Agenda and minutes

Matters arising

(1)       The Chairman stated that the LINk representation on the Committee needed to be formalised and asked that the LINk notify officers of their two representatives  before the next meeting of the Committee.

(2)       RESOLVED that the minutes of the meeting held on 2 October 2009 are correctly recorded and that they be signed by the Chairman subject to Mr G Cooke being added to the list of Members present. 

Refreshment Break

Mr A Cole (Head of Commissioning) NHS Eastern and Coastal Kent, Ms Z Fright (Senior Lead Commissioner Urgent Care) NHS Eastern and Coastal Kent, Mr K Gill  (Procurement Manager) NHS Eastern and Coastal Kent, Ms D Robertson (Deputy Chief Executive) NHS West Kent,  Ms D Stock  (Strategic Commissioning Manager) NHS West Kent were present for this item.

(1)       The Chairman welcomed colleagues from NHS Eastern and Coastal Kent and NHS West Kent to the meeting and invited them to give a brief introduction to the papers that they had submitted to the Committee. 

(2)       Members were invited to ask questions which including the following:-

• In response to questions on the way in out of hours GPs engaged with patients, both PCTs explained that there were a number of ways in which patients could be seen out of hours, GPs were available at certain bases and, if appropriate, patients could be asked to travel to them, generally an out of hours GP visit tended to be a option of last resort in order to make effective use of resources.
• What happened with the plan for integrated call centres?  An East Kent colleague explained that South East Coast Strategic health Authority had decided not to participate in the Department of Health’s single number or non urgent care pilot scheme.  However, they were ensuring that if this was rolled out nationally there would be a directory of services ready to use to support this service.
• How does information get from the out of hours service to the patients GP in a timely manner? Members were informed that at the end of every out of hours session all notes were faxed or conveyed electronically to the relevant GP’s by 8.00am on the next working day.
• Are there any plans to offer GP’s inducements to provide an out of hours service for their patients?  West Kent colleagues explained that their new out of hours contract would require the use of GPs who knew the local area, and if it was necessary to use locums from abroad the PCT would be informed so that checks could be carried out on training and language skills.
• In relation to the statement in the West Kent survey results (page 19 of papers) that half of patients had waited longer than half a day to make contact with the service, it was explained that this related to how long the patient had had the condition for before deciding that it was serious enough to contact the out of hours service.  The question was designed to help establish how patients were using the service.
• Regarding the figures (page 17 of the papers) which compared the value for money aspect of services, Eastern and Coastal Kent stated that the national audit office had carried out this survey in 2006 and that most providers had expressed concern that a standard approach was not used.  Work was being done with the Department of Health to produce a better tool to compare providers.   In their  ...  view the full minutes text for item 16.

(Mr P Edbrooke (Associate Director of Quality and Performance) NHS Eastern and Coastal Kent , Ms J Clabby (Assistant Chief Executive) NHS West Kent,  and , Ms D Robertson (Deputy Chief Executive)  NHS West Kent were present for this item.)

(1)       NHS colleagues presented papers and answered questions from Members on the progress they have made to separate Commissioner and Provider functions.  Questions and comments included the following:-

• In response to a question on when these arrangements had to be put in place and when they actually were put in place, Mr Edbrooke staked that Eastern and Coastal Kent Community Services was autonomous by April 2009.  In West Kent the timescale has slipped, they had been assessed by the Strategic Health Authority and were awaiting confirmation.  They had robust arrangements in place by 1 October 2009.
• It was agreed that in future NHS colleagues would be given an indication of the length and detail of information that should submitted to the Committee.
• In response to question Mr Edbrooke stated that the move to provider services was not a simple as making one decision, he referred to page 34 of the report which set out the 6 key areas that they were focusing on.  
• A question was asked on whether the split had led to an increase in the number of senior officials serving on Boards.  Mr Edbrooke stated that East Kent had decided that in order to have public accountability they would appoint a part time Chairman and 3 lay members to sit on the Board.  The only new professional appointment that they had made to the Board was a part time Medical Director who was a Doctor, which provides assurance to the Board that Doctors were being managed effectively.  Ms Clabby stated that West Kent had not made any senior appointments onto their Provider Services Sub-Committee, colleagues had moved from existing roles. On their Management Board they had 1 non executive director and had asked the Chairman of the Board to make 2 further independent appointments.  The detail of this was contained in their Board papers for September 2009.
• In relation to service efficiency, Ms Clabby emphasised the importance of good outcomes and consideration of patient needs.
• The importance of savings being made in governance was highlighted by Members.
• Mr Edbrooke stated that the ultimate goal in separating Commissioning and provider functions was to obtain the right care at the right level for the people of Kent. 

