Agenda and minutes

Councillor 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 held on 30 November 2012 are correctly recorded and that they be signed by the Chairman.

AGREED that the Committee note the report.

Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway), Peter Gilmour (Director of Communications, East Kent Hospitals NHS University Foundation Trust), Dr Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), Dr Sarah Montgomery (Senior Clinical Advisor, NHS Kent and Medway), Dr Brighton Chireka (GP Clinical Lead for Children Services, South Kent Coast CCG), Laura Counter (Commissioning Project Manager - Maternity Services, NHS Kent and Medway), and Abina Browne (Head of Midwifery, East Kent Hospitals NHS University Foundation Trust) were in attendance for this item.

(a)       The item was introduced with NHS representatives explaining that the report covered the implementation of the changes to maternity services introduced the previous year which the Committee had looked at in detail. One Member of the Committee commented it had been the best example of a review since the creation of HOSC.

(b)       One main area of discussion was how the changes were being publicised. NHS representatives explained that the information booklet ‘Your Birth, Your Choice’ had been produced and was available in key languages. Midwives were provided with copies to hand out and it was advertised in the GP Bulletin which went to all practices. This provided a link so that it could be downloaded and/or printed on demand. Members expressed the hope that this information would be actively promoted so that people were actively aware of the current arrangements for maternity services. A copy of the booklet was requested by Members and a hard copy left by NHS representatives for later circulation (see Appendix).

(c)        There would also be publicity around the formal opening of the new Margate Alongside Midwife-led Unit. This had been pushed back to 8 February from its original date as it had been possible to arrange for Pam Ferris, star of television programme Call the Midwife, to attend and formally open the unit.

(d)       A Member of the Committee referred to the meetings of early 2012 when the Committee had been informed of issues around midwife numbers in East Kent and asked for an update on recruitment and retention. It was reported that the recruitment campaign had achieved what it had set out to do and that retention was very high compared to other areas. There was an in-house training programme to allow midwives to develop their skills; this was enhanced by the presence of two Alongside Midwife-led Units in East Kent which helped develop skills and experience.

(e)       The question of monitoring and assessing performance of maternity services regarding the experience of patients was also raised. It was reported this was something the NHS was working on. Patient experience was important to assess but was difficult to get from purely quantitative information.

(f)         There was extensive discussion around births before the arrival of the midwife (BBA). There was clarification provided that although in the last three months there had been 17 BBA across East Kent, as stated in the report, there had been 52 across the whole  ...  view the full minutes text for item 5.

Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) and Kallie Heyburn (Associate Partner - Child Health and Maternity, Kent and Medway Commissioning Support) were in attendance for this item.

(a)       Members had before them reprints of NHS reports on audiology provided to the Committee in 2009 along with a new report providing updated information. It was explained to Members that given the state of transition in commissioning services, it may be that some questions would need to be taken away by NHS representatives for answers subsequent to the meeting.

(b)       NHS representatives explained that in the past the Committee had been informed about long waiting times for audiology services in Kent but that a concerted effort had been made to tackle this problem. All adult patients were now seen within 6 weeks for assessment and 18 weeks for treatment. Anecdotal evidence was given of waits longer than 18 weeks and NHS representatives asked for details of any instances to be given to them so they could look into it.

(c)        The 6 week target in paediatric audiology was being met in West Kent. In East Kent, there had been an increase in the number of referrals and length of waiting times at some clinics. A fourth audiologist was being recruited to cope with this issue. Members requested further detail on the breakdown of the length of waiting times for paediatric audiology services in East Kent over the three months listed on p.58 of the Agenda. NHS representatives undertook to do so.

(d)       The issue of maintaining hearing aids was discussed. A Member reported that Age Concern provided services in Folkestone and Hythe. The same Member reported that one provider requested hearing aids be sent by post for maintenance, which was not seen by the Member as the safest way to deliver maintenance services. The walk in service provided at Darent Valley Hospital was praised. The response was given that Hi Kent also provided maintenance services and that for a lot of people maintenance services closer to home and not at a hospital was more appropriate. NHS representatives undertook to provide further information on maintenance services.

(e)       In response to a question about the quality assurance of services, it was reported that all providers of NHS services would be registered with the Care Quality Commission, and this included those in the independent sector providing NHS services, but information would need to be provided separately about the quality assurance of other providers.

(f)         The question of financing was discussed. NHS spend on audiology services was roughly comparable in West and East Kent, at £6.6 million in the former and £6.7 million in the latter. The contracts were a mix of block contracts, service level agreements and cost per case. This meant the number of independent providers with contracts did not mean an increase in overall costs and that this enabled patient choice. Work was continuing on coding which would make it  ...  view the full minutes text for item 6.

Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Chris Stamp (Senior Operations Manager, South East Coast Ambulance Service NHS Foundation Trust), Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway) were in attendance for this item.

(a)       Representatives from South East Coast Ambulance Service NHS Foundation Trust (SECAmb) apologised for the lateness of the report submitted to the Committee. The main issue which the Trust wished to bring to the attention of the Committee was recent performance against their key performance indicator of responding to all Category A calls within 8 minutes 75% of the time. Across Kent and Medway, only 74% of Category A calls were being reached within 8 minutes. The key challenges to overcome in improving this were twofold.

(b)       Firstly, there was the rural nature of the Weald. This was being addressed by strategically looking at demand and ensuring the right resources were available at the right places. An additional 28 paramedics and technicians had been recruited and a further 28 were being sought. There had been an increase in the number of community first responders in the Weald and Single Responder Vehicles (SRVs) were being put in places like the White Rabbit in Maidstone as Maidstone and Tunbridge Wells were areas of higher demand. Carrying these plans out had seen a performance improvement over the first eight weeks. However, the three weeks immediately preceding the meeting has seen an unexpected rise in demand.

(c)        The other factor was the time taken for clinical handover at Pembury Hospital. It was stressed that handing over patients with accurate clinical information was the priority but that compared to other acute hospital sites in Kent, there was an issue at Pembury. This was being addressed in part with the presence of a SECAmb manager going into Pembury. Nationally, this was an area which was getting a higher focus. The recent document from the NHS Commissioning Board, ‘Everyone Counts’, set a handover target of 15 minutes with the possibility of fines for failure.

(d)       Separately, there was a specific issue with Darent Valley Hospital (DVH). DVH had always received ambulances from SECAmb and the London Ambulance Service (LAS), but the number of ambulances arriving from LAS had increased recently. SECAmb and DVH liaised regularly throughout any given day but the day before the meeting there had been a nearly continual conversation between the Trusts. There was a need to get more information from LAS in a timely fashion. This would prevent four ambulances from both Ambulance Trusts arriving at DVH near-simultaneously. In response to a question it was reported that there was consistency of clinical practice in both Ambulance Trusts. There was the same training and evidence base used by both. Equipment did vary, but would be used the same way.

(e)       Connected to this, the full impact of the Trust Special Administrator’s (TSA) report into South London Healthcare NHS Trust was yet  ...  view the full minutes text for item 7.