Agenda and minutes

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

(2)      Cllr Michael Lyons declared an 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 43 - Community Care Review: NHS Ashford CCG & NHS Canterbury & Coastal CCG. The CCGs had been asked to provide an update on the design of the community hubs.  An update email was circulated to Members on 20 August. A paper was being drafted and would be circulated to Members after public events in September.

(b)       Minute Number 49 - Child and Adolescent Mental Health Services (Written Update). Michael Ridgwell (NHS England (Kent and Medway Area Team)) had co-ordinated a joint response and update on performance across the four CAMHS tiers in Kent. The response was circulated to Members on 24 July.

(c)        Minute Number 53 - Kent Health & Wellbeing Board: Update and Strategy. In response to a question about statistical variances in the report and the utilisation of libraries and gateways, Mr Gough stated that he would need to check the differences in the statistics and would provide additional information on the utilisation of libraries and gateways. Responses were circulated to Members on 1 and 3 September.

(d)       Item 58 - Future of Services at Dover Medical Practice. A  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. Responses from NHS England (Kent and Medway Area Team) were circulated to Members on 24 July and 15 August.

(2)       The Scrutiny Research Officer requested that the following sentence be added to Minute 53: 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.

(3)       Mr Hoare requested that the following sentence be added to Minute 53: A Member made a comment about the number of people in Kent who could be potentially affected by the Assisted Dying Bill. Mr Gough stated that he was unable to provide a definitive answer as the Bill was going through its parliamentary passage. 

(4)       RESOLVED that, subject to the amendment in paragraph (2) and (3) above, the Minutes of the Meeting held on 18 July 2014 are correctly recorded and that they be signed by the Chairman.

Dr Phillip Barnes (Acting Chief Executive, Medway NHS Foundation Trust), Patricia Davies (Accountable Officer, NHS Swale CCG), Fiona Armstrong (Clinical Chair, NHS Swale CCG) and Gillian Wells (Governing Body Independent Lay Member, NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Barnes began by giving an overview of the last 15 months. As a Trust investigated by the Keogh Mortality Review, the Trust was inspected in June 2013. A Quality Improvement Plan (QIP) was developed in response to the inspection report and had been worked through by the Trust and external stakeholders. A re-inspection took place in April 2014 and the inspection report was published on 8 July. The Trust was rated as inadequate with particular concerns about emergency and surgical services.

(2)       Dr Barnes highlighted a number of themes from the report including leadership instability; over the last 18 months there had been 32 different board members. It was announced that the Council of Governors had appointed Shena Winning as the new Chairman of the Trust on Thursday 4 September. Interviews for a substantive Chief Executive would take place at the end of October. A new management structure will be introduced which would include a Chief Operating Officer. The Trust was receiving best practice guidance and support from University Hospitals Birmingham NHS Foundation Trust with its management and governance structure. The Trust had produced a very detailed action plan in response to the CQC inspection report. The action plan detailed proposals to improve staff engagement and ownership; and surgical leadership with seven day working for consultants.

(3)       It was reported that a further unannounced inspection of the emergency department by the CQC took place in August. In response to the inspection, the Trust had implemented a support team to challenge and hold the emergency department to account; changed the front of house assessment process; and made improvements to discharge as part of seven day working. The Trust had also received advice and guidance from Homerton University Hospital NHS Foundation Trust in Hackney.

(4)       The Chairman invited Ms Davies to speak. Ms Davies explained that  NHS Swale CCG’s concerns were with the speed and pace of delivery at the Trust. The CCG was working very closely with the Trust, Monitor, CQC, NHS England, NHS Medway CCG and wider CCGs to make improvements and reduce pressure on the Trust. NHS Swale CCG had released additional funds to extend the Integrated Discharge Team, provided nursing and quality support and expanded psychiatric liaison. She stated that NHS Swale CCG was using its commissioner levers to engender change; Monitor the regulator for NHS Foundation Trusts had the jurisdiction to enforce regulatory measures.

(5)       The Chairman invited Mr Bowles, a local Member, to speak. He thanked Dr Barnes for his openness at the meeting with HOSC and at a briefing with Swale Borough Council.

(6)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A question  ...  view the full minutes text for item 62.

Stuart Bain (Chief Executive, East Kent Hospitals University NHS Foundation Trust), Julia Bournes (Head of Outpatients, East Kent Hospitals University NHS Foundation Trust) and Mary Tunbridge (Divisional Director for Clinical Support Services, East Kent Hospitals University NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Bain began by expressing his disappointment with the CQC inspection report. He recognised that a number of improvements were required and were being addressed including engagement with staff, capacity, outpatient services and the quality of estate. He highlighted the caring nature of staff which was praised in the inspection report; in addition to the excellent mortality rates and clinical outcomes delivered by the Trust. Mr Bain welcomed the opportunity to share and discuss the action plan with the Committee on 10 October.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member welcomed the opportunity to discuss the Trust’s action plan at the October meeting. He stated that he was not surprised with the CQC’s findings from the anecdotal experiences of his constituents. He had concerns about the number of qualified staff but recognised their caring and compassionate nature.

