. Measles Dan has already covered so I'll just add a few points to that. Measles infections continue to rise nationally across southeast we're beginning to see a steady rise in numbers so all I'll add to additionally to what Dan said was there have been several probable cases in Kent but not yet any confirmed cases so that's good news for us but with what's going on in the rest of southeast England I guess it's just a matter of time. Members will be aware about whooping cough and also known as pertussis there's an increase in whooping cough across England and is occurring after a prolonged period of low cases there is usually a seasonal variation every two to three years or four years and so this is a kind of that variation it's in keeping with that but nonetheless it's higher than what a normal seasonal variation would be. It's it's thought that the current increases come at time when there's a steady decline in the uptake of the vaccine in pregnant women and children. In England there were 858 new laboratory confirmed cases of pertussis reported to UKHSA that's the UK health security agency in 2023 and 556 cases were lab confirmed in January and till date there have been 918 cases in February and 1319 cases in March so there's been quite a large number of cases and an upswing there also have been five reported deaths sadly in infants who develop pertussis in the first quarter of 2024. UKHSA and KCC comms are distributing messages to urge parents and carers to check their children's vaccination status. Parents are being asked to respond to invites from the NHS or to book an appointment with their GP practice if their child has not received all their routine vaccinations. Moving on we have received 98 applications this year for Kent and Medway's Better Mental Health and Wellbeing Community Fund with a total fund of 90,000 pounds available to award. Grant decisions are being shared with applicants on this Wednesday really and a brochure of all funded projects will be published in early June. Another really good news story we are very proud to announce that our Kent and Medway which is a multiple award winning team anyways Kent and Medway's suicide prevention program received an award at the National Positive Practice in Mental Health Award ceremony in the category for suicide prevention services. There were over 800 applications across 22 categories and the ceremony highlighted much of the incredible work up and down the country so our team was really thrilled and proud to win. As the nature of the award suggests and as we all know we couldn't be here and couldn't do what we do without multi-agency partnership working within our suicide prevention network so it's a great win for Kent and Medway ICB for the team, for public health and for our wonderful network and thank you to everyone who's been involved in our program and your continued support. In terms of children, young people and maternity the Family Hub program is in its third year as many of you will know and the component of it which reports here is the start for life component. We are planning quite robust plans actually for sustainability beyond year three with the intention of creating a new model and embedding it and expanding it as we go. Public consultation has completed on April 3rd around two major strategies, one around perinatal mental health and parent infant relationships and the other on infant feeding so those two are in the process of being finalised. In terms of some of the other things, the start grant we have received the funding for that and it's a very exciting prospect going forward but we have a substantive item later on in the agenda so I'm not going to dwell on that but come to it then. In terms of another point adding to Dan's point about the month health awareness campaign, it's also mental health awareness week this week. So this year's theme again linked with what Dan said fortunately is movement. So it's raising the awareness about how good physical activity is for the body and the mind. A quarter of the population will have some form of mental distress in their lifetime and it's important to know that what's good for the head is also good for the heart. Moving more is excellent and in many ways, many cases and for some people better than antidepressants. A study in UCLA found that on average a person can have three poor mental health days a month but with regular physical activity that's reduced by 40%. So this mental health awareness week is all about remembering our minds are connected to our bodies and we can all move more. Study progress is being made on the development of the work with district and borough councils and the development of healthy alliances and I'll come to that more in the section to do with the shared delivery plan where all the partners play a really crucial role and what's developing is really an exciting movement from bottom up. So I'm really optimistic about the impacts that we'll have over the next years to come. In terms of research, we have a research improvement and innovation hub in public health and recently we've agreed at corporate management team to set up a governance structure to underpin all research in the council. It is a very exciting prospect because there's a lot of inward investment coming in, especially to public health, around research. In terms of the Gypsy Roma Traveler community and this actually I have to say originated from this committee and the issues that members here highlighted last year around Gypsy Roma Traveler community, particularly Karen Constantine. And the focus is on Gypsy Roma Traveler community links being reestablished. A learning network has been reconvened with 25 participants in attendance. A project plan is in place for the first step of engagement with communities to prioritize actions and co-design health improvement programs. So the initial health needs assessment was with partners who engage with our Gypsy Roma Traveler community and this is not directly engaging with the community itself. A rather exciting and new development is also taking place in our collaboration and partnership working with Adult Social Care and that is around really looking at prevention from a different lens with the aim of trying to change the shape of demand principally but also provide care to residents closer to their homes and in the community and in that process preventing, reducing and dealing demand. So once that develops a little bit further, happy to bring that here as well. So I'll end the chair and hand back to you. Dr Goge, thank you very much for your update. Did members have any questions? I'll take Mr Struttfield first, followed by Miss Green. Thank you, Chair. It's just a question on the mental health awareness week and the grants. How far can you reassure us that the grants are going to the areas that need it most in terms of either postcode or demographic in terms of where the mental health issues are and where those charities are doing the work because obviously there's a quite wide disparity across the county but are those grants being focused onto the places that really need them, please? Yeah, I can assure you that they absolutely are. There is a panel that has been involved in grants. If you like, we can bring back the list of where it's eventually been granted but it has been obviously taking into account where the need is the most. Thank you, and Miss Green. Thank you, Chair. The question I have was regard to the MMR vaccine. It's certainly a note to myself that if I ever put up a post on social media, encouraging people to have vaccines, they are quickly flooded with people stressing the dangers of the vaccine and certainly this anti-vax rhetoric has spread or returned in the case of MMR. I wonder if we have any cons to kind of counter that or as non-medical people, information we should be sharing about that and if there is some sort of programme more generally around that for schools and people to be sharing? Yes, and all of those counts. We have quite an immersed involvement with the districts around this. We have data on primary care network level. We actually have the data even at individual GP practice level and especially targeting, I think it's 16 or 17 primary care network areas where the rates are less than 85%, so specifically targeting them, working with communities as well as our district council colleagues because they often have links and networks that we don't have in KCC to really try and galvanise the awareness around that. The kind of concerns public have around the MMR vaccine obviously are founded on misinformation that's been promulgated in the past and I would urge our residents to disregard that misinformation. These are safe vaccines, well established, have been around for decades and they have a direct impact on people and in fact the lack of them is what we're seeing. In fact, it's in reverse showing that when you don't have the vaccination coverage that is needed, the consequences of that can be life threatening, especially for our babies and young children. You seem deep in thought, Ms. Grant, is there a sort of a follow-up question or are you? Thank you. And Ms. Conson, I'm welcome, I know that you've been with us online for a while now and I understand that you have a question that you wish to put either to Mr. Watkins or Dr. Gosh. Dr. Gosh, if you can hear me OK. Thank you for the update on the GRT community and it was interesting to hear that there were 25 participants. I'm just wondering if you could clarify if those participants self-identify as Gypsy Roma or Parve Traveler because I think that's quite an important distinction to make about whether or not those people come from that community and obviously they're not a homogeneous community and I'm sure you'll be aware of that. My second point was about the suicide prevention scheme which obviously is very welcome. How do we know that it's successful suicide prevention? Because my radar has been picked recently by certain circumstances in Ramsgate where we've had three deaths which would appear to be of a suicide type but obviously nobody can know if people have particularly committed suicide. So how do we know we've been successful? Thank you and forgive the sunglasses. I've got terrible hay fever. Thank you. Thank you, Karen. Sorry for your hay fever. In terms of the 25 participants who whether they're self-identify as Gypsy Roma Traveler community and especially Parve, I'll come back to you on that. I actually don't know because I don't have first-hand information on that but we can get back to you and get back to this community with that information but I'm sure they are identifying that way. We have a dedicated staff who actually is working directly with the communities and we're trying to create a training the trainer type approach with the communities themselves so that they are equipped to be health champions themselves and kind of engage with their communities much better. So that's where this work is coming from but we can come back to you on that to confirm that and the numbers. In terms of suicide prevention that's a really good challenge. There is a suicide, a national suicide