(2) Mr Edbooke and Ms Clabby said that they would welcome the opportunity to come to a future meeting and seek the Committee’s view’s on the final model for PCT provider services.  A good time to do this would be early in 2010.

(3) RESOLVED that the update and comments made by Members be noted. 

(Ms Harrison (Director of Assurance and Strategic Development) NHS Eastern and Coastal Kent, Mr Meikle (Director of Commissioning,  Finance and Investment) NHS Eastern and Coastal Kent), Ms Shutler (Director of Strategic Development) East Kent Hospitals NHS University Foundation Trust, Mr Pearce (Environment Agency), Councillor Bano Dover District Council (on Behalf of Mr Prosser MP), Mr Ingleton (Head of Regeneration)  Dover District Council were present for this item.)

(1)       The Chairman explained that this item was being considered by the Committee as the NHS were reconsidering the site of the proposed healthcare facility due to a flooding objection raised by the Environment Agency.  He emphasised that the HOSC’s role was to consider the heatlh issues relating to the proposed new facility and could not get involved in the merits of planning issues.  He then invited Ms Harrison to set the context for the discussion.  She gave a brief background to the decision to proceed with a healthcare facility on a town centre site, which had been supported by this Committee in 2008.  Although the PCT were aware of the flood issue with the mid town site they had assumed that works could be carried out to alleviate the risk.  However, despite remedial works the were in the position of having to prove that it was the most suitable site and due to the flooding objection, they were having to consider other options.

(2)       Ms Harrison reaffirmed that the PCT’s priority was to get better healthcare for the people of Dover as soon as possible and because of time constraints they do not have time to carry out the full range of mitigation measures to make the mid town site safe.  As a PCT they did not provide direct investment in to the building but paid for the services provided and therefore needed to take account of affordability and durability.  The PCT Board had decided at its meeting in November to support whichever option was affordable and durable.  She referred to the time pressures to deliver this facility; the money that had been allocated would only be available for a short period and after that there was a danger that it would be lost to other health service projects.

(3)       Ms Shutler, on behalf East Kent Hospitals NHS University Foundation Trust who were responsible for the capital funding, explained that there was a pressure to get work started in Dover.  The original plan was for work to start on the mid town site in November 2009, and so there was already a significant delay.  This funding was not ring fenced and in order that it was not re-allocated to other schemes such as the enhancement of other hospital sites, it would be necessary for a decision to be made on the site at either the November or January meeting of the Board of Directors, so that the funding could be allocated within the next 2 years.

(4)       Mr Ingleton, Head of Regeneration for Dover District Council, stated that the  ...  view the full minutes text for item 18.

(1)       The Committee received a briefing paper which set out the background to Quality Accounts which were being introduced as part of the Health Bill currently going through Parliament.  The Department of Health were currently inviting responses to a consultation document about the proposed framework for Quality Accounts. One of the consultation questions asks whether Overview and Scrutiny Committees should be given the opportunity to comment on a provider’s Quality Account.  It was noted that the Executive would be responding to the consultation on behalf of KCC.  When Quality Accounts were introduced it was suggested that they would only be brought before the Committee if any appropriate issues arose that needed the Committees consideration.

(2)       RESOLVED that a response to the consultation from the Committee be delegated to the Overview, Scrutiny and Localism Manager in consultation with the Chairman, Vice-Chairman and spokesmen.

(1)       The Committee considered the draft work programme for November 2009 to July 2010.  

(2)       RESOLVED that the draft work programme for the Health Overview and Scrutiny Committee for November 2009 – July 2010 be approved subject to the following additions:-

-          5 February 2010 – Dover healthcare

-          23 July 2010 – Accessing Mental Health Services – add LINks as a witness.

-          September 2010 – visit Pembury Hospital

-          Future meeting – delay in diagnostic reporting from East Kent PCT.