Agenda and minutes

To note that the Borough and District Councils have now agreed to their four voting members on the Committee.  The Members are as follows:-

• Councillor John Burden, Gravesham Borough Council

• Councillor Richard Davison, Sevenoaks District Council

• Councillor Geoffrey Lymer, Dover District Council

• Councillor Michael Lyons, Shepway District Council

RESOLVED that the Minutes of the Meeting of 10 June 2011 are recorded and that they be signed by the Chairman.

Mark Devlin (Chief Executive, Medway NHS Foundation Trust) and Gerard Sammon (Deputy Chief Executive, Dartford and Gravesham NHS Trust) will be in attendance for this item.

Mark Devlin (Chief Executive, Medway NHS Foundation Trust) and Gerard Sammon (Deputy Chief Executive, Dartford and Gravesham NHS Trust) were in attendance for this item.

Adrian Crowther declared a personal interest in this item as a Governor of Medway NHS Foundation Trust.

(1)       Mr Devlin began by providing an overview and explained that the process was still in its early stages and that they were endeavouring to make it a transparent and open one. The driving force behind all the work was that both Trusts desired to provide first class services. As for the background to the rationale for bringing the two Trusts together, it was explained that both were mid-sized district general hospitals with Darent Valley being the smaller of the two and serving a population of 300,000 and Medway serving a population of 350,000. As a critical mass of population is necessary before certain services can be provided, serving a population of 650,000 will mean more services can be offered, including new ones which currently are not. The Royal College of Surgeons recommended population coverage of at least 500,000 for safe surgery and together the two Trusts achieved this. The population size meant that there would continue to be the full range of services such as maternity and accident and emergency on both sites.

(2)       Economies of scale in back office functions will mean savings realised to invest into services. The Trusts are currently in the feasibility testing stage and the Boards of both Trusts would decide at their meetings in September as to whether to proceed. It was stressed that the option could well mean acquisition of one Trust by the other, rather than merger, and that the processes were different with acquisition being in some regards the more straightforward option. The point was also made that the history of mergers in the NHS was mixed. The merger in South East London had taken place three years before but the combined Trust still had problems, whereas in East Kent the Trust was working well but it had taken time. There was also a national policy drive encouraging all NHS Trusts to achieve Foundation Trust status by 2014.

(3)       One Member questioned whether the merger of the two Trusts would be sufficient to realise the gains intended. Residents of Swale often accessed services at Medway or Maidstone and an argument could be made that these two hospitals would make a better merger. Another Member questioned the value of the merger to residents of Sheppey. In reply to these points, it was acknowledged that Medway was closer to Maidstone than Darent Valley but that the centre of gravity for Maidstone and Tunbridge Wells NHS Trust was further away due to the opening of the new hospital at Pembury. In addition, the populations that looked to Darent Valley and Medway shared more similarities in terms of health need. On the issue of Sheppey, the counter argument was given that services would be made available closer to home which would previously  ...  view the full minutes text for item 4.

Hazel Carpenter (Director of Commissioning Development and Workforce, NHS Kent and Medway), Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), and Dr. Sarah Montgomery (GP Clinical Commissioner) will be in attendance for this item.

Hazel Carpenter (Director of Commissioning Development and Workforce, NHS Kent and Medway), Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), Dr. Sarah Montgomery (GP Clinical Commissioner) and Sara Warner (Assistant Director Citizen Engagement, NHS Eastern and Coastal Kent) were in attendance for this item.

Michael Lyons declared a personal interest in this item as a Governor of East Kent Hospitals University NHS Foundation Trust.

(1)       The Chairman introduced the item by welcoming his guests and explaining to the Committee that the next meeting of the East Kent Maternity Review Board was going to be that afternoon and Members had the opportunity to make comments which would be fed back to the meeting through the NHS representatives attending for this item. NHS colleagues would return and present an update at the 9 September meeting, and in the interim the Chairman had approached a small number of Members who may be willing to form an informal HOSC Liaison Group to be involved in discussions over the summer and feed back to the Committee as well at the 9 September meeting. Several Members expressed an interest during the meeting.