prevention strategy on which is based our local suicide prevention strategy. One of the achievements of this group is being able to get real-time information where we don't have to take records to repeatedly going back to the coroner's office and doing really lengthy audits about what's going on and actually get the information in real-time and share it. So that itself is quite unique and I believe that can pioneered that approach. So that's one of the markers of success being able to firstly identify and know the information and get to grips with the risk factors underpinning where what happened and why and therefore contracting some of that. You're right that the suicide rates have gone up in the recent year or so. I do not think that that's a reflection necessarily of the suicide prevention team which is trying really hard to tackle all of this but it is something about a number of factors. Firstly, it's a statement about the state of affairs with mental health in our population in general and how that has deteriorated post-COVID and some of those impacts particularly among young people. There is something around a real join-up between mental health services across adults, children as well as public health and public mental health to reinforce some of the positive mental health messages and reducing stigma around accessing services etc. So there's a lot to do in this area so I wouldn't necessarily say that we can prevent every suicide even though having one suicide is one too many but I think we're heading in the right direction but there are challenges that are no doubt. Again, I can come back with more data if you need around the metrics that we used to understand our kind of indicators of success in this area. Right, thank you very much. Yes, sorry. Thank you very much and can I say thank you for your update which is really interesting and it's encouraging because you mentioned the family hubs, you mentioned the link of mind and body which is something I think we need to recognise more and more. You spoke of the importance of research and excitement of what's going on and the shared delivery plan. So what are, if any, are there some barriers to all this moving forward as fast as possible or is there anything we could explore further to help it move forward? It has by necessity got to take time obviously. Yeah, that's a really good point. Anyway, a million dollar question or a million pound question. So one of the barriers is funding. So we're in a resource stretched environment. The Council as everyone here knows is in a difficult financial position and the NHS financial position is even more challenged. So the challenge is that we have this ambitious plan. How can we go about it despite of that? And I would argue that actually this is why we need all the more needed in place because particularly around prevention we have to break that cycle of the usual way of doing things and do it differently. So it will take time. I think the important thing initially is relationships because this will move at the strength of trust and relationships that we're very carefully trying to develop with our local colleagues particularly with district councils, with one tree sector, with health partners in primary care. And unless we get the relationship right and start to achieve few modest initial goals which is where we're going with this. Establish credibility, momentum, trust, relationships and then layer on it more and more of the complicated stuff that we do need to deal with. So some of it is already going on and I'll talk about it more in the shared delivery plan. And the challenge is being like a small country in its own right is making sure everything points in the same direction which often is not the case and consolidating the work that's already going on. So that's almost the first phase of what we're trying to do. And the obvious barriers are around capacity, finance. I think the great strength is that there's enormous buy-in from the senior most leadership in this council, in the Medway Council, in the ICB as well as in the broader wider system. So that's really exhilarating to see. So I'm really hopeful but I think there are, I mean I could go on with a lot of the challenges which exist which you probably know of yourself. But I do feel we will get there and things will change. Thank you Chairman. And from that I heard the most, all the loudest that we need those conversations, for example, the districts and local level. Thank you. And thank you very much everybody for your for the questioning and thank you again for the updates. We move on to item six on the agenda which is the spending, the stop smoking services and sport grant and I believe it's back over to yourself Dr. Gosh for a resume of this report. It'll be led by Richard and I consultant but what I will say at the start is that this is a really exciting prospect. So we have new money to actually do things differently funded from central government. Kent has got, so the whole of all local authorities across England have got money for doing this work and we've got the biggest allocation across the country. So that makes it even more possible to do things differently. This paper is here because there's a key decision to do with the spending of the money. So there's a key decision taken earlier around receiving the money and this is the next follow-up. But I'll hand over to Richard, you want to steal her thunder. Thank you Chairman. Thank you, Anjan. Just to clarify, we came here in January to seek permission to secure the funding from government and what we're doing here today again is seeking for your approval on progressing the grant that we've received, part of which we've received already and bring to you the plan that we've developed with the team who are here with me today to seek approval of that as well as a framework that we've developed for future spending of that grant. It's in the paper, the details of it are in the paper but I'm going to highlight a couple of things that will be of interest. We do have pockets of variation in terms of prevalence and what we aim to do with enhancing existing services is try and address some of those variations where the prevalence is higher and particularly amongst communities who are deprived in Kent. So we're going to focus on those areas and the plan will reflect some of those intentions. We also have a downward trend which we talked about in the last paper in Kent, however we do have still about 11.6% of our population smoking so this money will help us support the people who want to stop smoking and engage with the services and alternative options as well for them to engage with to stop smoking. We know that over 60% of the population actually wish they'd never started smoking so it's a welcome additional funding that we're receiving to support our local people achieve better outcomes in their health. I will hand over to my colleagues who are here. I've got a couple of commissioners, Luke Edwards who is a senior commissioner and Chris who's also a commissioner within the team who helped us with getting the services in place and my colleague Debbie Smith who's a public health specialist who've been working really hard developing the plan in the background and will go through the details for you so you feel assured about what we're planning. So I hand you over to Chris right now. Thank you. Thank you for Tuja. I'll just give a bit more background on kind of why we're here and on the process today. On the fourth October 23, the government published Stopping the Star, our new plan for creating a smoke free generation. This included a program of funding to support current smokers quit smoking with £70 million worth of additional funding per year across local authorities to enhance stop smoking services and support. The aim of this additional funding is to create a nationwide and comprehensive stop smoking offer and to increase the number of smokers engaging with effective interventions to quit. This new in funding is in addition to the public health grant and will be provided to local authorities via a new section 31 grant on top of the current public health grant allocations. The funding is reinvented for local authorities to spend on stop smoking services and other stop smoking support. KCC received the full grant terms and conditions in February of 2024 and this detailed the relevant conditions and the full grant funding allocation for the first year of the grant which for Kent is just over £1,944,000. It's understood by government that local authorities will take time to fully commission and develop offers with this grant money. KCC will need to increase the number of individuals setting a quit date for smoking and also quitting smoking at four weeks. Local authorities have been given performance measures for this money and for Kent over the five years this ramps up each year with a bigger target each year but for Kent the number of set quit dates that we expected to get over the five years is 26,937 individuals and for the first year that is 1,347 individuals setting a quit date which is an additional 25% on what we currently already get in Kent through our stop smoking service. The report we've brought today outlines the proposed approach to deploying the funding to deliver against smoking cessation targets for KCC and the government and it builds upon the previous decision which we brought to this cabinet in January of 2024 and the decision taken in February of 2024. As already alluded to this is a great opportunity for KCC to increase and enhance the stop smoking services in Kent and improve outcomes for residents. The funding will be used to invest in enhancing stop smoking services and support for residents of Kent and increased targeting, build capacity to deliver expanded local stop smoking services and support, build demand for local stop smoking services and support and to deliver increases in the number of people setting a quit date and achieving a four week quit. I'll pause there for any questions. Thank you chair. Thank you and first of all thank you all for coming along this morning and sharing your your passion about this project. I can see at least one indication of questions so Miss Hawkins. Thanks chairman. Yeah so I just wondered what the actual service will be what is the actual support that people will receive to stop smoking. Also how do how are people referred for this service? What's what's the process and and how long will it take between them being referred and actually receiving the the support? Thank you. Thank you for asking that question. I will ask Debbie and Luke to field those two questions if I may. Thank you. Thank you for your question. The funding will increase and expand the range of different stop smoking support that people have on offer. Currently the behavioural support in addition to pharmacotherapy or nicotine replacement therapy is available to people over seven week program. That is considered to be the NHS best standard practice and the most successful way for people to quit smoking. So that will be retained. We will increase capacity in existing services and develop more