Agenda and minutes

(1)       Members of the Health Overview and Scrutiny Committee noted that Mr Bowles replaced Mr King as a member of the Committee.

(1)       There were no declarations of interests by Members in items on the Agenda for this meeting.

(1)       The Scrutiny Research Officer updated the Committee on the following actions that had been taken since 29 January 2016:

(a)       Minute Number 7 – North Kent: Adult Community Services. Following the discussion on 29 January, Mr Brookbank and Miss Harrison were contacted by a member of the public and one of the bidders regarding the extended standstill period. The CCGs were asked to provide a response which was circulated to the Committee on 29 February.  The CCGs stated that “On the 22nd December 2015 all four bidders were advised of the outcome of the process and were told in confidence who the preferred bidder was.  This was followed by the 10 day standstill in line with best practice where any of the bidders were able to raise queries or question the outcome of the evaluation.  During this time the CCG received a response from one of the providers which resulted in the standstill period being extended by a further five days so that the CCG could respond to the query, which it did so to that bidders satisfaction. The standstill period was lifted on 12th January 2016 and the public announcement made on 13th January 2016.” It was also noted that a “complaint from Dartford & Gravesham NHS Trust/Medway Community Healthcare (the third placed bidder) was made to Monitor on 15 January 2016.”

A further statement from the CCGs was provided to the Committee on 25 February which stated that the CCGs had “received notice of the issue of proceedings by an unsuccessful bidder in the Technology and Construction Court (part of the High Court of Justice).   The challenge has been brought under the Public Contracts Regulations 2006.   This triggers an “automatic suspension” under Regulation 47G of the Public Contracts Regulations 2006 which requires the CCGs to refrain from entering into a contract in respect of the services until the proceedings are determined, discontinued or otherwise disposed of”. As the CCGs were now involved in legal proceedings, they have been advised not to comment further at this point.

(b)       Minute Number 7 – NHS Swale CCG: Review of Emergency Ambulance Conveyances.  During the discussion on 29 January, a Member enquired if the closure of the A249 (Sheppey) had had an adverse impact on SECAmb; Patricia Davies stated that she had not been made aware of any adverse impact but undertook to check with SECAmb and provide the information to the Committee. A response from SECAmb was awaited.

(c)        The JHOSC scheduled for Friday 26 February was postponed at the request of NHS England South (South East) and the Kent and Medway CCGs. A new date in April would be scheduled in due course. A written briefing to update the JHOSC was circulated to the JHOSC Members on 26 February.

(2)       Miss Harrison expressed a view that the Committee had been kept fully informed regarding the extended standstill period.

(3)       The Scrutiny Research Officer committed to circulating the actions that had been taken since 29 January 2016 by email to the  ...  view the full minutes text for item 15.

Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) and Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Hazel Carpenter began by outlining the new national planning guidance which requires the NHS to develop five year Sustainability and Transformation Plans (STPs) by June 2016. She explained that there would be a STP for Kent and Medway and the East Kent Strategy Board would oversee the development of the plan for the East Kent population which would align and link to the Kent and Medway STP. She noted that the reviews of stroke and vascular services in Kent and Medway were key elements of work already underway. She stated that there would be public consultation on the strategy for East Kent following the submission of the STP in June 2016. She noted that complex work was being undertaken in East Kent around the emerging clinical models and the development of service options including the co-location of adjacent services; prior to the submission of the STP, the plan would be sent to the Kent, Surrey & Sussex Clinical Senate for approval. She reported that a public engagement group had been established which was chaired by Clive Hart, Lay Member for Public Engagement, NHS Thanet CCG. 

(2)       Members of the Committee then proceeded to make a number of comments about the inclusion of growth in the STP and presenting updates to local Health and Wellbeing Boards (HWBs). Ms Carpenter stated that the CCGs were beginning to proactively work with borough and district councils to understand and influence new developments. Mr Perks reported that the new developments provided a unique opportunity, which must be taken advantage of, to integrate health and social care in the community through provision in patients’ homes or in local facilities such as Whitstable Medical Practice led by Dr Ribchester. A Member requested that elected Members be kept informed about health’s role in new housing developments.  Mr Perks noted that a briefing paper had been circulated to local HWBs but it would timely to present an update. He stated that local HWBs and Community Networks provided a valuable opportunity for the CCGs to share their thinking and gain insight from their local community.

(3)       In response to a specific question about the Committee’s role in the timeline, Ms Carpenter explained that the Case for Change would be finalised by the end of Easter and highlight the financial and quality challenges in each locality; the emerging options and detailed content would be developed by the end of April.

(4)       RESOLVED that the report be noted and the East Kent Accountable Officers be requested:

(a)       to submit a written update detailing the Case for Change for the Committee’s meeting on 8 April;

(b)       to liaise with colleagues and arrange for a verbal presentation on the Kent and Medway Sustainability and Transformation Plan to be presented to the Committee on 8  ...  view the full minutes text for item 16.

Malcolm McFrederick (Executive Director of Operations, Kent & Medway NHS & Social Care Partnership Trust) and Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr McFrederick began by giving a general update to the Committee about the Trust’s financial and staffing position, the CQC inspection and the Trust’s plans and support for integration.

(2)       Mr McFrederick explained that the Trust had a planned deficit for this financial year and was in contract negotiations and sign-off with the CCGs and NHS England for the next financial year. He reported that the Trust has a rolling programme of recruitment and was working towards a more therapeutic model of staffing with therapists, psychologists and psychiatrics which had helped to decrease the ward staffing deficit by half in East Kent. He noted that it was challenging to recruit in North Kent particularly in Dartford as bordering Trusts paid a London weighting allowance. He reported that a sustainable model for the East Kent Liaison Psychiatry Service had been developed with the East Kent Hospitals University Foundation Trust (EKHUFT) which had led to a reduction in the hours of operations; NHS West Kent CCG and NHS Dartford & Gravesham CCG were looking to introduce a Liaison Psychiatry Service. He stated that the Trust was in discussions with Kent Community NHS Foundation Trust (KCHFT) about using the Knole Centre, Sevenoaks as a stepdown facility. The Trust had withdrawn from providing the specialist neurological rehabilitation inpatient services at the Knole Centre as it predominately provided physical health services.