(2)       Hazel Carpenter began by explaining that the Review Board included representatives from the emerging Clinical Commissioning Groups (CCGs) in East Kent. Of the 6 CCGs, 5 had patient flows into East Kent Hospitals NHS University Foundation Trust (EKHUFT). The detail required in the evidence was recognised. Representatives of the NHS welcomed the opportunity to return on 9 September with options and a consultation plan and looked forward to engaging with a smaller group of Members over the summer.

(3)       As a representative of one of the CCGs, Dr Montgomery explained that GPs are deeply concerned with this issue and were very close to the families affected. She explained that feedback from the 4 GPs on the Board was fed back to all Chairs of the CCGs and any options regarding future services would need to be based on robust evidence and the services needed to be safe and sustainable. The distance between hospitals was being considered by the panel but it needed to be made clear that standalone midwifery led units were not appropriate for all women and the admissions criteria was the same as for home birth and it was often the case that it was women from the more deprived areas which needed to travel to consultant led services more than others. These consultant led services were still available at Ashford and Margate.

(4)       In response to a range of questions Dr Neil began by explaining that all birth units in East Kent were safe and provided excellent care. The standalone midwifery units in Dover and Canterbury provided quality 1 to 1 care and this level of care in labour was the ideal. However, there was a cost related to the time for midwives to care. At Dover and Canterbury, there was a ratio of around 11 births for each  ...  view the full minutes text for item 5.

Judy Clabby (Assistant Chief Executive, NHS Kent and Medway) will be in attendance for this item.

Judy Clabby (Assistant Chief Executive, NHS Kent and Medway) was in attendance for this item.

(1)       The Chairman introduced the item and explained that the current full draft version of the Legacy Document ran to 89 pages and that it was an interesting document and Members were invited to suggest ways that the document could be improved.

(2)       One Member commented that a number of items were strategic documents which would be rewritten when new commissioning arrangements were brought in and that of more importance were the minutiae of daily business. Another Member suggested details of which Arms Length Bodies were still operating, or the ones which had been created, should be included. It was also felt important that arrangements be made to preserve the archives of the Primary Care Trusts so that records of key decisions could be located easily in the future.

(3)       Judy Clabby explained that the production of the Legacy Document was a requirement of the National Quality Board and it would go down to the level of detail suggested. It was also being used as a central collation point for the three Primary Care Trusts across Kent and Medway. As the handover to the Clinical Commissioning Groups approached, it would include the hot and topical information required. The current version was a draft and it would be continually refreshed until this time. On the issue of Arms Length Bodies, these were unlikely to be included if they were national organisations rather than local.

(4)       Members were invited to submit any further suggestions to Judy Clabby through the Research Officer to the Committee.

(5)       AGREED that the Committee note the report.

(1)       The Chairman indicated the written update on the NHS Transition produced by the Research Officer to the Committee and reminded Members that there would be an opportunity at the 9 September meeting to examine this topic further.

(2)       AGREED that the Committee note the attached report.

(1)       The Chairman introduced the item and explained that the work undertaken by the Committee in looking at financial sustainability across the whole spectrum of the NHS had been a very useful exercise. The report highlighted a number of the dichotomies facing the NHS, such as the dilemma between localism and what is often referred to as the postcode lottery. The Research Officer to the Committee was thanked for his assistance in producing the draft report.

(2)       A Member expressed the view that a combination of the financial sustainability report and written update from previous item would, read together, answer a lot of questions as the Committee continued its work after the summer.

(3)       One Member commented that the individual character of Kent compared to other areas of the country be highlighted. Kent was in part peninsular and had a number of separate population centres to which people looked for core services. This made delivering financial sustainability across the Kent health economy uniquely challenging.

(4)       The Committee agreed that this point should be included in the final version.

(5)       AGREED that the Committee approve the report.