services that will increase people's options for referral and different ways in which people can access services. It will also increase engagement motivation to help people want to quit smoking. We're also looking at introducing new different types of services where people who wouldn't normally access stop smoking services would be interested in trying to quit smoking. So this might be a little bit different but we do need to increase the breadth of people to want to be able to quit smoking. So we'll be looking at doing that as well. The current duration for stop smoking support is seven weeks but we would want to expand that as and when that's appropriate for people. Some people such as people with mental health conditions might need a little bit longer say 12 weeks something like that. So we'd want to be flexible to make sure that everybody who wants to engage can do so successfully. Chris have you anything to add? Thank you Chair. Thank you Mr Kennedy. Thank you Chairman. So well done. Thank you as one of those ghastly and sanctimonious ex smokers. I wish you well. I wish you very well. The two points I'd like to make, one question, one consideration and the question is I noticed from the report that almost half of the cost of smoking related illness is born by businesses and lost productivity. So I think it was 700 million from memory. Is anything being done to engage employers in this campaign to almost make smoking more difficult in the workplace such as not providing smoking shelters and educating their own staff as to the effects on their job and employment chances through absence through smoking. That's my first question but my second question and I'm sure you've considered this because you're the experts. I spent 20 years smoking and 20 years ago I quit and I quit because I woke up on New Year's morning having had a dinner party the night before with eight guests all of whom were smokers and I walked into my dining room and the ashtrays were full and the kitchen stank and my clothes stank and I said I don't want to do this anymore and I gave up that day New Year's Day 2004 and I've not smoked since it was bloody difficult but prior to that I'd had nicotine patches, I'd had hypnotherapy, I'd chewed gum, I'd had every remedy, they all failed and they failed because I did not want to give up. I was trying to give up because I knew it was the right thing to do but mentally I hadn't come to the point where that was the right decision for me and I wonder if we do too much trying to impose substitute products on smokers and we don't do enough on educating them to become to the position where they wanted to give up smoking because for me and I might be different to most for me it was reaching that pinnacle where I no longer wanted to smoke. Actually I hadn't wanted to smoke for 10 years but what not wanting to smoke was in addition to needing to give up for my own mental health and financial health. So I just do wonder if we maybe need to do more on education rather than the treating the symptom, treating the cause of the smoking. Thank you Chairman. Thank you for your question and your insights from having struggled with trying to stop I suppose. I imagine that's the story of many a smoker. It has to be a combination of your commitment as well as the support you can get. I will ask my colleagues who are far more experienced in Kent to take up those questions but certainly you raise some key points around how we might tackle the mental health aspects and developing more of the commitment which is also part of the service offered but I'll ask Chris, Luke and Debbie for relevant points that they might raise around what we do locally. Thank you for your questions. I think going back to the first one around the workplaces. So as part of the first thing we're looking to commission is to work in workplaces and to see if we can do things like smoke free places and such things like that to increase the likelihood of people wanting to quit and also work with employers to increase and to have that sort of communication with the people that they employ to give them the information of where to quit and that sort of referral routes in. So it's definitely something we're looking into doing and working in workplaces. Going back to the other one around motivating one of our key things around what we're looking to commission is around motivating people to want to quit but also giving them that motivation to quit. So firstly going out there to engage with people but then provide that motivation to do so. So that's certainly something we're definitely looking into but yeah I'll pause there. Is there any more? Yes thank you. Just to support what Luke said that we do see around a quarter of the routine and manual worker population are smokers so we can't underestimate the importance and the value of identifying workplaces and what that means for employers as well. So we will very much focus on workplace stop smoking support where that's wanted and can also offer workplaces and employers information on smoke free policies and developing smoke free policies if that's what they want to do if that's for them. I also wanted to mention that we can't underestimate the difficulty that most smokers have in trying to quit smoking. It is a nicotine addiction and it's very very hard to kick. So we have to be very mindful that it's going to take willpower as well as behavioral support and other support and vaping comes into that as well but it takes a lot of determination as well and so that is sort of why we have to get people to the point of being ready to once quit and that sort of supports Luke's comments around ensuring that services are able to do that. We are also looking at alternative providers and methods of quitting smoking something that works in a different way than the traditional services and that might help and support people who find that current stop smoking services aren't for them. Again we're just trying to expand all the different resources that are available and offer those to smokers and so that they can hopefully find something that is the right way to help them quit smoking. I hope that answers your question. Thank you very much. Ms. Wright. Thank you, Chairman. What other things you've said about therapy is really good but you're not mentioning, do you show videos of what can happen to people that are chronic smoke? Why I say it is a long, it was a long time ago at secondary school. We all had to sit and watch a video of the deterioration of a compulsive smoker. One of our teachers actually ran out through a cigarettes away and we never saw her with a fag again. Personally I was lucky I grew up with a grandfather with a chronic bronchitic condition and I've never smoked. I was scared to smoke and I think that's what you need to do with children and just frighten people a little bit. Shall I take them? Thank you, Ms. Wright, for asking that question. Very important that we actually look at a range of approaches to help people understand and particularly children young people and I will ask my colleagues to pick this up because again they know far more detail about what goes on on the front line but we do use a range of methods and some of those include sort of media communication about through media with young people but let Debbie pick up the work that we do with young people. Thank you. Yes, some graphic imaging is used in some PSHE tutorials but that's not mandatory in schools so not all schools find the time necessarily to include stop smoking within their curriculum and so that's rather unfortunate but there are resources and tutorials that do illustrate the graphic and ghastliness of smoking and what it does to people's bodies. It tends not to be the case so much for adults where the national campaign imagery has moved away from hard-hitting campaigns and there are arguments for and against that but we do recognise that there is a need for some people and for some smokers to need hard-hitting images and messaging to really help them decide that's it I do need to quit so that will be included in one of the alternative programs that we're looking to commission. It's not for everybody but we do need to find something for everybody so that will be included but it would be very useful if more schools or all schools included stop smoking support and the harms of tobacco are two young people to the pupils in their school. We would support that. Thank you. And thank you. Mr. Meade. Thank you Chairman and thank you very much for the work that's being done in what is a very important area. Given that this is a multi-year program I was just wondering from a governance perspective if it's your current intention to bring a report back to this committee each year just to provide us with an update and I asked that against the backdrop of the Kent targets as listed in table four and obviously those targets as the report states scale up and we're expected to have a 150 increase on our target by year five which is a rather lofty target but I think an entirely necessary target and the reason I ask that is because I think it's important that members do play a role in the monitoring and governance of these targets particularly because at 7.3 of the report it states that the Department of Health and Social Care will need notifying and I think this committee again needs to have foresight of that and just with that notification process are we likely to be penalised by the Department of Health and Social Care and have to return funding if we don't meet those targets. Can I answer the first part of that question there I'll turn to Ritugia for the second part. So firstly yeah if the if the committee wants those annual kind of reports we're obviously happy to do that. It's coming later on we are revising our dashboard performance dashboard and so we'll have that discussion there but it will reflect the data as we require to do it by the government based on this new run so you'll be having that coming to any ways as part of the in a basket of performance indicators. Thank you Mr. Mead I will pick up your question around what might happen if we don't meet the targets. We haven't got clarity on the fact whether the grant might be affected as a consequence but what's important for KCC to do right now is to ensure that we spend the money that we're allocated within the sort of grant conditions and ensure that we feed back our successes to through the route for data collection that's set up nationally and if there are any discrepancies we're told in year one that we can alert them and we will not be penalties won't be applied in the first year but we think we don't know that that might impact on the grant going forward so we are very keen to achieve the target and make sure that we have their enhanced services in place to support local people thank you Mr. Waldings thanks Chair I thought just maybe a late or possibly final comment if no one else is speak on this matter thank you to all members and and officers for an interesting discussion on the topic I really welcome the Prime Minister taking what is sort of quite bold action on the topic of smoking prevention quite a