(3)       Mr McFrederick stated that the CQC published its report in July 2015 following an inspection in March 2015. He noted that there were a number of outstanding services and a number of areas in which the Trust needed to improve including the variable quality of care particularly for older adults. The Trust had developed a quality plan which was monitored by the Trust Development Authority, the Care Quality Commission and local CCGs. The plan was divided into three areas for action: internal operational activities such as the embedding of medicine management to be completed by April 2016; capital spend to make improvements to estates regarding Section 136 suites and seclusion rooms by October 2016; and increasing bed capacity for younger adults and Psychiatric Intensive Care Units (PICU). He noted that the Trust was in discussions with East and West Kent commissioners about commissioning additional young adult and PICU bed capacity.

(4)       Mr McFrederick reported that the Trust was engaging with and supporting local heath economies’ plans for integration; the Trust was adjusting their community models to fit with local requirements. He noted that the Trust was benefiting and improving its relationship with Kent County Council (KCC) under a joint working Section 75 agreement; 250 KCC staff had been seconded to the Trust to provide an integrated mental health service in Kent.

(5)       Members of the Committee then proceeded to ask a series  ...  view the full minutes text for item 17.

Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust) and Shena Winning (Chairman, Medway NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Dwyer began by outlining the background to the inspection. She explained that the Trust had been subject to many inspections and the latest inspection in August 2015 had resulted in the Trust maintaining the inadequate rating and remaining in special measures; prior to the inspection the Trust had self-rated itself as inadequate. She noted that the Trust accepted the report in its entirety.  A quality summit was held on 8 January with over 90 stakeholders who were asked to make a positive commitment to help the Trust improve. She stated that the Trust had been rated good in the caring measure which was a strong foundation for improvement. She highlighted that areas of outstanding practice had been found during the inspection including maternity services which had been noted as having strong leadership and a focused team to improve results; wider learning from these services would be shared across the organisation.

(2)       Ms Dwyer reported that the Trust had 28 days to submit an improvement plan to the CQC which was aligned to the Trust’s existing 18 month recovery plan; 73 ‘must do’ and ‘should do’ actions were identified including the modernisation and expansion of the emergency department.   She noted that the Trust had put in place a specialist team, including staff from the buddy Trust at Guy's and St Thomas' NHS Foundation Trust, to coordinate and drive the improvement plan. She stated that there were a number of key milestones in the next few weeks including a new medical model which would reduce the number of handovers for patients; the opening of a new waiting area in the emergency department; and the launch of an in-house bank of locum nurses. She highlighted that the Trust was criticised by the CQC for its reliance on agency staffing; up to 50% of A&E staff and 25% of nurses across the Trust were agency. She reported that the Trust had held a number of events and open days which had led to the recruitment, subject to checks, of 70 – 80 nurses. The Trust was also looking to make joint appointment with Trusts in London where staff would rotate between sites and was working with the local universities to attract university students to the Trust. She noted that for the fourth month in a row more staff were arriving than leaving the Trust which was a significant improvement.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. In response to a specific question about when the Trust would be removed from special measures, Ms Dwyer stated that she was confident that the Trust now had the right level of clinical leadership to step up and take responsibility for change and improvement at the Trust. She noted that the Trust was  ...  view the full minutes text for item 18.

Ian Ayres (Accountable Officer, NHS West Kent CCG), Dave Holman (Head of Mental Health Programme Area, NHS West Kent CCG) and Samantha Bennett (Consultant in Public Health, Kent County Council) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Ayres began by stating that the working group, attended by a small group of Members and representatives from NHS West Kent CCG and KCC Public Health, was very useful and the Members comments had been incorporated into the paper submitted by the CCG.

(2)       Members of the Committee made a number of comments about transition, provision for children who attended private schools, partnerships with the universities and joint commissioning. Mr Holman explained that in the second year of the new contract the 0 – 25 model would be clarified; at present Kent and Medway NHS and Social Care Partnership Trust (KMPT) and Sussex Partnership NHS Foundation Trust were subject to Commissioning for Quality and Innovation (CQUIN) payment for 14 – 21 joint pathway. He reassured the Committee that under the new model that there would ne one payment for 0 – 25 services. Mr Ayres stated that any child in Kent could access NHS services for free at the point of the delivery; public health services would cover all state funded schools and academies. Mr Ayres noted that as part of the procurement they would look at providers who would have the capability to work in partnership with the universities. Mr Ayres reported that the Kent Emotional Wellbeing Strategy for Children, Young People and Young Adults would be one of the first jointly commissioned contracts by the NHS and Public Health and it had been an interesting challenge with lots of learning. Mr Scott-Clark stated that NHS West Kent CCG and Public Health had been having discussions about developing specifications together and incorporating prevention into pathways. He noted that Public Health was a member of the East Kent Strategy Board to provide advice about improving population health and ensuring public health commissioning aligned to the strategic plans.

(3)       RESOLVED that:

(a)       the Committee deems the new service specification in relation to the NHS commissioned aspect to be a substantial variation of service;

(b)       the Committee supports the procurement of the new service specification;

(c)        NHS West Kent CCG be invited to attend a meeting of the Committee in six months;

(d)       a working group be established to monitor the performance of the new contract and provider at the appropriate time.