Highlights from the Kingston Place Committee Meeting: 16 May 2023

Attendees

Iona Lidington, Convenor and Public Health Lead

Liz Meerabeau, Healthwatch Kingston Lead

Diane White, Carers Lead

Jen Allan, Mental Health Lead

Sanja Djeric Kane, Voluntary Sector Lead

Denise Madden, Place Development Programme Lead

Nick Merrifield, Primary Care Development Lead

Annette Pautz, Primary Care Provider Lead

Jo Farrar, Executive Lead

Tara Ferguson-Jones, Communications and Engagement Lead

Ed Montgomery, NHS Community Lead

Alison Danks, Associate Director of Health Services, Achieving for Children

Hannah Keates, Engagement Manager, Kingston and Richmond, NHS SWL ICB

Liam Bayly, Deputy Director of Finance, Kingston and Richmond, NHS SWL ICB

Thom Lafferty, Deputy Chief Executive and Director of Strategy, KHFT and HRCH

Daniel Green, Corporate Head of Health Behaviours & Public Health Services

Adult Social Care & Health

Fergus Keegan, Director of Quality, Kingston and Richmond, NHS SWL ICB

Sam Morrison, Assistant Director, Adult Social Care, Health Commissioning and Transformation, Royal Borough of Kingston

Dawn Secker, Interim Assistant Director Operations, Adult Social Care

Transformation

Mental health services in Kingston and Richmond

South West London and St George’s Estates Transformation

A new model for Adult Mental Health is being delivered in Kingston and Richmond in line with the principles of the Adult Community Mental Health Framework and the Long Term Plan. New operational structures for both the boroughs, launched in April this year, which include the integration of primary care mental health services having been transferred to SWL & St George’s Mental Health NHS Trust.

Local Healthwatch organisations are leading independent evaluations for both Richmond and Kingston adult mental health services to ensure it is delivering high quality care for local people.

The services will move from 1 April 2024, with a period of transition this year as the services move from Camden and Islington to South West London and St George’s NHS Trust.

Barnes Hospital

Following consultations with patients, service users, staff, and community stakeholders over several years, Barnes Hospital is currently being redeveloped, with construction due to begin shortly. We anticipate completion in the summer of 2024. Once final approvals are confirmed, construction works will start on the development of a brand-new mental health facility for adult outpatients at Barnes Hospital. This represents an investment of £11m in local NHS services and has been designed in partnership with staff, carers, patients, and service users.

Services at Barnes Hospital have temporarily relocated to a newly refurbished facility called Livingston House in Teddington, with all appointments previously based at Barnes Hospital now held there. Work is are also progressing on the refurbishment of a new facility at the former site of Richmond Royal, which will be home to Richmond Child & Adolescent Mental Health Services (CAMHS) later this year.

Kingston Better Care Fund

There was an update provided to the committee on the Better Care Fund programme which is in place to support local systems to successfully deliver the integration of health and social care.

Core objectives of the Better Care Fund 2023-25:

enable people to stay well, safe, and independent at home for longer
provide people with the right care, at the right place, at the right time

Key priorities:

improving overall quality of life for people, and reducing pressure on urgent and emergency care, acute and social care services through investing in preventative services: collaborative working with the voluntary, housing, and independent provider sectors
- investment in a range of preventative, community health and housing services
- supporting unpaid carers
- tackling delayed discharge and bringing about sustained improvements in discharge outcomes and wider system flow.

Kingston Direction of Travel and Ambitions 2023-25

Joint approaches / ways of working include:

Better Care Fund review to understand impact, improve outcomes and value for money (Place and SWL)
Improvement of discharge pathways following SWL review
Frailty programme / falls / heart failure
Further developing the proactive anticipatory care model / integrated neighbourhood teams
Autism pathway and autism strategy development
Embedding carers strategy action plan
Care market management / brokerage across discharge pathways
Working with the voluntary sector to enhance capacity / refreshed commissioning for older people and people with disabilities
Ageing Well programme
Partnership refresh of the joint strategic needs assessment
Engagement to understand priorities and shape plans (e.g., Joint SWL Forward Plan)

Kingston Hospital / Hounslow Richmond Community Hospital (HRCH) and Your Healthcare emerging strategy

The developing strategy for HRCH, Your Healthcare and Kingston Hospital was shared with committee members for discussion. The committee were informed that the ambition set out in the strategy is to support our places, our services, and people to thrive.

