Agenda and minutes

(1)       It was noted that the sentence in paragraph 3 on page 2 of the Minutes should read, “…Medway was closer to Maidstone than Darent Valley…”.

(2)       RESOLVED that, subject to this amendment, the Minutes of the Meeting of 22 July 2011 are recorded and that they be signed by the Chairman.

Roger Gough (Cabinet Member for Business Strategy, Performance and Health Reform, Kent County Council), Meradin Peachey (Kent Director of Public Health), Hazel Carpenter (Director of Commissioning Development and Transition, NHS Kent and Medway), Tish Gailey (Health Policy Manager, Kent County Council), Lorraine Denoris (Director of Citizen Engagement and Communications, NHS Eastern and Coastal Kent), Dr Mike Parks (Medical Secretary, Kent Local Medical Committee), and Di Tyas (Deputy Clerk, Kent Local Medical Committee) were in attendance for this item.

(1)       The Chairman introduced the item and explained that although the complete picture around the changes to the health sector was incomplete, it was important to take this opportunity to take stock and gain a better understanding of the ongoing changes. A large part of this was to understand the new language which was developing as time went on with GP Commissioning Consortia (GPCC) now being referred to as Clinical Commissioning Groups (CCG). A number of Members mentioned the plethora of acronyms which needed to be understood. It was observed that the Background Note which formed part of the Agenda was a useful and accessible summary of the changes and the new terms.

(2)       The Cabinet Member for Business Strategy, Performance and Health Reform at Kent County Council then provided an overview of the work which had been going on relating to the NHS Transition within Kent. The main element he wished to stress was the growing and positive relationship with the GP community as a whole and the emerging CCGs in particular. This was demonstrated by the fact that all CCGs wish to be represented on the Health and Wellbeing Board, which had been strengthened as a result of the ‘pause’ earlier this year, rather than delegate their role. County Council had approved the establishment of the Health and Wellbeing Board (HWB) in July and the first formal meeting would take place on 28 September. Precursor meetings earlier this year had looked at the Joint Strategic Needs Assessment (JSNA) which would in the future be produced by the HWB. As a general rule, awareness of it amongst GPs had not been high, but this was being looked at and the JSNA work would also feed into the production by the HWB of the Joint Health and Wellbeing Strategy. It was anticipated that not all work would be carried out at the County HWB level. Dover had also been awarded early implementer HWB status and there was good work being carried out there as well as by locality boards across the County. One ongoing issue was that CCGs tended not to be coterminous with Borough boundaries, with at least one crossing 4 of them. Moving on, he expressed the view that there was a natural and good division of labour between HOSC and the HWB. The Health Overview and Scrutiny Committee (HOSC) would be able to provide necessary challenge to the HWB on key areas  ...  view the full minutes text for item 3.

Nicola Brooks (Head of Medical Services, South East Coast Ambulance Service NHS Foundation Trust), Matthew England (Clinical Quality Manager, South East Coast Ambulance Service NHS Foundation Trust), Dr Marie Beckett (A&E Consultant, East Kent Hospitals NHS University Foundation Trust),Dr Patricia Davies (Dartford, Gravesham and Swanley Clinical Commissioning Group) andHelen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway) were in attendance for this item.

(1)       The Chairman welcomed the Members of Medway Council’s Health and Adult Social Care Committee who were present as guests of the Committee. Both Committees had previously examined the proposals but the Kent HOSC wished to follow up on a number of key issues.

(2)       There was a broad consensus around some of the main reasons why the trauma network in Kent and Medway needed developing. Nationally there was variation between the survival rates for trauma between hospitals and there was often a lack of appropriate coverage at the weekend. This had led to the development of a national plan and the appointment of a national tsar. However, the staffing requirements to give full coverage and the number of trauma patients in Kent and Medway annually meant it was not possible for every Accident and Emergency Department to contain a Trauma Unit. In the event of an incident, the aim is that patients whose injury was over 15 on the Injury Severity Score (ISS) be taken to a Trauma Unit for stabilisation. Of the 488,189 emergency cases across Kent and Medway in 2010/11, 202 of them, or 0.04% had an ISS of over 15. Of these, over 50% had been able to be taken to a Major Trauma Centre, mainly King’s in London, within 45 minutes. In sum, less than 100 patients a year require stabilisation.

(3)       Members asked a number of specific questions. In answer to one it was confirmed that all the designated Accident and Emergency Departments have a Majors area for seriously ill patients and a Resuscitation area for life threatening conditions. Another one confirmed that a patient from Broadstairs would be taken to Medway in the first instance and this was possible within the 45 minute target. Thirdly, it was not regarded as feasible to reverse the services available at Maidstone and Pembury respectively because of all the equipment necessary for a Trauma Unit which would also need to be moved.

(4)       Representatives from the South East Coast Ambulance Service explained the process of hot secondary transfer. Trauma was a priority for the service and Critical Care Paramedics would be despatched to an incident. Where there was a procedure which could not be carried out by a paramedic, perhaps involving the airways or a chest drain, then the process would be to take the patient to the nearest Trauma Unit, where the patient would stay on the ambulance trolley, for stabilisation before transfer to a Major Trauma Centre. There were also doctors who volunteered to attend the  ...  view the full minutes text for item 4.

Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), Dr. Sarah Montgomery (GP Clinical Commissioner), Lindsey Stevens, Head of Midwifery, East Kent Hospitals NHS University Foundation Trust), Ann Judges (Maternity Lead, NHS Kent and Medway), 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 thanking the Members of the Informal HOSC Liaison Group which had been established to consider this matter over the summer and those Members who had been able to attend a meeting at Kent and Canterbury Hospital on 17 August. He explained that these three, Nigel Collor, Dan Daley and Roland Tolputt would be asked to begin discussion of this item by providing a brief verbal report on their findings. The Chairman also explained that he had written to the MPs and District and Borough Council Leaders inviting their views on this matter but that it had been short notice and so the fact comments had not been received from all those who had been written to was no reflection on their interest. One comment from Roger Gale MP expressing support for the conclusions of the Hospitals Trust following a briefing with them was read out by the Chairman.

(2)       It was also explained by the Chairman that we were currently in the pre-engagement stage and that the role of the Committee was to challenge the NHS on behalf of Kent residents and ensure their concerns are debated and answered.

(3)       The Members of the informal HOSC Liaison Group each thanked colleagues in the NHS for their assistance over the summer and for arranging the informative meeting. A range of points arose from the feedback. Firstly there was a need to understand the broader context within which these changes were being proposed as the location of the existing hospitals was not necessarily ideal in that the Queen Elizabeth the Queen Mother (QEQM) Hospital in Margate had issues around difficulty of access, whereas Folkestone, the largest town in East Kent, had no hospital. The present arrangement of services came out of a reconfiguration 11 years ago and one Member commented that people would need to be assured that any proposals were sustainable in the longer term. It was also recognised that there were important difference between this situation and the reconfiguration of women’s and children’s services at Maidstone and Tunbridge Wells NHS Trust but that one lesson that needed to be learnt was the importance of ensuring the GP community supported the proposals. One Member reported having spoken to a number of people and there was a strong feeling in favour of the status quo. One Member expressed support for the concept of Alongside Midwifery Led Units as they struck the balance between choice and safety. It was felt that  ...  view the full minutes text for item 5.