Agenda and minutes

RESOLVED that the Minutes of the Meeting held on 26 November 2010 are recorded and that they be signed by the Chairman.

Elaine Biddle (Compliance Manager, Care Quality Commission), Maureen Hall (Dental Contract Manager, NHS West Kent), Dr Tim Hogan (Chairman, Kent Local Dental Committee), Stephen Ingram (Director of Primary Care, NHS West Kent), Bill Millar (Head of Primary, Community and Elective Care Commissioning Directorate, NHS Eastern and Coastal Kent), Allan Pau (Specialist Registrar in Public Dental Health), and Paula Smith (Lead Commissioner for Max Fax, Orthodontics and Dental, NHS Eastern and Coastal Kent) were present for this item.

(1)       As a representative of the Local Dental Committee (LDC), an organisation with the stated aim of representing the interests of the dental profession and patients, Dr Tim Hogan outlined some of the challenges inherent to the current dental system. He believed that the present system pleased no one and that what was needed was one that concentrated on oral health prevention and administering the appropriate treatments while paying dentists appropriately without any perverse incentives.

(2)       Two main issues were identified concerning finance and the current system. Firstly there was the system of three bands which determined the cost to NHS patients who were not exempt from charges. Mr Ingram reported that charges typically only covered two-thirds the cost of actually delivering the treatment and dentists were paid by the Primary Care Trust (PCT) for delivering Units of Dental Activity (UDAs). Dentists received a certain amount of money for each UDA and the income of the dentist was the difference between the dental charge and the money received for the number of UDAs involved. This was complicated by the value of a UDA being different for different dentists.  Dr Hogan gave the view of the LDC as being that this system achieved the opposite outcome of that intended.

(3)       The second issue was that PCT allocations for dentistry were set on historical spending in 2006. Mr Ingram reported that if NHS West Kent received the average allocation, the money available to spend on dentistry would increase by 21%, or around £5 million.

(4)       Representatives of the NHS outlined how the Department of Health was currently piloting different models for a future NHS dentist contract and how dental commissioning would be carried out by the proposed NHS Commissioning Board. This led to a discussion on the merits of capitation forming part of any new system, with the idea of a pure capitation contract where dentists are paid based on the number of patients registered with them, not finding favour amongst Members of the Committee. Dr Hogan made the observation that some private insurance schemes were akin to capitation through having a monthly fee.

(5)       This led to a discussion on private dentistry and how it was unknown how much treatment was provided privately as these figures were not collected so the true levels of dental access were unknown. It was also difficult to determine whether there was a shortage of dentists or a shortage of dentists willing to provide NHS services under the current system. Dr Pau was able to report a  ...  view the full minutes text for item 3.

(1)       Members were informed that alternative dates for the meeting with Roger Gough were being explored and would be conveyed to Members in due course.

(2)       RESOLVED that the Forward Work Programme be approved.

(1)       Members had before them correspondence from the Secretary of State for Health, NHS South East Coast and NHS West Kent concerning the recent decision concerning changes to women’s and children’s services at Maidstone and Tunbridge Wells NHS Trust.

(2)       They also had in front of them, the NHS South East Coast report on changes to women’s and children’s services at Maidstone and Tunbridge Wells NHS Trust.

(3)       A range of different opinions were expressed about different features of the report by NHS South East Coast, particularly around the opinions of GPs in the Maidstone area.

(4)       A number of Members felt that the recently announced review of maternity services in east Kent meant that the whole issue of maternity services across Kent needed to be reviewed.

(5)       Mrs. Whittle moved, Mr Cooke seconded:

1. That the Vice-Chairman of the Health Overview and Scrutiny Committee (HOSC) writes to the Secretary of State for Health, expressing profound disappointment with his decision to downgrade maternity and paediatric services at Maidstone that overrides the near-unanimous views of HOSC on 19 February 2010 and the local GPs opposing the reconfiguration plans.

2. That the Vice-Chairman of HOSC also requests that the Secretary of State for Health defers his decision until Maidstone GPs as future commissioners of local clinical services, are able to determine the future scope of maternity provision in the County Town.     

3. That KCC monitors the impact of the reconfiguration on the number of admissions to the consultant-led maternity units at Medway and Ashford Hospitals. 

4. In view of reported shortages of midwives and the temporary closure of the birthing units in East Kent over the Christmas and New Year period, that HOSC requests an urgent review of all birthing units and consultant-led maternity services in Kent.

Carried by 8 votes to1.

(6)       RESOLVED:

1. That the Vice-Chairman of the Health Overview and Scrutiny Committee (HOSC) writes to the Secretary of State for Health, expressing profound disappointment with his decision to downgrade maternity and paediatric services at Maidstone that overrides the near-unanimous views of HOSC on 19 February 2010 and the local GPs opposing the reconfiguration plans.

2. That the Vice-Chairman of HOSC also requests that the Secretary of State for Health defers his decision until Maidstone GPs as future commissioners of local clinical services, are able to determine the future scope of maternity provision in the County Town.     

3. That KCC monitors the impact of the reconfiguration on the number of admissions to the consultant-led maternity units at Medway and Ashford Hospitals. 

4. In view of reported shortages of midwives and the temporary closure of the birthing units in East Kent over the Christmas and New Year period, that HOSC requests an urgent review of all birthing units and consultant-led maternity services in Kent.

Dentistry

(1)       Members felt they had a good in depth exploration of many of the key issues around dentistry but as the Department of Health was in the process of piloting new dental contract models, it would be appropriate to revisit the subject once the results of these were known so that Members were better placed to evaluate the options for the future and make recommendations. More broadly, they would welcome further information about the Care Quality Commission and the work it does.

Women’s and Children’s Services at Maidstone and Tunbridge Wells NHS Trust

(2)       Some Members expressed reservations about the length of notice given about the wording of the motion and the amount of time allowed for the debate. Given recent events in east Kent, a number of Members hoped there would be the opportunity to find out more about changes to maternity services across the County and how they may affect each other.