(3)       A Member enquired if the Trust would receive any additional money as a result of being placed into special measures. It was explained that the Trust would not receive any additional money. Monitor would appoint an external Improvement Director and buddy Trust who would provide guidance and support in areas of weakness by the end of September. The Trust would be subject to enhanced monitoring each month to check the progress of the action plan.

(4)       Cllr Lyons, a Governor of East Kent Hospitals University NHS Foundation Trust, informed the Committee that the Governors of the Trust had written a report to Monitor and the Health Service Journal with their concerns about the CQC inspection report. He stated that the Governors were united and supportive of the Trust.

(5)       The Chairman invited Mr Bowles, a local Member, to speak. He thanked the Committee for putting this item on the Agenda and the guests for attending at short notice. Mr Bowles enquired if the Monitor appointed Improvement Director would be available to speak with the Committee. Mr Bain explained that the Terms of Reference for the Improvement Director were decided by Monitor; he stated he would feedback the comments to Monitor.

(6)       RESOLVED that the report be noted, the Trust take note of the comments made by Members during the meeting and be invited to attend the October meeting of the Committee.

Stuart Bain (Chief Executive, East Kent Hospitals University NHS Foundation Trust), Julia Bournes (Head of Outpatients, East Kent Hospitals University NHS Foundation Trust), Mary Tunbridge (Divisional Director for Clinical Support Services, East Kent Hospitals University NHS Foundation Trust) and Simon Perks (Accountable Officer, NHS Canterbury & Coastal CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Tunbridge began by giving an update on East Kent Outpatients Consultation. The outcome of the consultation was discussed at the East Kent Hospitals University NHS Foundation Trust (EKHUFT) Board in June 2014 and NHS Canterbury & Coastal CCG Governing Body in July 2014. Both the Board and Governing Body agreed to implement the new outpatient strategy at their respective meetings.

(2)       Following the decision to implement the strategy, mobilisation of the strategy had commenced.  A number of developments were outlined including the opening of the new Dover Hospital in March 2015 and the implementation of extended working days and Saturday clinics. Further engagement would be undertaken through NHS Canterbury & Coastal CCG’s proposed community networks. 

(3)       The Chairman invited Mr Gates and Mr Bowles, local Members, to speak. Mr Gates highlighted a letter circulated to the Committee by Save Faversham Hospitals which asked the Committee to recommend that the decision be deferred until the town Community Networks were in place and local health needs had been identified.

(4)       Mr Bowles stated he disagreed with decision to implement the outpatient strategy. He raised concerns about the centralisation of services and the Trust’s decision to subsidise public transport.

(5)       Mr Bain responded to the comments made by the local Members. He stated that facilities were poor at the 15 outpatients’ sites. The delivery of services at six fit for purpose sites would increase capacity with extended opening hours and Saturday clinics. It would also enable patients to receive their assessment, diagnostic tests and treatment plan on the same day at a one stop clinic.He stated that Kent was a challenging area to serve with its rural populations; some patients would face difficulty in reaching services wherever they were located. 80% of patients would access outpatients’ services in a car either by driving themselves or being driven by a relative or carer. The Trust had been in detailed negotiations with Stagecoach to subsidise £450,000 of public transport to improve access.

(6)       Miss Harrison reminded Members that she had  attended the two option appraisals for the North Kent site on behalf of the Committee. She stated that the process was extremely fair with no bias in favour or against a particular site.

(7)       Dr Eddy enquired about the transfer of outpatient services from Deal Hospital to Buckland Hospital. It was explained that acute services would move after the opening of Buckland Hospital in March 2015. The services would transfer as quickly as possible. The Scrutiny Research Officer agreed to arrange a meeting with Dr Eddy and NHS South Kent Coast CCG to discuss the future of services at Deal Hospital.

(8)  ...  view the full minutes text for item 64.

Geoff Catling (Programme Director, Estates, SECAmb), Sue Skelton (Deputy Director of Operations, SECAmb), Chris Stamp (Senior Operations Manager (Kent), SECAmb), Janine Compton (Head of Communications, SECAmb) and Patricia Davies (Accountable Officer, NHS Swale CCG) were in attendance for this item.

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

§  The future of the Emergency Operations Centres (EOC)

§  Drivers for reconfiguration

§  Proposals for reconfiguration

§  Preferred option – Two Emergency Operations Centres

§  Initial Engagement Plan

(2)       Ms Davies explained that NHS Swale CCG was the host commissioner of ambulance services on behalf of 22 CCGs and the resident population of 4.6 million people in Kent; Medway; Surrey; East and West Sussex; Brighton and Hove; and North East Hampshire. She stated that the CCG welcomed the SECAmb review of operational arrangements and the engagement that they were undertaking.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about collaboration with other emergency services. Mr Catling explained that SECAmb had been working closely with Surrey County Council on a project which looked at the collaboration of emergency services. Their research had found that in Surrey, only 0.9% of SECAmb responses were attended by another emergency service and 0.16% with both Fire & Rescue and Police. SECAmb were looking at the benefits of collaboration with Kent Fire & Rescue and Kent Police.

