Agenda item

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust), Mark Devlin (Chief Executive, Medway NHS Foundation Trust), Dr Amanda Morrice (Clinical Director of Accident and Emergency, Medway NHS Foundation Trust), Robert Rose (Divisional Director, Urgent Care and Long Term Conditions Division, East Kent Hospitals University NHS Foundation Trust), Chris Green (Principal Information Analyst, East Kent Hospitals University NHS Foundation Trust), Ashley Scarff (Associate Director of Strategy and Planning, Maidstone and Tunbridge Wells NHS Trust), Colette Donnelly (Associate Director of Operations for Emergency Care, Maidstone and Tunbridge Wells NHS Trust) and Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) were in attendance for this item.

(1)       The item was introduced with a reminder that this item built on what had been discussed at the previous meeting, and that the Acute Trusts were all represented at this meeting. The mental health dimension of the topic of reducing accident and emergency admissions would be considered in the New Year.

(2)       Members noted the useful and detailed information provided but in the case of the multi-site Trusts, more information by site would assist them. Common themes were identified as running through the written information provided and the short opening summaries given by representatives of the four Acute Trusts across Kent and Medway. It was given as a guiding principle for delivering effective health care that patients be seen by the right person at the right time and in the right place. An estimated figure was given of around 15-20% of patients in accident and emergency departments that could be seen more effectively elsewhere.

(3)       Representatives from all Trusts agreed that working with commissioners, other Trusts and social services was important in delivering a sustainable and appropriate reduction in attendances and admissions at accident and emergency departments.  Representatives from Maidstone and Tunbridge Wells NHS Trust (MTW) and from East Kent Hospitals University NHS Foundation Trust (EKHUFT) mentioned their participation in an Urgent Care Board and Integrated Care Board respectively which looked to achieve this.

(4)       Beyond this, while it was acknowledged that each Trust may require different solutions, there were some changes across the region which also needed to be recognised and taken into account. One of these was the development of major trauma units in three Acute sites across Kent and Medway, at Medway, Ashford and Pembury. While this did not mean any reduction in the number of accident and emergency departments, there were implications for clinical services. For example, this was given as one reason the accident and emergency department at the newly opened Pembury Hospital saw an increase in the number of attendees. If Pembury was where the clinicians able to undertake emergency surgery were located, then ambulances would go there direct. Work was underway with the Ambulance Trust on refining the care pathway. The air ambulance, though dealing with comparatively small numbers of patients, was a valued component in the development of the trauma network. The South East Coast wide procurement to deliver the non-emergency 111 number was seen by the NHS as an important change which would enable patients to be informed and guided correctly as to their choices.

(5)       The move to GP led commissioning through Clinical Commissioning Groups was also seen as important. Their knowledge would be vital in helping develop the right services for the population as well as educating patients and changing the nature of the patient mix going to accident and emergency departments. GPs also knew their individual patients’ histories, and this was valuable information to utilise in delivering effective treatment. In terms of GPs as service providers, a number of different points were raised. The view was expressed that where the changes to the GP contract meant that GPs could opt out of providing out-of-hours cover, people seeking treatment could turn to their nearest accident and emergency department through not understanding the alternatives. A different perspective was given by a Member who suggested GPs chose to send patients to be admitted via accident and emergency departments when waiting times for elective treatment were too long.

(6)       The confusion on the part of the public concerning the alternatives to accident and emergency departments was a theme picked up and emphasised by a number of Members. While a representative from the NHS stressed that minor injury units were often well used and well known in the areas where they were located, there was a valid point made about how people understood ‘minor injury’ and what services a walk-in-centre offered. One Member suggested that as a minimum, minor injury units have standardised opening hours across the County.

(7)       The importance of the accident and emergency department itself as a venue for signposting people to the appropriate service was also stressed. A number of sites had non-accident and emergency services co-located with the accident and emergency department so that although a patient may present there, it may not be the accident and emergency department which delivers the treatment. For example, Medway NHS Foundation Trust had a same day treatment centre alongside, run by Medway Community Health.

(8)       In other areas of Kent and Medway, MTW had made a bid with the Primary Care Trust for four acute physicians for both sites in order to carry our urgent assessments and run a turnaround clinic. There are also signposting services to GP and pharmacy services.

(9)       In East Kent, EKHUFT has four sites, accident and emergency departments at William Harvey Hospital in Ashford and the Queen Elizabeth the Queen Mother Hospital in Margate, an Emergency Care Centre at Kent and Canterbury Hospital and a Minor Injury Unit at Buckland Hospital in Dover. A consultation with staff is currently underway at the Trust in order to provide more equal service coverage over weekends compared to that available during the week. In Canterbury, GPs and hospital clinicians worked together in the Emergency Care Centre. At the William Harvey Hospital, there was an assessment unit and a short stay unit to which GPs could directly admit people. While admittedly it had been from a low base, direct admittance to the assessment unit by GPs had risen 240%. Direct attendance at the accident and emergency department has reduced 2%. Where there had been an issue with the number of reattendances at Buckland Hospital over the summer, this was due to patients returning to where they had received the initial treatment.

(10)     Dartford and Gravesham NHS Trust (DGH) had been impacted by two major developments. Firstly, there had been the closure in two stages of the accident and emergency department at Queen Mary’s Hospital in Sidcup, the nearest hospital to Darent Valley at 10 miles distance. Secondly, the decision last year by the community services provider to no longer run the walk-in-centre at Darent Valley meant the patients there were now included in the Trust’s total. The presence of a minor injury unit in Bexley meant that those patients that were directed to DGH were more serious cases and this has meant changes to the physical structure of the accident and emergency department had been undertaken recently. The presence of the innovative White Horse walk-in-centre at Northfleet had led to effective pilot work on the right kind of onwards referrals. In addition, work with local nursing homes on getting GPs to assess elderly patient first had seen a 30% reduction in the number of admissions from nursing homes.

(11)     A number of Members and representatives of the NHS made related points around the public health agenda on such issues as alcohol misuse which could have an impact on reducing the number of self-presenters.

(12)     The Chairman thanked the Committee’s guests for their time and the valuable discussion which had taken place.

(13)     AGREED that the Committee note the report.