Agenda and minutes

Vice-Chairman in the Chair.

(1)       A question was asked about the vascular services item from the previous meeting and the Committee was informed that Medway’s Health and Adult Social Care Overview and Scrutiny Committee had also determined that the proposed review constituted a substantial variation of service. This topic would therefore be considered at the appropriate time by the Joint Health Overview and Scrutiny Committee established with Medway Council.

(2)       RESOLVED that the Minutes of the meeting held on 7 September 2012 are correctly recorded and that they be signed by the Chairman.

Angela McNab (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), and Pippa Barber (Executive Director of Nursing and Governance, Kent and Medway NHS and Social Care Partnership Trust) were in attendance for this item.

(1)       The Chairman introduced the item and welcomed the Committee’s guests. Angela McNab was asked to provide an overview of the Foundation trust (FT) application. Referring to the copy of the presentation Members had before them included in their Agenda pack, attention was drawn to the overarching vision of the Trust and how achieving FT status would enable the Trust to realise this fully.

(2)       It was explained that the Trust’s clinical strategy underpinned all that Kent and Medway NHS and Social Care Partnership Trust (KMPT) undertook and this in turn has been clinician led with heavy user involvement. Four key strands could be identified in the vision. Firstly, stronger community services would enable a more localised service. Secondly, the services would be oriented to recovery. Thirdly, services should deliver quality patient experience. Fourthly, there was the goal to develop flagship specialist services. Forensic services run by the Trust were in the top 3 or 4 in the country. Expanding and enhancing specialist services would enable patients who would have needed to be travel outside of Kent for treatment to be treated at facilities within Kent in the future. Along with this repatriation repatriated to Kent, length of stay would be reduced.

(3)       In terms of the point of the FT process, a number of comments from Members were made about whether it made any difference to the quality of services and whether it was a distraction. It was explained that being granted FT status was a form of accreditation that the Trust was able to achieve high standards in governance and quality of service so that the connection between the two was close. The three key risks to achieving FT status were currently being examined by external assessors. Firstly, there was the need to achieve financial balance and demonstrate financial sustainability. Secondly, the safety of patients was essential. Thirdly, the need to engage staff and develop the organisation was necessary. When asked about the alternative, it was explained that the Trust could not remain as a NHS Trust in the way it was currently. If the FT application was not successful, it was possible that organisations based outside of Kent would take over the running of the services.

(4)       Another difference between FT status and KMPT’s current status as an NHS Trust was highlighted following a question on the Trust’s estate. It was conceded that the Trust had a large number of older properties which were not fit for purpose. These properties could currently only be sold if no other NHS organisation wished to use them. KMPT would be freer to sell properties and reinvest the proceeds with FT status. 

(5)       In addition, being an FT meant it was a Membership organisation. This meant that staff, service users, the  ...  view the full minutes text for item 3.

Roger Gough (Cabinet Member for Business Strategy, Performance and Health Reform, Kent County Council), Andrew Scott-Clark (Director of Health Improvement, Kent County Council), and Julie Van Ruyckevelt (Interim Head of Citizen Engagement for Health, Kent County Council) were in attendance for this item.

(1)       After being welcomed by the Chairman and invited to address the Committee, Mr Gough proceeded to explain that the Joint Health and Wellbeing Strategy (JHWS) was a core part of the work of the Health and Wellbeing Board and was mandated as such by the Health and Social Care Act 2012. The Joint Strategic Needs Assessment had existed for a few years, but the JHWS was a new kind of document. It was meant to inform the commissioning plans of the commissioners represented on the HWB. It was not an Operating Plan, and it was later explained that this is reason there were no financial costings in the JHWS. While it needed to be strategic, it could not be too high level to be essentially meaningless.

(2)       Members’ attention was drawn to the graphical representation of the structure of the JHWS on page 40 of the Agenda. Priorities for the JHWS came from a series of connected sets of information. Firstly, there was an examination of the areas of health where Kent performed worse than the national average. A closer look at the data would reveal the local priorities by showing where, for example, the areas of highest and lowest life expectancy would be found. These were given as King’s Hill and Margate respectively. Gaps in provision would also be considered. A lot of public health goals looked to the longer term, but quick wins could be achieved by looking at gaps in provision. All this contributed to identifying which services needed to be improved or transformed as a priority.

(3)       At the national level there were Outcomes Frameworks for the NHS, Public Health and Social Care with a possible one for children’s services in development. The JHWS was intended to form a single Outcomes Framework for Kent.

(4)       It was explained that the timeline set out in the papers had slipped slightly to enable the Strategy and associated engagement to be as robust as possible Phase 1 of the engagement process concentrated on key stakeholders but as some emerging CCGs were not fully able to comment at that time, there was a second opportunity. Mr Gough also made the offer that along with the current meeting he would welcome the opportunity to discuss the strategy further with any Member.

(5)       One specific example of an issue where comments and suggestions were welcomed arose in response to a comment from a Member that the JHWS lacked a certain ‘person centred’ feel. This thought was taken positively, but given that health and social care cover such a variety of patient and personal experiences it was a challenge to capture the diversity.

