Agenda and minutes

RESOLVED that the Minutes of the meetings held on 3 September and 20 September 2010 are recorded and that they be signed by the Chairman.

Break 11:20 – 11:30

Dr Jon Norman (Lead Clinician Chronic Pain, Maidstone and Tunbridge Wells NHS Trust), Ashley Scarff (Head of Business and Corporate Planning, Maidstone and Tunbridge Wells NHS Trust), Patricia Davies (Director of Service Improvement, NHS West Kent), Zoe McMahon (Commissioning Pathways Improvement Manager, NHS West Kent), Alison Davis (Assistant Director of Commissioning, NHS Eastern and Coastal Kent), Jo Staddon (Lead Commissioner for Musculoskeletal Services and Adult Therapies, NHS Eastern and Coastal Kent), Val Conway (Clinical Lead-Consultant Nurse Community Chronic Pain Service, NHS Eastern and Coastal Kent), Hilary Birrell (Community Chronic Pain and Orthopaedic Service Manager, NHS Eastern and Coastal Kent), Sheila Pitt (Head of Cancer, Long Term Conditions and Therapies, NHS Eastern and Coastal Kent), Dr Claire Butler (Medical Director, Pilgrims Hospice), Dr Bruce Pollington (Medical Director, Heart of Kent Hospice), and John Ashelford were present for this item.

(1)       Representatives from NHS West Kent presented an overview of the situation for patients in their health economy and explained that large number of patients did require pain management services and these did need to be developed locally.  Specialist services were accessed at Guy’s Hospital and elsewhere, but there were concerns that now a service based in Medway had been withdrawn, this would be too far for some patients to travel.  Community Hospitals were being utilised, and they were looking at developing a more specialised service at Maidstone Hospital.

(2)       An overview from representatives of NHS Eastern and Coastal Kent followed.  A review had been carried out in 2005 as it was recognised that pain management services were not delivering and this was followed by a redesign across the eastern half of the county.  The system in place involved those with complex pain being referred to the acute sector for interventions and to community services for non-complex interventions.

(3)       One Member observed that services in the east of the county appeared to be better than in the west and specifically asked about the pain clinic which had been withdrawn from Maidstone Hospital five years ago.  Dr Norman was able to provide the broader context as he had moved to Maidstone and Tunbridge Wells NHS Trust (MTW) after the closure of this service.  The previous service had been a single-handed service and was unsustainable, but more staff were hired and the service rebuilt.  The 18 week waiting time target was now being reached and in January 2009 the MTW board had agreed to set up a hub and spoke model and Sevenoaks had just opened as the first spoke.  A clinic at Maidstone Hospital would not be possible until July 2011 following the move of some services to the new Pembury Hospital to make facilities available at Maidstone.  There was no guarantee of funding and there was a possibility of a different provider appearing.  Separately, a cancer pain service had been established at Maidstone in 2005 and this was performing well.

(4)       A number of Members had personal experience of pain and pain services and this lead to a  ...  view the full minutes text for item 5.

Geraint Davies (Director of Business Development, South East Coast Ambulance Service NHS Trust), Geoff Catling (Director of Technical Services and Logistics, South East Coast Ambulance Service NHS Trust), and Darren Reynolds (Head of Business Development South East Coast Ambulance Service NHS Trust) were present for this item.

(1)       Prior to the meeting, Members of the Committee had had the opportunity to visit the Thanet Make Ready Depot and the Coxheath Emergency Dispatch Centre.  All Members who were able to attend found the visits highly informative and the Chairman thanked the South East Coast Ambulance Service (SECAmb) on their behalf for arranging these valuable opportunities.

(2)       The offer was made to provide further opportunities for Members to spend time at Coxheath at a future date.

(3)       Although some reservations had been expressed at the previous meeting on this subject, Members expressed the view that the logic behind the move to Make Ready Depots was inescapable and that it was a better use of resources and staff if paramedics were not expected to clean and stock their ambulances.  Community response posts to enable ambulances to be located where they are most needed are usually easy to find, though one was still being sought on the Isle of Sheppey.  Locations for Make Ready Depots were not as easy to locate.

(4)       The depots were appropriate for the way the modern ambulance service had changed over the years to where it now offered a mobile health service and often avoided the need for taking patients to an Accident and Emergency Department.

(5)       Make Ready Depots also allowed for an improvement in infection control measures, although rates had never been too bad in the service, as ambulances would be able to be deep cleaned every six weeks.  In between calls, universal precautions such as hand washing and wiping down the ambulance were used unless they were notified of a reportable disease that required further measures.

(6)       The nature of paramedic training was also developing with paramedic practitioners able to deal with a wider range of situations at the scene and critical care paramedics who were able to stabilise patients for transfer to a specialist centre, such as the primary angioplasty service at William Harvey Hospital.  In coming years there will also be an increasing range of technology available for use on ambulances such as portable x-ray machines, but improvements need to be made such as in this instance becoming smaller and chargeable.

(7)       The Emergency Dispatch Centre in Coxheath had a new Computer Aided Dispatch System installed earlier this year.  Sussex already had the same system and it had been installed in Surrey three days prior to the meeting.  This meant that the whole region was covered by the same system and the different dispatch centres could communicate efficiently to each other.  The system meant that 80% of the time, it could be predicted where ambulances needed to be deployed.

(8)       The gaps and inefficiencies in the organisation were often in rural  ...  view the full minutes text for item 6.

(1)       Members thanked the Chairman for the letter which had been sent to the Secretary of State for Health on behalf of the Committee and which was included in the Agenda pack.

(2)       However, Members were not content with the refusal of the South East Coast Strategic Health Authority to promise to send a copy of their report to the Secretary of State for Health on the grounds that it would be for the Secretary of State to decide who should see the report.

(3)       The Committee requested that the Chairman write to the Strategic Health Authority and request once more a copy of the report.

Members agreed the Forward Work Programme.

(1)       On the issue of Pain Management Services, several Members felt that the issue of what happens after patients from Kent had been discharged from tertiary centres in London in terms of communicating with parts of the local NHS.  Another Member requested the opportunity to visit the chronic pain services in East Kent and Officers undertook to explore this possibility.

(2)       Following the discussion with SECAmb, the place of Patient Transport Services in the future with GP Commissioning was raised as one area of note to investigate.

(3)       This lead to a range of concerns being raised about service provision in the medium term with the demise of Primary Care Trusts (PCTs) and that there was a need for a mapping of the services being provided as PCTs were abolished.  One Member felt that the Cabinet Member for Public Health would be able to provide a useful overview of the changes that are occurring.

(4)       More broadly, the Chairman made the observation that the Committee had a range of statutory powers and would continue to do so for a number of years.  These powers came with commensurate responsibilities and the Committee was well positioned to help the transition process and maintain an oversight of service standards in the NHS.