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.

(1)       In relation to Minute no 28 the Chairman informed the Committee that:

§  A meeting had been organised for Friday 9 May with the Chairman, Vice-Chairman, Group Representatives, Steve Inett and Tish Gailey to consider how the work of Healthwatch Kent could support the work of the Committee.

§  The Chairman had written to the Chief Executives of the four acute hospital trusts in Kent and Medway with a request for a small group of Members to meet with the Director of Finance to look at the Trust's financial performance in 2013/14 and projected forecast for 2014/15. Two responses were received. This working group would initially look at acute trusts’ finances and report back to the Committee.

§  The Chairman had invited Roger Gough to HOSC in July or September to give an update on integration.

§  The Scrutiny Research Officer circulated details of the NHS Leadership Academy after a request from Members for information on the future leadership of the NHS. 

§  A briefing note on GP recruitment and retirement was being produced for Members by the NHS England Kent and Medway Area Team. 

(2)       RESOLVED that the Minutes of the Meeting held on 7 March 2014 are correctly recorded and that they be signed by the Chairman.

Ian Ayres (Accountable Officer, NHS West Kent CCG), Dave Holman (Head of Mental Health Programme Area and Sevenoaks Locality Commissioning, NHS West Kent CCG), Lisa Rodrigues (Chief Executive, Sussex Partnership NHS Foundation Trust), Lorraine Reid (Managing Director, Specialist Services, Sussex Partnership NHS Foundation Trust), Simone Button (Divisional Director, Children and Young People’s Services, Sussex Partnership NHS Foundation Trust) and Jo Scott (Programme Director, Sussex Partnership NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. Mr Ayres began by acknowledging that the Committee had given NHS West Kent CCG and Sussex Partnership NHS Foundation Trust (SPFT) a challenging time at the previous meeting particularly in regard to the length of wait for an initial assessment. The CCG had recognised at the January meeting that CAMHS was not a good service when it was taken over by SPFT; the Trust had a significant task to turn around the service. The CCG and SPFT had taken HOSC’s recommendations seriously and had spent a long time working together to improve the service. By the end of August, the following targets should be met: referral to assessment within 4 – 6 weeks; urgent referral within 24 hours; and referral to treatment within 8 – 10 weeks.

(2)       Mr Ayres had been assured by the CCG’s clinical team that once an initial assessment had been held, the quality and performance of the service was good. SPFT had not fully recruited in Kent however, the full time vacancy rate was low enough for temporary staff to be recruited. The CCG had been working with Steven Duckwork from NHS England’s South East Coast Strategic Clinical Network. He was supporting the CCG to review Tier 4 services and their interface with Tier 3 and identify a best practice CAMHS service to benchmark against services in Kent. CAMHS was recognised as a national challenge, a number of national reviews had been launched and the CCG and SPFT were involved with those.

(3)       The CCG now had an agreement with KCC and NHS England to reintegrate the commissioning of CAMHS with a lead commissioner and single specification for the service. It was acknowledged that it had not been sensible for different sections of the service to be commissioned by three different commissioners. The Kent Health and Wellbeing Board had approved this direction of travel. The CCG were also working with the Police to commission a Section 136 place of safety for children which had not been commissioned under the previous arrangement. The CQC were inspecting safety and safeguarding arrangements in NHS West Kent CCG and NHS Dartford, Gravesham and Swanley CCG with a focus on CAMHS during the week of the meeting. No emergency findings had been identified at the time of the meeting; an emerging view from the CQC would be published within a month.

(4)       Mr Brookbank noted that he had received letters expressing concerns with CAMHS in Kent from The Rt  ...  view the full minutes text for item 32.

Ian Ayres (Accountable Officer, NHS West Kent CCG) and Dean Souter (Control and Planning Manager, NSL Care Services) were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. Mr Ayres began by updating the Committee on developments following the January meeting. At the beginning of the year, the contract was significantly underperforming. The contract had since been reset and stabilised and the six key targets were on a trajectory to be achieved by June. An independent monthly performance report had been introduced; figures from the February report were beginning to show improvement with day-to-day variation narrowing. By early June, the CCG would know if a recovery had been achieved. 

