Agenda and minutes

(1)       Mr Thomas declared an interest, in relation to any discussion regarding a new hospital in Canterbury, as a member of Canterbury City Council’s Planning Committee.

(2)       Mr Chard declared a Disclosable Pecuniary Interest as a Director of Engaging Kent.

(3)       Cllr Lyons declared an Other Significant Interest as a Governor at East Kent Hospitals University NHS Foundation Trust.

(1)       RESOLVED that the Minutes of the meeting held on 20 September 2017 are correctly recorded and that they be signed by the Chair.

Liz Shutler (Director of Strategic Development & Capital Planning & Deputy Chief Executive, EKHUFT), Lesley White (Divisional Director, East Kent Hospitals University NHS Foundation Trust), Simon Perks (Accountable Officer, NHS Ashford & NHS Canterbury and Coastal CCGs) and Hazel Smith (Accountable Officer, NHS South Kent CCG and NHS Thanet CCG) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee.

(2)       Members enquired about the appointment of a permanent Chief Executive and Chair and the Trust’s Financial Recovery Plan. Ms Shutler explained that Susan Acott and Dr Peter Carter OBE had joined the Trust as interim Chief Executive and Chair of the Trust. It was anticipated that interviews for a permanent Chair would take place in January with interviews for a permanent Chief Executive taking place as early as February. Ms Shutler noted that the Trust had a deficit target of £19m by the end of the financial year. She reported that the Trust was making good progress and had already delivered on over £30m of cost improvement savings. She noted that given the size of the organisation, the Trust's deficit was relatively low in comparison to other Trusts across the system. In response to a comment about saving targets resulting in service cuts, Ms White explained that savings related to efficiencies. She gave an example of the savings made within the Urgent Care and Long Term Conditions division; due to the successful recruitment of permanent middle grade staff in A&E, the division had made significant savings against agency spend. Ms Shutler noted that it was not efficient for the Trust to provide services on all sites; it was important for specialist services and teams to be co-located together.

(3)       Members asked about the pay award and staff recruitment particularly consultant recruitment at Queen Elizabeth The Queen Mother (QEQM) Hospital. Ms White explained that the pay award was a national issue. She noted the Trust was looking at new roles, particularly for Band 4 nurses and more senior nursing roles, to enable staff as part of their career development to move into specialist roles. She reported that the Trust was working to recruit medical staff both in the UK and abroad. Vacancies were being advertised in the BMJ and the Trust was looking to attract staff by offering clinical specialisms; flexible working; shared posts in the community; and potential research posts with universities.  Ms Shutler noted that the Trust had advertised 74 consultant posts and recruited 55 staff including 22 staff that had joined since June; however the Trust continued to have gaps in medicine and geriatric roles. Ms White stated the Trust had recruited two new consultants to the QEQM Hospital since June; a Respiratory Consultant who had subsequently left and a Geriatrician. She reported that the Trust was continuing to actively recruit to posts across all three sites.

(4)       A number of comments were made about sickness absence, the flu vaccine and appraisals. Ms Shutler acknowledged that the sickness absence was above the Trust’s 4%  ...  view the full minutes text for item 27.

Michael Ridgwell (Programme Director, Kent & Medway STP), Simon Perks (Accountable Officer, NHS Ashford & NHS Canterbury and Coastal CCGs), Hazel Smith (Accountable Officer, NHS South Kent Coast and Thanet CCGs), Liz Shutler (Director of Strategic Development & Capital Planning & Deputy Chief Executive, EKHUFT) and Lesley White (Divisional Director, East Kent Hospitals University NHS Foundation Trust), were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. The Chair noted that the Committee had received an additional report regarding reconfiguration of services in East Kent and the focus of the discussion would be on the new information rather than the general STP update which had been printed as part of the agenda. Ms Smith confirmed that the additional report had been published as part of the papers for the East Kent Joint CCG Committee.

