Agenda and minutes

(a)       Mr Nick Chard declared a personal interest in the Agenda as a Non-Executive Director of Health Watch Kent.

(b)       Councillor Michael Lyons declared a personal interest in the Agenda as a Governor of East Kent Hospitals University NHS Foundation Trust.

(a)       Ms Angela Harrison wished to pass on her thanks to the Chairman, committee staff and colleagues in the NHS for arranging a recent visit to Maidstone Hospital.

(b)       The Chairman explained that the Vice-Chairman and he had recently met with representatives of Health Watch and explained that he hoped the Committee and Health Watch Kent would develop a close and productive working relationship. As a beginning, his suggestion was to invite two representatives of Health Watch Kent to attend future meetings of the Committee. This suggestion was agreed to by the Committee.

(c)        RESOLVED that the Minutes of the meeting of 6 September 2013 are correctly recorded and that they be signed by the Chairman.

Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed Sally Allum to the meeting and introduced the item, explaining that the Committee had received a presentation on quality issues in July and had asked for a further update on this specific area. The full Government response to the Francis Report had been published the previous week and this was a subject which would be returned to in due course, so the focus of this meeting would be on the Quality Surveillance Group (QSG).

(b)       Sally Allum explained that she had attended the Committee in July with Dr Steve Beaumont and she was glad to hear that the visit to Maidstone Hospital had been a success. It was hoped this would be the beginning of a rolling programme. She then proceeded to talk to a presentation, a copy of which was included in the Agenda before Members. Following this, Members proceeded to ask questions and discuss areas of particular interest or concern.

(c)        There are QSGs across England, one for each of NHS England’s Local Area Teams, with four regional ones matching NHS England’s regional offices. It was explained that one of the lessons of the Francis Report was the need to bring disparate information together. The QSGs were set up in April to do just this and work proactively to obtain soft and hard information on the quality of care. Through an early warning system by looking at a whole range of indicators, it would then be possible to react to issues early. While the QSG had no executive powers, it can make recommendations to commissioners and regulators. It did not duplicate the work of safeguarding boards, to which it could also make recommendations.

(d)       It was explained that the membership of the Kent and Medway QSG included commissioners, regulators, Kent County Council and Medway Council, Health Watch and Health Education England. The regional tier also included professional regulators, clinical networks and senates, and the Ombudsman. In response to a question it was confirmed that the Director of Public health and the Director of Families and Social Care were the representatives from Kent County Council. As regards Clinical Commissioning Groups (CCGs), the NHS England Area Director insisted on senior accountable officers attending, and this made the QSG in Kent and Medway slightly different to others. It was explained that there had been full attendance at all meetings and that while good work had been done, the QSG was reviewing how it worked to see how it can improve further. Sally Allum reported that while Health Watch Medway was fully engaged and had added value to the work on Medway NHS Foundation Trust, the QSG did not have the right representation from Health Watch Kent. Mr Nick Chard offered to follow this up after the meeting.

(e)       The QSG was supported by Sally Allum’s team,  ...  view the full minutes text for item 4.

Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Helen Medlock (Associate Partner, KMCS), Patricia Davies (Accountable Officer, NHS Swale CCG), Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed the Committee’s guests and asked them to introduce the item. A number of Members of the Committee had had the opportunity to visit one of the 111 call centres in the region, and this experience was remarked on positively. The offer was made during the meeting to extend the opportunity to visit to other Members.

(b)       Representatives from NHS Swale CCG explained that this organisation was the lead CCG for commissioning both 111 and 999 services across the South East area, covering 22 CCGs in total. On behalf on the South East Coast Ambulance Service NHS Foundation Trust (SECAmb) it was explained that there were three key questions to answer. These were whether the service was improving, whether it was meeting the requirements of providing access to the service and how was the service going to be improved in the future. It was further explained that SECAmb was meeting the targets in terms of call answering and responding to calls and was working to improve transfers between clinicians, or ‘warm transfers’ as they were referred to.

(c)        Members of the Committee commented positively on the way the NHS had been honest about the problems the service had faced and the way it had dealt with them to improve the service. In response to questions arising from this it was explained that the 111 service was not perfect nationally or locally. It was a national service, tendered locally, and this had been carried out by the Primary Care Trusts which preceded Clinical Commissioning Groups. Locally, contract penalties had been applied and the rectification of the service had been successful. The SECAmb representative stated that discussions with the CCG had begun on contract variation.