wide range of measures he introduced in the autumn of last year and of course I very much welcome doubly welcome the fact that Ken residents are going to benefit from from this investment and one of the reasons that yeah I just think it's so helpful if we can help people get off smoking is this is no benefit to anyone from smoking when you look at the statistics 85 percent of people you smoke wish they had never done it and that's really sad when you think about it that essentially an addiction stops them from giving up something that they've had by their own calculations very little pleasure from which does make smoking quite different from some of the other mainstream issues we tackle the public you know in the public health realm so I think it is really welcome and you know grateful that that we've been able to secure you know what is quite a large investment two million pounds a year several years and it's been really good today to hear from from our colleagues all the innovative techniques we're going to use to spend that money wisely and really continue to see the rate of smoking to create in the coming years as a safe for the betterment of our residents so yeah thanks everyone for good discussion yes thank you everybody I've checked with the clock there was no requirement to read out all the recommendations which I'm sure you'll be pleased to hear and I'm sure that you've all read them and fully and are fully aware of the five points within the recommendation list can we please show by the usual method whether we agree with the recommendations delegations and approvals as listed on the agenda papers okay thank you so we now move on to agenda item number seven the Kent Community Health NHS Foundation Trust 12-month partnership extension and again I look to Dr. Ghosh to to start this conversation thank you chair my I suggest we take agenda items seven and eight together because they're essentially about the same thing there are two major providers in in public health so those are the KC-50s of the Kent Community Health NHS Foundation Trust which which actually is commissioned bulk of our contracts and the other is which is the second paper which is MTW so Matesdon and Trumbridge Wells NHS Trust so these are between them covering most of our statutory contracts we have come back to and will continue to come back to this committee with our public health transformation program and this sits in the context of that public health transformation program these are two key decisions given the amounts and the proposal is to extend the contracts for both and it's called a partnership agreement by a year so they're meant to expire March 2025 and the key decision is to extend it to March 2026 now this is not taken in a in a in a way of accidentally or just incidentally this is a part of a plan process around the public health transformation program to allow for it to properly take place in fact the process was instigated by the fact that the contracts will expire in March 2025 but as we've gone through the work as my colleague Chloe will talk about other things have come about and we realize that that's not enough time to complete the transformation program so I'll hand over to Chloe for the rest of it yeah thank you there are several points to highlight in relation to the paper so that to the two papers so the two papers are in relation to the proposed key decisions to extend the MTW that's Matesdon and Trumbridge Wells NHS Trust and Kent Community Health Foundation Trust partnerships both contracts expire on the 31st of March 2025 and the recommendation is to extend the contracts for 12 months from the 1st of April 2025 to the 31st March 2026 the extensions are being proposed have been deliberately planned and carefully considered well in advance of the contract end dates and they are being proposed to support the public health transformation program the transformation program is a complex but exciting opportunity to review and deliver improvements to all services in the seat of the public health grant many of the contracts being reviewed as part of transformation are part of the partnerships with KCHFT and MTW and services include health visiting, school health, sexual health, HIV services, postural stability, adult lifestyle services and NHS health checks services delivered by both providers consistently meet set targets and deliver high quality services and offer value for money through year-on-year efficiency savings the proposed contract extensions would help to collate and incorporate insights from underserved groups and service users that would help inform the future design services it would help to minimize risk the destabilizing of the workforce these especially services and the roles can be hard to recruit to the change of service model needs to be carefully managed with existing suppliers the extension would help to maximize interdependencies and time is required to explore and consider interdependencies with the external commissioning opportunities the extension would help to balance internal staff resource across a number of recommissioning programs it would also help make the most of external opportunities for example with VICB and help with the sustainability of external funding such as family hard funding the extensions would help to realize the benefits of the transformation program and develop robust business cases and finally the extensions would help to develop an understanding an application of new procurement legislation this is a new legislation called the provider selection regime which was introduced on the 1st of January this year the MTW and KCHFT partnerships were originally procured under the public contract regulations 2015 under regulation 12-7 legal advice has confirmed that under the new PSR legislation the procurement of partnerships i.e. reprocuring the current arrangement is not permitted the short extension will therefore support the financial and legal procurement implications of putting in place new service commissioning arrangements for each individual service currently operating under the partnerships this is particularly important given that there is no current case law for PSR whilst services cannot be re-precured as part of a partnership a 12 month extension is permitted under regulation 13 1D of PSR during the proposed extension period the transformation work will continue and will be delivered at pace in areas where complexity is low and where the preferred service model is clear where there's more risk or complexity the extension will allow time to consider potential impacts KCC will still have the ability to make moderate variations to the contracts during this time and during the extension all parties will remain committed to delivering efficiencies and financial savings in the extension year in line with current terms to ensure best value KCC will closely monitor expenditure alongside performance and any substantial proposed decisions new decisions will come to committee for a key decision in a similar way the committee will be presented with regular updates and changes to commissioning models for endorsement as the transformation work progresses happy to take any questions thank you very much are there i'm anticipating mr strepfield i've seen your indication first thank you this one is interesting because of the timing and and the numbers and my political antenna are going good and good and strong with the contract that ends on the 31st of march 2025 being extended for for another year without the kind of having not delivered the transformation that's that's required because we think it'll only be achieved by by this extension there's also some very very convenient numbers in in the paperwork in that the cost of the of the extension falls just under the threshold for being able for having to recommission this service so whilst i hear absolutely all of the well-made arguments about pressures in other parts of the budget in in giving time for kind of things to be things to be done and staff stability and staff pressures and all the other good good reasons for kicking the can down the road there's quite an overriding one that says we need to get on with it as soon as soon as possible regardless of those pressures because we are under such pressure and i would like some reassurance that the firstly on that kind of 31st of march is a kind of a necessary extension for the for the year and what the implications are of that financially for the for the contract and secondly the some more reassurance about the the percentage how how good the math is on the 21 percent of of the value being going to be under the threshold and whether you're going to come back here in a year or two years time and say actually the cost of this service falls at 30 percent and we should have done something previously thank you so firstly appreciate your points this is not taken lightly this decision and it's not a kind of a convenient slate of hand kind of a process the transformation program i would kind of push back about your point about it not delivering because it is delivering and a lot of this decision making is because the transformation program is showing up certain things which need to be dealt with differently there are 21 different programs of transformation underpinning this so it's a hugely complicated piece of work we chose to not do it to an external consultancy which would have added to the cost significantly without necessarily delivering huge benefits it's being done by our staff internally and it needs to be phased in consideration of a number of factors so the main factors for doing it in this way and you know kind of extending it for a year is because there are a number of really complicated decisions that need to be taken simultaneously so for example the sustainability of the family hub model which i spoke about as a next stage that's year three beyond this year so it's after this year and because that has come into play just as an example we're having to review how we're doing our health visiting program how we're doing our school nursing program how we're doing some of the other elements of the note to 19 service to a bring about a different way of doing things in terms of coordination integration etc but also carving up money to then sustain that new model when the funding runs out so all this is is is kind of new stuff it's not exactly started at the time the transformation took place and that's just one example the other thing is that it's not as if parts of the work won't go on so it is commercially sensitive so we haven't shared it here but there's a whole pipeline of actual programs of work which will take place between now and that extension so it's not as if only at that extension we're going to actually do things some will happen in the next six months some will happen within the next year and other ones will happen beyond that so it's a whole program of continuing implementation of the of these 21 programs which will take place so a lot of it is about those complications and because those complications relate to very specific large value parts of that overall contract that it would be