Agenda and minutes

(1)       Mr Nick Chard declared a Disclosable Pecuniary Interest as a Non-Executive Director of Healthwatch Kent.

(2)       Councillor Michael Lyons declared an other significant interest as a Governor of East Kent Hospitals University NHS Foundation Trust.

(3)       Mr Adrian Crowther declared an interest as a Governor of Medway NHS Foundation Trust.

(1)       Mr Nick Chard requested that the Minutes be amended to reflect the fact he declared a personal interest in the Agenda as a Non-Executive Director of Healthwatch Kent at the meeting.

(2)       Dr Mike Eddy requested that the Minutes be amended to reflect the fact that Mr Angell declared a personal interest, rather than a personnel interest, at the meeting.

(3)       RESOLVED that, subject to these changes being made, the Minutes of the Meeting held on 31 January 2014 are correctly recorded and that they be signed by the Chairman.

(1)       The Committee noted that Mr Crowther had replaced Mr Burgess as a UKIP representative and group spokesperson on this Committee.

Sean Crilley (Head of Planned Care Commissioning, NHS Ashford, Canterbury and Coastal, South Kent Coast and Thanet CCGs) and Karen Benbow (Chief Operating Officer, NHS South Kent Coast CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. The guests explained that they had been invited to update the Committee on the work of Musculoskeletal Services in East Kent. They had provided a paper which responded to questions raised by Members at January’s meeting. 

(2)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A number of Members enquired about alternative therapies. It was explained that osteopathy and chiropractics were not commissioned as part of the service in East Kent. The treatment criteria were based on clinical effectiveness which excluded many alternative therapies. The commissioning of alternative therapies may be considered by the CCG in the future.

(3)       Acupuncture was only available through Community Orthopaedics which was permitted under NICE guidance. The review into Community Orthopaedics has been completed; the redesigned service will be implemented from 1 May 2014. The new service will enable direct GP referral rather than an assessment by the Community Orthopaedics team.

(4)       Mr Crilley apologised for the data error in the previous report regarding the number of primary care referrals. The service was reviewing and developing corrective action for the next financial year.

(5)       RESOLVED that the  guests be thanked for their attendance and contributions today, and they be requested to take on board the comments made by Members during the meeting particularly with regards to alternative therapies and the Committee looks forward to receiving further updates in the future at the appropriate time within the next twelve months.

Dr Phil Barnes (Medical Director, Medway NHS Foundation Trust) and Mark Morgan (Interim Director of Operations, Medway NHS Foundation Trust) Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG), Dr Fiona Armstrong (Clinical Chair, NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. The representatives from Medway NHS Foundation Trust began by updating the Committee on the four main issues at the Trust: Quality Improvement Plan, Transforming Medway Programme, CQC regulatory action and Governance.

(2)       The Quality Improvement Plan was produced to deliver the six recommendations arising from the Keogh Review in July 2013. Under the six recommendations 50 targets were produced; 90% of these had been completed or on track to be finished by the end of March. There was an emerging view that whilst the Trust would deliver the Quality Improvement Plan, the plan may not deliver a high quality acute hospital. There was a need for strategic focus to examine and deliver the Keogh, Francis and Berwick Reports; Urgent & Emergency Care Review and operational pressures.

(3)       A new strategy, Transforming Medway, had been developed by the new executive team, following the decision not to proceed with the merger with Darent Valley Hospital. The strategy had the broad support of stakeholders and regulators. The strategy focused on seven high priority and high impact projects. The absolute priorities for the strategy were to improve the Emergency Care Pathway and to provide an excellent patient experience.

(4)       To improve the Emergency Care Pathway, the Trust planned to create a single acute admissions area. Hospitals nationally had found that emergency care delivered in one area had improved the flow of patients, reduced length of stay, improved quality and mortality rates. At present, the acute medical unit in the Emergency Department had only sixteen bed spaces rather than the 65 – 75 beds required; other areas of the hospital were frequently opened up for acute admissions. The Trust was also piloting seven day services, recruiting staff and re-designing medical rotas to ensure senior doctors were at the front end of the patient pathway.

(5)       To improve the patient experience, customer service issues such as car parking, appointment letters and the physical environment were being investigated to ensure a good healing experience for the patient; in addition to the concerns regarding quality and mortality rates.

(6)       In regards to CQC regulatory action, Maternity Services provided by the Trust were inspected unannounced in August 2013. A number of significant issues were raised in the CQC report; the most pressing being staffing levels. A compliance notice was issued by the CQC which was met by the December deadline; the Trust now met the best practice levels of staffing. Maternity Services had not been revisited by the CQC but will be the focus, alongside the emergency department, of a forthcoming major inspection by the Chief Inspector of Hospitals.

(7)       An unannounced inspection of the Trust’s  ...  view the full minutes text for item 25.