(6)       In response to a specific question it was explained that hard to reach groups  ...  view the full minutes text for item 4.

The Chairman explained that due to the close connection between Items 7 and 8 on the Agenda, they would be discussed together. The Minutes of this discussion are below.

Stuart Bain (Chief Executive, East Kent Hospitals University NHS Foundation Trust), Rachel Jones (Divisional Director for the Surgical Division, East Kent Hospitals University NHS Foundation Trust), Peter Gilmour (Director of Communications, East Kent Hospitals University NHS Foundation Trust), Paul Sutton (Chief Executive, South East Coast Ambulance Service NHS Foundation Trust), Matthew England (Clinical Quality Manager, South East Coast Ambulance Service NHS Foundation Trust), Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway), Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway), and Victoria Osborne-Smith (Senior Project Manager Trauma and Critical Care, NHS Kent and Medway) were in attendance for this item.

(1)       Following the Chairman’s welcoming of the guests, representatives of the NHS were asked to introduce the items. It was explained that the East Kent Hospitals University NHS Foundation Trust (EKHUFT) clinical strategy and the development of the trauma network were both broad and distinct strategies but that there were clear overlaps between the two.  

(2)       As regards major trauma, it was explained that Kent and Medway saw around 700 cases each year, or 2-3 each week. In East Kent the annual number was round 300. The clinical evidence supported the practice of taking patients directly to a major trauma centre which for Kent and Medway primarily meant King’s College Hospital in London. There were three elements to the strategy. Firstly, the elements needed organising in a network and there was now a South East London Kent and Medway Major Trauma Network. Secondly, the systems needed to have in place the appropriate protocols. Thirdly, rehabilitation and recovery had to be considered. Shadow rehabilitation prescriptions were currently being used to identify gaps in service.

(3)       It was being recommended that Medway Hospital and Tunbridge Wells Hospital be designated as a Trauma Unit. The original intention was also to recommend designation of William Harvey Hospital. Work was ongoing with EKHUFT as this formed part of their clinical strategy.

(4)       Responding to a specific question, it was explained that Birmingham did have a major trauma centre, but that the adult’s and children’s centres were separate.

(5)       Representatives from EKHUFT explained that they were currently in the engagement stage of developing their clinical strategy but that public consultation would follow should any major changes arise from it. It was accepted that in the past the NHS was legitimately criticised for presenting ‘take it or leave it’ choices and looked to improve on this. For example, the Royal College of Surgeons was coming into the Trust to provide some objective analysis.

(6)       It was explained that along with the trauma system, there was a need to improve out of hours emergency surgery. Nationally, the mortality rate is 11-15% higher than regular hours surgery. At EKHUFT the rate was 9% higher. In response to a question about measuring outcomes in surgery, it was explained that it was more than a black and white question around mortality as longer term complications from surgery and  ...  view the full minutes text for item 6.

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), and Dr Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       For this item, Members also had before them a copy of a presentation to which Trust representatives made reference during the discussion (see Appendix to Minutes).

(2)       The Chairman welcomed the Committee’s guests and invited the Chief Executive of Maidstone and Tunbridge Wells NHS Trust (MTW) to introduce the item. Mr Douglas reminded the Committee of the context five years previously when he took up the position of Chief Executive at MTW. The Trust was dealing with the impact of the report into Clostridium difficile. Without a new hospital, it would have been a possibility that the Kent and Sussex and Pembury Hospitals would have closed anyway but events at the Trust meant ambivalence at the Treasury and Department of Health towards building a new hospital became active support. As a result the new hospital, Tunbridge Wells at Pembury, is fit for purpose. Pictures were included in the presentation as a reminder of how much the quality of the estate has changed and improved. At the time, no alternative to the Private Finance Initiative (PFI) was available.

(3)       The 7% increase in NHS spending at the time meant the prospects for the PFI were looked at optimistically and the costs were considered worth paying. Looking at the financial figures closely, it was reported, the costs of the PFI are not the whole of the story. The PFI costs around £20 million in ‘rent’. The Pembury and Kent and Sussex Hospitals cost £7 million a year, so the new hospital adds £13 million. However, new building specifications have meant that even with the same number of beds, the hospital is 60% bigger. This in turn has meant the rates have risen from £350 thousand to £1.6 million. Running costs are also more in a bigger hospital. The Trust needs to deliver a 5% cost improvement programme each year just to stand still. The deflation of the tariff accounts for 4.5%, meaning 0.5% comes from other costs.

(4)       The Trust was one of seven where the Department of Health was looking to provide support for the PFI costs and the future success of the Trust in applying for FT status was dependent on the financial sustainability of the Trust, which was linked to the costs of the PFI. 

(5)       Mr Douglas pointed to the successful move to the new hospital and claimed that moving hospitals without closing A&E availability was one of his personal career highlights. However, the move was in some ways only the start. As the first all single roomed NHS hospital, new ways of working are needed. More nurses are needed to staff single rooms. An all single room environment is not a panacea for infection control issues. It is very effective for preventing the spread of norovirus, less so for Clostridium difficile. Being in a single  ...  view the full minutes text for item 7.