(2)       Ms Smith began by updating the Committee about the development of local care in East Kent which would not be subject to public consultation; GPs were working together to develop primary and community care to support their local populations of 30,000 – 60,000. She noted that a frailty pathway developed at a Kent & Medway level was being implemented locally with the same model across East Kent. In addition to this, she reported that five specialties, including rheumatology, cardiology, diabetes, and the tiers of care to support those specialities at a primary and secondary care level had been identified. She reported that in Thanet three primary care homes had been developed in Margate, Ramsgate and Quex & Broadstairs to bring  together GP practices in those areas; the aim was for the homes to provide services relevant to their populations and strengthen primary care. In Margate the CCG was working with the District Council to relocate relevant services, such as the Margate Task Force, to be part of the home. In South Kent Coast all GP practices had come together to form the Channel Health Alliance which had been contracted to provide three primary care hubs in Dover, Deal, Folkestone; an additional hub to support Hythe and Romney Marsh was being developed. Mr Perks noted, in addition to GPs working together and taking responsibility for their populations as part of the development of local care, there were tangible benefits; the provision of a multidisciplinary team at the Estuary View vanguard had reduced urgent care admissions by 7%.

(3)       Mr Ridgwell stated the importance of a local care model across Kent & Medway to meet the rising demand. He noted that the issues raised in the previous item, EKHUFT Operational Issues, had highlighted the case for change to acute services in East Kent.

(4)       Ms Shutler began by outlining the engagement with the Committee over the last 18 months including the presentation of the East Kent and Kent & Medway Cases for Change. She reported that urgent and emergency care and orthopaedic services had been identified as priority areas as it was not feasible for the Trust to continue to provide a large number of services across three hospital sites  ...  view the full minutes text for item 28.

(1)       Due to the amount of time taken to discuss other items on the Agenda, the Chairman determined to postpone consideration of this item until the next meeting.

Ivor Duffy (Director of Assurance and Delivery, NHS England South (South East)); Rachel Jones (Director of Commissioning and Performance, NHS Dartford, Gravesham & Swanley CCG & NHS Swale CCG); Simon Perks ( Accountable Officer, NHS Ashford & NHS Canterbury and Coastal CCGs) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chair welcomed guests to the Committee. Mr Duffy introduced the Winter Preparedness report, highlighting the fact that planning for winter had begun during the previous year and that two ‘wash up’ exercises were undertaken.  He noted that the 2017 assurance processes had been much more robust, with considerable joint working and information sharing with NHS England and other relevant partners, supported by significant testing of the plans to confirm that they were practical and effective.

(2)       Responding to Member questions regarding the seasonal flu vaccination uptake, Mr Duffy advised the Committee there was no authority to require anyone to receive the flu vaccine, NHS England had contributed significant resources to provide for social care staff and partners who wished to receive the vaccination.

(3)       Mr Wickings advised the Committee that the previous winter had posed challenges for the West Kent health economy, particularly in relation to patient discharge management involving care home provision and other factors.  He advised that work had been undertaken, supported by some additional BCF funding, which had addressed these issues to some extent, reducing the discharge delays.  Mr Wickings explained that work was ongoing around the Home First approach, which sought to ensure that those with the most significant frailty could have needs addressed appropriately in a way that minimised any delays to discharge; this involved ensuring processes were in place to manage ongoing care assessments and support plans outside of the hospital setting.  Mr Wickings commented that while the planning work had been positive and that progress had been made, winter always presented significant challenges to the NHS and he assured the Committee that these challenges were taken very seriously.

(4)       Ms Jones highlighted the challenges in the North Kent health economy related to domiciliary care.  She advised that work was ongoing to engage with relevant providers to identify solutions.  While this had not yet addressed all issues, Ms Jones advised the Committee that preparations were better in 2017 than they had been in the previous year.  Ms Jones also commented on the specific issues relating to Darent Valley Hospital as a key link with London whereby its demand level for care and support resources included patients from outside the CCG area.

