Agenda and minutes

Godfrey Horne MBE, In Memoriam.

Members, officers and guests stood in silence as a mark of respect for Godfrey Horne MBE, the late Chairman of the Health Overview and Scrutiny Committee, who had passed away suddenly on 13 November 2011.

RESOLVED that the Minutes of the Meeting held on 8 October 2010 are recorded and that they be signed by the Chairman.

Corrine Stewart (Senior Service Improvement Project Manager, Kent Cardiovascular Network) and Clare Boggia (Cardiology Matron, East Kent Hospitals University NHS Foundation Trust) were present for this item.

(1)       The Kent Cardiovascular Network led on the work to establish a coordinated pathway of care around a 24/7 emergency primary angioplasty service being established for Kent and Medway at William Harvey Hospital, Ashford.  Corrine Stewart and Clare Boggia were able to provide an overview of the first six months of the system in operation. A formal 6-month review was being undertaken, and this would be shared with the Committee once it had been completed.

(2)       Ambulances attending cases of suspected heart attacks were able to carry out electrocardiograms (ECGs) and transmit the results to William Harvey Hospital, where nurses were able to interpret the results to decide whether primary angioplasty was appropriate. Of 2255 ECGs transmitted, 476 patients were taken by ambulance direct to William Harvey Hospital, which equates to around 15 each week. Around 75% of those admitted received primary angioplasty. Some received thrombolysis for clinical reasons or because of patient choice. 5% are transferred to London for “cabbage” (coronary artery bypass graft surgery, or CABG). William Harvey Hospital works on an 8 am to 6 pm day and 60% of patients are admitted during these hours. The length of stay has been reduced to an average of 3.79 days, and the target is 3.5 days. Some patients are repatriated to hospitals closer to home where possible. In terms of geographical spread, 44% patients were from the NHS Eastern and Coastal Kent area, 34% from NHS West Kent and 22% from NHS Medway.

(3)       It was stressed that the primary angioplasty service at William Harvey was an emergency service only. The service was only appropriate for patients suffering from a type of heart attack called ST-elevated myocardial infarction (STEMI). This means that not every patient experiencing a heart attack would be sent to William Harvey or receives angioplasty.

(4)       The target is for 75% of patients to experience a call-to-balloon time of 150 minutes and this means the time from when medical help was called for to the time the angioplasty balloon is first inflated. Performance has been improving against this target since the service began and is now achieving the 75% target. The service was designed around a maximum travelling time of 75 minutes, but in practice the maximum time was 60 minutes from the furthest points in Kent. In response to a specific question from a Member, the time from Edenbridge was given as 50 minutes. As services in neighbouring areas like Surrey achieve the required standard, it may be that in the future the best option for patients in some areas of Kent would be to go to a different centre outside the county.

(5)       In terms of local factors which may affect travelling time, such as Operation Stack, it was explained that there was a memorandum of understanding with the police  ...  view the full minutes text for item 3.

LaurettaKavanagh (Director of Commissioning for Mental Health and Substance Misuse, Kent and Medway PCTs), Paul Absolon (Social Care Commissioner for Mental Health, Kent County Council), Erville Millar (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust),Marie Dodd (Executive Director of Operations, Kent and Medway NHS and Social Care Partnership Trust), John Hughes (Director Community Recovery Services, Kent and Medway NHS and Social Care Partnership Trust), Mark Fittock (LINk Governor), Cate Boland (LINk Development Worker),Di Tyas (Deputy Clerk, Local Medical Committee), and Dr James Kelly (Local Medical Committee) were present for this item.

(1)       This section of the meeting built on the meeting in June (Minute 3, 11 June 2010) when hospital based mental health services were considered. As then, Lauretta Kavanagh, as lead commissioner for mental health for Kent and Medway Primary Care Trusts, provided an introductory overview. She indicated the summaries of the Live it Well mental health and wellbeing strategy which had been provided for Members at the start of the meeting in addition to the information contained within their Agenda. This strategy had the support of the three PCTs in Kent and Medway along with Medway Council and Kent County Council.

