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 4 January 2013 are correctly recorded and that they be signed by the Chairman.

Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway), Deborah Tobin (Senior Project Manager – Patient Transport, NHS Kent and Medway), Alastair Cooper (Managing Director - Care Services and Passenger Transport, NSL Care Services), Felicity Cox (Chief Executive, NHS Kent and Medway), and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(a)       Members were reminded that this was a topic the Committee had looked at previously and were aware that the Patient Transport Service (PTS) was being tendered. There were two lots to the tender. The first was to run a single call centre, and the second was to run the PTS itself. NHS representatives explained that NSL Care Services had been awarded both lots. This company’s bid was ranked top on quality. It was also competitive on price, but was not the cheapest.

(b)       NSL Care Services ran other PTS services and the call centre for all these services was in Shrewsbury. It was explained that this call centre would receive the calls for PTS in Kent and book the journey, but the actual planning would be undertaken locally in Kent. A series of questions were asked about how local knowledge was factored in. The example was given of the existence of three towns or villages named Newington in Kent. NSL Care Services explained that the script used in the call centre got bookings pinpointed to a specific address, house number and street, and this made up for those occasions when no postcode was known by the caller. It was explained that the 999 services did not always have postcode information either. In addition, there was liaison with the locally based service planners.

(c)        A number of Members expressed concerns about situations where patients were discharged from hospital late at night and anecdotal evidence was provided of people being left outside their homes unable to get in following discharge. NHS representatives explained that late night discharge did happen on occasion, but it should be avoided where possible. It was also commented that patients attending accident and emergency departments who were then not admitted to hospital may be discharged at night as well. The duty of care was transferred to the PTS provider and NSL Care Services explained that it was part of their training of staff to ensure people were not abandoned. Where a home could not be accessed, or was uninhabitable, alternatives would be sought and this might involve returning them to hospital. No person would be simply abandoned.

(d)       In response to a specific question, NSL Care Services explained that volunteer drivers were used in some of its other areas, such as Lincolnshire. Volunteer drivers were checked out in the same way as permanent or bank staff. Volunteer drivers were often preferred due to their local knowledge, particularly in rural areas.

(e)       Developing this theme, it was explained that part of the service specification involved the requirement to refer callers who were  ...  view the full minutes text for item 4.

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Dr Chris Thom (Urgent Medical and Ambulatory Unit Clinical Lead / Lead Physician, Maidstone and Tunbridge Wells NHS Trust), Mr Akbar Soorma (A&E Consultant / Clinical Director for Acute & Emergency Medicine, Maidstone and Tunbridge Wells NHS Trust),Felicity Cox (Chief Executive, NHS Kent and Medway), and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(a)       The Chief Executive of Maidstone and Tunbridge Wells NHS Trust (MTW) introduced the item by explaining that he was present to explain changes to Maidstone Hospital which were underway and so concrete, not just aspiration. It was an opportunity to close the loop on the Trust’s reconfiguration when a lot of focus in recent years had been on the new Tunbridge Wells Hospital at Pembury. Several Members commented how please they were to see Maidstone Hospital had such a vibrant future.

(b)       One negative aspect was raised by Members regarding the appointment system, with the specific example given of being unable to change an appointment due to the absence that day of a particular member of staff. The Chief Executive of MTW responded to the specific example by saying it was clearly unacceptable but acknowledged that the appointments formed a high proportion of the complaints received by the Trust. Improvements had been made and would continue to be so.

(c)        One recent change was the opening of the new Urgent Medical and Ambulatory Unit (UMAU). This replaced the previous Medical Assessment Unit (MAU) and worked differently. The UMAU was designed to deal with patients for 24 hours only. After this time they would be discharged or admitted to the ward for the appropriate clinical specialty. The intention was to get as much of the necessary assessment and diagnostics done in the first 6-8 hours. There were two routes to the UMAU. Firstly, GPs could refer patients to it directly; patients passed through accident and emergency (A&E) where a nurse would be able to assess whether any treatment needed to be given immediately as the patient transited. Secondly, patients would arrive in A&E as usual and would be moved to the UMAU where appropriate after triage. Previously, all patients went through A&E.

(d)       There was also a new cardiac service. Cardiac services were a long established part of what Maidstone Hospital offered, but what was new was a very specific treatment for the most common form of the heart short-circuiting, ablation. This was currently only available in London and Maidstone was the only place in Kent which offered the service. This was a technology which did not exist 15 years ago and the service was likely to grow.

(e)       The new community ward, Romney Ward, was also discussed. It was explained that this was not the same as the old Boxley Ward. In part the new community ward was an ad hoc response to winter pressures and was more like a community hospital. Maidstone  ...  view the full minutes text for item 5.

Stewart Dicker (Clinical Director - Quality and Care, Kent and Medway Cancer Network), Felicity Cox (Chief Executive, NHS Kent and Medway), and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(a)       The representative from the Kent and Medway Cancer Network (KMCN) thanked the Committee for the opportunity to attend. He explained that the questions asked in advance related to the two-year old cancer strategy. Some information was not yet available; this included data on resection rates.

(b)       The general structure of cancer services was given as being a hub and spoke model with specialist services concentrated where appropriate. It was explained that Maidstone was the centre for chemotherapy, but as part of an outreach service, all acute sites in Kent and Medway provided it. In contrast testicular cancer, which mainly affected men up to the age of 26, was centralised at the Royal Marsden hospital.

(c)        There were no plans to change the current sites for services. KMCN would cease to exist after March 2013. Commissioning would move from the Primary Care Trusts (PCTs) to the CCG, or NHS Commissioning Board where the service was a specialist one. There would be a clinical network in the future covering Kent, Surrey and Sussex. This would include cancer along with other conditions in its work. Currently hosted by the PCTs, the future network would be hosted by the providers.

(d)       There was a discussion about reducing health inequalities. It was explained that the KMCN did a lot of work on prevention in the past, particularly around early diagnosis. In the future, the Health and Wellbeing Board (HWB) would have a role in ensuring health inequalities were tackled. The HWB had to approve the commissioning plans of the CCGs. The CCGs had to plan to achieve 4 national outcomes targets along with 2 chosen locally. They would need to demonstrate to the HWB how it was achieving these outcomes. There was an outcomes dataset which would enable progress to be measured, although it was conceded data was not collected on everything. NHS representatives undertook to send a copy of the outcomes dataset to the Committee. In addition, the new public health responsibilities of Kent County Council included prevention.

(e)       There was a debate around screening as a means to prevention, with Members questioning why there was not a national prostate cancer screening programme like there was for breast cancer. It was explained that while breast cancer diagnoses went up, the death rate stayed the same, which begged certain questions. Clinically, a screening programme needed to detect a cancer when there was still an opportunity to change the outcome and it needed a low false negative rate. The PSA test for prostate cancer did not meet these criteria. It was useful once the cancer had been diagnosed, but as a screening programme it would produce a low discovery rate for the number of tests. The biopsy can miss the tumour and potentially cause incontinence  ...  view the full minutes text for item 6.