(5)       Mr Perks highlighted the specific issues affecting the East Kent health economy, including having one of the worst performing A&Es in the country.  This meant that there was a risk around capacity to handle surges in demand over the winter period.  He noted that in previous winters, East Kent had managed most issues fairly well, with a surplus beds being available.  However, the changes to acute care meant that this would not necessarily  ...  view the full minutes text for item 30.

Bob Bowes (Chair, NHS West Kent CCG) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman invited West Kent CCG representative, Dr Bowes, to update the Committee on the decision of the CCG governing body to amend its prescribing policy so that over-the-counter medicines would no longer be prescribed for minor ailments.

(2)       Dr Bowes apologised to the Committee that the process followed in developing the proposals had not been in line with that set out to the Committee at previous meetings.  He advised the Committee that it was important to note that the CCGs were not able to enforce changes to what GPs were and were not allowed to prescribe  due to GPs’ contracts with the General Medical Council.  However, Dr Bowes explained that the CCG was of the view that when made aware of the significant cost implications of prescribing over the counter medications, many patients were happy to purchase their own for short-term use for minor ailments.  He confirmed that this proposal would not dictate how GPs prescribed but that by highlighting the issue, it was hoped that it would lead to change in prescribing habits and that this would equate to around £300,000 worth of savings out of the £1.7m budget currently in use.  Providing clarification to the Committee, Dr Bowes confirmed that the proposal was a recommendation to GPs, rather than a directive.

(3)       Members commented on the importance of encouraging healthier lifestyles to minimise a reliance on regular medication.

(4)       Responding to questions from Members, Dr Bowes explained that approximately 80% of patients did not pay for prescriptions and that it was this patient group that may be asked to buy low cost, short term prescriptions over the counter as part of the proposal.  He reassured the Committee, that the free prescription patient group did not get this entitlement based on their financial situation in the majority of cases, so it was not expected that there would be any significant negative impact and he reiterated that when given the appropriate advice by GPs regarding purchasing over the counter medication, most patients were agreeable to this approach.  Dr Bowes advised the Committee that where patients did still require a prescription, based on medical assessment, appropriate prescriptions would still be issued.  He confirmed that the proposal would mean that where many consultations already involved doctors providing information leaflets to help patients self-manage, this could now also include a recommendation to purchase the relevant over-the-counter medication themselves.  Dr Bowes also highlighted the Pharmacy First scheme, which provided an alternative method of accessing free prescriptions without additional medical consultation.

(5)       In response to comments, Dr Bowes agreed that whilst people were using the Pharmacy First scheme, it still had a greater potential.  He recognised that it was important to ensure a balance between appropriate access to primary care for medical consultations and seeking pharmaceutical advice outside these care settings.  This helped relieve pressure of GPs and  ...  view the full minutes text for item 31.

Stuart Jeffery (Chief Operating Officer, NHS Medway CCG) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance for this item.

(1)       Mr Jeffery advised the Committee that Medway CCG was the lead CCG for IVF and all assistive reproductive technologies (ART) in Kent.  He introduced the report which outlined proposals for a review of the service.  Mr Jeffery explained that the review outlined was undertaken as part of the CCG’s standard review cycle but also because it had become evident that the service offer provided by Kent and Medway was different to that offered in rest of the country, notably that Kent and Medway were offering two cycles of therapy when other health areas only offered one or fewer.  He also noted that it had recently been identified that the current policy may have discriminated against same sex couples, which was an issue the CCG was keen to address as soon as possible.  He advised that the report set out the process, timeline and planned consultation work as part of the review, which would latterly involve bringing the proposals back to the Committee for further consideration in due course.

