Agenda item

Mark Devlin (Chief Executive, Medway NHS Foundation Trust) and Gerard Sammon (Deputy Chief Executive, Dartford and Gravesham NHS Trust) will be in attendance for this item.

Mark Devlin (Chief Executive, Medway NHS Foundation Trust) and Gerard Sammon (Deputy Chief Executive, Dartford and Gravesham NHS Trust) were in attendance for this item.

Adrian Crowther declared a personal interest in this item as a Governor of Medway NHS Foundation Trust.

(1)       Mr Devlin began by providing an overview and explained that the process was still in its early stages and that they were endeavouring to make it a transparent and open one. The driving force behind all the work was that both Trusts desired to provide first class services. As for the background to the rationale for bringing the two Trusts together, it was explained that both were mid-sized district general hospitals with Darent Valley being the smaller of the two and serving a population of 300,000 and Medway serving a population of 350,000. As a critical mass of population is necessary before certain services can be provided, serving a population of 650,000 will mean more services can be offered, including new ones which currently are not. The Royal College of Surgeons recommended population coverage of at least 500,000 for safe surgery and together the two Trusts achieved this. The population size meant that there would continue to be the full range of services such as maternity and accident and emergency on both sites.

(2)       Economies of scale in back office functions will mean savings realised to invest into services. The Trusts are currently in the feasibility testing stage and the Boards of both Trusts would decide at their meetings in September as to whether to proceed. It was stressed that the option could well mean acquisition of one Trust by the other, rather than merger, and that the processes were different with acquisition being in some regards the more straightforward option. The point was also made that the history of mergers in the NHS was mixed. The merger in South East London had taken place three years before but the combined Trust still had problems, whereas in East Kent the Trust was working well but it had taken time. There was also a national policy drive encouraging all NHS Trusts to achieve Foundation Trust status by 2014.

(3)       One Member questioned whether the merger of the two Trusts would be sufficient to realise the gains intended. Residents of Swale often accessed services at Medway or Maidstone and an argument could be made that these two hospitals would make a better merger. Another Member questioned the value of the merger to residents of Sheppey. In reply to these points, it was acknowledged that Medway was closer to Maidstone than Darent Valley but that the centre of gravity for Maidstone and Tunbridge Wells NHS Trust was further away due to the opening of the new hospital at Pembury. In addition, the populations that looked to Darent Valley and Medway shared more similarities in terms of health need. On the issue of Sheppey, the counter argument was given that services would be made available closer to home which would previously have involved travelling to London and the increase in critical mass would improve the quality of the services delivered to all patients, including those delivered in the community hospitals on Sheppey and in Sittingbourne. In addition, the joining together of the Trusts did not preclude other partnerships; one such currently existed with Maidstone Hospital relating to cancer services.

(4)       Transport was one of the major areas of concern expressed by Members and the representatives of the two Trusts acknowledged this was something which needed to be addressed. Darent Valley itself was served by the Fast Track bus system and there was a good relationship with the bus companies. Transportation links between the two sites was an issue, as was car parking, though this was being looked at and very speculatively the possibility of a shuttle bus between the two sites was mooted by the Trust representatives. Travel issues around a number of specific areas were raised by Members, including travelling from Gravesham which was situated between the two Trusts and had bus links to Darent Valley but was less well served for Medway, and Sevenoaks and Swanley which were similar in that it was quicker to access hospitals in London. In answer to a specific question, the volunteer driver service was reported to still be in existence and use was based on need.

(5)       The impact of patient choice was also discussed. The two Trusts were looking to ensure that the same general services were available on both sites and would continue to be delivered in a sustainable way. More widely, patients were looking to choose good quality local services and this would involve being innovative in how they were delivered and how patients accessed them, including looking at transportation. For more specialised services like nephrology where patients currently have to travel to London, where this service could be developed and provided locally, then patients would have that additional choice.

(6)       The particular challenge of the Darent Valley Private Finance Initiative (PFI) was also discussed. Some Members were sceptical as to the usefulness of the scheme as it involved a large financial commitment each year in order to keep up repayments. This was recognised by Trust representatives but the positive side was outlined in that the Darent Valley PFI included comprehensive building and support services which meant that the estate was in better condition than non-PFI estates of the same age and so there would not be the longer term maintenance costs. The contract was for 30 years but the support services were tested for benchmarking every 5 years.

(7)       The joining together of the two Trusts was presented as the optimal option and in response to Members’ question as to what alternatives had also been considered it was explained that these included vertical integration with the mental health or community health Trust, or linkages with a London teaching hospital or network. These would be revisited if the feasibility study recommended against a formal joining.

(8)       The Chairman thanked the Committee’s guests for the useful and open discussion and the Trusts’ representatives undertook to keep the Committee informed and return at the appropriate time.

(9)       AGREED that the Committee note the report and return to this issue again at a later meeting.