Agenda and minutes

(1)       Mr Nick Chard declared a Disclosable Pecuniary Interest as a Director of Engaging Kent.

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

(3)       Mr Chris Hoare declared an interest as his son was being assessed for a statement and his wife was pregnant and receiving prenatal care from Maidstone and Tunbridge Wells NHS Trust.

(4)       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 43 - Community Care Review: NHS Ashford CCG & NHS Canterbury & Coastal CCG. The CCGs were asked to provide an update on the design of the community hubs. The paper was being drafted and would be circulated to Members informally.

(b)       Minute Number 44 - East Kent Outpatients Services: Consultation Update. The draft Minutes for this item had been circulated to EKHUFT Board and NHS Canterbury & Coastal CCG Governing Body in advance of their decision-making meetings.

(c)        Minute Number 48 - Kent Community Health NHS Trust: Community Dental Services (Written Update). KCHT was asked to produce a briefing note to clarify the percentage of local patients who were seen at the Deal Clinic and the commissioner’s view on the changes to community dental services. The briefing note was circulated to Members on 9 July 2014.

(d)       Minute Number 49 - Child and Adolescent Mental Health Services (Written Update). Michael Ridgwell was asked to co-ordinate a joint response and update on performance across the four CAMHS tiers in Kent. The paper was being drafted and would be circulated to Members informally in the week beginning 21 July 2014.

(e)       Minute Number 50 – Date of the next meeting. Following a request by a Member, Mr Gough was asked to include 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 his report to the Committee in July 2014.

(2)       The Scrutiny Research Officer requested that Minute 45 be amended to the Queen Elizabeth The Queen Mother Hospital.

(3)       RESOLVED that, subject to the amendment in paragraph (2) above, the Minutes of the Meeting held on 6 June 2014 are correctly recorded and that they be signed by the Chairman.

Mr Roger Gough (Cabinet Member for Education and Health Reform, Kent County Council) and Mr Tristan Godfrey (Policy Manager (Health), Kent County Council) were in attendance for this item.

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

·         The 2015 Challenge Declaration - NHS Confederation

·         The Initial Health & Wellbeing Strategy

·         The Refreshed Health & Wellbeing Strategy

·         Communication and Engagement Plan

·         Local Health and Wellbeing Boards

·         The complexity of the Kent landscape

·         Integration Pioneer programme

·         Better Care Fund

(2)       At the 6 June meeting, a Member of the Committee 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 Mr Gough’s presentation. Mr Gough gave an overview of the local Health and Wellbeing Boards in Kent. He explained that there was a distinctive set up in Kent with seven CCGs running across 12 local authority boundaries and three health economies. He highlighted the proposed merger between NHS Ashford CCG and NHS Canterbury & Coastal CCG.

(3)       Mr Gough explained that there was a developing relationship between the Kent Health and Wellbeing Board and the local Health and Wellbeing Boards. There was a mandate for local Health and Wellbeing Boards to look at national issues or particular areas such as falls and develop local strategies. The Kent Fire & Rescue Service presented to the Kent Health and Wellbeing Board in July about their contribution to health and wellbeing of Kent which would be taken forward by local boards.

(4)       Mr Gough explained that Local Health and Wellbeing Board were key stakeholders in the development of the refreshed strategy. As part of the communication and engagement plan, the local Health and Wellbeing Boards would be engaging with their local populations and reporting back to Kent Health and Wellbeing Board in November 2014. A number of local Health and Wellbeing Boards inputted into the Better Care Fund and reviewed local commissioning plans. Local Health and Wellbeing Boards had mixed economies with Chairs ranging from KCC Cabinet Members, District Council Leaders and CCG Chairs.

