Agenda item

Dr Robert Stewart (Medical Director, Kent and Medway Cluster and Chair of the Kent and Medway Trauma and Critical Care Network), Dr Patricia Davies (Locality Director, Dartford, Gravesham and Swanley GPCC and Lead Director for the Kent and Medway Trauma and Critical Care Network), Helen Belcher (Project Manager, East Kent Hospitals University NHS Foundation Trust), Dr Marie Beckett (Deputy Medical Director and Emergency Care Consultant, East Kent Hospitals University NHS Foundation Trust), Karen Barkway  (Performance and Governance Manager, NHS West Kent) were in attendance for this item.

(1)       The Chairman introduced the item and explained that there were a number of options the Committee could take following the developments of the trauma network in Kent and Medway. As the network did cover two local authority areas, Kent and Medway, the two Committees exercising the health scrutiny function may need to form a Joint HOSC to consider the item if both considered it a substantial variation of service.

(2)       Dr Stewart provided an overview of the proposals and the reasons underlying them. There was a need to develop trauma services in Kent and Medway because while there were no Major Trauma Centres in the area, not all patients could be taken to either London (mainly King’s) or Brighton within the recommended 45 minutes. A Major Trauma Centre required cardiothoracic, neuroscience and other specialities to hand to provide a full service as well as a certain throughput of patients in order to maintain skill levels. These factors precluded one being established in Kent and Medway, but the development of improved services as well as repatriation for rehabilitative care was possible. The Air Ambulance, although useful, could not be the complete solution as there were too many restrictions on when they could be used. Closer links were being developed with the South East London Trauma Network.

(3)       When responding to a major trauma incident, the paramedics assessed the situation and there were three options – taking the patient straight to a Major Trauma Centre, stabilising the patient before transfer, or treating the patient locally. The Kent and Medway Clinical Care and Trauma Network’s proposal was to develop three Major Trauma Units across Kent and Medway where additional expertise from consultants would be available and rehabilitation would be coordinated. These Major Trauma units would be linked to Major Trauma Centres which would assist with training and recruitment. The South East Coast Strategic Health Authority and London Trauma Board were supporting the proposals. The proposed sites for the Major Trauma Units were:

§         Pembury Hospital,

§         William Harvey Hospital, and

§         Medway Hospital

(4)       A range of questions were asked by Members over different aspects of the proposals. On the number of patients involved it was clarified that in Kent and Medway each year ½ million patients are seen in Accident and Emergency Departments each year; of these the 200 most severe, major trauma cases, go to King’s. The Network stressed the proposals were improvements to existing services and not the downgrading of Accident and Emergency Departments. On the selection of the sites, it was explained that the Acute Trusts had to express an interest but that there were strict criteria around what needed to be provided, such as 24 hour coverage by an Accident and Emergency specialist.

(5)       The sites proposed led to Members posing a number of specific questions. One Member suggested that the Pembury and Ashford sites were too close to the other, and specifically in relation to Pembury, it was pointed out that it was not on a motorway and served a large number of people outside of Kent and more information was needed on patient flows from those areas. Following on from this, the lack of any Major Trauma Centre between Brighton and London meant that Pembury was likely to become a hub and this raised questions around whether Pembury had sufficient capacity.

(6)       Issues around capacity were also raised around Darent Valley, with the additional pressures caused by the closure of the Accident at Emergency Department at Queen Mary’s. It was explained that Darent Valley was not selected as one of the sites as it falls within the 45 minute isochrones for accessing a Major Trauma Centre within London.

(7)       Capacity across the entire system was also questioned and the issue rose of where people would be taken if King’s was full. It was pointed out that while there was some prediction possible, trauma could not be completely planned for as to when and where it happened. One Member raised the issue of the possible use of private hospitals, such as the one being built in Maidstone.

(8)       The representatives attending on behalf of the Network were thanked for providing a succinct overview of the proposals in the time allowed and Members were asked to forward any outstanding questions they had to the Committee Researcher for answering when the Committee returned to the subject.

(9)       AGREED that the Trauma Network be invited to return to a future meeting of the Committee and that this meeting be in the form of a Joint HOSC with Medway should the equivalent Committee wish also to explore this matter further.