Both organisations have held around 70 meetings with teams of staff to inform development of the strategy, ensuring that staff were fully informed.

It was explained that by working together with partners THRIVE will enable the organisations to provide holistic health and care services aimed at improving the health and wellbeing of the local population and provide a range of more specialised services across south west London and beyond. The committee were told that the below points are the strategic principles that will guide the work forward:

Provide high quality care and strive for excellence in everything we do
Our workforce will operate at the top of its licence –making the best use of everyone’s skills
We will be a key provider in the delivery of integrated services across our places
We will work in a digitally mature system. Our digital tools will ensure all relevant information is available to decision makers at the point of care, so there are no delays in the provision of care.
We are committed to the Greener NHS Strategy, and we will do all we can to become carbon neutral by 2040 for the emissions we are in control of and by 2045 for those we can influence.
We will be recognised as an exemplar provider focusing on the prevention of ill-health, whilst working to reduce health inequalities in local populations.

Place partners felt that the Thrive Strategy resonated well and welcomed an opportunity to join a further engagement session for partners on this.

Regarding the digital aspect of the strategy, it was discussed by the committee that there is a need to integrate the digital strategy work already ongoing at place and at south west London together to inform the overall strategy.

Quality and Performance

Partnership agreement

The committee were informed that the purpose of the partnership delivery agreement is to set out the joint expectations between south west London Integrated Care Board (ICB) and Kingston place for delivering shared outcomes for the local population in line with the core purposes identified for each place.

The agreement also details the responsibility of place in supporting the delivery of south west London ICB’s delegated responsibilities as appropriate.

The committee was informed of the feedback received to date on the draft partnership agreement by partners. Feedback was also received from the place committee members and discussed at the meeting (see below):

Strategy is well produced and a good piece of work, except for the almost total lack of mention of carers. Working with carers is a requirement and there are several opportunities in here to strengthen that.
Care element of the joint health and care approach seems limited in vision.
Are the asks of place realistic, without the financial information to back this up?
Four Roles of Place – do not accurately reflect the Place relationship fully enough, should more closely reflect the purpose of the Integrated Care System (ICS).
Regarding finance – there was a query if health inequalities funding will be delegated to place?
The term health prevention is being used erroneously – we want to improve health not prevent it – it should either be ill health prevention or health improvement/health promotion
There was a query regarding who sits on the Place focus group.

Communications and Engagement

The committee was presented with a series of slides that describe the engagement work that has be done in Kingston between January – March 2023

The slides describe how the team, group their engagement work into areas e.g. health inequalities & community outreach, primary care and Primary Care Networks and prevention/early intervention, and gives examples of the work they have done and are doing under each area
The slides provide detail through worked examples of the engagement work that has been done in Kingston, demonstrating the impact and difference made for local people and communities
The team presented a case study of a local example of the engagement work that was done recently around bereavement and its impact on services
These slides are part of the Q4 report covering all 6 south west London boroughs that will be presented to the south west London People Communities Engagement Assurance Group (PCEAG) in early June for assurance purposes, to ensure the ICS is meeting its legal duty to involve
This is only the second time the report has been produced and it is a developing model – for this quarter PCEAG are keen for place committees to review the report and give comments and these will be included in the final PCEAG report.

The committee were given information aboutthe Winter outreach programme which has been running since October last year and were informed of the areas and groups the team have heard from between January – March this year.