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust), Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG), Dr Fiona Armstrong (Clinical Chair, NHS Swale CCG and Clinical Representative for NHS Dartford, Gravesham and Swanley CCG), Dr Philip Barnes (Medical Director, Medway NHS Foundation Trust), Mark Morgan (Interim Director of Operations, Medway NHS Foundation Trust) and Elliot Howard-Jones (Director of Operations and Delivery, NHS England Kent & Medway)were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. Ms Davies began by explaining that an additional £10 million winter funding had been made available in North Kent: Darent Valley Hospital (£4 million) and Medway Maritime Hospital (£6 million). Both hospitals had introduced a system governance structure to utilise the funding with clinicians designing and developing the winter plans.

(2)       Darent Valley Hospital had a challenging winter with wet but mild weather. The Dartford and Gravesham NHS Trust had developed good clinical relationships with the community team, mental health team and ambulance service to ensure the whole system worked well. The Integrated Discharge Team (IDT) was introduced as part of the winter funding in September to reduce inappropriate admission to hospital. The IDT were working with patients who initially required diagnostics and treatment in an acute setting but were  quickly discharged to receive further care and support in the community. The IDT leadership team was hosted by Darent Valley Hospital; the CQC noted that the IDT was an area of excellence in their inspection report.

(3)       The winter funds had also been used to develop telehealth and formulate the Better Care Fund application. Telehealth and telemedicine had been utilised in care homes enabling consultants to remotely monitor patients. The Better Care Fund application was proposing to expand the integrated discharge team and integrated primary care team. As part of the proposed collaborative model for primary care, district nurses would be moving back into GP practices. Changes in community services had moved district nurses out of surgeries; this had caused dissatisfaction amongst nurses who were not working with the same cohort of patients and did not have direct support and back up of specific GPs. Demand for primary care was  phenomenal with a large proportion of GPs coming up for retirement. An integrated primary care team would generate a different type of workforce and utilise skills to provide care outside of hospital.

(4)       Ms Acott noted that the IDT was created to respond to patients with more complex needs, such as dementia, who are not best served by coming into hospital.  There had been an increasing number of patients presenting with dementia; half of all medically stable patients in the hospital had dementia. The introduction of telemedicine had supported home care; it had enabled patients with dementia who would have been previously admitted to hospital, when their nursing or residential home could not cope, to stay in a familiar environment and give confidence to nursing  ...  view the full minutes text for item 26.

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust) was in attendance for this item.

(1)       The Chairman welcomed Ms Acott and asked her to introduce the item. Ms Acott began by setting out the new CQC inspection process which was  being overseen by Professor Sir Mike Richards. Dartford and Gravesham NHS Trust was selected as one of 18 Trusts to pilot the new inspection regime. The Trust was also selected to be one of three Trusts to pilot of the new rating system; Royal Surrey County Hospital NHS Foundation Trust and Heart of England NHS Foundation Trust were also included in this pilot.

(2)       The inspection was preceded by an Intelligence Monitoring report and a very detailed data pack produced by the CQC which listed the Trust’s achievements, outcomes, mortality statistics and demographic information on the population it serves. The inspection involved 40 inspectors who met with the public and held focus groups with junior and senior staff.

(3)       Ms Acott was very pleased, on the whole, with inspection: staff were found to be engaged and loyal, the organisation was caring, effective, safe and efficient. The following areas for improvement were also identified: A&E, qualifications of staff and a focus on the symptoms of very high occupancy. Pilot status enabled the Trust to shape and feedback to the CQC and Professor Sir Mike Richards directly. Ms Acott reported that there was lots of goodwill towards the inspection and that confidence in the CQC inspection regime was returning.

(4)       Members then proceeded to ask a series of questions and made a number of comments. An area identified for improvement by the CQC was the cascading of learning from a serious incident in a timely manner. The CQC found that it could take up to a year for learning from a serious incident to be implemented and staff often did not hear the outcome. A Member enquired about the steps that had been taken to address this. It was also suggested that the Committee look into key lines of enquiry used by the CQC.

(5)       Ms Acott explained that the key lines of enquiry were drawn from the data pack produced before the inspection which was published on the CQC website for transparency.   When a serious incident takes place, the Trust had to go through a specific investigatory process involving NHS England and the CCG. The investigation process was led by clinicians who carried out Root Cause Analysis. Following the CQC inspection, the Trust had introduced end dates to investigations, begun electronically reporting incidents and changed the Terms of Reference for its governance meeting to enable it to feedback outcomes and learning from incidents to staff.

(6)       A series of questions were asked about the cost of a CQC inspection and serious incident inspection. Ms Acott explained that a serious incident inspection did not have a financial cost, only an opportunity cost to the Trust. The cost of a CQC inspection is unknown.

(7)       The progress of single sex wards  ...  view the full minutes text for item 27.

(1)       Members considered the work programme as set out in the report and made a number of suggestions for additions to the work programme.

(2)       It was suggested that a working group be established to consider the financial situation of the four acute hospital trusts’ in Kent and Medway.

(3)       RESOLVED that:

(a)    the work programme as set out in the report be noted and that the following be added to the work programme:

§  CQC Inspection Regime

§  Integration

§  Future Leadership of the NHS

§  Profile of GPs in Kent

(b)    A working group be established to consider the financial position the four acute hospital trusts’ in Kent and Medway and report back to this Committee.