Agenda and minutes

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

(2)       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 which 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. An update paper on the Community Care Review was circulated to Members on 4 November 2014.

(b)       Minute Number 67 – NHS England: General Practice and the development of services. A meeting has been arranged for the working group to meet with Professor Tavabie (Interim Dean Director, Health Education Kent, Surrey & Sussex) in February 2015.

(c)        Minute Number 71 – Child and Adolescent Mental Health Services (CAMHS) – Tiers 1, 2 & 3. On 31 January 2014 HOSC requested that  NHS West Kent CCG to identify an outstanding trust to assess improvements that could be made in the way in which the Sussex Partnership Trust was carrying out the Kent and Medway CAMHS contract and to report back to the Committee.

Oxford Health NHS Foundation Trust was commissioned to carry out a high level review of Kent and Medway CAMHS (provided by Sussex Partnership NHS Foundation Trust) and to make recommendations about how the clinical service could continue to improve in line with the service recovery plan. The report was circulated to Members on 14 November 2014. The Committee will consider the report at a formal meeting on 10 April 2015.

The CAMHS papers submitted to HOSC for 10 October meeting were circulated to the Corporate Parenting Panel on 27 October.

(2)       RESOLVED that the Minutes of the Meeting held on 10 October 2014 are correctly recorded and that they be signed by the Chairman.                 

(1)       The Committee is asked to note the following dates for meetings in 2015:

Friday 30 January

Friday 6 March

Friday 10 April

Friday 5 June

Friday 17 July

Friday 4 September

Friday 9 October

Friday 27 November

(1)          The Committee noted the following dates for meetings in 2015:

Friday 30 January

Friday 6 March

Friday 10 April

Friday 5 June

Friday 17 July

Friday 4 September

Friday 9 October

Friday 27 November

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Dr Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Douglas began by giving an update on the clinical strategy. The strategy was being finalised and written. The Trust was required to produce a clinical strategy for the NHS Trust Development Authority (TDA) as part of their assurance process for clinical quality and sustainability. He stated that the Trust believed that they had a viable future.

(2)       Initial findings of the strategy had found that the Trust should focus on establishing a strategic hub for emergency care; improving productivity; serving a larger population base and developing patient pathways and community focus. There was an opportunity for the Trust to develop a Keogh Centre for emergency care at Tunbridge Wells Hospital to serve West Kent and parts of East Sussex. The Trust had already made £22.4 million of savings on the 2014/15 budget of £400 million; it was acknowledged further savings could be made through improving productivity and serving a larger population base including Medway and East Sussex. The Trust was also looking to carry out more elective surgery and outpatient services or expanding their emergency. It was stated that the Trust did not need to merge with the Conquest Hospital, Hastings or Medway Maritime Hospital to become a financially viable organisation.

(3)       Four key enablers had been identified to achieve the strategy: improving capability; promoting innovation to reduce costs; seizing opportunities for development and growth such as proactive care management; and being able to compete in tender processes. The Strategy will be taken to the Trust’s Board in December for approval. Mr Douglas stated that the strategy would be a dynamic document which would be regularly refreshed. An implementation plan, including a comprehensive stakeholder engagement plan, was being developed in addition to a review of the Trust’s governance structure.

(4)       Dr Sigston gave an update on the Trust’s plans for stroke service improvement as part of the clinical strategy. He explained that stroke was a major focus and concern for the Trust’s Board. A Stroke Improvement Board, Stroke Clinical Steering Group and Engagement Group had been established. He stated that the Trust was conscious of the need to meet the Government’s four tests for service reconfiguration. The Trust had undertaken early engagement with stroke patients and survivors, staff, GPs and MPs.

(5)       The Trust found that patients thought the service was good but the Trust had identified improvements. A clinical case for change had been developed. Both hospital sites did not meet stroke standards as measured by Sentinel Stroke National Audit Programme (SSNAP) data; improvements had been made during the last nine months with both sites moving from the lowest rating ‘E’ to ‘D’. The Trust had identified significant delivery options to improve their SNNAP performance to the highest rating ‘A’. The Trust  ...  view the full minutes text for item 81.

Ian Ayres (Accountable Officer, NHS West Kent CCG) and James Graydon (Account Director, Kent Care Services, NSL) were in attendance for this item.

(1)       Mr Ayres began by giving an update on the latest performance figures. He noted that there had been little improvement.  Whilst ‘Discharges/Transfers booked “On the Day” collected within 2 hours – 80%’ performance had improved, this had a negative effect on the other key performance indicators. He noted that there was a peak of discharges daily at 14.00 hours. He explained that Trusts were not booking discharges ahead of time; the majority of discharges were booked on the day as the Trusts struggled to clear beds for emergency admissions. 

(2)       Mr Ayres commended NSL for their support in helping Medway Maritime Hospital discharge patients. He noted improvements in the service since the appointment of James Graydon in July who provided local operational leadership. He stated that a discrete ring-fenced renal service would be introduced and tested in East Kent. 

(3)       Mr Ayres confirmed that CCGs in Kent and Medway, in discussions with providers, had agreed to re-procure at the end of the existing three year contract. A working group of CCGs and providers had been developing the project plan for re-procurement and the service specification. The group was aiming to complete the final draft service specification by the end of January 2015 in order to commence procurement from April 2015. He stated that there was no intention to change the eligibility criteria but there were discussions about options for the future delivery of the service – a Kent and Medway wide service or an individual service for each Trust.

(4)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about extreme waits for discharge. Mr Ayres explained that extreme waits were reducing slowly, since August there had been a focus on discharges. On an average day, there would be 30 – 40 booked discharges for Medway Maritime Hospital; recently there had been 100 discharges booked on one day as the Trust struggled to clear beds for emergency admissions.  He commented that PTS was an enabler of quality within a Trust; if PTS worked well, it enabled the hospital to perform better but if PTS did not work well, it put pressure on the rest of the hospital.

(5)       A number of comments were made about planned discharge. Mr Ayres explained that all Trusts estimated an approximate discharge date for each patient when admitted. He stated that it was much easier for NSL to plan if they were given the approximate discharge date in advance, even if it was later cancelled and rescheduled, than being booked on the day of discharge. He noted that the new specification would require a discharge protocol to be agreed between the PTS provider and each Trust.  Mr Graydon highlighted that NSL was engaging and reviewing the discharge policy with each acute trust to improve the booking of discharges. It  ...  view the full minutes text for item 82.

(1)       A Member noted and welcomed the update report which was produced in advance of the latest CQC inspection report published on 26 November 2014. The Member requested that the Trust be asked to produce an update on the patient journey through the Emergency Department, leadership stability and the use of technology when the Trust returns to the Committee.

(2)       RESOLVED that Medway NHS Foundation Trust and NHS Swale CCG be invited to attend the January meeting of the Committee to provide an update on actions taken to support Medway’s Emergency Department.

Proposed items:

§  North Kent: Emergency and Urgent Care Review and Redesign (Short Term)

§  SECAmb - Future of Emergency Operation Centres

§  CQC Report & RCS Report - Maidstone Hospital (Written Update)

§  Medway NHS Foundation Trust (Written Update)

§  Kent Community Health NHS Trust: Community Dental Clinics (Written Update)

(1)       Since Agenda publication on 20 November, with the Chairman's agreement, a number of the proposed agenda items had changed:

§  South Kent Coast CCG: Integrated Care Organisation

§  Medway NHS Foundation Trust and NHS Swale CCG - Medway Emergency

§  SECAmb - Future of Emergency Operation Centres (Written Update)

§  Kent Community Health NHS Trust: Community Dental Clinics (Written Update)

§  Faversham MIU (Written Update)