(5)       The Chairman invited Mr Bowles, a guest of the Committee, to speak. As the Chair of the Swale Health and Wellbeing Board, he raised concerns about financial and staffing pressures on the borough council to facilitate the local Health and Wellbeing Board in particular attendance at additional meetings and leading on public consultation. Mr Gough acknowledged the difficulties Swale faced in covering two CCG areas. He explained that he did not expect borough and districts to lead on consultations. It was for the CCGs to consult on their commissioning plans and the communication and engagement for the refreshed Health and Wellbeing Strategy was being led by KCC.

(6)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A Member raised a concern about  ...  view the full minutes text for item 53.

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust), Avey Bhatia (Chief Nurse, Maidstone and Tunbridge Wells NHS Trust) and Jayne Black (Director of Strategy & Transformation, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee and asked them to introduce the item. Mr Douglas began by giving an overview of the developing five-year strategy.

(2)       Mr Douglas stated that the biggest challenge for the clinical strategy was financial viability. The Trust was required to make an annual 5% cost improvement programme consistently over five years which was a quarter of current income. The Trust employed 5,500 staff which accounted for 80% of cost. The Trust was focusing on efficiency and a reduction of in non-elective activity to achieve financial viability. This would enable them to create capacity and deliver elective or full price non-elective care to a wider population. The Trust only received 30% of the tariff for emergency activity in excess of emergency activity in 2009 which cost the Trust £9 million each year.

(3)       He explained that the seven key drivers for change were identified:

1.    Quality issues to ensure sustainable clinical services such as the proposed development of the first hyper acute stroke unit in Kent by the Trust;

2.    Major financial challenges over the next five years;

3.    NHS West Kent CCG’s funding gap of £60 million by 2018/19;

4.    Predicted increases in demand for emergency non-elective services as the population gets older and lives longer; 

5.    Changes in technology to improve quality and efficiency;

6.    Workforce deficiencies;

7.    National recommendations including Sir Bruce Keogh’s recommendations to introduce seven day working and two levels of hospital emergency department: Emergency Centres and Major Emergency Centres. The Trust would like to establish one of two/three Major Emergency Centres identified for Kent.

(4)       He informed the Committee that a Clinical Strategy Group had been established which identified the four major work streams required to develop the strategy: emergency care; centres of excellence; seven day working; and integration & collaboration.

(5)                   He |highlighted the key messages from the strategy. The Trust needed to improve efficiency and productivity within the next two years including a reduction in the length of stay to below the national average. The Trust planned to redesign emergency pathways to achieve a reduction in non-elective activity and release 50% of capacity for other services. The Trust was aligning to West Kent’s five year commissioning strategy and engaging with local partners.

(6)       He stated that engagement with local partners included the Trust’s work with the Queen Victoria Hospital NHS Foundation Trust to establish a major hub at Maidstone Hospital. The Trust was working with Brighton and Sussex University Hospitals NHS Trust and High Weald Lewes Havens CCG to look at providing additional services at the Tunbridge Wells Hospital. The Trust was also in discussions with Medway NHS Foundation Trust to move some elective care to  ...  view the full minutes text for item 54.

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust), Avey Bhatia (Chief Nurse, Maidstone and Tunbridge Wells NHS Trust) and Jayne Black (Director of Strategy & Transformation, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee and asked them to introduce the item. Ms Bhatia began by giving an overview of the three CQC inspections, which had taken place since November 2013. The inspections took place unannounced in November 2013 at the Tunbridge Wells Hospital, in February 2014 at Maidstone Hospital and in April 2014, which looked at safeguarding in North and West Kent. The Trust believed that the Royal College of Surgeons report was the trigger for the CQC inspections.

(2)       Ms Bhatia stated that the main theme of the inspections was the provision of paediatric services. A concern highlighted in the Maidstone Hospital inspection was the shortage of paediatric-trained nurses in A&E which was a national issue.  The Trust was reviewing the emergency care pathways for children to enable a separate emergency paediatric and adult pathway at both sites. The Trust was exploring the option of a dedicated paediatric A&E department at Tunbridge Wells Hospital.