extremely risky to actually have that in fact it's not even deliverable within this March 2025 deadline so in order to get the best value for the public purpose it is required to extend it so accepting that that's the that's the case we appear to have unforeseen implications of transferring to the family hub model for public health services and that's why we've got why we need to put an extension on on this because obviously in other committees chair we have raised concerns about the family hub model and how well it was thought out and what what the implications would be and they appear to be being realized in another part of the parish so that gives me some some calls for concern I think the second point about the value of the contract and whether we're going to get some further reassurance about whether the value is going to remain inside because these get the cost in the papers are estimates can we can broadly expect them to fall in into under the legal limit can I have some more reassurance that that is going to be the case yeah so in terms of the financial values we have sought legal advice on on that and the calculations have been carried out in a very robust way and we've sought legal advice and it will remain well below the 25 percent that is permitted and that is the reason why it's only a 12 month extension to ensure that it does not exceed the 25 percent if it were to be in 18 month extension for example then it would start to creep upwards so that's why we've limited the amount to be well below 25 percent just on on that point because okay we we can play games with them with it with the money and the timings but if the point of principle is that you you need a certain amount of time to get to a level of security then we're we're kind of trying to dice between the practicality of of getting to that point and the principle of if your contract is going to be bigger than 25 percent you need to to to retender for it now we appear to be in a situation where that decision has been made on the basis of the size of the contract not on the necessity of the of the time I would disagree with that so it's not based on the size of the contract it's based on the practicality of the transformation and when it can take place and that involves a number of factors because I just use family hubs as an example and it isn't unforeseen it is foreseen but there's planning to do in terms of actual numbers and finance and outputs and all of that so that's what's taking place right now there are other bits of the program for example lifestyles NHS health checks weight management programs we've got a one-u service across the whole of Kent we've also got sexual health services in the mix so there's all kinds of other services that are also in play out here the decision to do this wasn't so it's not stemming from so the the intention is not to avoid going out to procurement or to the open market or to whatever idea is to create the space for the right decisions to be made so some of this through the PSR process which is quite a complicated process needs to be tested out and what we don't want to do is land up falling foul of that law procurement law which is untested there and that has changed fundamentally the way in which we're having to do a lot of this work the other thing is where there is kind of strong case for the existing provider to continue to provide that is the model which will go with where there is a strong case on parts of it which is emerging to go out to procure that's what we will do so this allows for that decision-making to take place based on firm evidence and principles and also in line with the legal requirements so that is the basis and not not to do it amounts of money and therefore we're going with this thank you Miss Hammond thank you very much chairman and I do have to just comment I don't think we're playing games I think we're going through a extremely complex process that is very likely highly likely for example with our family hubs to make things better for our residents and to make things work better for our residents we don't want to stay in the dark ages so I would like to just make that point and I would like to thank you for explaining and justifying it so well and I think what you're saying is that everything's not going to wait for that things are going to happen on the way but that's just the extension is just to protect in case anything happens because and I get that so thank you very much and thank you for such a Sarah presentation because I know you talked about those who were underserved you talked about the workforce being disrupted and you spoke about the need for interdependence so you know that's that's valuable stuff and thank you for everything you're doing thank you thank you um in which case oh one second Mr I do apologize the one person was outside my peripheral view your eye line absolutely yeah look I mean uh mr Phil they are they are valid points I just wanted to maybe respond to two of them I mean obviously it's not not the first time you suggested some Machiavellian reasons that we might be doing things in my directorate and all I can say again is hand on heart that it's not the there's no agenda here this is uh best practice uh recommissioning of services in in action um and yeah no politicking going on uh yeah when when I've had this explained to me I genuinely believe uh this is the best outcome for the residents of Kent um and I think one perspective that hasn't been mentioned so far and I think you know if you'd like backs that up we're looking at you know re procuring these services as part of a transformation to ensure we're getting best value of money for taxpayers as we should and getting good public health outcomes but let's reflect on where we are at the moment as we see in in the KPRAs for public health you know we're doing okay this isn't like a burning platform there hasn't been a massive problem or disaster which means me to fix something urgently that happens that happens in politics happens in business happens in all walks of life you have to do things urgently because something's going really wrong that's not the situation we're in and therefore when this was um broached with myself I sort of look at it and think well there isn't a huge urgency to rush the job and not get the best outcome simply because we have to fix something that is causing us great pain now no I think I think that the you know the public health work that's going on is delivering some some decent outcomes we're striving for better but when you're striving for better that does not mean you rush the job because then you won't achieve the very benefits of the transformation is trying to get through but look just to also reassure you that I mean I always like to see things done sooner rather than later just a personal choice and therefore you know um the the director will be looking to recommission some of those contracts where it can be done well ahead of the extended deadline possibly even by the the the original deadline as it's out of March 25 so there there might no more perspectives on it but you know thank you for the the debate today mr. Trevor I offer the christine keeler defense in the prouma case he would say that wouldn't he I think we'll draw a line under under that um what I what I propose is I know dr. ghost thank you for America making the the two discussions I think it was right to do so but we will take the um the vote in two parts so agenda item seven which is the recommendations again that they're on the papers before you in relation to the Kent community health NHS foundation trust to extend and delegate authority those in favor can you showing the agreed manner okay okay those against any abstentions three abstentions so that is that is carried sorry can I just check do we want these votes to be recorded yep happy with that okay I'll have that recorded in a minute so I'll do the same for the next and then if I can start you to put your mind to agenda item eight exactly the same but in this case it's in relation to the made stone and tumbler dwells NHS trust partnership those in favor thank you are there any against and any abstentions thank you that's also carried agenda item nine performance management overview public health commission services and well dr. ghost you seem to be leading on this one as well so thank you I will tend to my colleagues who've been working really hard to do this but just to remind colleagues and members here of the previous meeting where we talked about this and this is a direct response of that so if you remember and it has been noted by us and we've been working very hard on it our performance indicators have been largely green so it's become a sea of green which I've been here two years so it was amber and reds were there and they all moved to green which is actually a really good new story now but it does become there there is a point at which you start wondering what's the point of these if they're all continuously green and there's no sense of challenge within these indicators so what we endeavored to do is to review those indicators and there's a lot of really hard work going on to come up with an alternative set of indicators which do provide some challenge and there are areas where we have stretch targets and stretch goals to achieve now I would like to and and the other thing that we're also trying to do which will come this is not about the formed indicators but the thinking behind them so that it can be debated here but what will come eventually to the cabinet is two dashboards so one will be a dashboard that you're used to so it'll be the KPI type indicators albeit a slightly different version and a different set and then there will be another set which will be strategic indicators which link to the integrated care strategy which we'll be talking about subsequently and we'll give you a sense of the state of net nation if you like for Kent in terms of the overall public health progress on those now that second set of indicators is not necessarily things we have full control over because we don't commission a lot of what goes on in that space it is with other partners but it does give you a sense of what is going on in the overall system whereas the KPI will relate to commission services the indicated targets are often set based on national nationally prescribed targets so there's an element of that oftentimes especially with our services which have been performing above expectation that those national figures are often reached anyways so then we have a stretch target or a different target but those need to be negotiated then with our providers because having a stretch target implies more capacity more work more funding and so forth so it's not just a simply let's increase it by five percent and we can just do that we do have to negotiate with our providers so just wanted to give that background to this work and a lot like I said is being done by Yuzhan and Darren and I'll hand over to Yuzhan thank you Yuzhan as requested for the last meeting and to further elaborate on what Yuzhan's just been saying we have devised a performance management report which