Agenda and minutes

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

(b)       Several Members explained that they were diabetics and as diabetes services were on the Agenda they felt this should be made clear.

(a)       Mr Alan Willicombe requested that the Minutes be amended to reflect the fact he was present at the meeting.

(b)       RESOLVED that, subject to this change being made, the Minutes of the Meeting held on 1 February 2013 are correctly recorded and that they be signed by the Chairman.

(a)       The Chairman introduced the item and indicated that Members had before them letters received from Medway NHS Foundation Trust and NHS Kent and Medway on various matters arising from the Francis Report into events at Mid-Staffordshire Hospital. Attention was drawn to the website where Members would be able to access and read the full detailed Report. Given the importance of the Report, the Chairman felt certain this was something the Committee would look at again in the future and asked if Members had any comments. Members proceeded to express a range of views.

(b)       One Member identified two of the themes from the Francis Report set out on p.10 of the Agenda as being particularly important, namely the loss of corporate memory from constant reorganisation and the prioritisation of finance and targets over the quality of care.

(c)        On the subject of reorganisations, concern was expressed about patients and services potentially being overlooked during the transition from Primary Care Trusts (PCTs) to Clinical Commissioning Groups (CCGs). However, the view was also expressed that the constant reorganisations meant little to frontline staff in the NHS as they were continually working and focussed on patients.

(d)       There was a discussion over whether the kind of issues identified in the Francis Report were the result of the actions of a tiny minority of staff when the rest were dedicated and hard working, paying tribute to all staff groups including managers, or the result of a broader cultural problem. On this last point, the view was expressed that the NHS was not sufficiently self-critical. Connected with this, the view was expressed that patients felt reluctant to complain about a service they used and that within the NHS the potential penalties for whistle-blowing were too high.

(e)       On the subject of Medway NHS Foundation Trust, the view was expressed that the quality of service varied markedly by ward and service. Concern was expressed about what exactly the mortality statistics did and did not include.

(f)         It was commented that the Francis Report also had important lessons for patient and public involvement in the future. It was reported that representatives of the Kent LINk had visited the one in Staffordshire to provide support.

(g)       Members felt the role of HOSC in maintaining an overview of the actions taken resulting from the Francis Report was a challenging and important one. To this end, there was detailed discussion on the wording of the recommendation. The issue of timing was of particular concern, with the view expressed that not setting a specific time to look at this topic again meant it could slip of the Forward Work Programme, but other views expressed the notion that it was important to wait until the report into Medway NHS Foundation Trust was made available. It was also felt that it would not be possible to ignore the outcomes of the Francis Report.

(h)        The Chairman proposed the following recommendation:

·        That the Committee recognise the importance of the Francis report and  ...  view the full minutes text for item 4.

Huw Alban Davies (Patient Advocate Diabetes UK), Dr Abraham George (Assistant Director / Consultant in Public Health), John Nester (Commissioning Manager, NHS Kent and Medway), Carole Eastwood (Commissioning Manager, NHS Kent and Medway), Claire Martin (Diabetes Project Manager, Canterbury and Coastal CCG), Dr Balaji Chalapathy (Dartford, Gravesham and Swanley CCG Board Member), Gerry Clark (Commissioning Programme Manager – Long Term Conditions, Dartford, Gravesham and Swanley CCG), Paula Smith (Commissioning Delivery Manager and Planned Care Lead, Canterbury and Coastal Clinical Commissioning Group), Sean Crilly (Head of Planned Care Commissioning, East Kent  Federation of CCGs), Jochen Worsley (Head of Long Term Conditions - East Kent Federation of CCGs), and Ally Hiscox (Head of Commissioning, Swale CCG) were in attendance for this item.

(a)       The Chairman introduced the item and NHS colleagues explained that there were representatives of all 7 CCGs present. It was also explained that historical data would necessarily be based on PCT areas, so were not always directly comparable to CCG areas.

(b)       Members proceeded to ask a range of questions on diabetes and ophthalmology services, from which several themes arose.

(c)        One area of discussion was around diabetes services available at GP practices. The ones available were praised, but it was asked as to the reason why these were not available at all surgeries. It was explained that it depended a lot on the size of the GP practice and the special interests and training of the GPs. The provision of a one-stop shop for diabetes services involved a lot of different disciplines and specialists. This required surgeries of a certain size and for the right estate to be available. Care also needed to be taken not to duplicate secondary services. The way GP practises were being used was also being looked at, with options like one weekday afternoon or a Saturday morning being set aside for diabetes services being considered. The important point was for GPs to know what services were available and how to refer patients to them with a quality service available to all.

(d)       Building on this, questions were asked about the future priority which would be given to commissioning and funding diabetes services. Some Members were concerned it could become a ‘Cinderella service’ and the example of the new Pembury hospital not having a diabetes service given as an example, though it was also noted there was a service elsewhere in Tunbridge Wells. On behalf of the East Kent Federation of CCGs it was explained that, working with the Paula Carr Diabetes Trust, an expert commissioner had been employed to produce recommendations by the end of the year. West Kent also treated diabetes services as a priority and were redesigning their diabetes services. There was a focus on addressing the high levels of people with diabetes who had not been diagnosed. The overall aim was to address diabetes early and so free up acute capacity so that Level 3 services with a consultant would be reserved for  ...  view the full minutes text for item 5.