(d)       The broader point was raised that although the idea of commercial confidentiality was well understood, the Committee needed to think about how best to examine and scrutinise the use of public money. The Committee was informed that all the relevant financial information could be found in the SECAmb Board Papers and that these were publicly available on their website.

(e)       There was a discussion on the need to effectively promote and communicate the existence of the 111 service. Although many measures were being taken, it was explained that there were restrictions on local areas advertising the service ahead of a national campaign which had yet to take place.

(f)         The pressure on accident and emergency departments was raised. CCG representatives explained that Swale CCG and Dartford, Gravesham and Swanley CCG were working with the King’s Fund on this topic. Data from north Kent suggested that attendances at accident and emergency departments were flat and that the  ...  view the full minutes text for item 5.

Dr Mark Jones (Chair, NHS Canterbury and Coastal CCG), Simon Perks (Accountable Officer, NHS Canterbury and Coastal CCG), Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. The representatives of NHS Canterbury and Coastal CCG began by setting out a short chronology. Three weeks prior to the Committee meeting, the CCG had considered the outcome of the tendering service for the Minor Injuries Unit at Faversham Cottage Hospital. There were no successful bidders and the decision was taken to serve notice and close the service. The request was made by the CCG to bring the topic to HOSC. Since the announcement two weeks before, there had been a lot of interest and concern expressed. Stakeholder meetings had been held and would continue to be held.

(b)       The Chairman then asked Mr Andrew Bowles to speak as a guest of the Committee. Mr Bowles thanked the Chairman for the opportunity to address the Committee and also thanked the representatives of the CCG for including him in other meetings which had taken place and were due to take place. He read out a message from the local MP, Hugh Robertson. Mr Robertson expressed his concern at the closure of a valued local service as well as the impact of the longer journey times to the alternative sites and the congestion which could be caused at them.

(c)        Mr Bowles added that part of the problem was that this proposal had not been known about in advance and so this had not allowed for any discussions with the Borough Council on possible solutions. Mr Bowles explained that he was Leader of Swale Borough Council and a former non-executive director of a Primary Care Trust. In light of this experience, he thought that when a procurement exercise had begun with nineteen interested parties, which then resulted in eight attending a bidder event, and ultimately one bid which was found wanting, then the whole process should be looked at again. The Council had recently voted unanimously to write to the Secretary of State on this issue which was one of great concern locally and would impact on the 28,000 residents of Faversham. The request had been made to the CCG asking them to go back to stage one of the procurement and undertake it again, consulting the Borough Council and Kent County Council (KCC), particularly in light of KCC expertise in procurement. Mr Bowles added that Estuary View in Whitstable was a good service, but it was 5-6 miles away and there were inadequate public transport links. This meant people were more likely to travel to the Kent and Canterbury Hospital, adding to the pressures at that site.

(d)       Mr Bowles also made reference to a statement issued by the local GPs in Faversham explaining that they were not  ...  view the full minutes text for item 6.

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.

(a)       As mentioned earlier in the meeting, two Members of the Committee had had the opportunity to visit Maidstone Hospital with the Chief Nurse of NHS West Kent CCG and speak to staff and patients. As one of the Members to attend, the Vice-Chairman was invited to provide feedback to the Committee on this visit.

(b)       The Vice-Chairman explained that they had received a very warm welcome at the Hospital and the visit began with the opportunity to speak to the Chief Nurse at the Hospital as well as other senior members of staff. There was then the opportunity to visit a couple of wards and then discuss what had been seen at the end. A wide range of quality issues were covered and discussed. The Hospital appeared exceptionally clean and well organised with infection control a particular strength. Patients spoke highly of their treatment.

(c)        The positive comments of the Vice-Chairman were echoed by Ms Angela Harrison who also took part in the visit. She explained that they had the opportunity to speak with staff at all levels of the organisation as well as patients. It was explained that what came through particularly strongly was the enthusiasm of both staff and patients.

(d)       Both wished to put on the record their thanks to Dr Steve Beaumont and the other NHS colleagues involved in the visits. The Chairman offered to write a letter of thanks on their behalf and explained that it was hoped that further visits to this and other sites would be arranged in the future.

(e)       A local Member explained that he was glad to hear these positive comments and spoke of the different ways the Hospital was developing a variety of specialised services for the future. He hoped more Members took the opportunity to visit.

(f)         The Chairman wished everyone a Merry Christmas and a Happy New Year.