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)       It was highlighted that page 1 of the Minutes Section 3(a) should read ‘one of the issues.’

(b)       RESOLVED that, subject to this amendment, the Minutes of the meeting of 19 July 2013 are correctly recorded and that they be signed by the Chairman.

Felicity Cox (Kent and Medway Area Director, NHS England) was in attendance for this item.

(a)       Approval was expressed of the idea of visiting the Deal Hospital site as it had been the subject of a recent public meeting. It was suggested that a visit to the Buckland Hospital site could also be included. The Chairman undertook to look into what could be arranged.

(b)       The subject of winter planning by acute hospitals was raised. Felicity Cox explained that through the Urgent Care Board, she would be able to make available to the Committee the winter plans once they had been signed off.

(c)        Clarification was sought about the Adult Mental Health Inpatient Services Action Plan suggested for January 2014. It was explained that this was a specific report arising from the work of the Kent and Medway NHS Joint Overview and Scrutiny Committee and did not preclude the Committee considering other mental health issues. The topic of Child and Adolescent Mental Health Services (CAMHS) was mentioned. It was explained that the Corporate Parenting Panel received quarterly updates on this topic. The Vice-Chairman explained that CAMHS was a complex subject and it would be a question of the most appropriate time to consider the subject given that there was a relatively new provider. The Chairman and he were to meet with Mrs Whittle soon and a suggested date would be brought to the next meeting of the Committee.

(d)       The request was made for the Committee to have the opportunity to hear from the CCGs across Kent, perhaps in geographical clusters, as soon as possible and the Chairman explained that this was being actively pursued.

(e)       AGREED that the Health Overview and Scrutiny Committee note the report.

Mark Devlin (Chief Executive, Medway NHS Foundation Trust) and Felicity Cox (Kent and Medway Area Director, NHS England) were in attendance for this item.

(a)       The Chairman of the Committee welcomed the Chief Executive of Medway NHS Foundation Trust (MFT) who then proceeded to introduce the item. Mr Devlin explained that following the publication of the Francis Report, 14 Hospital Trusts across England were selected on the basis of having been outliers for 2 years in one of 2 mortality statistical measures – Hospital Standardised Mortality Ratio (HSMR) and Summary Hospital-level Mortality Indicator (SHMI). Sir Bruce Keogh was asked to investigate why the statistics were as they were and to ensure that the hospitals were improving. The Trust was visited by a 25 strong group involving active clinicians, regulators and local Clinical Commissioning Group (CCG) representatives. There was an announced visit followed by a second unannounced visit. Public meetings were held in Chatham and Sheppey. MFT was one of only 2 Trusts out of the 14 which had no issues escalated to regulatory bodies. The review concluded that there was good practice at the Trust, but that it was inconsistent; Mr Devlin agreed this was fair comment. Some of the improvements to be made could be undertaken solely by the Trust but some would involve the assistance of other bodies. 

(b)       It was further explained that most of the recommendations made by the review were in progress anyway. An example was given of the mortality working party set up by the end of 2012. This was chaired by the Medway Director of Public Health and involved Trusts with a good record around mortality. There were 50 points in the action plan and there were 6 areas where improvements were to be focused and these were set out in the Agenda on pages 38-40. HSMR and SHMI were useful as a ‘smoke alarm’ but did not tell the whole story of what as happening in a hospital. The SHMI at MFT was now at the lowest it had ever been and while the HSMR was still at 12, this was an improvement on the previous year.

(c)        MFT was the busiest hospital in Kent and getting the right skill mix was central to being able to deliver 24/7 care. A review of the nursing and midwifery establishment was underway. More acute physicians were being recruited and there was a clear correlation between their numbers and safety. 25 consultants were being sought and 16 had already been recruited, all high calibre candidates. In response to a question, it was acknowledged that staffing levels were lower at weekends and at holidays and that this was being looked at. On the other hand, in response to being asked whether MFT would have responded as well as it had to the previous day’s major traffic accident on the Sheppey Crossing if the accident had occurred on a Sunday, Mr Devlin explained that it would. He was proud of the way the hospital had dealt with  ...  view the full minutes text for item 5.

Ian Ayres (Chief Officer, NHS West Kent CCG), Dr Bob Bowes (Chair, NHS West Kent CCG), Felicity Cox (Kent and Medway Area Director, NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman introduced the item and welcomed representatives of NHS West Kent CCG as the first CCG to bring their strategic plans to the Committee.

(b)       Dr Bowes presented an overview and began by explaining that the Mapping the Future programme was a long term project aimed at dealing with the funding shortfalls of £20 million each year. With an ageing population and long terms conditions on the rise, if no changes were made there would be a £62 million shortfall in the next five years. In the past, old style management consultant exercises had been carried out to identify efficiencies. These had gone nowhere as providers had not been involved. The Mapping the Future programme involved them, commissioners, and the public in the redesign, with 4 different clinical scenarios used to develop ideas. Seeking the views of HOSC was a core part of this engagement exercise. There was a diagram on page 73 of the Agenda which set out how the relationship between the sectors of the health economy could be redone.

(c)        All of this was underpinned by a tremendous data challenge and the Department of Health was working with GPs to work out the best way to use data effectively and be able to share it across organisations.

(d)       A question was posed about how Mapping the Future was being publicised and communicated. The offer was made to send the Committee a written report setting this out in more detail.

(e)       A question was posed about the structure of the health service and whether this meant organisations were more in silos than in the past. It was conceded that there were more autonomous organisations but now that 5-6 years of expanding budgets had ended, there was more of an emphasis on collaboration. CCG representatives explained that 3 key ideas had come out of Mapping the Future workshops. First, it was recognised that continuing to do the same things, but working harder and faster, would buy a little bit of time but there was rather a need to do something fundamentally different. Second, there was a recognition that all sectors were impacted and needed to respond and act. Third, there was increasing acceptance of the idea of ‘the Kent Pound.’ This phrase was used as shorthand for the recognition that there was only one finite sum of money for health and care across Kent and health and social services needed to work together, if debt was not to be just moved around the system.

(f)         A number of specific questions were asked about the financial structure of the new NHS, some of which were more generic than specifically about West Kent. On behalf of NHS England, Felicity Cox undertook to provide the Committee with a breakdown  ...  view the full minutes text for item 6.