Agenda and minutes

RESOLVED that the Minutes of the meeting of 14 October 2011 are correctly recorded and that they be signed by the Chairman.

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust), Mark Devlin (Chief Executive, Medway NHS Foundation Trust), Dr Amanda Morrice (Clinical Director of Accident and Emergency, Medway NHS Foundation Trust), Robert Rose (Divisional Director, Urgent Care and Long Term Conditions Division, East Kent Hospitals University NHS Foundation Trust), Chris Green (Principal Information Analyst, East Kent Hospitals University NHS Foundation Trust), Ashley Scarff (Associate Director of Strategy and Planning, Maidstone and Tunbridge Wells NHS Trust), Colette Donnelly (Associate Director of Operations for Emergency Care, Maidstone and Tunbridge Wells NHS Trust) and Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) were in attendance for this item.

(1)       The item was introduced with a reminder that this item built on what had been discussed at the previous meeting, and that the Acute Trusts were all represented at this meeting. The mental health dimension of the topic of reducing accident and emergency admissions would be considered in the New Year.

(2)       Members noted the useful and detailed information provided but in the case of the multi-site Trusts, more information by site would assist them. Common themes were identified as running through the written information provided and the short opening summaries given by representatives of the four Acute Trusts across Kent and Medway. It was given as a guiding principle for delivering effective health care that patients be seen by the right person at the right time and in the right place. An estimated figure was given of around 15-20% of patients in accident and emergency departments that could be seen more effectively elsewhere.

(3)       Representatives from all Trusts agreed that working with commissioners, other Trusts and social services was important in delivering a sustainable and appropriate reduction in attendances and admissions at accident and emergency departments.  Representatives from Maidstone and Tunbridge Wells NHS Trust (MTW) and from East Kent Hospitals University NHS Foundation Trust (EKHUFT) mentioned their participation in an Urgent Care Board and Integrated Care Board respectively which looked to achieve this.

(4)       Beyond this, while it was acknowledged that each Trust may require different solutions, there were some changes across the region which also needed to be recognised and taken into account. One of these was the development of major trauma units in three Acute sites across Kent and Medway, at Medway, Ashford and Pembury. While this did not mean any reduction in the number of accident and emergency departments, there were implications for clinical services. For example, this was given as one reason the accident and emergency department at the newly opened Pembury Hospital saw an increase in the number of attendees. If Pembury was where the clinicians able to undertake emergency surgery were located, then ambulances would go there direct. Work was underway with the Ambulance Trust on refining the care pathway. The air ambulance, though dealing with comparatively small numbers of patients, was a valued component in the development of the trauma network. The South East Coast wide procurement to deliver the  ...  view the full minutes text for item 3.

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust) and Mark Devlin (Chief Executive, Medway NHS Foundation Trust), and Dr Amanda Morrice (Clinical Director of Accident and Emergency, Medway NHS Foundation Trust) were in attendance for this item.

(1)       Members of the Committee had previously discussed this topic on 22 July 2011 and the Chief Executives of both Trusts began by saying they were glad to have the opportunity to provide a further update.

(2)       The overall vision for combining the two Trusts was to develop a platform to provide health services to a combined population of around 630,000 and increase the number of specialist services available in Kent and Medway as well as maintaining current services. The broader context was that two medium sized district general hospitals such as Medway NHS Foundation Trust (MFT) and Dartford and Gravesham NHS Trust (DGH) had sustainability issues in the current climate of flat funding and reductions to the tariff coupled with a shift of emphasis towards health service provision in the community and not Acute settings. This meant the Acute sector as a whole had to be smaller but work harder. There was also a national policy drive that all NHS Trusts achieve Foundation Trust status, which MFT had achieved but DGH had not.

(3)       A number of Members made related points about the point of devoting effort to merging when there were other priorities, as well as the need to make certain that the merger did not lead to a diminution of the number and range of services currently available. The Chief Executives of both Trusts stressed that the Trusts were not looking to reduce services and focussed on four key services which would remain on both sites. These were consultant led accident and emergency departments, maternity services, children’s services and outpatient services. The population base was increasing in north Kent which meant that the services would remain viable. In addition to which any changes to service provision would need to be brought to the Committee. The aim was to repatriate some services currently only available in London. One Member indicated that many people in the area found it easier to access tertiary services in London and the reply was given that this was part of what the current consultative process was looking at. NHS representatives highlighted the need to continue to deliver services safely and indicated the evidence that combining clinical teams lead to more sustainable and effective health care.

(4)       It was pointed out that cooperation in delivering services across the two Trusts was already well established. MFT delivered the dermatology and ear, nose and throat (ENT) services at DGH and urology services had been consolidated at MFT so that while services were delivered on both sites, when a patient needed surgery, consultants went to MFT to carry it out.

(5)       One Member commented that the report provided by the Trusts was perhaps overly optimistic and requested fuller detail about the savings and efficiencies required. A number of  ...  view the full minutes text for item 4.

Roger Gough (Cabinet Member for Business Strategy, Performance and Health Reform, Kent County Council) was in attendance for this item.

(1)       Mr. Gough introduced the item by giving a presentation on the main points of the topic. This is attached as an Appendix to the Minutes. The last update had been given to HOSC on 9 September. Since this time there had been two meetings of the Shadow Health and Wellbeing Board (HWB) and this was where a lot of focus had been. Mr. Gough explained that the HWB was to be the local systems leader in health and had the responsibility for overseeing the Joint Strategic Needs Assessment which provided the data to inform the Joint Health and Wellbeing Strategy and beyond this, individual commissioning plans. Work was currently underway to prepare for running the proposed new health system virtually during 2012/13 before the old NHS structures went in April 2013.

(2)       Beyond the commissioners, who were represented on the HWB, Mr. Gough also outlined issues around engagement with health service providers as there was a split between the two functions but also a need to draw on clinical advice to redesign care pathways. Kent County Council (KCC) had proposed Pathway Advisory Groups in its response to the Department of Health listening exercise on the proposals earlier this year, and there was also a Clinical Leadership Group set up in Kent to test models of possible HWB/Clinical Commissioning Group (CCG) engagement with providers. There was also a recent KCC initiative, The Kent Health Commission, focused on Dover at present, which was looking at how new ways of working could deliver better care. One Member expressed a measure of scepticism around ideas such as the Pathway Advisory Groups and Clinical Leadership Groups which went against the NHS division between commissioner and provider; Mr. Gough explained that similar reservations were expressed during the discussion on relationships with the provider organisations at that week’s Shadow Health and Wellbeing Board. 

(3)       There were a number of ongoing issues which needed further consideration, including ensuring children’s services were not overlooked, the appropriate way of dealing with service reconfiguration, the role of scrutiny, and operating in a two-tier authority County.

(4)       Members of the Committee picked up on this last aspect and it was pointed out that from the perspective of Locality Boards it was important to know who was in control of the finances. Mr. Gough replied that the CCGs had the largest budgets and were the commissioners of health services, but that it was important not to overlook the role of the NHS Commissioning Board as well as the public health and social services budgets controlled by KCC directly. Mr. Gough stated that a key role for health scrutiny in the future would be holding commissioners and providers to account.

(5)       On behalf of the Kent LINk, Dr. Eddy raised a number of specific points about the HealthWatch update made available to Members before the meeting. While Mr. Gough agreed with the  ...  view the full minutes text for item 5.

AGREED that the Committee note the report.