provides an overview of key performance indicators for the public health commission services at Kent County Council Commission this report includes the approach of the Kent Analytics performance team to the selection and target setting of key performance indicators for each service the report covers the primary service aims the rationale for KPI selection and the approach to target settings these are then presented in the health reform public health cabinet committee paper and to the cabinet quarterly performance report lastly as mentioned the paper provides a summary of plan changes to the report for 24-25 which will be presented here as part of the quarter fours reported in July this will include KPI proposals for 24-25 and we're available benchmarking data and from quarter one there will also be the introduction of strategic indicators from the Kent public health observatory we're very happy to take any questions thank you um in this order um Ms Grian, Mr Kennedy and Mr Stratford thank you chair um thank you for these statistics which on the face of it look promising when you see a sea of green but the issue I always have or the worry I always have with data is I think it loses a lot of the detail or the nuance the particular questions I have are with regards to health visiting um there's various statistics here about how many mothers or infants are seen have we got any data about how many of those are online meetings and how many of those are in-person meetings um because I think this is this is one area where I think online meetings are not sufficient in my view um for new moms or expectant moms I also note that with um the mental health well-being thing we've got a question about how many people would recommend the service I wonder if we're asking similar questions for health visiting but also for um substance misuse and sexual health thank you question um first the first part of the question ran a health visiting we do record face-to-face contacts and online contacts so we do we do hold that data and we can give the breakdown in the report um can I post over to you for second question so in terms of um the recommendation measure we do collect that for um I think health visiting health visiting and I believe we do so for substance abuse services as well while we'll check that and come back to you I think we do okay uh chair with your permission I'll be grateful if I could have um have those sent to me and just if I could see the difference between how many people are seen online and how many are seen in person with regards to health visiting would that be okay thank you thank you thank you um mr Kennedy thank you sir um thank you for these uh latest KPIs um so I've raised continually over the last three years including when I've chaired this committee was the difficulty in judging our effectiveness both against our own preset targets but also against national targets and also what I would call um similar councils such as Hampshire and Essex I think it's very easy to set a target and then say we've achieved this and I'm not belittling that work I know a lot of effort goes into reaching those goals but in business you would probably compare yourself not to your own targets to how your competitors for want of a better description during although I wouldn't say Essex was a competitor of us I'm sure you know what I mean it would be quite helpful I think for members of this committee to actually have sight of the performance of other councils on this K um against these KPIs so we know if we're doing better or as well as we can expected thank you we will be from call to one um listing sort of arts and benchmark data against our KPIs and we'll be listing where we perform against nearest neighbors and nationally so there will be some comparable data within the report going forward thank you that's very helpful and I'm pleased to hear that thank you and mr Strepard yes thank you my questions on the uh on the integration with the of these KPIs with the strategy and the delivery plan part of which we're just about to to discuss because I think that both of those the committee has agreed that are extremely good and useful documents and I was wondering whether the KPIs could be further integrated onto those two aspects taking into account your point dot to go about the uh the fact that you're not responsible for some some of the delivery of that but just having to make to make the KPIs clearly part of an integrated plan where we are responsible ourselves to have those identified but where we're not and what's going on in that area so that we can see uh the both the effort to integrate it and where we're where there might be gaps in the in the in the delivery of that because I think at the moment whilst we're getting a good sense of what Kent is responsible for and I would hate to see those things continue to be on different tracks as though the council wasn't actually fully participating in the integrated plan I think we should see it as as one is there is there any kind of further reassurance you can give us that that we won't continue just to report on our own part of the problem or the performance indicators but all parts um short answers yes we you can but I'll just try and um reflect back to what I understood your question to be so in terms of the actual KPIs because we we don't have the final version here yet uh what like uh yours I'm not saying it will have those benchmark data it'll have trend analysis all of that will be there in it um so if I'm understood you currently what you're saying is for those existing KPI to link them to the six outcomes and that we can do we can reference which which of those six outcomes each of those KPIs relate to so we could create a column and do that in that um there is a separate which will come to in the next section there there are two aspects to this one is the overall from a public health point of view angled strategic indicators and they're just in set of indicators because uh which I'll come to in a second the principles behind this but that we already are doing there is the underpinning the shared delivery plan is going to be a Kent plan so yeah as in a KCC plan sorry there's going to be lots of Kent plans but there's going to be a specific KCC plan and that will be underpinned by some of those indicators too so that could come here in some form once we've developed that bit a bit more so there are two parts so one is what public health overall is kind of looking at and then there is the as a KCC plan what is it delivering for the shared delivery plan um I have to say that because I've seen it there's a huge number of indicators behind the scenes which are collected huge number I mean it's just a gobsmacking the exhaustive list of indicators and KPIs so what we're doing and in in some ways that is the challenge to pick the right ones to give a sense so they're not exhaustive they're not showing everything but they're kind of almost like um sentinel indicators if you like so if those are not going right then definitely something is going wrong those kind of indicators is what we're trying to pick whether it's for our KPIs as well as for our uh strategic indicators so I'm just hoping that that thank you yes it does give me a chance to um have a have a thing about how I want to express this for other better so we've got strategy and delivery KPIs for both the integrated service for ourselves public health and others partners who are delivering on that plan my point is to trying to integrate that as much as possible and reduce the number of KPIs that we see that are just KCC alone I mean what in terms of because I don't think if we're going to really make the best of the integration if we're still continuing to do just our own work and not considering the effect on partners then that probably reduces the effectiveness of an integrated care strategy overall and I totally agree because it's um you're anticipating my point point for the next discussion is that the order of data that is uh in in that document of delivery and choosing which ones to to have as the KPIs I think is that is going to be extremely difficult but um but I'd be welcome your view on that when we when we come come to that for this discussion as well thank you very much um so the recommendation before us today is that we note the approach being taken to the KPI selection and target setting I'll be happy to note the report as set before us thank you very much item 10 on the agenda today the draft kenden medway integrated care strategy joint local health and well-being strategy delivery plan and um again uh dr gevish over to you please thank you chair um I have my partner in crime behind me uh mike gogatti who'll be who's basically the guru for me on a lot of this because he's got his hands in all the pies but I'll give an intro and a handover to him for if he wants to add any comments and then we'll open up to questions so firstly as as dph I'd really welcome this piece of work and I feel really proud of what's happened and the work that's been developed by colleagues both in the CCC sorry kcc and as well wider in the system uh this document coming here it's still in its draft stage so it's still under development there's a lot of work going on behind the scenes but I just wanted to explain to you the format of the document as well as its purpose uh reason for coming here is that it's part of the sign-off process so it comes here then it goes to cmm on monday and then it uh goes on for a final sign-off at the integrated care partnership uh meeting in june like I said it's still a draft and a lot of work is underway it's it's taking a lot of comments from different people and hopefully here too from members it is a complex document so it's underpinned by something that is called the log frame and that's also shared here so log frame stands for logical framework and essentially it's a set of indicators which are um if you like mapped onto the six shared outcomes of the integrated care strategy and it's got a set of micro outcomes which then collectively result in a miso a middle-level outcome being achieved and that in turn then impacts on a long-term outcome being achieved uh like I've said before that while this is the time horizon for this strategy is around five years and this actual work is for around two to three years the initial shared delivery plan this is really a 10 year program of work this is going to take a long time to really start to change things um it is structured even this shared delivery plan that's uh on the screen and in front of you it's structured in terms of the integrated care strategy six shared outcomes now under each outcome are a set of priorities which are identified and under each priority is a set of actions against which current plans and strategies are mapped so it is very difficult to actually capture what it's trying to do which is very detailed plans which sit under it into a single document so it's trying to do that and of the necessity it's somewhat high level although detailed now what this document's use is it is a single place where as a framework it consolidates all the activities across