Agenda and minutes

(1)      Mr Nick Chard declared a Disclosable Pecuniary Interest as a Director of Engaging 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)       The Scrutiny Research Officer updated the Committee on the following actions that had been taken:

(a)       Minute Number 35 - Redesign of Community Services and Out-of-Hours Services – Swale. NHS Swale CCG had been asked for the proposed dates for procurement, public consultation and the board meetings to enable the development of a timetable to be agreed between HOSC and NHS Swale CCG.  A response was awaited.

(b)       Minute Number 36 - Folkestone Walk-In Centre: Written Update. a response from NHS South Kent Coast CCG regarding engagement activity in Deal on 24 April had been circulated to Members of the Committee.

(c)        Minute Number 38 - East Kent Outpatients Consultation: Written Update. The Chairman had written to EKHUFT to clarify concerns raised regarding the redeployment of non-clinical staff prior to the independent analysis of the consultation. A response had been circulated to the Committee on 5 June 2014.

(2)       RESOLVED that the Minutes of the Meeting held on 11 April 2014 are

correctly recorded and that they be signed by the Chairman.

(1)       Members of the Health Overview and Scrutiny Committee are asked to note that:

(a)       Mr Hoare has replaced Mr Latchford as a UKIP representative on this Committee.

(b)       Mr Elenor has replaced Mr Crowther as the UKIP group spokesperson on this Committee.

(1)       The Committee noted that:

(a)          Mr Hoare had replaced Mr Latchford as a UKIP representative on this Committee.

(b)          Mr Elenor had replaced Mr Crowther as the UKIP group spokesperson on this Committee.

(c)          Cllr Burden (Gravesham Borough Council) had replaced Cllr Woodward (Tunbridge Wells Borough Council) as a borough representative on this Committee.

(d)          Cllr Davison (Sevenoaks District Council) had replaced Cllr Spence (Tonbridge & Malling Borough Council) as a borough representative on this Committee.

Simon Perks (Accountable Officer, NHS Ashford and NHS Canterbury and Coastal CCGs) was in attendance for this item.

(1)       The Chairman welcomed Mr Perks to the meeting and asked him to introduce the item. Mr Perks thanked the Committee for the opportunity to present the community care review undertaken by NHS Ashford CCG and NHS Canterbury and Coastal CCG.

(2)       Mr Perks noted that he had recently attended the NHS Confederation conference; a major theme of the conference had been the importance of community services. The review of health and social care services provided within a community setting was the CCGs response to this challenge. 

(3)       He explained that NHS Ashford CCG and NHS Canterbury and Coastal CCG were committed to providing health services closer to people’s homes. The CCGs had inherited a significant number of community-based contracts covering a number of different services. To ensure that these services were high quality, value for money and fit for the changing health needs the CCGs had initiated a review of a cross-section of these services. The review was carried out in the broader context of tighter healthcare budgets and an ageing population. It had been acknowledged that efficiencies would not meet these needs; new ways of care, both formal and informal, would need to be introduced. A joint appointment of a programme manager had been made by the CCGs and Kent County Council to lead this work. Mental health and children’s services were excluded to make the scope of the project manageable.

(4)       The review focused on actions which could be taken tactically to remove duplication of payments (without directly affecting services) and the strategic options for improving the commissioning of community-based services. Five work streams were identified:

1.    Contracting and Procurement

2.    Customer and Market Analysis

3.    Finance and Information

4.    Patient and Public Engagement

5.    Quality and Safety

(5)       Two key findings of the review were highlighted. Physiotherapy services were predominately used by adults of working age rather the frail and the elderly. More community spend did not mean better outcomes or improved patient experience; Canterbury spent more than £10 million on community services than Ashford but the quality of service was found to be the same.

(6)       Community services principles were established, based on the findings of the review, to underpin commissioning of community-based services in the future. The principles were service development; market development; contracting and procurement; and performance management. 

(7)       A draft framework for commissioning community-based services was developed to ensure that health, social care and voluntary services were based around individuals and the communities they live and work. The framework had been termed Community Hubs and would be based around clustering of GP practices and local communities which the CCGs service. The CCGs would commission an integrated suite of health, social and voluntary services from local providers within a defined budget with more service-user centric outcomes. Selection and design of these services would be carried out in partnership with local patients, services users, provider and  ...  view the full minutes text for item 43.

Simon Perks (Accountable Officer, NHS Ashford and NHS Canterbury and Coastal CCGs), Liz Shutler (Director of Strategic Development & Capital Planning, East Kent Hospitals University Foundation Trust), Rachel Jones  (Director of Business and Strategy Development, East Kent Hospitals University Foundation Trust) and Marion Clayton (Divisional Director, Surgical Services, East Kent Hospitals University Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Shutler introduced the item and proceeded to give a presentation which covered the following key points:

·         The Trust’s justifications for change

·         Consultation and engagement process

·         Feedback from patients

·         Outpatient Services Strategy

·         The six proposed Outpatients sites

·         Option appraisal for the North Kent site

·         Next steps - decision-making at the EKHUFT and CCG boards

(2)       The Chairman asked Miss Harrison to comment on the optional appraisals which she attended on behalf of the Committee on 22 April and 29 May. Miss Harrison observed that she had been impressed and surprised by the thoroughness of each appraisal. The final option appraisal in May was held following the receipt of information from NHS Property services.