(3)       Ms Bhatia explained that other issues identified in the inspection report, including governance, had been developed into a 20-point action plan with the CQC to deliver improvements. The improvement plan was updated monthly and shared with the CQC. The Trust was expecting a re-inspection towards the end of the year under the new model of inspection to assess compliance with CQC standards. 

(4)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A specific question was asked about the recruitment of paediatric-trained A&E nurses. Ms Bhatia explained that paediatric-trained A&E nurses wanted to work in dedicated paediatric emergency department rather than in a mixed model. Ms Bhatia stated that when the model changed to a dedicated emergency paediatric unit, the Trust would be able to recruit. The CQC had become prescriptive about the recruitment of paediatric-trained A&E nurses to all Trusts.  Mr Douglas explained that Tunbridge Wells had a fully staffed paediatric unit with paediatricians and paediatric nurses, which received good shortlists when jobs were advertised. A rotation of staffing between the proposed emergency paediatric department and paediatric unit at Tunbridge Wells was being considered.

(5)       Mr Angell thanked the guests for facilitating a visit to Maidstone Hospital with Miss Harrison in November 2013.  He explained that he had recently met with the Trust’s Finance Director who had stated that a high proportion of patients at both sites had dementia and he enquired about dementia training for staff. Ms Bhatia explained that there was lots of training for staff on dementia. Engaging with family members and carers was essential as they knew the needs of the patients. The Trust had introduced the ‘This Is Me’ booklet,  ...  view the full minutes text for item 55.

Ian Ayres (Accountable Officer, NHS West Kent CCG) was in attendance for this item.

(1)       The Chairman welcomed Mr Ayres to the Committee and asked him to introduce the item. Mr Ayres began by updating the Committee on NSL’s performance. He explained that although there had been an improvement in the transport of renal patients, the rest of the service’s performance had flat lined for three months.

(2)       Mr Ayres explained that the contract with NSL was a standard NHS contract; the contract was for three years with two twelve-month extension periods. There were two clauses for early termination: a no fault termination by either party to terminate the contract early with a twelve month notice period or termination by one of the parties, with immediate effect, if the contract had been breached including the persistent and repetitive breach of a quality requirement. Although the CCG believed that NSL had breached the quality requirement; if this route was pursued by the CCG, it was likely that there would be a legal challenge by NSL to determine a breach.

(3)       Mr Ayres confirmed that the CCG was reviewing the contract with procurement experts. As a large and significant contract, it would need to be re-procured with an advert in the European Journal. It would be a full procurement lasting a minimum of 12 – 15 months and a maximum of 18 months. This would mean that the earliest the contract would be re-procured was nine months before the contract expired.

(4)       Mr Ayres stated that the CCG would be in a position to talk publically about the future of the contract by September following discussions with NSL and the acute trusts. There were no providers who would be able to deliver the Kent and Medway contract immediately. NSL was now the biggest Patient Transport Services (PTS provider) in the country. It had grown from a small to large company in five years. Mr Ayres raised concerns about the rapid growth of the company and local leadership. Mr Ayres noted that the specification would be revised in advance of procurement at which time the  CCG would ask the Committee if it views the changes as a substantial variation of service.

(5)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A Member raised a concern about the quality of the contract. Mr Ayres explained that in the first three – six months there was a range of problems with the quality of the contract; these had been remedied and resolved by December 2013. For the last six months, there was no explanation for NSL’s performance; the road networks, geography, staff and vehicles did not hinder performance.

(6)       A specific question was asked about the achievability of the contract. Mr Ayres explained that the CCG had looked at targets set, by other CCGs, for PTS providers; the targets for NSL were reasonable and achievable. It was difficult to compare NSL to the service before;  ...  view the full minutes text for item 56.