(2)       Steve Inett, Chief Executive, Healthwatch Kent, extended an offer to support stakeholder engagement to assist the CCG with capturing public views and identifying potential issues.  He also queried how the CCGs were planning to align ongoing service changes to ensure effective consultation.  Mr Jeffery, explained that consultation planning was ongoing and that stakeholder engagement was planned, with potential for agencies to be employed to support this work.  Mr Wicking noted the large scale of the Kent and Medway area and that it contained a significant range of different population and stakeholder groups.  He also explained that work was undertaken by the Commissioning Support Unit (CSU) to try to plan and programme in consultation and engagement activity so that the schedule was not overwhelming or confusing for stakeholders.  Mr Jeffery reassured the Committee that the planned consultation work would involve using professional organisations to support obtaining a representative sample of views.

(3)       Responding to questions regarding the proposed reductions, Mr Jeffery explained that each cycle included one frozen embryo and one fresh embryo.  This meant that the current two cycle approach involved four embryos and it was proposed that this drop to two, in line with wider practice nationally. 

(4)       Responding to a question regarding the planned provision for patients who may require ART in order to conceive as a result of injury or trauma, Mr Jeffery advised the he would confirm the full policy details and provide the information in due course.

(5)       Mr Jeffery reassured the Committee that there was no appetite in the CCG to completely remove ART provision but there was a recognition that it was appropriate to review and change the way it was provided.  As per the early stage proposals, it had been assessed that a reduction from two cycles to one cycle of treatment was appropriate.  Mr Wickings also  ...  view the full minutes text for item 32.

Steve Inett (Chief Executive, Healthwatch Kent) was in attendance for this item.

(1)       Steve Inett presented Healthwatch Kent’s Annual Report.  He highlighted the following points:

§  The report sought to present a balance between activities taken by Healthwatch Kent (HWK) and the outcomes that had been achieved.  This reflected the collaborative approach Healthwatch endeavoured to take when working with the Council and the NHS.

§  HWK’s 70 volunteers were reviewing their role to identify how they could offer best value.  Mr Inett commented that their commitment was excellent, supported by HWK’s recent receipt of the Investors in Volunteers award.

§  HWK’s budget during the period covered by the Annual Report had been at £666,000 (10% reduction from the year before) and that this budget had since been reduced by a further 20% to £511,000.  Mr Inett explained that some of the funding had previously been put aside to support engagement work within their operational budget but that this area had largely had to cease because of the budget cuts.

(2)       Responding to questions, Mr Inett explained that work was ongoing to shift the public focus on to the Healthwatch volunteers, as historically the paid staff had been more visible through organisation engagement.

(3)       Members commented on the positive work conducted by Healthwatch, noting in particular the progress made with engaging with Gypsy and Traveller communities.  Mr Inett confirmed that engaging with seldom heard communities was a key priority for Healthwatch.  Part of this work involved working in different districts to enable engagement across the county and across all the protected characteristics.  He also noted the support provided by KCC’s Gypsy and Traveller service in engaging with the community.  Mr Inett highlighted that the work with the seldom heard communities had led to the development of the Help Card which allowed those in need to discreetly ask for assistance.  He noted that that the majority of CCGs and practices have signed up to this programme.  Linked with this activity, Mr Inett highlighted Healthwatch’s support of the Accessible Information Standard from NHS England.  Healthwatch had requested updates from all NHS trusts on how they assess people’s additional communication and support needs, as it was now a legal requirement to do so.  He advised the Committee that Healthwatch have been visiting Kent hospitals to test staff’s knowledge of these processes.

(4)       Responding to questions, Mr Inett confirmed that the funding for Healthwatch Kent was from the Department for Health, administered and commissioned via Kent County Council.

(5)       In response to a question regarding the new physical disability forum, Mr Inett advised that the forum was very successful and that attendance varied depending on the types of meetings being held.  Some sessions were open sessions to gather public views from a wider group and that these were supported by smaller working group sessions aimed at developing plans for progressing the issues raised through the wider forum.  He highlighted the positive work already achieved; recommendations had been shared with relevant agencies, including the promoting of  ...  view the full minutes text for item 33.