(2)       She explained that the strategy took a twin-track approach, that of promoting mental health and improving access and outcomes. There were three areas where large scale transformation was envisaged. The first was to increase the confidence and ability of primary care professionals in dealing with mental health. The second was to redesign community services so there was less reliance on hospital based services; the vital role played secondary care was acknowledged, but this redesign was aimed at enabling secondary settings to deal with the more severe cases more effectively. Thirdly there was a need to develop currencies and tariffs in mental health to shift from the current block contract to payment by results.

(3)       As Chief Executive of Kent and Medway NHS and Social Care Partnership Trust (KMPT), the largest provider of mental health services in the county, Erville Millar provided an overview of the range of community health services available. He explained that increasingly self-referral to services will be seen as important as GP referrals. The Increasing Access to Psychological Therapies programme (IAPT) was increasingly important. Among the other services available, there was also the Early Intervention in Psychosis Service that was aimed at the 14-35 age group, the First Response Intervention Service (FRIS) as the first line of assessment and the 24/7 crisis services which looked to prevent admission to accident and emergency departments wherever possible.

(4)       Mark Fittock, a LINK Governor, introduced a draft version of a LINk report into mental health services and which Members had before them. Mental health problems affected 1 in 4 of the population and LINks had difficulty getting to grips with the subject and the service available. He explained that LINks felt that although KMPT had there own user group, there needed to be better public/service user engagement  ...  view the full minutes text for item 4.

Di Tyas (Deputy Clerk, Local Medical Committee), and Dr James Kelly (Local Medical Committee) were present for this item.

Members had before them written information providing an update on the subject of the future of NHS community service providers following on from the meeting of 3 September when this topic was last considered and prior to the meeting of 4 February 2011 when this topic will be revisited.

There was a broader discussion of the context within which these changes were taking place, in particular the move to GP commissioning and the possible distraction from service delivery it would involve. Members felt there was a lot of confusion around key areas such as the transfer of estates and the cost of the changes.

Dr Kelly conceded there were risks in the move to GP commissioning and mentioned the ‘clean slate’ campaign of the British Medical Association. Community services were given as one of the biggest frustrations felt by GPs and that GPs felt that under the current system is was often the most vulnerable, such as children, the elderly, and those with mental health needs, who suffered most.  

(1)       Members expressed regret that the response of the Strategic Health Authority did not result in the Committee receiving a copy of the report submitted to the Secretary of State for Health. Members then discussed a range of possible follow up actions.

(2)       Mr. Cooke moved, Mr. Ferrin seconded, that a Freedom of Information Act request be made to the Secretary of State to ask him to release to the Committee a copy of the report he had commissioned to be prepared by the South East Coast Strategic Health Authority on the reconfiguration of Women’s and Children’s Services within the Maidstone and Tunbridge Wells NHS Trust.

Carried by 9 votes to 1.

(3)       RESOLVED that a Freedom of Information Act request be made to the Secretary of State to ask him to release to the Committee a copy of the report he had commissioned to be prepared by the South East Coast Strategic Health Authority on the reconfiguration of Women’s and Children’s Services within the Maidstone and Tunbridge Wells NHS Trust.

(1)       Members discussed the item on primary angioplasty and felt that the concerns raised during the discussion had been dealt with in a most satisfactory manner.

(2)       On returning to the request that the Committee consider CAMHS as a matter of urgency, a range of views were expressed including whether the topic could best be approached by breaking it apart into different aspects and whether it would be more useful to wait six months given the recent publication of the Ofsted report into safeguarding children. Due to its cross-cutting nature, Paul Wickenden, the Overview Scrutiny and Localism Manager, undertook to bring the matter to the attention of the Scrutiny Board to discuss what would be the most appropriate forum for the subject.