Bill Miller (Chief Operating Officer, NHS Ashford CCG & NHS Canterbury & 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 Miller to the Committee and asked him to introduce the item. Mr Miller began by outlining the key points in the NHS Canterbury & Coastal CCG paper. Since discussions with HOSC in November 2013, the CCG had worked with the local community through a steering group to explore alternative ways of delivering services at the Minor Injuries Unit (MIU). The recommendations of the steering group were supported by the CCG at its governing body meeting in June. The CCG was in discussions with providers to deliver the new service specification. The specification included direct access x-ray to enable more patients to be seen and treated which was more attractive to providers. The CCG was grateful for the support of the local community and the current provider IC24. The new service would commence in April 2015.

(2)       The Chairman invited the local Members, Mr Bowles and Mr Gates, to speak. Mr Bowles explained that the local community was pleased with the outcome. He hoped that a provider would be found to deliver the services. He was grateful to the CCG for listening but expressed concern about how close the MIU had been to shutting. He thanked the Committee for their intervention and sincere support. In addition, he thanked the Cabinet Member for Community Safety and Health at Swale Borough Council and the Mayor of Faversham.

(3)       Mr Gates thanked the Committee, Chairman and staff for keeping him informed and updated. He was grateful to the Committee for their hard work in preventing the MIU’s closure. He supported the new specification but enquired if the x-ray activity could be increased in the future.

(4)       Mr Miller responded to the comments made by local Members. He explained that in Faversham a community network had been developed with local people and the CCG. The network had stimulated discussion and enabled future services to be planned collaboratively with the local community. The CCG was hoping to develop similar networks across the Ashford and Canterbury & Coastal areas. In regards to the extension of x-ray services in the future, it was explained that additional services would be dependent on demand from patients.

(5)       A Member highlighted the positive impact the Committee had. The importance of communication with the local community was stressed. A comment was made about contract specification; CCGs were encouraged to ask KCC if they required assistance with contract writing and monitoring.

(6)       Mr Inett was invited to speak about the report submitted by Healthwatch Kent. He explained that Healthwatch had powers to conduct ‘Enter and View’ visits. Healthwatch Kent had attended the steering group meetings and wanted to gain additional insight by visiting the MIU. The visit was conducted on Saturday 31 May during the MIU’s busiest time. The staff  ...  view the full minutes text for item 57.

(1)       The Committee received a report from NHS England (Kent and Medway) regarding the future of services at Dover Medical Practice. The paper set out two options available to NHS England to ensure the continued provision of local GP services to patients which requested the Committee to confirm its views on each of the options.

(2)       A Member noted that the Committee had been informed that the provider, Concordia Health Limited, had also requested that their contract at The Broadway, Broadstairs be terminated early.

(3)       Another Member asked for clarification regarding the status of Dover Medical Practice as one of 13 practices in Dover and Folkestone to pilot extended and more flexible access to GP services as part of the Prime Minister’s Challenge Fund.

(4)       A number of comments were made about the sustainability of GP services in Kent. Mr Ridgwell explained that sustainability of primary care was a national issue. Dr Parks stated that there were an increasing number of practices that had requested their contract be terminated early. Also General Practice had become unattractive to providers, junior doctors and medical students. Dr Parks was concerned about the capacity for patients to register with an alternative local GP practice.

(5)       A Member made a comment about the use of interpreters at GP consultations and asked whether patients should be encouraged to bring someone with them to interpret. Mr Ridgwell explained that it was not always appropriate for a family member to attend and interpret due to the personal nature of the matters to be discussed. He confirmed that interpreting services were available at all GP practices and the cost was funded by NHS England.

(6)       RESOLVED that the report be noted, NHS England (Kent and Medway Area Team) take note of the comments made during the meeting and it be noted that there would be a wider discussion on General Practice and the development of services at the next meeting.

Proposed items:

§  Medway NHS Foundation Trust: Update

§  NHS England: General Practice and the development of services

§  East Kent Outpatients Services

(1)       The Chairman confirmed that Patient Transport Services would return to the Committee in September 2014.

(2)       A Member requested fewer items on the next Agenda to allow time for discussions on General Practice and the development of services.