Agenda and minutes

RESOLVED that the Minutes of the Meeting of 19 April 2011 are recorded and that they be signed by the Chairman.

Dr Robert Stewart (Medical Director, Kent and Medway Cluster and Chair of the Kent and Medway Trauma and Critical Care Network), Dr Patricia Davies (Locality Director, Dartford, Gravesham and Swanley GPCC and Lead Director for the Kent and Medway Trauma and Critical Care Network), Helen Belcher (Project Manager, East Kent Hospitals University NHS Foundation Trust), Dr Marie Beckett (Deputy Medical Director and Emergency Care Consultant, East Kent Hospitals University NHS Foundation Trust), Karen Barkway  (Performance and Governance Manager, NHS West Kent) were in attendance for this item.

(1)       The Chairman introduced the item and explained that there were a number of options the Committee could take following the developments of the trauma network in Kent and Medway. As the network did cover two local authority areas, Kent and Medway, the two Committees exercising the health scrutiny function may need to form a Joint HOSC to consider the item if both considered it a substantial variation of service.

(2)       Dr Stewart provided an overview of the proposals and the reasons underlying them. There was a need to develop trauma services in Kent and Medway because while there were no Major Trauma Centres in the area, not all patients could be taken to either London (mainly King’s) or Brighton within the recommended 45 minutes. A Major Trauma Centre required cardiothoracic, neuroscience and other specialities to hand to provide a full service as well as a certain throughput of patients in order to maintain skill levels. These factors precluded one being established in Kent and Medway, but the development of improved services as well as repatriation for rehabilitative care was possible. The Air Ambulance, although useful, could not be the complete solution as there were too many restrictions on when they could be used. Closer links were being developed with the South East London Trauma Network.

(3)       When responding to a major trauma incident, the paramedics assessed the situation and there were three options – taking the patient straight to a Major Trauma Centre, stabilising the patient before transfer, or treating the patient locally. The Kent and Medway Clinical Care and Trauma Network’s proposal was to develop three Major Trauma Units across Kent and Medway where additional expertise from consultants would be available and rehabilitation would be coordinated. These Major Trauma units would be linked to Major Trauma Centres which would assist with training and recruitment. The South East Coast Strategic Health Authority and London Trauma Board were supporting the proposals. The proposed sites for the Major Trauma Units were:

§         Pembury Hospital,

§         William Harvey Hospital, and

§         Medway Hospital

(4)       A range of questions were asked by Members over different aspects of the proposals. On the number of patients involved it was clarified that in Kent and Medway each year ½ million patients are seen in Accident and Emergency Departments each year; of these the 200 most severe, major trauma cases, go to King’s. The Network stressed the proposals were improvements to existing services and not the downgrading  ...  view the full minutes text for item 3.

Philip Greenhill (Interim Deputy Chief Executive, Kent Community Health NHS Trust), Chris Wright (Interim Director of Finance, Kent Community Health NHS Trust), Oena Windibank (Interim Director of Operations – East, Kent Community Health NHS Trust), Marie Dodd (Acting Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), James Sinclair (Director of Partnerships and Social Care, Kent and Medway NHS and Social Care Partnership Trust ), Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Robert Bell (Acting Director of Finance, South East Coast Ambulance Service NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman introduced the item and explained that this was the third and final meeting in a series examining NHS Financial Sustainability and that the Trusts present would be invited to provide an overview from their perspective.

(2)       Philip Greenhill from the Kent Community Health NHS Trust began with the information that the Trust employed 5,700 staff and had a budget of around £200 million. They needed to find £14 million in efficiency savings. Most of the income for the Trust came from block contracts but the value of these had been reduced by 1.5% which equated to a £2.6 million cost pressure. There were also cost pressures because of pay uplifts and high cost drugs. Part of the solution was in back office savings but the biggest was in workforce productivity and this was being examined as the Trust was carrying out the largest community services staff study in England. Nationally, district nurses spend 22% of their time with patients; Kent has managed to increase this to 45-46%. Another area is improving community hospital throughput. The biggest cost pressure was identified as demand in the acute sector as the tariff increases the cost with activity. Both community services and social services have a role to play in reducing demand, as does the new 111 number which will assist in getting the entry point for patients correct.

(3)       Responding to a particular question about the hospital at home scheme run in Medway, it was explained that this did not involve a double-payment as the service was provided by Medway NHS Foundation Trust and paid for out of the tariff paid to the hospital before the patient is discharged to the care of his or her GP.

(4)       It was further explained that the £14 million which the Community Health Trust needed to find was 8% of the revenue budget. This provided part of the context within which the Trust was embarking on the journey to Foundation Trust status because attaining FT status meant there was more freedom to focus on the right financial strategies.

(5)       On the subject of the Minor Injuries Unit at Sheerness it was explained that this was only a temporary closure on safety grounds and that it was back open 9am to 9pm Monday to Friday and would be open at the weekend  ...  view the full minutes text for item 4.

(1)       The Chairman indicated that a written update from NHS Eastern and Coastal Kent on the East Kent Maternity Services Review had been provided for Members (see Appendix). This item would also be on the Agenda for the 22 July meeting.

(2)       The Chairman also undertook to have a written update on the NHS Transition for the 22 July meeting. This would be followed up be a fuller discussion at the 9 September meeting, though the comments from some Members that the full picture may still not be known was acknowledged. As part of this it was felt that a fuller understanding of the role of locality boards and the Health and Wellbeing Boards would be useful.

(3)       The Chairman also undertook to explore when mental health could be considered, perhaps incorporating a review of the responses received from the NHS to reports produced in 2010 by both the Kent LINk and the Maidstone and Tunbridge Wells Borough Councils Joint Mental Health Services Working Group. Similarly, the feasibility of considering neurology services would be considered.

(4)       APPROVED the Forward Work Programme.