Agenda and minutes

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

RESOLVED that the Minutes of the meeting of 6 January 2012 are correctly recorded and that they be signed by the Chairman. There were no matters arising.

(1)       The Chairman introduced the item by saying that the report in the Agenda was produced in response to a request made at the previous meeting and thanked the Officers for preparing what was a useful and timely summary of the position relating to health scrutiny regulations as it currently stands and which will continue until at least April 2013.

(2)       In response to a query about membership, it was clarified that the Committee was able to co-opt experts and others on to the Committee on a non-voting basis. The situation regards locality boards was still being developed. The Chairman reminded the Committee of the discussion paper brought to the Committee in October which indicated the room for a more localist view to feed into the discussions of the Committee, particularly as there was more to health than the NHS and the impact of housing, for example, needed to be recognised.

(3)       A representative from LINk raised the issue of social care referrals as something to be aware of. While LINk had the ability to refer health and social care matters, HOSC only dealt with health.

(4)       AGREED that the Committee note the report.

LaurettaKavanagh (Kent and Medway Director of Commissioning for Mental Health and Substance Misuse, NHS Kent and Medway), Bob Deans (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), David Tamsitt (Director Acute Services, Kent and Medway NHS and Social Care Partnership Trust), Justine Leonard (Director Older Adults and Specialist Services, Kent and Medway NHS and Social Care Partnership Trust), and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(1)       In introducing the item, the Chairman reminded Members that this was the third meeting looking into the topic of reducing accident and emergency attendances. He explained that his intention was to circulate a draft report drawing on the findings of all three meetings and the discussion around the preliminary findings presented at the 6 January meeting for Members’ comments as soon as was practical.

(2)       One Member referred to recent media reports around national findings of differing levels of accident and emergency at the weekend compared to weekdays meaning the subject was an important and topical one.

(3)       The broader context of mental health was set out by representatives of the NHS. One in four people will suffer from a mental health problem at some stage in their lives, and on any given day the number was one in six. There was a need to raise the profile of the issue and reduce the stigma attached to it. The continuing interest of the HOSC and other Committees at Kent County Council was commented on positively by health colleagues. Similarly, the recent report on mental health produced by the Kent LINk was referenced as a useful contribution to the subject of mental health.

(4)       This broader context translated into a major challenge for the health services, particularly as physical and mental health problems were often experienced by people simultaneously, sometimes complicated by alcohol misuse. The preventive health and wellbeing agenda involved a whole range of sectors, including employers. The valuable role Borough/City/District Councils played in providing such services as housing and leisure could not be underestimated. There were good examples of partnership working, including the Live it Well strategy produced by local NHS commissioners, Kent County Council and Medway Council and the work between KCC and the NHS on dementia prevention. Third sector providers also had a key role to play. In responding to a specific request from a Member of the Committee, representatives of NHS Kent and Medway and Kent and Medway NHS and Social Care Partnership Trust present at the meeting undertook to produce a series of bullet points about how each sector could contribute to improving mental health across the community and make the report available to Members of the Committee.

(5)       In terms of mental health services along the urgent and emergency care pathway, there were two services in particular which NHS representatives brought to the attention of the Committee: Crisis Resolution Home Treatment Teams and Liaison Psychiatry.

(6)       Crisis Resolution Home Treatment Teams were  ...  view the full minutes text for item 5.

Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals NHS University Foundation Trust), Noel Wilson (Divisional Medical Director for Surgical Services, East Kent Hospitals NHS University Foundation Trust), Robert Rose (Divisional Director for Urgent Care and Long Term Conditions, East Kent Hospitals NHS University Foundation Trust), Carmen Dawe (Assistant Director of Marketing and Fundraising, East Kent Hospitals NHS University Foundation Trust), and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(1)       The Chairman introduced the item and explained that the Chief Executive of East Kent Hospitals NHS University Foundation Trust had requested the opportunity for the Trust to bring the work being done on developing a clinical strategy to the Committee. The subject had also generated some media interest in the East of the County and so the Chairman hoped there would be clarification around it as a result of the day’s meeting.

(2)       Trust representatives outlined the main features and drivers of the review. It had begun in October 2010 to look at various clinical issues and those raised by the need to continue to provide core services as well as enable healthcare closer to home. No decisions around service configuration had been made but the Committee would be continually involved in the Trust’s developing strategy.

(3)       The whole development of the strategy needed to be seen in the context of a shift of emphasis nationally from the work which had been done to improve planned care, such as the 18-week pathway, and towards improving emergency care. Emergency care was a high risk area, and one of the drivers for change was the Royal College of Surgeons report, Standards for Emergency Care. Members had a summary of this document in their Agenda pack and several Members highlighted the finding in the report that 80% of surgical mortality arises from unplanned/emergency surgical intervention and it was clarified that this referred to 80% of deaths which occurred as a result of surgery. The emergency surgery mortality rate for the Trust was below the national average, but this was not seen as a reason for complacency.

(4)       The same principles around clinical care applied in East Kent as they did elsewhere, such as in West Kent, and would continue to do so and there were areas where work was being done with West Kent, such as vascular surgery.

(5)       Consultants were rightly involved in planned care, but emergency care could be improved by involving them more at the ‘front door’ of hospitals to establish a quality care plan for emergency patients with a one stop assessment. Consultant acute physicians had already been brought into front door services and EKHUFT achieved 97% against the 4-hour A&E target in January, which is a very challenging month.

(6)       Consultants needed to be supported by appropriately skilled teams and so achieving this raised workforce issues. There was a need to maintain locally accessible services, but there was also a requirement for specialisation of services in  ...  view the full minutes text for item 6.

(1)       The Chairman introduced the item and explained that the consultation had recently closed and the NHS had provided a written update and looked to bring the decision to HOSC at its meeting of 13 April

(2)       He also took the opportunity to once again thank the Members of the informal HOSC Liaison Group for the work they had done with the Trusts in between formal HOSC Meetings. Several Members felt this was a good example of the valuable work a small group of Members could do and more broadly the Committee felt this was one area where HOSC had added real value.

(3)       One Member reported that he had been able to attend two of the public meetings held as part of the consultation. Attendance at the first one had been hampered by weather and timing, but the second had been well attended with a good cross section of the population present. At this meeting, the high levels of affection they had for the Dover facility had been made clear.

(4)       Making a broader point about consultations, one Member asked whether the different health consultations could not be pulled together to prevent consultation weariness and the Chairman undertook to consider this notion after the meeting.

(5)       As Mr Daley had been a Member of the informal HOSC Liaison Group, the Chairman asked him to put forward a recommendation for the Committee.

(6)       AGREED that the Committee note the report and also notes that its recommendations made during the proceedings of the public consultation were largely followed and that we are therefore pleased to note that the consultations appear to have been successfully concluded, and now look forward to the presentation of the final report and the results of the collated opinions to the Boards of EKHUFT and the PCT for their decisions in April.

(1)       The Chairman introduced the item and explained that the paper provided further information about the upcoming mental health services review. A more detailed paper would be available for the 9 March meeting and that this topic might involve the establishment of a Joint HOSC with Medway Council’s Health and Adult Social Care Overview and Scrutiny Committee.

(2)       AGREED that the Committee note the report.