(2)      Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about the additional costs to the contract.  Mr Ayres explained that there were three components to the additional costs. The first, £100,000 was a financial settlement for additional costs incurred between July and December. Both the commissioner and provider were found to be culpable. The second, £600,000 was to cover the costs of additional staff being transferred to the provider which had not been disclosed to bidders. The third, £1.6 million per annum, resulted from the re-basing of the contract. Mr Ayres noted that with these additional costs, NSL would have still won the contract. He reported that from June there were would be no further recovery plans; if performance was not turned around, the CCG would l seriously reflect on the future of the contract.

(3)      A Member raised concerns about the quality of service provided by NSL. Mr Ayres explained that two key learning points had arisen from the tendering process.  Firstly the contracting team should have included a manager with knowledge of running a Patient Transport Service to evaluate the quality of the bid.  Secondly the CCG should have better understood the balance between quality and price. NSL scored significantly higher on quality and value for money. Mr Ayres accepted that this was a failure of the commissioners to show due diligence. Mr Souter reported that NSL successfully ran services in Shropshire, Herefordshire and the East Midlands. These areas recognised NSL as quality service provider. In response to the increased patient activity, NSL had invested in 75 new staff and 15 new vehicles in Kent to improve quality. He stated that NSL committed to continuing to provide an improved service for the people of Kent.

(4)      A question was asked about the recovery plan and the target to meet ‘most’ Key Performance Indicators (KPI) by Easter. Mr Ayres reported that there were 20 KPI; he understood that 15 -16 KPI had been met. The six critical targets were due to be met by June:

1.    Delivering a renal patient to an appointment

2.    Collecting a renal patient from an appointment

3.    Delivering an outpatient to an appointment

4.    Collecting an outpatient from an appointment  ...  view the full minutes text for item 33.

Simon Perks (Accountable Officer, NHS Canterbury and Coastal CCG), Andrew Bowles (Leader of Swale Borough Council and KCC Member for Swale East) and Tom Gates (KCC Member for Faversham) were in attendance for this item.

(1)       The Chairman welcomed Mr Perks and asked him to introduce the item. Mr Perks began by updating the Committee on progress. At the November meeting, the Committee raised a number of serious and legitimate concerns about the procurement and lack of engagement with stakeholders. The Committee asked the CCG to set aside the decision to close the Minor Injuries Unit (MIU) and rethink the proposals. Mr Perks reported that the governing body had actioned the Committee’s recommendation and secured an extension of the contract until September 2014.

(2)      Fresh engagement work began in December with a number of public meetings; in January a steering group chaired by the Mayor of Faversham was established with local stakeholders. Stakeholders included a retired PCT Finance Director and three Faversham GPs. Through the steering group, the CCG had been able to share information regarding finance and activity forecast with a much wider stakeholder group. At the last steering group meeting, it was acknowledged that putting together a specification which was accessible and to the required standard with the money available would be incredibly challenging. Further, if the specification was not right, it would not be viable to put out to tender. The CCG and steering group were looking at other service elements which would make it affordable and viable to the provider. The original specification with the x-ray facility had made the previous tender unviable. The eight options for the Faversham MIU would be discussed at the next meeting of the steering group on 15 April; the most likely model for the unit is access Monday to Friday between 08.00 – 18.00 with an x-ray facility. It was also proposed that there would be direct access for GPs to make a referral for an x-ray.

(3)      The Chairman invited Mr Gates and Mr Bowles to speak. Mr Gates thanked the Committee for their recommendation; full consultation with the people of Faversham had now been carried out as a result. Mr Gates highlighted that the MIU covered a larger area than just Faversham; it included 17 parishes and a large number of tourists in the high season. Mr Gates enquired about the proposed models for the service.

(4)      Mr Perks explained that proposed models included options for different opening hours and running with and without an x-ray service. Through engagement activities, it was found that most people currently use the service Monday to Friday between 08.00 – 18.00; rather than the weekends and evenings which had been anticipated by the CCG. It was important that the unit met the needs of the community to be viable as the smallest MIU in Kent. The CCG were hoping to attract users who had previously attended the Estuary View Medical Centre and the Kent and Canterbury Hospital. The CCG had also  ...  view the full minutes text for item 34.

