Agenda item

Michael Ridgwell (STP Programme Director), Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust) and Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Mr Ridgwell began by explaining that service models and hurdle criteria had been developed; the long list of options would be identified using the service models. The long list options will be evaluated using the hurdle criteria to get the preferred options which would be submitted to NHS England for review and assurance before going out to public consultation.   

(2)       Mr Perks stated that feedback from the public had been reflected in the development of the service model for local care which included more joined up services and better access to primary care. He noted that there were 300 patients in East Kent hospital beds who did not require acute care and would be more appropriately cared for by the proposed local care model. He reported that this was particularly important for the frail and elderly as hospital stays could lead to loss of muscle tone and make it more difficult for them to return home.

(3)       Ms Shutler reported that the proposed model for hospital care included the creation of centres of excellence with access to specialist teams; evidence showed that access to specialist services, rather than the time taken to access the services, led to improved outcomes for patients. She noted that stroke services were currently provided in seven sites across Kent and Medway and did not have as good outcomes as centralised stroke centres. Similarly the centralisation of orthopaedic services reduced infection rates and patient stay and improved efficency and patient outcomes. Emerging thinking as part of the STP in East Kent included a proposal to have an emergency care hospital with an A&E and specialist services; an emergency care hospital with an A&E and a planned care hospital.  She stated that all the options were being considered and a second round of engagement events was scheduled.

(4)       Members then proceeded to ask a number of questions and make a number of comments. A Member enquired about the impact of growth, capital investment, the lessons learnt from the potential closure of Faversham minor injuries unit in 2013 and the management of chronic conditions. Mr Ridgwell explained that growth was challenging but had been factored into the planning and the NHS was working with KCC to ensure the models were kept up-to-date. Mr Perks stated that primary care in Ashford, as one of the major growth areas, had some of the best facilities in the county including an extension to the New Hayesbank Centre. Mr Ridgwell stated that there was an ongoing dialogue with NHS England regarding capital investment required to make changes.  Mr Perks noted that the key lesson learnt from Faversham minor injuries unit was the importance of working with the local community and GPs in developing future models of care. Mr Perks reported that the integration of primary and community care, as set out in points A - E in the table on page 25 of the Agenda, would enable the proactive local management of chronic conditions by working with the patient to develop their care plans. He stressed the importance of providing a consistent service across Kent and Medway. He acknowledged that there were similar workforce challenges with GPs as there were with hospital consultants.

(5)       In response to a specific question about the centralisation of services, Ms Shutler explained in terms of stroke services that there was a significant challenge in providing these across seven sites and performance was variable and inconsistent. There was a proposal to centralise stroke services to a fewer number of sites with a maximum travel time of 60 minutes to improve patient outcomes. She confirmed that travel times to all seven sites were being reviewed. Mr Ridgwell clarified that a 120 minute call to needle standard was recommended for thrombolysis. In terms of elective surgery, Ms Shutler explained that planned surgery was currently carried out on the same sites as emergency surgery in East Kent which resulted in cancellations of elective surgery due to emergency cases; this would be prevented if elective services were centralised and located on a different site from emergency and specialist services.

(6)       A number of comments were made about the Estuary View Medical Centre. Mr Perks stated that the Estuary View Medical Centre was a national vanguard pilot and provided integrated community healthcare. There was small scale evidence to demonstrate that through the delivery of local care at the Estuary View Medical Centre, it had reduced the number of patients attending hospital. The CCGs in Ashford and Canterbury were planning to scale up their local care models from autumn which was expected to significantly reduce hospital attendance. He stressed that the local care model did not require an Estuary View Medical Centre in every locality. The local care model was looking to deliver as much care as possible to people’s home and provide support to enable the population to stay well and manage their own care.

(7)       A Member asked about the development of a medical school and a new hospital in Canterbury. Ms Shutler commented that the Trust was supportive of a medical school and would help to recruit and retain staff. She confirmed that the Trust had been approached by a developer and local landowner with the offer to build a shell of a hospital in Canterbury. She reported that the cost of a new hospital would be £600 million if supported by a successful local care model or £750-800 million without; it could take 4-5 years to fund and 4-5 years to build but may be able to take less time depending on the offer from the developer and planner. She stated that the Trust was undertaking a due diligence process to determine if it is a viable option. Mr Thomas declared an interest as a Member of Canterbury City Council’s Planning Committee and took no part in the discussion. 

(8)       Members enquired about the implementation of care navigators, GPs support of the care model and public consultation. Mr Perks explained that the care navigators would most likely be clinicians and in Canterbury & Coastal CCG would be part of a community hub so that they had an overview of all services provided locally. Mr Perks stated that GPs were supportive of the care models but had concerns about the resources required to implement the new model. Mr Perks reported that public consultation was due to take place in spring 2018 but there was a possibility that this could be brought forward following the emergency transfer of services in East Kent and requests by NHS England and NHS Improvement.

(9)       RECOMMENDED that the report on the service models and hurdle criteria for the Kent and Medway Sustainability and Transformation Plan be noted and an update be presented to the Committee at the appropriate time.