Kent and Medway mapped against the integrated care strategy and it presents them in one place and like I said before under it sits a number of other plans so we're developing and they're actually really well underway uh 12 district borough plans one plan with the parish councils through Calc uh I've mentioned before a KCC plan plus links with the health and care partnerships and their plans there's a separate committee called the integration sorry the in inequalities prevention and population health committee and under that sits a prevention plan it links with that too once we've done a lot of this work we also intend to do a similar plan with the police and with Kent and Medway housing group each district now barring one uh has developed a healthy alliance so they're not necessarily called that in in east Kent they definitely are but in west Kent and DGS they're called different names but their function is the same which is a coalition of the willing who have identified the priorities that they will you know kind of focus on for the next two to three years so that already is not just well underway but they've also identified different priorities and are working on it so it's really exciting work because the idea here was to not do it how we've always done it which is impose a top-down approach that this is what we think and this is what you should do rather turning to our communities turning to our different voluntary sector groups turning to our districts to really craft this grassroot based bottom-up approach and that obviously will bear fruit over a much longer period of time so the idea initially this is a living document it will edit and change as we go along in this process initially consolidated activity and ensure strategic coherence i was talking about this earlier in other words all the arrows pointing in the same direction my own experience of Kent in these two years and some months has been that Kent is really like this gigantic frigate just turning it or even stopping it from moving in one direction moving it in another it takes time and this is what this initial effort is to try and do then to overlay on that new actions and interventions and what this also does is it also takes a pragmatic approach to our current financial situation where there is no new money in the system in fact there is no money in the system and we're still trying to make this happen the shared delivery plan is also the formal NHS Forward Plan so ICB has to produce by NHS England and NHS Forward Plan and that is subsumed into this shared delivery plan the time horizon initially is for the next two years so 24/25/25/26 then intention is to review and like i said before it takes into account the current climate we're in from many different angles therefore the emphasis on consolidation and coherence and then layering lastly i'd like to thank everyone including members because everyone has really participated in developing the integrated care strategy and especially officers who are directly involved across both Kent and Medway in helping to develop a document which i'm personally really proud of and would comment to the committee and turn to Mike if you want to say anything don't say very much because that was really really brilliant and and captures very well just to say that however good your document is nobody's going to feel any healthier nobody's going to live any longer and what we're talking about here is as this being a catalyst alongside of the work that engines being involved in to really start to to move the dial on on the health issues that we we need to address within in Kent so i think this is the start of a journey very much and this in itself is only sort of a call to action and i think that the the work that's going on i think people like calc um like the districts are really really stepping up into this space in a really fantastic way they're always there they always wanted to do it but i think that that um this are the the approach now the coordination agreement the recognition of their importance the central role in this has been critical similar with Kent County Council the more you look at Kent County Council there's no part of Kent County Council that doesn't have a profound and fundamental effect on the health and well-being of those we serve um and i look forward to uh to seeing um the real change on the ground to enable this to to happen thank you very much thank you thank you very much are there any questions mr. shrimpfield uh first of all i'm really glad to see that the strategy is feeding down into delivery and i think one of the one of my big questions from previous committee meetings has been answered in this document it's really good to see the level of level of detail uh there's two questions that i have um or detail questions one is in terms of increased population increase and percentages per hundred thousand have we mapped the absolute numbers that this is going to uh or the kind of reductions we're making for example in numbers of uh so that obesity figures fall from 63 percent to 60 percent and but in a kind of increasing population size those numbers probably are going to go up overall and therefore can services if there's no more money in the system cope with the cope with the increase um and has that been worked out there's some i appreciate that it is still a draft and that there is still work to do but there's very obvious kind of the workforce development piece there's lots of gaps in the information about what kind of improvements are going to be made for to be able to retain and grow the workforce uh welcome to some more information on that um and jj i'll leave you there thanks jj but overall i i agree with dr coach this is a very good kind of first draft thank you um i'll turn to mike in a second but uh good point about population adjustments um i think there's been a there's a committee behind these indicators as well as the i mean officer level committee um and behind the log frame and it's been carefully calibrated taking that into account so some of the targets have been said because they uh on the surface going to be a percentage but actually it's going to get tougher because of the demographic changes and that's why some of them have been uh i guess moderated uh and uh and you know kind of taken more into a more realistic space uh one of the things which actually links in a way with the previous conversation about the transformation program uh we have a tool called cohort modeling uh which we're uh kind of pioneering in kent with our uh kent public health observatory now what that tool does so there are two tools which are very powerful in this space one is a risk stratification type two which enables us to then identify in in a particular population who all are sitting in what risk groups and and therefore are uh you know potentially the target for what we do in terms of interventions what the risk stratification tool doesn't do is where the cohort modeling tool takes off which is uh look at that into the future so the cohort modeling is is a is a process called system dynamic modeling and what it does is it looks at a particular population adds on to it all those demographic assumptions that you were talking about and takes that population forward two years five years ten years and you can overlay on that interventions and combinations of interventions so almost like if you didn't do anything what would it look like if you did uh one of those interventions how does that change if you did three of them combined in any different combination how would it change so we're doing a lot of that work as part of the um transformation program as well but that is specific to our 21 programs but the intention is also to use that here uh once in a way we're trialing it out with our transformation program um I don't know whether you wanted to add anything like on that um yeah a couple of things really I think that in terms of the the first point you made which is the one around um 65 to 65 cent population we go away in a piece there's no way in a million years we can commission for either of those figures because that's hundreds of thousands of people so this is where the thinking of of calc thinking with local communities comes in because actually we need a different approach to weight loss in these spear armpit support losing weight is uh it's hard to do but it's not rocket science uh it's simply eating less calories than you need so I think we just need a different approach to that rather than simply focusing on a commission service that can't really deliver the right sort of levels anyway um I think in addition to that the next point you made was around um the workforce approaches and I think one of the things you've done because this is a very bottom up model is a different element it's it's a bit of a messy document in that there's different levels of detail and different levels of uh uh information in different areas and the HROD one is one that's a bit light within the work we've been doing within County County Council to define not the whole system role but they can't counter cultural contribution to that there's a lot more detail around that um and that will be within part of the internal uh can can cancel plans around this just one very brief one I think the document is so rich with data and plans and indicators and just reading it by the time you're at the end of kind of you're on on overload uh I wondered whether it would be uh and I'm particularly interested in the system dynamic modeling um as a as a subject whether we might consider later on in the work plan whether some kind of uh workshop or um a way day or something to better understand this as members so that when we're making decisions about public health going forward that at least we understand where the where the dynamic is um in a in a better way because it's yeah there was just a lot to take in for it for the for the last item on a on a packed agenda it was a um it was an interesting read but one I didn't feel I've really got got the full benefit of um thank you mr stretch for your your points being um noted we can look at the agenda setting um after the meeting after we've discussed the work plan um not on unreasonable request um mrs cole thank you chair um yes I actually agree with mr stretch well there's an awful lot of uh reading in here to get to grips with and and completely think oh yes I I know exactly what what we were looking at doing that um just a quick thing that I've just had a quick sort of look through um and I may have missed it I'm not sure but um under the shared outcome supporting happy and healthy living there is a there's mention of resilience um in communities and that seems to strike me as being for the older population um and then when I go back to the first outcome which is give children young people the best start in life there is talk about mental health and and um helping uh children with mental health issues I'd also like to say a bit about talking about resilience in children I mean as a parent you do with two children you do feel you you try and protect your children as much as possible and in doing