(4)       A question was asked about the two options which were not chosen: the retention of three EOCs and the implementation of one large central EOC. Ms Compton explained that it would be expensive to retain three EOCs and they would be unable to expand due to limited space. It was stated that one EOC would not be resilient in the event of system failure. Under the proposed two EOC configuration, Mr Catling confirmed that both sites would be located on different parts of the BT Super Highway and National Grid which would make the EOCs super-resilient. Ms Skelton explained that in the event of system failure at one EOC, the other would be able to respond immediately.

(5)       In response to a specific question about establishing a Centre of Excellence, it was explained that the EOC was already a Centre of Excellence. Under the proposals, there would be one Emergency Operations Centre which would operate over two locations in state of the art buildings. Clinical outcomes for patients and training for staff would be the same at each site. It was highlighted that staff at EOCs were highly trained and the Trust wanted to retain as many skilled staff as possible. If the Trust moved to one EOC, it was stated that this could affect some highly skilled staff.

(6)       RESOLVED that guests be thanked for their attendance at the meeting, that they be requested to take note of the comments made by Members during the meeting  ...  view the full minutes text for item 65.

(1)       The Committee received a report from NHS West Kent CCG which provided an update on the performance of the Patient Transport Services contract held by NSL Kent.

(2)       RESOLVED that the report be noted and that CCG colleagues be invited to attend the November meeting of the Committee.

(3)       The meeting adjourned until 13.30.

Stephen Ingram (Head of Primary Care, Kent & Medway Area Team, NHS England), Dr Mike Parks (Medical Secretary, Kent LMC) and Dr John Allingham (Medical Secretary, Kent LMC) were in attendance for this item.

(1)       The meeting reconvened at 13.30. The Chairman welcomed the guests to the Committee. Members of the Committee then proceeded to ask a number of questions and made a number of comments.

(2)       A Member enquired about the challenges of general practice. Mr Ingram explained that the role of the GP had changed with multi factorial challenges which included running a business; maintaining professional accreditation; complying with regulations; involvement with CCGs in addition to providing services to patients.

(3)       A question was asked about succession planning. Mr Ingram stated it was extremely difficult to replace GPs on a like-for-like basis. Health Education England had set a target for 50% of all medical students to become GPs but this was not producing GPs as quickly as they were required. Dr Parks stated that the Kent LMC was actively discussing the fragility of the service and the importance of succession planning with practices.

(4)       Mr Ingram and Dr Parks stressed the importance of the wider primary care team in managing GP workload. The use of nurse practitioners to deliver care for long term conditions; accreditation for community pharmacists and nurse practitioners to independently prescribe; and the introduction of physician associates, science graduates who complete two years of intense training, to support GPs in the diagnosis and management of patients were discussed.

(5)       Dr Parks explained that Health Education Kent, Surrey and Sussex had identified recruitment to primary care as a key issue for the Deanery in particular the shortage of nurses in primary care. Dr Parks acknowledged that nurses in training had little experience of primary care. The Deanery was establishing community networks to provide mentoring and training for nurses in order to make it easier for them to move from acute to community roles.

(6)       A number of comments were made about holistic care and GPs directly employed by the NHS. Dr Parks explained that GPs were generalists and closest to providing holistic care. He stated that the average consultation time had increased to 12 minutes. The Royal College of General Practitioners was campaigning for 15 – 20 minutes consultations as patients were attending with multiple problems. As part of a holistic approach, multiple problems could be assessed over a number of consultations with the most important being dealt with first. Mr Ingram stated than in his experience GPs directly employed by the NHS had not worked well.

(7)       In response to a specific question about sustainability, Mr Ingram explained that the current model of general practice was not sustainable. Proposals for a new model of general practice included the introduction of place based services whereby an integrated team including GPs could provide health and social care for their local populations. He stated that CCGs were developing community hubs, based around a clustering of GP practices and  ...  view the full minutes text for item 67.

Proposed items:

• Child and Adolescent Mental Health Services (CAMHS)
• West Kent Primary Care: Urgent and Emergency Provision
• Dermatology Redesign: North and West Kent
• CQC Inspection: East Kent Hospitals University Foundation Trust

(1)       The Chairman confirmed that CAMHS Tiers 1, 2 & 3 would return to the Committee on 10 October 2014.

(2)       A number of Members raised concerns about the CQC and their inspection regime. A Member enquired if there was a strategic overview of quality issues in Kent. Mr Inett noted that a joint report on quality issues by Healthwatch Kent and Roger Gough would be taken to the Health and Wellbeing Board on Wednesday 17 September. Mr Godfrey confirmed that there was a HOSC section in the report which gave examples of the Committee’s consideration of quality issues. It was agreed the Scrutiny Research Officer would circulate the paper to the Committee when the Agenda was published on Tuesday 9 September.