The team has focused their engagement on the groups they hear from the least within Kingston and those experiencing health inequalities e.g., men, those experiencing mental health issues, the Korean community, young people, and people living in areas of deprivation
The team highlighted to the committee the emerging themes from the insight that has been gathered from these groups:
- People rely on their community, the community leaders and voluntary and community organisations that support them for trusted health advice and information – so it’s key we engage with these organisations to deliver healthcare messages and use these trusted voices to help us have conversations with communities about local health and care services
- Primary care – all groups we spoke to have views on their GP practices and common themes were– online and triage services are a barrier to those who don’t speak English as a first language, difficulties getting urgent or same day appointments and big variations in how practices work across Kingston
- Vaccinations – hesitancy from some groups to get boosters for a range of reasons including previous side effects, is covid still an issue – but equally lots of groups are positive and many we spoke to were fully vaccinated and happy to talk about flu and other vaccines too.
- Hospitals – people are experiencing long wait times and more people than usual, mentioned routine outpatient appointments being cancelled
- Mental health services – especially young people are struggling to access them due to long wait times and lack of knowledge or support available.

Assurance reports for information

Finance Delivery Group

The place committee was asked to confirm support for the approach outlined in the paper. The update summarised the aims of the Integrated financial performance group IFPG. The paper outlines that there is agreement to work together and to non-recurrently support the establishment of investment that has an overall benefit for the Kingston and Richmond (K&R) System.

The achievements over the last year were highlighted in the paper, including the fostering of closer relationships across system partners and the establishment of an innovation fund, followed by the ambition for 2023/24 and beyond. The paper indicated that there is recognition that Kingston place will need to work differently together to achieve the required financial and workforce sustainability. The process will be to support the priorities emerging through the Transformation Delivery Group / A&E Delivery Board.

To date the IFPG has achieved:

Engagement from system finance partners across Kingston and Richmond: Social Care, Integrated Care Board, place, Hounslow Richmond Community Healthcare, Your Healthcare and Kingston Healthcare Foundation Trust.
Establishment of a K&R place investment fund to provide non-recurrent pump priming support for proposals which will go on to be self-sufficient. All proposals are overseen by the transformation delivery group to ensure alignment with the 5 agreed strategic priorities. To date four proposals have been approved for support: Heart failure nurses, Patienteer, Admiral nurses for dementia, Falls
An open book approach has been established which is expected to deepen over time. It has been agreed that any efficiency savings achieved from pump primed investment should be reinvested to the level of original investment; to support maintenance of the fund.
The ambition for the future is to continue working together in partnership to achieve future financial and workforce sustainability. As partners there is a need to work differently together if we are to achieve optimal benefits across Kingston and Richmond Place and beyond.

Quality Delivery Group

The Quality Delivery Group (QDG) is established to provide assurance and oversight to the Place Partnerships on the quality of services and programmes delivered across the Kingston and Richmond Places. An additional reporting line exists from the Chief Nursing Officer (CNO) through to SWL CNO through the SWL System Quality Council which meets monthly.

The committee were informed via the paper about key matters to date that the QDC have received –

Quality place delivery plan – either completed or in development that delivers on quality improvement at Place, which draws together quality planning, quality control, quality improvement and assurance functions to deliver care that is high-quality, personalised, and equitable
An understanding of current Integrated Care System governance arrangements
Measuring quality: An agreed way to measure quality, including safety, using key quality indicators triangulated with intelligence and professional insight, which is reported publicly and transparently at Board-level to inform decision-making and effective management of quality risks.

The committee were informed that a forward plan is in place which covers the areas identified in the recently revised Place Partnership Delivery Agreement including:

• Primary Care

• Safeguarding – adults and children

• Children Looked After

• SEND

• Patient safety and learning

• Continuing Health Care

• Infection and prevention control

Next steps for the QDC are to:

Continue to provide high degree of focus and leadership on emergency services – this remains a priority as the increased waiting times could have a negative impact on both patient experience and length of stay