so you may not necessarily give them the resilience that they need especially in the world that we are living in now with social media and everything and I think I I may have missed this I've had a look through but I would like to see a bit more about giving children the resilience and how we do that to live in the world that we're living in because it is really really different as a parent not having had social media and now my children are adults so they actually went through that phase and sort of at the tail end of all the social media but it's it's I would hate to be a parent of a school age child now it's it's it's I suppose all parents say that um but uh I do think we need to arm our children with a lot more resilience than and help parents to give children that resilience so it may be in there I may have missed it but I think that resilience is not just adults it's for children it's for all of us okay um I agree with you um and I'm surrounded up in the internal can't cancel I can't remember what's in which one but absolutely it should be in it I would take that away thinking thank you and uh Ms. Compson dine if you're still um still with us I don't necessarily have a question thanks very much yes thank you very much chair um this this the ambition of this plan was absolutely huge uh I heard council's track field say that you know he thought it was a big plan I mean and that we've got through it at the end of a busy day uh and the detail contained in it and the ambition is really um it's just huge it's almost I would say mind-blowing I love the ambition of it I love the way that it's been um set down I do think um it requires a deeper dive into the into the subject matter to thoroughly understand how it works I think it's something for the various political groups to really be able to grapple with as we pass the bat on along if if we're looking at um 10 years strategy and it's highly likely that some others won't be in the chamber in in 10 years perhaps who knows and so it's something for political groups to grapple with I found the scale of it while the daunting and I wondered if it was possible to look at some microsteps um so that we could see some of the progression towards these targets it may be very difficult to measure for instance um um life expectancy because that's obviously going to take place over a lifetime and that's going to be difficult to measure to some extent but I thought things like um income could be looked at and we could say in 12 months time has income improved because we know if people spend more money um they're generally there you know economic health also as an impact on physical health so that would be useful to uh to look at and it's almost like we could do with a narrative uh from the people who these plans are targeted towards to see how they are being impacted and hopefully positively impacted and I did I miss any sort of strategic intention to align resources to need because I know in my area of um fannet in in ramsgate in particular life expectancy for women is very poor I mean so I think it's the poorest in the county so are we going to tailor any of any of these priorities to meet those needs a lot of questions um I just think we do need to deep dive into this and anyway thank you very much for the document um thank you I'll endorse um the comments from from many people that is an incredibly detailed and complex document um I'm not sure if um mr. Constantine you were relating to the the purpose number p2 which which states that by 2028 the average income in kenden medway will be five percent higher than the national average up from two percent higher in 2022 and then these are sort of assumptions based on on best place calculations and and monitoring and whether you were just picking that out as an example where you wanted some um some spot sampling just to see whether we were sort of on on track with some of these um precursors and I can put you on video and you're sort of you have some indicating that that's that's where you would like to be uh but I think the same level of detail needs to be applied to the whole plan I think we need sort of greater insight but I thought measurement of income is is factual it's easy to measure actually um and it's something that could be done division by division and we would be able to plot the progress and I think that's what we're going to need to be able to do to see if this document has teeth as it goes forward because as I said I don't think I'll be here in 10 years time and I'd like to think some progress was being made thank you chair yeah thank you um Dr. Gove you indicated you wanted it come back yeah I take a councilor Constantine's points and they're very good points um I think it's neither our intention because in 10 years time who knows who's who'll be where so uh the idea is to have a yearly I mean something that breaks it down by year and it also breaks it down to shorter intervals so this is where that whole micro indicator contributing to a meso indicator contributing to a macro indicator comes in because the macro is that longer term meso is say three to five years and the micro is uh in a year's time in uh in two years time the uh income one is really interesting one um one of the underlying principles for the integration uh in the integrated care strategies everybody has to play their part and that includes uh private businesses uh organizations that offer employment as well as other other partners as well and many of them are not often brought in in that health area and and they have started to be in the integrated care partnership as well so that particular one is is predicated on the economic delivery plans and strategy for Kent County Council as well as there's a separate one for ICB uh and and a separate one for Medway so it is really definitely looking at all of that and income is a super important area because obviously as everyone knows it's one of the um if you like indicators of or outcomes which determine reductions in health inequalities so definitely um that's something to look at in terms of the detailed bits or what can be done on them you know kind of a bit more smaller chunks in the shared delivery plan towards the end there's the district priorities all listed and by the end we'll list every single one of them that would be where I would suggest we go with that you know kind of looking at what exactly is going on at the grassroots level and right now so there is kind of even within that document even though it's quite big there are things which immediately point to areas uh where we're working uh very specifically on certain things thank you Dr Gosh um yeah certainly an area that will require ongoing monitoring and I think it would probably be too much to expect the committee to come up with a coming plan today as to how we're going to break this down into bite-sized chunks and how we want to go for but it's something that um collectively we can look at an overview to decide how we want to um target these uh sort of future uh updates uh to make sure that we don't miss anything but we're we're we're honing in on the the areas which are deemed to be um most important and I say that very carefully because everything within the document this is important but that members may have a uh a choice over um prioritization and I've saw myself what can say in first and then I'll ask Ms Hammond to come yes Chair on on that point I was going to say also I guess we we should think about whether sort of future assurance or scrutiny of of the strategy however we we describe it whether it is done here or at the health and overview scrutiny committee because that would be another place that it would it would sit I mean we spend a lot of time talking about the integrated care strategy at public health committee because obviously our experts in public health um are very much you know looking at the wider determinants of health and they've very much led the strategy and the work we're doing with no way council with um the NHS but actually um we'll I mean I think we'll we'll have a discussion uh you know in the coming weeks and and have a think about where that might go talking to you know the the chair of this committee and I think Chair of Hosk as well be another place that it could be could be considered given the topic is quite broad we don't want too much duplication but we absolutely want to make sure that things are uh uh working as I should as we um yeah um evaluate the results thank you uh thank you Mr. What's Miss Hammond? Thank you very much Chairman I just wanted to refer back to Mrs. Cole's point about resilience um because it immediately reminded me of the horrendous episodes we've had not only in my division but across the country of young people with catapults abusing animals and and we know if that behavior is directed towards animals I happen to be very very against animal but I recognize that not everybody shares my sentiment but we do know that that behavior translates into aggression towards humans as well vulnerable humans and this has been um promoted on the internet and therefore again would appeal to those who are shall we say emotionally vulnerable so I just wanted to echo Mrs. Cole's concern about resilience particularly with that that kind of issue and what we're seeing in terms of behavior and it's being promoted on the internet at a pace that we can't always catch up with thank you Miss Hammond thank you very much um so the recommendation before us is that we note the progress and proposed work in developing a shared delivery plan for the integrated care strategy and two that we support the continued development of the shared delivery plan alongside the log frame matrix to support assurance on delivery of the integrated care strategy are we all in agreement agreed thank you the final item on the agenda agenda item 11 is the work program and you will see before you the items which have been identified and set for the next five meetings we will see that July is already quite a heavily populated meeting so and this is anything which is that member wishes to bring which is critical or exceedingly important I wouldn't propose adding anything onto that uh meeting um are there any items that members would wish to be considered to be incorporated into into future meetings so can I just interject do we want to leave any further substantial discussion to the agenda settings or so if yes if you're you know good good fine if if members are happy to um to sort of uh consider and agree the work program as on the agenda papers and then we can have a an agenda setting meeting the conclusion of this meeting it may be the better way forward thank you for the um suggestion so our members happy to uh accept the papers as before super thank you very much um can I think that actually concludes the meeting today can I think everybody who's who's still here present and also those who who left for to go back to other things it's been an enlightening um an interesting discussion today um quite heavy in places but um very worthwhile and I thank you all for your input have a safe journey home today and um thank you for your input bye bye