Patricia Davies (Accountable Officer, NHS Swale CCG), Ken Pugh (Cabinet Member for Community Safety and Health, Swale Borough Council) and Andrew Bowles (Leader of Swale Borough Council and KCC Member for Swale East) were in attendance for this item.

(1)      The Chairman welcomed Ms Davies to the meeting and asked her to introduce the item. Ms Davies began by explaining that the provider of the  out-of-hours contract had been changed on a temporary basis following recommendations from the Keogh Review relating to Medway NHS Foundation Trust and listening exercises with the public and Swale Borough Council. The original out-of-hours contracts were commissioned in 2010 by East Kent and West Kent PCTs where IC24 won the contracts. The contracts were due to expire in March 2014; most CCGs in Kent had extended their contract with IC24 until 2016.

(2)      Recommendations from the Keogh Review and the Emergency Care Intensive Support Team at Medway NHS Foundation Trust indicated the need for coordination of non-elected out-of-hours care in Medway and Swale. Prior to 31 March 2014, out-of-hours services in Medway were provided by Medway On Call Centre (MedOCC) whilst the service in Swale was provided by IC24; this had caused problems with inappropriate admissions and discharge.

(3)      In addition, NHS Swale CCG was encourage to look at a review of community services, community nursing and out-of-hours services as part of the Keogh Review recommendations. The CCG had held a series of engagement events and governing body meetings where members of the public raised concerns regarding the difficulty accessing IC24 services at the weekends and evening; travelling long distances to Canterbury for out-of-hours appointments and the perceived lack of access to visiting services on the Isle of Sheppey.

(4)      NHS Swale CCG had therefore transferred the out-of-hours services to MedOCC for twelve months. This would enable further public engagement and the procurement of the out-of-hours services to link up with other procurements including MIUs and Walk-In Centres. Ms Davies congratulated IC24 and MedOCC for their tireless work and reaching a solution together.

(5)      The Chairman invited Cllr Pugh and Mr Bowles to speak. Cllr Pugh explained that Swale Borough Council had worked extremely closely with the CCG to review out-of-hours and community services. As Cabinet Member for Community Safety and Health at Swale Borough Council, he fully endorsed the report and approach of the CCG to engage with the public as part of the full procurement.

(6)      Mr Bowles explained that as Leader of Swale Borough Council and Chair of the Health and Wellbeing Board in Swale he welcomed the way forward proposed by NHS Swale CCG. He believed that there would be genuine consultation with the public, the decision would not be rushed and would result in the right decision being made for Swale.

(7)      A Member asked about the NHS England review of the walk-in centre at Sheppey Hospital. The Committee had been involved with the set-up of the walk-in centre and the Member believed that this was something the  ...  view the full minutes text for item 35.

(1)       A Member highlighted concerns with engagement work carried out in Deal and questioned its replication in Folkestone.

(2)      RESOLVED that report be noted and the Chairman write to NHS South Kent Coast CCG, prior to the visit to Deal Hospital, requesting an outline of the engagement work carried out in Deal.

(1)       A Member asked for further details regarding the additional costs resulting from the contract variation with the current provider, the working group and a timescale for procurement.

(2)       RESOLVED that the e report be noted and the Chairman seek written clarification in regards to the additional costs resulting from the contract variation with the current provider, the working group and a timescale for procurement.

(1)       A Member raised concerns that non-clinical staff were redeployed on 1 April prior to the independent analysis of the consultation.

(2)       RESOLVED that the report be noted and the Chairman to write to EKUHFT to clarify the concerns raised regarding the redeployment of non-clinical staff prior to the independent analysis of the consultation.

Proposed items:

§  East Kent Integrated Care Strategy

§  East Kent Community Services Review

§  East Kent Outpatients Consultation

§  Kent and Medway NHS and Social Care Partnership Trust: Safeguarding and Dementia