(3)       Mr Inett was also invited to comment. He explained that Healthwatch Kent had been working with the Consultation Institute; they had been using the consultation as a test case to look at their role as a critical friend. The focus of the consultation by the Trust had been on Landsley’s four tests for service reconfiguration. Mr Inett highlighted that if there was a legal challenge, the Gunning Principles would be applied instead. One of the Gunning Principles was that consultation must take place when the proposal was still at a formative stage. Mr Inett requested additional information regarding the public’s involvement in option development. He also sought clarification about the support for six outpatients’ clinics (question 7 on page 59 of the agenda pack) and the involvement of minority groups in focus groups. Mr Inett commented that the consultation focused on the North Kent site and that Healthwatch had been made aware of concerns from the public regarding the effectiveness of the one stop shop process. Healthwatch Kent was looking at one stop shops across the country. Healthwatch Kent were meeting with the Trust to discuss issues in detail.

(4)       Ms Shutler responded to the comments and questions raised by Mr Inett. It was explained that the six sites were modelled technically looking at patients, travel times and demographics of the local communities. Patient and professional representatives were on the working group which developed the outpatients’ strategy; patient surveys and public stakeholder meetings were also held. Concerns had been raised by elderly groups about the time appointments would take and facilities at the one stop shop. The Trust stated that giving more power to patients to book appointments would improve the flow and patient experience. The Trust commissioned the University of Kent to undertake the focus groups; the outcomes of these focus groups were detailed in the report. During the consultation period, the Trust was  ...  view the full minutes text for item 44.

Liz Shutler (Director of Strategic Development & Capital Planning, East Kent Hospitals University Foundation Trust), Rachel Jones  (Director of Business and Strategy Development, East Kent Hospitals University Foundation Trust) and Marion Clayton (Divisional Director, Surgical Services, East Kent Hospitals University Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee and asked them to introduce the item. Marion Clayton began by updating the Committee on the Trust’s service reconfiguration of adult high risk and emergency general surgery.

(2)       A broad definition of high risk surgery was given: patients with a predicted mortality rate of 5%; patients undergoing emergency abdominal procedures, major gastric and bowel surgery; patients over 50 undergoing emergency redo surgery; and acute patients with comorbidities including renal, cardiac, respiratory and thoracic conditions. A number of examples were identified including laparotomy, removal of the spleen, gall bladder and appendix.

(3)       Members were reminded that the Trust had presented their clinical strategy to the Committee in June 2013. A number of options for the provision of high risk and emergency general surgery were presented to the Committee including the centralisation of surgery and a potential hub and spoke model.

(4)       In 2012 the Trust invited the Royal College of Surgeons (RCS) to assess and review surgical service provision.  The RCS had found that the Trust was not providing a continuity of care for patients due to the provision of high risk surgery at three acute sites with different on call models and a mix of appropriately skilled substantive and locum surgeons. The RCS made a number of recommendations including the provision of continuity of care for patients and the recruitment of substantive posts.

(5)       The Trust took on board the recommendations and identified the need to centralise high risk surgery at the Kent and Canterbury Hospital on an interim basis with a robust on call service. This would enable the Trust to provide continuity of care and expertise on a single central site. In January 2014, the Trust began a review into how this model would be delivered. A number of significant risks were identified including the transfer of patients to a central hub in Canterbury; the provision of beds in the Intensive Care Unit (ICU), the High Dependency Unit (HDU) and wards; and the requirement for additional theatre space. The Trust concluded that the centralisation of surgery would not meet the timescale for implementation.

(6)       An interim solution was presented to the Trust Board by surgeons from the William Harvey Hospital and the Queen Elizabeth Queen Mary Hospital.  The surgeons proposed a 1 in 8 model with 8 surgeons with the appropriate skills at each site providing an on call Monday – Friday rota.

(7)       The Trust identified a number of risks with the proposed model; there were concerns that, without additional recruitment, patients would not receive continuity of care from a consultant with the appropriate skills. The Trust revised the proposal to a 1 in 8 model on a 4:3  ...  view the full minutes text for item 45.

(1)       RESOLVED that the Committee note the report.

(1)       RESOLVED that the Committee note the report.

(1)       A Member asked for clarification regarding the percentage of local patients who were seen at the Deal Clinic and the commissioner’s view on the changes to community dental services.

(2)       RESOLVED that the report be noted and that written clarification circulated to the Committee in regards to the percentage of local patients who were seen at the Deal Clinic and the commissioner’s view on the changes to community dental services.

Michael Ridgwell (Director of Commissioning, Kent and Medway Area Team, NHS England) was in attendance for this item.

(1)       The Chairman informed the Committee that he had received a letter from Julian Brazier, who had also written to the Secretary of State and received a similar response. Mr Brazier had expressed his thanks to the Committee for their work to highlight this issue.

(2)       Members requested an update on waiting times for assessment and initial treatment & the quality and outcome of treatment. Mr Ridgwell offered to co-ordinate a joint response and update on performance across the four tiers of the service.

(3)       RESOLVED that the Committee note the report and it was noted that Mr Ridgwell would co-ordinate a joint response and update on performance across the four tiers of the service.

Proposed items:

§  Kent Health and Wellbeing Strategy: Update

§  Maidstone and Tunbridge Wells NHS Trust: Service Development

§  Patient Transport Services

(1)       A Member made a comment about the use of acronyms in the NHS reports. The Scrutiny Research Officer undertook to remind NHS colleagues to avoid the use of acronyms in their reports to the Committee.

(2)       The Chairman confirmed that Faversham MIU would return to the Committee in July 2014.

(3)       A Member requested an update on the local Health and Wellbeing Boards' relationship with the Kent Health and Wellbeing Board and the input of local Boards into the Kent Health and Wellbeing Strategy as part of the proposed agenda item on the Kent Health and Wellbeing Strategy for July. The Chairman undertook to ask Mr Gough to include this in his report to the Committee in July 2014.